Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 74
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Ear Nose Throat J ; : 145561320931304, 2020 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-32525692

RESUMO

With the broad indications for dental implantation, complications rates have increased. Dental implant displacement into the maxillary sinus, although rare, can occur during the restoration of maxillary posterior teeth. We performed a 6-year retrospective review and found 3 cases with displaced implants in the maxillary sinus. Detailed information, including surgical indications and dental implant removal methods, is provided. Dental implants can be dislocated to the maxillary sinus perioperatively or postoperatively. Endoscopic sinus surgery can be performed to remove the implant and restore sinus patency. If the implant is displaced to deeper areas (commonly anterior and inferior) of the maxillary sinus, a prelacrimal recess approach can provide a panoramic view of the maxillary sinus and is a good alternative to the Caldwell-Luc operation in terms of mucosal preservation and postoperative complications.

2.
Laryngoscope ; 2020 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-32125703

RESUMO

OBJECTIVES/HYPOTHESIS: Empty nose syndrome (ENS) is a controversial disorder and the change of histopathology has never been discussed. This study aimed to conduct a structured histological review to improve the diagnosis and understanding of ENS. Further immunohistochemical staining of transient receptor potential channel melastatin 8 (TRPM8) was performed. STUDY DESIGN: A prospective case-control study in a tertiary medical center. METHODS: Consecutive patients with ENS who were diagnosed and received surgical intervention after failure of conservative management were included. Patients with benign pituitary gland tumor receiving transsphenoidal excision were enrolled as control group. Biopsy of inferior turbinate was obtained during surgery for histological review and immunohistochemical staining. RESULTS: Seventeen patients with ENS and six patients as a control group were established for structured histological review. Patients with ENS presented significantly more squamous metaplasia, a higher rate of submucosal fibrosis, and a lower submucosal gland number grading. Additionally, a unique histological change called goblet cell metaplasia was found in the ENS group. The respiratory epitheliums of ENS were mostly intact with preservation of ciliated cells and goblet cells. The ENS group had a significantly lower expression level of TRPM8. CONCLUSIONS: The nasal mucosa of ENS experienced some airway remodeling and thermoreceptors downregulation, which contribute to clinical symptoms. The distinct histology of ENS included preserved respiratory epithelium and goblet cell metaplasia, accompanying with characteristics similar to atrophic rhinitis. Biopsy of the inferior turbinate may help diagnose ENS. LEVEL OF EVIDENCE: 4 Laryngoscope, 2020.

3.
Laryngoscope ; 130(4): 1051-1055, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31169921

RESUMO

OBJECTIVES: In the past two decades, endoscopic sinus surgery (ESS) has been performed frequently in children with medically recalcitrant chronic rhinosinusitis (CRS). However, surgical success rates vary according to age. The causes of failure and prognostic factors for revision ESS remain unclear. The aims of the present study were to evaluate prognostic factors related to revision surgery after ESS, and to determine the most optimal timing for surgery in the pediatric population. METHODS: This was a retrospective review in a tertiary medical center. Children who underwent ESS for CRS between 2004 and 2017 were enrolled. Demographics, sinonasal examination findings, previous operation history, laboratory data, comorbidities, and computed tomography (CT) results were collected from medical records. Prognostic factors for revision surgery were analyzed. RESULTS: A total of 188 pediatric patients were enrolled in this study. Twenty-four patients (12.8%) required revision surgery. Multivariate logistic regression analysis identified patients with nasal allergy (OR = 6.258; P = .010) and higher Lund-Mackay score on preoperative sinus CT (OR = 1.658; P = .043) had worse outcomes, while older age was a positive prognostic factor (OR = 0.702; P = .018). A cut-off point of 15.68 years of age and mean Lund-Mackay score of 10.5 showed the best predictive power for revision surgery. CONCLUSION: Because ESS is performed with increasing frequency in children, knowledge of prognostic factors for revision surgery is important. In this study, patients with younger age, nasal allergy, and higher Lund-Mackay score on preoperative sinus CT had worse outcomes. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:1051-1055, 2020.

4.
Sci Rep ; 9(1): 19839, 2019 12 27.
Artigo em Inglês | MEDLINE | ID: mdl-31882693

RESUMO

Streptococcus pneumonia, one of the major colonizers in nasopharyngeal adenoids, has been the predominant pathogen causing acute otitis media (AOM) in children. Recent evidence suggests an association between IL-17A-mediated immune response and the clearance of pneumococcal colonization in nasopharyngeal adenoids. Here, we evaluated the expressions of IL-17A and associated genes in hypertrophic adenoid tissues of children with sleep-disordered breathing (SDB) and otitis media with effusion (OME) and their association with pneumococcal carriage. Sixty-six pediatric patients with adenoid hypertrophy were enrolled. During adenoidectomy, nasopharyngeal swab and adenoid tissues were used to determine pneumococcal carriage and IL-17A expression. Our results revealed significantly higher levels of IL-17A and IL-17A:IL-10 mRNA in the SDB patients positive for nasopharyngeal pneumococcal carriage than those negative. However, these differences were not significant in the OME group. These results suggested, in OME patients, prolonged or chronic pneumococcal carriage may occur because of insufficient IL-17A-mediated mucosal clearance, and could further lead to AOM and OME development.

5.
Sci Rep ; 9(1): 15357, 2019 10 25.
Artigo em Inglês | MEDLINE | ID: mdl-31653934

RESUMO

A potential mechanism underlying cigarette smoke-induced airway disease is insufficient tissue repair via altered production of matrix metalloproteinases (MMPs). Osteitis is a signature feature of recalcitrant chronic rhinosinusitis (CRS) and often results in revision surgery. The present study aimed to investigate MMP expression in the nasal tissues of asthmatic patients with CRS and any association with cigarette smoking and osteitis. Thirteen smokers with CRS and asthma, 16 non-smokers with CRS and asthma, and seven non-smoker asthmatic patients without CRS were prospectively recruited. The expression of MMPs and associated immunological factors in surgically-obtained nasal tissues was evaluated via real-time PCR and western blotting. Maximal bone thickness of the anterior ethmoid (AE) partition was measured in axial sinus computed tomography (CT) sections. MMP-1 and MMP-9 expression was increased in the nasal tissues of smokers with asthma and CRS via real-time PCR and western blot. Maximal AE partition bone thickness was greater in smokers with CRS and asthma than in non-smokers with CRS and asthma. MMP-1 and MMP-9 levels were correlated with maximal AE bone thickness. Cigarette smoking was associated with the up-regulation of MMP-1 and MMP-9 in the nasal tissues of patients with airway inflammatory diseases, and with AE osteitis, and with therapeutic resistence.

6.
Nitric Oxide ; 92: 55-59, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31408674

RESUMO

BACKGROUND: Although cases of empty nose syndrome (ENS) are not very common, the suffering that ENS causes patient is immense and could be very difficult to imagine. Nasal nitric oxide (nNO) is an airway disease biomarker, and its levels increase after endoscopic sinus surgery. The trend of nNO levels in ENS before and after surgical treatment remains unknown. This study aimed to evaluate the role of nNO in ENS. METHODS: Patients with ENS who received surgical implantation and with chronic hypertrophic rhinitis (CHR) who underwent turbinoplasty and completed at least 1 year of follow-up were prospectively enrolled. nNO measurements and subjective assessments [SinoNasal Outcome Test (SNOT)-22, Beck Depression Inventory (BDI)-II, and Beck Anxiety Inventory (BAI)] were performed preoperatively and at 3, 6, and 12 months postoperatively. RESULTS: We enrolled 19 ENS and 12 CHR patients. nNO levels were significantly lower in the ENS than in the CHR patients before surgical treatment (p < 0.001). nNO levels in the ENS patients significantly increased 3 months after implantation and remained plateaued (p = 0.015). BDI-II and BAI scores significantly improved after surgical treatment for the ENS patients but not for the CHR patients; changes in nNO levels correlated well with improvements in BDI-II and BAI scores (p = 0.025 and 0.035, respectively). CONCLUSIONS: nNO significantly increased at third month after surgical treatment and remained plateaued in ENS patients. This increase correlated with improvements in BDI-II and BAI scores. Therefore, nNO may be important in assessing the psychiatric status of empty nose syndrome.


Assuntos
Óxido Nítrico/metabolismo , Doenças Nasais/metabolismo , Doenças Nasais/psicologia , Nariz/química , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Hipertrofia/diagnóstico , Hipertrofia/metabolismo , Hipertrofia/psicologia , Masculino , Pessoa de Meia-Idade , Óxido Nítrico/análise , Doenças Nasais/diagnóstico , Rinite/diagnóstico , Rinite/metabolismo , Rinite/psicologia , Síndrome , Adulto Jovem
7.
Eur J Pharmacol ; 856: 172400, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31103630

RESUMO

Eosinophils and their granular proteins are crucial for combating allergic airway diseases. Eosinophils derived from HL-60 clone 15 (HC15) cells have been established as a feasible alternative cell model for human primary eosinophils. Simvastatin, a cholesterol-lowering agent, has been shown to exhibit anti-inflammatory and anti-allergic effects. Among the granular eosinophil proteins, eosinophil cationic protein (ECP) is the one best recognised in allergic airway diseases. The aim of our study is to investigate the effect and regulatory mechanisms of simvastatin on ECP levels derived from eosinophils. Both HC15 cell counts and ECP levels decreased after simvastatin treatment in the animal and cell models; however, after a cell count adjustment, simvastatin was not observed to exert a significantly inhibitory effect on ECP expression. Real-time polymerase chain reaction and Western blotting analyses demonstrated that simvastatin did not inhibit the intracellular formation or release of ECP. Cell cycle analysis showed that the percentage of HC15 cells in the G1 and S phases significantly increased and decreased, respectively, after simvastatin treatment. Simvastatin inhibited the proliferation of HC15-derived eosinophils by inducing G1/S cell cycle arrest in a dose-dependent manner. Its effect on the cell cycle involved the downregulation of cyclin A but without the presence of mevalonate; therefore, total ECP expression from eosinophils decreased, not by suppressing the actual formation or release of ECP but by arresting the G1/S cell cycle phase and inhibiting subsequent cell proliferation through the mevalonate pathway.


Assuntos
Eosinófilos/citologia , Eosinófilos/efeitos dos fármacos , Pontos de Checagem da Fase G1 do Ciclo Celular/efeitos dos fármacos , Pontos de Checagem da Fase S do Ciclo Celular/efeitos dos fármacos , Sinvastatina/farmacologia , Animais , Proliferação de Células/efeitos dos fármacos , Células Clonais/citologia , Relação Dose-Resposta a Droga , Regulação da Expressão Gênica/efeitos dos fármacos , Células HL-60 , Humanos , Masculino , Ácido Mevalônico/farmacologia , Ratos , Ratos Sprague-Dawley , Sinvastatina/antagonistas & inibidores
8.
Rhinology ; 57(1): 57-66, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30609423

RESUMO

Background: Cigarette smoke have adverse effects in the control of asthma and chronic rhinosinusitis (CRS). Interleukin (IL)-17A, the signature cytokine of helper T 17 cells and group 3 innate lymphoid cells (ILC3), has been reported to link with resistance to therapy in airway inflammation. This study aimed to investigate the impact of cigarette smoking and IL-17A activation on the clinical outcomes of asthmatic patients with chronic rhinosinusitis. Methods: 33 patients with CRS and asthma, including 15 smokers and 18 non-smokers, and 7 asthmatic patients without CRS and smoking were prospectively recruited. The Sino-Nasal Outcome Test-22 and Asthma Control Test were used to evaluate sinonasal symptoms and the level of asthma control, respectively. Real-time PCR and immunostaining were applied to evaluate the expression levels of IL-17A and associated immunological factors on surgically-obtained nasal tissues. Results: Nasal surgery improved both sinonasal symptoms and asthma control. Compared to non-smokers, smokers showed poorer improvement in asthma control. The expression of IL-17A, IL-22, aryl hydrocarbon receptor (AhR), and ILC3 was increased in the nasal tissues of smokers with asthma and CRS. The expression of IL-17A mRNA was correlated with that of AhR and with positive nuclear AhR-AhR nuclear translocator staining cells, and that of cyclooxygenase-2 enzyme (COX-2). ILC3 cells were associated with IL-17A, IL-22, AhR, and COX-2 mRNA expression. Conclusions: Cigarette smoking was related to lesser improvement in asthma control after nasal surgery and to IL-17A activation in the nasal tissues of patients with inflammatory airways.


Assuntos
Asma , Interleucina-17 , Rinite , Sinusite , Humanos , Interleucina-17/metabolismo , Rinite/diagnóstico , Rinite/etiologia , Fumar
9.
Laryngoscope ; 129(5): 1041-1045, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30582161

RESUMO

OBJECTIVES/HYPOTHESIS: Maxillary sinus fungus ball (MSFB) is the most common type of noninvasive fungal rhinosinusitis. Surgical removal of the ball achieves good outcomes. Making a rapid and accurate diagnosis is important to avoid unnecessary medical therapy. Intralesional hyperdensity (IH) on computed tomography (CT) is reportedly a good indicator. The aim of this study was to evaluate the diagnostic features of MSFB without IH on preoperative CT images. STUDY DESIGN: Retrospective database review. METHODS: Two hundred fifty-eight patients with histopathological evidence of a sinus fungal ball were retrospectively investigated. Forty-seven of 222 patients with MSFB did not show IH on preoperative CT images and were enrolled in the MSFB group. Forty-one patients with unilateral nonfungal chronic rhinosinusitis were enrolled in a control group. CT features previously reported to have diagnostic significance were evaluated. RESULTS: Sclerosis of the lateral sinus wall, erosion of the inner sinus wall, and irregular surface of the material were significantly more common in the MSFB group than in the control group. In the subgroup of patients with total opacification in the maxillary sinus, the sensitivity, specificity, and positive and negative predictive values for erosion of the inner sinus wall were more than 90%. In the subgroup with partial opacification, the sensitivity, specificity, and positive predictive value of an irregular surface of the material were more than 80%. CONCLUSIONS: We have devised an algorithm to help diagnose MSFB without IH on preoperative CT images. Use of this algorithm would improve the diagnostic accuracy and ensure appropriate treatment. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:1041-1045, 2019.


Assuntos
Aspergilose/diagnóstico por imagem , Seio Maxilar , Rinite/diagnóstico por imagem , Rinite/microbiologia , Sinusite/diagnóstico por imagem , Sinusite/microbiologia , Tomografia Computadorizada por Raios X , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
10.
Sci Rep ; 8(1): 16770, 2018 11 13.
Artigo em Inglês | MEDLINE | ID: mdl-30425273

RESUMO

Tonsil and adenoid-tissue hypertrophy (AH) is the most common cause of pediatric sleep-disordered breathing (SDB), with AH possibly initiated by repeated exposure to infectious agents or allergens. Here, we evaluated IL-17A activity in adenoid tissue from children with SDB and its association with AH and pneumococcal carriage. Thirty-five children (aged 3-12 years) with SDB and receiving adenoidectomy and tonsillectomy were enrolled. During surgery, nasopharyngeal carriage was determined by bacterial culture and multiplex PCR via nasopharyngeal swab, and adenoid samples were collected. IL-17A and associated cytokine expression was evaluated by real-time PCR and western blotting. The mRNA analysis showed that IL-17A level, IL-17A:IL-10 ratio, and RAR-related orphan receptor-γt:forkhead box P3 ratio were significantly higher in adenoid tissues with AH, as were IL-17A level and IL-17A:IL-10 ratio in adenoid tissues with pneumococcal carriage. Additionally, pneumococcal carriage was more common in nasopharyngeal adenoids from patients without AH than those with AH. IL-17A was upregulated in adenoid tissues from patients with AH and with pneumococcal carriage. These results suggested that pneumococcal carriage initiates an IL-17A-mediated immune response in nasopharyngeal adenoids, which might be associated with AH in patients with SDB.


Assuntos
Tonsila Faríngea/metabolismo , Regulação da Expressão Gênica , Interleucina-17/metabolismo , Respiração , Transtornos do Sono-Vigília/microbiologia , Transtornos do Sono-Vigília/fisiopatologia , Streptococcus pneumoniae/fisiologia , Tonsila Faríngea/microbiologia , Tonsila Faríngea/patologia , Criança , Pré-Escolar , Feminino , Humanos , Hipertrofia , Interleucina-17/genética , Masculino , Transtornos do Sono-Vigília/metabolismo , Transtornos do Sono-Vigília/patologia
11.
J Otolaryngol Head Neck Surg ; 47(1): 12, 2018 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-29402308

RESUMO

BACKGROUND: Sinonasal adenoid cystic carcinoma is a rare malignancy of the head and neck. Cavernous sinus invasion from sinonasal adenoid cystic carcinoma and its related management have rarely been investigated. This study evaluated the relationship between treatment outcome and cavernous sinus involvement in addition to other parameters. METHODS: A retrospective case series study was conducted at a tertiary referral center. The medical records of 47 patients diagnosed with primary sinonasal adenoid cystic carcinoma between 1984 and 2015 were retrospectively reviewed. The survival impact of the primary treatment modalities and the anatomic sites of tumor involvement were analyzed. RESULTS: Cavernous sinus invasion was observed in 8 patients (17%), of whom 7 had ACC tumors originating from the maxillary sinus. The results of univariate analysis revealed that tumor stage, primary surgery, and the absence of skull-base and infratemporal fossa invasion were associated with better overall survival (P = 0.033, P = 0.012, P = 0.011, and P = 0.040, respectively) and better disease-free survival (P = 0.019, P = 0.001, P = 0.017, and P = 0.029, respectively). Multivariate analysis identified primary surgery as the only independent prognostic factor for disease-free survival (P = 0.026). Cavernous sinus invasion by sinonasal adenoid cystic carcinoma was not associated with worse overall survival or disease-free survival (P = 0.200 and P = 0.198, respectively). CONCLUSIONS: Because maxillary adenoid cystic carcinoma is associated with a higher rate of cavernous sinus invasion, such cases warrant caution during preoperative planning. Primary surgery as the initial therapy provides better locoregional control and survival for patients with sinonasal adenoid cystic carcinoma. Cavernous sinus invasion did not significantly impact survival; thus, it should not be regarded as a contraindication for curative treatment.


Assuntos
Carcinoma Adenoide Cístico/mortalidade , Carcinoma Adenoide Cístico/terapia , Seio Cavernoso/patologia , Neoplasias dos Seios Paranasais/mortalidade , Neoplasias dos Seios Paranasais/terapia , Adulto , Idoso , Carcinoma Adenoide Cístico/patologia , Quimiorradioterapia Adjuvante , Estudos de Coortes , Terapia Combinada , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Neoplasias dos Seios Paranasais/patologia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Centros de Atenção Terciária
12.
PLoS One ; 13(1): e0190507, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29304178

RESUMO

PURPOSE: Acute otitis media (AOM) is a common infectious disease in children and usually accompanied by a preceding viral respiratory tract infection, especially in the preschool-age population. The study aimed to evaluate impact of influenza vaccine on childhood otitis media. METHODS: This retrospective cohort study included data for 803,592 children (<10 years old) recorded in Taiwan's National Health Insurance Research Database. AOM incidence and tympanostomy tube insertion incidence in each influenza season before and after the introduction of traditional injectable trivalent influenza vaccine (TIV) were compared using the Poisson regression analysis to estimate the incidence rate ratios (IRRs) and 95% confidence intervals (CIs). RESULTS: In children < 2 years old, the age group eligible for free influenza vaccination, there was a significant reduction in seasonal AOM incidence after TIV introduction in 2004 (from 98.4 episodes/1000 person-seasons [95% CI: 96.4-100.5] to 66.1 episodes/1000 person-seasons [95% CI: 64-68.1]). In addition, with the increased vaccine coverage rate, the outpatient visits for AOM in the influenza season of 2005 and 2006 were significantly lower than that in 2004 (IRR = 0.85 and 0.80, respectively, p < 0.0001). CONCLUSIONS: A significant reduction in primary care consultations for children <2 years old was observed after the introduction of the TIV in Taiwan in 2004. With the increased vaccine coverage, there was an additional decline in 2005 and 2006. In addition of the direct protection provided by the vaccination, we believe that TIV may have induced some herd immunity that further contributed to the reduction in influenza attack rates and the rates of associated AOM in that age group. These reductions were observed only in vaccine-eligible children, while older children, who were not enrolled in the influenza vaccination program during the study period, have experienced increases in the AOM incidence during the 2004-2006 period compared to the 2000-2003 period.


Assuntos
Vacinas contra Influenza/administração & dosagem , Otite Média/prevenção & controle , Criança , Pré-Escolar , Humanos , Lactente , Taiwan
13.
Laryngoscope ; 128(3): 554-559, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28714537

RESUMO

OBJECTIVE/HYPOTHESIS: Endonasal submucosal implantation has been confirmed to be beneficial for patients with empty nose syndrome (ENS). However, the optimal implantation site has not been defined. This study aimed to evaluate whether lateral nasal wall implantation is superior to inferior nasal wall implantation in terms of clinical benefits and improvements in quality of life. STUDY DESIGN: Retrospective study in a tertiary medical center. METHODS: Consecutive ENS patients between 2010 and 2015 with operative histories of inferior turbinectomies and indicated for surgical implantation were enrolled, with at least 1-year follow-up. Patients were divided into lateral and inferior nasal wall groups. SinoNasal Outcome Test (SNOT)-22, Beck Depression Inventory (BDI)-II, and Beck Anxiety Inventory (BAI) were applied before and 1 year after implantation. RESULTS: Of the total 30 ENS patients analyzed, 14 were in the inferior nasal wall group and 16 were in the lateral nasal wall group. There were no significant intergroup differences in demographic data and preoperative SNOT-22, BDI-II, and BAI scores. Postoperative assessment revealed that the lateral nasal wall group had significantly better SNOT-22 score improvements than the inferior nasal wall group, particularly regarding rhinological symptoms and sleep function. CONCLUSION: Lateral nasal wall implantation may provide significantly better clinical outcomes than inferior nasal wall implantation, and thus may be the preferred, more optimal site for implant placement in ENS patients. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:554-559, 2018.


Assuntos
Obstrução Nasal/cirurgia , Doenças Nasais/cirurgia , Nariz/cirurgia , Implantação de Prótese/métodos , Rinoplastia/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Síndrome , Resultado do Tratamento
14.
Laryngoscope ; 128(6): 1261-1267, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-28921521

RESUMO

OBJECTIVES: To determine a paradigm for evaluating and managing maxillary sinus conditions before dental implantation via preoperative sinonasal assessment. STUDY DESIGN: Prospective cohort study. METHODS: Eighty-four patients who underwent dental implantation with or without sinus augmentation were included. Maxillary sinus conditions were classified into groups 1 to 6 according to cone-beam computed tomography (CT) findings: 1) nonspecific findings, 2) solitary polyp or cyst, 3) mucosal thickening, 4) air-fluid level or fluid accumulation, 5) near-total opacification of the maxillary or other paranasal sinus, and 6) calcification spots in the maxillary sinus. Dental implantation with or without sinus augmentation was suggested with postoperative sinus observation (groups 1-3), after medication for acute sinusitis (group 4), and after comprehensive treatment of chronic or fungal sinusitis (groups 5-6). Intraoperative and postoperative sinus-related complications were recorded. RESULTS: Two patients (groups 1 and 3) developed acute rhinosinusitis after sinus augmentation; both recovered completely with medical treatment. Schneiderian membrane perforation occurred during sinus lift surgery in six patients (group 1): five recovered after conservative medical therapy and close observation, whereas one required endoscopic sinus surgery and recovered well. No chronic rhinosinusitis developed after dental implantation. CONCLUSION: Craniofacial CT is crucial for pre-dental implantation sinonasal evaluation. The risk of dental implant-related chronic rhinosinusitis is low for patients with cysts, polyps, or mucosal thickening in the maxillary sinus. However, preventive endoscopic sinus surgery is recommended for patients with incurable chronic rhinosinusitis, fungal sinusitis, and large polyps or cysts. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:1261-1267, 2018.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Implantação Dentária Endo-Óssea/métodos , Seio Maxilar/diagnóstico por imagem , Sinusite Maxilar/diagnóstico por imagem , Levantamento do Assoalho do Seio Maxilar , Estudos de Coortes , Implantação Dentária Endo-Óssea/efeitos adversos , Humanos , Maxila/diagnóstico por imagem , Maxila/cirurgia , Seio Maxilar/cirurgia , Sinusite Maxilar/cirurgia , Mucosa Nasal/lesões , Complicações Pós-Operatórias , Estudos Prospectivos , Sinusite/etiologia
15.
Medicine (Baltimore) ; 96(25): e7277, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28640138

RESUMO

RATIONALE: Plasma cell neoplasms are categorized by neoplastic proliferation of a single clone of plasma cells which produce a monoclonal immunoglobulin. Plasma cell neoplasms can present as a solitary plasmacytoma or as multiple myeloma. Both of them can progress to multiple myeloma. Once a diagnosis of plasmacytoma has been made, thorough examinations should be carried out for identifying the disease entity. PATIENT CONCERNS AND DIAGNOSES: Herein, we describe an extraordinary rare case of multiple myeloma with initial presentation of a left sphenoid neoplasm resulting in left-sided headache and rapid deterioration of visual acuity. Histo-pathologic analysis revealed a plasma cell neoplasm with positive immunostaining for cluster of differentiation (CD)138, CD79a, and kappa light chain of immunoglobulin. A bone marrow aspiration was then performed, and the diagnosis of multiple myeloma was then confirmed. INTERVENTIONS AND OUTCOMES: After investigative workup, our patient received chemotherapy, localized radiotherapy, and autologous stem cell transplantation. Her visual acuity recovered to the baseline and she sustained a partial response without subjective discomfort. LESSONS: Extramedullary plasmacytoma is an interesting but infrequent presentation of multiple myeloma. Moreover, involvement of the sphenoid sinus in multiple myeloma resulting in extrinsic optic nerve compression is extremely rare. Clinicians should consider plasmacytoma as a diagnostic possibility when presented with cases of solitary sphenoid neoplasm and rapid progression of clinical course.


Assuntos
Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/terapia , Transtornos da Visão/diagnóstico , Transtornos da Visão/terapia , Diagnóstico Diferencial , Feminino , Lateralidade Funcional , Cefaleia/diagnóstico , Cefaleia/etiologia , Cefaleia/patologia , Cefaleia/terapia , Humanos , Pessoa de Meia-Idade , Mieloma Múltiplo/complicações , Mieloma Múltiplo/patologia , Plasmocitoma/complicações , Plasmocitoma/diagnóstico , Plasmocitoma/patologia , Plasmocitoma/terapia , Transtornos da Visão/etiologia , Transtornos da Visão/patologia
16.
PLoS One ; 12(2): e0171047, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28199345

RESUMO

Coexistence of chronic rhinosinusitis (CRS) with asthma appears to impair asthma control. Type-2 innate lymphoid cells (ILC2s) respond to the cytokines of thymic stromal lymphopoietin (TSLP), interleukin (IL)-25 and IL-33, thus contributing to airway diseases such as CRS and asthma. We investigate whether the augmented Th2-cytokines in CRS might be related to sinonasal tract ILC2s corresponding to enhanced IL-25, IL-33 and TSLP release in severe asthmatics, and be involved in asthma control. Twenty-eight asthmatics (12 non-severe and 16 severe) with CRS receiving nasal surgery were enrolled. The predicted FEV1 inversely associated with CRS severity of CT or endoscopy scores. Higher expression of Th2-driven cytokines (IL-4, IL-5, IL-9, and IL-13), TSLP, IL-25 and IL-33 in nasal tissues was observed in severe asthma. Severe asthmatics had higher ILC2 cell counts in their nasal tissues. ILC2 counts were positively correlated with Th2-cytokines. Nasal surgery significantly improved asthma control and lung function decline in severe asthma and CRS. The higher expression of IL-33/ILC2 axis-directed type 2 immune responses in nasal tissue of CRS brought the greater decline of lung function in severe asthma. ILC2-induced the upregulated activity of Th2-related cytokines in asthmatics with CRS may contribute to a recalcitrant status of asthma control.


Assuntos
Asma/diagnóstico , Rinite/diagnóstico , Sinusite/diagnóstico , Adulto , Asma/complicações , Asma/patologia , Doença Crônica , Citocinas/genética , Citocinas/metabolismo , Endoscopia , Feminino , Humanos , Imuno-Histoquímica , Interleucina-17/genética , Interleucina-17/metabolismo , Interleucina-33/genética , Interleucina-33/metabolismo , Masculino , Microscopia Confocal , Pessoa de Meia-Idade , Mucosa Nasal/metabolismo , Mucosa Nasal/patologia , Pólipos Nasais/metabolismo , Pólipos Nasais/patologia , Reação em Cadeia da Polimerase em Tempo Real , Rinite/complicações , Rinite/cirurgia , Índice de Gravidade de Doença , Sinusite/complicações , Sinusite/cirurgia
17.
PLoS One ; 12(2): e0171965, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28199369

RESUMO

Unilateral sinus disease (USD) can sometimes be difficult to accurately diagnose before surgery. The application of nasal nitric oxide (nNO) for USD diagnosis and its surgical outcome in USD has not been reported in the literature. We prospectively enrolled sixty-six USD patients who underwent endoscopic sinus surgery for fungal rhinosinusitis (n = 19), chronic rhinosinusitis (CRS) without nasal polyps (n = 13), CRS with nasal polyps (n = 12) and sinonasal mass lesions (n = 22). nNO levels were measured preoperatively and at three and six months postoperatively. Correlations between nNO levels and potential clinical parameters, type of disease, disease severity, and disease-related quality of life (QOL) were assessed. Unlike bilateral CRS, in USD, nNO levels did not correlate with disease severity or postoperative QOL improvements. Except for fungus group, there were no differences in nNO levels between lesion and non-lesion sides in all the other groups. nNO levels on both sides were significantly elevated six months postoperatively in all groups. Fungal rhinosinusitis patients had the lowest preoperative nNO levels, and a cutoff of 239.3 ppb had the best sensitivity (79.0%) and specificity (87.2%) for preoperative diagnosis. While preoperative nNO levels cannot serve as an alternative marker for disease severity of USD, they were lower in fungal rhinosinusitis patients than in other USD patients and may be useful for more accurate diagnosis prior to surgery.


Assuntos
Cavidade Nasal/metabolismo , Óxido Nítrico/metabolismo , Sinusite/diagnóstico , Área Sob a Curva , Endoscopia , Feminino , Fungos/fisiologia , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Seios Paranasais/patologia , Seios Paranasais/cirurgia , Período Pré-Operatório , Estudos Prospectivos , Qualidade de Vida , Curva ROC , Rinite/diagnóstico , Rinite/metabolismo , Rinite/microbiologia , Rinite/patologia , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Sinusite/metabolismo , Sinusite/patologia , Resultado do Tratamento
18.
Medicine (Baltimore) ; 96(8): e6147, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28225496

RESUMO

The united airways concept suggests that patients with asthma typically exhibit parallel inflammation in the upper airway. The resulting nasal symptoms should reduce quality of life and substantially affect the evaluation of asthma control among these patients. This study aimed to assess the association of nasal symptoms with the evaluation of asthma control.Fifty-eight patients with asthma and persistent nasal symptoms were prospectively recruited for evaluations of their sinonasal symptoms and asthma control in a cross-sectional study from August 2013 to June 2016. Participants underwent thorough nasal endoscopy, sinus computed tomography, pulmonary function testing, the asthma control test (ACT), and the Sino-Nasal Outcome Test-22 (SNOT-22) questionnaires to evaluate their asthma control and sinonasal symptoms.There was a significant association between ACT and SNOT-22 scores. Among patients with asthma and chronic rhinosinusitis, ACT scores were closely related to the symptoms of cough, post-nasal discharge, dizziness, waking up at night, absence of a good night's sleep, and waking up tired. Among patients with asthma and chronic rhinitis, the forced expiratory volume in 1 second was closely related to the symptoms of needing to blow nose, runny nose, and cough. Patients with emergency clinic visits during the previous 3 months had relatively high SNOT-22 scores, especially for the symptoms of sneezing, runny nose, nasal blockage, cough, and dizziness.Sinonasal symptom severity was closely associated with measured asthma control status among patients with asthma and persistent nasal symptoms. Therefore, upper and lower airway inflammations should be considered and treated simultaneously.


Assuntos
Asma/diagnóstico , Asma/fisiopatologia , Asma/tratamento farmacológico , Asma/epidemiologia , Estudos Transversais , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seios Paranasais/diagnóstico por imagem , Estudos Prospectivos , Rinite/diagnóstico , Rinite/tratamento farmacológico , Rinite/epidemiologia , Rinite/fisiopatologia , Índice de Gravidade de Doença , Sinusite/diagnóstico , Sinusite/tratamento farmacológico , Sinusite/epidemiologia , Sinusite/fisiopatologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
19.
Medicine (Baltimore) ; 96(51): e9134, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29390442

RESUMO

RATIONALE: Schwannomas are solitary neurogenic tumors that arise from cells of the neural sheath. Ancient schwannoma is a relatively rare variant of schwannoma, characterized by increased cellularity and atypia. These cellular changes could be confusing and make the accurate pathologic diagnosis difficult. PATIENT CONCERNS AND DIAGNOSES: A 36-year-old man presented with painless swelling in left submandibular region for more than 2 years. The computed tomography confirmed a well-defined cystic lesion in the left submandibular space, which caused superior and posterior displacement of the left submandibular gland. Surgical excision was performed and the pathology confirmed the diagnosis of ancient schwannoma. To our knowledge, this patient is the second case of primary submandibular ancient schwannoma reported in the literatures. INTERVENTIONS AND OUTCOMES: The patient underwent tumor resection and postoperative recovery was uneventful. There were no nerve deficits after the operation. There was no recurrence within 1 year of follow-up. LESSONS: Schwannoma originated from the submandibular gland is extremely rare and only a few cases have been reported. Ancient schwannoma is an even more rare tumor. The increased cellularity and atypia of ancient schwannoma can resemble features of malignancy. Great care must be taken to make differential diagnosis with fibrosarcomas and malignant schwannoma.


Assuntos
Neurilemoma/patologia , Neoplasias da Glândula Submandibular/patologia , Adulto , Humanos , Masculino , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Neoplasias da Glândula Submandibular/diagnóstico por imagem , Neoplasias da Glândula Submandibular/cirurgia
20.
Medicine (Baltimore) ; 95(47): e5432, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27893686

RESUMO

Cigarette smoke plays a substantial role in the development of airway inflammatory diseases, including asthma and chronic rhinosinusitis (CRS). Interleukin (IL)-17A might contribute to cigarette smoke-related inflammation of the airway. This study aimed to investigate the association between cigarette smoking and IL-17A expression in the nasal tissues of patients with CRS and asthma.We prospectively recruited 24 patients (13 smokers, 11 nonsmokers) with CRS and asthma and 6 patients with asthma but without CRS (control group) in a tertiary medical center. Nasal mucosa was obtained as part of the nasal surgery. Protein and mRNA levels of IL-17A in the nasal tissues were determined by immunostaining and real-time polymerase chain reaction.The number of unexpected emergency clinic visits for acute asthma attacks were higher among smokers than among nonsmokers. Interleukin-17A protein and mRNA levels in the nasal tissues of smokers were greater compared to those in the nasal tissues of nonsmokers (P = 0.02 both) and control patients (P = 0.05 and 0.04, respectively).Cigarette smoking was associated with an increase in the number of unexpected emergency clinic visits due to acute asthma attack and in the expression of IL-17A in the nasal tissues of patients with airway inflammatory diseases.


Assuntos
Asma/metabolismo , Interleucina-17/metabolismo , Mucosa Nasal/metabolismo , Rinite/metabolismo , Sinusite/metabolismo , Fumar/efeitos adversos , Biomarcadores/metabolismo , Estudos de Casos e Controles , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , RNA Mensageiro/metabolismo , Reação em Cadeia da Polimerase em Tempo Real , Inquéritos e Questionários
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA