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1.
Otolaryngol Head Neck Surg ; : 1945998221089187, 2022 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-35349388

RESUMO

OBJECTIVE: To compare health care resource utilization (HRU) and costs among commercially insured patients with nasal polyposis (NP) with and without recurrence after endoscopic sinus surgery (ESS). STUDY DESIGN: Retrospective matched cohort study. SETTING: Adults with initial ESS or an NP excision after a new NP diagnosis were identified in Optum's Clinformatics Data Mart Database (October 1, 2014-December 31, 2019). METHODS: The index date was the date of NP recurrence, identified with a claims-based algorithm for the recurrent cohort, or a random date for the nonrecurrent cohort. Patients in both cohorts were matched 1:1 on baseline characteristics (12 months preindex) via propensity scores and exact matching factors. Annual HRU and costs (2019 US$) were compared between the matched cohorts at 12 months postindex. RESULTS: NP recurrence was identified among 3343 of 16,693 patients with initial ESS; after matching, each cohort comprised 1574 patients (median age, 54 years; 40% female) with similar baseline health care costs (recurrent, $34,420; nonrecurrent, $33,737). At 12 months postindex, the recurrent cohort had higher HRU, including 36% and 51% more outpatient and emergency department visits, respectively (all P < .01). Mean health care costs were $9676 higher in the recurrent cohort ($24,039) relative to the nonrecurrent cohort ($14,363, P < .01). The mean cost difference between cohorts was driven by $8211 in additional outpatient costs, as well as $6062 in additional NP-related outpatient costs, in the recurrent cohort (all P < .01). CONCLUSION: NP recurrence is associated with a substantial economic burden, which appears to be driven by outpatient services.

2.
Artigo em Inglês | MEDLINE | ID: mdl-35019237

RESUMO

INTRODUCTION: Topical steroids are a mainstay in the treatment of chronic rhinosinusitis (CRS). Multiple delivery methods of topical steroids following sinus surgery have been investigated. The purpose of this trial is to evaluate the effect of triamcinolone-impregnated absorbable nasal packing on healing following endoscopic sinus surgery (ESS). METHODS: This is a prospective, randomized, double-blind, placebo-controlled trial. A total of 22 subjects (14 without polyps and eight with polyps) were enrolled and were randomized to receive triamcinolone-impregnated packing in one sinus cavity and normal saline-soaked packing in the contralateral sinus cavity. Endoscopic evaluation was completed at the first two postoperative visits, and Lund-Kennedy (LK) endoscopic scores and perioperative sinus endoscopy (POSE) scores were calculated at each visit. RESULTS: The results of this study found no significant difference in the appearance of the sinuses at either postoperative visit. Mean LK scores for the triamcinolone and saline groups at the first and second postoperative visits were 2.09 ± 1.23 versus 2.18 ± 1.01 (p = 0.79) and 1.79 ± 1.08 versus 1.68 ± 1.16 (p = 0.77), respectively. POSE scores were 2.59 ± 1.71 versus 2.68 ± 1.62 (p = 0.86) and 1.74 ± 1.15 versus 1.95 ± 1.22 (p = 0.59). CONCLUSION: The results of this study demonstrated no significant difference in healing, crusting, polyps, edema, or secretions between the triamcinolone-treated and non-triamcinolone-treated sinuses. There were no adverse effects from the use of triamcinolone-impregnated absorbable packing. Further studies will be necessary to determine the impact of triamcinolone-impregnated absorbable packing following ESS.

4.
Laryngoscope ; 132(5): 926-932, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34232507

RESUMO

INTRODUCTION: Prior studies suggest that there may be a link between human papillomavirus (HPV) infection and malignant sinonasal inverted papilloma (SNIP). This systematic review and meta-analysis was performed to further evaluate this potential association. STUDY DESIGN: Systematic review with meta-analysis. METHODS: The Medline and Embase databases were used to identify case-control studies reporting the risk of malignant SNIP in patients with high-risk HPV subtypes identified by polymerase chain reaction (PCR). Meta-analysis was performed to determine pooled odds ratios (ORs) and 95% confidence intervals (CI). RESULTS: Twenty-one studies were identified, including a total of 841 subjects with SNIP. Seventeen studies were included in the final analysis, as four studies did not have any HPV-positive tumors in either group. A total of 56 malignant SNIP and 551 benign SNIP were ultimately identified. The pooled log-OR was 1.80 (95% CI: 1.03-2.57) for all high-risk HPV subtypes. Stratification by high-risk HPV subtype showed a log-OR of 1.67 (95% CI: 0.88-2.46) for HPV-16 and log-OR of 2.68 (95% CI: 1.30-4.05) for HPV-18. CONCLUSION: Infection with high-risk HPV subtypes may be associated with an increased risk of malignant SNIP. HPV-18 showed the greatest overall average effect size of the common high-risk subtypes. LEVEL OF EVIDENCE: NA Laryngoscope, 132:926-932, 2022.


Assuntos
Neoplasias Nasais , Papiloma Invertido , Infecções por Papillomavirus , Neoplasias dos Seios Paranasais , Papillomavirus Humano 18 , Humanos , Neoplasias Nasais/patologia , Papiloma Invertido/patologia , Papillomaviridae/genética , Infecções por Papillomavirus/complicações , Neoplasias dos Seios Paranasais/patologia , Reação em Cadeia da Polimerase
5.
Am J Rhinol Allergy ; 36(1): 33-40, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33910378

RESUMO

BACKGROUND: Currently, no consensus exists on the appropriate control specimen site to utilize in studies evaluating for biomarkers in chronic rhinosinusitis (CRS). Studies thus far have utilized tissue from various anatomic sites despite regional heterogeneity. OBJECTIVE: We set out to quantify the differences in biomarker levels present in inferior turbinate versus sphenoid sinus mucosa in paired healthy control patients. We hypothesize that statistically significant differences in cytokine/chemokine expression exist between these two distinct sites. METHODS: A 38-plex commercially available cytokine/chemokine Luminex Assay was performed on 54 specimens encompassing paired inferior turbinate and sphenoid sinus mucosa samples from 27 patients undergoing endoscopic anterior skull base surgery. Patients with a history of CRS were excluded. Paired sample t-tests and Fisher's exact tests were performed. RESULTS: Twenty-seven patients were included in the study, including 10 male and 17 female patients with an average age of 48 years. The following 8 biomarkers had statistically significant concentration differences between inferior turbinate mucosa and sphenoid mucosa sites: Flt-3L, Fractalkine, IL-12p40, IL-1Ra, IP-10, MCP-1, MIP-1ß, and VEGF, with all P-values <0.01. CONCLUSION: No consensus exists regarding the optimal choice of control specimen for CRS research. We present statistically significant quantitative differences in biomarker levels between paired inferior turbinate and sphenoid mucosa samples. This confirms the presence of heterogeneity between different subsites of sinonasal mucosa and highlights the need for standardization in future CRS research.


Assuntos
Pólipos Nasais , Rinite , Sinusite , Biomarcadores , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Nasal/patologia , Pólipos Nasais/patologia , Rinite/diagnóstico , Rinite/patologia , Sinusite/diagnóstico , Sinusite/patologia , Conchas Nasais/patologia , Conchas Nasais/cirurgia
6.
Ear Nose Throat J ; 100(6_suppl): 862S-864S, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34427140

RESUMO

We present a case of an 80-year-old female patient who had an extensive dural bleed after endoscopic sinus surgery. A review of the literature regarding the surgical tools and materials used to treat dural hemorrhage was performed. We describe our preferred method of using the combination of endoscopic bipolar, DuraGen Plus, and DuraMatrix to stop significant dural bleeding and show effective hemostatic regulation.


Assuntos
Hemorragia Cerebral/etiologia , Dura-Máter , Endoscopia/efeitos adversos , Seio Frontal/cirurgia , Hemorragia Pós-Operatória , Sinusite/cirurgia , Idoso de 80 Anos ou mais , Hemorragia Cerebral/terapia , Endoscopia/métodos , Feminino , Técnicas Hemostáticas , Humanos , Hemorragia Pós-Operatória/terapia
7.
Chest ; 160(2): e173-e176, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34366039

RESUMO

Sweet's Syndrome (SS), also known as acute febrile neutrophilic dermatosis, is one of several cutaneous inflammatory disorders classified as neutrophilic dermatoses. Respiratory complications are described in <50 cases in the literature,1 without prior report of lung transplantation (LT). This article explains the clinical course of the first patient to receive LT for pulmonary SS and presents evidence suggesting recurrence of the primary lung disease in the allograft.


Assuntos
Transplante de Pulmão , Síndrome de Sweet/diagnóstico , Corticosteroides/uso terapêutico , Adulto , Diagnóstico Diferencial , Diagnóstico por Imagem , Feminino , Humanos , Imunossupressores/uso terapêutico , Testes de Função Respiratória , Síndrome de Sweet/tratamento farmacológico
8.
Int Forum Allergy Rhinol ; 11(11): 1557-1569, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34096200

RESUMO

BACKGROUND: Racial and ethnic disparities in cancer outcomes have been demonstrated for several different malignancies. In this study we aimed to quantify disease-specific survival (DSS) and the 5-year conditional disease-specific survival (CDSS, the change in life expectancy with increasing survivorship) for paranasal sinus cancer by race and ethnicity. METHODS: Patients with sinus cancer between 1973 and 2015 were extracted from the Surveillance, Epidemiology, End Results (SEER) registry. Kaplan-Meier analysis for DSS was stratified by race and ethnicity. Cox regression models of DSS were generated controlling for stage, age, race, and ethnicity. CDSS was calculated using Cox models. Logistic regression was conducted to identify risk factors for younger age at diagnosis, late-stage at diagnosis, and likelihood of receiving surgical intervention when recommended. RESULTS: The analysis included a total of 5202 patients. DSS was significantly different when stratified by race (p < 0.01). Compared with White patients, Black patients (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.13-1.45; p < 0.001) and American Indian/Alaskan Natives (HR, 1.94; 95% CI, 1.37-2.74, p < 0.001) exhibited increased mortality when controlling for other factors. Black patients had worse CDSS for regional and distant staged cancer compared with other races; American Indian/Alaskan Native patients had worse CDSS for cancers of all stages. Hispanic patients were more likely to present with advanced disease (odds ratio [OR], 1.47; 95% CI, 1.07-2.07; p = 0.020). American Indian/Alaskan Native patients were less likely than White patients to receive surgical intervention when recommended (OR, 0.42; 95% CI, 0.21-0.04; p = 0.024). Nonwhite patients were more likely to be diagnosed at a younger age. Variations in racial and ethnic disparities were observed over time. CONCLUSION: Race and ethnicity significantly impact paranasal sinus cancer outcome metrics. Disparities in outcomes are likely multifactorial.


Assuntos
Neoplasias dos Seios Paranasais , Humanos , Estimativa de Kaplan-Meier , Neoplasias dos Seios Paranasais/epidemiologia , Estados Unidos/epidemiologia
9.
Int Forum Allergy Rhinol ; 11(12): 1617-1625, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34176231

RESUMO

BACKGROUND: Management of sinonasal malignancy (SNM) often includes surgical resection as part of the multimodality treatment. Treatment-related surgical morbidity can occur, yet risk factors associated with complications in this population have not been sufficiently investigated. METHODS: Adult patients with histologically confirmed SNM whose primary treatment included surgical resection were prospectively enrolled into an observational, multi-institutional cohort study from 2015 to 2020. Sociodemographic, disease, and treatment data were collected. Complications assessed included cerebrospinal fluid leak, orbital injury, intracranial injury, diplopia, meningitis, osteoradionecrosis, hospitalization for neutropenia, and subsequent chronic rhinosinusitis. The surgical approach was categorized as endoscopic resection (ER) or open/combined resection (O/CR). Associations between factors and complications were analyzed using Student's t test, Fisher's exact test, and logistic regression modeling. RESULTS: Overall, 142 patients met the inclusion criteria. Twenty-three subjects had at least 1 complication (16.2%). On unadjusted analysis, adjuvant radiation therapy was associated with developing a complication (91.3% vs 65.5%, p = 0.013). Compared with the ER group (n = 98), the O/CR group (n = 44) had a greater percentage of higher T-stage lesions (p = 0.004) and more frequently received adjuvant radiation (84.1% vs 64.4%, p = 0.017) and chemotherapy (50.0% vs 30.6%, p = 0.038). Complication rates were similar between the ER and O/CR groups without controlling for other factors. Regression analysis that retained certain factors showed O/CR was associated with increased odds of experiencing a complication (odds ratio, 3.34; 95% confidence interval, 1.06-11.19). CONCLUSIONS: Prospective, multicenter evaluation of SNM treatment outcomes is feasible. Undergoing O/CR was associated with increased odds of developing a complication after accounting for radiation therapy. Further studies are warranted to build upon these findings.


Assuntos
Neoplasias Nasais , Neoplasias dos Seios Paranasais , Estudos de Coortes , Humanos , Neoplasias Nasais/cirurgia , Neoplasias dos Seios Paranasais/epidemiologia , Neoplasias dos Seios Paranasais/cirurgia , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
10.
Sci Rep ; 11(1): 9608, 2021 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-33953319

RESUMO

The purpose of this study was to investigate whether the incidence of Parkinson's disease (PD) is increased among patients with obstructive sleep apnea (OSA) and whether surgical treatment can prevent such an increase. This was a retrospective cohort study. We analysed the claims data from the Korea National Health Insurance Service. A total of 202,726 patients who were newly diagnosed with OSA between 2007 and 2014 were included. The patients were divided into two groups: patients who underwent uvulopalatopharyngoplasty (surgery group, n = 22,742) and those who did not (conservative group, n = 179,984). The control group (n = 1,013,630) was selected by propensity score matching. They were tracked until 31st December 2015. The hazard ratio of PD diagnosis (95% confidence interval) in the OSA group with respect to the control group was calculated using the Cox proportional hazard model. In the conservative group, the incidence of PD (hazard ratio 2.57 [2.32-2.85]) was significantly higher than that in the control group, while the incidence of PD in the surgery group was similar to that in the control group (hazard ratio 1.45 [0.89-2.22]). Patients with OSA are at an increased risk of developing PD, and uvulopalatopharyngoplasty may mitigate this risk.


Assuntos
Palato/cirurgia , Doença de Parkinson/epidemiologia , Faringe/cirurgia , Apneia Obstrutiva do Sono/cirurgia , Úvula/cirurgia , Adulto , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Bucais , Procedimentos Cirúrgicos Otorrinolaringológicos , Doença de Parkinson/etiologia , Estudos Retrospectivos , Apneia Obstrutiva do Sono/complicações , Resultado do Tratamento
11.
Medicine (Baltimore) ; 100(6): e24659, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578596

RESUMO

ABSTRACT: Some studies have demonstrated an increased risk of prostate cancer in patients with obstructive sleep apnea (OSA). However, the relationship is unclear and the results are conflicting. This study aims to investigate associations between OSA and prostate cancer using the Korea National Health Insurance Service database.A total of 152,801 men (≥ 20 years of age) newly diagnosed with OSA between 2007 and 2014 were included. A control group of 764,005 subjects was selected using propensity score matching by age and sex. The mean follow-up time was 4.6 years (range 2.3-6.9). The primary endpoint was newly diagnosed prostate cancer. The prostate cancer hazard ratio (95% confidence interval) was calculated for patients with OSA and compared to the control group.The incidence of prostate cancer among patients with OSA was significantly higher than that in controls (1.34 [1.23-1.49]). In particular, the incidence of prostate cancer was highest in patients aged 40-65 years (1.51 [1.32-1.72]).This study provides additional evidence for a link between OSA and prostate cancer.


Assuntos
Formulário de Reclamação de Seguro/estatística & dados numéricos , Neoplasias da Próstata/etiologia , Apneia Obstrutiva do Sono/complicações , Adulto , Idoso , Estudos de Casos e Controles , Bases de Dados Factuais , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/epidemiologia , República da Coreia/epidemiologia , Fatores de Risco , Apneia Obstrutiva do Sono/diagnóstico
12.
Laryngoscope ; 131(4): E1035-E1037, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-32965695

RESUMO

BACKGROUND: There has been a rapid increase in electric motorized scooter (e-scooter) usage after the introduction of dockless, shareable devices. METHODS: Case series from three tertiary hospitals in Los Angeles between May-September 2019. RESULTS: Five patients had skull base fractures and CSF leaks or pneumocephalus after e-scooter accident, none wore helmets. Two patients were treated with observation alone, two patients were treated with lumbar drain or external ventriculostomy placement, and one patient died of their injuries prior to definitive management. CONCLUSION: Without appropriate safety policies in place, the number of such injuries may increase as the use of e-scooters increase. Laryngoscope, 131:E1035-E1037, 2021.


Assuntos
Acidentes de Trânsito , Vazamento de Líquido Cefalorraquidiano/etiologia , Vazamento de Líquido Cefalorraquidiano/terapia , Adolescente , Adulto , Intoxicação Alcoólica , Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Feminino , Humanos , Masculino , Veículos Automotores , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/etiologia , Pneumocefalia/terapia , Fraturas Cranianas/diagnóstico por imagem , Fraturas Cranianas/etiologia , Fraturas Cranianas/terapia
13.
Laryngoscope ; 131(5): E1422-E1428, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33098341

RESUMO

OBJECTIVES: To characterize the incidence, causes, risk factors, and costs of 30-day readmission after inpatient functional endoscopic sinus surgery (FESS) for patients with chronic rhinosinusitis. STUDY DESIGN: Retrospective cohort study. METHODS: The Nationwide Readmissions Database was used to characterize readmission after inpatient sinus surgery for chronic rhinosinusitis from 2015 to 2017. International Classification of Disease codes were used to identify the patient population, which included 5,644 patients. Incidence, causes, costs, and predictors of readmission were analyzed and determined. RESULTS: Among 6,386 patients who underwent inpatient FESS, 742 (11.6%) were readmitted within 30 days of discharge. On univariate analysis, patients who were readmitted were more commonly older than 70 years (23.3% vs. 16.2%); had a higher burden of comorbidities including chronic kidney disease (15.0% vs. 7.8%), diabetes (25.6% vs. 20.4%), and hypertension (13.5% vs. 8.5%); had a greater rate of postoperative complications (20.7% vs. 12.2%); and had a longer length of stay (12.4 vs. 6.9 days) compared to patients who were not readmitted. Readmissions cost an additional $27,141 per patient. On multivariable analysis, age greater than 70 years, Medicaid insurance, several comorbidities, prolonged length of stay, postoperative neurologic complications, and lower hospital volume were independent predictors of 30-day readmission. The most common cause for readmission was infection (36.3%). CONCLUSION: Readmission following inpatient FESS is not uncommon. Identification and management of preoperative comorbidities, optimized patient selection for inpatient surgery, and thorough postoperative discharge care may improve patient outcomes and decrease healthcare expenditures. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E1422-E1428, 2021.


Assuntos
Endoscopia/efeitos adversos , Procedimentos Cirúrgicos Nasais/efeitos adversos , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Rinite/cirurgia , Sinusite/cirurgia , Idoso , Doença Crônica/epidemiologia , Doença Crônica/terapia , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Custos Hospitalares/estatística & dados numéricos , Humanos , Hipertensão/epidemiologia , Incidência , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Readmissão do Paciente/economia , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/etiologia , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Rinite/epidemiologia , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Sinusite/epidemiologia , Fatores de Tempo , Estados Unidos/epidemiologia
14.
Laryngoscope ; 131(6): E1750-E1752, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33107603

RESUMO

INTRODUCTION: Reconstruction of skull base defects are determined by size, location, and complexity of the defect. METHODS: Case report. CASE DISCUSSION: An 11-year old girl presented with a right frontoethmoidal encephalocele after an episode of meningitis. An endoscopic approach was performed with a Draf III to provide exposure. The skull base defect extended superolateral over the orbit, which limited the choice of reconstructive options. The defect was successfully repaired with a single layer onlay graft of bovine collagen matrix. CONCLUSIONS: Single layer repairs using commercial biomaterials should be considered where multilayer closure or vascularized flaps may not be possible. Laryngoscope, 131:E1750-E1752, 2021.


Assuntos
Matriz Óssea/transplante , Transplante Ósseo/métodos , Encefalocele/cirurgia , Seio Frontal/cirurgia , Base do Crânio/cirurgia , Criança , Encefalocele/microbiologia , Feminino , Humanos , Meningite/complicações
15.
Allergy Rhinol (Providence) ; 11: 2152656720973689, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33343991

RESUMO

BACKGROUND: Schneiderian papillomas (SP) are aggressive sinonasal tumors that occasionally extend into areas that are surgically unresectable. OBJECTIVE: evaluate the signifcance of cyclo-oxygenase-2 (COX-2) expression in SP. METHODS: Immunohistochemistry for COX-2 was performed on SP samples and middle turbinates from chronic rhinosinusitis without nasal polyps controls obtained during surgical resection between 2009-2017. A positive stain was defined as having 10% or more cells exhibiting diffuse immunoreactivity. Comparisons were performed using Fisher Exact tests, t-tests, and ANOVA. RESULTS: The study included 67 tumor samples and 9 controls from two academic institutions. The mean age of the SP group was 55.4 years and 53.2 years in the control group (p = 0.71). Thirty-nine (58.2%) SP patients had previous surgery compared to 1 (11.1%) in the control group (p = 0.01). The most common tumor attachment sites were the maxillary (47.8%) and ethmoid (25.4%) sinuses. Fifteen (22.4%) SP samples stained strongly positive for COX-2 and 24 (35.8%) stained weakly positive compared to no positive stains in the control group (p < 0.01). When stratified by COX-2 intensity, there were no statistically significant differences in gender, smoking history, history of previous sinus surgery, site of attachment, papilloma subtype, or future recurrence between SP samples. CONCLUSION: COX-2 was overexpressed in 58.2% of SP cases, and strongly positive in 22.4% of cases, compared to no positive staining among controls. No significant differences in COX-2 expression were observed between SP subtypes or recurrent tumors. Further studies are warranted to evaluate COX-2 as a possible therapeutic target in tumors that overexpress the enzyme.

16.
Otolaryngol Head Neck Surg ; 163(6): 1270-1273, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32746765

RESUMO

Airway epithelia express intrinsic antimicrobial and nutrient-sequestering factors, which contribute to the host defense of the respiratory tract. Hepcidin is an endogenous peptide hormone that serves as a key regulator of iron metabolism, and ferroportin and ZIP8 are iron transporters. All exhibit innate antimicrobial activity. The purpose of this pilot study is to determine if molecules involved in iron regulation are expressed within sinus epithelia and to compare levels of expression between patients with and without chronic rhinosinusitis (CRS). Sinus mucosa was obtained from patients with (n = 19) and without (n = 14) CRS. Real-time polymerase chain reaction following RNA extraction was used to quantify expression of hepcidin, ferroportin, and ZIP8 mRNA. Hepcidin, ferroportin, and ZIP8 were all detected in the sinus epithelia of patients with and without CRS. However, only ZIP8 was significantly changed in CRS, with a 2.5-fold mean increase in mRNA expression relative to controls (P = .005). These findings suggest that ZIP8 may play a role in the innate epithelial defense of the paranasal sinuses.


Assuntos
Proteínas de Transporte de Cátions/metabolismo , Hepcidinas/metabolismo , Rinite/metabolismo , Sinusite/metabolismo , Adulto , Estudos de Casos e Controles , Doença Crônica , Feminino , Humanos , Masculino , Pólipos Nasais/metabolismo , Projetos Piloto
17.
Int Forum Allergy Rhinol ; 10(4): 533-538, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32104956

RESUMO

BACKGROUND: Inverted papilloma (IP) is a benign epithelial tumor of the sinonasal cavity that is locally aggressive and has a propensity for recurrence. Tumors involving the anterior maxillary sinus can be challenging to reach endoscopically, and have historically been approached through a Caldwell-Luc or canine fossa trephination. We present a case series of 22 patients with maxillary IPs originating from the anterior wall, which were successfully resected using a modified endoscopic Denker (MED) procedure. This technique enables access to the entire maxillary sinus without the need for a separate transseptal or sublabial incision. METHODS: A retrospective chart review was performed on patients who underwent the MED approach for management of maxillary IPs involving the anterior wall from 2012 to 2018. The demographic data, clinical presentation, radiographic findings, pathology, and surgical outcomes were reviewed. RESULTS: Twenty-two patients were identified, including 13 males and 9 females. Eighteen of the 22 patients had prior surgery and all had Krouse stage 3 disease. After a mean follow-up of 24 (range, 4-63) months, only 1 patient (4.5%) developed a recurrence, which was treated successfully with endoscopic resection. Complications included 1 patient with preoperative epiphora who required dacryocystorhinostomy, epistaxis in another, and 1 patient with transient upper lip numbness. No patients developed alar notching or pyriform aperture stenosis. CONCLUSION: The MED technique is highly effective for surgical resection of primary and recurrent maxillary IPs involving the anterior wall, providing complete access to the entire maxillary sinus. In many cases, the MED can obviate the need for an adjunctive sublabial or transseptal incision, while also providing excellent exposure for postoperative surveillance.


Assuntos
Neoplasias do Seio Maxilar , Papiloma Invertido , Neoplasias dos Seios Paranasais , Endoscopia , Feminino , Humanos , Masculino , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/cirurgia , Neoplasias do Seio Maxilar/diagnóstico por imagem , Neoplasias do Seio Maxilar/cirurgia , Recidiva Local de Neoplasia/cirurgia , Papiloma Invertido/cirurgia , Neoplasias dos Seios Paranasais/diagnóstico por imagem , Neoplasias dos Seios Paranasais/cirurgia , Estudos Retrospectivos
19.
Int Forum Allergy Rhinol ; 10(2): 159-164, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31610616

RESUMO

BACKGROUND: Posterior nasal nerve (PNN) cryoablation is a novel surgical technique to address allergic and nonallergic rhinitis. Periprocedural pain has been reported after PNN cryoablation and there are no standardized protocols for optimal in-office local anesthesia. This study sought to evaluate the effect of gabapentin on patient discomfort following in-office PNN cryoablation. METHODS: Multi-institutional prospective analysis of patients undergoing in-office PNN cryoablation for allergic or nonallergic rhinitis between March 2018 and April 2019. Patients received local anesthesia with or without 600 mg oral gabapentin 1 hour preprocedure. Rhinitis diagnosis, demographics, and baseline disease-specific quality of life (mini-Rhinoconjunctivitis Quality of Life Questionnaire [RQLQ] and Total Nasal Symptom Score [TNSS]) were recorded. Patient discomfort was measured by the pain visual analogue scale (VAS) posttreatment and rated 0 to 10 on an ordinal scale. Fisher's exact and Wilcoxon 2-sample tests were used to evaluate differences between the 2 groups. RESULTS: A total of 26 patients were enrolled (gabapentin n = 15, control = 11). Baseline TNSS scores in the gabapentin vs control group were median [25th percentile to 75th percentile]) 10 (7.5 to 11.0) and 9 (6.0 to 10.0) (p = 0.35). Baseline Mini-RQLQ scores in gabapentin vs control groups were 3.21 (2.0 to 4.0) and 2.92 (2.78 to 4.35) (p = 0.51). The median VAS pain scores at 5, 20, and 30 minutes in the gabapentin vs control group were 0.0 (0.0 to 2.0) vs 3.0 (1.0 to 4.0), 2.0 (0.0 to 3.0) vs 8.0 (6.0 to 10.0), and 1.0 (0.0 to 1.0) vs 5.0 (4.0 to 6.0) (p = 0.02, p = 0.0043, and p = 0.003, respectively). CONCLUSION: Preprocedure gabapentin significantly reduces immediate and delayed postprocedural patient discomfort following PNN cryoablation.


Assuntos
Analgésicos/administração & dosagem , Criocirurgia , Gabapentina/administração & dosagem , Mucosa Nasal/inervação , Dor Pós-Operatória/tratamento farmacológico , Dor Processual/tratamento farmacológico , Nervos Periféricos/cirurgia , Adulto , Idoso , Assistência Ambulatorial , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Nasal/cirurgia , Procedimentos Cirúrgicos Nasais , Cuidados Pré-Operatórios
20.
Int Forum Allergy Rhinol ; 10(1): 110-113, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31589814

RESUMO

BACKGROUND: Unplanned readmissions within 30 days of discharge is a quality measure introduced by the Centers for Medicare Services. This measure has been used to rate hospital quality and also to penalize hospitals for excess readmissions. It has been hypothesized that shorter hospital stays and fewer readmissions are associated with endoscopic skull base procedures. In this study we analyze endoscopic skull base procedures performed at our institution over a 10-year period to identify rates and factors associated with readmissions after endoscopic skull base surgery. METHODS: A retrospective chart review was performed at a tertiary care academic medical center identifying patients who underwent endoscopic skull base surgery over the past 10 years. Data on patient demographics and tumor variables, as well as patient variables such as body mass index (BMI), revision surgery, history of skull base radiation, medical comorbidities, intraoperative cerebrospinal fluid (CSF) leaks, and postoperative CSF leaks, were recorded. RESULTS: Eight hundred thirty-three patients were included in our study. Sixty-one patients (7.3%) were readmitted a total of 66 times within 30 days. The most common reasons were as follows: hyponatremia (n = 18); CSF leak (n = 17); epistaxis (n = 3); diabetes insipidus (n = 3); rhinorrhea (n = 3); as well as other reasons. Statistical analysis revealed that the presence of intraoperative CSF leak was the only statistically significant variable associated with increased rate of readmissions within 30 days of discharge (p < 0.001). CONCLUSION: Presence of intraoperative CSF leak was the only statistically significant variable associated with an increased risk for readmission after surgery. Other tumor and patient variables were not associated with an increased risk of readmission within 30 days.


Assuntos
Endoscopia/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Base do Crânio/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Endoscopia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Base do Crânio/patologia , Neoplasias da Base do Crânio/cirurgia , Centros de Atenção Terciária , Adulto Jovem
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