Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.425
Filtrar
1.
Artigo em Chinês | MEDLINE | ID: mdl-31446739

RESUMO

SummaryRenal clear cell carcinoma(RCCC) is the most common type of renal cell carcinoma, but metastasis to the nasal cavity is extremely rare. A case of RCCC to the nasal cavity and paranasal sinuses was reported. The early clinical manifestations of this case were intermittent epistaxis and subsequent massive epistaxis. Imaging examination revealed that there were masses in the nasal cavity and paranasal sinus, accompanied by bleeding and destruction of the skull base. Renal CT examination showed a tumor in the right kidney, and considered the patient suffering from renal cell carcinoma. The patient underwent a nasal side incision to remove the tumor, the patient's pathological return; nasal nephrogenic clear-cell carcinoma.


Assuntos
Adenocarcinoma de Células Claras/complicações , Carcinoma de Células Renais/complicações , Neoplasias Renais/complicações , Cavidade Nasal/patologia , Neoplasias dos Seios Paranasais/secundário , Adenocarcinoma de Células Claras/diagnóstico , Humanos , Seios Paranasais/patologia
2.
Zhonghua Shao Shang Za Zhi ; 35(6): 441-445, 2019 Jun 20.
Artigo em Chinês | MEDLINE | ID: mdl-31280537

RESUMO

Objective: To explore the advantages of endoscopy combined with contrast fistulography in the clinical diagnosis and treatment of chronic wound with sinus tract adjacent to body cavity. Methods: Thirty-two patients (14 males and 18 females, aged 17 to 87 years) of chronic wounds with sinus tracts adjacent to body cavity, who underwent endoscopy combined with contrast fistulography (CT or magnetic resonance imaging) for the diagnosis and treatment in the Outpatient Department of Wound Healing Center of our hospital from October 2017 to March 2019, were enrolled in the study. Their diagnosis and treatment results were retrospectively analyzed. The following data were calculated. (1) The incidence rates of sinus wound involving body cavity or fistula. (2) The detection rates of sinus wound involving body cavity detected by routine examination and by endoscopy combined with contrast fistulography. (3) The detection rate of pathological features at deep part of wound by routine examination and by endoscopy combined with contrast fistulography. (4) The proportion of patients who benefited from routine examination and from endoscopy combined with contrast fistulography. Data were processed with paired chi-square test and Fisher's exact probability test. Results: (1) The incidence rate of sinus wound involving body cavity was 43.75% (14/32); the incidence rate of fistula was 0. (2) The detection rate of sinus wound involving body cavity detected by endoscopy combined with contrast fistulography was 43.75% (14/32), which was obviously higher than that by routine examination [12.50% (4/32), χ(2)=32.0, P<0.01]. (3) The detection rate of pathological features at deep part of wound by endoscopy combined with contrast fistulography was 37.50% (12/32), which was obviously higher than that by routine examination (0, P<0.01). (4) The proportion of patients who benefited from endoscopy combined with contrast fistulography was 71.43% (20/28), which was obviously higher than that from routine examination [12.50% (4/32), χ(2)=21.6, P<0.01]. Conclusions: Compared with routine examination, endoscopy combined with contrast fistulography is more accurate in detecting chronic wound with sinus tract adjacent to body cavity. The diagnosis and treatment of chronic wound with sinus tract adjacent to the body cavity can benefit from this joint examination.


Assuntos
Endoscopia , Fístula/diagnóstico por imagem , Seios Paranasais/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seios Paranasais/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Cicatrização , Adulto Jovem
3.
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 33(5): 447-450;454, 2019 May.
Artigo em Chinês | MEDLINE | ID: mdl-31163555

RESUMO

Objective: To investigate the clinicopathological features and the clinical characteristics of inflammatory myofibroblastic tumor(IMT) of paranasal sinus. Method: Five cases of IMT of paranasal sinus treated from 2011 to 2018 were analyzed retrospectively. Of the 5 patients, CT and MRI were performed before operation. All tumors originated from paranasal sinus, and orbital, pterygopalatine fossa and palate was involved with variable degrees. All patients had been given operation and recovered well. Two cases received additional glucocorticoid therapy(prednisone) postoperatively. Result: After a follow-up of 3-80 months, one case recurred 2 years postoperatively and received surgery again. No recurrence was found after operation in the other four patients. The finial diagnosis depended on pathological findings. Postoperative pathological examination showed that the tumor cells were mainly composed of spindle fibroblasts and chronic inflammatory cells. Immunohistochemical staining showed positive expression of SMA protein. Conclusion: IMT of paranasal sinus is a rare clinical entity without specific clinical manifestations and the extent of the lesion can be assessed by imaging examinations. Pathological examination is required for final diagnosis. Radical resection should be taken for limited lesions. Besides surgery, corticosteroid administration and irradiation therapy is recommended in some circumstances. The overall prognosis is good.


Assuntos
Neoplasias dos Seios Paranasais/cirurgia , Humanos , Recidiva Local de Neoplasia , Neoplasias dos Seios Paranasais/patologia , Seios Paranasais/patologia , Seios Paranasais/cirurgia , Prednisona/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento
4.
J Forensic Leg Med ; 66: 79-85, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31229802

RESUMO

Although the diagnosis of drowning may appear straightforward the reality is that it is sometimes one of the most difficult in forensic pathology. To begin with, there is no universal agreement on what constitutes drowning with some definitions using the term in the absence of a lethal outcome. Next are the significant problems that arise in finding immersed bodies and in assessing the death scene. Prolonged post mortem intervals are associated with artefactual modifications of the body from putrefaction and post mortem animal predation. Both of these may create and disguise injuries. The absence of pathognomonic pathological features at autopsy and the presence of potentially life threatening underlying organic illnesses complicate determination of both the cause and manner of death. There may even be no autopsy findings to indicate that immersion had occurred. Finally, the unreliability of laboratory tests with significant overlap with control cases where death had no association with immersion presents further problems. Thus lethal drowning remains a complex event that requires the use of a wide variety of information sources, not just data gleaned from the dissection table.


Assuntos
Afogamento/diagnóstico , Patologia Legal/métodos , Animais , Aorta/patologia , Comorbidade , Consenso , Diatomáceas/isolamento & purificação , Afogamento/patologia , Eletrólitos/análise , Hemorragia/patologia , Humanos , Pulmão/patologia , Tamanho do Órgão , Seios Paranasais/patologia , Mudanças Depois da Morte , Sistema Respiratório/patologia , Pele/patologia , Baço/patologia , Terminologia como Assunto , Tomografia Computadorizada por Raios X , Túnica Íntima/patologia
5.
Eur Arch Otorhinolaryngol ; 276(8): 2267-2271, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31098874

RESUMO

PURPOSE: The aim of the study is to investigate the relation between paranasal sinus volumes and headache in patients with no other rhinologic causes. METHODS: Two hundred patients with chronic headache and 99 subjects with no headache or facial pain history in the last 6 months were included in the study. Paranasal computed tomography (CT) scans of both patient and control groups were evaluated. Sixty one patients were excluded from the study due to possible rhinogenic headache CT findings such as secretions and contact points. Sinus volume index (SVI) formula created by Barghouth et al. in 2002 was used to calculate paranasal sinus volumes: SVI = ½. A × B × C. Mann-Whitney U test was used to compare an independent continuous variable and a continuous variable with non-normal distribution. RESULTS: In the patient group, the total sinus, frontal sinus, and maxillary sinus volumes were found to be significantly lower than those of the control group (p < 0.001). Although the total sphenoid sinus volume was found to be lower in the patient group, there was no significant difference between the two groups (p = 0.013). CONCLUSION: Although rhinogenic findings are often related to secondary headache, the relation between paranasal sinus volume and headache is scarcely investigated in the literature. Our study showed that paranasal sinus volumes might have a role in secondary headaches. Furthermore, in contrast to the literature, our study showed a significant relation between headache and smaller paranasal sinus volumes.


Assuntos
Dor Facial , Cefaleia , Seios Paranasais , Adulto , Correlação de Dados , Dor Facial/diagnóstico , Dor Facial/etiologia , Feminino , Cefaleia/diagnóstico , Cefaleia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Seios Paranasais/diagnóstico por imagem , Seios Paranasais/patologia , Estatísticas não Paramétricas , Tomografia Computadorizada por Raios X/métodos , Turquia
7.
Eur Arch Otorhinolaryngol ; 276(7): 1969-1974, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30900021

RESUMO

BACKGROUND: Sarcoidosis is a chronic disease, which predominantly affects the lung. Since sinonasal sarcoidosis is rare, little is known about the sarcoidosis manifestation at this site. Therefore, the aim of our study was to detect the prevalence of sinonasal sarcoidosis, its clinical occurrence, diagnosis, and therapy. METHODS: The database of all patients having visited the otorhinolaryngology departments of the universities in Göttingen and in Bonn between 2003 and 2016 was searched for the diagnosis of sinonasal sarcoidosis. RESULTS: Thirteen patients with a biopsy-proven sinonasal sarcoidosis were identified. Most patients presented non-specific clinical symptoms, which are also found in acute and chronic sinusitis. None of the patients was suspected to have sinonasal sarcoidosis by the ENT doctor before histological validation. The mean diagnostic delay was 262 (± 195) days. An additional pulmonary involvement was detected in four of six patients. CONCLUSIONS: Sinonasal sarcoidosis is presenting with heterogeneous clinical presentations. An early biopsy of granulomatous lesions is mandatory. A multidisciplinary approach is needed to exclude serious lung or heart manifestations, because even asymptomatic organ involvement is possible. A CT-scan may be useful even if unspecific. Local or systemic therapy has to be prepared individually using local and systemic corticosteroids, antimetabolites, or anti-TNF-alpha.


Assuntos
Doenças dos Seios Paranasais , Seios Paranasais , Sarcoidose , Biópsia/métodos , Diagnóstico Tardio/prevenção & controle , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças dos Seios Paranasais/diagnóstico , Doenças dos Seios Paranasais/epidemiologia , Doenças dos Seios Paranasais/terapia , Seios Paranasais/diagnóstico por imagem , Seios Paranasais/patologia , Administração dos Cuidados ao Paciente/métodos , Sarcoidose/diagnóstico , Sarcoidose/epidemiologia , Sarcoidose/terapia , Tomografia Computadorizada por Raios X/métodos
8.
Eur Arch Otorhinolaryngol ; 276(6): 1677-1684, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30879192

RESUMO

PURPOSE: Phosphaturic mesenchymal tumour (PMT) of the paranasal sinuses is a rare tumour that is associated with oncogenous osteomalacia causing predominant musculoskeletal symptoms. We present a series of eight patients diagnosed to have PMT of the paranasal sinuses with varied presentation and highlight the appropriate evaluation required to arrive at the diagnosis. METHODS: Retrospective review of eight patients diagnosed to have PMT-causing tumour-induced osteomalacia with follow-up data. RESULTS: Eight patients, 4 males and 4 females, aged 36-67 years (mean = 44 years) presented with vague musculoskeletal symptoms (6 patients) or epistaxis (3 patients). Six patients were found to have hypophosphatemia, phosphaturia and raised FGF-23 levels preoperatively. All eight patients were found to have a tumour in the nose and/ paranasal sinuses with one patient having intracranial extension. All patients were treated with endoscopic excision of these tumours which resulted in resolution of symptoms and normalisation of biochemical abnormalities. In addition, one patient required a craniofacial resection. Histopathological features were consistent with PMT mixed connective tissue variant. Two atypical patients were seen. The longest follow-up was for 5 years and there was no evidence of recurrence during the follow-up period in any patient. CONCLUSION: Diagnosis of PMT of the paranasal sinuses causing oncogenous osteomalacia requires a high index of suspicion when there are no ENT symptoms. Appropriate biochemical tests and histopathology lead to the correct diagnosis. Total endoscopic surgical excision leads to a good outcome.


Assuntos
Hipofosfatemia , Mesenquimoma , Osteomalacia , Neoplasias dos Seios Paranasais , Adulto , Epistaxe/diagnóstico , Epistaxe/etiologia , Feminino , Fatores de Crescimento de Fibroblastos , Seguimentos , Humanos , Hipofosfatemia/diagnóstico , Hipofosfatemia/etiologia , Masculino , Mesenquimoma/sangue , Mesenquimoma/patologia , Mesenquimoma/fisiopatologia , Recidiva Local de Neoplasia/complicações , Osteomalacia/diagnóstico , Osteomalacia/etiologia , Neoplasias dos Seios Paranasais/sangue , Neoplasias dos Seios Paranasais/patologia , Neoplasias dos Seios Paranasais/fisiopatologia , Seios Paranasais/diagnóstico por imagem , Seios Paranasais/patologia , Estudos Retrospectivos
9.
Int J Pediatr Otorhinolaryngol ; 121: 127-136, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30897372

RESUMO

INTRODUCTION: Burkitt lymphoma (BL), an aggressive form of B-cell non-Hodgkin's lymphoma, arising from the nose and paranasal sinuses is relatively rare. It can present with various symptoms leading to potential misdiagnosis and delayed treatment. BL is fatal if left untreated, while early identification and treatment can improve prognosis. OBJECTIVES: 1) To review clinical presentations and sites of involvement of six cases of pediatric BL with rhinologic manifestations and compare these with the current literature. 2) To raise awareness on the variety of presentations of BL in this particular anatomic location. METHODS: A series of six cases of pediatric (0-18 years) BL with rhinologic manifestations is presented. Age, sex, ethnicity, symptoms, imaging, staging, treatment and outcome were recorded. A systematic review of literature was also conducted using PRISMA guidelines. The search strategy used keywords related to rhinologic manifestations of BL (nasal cavity, nasopharynx, paranasal sinus etc.; Burkitt etc.) and included studies published in English and French describing patients 0-18 years of age. RESULTS: 42 patients were included (six from case series and 36 from current literature). Most common presenting symptoms were: nasal obstruction (29%), facial swelling (24%), headache (21%) and proptosis (19%). Most frequent sites of presentation were: nasopharynx (40%), maxilla (40%) and sphenoid (33%). More than half (60%) had systemic involvement, of which the most common locations were: kidney (19%), pancreas (17%) and liver (17%). Mortality from BL in children from this study population was correlated with a longer duration of symptoms prior to presentation, as well as a misdiagnosis preceding the final diagnosis of BL. CONCLUSIONS: This study brings understanding to the numerous presentations of the same aggressive disease, promotes high clinical suspicion when evaluating common otolaryngologic symptoms and can guide healthcare providers in diagnosing pediatric BL with rhinologic manifestations.


Assuntos
Linfoma de Burkitt/complicações , Linfoma de Burkitt/diagnóstico , Edema/etiologia , Face , Cefaleia/etiologia , Obstrução Nasal/etiologia , Adolescente , Linfoma de Burkitt/patologia , Criança , Pré-Escolar , Exoftalmia/etiologia , Feminino , Humanos , Lactente , Neoplasias Renais/etiologia , Neoplasias Hepáticas/etiologia , Masculino , Maxila , Nasofaringe , Neoplasias Pancreáticas/etiologia , Seios Paranasais/patologia
10.
Laryngoscope ; 129(7): 1545-1548, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30835847

RESUMO

OBJECTIVE: Chronic rhinosinusitis (CRS) is a proposed risk factor for meningitis and other intracranial complications following the endoscopic endonasal transsphenoidal approach (TSA). Some have recommended staging TSA following surgery for CRS; however, delaying TSA has important ramifications. The objective of this study is to determine whether asymptomatic sinonasal inflammation (RSNI) on preoperative computed tomography scans, without clinical CRS, is associated with postoperative complications following TSA. METHODS: All consecutive TSA cases performed at a single tertiary care institution from January 1, 2009, to December 31, 2017, were reviewed for patient demographics, prior surgery, presence of RSNI on preoperative computed tomography scan based on Lund-Mackay (LM) score, intraoperative cerebrospinal fluid (CSF) leak, and postoperative complications (postoperative CSF leak, bleeding, infection). The association between preoperative RSNI and postoperative complications was analyzed via multivariate logistic regression. RESULTS: One hundred seventy-one cases of TSA were included with mean patient age of 52.6 years, 42.7% males, 18.1% revision cases, and mean LM score of 1.9 ± 2.7. Complications were identified in 9.9% of patients at the following rates: 5.3% postoperative CSF leak, 2.9% bleeding, and 1.8% infection (all sinusitis, no episodes of meningitis). Neither total LM score nor LM score > 5 (representative of clinically significant radiographic CRS) were predictors of any postoperative complication (both P > 0.05). Age, sex, revision status, intraoperative CSF leak, and total LM score were not independent predictors of any postoperative complication on multivariate analysis (all P > 0.05). CONCLUSION: In asymptomatic patients, radiographic evidence of sinonasal inflammation is not associated with increased risk of complications following TSA. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:1545-1548, 2019.


Assuntos
Endoscopia/efeitos adversos , Doenças da Hipófise/cirurgia , Complicações Pós-Operatórias/etiologia , Rinite/complicações , Sinusite/complicações , Adulto , Idoso , Doenças Assintomáticas , Doença Crônica , Endoscopia/métodos , Feminino , Humanos , Inflamação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Nariz , Seios Paranasais/diagnóstico por imagem , Seios Paranasais/patologia , Doenças da Hipófise/complicações , Doenças da Hipófise/patologia , Hipófise/cirurgia , Complicações Pós-Operatórias/epidemiologia , Período Pré-Operatório , Estudos Retrospectivos , Rinite/diagnóstico por imagem , Rinite/patologia , Sinusite/diagnóstico por imagem , Sinusite/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
11.
Surv Ophthalmol ; 64(3): 365-379, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30707923

RESUMO

Idiopathic orbital inflammation developed in the right orbit of a woman in her mid-thirties, causing tearing, photophobia, diplopia, altered depth perception, proptosis, and pain on eye movements. Computed tomography disclosed a mass involving the intraconal and extraconal nasal right orbit, extending to the orbital apex with anterior displacement of the globe, effacement of the medial rectus muscle, portions of the fat plane, and the superior oblique muscle, and bone destruction with extension of the mass through the orbital floor into the superior maxillary sinus and through the lamina papyracea into the ethmoid sinus. Orbital biopsy disclosed dense fibrous connective tissue with numerous lymphocytes and macrophages. Immunohistochemical stains supported a diagnosis of idiopathic inflammatory pseudotumor involving the orbit and sinus mucosa. Treatment with a prednisone taper and a retrobulbar injection of triamcinolone acetonide have relieved her symptoms and diminished her proptosis. This patient highlights the rare potential of idiopathic orbital inflammation to erode though bone into adjacent cranial structures.


Assuntos
Pseudotumor Orbitário/patologia , Seios Paranasais/patologia , Adulto , Exoftalmia/patologia , Feminino , Humanos
12.
mSphere ; 4(1)2019 02 06.
Artigo em Inglês | MEDLINE | ID: mdl-30728283

RESUMO

Chronic rhinosinusitis (CRS) is a heterogeneous condition characterized by persistent sinus inflammation and microbial dysbiosis. This study aimed to identify clinically relevant subgroups of CRS patients based on distinct microbial signatures, with a comparison to the commonly used phenotypic subgrouping approach. The underlying drivers of these distinct microbial clusters were also investigated, together with associations with epithelial barrier integrity. Sinus biopsy specimens were collected from CRS patients (n = 23) and disease controls (n = 8). The expression of 42 tight junction genes was evaluated using quantitative PCR together with microbiota analysis and immunohistochemistry for measuring mucosal integrity and inflammation. CRS patients clustered into two distinct microbial subgroups using probabilistic modelling Dirichlet (DC) multinomial mixtures. DC1 exhibited significantly reduced bacterial diversity and increased dispersion and was dominated by Pseudomonas, Haemophilus, and Achromobacter DC2 had significantly elevated B cells and incidences of nasal polyps and higher numbers of Anaerococcus, Megasphaera, Prevotella, Atopobium, and Propionibacterium In addition, each DC exhibited distinct tight junction gene and protein expression profiles compared with those of controls. Stratifying CRS patients based on clinical phenotypic subtypes (absence or presence of nasal polyps [CRSsNP or CRSwNP, respectively] or with cystic fibrosis [CRSwCF]) accounted for a larger proportion of the variation in the microbial data set than with DC groupings. However, no significant differences between CRSsNP and CRSwNP cohorts were observed for inflammatory markers, beta-dispersion, and alpha-diversity measures. In conclusion, both approaches used for stratifying CRS patients had benefits and pitfalls, but DC clustering provided greater resolution when studying tight junction impairment. Future studies in CRS should give careful consideration to the patient subtyping approach used.IMPORTANCE Chronic rhinosinusitis (CRS) is a major human health problem that significantly reduces quality of life. While various microbes have been implicated, there is no clear understanding of the role they play in CRS pathogenesis. Another equally important observation made for CRS patients is that the epithelial barrier in the sinonasal cavity is defective. Finding a robust approach to subtype CRS patients would be the first step toward unravelling the pathogenesis of this heterogeneous condition. Previous work has explored stratification based on the clinical presentation of the disease (with or without polyps), inflammatory markers, pathology, or microbial composition. Comparisons between the different stratification approaches used in these studies have not been possible due to the different cohorts, analytical methods, or sample sites used. In this study, two approaches for subtyping CRS patients were compared, and the underlying drivers of the heterogeneity in CRS were also explored.


Assuntos
Bactérias/isolamento & purificação , Microbiota , Seios Paranasais/microbiologia , Sinusite/microbiologia , Adulto , Bactérias/classificação , Biópsia , Doença Crônica , Humanos , Inflamação/genética , Membrana Mucosa/imunologia , Membrana Mucosa/microbiologia , Pólipos Nasais/microbiologia , Seios Paranasais/patologia , Sinusite/classificação , Junções Íntimas/genética
13.
BMJ Case Rep ; 12(2)2019 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-30737321

RESUMO

We report an extremely rare case of a hybrid tumour of the maxillary sinus. A 51-year-old man presented with a 6-week history of nasal congestion and epiphora. Radiological imaging demonstrated a maxillary sinus tumour, with extensive local invasion. Surgical excision included maxillectomy, left eye exenteration and free flap closure. Histology of the excised specimen showed a rare hybrid tumour containing adenoid cystic carcinoma, salivary duct carcinoma, epithelial-myoepithelial carcinoma and basal cell adenoma. Hybrid tumours are very rare tumour entities which are composed of at least two distinct tumour types. Each tumour entity conforms with a defined tumour type. The tumour entities of a hybrid tumour are not separated but have an identical origin within a definite topographical area. Diagnosis and appropriate management requires high index of suspicion, pathological endeavour to look for a more aggressive accompanying tumour and adequate oncological treatment according to the highest grade of tumour.


Assuntos
Carcinoma Adenoide Cístico/patologia , Imagem por Ressonância Magnética , Neoplasias do Seio Maxilar/patologia , Neoplasias Primárias Múltiplas/patologia , Neoplasias Orbitárias/patologia , Seios Paranasais/patologia , Neoplasias das Glândulas Salivares/patologia , Carcinoma Adenoide Cístico/diagnóstico por imagem , Carcinoma Adenoide Cístico/terapia , Osso Etmoide/patologia , Osso Etmoide/cirurgia , Humanos , Obstrução dos Ductos Lacrimais/diagnóstico por imagem , Masculino , Neoplasias do Seio Maxilar/diagnóstico por imagem , Neoplasias do Seio Maxilar/terapia , Pessoa de Meia-Idade , Obstrução Nasal/diagnóstico por imagem , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/terapia , Neoplasias Orbitárias/diagnóstico por imagem , Neoplasias Orbitárias/terapia , Procedimentos Cirúrgicos Ortognáticos , Radioterapia Adjuvante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias das Glândulas Salivares/diagnóstico por imagem , Neoplasias das Glândulas Salivares/terapia , Resultado do Tratamento
14.
Am J Rhinol Allergy ; 33(3): 310-316, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30674195

RESUMO

BACKGROUND: Allergic fungal rhinosinusitis (AFRS) is characterized by higher revision endoscopic sinus surgery (ESS) rates and unique radiographic features when compared to chronic rhinosinusitis with nasal polyposis (CRSwNP) or chronic rhinosinusitis without nasal polyposis (CRSsNP). OBJECTIVE: We hypothesized that an increased frequency of concha bullosa in AFRS or other radiographic nuances might allow for accumulation of allergic mucin and contribute to increased ESS revision rates. METHODS: A retrospective cohort study was performed. Patient diagnosis (AFRS, CRSwNP, and CRSsNP), basic demographics, and prior ESS rates were collected. RESULTS: A total of 210 consecutive patients were included (AFRS = 70, CRSwNP = 70, and CRSsNP = 70). Pediatric AFRS patients had more unilateral disease (38.1% vs 4.4%; P = .007) and anterior ethmoid skull base erosion (23.8% vs 6.7%; P = .047) than adult AFRS patients. AFRS patients were more likely to be younger (24.9 ± 10.1 years vs 45.6 ± 14.4 years vs 48.7 ± 18.2 years; P < .001), African American (70% vs 14.3% vs 11.4%; P < .001), and have undergone prior ESS (54.3% vs 45.7% vs 31.4%; P = .02) than CRSwNP or CRSsNP patients. Concha bullosa were more prevalent in AFRS patients than CRSwNP or CRSsNP patients across the population (42.9%, 18.6%, and 14.3%; P < .001) and in the setting of no previous surgery (53.1%, 31.6%, and 16.7%; P < .001). CONCLUSION: In this cohort, pediatric AFRS patients had more unilateral disease and anterior ethmoid skull base erosion. Concha bullosa prevalence was significantly higher in AFRS as compared to those with CRSwNP or CRSsNP, despite prior ESS. Surgeons should consider concha bullosa as a potential anatomical subsite to harbor recurrent or residual disease.


Assuntos
Rinite Alérgica/diagnóstico por imagem , Sinusite/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Criança , Doença Crônica , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/diagnóstico por imagem , Micoses/patologia , Micoses/cirurgia , Pólipos Nasais/diagnóstico por imagem , Pólipos Nasais/patologia , Pólipos Nasais/cirurgia , Seios Paranasais/diagnóstico por imagem , Seios Paranasais/patologia , Seios Paranasais/cirurgia , Reoperação , Estudos Retrospectivos , Rinite Alérgica/microbiologia , Rinite Alérgica/patologia , Rinite Alérgica/cirurgia , Fatores de Risco , Sinusite/microbiologia , Sinusite/patologia , Sinusite/cirurgia , Adulto Jovem
15.
Am J Rhinol Allergy ; 33(3): 294-301, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30656950

RESUMO

BACKGROUND: A remarkable relationship between upper airway conditions and lung diseases has been reported. At the same time, sinonasal findings in chronic cough patients have not been fully examined. OBJECTIVE: The purpose of this study is to show paranasal sinus findings and lung function in chronic cough patients without asthma and chest X-ray abnormalities. METHODS: A total of 1412 patients with persistent cough were enrolled in this study. Of these patients, 376 patients were evaluated for further examination, as the patients with asthma and/or chest X-ray abnormality were excluded from the study. Normal control subjects without any chronic respiratory symptoms were also recruited. Pulmonary function was examined by spirometry. A bronchial obstruction reversibility test was applied. The Lund-Mackay computed tomography (CT) score, peripheral blood eosinophil count, and immunoglobulin E concentration in serum samples were examined. The Sino-Nasal Outcome Test was used to determine the severity of clinical symptoms. RESULTS: The patients with an abnormal soft tissue shadow in the paranasal sinus had significant obstructive lung function. The percent predicted forced expiratory volume in 1 second (FEV1.0) and the FEV1.0/forced vital capacity ratio negatively correlated with Lund-Mackay CT scores both before and after bronchodilator inhalation. There was a statistically significant correlation between pulmonary function and eosinophil count. CONCLUSION: The patients with chronic cough frequently had paranasal sinus abnormalities. The Lund-Mackay CT score may be useful for assessing the condition of the lower airway in chronic cough patients. Upper airway examinations should play a part in the management of chronic cough.


Assuntos
Tosse/diagnóstico por imagem , Tosse/fisiopatologia , Pulmão/fisiopatologia , Seios Paranasais/fisiopatologia , Tomografia Computadorizada por Raios X , Adulto , Doença Crônica , Tosse/patologia , Eosinófilos/metabolismo , Feminino , Humanos , Imunoglobulina E/sangue , Contagem de Leucócitos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Seios Paranasais/diagnóstico por imagem , Seios Paranasais/patologia , Testes de Função Respiratória , Índice de Gravidade de Doença , Sinusite/patologia , Sinusite/fisiopatologia
16.
Eur Arch Otorhinolaryngol ; 276(5): 1341-1347, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30689038

RESUMO

PURPOSE: Cystic Fibrosis (CF) is the most common autosomal recessive disease in Caucasian population. Due to its pathological mechanism, chronic rhino sinusitis (CRS) associated or not with nasal polyposis usually occurs in adults and affects close to one-half of all CF patients. The goal of our work was to evaluate the impact of Endoscopic Sinus Surgery (ESS) in the quality of life (QoL) of the CF patients and demonstrate an improvement of the functional outcomes in the patients underwent the surgical procedure rather than in the not treated ones, particulary in lung transplant patients. METHODS: We studied 54 adult patients affected by CF. Lund-Kennedy, Lund-Mackay scores, and SNOT-22 were analysed. 14 had lung transplant and 9 had both lung tranplant and ESS procedures. RESULTS: 22 (40.7%) out of 54 CF patients underwent ESS. This group presented more likely complaints consistent with CRS. Lund-Kennedy and Lund-Mackay scores appeared higher in the ESS group: 10 (range of 6-12) and 15 (range of 12-20), respectively. SNOT-22 showed median values for non-ESS and ESS group of 20 (range of 3-68) and 40 (range of 10-73), respectively. CONCLUSIONS: ESS represents the best option to improve clinical QoL of CF patients who do not response to conventional medical therapy, with a stabilization of respiratory function after transplantation.


Assuntos
Fibrose Cística , Endoscopia/métodos , Transplante de Pulmão , Pólipos Nasais , Seios Paranasais/cirurgia , Qualidade de Vida , Sinusite , Adulto , Doença Crônica , Fibrose Cística/complicações , Fibrose Cística/psicologia , Fibrose Cística/cirurgia , Feminino , Humanos , Transplante de Pulmão/efeitos adversos , Transplante de Pulmão/métodos , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/complicações , Pólipos Nasais/cirurgia , Seios Paranasais/patologia , Seios Paranasais/efeitos da radiação , Rinite/complicações , Rinite/cirurgia , Sinusite/complicações , Sinusite/cirurgia , Resultado do Tratamento , Adulto Jovem
17.
Eur Arch Otorhinolaryngol ; 276(4): 1057-1064, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30617426

RESUMO

OBJECTIVES: We investigated the relationship between Onodi cells and optic canal by paranasal sinus computed tomography (PNSCT). METHODS: In this retrospective study, 508 PNSCT (265 males and 243 females) was examined. Onodi cell presence, pneumatization types, optic canal types; and also sphenoid sinusitis and anterior clinoid process pneumatization were evaluated. RESULTS: The prevalence of Onodi cells was 21.2% of the patients. Onodi cells were observed 40.7% on the right side and 25.9% on the left side. In 33.4% of the patients, bilateral Onodi cells were present. Male/Female ratio was 24.5%/17.6%. Onodi cell types were detected as Type I > Type II > Type III bilaterally. There was a positive correlation between the right and left Onodi cell types (p < 0.05). Optic canal types were detected as Type IV > Type I > Type II > Type III. bilaterally. There was a positive correlation between right and left optic canal types. Onodi cell presence and ACP pneumatization were found as statistically significant (p < 0.05). In 65.5% of the patients, Onodi cells and ACP pneumatization were absent. ACP pneumatization was present in 35.4% of the cases. In nine cases, bilateral Onodi cells and ACP pneumatization were detected. Sphenoid sinusitis was detected in 11.4% of Type I and 13.8% of the Type II Onodi cells on the right side. On the left side, it was detected in 12.9% of the Type I and 19.0% of Type II Onodi cells. CONCLUSION: Identification of Onodi cell is very important clinically because of its proximity to optic nerve canal. We concluded that type IV Onodi-optic canal relationship was the most common finding in our study. Onodi cell presence and their patterns of pneumatization must be evaluated on PNSCT preoperatively to avoid optic canal damage.


Assuntos
Nervo Óptico/diagnóstico por imagem , Seios Paranasais , Osso Esfenoide , Seio Esfenoidal , Sinusite Esfenoidal/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Osso Etmoide/diagnóstico por imagem , Osso Etmoide/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seios Paranasais/diagnóstico por imagem , Seios Paranasais/patologia , Prevalência , Estudos Retrospectivos , Osso Esfenoide/diagnóstico por imagem , Osso Esfenoide/patologia , Seio Esfenoidal/diagnóstico por imagem , Seio Esfenoidal/patologia
18.
Am J Rhinol Allergy ; 33(1): 44-50, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30311505

RESUMO

BACKGROUND: Odontogenic maxillary sinusitis (OMS) and rhinogenic sinusitis (RS) are the main types of chronic rhinosinusitis (CRS) and have a significant impact on health-related quality of life (HRQL), but the difference in HRQL and symptom presentation between them has not been specifically evaluated to date. Obejctive: Our aim was to compare patterns of symptoms and HRQL disease-specific domains in patients affected with these 2 types of CRS. METHODS: A group of 201 patients with CRS (99 with rhinogenic and 102 with odontogenic origin) completed the Sino-Nasal Outcome Test 22 (SNOT-22) questionnaire before treatment. Data sets were analyzed by using principal component analysis (PCA) to identify a set of symptom components together with the items excluded from PCA, which were then analyzed for differences between patients with OMS and RS. RESULTS: PCA of SNOT-22 items identified 5 components: "rhinologic," "extranasal rhinologic," "ear/facial," "sleep and functional disturbance," and "emotional disturbance." Sneezing was excluded from PCA and treated as separate outcome variable and was significantly worse in RS patients. Patients with OMS scored significantly higher scores with regard to emotional disturbance, while RS patients scored significantly worse in sleep and functional disturbance. The extra symptom "malodor" was the most different symptom and was significantly worse in OMS patients. The total SNOT-22 score was not significantly different between the groups. CONCLUSION: With controlling of covariates that may influence the severity of the disease, this study showed some significant differences in symptom patterns and HRQL impairment between patients with OMS and RS. Malodor is the most characteristic feature of OMS. Therefore, OMS should always be suspected in patients complaining of bad breath.


Assuntos
Seios Paranasais/patologia , Rinite/diagnóstico , Sinusite/diagnóstico , Dente/patologia , Adulto , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Odorantes , Análise de Componente Principal , Estudos Prospectivos , Qualidade de Vida , Rinite/fisiopatologia , Sinusite/fisiopatologia , Inquéritos e Questionários
19.
Am J Rhinol Allergy ; 33(2): 113-120, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30430853

RESUMO

BACKGROUND: Chronic rhinosinusitis (CRS) is a heterogeneous disease process that can arise in the context of odontogenic disease from the maxillary teeth. The histopathologic features of odontogenic CRS (CRSo) have yet to be determined and may have important implications on disease management and need for escalation of therapy. OBJECTIVES: The objectives of this study are to characterize the histopathologic features of CRSo and determine whether the inflammatory profile of CRSo contributes to its recalcitrance to medical therapy and need for surgery in a subset of patients with this disease. METHODS: A structured histopathology report was used to analyze sinus tissue removed during functional endoscopic sinus surgery (FESS). Histopathology variables, Lund-Mackay scores (LMS), and Sinonasal Outcome Test-22 scores were compared among CRSo patients, CRS without nasal polyps (CRSsNP) patients, and CRS with nasal polyps (CRSwNP) patients. RESULTS: Twenty-three CRSo, 38 CRSwNP, and 53 CRSsNP patients who underwent FESS were analyzed. Compared to CRSsNP, CRSo exhibited increased moderate-severe inflammation (73.9% vs 41.5%, P < .009). Compared to CRSwNP, CRSo had decreased squamous metaplasia (0.0% vs 18.4%, P < .03) and decreased fibrosis (26.1% vs 63.2%, P < .005). Eosinophilia was prevalent in CRSo but to a lesser extent than in CRSwNP (39.1% vs 63.2%, P < .05). CRSo cases had significantly lower mean LMS compared to CRSwNP (7.83 ± 2.77 vs12.18 ± 6.77, P < .005). CONCLUSION: CRSo exhibits histopathologic features similar to those of CRSsNP with more severe inflammation. Moreover, eosinophilia, which is not typically considered to coexist with CRSo, was present in a large portion of CRSo patients. These findings may help explain at the inflammatory level why select cases of CRSo may be recalcitrant to medical and dental therapy.


Assuntos
Doenças Maxilares/complicações , Sinusite/etiologia , Sinusite/patologia , Doença Crônica , Endoscopia , Eosinofilia/patologia , Feminino , Humanos , Inflamação/patologia , Masculino , Doenças Maxilares/patologia , Doenças Maxilares/cirurgia , Pessoa de Meia-Idade , Pólipos Nasais/complicações , Pólipos Nasais/patologia , Pólipos Nasais/cirurgia , Seios Paranasais/patologia , Seios Paranasais/cirurgia , Rinite/etiologia , Rinite/patologia , Rinite/cirurgia , Índice de Gravidade de Doença , Sinusite/cirurgia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA