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1.
Radiol Med ; 127(10): 1124-1133, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36018486

RESUMO

OBJECTIVE: To assess the diagnostic utility of various radiologic criteria such as the lateral margin or dislocation of the retromandibular vein (RMV), Utrecht line, facial nerve line, Conn's arc, lines passing from the lateral margin of the masseter muscle to the facial nerve trunk or RMV, minimum distance from the fascia to the tumor (MDFT), and direct tracing of the intraparotid facial nerve (DT) for differentiating a parotid deep lobe tumor from a superficial lobe tumor. METHODS: Twenty-one studies with 2225 participants from PubMed, Embase, Web of Science, Cochrane Library, SCOPUS, and Google Scholar up to March 2022 were analyzed. Sensitivity, specificity, and negative and positive predictive values of the methods were extracted. RESULTS: The diagnostic odds ratio (DOR) of radiologic criteria compared to surgical findings was 18.9109. The area under the summary receiver operating characteristic curve was 0.879. The sensitivity and specificity were 0.6663 and 0.9190. MDFT (DOR 61.2917) and DT (DOR 91.9883) showed superior results as diagnostic landmarks. For tumors crossing the anatomical criteria line, strict way (any tumor crossing the line) could help differentiate a deep lobe tumor more accurately than conventional way (> 50% of the tumor volume located medial to the line). CONCLUSION: Various radiologic criteria, especially MDFT and DT, showed good diagnostic accuracy for differentiating a parotid deep lobe tumor.


Assuntos
Neoplasias Parotídeas , Nervo Facial/patologia , Humanos , Glândula Parótida/diagnóstico por imagem , Neoplasias Parotídeas/diagnóstico por imagem , Neoplasias Parotídeas/patologia , Neoplasias Parotídeas/cirurgia , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
2.
Eur Arch Otorhinolaryngol ; 276(1): 3-10, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30238311

RESUMO

OBJECTIVES: The use of greater palatine canal (GPC) injections of a local anesthetic and a vasoconstrictor to decrease surgical bleeding during endoscopic sinus surgery (ESS) is controversial. We investigated the role of a preoperative GPC injection to minimize intraoperative bleeding during ESS in patients with chronic sinusitis through a meta-analysis of the relevant literature. DATA SOURCES: PubMed, SCOPUS, and the Cochrane database. REVIEW METHODS: We screened the relevant literature published before May of 2018. Five articles that compared the pre-operative GPC injection (treatment group) with a placebo or no treatment (control group) were included for this analysis of the outcomes, which included an endoscopic grade of nasal bleeding and intraoperative hemodynamic stability during ESS. RESULTS: The endoscopic grade in the treatment group was significantly reduced when compared with the control group. No significant adverse effects were reported in the enrolled studies. The subgroup analyses of these results compared the concentrations of adrenalin (1:80,000 or 1:100,000), and adrenalin 1:80,000 showed significant effects on intraoperative bleeding when compared to adrenalin 1:100,000. CONCLUSION: This study demonstrated that GPC injections of local anesthesia with 1:80,000 adrenaline for ESS effectively reduced intraoperative bleeding. Additionally, this procedure showed no significant adverse effects, such as hemodynamic instability. However, the standardized dosing needs further investigation and more trials. LEVEL OF EVIDENCE: Ia.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Endoscopia/métodos , Epistaxe/prevenção & controle , Seios Paranasais/cirurgia , Sinusite/cirurgia , Humanos , Injeções
3.
Ann Hematol ; 97(9): 1695-1700, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29766236

RESUMO

Inhibitor development is the most serious complication in patients with hemophilia. We investigated association of HLA genotypes with inhibitor development in Korean patients with severe hemophilia A (HA). HLA genotyping was done in 100 patients with severe HA including 27 patients with inhibitors. The allele frequencies between inhibitor-positive and inhibitor-negative patients were compared. HLA class I alleles were not associated with the inhibitor status. In HLA class II, DRB1*15 [n = 100, odds ratio (OR) 0.217, P = 0.028] and DPB1*05:01 [OR 0.461, P = 0.026] were negatively associated with inhibitor development. In a subgroup of patients with intron 22 inversion, C*07:02 was positively associated with inhibitor development [n = 30, OR 5.500, P = 0.043]. In the subgroup of patients without intron 22 inversion, the negative association between DPB1*05:01 and inhibitor development was reinforced [n = 70, OR 0.327, P = 0.010], and positive association of DRB1*13:02 and DPB1*04:01 with inhibitor development was identified [OR 3.059, P = 0.037 for both]. Previously reported risk alleles were not consistently associated with inhibitor risk in our series. This study demonstrated the profile of HLA alleles associated with inhibitor risk in Korean patients with severe HA was different from that in patients of other ethnicities, which needs to be considered in risk assessment and management.


Assuntos
Inibidores dos Fatores de Coagulação Sanguínea/sangue , Genótipo , Antígenos HLA-C/genética , Cadeias HLA-DRB1/genética , Hemofilia A/sangue , Hemofilia A/genética , Adolescente , Adulto , Idoso , Povo Asiático , Inibidores dos Fatores de Coagulação Sanguínea/genética , Criança , Pré-Escolar , Feminino , Hemofilia A/epidemiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Fatores de Risco
4.
J Craniofac Surg ; 29(5): e497-e499, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29762329

RESUMO

Juvenile psammomatoid ossifying fibroma (JPOF) is a rare tumor that occurs in maxillary sinus or orbit. Complete removal is required due to the aggressive and locally destructive nature. It is hard to distinguish from psammomatoid meningioma in cranial lesion and to remove completely. The authors are presenting a case of 26-year-old male with JPOF on skull base and report this case with review of literature.


Assuntos
Fibroma Ossificante/diagnóstico por imagem , Neoplasias da Base do Crânio/diagnóstico por imagem , Adulto , Fibroma Ossificante/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias Nasais/diagnóstico por imagem , Neoplasias Nasais/patologia , Neoplasias dos Seios Paranasais/diagnóstico por imagem , Neoplasias dos Seios Paranasais/patologia , Neoplasias da Base do Crânio/patologia , Tomografia Computadorizada por Raios X
5.
J Craniofac Surg ; 29(3): e319-e322, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29485571

RESUMO

BACKGROUND: To investigate the effect of rhinosinusitis in patients who undergo surgery via the endoscopic endonasal transsphenoidal approach (EETSA). METHODS: The authors retrospectively reviewed the medical records of patients who underwent surgery via the EETSA between February 2009 and November 2016. In total, 505 patients were included in the study. Preoperative paranasal sinus computed tomography, sellar magnetic resonance imaging, and nasal endoscopy were performed for all the patients. RESULTS: Fifteen patients without sphenoid sinusitis underwent surgery with the concomitant transsphenoidal approach and functional endoscopic sinus surgery, and showed no central nervous system (CNS) complication. During surgery via the EETSA, the presence of rhinosinusitis did not significantly affect the incidence of postoperative CNS infection (P = 0.051), except for sphenoid sinusitis (P = 0.003). Conversely, the incidence of postoperative CNS infection was not related significantly to the Lund-Mackay score or tumor size. The risk of CNS infection was 12.151-fold higher in patients with sphenoid sinusitis (95% confidence interval, 3.153-46.827; P ≤ 0.001). CONCLUSION: Surgery via the EETSA and functional endoscopic sinus surgery can be safely performed together in most patients with rhinosinusitis. However, sphenoid sinus infection appears to be a predisposing factor for postoperative CNS infection. Therefore, a separate surgical procedure for sphenoid lesions should be considered in these patients before the use of the EETSA.


Assuntos
Infecções do Sistema Nervoso Central/etiologia , Endoscopia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Sinusite/complicações , Neoplasias da Base do Crânio/cirurgia , Seio Esfenoidal/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Endoscopia/métodos , Feminino , Humanos , Incidência , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Nariz/cirurgia , Seios Paranasais/diagnóstico por imagem , Estudos Retrospectivos , Rinite/complicações , Fatores de Risco , Base do Crânio/cirurgia , Osso Esfenoide/cirurgia , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
6.
J Craniofac Surg ; 29(3): 543-546, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29283943

RESUMO

BACKGROUND AND OBJECTIVE: The aim of this study is to investigate the relationships between tumor size, nasal symptoms including olfactory function, and posoperative atrophic mucosal changes after the endoscopic endonasal transsphenoidal approach (EETSA). METHODS: This was a retrospective review of the medical records of 112 patients who underwent the 2 nostrils/4 hands EETSA with bilateral modified nasoseptal rescue flaps between February 2009 and January 2016. Pre- and postoperative paranasal sinus computed tomography, nasal cavity endoscopic images, the Connecticut Chemosensory Clinical Research Center (CCCRC) test, Cross-Cultural Smell Identification Test (CCSIT), the Nasal Obstruction Symptoms Evaluation, and the Sino-Nasal Outcome Test-20 were conducted. Nasal mucosal changes as determined by endoscopy were divided into 4 groups: normal to normal, Group A; atrophy to atrophy, Group B; normal to atrophy, Group C; and atrophy to more atrophy, Group D. The Mimics program was used to calculate nasal cavity volume changes after surgery. RESULTS: There were significant differences between pre- and postoperative olfactory function as reflected by the CCCRC (P < 0.001) and CCSIT (P < 0.001) scores. There was also a correlation between tumor size and olfactory function scores such as the CCCRC (P = 0.012) or CCSIT (P = 0.015). Moreover, nasal mucosal atrophic changes were related to tumor size and olfactory function tests. CONCLUSION: The tumor size was related to olfactory function and atrophic mucosal changes. Therefore, patients with large tumors should be informed that, after the EETSA, their olfaction may be altered and that nasal symptoms related to mucosal atrophy could occur.


Assuntos
Endoscopia/métodos , Nariz/cirurgia , Transtornos do Olfato/etiologia , Complicações Pós-Operatórias/etiologia , Neoplasias da Base do Crânio/cirurgia , Base do Crânio/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Cavidade Nasal/anatomia & histologia , Mucosa Nasal/patologia , Obstrução Nasal/etiologia , Seios Paranasais/diagnóstico por imagem , Estudos Retrospectivos , Retalhos Cirúrgicos , Tomografia Computadorizada por Raios X , Adulto Jovem
7.
J Craniofac Surg ; 28(4): 1005-1006, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28230588

RESUMO

OBJECTIVE: A method of opening the posterior ethmoid air cells with minimal manipulation is important for adequate exposure of the sella floor and minimal nasal morbidity. METHODS: Between February 2009 and August 2016, 373 patients with skull-base tumors underwent surgery via endoscopic endonasal transsphenoidal approach with the 2-nostrils/4-hands technique using this technique. RESULTS: A linear incision was made laterally toward one-third of the superior turbinate along the superior border of the sphenoid sinus ostium. Then, the superior turbinate mucosa was fully elevated to expose the superior turbinate bone. This allowed us to expose the entire sella floor and adjacent vital structures, such as the optic and carotid protuberances, medial and lateral opticocarotid recesses, planum sphenoidale, and clivus, leaving the superior turbinate and surrounding nasal mucosa intact. CONCLUSION: This technique could improve the manipulability of surgical instruments and increase the accessibility of the parasellar region. This approach better conserves the nasal mucosa, posterior ethmoid, and superior and supreme turbinates and more efficiently exposes skull-base tumors than traditional methods with pathology of the anterior cranial fossa and parasellar region. This technique also prevents the drilling procedure from damaging the surrounding nasal mucosa, including the exfoliated and laterally preserved posterior sphenoid mucosa.


Assuntos
Fossa Craniana Anterior/cirurgia , Endoscopia/métodos , Neoplasias da Base do Crânio/cirurgia , Osso Esfenoide/cirurgia , Humanos , Cavidade Nasal , Cirurgia Endoscópica por Orifício Natural/métodos , Estudos Retrospectivos
8.
J Craniofac Surg ; 28(2): 468-471, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28045816

RESUMO

OBJECTIVE: Reconstruction of the skull base using a pedicled nasoseptal flap (NSF) seems to be advantageous after the endoscopic endonasal transsphenoidal approach (EETSA). A few reports have evaluated the cause of flap failure in EETSA using NSFs. The aim of this study was to evaluate the perioperative risk factors for NSF failure. STUDY DESIGN: Patient series. SETTING: Retrospective review of medical records at a tertiary referral center. METHODS: The study population comprised patients who underwent EETSA with NSF elevation between February 2009 and March 2014. The authors retrospectively reviewed the all patients' medical records, including operative findings. RESULTS: Four hundred thirteen patients (203 males and 210 females) underwent EETSA, and 315 patients underwent EETSA with NSF elevation. The mean patient age was 48.0 years. The total number of patients of NSF failure was 6 (overall rate: 1.61%, 6/315; flap elevation: 0.31%, 1/315; flap reconstruction: 15.1%, 5/33). Two patients had diabetes mellitus. One patient had cardiovascular problems. Five patients were elderly (>60 years; mean age: 70 years). Five patients had postoperative nasal infection. One patient underwent preoperative radiation therapy. CONCLUSION: Nasoseptal flap is a usually safe and effective technique for skull base reconstruction. However, the management of patients with diabetes mellitus, cardiovascular problems, advanced age, postoperative nasal infection, and radiation therapy may require more attention to improve NSF survival.


Assuntos
Base do Crânio/cirurgia , Retalhos Cirúrgicos , Idoso , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nariz , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Retalhos Cirúrgicos/patologia , Falha de Tratamento
9.
J Craniofac Surg ; 28(4): 959-962, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28582956

RESUMO

OBJECTIVE: In February 2009, the authors' center formed a team of neurosurgeons, otolaryngologists, endocrinologists, and radiologists to perform pituitary surgery using the endoscopic endonasal transsphenoidal approach (EETSA). This paper reviews the authors' experience with the technique, pathological outcomes, hormone profiles, and postoperative complications. METHODS: Between February 2009 and December 2015, 535 patients underwent the EETSA with 2-nostrils/4-hands surgery. All of the patients had preoperative neurophthalmological and endocrinological assessments and neuroimaging. Patients were followed for at least 6 months with otolaryngological evaluations. RESULTS: The most common pathology treated was pituitary adenomas, with 390 (72.9%) patients. Of these, 287 (73.6%) were nonfunctioning adenomas. As the surgical method, the conventional 2-nostrils/4-hands technique was performed in 77 patients (14.4%), a right conventional nasoseptal flap and left modified nasoseptal rescue flap technique was used in 135 patients (25.2%), and bilateral modified nasoseptal rescue flaps were used in 323 patients (60.4%). Postoperative complications occurred in 46 patients (8.6%). The most common complications were vascular injury or hematoma (10 patients, 1.9%), and the most common postoperative sinonasal complaints were hyposmia or anosmia. Olfactory function was significantly decreased according to the Connecticut Chemosensory Clinical Research Center test (P <0.001) and Cross-Cultural Smell Identification Test scores (P <0.001) evaluated 6 months postoperatively. CONCLUSIONS: Skull-base tumor surgery via an EETSA with a team approach was performed for various extended tumors. It is important to consider postoperative sinonasal dysfunction, such as hyposmia or anosmia, and to have this followed by an otolaryngologist.


Assuntos
Adenoma/cirurgia , Cirurgia Endoscópica por Orifício Natural/métodos , Neoplasias Hipofisárias/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Criança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Procedimentos de Cirurgia Plástica , Estudos Retrospectivos , Seio Esfenoidal , Cirurgiões , Retalhos Cirúrgicos , Resultado do Tratamento , Adulto Jovem
10.
Eur Arch Otorhinolaryngol ; 272(2): 263-70, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24682602

RESUMO

Transnasal endoscopy can cause pain or discomfort for the patient. Topical anesthetic has been used in an attempt to reduce this. However, there is no consensus on whether topical anesthetic is effective in optimizing patient experience during the procedure. The goal of this study was to perform a systematic review with meta-analysis of the efficacy of topical anesthetic on pain and comfort outcomes during endoscopy. Two authors independently searched the databases from inception to September 2013. Studies comparing topical anesthetic with placebo where the outcomes of interest were pain, comfort, or side effect outcomes were included. Sufficient data for meta-analysis were retrieved for ten trials with a total of 837 patients. The evidence suggests that local anesthetic alone or in combination with a vasoconstrictor is beneficial to patients' pain [standardized mean difference (SMD) = -0.21; p = 0.045] and comfort (SMD = -0.51; p < 0.001) outcomes when performing transnasal endoscopy. However, the topical anesthetic caused unpleasant sensation with respect to an unpleasant taste (SMD = 0.77; p < 0.001). In addition, there was no significant difference between a topical anesthetic spray and cotton type in pain and discomfort values. Applying topical anesthetic during transnasal endoscopy could reduce pain and discomfort. The spray and cotton type methods of topical anesthetic preparation showed no significant difference in terms of pain and discomfort during the procedure. However, further trials with good research methodology should be conducted to confirm our results.


Assuntos
Anestésicos Locais/administração & dosagem , Endoscopia , Dor/prevenção & controle , Humanos , Cavidade Nasal , Vasoconstritores/uso terapêutico
11.
J Craniofac Surg ; 26(3): 849-52, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25901673

RESUMO

We conducted this study to identify preoperative factors that are associated with the postoperative nasal synechiae in patients with nasal bone fracture who underwent closed reduction.In the current single-center, retrospective study, we evaluated the fracture type, septal deviation angle (SDA), synechia scores (SSs) and visual analog scale (VAS) scores through a retrospective review of the medical records and computed tomography scans of 42 patients (n = 42) who had undergone closed reduction for nasal bone fracture at our medical institution during a period ranging from April to August 2013.The mean SS was significantly lower in the plane I group (n = 25) as compared with the plane II group (n = 17) (1.28 ± 1.77 vs 2.76 ± 1.89, P = 0.013). There was a significant positive correlation between the SDA and the SS with a formula of SS = 0.216SDA - 0.322 (r(2) = 0.532, P < 0.001) and between the SS and the VAS with a formula of VAS = 1.280SS + 0.612 (r(2) = 0.648, P < 0.001). Both the SS and VAS were significantly higher on the convex side as compared with the concave side of the nasal cavity.Our results indicate that patients with higher SDA or combined septal fractures might be at increased risks of developing the postoperative synechiae. Further large-scale, prospective studies are warranted to establish our results.


Assuntos
Fixação de Fratura/efeitos adversos , Osso Nasal/lesões , Complicações Pós-Operatórias/diagnóstico , Fraturas Cranianas/diagnóstico , Aderências Teciduais/diagnóstico , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osso Nasal/diagnóstico por imagem , Osso Nasal/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Fraturas Cranianas/cirurgia , Aderências Teciduais/etiologia , Aderências Teciduais/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
12.
Eur Arch Otorhinolaryngol ; 271(8): 2219-25, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24362681

RESUMO

Recently, the endoscopic transsphenoidal approach for sphenoid sinus or intracranial lesion has gained more popularity and the study of the surgical anatomy and relationships of the sphenoid sinus has gained increased significance. The aim of this study was to clarify the anatomical features of the sphenoid sinus including surrounding structures as seen in the operative view of endoscopic transsphenoidal surgery. The various distances in the sphenoid sinus as well as the relationships between the sphenoid sinus ostium (SO) and important structures such as the optic canal (OC) and carotid artery (CA) according to the presence of Onodi cell (sphenoethmoidal cell; Onodi group vs. non-Onodi group) were assessed using multiplanar and three-dimensional model of CT scans in 100 patients. The SO was more inferior in Onodi group and located superior to the lowest point of the sella. The horizontal distance from the SO to sella was approximately 13 or 14 mm depending on the existence of Onodi cells. Regardless of Onodi cell, the whole course of the OC in the sinus ran superolaterally to inferomedially in the endoscopic view. However, Onodi cell made the angles from the SO to OC larger. In Onodi group, the CA was located from the SO in a superolateral direction, but in non-Onodi group, the CA was located from the SO in the inferolateral direction. This study provides anatomical information about the sphenoid sinus, with important surgical distances between the SO and surrounding structures measured, which is essential to avoid complications during transsphenoidal surgery.


Assuntos
Endoscopia/métodos , Imageamento Tridimensional , Tomografia Computadorizada Multidetectores , Seio Esfenoidal/diagnóstico por imagem , Seio Esfenoidal/cirurgia , Adulto , Idoso , Artérias Carótidas/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seios Paranasais/diagnóstico por imagem , Estudos Retrospectivos , Osso Esfenoide/diagnóstico por imagem , Adulto Jovem
13.
J Clin Tuberc Other Mycobact Dis ; 36: 100455, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38983442

RESUMO

Objectives: Nasopharyngeal tuberculosis is a rare form of tuberculosis in which Mycobacterium tuberculosis infects the nasopharyngeal tissue. In this study, we analyzed key clinical features to prevent misdiagnosis and to raise awareness of the condition, while recommending suitable treatments. We also report a case of nasopharyngeal tuberculosis presenting with nasal congestion and intermittent ear fullness, contributing valuable educational insight for diagnosis. Methods: Demographic and clinical data from patients with nasopharyngeal tuberculosis were collected from PubMed, Embase, Web of Science and the Cochrane Central Register of Controlled Trials up to September 2022. In total, 280 patients from 69 studies were analyzed. Results: Reports indicate that the incidence of nasopharyngeal tuberculosis has doubled every decade, particularly in Asia. Most patients are female, presenting with granulomatous pathology and findings such as masses, lymphoid hyperplasia, polypoid formations, or swelling on endoscopic examination. Common symptoms include nasal obstruction, hearing impairment, sore throat, and dysphagia, usually accompanied by cervical lymphadenopathy. The mean duration from symptom onset to diagnosis is ∼2.88 months, and the average time from the start of treatment to resolution of symptoms is âˆ¼ 4.90 months. The antituberculosis treatment regimen and duration are significantly associated with the time to resolution (r = -0.648, p = 0.003 and r = 0.584, p = 0.028, respectively). Conclusion: These results suggest that an extended regimen of antituberculosis drugs may expedite symptom relief. However, there is a need for more standardized data on patient outcomes and treatment efficacy due to the current lack of comprehensive data.

14.
Auris Nasus Larynx ; 51(2): 242-250, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38061935

RESUMO

OBJECTIVE: Fungal balls (FB) are the main form of non-invasive fungal rhinosinusitis found in immunocompetent hosts. Bacterial coinfection affects clinical symptoms. We investigated the sinonasal microbiome and inflammatory profiles in FB and chronic rhinosinusitis (CRS) patients. METHODS: Thirty-three participants were prospectively recruited. Nasal swab samples and sinonasal tissues were collected from controls, and FB and CRS patients. DNA extraction and microbiome analysis using V3-V4 region 16S rRNA sequencing were performed. Inflammatory cytokine levels in the sinonasal tissues, blood eosinophil counts, and serum total IgE were measured. RESULTS: No significant differences were observed in species richness or evenness measures. The phylogenetic tree demonstrated that the FB samples were different from the controls. The sinus bacteria composition differed among the groups. At the phylum level, Firmicutes in FB were significantly depleted compared with those in CRS, while Proteobacteria were more enriched in FB than that in controls and CRS. At the genus level, in FB, Staphylococcus and Corynebacterium were significantly decreased compared to those in the controls. The prevalence of Haemophilus was the highest in FB. Blood eosinophil counts and IL-5 and periostin levels in the sinonasal tissue of the FB group were significantly lower than those in the CRS group. CONCLUSIONS: FB patients had different microbiome compositions and fewer type 2 inflammatory profiles than CRS patients did. However, whether these findings cause FB or result from bacterial and/or fungal infection remains unclear. Further studies are needed to reveal how these differences occur and affect the development of FB and clinical symptoms.


Assuntos
Microbiota , Rinite , Rinossinusite , Sinusite , Humanos , RNA Ribossômico 16S/genética , Filogenia , Rinite/microbiologia , Sinusite/microbiologia , Bactérias/genética , Microbiota/genética , Doença Crônica
15.
Toxics ; 12(6)2024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38922087

RESUMO

Pyroptosis represents a type of cell death mechanism notable for its cell membrane disruption and the subsequent release of proinflammatory cytokines. The Nod-like receptor family pyrin domain containing inflammasome 3 (NLRP3) plays a critical role in the pyroptosis mechanism associated with various diseases resulting from particulate matter (PM) exposure. Tert-butylhydroquinone (tBHQ) is a synthetic antioxidant commonly used in a variety of foods and products. The aim of this study is to examine the potential of tBHQ as a therapeutic agent for managing sinonasal diseases induced by PM exposure. The occurrence of NLRP3 inflammasome-dependent pyroptosis in RPMI 2650 cells treated with PM < 4 µm in size was confirmed using Western blot analysis and enzyme-linked immunosorbent assay results for the pyroptosis metabolites IL-1ß and IL-18. In addition, the inhibitory effect of tBHQ on PM-induced pyroptosis was confirmed using Western blot and immunofluorescence techniques. The inhibition of tBHQ-mediated pyroptosis was abolished upon nuclear factor erythroid 2-related factor 2 (Nrf2) knockdown, indicating its involvement in the antioxidant mechanism. tBHQ showed potential as a therapeutic agent for sinonasal diseases induced by PM because NLRP3 inflammasome activation was effectively suppressed via the Nrf2 pathway.

16.
Am J Otolaryngol ; 34(5): 505-7, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23731849

RESUMO

PURPOSE: Physiologically acidic nasal pH depends on intact nasal mucosal function. The aim of this study was to determine nasal pH in patients with chronic rhinosinusitis and to investigate the changes in pH related to mucosal healing after endoscopic sinus surgery. MATERIALS AND METHODS: Normal subjects and the patients with chronic rhinosinusitis who showed no recurrence after endoscopic sinus surgery were enrolled. Using a portable pH meter and a glass-tipped probe, nasal pH was measured in the inferior meatus in normal subjects and patients before and after surgery at 3 months. RESULTS: The mean (±SD) nasal pH was 6.5 ± 0.5 (5.9 to 7.3) in 19 normal subjects, and 6.7 ± 0.6 (5.3 to 7.6) in 19 CRS patients before surgery, which showed no significant difference between the groups. The nasal pH values were in the range of 3.8-7.7 (mean ± SD 5.7 ± 0.9) at 3 months after surgery, and significantly lower than the preoperative values in patients (P=.004). The patients showing pH lower than 6.0 accounted for 10.5% before surgery, but 68.4% after surgery. CONCLUSIONS: Normal nasal pH was in the slightly acidic range, and the mean nasal pH of patients with chronic rhinosinusitis fell within normal limits as well, which indicates that chronic rhinosinusitis may not disturb the electrolyte milieu of the nasal mucosa. The average nasal pH measured at 3 months after endoscopic sinus surgery exhibited acidity of pH5.7. The factors causing a fall in nasal pH during the healing period after the sinus surgery remain to be elucidated.


Assuntos
Cavidade Nasal/metabolismo , Procedimentos Cirúrgicos Otorrinolaringológicos , Rinite/metabolismo , Sinusite/metabolismo , Adulto , Doença Crônica , Endoscopia , Feminino , Seguimentos , Humanos , Concentração de Íons de Hidrogênio , Masculino , Período Pós-Operatório , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Rinite/cirurgia , Sinusite/cirurgia
17.
Eur Arch Otorhinolaryngol ; 270(4): 1355-9, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23081674

RESUMO

Recent studies have indicated the usefulness of endoscopic endonasal transsphenoidal approach (EETSA). A few studies have reported on the postoperative nasal symptoms of patients who have undergone EETSA. Therefore, we adopted a rhinologic perspective to compare preoperative and postoperative nasal symptoms after performing a binostril, four-hand EETSA. Patients who were scheduled to undergo binostril, four-hand EETSA underwent preoperative nasal evaluation using the Nasal Obstruction Symptom Evaluation (NOSE), Sino-Nasal Outcome Test-20 (SNOT-20), and a visual analogue scale (VAS) to assess several nasal symptoms. Repeat testing was performed 6 months postoperatively. Paired Student's t tests were used to compare preoperative and postoperative scores. A total of 142 patients who underwent a binostril, four-hand EETSA were included in this study. We found no statistically significant differences between preoperative and postoperative NOSE, total SNOT-20 scores, or scores on the VAS for nasal obstruction, sneezing, rhinorrhea, snoring, or facial pain. However, VAS of olfactory change increased significantly after EETSA (p < 0.05). The binostril, four-hand EETSA would be a useful method because it permits operative manipulability and a wide visual field for skull base lesions. However, rhinologists must consider postoperative nasal symptoms and perform a proper preoperative examination, especially with regard to the olfactory function, and inform patients scheduled for EETSA of potential postoperative changes.


Assuntos
Adenoma/cirurgia , Fossa Craniana Anterior/cirurgia , Endoscopia/métodos , Obstrução Nasal/diagnóstico , Transtornos do Olfato/diagnóstico , Medição da Dor , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/diagnóstico , Neoplasias da Base do Crânio/cirurgia , Seio Esfenoidal/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Dor Facial/diagnóstico , Feminino , Cefaleia/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/diagnóstico , Espirro , Resultado do Tratamento , Adulto Jovem
18.
J Craniofac Surg ; 24(5): 1569-72, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24036728

RESUMO

A nasoseptal flap is used to reconstruct defects in the skull base when cerebrospinal fluid (CSF) leaks after the endoscopic endonasal transsphenoidal approach (EETSA). We evaluated the usefulness of elevating bilateral nasoseptal flaps with the EETSA. Sixty-seven patients (71 procedures, including 4 revisions) underwent the EETSA with bilateral nasoseptal flap elevation. We retrospectively reviewed patients' medical records, including demographic data, surgical procedures, outcomes, and complications. The entire sellar floor was exposed after elevating bilateral nasoseptal flaps. We reconstructed the defect using a right nasoseptal flap in 14 cases with intraoperative CSF leakage. The denuded sphenoidal sinus was covered with a left nasoseptal flap in 13 cases with excessive loss of sphenoidal sinus mucosa. Unused flaps (57 right flaps and 58 left flaps) were repositioned in the original sites. No postoperative CSF leak occurred. All sphenoidal sinuses covered with the left nasoseptal flap healed well without excessive crust. Two patients experienced immediate postoperative bleeding. Septal perforation occurred in 1 patient who underwent a revision operation. Bilateral nasoseptal flap elevation provided good exposure of the sellar floor with the EETSA. The nasoseptal flap could be used to reconstruct the defect after the EETSA and to cover the denuded sphenoidal sinus. The unused flaps could be repositioned in their original sites to minimize the septal defect and could be reused in revision surgery. We suggest that elevating bilateral nasoseptal flaps is a useful surgical technique in a variety of settings with the EETSA.


Assuntos
Rinorreia de Líquido Cefalorraquidiano/cirurgia , Endoscopia/métodos , Complicações Intraoperatórias/cirurgia , Septo Nasal/cirurgia , Neoplasias Hipofisárias/cirurgia , Rinoplastia/métodos , Seio Esfenoidal/cirurgia , Retalhos Cirúrgicos/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Base do Crânio/cirurgia
19.
Asian Pac J Allergy Immunol ; 31(1): 20-5, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23517390

RESUMO

BACKGROUND AND OBJECTIVES: The most reliable method for confirming the causative allergens of allergic rhinitis is the skin prick test, followed by the multiple allergen simultaneous test (MAST), which reportedly has acceptable sensitivity and specificity. This study was designed to confirm whether a novel MAST-immunoblot assay can reliably diagnose allergic rhinitis. METHODS: A retrospective chart review was conducted of chronic rhinitis patients who visited Yeouido St. Mary's Hospital between January 2010 and June 2011. RESULTS: In total, 193 subjects (111 male, 82 female) were included, with a mean age of 30.08 years (range 6-77). The skin prick test detected 132 subjects as having one or more positive responses to allergens, and MAST detected 105 subjects as having one or more positive response. The sensitivity, specificity, and efficiency of the MAST assay were 63.16%, 65.57%, and 63.92%, respectively. Sensitivity, specificity and efficacy for common allergens were not high enough for MAST to replace skin prick test in detecting causative allergens. When correlation was defined as a difference between the classes of MAST and SPT of less than 2, the correlation rates for Dermatophagoides farina and Dermatophagoides pteronyssinus were 65.80% and 59.07%, respectively. CONCLUSION: The correlation between MAST and the skin prick test is not sufficiently strong to use MAST as a diagnostic test to confirm the causative allergen in allergic rhinitis. Further studies to confirm the reliability of MAST should be conducted.


Assuntos
Alérgenos , Western Blotting , Rinite/diagnóstico , Testes Cutâneos , Adolescente , Adulto , Idoso , Alérgenos/imunologia , Animais , Western Blotting/métodos , Criança , Doença Crônica , Feminino , Humanos , Imunoglobulina E/imunologia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Testes Cutâneos/métodos , Adulto Jovem
20.
Surg Radiol Anat ; 35(7): 565-71, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23404562

RESUMO

PURPOSE: This study aimed to investigate the anatomy of the infraorbital foramen (IOF), infraorbital canal (IOC), and infraorbital groove (IOG) with regard to surgical and invasive procedures using three-dimensional reconstruction of CT scans. METHODS: The CT scans of 100 patients were evaluated retrospectively. The morphology of the IOF, IOC, and IOG as well as their relationships to different anatomic landmarks was assessed in a three-dimensional model. RESULTS: The mean length of the IOC and IOG and the angle of the IOC relative to IOG were 11.7 ± 1.9, 16.7 ± 2.4 mm, and 145.5° ± 8.5°, respectively. The mean angles of the IOC relative to vertical and horizontal planes were 13.2° ± 6.4° and 46.7° ± 7.6°, respectively. In the relationships between the IOF and different anatomic landmarks, the mean distances from the IOF to supraorbital notch/foramen, facial midline, and infraorbital rim were 5.6 ± 3.1 mm laterally, 26.5 ± 1.9 mm laterally, and 9.6 ± 1.7 mm inferiorly, respectively. The mean distance from the IOF to anterior nasal spine (ANS) was 35.0 ± 2.6 mm, and the mean angle of the axis that passed the IOF and ANS relative to horizontal plane was 28.8° ± 4.1°. In addition, the mean soft tissue thickness overlying the IOF was 11.4 ± 1.9 mm. CONCLUSIONS: These results provide detailed knowledge of the anatomical characteristics and clinical importance of the IOF. Such knowledge is of paramount importance for surgeons when performing maxillofacial surgery and regional block anesthesia.


Assuntos
Imageamento Tridimensional , Modelos Anatômicos , Órbita/anatomia & histologia , Órbita/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Fatores Etários , Idoso , Pontos de Referência Anatômicos , Cefalometria/métodos , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Fatores Sexuais , Adulto Jovem
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