Skull base osteitis following fungal sinusitis

1998 ◽  
Vol 112 (1) ◽  
pp. 92-97 ◽  
Author(s):  
Andrew C. Swift ◽  
David W. Denning
Keyword(s):  
Skull Base ◽  
Antifungal Agents ◽  
Treatment Options ◽  
Surgical Excision ◽  
Invasive Disease ◽  
Fungal Sinusitis ◽  
Non Invasive ◽  
Oral Itraconazole ◽  
Cranial Neuropathies

AbstractAspergillus sp. sinusitis is not uncommon in immunocompromised patients but is unusual in patients who are not immunocompromised. The disease may occur as a saprophytic condition, as an allergic sinusitis or as a potentially lethal invasive disease. The differentiation between non-invasive and invasive Aspergillus sp. sinusitis is crucial and this distinction is fully discussed. The treatment options are also considered. Invasive disease requires aggressive treatment with long-term antifungal agents in sufficient doses combined with wide surgical excision.We present a patient who presented with invasive Aspergillus fumigatus sinusitis and subsequently developed cranial neuropathies and skull base osteitis. She was initially treated with oral itraconazole (400 mg daily) for 18 months but due to lack of response this was changed to a new experimental oral azole (voriconazole) which was continued for a further 14 months. She has since remained well for the last five years.

scholarly journals Non-invasive fungal sinusitis resulting in multiple cranial nerve neuropathies

2019 ◽  
Vol 12 (4) ◽  
pp. e229094 ◽  
Author(s):  
Thomas Hendriks ◽  
Samuel Leedman ◽  
Mark Quick ◽  
Aanand Acharya
Keyword(s):  
Schizophyllum Commune ◽  
Invasive Disease ◽  
Sinus Surgery ◽  
Fungal Sinusitis ◽  
Upper Respiratory Tract ◽  
Radiological Investigation ◽  
Non Invasive ◽  
Invasive Fungal Sinusitis ◽  
Cranial Neuropathies ◽  
Upper Respiratory

A 33-year-old man presented to the emergency department with a right-sided facial paralysis and maxillary division (V2, trigeminal nerve) paraesthesia. He had been suffering with upper respiratory tract symptoms in the preceding 2 months, including rhinorrhoea, fever and headache. The patient was otherwise fit and immunocompetent. Urgent radiological investigation revealed extensive fungal sinusitis with sphenoid sinus dehiscence and skull base osteitis. The patient underwent emergency endoscopic sinus surgery revealing concretions and debris in the ethmoid and sphenoid sinuses. He was commenced on systemic antifungal therapy and made a full recovery with resolution of his cranial neuropathies. The fungusSchizophyllum communewas isolated and is a rare cause of fungal sinusitis, but with the potential for invasive disease in immunosuppressed individuals.

scholarly journals Treatment of Aspergillosis

2018 ◽  
Vol 4 (3) ◽  
pp. 98 ◽  
Author(s):  
Jeffrey Jenks ◽  
Martin Hoenigl
Keyword(s):  
Neutropenic Patient ◽  
Treatment Options ◽  
Primary Treatment ◽  
Antifungal Prophylaxis ◽  
Successful Outcome ◽  
High Morbidity ◽  
Oral Itraconazole ◽  
Chronic Pulmonary Aspergillosis ◽  
Patient Groups

Infections caused by Aspergillus spp. remain associated with high morbidity and mortality. While mold-active antifungal prophylaxis has led to a decrease of occurrence of invasive aspergillosis (IA) in those patients most at risk for infection, breakthrough IA does occur and remains difficult to diagnose due to low sensitivities of mycological tests for IA. IA is also increasingly observed in other non-neutropenic patient groups, where clinical presentation is atypical and diagnosis remains challenging. Early and targeted systemic antifungal treatment remains the most important predictive factor for a successful outcome in immunocompromised individuals. Recent guidelines recommend voriconazole and/or isavuconazole for the primary treatment of IA, with liposomal amphotericin B being the first alternative, and posaconazole, as well as echinocandins, primarily recommended for salvage treatment. Few studies have evaluated treatment options for chronic pulmonary aspergillosis (CPA), where long-term oral itraconazole or voriconazole remain the treatment of choice.

scholarly journals Long term assessment of intralipotherapy in Madelung’s disease

2014 ◽  
Vol 47 (03) ◽  
pp. 427-431 ◽  
Author(s):  
Silvia Scevola ◽  
Giovanni Nicoletti ◽  
Antonino Neri ◽  
Angela Faga
Keyword(s):  
Palliative Treatment ◽  
Surgical Excision ◽  
Invasive Treatment ◽  
Non Invasive ◽  
Madelung's Disease ◽  
Madelung’S Disease ◽  
Average Size ◽  
Head Neck

ABSTRACTMadelung’s disease is characterised by multiple symmetric abnormal fat masses in the head, neck and upper limbs. Surgical excision or liposuction is the only realistic available option, although palliative in nature. The serial intralipotherapy with phosphatidylcholine/deoxycholate has been proposed as a non-invasive treatment of Madelung’s disease. The authors used serial intralipotherapy with phosphatidylcholine/deoxycholate in two patients affected by Madelung’s disease. Three injections per lesion per patient were performed with 1 month’s interval. Pre- and 6 months’ post-treatment dimensions were assessed with ultrasound scan and patients were observed along a 5 years’ clinical follow-up. A 42.5% average size reduction was reported in all treated lesions. About 33% recurrence rate was observed in the 5 years’ follow-up. We confirm the efficacy of intralipotherapy in the non-invasive palliative treatment of Madelung’s disease, as a valid option to reduce the volume and limit the growth of the pathological adipose masses.

scholarly journals Surgical management of extensive hypertrophic scarring of the halluces secondary to a decade of untreated onychocryptosis: An illustrative case report

2017 ◽  
Vol 5 ◽  
pp. 2050313X1774051
Author(s):  
Dean J Samaras ◽  
Andrew C Kingsford
Keyword(s):  
Treatment Options ◽  
Rare Condition ◽  
Surgical Excision ◽  
Current Treatment ◽  
Illustrative Case ◽  
Hypertrophic Scarring ◽  
Psychosocial Effects ◽  
Term Outcome ◽  
Long Term Outcome

Extensive hypertrophic scarring of the halluces secondary to chronic onychocryptosis is a rare condition, which causes significant physical and psychosocial effects. In this case, a 31-year-old male developed large lesions on both great toes after he delayed treatment of chronic hallucal onychocryptosis for over a decade. Current treatment options for hypertrophic and keloid lesions in the foot and ankle vary considerably and differentiation is critical for appropriate treatment planning. In this case, surgical excision with total matrixectomy (modified Zadik–Syme) was considered optimal management. Histopathology testing confirmed the diagnosis of irritated hypertrophic scar secondary to onychocryptosis. The patient was monitored closely and at 3 months post-operatively, the incisional scars exhibited progressive maturation, and there was no recurrence of the lesions and no nail regrowth. Furthermore, the halluces were only marginally shorter providing good function and cosmesis. At the long-term follow-up consultation (5.5 years), the patient indicated complete satisfaction and had returned to regular footwear and social activities. Chronic onychocryptosis can trigger and facilitate proliferation of large benign keloid-like fibrous lesions; excision with total matrixectomy can provide an excellent long-term outcome.

Idiopathic hypertrophic cranial pachymeningitis

1993 ◽  
Vol 79 (2) ◽  
pp. 270-276 ◽  
Author(s):  
Adam N. Mamelak ◽  
William M. Kelly ◽  
Richard L. Davis ◽  
Mark L. Rosenblum
Keyword(s):  
Age Groups ◽  
Surgical Excision ◽  
Mass Effect ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Content Type ◽  
Cranial Nerve Palsies ◽  
Cranial Neuropathies ◽  
Hypertrophic Cranial Pachymeningitis

✓ Hypertrophic cranial pachymeningitis is a rare, idiopathic form of granulomatous pachymeningitis. This report describes three cases of hypertrophic cranial pachymeningitis and discusses the clinical, radiographic, and pathological findings in these and other reported cases. These lesions typically cause progressive cranial nerve palsies, headaches, and cerebellar dysfunction. They occur in patients of all age groups; the peak incidence is in the sixth decade. Hypertrophic cranial pachymeningitis is best identified by magnetic resonance imaging. The diagnosis is established by excluding all other granulomatous and infectious diseases. A dural biopsy is essential to confirm the diagnosis. Hypertrophic cranial pachymeningitis is initially responsive to steroid therapy, but in most cases it recurs or progresses despite treatment. Surgical excision of granulomas is occasionally necessary to alleviate a mass effect. The long-term outcome remains uncertain for most patients, but progressive disease is usually fatal owing to cranial neuropathies.

scholarly journals Urinary nucleic acids can be concentrated, dried on membranes and stored at room temperature in vacuum bags

2014 ◽  
Author(s):  
Fanshuang Zhang ◽  
Yuan Yuan ◽  
Jianqiang Wu ◽  
Youhe Gao
Keyword(s):  
Nucleic Acids ◽  
Large Scale ◽  
Room Temperature ◽  
Invasive Disease ◽  
The Body ◽  
Clinical Samples ◽  
Good Source ◽  
Disease Biomarkers ◽  
Non Invasive

Urine accumulates traces of changes that occur in the body and can potentially serve as a better biomarker source. Urinary nucleic acids are a promising class of non-invasive disease biomarkers. However, long-term frozen human urine samples are not a good source for the extraction of nucleic acids. In this paper, we demonstrate that urinary nucleic acids can be concentrated, dried on membranes and stored in vacuum bags at room temperature for several months. The amount of total RNA on the membranes after storage at room temperature for three months was unchanged. The levels of miR-16 and miR-21 exhibited no significant differences (P = 0.564, 0.386). This simple and economical method makes the large-scale storage of clinical samples of urinary nucleic acids possible.

Current Concepts in the Management of Tumors of the Skull Base

1998 ◽  
Vol 5 (2) ◽  
pp. 138-149 ◽  
Author(s):  
Akio Morita ◽  
Laligam N. Sekhar ◽  
Donald C. Wright
Keyword(s):  
Skull Base ◽  
Malignant Tumors ◽  
Surgical Techniques ◽  
Surgical Excision ◽  
Cranial Base ◽  
Benign Tumors ◽  
Tumor Control ◽  
High Morbidity ◽  
Fractionated Radiotherapy

Background: Due to their involvement with critical neurovascular structures, tumors located in the cranial base present challenges to neurosurgeons and are associated with high morbidity and mortality. Methods: Rates of tumor control, complications, patient outcomes, and recurrences were extracted and summarized from two decades of our surgical and radiological treatment follow-up and review of the medical literature. Results: Recent advances in surgical techniques involving cranial base approaches have made surgical intervention safer and curative resection more likely. In managing benign tumors, surgical resection is the gold standard for treatment. While immediate complications are still significant, long-term outcomes in most cases are excellent. Focused radiosurgery using a gamma knife or linear accelerator has produced favorable outcomes, and it improves the management of small or minimally symptomatic cranial base tumors. For slow-growing malignant tumors, extensive surgery followed by radiotherapy achieves the best outcome. In managing highly malignant tumors, outcome is determined by the effects of chemotherapy and radiotherapy. On some occasions, surgery is needed to obtain greater control of highly malignant tumors. Conclusions: Skull base tumors are relatively common, and management of these tumors is rapidly evolving. The combination of surgical excision using cranial base techniques, radiosurgery, fractionated radiotherapy, and chemotherapy should be individually tailored based on the location and pathological aggressiveness of the tumor and the symptomatology of the patient. Appreciation is expressed to Jennifer Pryll for her illustrative and photographic assistance and to Joseph Reister for editing and preparing the manuscript.

scholarly journals Urinary nucleic acids can be concentrated, dried on membranes and stored at room temperature in vacuum bags

2014 ◽  
Author(s):  
Fanshuang Zhang ◽  
Yuan Yuan ◽  
Jianqiang Wu ◽  
Youhe Gao
Keyword(s):  
Nucleic Acids ◽  
Large Scale ◽  
Room Temperature ◽  
Invasive Disease ◽  
The Body ◽  
Clinical Samples ◽  
Good Source ◽  
Disease Biomarkers ◽  
Non Invasive

Urine accumulates traces of changes that occur in the body and can potentially serve as a better biomarker source. Urinary nucleic acids are a promising class of non-invasive disease biomarkers. However, long-term frozen human urine samples are not a good source for the extraction of nucleic acids. In this paper, we demonstrate that urinary nucleic acids can be concentrated, dried on membranes and stored in vacuum bags at room temperature for several months. The amount of total RNA on the membranes after storage at room temperature for three months was unchanged. The levels of miR-16 and miR-21 exhibited no significant differences (P = 0.564, 0.386). This simple and economical method makes the large-scale storage of clinical samples of urinary nucleic acids possible.

Semi-invasive allergic aspergillosis of the paranasal sinuses

2000 ◽  
Vol 114 (4) ◽  
pp. 290-292 ◽  
Author(s):  
M. F. Oyarzabal ◽  
E. B. Chevretton ◽  
R. J. Hay
Keyword(s):  
Paranasal Sinuses ◽  
Immunocompromised Patient ◽  
Bone Destruction ◽  
Non Invasive ◽  
Tissue Invasion ◽  
Oral Itraconazole ◽  
Cranial Fossa ◽  
Nose And Paranasal Sinuses ◽  
Fungal Tissue

Aspergillosis of the nose and paranasal sinuses has classically been divided into four types: allergic, non-invasive, invasive and fulminant. Recent reports have suggested that a semi-invasive form with bone destruction and erosion, but without fungal tissue invasion, may occur. We present a case of allergic non-invasive aspergillosis of the paranasal sinuses with associated bone destruction extending into the orbit and anterior cranial fossa, in a non-immunocompromised patient. Surgical debridement combined with a prolonged course of oral itraconazole has resulted in long-term resolution with no evidence of recurrence of disease five years later.

scholarly journals Comprehensive Review of Uterine Fibroids: Developmental Origin, Pathogenesis, and Treatment

2021 ◽  
Author(s):  
Qiwei Yang ◽  
Michal Ciebiera ◽  
Maria Victoria Bariani ◽  
Mohamed Ali ◽  
Hoda Elkafas ◽  
...  
Keyword(s):  
Molecular Mechanisms ◽  
Treatment Options ◽  
Uterine Fibroids ◽  
Current Treatment ◽  
Future Perspectives ◽  
Invasive Treatment ◽  
Treatment Interventions ◽  
Comprehensive Review ◽  
Non Invasive

Abstract Uterine fibroids are benign monoclonal neoplasms of the myometrium, representing the most common tumors in women worldwide. To date, no long-term or non-invasive treatment option exists for hormone-dependent uterine fibroids due to the limited knowledge about the molecular mechanisms underlying the initiation and development of uterine fibroids. This paper comprehensively summarizes the recent research advances on uterine fibroids, focusing on their risk factors, development origin, pathogenetic mechanisms, and treatment options. Additionally, we describe the current treatment interventions for uterine fibroids. Finally, future perspectives on uterine fibroids studies are summarized. Deeper mechanistic insights into tumor etiology and uterine fibroids’ complexity can contribute to the newer targeted therapies.

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