scholarly journals Orbital Apex Lesions: A Diagnostic and Therapeutic Challenge

2017 ◽  
Vol 79 (04) ◽  
pp. 386-393 ◽  
Author(s):  
Sung-Woo Cho ◽  
Won-Wook Lee ◽  
Dae Ma ◽  
Ji-hoon Kim ◽  
Doo Han ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Clinical Characteristics ◽  
Inflammatory Pseudotumor ◽  
Definitive Treatment ◽  
Fungal Sinusitis ◽  
Orbital Apex ◽  
Radiological Findings ◽  
Presenting Symptoms ◽  
Invasive Fungal Sinusitis ◽  
Significant Difference

Objective To analyze the clinical characteristics of and treatment outcomes for orbital apex lesions according to their pathological diagnosis and identify clinical characteristics that could aid in their differential diagnosis. Design Retrospective analysis design was used for this study. Setting The study was conducted in a single tertiary institution. Participants Patients with pathologically confirmed lesions centered in the orbital apex who were admitted between January 2011 and December 2015. Main Outcome Measures Clinical characteristics, including demographics, predisposing factors, presenting symptoms, radiological findings, intraoperative findings, biopsy results, and treatment outcomes. Results Nine patients with invasive fungal sinusitis, six with inflammatory pseudotumor, and six with neoplastic or tumorous lesions were enrolled. The most common presenting symptom was orbital pain or headache, followed by ophthalmoplegia and vision loss, which exhibited overall recovery rates of 62.5% and 33.3%, respectively, after definitive treatment. The prognosis was worse for patients with invasive fungal sinusitis. There was no significant difference in age, underlying medical conditions, absolute neutrophil count, C-reactive protein level, and radiological findings among the three groups. Grossly necrotic tissues around the orbital apex area at biopsy were more frequently found in patients with invasive fungal sinusitis than in the other patients. In most cases, pain ameliorated after surgical intervention. There were no surgery-related morbidities. Conclusions Lesions centered in the orbital apex included invasive fungal sinusitis, inflammatory pseudotumor, and tumorous lesions. However, clinical features that clearly differentiated chronic invasive fungal sinusitis from inflammatory pseudotumor could not be identified. Our findings suggest that prompt biopsy is warranted for timely diagnosis, symptom relief, and early implementation of definitive treatment.

scholarly journals Two cases of invasive fungal sinusitis showing orbital apex syndrome

2016 ◽  
Vol 25 (3) ◽  
pp. 325-332
Author(s):  
Keiichi Koshizuka ◽  
Toyoyuki Hanazawa ◽  
Hiroko Nakamura ◽  
Tomohisa Iinuma ◽  
Kazuki Yamasaki ◽  
...  
Keyword(s):  
Fungal Sinusitis ◽  
Orbital Apex ◽  
Orbital Apex Syndrome ◽  
Invasive Fungal Sinusitis

Invasive Fungal Sinusitis in the Immunocompromised Pediatric Patient

1995 ◽  
Vol 74 (8) ◽  
pp. 566-573 ◽  
Author(s):  
Bryan K. Lansford ◽  
Charles M. Bower ◽  
Robert W. Seibert
Keyword(s):  
Pediatric Population ◽  
Treatment Protocol ◽  
Underlying Disease ◽  
Antineoplastic Drugs ◽  
Fungal Sinusitis ◽  
Rare Entity ◽  
Review Of The Literature ◽  
Presenting Symptoms ◽  
Invasive Fungal Sinusitis ◽  
Histopathologic Findings

Invasive fungal sinusitis in the pediatric population appears to be a relatively rare entity. An increasing incidence has been noted in accordance with the widespread use of antibiotics, steroids, antineoplastic drugs and radiation therapy. Three illustrative cases are described which outline the initial presenting symptoms, findings on physical examination, computed tomography (CT), intraoperative findings, and histopathologic findings. A review of the literature is presented and a treatment protocol is proposed once a diagnosis is made. Early suspicion and diagnosis are the most important prerequisites for successful treatment which consists of control of the underlying disease, surgical debridement, and systemic antifungal therapy. Cooperation between the otolaryngologist, pediatric specialists, and pathologists are key to the survival of children with invasive fungal sinusitis. Survival in this series was dependent upon return of an immune competent state.

scholarly journals Orbital apex syndrome with frontal abscess secondary to sinusitis due to Candida guilliermondii

2021 ◽  
Vol 3 (2) ◽  
pp. 133-138
Author(s):  
Muhd-Syafi Abd Bari ◽  
Mas Edi ◽  
Hudzaifah Nordin ◽  
Rosdan Salim ◽  
Zamzuri Idris ◽  
...  
Keyword(s):  
Immunocompromised Patient ◽  
Opportunistic Pathogen ◽  
Candida Guilliermondii ◽  
Intracranial Extension ◽  
Fungal Sinusitis ◽  
Team Management ◽  
Orbital Apex ◽  
Orbital Apex Syndrome ◽  
Case Presentation ◽  
Invasive Fungal Sinusitis

Candida guilliermondii is an opportunistic pathogen that rarely causes invasive candidiasis even in immunocompromised humans. We report a case presentation of invasive C. guilliermondii rhinosinusitis causing an orbital and intracranial extension (frontal lobe abscess). An aggressive multidisciplinary team management is a key approach in invasive fungal sinusitis and avoided mortality in this case. When orbital apex syndrome secondary to sinusitis is encountered in an immunocompromised patient, the treating physician should consider fungal infection as a causative agent.

Prognostic value of age in nasopharyngeal carcinoma patients: A single institution analysis

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6080-6080
Author(s):  
N. L. Downing ◽  
P. Wong ◽  
D. Petrik ◽  
W. Hara ◽  
Q. Le
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Treatment Outcomes ◽  
Induction Chemotherapy ◽  
Age Groups ◽  
External Beam Radiation ◽  
Definitive Treatment ◽  
Single Institution ◽  
Treatment Characteristics ◽  
Significant Difference ◽  
Two Age Groups

6080 Background: Nasopharyngeal carcinoma (NPC) has a bimodal age distribution with peaks at 15–25 and 40–50 years of age, though it is unclear if the prognosis differs significantly between the two age groups. Here, we compare treatment outcomes between two age groups of patients treated at a single institution. Methods: We retrospectively analyzed the data of 99 NPC patients who received definitive treatment at our institution between March 1985 and June 2004. All patients received a median dose of 66 Gy of external beam radiation therapy and 70% received either concurrent or induction chemotherapy. We compared patient, tumor, and treatment characteristics as well as treatment outcomes in juvenile patients (age = 25 years at diagnosis), versus adult patients (age > 25 years at diagnosis). Survival curves were estimated by the Kaplan-Meier method. Results: There was a significant difference in the ethnic composition between the age groups, with more Asians and fewer Whites and Hispanics in the adult group (see table ). Also, there was a significant difference between the groups in the proportion of patients receiving chemotherapy, especially induction chemotherapy (see table ). There was no difference in the distribution of tumor stage and WHO histology between the two age groups. At a median follow-up for all patients of 42 months (range 4 to 234), there were no statistically significant differences in treatment outcomes between the two age groups although the survival data numerically favored the juvenile patients (see table ). Conclusions: Although there were significant differences in racial distributions and treatment characteristics between the two age groups, treatment outcomes were similar. Aggressive treatment with radiotherapy and chemotherapy resulted in excellent outcomes for both patient populations. No significant financial relationships to disclose. [Table: see text]

Long-term follow-up of clinical presentation and outcomes of patients with urinary bladder paragangliomas.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 507-507
Author(s):  
Kareem Rayn ◽  
Michael Daniel Weintraub ◽  
Gustavo Pena-LaGrave ◽  
Samuel Gold ◽  
Graham R. Hale ◽  
...  
Keyword(s):  
Urinary Bladder ◽  
Symptom Onset ◽  
Clinical Characteristics ◽  
Cancer Recurrence ◽  
Plasma Catecholamine ◽  
Presenting Symptoms ◽  
Surgical Methods ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Metastatic Sites

507 Background: Urinary bladder paragangliomas (UBPGLs) are extremely rare, accounting for less than 6% of paragangliomas (PGLs) and 0.06% of bladder tumors. The goal of this study is to examine the presentation, clinical characteristics and outcomes of patients with UBPGLs. Methods: We determined the presenting symptoms, clinical characteristics, and outcomes of patients who presented to a single institution with UBPGLs from 2000-2017. Results: 28 patients with an average age of 27 ± 15.6 at symptom onset presented to the NIH from 2000-2017. The majority had standard paraganglioma symptoms (n = 24, 85.7%) defined as headaches, palpitations, pallor and anxiety, and hypertension (n = 20, 71.4%) on presentation. 8 patients (29%) presented with hematuria; hematuria was the only presenting symptom in 1 of these patients. 3 (10.7%) of the patients were completely asymptomatic and were discovered to have bladder paragangliomas incidentally on imaging. Overall, 9 patients (32%) were under 18 (average age = 10.9 ± 3.9) at symptom onset. 14 (50%) patients developed metastasis, with bone (n = 9) and lung (n = 8) being the most common metastatic sites. All but 1 patient received surgical treatment, with 6 patients receiving transurethral resection of bladder tumor (TURBT), 3 receiving robotic-assisted partial cystectomy (RAPC) and the remaining patients undergoing open cystectomy. In total, 2 patients experienced bladder cancer recurrence, both of whom had undergone TURBT. Comparing patients with and without hematuria, metastasis and standard paraganglioma symptoms, we found no statistically significant difference in mean diameter of the largest lesion or plasma catecholamine values. Conclusions: Our experience reveals that most patients with UBPGLs present at an early age with characteristic paraganglioma symptoms. Despite the variety of surgical methods used to manage these patients, the only 2 recurrences were in patients who underwent TURBT. Further work is necessary to establish preoperative indicators of disease severity in patients with UBPGLs. This research was supported by the Intramural Research Program of the National Cancer Institute, NIH and NIH Medical Research Scholars Program

Clinical Characteristics of Children with COVID-19: A Multicenter Study in the United Arab Emirates (Preprint)

2021 ◽  
Author(s):  
Farah Ennab ◽  
Mariam ElSaban ◽  
Eman Khalaf ◽  
Hanieh Tabatabaei ◽  
Amar Hassan Khamis ◽  
...  
Keyword(s):  
United Arab Emirates ◽  
Multicenter Study ◽  
Clinical Characteristics ◽  
Pediatric Population ◽  
Contact Tracing ◽  
Severe Illness ◽  
Published Data ◽  
Presenting Symptoms ◽  
Asymptomatic Children ◽  
Significant Difference

BACKGROUND Coronavirus disease 2019 (COVID-19) has infected over 123 million people globally. The first confirmed case in the United Arab Emirates (UAE) was reported on 29th January 2020.  COVID-19 has fared mildly in the pediatric population according to available literature out of early epicenters of the pandemic. To date there is a lack of published data about COVID-19 infection among children in the Arabian region. OBJECTIVE Investigate the clinical characteristics, laboratory findings, treatment, and outcomes of children with COVID-19. METHODS This cross-sectional multicenter study included children with confirmed COVID-19 infection admitted between March 1st and June 15th, 2020 to three large hospitals in Dubai, UAE. Serial COVID-19 polymerase chain reaction (PCR) testing was collected, and patients' demographics, pre-morbid clinical characteristics and inpatient hospital course were investigated. RESULTS 111 children were included in our study and represented 22 nationalities. Fifty-nine (53.2%) were boys. The mean age was 7 years (±5.3). 15.3% of children were younger than 1 year. Only 4 (3.6%) of the patients had pre-existing asthma all of whom had uneventful courses. At presentation 43 (38.7%) were asymptomatic, 68 (61.2%) had mild or moderate symptoms and none had severe illness requiring intensive care. Fever (20.7%), cough (19.8%) and rhinorrhea (15.3%) were the most common presenting symptoms and most symptoms resolved by day 5 of hospitalization. Most patients had no abnormality on chest x-ray. The most common laboratory abnormalities on admission included variations in neutrophil count (24.7%), aspartate transaminase (22.5%), alkaline phosphatase (36.7%) and lactate dehydrogenase (42.5%). Children were infrequently prescribed targeted medications, with only 4 (3.6%) receiving antibiotics. None of the 52 patients tested for viral co-infections were positive. COVID-19 PCR turned negative at a median of 10 days [6-14] after first positive test. Overall, there was no significant difference of time to negative PCR results between symptomatic and asymptomatic children. CONCLUSIONS This study of COVID19 presentations and characteristics presents a first look into the burden of COVID19 infection in the pediatric population in the UAE. We conclude that a large percentage of children experienced no symptoms, and severe disease is uncommon in the UAE. Various laboratory abnormalities were observed despite clinical stability. Ongoing surveillance, contact tracing and public health measures will be important to contain future outbreaks.

scholarly journals A Case of Orbital Apex Syndrome to Invasive Fungal Sinusitis

2014 ◽  
Vol 25 (2) ◽  
pp. 219-223
Author(s):  
Dong Hyun Lee ◽  
Jang Won Choi ◽  
Yeon Mee Kim ◽  
Yong Wan Kim
Keyword(s):  
Fungal Sinusitis ◽  
Orbital Apex ◽  
Orbital Apex Syndrome ◽  
Invasive Fungal Sinusitis

scholarly journals Clinical characteristics and treatment outcomes of patients with macrolide-resistant Mycobacterium avium complex pulmonary disease: a systematic review and meta-analysis

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Youngmok Park ◽  
Eun Hye Lee ◽  
Inkyung Jung ◽  
Goeun Park ◽  
Young Ae Kang
Keyword(s):  
Systematic Review ◽  
Treatment Outcomes ◽  
Pulmonary Disease ◽  
Surgical Resection ◽  
Mycobacterium Avium ◽  
Clinical Characteristics ◽  
Meta Analysis ◽  
Treatment Modalities ◽  
Significant Difference ◽  
Newcastle Ottawa Scale

Abstract Background Macrolide is a key drug in the treatment of Mycobacterium avium complex pulmonary disease (MAC-PD). Macrolide-resistant MAC is gaining importance, but there are little data in clinical characteristics and treatment outcomes of macrolide-resistant MAC-PD (MR-MAC-PD). Methods We performed a systematic review and meta-analysis of published studies reporting clinical characteristics and treatment outcomes of patients with MR-MAC-PD. Risk of bias was assessed using the modified Newcastle-Ottawa Scale. Results Nine studies (seven retrospective and two prospective) comprising 319 patients were identified through a database search. Around 73% were women, and 52% had the fibrocavitary form. Pooled sputum culture conversion rate after combined multiple antibiotics or surgical resection was 21% (95% confidence interval [CI], 14–30%), and the one-year all-cause mortality was 10% (95% CI, 5–20%). There was no significant difference in treatment outcomes between nodular bronchiectatic and fibrocavitary types. Conclusions Even combination therapy with fluoroquinolone, aminoglycoside, and surgical resection, the treatment outcomes of MR-MAC-PD were poor. The investigation of new treatment modalities is urgent.

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