Surgical Management of Sinus Disease in Children

1992 ◽  
Vol 101 (1_suppl) ◽  
pp. 42-45 ◽  
Author(s):  
Scott C. Manning
Keyword(s):  
Chronic Disease ◽  
Care Setting ◽  
Pediatric Patients ◽  
Underlying Disease ◽  
Sinus Surgery ◽  
Sinus Disease ◽  
Endoscopic Techniques ◽  
The Past ◽  
Disease States ◽  
Societal Pressure

In the past few years, interest in pediatric sinus surgery has increased in response to the introduction of new endoscopic techniques and to mounting societal pressure to resolve the problem of persistent rhinosinusitis in the day-care setting. As yet, there are no prospective controlled studies demonstrating efficacy of sinus surgery in children with uncomplicated acute or recurrent acute sinusitis, and medical management overwhelmingly remains the treatment of choice for these patients. Sinus surgery may be indicated, however, for three groups of pediatric patients: those with true chronic disease, those with serious underlying disease states aggravated by recurrent sinusitis, and those with suppurative complications of sinusitis.

scholarly journals In-office Balloon Dilation and Drainage of Frontal Sinus Mucocele

2013 ◽  
Vol 4 (1) ◽  
pp. ar.2013.4.0041 ◽  
Author(s):  
Jean Anderson Eloy ◽  
Pratik A. Shukla ◽  
Osamah J. Choudhry ◽  
Jean Daniel Eloy ◽  
Paul D. Langer
Keyword(s):  
Patient Satisfaction ◽  
Operating Room ◽  
Endoscopic Sinus Surgery ◽  
Frontal Sinus ◽  
Balloon Dilation ◽  
Sinus Surgery ◽  
Surgical Drainage ◽  
Sinus Disease ◽  
The Past ◽  
Office Procedures

Treatment of frontal sinus disease represents one of the most challenging aspects of endoscopic sinus surgery. Frontal sinus mucocele drainage may be an exception to the rule because in many instances, the expansion of the mucocele widens the frontal sinus recess and renders surgical drainage technically undemanding. Recently, there has been an increased interest in in-office procedures in otolaryngology because of patient satisfaction and substantial savings of time and cost for both patients and physicians. Similarly, the past few years have witnessed an increased use of balloon dilation devices in sinus surgery. Previously, we have described the in-office use of this device in treating patients who failed prior conventional frontal sinusotomy in the operating room. In this report, we describe our step-by-step in-office experience using this tool for drainage of a large frontal sinus mucocele.

Combined Endoscopic Trephination and Endoscopic Frontal Sinusotomy for Management of Complex Frontal Sinus Pathology

2005 ◽  
Vol 19 (5) ◽  
pp. 435-441 ◽  
Author(s):  
Pete S. Batra ◽  
Martin J. Citardi ◽  
Donald C. Lanza
Keyword(s):  
Frontal Sinus ◽  
Demographic Data ◽  
Symptom Relief ◽  
Subjective Symptom ◽  
Sinus Surgery ◽  
Combined Approach ◽  
Sinus Disease ◽  
Endoscopic Techniques ◽  
Difficult Cases

Background The advances in endoscopic sinus surgery have revolutionized the management of frontal sinus disease. Despite the successes, the purely endoscopic approach has its limitations, especially in patients with alterations in anatomy caused by previous surgical intervention or complex frontal sinus pneumatization patterns. The purpose of this study was to evaluate the efficacy of combined endoscopic trephination and endoscopic frontal sinusotomy (the above and below approach) in the management of these difficult cases. Methods Chart review was performed on patients undergoing the combined approach from October 1999 to June 2004. Demographic data, symptomatology, comorbidity, previous surgery, and primary pathology were determined. Outcome was assessed based on subjective symptom relief and objective endoscopic patency. Results Twenty-two patients with a mean age of 49.2 years underwent the combined approach. The primary pathology included mucoceles (15 patients), frontal sinusitis (2 patients), inverted papilloma (2 patients), osteoma (1 patient), fibrous dysplasia (1 patient), and pneumocephalus (1 patient). A total of 25 above and below procedures (22 primary and 3 revision procedures) were performed to manage the pathology. Postoperatively, headaches resolved in 47%, improved in 35%, and remained unchanged in 18% of the patients. Orbital symptoms resolved in 63%, improved in 25%, and remained unchanged in 12% of the patients. Endoscopic patency of the frontal sinusotomy was confirmed in 19 of 22 cases (86%) at a mean follow-up of 16.2 months. Conclusion Management of complex frontal sinus pathology may require adjunct approaches in conjunction to the standard endoscopic techniques. In this series, the above and below approach was used successfully in 22 patients. The combined approach may serve as an important adjunct for management of complex frontal sinus disease.

Use of a Foley catheter for short-term drainage in frontal sinus surgery

1989 ◽  
Vol 103 (4) ◽  
pp. 375-378 ◽  
Author(s):  
T. G. A. Ijaduola
Keyword(s):  
Chronic Disease ◽  
Surgical Technique ◽  
Frontal Sinus ◽  
Foley Catheter ◽  
University Teaching ◽  
Sinus Surgery ◽  
Short Term ◽  
Sinus Disease ◽  
Frontal Sinus Surgery ◽  
Drainage Technique

AbstractFrontal sinus surgery for chronic disease presents a variety of problems, in particular that of drainage. No matter how successful the surgical technique is in clearing disease from the sinus, it is still important that the fronto-nasal duct is kept patent unless the procedure is an obliterative one. Usually a tube is inserted for drainage and has to be kept in place for several weeks or months. This paper presents a study of 16 patients, suffering from frontal sinus disease, in whom a short-term drainage technique using a Foley catheter was employed between 1979 and 1988 at Lagos University Teaching Hospital, Nigeria. This type of drainage allows effective anchorage and irrigation with a decongestant. It has been found to give satisfactory results after 14 days in place and has had no unusual complications. It is therefore recommended for use in such cases.

scholarly journals Impact on an integrated psychiatric pharmacy service in a primary care clinic

2019 ◽  
Vol 9 (4) ◽  
pp. 269-274
Author(s):  
Benjamin Chavez ◽  
Emily Kosirog
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Care Setting ◽  
Primary Care Setting ◽  
Pharmacy Service ◽  
Psychiatric Disease ◽  
Care Practice ◽  
Psychiatric Medication ◽  
State Management ◽  
Disease States

Abstract Introduction Traditionally, clinical pharmacists have been employed in the primary care setting to help manage chronic disease states, such as diabetes and hypertension. Although the benefits of pharmacists managing chronic conditions have been extensively published, published data for clinical pharmacist mental health services in primary care is limited to Veterans Affairs populations. This article describes a practice model in which pharmacists are providing psychiatric medication management and consultation in a federally qualified health center. Methods A period of 1 year from the psychiatric pharmacy service was analyzed from April 1, 2017, to March 31, 2018. Reports were generated that included information about psychiatric pharmacy consults, 1-on-1 psychiatric pharmacy visits, and psychotropic medication prescribing/dispensing trends. Each consult was further reviewed for additional details, including patient characteristics, medications prescribed, psychiatric diagnoses involved, and actions taken. Results A review of this pharmacy service showed significant pharmacist involvement in psychiatric medication consults and 1-on-1 visits. Common disease states consulted on were depressive disorders, anxiety disorders, and neurologic disorders, which reflects psychiatric disease states commonly seen in primary care practice. Provider satisfaction survey results showed that the service was valued and that providers felt their comfort in prescribing psychotropic medications improved due to the service. Discussion The service described here exemplifies the potential for pharmacists in the ambulatory care setting to expand beyond the traditional chronic disease state management. It also speaks to a potential role for psychiatric pharmacists in the primary care setting.

Wegener's Granulomatosis: The Role of Endoscopic Sinus Surgery

1993 ◽  
Vol 7 (6) ◽  
pp. 261-266 ◽  
Author(s):  
Albert H. Park ◽  
James A. Stankiewicz
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Wegener’S Granulomatosis ◽  
Systemic Disease ◽  
Disease Process ◽  
Underlying Disease ◽  
Wegener's Granulomatosis ◽  
Sinus Surgery ◽  
Endoscopic Drainage ◽  
Sinus Disease

Conventional wisdom has dictated that the patient with Wegener's Granulomatosis may benefit from a Caldwell Luc or external ethmoidectomy in the treatment of sinusitis. No studies, however, have specifically evaluated the efficacy of such drainage procedures especially with respect to endoscopic sinus surgery (ESS). Nineteen patients diagnosed with Wegener's Granulomatosis were evaluated to assess the efficacy of medical and surgical treatment of their sinus disease. Four of these patients eventually required ESS after failure to treat their sinus disease medically. ESS was performed to drain the obstructed sinuses (three patients) or a mucocele (one patient). Initially, the sinuses were patent, but two patients developed persistent scarring and crusting associated with the chronicity and activity of their systemic disease. These results underscore the difficulty in treating these patients and the fact that despite adequate endoscopic drainage and meticulous postoperative care the underlying disease process may relentlessly cause scarring and sinus obstruction. These patients require continuous medical and intensive surgical therapy for the best chance for sinus disease control.

scholarly journals Infliximab: A Review of its use in the Treatment of Pediatric Crohn's Disease

2010 ◽  
Vol 2 ◽  
pp. CMT.S2840
Author(s):  
Arkady Broder ◽  
Joel R. Rosh
Keyword(s):  
Monoclonal Antibodies ◽  
Crohn’S Disease ◽  
Chronic Disease ◽  
Crohn's Disease ◽  
Tumor Necrosis ◽  
Immune Dysregulation ◽  
Necrosis Factor Alpha ◽  
The Past ◽  
Factor Alpha ◽  
Necrosis Factor

The past decade has brought great change to the treatment of pediatric Crohn's disease. The majority of affected patients now receive therapy directed at the underlying immune dysregulation that is associated with this chronic disease. The monoclonal antibodies directed against tumor necrosis factor alpha play an increasing role in such therapy. Infliximab is the prototype of this class of biologic based therapy. This review covers the basic pharmacokinetics of infliximab while reviewing the data on its efficacy in pediatric Crohn's disease patients. Current issues related to infliximab dosing and safety are also reviewed.

Anemia of Inflammation

Hematology ◽  
2010 ◽  
Vol 2010 (1) ◽  
pp. 276-280 ◽  
Author(s):  
Cindy N. Roy
Keyword(s):  
Inflammatory Diseases ◽  
Underlying Disease ◽  
Comorbid Condition ◽  
Regulatory Pathways ◽  
Hepcidin Expression ◽  
Disease States ◽  
Poor Outcomes ◽  
The Impact ◽  
Inflammatory Insult ◽  
Anemia Of Inflammation

Abstract Inflammation arising from various etiologies, including infection, autoimmune disorders, chronic diseases, and aging, can promote anemia. The anemia of inflammation (AI) is most often normocytic and normochromic and is usually mild. Characteristic changes in systemic iron handling, erythrocyte production, and erythrocyte life span all contribute to AI. The preferred treatment is directed at the underlying disease. However, when the inflammatory insult is intractable, or the cause has not been diagnosed, there are limited options for treatment of AI. Because anemia is a comorbid condition that is associated with poor outcomes in various chronic disease states, understanding its pathogenesis and developing new tools for its treatment should remain a priority. Hepcidin antimicrobial peptide has taken center stage in recent years as a potent modulator of iron availability. As the technology for quantitative hepcidin analysis improves, hepcidin's role in various disease states is also being revealed. Recent insights concerning the regulatory pathways that modify hepcidin expression have identified novel targets for drug development. As the field advances with such therapeutics, the analysis of the impact of normalized hemoglobin on disease outcomes will confirm whether anemia is a reversible independent contributor to the morbidity and mortality associated with inflammatory diseases.

Endoscopic Septal Spur Resection

1993 ◽  
Vol 7 (5) ◽  
pp. 213-216 ◽  
Author(s):  
Donald C. Lanza ◽  
Deborah Farb Rosin ◽  
David W. Kennedy
Keyword(s):  
Surgical Technique ◽  
Endoscopic Sinus Surgery ◽  
Chronic Sinusitis ◽  
Sinus Surgery ◽  
Surgical Approaches ◽  
Postoperative Results ◽  
Valuable Alternative ◽  
Perioperative Morbidity ◽  
The Past ◽  
Septal Spur

A variety of surgical approaches exists for the management of nasal septal spurs in patients who undergo endoscopic sinus surgery (ESS). Treatment of septal spurs in the past has been frequently addressed by septoplasty which can result in increased bleeding and length of surgical procedure as well as mandate postoperative nasal packing. Individually each of these problems can jeopardize the success of endoscopic sinus surgery. An endoscopic approach, which targets the septal spur alone, can minimize perioperative morbidity. The purpose of this paper is to demonstrate the effectiveness of endoscopic septal spur resection (ESSR) for the management of significant septal spurs in 8 patients who underwent concurrent ESSR during ESS for chronic sinusitis. Surgical technique and postoperative results are discussed and suggest that ESSR is a valuable alternative to more traditional techniques.

Prostatic Abscess in a Patient with Chronic Granulomatous Disease: A Multi-Disciplinary Intervention

2017 ◽  
Vol 84 (4) ◽  
pp. 267-269 ◽  
Author(s):  
Alberto Martini ◽  
Ioannis Katafigiotis ◽  
Sofia Kalantzi ◽  
Ioannis Anastasiou ◽  
Ioannis Adamakis ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Chronic Granulomatous Disease ◽  
Urine Culture ◽  
Underlying Disease ◽  
Multidrug Resistant ◽  
Granulomatous Disease ◽  
Prostatic Abscess ◽  
The Past ◽  
First Case

Introduction Chronic granulomatous disease (CGD) is a rare pathology that increases patients’ susceptibility to infections, given the inability to generate oxygen radicals to fight microorganisms. In the context of CGD, primary prostatic involvement has been described only once in the past, in a pediatric patient. Case Report We report the case of a 35-year old patient with CGD presenting with persistent fever. After hospital admission, blood and urine were sent for culture and antibiotic therapy was initiated. Patient's conditions continued to deteriorate and an aggressive antibiotic therapy was administered to treat the septic scenario. Urine culture grew a multidrug-resistant Escherichia Coli. After patient's condition improved, a CT scan was performed. The depiction showed multiple abscesses within the prostate. A rectal approach was excluded given patient's underlying disease. A TURP was performed and prostatic pathology resolved. Patient was discharged on postoperative day 14. At 6-month follow-up he hasn't experienced major infections. To the best of our knowledge, this is the first case of septic shock originating from a prostatic abscess in an adult patient with CGD. Conclusions Aggressive medical therapy along with TURP resulted curative in our case. A multi-disciplinary approach was mandatory.

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