scholarly journals Management of Fungal Rhinosinusitis – A Retrospective Study from a Tertiary Hospital in Kerala

2021 ◽  
Vol 10 (38) ◽  
pp. 3374-3379
Author(s):  
Ike Thomas ◽  
Tina Thomas ◽  
Reena Anie Jose ◽  
Elizabeth Joseph
Keyword(s):  
Chronic Rhinosinusitis ◽  
Tertiary Hospital ◽  
Surgical Removal ◽  
Topical Steroids ◽  
Imaging Features ◽  
Radiological Imaging ◽  
Tissue Samples ◽  
Duration Of Symptoms ◽  
Fungal Ball ◽  
Fungal Rhinosinusitis

BACKGROUND Fungal rhinosinusitis (FRS) is an increasingly common pathology in chronic rhinosinusitis and is often diagnosed late. The present study intended at analysing and understanding the clinical, pathological, microbiological, radiological characteristics of the disease in a tertiary hospital in Kerala. METHODS Case records of patients with pathologic or microbiologic diagnosis of FRS were retrospectively studied from January 2015 to January 2021, with reference to their demography, clinical presentation, comorbidities, and imaging features. The treatment aspects were also studied. RESULTS A total of 36 patients with pathological or microbiologic evidence of FRS were studied. There were 58 % cases of allergic FRS, 33 % cases of fungal ball and 8.3 % cases of invasive FRS. 58 % of patients were females, 77 % patients had nasal block as their presenting symptom, and 66 % of patients had duration of symptoms between 1-6 months. In radiological imaging, the maxillary sinus was most commonly involved. Treatment was always surgical removal. Allergic FRS (AFRS) needed prolonged topical steroids and invasive FRS needed systemic antifungals. CONCLUSIONS Our study suggests the importance of early diagnosis of FRS in all chronic rhinosinusitis patients by a high index of clinical suspicion. Tissue samples from the nose and sinuses should be studied for pathology and microbiology in all suspected cases to reach a diagnosis. Radiological imaging can aid in concluding diagnosis. Surgical options, supported by medical management play a vital role in the effective management of the disease. KEY WORDS Fungal rhinosinusitis, Allergic fungal rhinosinusitis, Fungal ball, Invasive fungal rhinosinusitis

scholarly journals Arginase Isoform Expression in Chronic Rhinosinusitis

2019 ◽  
Vol 8 (11) ◽  
pp. 1809 ◽  
Author(s):  
Diana Vlad ◽  
Silviu Albu
Keyword(s):  
Nitric Oxide ◽  
Chronic Rhinosinusitis ◽  
Defense Mechanisms ◽  
Upper Airway ◽  
Control Group ◽  
Mrna Levels ◽  
Tissue Samples ◽  
Endoscopic View ◽  
Important Regulator ◽  
Arginase I

Nitric oxide (NO) has emerged as an important regulator of upper airway inflammation, mainly as part of the local naso-sinusal defense mechanisms. Increased arginase activity can reduce NO levels by decreasing the availability of its precursor, L-arginine. Chronic rhinosinusitis (CRS) has been associated with low levels of nasal nitric oxide (nNO). Thus, the present study investigates the activity of arginase I (ARG1) and II (ARG2) in CRS and its possible involvement in the pathogenesis of this disease. Under endoscopic view, tissue samples of pathologic (n = 36) and normal (n = 29) rhinosinusal mucosa were collected. Arginase I and II mRNA levels were measured using real-time PCR. Our results showed low arginase I activity in all samples. The levels of ARG2 were significantly higher in patients with chronic rhinosinusitis compared to the control group (fold regulation (FR) 2.22 ± 0.42 vs. 1.31 ± 0.21, p = 0.016). Increased ARG2 expression was found in patients with CRS without nasal polyposis (FR 3.14 ± 1.16 vs. 1.31 ± 0.21, p = 0.0175), in non-allergic CRS (FR 2.55 ± 0.52 vs. 1.31 ± 0.21, p = 0.005), and non-asthmatic CRS (FR 2.42 ± 0.57 vs. 1.31 ± 0.21, p = 0.028). These findings suggest that the upregulation of ARG2 may play a role in the pathology of a distinctive phenotype of CRS.

Demonstration of Biofilm in Human Bacterial Chronic Rhinosinusitis

2005 ◽  
Vol 19 (5) ◽  
pp. 452-457 ◽  
Author(s):  
Berrylin J. Ferguson ◽  
Donna B. Stolz
Keyword(s):  
Chronic Rhinosinusitis ◽  
Culture Media ◽  
Cellular Membrane ◽  
Anaerobic Growth ◽  
Bacterial Biofilms ◽  
Topical Steroids ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Planktonic Bacteria ◽  
Transmission Electron

Background Bacterial biofilms may explain why some patients with bacterial chronic rhinosinusitis (CRS) improve while on antibiotics but relapse after completion of the antibiotic. In the human host, biofilms exist as a community of bacteria surrounded by a glycocalyx that is adherent to a foreign body or a mucosal surface with impaired host defense. Biofilms generate planktonic, nonadherent bacterial forms that may metastasize infection and generate systemic illness. These planktonic bacteria are susceptible to antibiotics, unlike the adherent biofilm. Methods We reviewed four cases of CRS using transmission electron microscopy (TEM) to assay for typical colony architecture of biofilms. Bacterial communities surrounded by a glycocalyx of inert cellular membrane materials consistent with a biofilm were shown in two patients. Results In the two patients without biofilm, a nonbacterial etiology was discovered (allergic fungal sinusitis) in one and in the other there was scant anaerobic growth on culture and the Gram stain was negative. Culture of the material from the biofilm grew Pseudomonas aeruginosa in both patients. Pseudomonas from the biofilm showed a glycocalyx, not present in Pseudomonas cultured for 72 hours on culture media. Both patients’ symptoms with bacterial biofilms were refractory to culture-directed antibiotics, topical steroids, and nasal lavages. Surgery resulted in cure or significant improvement. Conclusion Biofilms are refractory to antibiotics and often only cured by mechanical debridement. We believe this is the first TEM documentation of bacterial biofilms in CRS in humans.

scholarly journals Comparison of the Frequency of Detection of Some Radiological Signs in Chronic Maxillary Sinusіtis of Fungal and Non-Fungal Origin

2020 ◽  
Vol 5 (6) ◽  
pp. 202-207
Author(s):  
Ya. V. Shkorbotun ◽  
◽  
Keyword(s):  
Computed Tomography ◽  
Maxillary Sinus ◽  
Chronic Rhinosinusitis ◽  
Chronic Sinusitis ◽  
Maxillary Sinusitis ◽  
Biologically Active ◽  
Differential Diagnostics ◽  
Diagnostic Significance ◽  
Fungal Ball ◽  
The One

The one of the most informative method of preoperative diagnosis of fungal paranasal sinuses is computed tomography. The radiological marker that allows to identify chronic sinusitis of fungal origin is an eclipse with hyperintensive inclusions. The sensitivity of this criterion for fungal ball is about 80%. In addition, a sign of recalcitrant chronic sinusitis is the presence of reactive changes in the bone wall of the sinus – "osteitis". The purpose of the work was to study the frequency of radiological signs of osteitis and areas of increased radiological density in the maxillary sinuses of the patients with chronic sinusitis of fungal and non-fungal etiology, to clarify the diagnostic significance of these symptoms in the differential diagnostics. Material and methods. The results of a retrospective study of computer tomography data of 60 people with chronic rhinosinusitis (intraoperative was verified fungal ball in the maxillary sinus space of 30 patients, other 30 patient had no signs of fungal etiology). Results and discussion. In patients with chronic rhinosinusitis of non-fungal nature, hyperintensive inclusions in the sinus were found in 13.3%, and signs of osteitis were detected in 36.7%, which was significantly less common than in patients with fungal processes, 83.3% and 80,0% respectively (p <0,05). The presence of both of the radiological symptoms was observed in 63.3% of patients from the group of chronic rhinosinusitis in the presence of a fungal body in the space of the sinus and in 6.7% of cases the chronic rhinosinusitis of non-fungal etiology. The severity of osteitis according to KOS, in patients with a fungal body in the sinus was 0.71 ± 0.15 points, and 0.55 ± 0.2 points in patients without a fungus. The pathogenesis of osteitis in the cases of sinusitis with fungal origin is a violation of bone trophism, which develops due to periostitis after the influence of biologically active substances secreted by the fungus. The increase of radiation density in areas of osteitis indicates the predominance of osteogenesis over osteolysis in the inflammatory focus of the bone wall of the maxillary sinus. Conclusion. The frequency of detecting radiological signs of osteitis in patients with chronic rhinosinusitis of the maxillary sinus with fungal bodies was 80%, that was comparable to the frequency of detecting hyperintense inclusions in the lumen of the sinus in these patients (83.3%), and was significantly more than in patients with chronic sinusitis nonfungal etiology. The presence of radiological signs of osteitis of the bone wall of the maxillary sinus in computed tomography should be regarded as an additional symptom in the differential diagnosis of maxillary sinusitis of fungal origin

Acute invasive fungal rhinosinusitis: MR imaging features and their impact on prognosis

2018 ◽  
Vol 60 (7) ◽  
pp. 715-723 ◽  
Author(s):  
Ye Ra Choi ◽  
Ji-hoon Kim ◽  
Hye Sook Min ◽  
Jae-Kyung Won ◽  
Hyun Jik Kim ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Imaging Features ◽  
Fungal Rhinosinusitis ◽  
Acute Invasive Fungal Rhinosinusitis ◽  
Invasive Fungal Rhinosinusitis

Meningioma: analysis of recurrence and progression following neurosurgical resection

1985 ◽  
Vol 62 (1) ◽  
pp. 18-24 ◽  
Author(s):  
René O. Mirimanoff ◽  
Daniel E. Dosoretz ◽  
Rita M. Linggood ◽  
Robert G. Ojemann ◽  
Robert L. Martuza
Keyword(s):  
Subtotal Resection ◽  
Surgical Removal ◽  
Progression Rate ◽  
Total Excision ◽  
Duration Of Symptoms ◽  
Content Type ◽  
Olfactory Groove ◽  
Free Rate ◽  
Sphenoid Ridge ◽  
Fine Print

✓ The rates of survival, tumor recurrence, and tumor progression were analyzed in 225 patients with meningioma who underwent surgery as the only treatment modality between 1962 and 1980. Patients were considered to have a recurrence if their studies verified a mass effect in spite of a complete surgical removal, whereas they were defined as having progression if, after a subtotal excision, there was clear radiological documentation of an increase in the size of their tumor. There were 168 females and 57 males (a ratio of 2.9:1), with a peak incidence of tumor occurrence in the fifth (23%), sixth (29%), and seventh (23%) decades of life. Anatomical locations were the convexity (21%), parasagittal area (17%), sphenoid ridge (16%), posterior fossa (14%), parasellar region (12%), olfactory groove (10%), spine (8%), and orbit (2%). The absolute 5-, 10-, and 15-year survival rates were 83%, 77%, and 69%, respectively. Following a total resection, the recurrence-free rate at 5, 10, and 15 years was 93%, 80%, and 68%, respectively, at all sites. In contrast, after a subtotal resection, the progression-free rate was only 63%, 45%, and 9% during the same period (p < 0.0001). The probability of having a second operation following a total excision after 5, 10, and 15 years was 6%, 15%, and 20%, whereas after a subtotal excision the probability was 25%, 44%, and 84%, respectively (p < 0.0001). Tumor sites associated with a high percentage of total excisions had a low recurrence/progression rate. For example, 96% of convexity meningiomas were removed in toto, and the recurrence/progression rate at 5 years was only 3%. Parasellar meningiomas, with a 57% total excision rate, had a 5-year probability of recurrence/progression of 19%. Only 28% of sphenoid ridge meningiomas were totally resected, and at 5 years the probability of recurrence/progression was 34%. In patients undergoing a second resection, the probability of a third operation at 5 and 10 years was 42% and 56%, respectively. There was no difference in the recurrence/progression rates according to the patients' age or sex, or the duration of symptoms. Implications for the potential role of adjunctive medical therapy or radiation therapy for meningiomas are discussed.

Neurosurgical management of low-grade astrocytoma of the cerebral hemispheres

1984 ◽  
Vol 61 (4) ◽  
pp. 665-673 ◽  
Author(s):  
Edward R. Laws ◽  
William F. Taylor ◽  
Marvin B. Clifton ◽  
Haruo Okazaki
Keyword(s):  
Neurological Deficit ◽  
Important Variable ◽  
Surgical Removal ◽  
Low Grade ◽  
Survival Times ◽  
Duration Of Symptoms ◽  
Content Type ◽  
Long Duration ◽  
Fine Print

✓ The authors conducted a retrospective review of surgically treated, histologically proven cases of low-grade (Grade 1 or 2) astrocytomas. Follow-up analysis, with survival time as the end-point, was completed using multivariant statistical analysis. In the 461 cases of supratentorial low-grade astrocytoma in this study, age of the patient at the time of surgery was by far the most important variable in predicting length of survival. Other variables correlating with increasing survival times were: gross total surgical removal, lack of major preoperative neurological deficit, long duration of symptoms prior to surgery, seizures as a presenting symptom, lack of major postoperative neurological deficit, and surgery performed in recent decades. The multi-variant regression analysis showed that radiation therapy was of clear benefit, primarily in older patients with incompletely removed tumors. For purposes of establishing prognosis and testing the results, a “score” was developed to predict survival times, based on the most important variables. The data in this study provide a basis for the analysis of future modes of management of low-grade gliomas.

Preoperative Management of Chronic Rhinosinusitis Prior to Office Balloon Sinus Dilation: A 2011–2014 MarketScan® Analysis

2019 ◽  
Vol 33 (4) ◽  
pp. 347-353 ◽  
Author(s):  
David W. Jang ◽  
Cecily Abraham ◽  
Derek D. Cyr ◽  
Kristine Schulz ◽  
Ralph Abi Hachem ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Practice Patterns ◽  
Sinus Surgery ◽  
Ct Scans ◽  
Administrative Database ◽  
Control Group ◽  
Topical Steroids ◽  
Preoperative Period ◽  
Office Visits ◽  
Preoperative Management

Background In-office balloon sinus dilation (BSD) has recently gained popularity as a surgical treatment option for chronic rhinosinusitis (CRS). However, utilization, indications, and practice patterns surrounding in-office BSD remain unclear. Objective The purpose of this study was to use a large national administrative database to assess preoperative management of CRS prior to in-office BSD. Methods Patients undergoing standalone in-office BSD from 2011 to 2014 were identified on MarketScan and compared to a control group undergoing functional endoscopic sinus surgery (FESS). Visits to the otolaryngologist, number of computed tomography (CT) scans, number of antibiotic and steroid prescriptions, and duration of time from first visit to procedure were compared. Results When compared to the FESS group, the in-office BSD group overall had fewer office visits (2.0 vs 2.2), CT scans (1.0 vs 1.1), prescriptions for antibiotics (2.0 vs 2.2), prescriptions for systemic steroids (1.5 vs 1.8), and topical steroids (1.4 vs 1.5) in the preoperative period. They also had a shorter mean duration of time between first visit and CT scan (17.5 vs 21.4 days) as well as between first visit and procedure (55.0 vs 67.8 days). All of these findings were statistically significant. Conclusion In-office BSD for CRS was overall associated with less intense management in the preoperative period when compared to FESS. Such differences may reflect ongoing shifts in practice patterns and need to be further investigated.

scholarly journals Chronic Rhinosinusitis: Does Allergy Play a Role?

2019 ◽  
Vol 7 (2) ◽  
pp. 30 ◽  
Author(s):  
Sonya Marcus ◽  
John M. DelGaudio ◽  
Lauren T. Roland ◽  
Sarah K. Wise
Keyword(s):  
Chronic Rhinosinusitis ◽  
Strong Association ◽  
Central Compartment ◽  
Atopic Disease ◽  
Fungal Rhinosinusitis ◽  
Allergic Fungal Rhinosinusitis ◽  
The Relationship

A few chronic rhinosinusitis (CRS) variants have demonstrated a strong association with environmental allergy, including allergic fungal rhinosinusitis (AFRS) and central compartment atopic disease (CCAD). However, the overall relationship between CRS and allergy remains poorly defined. The goal of this review is to evaluate the relationship between CRS and allergy with a focus on specific CRS variants.

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