scholarly journals Invasive Sino-aspergillosis in Immunocompetent Individuals: Atypical Presentations

2009 ◽  
Vol 2 (3) ◽  
pp. 27-32 ◽  
Author(s):  
Zareen A Lynrah ◽  
Gopika Kalsotra
Keyword(s):  
Invasive Aspergillosis ◽  
Amphotericin B ◽  
Sphenoid Sinus ◽  
Management Protocol ◽  
Intracranial Complications ◽  
Intravenous Amphotericin ◽  
Atypical Presentations ◽  
Lost To Follow Up ◽  
Fungal Serology

ABSTRACT Aims To describe the demographic, clinical and radiological findings of invasive aspergillosis of the orbit and paranasal sinuses in immunocompetent individuals that presented without any nasal symptoms and to review the role of voriconazole in such cases. Materials and methods A series of 13 cases is being reported with review of literature. All these cases except one underwent complete surgical debridement of the disease at the time of biopsy. On histopathological confirmation of invasive aspergillosis, the cases with sphenoid sinus involvement were given 2.5 gm of intravenous Amphotericin B (1 mg/kg/day) followed by oral itraconazole in a dose of 10 mg/kg/day for 6 months. The cases where there were lesser chances of intracranial involvement or the cases that refused for intravenous Amphotericin B were started on voriconazole 200 mg twice a day for six to twelve months. All these cases were followed up with the help of radiology, clinical improvement in symptoms and signs and fungal serology. Results We found isolated sphenoid sinus involvement in 10 (76.92%) cases, isolated maxillary sinus involvement 2 (15.38%) cases and isolated orbital involvement 1 (7.69%). Our protocol was successful in 11 (84.61%) cases, one patient was lost to follow-up while one died due to intracranial complications during the third week of therapy. Conclusion This study showcased the atypical presentations of invasive aspergillosis in immunocompetent individuals and the high degree of suspicion required to diagnose this entity. An aggressive, effective and optimal management protocol has been suggested and the role of voriconazole has been highlighted.

scholarly journals The Role of a Conservative Minimal Interventional Management Protocol in the Fractures of the Dentate Portion of the Adult Mandible

2016 ◽  
Vol 9 (1) ◽  
pp. 020-028
Author(s):  
Balasubramanian Krishnan
Keyword(s):  
Mouth Opening ◽  
Mandibular Fractures ◽  
Minimal Intervention ◽  
Soft Diet ◽  
Arch Bar ◽  
Management Protocol ◽  
Intervention Protocol ◽  
Lost To Follow Up

Mandibular fractures are commonly encountered by the maxillofacial surgeon. Maxillomandibular fixation (MMF) and open reduction and internal fixation (ORIF), or a combination of both, are the accepted standard treatments. This study aims to assess the role of a conservative minimal intervention protocol in the management of undisplaced/minimally displaced fractures of the dentate portion of the adult mandible and the complications associated with such minimalistic intervention. Thirty-four patients with undisplaced/minimally displaced fractures of the dentate portion of the adult mandible were advised to restrict mouth opening and limit themselves to a soft diet for a minimum of 4 weeks. All patients were advised follow-up at regular intervals for at least 3 months. Five patients were lost to follow-up. Symphysis and parasymphysis fractures were the most common fracture locations. Fourteen patients needed tension band stabilization with a mandibular arch bar/bridle wiring and three patients required extraction of luxated teeth. All patients showed satisfactory healing except three in whom additional intervention (ORIF) was performed. The improvement in mouth opening was statistically significant. Complications were seen more frequently among smokers and alcoholics. For patients with minimally displaced mandibular fractures, it is necessary to consider if the perceived benefits of intervention justify the associated added costs and possible complications. Patients have to be fully informed about the possible complications while using this minimal intervention protocol. This study concludes that a conservative minimal intervention management protocol for such fractures of the dentate portion of the mandible can produce satisfactory results.

scholarly journals Salvage therapy of bleeding esophageal tumor by fully covered self-expandable metallic stent: A case report

2021 ◽  
Vol 9 ◽  
pp. 2050313X2199719
Author(s):  
Sundus Bilal ◽  
Saad Muhammad Saeed ◽  
Muhammad Zeeshan Siddique ◽  
Muhammad Saqib ◽  
Shafqat Mehmood ◽  
...  
Keyword(s):  
Case Reports ◽  
Esophageal Tumor ◽  
Metallic Stent ◽  
Diverse Group ◽  
Expandable Metallic Stent ◽  
Lost To Follow Up ◽  
Expandable Metallic Stents ◽  
Tamponade Effect

The role of self-expandable metallic stents is gradually evolving for a diverse group of benign and malignant gastrointestinal tract problems, with luminal obstruction being by far the most common. Although its role in refractory variceal bleeding is well established, it has rarely been tried for tumor-related bleeding, with only a few case reports in this regard. We share our experience of successfully controlling esophageal tumor–related bleeding with the use of a fully covered self-expandable metallic stent. A 58-year-old woman with irresectable distal esophageal cancer, presented with hematemesis. Esophago-gastro-duodenoscopy revealed an obstructing esophageal tumor with diffuse oozing of blood. This was unamenable to local injection of adrenaline and hemospray; therefore, a temporary self-expandable metallic stent was parked to create a tamponade effect. This successfully stopped bleeding and the patient remained asymptomatic till discharge. However, she was lost to follow-up, and therefore, the stent was removed after a period of 5 months instead of 2 weeks.

Ossifying fibromyxoid tumour of the sphenoid sinus

2009 ◽  
Vol 124 (4) ◽  
pp. 437-440
Author(s):  
S D Shetty ◽  
R J Salib ◽  
S B Nair ◽  
N Mathad ◽  
J Theaker
Keyword(s):  
Skull Base ◽  
Sphenoid Sinus ◽  
Neoplastic Disease ◽  
Clinical Effects ◽  
Soft Tissue Neoplasm ◽  
Transnasal Approach ◽  
Fibrous Stroma ◽  
Neuroectodermal Origin ◽  
Endoscopic Transnasal Approach

AbstractIntroduction:Ossifying fibromyxoid tumour is a recently described, rare but morphologically distinctive soft tissue neoplasm characterised by a combination of myxoid and/or fibrous stroma with areas of ossification. Although most authors postulate a neuroectodermal origin for this peculiar tumour, there is no agreement in the literature regarding its histopathogenesis. To our knowledge, this is the first reported case of ossifying fibromyxoid tumour involving the sphenoid sinus.Histological findings:Tumour of low cell density, composed of small, spindle-shaped or stellate cells with small, irregular nuclei set in a fibromyxoid stroma.Management:Following discussion at the skull base multidisciplinary team meeting, a combined surgical team including an otorhinolaryngologist and a neurosurgeon carried out resection of the lesion, using an endoscopic transnasal approach, followed by reconstruction of the defect.Conclusions:An awareness of the distinctive histopathological features of ossifying fibromyxoid tumour, and of its clinical effects, is crucial to establishing a definitive diagnosis and thereby instituting appropriate management. This case report also reinforces the evolving role of the endoscopic transnasal approach in the management of inflammatory and neoplastic disease involving the skull base. This is increasingly being made possible by close collaboration between multiple surgical specialties, including otorhinolaryngology and neurosurgery.

Candida Esophagitis and Laryngitis in Chronic Mucocutaneous Candidiasis

PEDIATRICS ◽  
1980 ◽  
Vol 66 (3) ◽  
pp. 380-384
Author(s):  
Roger H. Kobayashi ◽  
Howard M. Rosenblatt ◽  
Jean M. Carney ◽  
William J. Byrne ◽  
Marvin E. Ament ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Topical Therapy ◽  
Signs And Symptoms ◽  
Poor Correlation ◽  
Chronic Mucocutaneous Candidiasis ◽  
Oral Lesions ◽  
Mucocutaneous Candidiasis ◽  
Left Mainstem ◽  
Repeat Endoscopy ◽  
Intravenous Amphotericin

Five children (aged 11 to 19 years) with lifelong chronic mucocutaneous candidiasis had 12 episodes of esophageal and/or laryngeal candidiasis documented by endoscopy. Symptoms included hoarseness (8/12), dysphagia (6/12), and hemoptysis (1/12). There was poor correlation between oral lesions and esophageal or laryngeal involvement. On fiberoptic endoscopy, the esophagus was involved alone in four episodes (33%), the larynx in two episodes (17%), and both structures in six episodes (50%). In six of eight instances, the esophagram was nondiagnostic or markedly underestimated the extent of inflammation. Intravenous amphotericin B or miconazole resulted in the resolution of these infections for variable periods of time. Repeat endoscopy was used to follow the course of the disease. Aerosolized amphotericin B was effective on one occasion in clearing candidal lesions of the larynx and one small area of the left mainstem bronchus. Oral topical therapy was not beneficial. Since the signs and symptoms of laryngitis or esophagitis are often minimal or absent and complications, including strictures, may arise from chronic inflammation, periodic endoscopy and systemic therapy may be necessary.

Combination therapy with caspofungin and liposomal amphotericin B for invasive aspergillosis

2003 ◽  
Vol 22 (7) ◽  
pp. 653-656 ◽  
Author(s):  
ZIJU ELANJIKAL ◽  
JAN SÖRENSEN ◽  
HELGA SCHMIDT ◽  
WOLFGANG DUPUIS ◽  
KATHRIN TINTELNOT ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Invasive Aspergillosis ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Liposomal Amphotericin B

Permeabilization of mercury-supported biomimetic membranes by amphotericin B and the role of calcium ions

2013 ◽  
Vol 112 ◽  
pp. 719-726 ◽  
Author(s):  
Lucia Becucci ◽  
Massimo Innocenti ◽  
Silvano Bellandi ◽  
Rolando Guidelli
Keyword(s):  
Amphotericin B ◽  
Calcium Ions ◽  
Biomimetic Membranes

scholarly journals Sequential or Combination Antifungal Therapy with Voriconazole and Liposomal Amphotericin B in a Guinea Pig Model of Invasive Aspergillosis

2006 ◽  
Vol 50 (4) ◽  
pp. 1567-1569 ◽  
Author(s):  
William R. Kirkpatrick ◽  
Brent J. Coco ◽  
Thomas F. Patterson
Keyword(s):  
Guinea Pig ◽  
Invasive Aspergillosis ◽  
Amphotericin B ◽  
Antifungal Therapy ◽  
Liposomal Amphotericin ◽  
Pig Model ◽  
Liposomal Amphotericin B ◽  
Guinea Pig Model

ABSTRACT We evaluated combinations of voriconazole (VRC) and liposomal amphotericin B (L-AMB) in a guinea pig invasive aspergillosis model. Simultaneous VRC and L-AMB was most effective, although VRC monotherapy was also effective. These regimens as well as sequential L-AMB followed by VRC were more effective than L-AMB alone or VRC followed by L-AMB.

scholarly journals Efficacy of Voriconazole in a Guinea Pig Model of Disseminated Invasive Aspergillosis

2000 ◽  
Vol 44 (10) ◽  
pp. 2865-2868 ◽  
Author(s):  
William R. Kirkpatrick ◽  
Robert K. McAtee ◽  
Annette W. Fothergill ◽  
Michael G. Rinaldi ◽  
Thomas F. Patterson
Keyword(s):  
Guinea Pig ◽  
Invasive Aspergillosis ◽  
Amphotericin B ◽  
Pig Model ◽  
Treatment Regimens ◽  
Guinea Pig Model

ABSTRACT Voriconazole (VRC) was evaluated in an immunosuppressed-guinea pig model of invasive aspergillosis. VRC was more effective than amphotericin B or similar doses of itraconazole in the clearance ofAspergillus from tissues. VRC treatment regimens improved survival and significantly reduced tissue colony counts compared with those of controls.

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