bluuebunny/crossref_metadata_2025_split huggingface dataset:
Expression of TLR2 and TLR4 Messenger RNA in the Epithelial Cells of the Nasal Airway
Authors: Dong Zhen , Yang Zhanquan , Wang Chengshuo 
Published: August 2018

Background Epithelium of nasal mucosa is the first line of defense against invading pathogens. This study investigated the expression of Toll-like receptor (TLR) 2 and TLR4 in epithelial cells of nasal mucosa and understood the role of TLRs in the innate immunity of nasal mucosa. Methods Human nasal epithelial cells were obtained by scraping the middle one-third of inferior turbinates from 30 patients with chronic rhinosinusitis and 20 healthy adult volunteers. The epithelial cells are made into smears. In situ hybridization was performed for TLR2 and TLR4 messenger RNA (mRNA). Results TLR2 and TLR4 mRNA were expressed in the nasal epithelial cells. The expression of the two genes was significantly higher in the chronic rhinosinusitis group than in the normal control (TLR2, t = 8.605, p < 0.0005; TLR4, t = 9.050, p < 0.0005). Conclusion This study is the first to establish the presence of both TLR2 and TLR4 mRNA on epithelial cells of nasal mucosa, and their expression can be up-regulated in infectious conditions. These results show that TLR2 and TLR4 may play a important role in local host defense of nasal mucosa.
Endoscopic Sinus Surgery: Advantages of the Bimanual Technique
Authors: Briner Hans Rudolf , Simmen Daniel , Jones Nick 
Published: August 2018

Background The orthodox endoscopic sinus surgical technique is “one-handed,” which means that the surgeon holds the endoscope in one hand and uses the free hand for other instruments or suction. This technique has its limitations. When there is a lot of bleeding or when tension needs to be kept on tissue so that it can be cut cleanly, this is best done using both hands. This “bimanual” technique was described >10 years ago, and although it offers several advantages, it is rarely used. The main reason is the requirement for two trained endoscopists. In a prospective randomized interventional study, the duration of the operation using the one-handed technique as opposed to the bimanual technique was compared. Methods Patients undergoing endoscopic sinus surgery for chronic rhinosinusitis were evaluated. One side of the nose underwent the conventional one-handed technique, while the other side had the bimanual technique. The operation time for each side was noted. Results Fifty patients (31 men and 19 women) with a mean age of 47.6 years (22–80 years) were evaluated. The mean operation time with the one-handed technique was 39.3 minutes (9–93 minutes). With the bimanual technique, the mean operation time was 31.0 minutes (6–78 minutes). The reduction in operation time with the bimanual technique was 21% and was highly significant (p < 0.001). Conclusion The bimanual endoscopic sinus surgery technique leads to a significant reduction in operation time. The patient may benefit from a shorter operation time and the surgeon has better visibility that may reduce the incidence of complications. Furthermore, there are potential economic advantages because of the increased efficiency of surgical time.
Endoscopic Power-Assisted Orbital Exenteration
Authors: Batra Pete S. , Lanza Donald C. 
Published: August 2018

Background Orbital exenteration can be accomplished by either an external eyelid-sparing or eyelid-sacrificing approach. The purpose of this study was to describe an alternative technique for orbital exenteration and its specific advantages over traditional methods. Methods A retrospective analysis at a tertiary care referral center was performed. Three patients with sinonasal malignancy (two cases) and fulminant invasive fungal sinusitis (one case) are reported. Intraconal involvement was evident in all patients by imaging and surgical pathology. Advanced endoscopic techniques in conjunction with image guidance and soft-tissue shaver technology were used for resection in all cases. Results The orbit was successfully exenterated via an eyelid-sparing endoscopic approach with minimal blood loss in all three patients. Exenteration was completed within 30–45 minutes. Uninvolved superior and lateral orbital periosteum was preserved in all patients, which permitted cavity “mucosalization” within 8 weeks. Two patients are alive without disease at 15-month follow-up. One patient with persistent cavernous sinus malignant peripheral nerve sheath tumor died 4 months after resection despite proton beam therapy. Conclusion This preliminary experience showed endoscopic power-assisted orbital exenteration to be an effective technique for exenteration of the orbit. Endoscopic power-assisted orbital exenteration offers two critical advantages: (1) direct transnasal control of the ophthalmic artery as it emerges from the optic foramen and (2) the ability to preserve the uninvolved superior and lateral periorbita. This can facilitate mucosal coverage of the exenterated space and obviate the need for tissue grafts and/or packing. Additionally, intraorbital pathology can be better visualized and blood loss and operative time are minimized. This technique may serve as an important adjunct for management of the orbit in patients with sinonasal malignancy or invasive fungal rhinosinusitis.
Anatomic Risk Factors for Sinus Disease: Fact or Fiction?
Authors: Caughey Robert J. , Jameson Mark J. , Gross Charlie W. , Han Joseph K. 
Published: August 2018

Background Sinonasal anatomic variants have been postulated as a risk factor for sinus disease. Therefore, a study was conducted to examine the correlation of sinus disease to septal deviation, concha bullosa, and infraorbital ethmoid cells. Methods Two hundred fifty consecutive sinus and orbital computed tomography scans were examined at the University of Virginia over a 2-year period. Coronal, sagittal, and axial views were examined for the presence and size of concha bullosa and infraorbital ethmoid cells. Septal deviations were measured by examining the width of the nasal cavity at the level of the maxillary sinus ostium. The severity of mucosal thickening in the maxillary, ethmoid, and frontal sinuses was recorded. The correlation between mucosal disease of the sinuses to the anatomic variants was then compared. Results Computed tomography images were reviewed in 250 consecutive studies (500 sides). Of the 500 sides, 67.2% of sides had some level of mucosal thickening. Concha bullosa and infraorbital ethmoid cells were both present in 27% of the sides. Concha bullosa was associated with maxillary sinus disease (p < 0.01). Infraorbital ethmoid cells were associated with both ethmoid (p < 0.05) and maxillary (p < 0.01) mucosal disease. Frontal sinus disease had no significant correlation with these anatomic variants (p > 0.05). For sinuses with infraorbital ethmoid cells or concha bullosa, there were a higher number of diseased sinuses with larger anatomic variants (p < 0.01). Narrow nasal cavities were associated with maxillary sinus disease (p < 0.01). Conclusion Septal deviations, concha bullosa, and infraorbital ethmoid cells, which contribute to the narrowing of the osteomeatal complex, are associated with mucosal disease.
Revision Functional Endoscopic Sinus Surgery: Objective and Subjective Surgical Outcomes
Authors: McMains K. Christopher , Kountakis Stilianos E. 
Published: August 2018

Background The aim of this study was to report objective and subjective outcomes after revision sinus surgery (RESS) for chronic rhinosinusitis (CRS). Methods We performed a retrospective analysis of prospectively collected data in 125 patients requiring revision functional endoscopic sinus surgery after failing both maximum medical therapy and prior sinus surgery for CRS. Patients were seen and treated over a 3-year period (1999–2001) in a tertiary rhinology setting. Computed tomography (CT) scans were graded as per Lund-MacKay and patient symptom scores were recorded using the Sinonasal Outcome Test 20 (SNOT-20) instrument. Individual rhinosinusitis symptoms were evaluated on a visual analog scale (0–10) before and after surgery. All patients had a minimum 2-year follow-up. Results The mean number of prior sinus procedures was 1.9 ± 0.1 (range, 1–7) and the mean preoperative CT grade was 13.4 ± 0.7. Patients with asthma and polyposis had higher CT scores than those without these processes. Preoperative mean SNOT-20 and endoscopy scores were 30.7 ± 1.3 and 7.3 ± 0.4, respectively. At the 2-year follow-up, mean SNOT-20 and endoscopy scores improved to 7.7 ± 0.6 and 2.1 ± 0.4, respectively (p < 2.8 X 10-10). At 12-month follow-up, each individual symptom score decreased significantly. Overall, 10 patients failed RESS and required additional surgical intervention for an overall failure rate of 8.0%. All patients who failed RESS had nasal polyposis. Conclusion Revision functional endoscopic sinus surgery benefits patients that fail maximum medical therapy and prior sinus surgery for CRS by objective and subjective measures.
Luffa Operculata Affects Mucociliary Function of the Isolated Frog Palate
Authors: Menon-Miyake Mônica Aidar , de Oliveira Regiani Carvalho , Lorenzi-Filho Geraldo , Saldiva Paulo Hilário Nascimento , Butugan Ossamu 
Published: August 2018

Background Luffa operculata is a medicinal plant used in homeopathic and alternative medicine. In the United States, it is sold in a purified spray form, whereas a homemade L. operculata dry fruit infusion (DFI) is commonly used in Latin America. The L. operculata DFI is applied intranasally, inducing profuse mucous secretion and relieving nasal symptoms. Nevertheless, this medication may cause irritation of the nasal mucosa, as well as epistaxis or anosmia. Given the growing popularity of alternative medicine, a decision was made to evaluate the effects of this substance on mucous membranes. Methods The effects of L. operculata DFI on mucociliary transport velocity, ciliary beat frequency, and transepithelial potential difference (PD) were evaluated in an isolated frog palate preparation. We tested 46 palates immediately before immersion and again at 5 and 20 minutes after immersion. Four groups (n = 10) were tested in frog Ringer: control; L. operculata DFI, 60 mg/L; 600 mg/L; and 1200 mg/L. An additional group was tested using L. operculata DFI prepared with water (600 mg/L of H2O, n = 6). Epithelial samples were harvested for ultrastructural study. Results In treated palates, mucociliary transport velocity and ciliary beat frequency decreased significantly (p < 0.001 and p < 0.008, respectively). There was a dose-dependent decrease in PD modulus (p < .007). Our PD findings indicated ion-fluid transport abnormalities, which were confirmed by transmission electron microscopy that showed enlargement of interepithelial spaces. Conclusion In this ex vivo model, the L. operculata DFI infusion promoted significant changes in the mucociliary function of the epithelium, suggesting that it is potentially noxious to human nasal mucosa.
Catheter- and Antibiotic-Related Complications of Ambulatory Intravenous Antibiotic Therapy for Chronic Refractory Rhinosinusitis
Authors: Lin Jerry W. , Kacker Ashutosh , Anand Vijay K. , Levine Howard 
Published: August 2018

Background Chronic rhinosinusitis has several features of a prolonged bacterial infection including positive bacterial cultures and abnormal computed tomography findings such as mucosal thickening and hyperostotic bone. Recent studies have suggested that chronic rhinosinusitis may be treated successfully by outpatient parenteral antibiotic treatment (OPAT). In this setting, antibiotics are administered through a peripherally inserted central catheter (PICC). This study evaluates complications arising from OPAT for chronic rhinosinusitis. Methods A chart review was performed of 177 patients who underwent OPAT for chronic rhinosinusitis. Results PICC line–related infections (4/177, 2%)) included line thrombosis in three patients and septicemia in one patient. In the three patients with line thrombosis, the PICC lines were removed and replaced, allowing for completion of the antibiotic course. Antibiotic complications (29/177, 16%) included four patients with transient neutropenia and one patient with elevated liver function tests. Of the four patients with neutropenia, only one required a change in antibiotics. The patient with elevated liver function tests did not require a change in antibiotics. Minor complications from antimicrobial treatment such as rash, itchiness, flushing, and diarrhea were reported by 25 patients, 9 of these patients required a change in antibiotics. There were no permanent complications or deaths in this study. Conclusion Intravenous antimicrobial treatment administered through a PICC line in an outpatient setting is well-tolerated for chronic rhinosinusitis. Although PICC line and antibioticrelated complications are relatively infrequent, the physician should be aware of these complications and consider them in selecting patients for OPAT.
Lack of Significant Correlation between Rhinosinusitis Symptoms and Specific Regions of Sinus Computer Tomography Scans
Authors: Holbrook Eric H. , Brown Christopher L. , Lyden Elizabeth R. , Leopold Donald A. 
Published: August 2018

Background The sinonasal computer tomography (CT) scan is frequently used to help confirm the diagnosis of rhinosinusitis. However, little data exist correlating patient symptoms with CT findings. Methods Immediately preceding CT of the sinuses, 94 subjects without evidence of trauma, nasal tumors, or previous sinus surgery completed the Rhinosinusitis Outcome Measure 31 symptom questionnaire and were asked to locate areas of facial pain or pressure. CT scans were graded according to the Lund-MacKay system, and agger nasi and ethmoid bulla cells were measured. Data from CT scans and symptom/pain questionnaire responses were analyzed for significant correlations. Results No correlation was identified when comparing total Lund-MacKay scores, opacification of individual sinuses, and size of the agger nasi and ethmoid bulla cells with the Rhinosinusitis Outcome Measure 31 subset scores and areas of facial pain or pressure. Conclusion The sinus CT scan is a necessary tool for preoperative planning; however, it should not be used to predict symptoms or to localize areas responsible for facial pain or pressure.
Fluoroquinolone-Induced Arthralgia and Myalgia in the Treatment of Sinusitis
Authors: O-Lee Tsungju , Stewart Charles E. , Seery Loren , Church Christopher A. 
Published: August 2018

Background Because of their broad-spectrum coverage, fluoroquinolone antibiotics are widely used in the treatment of acute sinusitis and acute exacerbations of chronic sinusitis. Generally, they are well tolerated, and adverse effects are usually mild. In our experience with quinolones, patients have frequently complained of arthralgias and/or myalgias. Although tendon rupture has been described as one of the more severe side effects, there are few published reports of arthralgias and/or myalgias associated with these drugs. Methods A retrospective review of fluoroquinolone prescriptions in a tertiary rhinology clinic was completed. Patients treated with oral levofloxacin for sinusitis over a 12-month period were contacted by mail and asked to complete an anonymous survey regarding adverse effects. Of 81 patients identified, 36 responses were received. Results Among respondents, the incidence of arthralgias and/or myalgias was 25%, which was more than twice the incidence of any other adverse effect reported. Occurrence of arthralgias and/or myalgias did not appear to be influenced by respondent age, course length, concurrent use of oral steroids, or a history of arthritis. Among those reporting arthralgia or myalgia, symptoms began after an average of 3 days of therapy and resolved an average of 7.5 days after cessation of treatment. Fourteen percent of respondents were unable to complete their course of therapy because of arthralgias and/or myalgias. Conclusion Although effective and generally well tolerated in the treatment of sinusitis, fluoroquinolone antibiotics may produce adverse effects of arthralgia and/or myalgia.
Extraocular Muscle Damage Associated with Endoscopic Sinus Surgery: An Ophthalmology Perspective
Authors: Thacker Neepa M. , Velez Federico G. , Demer Joseph L. , Wang Marilene B. , Rosenbaum Arthur L. 
Published: August 2018

Background Orbital complications associated with endoscopic sinus surgery are well documented. Damage to the medial rectus muscle results in complicated strabismus and disturbing diplopia. The aim of this study was to characterize the types of extraocular muscle injury and the number of muscles involved that may complicate endoscopic sinus surgery and correlate its occurrence to factors in the surgical procedure itself. Methods A retrospective chart review was performed of 14 patients with strabismus after endoscopic sinus surgery. Operative notes of the surgical procedure, pathology reports of the intraoperative specimens, postoperative pattern of strabismus, the extraocular muscle involved, and the type of muscle injury characterized by orbital imaging were reviewed in each patient. Results In our series, not only the medial rectus muscle but also the inferior rectus and the superior oblique muscles were damaged with multiple muscles being involved in one patient. Extraocular muscle injury varied from hematoma, entrapment of muscle in the fractured orbital wall, damage to the oculomotor nerve entry zone, muscle transection, and partial or complete muscle destruction with entrapment in scar tissue. Use of the microdebrider causes extensive irreparable muscle damage. Conclusion Extraocular muscle damage complicating endoscopic sinus surgery can produce therapeutically challenging complicated strabismus.
Osteoplastic Flap for Frontal Sinus Obliteration in the Era of Image-Guided Endoscopic Sinus Surgery
Authors: Anand Vijay K. , Hiltzik David H. , Kacker Ashutosh , Honrado Carlo 
Published: August 2018

Background This study evaluates the management of frontal sinus disease using osteoplastic flap surgery (OPFS) in the current era of image-guided endoscopic sinus surgery (IGESS). Study Design: A retrospective chart review was performed of patients who underwent OPFS and imaged-guided endoscopic frontal sinus surgery in the past 10 years at a tertiary care teaching hospital. Methods Chart reviews of clinic patients and inpatients who underwent OPFS were performed. Indications for surgery, prior sinus surgeries, time to OPFS, post-OPFS sinus surgeries, and associated comorbid factors were reviewed. Results In the period under review, 710 IGESS cases were performed. Thirty patients, who were candidates for OPFS, underwent IGESS for frontoethmoid disease. Fourteen patients from this group failed IGESS and underwent OPFS. The indications for OPFS included mucocele in 10 cases, tumors in 2 cases, and trauma in 2 cases. Four patients underwent revision OPFS. The patients who failed IGESS had prior trauma, tumor resection, radiation, or large septate frontal sinus with lateral extension in which the mucocele could not be drained endoscopically. The average time to OPFS was 6.2 years (0–27 years). Nine patients had prior sinus surgery (1–7 prior surgeries) and five patients had subsequent endoscopic surgical procedures. Conclusion In all patients with frontal mucocele, surgery should be attempted endoscopically using IGESS because of the low morbidity of the procedure. Patients with risk factors for failure should be considered for OPFS if IGESS proves to be unsuccessful.
Staged Endoscopic and Combined Open/Endoscopic Approach in the Management of Inverted Papilloma of the Frontal Sinus
Authors: Dubin Marc G. , Sonnenburg Robert E. , Melroy Christopher T. , Ebert Charles S. , Coffey Charles S. , Senior Brent A. 
Published: August 2018

Background The endoscopic management of inverted papilloma has gained increasing popularity over the last 10 years. Although early concerns over an increased risk of recurrence seem to have been allayed, the appropriate management of lesions involving the frontal sinus and frontal recess still has to be determined. Methods We performed a retrospective review of the results of all patients with inverted papilloma from 2000 to 2004. Results A total of 18 patients were treated between October 2000 and January 2004. Six patients had frontal sinus involvement at the time of initial evaluation. One of these patients had isolated frontal sinus involvement. These patients were managed with either initial endoscopic resection with determination for the need for an additional procedure at the time of endoscopic resection (n = 5) or open/endoscopic approach for isolated frontal sinus involvement (n = 1). Of the five patients who had their disease managed endoscopically, three patients were determined at the initial procedure to need an osteoplastic flap and, subsequently, were managed successfully with a combined approach. One other patient was initially successfully managed endoscopically but ultimately required an osteoplastic flap for definitive management. The fifth patient was managed entirely endoscopically with multiple procedures. All patients treated with this protocol remain disease free with an average follow-up of 13.3 months. Conclusion The limitations of endoscopic resection of inverted papilloma of the frontal recess can be managed with staged procedures. Initial endoscopic resection of ethmoid/maxillary disease with subsequent open treatment of the frontal sinus has been successful in our experience.
Endoscopic Management of Extensive Inverted Papilloma
Authors: Jameson Mark J. , Kountakis Stilianos E. 
Published: August 2018

Background Given the malignant potential and propensity for recurrence of inverted papilloma (IP) of the sinonasal cavity, complete excision is warranted. For disease extending to multiple sites, open surgical oncological procedures are associated with high morbidity and do not assure complete control of the tumor. The endoscopic approach provides excellent visualization, permits removal of diseased mucosa while preserving vital anatomic structures, and allows for excellent postoperative surveillance. Recurrences are identified early and endoscopic resection is repeated as necessary until there is no evidence of disease. Methods Data were prospectively collected and subsequently reviewed on 18 consecutive patients who underwent endoscopic management of extensive IP (present at more than one anatomic site) between 1999 and 2003. Results Fourteen men and four women with a mean age of 54 years (range, 36–74 years) were followed for an average of 29 months (range, 6–46 months) after initial endoscopic resection. Seventy-eight percent (14 patients) complained of nasal airway obstruction for more than 6 months and 22% (4 patients) were incidentally noted to have a nasal mass on endoscopy or computed tomography. Eleven patients had undergone therapeutic procedures on initial evaluation. The most common sites affected were maxillary sinus, lamina papyracea, and ethmoid sinus. Patients required an average of 1.6 endoscopic surgeries (range, 1–3 surgeries) to achieve local control; 10 patients (56%) required only one. All patients were symptomatically improved and complications were limited to one cerebrospinal fluid leak, which was repaired intraoperatively. Conclusion Extensive IP can be controlled using minimally invasive endoscopic procedures as long as close follow-up is maintained. Operative risk and postoperative morbidity are significantly less than observed with open procedures.