bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sellar Reconstruction: Is it Necessary?
Authors: Sonnenburg Robert E. , White David , Ewend Matthew G. , Senior Brent 
Published: August 2018

Background Sellar reconstruction is practiced routinely during the transsphenoidal approach to pituitary tumor resection. This practice exposes the patient to risks of donor site complications and may interfere with measuring postoperative tumor reduction. We propose that it is not a necessary component of transsphenoidal pituitary surgery in the absence of intraoperative cerebrospinal fluid (CSF) leak. Methods A retrospective chart review of 45 cases of minimally invasive pituitary surgery were reviewed. Twenty-eight cases were identified with no sellar reconstruction being performed. Age, sex, revision surgery, postoperative CSF leak, days with lumbar drain, meningitis, ophthalmoplegia, visual acuity loss, postoperative epistaxis, diabetes insipidus, development of empty sella syndrome, and length of stay were investigated in these cases. Results Twenty-three cases were the primary procedure and five cases were revision surgery. Complication rates were low and compared favorably with those reported in the literature. Five cases of transient diabetes insipidus occurred. There was one postoperative CSF leak that required 4 days with a lumbar drain. No cases of empty sella syndrome developed. There were no cases of meningitis. The average length of stay was 2.9 days. Conclusion Sellar reconstruction during transsphenoidal approach to pituitary tumor resection is not required for patients without evidence of an intraoperative CSF leak. This practice exposes the patient to the risks of donor site complications without reducing the rate of postoperative complications.
Objective Testing and Quality-of-Life Evaluation in Surgical Candidates with Chronic Rhinosinusitis
Authors: Smith Timothy L. , Rhee John S. , Loehrl Todd A. , Burzynski Mary L. , Laud Prakash W. , Nattinger Ann B. 
Published: August 2018

Background Discordance has been reported between patient symptoms and objective measures of disease in chronic sinusitis, such as radiographic evaluation. The objective of this study was to evaluate the association between presurgical objective studies and presurgical quality of life (QOL). This work was designed as a cross-sectional study of 90 consecutive patients presenting to a tertiary rhinology practice for surgical management of sinonasal disease. Methods QOL assessment was performed using disease-specific instruments (Chronic Sinusitis Survey and Rhinosinusitis Disability Index). Computed tomography (CT) scans were scored according to the Lund-Mackay CT scoring system and endoscopy evaluation was scored by the system proposed by Lund and Kennedy. Results Ninety surgical candidates were enrolled and included in the analysis. Correlation between the QOL total scores and subscale scores was excellent (r = 0.39; p = 0.0001) as was the correlation between CT and endoscopy scores (r = 0.59; p = 0.0001). In contrast, correlation between QOL and objective measures was poor. These results were not significantly influenced by subgroup analysis by diagnosis, comorbidity, and other patient factors. Conclusion Preoperative objective measures of CRS disease show little, if any, correlation with disease-specific QOL measures in surgical candidates. It is likely that CT and endoscopy are measuring a different aspect of CRS disease than the QOL measures. In addition, it is possible that preoperative QOL, either alone or in combination with CT and endoscopy, may prove important in selecting patients most likely to benefit from surgery.
A Comparison of the Efficacy of Telithromycin versus Cefuroxime Axetil in the Treatment of Acute Bacterial Maxillary Sinusitis
Authors: Buchanan Patricia P. , Stephens Thad A. , Leroy Bruno 
Published: August 2018

Background Telithromycin, a new ketolide, exhibits potent activity against respiratory pathogens, including resistant strains. Methods Five days of telithromycin (800 mg once daily) was compared with 10 days of cefuroxime axetil (250 mg twice daily) in subjects (n = 593) with acute bacterial maxillary sinusitis (ABMS). Bacteriologic sampling was accomplished by sinus puncture or nasal endoscopy. The primary efficacy variable was clinical outcome at the posttherapy/test-of-cure evaluation in clinically evaluable patients. Results Clinical cure was achieved in 85.2% of telithromycin patients and 82.0% of cefuroxime axetil patients (difference in proportions, 3.2%; 95% confidence interval, 27.1–13.4%). Satisfactory bacteriologic response rates were comparable. Treatment-emergent adverse events for both drugs were mild or moderate. The most frequently reported treatment-emergent adverse events were nausea and diarrhea. Conclusion Once-daily telithromycin for 5 days was equivalent in efficacy to twice-daily cefuroxime axetil for 10 days in patients with ABMS. Telithromycin is a suitable option for short-course therapy of ABMS.
Particle Deposition of Therapeutic Aerosols in the Nose and Paranasal Sinuses after Transnasal Sinus Surgery: A Cast Model Study
Authors: Saijo Ryuichiro , Majima Yuichi , Hyo Noboru , Takano Hiroshi 
Published: August 2018

Background The topical administration of steroids or antibiotics to the nose and the sinuses is one of the important postsurgical therapies of endoscopic sinus surgery (ESS). Methods To investigate the effective deposition of aerosols in the paranasal sinuses after ESS, we restored the human nasosinus model that underwent ESS and studied the particle depositions on the ostiomeatal complex (OMC), maxillary, and ethmoid sinuses quantitatively. Results A 45° nozzle insertion angle significantly increased the particle depositions more than the 30° angle (p < 0.05). A computer simulation-assisted analysis shows that the inertial deposition at OMC increased with a nozzle angle of 45° versus 30°. The particles with 5.63 mm in diameter significantly deposit on OMC and maxillary sinus compared with the particles with 16.37 mm (p < 0.05). Conclusion The topical administration of drugs to the paranasal sinuses postoperatively must be performed in consideration with aerodynamics of aerosols.
Treatment of Allergic Rhinitis during Pregnancy
Authors: KeleSl Nesil 
Published: August 2018

Background Allergic rhinitis (AR) affecting ∼20–30% of women in childbearing age can be considered one of the most common group of medical conditions that complicate pregnancy. AR with symptoms of nasal obstruction, sneezing, and itching may require pharmacotherapy. However, there are concerns regarding the safety of different available agents that can be used during pregnancy with respect to both maternal and fetal well being. Conclusions The best first-line approach in the management of AR is avoidance of allergens. If environmental modification is ineffective, then the pharmacologic agents should be chosen. For symptoms of rhinorrhea, sneezing, or itching, intranasal cromolyn, with its excellent safety profile, should be considered as first-line therapy. If cromolyn is ineffective or poorly tolerated, first-generation (e.g., chlorpheniramine and tripelennamine) and second generation (e.g., cetirizine and loratadine) antihistamines can be given. Intranasal steroids (e.g., beclomethasone dipropionate, and budesonide) can be added to first-line therapy especially for severe nasal obstruction. There are no epidemiological studies with newer intranasal steroids (e.g., flunisolide, triamcinolone acetonide, fluticasone propionate, and mometasone furoate) during the first trimester of pregnancy. Immunotherapy has not proven to be teratogenic and is clinically useful in improving symptoms. Oral and topical decongestants can be considered as second-line therapy, for short-term relief, when no safer alternative is available.
A Post-Traumatic Nasal Epidermoid: An Endoscopic Approach
Authors: Colreavy Michael P. , Oleary Stephen J. , Mckelvie Penny A. 
Published: August 2018

Background Epidermoid cysts are thought to arise as a result of implantation of epidermal cells into the deeper dermal elements. These cysts have previously been described postsurgery but not after accidental nasal trauma. Methods We outline a case of a nasal epidermoid occurring post-blunt nasal trauma and its subsequent excision. Results The lesion was excised successfully endoscopically without recourse to an open technique. Conclusion We describe, for the first time, the successful intranasal removal of a post-traumatic epidermoid cyst via an endoscopic approach.
Invasive Fungal Sinusitis: A 15-Year Review from a Single Institution
Authors: Parikh Shatul L. , Venkatraman Giridhar , Delgaudio John M. 
Published: August 2018

Background The aim of this study was to review our experience with patients with invasive fungal sinusitis (IFS) to determine outcomes and identify factors that may affect patient survival. Methods A retrospective review was performed. Results Forty-three patients were identified accounting for 45 cases of IFS. The underlying reasons for immunosuppression were hematologic malignancy (28 patients), diabetes mellitus (10 patients), solid organ transplant (3 patients), chronic steroid use (3 patients), and acquired immunodeficiency syndrome (1 patient). Eight of 45 cases (18%) died of IFS. Of the 28 cases associated with hematologic malignancy, 3 patients died of IFS (11%) and 4 patients (14%) died of other causes with persistent IFS. None of these 7 patients had recovery of their absolute neutrophil count, and all patients who recovered from IFS recovered to a normal absolute neutrophil count. Four of 10 (40%) diabetic patients died of IFS, and 66% of survivors had persistent neurological or visual morbidity. The mortality rate was 29% for patients infected with Mucor and 11% for patients infected with Aspergillus. Conclusion We have found the overall mortality rate directly related to IFS to be 18%. The rate is higher for diabetic patients than for patients with hematologic causes for their immunosuppression. This is likely because of the higher index of suspicion and early diagnosis and treatment of patients with neutropenia and a less-fulminant, slower-progressing form of IFS from Aspergillus, apparently a less virulent fungus than Mucor. Intracranial involvement and failure to recover from neutropenia are the factors that led to poor prognosis in this series.
Myeloperoxidase in Nasal Secretion as a Cell-Activation Marker in Acute Sinusitis
Authors: Haxel Boris R. , Woywode Claudia , Mewes Torsten , Mann Wolf J. 
Published: August 2018

Background Acute bacterial infections of the upper respiratory tract, including the nasal sinuses, lead to an activation of neutrophil granulocytes. The protein myeloperoxidase (MPO) is released by this cell type only and therefore can act as a marker for activity of inflammation. Methods In a prospective multicenter study, 45 patients with acute bacterial sinusitis (diagnosed by clinical examination, ultrasonography, and X ray or computed tomography scan) were treated with two different antibiotics (Cefditoren or Cefuroxim twice a day for 10 days). Nasal secretions were collected with absorbing foam-rubber samplers and a concentration of MPO was evaluated before the therapy and after 7 ± 1 days and 14 ± 2 days of antibiotic treatment. The concentrations of MPO were measured by a radioimmunoassay method and the dilution factors were determined by the lithium method. Results Significant differences in the MPO concentration in nasal secretions between the first and third visit could be found in both groups (p < 0.01 each). No significant difference was seen within the two different antibiotics used. Conclusion Measurement of MPO concentration in nasal secretions showed a significant change after antibiotic treatment of acute bacterial rhinosinusitis. The reduction of MPO levels correlated with the observed clinical and radiological improvement of the disease. Additional investigations are needed to achieve more knowledge about basal concentrations of MPO in healthy persons and different activation patterns before it can be determined whether the MPO measurement could be a suitable method for monitoring the success of an antibiotic treatment in acute bacterial sinusitis.
Propagation of Human Nasal Chondrocytes in Microcarrier Spinner Culture
Authors: Shikani Alan H. , Fink David J. , Sohrabi Afshin , Phan Phong , Polotsky Anna , Hungerford David S. , Frondoza Carmelita G. 
Published: August 2018

Objective The aim of this study was to test the effectiveness of nasal septal chondrocytes, propagated in microcarrier spinner culture, as an alternative tissue source of chondrocytic cells for cartilage grafts for head and neck surgery and for articular cartilage repair. Methods We harvested chondrocytes from 159 patients, ranging in age from 15 to 80 years and undergoing repair of a deviated nasal septum, and propagated the cells in a microcarrier spinner culture system. The nasal chondrocytes proliferated and produced extracellular matrix components similar to that produced by articular chondrocytes. Results In microcarrier spinner culture on collagen beads, chondrocyte numbers increased up to 14-fold in 2 weeks. After a month, the microcarriers seeded with nasal chondrocytes began to aggregate, producing a dense cartilage-like material. The newly synthesized extracellular matrix was rich in high molecular weight proteoglycans, and the chondrocytes expressed type II collagen and aggrecan but not type I collagen. Conclusion These studies support the feasibility of engineering cartilage tissue using chondrocytes harvested from the nasal septum. Injectable and solid formulations based on this technology are being evaluated for applications in craniomaxillofacial reconstructive surgery and for plastic and orthopedic surgery practices.
Acute Effects of 1,1,1-Trichloroethane on Human Olfactory Functioning
Authors: Muttray Axel , Moll Bertram , Faas Michael , Klimek Ludger , Mann Wolf , Konietzko Johannes 
Published: August 2018

Background Animal experiments indicate that 1,1,1-trichloroethane can cause degeneration of the olfactory epithelium. The effects of 1,1,1-trichloroethane on human odor perception still have not been investigated. The goal of this study was to learn more about acute effects of 1,1,1-trichloroethane. Methods Twelve healthy, nonsmoking students were exposed to 200 and 20 ppm (control) 1,1,1-trichloroethane in an exposure chamber for 4 hours according to a crossover design. Olfactory functioning was investigated with the Sniffin’ Sticks. The test includes the determination of the detection threshold for n-butanol and an odor identification test. Results After 1 hour of exposure to 200 ppm 1,1,1-trichloroethane, no effects on olfactory functioning were observed. After 4 hours, the olfactory threshold for n-butanol was slightly (p = 0.04) elevated. Conclusion The threshold shift may be caused by different mechanisms, including inflammation of the olfactory mucosa or degeneration of receptor cells.
Endoscopic Sinus Surgery in Geriatric Population
Authors: Ramadan Hassan H. , Vanmetre Ray 
Published: August 2018

Background With the baby boomers getting older, endoscopic sinus surgery (ESS) is being performed more on elderly people than before. We compared patients undergoing ESS who were >65 years of age with those <65 years. Materials and Methods We reviewed our database of cases who had ESS between 1992 and 2002. Demographics and patient characteristics and complications encountered intraoperatively and immediately postoperatively were reviewed. Results Forty-six (8.1%) patients were older than 65 years of age compared with 522 patients who were 18–64 years old. The older group had a 24% revision rate compared with 34% in the younger group. Complication rates were 21.7% for the elderly compared with 12.8% for the younger group. There was a significantly higher complication rate in the older group of people who were having revision ESS. Conclusion The elderly people who were having revision surgery had a higher risk for complications compared with those having primary surgery or those <65 years old.
Multi-Use Venturi Nasal Atomizer Contamination in a Clinical Rhinologic Practice
Authors: Dubin Marc G. , White David R. , Melroy Christopher T. , Gergan Maria T. , Rutala William A. , Senior Brent A. 
Published: August 2018

Introduction Cross-contamination of Venturi atomizers has been reported. Methods In phase I, 16 atomizers were sterilized and refilled with either 1% lidocaine or 0.1% Tyzine (day 0). During phase II, atomizers were wiped with isopropyl alcohol wipes between uses. In both phases, on days 7, 14, 21, and 28, the contents of the atomizer were sprayed onto two culture media. If a culture was found positive, cultures from the nozzle, lumen, and solution were taken and cultured in depth. Results Twelve lidocaine bottles and three Tyzine bottles were initially positive. There were more positive cultures from lidocaine bottles than Tyzine bottles at 2 weeks (p = 0.02). After wiping with isopropyl alcohol, contamination was significantly reduced in the lidocaine bottles at 2 weeks (p = 0.02). Conclusion Microbial contamination of questionable clinical significance may occur with nasal atomizers. Regardless of this significance, wiping the devices with isopropyl alcohol can eliminate microbial growth for a 2-week interval.
Evaluation of Telomerase Activity in Nasal Polyps
Authors: Bruno Ernesto , Bonmassar Enzo , Di Girolamo Stefano , Adamo Riccardo , Alessandrini Marco , Ottaviani Fabrizio , Rosati Faustino , Franzese Ornella 
Published: August 2018

Background The objective of this study was to assess if nasal polyps express telomerase activity and whether a difference could be found between the polyp and the surrounding mucosa of the middle meatus and between different portions of the polyp itself. Methods Nine patients affected by nasal polyposis were included in this study; four of these patients had recurring polyposis. Telomerase activity was measured by telomeric repeat amplification protocol assay. In six patients, the telomeric repeat amplification protocol assay was performed on the polyp and on the mucosa from the ipsilateral middle meatus. In a polyp, we were able to investigate telomerase activity of its different portions, corresponding to pedicle and fundus. Results Telomerase activity observed in nasal polyps was higher than that observed in samples from the ipsilateral middle meatus mucosa. High or intermediate telomerase activity was found to be related to predominant recurring polyposis. Conclusion Therefore, it could be postulated that telomerase activity could be related with the tendency of polyps to recur.
Software-Enabled Computed Tomography Analysis of the Carotid Artery and Sphenoid Sinus Pneumatization Patterns
Authors: Batra Pete S. , Citardi Martin J. , Gallivan Ryan P. , Roh Hwan-Jung , Lanza Donald C. 
Published: August 2018

Background The critical relationship of the carotid artery with the sphenoid sinus has been long established. Sophisticated imaging software in conjunction with three-dimensional high-resolution computed tomography (CT) imaging now facilitates detailed analysis of these anatomic relationships. Methods Siemens VolumeZoom CT scanner was used to obtain high-resolution computed tomography data that was subsequently transferred to the CBYON Suite Doctor Station version 2.6 for analysis. Various surgical planning tools were used for evaluating the CT scans. The relationship of the carotid artery with the sphenoid sinus was delineated. Results One-hundred twenty-eight sides in 64 cadaveric specimens were reviewed. Pneumatization of the sphenoid sinus was classified into four categories: conchal, presellar, sellar, and postsellar. The incidence of these four types was 4.7, 4.7, 25, and 65%, respectively. Carotid artery exposure was categorized as follows: no exposure, <90°, >90 to <180°, and >180°. The incidence of the carotid exposure was 12.5, 32.8, 50, and 4.7%, respectively. Septal insertions onto the carotid artery were noted in 37.5% and dehiscences in 19.5% of the specimens. Conclusion Computer-aided CT analysis allows for a detailed study of the critical relationship of sphenoid pneumatization and carotid artery position. Such technology can be invaluable in surgical planning and navigation during endoscopic sinus surgery. In lieu of these findings, sinus surgeons must exercise extreme caution when operating in this region to prevent unintentional injury to the carotid artery.
Chronic Invasive Fungal Rhinosinusitis: Two New Cases and Review of the Literature
Authors: Dufour Xavier , Kauffmann-Lacroix Catherine , Roblot France , Goujon Jean Michel , Breux Jean Philippe , Ferrie Jean Claude , Michel Klossek Jean 
Published: August 2018

Background Chronic invasive fungal rhinosinusitis is rare in the immunocompetent patient. Few cases have been published except for in a specific geographic area (Sudan, India). Methods and Results We reported two new cases of chronic invasive fungal rhinosinusitis due to Aspergillus, which was successfully treated, to analyze the different clinical, radiological, and mycological criteria. Conclusion Through these two new clinical cases and the analysis of the literature, we suggested, in the absence of general agreement on the surgical and medical management, the current strategies available for this rare pathology. New antifungal drugs seem to be an efficient alternative to classic antifungal agents, especially those that require an extended course of oral therapy for the chronic invasive form.
Prognostic Factors of Maxillary Sinus Malignancies
Authors: Nazar Gonzalo , Rodrigo Juan P. , Llorente José L. , BaragaNto Lucía , Suárez Carlos 
Published: August 2018

Background Analysis of a series of tumors of the maxillary sinus show contradictory outcome data. The purpose of this article was to study the prognostic factors that may have implications for patient management. Methods We present a retrospective review of 57 patients who underwent a maxillectomy over a 20-year period. Results At the time of presentation, 86% of patients had advanced local disease (T3–T4). The 5-year disease-specific survival rate of this series was 39%. No significant differences on survival were observed according the histology of the tumor (p = 0.213), extension to the infratemporal fossa (p = 0.314), and postoperative radiotherapy (p = 0.723). Factors that revealed a significant reduction of survival were skull base involvement (p = 0.013), involvement of the orbit (p = 0.043), and recurrent disease (p = 0.048). Multivariate analysis confirmed that the skull base and orbital involvement were significantly associated with disease-specific survival. Conclusion Advanced T stage, base of skull involvement, orbital extension, and local recurrence are highly predictive of poor survival.
Transforming Growth Factor β1 in Nasal Remodeling: Differences between Chronic Rhinosinusitis and Nasal Polyposis
Authors: Watelet Jean-Baptiste , Cindy  , Perez-Novo Claudina , Gevaert Philippe , Van Cauwenberge Paul , Bachert Claus 
Published: August 2018

Background Chronic rhinosinusitis (CRS) and nasal polyposis (NP) are histopathologically characterized by different gross morphological aspects. Transforming growth factor (TGF) β1 plays an important role in tissue remodeling, which is poorly understood in chronic diseases of the sinuses. Methods The expression of TGF-β1 was analyzed by enzyme-linked immunosorbent assay, quantitative reverse-transcription polymerase chain reaction, and immunohistochemistry in nasal tissue from controls (n = 6), CRS (n = 19), or NP (n = 19). Results CRS presented significantly higher concentrations of TGF-β1 at protein (p = 0.0008) and mRNA levels (p = 0.025) when compared with NP samples. In CRS, TGF-β1+ staining of the extracellular matrix was found abundantly and related to fibrosis. In contrast, no TGF-β1 staining was found in the pseudocyst areas in NP. Conclusions CRS was histologically characterized by fibrosis, which was reflected by a significantly higher expression of TGF-β1 at RNA and protein levels when compared with NP. We show that TGF-β1 expression is related to fibrosis, differentiating CRS without polyps from NP.