bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Chronic Rhinosinusitis on Liver Transplant Patients
Authors: Moon Byoung Jae , Han Ju Hee , Jang Yong Ju , Lee Bong-Jae , Chung Yoo-Sam 
Published: February 2010

Background The use of immunosuppressant after liver transplantation makes transplant recipients susceptible to infections. Most infections that can alter mortality after liver transplantation are wound infections, urinary infections, and pneumonias. There is no evidence, however, that chronic rhinosinusitis can alter mortality in patients awaiting liver transplantation. We have therefore assessed the association of rhinosinusitis with mortality and prognosis after liver transplantation. Methods The clinical records of 996 patients who received liver transplants between January 1995 and March 2005 were reviewed and the collected data were analyzed. Results Of the 996 patients who received liver transplants between January 1995 and March 2005, 28 (2.8%) had pretransplant rhinosinusitis. Of the latter, 5 patients were treated medically, 1 patient had endoscopic sinus surgery, and 22 patients had no treatment before liver transplantation. Untreated rhinosinusitis before liver transplantation was associated with aggravated rhinosinusitis after transplantation but did not contribute to an increase in infectious mortality or overall mortality rate. Conclusion Pretransplant chronic rhinosinusitis does not contribute to mortality in patients undergoing liver transplantation.
Changes in the Maxillary Sinus Volume and the Surgical Outcome after the Canine Fossa Puncture Approach in Pediatric Patients with an Antrochoanal Polyp: Results of a Minimum 3-Year Follow-Up
Authors: Lee Jae Yong , Baek Byoung Joon , Kim Dong Wook , Byun Jang Yul , Lee Seung Won , Hong Hyun Sook 
Published: February 2010

Background An antrochoanal polyp (ACP) originates from the maxillary antrum and simple excision results in high recurrence rates. Canine fossa puncture (CFP) has been proposed as an alternative method of accessing the entire maxillary antrum. To investigate the long-term effects of the CFP approach on changes in the maxillary sinus volume in pediatric patients with an ACP, we compared the sinus volume on the operated and normal sides, using preoperative computed tomography (CT), and postoperative CT performed at least 3 years after the procedure. The surgical outcomes were also assessed using endoscopic and CT findings. Methods Seven patients met the inclusion criteria and the ACP was removed via the CFP approach. After a mean follow-up period of 43.9 months, we compared the changes in the maxillary sinus volume between the operated and normal sides, using the pre- and postoperative CT data. Results No contractures or decrease in the maxillary sinus volume on the diseased side were observed in any of the patients on postoperative CT, and the average volume of both maxillary sinuses was greater on postoperative CT compared with the preoperative scans. None of the patients showed evidence of recurrence on the endoscopic and CT examinations. Conclusion CFP did not affect the maxillary sinus volume in pediatric patients with an ACP and led to a successful surgical outcome in all of the patients. Based on these results, we recommend CFP as a safe, effective method for the treatment of ACP.
Inferior Turbinate Pedicle Flap for Endoscopic Skull Base Defect Repair
Authors: Harvey Richard J. , Sheahan Patrick O. , Schlosser Rodney J. 
Published: February 2010

Background Endoscopic skull base reconstruction (ESBR) is an important advance in the management of skull base defects. Large dural defects usually require the use of pedicled mucosal flaps for successful repair and prevention of cerebral spinal fluid leak. Planning for pedicled flaps is important because raising the flap is often required before tumor removal or initial surgical access. The potential utility of the inferior turbinate pedicled flap (ITPF) in ESBR is assessed. Methods The ITPF was raised in nine cadaver heads. The most anterior extent reached on the anterior cranial fossa (ACF) and inferior limit on the posterior cranial fossa (PCF) were recorded with image-guided surgery. Measurements were calculated as a percentage of ACF or PCF length from easily reproducible measurements from preoperative radiology. The width was defined as the widest measurement in the distal third. The length-to-height ratio of the skull base was also assessed as a confounding factor. Results Mean length for the ITPF was 54.0 ± 4.9 mm with a width of 22.1 ± 3.7 mm. The mean reach was 112 ± 21% (range, 90–150%) of the PCF. The ACF was less accessible with a mean reach of 67 ± 9.9% (range, 52–84%). The skull base proportions did not have a strong association on utility (p = 0.74 and 0.29). Conclusion ITPF presents one option for ESBR of larger skull base defects. It has several limitations with access to the anterior ACF. The ITPF may be an excellent salvage flap when previous septectomy has been performed or with septal involvement by tumor. Careful preoperative assessment of potential defect can estimate the reach of the ITPF.
Nasal Polyp Cell Populations and Fungal-Specific Peripheral Blood Lymphocyte Proliferation in Allergic Fungal Sinusitis
Authors: Pant Harshita , Beroukas Dimitra , Kette Frank E. , Smith William B. , Wormald Peter J. , Macardle Peter J. 
Published: February 2010

Background Allergic fungal sinusitis (AFS) is considered a different disease from other polypoid chronic rhinosinusitis diseases (CRS) with eosinophilic mucus (EM) termed eosinophilic mucus chronic rhinosinusitis (EMCRS). To substantiate this, studies on cellular responses to fungi and sinus mucosal inflammatory cell populations in AFS and other EMCRS diseases are required. This study was designed to examine polyp inflammatory cell populations and peripheral blood fungal–specific T-cell responses in AFS, other EMCRS subgroups (defined later), and polypoid CRS without EM. Methods A prospective study was performed. Clinical characteristics, including CRS symptoms, sinus computed tomography (CT) scans, allergy status, intraoperative endoscopy, presence of EM, and fungal culture results were used to define patient groups. Polyps and peripheral blood were examined for populations of eosinophils, lymphocytes (CD4+, CD8+ T cells, natural killer cells, and B cells), and neutrophils using immunohistochemistry, cytospin preparations and flow cytometry. Fungal-specific peripheral blood lymphocyte proliferation was examined in AFS patients, other EMCRS patients, CRS patients, and controls. Results There was no significant difference in the percentage of cell populations and fungal-specific lymphocyte proliferation between AFS and other EMCRS diseases. However, AFS and other EMCRS polyps had a higher percentage of eosinophils and CD8+ T cells whereas CRS polyps had higher CD4+ T cells. Fungal-specific lymphocyte proliferation was significantly greater in AFS and other EMCRS patients regardless of fungal allergy, whereas in CRS and controls, higher proliferation was observed in fungal-allergic individuals. Conclusion These findings question the basis for differentiating AFS from other EMCRS diseases based on fungal allergy and fungi in EM. Fungal-specific cellular response was present in AFS and other EMCRS diseases, different from that associated with fungal allergy, suggesting a nonallergic fungal immune response. Increased CD8+ T cells in EMCRS polyps signify a different type of inflammation to CRS that may be driven by CD8+ T cells.
Eosinophil Degranulation Patterns in Nasal Polyposis: An Ultrastructural Study
Authors: Armengot Miguel , Garín Luis , Carda Carmen 
Published: February 2010

Background Eosinophils are possibly the most important inflammatory cells in the pathogenesis of rhinosinusitis with nasal polyposis. Eosinophil degranulation is the mechanism by which these cells exert their inflammatory action. Knowledge of eosinophil state and degranulation mode therefore may help us to better understand this disease. A study is made of eosinophil state and degranulation mode using transmission electron microscopy (TEM), attempting to establish correlations with certain clinical variables considered to be of importance in patients with nasal polyposis. Methods A prospective TEM study was made to examine 582 eosinophils under 5000× magnification, classifying them according to their state and degranulation mode. The cells originated from 36 cases of nasal polyposis and were catalogued according to the clinical–radiological presentation of the disorder, the presence of asthmatic disease, or acetilsalicilic acid (ASA) triad syndrome (nasal polyposis, asthma, and nonsteroidal anti-inflammatory drug intolerance), and the degree of nasal tissue eosinophilia of the case of origin. Results A total of 30.75% of the eosinophils were inactive, 41.75% exhibited piecemeal degranulation (PMD), 27.5% exhibited cytolysis, and 0.34% were in apoptosis. The degranulation mode was significantly correlated to the clinical and histological parameters studied. Thus, cytolysis tended to be less pronounced and PMD greater, in the cells from cases with intense eosinophilia or severe polyposis (high clinical stage and ASA triad). Conclusion Cytolysis and PMD are the principal degranulation modes of eosinophils in nasal polyposis—apoptosis being very infrequent. Nasal polyposis shows a correlation between eosinophil degranulation mode and the clinical and radiological stage and the degree of tissue eosinophilia of the case of origin.
Can Nasal Surgery Improve Obstructive Sleep Apnea: Subjective or Objective?
Authors: Li Hsueh-Yu , Lee Li-Ang , Wang Pa-Chun , Fang Tuan-Jen , Chen Ning-Hung 
Published: February 2010

Background This study assessed changes in sleep-related symptoms and polysomnographic parameters after nasal surgery for nasal obstruction in obstructive sleep apnea (OSA) adults in Taiwan. Methods A total of 66 patients with OSA and chronic nasal obstruction were recruited (surgical, n = 44; control, n = 22). Nasal surgery alone was the treatment in surgical patients. Outcomes were measured in a Snore Outcome Survey (SOS), Epworth Sleepiness Scale (ESS), rhinomanometry, and polysomnographic parameters at baseline and again after 3 months. Results Significantly improved nasal resistance as measured by the SOS and ESS were found only in the surgical group (all, p < 0.001). Both groups revealed insignificant changes in polysomnographic parameters. The patients with lower body weight index, less daytime sleepiness, and lower tongue position had a better success rate than the others (50% versus 3%; p < 0.001). Conclusion Although nasal surgery relieved snoring and daytime sleepiness, it had variable effects on polysomnographic parameters.
Computed Tomography Findings in Sinonasal Wegener's Granulomatosis
Authors: Grindler David , Cannady Steven , Batra Pete S. 
Published: February 2010

Background Wegener's granulomatosis (WG), an autoimmune disease, is intimately associated with the sinonasal tract, with involvement reported in 85% of patients during the course of the disease process. The objective of this study was (1) to describe Lund-Mackay (L-M) scores, (2) to delineate patterns of neo-osteogenesis and bony erosion, and (3) to analyze the impact of surgery on the computed tomography (CT) findings of WG patients. Methods A retrospective review was performed on 74 patients with WG presenting to a tertiary care referral center. CT analysis was performed and graded by two independent reviewers. Results The mean age was 53 years with a male/female ratio of 0.6:1. The average L-M score was 10.0. Neo-osteogenesis was evident in 78% of the patients with overall average neo-osteogenesis score of 4.2 (range, 0–16). Bony erosion was noted on imaging in 62% of patients with overall average score for bony erosion of 2.0 (range, 0–8). Patients having undergone previous sinus surgery compared with no previous surgery had statistically significant elevation of overall L-M, bony erosion, and neo-osteogenesis scores (p = 0.024, 0.0009, and 0.0015, respectively). Conclusion CT imaging in WG patients shows elevated L-M scores and evidence of bony erosion and neo-osteogenesis. Furthermore, surgical manipulation in WG patients is associated with increased bony abnormalities and greater elevations of L-M scores, possibly because of worsening vasculitis and/or inflammation. The presence of concurrent neo-osteogenesis and bony destruction of the paranasal sinuses should raise clinical suspicion of WG in patients presenting with symptoms of chronic rhinosinusitis.
The Effect of Functional Endoscopic Sinus Surgery on Nasal Spray Distribution to the Middle Meatus in Patients with Rhinosinusitis
Authors: Tsikoudas Alexandros , Barnes Martyn L. , White Paul S. 
Published: February 2010

Background Because the principle behind functional endoscopic sinus surgery (FESS) recognizes the middle meatus as essential for the control of the disease, the effect of the operation in the distribution of drugs in the same area should be of similar importance. This study was designed to clarify whether nasal drug delivery is improved in patients after FESS. The study involved a prospective assessment within subject comparison. The subjects were 20 adult (>18 years old) patients on the waiting list for FESS. It was conducted within two teaching hospitals in the East of Scotland. Methods A novel method was used, positioning a neurosurgical patty in the middle meatus and assessing blue dye nasal spray absorption on a 4-point scale. Results A significant improvement was observed in the distribution of the indicator in the middle meatus postoperatively. Seventy percent of the patients showed improvement in the drug distribution after FESS. The median result for absorption score was 2 preoperatively (<50%) and 3 postoperatively (>50%). The difference was statistically significant (p < 0.001). Conclusion The distribution of nasal drugs is improved in the middle meatus after FESS. This can have important clinical applications that can benefit patients in otolaryngology as well as other disciplines.
Diagnosis and Endoscopic Surgery of Chronic Invasive Fungal Rhinosinusitis
Authors: Li Yongqi , Li Yuan , Li Peng , Zhang Gehua 
Published: February 2010

Background Chronic invasive fungal rhinosinusitis (CIFRS) was thought to be a rare fungal disease of the sinus but is becoming increasingly common. Methods for the early diagnosis of CIFRS and treatment efficacy have not been thoroughly explored. This study was designed to summarize the diagnosis and endoscopic surgical treatment of a group of patients with CIFRS. Methods Twenty-eight cases of CIFRS treated by nasal endoscopic sinus surgery between January 2000 and December 2006 were retrospectively analyzed. Results Each case underwent nasal endoscopic debridement surgery; six cases with progressive symptomatology were given systemic broad-spectrum antifungal drugs for at least 12 weeks after the operation. Long-term outcome was positive in most cases. Twenty-three cases were cured while five recurred, of which two recurred within 6 months. Four cases underwent further endoscopic surgery, two were subsequently cured, one died of severe intracranial Mucor infection, and one was lost to follow-up. The overall cure rate was 89.3%. Conclusion Endoscopic surgery is an effective and microinvasive therapy for patients with CIFRS. The procedure includes elimination of the diseased sinus mucosa with or without simultaneous administration of broad-spectrum antifungal medicines. Early diagnosis of CIFRS and surgical nasal sinus debridement can improve prognosis.
The Effect of Adenotonsillectomy on Changes of Position during Sleep in Pediatric Obstructive Sleep Apnea Syndrome
Authors: Choi Ji Ho , Kim Eun Joong , Choi Jun , Kim Tae Hoon , Kwon Soon Young , Lee Sang Hag , Shin Chol , Lee Seung Hoon 
Published: February 2010

Background It is unknown whether adenotonsillectomy influences changes of position during sleep in children with obstructive sleep apnea syndrome (OSAS). The aim of this study was to evaluate the effect of adenotonsillectomy on changes of position during sleep as determined by polysomnography in children with OSAS. Methods Forty-four polysomnograms from 22 children with OSAS were analyzed. We compared the frequency of positional changes during sleep and the distribution of sleep positions before and after adenotonsillectomy. Results Adenotonsillectomy significantly improved all respiratory parameters studied. The arousal index and sleep efficiency were improved among the sleep parameters. There was a significant decrease in the total number of positional changes during sleep ( p < 0.001) and positional change index ( p < 0.001). The proportion of sleep time spent in the supine position was significantly increased (p = 0.001), and the proportions spent in lateral ( p = 0.003) and up (p = 0.018) positions were significantly decreased. Conclusion Significant changes were found in the frequency of positional changes during sleep and the distribution of sleep positions in children with OSAS after adenotonsillectomy.
Technical Feasibility of Transnasal Endoscopic Anterior Ethmoid Artery Ligation: Assessment with Intraoperative Ct Imaging
Authors: Solares C. Arturo , Luong Amber , Batra Pete S. 
Published: February 2010

Background The objective of this study was to evaluate the technical feasibility of endoscopic anterior ethmoid artery (AEA) ligation for acute control of epistaxis. Methods A prospective study was conducted using eight cadaver heads. Pre- and intraoperative CT scans were performed using the xCAT (Xoran Technologies, Inc., Ann Arbor, MI). Skull base anatomy relative to the AEA was reviewed preoperatively. Endoscopic AEA ligation was attempted in all sides with a mesentery. Ligation was not deemed feasible in AEAs without a mesentery. It was attempted on two sides without a mesentery to assess risk of skull base and orbital disruption. Intraoperative CT scans were performed to assess the position of the clips and the integrity of the skull base and lamina papyracea. Results The mean lateral lamella height was 4.75 and 4.83 mm on the right and left, respectively. Of the 16 arteries, 6 (37.5%) of the AEAs were within a bony mesentery. No AEA canals were dehiscent. Four of the six AEAs (66%) within a mesentery were successfully clipped and two (33%) were partially clipped by endoscopic evaluation. Both arteries without mesentery where clipping was attempted were partially clipped by endoscopic examination. Review of intraoperative CT scans showed that the AEA with a mesentery was clipped successfully on three sides, partially on one side, and unsuccessfully on two sides. AEA clipping was unsuccessful on both sides without a mesentery. One AEA without a mesentery showed skull base disruption after ligation by endoscopy and CT. None of the specimens showed orbital injury. Conclusion Intraoperative CT scanning revealed that AEA ligation was less successful than was apparent endoscopically. Effective AEA clipping was performed in 50% of cases with a mesentery. Endoscopic clipping was not technically feasible in cases with AEA without a mesentery. Overall, AEA clipping was only technically feasible in 3 of 16 sides (18.8%).
Loratadine and Montelukast Administered in Combination Produce Decongestion in an Experimental Feline Model of Nasal Congestion
Authors: McLeod Robbie L. , Mingo Garfield G. , Xu Xiaoying , Palamanda Jairam , Hunter John C. , Jia Yanlin 
Published: February 2010

Background Histamine and leukotrienes act to exert numerous local and systemic effects that contribute to the pathophysiology of allergic rhinitis. The aim of these experiments was to evaluate the nasal decongestant effects of loratadine and montelukast alone and in combination in a feline model of nasal congestion. We also studied the decongestant actions of the alpha-agonist adrenergic agonist D-pseudoephedrine with and without desloratadine. Methods Acoustic rhinometry was used to determine nasal cavity dimensions after intranasal compound 48/80. Cats were given D-pseudoephedrine (0.3 mg/kg) alone or in combination with desloratadine (5 mg/kg) 1 hour before nasal provocation with compound 48/80 (1%, 75 microliters) to either the left or right nasal passageway. Using a similar design, the nasal decongestant effects of montelukast (1 mg/kg) and loratadine (10 mg/kg) were studied alone and in combination. Results The addition of desloratadine to D-pseudoephedrine did not improve decongestant efficacy compared with each drug given individually. In contrast, when montelukast (1 mg/kg) was given in combination with loratadine (10 mg/kg), the decongestant activity was greater than when these drugs were administered separately. Sixty minutes after compound 48/80 provocation the nasal cavity volume ratio (volume ratio of the compound 48/80 treated/untreated nasal passageway) for the control, montelukast alone, loratadine alone, and the montelukast plus loratadine–treated groups were 0.20 ± 0.03, 0.24 ± 0.01, 0.28 ± 0.03, and 0.50 ± 0.03. Conclusion Concomitant montelukast plus loratadine produces a greater degree of nasal decongestion compared with montelukast or loratadine alone in an experimental model of nasal congestion.
Impaired Mucosal Healing and Infection Associated with Staphylococcus Aureus After Endoscopic Sinus Surgery
Authors: Jervis-Bardy Joshua , Foreman Andrew , Field John , Wormald Peter John 
Published: February 2010

Background Differentiating normal nasal discharge and postoperative crust from infection after endoscopic sinus surgery (ESS) can be difficult. We investigated whether bacteria cultured at operation was predictive for postoperative mucosal infection—defined as frank pus, thick mucus, and/or abnormal crusting seen on endoscopic examination associated with positive microbiology. Methods The records of 48 patients with chronic rhinosinusitis (CRS) with infection at the time of ESS were retrospectively reviewed. Results of intraoperative cultures were compared with those taken at the time of postoperative mucosal infection. Results Fourteen of 16 patients (87.5%) with intraoperative infection with Staphylococcus aureus progressed to postoperative mucosal infection with S. aureus, whereas patients who cultured “other” bacteria intraoperatively progressed to postoperative mucosal infection in 6/19 cases (31.6%), with S. aureus cultured in only 3/19 cases (15.8%; p = 0.0001). Conclusion S. aureus infection at ESS predicts for abnormal, S. aureus–associated mucosal healing and infection post-ESS. Although a prospective trial is warranted, these findings suggest a future role for aggressive anti–S. aureus therapy peri- and/or postoperatively in patients who culture positive for this organism to improve postsurgical outcomes.