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TREATMENT OF ACUTE MAXILLARY SINUSITIS .4. AMPICILLIN, CEPHRADINE AND ERYTHROMYCINESTOLATE WITH AND WITHOUT IRRIGATION

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ACTA OTO-LARYNGOLOGICA 1975年第5-6期79卷 466-472页

作者： AXELSSON, A GREBELIUS, N JENSEN, C MELIN, O SINGER, F LUNDBY MED CTR DEPT OTOLARYNGOLGOTHENBURGSWEDEN LUNDBY MED CTR DEPT RADIOLGOTHENBURGSWEDEN

Six groups, eack cnta/ning 50 patients with acute maxillary sinusitis, were treated with ampicillin plus nasal decongestant, ampicillin plus irrigation, cephradine plus nasal decongestant, cephradine plus irrigation, erythromycinestolate plus nasal decongestant, erythromycinestolate plus irrigation. The diagnosis was radiologically established and the healing likewise radio-logically assessed on the fifth, tenth and fifteenth day. Treatment was given for 10 days. All groups demonstrated a similar radiological healing except cephradine plus nasal decongestant which was inferior to the others. Contrarily, side effects were least frequent in the cephradine groups and most frequent in patients cured with ampicillin. The difficulty in choosing the best treatment is discussed in relation to such factors as therapeutic results, side effects, long-term consequences of antibiotic treatment, establishment of any bacterial etiology and penetration characteristics of antibiotics into the diseased *** Gruppen bestehend aus je 50 Patienten mit akuter Maxillarsinusitis wurden mit Ampicillin und Nasen-tropfen, Ampicillin und Kieferhöhlenpunktion, Cepha-drine und Nasentropfen, Cephadrine und Kieferhöhlenpunktion, Erythromycinestolate und Nasentropfen sowie mit Erythromycinestolate und Kieferhohlenpunktion be-handelt. Die Diagnose wurde radiologisch verifiziert, und die Heilung wurde ebenfalls radiologisch kontrolliert, und zwar am fünften, zehnten und fiinfzehnten Tag. Die Behandlung erstreckte sich über zehn *** Gruppen zeigten radiologisch einen ähnlichen Heilungsverlauf mit Ausnahme der Gruppe, die mit Cephadrine und Nasentropfen behandelt wurde. Diese zeigte weniger gute Resultate. Dagegen waren Nebener-scheinungen bei Behandlung mit Cephadrine seltener und bei der Ampicillinbehandlung häufiger. Die Schwierig-keiten, die beste Behandlung zu finden, werden diskutiert, und zwar in bezug auf Faktoren wie Behandlungsresultat, Nebenerscheinungen, Spätkons

关键词：急性病氨苄西林/治疗应用头孢菌素类/治疗应用头孢拉定/治疗应用红霉素/类似物和衍生物无味红霉素/治疗应用上颌窦鼻窦炎/药物疗法灌洗疗法时间因素女(雌)性人类男(雄)性

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PENETRATION OF AZIDOCILLIN INTO SECRETION AND TISSUES IN CHRONIC MAXILLARY SINUSITIS AND TONSILLITIS

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ACTA OTO-LARYNGOLOGICA 1975年第5-6期79卷 460-465页

作者： JOKINEN, K RAUNIO, V UNIV OULU DEPT OTOLARYNGOLSF-90100 OULUFINLAND UNIV OULU DEPT MICROBIOLOULUFINLAND

The penetration of azidocillin into the sinus mucosa and secretion as well as into tonsils and adenoids was studied. Altogether 73 patients were included and they were arranged in four groups according to age, diagnosis and drug dose. The average azidocillin concentration was satisfactory and predictable in all tissues and well over the MIC for most upper respiratory tract pathogens studied. In the maxillary antrum secretion the values were much lower and in many cases under the MIC for hemophilus. This is thought to depend upon the drug's being bound to proteins in the secretions. The clinical results were good in all cases and the contribution of the surgical operation, particularly in providing drainage for the secretion, is obvious.

关键词：增殖腺/代谢慢性病上颌窦/代谢鼻黏膜/代谢腭扁桃体/代谢青霉素G/类似物和衍生物青霉素G/血液青霉素G/代谢青霉素G/治疗应用青霉素类/治疗应用鼻窦炎/血液鼻窦炎/药物疗法鼻窦炎/代谢扁桃体炎/血液扁桃体炎/药物疗法扁桃体炎/代谢青少年成年人老年人儿童儿童学龄前人类中年人

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Ophthalmic manifestations of allergic fungal sinusitis

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AMERICAN JOURNAL OF OPHTHALMOLOGY 1999年第2期127卷 189-195页

作者： Carter, KD Graham, SM Carpenter, KM Univ Iowa Coll Med Dept Ophthalmol & Visual Sci Oculoplast Orbit & Oncol Serv Iowa City IA 52242 USA Univ Iowa Coll Med Dept Otolaryngol Head & Neck Surg Div Head & Neck Surg Iowa City IA 52242 USA Univ Iowa Hosp & Clin Iowa City IA 52242 USA Duluth Clin Otolaryngol Sect Duluth MN USA

PURPOSE: To highlight allergic fungal sinusitis as a cause of ophthalmic and sinus problems by identifying the profile of the patient with allergic fungal sinusitis and presenting a successful treatment approach. METHODS: Six consecutive cases of patients with ophthalmic manifestations of allergic fungal sinusitis were reviewed. Ophthalmic findings, sinus involvement, mycology, immune response, imaging studies, and treatment were examined, The characteristics of this patient group with ophthalmic manifestations of allergic fungal sinusitis were compared with those of the general group of patients with allergic fungal sinusitis. RESULTS: All six patients had proptosis, One had symptomatic diplopia and one had visual loss. Imaging studies, fungal characterization, and immune profiles were similar to the reported allergic fungal sinusitis population, After treatment there was no recurrence of ophthalmic or sinus symptoms at a mean follow up of 34 months (range, 8 to 48 months). There were no complications of treatment. CONCLUSIONS: Initial diagnosis of allergic fungal sinusitis requires suspicion on the part of the ophthalmologist, Proptosis is the most common ophthalmic sign. Differentiation from invasive forms of fungal sinus dis ease is crucial, because systemic antifungal medication and extensive surgical tissue debridement are not required in allergic fungal sinusitis. Treatment consists of extirpation of the allergic mucin and fungus, sinus aeration, and systemic and topical corticosteroids. (Am J Ophthalmol 1999;127:189-195. (C) 1999 by Elsevier Science Inc. All rights reserved,)

关键词：抗生素类抗真菌/治疗应用药物疗法联合突眼/药物疗法突眼/微生物学突眼/放射摄影术眼感染真菌性/药物疗法眼感染真菌性/病因学眼感染真菌性/放射摄影术真菌/分离和提纯糖皮质激素类/治疗应用超敏反应速发型/诊断超敏反应速发型/药物疗法超敏反应速发型/微生物学免疫球蛋白E/分析灌洗真菌病/药物疗法真菌病/微生物学真菌病/放射摄影术鼻窦/微生物学鼻窦/放射摄影术鼻窦炎/药物疗法鼻窦炎/微生物学鼻窦炎/放射摄影术体层摄影术 X线计算机青少年成年人老年人女(雌)性人类男(雄)性

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Interleukin-1β, interleukin-5, interleukin-6, interleukin-8, and tumor necrosis factor-α in chronic sinusitis:: Response to systemic corticosteroids

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AMERICAN JOURNAL OF RHINOLOGY 2000年第6期14卷 367-373页

作者： Lennard, CM Mann, EA Sun, LL Chang, AS Bolger, WE Walter Reed Army Med Ctr Div Otolaryngol Washington DC 20307 USA

Recently the role of various cytokines in the pathogenesis of chronic rhinosinusitis has come under investigation. Various studies have reported increased levels of interleukin-3, interleukin-4, interleukin-5, interleukin-13, and granulocyte macrophage-colony stimulating factor in the sinonasal mucosa of patients with chronic rhinosinusitis. The present study investigated the levels of pro-inflammatory cytokines, including interleukin-1 beta (IL-1 beta), interleukin-5 (IL-5), interleukin-6 (IL-6), interleukin-8 (IL-8), and turner necrosis factor-alpha (TNF-alpha), in the sinonasal mucosa of patients with chronic rhinosinusitis, and evaluated the response of these cytokines to oral corticosteroids. Chronic rhinosinusitis subjects (n = 15) and control subjects (n = 9) underwent ent nasal endoscopy and biopsy of the sinonasal mucosa. Chronic rhinosinusitis subjects were subsequently tr treated with a 10-day tapering dose of prednisone followed by a second sinonasal endoscopic exam and biopsy. Mucosal biopsy specimens were immunostained for IL-I beta, IL-5, IL-6, IL-8, and TNF-a. In chronic rhinosinusitis subjects, mucosal levels of IL-1 beta IL,-6 IL-8, and TNF-alpha were significantly elevated when compared with control subjects, and levels of IL-5 demonstrated a strong trend toward elevation. In posttreatment chronic rhinosinusitis subjects, levels of IL-6 were significantly decreased when compared with pretreatment levels, and TNF-alpha levels demonstrated a significant trend coward reduction. These findings support the hypothesis that the inflammatory response in chronic rhinosinusitis is associated with elevated levels of pro-inflammatory cytokines, and suggest that oral corticosteroids may evert a benefic beneficial effect by significantly reducing the levels of IL-6 and TNF-alpha.

关键词：投药口服消炎药/投药和剂量消炎药/治疗应用慢性病细胞因子类/生理学内窥镜检查免疫组织化学白细胞介素1/生理学白细胞介素5/生理学白细胞介素8/生理学鼻息肉/药物疗法泼尼松/投药和剂量泼尼松/治疗应用鼻炎/药物疗法鼻炎/病理学鼻炎/病理生理学鼻窦炎/药物疗法鼻窦炎/病理学鼻窦炎/病理生理学肿瘤坏死因子α/生理学成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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A retrospective analysis of treatment outcomes and time to relapse after intensive medical treatment for chronic sinusitis

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AMERICAN JOURNAL OF RHINOLOGY 2002年第6期16卷 303-312页

作者： Subramanian, HN Schechtman, KB Hamilos, DL Washington Univ Sch Med Div Allergy & Immunol St Louis MO 63110 USA Washington Univ Sch Med Div Biostat St Louis MO 63110 USA

Background: Despite the high prevalence of chronic sinusitis, there are few published studies assessing its response to medical treatment. We analyzed, retrospectively, 40 patients seen in our center who were treated for chronic sinusitis with a protocol of intensive medical therapy. Both symptomatic and radiographic improvements were assessed as well as factors associated with early relapse. Methods: Intensive medical treatment consisted of 1 month of antibiotics, a short course of oral steroids, and adjunctive therapy (e.g., nasal irrigations plus intranasal steroids). After intensive medical therapy, adjunctive medical therapy was continued. A sinus computed tomography was performed at baseline and 6-8 weeks later and scored for extent of disease. Pre- and posttreatment symptom scores also were assessed. Time to relapse was defined as the time interval after antibiotic treatment at which a recurrence of symptoms necessitated reinstitution of antibiotics and/or oral steroids. Results: Thirty-six of the 40 patients improved either symptomatically, radiographically, or both following the medical regimen. Twenty-six patients had sustained symptomatic benefit beyond 8 weeks after initial treatment. A statistically significant correlation was found between the change in pre- to posttreatment symptom scores and computed tomography scores. Using a log-rank test to compare rates of sinusitis relapse, nasal polyposis and a history of sinus surgery were significantly associated with earlier relapse (p = 0.006 and 0.018, respectively). In contrast, atopy, asthma, and persistent obstruction of the ostiomeatal unit were not associated with early relapse. Conclusion: Intensive medical treatment resulted in symptomatic and radiographic improvement in chronic sinusitis, and the majority of patients remained free of a relapse for >8 weeks. A history of nasal polyposis or previous sinus surgery was associated with earlier relapse of sinusitis symptoms. In contrast, the presence of

关键词：投药鼻内抗菌药/治疗应用消炎药/治疗应用慢性病计算机制图药物疗法联合泼尼松/治疗应用比例危险度模型复发/预防和控制回顾性研究鼻窦炎/药物疗法鼻窦炎/放射摄影术氯化钠/治疗应用治疗结果青少年成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Yamik sinus catheter in the topical treatment of patients with acute rhinosinusitis after previous sinus surgery

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AMERICAN JOURNAL OF RHINOLOGY 2002年第6期16卷 297-302页

作者： Gosepath, J Ecke, U Kozlov, VS Mann, WJ Yaroslavl Reg Hosp Dept Otolaryngol Head & Neck Surg Yaroslavl Russia

Background: The Yamik sinus catheter was designed as a new device for the topical treatment of rhinosinusitis. It creates intermittent positive and negative intranasal pressure after sealing the ipsilateral nostril and choana with two inflatable cuffs. Affecting the nasal cavity and all paranasal sinuses of one side at a time, it is used to evacuate mucous and secretions as well as and to introduce antiseptic, antibacterial, or antifungal solutions. Methods: This study was designed to evaluate the effectiveness of the Yamik catheter in cases of acute purulent rhinosinusitis in patients who previously underwent endonasal sinus surgery for chronic rhinosinusitis. Twenty patients were treated at repeated visits to the outpatient clinic of our institution. At each visit, their clinical symptoms as well as findings on anterior rhinoscopy, nasal endoscopy, and A-mode ultrasound were evaluated. Results: Acute disease resolved completely within 10 days of treatment in 17 of the 20 patients. Two patients discontinued treatment after repeated visits, showing only mild improvement. One patient felt uncomfortable during the application of the Yamik catheter and did not continue after the initial treatment. Conclusion: Our results suggest that the Yamik catheter may be a helpful device in the topical treatment of acute rhinosinusitis and it appears possibly helpful in patients who suffer from episodes of acute purulent infection after previous sinus surgery.

关键词：投药鼻内抗感染药局部/投药和剂量导管插入术/仪器和设备设备设计随访研究聚维酮碘/投药和剂量回顾性研究鼻炎/药物疗法鼻炎/外科学鼻窦炎/药物疗法鼻窦炎/外科学成年人女(雌)性人类男(雄)性中年人

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Endoscopic sinus surgery in previously irradiated patients

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AMERICAN JOURNAL OF OTOLARYNGOLOGY 2001年第2期22卷 100-106页

作者： Civantos, FJ Yoskovitch, A Casiano, RR Univ Miami Sch Med Dept Otolaryngol Sylvester Comprehens Canc Ctr Miami FL 33136 USA

Purpose: Our purpose was to evaluate the safety and efficacy of endoscopic sinus surgery in irradiated patients with absolute indications for sinus surgery. Patients and Methods: During 5 years at a tertiary referral center, more than 200 patients received irradiation to a field that included the paranasal sinuses. Complaints related to the sinuses are common in such patients and often include crusting and increased mucus drainage. Six patients presented with significant sinus infections in the absence of tumor recurrence and failed medical management. Additional problems included epiphora and nasal obstruction caused by cicatricial choanal stricture. Surgical interventions included ethmoidectomy, multiple osteotomies, debridement of scarred or devitalized tissue, and dacryocystorhinostomy. Outcome measures included intraoperative findings and complications, length of hospital stays, endoscopic assessments of the healing over 6 months postoperatively, and improvement or persistence of symptoms over 2 to 3 years of follow-up. Results: Surgery can be technically difficult because of derangements of normal anatomy and dehiscence of important structures. Although bleeding problems, prolonged admission, and delayed healing were noted in certain cases, they did not result in long-term morbidity. Conclusions: Endoscopic sinus surgery has become an invaluable tool in the treatment of refractory sinusitis. Our literature review has revealed no information, however, regarding endoscopic sinus surgery in previously irradiated patients. Theoretically, such patients are at risk for healing problems and anatomic derangements, which could lead to complications. There is, nevertheless, a theoretical benefit to avoiding external approaches in patients who might heal poorly.

关键词：抗菌药/治疗应用内窥镜检查耳鼻咽喉肿瘤/病理学耳鼻咽喉肿瘤/放射疗法耳鼻咽喉肿瘤/外科学鼻窦/病理学鼻窦/辐射效应鼻窦/外科学鼻窦炎/药物疗法鼻窦炎/病理学鼻窦炎/外科学治疗结果青少年成年人女(雌)性人类男(雄)性中年人

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The economic burden and symptom manifestations of chronic rhinosinusitis

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AMERICAN JOURNAL OF RHINOLOGY 2003年第1期17卷 27-32页

作者： Bhattacharyya, N Harvard Univ Sch Med Brigham & Womens Hosp Dept Otol & LaryngolDiv Otolaryngol Boston MA 02115 USA

Background: The aim of this study was to delineate patient symptoms and economic burdens of chronic rhinosinusitis (CRS). Methods: Adult patients with CRS were assessed prospectively with a survey instrument. Symptom scores for major and minor symptoms of CRS, medication use, physician visits for CRS, and work days missed were determined. Cost analyses were conducted. Results: Three hundred twenty-two patients were studied prospectively (mean age, 42.3 years). Nasal obstruction and facial congestion were the most common and severe major symptoms, and headache and fatigue were the most common and severe minor symptoms. Patients received an average of 2.7 antibiotic courses and used nasal steroids and prescription antihistamines 18.3 and 16.3 weeks, respectively, in a 12-month period. Mean medical resource costs were $921 per patient-year. CRS caused an average of 4.8 days of missed work per 12-month period. The overall yearly economic cost of CRS was $1539 per patient. Conclusion: Nasal and facial symptoms prevail over systemic and oropharyngeal symptoms in CRS. Significant medical resource expenditures and global economic costs accompany CRS.

关键词：抗菌药/经济学抗菌药/治疗应用波士顿/流行病学慢性病成本及成本分析组胺H1拮抗剂/经济学组胺H1拮抗剂/治疗应用处方药物/经济学患病率前瞻性研究生活质量问卷调查鼻炎/药物疗法鼻炎/经济学疾病严重程度指数鼻窦炎/药物疗法鼻窦炎/经济学统计数据甾类/经济学甾类/治疗应用青少年成年人老年人人类中年人

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Allergic fungal sinusitis-induced visual loss

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AMERICAN JOURNAL OF RHINOLOGY 1999年第3期13卷 191-195页

作者： Marple, BF Gibbs, SR Newcomer, MT Mabry, RL Univ Texas SW Med Ctr Dept Otolaryngol Dallas TX 75235 USA

In this report we review 56 adult and 26 pediatric patients who presented to our practice with pathologically confirmed allergic fungal sinusitis from 1989 to 1997. Of this group, three patients presented with visual ... 详细信息

关键词：消炎药/治疗应用真菌病/并发症真菌病/药物疗法真菌病/外科学泼尼松/治疗应用回顾性研究鼻窦炎/并发症鼻窦炎/药物疗法鼻窦炎/外科学视觉障碍/病因学青少年成年人老年人儿童女(雌)性人类男(雄)性中年人

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Bacteriologic findings from the nose, ethmoid, and bloodstream during endoscopic surgery for chronic rhinosinusitis: Implications for antibiotic therapy

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AMERICAN JOURNAL OF RHINOLOGY 1999年第2期13卷 91-96页

作者： Rontal, M Bernstein, JM Rontal, E Anon, J William Beaumont Hosp Royal Oak MI 48072 USA

This study addresses the bacterial flora of chronic rhinosinusitis at the time of endoscopic sinus surgery. We risen the consensus definition of chronic rhinosinusitis as the presence of paranasal sinus inflammation present Sor greater than IZ weeks. In our patient study group, all cases of chronic rhinosinusitis had failed to respond to antibiotic therapy and had not been treated previously with surgery. By microscopic examination, chronic inflammatory changes were confirmed ill the resected sinus lining of all study patients. Intraoperative cultures,were obtained from the nasal vestibule, the middle meatus,, ethmoid lining, and peripheral blood during mid after the endoscopic procedure. We found approximately 30% of the patients with sterile sinuses, 50% with coagulase-negative staphylococci, and the remainder with a mixed group of "nonpathogenic" organisms. Anaerobes were conspicuously rare. The blood cultures were positive in 7% of cases and were consistent with ail organism of the operative site. This is the first time bacteremia. has been reported in association with endoscopic skills surgery. The results suggest that chronic rhinosinusitis is not a bacterial disease, but rather the result. of chronic inflammation produced bg a previous acute inflammation. The incidence of positive blood cultures,,while relatively lon and cleared quickly, should alert the physician for the possible need for prophylactic antibiotics in patients with car diac, prosthetic, or systemic conditions that could lead to metastatic infection.

关键词：抗生素预防菌血症/并发症菌血症/诊断菌血症/预防和控制细菌需氧/分离和提纯细菌厌氧/分离和提纯慢性病集落计数微生物抗药性微生物内窥镜检查筛窦/微生物学监测手术中鼻/微生物学手术后并发症/微生物学手术后并发症/预防和控制鼻炎/药物疗法鼻炎/微生物学鼻炎/外科学鼻窦炎/药物疗法鼻窦炎/微生物学鼻窦炎/外科学女(雌)性人类男(雄)性

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