Embedded Files
carboxymethylcellulose has been shown to reduce the incidence of post-operative adhesions [62, 63]. Atraumatic endoscopy and instrumentation techniques minimise the incidence of adhesions. Technology The use of high-quality operating equipment assists the sinus surgeon with visualisation and instrumentation during FESS [64]. The ever-increasing variety of two- and three-dimensional endoscopes, microdebriders and drills allow the surgeon to find the instrument he or she is most comfortable with. Image-guided navigation systems are useful adjuncts in revision FESS cases, where normal anatomical landmarks may be distorted or previously resected. The American Association of Otolaryngology–Head and Neck Surgery advocates the use of navigation systems for advanced FESS, revision cases and tumour resection [65]. A large meta-analysis has shown reduction in overall and major complication rates with the use of image-guided navigation during FESS [66].Conclusion A majority of patients undergoing FESS have a positive outcome from a single operation, with no morbidity or recurrence. The FESS surgeon must be competent in recognising and dealing with potential complications, as well as approaching complex revision cases. Article PubMed Google Scholar •• Hopkins C, Rimmer J, Lund VJ. Does time to endoscopic sinus surgery impact outcomes in chronic rhinosinusitis? Prospective findings from the National Comparative Audit of Surgery for Nasal Polyposis and Chronic Rhinosinusitis. Rhinology. 2015;53:10–7. This study shows that patients with asthma are more likely to experience a delay in surgical intervention compared with other patients. This study also shows that delayed surgical intervention leads to reduced improvement in symptoms Article CAS PubMedAspergillus,More, much needed, rapid methods that do not require invasive procedures, such as serology-based point-of-care, or metabolomics-based breath tests, are being developed and hopefully will be evaluated in the near future. Author Contributions: Conceptualization, A.S.; methodology, A.S., I.P., M.D.-A., formal analysis, A.S., I.P.,Chakrabarti, A. Global EpiIntroduction: Rhinocerebral mycosis is a rapidly progressive fatal opportunistic infection, predominantly affecting people in an immunocompromised state. Aggressive surgical therapy, with repeated debridement in combination with intravenous amphotericin B can lead to a high rate of cure. Aim: To determine the predictors of mortality in rhinocerebral mycosis. Materials and Methods: The demographic data, clinical features, radiological (MRI/CT) findings, treatment details of patients with a diagnosis of rhinocerebral mycosis confirmed on histopathology were analyzed retrospectively. The outcome was assessed as alive and dead. Univariate analysis with odds ratio (OR) was employed in data analysis. Chi-square test was used for P value. Results: There were 38 patients. The age range was 7-82 (mean 48.68) years; 30 (79%) were males. Craniofacial pain was the most common initial presenting symptom, noted in 29 (76.3%). Rhino-orbital involvement was noted in 24 (63.2%) and 12 (31.6%) had associated focal neurological deficits. Immunocompromised state was noted in 24 (63.2%). Eighteen (47.4%) patients died. The predictors for mortality: odds ratio (95% CI) were 2.45 (1.01-3.89) for elderly age, 5.67 (4.13-7.21) for intracranial extension, 2.6 (1.26-3.94) for immunocompromised state, 2.62 (1.25-3.99) for infection with zygomycosis and 2.33 (1.01-3.65) for anemia. Conclusion: Rhinocerebral mycosis is associated with high mortality in spite of aggressive therapy. Intracranial extension with focal neurological deficits is a major predictor of mortality in rhinocerebral mycosis. Paltauf [1] first identified rhinocerebral mycosis in 1885. He described a case of rhinocerebral mucormycosis . Aspergillosis and zygomycosis are the commonest causes of central nervous system (CNS) mycosis. Cryptococcus, Candida, coccidioides, histoplasma and cladosporium are the other fungi causing CNS mycoses. Aspergillosis is caused by Aspergillus fumigatus in the majority of cases, but A. flavus, A. glaucus and A. niger are not rare. Zygomycosis includes the fungi of family Mucoraceae . It includes Mucor, Rhizopus, Rhizomucor and Absidia . [2]In rhinocerebral mycosis the disease originates in the nasal/sinus mucosae, after inhalation of fungal spores and takes a rapidly progressive course by extending to neighboring tissues including the orbit and central nervous system. [3] The initial clinical findings in orbital involvement are most commonly headache, lethargy and facial pain. These may be rapidly followed by restriction of ocular movements,
Report abuse