ABSTRACT
Background: Chronic invasive Aspergillus sinusitis is an uncommon fungal infection that usually occurs in immunocompromized patients and rarely in healthy immunocompetent individuals. Chronic invasive Aspergillus sinusitis affecting the maxillary sinus may cause tremendous effects as maxillary bone destruction, displacement of teeth, bronchopulmonary infection and orbital involvement that may lead to proptosis and decreased vision. The maxillary sinus infection may result from direct inhalation of spores and not as a secondary infection from the oral cavity, endodontic treatment, or oro-antral fistulae. Case Summary: A 30 years old male patient presented to clinic complaning of right sided facial swelling and nasal obstruction. Clinical examination, Ortho-Pantomogram (OPG) and Cone Beam Computerized Tomography (CBCT) revealed a right maxillary sinus mass; laboratory investigations exclude presence of any systemic disease. Antrostomy of the lateral sinus wall (Caldwell-Luc surgery) was performed under local anesthesia to remove the sinus lining and mass. The mass was sent for histopathological investigation. The defect of bone was covered with the integrum periostium (the mucosal flap) without any bone graft or meshes. No antifungal drugs were prescribed. Post operative OPG and CBCT revealed complete removal of the lesion and clearance of the right side nasal air way. The histopathological examination found that the aspergillus Hyphae, fruits bodies and spores are present which confirmed the diagnosis. One year follow-up revealed that there is no recurrent infection; the drifted teeth realigned again and the maxillary sinus returns to its normal size. Conclusion: Early diagnosis and therapeutic intervention is the key to successful treatment of chronic invasive aspergillosis of the maxillary sinus. Surgical debridement can be done under local anesthesia without antifungal drug prescription and good prognosis was achieved.
ABSTRACT
Introduction: Ischemia and reperfusion [I/R] injury is a common complex inflammatory phenomenon encountered in medical practices. The initial site of abnormality in ischemia has recently emphasized on the cellular mitochondria. The damage is dramatically magnified by large number of events, such as oxygen free radical formation, release of iron storage, damage of the microvasculature of [I/R] organs, inflammatory cytokines, complement activation and neutrophil infiltration of the site of injury
Aim of the Work: To determine which is more injurious to liver tissue, ischemia or reperfusion? and to investigate the protective effect of ascorbic acid, DDB* and Silymarin preconditioning on [l/R] injury in a rat model
Materials and Methods: eighty rats were exposed to different periods of [l/R] injury with total time of 60 minutes, They were divided equally into 4 groups. One of them was used as a control group while the others were exposed to 10; 20 and 30 minutes ischemia respectively. Each group was subdivided into 4 subgroups which were preconditioned with either no medication, Ascorbic acid, DDB or Silymarin respectively. Blood samples were taken twice, after the periods of ischemia and reperfusion where serum levels of malondialdehyde [MDA], ALT, AST and LDH were determined. Liver biopsy also, was taken twice, after ischemia and after reperfusion, for histopathological study
Results: The pathological results showed that [I/R] injury was time related. In short periods of ischemia [10 min and 20 min] the pathological changes improved during the reperfusion periods while in longer duration of ischemia [30 min] the pathological changes were irreversible and even worsen during the reperfusion period. Preconditioning with Ascorbic acid, DDB and Silymarin minimize the pathological changes in all periods of ischemia when compared with the corresponding non-treated groups. The best results were detected with Ascorbic acid subgroup then DDB. The laboratory results showed that serum levels of MDA. ALT, AST and LDH were greater in the post reperfusion samples than that of the post-ischemic samples and were time-related. Preconditioning decreased the serum levels of MDA, ALT. AST and LDH in all groups after exposure to [I/R] as compared with non-treated group, but not to the significant level. The best results were detected with Ascorbic acid subgroup then DDB
Conclusion: The reperfusion plays the main rule in hepatic [I/R] injury. Preconditioning with Ascorbic acid, DDB or Silymarin attenuated the hepatic [I/H] injury. However, Ascorbic acid showed the best results, then DDB while Silymarin was the last. *DDB. Chinese herbal therapy used as a hepato-protective