Fungal rhinosinusitis of the immunocompetent host: correlation study between computed tomography scan, mycological and histopathology

Background: Fungal rhinosinusitis is a characteristic disease that requires a great deal of interest. Knowing the fungal flora, its prevalence and symptomatic presentation in patients with chronic fungal rhinosinusitis will allow a better understanding of this disease, correct diagnosis, and treatment and developing its prognosis. Clinical presentation can provide to the subcategories of fungal rhinosinusitis however, histopathological and microbiological examinations provide accurate diagnosis and classification

Patients and Methods: This study was conducted on fifty patients of chronic fungal rhinosinusitis who had been referred to otorhinolaryngology surgeon for endoscopic sinus surgery in the last 2 years in Dr. Soliman Fakeeh Hospitals in Jeddah, Kingdom of Saudi Arabia, We selected some immunocompetent chronic rhinosinusitis patients with signs and symptoms of inflammation of nasal and paranasal sinuses. These patients had positive computed tomography and /or histopathological examinations. We evaluated clinical history, otolaryngologic examination with nasal endoscopy, computed tomography scan, mycological and bacterial cultures and histopathological examinations

Results: Fungal rhinosinusitis was the cause of chronic rhinosinusitis in 16.2% of patients with chronic rhinosinusitis submitted to paranasal sinuses endoscopic surgery. Fungal cultures were positive in 60% of specimens with predominance of 63.3% Aspergillus fumigatus, 20% Aspergillus flavus, 3.33% Aspergillus niger and 13.33% Candida albicans. While 40% of patients with rhinosinusitis showed no fungal growth. Bacteriological cultures indicated there is an association of bacterial infection in 16 patients out of 50 as; Staphylococcus aureus [43.75%], Staphylococcus haemolyticus [25%], Pseudomonas aeruginosa [18.75%] and klebsiella pneumonia [12.5%]. In 28% specimens there was no bacterial growth, and in 40% specimens the bacterial examination were not performed. Mixed bacterial and fungal infections were found in 30% as the following: Staphylococcus aureus and Aspergillus fumigatus, Staphylococcus aureus and Aspergillus flavis, Pseudomonas aeruginosa and Aspergillus fumigatus, Klebsiella pneumoniae and Candida albicans, and Staphylococcus haemolyticus and Candida albicans in 33.33%, 22.22%, 22.22%, 11.22% and 11.22% respectively. According to the histopathological findings the detected types were fungal rhinosinusitis, allergic rhinosinusitis, non specific inflammation and mixed reaction in 54%, 22%, 6%, and 18% respectively. All patients presented some type of findings in paranasal sinuses by computed tomography [CT] scan were classified as 60% allergic fungal sinusitis, 34% chronic invasive fungal sinusitis, 4% fungal ball and 2% acute invasive fungal sinusitis. As regards correlation of histopathology, CT and fungal cultures results of the studied 50 patients and according to CT classification of fungal sinusitis, positive histopathological findings were found in 53.33% of cases that were classified as allergic fungal sinusitis, while positive fungal culture were seen in 40%. In chronic invasive fungal sinusitis, histopathological findings were positive in all cases [100%] while positive fungal cultures were seen in 88.23%. In acute invasive fungal sinusitis and fungal ball CT classification, both histopathology and fungal cultures were positive in all cases [100%]

Aim of work: The aim of this study is to analyze and compare the results of clinical endoscopic findings, radiological, mycological, and histological criteria for optimizing the diagnosis of true fungal sinusitis

Conclusion: Early and specific diagnosis of fungal rhinosinusitis is necessary. The traditional methods used in routine practice for the diagnosis of fungal rhinosinusitis may be insensitive and nonspecific. Moreover, the allergic fungal rhinosinusitis represents an immunologic rather than infectious disease. The optimal duration of treatment and the role of patient preferences in clinical decision making also needed to be addressed. The maximum diagnosis will be available by combining traditional culture, histopathology and radiology. In this circumstance, molecular techniques are perhaps best placed to enable rapid and accurate identification

Laparoscopic adjustable gastric banding for morbid obesity: radiographic management and imaging of postoperative complications

We present the results of our experience in 150 individuals underwent laparoscopic adjustable gastric banding [LAGB] to assess its efficacy in terms of weight loss and safety as well as to validate the role of radiographic assessment in determining the range of early and late possible postoperative complications. 150 consecutive [105 women, 45 men] morbidly obese patients with BMI of >40 kg/m[2] or BMI of >35 kg/m[2] with one obesity related disease who underwent LAGB were included in this study. Water soluble upper gastrointestinal study was done on the second postoperative day to ensure adequate position of the band, check the device components, and exclude perforation. 4 weeks after surgery stoma size adjustment was performed. Additional sessions were scheduled depending on the patient's ability to eat, weight loss curve, or manifestation of complications. Patients were followed up to 36 months. The% mean excess weight loss [EWL] at 1 year, 2 years, and 3 years was 44.4% [ +/- 17.8], 51.8% [ +/- 20.9], and 52.0% [ +/- 19.6], respectively. Complications relating to the gastric band occurred in 10 patients [6.5%]. Acute Gastric Perforation occurred in 2 patients [1.3%], band erosion in 4 patients [2.6%], slippage of the gastric band with gastric strangulation in 4 patients [2.6%]. Tube-related complications were detected in 15 patients [10%] and included port site discomfort in 3 patients [2%], port infections in 5 patients [3.3%], tube disconnection in 3 patients [2%] and tube leak in 4 patients [2.7%]. The LAGB procedure is a minimally invasive, totally reversible laparoscopic alternative in the treatment of morbid obesity. Various complications may be detected on follow-up imaging studies. The radiologist should be aware of these possible complications and their radiologic appearances

Management and imaging strategies in vertebral artery injuries due to penetrating neck trauma

Eleven patients with vertebral artery injury due to penetrating trauma were included in this prospective study. They were classified according to the clinical evidence of vascular injury into two groups: Group A included six patients showing hard signs suggestive of vascular injury and group B included five patients who were showing soft signs suspicious of vascular injury. Patients from group A who were vitally unstable [four patients] were taken immediately to the operation theater, while the other stable patients [two patients] did angiography to locate the site of injury and plan surgical approach. Proximal and distal ligation to the injured vertebral artery was done in three patients. Proximal ligation and packing with hemostatic agent were mandatory in two patients. A damage control was utilized in one patient. Patients from group B were subjected to MRA which was reliable to detect the site and type of injury; conservative treatment was adopted in all of them. The mortality rate was 9%. Massive blood transfusion, chylous fistula and pneumonia were the main postoperative complications. In spite of the ligation of the vertebral artery, none of the patients developed a neurological deficit. Patients who were managed conservatively and those who had proximal ligation and packing by hemostatic agents did not develop any late complications during the follow up period

role of non invasive imaging in the surgical management of the patients with mesenteric venous thrombosis

Twenty-one patients of surgically confirmed diagnosis of mesenteric venous thrombosis were included in this study. A detailed history was taken and thorough clinical examination was performed. The patients were divided into two groups: Group A included eight patients who showed an evidence of localized or generalized peritonitis and group B included 13 patients who showed nonspecific clinical findings. The duration of symptoms was significantly longer in patients from group A than group B. All patients were subjected to ultrasonographic abdominal examination with color flow Doppler scanning. It could suspect the diagnosis of mesenteric venous thrombosis in 62.5% and 76.9% of the patients in group A and B, respectively. Immediate surgical exploration was performed in all patients from group A without any further investigations. Contrast enhanced spiral CT was done in 11 patients from group B, while contrast enhanced MRI was done in the other 2 patients. A surgical exploration was done in all of them

impact of early diagnosis and associated injuries on the outcome of patients with traumatic diaphragmatic rupture

Thirty-eight patients with surgically confirmed diagnosis of traumatic diaphragmatic rupture were included in this prospective study. They were classified into two age and sex matched groups: Group A included 22 patients where the diaphragmatic rupture was the prime indication for surgical intervention and group B included 16 patients where associated thoraco-abdominal injuries mandated an urgent surgical intervention. In conclusion, a high index of suspicion and awareness of the mechanism of injury are required for the early diagnosis of diaphragmatic rupture. The initial plain chest X-ray is reliable in detecting the diaphragmatic tear, especially in the presence of herniated hollow viscera. Ultrasonography and CT scan are useful auxiliary investigations which improve dramatically the early preoperative diagnosis of diaphragmatic rupture. Due to the severity of trauma required to rupture the diaphragm, associated injuries are common. However, no specific associated injury proved to be a sensitive index for diaphragmatic rupture. During exploratory laparotomy for abdominal trauma, a thorough examination of both hemidiaphragms is mandatory. Postoperative morbidity and mortality could be attributed to the severity of trauma indices and associated injuries but not to the diaphragmatic tear itself