Treatment of invasive fungal sinusitis with liposomal amphotericin B: a report of four cases.

Invasive fungal sinusitis increasingly causes significant morbidity and mortality in immunocompromised patients. It is difficult to treat. Despite standard treatment by surgical debridement and intravenous amphotericin B, morbidity and mortality remain high. Conventional amphotericin B is the standard drug but its use is limited by dose-related nephrotoxicity and infusion-related acute toxicity. Liposomal amphotericin B has proven to be as effective as conventional amphotericin B with less nephrotoxicity and infusion reaction. We report four cases of invasive fungal sinusitis who were treated with liposomal amphotericin B after having severe side effects from conventional amphotericin B. There were two cases of mucormycosis and two cases of aspergillosis. All patients had diabetes millitus. One patient had systemic lupus erythematosus and another was receiving immunosuppressive drugs after kidney transplantation. All cases needed multiple operations for sinus surgery. Two cases had acute reaction to amphotericin B infusion, one had active lupus nephritis with renal insufficiency, and one was considered treatment failure from amphotericin B. The patients received liposomal amphotericin B at the total doses of 4.55-8.85 g. Two cases of mucormycosis were considered to be successfully treated. In cases of aspergillosis, one was considered improved and another one with immunocompromised status died with active disease. From our experience, surgery is the main treatment for patients with invasive fungal sinusitis and liposomal amphotericin B is an effective alternative drug for adjuvant medical treatment. However, the degree of immunosuppression of the patients, the extension of fungal sinusitis and perhaps the species of fungus are important factors determining the clinical response.

CO2 laser surgery in otorhinolaryngology-site and complications: a 10-year experience at Ramathibodi Hospital.

OBJECTIVE: To present data on ten years' experience in CO2 laser surgery and associated complications among otorhinolayngologic patients. MATERIAL AND METHOD: The study involved examining records of otorhinolaryngologic patients who underwent CO2 laser operations during a 10-year period (July 1, 1986-June 30, 1996). The sample consisted of 733 patients: 370 male and 363 female patients. CO2 laser surgery in otorhinolaryngology was first used in Ramathibodi Hospital on July 10, 1986. RESULTS: These patients were aged 2 months to 93 years with the mean age of 24.3 years (median = 16 years). Among 1,725 operations, 1,570 operations (91%) were performed under general anesthesia and 155 operations (9%) were performed under local anesthesia. In our series, the most frequent sites for laser surgery were as follows: larynx (77.22%), oral cavity and oropharynx (12.64%), skin (5.04%) and nose and paranasal sinuses (3.31%). Intraoperative complications occurred in 18 out of 1,725 (intra-operative complication rate of 1%). Laser-related complications were found in 13 out of 1,725 operations (0.75%) and non laser-related complications were found in 5 out of 1,725 operations (0.25%). There was no mortality. CONCLUSION: CO2 laser is a useful modality of treatment in otorhinolaryngologic surgery especially in the larynx. Our experience demonstrates the relative low incidence of complications (1%) and no mortality in otorhinolaryngology head and neck surgery.