Caracterización epidemiológica, clínica y tomográfica de pacientes con afecciones no traumáticas de los senos paranasales / Clinical, epidemological and tomographic characterization of patients with non traumatic disorders of the paranasal sinuses

Se realizó una investigación observacional, descriptiva y transversal de 132 pacientes con afecciones no traumáticas de los senos paranasales, atendidos en el Servicio de Otorrinolaringología del Hospital Provincial Docente Saturnino Lora Torres de Santiago de Cuba, desde enero del 2013 hasta diciembre del 2015, a fin de caracterizarles según variables epidemiológicas, clínicas y tomográficas de interés. En la serie predominaron los afectados de 39-58 años de edad (42,4 por ciento), el hábito de fumar (62,1 por ciento) y las infecciones dentarias (59,1 por ciento) como los principales factores de riesgo, así como los procesos inflamatorios sinusales (62,1 por ciento) que afectaron preferentemente el seno maxilar. Se halló coincidencia entre el diagnóstico definitivo y los signos tomográficos en 66 pacientes, con un coeficiente de Kappa de 0,80.

An observational, descriptive and cross-sectional investigation of 132 patients with non traumatic disorders of the paranasal sinuses, assisted in the Otolaryngology Service of Saturnino Lora Torres Teaching Provincial Hospital in Santiago de Cuba, was carried out from January, 2013 to December, 2015, in order to characterize them according to clinical, epidemiological and tomographic variables of interest. In the series there was a prevalence of the affected patients aged 39-58 (42.4 percent), the smoking habit (62.1 percent) and dental infections (59.1 percent) as the main risk factors, as well as the sinusal inflammatory processes (62.1 percent) that preferably affected the maxillary sinus. There was a coincidence between the definitive diagnosis and the tomographic signs in 66 patients, with a Kappa coefficient of 0.80.

Patología unilateral de senos paranasales con compromiso predominante de un seno: Descripción de serie de casos / Unilateral paranasal sinus disease with predominant commitment of one sinus: Case series description

Introducción: El velamiento de una cavidad paranasal representa un desafío diagnóstico y puede ser causado por diversas patologías. El examen clínico generalmente es insuficiente para orientar la conducta siendo necesario un estudio completo que incluya endoscopía, imágenes e histología para lograr un diagnóstico definitivo. Objetivo: Describir la impresión clínica, imagenológica, quirúrgica e histológica de pacientes con patología unilateral de senos paranasales. Material y método: Serie retrospectiva de 32 pacientes con patología sinusal unilateral operados en Hospital Clínico de la Universidad de Chile entre 2012 y 2014. Se consideró como criterio de inclusión el compromiso predominante de un seno paranasal en el estudio imagenológico. Se describen las variables: síntoma principal, impresión diagnóstica; clínica, imagenológica, quirúrgica, seno comprometido, entre otras. Resultados: El síntoma principal más frecuente fue obstrucción nasal (56%). Los diagnósticos más frecuentes fueron: patología inflamatoria (84%): pólipo antrocoanal (31%), mucocele (22%) y bola fúngica (22%) y patología tumoral benigna: papiloma invertido (16%), siendo el seno maxilar el más afectado (90%). La impresión diagnóstica quirúrgica fue más precisa que la imagenológica en determinar el diagnóstico definitivo, aunque esta diferencia no alcanzó significancia estadística. Discusión: Patología compleja que requiere estudio completo incluyendo endoscopía. Las imágenes son el segundo pilar en el diagnóstico y deben solicitarse de acuerdo a los hallazgos. El diagnóstico quirúrgico provee una mayor precisión diagnóstica. Conclusiones: Se incluyen varias patologías bajo este concepto, la patología inflamatoria predomina pero se debe tener alto índice de sospecha dado la relativa frecuencia de patología tumoral.

Introduction: Paranasal sinus opacity represents a diagnostic challenge and can be caused by diverse pathologies. Clinical examination is generally insufficient to achieve a definitive diagnosis and it is necessary a complete study including endoscopy, imaging and histology. Aim: To describe clinical, radiographical, surgical and histological diagnostic impressions of patients with unilateral sinus disease. Material and method: 32 retrospective serie with unilateral sinus disease treated at Hospital Clínico de la Universidad de Chile, between 2012 and 2014. The predominant commitment of one sinus on the tomography was considered as inclusion criterion. Principal symtom, clinical, radiographical and surgical diagnostic impressions, committed sinus, among others variables were studied. Results: The most frequent symtom was nasal obstruction (56%). The most frequent diagnoses were: inflammatory disease (84%): antrochoanal polyp (31%), mucocele (22%) and fungus ball (22%) and benign tumor: inverted papilloma (16%). The maxillary sinus was affected in 90%. Surgical diagnostic impression was more precise than radiographical impression in determining the definitive diagnosis, although this difference did not reach statistics significance. Discussion: Unilateral sinus disease is a complex pathology that requires comprehensive study including endoscopy. Images are the second pillar in the diagnosis and should be requested according to the findings. Surgical diagnostic impression provides greater diagnostic presicion. Conclusions: Several pathologies are included under this concept, inflammatory disease prevails but it is necessary to have high index of suspicion in view of the relative frequency of tumour pathology.

Mucormicosis: Una micosis emergente / Mucormycosis: An emergent mycosis

El objetivo de este trabajo es presentar la incidencia, frecuencia, características clínicas y evolución de los pacientes con mucormicosis atendidos en el Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, entre los años 1982 y 2010. Durante ese período se diagnosticaron 10 casos de mucormicosis. Los tres primeros entre 1982 y 2004 y los últimos 7 entre 2005 y 2010. La incidencia y frecuencia de esta enfermedad, para el período 1980-2004 fue 0.13 pacientes/año y 0.1 casos/10 000 egresos (IC 95%: 0.00 a 0.3) respectivamente. En el período 2005-2010 la incidencia fue 0.86 pacientes/año y la frecuencia de 1.1 casos/10 000 egresos (IC 95%: 0.5 a 2.4). Hubo nueve casos de mucormicosis rinosinuso-orbitaria, siete en pacientes con diabetes mellitus, uno en una paciente con una hemopatía maligna y neutropenia, y el restante en un paciente con HIV/sida que además estaba neutropénico y con un síndrome hemofagocítico. En una paciente se realizó el diagnóstico post mortem de mucormicosis pulmonar. El diagnóstico se efectuó por la observación de filamentos cenocíticos en los diez casos. Hubo desarrollo de mucorales en los cultivos de 8/9 pacientes; cinco Rhizopus spp y tres Mucor spp. Todos los pacientes recibieron un tratamiento inicial con anfotericina B deoxicolato, que en tres de ellos fue continuado con anfotericina B liposomal, y cirugía. Tres enfermos recibieron además un tratamiento adyuvante con oxigeno hiperbárico. La mortalidad fue 30%.

Mucormycosis is an opportunistic infection caused by fungi of the order Mucorales. It is characterized by rapid progression and high morbidity and mortality in the absence of early diagnosis and prompt treatment. It was an infrequent disease, but in recent years, its incidence appears to have increased. The aim of this paper is to report the cases of mucormycosis diagnosed from 1982 to 2010 at the Hospital de Clinicas José de San Martín, University of Buenos Aires. We diagnosed 10 cases of mucormycosis; the first three between 1982 and 2004 and the last 7 between 2005 and 2010. The incidence from 1980 to 2004 was 0.13 patient-years and the frequency 0.1/10 000 discharges (95% CI 0.00- 0.3). In the period 2005 to 2010, the incidence was 0.86 patients per year with 1.1/10 000 discharges (95% CI 0.5-2.4). There was a pulmonary mucormycosis case (in a patient treated with corticosteroids) and nine rhinocerebral cases, two in neutropenic and seven in diabetic patients. The diagnosis was made by observation of cenocytic hyphae in 10/10 patients. Mucorales were recovered in 8/9 cultures (5 Rhizopus spp and 3 Mucor spp.). In one case diagnosis of pulmonary mucormycosis was made post-mortem. Nine patients were treated with amphotericin B deoxycholate (in 3 patients supplemented with liposomal amphotericin B) and surgery. Three patients underwent hyperbaric chamber. Seven patients had favorable outcome. In conclusion, mucormycosis is a rare disease, but its incidence has increased over the past five years. A good evolution of the patients is linked to early diagnosis and treatment.

[Fungus paranasal sinusitis in non-immunocompromised patients in Tehran, Iran [2006-07]]

Incidence of fungal infections particularly fungal sinusitis is increasing in Iran and identification of causative agents is essential for its control and treatment. This study was carried out to determine the fungus paranasal sinusitis in non-immuno-compromised patients in Tehran, Iran. This cross-sectional study was done on 108 patients [73 males, 35 females] with chronic sinusitis ranged from 9 to 68 years, admitted to Amir Alam and Emam Khomeini hospitals in Tehran, Iran during 2006-07. Sinusitis in patients confirmed by radiologic images. Complementry information were obtained using questionnaires which including gender, job, presence of disposing disease diabetes and consumption immunocompromised drugs. Sinus samples were collected by washing and biopsy were carried out by two methods of fenestration and Cald-wel luc operations. Subsequently they were cultured on Sabouraud dextrose agar [SDA], SDA+chloramphenicol and blood agar [BA] media at 30 C and 37 C. Direct examination and fixative sample for histhologic evaluation was done and for colonies confirmation the slide culture method also was used. 8 cases [7.4%] were positive for fungal sinusitis with following sub type: 6 cases [Alternaria Spp], 1 case [Paecilomyces] and 1 case [Aspergillus flavus]. The most fungal sinusitis [5 cases] were observed in 30-39 years patients. Considering the prevalence of 7.4% fungal sinusitis and isolation of paecilomyces which is a rare subtype complematry investigation is recommended, in the field of research

incidence of concha bullosa and its association with chronic rhinosinusitis deviated nasal septum and osteomeatal complex obstruction

To determine the incidence of concha bullosa and its association with deviated nasal septum, obstruction of osteomeatal complex and chronic rhinosinusitis. Retrospective study. Otorhinolaryngology, head and neck surgery department. Nine hundred thirty-one consecutive paranasal sinus CTs taken between 2008 and 2010 were reviewed; 347 cases of concha bullosa [CB] were identified. Those cases were reviewed radiologically for the presence and severity of deviated nasal septum, obstruction of the osteomeatal complex and sinus disease. The significance of associations was tested using chi-square or Fischer exact tests. Patient's age ranged from 8 to 84 years with a mean age of 32.6 years. Two hundred twenty-nine [66%] were females. Three hundred forty-seven [37.3%] had CB and 224 [64.6%] had deviated nasal septum with CB. No association between a unilateral or dominant CB and ipsilateral or contralateral DNS and ipsilateral or contralateral maxillary, ethmoid and sphenoid sinus involvement was found. Similarly, there was no association with disease in the ipsilateral or contralateral osteomeatal complex. Although concha bullosa is a common occurrence in the nasal cavity, no statistically significant relationships between the presence of concha bullosa, deviated nasal septum, obstruction of osteomeatal complex and sinus disease was found

Doença nasossinusal em pacientes HIV positivos / Naso-sinus sickness in HIV positive patients

A doença nasossinusal é extremamente prevalente em pacientes com sorologia positiva para o vírus da imunodeficiência humana (HIV +), por isso a necessidade de que muitos estudos sejam realizados sobre esta doença, principalmente com o advento das novas drogas anti-retrovirais. Foi realizado um estudo de revisão bibliográfica buscando razões para justificar esta alta prevalência, sendo determinada a alteração da imunidade humoral e celular, distúrbios da mobilidade ciliar e alterações anatômicas prévias como fatores etiológicos. Verificou-se que o diagnóstico é eminentemente clínico e a conduta terapêutica inicial é semelhante a da população não infectada. Nestes pacientes se faz necessário um acompanhamento mais criterioso e atenção especial deve ser dada ao nível de linfócitos T helper (CD4), pois tem se verificado casos de dificil manejo terapêutico e aparecimento de complicações nasossinusais em pacientes com níveis de células CD4 abaixo de 200 por milímetro cúbico(mm3). Os autores relatam que a ausência de resposta ao tratamento clínico após punção, lavagem e cultura da secreção dos seios maxilares determina a indicação do tratamento cirúrgico que, na maioria dos casos, melhora a qualidade de vida destes pacientes.