Balloon catheter sinuplasty for chronic rhinosinusitis: feasibility and impact on quality of life

To evaluate the outcome of balloon sinuplasty for patients with chronic rhinosinusitis [CRS] and its impact on patients' symptom and quality of life scoring The study included 35 patients with mean age of 34.1 +/- 4.4 years. All patients underwent complete otorhinolaryngological examination and endoscopic staging according to Lund and Kennedy endoscopic score. CT scans of paranasal sinuses were assessed according to Lund-Mackay scale. All patients underwent symptoms and quality of life assessment using Sino Nasal Outcome Test-20 [SNOT-20]. All patients underwent balloon catheter sinuplasty under guide of fiberoptic nasal endoscope. Patients were assessed at three and six months after dilatation for SNOT-20 score. Intraoperative catheter insertion and advancement was accomplished successfully in 26 patients with a procedural success rate of 92.9% and the other two patients were shifted to FESS and were excluded of follow-up. No intraoperative or postoperative complications were encountered. Intraoperative bleeding was minimal and controllable without the need for nasal packing and all patients were discharged once they were ready for. All patients showed progressive improvement of SNOT-20 scoring that showed significant improvement at 3-months and 6-months follow-up evaluation compared to baseline score with significantly lower scores determined at 6-months compared versus 3-months. Balloon catheter sinuplasty is a feasible, safe and effective therapeutic modality for CRS associated with significant improvement of patients' quality of life and could be managed as one-day surgical procedure

Percutaneous tracheostomy versus surgical tracheostomy in ICU patients

Tracheostomy is one of the most commonly performed surgical procedures in the critically ill patient. This procedure has been performed using standard surgical principles. Percutaneous dilatational tracheostomy [PDT] was first described in 1957 5 and became increasingly popular after the release of a commercially available kit in 1985. The aim of this study is to compare percutaneous dilatational tracheostomy with surgical tracheostomy in regards to the overall mortality as well as major perioperative and postoperative complications. Fifty ICU patients indicated for tracheostomies were included in prospective randomized study. Our patients were divided into 2 equal groups; percutaneous tracheostomy and surgical tracheostomy group. The outcome measures were divided into perioperative, early postoperative and late postoperative complications. The perioperative designation was used to categorize complications that occur between initiation of the procedure and 24 hours postoperatively. Early postoperative evaluation was performed daily during the first week and then on the 14th day. Long-term evaluation was done 3 months after decannulation. The total incidence of perioperative complications was 28% and 24% in the surgical and percutaneous tracheostomy group respectively. Early postoperative complications were significantly more frequent after surgical tracheostomy [52%] than after percutaneous tracheostomy [20%]. Long-term evaluation was completed in 32 patients [18 SgT and 14 PDT]. Eighteen patients died of their underlying disease. 6 patients [2 SgT and 4PDT] still needed their tracheostomy. The cumulative incidence of long-term complication was 77% and 35% in the SgT and PDT groups respectively. Percutaneous tracheostomy and surgical tracheostomy are both safe when performed by experienced skilled practitioners. However, percutaneous dilatational tracheostomy is simpler and faster technique than surgical tracheostomy