ABSTRACT
Fungal sinusitis secondary to Pseudallescheria boydii is rare, as only 25 cases have been previously reported in the literature. Although Pboydii resembles Aspergillus on pathologic examination, it is typically resistant to amphotericin B. Therefore, culture is necessary to differentiate the two. Patients with P boydii sinusitis should generally be treated with a combination of surgery and antifungal therapy. Combination treatment is particularly important for immunocompromised patients with fungal invasion because mortality among these patients is high. The prognosis is better for immunocompetent patients, even those with fungal invasion. We describe a new case of invasive fungal sinusitis secondary to P. boydii infection, and we review the literature on this emerging pathogen.
Subject(s)
Mycetoma/complications , Pseudallescheria/pathogenicity , Sinusitis/microbiology , Aged , Antifungal Agents/therapeutic use , Fatal Outcome , Humans , Immunocompromised Host , Magnetic Resonance Imaging , Male , Mycetoma/drug therapy , Mycetoma/surgery , Paranasal Sinuses/surgery , Pseudallescheria/isolation & purification , Sinusitis/drug therapy , Sinusitis/surgery , Tomography, X-Ray ComputedABSTRACT
OBJECTIVES: The symptoms, patterns of reflux, and clinical manifestations of laryngopharyngeal reflux (LPR) differ from those of gastroesophageal reflux disease (GERD) in many ways. The purposes of this study were to determine the prevalence of Barrett's esophagus in patients with LPR using transnasal esophagoscopy (TNE) and to determine if there is agreement between TNE clinical findings and pathology results when using TNE for Barrett's screening. STUDY DESIGN: This study involved a retrospective review of the records of 200 consecutive patients with LPR undergoing esophageal screening. METHODS: The prevalence of patients with findings clinically suspicious for Barrett's and the biopsy results for those patients were reviewed. RESULTS: Of the 200 patients with LPR who were screened with TNE, 10% (20 of 200) had findings suspicious for Barrett's esophagus, and, of those, only 30% (six of 20) had biopsy-proven Barrett's metaplasia. CONCLUSION: Although TNE may be a useful screening tool for Barrett's, there is incongruence between TNE findings and biopsy results, which likely reflects suboptimal biopsy methods with TNE. New biopsy techniques such as the CDx brush biopsy may enhance the sensitivity of TNE biopsies, and future studies are needed in this area.
Subject(s)
Barrett Esophagus/diagnosis , Esophagoscopy , Gastroesophageal Reflux/complications , Barrett Esophagus/epidemiology , Barrett Esophagus/etiology , Barrett Esophagus/pathology , Female , Gastroesophageal Reflux/diagnosis , Humans , Male , Mass Screening , Middle Aged , PrevalenceABSTRACT
OBJECTIVE: To evaluate the indications, results, and safety of revision Gore-Tex medialization laryngoplasty (GML). METHODS: A retrospective chart review of 156 patients that underwent GML procedures between the years 1998-2002. Study population consisted of those patients who required revision surgery for any reason. RESULTS: Sixteen patients required 22 revision procedures. Indications for revision were divided into 2 groups, complications and glottal closure problems. Complications included extruded or displaced implants (n = 4). The most common glottal closure problem was undercorrection (n = 9). Others included anterior overcorrection (n = 1) and persistent posterior glottal gap (n = 2). Revision procedures included GML (n = 9), injection augmentation (n = 9), endoscopic implant removal (n = 2), and arytenoid adduction (n = 2). In patients with glottal closure problems, the GCI improved in all 10 and the voice rating scale improved in 9. CONCLUSION: Reasons for revision of GML are variable, the most common being undercorrection. A variety of safe, effective revision techniques are available with a high success rate.
