An open-label, noncomparative study to evaluate the efficacy, safety, and tolerability of azithromycin in the treatment of patients with acute sinusitis.

The efficacy, safety, and tolerability of a 5-day, once-daily course of azithromycin were assessed in patients with acute sinusitis. Patients received two 250-mg capsules of azithromycin on day 1 and one 250-mg capsule on days 2 through 5. Of 102 clinically assessable patients, 27 (26.5%) were cured and 69 (67.6%) were improved on days 5 to 7. At days 12 to 16, 88 (86.3%) had a favorable clinical response. A total of 64 patients experienced adverse events; in all but two patients, adverse events were of mild or moderate severity. Thus azithromycin given once daily for 5 days was an effective treatment for patients with acute sinusitis.

Autografts of uncrushed and crushed bone and cartilage. Experimental observations and clinical implications.

This study evaluated autografts of bone and cartilage, uncrushed and crushed, in the perichondrial space of the ear and subcutaneously in the paraspinal region in rabbits six weeks and six months after transplantation. The results support the belief that in a clinical setting it is important to preserve perichondrium because it facilitates growth of new cartilage. This study suggests that when autogenous tissue is to be used for subcutaneous augmentation, it is best to use crushed or uncrushed cartilage or uncrushed bone because they remain viable. In the perichondrial space, crushed and uncrushed cartilage grafts not only remain viable but also induce growth of new cartilage and bone. Autogenous crushed bone does not survive in the perichondrial space of the rabbit ear.

Facial palsy: unusual etiology.

This is a report of three patients who presented at the Mayo Clinic over a two-year period. All were initially diagnosed as having Bell's palsy but were later found to have a malignant neoplasm causing the paralysis. Two of the patients had breast carcinoma metastases involving the mastoid portion of the facial nerve. The third patient had an adenocarcinoma of the deep lobe of the parotid that involved the facial nerve distal to the stylomastoid foramen. The course of the facial paralysis in the two patients with the metastitic breast disease was almost identical. It consisted of episodes of pain in the mastoid area. generally in the late evening or during the night, often awakening the patient from sleep. This was then followed by peripheral facial-nerve paralysis, sometimes partial and at other times complete. These episodes lasted from 10 minutes to several hours and then resolved completely. They recurred over several months. The patients were completely asymptomatic and normal on examination in the intervals between episodes of paralysis until it became permanent. Metastatic lesions causing facial paralysis are extremely rare in the literature. In those cases that have been reported, the paralysis was progressive from the start and in the vast majority of cases was either painless or associated with other aural symptoms such as otorrhea, hearing loss, and periauricular swelling. There are two unusual features of these two cases: 1. the initial presentation of a breast metastasis as a facial paralysis; in the first case there were no other metastatic lesions present at diagnosis, whereas the second patient had other, asymptomatic, metastatic nodules; and 2. the multiple, brief, recurring episodes of facial paralysis, which have not previously been reported as a mode of presentation of metastitic disease. The third patient was diagnosed as having Bell's palsy. A facial nerve decompression was performed, and the nerve apparently looked normal. The paralysis failed to resolve. He was later found to have adenocarcinoma of the deep lobe of the parotid that involved the facial nerve distal to the stylomastoid foramen. A report of only one similar case could be found in the literature. The sequence of events in these three cases emphasizes the importance of submitting a patient suspected of having Bell's palsy to a thorough otoneurologic examination.