Gender differences in the bacteriology of rhinosinusitis.

Evaluating gender differences in pathogens involving sinonasal tract disease in patients undergoing nasal surgery for chronic and recurrent rhinosinusitis (C/R RS). Retrospective analysis of 164 positive sinonasal swab cultures taken during endoscopic sinonasal surgery between the years 2006 and 2013. Study population included 79 (48.8%) female patients and 84 (51/2%) males with a mean age of 47.3 (13-88) years. Positive Staphylococcal growth was found in 38 (23.2%) patients, positive anaerobic growth in 25 (15.2%) patients and 67 (40.9%) patients had polymicrobial growth. Staphylococcal growth in the male population was significantly higher compared to the female population (p = 0.04). Odds ratio for a polymicrobial infection in males over 60 years old compared to females was 2.17 (CI 0.63-8.08, 95%). Anaerobes were found to be more frequent in males (17.9%) than in females (12.5%). Species of Streptococci showed no difference between gender and age groups. The results obtained suggest a difference between the causing pathogens in C/R RS between females and males. In the male population, staphylococcal species were found to be significantly more common with a greater tendency to polymicrobial pathogens and higher rates of anaerobes. These results might suggest different management protocols perioperatively in males and females.

Acute stroke revealing Takayasu's arteritis in a patient with Crohn's disease.

A 36-year-old Caucasian male with Crohn's disease exhibited acute ischaemic stroke as the first manifestation of Takayasu's arteritis. Stroke as the first clinical manifestation of Takayasu's arteritis has been rarely reported. Though rare in Western countries, Takayasu's arteritis should be considered as a possibility in young patients presenting with stroke. Both Takayasu's arteritis and Crohn's disease may increase the risk of ischaemic stroke. Furthermore, their coexistence is much higher than that expected by chance and suggest a pathophysiological link between these diseases.

Partial thickness corneal tissue as a patch graft material for prevention of glaucoma drainage device exposure.

BACKGROUND: To protect from erosion of the tube in glaucoma drainage device (GDD), the tube is covered by a biologic tissue which is roofed by the conjunctiva. Sclera, pericardium, dura mater and cornea are available as a patch graft. Drawbacks of some of these materials may include high cost and poor appearance. The purpose of this study is to report the long-term outcomes of partial thickness corneal grafts to cover the tube and prevent its exposure, in GDD surgeries. METHODS: This was a retrospective review of all patients who underwent Ahmed glaucoma valve implantation and had a minimum follow-up of 12 months. The tube was covered by a 300-micron partial thickness corneal graft taken either from a previous Descemet stripping endothelial keratoplasty procedure or cut from a whole corneal graft button unsuitable for keratoplasty. RESULTS: Forty-four patients (45 eyes, mean follow-up of 27.6 ± 11.4 months) were enrolled. The partial thickness corneal grafts maintained clarity throughout follow-up with satisfactory cosmetic results. Mild conjunctival retraction occurred in 4 eyes (8.9%) between 1 and 12 months after the surgery. Corneal graft melting occurred in 3 (6.7%) eyes. Tube exposure and additional surgery to re-patch or suture the conjunctiva over the tube was needed in 1 (2.2%) eye. None of the patients had graft infection or immunologic rejection. CONCLUSIONS: Partial thickness corneal grafts have favorable long-term outcome as a patch for GDD tubes with low rates of tube exposure and other complications.

Bacteriology of peritonsillar abscess in patients over 40 years--a neglected age group.

The clinical presentation of peritonsillar abscess (PTA) in patients over 40 years is scarcely reported. Since older patients present differently than younger patients, our aim was to investigate possible correlation between illness severity in the older age group and their bacteriologic studies. A retrospective study on all cases of PTA admitted between June 1996 and June 2003 was carried out. Details regarding sex and age were obtained. Bacteriologic studies were analyzed for gram stain, aerobic and anaerobic culture results. Two hundred and eighty-two patients (143 male and 139 female) had 311 hospitalizations due to PTA with known results of the microbiologic studies. Mean age was 29.6 (range 4-80 years). Sixty-five adults over 40 of age were found comprising 23 % of our cohort. Aerobic growth in the older group was found to be significantly lower (P < 0.05). Anaerobic growth was identified in 44.7 % of the positive pathogen growth. The older age group also showed a tendency to higher rates of anaerobic bacterial growth (57.1 % compared to 41 % in the young age group; P = 0.09, OR = 1.91). Older population with PTA presents with significant lower rates of aerobic bacteria and a tendency towards higher rates of anaerobic growth. The dangerous combination of the latter with the higher reported rates of comorbidities and less prominent symptoms and signs compared to the younger patients might clarify the need for prompt and aggressive surgical and antibiotic treatment.