Functional endoscopic sinus surgery in aviators with recurrent sinus barotrauma.

Recurrent sinus barotrauma in an aviator is difficult to treat successfully. Exacerbations frequently result in marked aviator discomfort, cycles of temporary restriction from aviation duties, or even permanent disqualification for flying duties. Medical management and standard sinus operations are often ineffective, seldom curative, and have a disappointing record in returning the aviator to flying duties. Detailed computerized tomographic scanning of the paranasal sinuses coupled with the functional endoscopic sinus surgery approach directs treatment at the causative pathology. Sinus ventilation is improved while making possible a return to active flight status without recurrence of sinus barotrauma. Initial experience with the functional endoscopic sinus surgery technique in such a patient population is reported. A discussion of recurrent sinus barotrauma, paranasal sinus anatomy, and the theory of endoscopic surgical management for sinus disease is included.

Trimethoprim-sulfamethoxazole therapy of experimental Escherichia coli meningitis in rabbits.

We used two strains of ampicillin-susceptible Escherichia coli to produce meningitis in rabbits and utilized these models (i) to compare the killing effects of parenteral trimethoprim-sulfamethoxazole (TMP-SMZ) and ampicillin on E. coli in cerebrospinal fluid after 8 h of treatment and (ii) to measure the penetration of TMP-SMZ and ampicillin into cerebrospinal fluid and the brain. At 16 h after intracisternal inoculation with a test strain, rabbits were treated with TMP (6 mg/kg per h) and SMZ (30 mg/kg per h), ampicillin (40 mg/kg per h), or saline intravenously for 8 h. TMP-SMZ levels were measured by high-pressure liquid chromatography, and ampicillin levels were measured by microbiological assay. Mean +/- standard deviation concentrations of TMP, SMZ, and ampicillin in cerebrospinal fluid (mean percent penetration) at the completion of 8 h of therapy were 0.80 +/- 0.41 (18%), 15.7 +/- 21.1 (27.2%), and 2.6 +/- 1.7 (8.9%) microgram/ml, respectively. TMP, SMZ, and ampicillin levels in brain homogenate after 8 h of therapy were 0.23 +/- 0.07 (6.6%), 3.31 +/- 3.3 (5.5%), and 0.6 +/- 4.53 (1.9%) microgram/g, respectively. TMP-SMZ infusion for 8 h produced a significant reduction in mean bacterial counts in cerebrospinal fluid in both models of meningitis compared with saline controls. The decrease in mean bacterial counts with TMP-SMZ therapy was equivalent to that produced by ampicillin.