1/4. Sinogenic subdural empyema and streptococcus anginosus.Subdural empyema (SDE) is most commonly caused by sinusitis and, without early diagnosis and neurosurgical intervention, is associated with high mortality. In a patient with sinusitis who presents with mental status changes, the diagnosis of SDE should be suspected on clinical grounds, even in the absence of significant computed tomographic findings. Computed tomography with contrast is a useful aid in the diagnosis of SDE, but findings may be subtle, and contrasted magnetic resonance imaging is superior. The association of streptococcus anginosus sinusitis and related intracranial sequelae is important owing to the potentially catastrophic complications and should be recognized by otolaryngologists. In view of the rapidly progressing nature of sinogenic SDE, physicians should strongly consider early institution of aggressive therapy consisting of craniotomy with concurrent sinus drainage in patients in whom sinogenic SDE is suspected on clinical grounds, particularly in the presence of S. anginosus-positive sinus cultures.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/4. Bilateral ethmoid sinusitis with unilateral proptosis as an initial manifestation of metastatic prostate carcinoma.This article presents a case of bilateral ethmoid sinusitis with unilateral proptosis as a presenting sign of an unsuspected prostate carcinoma. A 59-year-old Hispanic male presented to his primary care physician with nasal congestion and rhinitis. He was treated with antibiotics and antihistamine decongestants for 3 weeks without improvement. A trial of steroids resulted in brief improvement followed by a rapid onset of nasal obstruction with proptosis. A computed tomography scan revealed opacification of the ethmoid sinus with right proptosis. The presumptive diagnosis was orbital cellulitis secondary to chronic ethmoid sinusitis. Endoscopic sinusotomy and bilateral ethmoidectomies were performed. biopsy results returned as metastatic adenocarcinoma, probably of prostate origin. Urological work-up and evaluation with biopsy confirmed the diagnosis of prostatic carcinoma. The patient was treated with chemotherapy and radiation therapy. He died 7 months later with disseminated disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/4. Chronic fatigue cured by nasal surgery.Two cases of severe unexplained fatigue with mid-facial pain and rhinitis are presented. Sinus computerized tomography (CT) findings were minor, but both responded to functional endoscopic nasal surgery with resolution (Case 1) or near resolution (Case 2) of chronic fatigue. Possible mechanisms linking nasal disease and chronic fatigue include reflex etiology and sleep disturbance associated with abnormal nasal airflow. Often not considered by the primary care physician in differential diagnosis of fatigue, chronic sinusitis should be explored as a cause in unexplained cases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/4. Pediatric ethmoid mucoceles in cystic fibrosis: long-term follow-up of reported cases.Ethmoid mucocele, a condition that usually affects adults, can be found in both children and infants with cystic fibrosis. We have cared for two patients with cystic fibrosis and ethmoid mucoceles. Because we could find no references to the prognosis or any long-term follow-up data for this disorder, we contacted the physicians and families of six of the seven patients with this condition previously reported in the English literature to determine how they were managed surgically and the incidence of recurrence. Regardless of the mode of therapy, none of the mucoceles recurred.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |