1/17. Severe steroid-dependent asthma with IgG-2 deficiency and recurrent sinusitis: response to treatment with high-dose intravenous immunoglobulin.patients with severe asthma pose a dilemma to the physician since the treatment they need, namely high doses of oral steroids, has serious side effects, especially among the pediatric population. Deficiency in one or more of the IgG subclasses has been associated with abnormal pulmonary function, as well as with recurrent sinopulmonary infections in adults and children. In the last years attention has been focused on alternative therapies for these patients. One of these alternatives is the treatment with intravenous immunoglobulin (IVIG). We report an 11-year-old boy with severe asthma since the age of two years and multiple hospital admissions due to asthmatic crisis even more frequent and severe, to the point of needing, in the last year, daily treatment with high doses of oral steroids (20 mg). During six months the patient was given high doses of intravenous immunoglobulin. After one month of treatment a clinical and spirometric improvement was apparent allowing to taper down the oral steroids until their complete substitution by inhaled budesonide (1,600 microg/day). The only side effects noted were severe headaches after gammaglobulin infusions which responded well to oral paracetamol. This improvement was sustained throughout the treatment period, but few weeks after the IVIG was suspended the clinical and spirometric parameters started to worsen again.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/17. Chronic sinusitis in patients with cystic fibrosis.cystic fibrosis is a lethal genetic disorder whose victims currently have a median life span of approximately 30 years. With this increased life span, new aspects of the disease are identified in patients with cystic fibrosis, including chronic sinusitis. sinusitis severely affects the quality of life of patients with sinusitis. This article discusses several aspects of sinusitis in patients with cystic fibrosis, including clinical presentation, radiologic findings, and treatment options. By recognizing and treating sinusitis in patients with cystic fibrosis, physicians may improve the quality of life of these patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/17. Acquired angioedema associated with sinusitis.Acute and chronic sinusitis are major clinical problems faced by physicians in several disciplines. Although there is a much studied relationship between sinusitis and asthma, as well as a well-known association of sinusitis and Wegener's granulomatosis, there is scant evidence suggesting an association of angioedema with sinusitis. angioedema can be extremely disfiguring, and is potentially lethal due to compromised airways. It is also a frustrating diagnostic dilemma for patients and physicians. A diagnosis is found in fewer than 25% of chronic urticaria patients and much less for angioedema. In this study, we report the cases of nine patients who were treated for chronic sinusitis, but who were referred for episodes of angioedema. patients with a known diagnosis, such as the hereditary form, or drug or food allergies, were excluded. Based on clinical suspicion or CT scan results, nine patients were treated for chronic sinusitis. Only three had symptoms suggesting a sinus infection at presentation. After sinusitis treatment, all nine patients had a marked improvement in their angioedema. None had further severe angioedema episodes. Some patients continued to have mild episodes of angioedema, which they related to recurrence of sinusitis symptoms, and which responded to antibiotics. The nine angioedema patients in this series all had strong evidence of sinusitis, albeit, most patients had occult disease identified by CT scan. The dramatic improvement in angioedema with sinusitis treatment corroborates a causal relationship. Such findings encourage the investigation of sinusitis in these otherwise idiopathic patients. sinusitis evaluation may also be indicated for urticaria.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
4/17. Cutaneous acanthamoeba in a patient with AIDS: a case study with a review of new therapy; quiz 386.GOAL: To describe the presenting signs of an acanthamoeba infection. OBJECTIVES: Upon completion of this activity, dermatologists and general practitioners should be able to: 1. Discuss the clinical presentation of acanthamoeba infection. 2. Describe the conditions that make a patient susceptible to acanthamoeba. 3. Outline treatment options for acanthamoeba infection. CME: This article has been peer reviewed and approved by Michael Fisher, MD, Professor of medicine, Albert Einstein College of medicine. review date: April 2001. This activity has been planned and implemented in accordance with the Essentials and Standards of the accreditation Council for Continuing Medical education through the joint sponsorship of Albert Einstein College of medicine and Quadrant HealthCom, Inc. The Albert Einstein College of medicine is accredited by the ACCME to provide continuing medical education for physicians. Albert Einstein College of medicine designates this educational activity for a maximum of 1.0 hour in category 1 credit toward the AMA Physician's Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity. This activity has been planned and produced in accordance with ACCME Essentials.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
5/17. A craniocerebral infectious disease: case report on the traces of Hippocrates.A modern case of complicated sinusitis, with osteitis of the cranium and intraorbital-intracranial empyema, closely corresponds to descriptions reported in the Hippocratic treatise Diseases II. The therapeutic measures suggested in that work can be regarded as suitable according to modern practice. An ancient physician who followed the Hippocratic doctrine probably would have been able to recognize this complicated disease and possibly save the patient.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/17. Radiologic imaging in the management of sinusitis.sinusitis is one of the most common diseases treated by primary care physicians. Uncomplicated sinusitis does not require radiologic imagery. However, when symptoms are recurrent or refractory despite adequate treatment, further diagnostic evaluations may be indicated. Plain radiography has a limited role in the management of sinusitis. Although air-fluid levels and complete opacification of a sinus are more specific for sinusitis, they are only seen in 60 percent of cases. Noncontrast coronal computed tomographic (CT) images can define the nasal anatomy much more precisely. Mucosal thickening, polyps, and other sinus abnormalities can be seen in 40 percent of symptomatic adults; however, clinical correlation is needed to avoid overdiagnosis of sinusitis because of nonspecific CT findings. Use of CT is typically reserved for difficult cases or to define anatomy prior to sinus surgery. magnetic resonance imaging (MRI) cannot define bony anatomy as well as CT. MRI is only used to differentiate soft-tissue structures, such as in cases of suspected fungal infection or neoplasm. Referral will occasionally be needed in unusual or complicated cases. Immunocompromised persons and smokers are at increased risk for serious sinusitis complications.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/17. Gradenigo syndrome: a case report and review of a rare complication of otitis media.otitis media is a commonly seen condition in the Emergency Department. The complications of otitis media that were seen frequently in the preantibiotic era are now rare today. We report a case of a diabetic man who presented with otorrhea, retro-orbital pain, and diplopia secondary to a sixth cranial nerve palsy--Gradenigo syndrome. This syndrome occurs as infection from the middle ear spreads medially to the petrous portion of the temporal bone. The emergency physician should consider this condition in patients with chronic ear drainage or pain not responsive to conventional treatment or in any patient with a cranial nerve palsy in the setting of acute or chronic otitis. work-up should include a CT scan of the temporal bones. otolaryngology consultation and admission for i.v. antibiotics is recommended.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/17. A rare complication of endoscopic sinus surgery: necrotizing fasciitis of the eyelid.Necrotizing fasciitis is a soft tissue infection characterized by necrosis of fascia and subcutaneous tissue. It frequently involves the groin, abdomen and lower extremities, but rarely involves the head and neck region. An unusual occurrence of periorbital necrotizing fasciitis after a routine endoscopic sinus surgery in a 57-year-old woman with a history of type II diabetes mellitus is presented. Although the disease is very rare, all the physicians should be aware of the manifestations of this disorder and its treatment. Early recognition and prompt intervention plays an important role in minimizing the morbidity and mortality rates.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/17. Toxic streptococcal syndrome.The streptococcal toxic shocklike syndrome is a recently recognized, multisystem disorder that shares many of the features of staphylococcal toxic shock syndrome, but is caused by toxins elaborated by group A beta-hemolytic streptococcus. We describe a patient who fulfilled the major criteria for the clinical diagnosis of toxic shock syndrome (fever, hypotension, multisystem dysfunction, and diffuse macular erythroderma followed by desquamation) and who demonstrated serologic evidence suggesting streptococcal infection. In patients presenting with clinical findings consistent with a toxic shocklike syndrome, the emergency physician should consider streptococcal infection as a potential etiology.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/17. Intracranial complications of sinusitis.sinusitis is a common problem that is routinely diagnosed and treated by most primary care physicians. Although most cases usually respond to appropriate therapy, some occasionally progress to the development of intracranial complications, including meningitis, osteomyelitis, epidural and subdural empyema, intracranial mucocele or polyps, and frank brain abscess. It is important to develop a rational approach to the diagnosis and treatment of these conditions. A high clinical index of suspicion must always be maintained, since symptoms are often masked by previous antibiotic therapy. Radiologic evaluation must always include computerized tomography (CT) for accurate diagnosis and surgical planning. Therapy includes surgical drainage and high doses of appropriate intravenous antibiotics. cefuroxime and metronidazole provide excellent broad spectrum antibacterial coverage. Only early recognition and appropriate therapy can reduce the potential morbidity and mortality associated with these life-threatening complications.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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