Predictive capabilities of serum eosinophil cationic protein, percentage of eosinophils and total immunoglobulin E in allergic rhinitis without bronchial asthma

This study identified cut-off values for allergy markers for use in the diagnosis of allergic rhinitis in the absence of other allergic diseases. Total immunoglobulin E (IgE), eosinophil cationic protein (ECP) and the numbers of eosinophils were measured in serum samples from 442 patients with typical symptoms of allergic rhinitis. A definite diagnosis was made on the basis of the presence of specific IgE levels. Cut-off values with a maximal discrimination to diagnose allergic rhinitis were found to be 98.7 IU/ml, 24.7 μg/ml and 4.0% for total IgE, ECP and eosinophils, respectively. Sensitivity, specificity and odds ratio for these values were 75.2%, 69.7% and 6.93, respectively, for total IgE, 55.7%, 74.4% and 3.70 for ECP, and 57.5%, 72.0% and 3.47 for eosinophils. A composite score representing positive results for all three markers had a positive predictive value of 85.3%, with an odds ratio of 8.55. It was concluded that total serum IgE, ECP and eosinophil percentage are strong predictors of allergic rhinitis and the determination of cut-off values for these markers can aid in the diagnosis of allergic rhinitis in the clinical setting.     

Impact of gender and sleep position on relationships between anthropometric parameters and obstructive sleep apnea syndrome

Sleep and Breathing - Considering the mechanisms by which obesity affects obstructive sleep apnea syndrome (OSAS) and the differences of fat distribution depending on gender, associations between...     

Sinonasal inverted papilloma: value of convoluted cerebriform pattern on MR imaging

BACKGROUND AND PURPOSE: A convoluted cerebriform pattern (CCP) has been reported as a valuable MR imaging feature of inverted papilloma (IP). The purpose of this study was to validate the usefulness of CCP for distinguishing IP from various malignant sinonasal tumors in a relatively large number of patients.MATERIALS AND METHODS: We retrospectively reviewed MR images of 30 patients with IP and 128 patients with various malignant sinonasal tumors proved on histologic examination and compared the prevalence of a CCP between the 2 groups. In 8 patients with IP concomitant with squamous cell carcinoma, we also tried to find the MR features to help suggest coexistent malignancy.RESULTS: A CCP was demonstrated in all 30 (100%) of the IPs and 17 (13%) of the 128 malignant sinonasal tumors on MR imaging. There was a significant statistical difference in the prevalence of a CCP between IP and malignant sinonasal tumors with the overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy 100%, 87%, 64%, 100%, and 89%, respectively. Of 8 IPs concomitant with squamous cell carcinoma, a focal loss of a CCP was demonstrated in 4 tumors, 3 of which also showed aggressive bone destruction with extrasinonasal extension on MR images.CONCLUSION: Although a CCP is a reliable MR imaging feature of sinonasal IPs, it can also be seen in various malignant sinonasal tumors. A focal loss of a CCP might be a clue to the diagnosis of IPs concomitant with malignancy.

Inverted papilloma (IP) is an uncommon benign epithelial tumor of the sinonasal tract, accounting for 0.5% to 4.0% of primary nasal tumors.^1,2 Although benign, it has a known propensity for a high rate of recurrence, local aggressiveness, multicentricity, and association with synchronous or metachronous squamous cell carcinoma (SCC).^3-12 Although CT and MR imaging are useful for preoperative assessment of sinonasal IP, differentiation of IP from other malignant sinonasal tumors is often difficult because of a significant overlap of the imaging features.^13-19Barnes et al²⁰ described a distinctive gross mucosal morphology of IP, a so-called convoluted cerebriform pattern (CCP), which can be reflected on MR imaging by the characteristic alternating hypointense and hyperintense bands on T2-weighted and contrast-enhanced T1-weighted images, as reported by Ojiri et al¹⁷ and supported by Maroldi et al¹⁹ years later. It would be useful for planning therapeutic strategies if the CCP on MR imaging can suggest the preoperative diagnosis of IP, because more aggressive surgical approaches would be needed for IPs concomitant with SCC and other malignant sinonasal tumors. However, one previous study reported by Yousem et al¹³ failed to find this sign as a specific MR imaging finding to diagnose IP. The purpose of this study was to evaluate the diagnostic accuracy of a CCP depicted on MR imaging for distinguishing IP from other malignant sinonasal tumors in a relatively large number of patients.     

Sinonasal organized hematoma: CT and MR imaging findings

BACKGROUND AND PURPOSE: Sinonasal organized hematoma (OH) is an uncommon, nonneoplastic benign condition that can be locally aggressive. The purpose of this work was to characterize the CT and MR imaging findings of sinonasal OH.MATERIALS AND METHODS: CT (n = 11) and MR (n = 10) images of 12 patients (9 men and 3 women; mean age, 41 years; range, 12–76 years) with pathologically proved sinonasal OH were retrospectively reviewed. Particular attention was put on the location, shape, size, extent, internal architecture, and enhancement pattern of the lesion and associated sinus wall change.RESULTS: The lesions were seen as an expansile (n = 9) or nonexpansile (n = 3) mass, ranging in size from 2.2 to 6.0 cm (mean, 4.2 cm), primarily involving the maxillary sinus (n = 11) or nasal cavity (n = 1) unilaterally. The ipsilateral nasal cavity was also involved in 9 of 11 maxillary sinus lesions. Smooth sinus wall erosion other than the medial maxillary sinus wall was noted in 8 lesions. The internal architecture was best displayed on T2-weighted MR images on which all of the lesions were seen as a mixture of marked heterogeneous hypointensity and isointensity, surrounded by a hypointense peripheral rim, reflecting histologic heterogeneity of the lesion composed of hemorrhage, fibrosis, and neovascularization. Marked irregular nodular, papillary, or frondlike enhancement at the areas of neovascularization was also a typical finding seen in all of the lesions.CONCLUSION: An expansile soft tissue mass, smooth sinus wall erosion, marked heterogeneous signal intensity with a hypointense peripheral rim on T2-weighted MR images, and marked irregular nodular, papillary, or frondlike enhancement are characteristic CT and MR imaging findings of sinonasal OH.

Sinonasal organized hematoma (OH) is an uncommon, nonneoplastic benign condition that can be locally aggressive. Without careful evaluation of all of the imaging features, this may be mistaken for a malignant lesion both clinically and radiologically. It most commonly affects the maxillary sinus and can result from various causes of hemorrhage with chronic hematoma formation, followed by the process of organization through fibrosis and neovascularization.^1,2 Since the first report by Ozhan et al³ in a patient with von Willebrand disease, only fewer than 40 cases have been reported in the English literature under various names, including pseudotumor,^3,4 hematoma,⁵ organized or organizing hematoma,^1,2,6–8 and hematoma-like mass of the maxillary sinus.⁹Correct preoperative diagnosis of sinonasal OH is important to avoid unnecessary extensive surgery, because this condition is curative with a simple, conservative surgical approach and rarely recurs. Although there have been a few reports on the CT findings of sinonasal OH,^1–3,5–9 which are reported to be rather nonspecific, to our knowledge, the MR imaging features have not systematically been analyzed previously. Only 2 studies had briefly mentioned the MR imaging features.^8,9 Yagisawa et al⁹ reported that masses were well demarcated from the surrounding structures and heterogeneous in signal intensity on both T1- and T2-weighted MR images. Song et al⁸ reported that the lesions appeared as isosignal intensity with a margin that had a slightly higher signal intensity on T1-weighted images and a mosaic of various signal intensities and a low signal intensity rim on T2-weighted images. The purpose of this study was to report the CT and MR imaging findings, which are believed to be characteristic for sinonasal OH.     

Cerebrospinal fluid leakage after gamma knife radiosurgery for skull base metastasis from renal cell carcinoma: a case report

We report a rare case of cerebrospinal fluid (CSF) leakage after radiosurgery for skull base metastasis from renal cell carcinoma. A mass invading the left petrous bone and sphenoid sinus was treated with gamma knife radiosurgery, and CSF rhinorrhea developed 4 months after the procedure. The CSF leak was successfully controlled by endoscopic sinus surgery. CSF leakage may develop as a rare complication after radiosurgery for skull base lesions, and the endoscopic repair technique is a useful therapeutic method.     

Influence of upper airway narrowing on the effective continuous positive airway pressure level

BACKGROUND AND OBJECTIVES: The aim of this study was to determine the relationship between the continuous positive airway pressure (CPAP) titration level and upper airway variables in obstructive sleep apnea syndrome (OSAS). SUBJECTS AND METHODS: Forty-seven patients suffering from OSAS were enrolled in this study. They were asked to answer a questionnaire about nasal stuffiness and mouth breathing, and the degree of tonsillar hypertrophy and shape of the oropharyngeal inlet were evaluated. The minimal cross-sectional area (MCA) of the nasal cavity was measured with acoustic rhinometry, followed by optimal CPAP level titration. We compared optimal CPAP levels with body mass index (BMI), perceived nasal stuffiness, and anatomic upper airway narrowing. RESULTS: The mean CPAP level was 6.32 +/- 2.17 cm H2O. We found a significant correlation between CPAP levels and BMI (P = .01), apnea-hypopnea index (P = .015), and the degree of tonsillar hypertrophy (P = .011). Furthermore, the CPAP level increased significantly with the MCA on the narrow side of the nasal cavity (P = .038) in patients with a BMI less than 25. Other variables, such as subjective symptoms and anatomic nasal airway occlusion in obese patients (BMI > or = 25), revealed no correlation with the CPAP level. CONCLUSIONS: Upper airway occlusion including nasal obstruction or tonsillar hypertrophy might increase the effective CPAP level.     

Changes of maxillary sinus volume and bony thickness of the paranasal sinuses in longstanding pediatric chronic rhinosinusitis

OBJECTIVES: To evaluate the chronic bony changes in the paranasal sinuses of longstanding chronic rhinosinusitis (CRS) in pediatric patients and to compare them with normal controls. STUDY DESIGN: A single-institution retrospective analysis. METHOD: Thirty 15- and 16-year-old children with longstanding CRS, for more than 2 years, despite maximal medical treatment and had a Lund CT score over 20 were enrolled as the CRS group. They were compared with 45 age and gender matched randomly selected normal controls without CRS. No enrolled patient had a history of nasal or adenoid surgery. The volume of the maxillary sinus was measured using a three-dimensional CT reconstruction program (V-works 4.0). The bony thickness of the maxillary (MS) and ethmoid sinuses (ES) and the middle turbinate (MT) was measured and compared. In addition, we evaluated the effect of disease duration on the sinus volume and bony thickness. RESULTS: The mean volume of the MS was 22.5+/-4.4 cm(3) in the normal group and 20.0+/-4.1 cm(3) in the CRS group; this difference was statistically significant (p=0.02). However, there was no correlation found between the disease duration and maxillary sinus volume (r=-0.07, p=0.69). The mean thicknesses of the bony walls were 1.0+/-0.4 mm (MS), 0.8+/-0.4 mm (ES) and 1.8+/-0.5 mm (MT) in the normal group and 1.2+/-0.3 mm (MS), 1.2+/-0.4 mm (ES) and 2.4+/-0.5 mm (MT) in the CRS group; these differences were significant (p<0.01). In addition, the bony thickness of the ES was significantly correlated with the duration of symptoms (r=0.44, p=0.03). CONCLUSION: The volume of the maxillary sinuses decreased and the bony thickness of the paranasal sinuses increased with longstanding pediatric CRS.     

Effect of endoscopic sinus surgery on asthmatic patients with chronic rhinosinusitis.

There have been several reports on the effectiveness of endoscopic sinus surgery (ESS) in asthmatic patients with chronic rhinosinusitis. Whether ESS has a positive effect on the clinical course of asthma still remains controversial. There have been several subjective evaluations but few objective results. We performed a study to evaluate the effectiveness of ESS in 19 patients with asthma who underwent ESS for rhinosinusitis. The use of antiasthma medication and postoperative asthma symptoms was analyzed. Objective changes of pulmonary function tests were evaluated. There was a significant improvement in diurnal and nocturnal asthma symptoms. Improvements in asthma medication scores were also confirmed, and individual asthma symptoms (dyspnea, cough, wheezing, and sputum production) improved significantly. Despite a reduction in use of antiasthma medication after ESS, the parameters of the pulmonary function tests did not change. Both subjectively and objectively, it seems that ESS, when used to treat asthmatic patients with chronic rhinosinusitis, can play a significant role in the clinical improvement of asthma.