The International Frontal Sinus Anatomy Classification (IFAC) and Classification of the Extent of Endoscopic Frontal Sinus Surgery (EFSS)

The frontal recess and frontal sinus anatomy can vary from simple to complex. The variations in the anatomy of the frontal recess and frontal sinus are considerable but almost all variations can be classified if the various cell patterns are analyzed. This consensus document was developed to improve the ability of the surgeon to understand these possible variations, plan the surgery, and communicate these complexities when teaching or reporting outcomes. Once the surgeon understands the anatomical pattern of the frontal sinus and recess cells, the extent of surgery can be planned. This document presents a classification of the extent of surgery based on the anatomical classification.     

What are the challenges in choosing pharmacotherapy for rhinosinusitis?

ABSTRACT

Introduction: Rhinosinusitis is an extremely prevalent condition with significant health-care expenditure and socio-economic burden. Although symptomatically patients with acute and chronic rhinosinusitis present similarly, the underlying pathogenesis of these conditions is different.

Areas covered: This perspective discusses the various treatment options for both acute and chronic rhinosinusitis and examines some of the challenges in choosing appropriate pharmacotherapy. It examines the evidence supporting the commonly used agents including saline irrigations, topical and oral corticosteroids and antibiotics and makes recommendations based on the highest level of evidence available. Furthermore, the role or precision medicine and emerging therapies such as biologics are discussed.

Expert opinion: Despite being commonly prescribed, the evidence supporting the routine use of oral antibiotics for CRS and the majority of ARS is lacking. The authors suggest judicious use of these medications after clear consideration of the indications. Topical intranasal corticosteroids and saline irrigations remain a safe and effective treatment for rhinosinusitis and should be considered as first-line therapy. In patients who fail to respond to appropriate treatment, therapy should be escalated after consultation and review by a specialist.     

Autosomal dominant medullary cystic kidney disease: evidence of gene locus heterogeneity

Autosomal dominant medullary cystic kidney disease (ADMCKD; synonym: medullary cystic disease, MCD) is an autosomal dominant kidney disorder, sharing morphological and clinical features with recessive juvenile nephronophthisis (NPH), such as reduced urinary concentration ability and multiple renal cysts at the corticomedullary junction. While in NPH end-stage renal disease (ESRD) occurs in adolescence, ADMCKD leads to ESRD in adulthood. Recently a gene locus for ADMCKD has been localized to chromosome 1q21 in two large Cypriot families. This prompted us to examine linkage in three ADMCKD-families, using the same set of polymorphic microsatellite markers spanning the critical region on chromosome 1q21. Haplotype analysis revealed that none of the three families showed linkage to this locus, thus demonstrating evidence for genetic locus heterogeneity. Additional linkage analysis studies need to be performed in order to identify further gene loci cosegregating with this autosomal dominant kidney disorder.     

Alterations in Thyroid Hormones and Thyrotropin (TSH) in Morbidly Obese Patients before and after Vertical Gastroplasty

Background: Published results of studies of thyroid function in obesity and after weight loss have differed. Methods: The circulating concentrations of thyroid hormones and TSH were studied in 30 consecutive, euthyroid morbidly obese patients before and after weight loss from vertical gastroplasty, with the aim to determine the relation between body weight loss and pituitarythyroid axis function. Serum TSH, free T3 (FT3) and free T4 (FT4) were measured before operation and repeated 6 and 18 months postoperatively. Results: A significant increase, but within normal levels, in FT3 value at 6 and, mainly, at 18 months after gastroplasty was observed (p = 0.002). The FT4 value was slightly increased at the same time and serum TSH was found to be significantly decreased (p = 0.03 and p = 0.01 respectively). The relative increase in FT4 was negatively correlated with excess body weight and Body Mass Index reduction. This correlation was only moderate with values ranging from r = 0.34 to r = 0.47. Conclusions: Although there were statistically significant differences in thyroid function tests before and after loss of weight, these were not biologically significant. The hypophyseal/thyroid axis remains always active and contributes to body weight homeostasis and its regulation.