Impact of Endoscopic Sinus Surgery on Symptom Manifestation of Chronic Rhinosinusitis

Background

Rhinosinusitis is a significant health problem which results in large financial burden on society. The study evaluated the prevalence and severity of individual symptoms of chronic rhinosinusitis (CRS) and the impact of endoscopic sinus surgery (ESS) on the symptoms and medication used in patients with CRS.

Methods

Patients with refractory CRS were assessed prospectively with ESS intervention. We studied the symptoms, change in medical therapy, complications of surgery and effect of other factors like smoking, polyposis and asthma on endoscopy and computed tomography scan scores.

Result

A total of 81 patients underwent ESS for CRS. Post nasal drip (95%), headache (91%), nasal discharge (90%) and nasal obstruction (86%) were the commonest symptoms. Postoperatively, the highest improvement was seen in nasal blockage (87.2%), postnasal drip (84.4%) and headache (82.4%). Endoscopy scores were significantly worse in patients with polyps, asthma and smoking. A significant reduction in use of antibiotic and antihistaminics was seen post surgery. Seven patients who had extensive polyposis preoperatively, had recurrence and required revision surgery. Nasal synechiae formation and mild bleeding were the minor complications.

Conclusion

Endoscopic sinus surgery results in significant improvement in the symptoms of patients with CRS alongwith a definitive decrease in antibiotic and antihistaminic requirement. We conclude that ESS is an effective treatment for CRS in those who fail to respond to medical treatment.Key Words: Chronic rhinosinusitis, Endoscopic sinus surgery     

Impairment of methionine sulfoxide reductase during UV irradiation and photoaging

During chronic UV irradiation, which is part of the skin aging process, proteins are damaged by reactive oxygen species resulting in the accumulation of oxidatively modified protein. UV irradiation generates irreversible oxidation of the side chains of certain amino acids resulting in the formation of carbonyl groups on proteins. Nevertheless, certain amino acid oxidation products such as methionine sulfoxide can be reversed back to their reduced form within proteins by specific repair enzymes, the methionine sulfoxide reductases A and B. Using quantitative confocal microscopy, the amount of methionine sulfoxide reductase A was found significantly lower in sun-exposed skin as compared to sun-protected skin. Due to the importance of the methionine sulfoxide reductase system in the maintenance of protein structure and function during aging and conditions of oxidative stress, the fate of this system was investigated after UVA irradiation of human normal keratinocytes. When keratinocytes are exposed to 15 J/cm(2) UVA, methionine sulfoxide reductase activity and content are decreased, indicating that the methionine sulfoxide reductase system is a sensitive target for UV-induced inactivation.     

Angiographic morphology impacts outcomes in STEMI patients with LAD occlusion

Objectives and background: Acute proximal occlusion of the left anterior descendent coronary artery (LAD) is a critical medical condition often leading to heart failure and death. Our objective was to investigate how additional angiographic findings might influence prognosis. Methods: In a single center setting by using consecutive data from the Swedish angiography and angioplasty registry (SCAAR), we identified all patients with acute myocardial infarction (AMI) related to the proximal LAD referred for primary coronary angioplasty. Clinical and angiographic data were collected from January 2004 to December 2008. Results: In the study period, 359 patients (mean age 67.9 ± 12.3 years, 111 women) were identified as having proximal LAD‐related culprit lesion. Follow‐up was up to 5.5 years. Compared to patients with LAD occlusion only, having both a small conus branch (<0.5 mm in diameter) and an occluded first septal perforator was associated with increased risk of death after adjustment for age, diabetes mellitus and prior AMI (hazard ratio 4.5, 95% CI; 1.1–18, P = 0.033). A small conus branch in itself was not important. Multivessel coronary artery disease in addition to occlusion of the first septal perforator branch and having a small conus branch was also associated with increased risk of death (hazard ratio 5.2, 95% CI; 1.3–20), P = 0.018). Conclusions: In patients with STEMI because of a proximal LAD lesion treated by primary PCI, the combination of a small conus branch and an occluded first septal perforator branch is associated with a poorer outcome. Additional presence of multivessel coronary artery disease further aggravates outcome. © 2010 Wiley‐Liss, Inc.