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18 Nasal polyps recurrence interval: Comparing surgical and medical treatment
VOLUME NUMBER
17
Abstracts
87 1. PART 2
HypcdMIA M.D..
B.J.
cnwart.
. K. FlvnnF&D.. S.J,
19
The asscciatial betwell hypaapiad (1) In allergicrhinitis (AR) wa8 srarmned: 134patientswivlARsyllptomsaIxl68ncmat&c antrols, olfactorythzshold for ~alcd-lolwasassess&. AR patie ~tedsignificz3ntlyhigherthresholds than ocmtr0l.s (g = .OO2). Of AR patients, 17% suffered a clinically significant snell loss txmpar& with 3% of axltrols. (2) lbtal nasal resistance (t3lR) has lneasuredin91AR p&i&and 62 ccntxols. patientswith elevated tNFt (> .35 pascdls/ml/sec) were nmre likslytbnatherARpatientstobehyposaic, but this relaticmship fell short of statistical siqnificaxe (B < .07). Of hypoenicpatieIb,53%hadelevatedtNR oxpared witi 29% of 1lorm0QRic patients axl 6.5% of ccprtrols. (3) Eiat of 23 hyposnic patients (35%) wsre niagnosed with sinusitis, and6recaverednormalolfactionwtEntreated withanantimicrobial. We am2luSe that: (1) AR patients exhibit olfactory ssnsitivity significantly B relative to mmic subjects. (2) Nasal ckdmctim alone cannot fully acc4xnt for (3) Sinusitis may play a role in this loss. thehyposniafanxlinAR,whichmaybe revex&byappxpriatetreab~~~~~&
18
fws%PCCYPSm
IMWVAL:
cmmwllrc;
SIR-
GIWAbDf~ICALTl?EATMNT.Gn/A.Setti~, M.D.. Donald E. Klein. M.D., & Robed J. Setti.~, M.D., Rovidence, F&K& Island Theprposeof this study istodetennine the rw interval of nasal polyps foLLu&ng su-gical polypedomy~ed to the-interval following a 12-day CDuse of oral predni-.INeinterviewed39patientstitt, nasal polypsfrancu-aFficeandtheF?hodelsLandtbspita1 Allergy Clinic. A history of surgical pdypectony was verified by the operative rejxrt. Frecipitating factors for polyp w were -respiratory infectLax ardseasona L factors in pollen-sensitive patients. ALL new patients vvitt~ acute pelvis initially given a de-. creasingprechisone bLTstbegimingat6&g,terminating in 12 days. Steroid failu-es ware referredfcr su-gical poLypectony.h+airrt~ therapy incLu&dtcpicaL -1 steroids. Theinterval of -enwe in 29su-gicaLLy treated patients wa5 6.3 years (range l-24 y-s). The ecu-t-interval followi~a~scx-ie ztrws 0.9 yea-s (range 0.2-7 yrs). Sug~caLLy treated patients with aspirin intolerance had a ecu-rinterval, 3.7 yshorter-r (v 1-5~) thanother su-gically treated patients.. ALthou& Less b-aumtLc, medical polyPectomy LS mte3s effectiveas surgical polypectanyas far asint-Lofrearrenceiscancenred.usingthep-esent treatment. Patients withaspirin irrtoler-haveashorterrearr-period.
143
COMPARISONOF CEFIXIME QD AND AMOXICILLIN TID FOR ACUTE SINUSITIS. S. Avner, M.D., J. Buckley, M.D., D. Pearlman, M.D., and J. Vitanza, M.D., Aurora, CO. We compared the efficacy and safety of cefixime (cef) to amoxicillin (amox) for treatment of acute sinusitis. Adults (ages 18-84 y; mean 39.9 y) who had clinical and x-ray evidence of acute maxillary sinusitis were randomized to receive cef 400mg qd (n=16) or amox 500mg tid (n=l9) for 9-19 days. Patients had either mucosal thickening greater than 5mm (29%), opacification (40%), or an air-fluid level (31%) of at least one sinus. They underwent antral tap with aspiration for culture and sensitivity. Patients placed on amox who had resistant pathogens were switched to AugmentinR (Aug) (n=3). A fourth patient was changed to Aug prophylactically after facial cellulitis developed following the tap. Eighty-three percent of aspirates had positive cultures, but only 55% of these were considered pathogens. All patients, except one who received amox, were improved clinically at the end of therapy. The group on ccf had a greater number of complete clinical cures (56%) than those on amox/Aug (37%), despite an equivalent average number of days on therapy. Fifty three percent on cef and 68% on amox/Aug had x-ray improvement at follow-up, with the remainder showing no improvement or worsening. Fortyone percent on cef and 33% on amox/Aug had side effects. These were generally GI-related in both groups and were not severe; however, one patient on cef developed antibiotic induced colitis which was treated successfully. Once daily cef appears to be as safe and effective as amox tid for treating acute sinusitis.
20 ALLERGIC FUNGAL SINUSITIS [AFSI IN A PATIENT THE FIRST REPORTED WITH CYSTIC FIBROSIS [CF]. M.D., CA Syms III, M.D., NL CASE. AF Bitner, San Schweitz, M.D., Jorgensen, M.D., LA Antonio, Texas to be complicated by CF his been found Allergic Bronchopulmonary Aspergillosis [ABPAI AFS, a recently characterin 10-15X of cases. is pathophysiologically ized allergic disease, similar to ABPA. Four and histologically been reported who had patients [pts] have concurrent ABPA and AFS. We present the first reported case of a CF pt with AFS. L.J. is a 30 year old white female with CF complicated by chronic sinusitis and CT scan showed soft tissue nasal polyposis. densities filling the maxillary and ethmoid sinuses. Multiple mold skin tests were positive. Functional endoscopic sinus IgE was 192 IU/ml. revealed pansinusitis, polyposis and surgery mucus. Histopathological thick inspissated examination revealed typical allergic mucin with eosinophils, Charcot-Leyden crystals, and AsperThere was no tissue gillus hyphae on GMS stain. Invasion. Fungal culture from the ethmoid sinus post-surgically revealed Aspergillus terreus. specimens from 6 the pathologic We reviewed pts with CF who underwent sinus surgery over the Three pts had past 3 years at our institution. of focal eosinophilic infiltrates but areas lacked the typical allergic mucin. CF and allergic fungal disease of the pulSimilar pathomonary system are associated. physiology may predispose CF pts to both ABPA and AFS. Increased awareness of this possibility if an association between should help determine CF and AFS exists.
17
Abstracts
87 1. PART 2
HypcdMIA M.D..
B.J.
cnwart.
. K. FlvnnF&D.. S.J,
19
The asscciatial betwell hypaapiad (1) In allergicrhinitis (AR) wa8 srarmned: 134patientswivlARsyllptomsaIxl68ncmat&c antrols, olfactorythzshold for ~alcd-lolwasassess&. AR patie ~tedsignificz3ntlyhigherthresholds than ocmtr0l.s (g = .OO2). Of AR patients, 17% suffered a clinically significant snell loss txmpar& with 3% of axltrols. (2) lbtal nasal resistance (t3lR) has lneasuredin91AR p&i&and 62 ccntxols. patientswith elevated tNFt (> .35 pascdls/ml/sec) were nmre likslytbnatherARpatientstobehyposaic, but this relaticmship fell short of statistical siqnificaxe (B < .07). Of hypoenicpatieIb,53%hadelevatedtNR oxpared witi 29% of 1lorm0QRic patients axl 6.5% of ccprtrols. (3) Eiat of 23 hyposnic patients (35%) wsre niagnosed with sinusitis, and6recaverednormalolfactionwtEntreated withanantimicrobial. We am2luSe that: (1) AR patients exhibit olfactory ssnsitivity significantly B relative to mmic subjects. (2) Nasal ckdmctim alone cannot fully acc4xnt for (3) Sinusitis may play a role in this loss. thehyposniafanxlinAR,whichmaybe revex&byappxpriatetreab~~~~~&
18
fws%PCCYPSm
IMWVAL:
cmmwllrc;
SIR-
GIWAbDf~ICALTl?EATMNT.Gn/A.Setti~, M.D.. Donald E. Klein. M.D., & Robed J. Setti.~, M.D., Rovidence, F&K& Island Theprposeof this study istodetennine the rw interval of nasal polyps foLLu&ng su-gical polypedomy~ed to the-interval following a 12-day CDuse of oral predni-.INeinterviewed39patientstitt, nasal polypsfrancu-aFficeandtheF?hodelsLandtbspita1 Allergy Clinic. A history of surgical pdypectony was verified by the operative rejxrt. Frecipitating factors for polyp w were -respiratory infectLax ardseasona L factors in pollen-sensitive patients. ALL new patients vvitt~ acute pelvis initially given a de-. creasingprechisone bLTstbegimingat6&g,terminating in 12 days. Steroid failu-es ware referredfcr su-gical poLypectony.h+airrt~ therapy incLu&dtcpicaL -1 steroids. Theinterval of -enwe in 29su-gicaLLy treated patients wa5 6.3 years (range l-24 y-s). The ecu-t-interval followi~a~scx-ie ztrws 0.9 yea-s (range 0.2-7 yrs). Sug~caLLy treated patients with aspirin intolerance had a ecu-rinterval, 3.7 yshorter-r (v 1-5~) thanother su-gically treated patients.. ALthou& Less b-aumtLc, medical polyPectomy LS mte3s effectiveas surgical polypectanyas far asint-Lofrearrenceiscancenred.usingthep-esent treatment. Patients withaspirin irrtoler-haveashorterrearr-period.
143
COMPARISONOF CEFIXIME QD AND AMOXICILLIN TID FOR ACUTE SINUSITIS. S. Avner, M.D., J. Buckley, M.D., D. Pearlman, M.D., and J. Vitanza, M.D., Aurora, CO. We compared the efficacy and safety of cefixime (cef) to amoxicillin (amox) for treatment of acute sinusitis. Adults (ages 18-84 y; mean 39.9 y) who had clinical and x-ray evidence of acute maxillary sinusitis were randomized to receive cef 400mg qd (n=16) or amox 500mg tid (n=l9) for 9-19 days. Patients had either mucosal thickening greater than 5mm (29%), opacification (40%), or an air-fluid level (31%) of at least one sinus. They underwent antral tap with aspiration for culture and sensitivity. Patients placed on amox who had resistant pathogens were switched to AugmentinR (Aug) (n=3). A fourth patient was changed to Aug prophylactically after facial cellulitis developed following the tap. Eighty-three percent of aspirates had positive cultures, but only 55% of these were considered pathogens. All patients, except one who received amox, were improved clinically at the end of therapy. The group on ccf had a greater number of complete clinical cures (56%) than those on amox/Aug (37%), despite an equivalent average number of days on therapy. Fifty three percent on cef and 68% on amox/Aug had x-ray improvement at follow-up, with the remainder showing no improvement or worsening. Fortyone percent on cef and 33% on amox/Aug had side effects. These were generally GI-related in both groups and were not severe; however, one patient on cef developed antibiotic induced colitis which was treated successfully. Once daily cef appears to be as safe and effective as amox tid for treating acute sinusitis.
20 ALLERGIC FUNGAL SINUSITIS [AFSI IN A PATIENT THE FIRST REPORTED WITH CYSTIC FIBROSIS [CF]. M.D., CA Syms III, M.D., NL CASE. AF Bitner, San Schweitz, M.D., Jorgensen, M.D., LA Antonio, Texas to be complicated by CF his been found Allergic Bronchopulmonary Aspergillosis [ABPAI AFS, a recently characterin 10-15X of cases. is pathophysiologically ized allergic disease, similar to ABPA. Four and histologically been reported who had patients [pts] have concurrent ABPA and AFS. We present the first reported case of a CF pt with AFS. L.J. is a 30 year old white female with CF complicated by chronic sinusitis and CT scan showed soft tissue nasal polyposis. densities filling the maxillary and ethmoid sinuses. Multiple mold skin tests were positive. Functional endoscopic sinus IgE was 192 IU/ml. revealed pansinusitis, polyposis and surgery mucus. Histopathological thick inspissated examination revealed typical allergic mucin with eosinophils, Charcot-Leyden crystals, and AsperThere was no tissue gillus hyphae on GMS stain. Invasion. Fungal culture from the ethmoid sinus post-surgically revealed Aspergillus terreus. specimens from 6 the pathologic We reviewed pts with CF who underwent sinus surgery over the Three pts had past 3 years at our institution. of focal eosinophilic infiltrates but areas lacked the typical allergic mucin. CF and allergic fungal disease of the pulSimilar pathomonary system are associated. physiology may predispose CF pts to both ABPA and AFS. Increased awareness of this possibility if an association between should help determine CF and AFS exists.