Endoscopic sinus surgery in individuals with facial pain due to chronic maxillary sinusitis ? a functional controlled study

Objective: To measure the intra-sinus pressure and the maxillary sinus functional efficiency (MSFE) in individuals with chronic facial pain after conservative or conventional endoscopic maxillary surgery, as well as in controls. Method: Sinus manometry was performed 5 times during inhalation. Results: The resemblance of pressure values comparing those treated with minimally invasive surgery and controls was remarkable, while traditional surgery significantly decreased intrasinusal pressures. The MSFE was 100% in the three tested times for controls, close to that in those submitted to minimally invasive surgery (98.3%, 98.8%, and 98.0%) and significantly impaired after conventional surgery (48.8%, 52.1%, 48.5 %, p<0.01). All patients submitted to minimally invasive surgery remained pain-free after three months of surgery, relative to 46.7% of the submitted to conventional surgery (p<0.05). Conclusion: Minimally invasive sinus surgery is associated with functionality of the chambers that resemble what is found in normal individuals

The Biometeorology of COVID-19: A Novel Therapeutic Strategy?

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Magnetic resonance imaging in the pre-operative evaluation of obstructive epiphora: true-FISP and VIBE vs gadolinium

Purpose: To assess unenhanced magnetic resonance imaging (MRI) in the preoperative evaluation of obstructive epiphora in patients undergoing dacryocystorhinostomy (DCR) and in particular, to evaluate the efficacy of this technique in the detection of the exact level of obstruction occurring in the naso-lachrymal duct (NLD). The correct identification and characterization of the NLD and its obstructions lead to a more effective surgery, preventing recurrent dacryocystitis after the surgical treatment. Methods: From January 2009 to December 2014, 127 obstructive epiphoras were diagnosed and treated in 127 patients (35 M, 92 F; mean age 60.7 ± 7.48 years, range 42–75 years) with endoscopic DCR, in a IRB-approved protocol. To precisely define the morphology of the NLD and the site of obstruction, some of these patients (67/127) underwent unenhanced 1.5-T MR with TrueFISP and VIBE sequences, while the remaining (60/127) underwent Gadolinium-enhanced 1.5-T MR. Afterwards, surgery checked the real site of obstruction in both groups of patients (enhanced and unenhanced MR), with surgical outcomes matched with previous MR reports. Results: In all cases, unenhanced MRI was able to detect the exact site of obstruction along the NLD, allowing a correct planning of surgical endoscopic procedures. On the contrary, enhanced MRI wrongly diagnosed six patients with proximal stenosis (6/60, 10.0%) as intermediate NLD obstruction. Unenhanced MRI was found to be more accurate than enhanced MRI with a statistical significant difference (p value = 0.0256) and obviously cheaper and easier to perform. All imaging reports were verified with surgery. The correct identification of the level of obstruction allowed successful surgery in around 73% (93/127) of patients, who had no recurrence during 6-month follow-up. Conclusion: In patients with epiphora, unenhanced MR showed to be highly reliable and even more effective than enhanced MR in the preoperative characterization of NLD stenosis, with no need of performing complex, time-wasting and expensive procedures for the administration of topical contrast media