Multicenter Observational Study to Evaluate the Diagnostic Value of Sonography in Patients with Chronic Rhinosinusitis

(1) Background: Computed tomography (CT) is considered mandatory for assessing the extent of pathologies in the paranasal sinuses (PNS) in chronic rhinosinusitis (CRS). However, there are few evidence-based data on the value of ultrasound (US) in CRS. This multicenter approach aimed to compare diagnostic imaging modalities in relation to findings during surgery. (2) Methods: 127 patients with CRS were included in this prospective multicenter study. Patients received preoperative US and CT scans. The sensitivity and specificity of CT and US were extrapolated from intraoperative data. (3) Results: CT scans showed the highest sensitivity (97%) and specificity (67%) in assessing CRS. Sensitivities of B-scan US were significantly lower regarding the maxillary sinus (88%), the ethmoid sinus (53%), and the frontal sinus (45%). The highest overall sensitivity was observed for assessing the pathology of the maxillary sinus. (4) Conclusions: We observed high accuracy with CT, confirming its importance in preoperative imaging in CRS. Despite the high US expertise of all investigators and a standardized examination protocol, the validity of CT was significantly higher than US. Ultrasound of the PNS sinuses is applicable in everyday clinical practice but lacks diagnostic accuracy. Nevertheless, it might serve as a complementary hands-on screening tool to directly correlate the clinical findings in patients with PNS disease

Multicenter observational study to evaluate the diagnostic value of sonography in patients with chronic rhinosinusitis

(1) Background: Computed tomography (CT) is considered mandatory for assessing the extent of pathologies in the paranasal sinuses (PNS) in chronic rhinosinusitis (CRS). However, there are few evidence-based data on the value of ultrasound (US) in CRS. This multicenter approach aimed to compare diagnostic imaging modalities in relation to findings during surgery. (2) Methods: 127 patients with CRS were included in this prospective multicenter study. Patients received preoperative US and CT scans. The sensitivity and specificity of CT and US were extrapolated from intraoperative data. (3) Results: CT scans showed the highest sensitivity (97%) and specificity (67%) in assessing CRS. Sensitivities of B-scan US were significantly lower regarding the maxillary sinus (88%), the ethmoid sinus (53%), and the frontal sinus (45%). The highest overall sensitivity was observed for assessing the pathology of the maxillary sinus. (4) Conclusions: We observed high accuracy with CT, confirming its importance in preoperative imaging in CRS. Despite the high US expertise of all investigators and a standardized examination protocol, the validity of CT was significantly higher than US. Ultrasound of the PNS sinuses is applicable in everyday clinical practice but lacks diagnostic accuracy. Nevertheless, it might serve as a complementary hands-on screening tool to directly correlate the clinical findings in patients with PNS disease

Detection of occult carcinomatous diffusion in lymph nodes from head and neck squamous cell carcinoma using real-time RT–PCR detection of cytokeratin 19 mRNA

The aim of the present study was to evaluate the occult lymph node carcinomatous diffusion in head and neck squamous cell carcinoma (HNSCC). A total of 1328 lymph nodes from 31 patients treated between 2004 and 2005 were prospectively evaluated by routine haematoxylin–eosin–safran (HES) staining, immunohistochemistry (IHC) and real-time Taqman reverse–transcriptase polymerase chain reaction (real-time RT–PCR) assay. Amplification of cytokeratin 19 (CK19) mRNA transcripts using real-time RT–PCR was used to quantify cervical micrometastatic burden. The cervical lymph node metastatic rates determined by routine HES staining and real-time RT–PCR assay were 16.3 and 36.0%, respectively (P<0.0001). A potential change in the nodal status was observed in 13 (42.0%) of the 31 patients and an atypical pattern of lymphatic spread was identified in four patients (12.9%). Moreover, CK19 mRNA expression values in histologically positive lymph nodes were significantly higher than those observed in histologically negative lymph nodes (P<0.0001). These results indicate that real-time RT–PCR assay for the detection of CK19 mRNA is a sensitive and reliable method for the detection of carcinomatous cells in lymph nodes. This type of method could be used to reassess lymph node status according to occult lymphatic spread in patients with HNSCC

Epistaxis - eine häufig unterschätzte mitunter lebensbedrohliche Erkrankung

Hintergrund: Epistaxis ist einer der häufigsten Notfälle in der HNO. Die Ursachen von Epistaxis sind vielfältig und die Ausprägung reicht von der spontan sistierenden bis hin zur lebensbedrohlichen Blutung. Durch die breite Anwendung von Antikoagulantien (DOAK) ist die Inzidenz ansteigend.Patienten und Methoden: Im Zeitraum von Januar bis November 2016 wurden 1068 Patienten mit akuter Epistaxis behandelt. Bei zwei dieser Patienten (0,2 %) kam es zu einem letalen Verlauf (ein Patient mit hämorrhag. Schock bei Einlieferung; eine 90 jährige Patientin entwickelte trotz intensivmed. Behandlung ein Multiorganversagen). Bei beiden Patienten bestand eine post. Epistaxis, welche mittels Nasentamponade nicht suffizient beherrscht werden konnte. Am Aufnahmetag waren beide bereits in einem extrem reduz. AZ mit Zeichen einer anämischen Hypoxie. Beide Patienten wiesen multiple kardiovaskuläre Vorerkrankungen (VE) auf und standen unter DOAK mit Marcumar.Ergebnis: Da es derzeit keine wissenschaftl. Leitlinie zur Therapie der Epistaxis gibt, sahen wir die dargestellten Fälle als Anlass für die Erstellung eines hausinternen Algorithmus zur Therapie akuter Epistaxis. Ziel des Algorithmus ist es Hochrisikopatienten zu selektieren. Patienten mit post. Blutung, kardiovask. VE und instabilen Vitalparametern benötigen eine engmaschige, monitorgestützte Überwachung und bei Zeichen von anämischer Hypoxie die frühzeitige Transfusion von Erythrocytenkonzentraten. Die Indikation der operativen Blutstillung ist in diesen Fällen großzügig zu stellen.Schlussfolgerung: Epistaxis ist, wenngleich oftmals eine Bagatelle, gerade bei älteren, multimorbiden und unter DOAK stehenden Patienten, eine ernstzunehmende, lebensbedrohliche Akutsituation, die einer sofortigen und mitunter interdisziplinären Therapie bedarf.Der Erstautor gibt keinen Interessenkonflikt an