Sinusitis, treatment

A 56-year-old chronic intranasal cocaine abuser with a visible nasal defect presented with a hole in the roof of his mouth. He had been reportedly drug free for 2 weeks. He had an oronasal fistula with adjacent black necrotic areas and erosive destruction of the nasal septum, turbinates, and antrum, with mucoperiosteal thickening of the sphenoid and maxillary sinuses. Treatment included antibiotics and a prosthesis plate construction... 

Other Infections. The slowly excreted sulfonamides (eg, sulfamethoxypyrida2ine, sulfadimethoxine) are used for treatment of minor infections such as sinusitis or otitis, or for prolonged maintenance therapy. Soluble sulfonamides are sometimes used for proto2oal infections in combination with other agents. Pyrimethamine, combined with sulfonamides, has been used for toxoplasmosis or leishmaniasis, and trimethoprim with sulfonamides has been used in some types of malaria. In nocardiosis, sulfonamides have been used with cycloserine [68-41-7] (17). 

Rhinitis is characterized by nasal stuffiness with partial or full obstmction, and itching of the nose, eyes, palate, or pharynx, sneezing, and rhinorrhoea. If left untreated it can lead to more serious respiratory diseases such as sinusitis or asthma. Although several types of dmgs are available for treatment, nasal spray topical corticosteroids are widely regarded as the reference standard in rhinitis therapy (250). 

Class IV antiarrhythmic drugs are Ca2+ channel blockers, which predominantly slow sinus rate and atrioventricular conduction and thus are used in the treatment of supraventricular tachyarrhythmias. These drugs exert a pronounced negative inotropic effect. 

Einhaupl KM, Villringer A, Meister W, Mehraein S, Garner C, PeUkofer M, Haberl RL, Pfister HW, Schiedek P. Heparin treatment in sinus venous thrombosis. Lancet 1991 338 597-600. 

Tsai FY, Wang AM, Matovich VB, Lavin M, Berberian B, Simonson TM, Yuh W. MR staging of acute dural sinus thrombosis correlation with venous pressure measurements and implications for treatment and prognosis. Am J Neuroradiol 1995 16 1021-1029. 

Horowitz M, Purdy P, Unwin H, Carstens G, Greenlee R, Hise J, Kopitnik T, Batjer H, Rollins N, Samson D. Treatment of dural sinus thrombosis using selective catheterization and urokinase. Ann Neurol 1995 38 58-67. 

Di Rocco C, lannelli A, Leone G, Moschini M, Valori VM. Heparin-urokinase treatment in aseptic dural sinus thrombosis. Arch Neurol 1981 38 431 35. 

Holder CA, Bell DA, Lundell AL, Ulmer JL, Glazier SS. Isolated straight sinus and deep cerebral venous thrombosis successful treatment with local infusion of urokinase. J Neurosurgery 1997 86 704-707. 

Smith TP, Higashida RT, Barnwell SL, Halbach VV, Dowd CF, Fraser KW, Teitelbaum GP, Hieshima GB. Treatment of dural sinus thrombosis by urokinase infusion. Am J Neuroradiol 1994 15 801-807. 

Compare and contrast appropriate nonpharmacologic and pharmacologic treatment options for sinus bradycardia and AV nodal blockade. 

Design individualized drug therapy treatment plans for patients with (1) sinus bradycardia (2) AV nodal blockade (3) AF (4) PSVT (5) VPDs (6) VT (including torsades de pointes) and (7) VF. 

Many individuals, particularly those who partake in regular vigorous exercise, have heart rates less than 60 bpm. For those individuals, sinus bradycardia is normal and healthy, and does not require evaluation or treatment. However, some individuals develop symptomatic sinus node dysfunction. In the absence of correctable underlying causes, idiopathic sinus node dysfunction is referred to as sick sinus syndrome,12 and occurs with greater frequency with advancing age. The prevalence of sick sinus syndrome is approximately 1 in 600 individuals over the age of 65 years.12... 

Treatment of sinus bradycardia is only necessary in patients who become symptomatic. If the patient is taking any med-ication(s) that may cause sinus bradycardia, the drug(s) should be discontinued whenever possible. If the patient remains in sinus bradycardia after discontinuation of the drug(s) and after five half-lives of the drug(s) have elapsed, then the drugs(s) can usually be excluded as the etiology of the arrhythmia. In certain circumstances, however, discontinuation of the medication(s) may be undesirable, even if it may be the cause of symptomatic sinus bradycardia. For example, if the patient has a history of myocardial infarction or HF, discontinuation of a (3-blocker is undesirable, because (3-blockers have been shown to reduce mortality and prolong life in patients with those diseases, and the benefits of therapy with... 

The desired outcomes for treatment are to restore normal sinus rhythm and alleviate patient symptoms. 

Acute treatment of patients with second- or third-degree AV nodal blockade consists primarily of administration of atropine, which maybe administered in the same doses as recommended for management of sinus bradycardia. In patients with hemodynamically unstable or severely symptomatic AV nodal blockade that is unresponsive to atropine and in whom temporary or transvenous pacing is not available or is ineffective, epinephrine (2 to 10 mcg/minute, titrate to response) and/or dopamine (2 to 10 mcg/kg/minute) maybe administered.14... 

The desired outcomes for treatment are to terminate the arrhythmia, restore sinus rhythm, and prevent recurrence. Drug therapy is employed to terminate the arrhythmia and restore sinus rhythm nonpharmacologic measures are employed to prevent recurrence. 

Sinusitis, or inflammation of the paranasal sinuses, is better described as rhinosinusitis that also involves inflammation of contiguous nasal mucosa, which occurs in virtually all cases of viral respiratory infections. Acute rhinosinusitis is characterized by symptoms that resolve completely in less than 4 weeks, whereas chronic rhinosinusitis typically persists as cough, rhi-norrhea, or nasal obstruction for more than 90 days. Acute bacterial rhinosinusitis (ABRS) refers to an acute bacterial infection of the sinuses that can occur independently or be superimposed on chronic sinusitis. The focus of this section will be on ABRS and appropriate treatment. 

Although many clinical studies have been performed evaluating antibiotics for ABRS, no randomized, double-blind, placebo-controlled studies have used pre- and posttreatment sinus aspirate cultures as an outcome measure. Despite this, antibiotics appear to resolve symptoms more quickly and reduce failure rates and complications compared with no treatment.35-37 Since diagnosis usually is based on clinical presentation and not sinus aspirate cultures, clinicians must attempt to differentiate ABRS from viral rhinosinusitis. Therefore, it is important to limit antibiotic use to cases where infection is unlikely to resolve without causing prolonged disease patients with mild to moderate symptoms that persist for 10 days or worsen over 5 to 7 days and patients with severe symptoms,31,34... 

Treatment guidelines developed by the Sinus and Allergy Health Partnership reflect antibiotic choices that are likely to result in favorable clinical and bacteriologic outcomes based on pathogen distribution, spontaneous resolution rates, and nationwide resistance patterns.310 These guidelines (Figs. 69-3 and 69-4) stratify therapy based on severity of disease and risk of infection with resistant organisms, defined as mild disease in patients with prior antibiotic use within 4 to 6 weeks. Other risk factors for resistance include day-care attendance or frequent... 

Ioannidis JP, Lau J. Technical report Evidence for the diagnosis and treatment of acute uncomplicated sinusitis in children—A systematic overview. Pediatrics 2001 108(3) e57. 

There are certain histologic subtypes of diffuse, aggressive NHL that respond less well to treatment with conventional regimens such as CHOP. Burkitt s lymphoma, lymphoblastic lymphoma, mantel cell lymphoma, and primary CNS lymphoma are examples of disease that benefit from more intensive therapy. Regimens such as hyper-CVAD, which alternate cycles of hyperfractionated cyclophosphamide, doxorubicin, vincristine, and dexamethasone with high-dose cytarabine and methotrexate, often are substituted for CHOP. Intrathecal therapy with methotrexate is indicated with documented CNS infiltration of tumor or involvement of the sinuses. The recent appreciation of the etiology of Helicobacter pylori in the etiology of peptic ulcer disease and the association between colonization and mucosal-associated lymphoma (MALT) has spurred... 

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