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1

Filho, Bernardo Cunha Araújo. "Estudo da anatomia do seio esfenoidal através da dissecção endoscópica em cadáveres." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/5/5143/tde-10072008-160428/.

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Introdução: O seio esfenoidal apresenta relações anatômicas extremamente importantes com estruturas neurovasculares. Estas podem apresentar diversas variações, tornando as suas relações com seio esfenoidal bastante complexas e potencialmente associadas a graves lesões durante sua abordagem. Objetivo: O objetivo deste estudo prospectivo foi descrever, através da dissecção endoscópica em cadáveres, os detalhes das variações anatômicas do SE, avaliando a concordância entre os lados e as diferenças dessas variações entre o gênero e a cor da pele. Casuística e Métodos: Quarenta e cinco cadáveres (90 fossas nasais) de ambos os sexos com idade no óbito entre 30 e 83 anos foram submetidos à dissecção endoscópica meticulosa do seio esfenoidal. A distância da parede anterior do SE à espinha nasal anterior; a localização e o formato do óstio do SE, o grau de pneumatização do SE, a presença de células de Onodi, a dominância entre os lados, a inserção de septo interssinusal e de cristas, a presença de proeminências e/ou deiscências da artéria carótida interna, do nervo óptico, do nervo maxilar e do nervo vidiano, assim como a presença de recessos óptico-carotídeo, pterigóide e lateral foram descritos. As prevalências foram comparadas entre o gênero e diferentes cor da pele. Também foi analisada a simetria entre os lados direito e esquerdo. Resultados: O óstio estava localizado medialmente à inserção póstero-inferior da concha superior em 85,6% das fossas nasais estudadas e em 50% apresentava-se com formato arredondado. A distância média do óstio do seio esfenoidal à espinha nasal anterior foi de 68 mm (+- 4,6mm) para ambos os lados. Não havia dominância dos lados direito ou esquerdo em 21 (46,7%) dos cadáveres. Em 17 cadáveres (37,8%) o seio esquerdo se apresentou mais pneumatizado e em 7 (15,6%), o seio esfenoidal direito apresentou dominância em relação ao esquerdo. O tipo selar foi o mais prevalente (53%) seguido do pré-selar (38%). O recesso mais prevalente foi o pterigóide (47,8%). As cristas estivaram presentes em 22,7% dos lados. O septo intersinusal se inseriu no trajeto da artéria carótida interna e do nervo óptico, respectivamente, em 16,7% e 2,2%. A artéria carótida interna esteve proeminente em 48,9% e deiscente em 31,1% das fossas estudadas. O nervo óptico estava proeminente e deiscente em 35,6% e 8,9%, respectivamente. O nervo vidiano foi a estrutura com proeminência mais prevalente (50%). O nervo maxilar esteve deiscente em 5,6% dos lados estudados. Uma célula de Onodi esteve presente em 23 (25,6%) dos lados dissecados. A análise da simetria mostrou concordância perfeita com relação ao grau de pneumatização e se apresentou bastante variável de acordo com a estrutura estudada. Cadáveres do sexo feminino apresentaram de forma estatisticamente significante maior prevalência de deiscência de carótida interna (p=0,002) e do nervo maxilar (p=0,02), assim como proeminência do nervo óptico (p < 0,001). Conclusão: Os dados demonstram a complexa anatomia interna do seio esfenoidal, e o conhecimento desta anatomia é de grande importância para evitar as potenciais complicações cirúrgicas nesta região.<br>Introduction: There are extremely important anatomic relationships between the sphenoid sinus (SS) and neurovascular structures. These structures may have several anatomic variations, which makes their relationship with the sphenoid sinus complex and carries risks of severe injuries during surgery. Objective: This prospective study used endoscopic cadaver dissection to describe details of SS anatomic variations and to evaluate agreement between sides and differences between sexes and ethnic groups. Casuistic and Methods: Fourty-five cadavers (90 nasal fossae) of both sexes ageing between 30 and 83 years underwent careful dissection of the sphenoid sinus. Distance from the SS anterior wall to the anterior nasal spine, the position and shape of the SS, the degree of SS pneumatization, the presence of Onodi cells, the dominance between sides, the insertion of the intersinus septum and crests, the presence of dehiscence and protrusions of the internal carotid artery (ICA), optic nerve (ON), maxillary and vidian nerves, and the presence of optic-carotid, pterygoid and lateral recesses were described. Data were analyzed according to sex, skin color and symmetry between nasal fossae of each cadaver. Results: Ostia were located medially to the posteroinferior insertion of the superior turbinate in 85.6% of the nasal fossae, and were circular in 50% of the cases. The mean distance from the ostium to the anterior nasal spine was 68 mm (+- 4.6 mm) for both sides. No dominance of right or left side was found in 21 (46.7%) of the cadavers. In 17 cadavers (37.8%), the left sinus was more pneumatized, and in 7 (15.6%), the right sphenoid sinus showed dominance over the left sinus. The sellar type was the most prevalent (53%), followed by the presellar type (38%). Pterygoid recesses were the most prevalent (47.8%). Crests were found in 22.7% of the sides. The intersinus septum was inserted on the course of the internal carotid artery and optic nerve in 16.7% and 2.2 % of the cases. ICA protrusions were found in 48.9% of the cases, and dehiscence in 31.1% of the fossae under study. Dehiscence and protrusion of the ON were found in 35.6% and 8.9% of the cases. The vidian nerve was the structure with the most prevalent protrusion (50%). Dehiscence over the maxillary nerve was found in 5.6% of the sides. Onodi cells were found in 23 (25.6%) of the dissected sides. The analysis of symmetry revealed perfect agreement of the degree of pneumatization and was greatly variable depending on the structure analyzed. Female cadavers had a statistically greater prevalence of dehiscence over the internal carotid artery (p = 0.002) and over the maxillary nerve (p = 0.02), as well as greater prevalence of optic nerve protrusion (p < 0.001). Conclusion: Our data showed that the SS internal anatomy is complex, and its knowledge is essential during surgical approaches to the sphenoid sinus.
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2

GIARRATANO, GABRIELLA. "Endoscopic Pilonidal Sinus Treatment (E.P.Si.T): a new minimally invasive technique for the treatment of sacrococcygeal pilonidal sinus." Doctoral thesis, Università degli Studi di Roma "Tor Vergata", 2014. http://hdl.handle.net/2108/211285.

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The present study analyzed the results of a new video-assisted minimally invasive technique for the treatment of sacrococcygeal pilonidal disease (E.P.Si.T: endoscopic pilonidal sinus treatment). From May 2013 to June 2015 a total of 85 consecutive patients (68M, 17F), mean age 27.5 years referred to our surgical department. 75 patients had a primary sacrococcygeal pilonidal sinus, 10 patients had a recurrent pilonidal sinus and all underwent to E.P.Si.T. A fistuloscope is introduced through the external opening and the sinus cavity is completely ablated under direct vision. Patients' postoperative complications, wound infection rate, recurrence rate, time until return to work and satisfaction score were recorded during follow-up or at the last interview. Clinical data were obtained at 7 days, 15 days, 30 days, 6 month and 12 months following surgery. RESULT: All patients were followed up. Mean operative time was 18 min (range 12-30 min). The mean hospital stay was 6,5h (range 5-9) and mean time to return to work was 5 days. Mean follow-up was 16,8 (range 4-29) months. Mean healing time was 32,7 days. There were no major complications and infection; 5 recurrences. Overall satisfactory rate 98%. CONCLUSION: The ideal surgical treatment for pilonidal sinus disease must be simple and effective. In our experience, E.P.Si.T can be performed as a day care surgery with early return to work. This technique is also associated with a low recurrence rate and postoperative morbidity rate and a good aesthetic result INTRODUCTION Pilonidal sinus (PS) is a common health problem of the sacrococcygeal region mainly in young men (1), it is associated with obesity, sedentary occupation, local irritation (2) and hirsutism (3). Actually PS is considered an acquired disease due to the obstruction of hair follicles in the natal cleft (4). The symptoms are variable, ranging from asymptomatic pits to acute abscess to chronic cyst. This pathology has an important impact in quality of life causing absenteeism from work and school. The surgical treatment of PS still remains challenging and a lot of surgical treatment have been proposed. Recurrence rates vary with the technique. The aims of treatment of PS are eradication of the sinus tract, complete healing, prevention of recurrence and a good aesthetic result. Open excision and healing by secondary intention is used in the treatment of PS but this technique offers a poor quality of life and close observation as reported in a lot of study (5). Several authors propose excision of PS with primary closure using different technique like midline closure or flap-based procedure (4). These surgical modalities have low rates or efficacy and a prolonged postoperative wound healing. Enriquez-Navascues et al. (6) in a meta-analysis reported recurrence for every surgical approach range from 0 to 40% and concluded that in the treatment of PS “less is more”. In the last years, some authors developed new minimally invasive technique in the treatment of PS: Gupta et al. (7) proposed radio-surgery, Isik et al. (8) used fibrin glue without surgery, Meinero et al. (9), in a small series, proposed the use of a fistuloscope with an operative channel to destroy the sinus cavity and sinus tracts under direct vision, Milone et al. (10) proposed a similar technique using a hysteroscope. The present observational prospective study analyzed the results of E.P.SI.T (Endoscopic Pilonidal Sinus treatment) technique in treating PS.
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3

Ali, Mahmoud El-Sayed. "Mucin gene expression in chronic sinusitis patients undergoing functional endoscopic sinus surgery." Thesis, University of Newcastle upon Tyne, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.246606.

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4

Castillo, Laurent. "Iatrogenie et complications de la chirurgie sinusienne endonasale per-endoscopique : prevention, reparation." Nice, 1991. http://www.theses.fr/1991NICE6841.

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5

Chen, Min Si. "Calibration and registration of an image enhanced surgical navigation system for endoscopic sinus surgery." Thesis, University of East Anglia, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.439900.

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6

Shaw, Chi-kee Leslie. "Evaluation of sheep model with regard to healing of nasal epithelium after endoscopic sinus surgery." Title page, contents and abstract only, 2001. http://web4.library.adelaide.edu.au/theses/09MS/09mss534.pdf.

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Bibliography: leaves 109-125. This thesis validated the use of sheep as a suitable animal model to study endoscopic sinus surgery (ESS) and to evaluate factors that may play a role in the healing of nasal epithelium after surgery. Nasal packing was shown to cause a significant injury and should be used by ESS surgeons with caution. Full-thickness wounds should be avoided in the nose where possible as the re-ciliation was significantly reduced when compared to partial-thickness wounds. In addition the healing of the nose took significantly longer than previously thought and was incomplete 84 days after surgery. Scanning electron microscopy was shown to be an important outcome measure for the healing of the nasal mucosa after ESS and a new technique for measuring the re-ciliation was validated.
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7

Georgel, Thomas Jankowski Roger. "Chirurgie endoscopique transnasale de l'adénocarcinome des travailleurs du bois." [S.l.] : [s.n.], 2007. http://www.scd.uhp-nancy.fr/docnum/SCDMED_T_2007_GEORGEL_THOMAS.pdf.

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8

Macdonald, Kristian I. "Development and Validation of an Administrative Data Algorithm to Identify Adults who have Endoscopic Sinus Surgery for Chronic Rhinosinusitis." Thesis, Université d'Ottawa / University of Ottawa, 2016. http://hdl.handle.net/10393/35148.

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Objective: 1) Systematic review on the accuracy of Chronic Rhinosinusitis (CRS) identification in administrative databases; 2) Develop an administrative data algorithm to identify CRS patients who have endoscopic sinus surgery (ESS). Methods: A chart review was performed for all ESS surgical encounters at The Ottawa Hospital from 2011-12. Cases were defined as encounters in which ESS for performed for Otolaryngologist-diagnosed CRS. An algorithm to identify patients who underwent ESS for CRS was developed using diagnostic and procedural codes within health administrative data. This algorithm was internally validated. Results: Only three studies meeting inclusion criteria were identified in the systematic review and showed inaccurate CRS identification. The final algorithm using administrative and chart review data found that encounters having at least one CRS diagnostic code and one ESS procedural code had excellent accuracy for identifying ESS: sensitivity 96.0% sensitivity, specificity 100%, and positive predictive value 95.4%. Internal validation showed similar accuracy. Conclusion: Most published AD studies examining CRS do not consider the accuracy of case identification. We identified a simple algorithm based on administrative database codes accurately identified ESS-CRS encounters.
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9

Khatri, Hershil. "Modelling the effects of middle meatal synechiae post-endoscopic sinus surgery using computational fluid dynamics (CFD) and virtual surgery." Thesis, The University of Sydney, 2022. https://hdl.handle.net/2123/29534.

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Chronic rhinosinusitis (CRS) is a common sinonasal condition carrying a significant disease burden. Functional endoscopic sinus surgery (FESS) is often indicated where medical management fails. Middle turbinate lateralisation and adhesion formation (MiTLAF) is a common cause of failed FESS. Various MiTLAF prevention techniques have been described in the literature; however, no studies objectively analyse the physiological sequelae. This thesis reviews the literature regarding MiTLAF prevention techniques to determine the most efficacious and safe technique(s). As a proof of concept, computational fluid dynamics (CFD) analysis was employed to model aerodynamic changes occurring in the presence of MT synechiae. Systematic review was performed following the PRISMA guidelines. The effects of post-operative MT synechiae on airflow velocity and streamlines, temperature, and relative humidity levels were done using CFD. A three-dimensional sinonasal model was segmented from the data, and virtual surgery was performed to simulate a full-house functional endoscopic sinus surgery. Multiple synechiae models were virtually created in locations to reflect those most commonly seen in clinical practice. CFD analysis was performed on each model, in comparison with a control model without synechiae. Mass-weighted averages for airflow velocity, relative humidity and mucosal temperature were recorded to assess for dynamic changes in the presence of synechiae. The reviewed literature suggests that silastic splints and conchopexy are most safe and effective in MiTLAF prevention. CFD analysis demonstrated aberrant downstream airflow in all models. There was reduced airflow and increased air temperature/humidity in ipsilateral frontal, ethmoid and sphenoid sinuses with increased airflow velocity and reduced air/mucosal surface temperature in a concentrated central “jet” in the middle meatus. Effects were more significant with larger synechia. Bulk inspired airflow at the nasopharynx was largely unaffected. These findings may explain the persistent symptoms seen in post-FESS CRS patients with MT synechiae and reinforce the importance of prevention and adhesiolysis. Further studies with multiple models of actual post-FESS patients with synechiae are required to validate these findings.
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Gröbner, Christina. "Untersuchungen zur Anwendung eines mechatronischen Endoskopmanipulators für die endoskopische Nasennebenhöhlenchirurgie." Doctoral thesis, Universitätsbibliothek Leipzig, 2015. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-179646.

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In dieser Arbeit wurde der Einsatz eines miniaturisierten Endoskop-Manipulator-Systems (EMS [TUM, MiMed, München]) in der endo- und transnasalen Chirurgie untersucht. In einem Modellversuch wurden an einem Nasennebenhöhlenmodell drei typische anatomische Landmarken je einmal manuell und zum Vergleich mit dem Endoskopmanipulator aufgesucht. Insgesamt wurden 240 Messwerte aufgenommen. Es wurden die benötigten Zeiten und die Genauigkeit der Endoskopposition gemessen. Grundlage des klinischen Versuchsteils war es, 31 funktionelle Nasennebenhöhleneingriffe durchzuführen. Dabei wurden die gewählten Endoskoppositionen, die Wechsel der Endoskoppositionen und die konzeptionsbedingten Unterbrechungen erfasst. Als Ausblick für eine Anwendung des EMS bei Operationen erhöhten Schwierigkeitsgrades wurde im Rahmen eines Kadaver-Versuches ein endoskopischer Zugang zur Hypophyse mit dem EMS erprobt. Es konnte weder im Laborversuch noch im klinischen Versuchsteil eine Unterlegenheit beim Einsatz des EMS bezüglich der Dauer und der Genauigkeit der assistierten Endoskopführung festgestellt werden. Die Anzahl der Positionswechsel lag durchschnittlich bei 6,4 pro Seite. Eine beidhändige Instrumentation war in allen untersuchten Fällen möglich, mit Ausnahme von Bereichen mit Hochrisikostruktu-ren (Lamina papyracea, Recessus frontalis), in welchen der Operateur aus Sicherheitsgründen auf eine manuelle Endoskopführung umstellte. Das untersuchte EMS wurde erfolgreich in den chirurgischen Workflow der endo- und transnasalen Chirurgie integriert, wobei die geringe Anzahl der Endoskoppositionswechsel eine beidhändige Instrumentation ermöglichte. Als Entwicklungspotenzial kann die Ergänzung der Joystickkonsole um eine Force-Feedback-Funktion bzw. die Möglichkeit einer rein navigiert-kontrollierten Steuerung hervorgehoben werden. Damit wird die Häufigkeit einer Unterbrechung des Workflows für die händische Steuerung über die Joystickkonsole minimiert.
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Meißner, Christian. "Perspektivenorientierte Erkennung chirurgischer Aktivitäten im Operationssaal." Doctoral thesis, Universitätsbibliothek Leipzig, 2015. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-163366.

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Die Dissertation beschäftigt sich mit der automatischen Erkennung chirurgischer Aktivitäten im Operationssaal, welche einen wichtigen Bestandteil im automatischen chirurgischen Assistenzprozess darstellt. Die automatische Assistenz ist eine der wichtigen Entwicklungen bei der fortschreitenden Technisierung in der Chirurgie. Es werden Anforderungen an ein Erkennungssystem definiert sowie ein entsprechendes Erkennungsmodell entworfen und untersucht. Die Evaluation bedient sich simulierter chirurgischer Eingriffe mit hoher Realitätsnähe. Die Ergebnisse zeigen eine grundlegende Eignung des Modells für die automatische Aktivitätserkennung multipler Eingriffstypen. Mögliche Weiterentwicklungen könnten die vorgestellte Lösung weiter vorantreiben.
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François, Jean-Marc. "Méat moyen nasal de l'enfant : étude anatomique tomodensitométrique et endoscopique et applications chirurgicales." Bordeaux 2, 1994. http://www.theses.fr/1994BOR23055.

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13

Andrews, P. J. "A prospective, controlled study on 131 patients assessing patient safety and nasal function outcomes following human olfactory mucosa biopsy as a source of cells for central nervous system regeneration during Endoscopic Sinus Surgery." Thesis, University College London (University of London), 2016. http://discovery.ucl.ac.uk/1530783/.

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Hypotheses: The primary hypothesis states; olfactory harvesting is a safe procedure and does not incur a reduction in nasal function including the sense of smell when compared to a control group. The secondary hypothesis states; ESS improves olfactory outcome in CRS patients with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). Materials and Methods: Full Ethical and Research and Development (R&D) approval was granted; Ref: 05/Q0512/103. 131 patients were recruited over a 2 year period and non-randomised into the olfactory biopsy and control arms. Statistical significance was accepted at the 5% level (< 0.05) and powered at 80%. Complication rates as well as patient and surgeon reported outcome measures were recorded in each arm both pre operatively and 6 months post operatively. The sense of smell was evaluated using the University of Pennsylvania Smell Identification Test (UPSIT). Results: 65 patients underwent superior turbinate biopsy with 66 controls. The complication rate, the nasal function and the sense of smell outcomes of the biopsy group were statistically the same when compared to the control group. In the CRS subgroup analysis the sense of smell improved in both groups following ESS but only in the CRSwNP subgroup was it found to be significant. Conclusions: The primary hypothesis was shown to be true and demonstrated that patient morbidity and beneficial outcomes following harvesting human olfactory nasal mucosa during ESS is statistically the same when compared to the control group. The secondary hypothesis was equally shown to be true and demonstrated that sinus surgery improved olfaction in both the CRSwNP and CRSsNP subgroups but only in the CRSwNP subgroup was the olfactory improvement significant.
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Sakano, Eulalia 1950. "Avaliação endoscopica, laboratorial e tomografica das vias aereas superiores de pacientes com fibrose cistica e sua correlação com genotipo e a gravidade da doença." [s.n.], 2006. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309975.

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Orientador: Jose Dirceu Ribeiro<br>Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas<br>Made available in DSpace on 2018-08-07T02:23:41Z (GMT). No. of bitstreams: 1 Sakano_Eulalia_D.pdf: 4393830 bytes, checksum: 9f6f7365bd3d89dbba87535f36bbc052 (MD5) Previous issue date: 2006<br>Resumo: Muitos estudos têm avaliado os aspectos clínicos e funcionais do comprometimento das vias aéreas inferiores na fibrose cística (FC). Entretanto, poucos estudos têm sido realizados para avaliar as alterações clínicas e funcionais das vias aéreas superiores. O objetivo do presente trabalho foi correlacionar variáveis obtidas por endoscopia nasossinusal, laboratoriais e tomográficas dos seios paranasais e, verificar a associação com a gravidade e o genótipo de pacientes com fibrose cística, de um centro universitário de referência em tratamento de FC no Brasil. Realizou-se um estudo clínico, laboratorial com 50 fibrocísticos. Todos foram submetidos a tomografia computadorizada dos seios paranasais, estudo genético das mutações da FC, endoscopia nasossinusal e bacterioscopia dos seios maxilares, orofaringe e traquéia. A gravidade da FC foi avaliada pelo escore de Shwachman. A prevalência de polipose na população estudada foi de 36% e maior entre homozigotos para ?F508. O escore de Shwachman correlacionou-se com a idade. Não houve correlação do genótipo e do grau de gravidade com as outras variáveis estudadas. Os sujeitos apresentaram alta prevalência de colonização precoce para P. aeruginosa. Concluiu-se que a doença sinusal em pacientes fibrocísticos é muito freqüente, apresenta alterações nasofibroscópicas, tomográficas e clínicas, embora a maioria das variáveis estudadas, não apresenta correlação com a gravidade e o genótipo da doença<br>Abstract: Many studies have assessed clinical and functional aspects of lower airway affections in cystic fibrosis. Conversely, few studies have been performed to assess the clinical and functional affections of upper airways. The objective of the present study was to correlate the variables obtained by nasal and paranasal sinuses endoscopy, paranasal sinus laboratory and computed tomography (CT) scan findings, and to check the association with severity and genotype of cystic fibrosis patients. Clinical and laboratory study of 50 patients with cystic fibrosis at a university center. All patients were submitted to CT scan, nasal and paranasal endoscopy and bacterioscopy of maxillary sinus, trachea and oropharynx secretion. Severity of cystic fibrosis was assessed by Shwachman score and the most frequent genetic mutations were identified. The prevalence of polyposis in the studied population was 36% and it was greater among homozygote for ?F 508. Shwachman score was correlated with age (p=0,003). The genotype was correlated with nasal polyposis (p=0,006). There was no association between affections in CT scan and severity of cystic fibrosis (CF). Patients presented high prevalence of early colonization of Pseudomonas aeruginosa. Sinus disease in CF patients are very frequent and presents several clinical, endoscopic and tomographic affections and most of them are not correlated with severity and disease genotype<br>Doutorado<br>Otorrinolaringologia<br>Doutor em Ciências Médicas
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Chang, Yu-Chien, and 張煜謙. "The Role of Functional Endoscopic Sinus Surgery in Moderate-to-Severe Chronic Rhinosinusitis: Evaluation by Patient Perception Score, Endoscopy and CT Scan." Thesis, 2007. http://ndltd.ncl.edu.tw/handle/84238166115299041164.

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碩士<br>中國醫藥大學<br>醫學研究所碩士班<br>95<br>Objectives Chronic Rhinosinusitis (CRS) is a common upper airway respiratory disease in Taiwan. Although it is clear from a popular standpoint that CRS makes a negative influence on patient’s quality of life, the level of personal influence may vary widely from individual to individual. For patient’s perception, symptom severity can easily be classified as none, mild, moderate and severe. Medical treatment is reasonable to treat patients with mild symptoms of CRS. For patients with severe symptoms of CRS, or CRS is due to nasal polyp, sinonasal tumor, fungal infection or identified sinonasal anatomic variations, surgical intervention is indicated if they have been refractory to medical treatment. FESS has been the main stream of surgical methods to treat CRS for about 20 years. Few literatures offered adequate discussions focusing on the role of FESS for patients with perceived moderate-to-severe symptoms of CRS. The aim of this study was to investigate the role of FESS in moderate-to-severe chronic rhinosinusitis by using subjective symptom score and objective endoscopy and CT scan. Materials and Methods We used Visual Analogue Score (VAS) Questionnaire to evaluate CRS symptoms status. Symptoms include nasal obstruction, rhinorrhea / postnasal drip, headache, facial pain and olfactory disturbance and overall discomfort. Each symptom was scored on a scale from 0 to 10 which 0 presented no symptom and 10 presented the most severe symptom. According to the VAS questionnaire, patients with equal to or over 8 scales in at least two symptom items and overall discomfort scales also equal to or over 8 scales were included into our study. They were regarded as having moderate-to-severe symptoms of CRS. Patients with nasal polyp, sinonasal tumor, fungal sinusitis or sinonasal anatomic variations were excluded. Analysis of prospectively collected data was performed. These patients filled the VAS Questionnaire in the initial visit. Diagnostic nasal endoscopy was performed and given a score from 0 to 20 according to the scoring system proposed by Lund and Kennedy. Sinus CT scan were assessed and given a score from 0 to 24 according to the Lund-Mackay staging system. Functional endoscopic sinus surgery (FESS) was suggested if patient was refractory to maximal medical treatment. Patients who have undergone FESS filled VAS Questionnaire and were assessed with nasal endoscopy at least 6 months postoperatively. Those without FESS due to personal reasons also filled VAS Questionnaire and were assessed with nasal endoscope at least 6 months after initial visit. Results Thirty two patients were included in this study. There were 22 males and 10 females. The mean patient age was 38.2 years (range, 18-56 years). Mean follow-up period was 11.8 months (range, 7-19 months). Thirteen patients were allergen positive proved by specific IgE antibody in serum. Eighteen patients underwent FESS. After statistical analysis, the endoscopic findings correlate with the subjective symptom severity (p&amp;lt;0.05). Moreover, there was excellent correlation between the endoscope score and CT score (p&amp;lt;0.001). In contrast, there was no significant correlation between VAS score and CT score (p&amp;gt;0.05). There was also no statistically significant difference in VAS score and CT score between atopic and non-atopic group in the pre-treatment period (p&amp;gt;0.05). There was no statistically significant difference between surgical and non-surgical group in the three parameters in the pre-treatment period (p&amp;gt;0.05). However, the VAS score, endoscopy score had more marked reduction in surgical group than non-surgical group in the post-treatment period (p&amp;lt;0.05). Conclusions This study demonstrated that findings on the CT scan do not correlate with the severity of nasal symptoms. Although atopy constitute is an important factor, there was no significant difference between atopic and non-atopic CRS patients on VAS symptom score and CT score in the pre-treatment period. The VAS score, endoscopy score had significantly marked reduction in surgical group than non-surgical group. For patients with moderate-to-severe symptoms of CRS, if they have been refractory to adequate medical treatment, FESS is an effective treatment method.
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Couto, Marcelo Harduin. "Avaliação das alterações na membrana sinusal no levantamento atraumático do seio maxilar em humanos via endoscópica e sobrevida dos implantes 10 anos após a sua implantação." Master's thesis, 2016. http://hdl.handle.net/10284/5415.

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Este estudo utilizou a endoscopia para a avaliação das alterações na membrana sinusal, quantificar o aumento vertical da altura óssea mantendo-se a integridade da membrana sinusal no levantamento atraumático do seio maxilar com o uso de osteótomos (Técnica de Summers) em humanos, e avaliar a sobrevida dos implantes 10 anos após a sua implantação. Foram incluídos neste estudo 6 pacientes, 4 do género feminino e 2 do género masculino com idade entre 26 e 74 anos. Em cada paciente a enxertia utilizada foi de origem xenógena (Bio-oss®), e os implantes com tratamento de superfície (3 i® ou Nobel®). Os pacientes foram operados sob anestesia local e sedação venosa com Fentanil®em ambiente hospitalar. As imagens para análise das alterações na membrana foram obtidas através de câmera Panasonic®. Desta forma esta tecnologia fornece um instrumento de constatação do sucesso do procedimento e ao mesmo tempo é uma ferramenta valiosa para preservação dos implantes instalados. O estudo concluiu que a técnica do osteótomo constitui-se de um método eficaz para inserção de implantes ossoeintegrados, sobretudo com o uso do endoscópio; ocorreram perfurações na membrana sinusal que seriam imperceptíveis pela técnica original, podendo ocasionar desde patologias e infecções no seio maxilar à perda do implante. A taxa de sobrevida dos implantes 10 anos após a sua implantação foi de 91,66%. O uso do endoscópio deve ser estimulado, entretanto as dificuldades na execução da sinusoscopia simultaneamente à técnica do osteótomo, e o aumento nos custos, ainda limitam o seu uso como rotina.<br>These study used endoscopy for evaluation of the alterations on sinus membrane, quantify the vertical increase of the bone height without sinus membrane perforations in the atraumatic sinus floor elevation with use of the osteotomes (“Summers Technique”) in humam, and evaluate the survival of the implants 10 years after their implantation. From the 6 patients included in this study, 4 female gender and 2 male gender aged 26 to 74 years old. In one of them the used graft was xenogenic origin (Bio-oss™), and the implants with treated surface (3i™ or Nobel™). The pacients was operated under local anesthesia and venous sedation with FentanilTMin hospitalar ambience. The images for analysis of alterations on the membrane was performed by Panasonic™ camera. Therefore this technology gives us instrument that can measure the success of the procedure and at the same time gives us a valuable tool for the follow up of the osseointegrated implants. The study concluded wich the osteotome technique constitute a reliable method for insertion of the osseointegrated implant, specially with the use of endoscopy; occurred perforation on the sinusal membrane wich was being imperceptible by the original technique, could be leave since infection and pathology on maxillary sinus to loss the implant. The survival rate of the implants 10 years after their installation was 91,66% .The use of endoscopy must be stimulated, however, the difficults on performer of the sinusoscopy simultaneously the osteotome technique, and the increase on costs, still limits they use on routine.
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Bassiouni, Ahmed Mokhtar Abdelkhalek. "The role of surgery and disease load in refractory chronic rhinosinusitis." Thesis, 2015. http://hdl.handle.net/2440/100745.

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Chronic rhinosinusitis (CRS) is chronic inflammation of the sinonasal mucosa. It is a disease of significant impact on public health, one that affects about 10-15% of the population. Functional Endoscopic Sinus Surgery (FESS) is the “gold standard” surgical treatment for CRS; its original philosophy or concepts are based upon the sinonasal mucociliary clearance studies by Messerklinger and Stammberger, which emphasize the role of the osteo-meatal complex (OMC). However, although the success rate of FESS is about 90%, there is a subgroup of patients who exhibit no improvement, and thus require repeated surgeries. This subgroup of patients suffers from refractory chronic rhinosinusitis (rCRS), which is the main focus of this thesis. In this thesis the current understanding of the pathogenesis and causes of surgical failure in CRS are reviewed. This thesis presents the hypothesis that our understanding of the pathogenesis of CRS has advanced since the original concepts of FESS were put forward, and that patients who develop rCRS have other pathogenic features that cannot be addressed by these concepts. We revisit middle turbinate lateralization (MTL) as a surgery-related factor of rCRS in Chapter 6, and we pose the question: Is MTL a complication associated with worse surgical outcomes, or just a harmless sequela, of the surgical destabilization of the middle turbinate during sinus surgery? Our findings show that MTL plays a role in surgical failure and requiring revision surgery, but suggest that the clinical significance of MTL may be related to frontal sinus obstruction and not necessarily to the OMC. We then present two novel hypotheses: the inflammatory load hypothesis in Chapter 7, and the irreversible disease hypothesis in Chapter 8. In Chapter 9, we investigate nasal polyp recurrence in CRS with Nasal Polyposis (CRSwNP) as an important cause of rCRS. We study the patterns of polyp recurrence and the clinical factors associated with more aggressive recurrence. The findings show that firstly, comorbid factors such as asthma and aspirin sensitivity contribute to the disease load and rCRS; and secondly, that more aggressive surgical removal of that disease load and maximal opening of the sinuses through a frontal drillout procedure improve the surgical outcome and disease control for these rCRS patients. We then proceed to investigate the relevance of our two novel hypotheses to refractory CRSwNP through a histopathological study in Chapter 10. We also describe the evolution of the inflammatory load in patients with rCRS from first to second surgery, a topic rarely addressed in the literature. We found that a higher inflammatory load is present in patients who fail surgery and go on to develop refractory CRS, when compared to patients who respond to surgery, with a particular significance to the eosinophilic load. In summary, our findings suggest that the inflammatory load is associated with long-term surgical outcomes. The recommendation based upon findings in this thesis is that surgery offered for CRS should be viewed as a tool for addressing and controlling disease load, and not just for the conservative clearance of disease of the OMC.<br>Thesis (Ph.D.) (Research by Publication) -- University of Adelaide, School of Medicine, 2015.
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Wabnitz, David Alexander Michael. "Factors affecting mucosal healing, reciliation, and ciliary function after endoscopic sinus surgery in the sheep." 2005. http://hdl.handle.net/2440/37719.

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The effect of absorbable packing on the healing of nasal respiratory epthelium after endoscopic sinus surgery (ESS) was examined in a diseased sheep model. Full thickness injuries were created on the lateral nasal wall of sheep infested with Oestrus ovi. Sites of injury were packed on one side with hyaluronic acid (HA) packing or hyaluronic acid packing impregnated with insulin-like growth factor- 1 (HA+IGF1) in a randomized fashion. The opposite side was left unpacked as a control. Biopsies were obtained for light microscopy, scanning electron microscopy, and ciliary beat frequency (CBF) analysis over a period of 16 weeks. Statistical analysis of results was performed in order to determine if any intervention had any impact on healing and to determine if there was any correlation between extent of regeneration as assessed by electron microscopy and CBF. Furthermore assessment of the effect of isotonic and hypertonic saline on ciliary beat frequency was performed in healthy human volunteers. Reepithelialization was increased in the HA+IGF1 group compared to the HA group and controls at eight weeks after injury but not at later time points. Cilial regeneration was improved in the HA+IGF1 group compared to the HA group and controls at 16 weeks. CBF was noted to be worse at the eight week time point with the HA+IGF1 group compared to the HA group and controls, but no other statistically significant effects on CBF were noted. This most likely represents a spurious finding. Wide distributions of CBF results were noted, reflecting numerous missing data points due to methodological difficulties. There was a trend noted toward increased CBF with improved grades of reciliation, although this correlation was not statistically significant. However this trend was supported by the finding of statistically significant differences between individual and combined grades of reciliation. Hypertonic saline was found to have a ciliostimulatory effect when compared to normal saline at 5 minutes after administration in healthy human subjects. This effect had disappeared by 60 minutes after administration. It is suggested that the presence of insulin-like growth factor- 1 at the time of mucosal injury improves epithelial regeneration in the short term, but is not sufficient for this effect to be sustained. This improved early epithelial regeneration forms a foundation for cilial regeneration, as is reflected in an improved grade of reciliation at 16 weeks. Our interventions had no effect on CBF, and various experimental problems made it difficult to provide further comment on CBF results. There is evidence that CBF improves as the grade of cilial regeneration improves following ESS. Furthermore, hypertonic saline appears to also have a positive impact on CBF, which is likely to reflect changes in the rheological properties of mucous. A number of possible avenues of enquiry are delineated and recommendations for future research are outlined.<br>Thesis (M.S.)--Department of Surgery, 2005.
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Rong-San and 江榮山. "Effect of Functional Endoscopic Sinus Surgery on the Olfactory Function of Patients with Chronic Rhinosinusitis." Thesis, 2008. http://ndltd.ncl.edu.tw/handle/16268797292612734205.

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博士<br>中山醫學大學<br>醫學研究所<br>96<br>Objectives: This study aims to investigate the change of olfactory function in patients with chronic rhinosinusitis after functional endoscopic sinus surgery and explore the potential prognostic factors. Methods: Patients with chronic rhinosinusitis who had previously undergone functional endoscopic sinus surgery were enrolled in the study. On the day before FESS, olfactory function was evaluated by a symptom score, a phenyl ethyl alcohol odor detection threshold test (STT), the University of Pennsylvannia Smell Identification Test (UPSIT) and a short-term odor memory/discrimination test, and re-evaluated by the same methods 6 months after FESS. The potential prognostic factors (nasal obstruction, cross-sectional area of nasal cavity, rhinosinusitis severity, preoperative olfactory loss, nasal polyps, allergic rhinitis, concurrent septoplasty and turbinal surgery, postoperative steroid treatment) for improvement in olfaction after FESS were also evaluated in these patients. Results: A total of 70 patients with chronic rhinosinusitis were enrolled in the study. Fifty-two patients noticed their olfactory function was impaired before surgery, but the olfactory threshold was above –6 in 66 patients, and 62 patients’ UPSIT scores were below 30. After surgery, the olfactory function was improved in 27 patients using patients’ reports, in 30 patients by STT and in 36 patients by UPSIT. A good agreement existed between STT and UPSIT results and patients’ reports. Among potential prognostic factors, nasal obstruction, cross-sectional area of nasal cavity, rhinosinusitis severity, preoperative olfactory loss, nasal polyps and allergic rhinitis were not significantly reliable to predict improvement in olfaction after surgery, but patients with severe rhinosinusitis and severe preoperative olfactory loss and those with allergic rhinitis or without nasal polyps tended to show olfactory improvement. Concurrent septoplasty and turbinal surgery did not increase the rate of olfactory improvement after FESS, but postoperative use of nasal steroids did increase the rate of olfactory improvement, although the difference was not significant. Conclusion: Although many methods have been used to evaluate olfactory function, and the domains of olfactory function evaluated were not the same among these methods, our study showed that UPSIT should be the test of choice for evaluating olfactory function in patients with chronic rhinosinusitis. For these patients, disease severity, coexistence of nasal polyps and allergic rhinitis, and postoperative use of nasal steroids were found to be more reliable prognostic factors for improvement in olfaction after FESS, but these factors were not significantly reliable.
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Chang, Chih-Ming, and 張智銘. "Quantitative Evaluation of the Surface Registration Accuracy of Navigation Systems – in Live Endoscopic Sinus Surgery." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/zq3n5a.

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博士<br>國立臺灣大學<br>醫學工程學研究所<br>105<br>Functional endoscopic sinus surgery has gained wide application in the management of sinus disease since the 1980s. The use of computer-aided surgery (CAS) technology was developed to assist surgeons in identifying anatomic landmarks during sinus surgery since the 1990s. In CAS, a correlation between a stored preoperative image data set and specific landmarks in the surgical area is required. However, studies on the performance of surface registration and comparisons between optic and electromagnetic navigation systems were lacking. Hence, the purpose of our study is to investigate time efficiency of system preparation and operation as well as the precision of optic and electromagnetic navigation systems using the surface registration in live endoscopic sinus surgery. Forty patients with bilateral chronic paranasal pansinusitis underwent endoscopic sinus surgery. The surgeries were performed under electromagnetic navigation guidance after the surface registration had been carried out on all of the patients. The intraoperative measurements indicate the time taken for equipment set-up, surface registration and surgical procedure, as well as the degree of navigation error along the 3 axes. The result revealed that the deviation in the medial-lateral direction was significantly less than that in the anterior-posterior and cranial-caudal directions. In the second part of our study, thirty patients with bilateral chronic paranasal pansinusitis underwent surgery on one side using optic navigation guidance and on the other side using electromagnetic navigation guidance. The intraoperative measurements performed included the time taken for the surface registration and surgical procedure on each side, as well as the navigation errors at the different locations. The result showed that the time for surface registration was significantly longer in the optic navigation group than the electromagnetic group. However, the time for surgical procedure has no significant difference between these 2 groups. A comparison of the navigation errors along the 3 axes showed that the deviation in the medial-lateral direction was significantly less than that in the anterior-posterior and cranial-caudal directions in the optic navigation group as well as the electromagnetic group. Furthermore, in comparison to the navigation error in each specific location, there was no significant difference between the optical and electromagnetic navigation groups. In conclusion, the procedures of equipment set-up in electromagnetic navigation system, surface registration in both optic and electromagnetic navigation tracking are efficient, convenient and easy to manipulate. The accuracy of both navigation systems is comparable and within acceptable ranges for clinical use. In addition, the best accuracy was measured in the medial-lateral direction compared with the other two axes, either in optic or electromagnetic navigation system.
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Shaw, Chi-kee Leslie. "Evaluation of sheep model with regard to healing of nasal epithelium after endoscopic sinus surgery." Thesis, 2001. http://hdl.handle.net/2440/128833.

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Four studies were performed to evaluate the influence of endoscopic sinus surgery (ESS) on the healing of nasal respiratory epithelium in a sheep model. The first study validated the sheep as a suitable animal model. As part of the standardization of the animal model a middle turbinectomy needed to be performed. The effects of middle turbinectomy on the nasal respiratory epithelium and cilial function were studied. At 3 weeks post turbinectomy the cilial function and histology of the respiratory epithelium was unchanged. The standardized and validated model could now be used to conduct further studies on the effect of ESS on respiratory epithelium. The second study investigated the effects of pre-operative packing with ribbon gauze and neuropatties on the nasal mucosa of sheep. Both ribbon gauze and neuropatties caused significant mucosal loss when compared with the control. The neuropatties caused less mucosal damage when compared with the ribbon gauze but this difference was not statistically significant. This damage to the epithelium is significant as it may add to the insult of ESS and may cause stasis of secretions with crusting in the post-operative phase. The third study assessed the temporal healing process of nasal epithelium after full-thickness and partial thickness mucosal removal in sheep. On day 84 post injury there was no significant difference between partial and full-thickness injuries. However there was a significant difference in the re-ciliation of the two types of wounds. The baseline mucociliary clearance did not differ significantly for either the partial thickness or the full-thickness wounded side. A significant interesting finding was that the healing process took much longer than expected and was still incomplete on day 84 when the sheep were sacrificed. This may account for some of the symptoms seen in the healing period in patients after ESS. The fourth study assessed cilial regeneration post mucosal injury by scanning electron microscopy. Using a new technique, two blinded observers validated the technique with little intra- or inter-individual difference seen when assessing the specimens. This technique may be useful in further studies as re-ciliation after surgery is crucial for nasal epithelium to gain health and normal function. This thesis has validated the sheep as a suitable animal model to study ESS and to evaluate factors that may play a role in the healing of nasal epithelium after surgery. Nasal packing was shown to cause a significant injury and should be used by ESS surgeons with caution. Full-thickness wounds should be avoided in the nose where possible as the re-ciliation was significantly reduced when compared to partial-thickness wounds. In addition the healing of nose took significantly longer than previously thought and was incomplete 84 days after surgery. Scanning electron microscopy was shown to be an important outcome measure for the healing of the nasal mucosa after ESS and a new technique for measuring the re-ciliation was validated.<br>Thesis (MS) -- University of Adelaide, Department of Surgery, 2002
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Athanasiadis, Theodore. "The effect of topical antifibrinolytics and a novel chitosan gel on haemostasis and wound healing in endoscopic sinus surgery." 2009. http://hdl.handle.net/2440/58972.

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Introduction: Endoscopic sinus surgery (ESS) is at present the gold standard therapeutic modality for chronic rhinosinusitis (CRS) resistant to medical therapy. Whilst results from ESS for CRS are generally good, postoperative bleeding and impaired wound healing with adhesion formation remains a concern. Due to patient discomfort and the detrimental effects on wound healing caused by most packing materials, many surgeons no longer routinely use nasal packing. Surgeons have in the past sought agents which would provide post-operative haemostasis without detrimentally affecting wound healing. Antifibrinolytics have been available for many years, however, their topical application has only been explored in the last few years. Recently different forms of chitosan have separately shown significant promise as powerful haemostatic and anti-adhesion agents. The aim of this thesis was to explore the progressive understanding of the interaction between haemostasis and wound healing with possible development of a novel agent. Methods: The first step to scientifically assess bleeding after sinus surgery was to develop a standardised method of video endoscopy and grading the surgical field during ESS. This was done as a multinational collaborative trial. Once this assessment tool was validated a randomised controlled trial evaluating the effect of two antifibrinolytics (epsilon aminocaproic acid and tranexamic acid) was conducted. Further evaluation was then conducted on other possible hemostatic and antiadhesion substances. This included various combinations of a novel chitosan gel. These gels were trialled in vitro to determine their effect on human nasal fibroblasts derived from CRS patients. Fibroblast adhesion and proliferation as well as closure of standardised wounds were studied. The most promising of these gels was then used in an in vivo sheep model. Once effectiveness of the chitosan-dextran gel was shown in the laboratory, this was evaluated against a number of currently available hemostatic and anti-adhesion substances in a standardised model of wound healing in sheep with CRS. This model had been previously extensively validated in our department. Full thickness mucosal injuries were created on the lateral nasal wall and ethmoids of twenty sheep and recombinant tissue factor (rTF), SprayGel or Chitosan-Dextran derivative gel applied topically in a randomized fashion. Adhesion formation and severity as well as microscopic wound healing and ciliary function were analysed at day 28, 56, 84 and 112 post initial surgery. A further sheep study was conducted applying chitosan dextran gel to standardised mucosal injuries and comparing its effect on the control of bleeding to control. Bleeding time and grade were recorded and wound healing monitored via serial videoendoscopy over two weeks and objectively measured. Results: a) Assessment of the bleeding scales showed that inter and intra observer reliability for both scales tested were significantly improved by employing a standardized video-endoscopy technique. The Wormald scale proved to be more reliable and sensitive to changes in the most common surgical fields encountered in ESS. b) Tranexamic acid showed a modest but clinically significant improvement in the surgical field at 2, 4 and 6 minutes after application. Epsilon aminocaproic acid did not effectively improve the surgical field. c) Nasal fibroblast adhesion and proliferation were significantly impaired with dextran and chitosan. The most effective ratio that delayed but did not prevent wound closure were 5 % chitosan: 5 % dextran gel. d) In a standardised sheep model of mucosal wound healing the chitosan gel significantly decreased lateral nasal wall and ethmoidal adhesions at all time points. The chitosan group had a significantly greater percentage of re-epithelialisation and reciliation than control and rTF. In addition the mean cilial grade in the chitosan group was significantly better than control. e) The chitosan dextran gel was significantly more haemostatic at 2,4, and 6 minutes after injury with no significant difference noted in wound healing. Conclusions: Standardised methods of videoendoscopy and grading the surgical field in ESS are valuable tools for further research. Tranexamic acid significantly improved the surgical field to a moderate degree in ESS compared to control. Chitosan gel is a promising new powerful haemostatic bio-polymer which has a mild inhibitory effect on fibroblast attachment and proliferation. This may partially explain the significant improvement in microscopic wound healing and reduction in adhesion formation seen in a sheep model of chronic sinusitis. Future work evaluating this gel in the setting of a human trial is currently underway.<br>http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1375402<br>Thesis (Ph.D.) -- University of Adelaide, School of Medicine, 2009
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Dias, André Ferreira. "Abordagem Transcutânea da Órbita de Tumores do Seio Frontal." Master's thesis, 2018. http://hdl.handle.net/10316/82002.

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Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de Medicina<br>As neoformações do seio frontal são tratadas desde tempos pré-históricos. Foram descritas cirurgias precoces com remoção de parte da parede anterior do seio frontal, com deformidades estéticas significativas. Cirurgias mais diferenciadas foram desenvolvidas a partir do século XIX, até ao aparecimento, nos anos 80, da endoscopia nasossinusal. Atualmente, a técnica mais utilizada para aceder aos seios perinasais é a endoscopia funcional, cujo principal objetivo é restabelecer a sua drenagem e adequada ventilação por via endoscópica. As abordagens externas do seio frontal têm indicações precisas, quer pelo controlo visual direto, quer pela inacessibilidade do acesso endoscópico a determinadas zonas deste. As principais indicações para este tipo de abordagem são: extensa osteoneogénese no recesso frontal, mucocelos, tumores ou trauma do seio frontal, não acessíveis por via endonasal. Apresentamos um caso clínico de um mucocelo frontal com invasão do espaço orbitário em que foi realizada uma abordagem combinada, utilizando-se a via endoscópica e a abordagem transcutânea da órbita a partir da prega palpebral superior, para aceder ao espaço extracónico e proceder à excisão da lesão. A anatomia do seio frontal é particularmente desafiante para o cirurgião. A propósito da descrição de um caso clínico pretende-se efetuar uma revisão das abordagens cirúrgicas para remoção de lesões localizadas no seio frontal com invasão orbitária, identificando limitações de cada uma das técnicas e possíveis vantagens de uma abordagem combinada.<br>Frontal sinus tumors have been treated since prehistoric times. Early surgeries were described with removal of part of the anterior wall of the frontal sinus, with significant aesthetic deformities. More differentiated surgeries were developed from the 19th century until the appearance of nasal endoscopy in the 1980s. Currently, the most used technique to access the paranasal sinuses is the functional endoscopic sinus surgery, whose main objective is to restore normal drainage and adequate ventilation using an endoscopic approach.External approaches to the frontal sinus have precise indications, either by direct visual control or by the inaccessibility of endoscopic access to certain areas of the frontal sinus. The main indications for this type of approach are: extensive osteoneogenesis in the frontal recess, mucoceles, tumors or trauma of the frontal sinus, not accessible by the endonasal approach.We present a case of a frontal mucocele with invasion of the orbital space in which a combined approach was used, using an endoscopic approach and an upper lid transcutaneous approach to the orbit, to access the extraconal space and proceed to the excision of the lesion.The anatomy of the frontal sinus is particularly challenging for the surgeon. We report an unusual case and review the surgical approaches for the removal of lesions located in the frontal sinus with orbital invasion, identifying limitations from each of these techniques and possible advantages of a combined approach.
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Singhal, Deepti. "Bacterial & fungal biofilms in chronic rhinosinusitis." Thesis, 2011. http://hdl.handle.net/2440/72282.

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Chronic Rhinosinusitis (CRS) is a recalcitrant disease, characterized by headache, nasal discharge / blockage, which substantially impairs daily functioning and negatively affect quality of life. Endoscopic Sinus Surgery (ESS) is an important treatment option for CRS, but has variable success rates. Biofilms are well organised heterogeneous communities of microbes embedded in a mosaic of extracellular matrix, adherent to biotic / abiotic surfaces. As they are resistant to host defences and medical treatments, they have been touted as possible pathogenic factors in CRS, which may perpetuate the recurrent and recalcitrant character of the disease and negatively affect treatment outcomes. This thesis encompasses research undertaken to enhance our understanding about the effect that presence and types of biofilms have on the clinical profile and treatment outcomes of patients suffering with chronic rhinosinusitis. An in-vitro model of fungal biofilms and a potential tool to assay in-vivo mucosal biofilms on sinonasal tissues has also been described. Chapter 1 of the thesis comprehensively reviews the scientific literature pertaining to biofilms and CRS, and exhaustively evaluates the evidence present in relation to bacterial and fungal biofilms in CRS. Chapter 2 describes a study to investigate the effect of biofilms on outcomes following ESS in CRS patients using internationally accepted standardised symptom scores, quality of life measures and endoscopy scores to assess the disease. It showed that patients with biofilms presented with more severe disease before surgery, and after surgery had persistent symptoms, ongoing mucosal inflammation and infections necessitating extra post-operative visits and multiple antibiotic treatments. This study thus strengthened the evidence for the role that biofilms may play in recalcitrant CRS. Chapter 3 describes a further subgroup analysis of the above patients in whom the specific organisms forming the biofilms were identified and how patients with specific biofilm types progressed after surgery was studied. Patients with polymicrobial biofilms suffered more severe disease and had worse post-surgery mucosal outcomes requiring more post–operative visits. S.aureus biofilms played a dominant role in negatively affecting outcomes of ESS with persisting post-operative symptoms, ongoing mucosal inflammation and infections. Chapter 4 describes an in-vitro model characterizing A. fumigatus biofilm formation on primary human sinonasal epithelium cultures under different growth conditions. 3-dimensional biofilm structures with parallel-packed and cross-linked hyphae, channels/passages, extracellular matrix (ECM) encasing the hyphae, were formed. Biofilms formed under flow conditions displayed more robust and faster growth kinetics as compared to those under static conditions, with extensive ECM production. Chapter 5 investigates application of an analysis program ‘COMSTAT 2’ for assaying & quantitatively describing the 3-dimensional in-vivo biofilm structures observed via confocal scanning microscopy on sino-nasal mucosal samples. This can be used for temporal analysis of biofilm development, comparison of different types of biofilms formed under controlled conditions, analysis of influence of varying environmental factors on biofilms and the efficacy of different antibiofilm treatments. Chapter 6 summarises and discusses the salient features of the studies included in this thesis which has attempted to characterize fungal and bacterial biofilms and the impact they may have in CRS patients.<br>Thesis (Ph.D.) -- University of Adelaide, School of Medicine, 2011
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Meißner, Christian. "Perspektivenorientierte Erkennung chirurgischer Aktivitäten im Operationssaal." Doctoral thesis, 2014. https://ul.qucosa.de/id/qucosa%3A13219.

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Die Dissertation beschäftigt sich mit der automatischen Erkennung chirurgischer Aktivitäten im Operationssaal, welche einen wichtigen Bestandteil im automatischen chirurgischen Assistenzprozess darstellt. Die automatische Assistenz ist eine der wichtigen Entwicklungen bei der fortschreitenden Technisierung in der Chirurgie. Es werden Anforderungen an ein Erkennungssystem definiert sowie ein entsprechendes Erkennungsmodell entworfen und untersucht. Die Evaluation bedient sich simulierter chirurgischer Eingriffe mit hoher Realitätsnähe. Die Ergebnisse zeigen eine grundlegende Eignung des Modells für die automatische Aktivitätserkennung multipler Eingriffstypen. Mögliche Weiterentwicklungen könnten die vorgestellte Lösung weiter vorantreiben.
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Costa, Marta Garcia. "Juvenile Ossifying Fibroma compromising the Zinn's Annulus." Master's thesis, 2018. http://hdl.handle.net/10316/82773.

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Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de Medicina<br>O Fibroma Ossificante Juvenil é uma neoplasia fibro-óssea rara que afeta sobretudo os ossos da órbita e seios perinasais. Apesar de benigno, apresenta um comportamento localmente agressivo e uma elevada taxa de recidiva pelo que um diagnóstico precoce e tratamento multidisciplinar são cruciais para melhorar o prognóstico e prevenir sequelas. O diagnóstico de neoplasias dos seios perinasais e porção medial da órbita é realizado através da correlação entre clínica, imagiologia e histopatologia, sendo que a TC e biópsia pré-operatória desempenham um papel muito importante. O tratamento de primeira linha passa pela resseção cirúrgica sendo recomendada a via endoscópica endonasal devido estar associada a menor taxa de morbilidade. No entanto, em alguns casos, outras opções devem ser consideradas de forma a possibilitar a resseção completa e preservação da função. O presente trabalho relata o caso clínico de uma jovem com Fibroma Ossificante Juvenil do tipo psamomatóide com afeção do aspeto medial do Annulus de Zinn, sujeita a tratamento cirúrgico misto com descompressão do nervo ótico, combinando via aberta transcraniana bicoronal e endoscopia endonasal. O sucesso na abordagem clínica do Fibroma Ossificante Juvenil com compromisso da órbita pode ser alcançado através de um plano pré-operatório rigoroso, avaliação multidisciplinar e utilização das técnicas mais adequadas a cada caso, dependendo essencialmente das caraterísticas do tumor, especialmente tamanho e localização.Palavras-chave: Neoplasias Seios Perinasais; Fibroma Ossificante; Cirurgia Endoscópica de Orifícios Naturais; Rinocirurgia.<br>Abstract: Juvenile ossifying fibroma is a rare fibro-osseous neoplasm that mainly affects the bones of the orbit and paranasal sinuses. Although benign, it presents a locally aggressive behavior and a high relapse rate. In specific locations, it poses a great treatment challenge so that early diagnosis and multidisciplinary treatment are crucial to improve the prognosis and delay clinical sequelae. Sinuses and medial orbit neoplasms diagnosis is made from clinical, imaging and histopathological exams. CT-scans and preoperative biopsy play an important role. The treatment of choice is a surgical resection. Endoscopic nasal approach is recommended because of its lower morbidity. However, there are some cases in which other options must be considered to perform resection as complete as possible and preserve function. We report a case of a young woman with psammomatoid type juvenile ossifying fibroma of the medial aspect of the Zinn´s annulus, undergoing surgical optic nerve decompression, combining a transcranial bicoronal open and endonasal endoscopic surgery. Functional success in clinical practice dealing with juvenile ossifying fibroma of the orbit is associated to a rigorous preoperative planning, multidisciplinary approach, and the use of the most appropriate techniques for each case, depending mostly on the characteristics of the tumor, especially size and location.Keywords: Paranasal Sinus Neoplasms; Fibroma, Ossifying; Natural Orifice Endoscopic Surgery; Rhinosurgery
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Bendouah, Zohra. "Implication des biofilms dans la rhinosinusite chronique et l’évaluation des traitements avec un modèle in vitro." Thèse, 2008. http://hdl.handle.net/1866/4358.

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Introduction : La chronicité de la rhinosinusite, sa résistance aux antibiotiques, et ses exacerbations aiguës laissent croire que les biofilms sont impliqués dans la rhinosinusite chronique. Objectifs : Nous avons évalué la capacité des bactéries Pseudomonas aeruginosa, staphylocoques à coagulase négative et Staphylococcus aureus à former des biofilms par un essai in vitro, et si cette capacité de formation a un lien avec l’évolution de la maladie. Nous avons évalué in vitro l’effet de la moxifloxacine, un antibiotique utilisé dans le traitement de la rhinosinusite chronique sur des biofilms matures de Staphylococcus aureus. Méthodes : Trent et une souches bactériennes ont été isolées de 19 patients atteints de rhinosinusite chronique et qui ont subit au moins une chirurgie endoscopique des sinus. L’évolution de la maladie a été notée comme "bonne" ou "mauvaise" selon l’évaluation du clinicien. La production de biofilm a été évaluée grâce à la coloration au crystal violet. Nous avons évalué la viabilité du biofilm après traitement avec la moxifloxacine. Ces résultats ont été confirmés en microscopie confocale à balayage laser et par la coloration au LIVE/DEAD BacLight. Résultat et Conclusion : Vingt deux des 31 souches ont produit un biofilm. La production d’un biofilm plus importante chez Pseudomonas aeruginosa et Staphylococcus aureus était associée à une mauvaise évolution. Ceci suggère un rôle du biofilm dans la pathogenèse de la rhinosinusite chronique. Le traitement avec la moxifloxacine, à une concentration de 1000X la concentration minimale inhibitrice réduit le nombre des bactéries viables de 2 à 2.5 log. Ces concentrations (100 µg/ml - 200 µg/ml) sont faciles à atteindre dans des solutions topiques. Les résultats de notre étude suggèrent que l’utilisation de concentrations supérieure à la concentration minimale inhibitrice sous forme topique peut ouvrir des voies de recherche sur de nouveaux traitements qui peuvent être bénéfiques pour les patients atteints de forme sévère de rhinosinusite chronique surtout après une chirurgie endoscopique des sinus.<br>Introduction: The role of biofilms in chronic diseases is increasingly recognized. Chronic rhinosinusitis, with its chronic indolent course, resistance to antibiotics, and acute exacerbations, has an evolution that parallels that of other biofilm-related diseases. Objectives: 1-To develop an in vitro method to assess the biofilm formation capacity. 2- To determine whether biofilm-forming capacity of bacteria demonstrated in chronic rhinosinusitis has an impact on persistence of the disease following endoscopic sinus surgery. 3- To determine the in vitro activity of moxifloxacin against Staphyylococcus aureus in biofilm form. Method: Thirty-one bacterial strains recovered from 19 patients with chronic rhinosinusitis at least one year post-endoscopic sinus surgery. Evolution of disease was assessed by questionnaire and endoscopy as favorable or unfavorable. The bacteria were cultured on a 96-well culture plaque and a semi-quantitative method using crystal violet to quantify biofilm production was used. Confirmation of the effect of the antimicrobial agents on viability was performed with confocal laser microscopy, using a LIVE/DEAD BacLight staining. Results: Twenty-two of 31 samples produced a biofilm thicker or equal to the positive control. Biofilm formation was associated with a poor evolution for Pseudomonas aeruginosa and Staphylococcus aureus, but not for coagulase-negative staphylococci. Biofilm treated with moxifloxacin at 1000X (0.1mg/ml – 0.2 mg/ml) gave a 2 to 2.5 log reduction in number of viable bacteria. Conclusion: We have shown that Crystal violet method is able to detect biofilm formation. There is a correlation between in vitro biofilm production by Pseudomonas aeruginosa and Staphylococcus aureus and unfavorable evolution after endoscopic sinus surgery, suggesting a role for biofilm in chronic rhinosinusitis. Increased concentrations of moxifloxacin, easily attainable in topical solutions have a potential role in the management of biofilm infections.
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Vediappan, Rajan Sundaresan. "Modifying Post-Surgical Wound Healing." Thesis, 2021. http://hdl.handle.net/2440/130740.

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“Surgery is a profession defined by its authority to cure by means of bodily invasion. The brutality and risks of opening a living person's body have long been apparent, the benefits only slowly and haltingly worked out”, says Atul Rawande on reviewing 200 yrs. of Surgery as a specialty in NEJM. My research focuses on working out these benefits, specifically looking at reduction of scar tissue formation in ENT, Abdominal & Spine surgery. Scar tissue formation is an outcome of healing process that can be excessive due to inflammation or infection and thereby has the ability to curtail the benefits or warrant revision surgery. Multiple strategies have been tested and employed thus far and none have given favourable results without causing additional harm or economic burden in health care costs. I propose to use a hydrogel synthesized by combining Chitosan and Dextran aldehyde -Chitin is an exoskeleton extracted polymer and Dextran Aldehyde a sugar, with added noveldrugs Deferiprone and Gallium Protoporphyrin providing additional anti scaring and antibiotic properties which could potentially augment the healing properties of the gel. I have conducted 3 types of studies. There are 2 animal studies and a Phase 1 Human clinical trial. The animal studies are an abdominal surgery rat model and a spine surgery sheep model. These studies show the safety and efficacy of this chitogel-drug combination at various dosages and illustrate the healing benefits of gel-drug combination.<br>Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 2021
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