Biomedical subjects

C Arturo Solares

Publications and source records attributed to C Arturo Solares.

18 recordsLinked to original sources

PubMed2006

Increased frequencies of cochlin-specific T cells in patients with autoimmune sensorineural hearing loss.

Autoimmune sensorineural hearing loss (ASNHL) is the most common cause of sudden hearing loss in adults. Although autoimmune etiopathogenic events have long been suspected in ASNHL, inner ear-specific Ags capable of targeting T cell autoreactivity have not been identified in ASNHL. In this study, we show by ELISPOT analysis that compared with normal hearing age- and sex-matched control subjects, ASNHL patients have significantly higher frequencies of circulating T cells producing either IFN-gamma (p = 0.0001) or IL-5 (p = 0.03) in response to recombinant human cochlin, the most abundant inner ear protein. In some patients, cochlin responsiveness involved both CD4+ and CD8+ T cells whereas other patients showed cochlin responsiveness confined to CD8+ T cells. ASNHL patients also showed significantly elevated cochlin-specific serum Ab titers compared with both normal hearing age- and sex-matched control subjects and patients with noise- and/or age-related hearing loss (p < 0.05 at all dilutions tested through 1/2048). Our study is the first to show T cell responsiveness to an inner ear-specific protein in ASNHL patients, and implicates cochlin as a prominent target Ag for mediating autoimmune inner ear inflammation and hearing loss.

Aged↗

PubMed2005

Closure of persistent tracheocutaneous fistula following "starplasty" tracheostomy in children.

OBJECTIVE: The "starplasty" technique of pediatric tracheostomy was introduced in 1990 as an alternative pediatric tracheostomy technique associated with several advantages. The only apparent drawback of this technique is the higher incidence of persistent tracheocutaneous fistula following decannulation. Several methods have been proposed for closure of persistent tracheocutaneous fistula in children, including fistulectomy with primary closure and fistulectomy with healing by secondary intent. Some authors advocate placement of a drain at the time of primary closure. We present our experience with closure of persistent tracheocutaneous fistula following starplasty in children over the past 15 years. METHODS: Ninety-six starplasty procedures were performed on 96 children from 1990 to present, all by the senior author or under the guidance of the senior author. Twenty-eight of these children have been decannulated. Three fistulas closed spontaneously following decannulation. Of the remaining 25 children, 13 have undergone surgical closure of the tracheocutaneous fistula by the senior author. All tracheocutaneous fistula closures were performed as a fistulectomy with primary closure in three layers. Drains were not used in any of the patients. RESULTS: There were three minor complications in the postoperative period (wound infection and airway granuloma) and no major complications. None of the patients have experienced any degree of airway stenosis and there was no need for a repeat tracheotomy in any of the tracheocutaneous fistula closure patients. The cosmetic results were deemed to be good. CONCLUSIONS: "Starplasty" is a safe, reliable pediatric tracheostomy technique that has been shown to decrease the incidence of perioperative morbidity and mortality. The only drawback appears to be a high incidence of postoperative tracheocutaneous fistula. Our method of persistent tracheocutaneous fistula closure following starplasty is safe and effective, with no major complications and no incidence of postoperative airway narrowing.

Child↗

PubMed2005

Oncologic effectiveness of selective neck dissection in the N0 irradiated neck.

BACKGROUND: The incidence and patterns of nodal spread in previously irradiated N0 necks are not well defined. Therefore, the safety and efficacy of selective neck dissection (SND) in this patient population is not well established. In a previous report from our institution, SND in irradiated patients with recurrent disease at the primary site but clinically negative necks resulted in excellent tumor control in the neck. The objective of this study is to validate our initial observations in a larger sample of patients with longer follow-up. METHODS: A retrospective chart analysis of patients previously treated with primary radiation therapy or chemoradiotherapy for squamous cell carcinoma (SCC) of the head and neck between January 1997 and June 2003 was performed. Patients with recurrent or persistent disease at the primary site or a second primary head and neck SCC, with no clinical or radiologic disease in the neck, who underwent surgical salvage with resection of the primary site along with a site-specific SND were analyzed. Patients who remained disease free at the primary site were analyzed for regional control after SND. RESULTS: Sixty-nine patients underwent a total of 96 site-specific SNDs. The mean age was 64.1 years (range, 39-91 years). There was histologically positive nodal disease in 17 of 69 patients (25%), and 22 of 96 necks (23%). Fifty-three patients had at least a 12-month follow-up. The mean follow-up was 23.3 months (range, 1-96 months). Of the patients with 1-year of follow-up, six patients died from recurrence at the primary site, and nine died from distant metastasis. There were no cases of neck recurrence with the primary site controlled. All patients who had more than two positive nodes had recurrence either at the primary site or distant metastasis. CONCLUSIONS: Our results confirm that the patterns of lymphatic spread are not affected by radiation. We conclude that SND is oncologically safe in the management of the N0 irradiated neck and that the finding of more than two positive nodes predicts a poor outcome.

Adult↗

PubMed2005

Expression of the carrier protein apolipoprotein D in the mouse inner ear.

The cochlear portion of the inner ear converts movements produced by sound waves into electrical impulses. Transcripts enriched in the cochlea are likely to have an important role in hearing. In this paper, we report that microarray analyses of the Soares NMIE inner ear library revealed cochlear enriched expression of apolipoprotein D (apoD), a glycoprotein and member of the lipocalin family that transport small hydrophobic ligands. The cochlear enriched expression of Apod was validated by quantitative real time PCR analysis. To investigate the function of apoD in the inner ear the transcript and protein were localised in the cochlea. Apod messenger RNA (mRNA) expression was localised to the spiral ligament and spiral limbus, particularly in the suprastrial and supralimbral regions. The apoD protein was detected in the spiral ligament, spiral limbus and also in the outer hair cells of the organ of Corti. Investigation of cell lines exhibiting characteristics of hair and supporting cells revealed no Apod mRNA expression in these cells. This suggests transport of the protein within the cochlea, followed by internalisation into outer hair cells. The spiral limbus and ligament contain subpopulations of fibrocytes that are intimately involved in regulation of ion balance in the cochlear fluids and type I, II and III fibrocytes of the spiral ligament were all shown to be positive for apoD protein. On the basis of these results it was hypothesised that apoD could be involved in maintaining cochlear fluid homeostasis. To determine whether the apoD gene product was important for normal auditory function the hearing ability of an apoD knockout mouse was tested. The mouse was found to have a hearing threshold that was not significantly different to the control strain.

Animals↗

PubMed2005

Transnasal endoscopic resection of lesions of the clivus: a preliminary report.

OBJECTIVE: To review our experience with transnasal endoscopic resection of clival lesions. BACKGROUND: Because of the surrounding vital structures and the difficulties in achieving wide surgical exposure, the treatment of clival lesions is challenging. In an effort to overcome these obstacles, many centers use facial incisions and osteotomies to approach clival lesions. Minimally invasive endoscopic techniques have the potential to minimize morbidity while yielding similar surgical results. STUDY DESIGN: Retrospective chart analysis. MATERIALS AND METHODS: Patients with tumors involving the clivus that underwent endoscopic resection between 2000 and 2004 were identified. Charts were reviewed for clinical characteristics, previous therapies, diagnosis, tumor extent, management modalities, length of hospital stay, complications, and outcome. RESULTS: A total of six patients were identified. There were four males and two females with a mean age of 50 years, ranging from 29 to 66 years. The most common presenting symptoms were visual disturbances. Three patients had prior craniotomy with subtotal tumor resection. The pathology included three clival chordomas, and one each of meningioma, adenoid cystic carcinoma, and sinonasal undifferentiated carcinoma. All patients were managed with computer-aided transnasal endoscopic tumor resection with neurosurgical standby or involvement. None of the patients required additional craniotomies. The mean follow-up was 13 (range, 8-24) months. Intensity-modulated radiation therapy was used in three patients, and two patients are currently undergoing proton beam radiation therapy (PBRT). The average length of hospital stay was 2 (range, 2-3) days. There were no major postoperative complications. At the last follow-up, five patients were alive with two patients being free of disease. Two patients with residual disease are currently undergoing PBRT, and one patient developed distant metastasis. One patient died of unrelated causes. CONCLUSIONS: This preliminary report suggests that transnasal endoscopic management of clival lesions is a viable option to traditional open approaches with acceptable morbidity and mortality. The use of computer-aided surgery further minimizes surgical risks while maximizing tumor resection.

Adult↗

PubMed2005

ELISPOT determination of interferon-gamma T-cell frequencies in patients with autoimmune sensorineural hearing loss.

Autoimmune sensorineural hearing loss (ASNHL) is the most common cause of sudden hearing loss in adults. Although the etiopathogenesis of this disease is unclear, it is widely believed that antibody and/or T-cell responses directed against inner ear-specific proteins may mediate ASNHL. Using the enzyme-linked immunospot (ELISPOT) assay, we have recently found that many patients with ASNHL have increased frequencies of peripheral blood T-cells capable of producing interferon (IFN)-gamma in response to a homogenate of human inner ear tissue. Our studies may ultimately lead to the identification of inner ear-specific autoimmune targets in ASNHL, and our ELISPOT approach may be particularly useful in supporting the diagnosis of this disease entity. In the current chapter we detail how to use the ELISPOT assay for measuring frequencies of IFN-gamma-producing T-cells in patients with ASNHL.

Adult↗

PubMed2004

Safety and efficacy of powered intracapsular tonsillectomy in children: a multi-center retrospective case series.

OBJECTIVE: To determine the efficacy of powered intracapsular tonsillectomy (PIT, e.g. regrowth rate) in children who underwent PIT at three different institutions. We also wanted to determine if the trend to greater safety through reduced bleeding and re-admission for dehydration, noted in our initial reports, would become statistically significant in a larger sample. STUDY DESIGN AND SETTING: Multi-center retrospective case series. PATIENTS AND METHODS: We retrospectively reviewed all charts' of children who underwent PIT at three different institutions: the Children's Hospital at the Cleveland Clinic, Alfred I. DuPont Hospital for Children, and the New York Otolaryngology Institute. For comparison, we reviewed the outpatient and inpatient records of all children who underwent conventional tonsillectomy performed by the same surgeons at the Children's Hospital at the Cleveland Clinic and Alfred I. DuPont Hospital for Children during the same period. No comparison group was available for the New York Otolaryngology Institute group. Three outcome measures were recorded: regrowth, bleeding and re-admission for dehydration rates. All statistical analyses were performed using SAS, and P < 0.05 was considered statistically significant. RESULTS: We identified 870 children that underwent PIT at three different institutions. In addition, 1121 children underwent conventional tonsillectomy at two of the three institutions. The mean follow-up for the PIT group was 1.2 years (range, 0.1-2.6 years) and 1.5 years (range, 0.1-3.0 years) for the conventional tonsillectomy group. The incidence of and 95% CI for the outcome measures were as follows regrowth 0.5% (0%, 1.4%), delayed post-operative bleeding 0.7% (0%, 1.9%), re-admission for dehydration 1.3% (0.05%, 2.6%), and overall major complications 0.46% (0.009%, 0.9%). When comparing conventional tonsillectomy to PIT, the bleeding rate, re-admission for dehydration, and the overall incidence of major complications were significantly lower in the PIT group (P = 0.001, P = 0.002, and P < 0.001, respectively). CONCLUSION: PIT is a safe and effective technique in the management of obstructive sleep disordered breathing in children. PIT has the advantages of decreased pain, dehydration and post-operative bleeding, and with a mean follow-up of 1.2 years, a low incidence of tonsillar regrowth thus far.

Child↗

PubMed2004

Starplasty: revisiting a pediatric tracheostomy technique.

OBJECTIVE: To determine the efficacy the "starplasty" pediatric tracheostomy technique in reducing the incidence of major complications and tracheotomy-related death. METHODS: Retrospective chart analysis of all the cases of starplasty performed at 2 tertiary care centers between 1990 and 2002. RESULTS: There were 94 children in our cohort ranging in age from 2 days to 14 years. Of the patients, 47 (50%) were females and 47 (50%) were males and 60 of the children (64%) were younger than 1 year of age. Forty-one patients (44%) had neurologically related airway problems as their primary indication for tracheostomy, 34 (36%) had upper airway obstruction, and the remainder had pulmonary diseases, prolonged intubation, or metabolic-related airway problems. There were 41 short-term complications including 5 cases of tracheal tube dislodgement. There were no instances of pneumothorax or tracheostomy-related death. There were 26 long-term complications. There were no cases of clinically relevant suprastomal collapse that compromised decannulation and no instances of tracheal stenosis. Twenty-six patients underwent decannulation, all of whom developed a tracheocutaneous fistula (TCF). Two patients had spontaneous closure of the TCF; 9 patients underwent surgical repair of their fistulas, 53 patients remain tracheostomy-dependent, and 8 patients died of their primary disease. CONCLUSION: The need for pediatric tracheotomy has increased as a consequence of our success in treating chronically ill children. Starplasty reduces the incidence of major complications, including pneumothorax and death from accidental decannulation. Its major drawback is the need for secondary reconstruction of a tracheocutaneous fistula. EBM RATING: C.

Adolescent↗

PubMed2004

Murine autoimmune hearing loss mediated by CD4+ T cells specific for inner ear peptides.

Autoimmune sensorineural hearing loss (ASNHL) is characterized typically by bilateral, rapidly progressive hearing loss that responds therapeutically to corticosteroid treatment. Despite its name, data implicating autoimmunity in the etiopathogenesis of ASNHL have been limited, and targeted self-antigens have not been identified. In the current study we show that the inner ear-specific proteins cochlin and beta-tectorin are capable of targeting experimental autoimmune hearing loss (EAHL) in mice. Five weeks after immunization of SWXJ mice with either Coch 131-150 or beta-tectorin 71-90, auditory brainstem responses (ABR) showed significant hearing loss at all frequencies tested. Flow cytometry analysis showed that each peptide selectively activated CD4(+) T cells with a proinflammatory Th1-like phenotype. T cell mediation of EAHL was determined by showing significantly increased ABR thresholds 6 weeks after adoptive transfer of peptide-activated CD4(+) T cells into naive SWXJ recipients. Immunocytochemical analysis showed that leukocytic infiltration of inner ear tissues coincided with onset of hearing loss. Our study provides a contemporary mouse model for clarifying our understanding of ASNHL and facilitating the development of novel effective treatments for this clinical entity. Moreover, our data provide experimental confirmation that ASNHL may be a T cell-mediated organ-specific autoimmune disorder of the inner ear.

Adoptive Transfer↗

PubMed2003

Anatomical variations of the facial nerve in first branchial cleft anomalies.

OBJECTIVE: To review our experience with branchial cleft anomalies, with special attention to their subtypes and anatomical relationship to the facial nerve. STUDY DESIGN: Case series. SETTING: Tertiary care center. PATIENTS: Ten patients who underwent resection for anomalies of the first branchial cleft, with at least 1 year of follow-up, were included in the study. The data from all cases were collected in a prospective fashion, including immediate postoperative diagrams. INTERVENTION: Complete resection of the branchial cleft anomaly was performed in all cases. Wide exposure of the facial nerve was achieved using a modified Blair incision and superficial parotidectomy. Facial nerve monitoring was used in every case. MAIN OUTCOME MEASURES: The primary outcome measurements were facial nerve function and incidence of recurrence after resection of the branchial cleft anomaly. RESULTS: Ten patients, 6 females and 4 males,with a mean age of 9 years at presentation, were treated by the senior author (P.J.K.) between 1989 and 2001. The lesions were characterized as sinus tracts (n = 5), fistulous tracts (n = 3), and cysts (n = 2). Seven lesions were medial to the facial nerve, 2 were lateral to the facial nerve, and 1 was between branches of the facial nerve. There were no complications related to facial nerve paresis or paralysis, and none of the patients has had a recurrence. CONCLUSIONS: The successful treatment of branchial cleft anomalies requires a complete resection. A safe complete resection requires a full exposure of the facial nerve, as the lesions can be variably associated with the nerve.

Adolescent↗

PubMed2003

Thyroglossal duct cysts: presentation and management in children versus adults.

OBJECTIVES: To determine if the clinical presentation of thyroglossal duct cysts (TGDC) varies between children and adults and whether this knowledge helps optimize the surgical management. METHODS: We retrospectively identified all patients with TGDC managed in our department between 1992 and 2002. We reviewed the patients' charts and recorded their gender, age at diagnosis, clinical presentation, radiologic imaging, surgical management, post-operative complications, and recurrence rate and compared the variables between the children and adults. RESULTS: Twenty-one children and 41 adults were treated for TGDC. Of the children, 57% were male and 43% were female, whereas 49% of the adults were male and 51% were female (P = 0.53). The average age was 6 +/- 5 years in children and 45 +/- 16 years in adults, which demonstrates a bimodal distribution. Forty-three percent of children and 42% of adults presented with an infected neck mass (P > 0.99). Among our patients, 96% of the adults and 100% of the children underwent a Sistrunk operation. Four children developed a wound infection that resolved with antibiotics. One adult developed a haematoma and another developed a wound seroma. There was one recurrence among adults and one among children, both of whom were treated with a second Sistrunk procedure. CONCLUSIONS: There appears to be a bimodal distribution for age at presentation of TGDC. Since the differential diagnosis among adults is broader, the opportunity for misdiagnosis is greater. However, once the correct diagnosis is made, the surgical management and post-operative outcome between adults and children is the same.

Adult↗

PubMed2003

Tachycardia-induced cardiomyopathy.

Systolic dysfunction associated with chronic tachyarrhythmias, known as tachycardia-induced cardiomyopathy, is a reversible form of heart failure characterized by left ventricular dilatation that is usually reversible once the tachyarrhythmia is controlled. Its development is related to both atrial and ventricular arrhythmias. The diagnosis is usually made following observation of a marked improvement in systolic function after normalization of heart rate. Clinicians should be aware that patients with unexplained systolic dysfunction may have tachycardia-induced cardiomyopathy, and that controlling the arrhythmia may result in improvement and even complete normalization of systolic function.

Cardiomyopathy, Dilated↗

PubMed2003

Autoimmune sensorineural hearing loss: an immunologic perspective.

Autoimmune sensorineural hearing loss (ASNHL) typically produces a bilateral rapidly progressive loss of hearing that may occur suddenly. The diagnosis is made by excluding ototoxicity, systemic disease, and other factors that mimic ASNHL and by showing a therapeutic response to corticosteroid treatment. Although autoantibodies and autoreactive T cells have been implicated in the etiopathogenesis of ASNHL, several central issues remain unresolved, including the relative prominence of B cell or T cell autoimmunity in the initiation and progression of ASNHL, the identity of the putative inner ear self-antigen(s) that target ASNHL, and the development and application of immunosuppressive therapies for preventing the progressive hearing loss which may be profound and require cochlear implantation. In this review, we will examine the seminal human and animal studies that have led to our current views regarding the autoimmune etiopathogenesis of ASNHL. In addition, we will address the need for developing an inner ear-specific mouse model for ASNHL that may define the stages leading to the development of ASNHL and may also provide new diagnostic markers and help develop novel and effective treatments for preventing progressive hearing loss in ASNHL.

Animals↗

PubMed2003

Intracapsular tonsillar reduction (partial tonsillectomy): reviving a historical procedure for obstructive sleep disordered breathing in children.

OBJECTIVE: We sought to reintroduce a historical procedure-intracapsular tonsillar reduction (partial tonsillectomy or tonsillotomy)-for tonsillar hypertrophy causing obstructive sleep disordered breathing (OSDB) in children, as well as to determine whether partial tonsillectomy, compared with conventional (total) tonsillectomy when performed by more than one surgeon, is equally effective for the relief of OSDB while resulting in less pain and more rapid recovery. STUDY DESIGN: We conducted a retrospective case series at a tertiary children's hospital. The charts of children who underwent partial tonsillectomy and total tonsillectomy (1998 through 2002) for postoperative complications were reviewed. The caregivers were surveyed to assess postoperative pain, rapidity of recovery, and effectiveness of surgery for relieving symptoms of OSDB. RESULTS: Two hundred forty-three children underwent partial tonsillectomy and 107 children underwent total tonsillectomy. There were no significant differences in immediate and delayed complications between the groups. Both operations were equally effective in relieving OSDB. Children who had partial tonsillectomy had significantly less postoperative pain and significantly more rapid recovery. CONCLUSION: Intracapsular tonsillar reduction with an endoscopic microdebrider relieves OSDB as effectively as conventional tonsillectomy, but results in less postoperative pain and a more rapid recovery.

Child↗

PubMed2002

Intracapsular partial tonsillectomy for tonsillar hypertrophy in children.

OBJECTIVE: To review our experience with intracapsular tonsillectomy using powered instrumentation in the management of tonsillar hypertrophy causing obstructive sleep-disordered breathing in children. STUDY DESIGN: Retrospective case series. METHODS: Intracapsular tonsillectomy, a form of partial tonsillectomy performed with an endoscopic microdebrider, preserves the tonsillar capsule as a barrier to exposure of the pharyngeal muscles. Results in 150 children who underwent this procedure were compared with those in 162 children who had standard tonsillectomy. RESULTS: Children who underwent intracapsular tonsillectomy had significantly less pain throughout the recovery period than those who had standard tonsillectomy. There was no significant difference between the two groups in intraoperative blood loss, and no episodes of immediate postoperative bleeding occurred in either group. Six patients who had the standard operation and one patient who had the intracapsular procedure had delayed hemorrhage requiring hospital readmission. Five children in the standard group and one in the intracapsular group were readmitted because of dehydration. Thus, in all, 11 readmissions were necessary among children who underwent standard tonsillectomy, whereas 2 were required among those who had intracapsular tonsillectomy. CONCLUSION: Intracapsular tonsillectomy is as effective as standard tonsillectomy in relieving obstructive sleep-disordered breathing but produces less postoperative pain and fewer episodes of delayed hemorrhage and dehydration.

Case-Control Studies↗

PubMed2002

Interferon-gamma production to inner ear antigens by T cells from patients with autoimmune sensorineural hearing loss.

Autoimmune sensorineural hearing loss (ASNHL) typically produces bilateral rapidly progressive loss of hearing over a few days or weeks, but may also produce sudden loss over a few hours. The diagnosis is made by excluding ototoxicity, systemic disease, and other factors that mimic ASNHL and by showing a therapeutic response to corticosteroid treatment. Antibody production and T-cell proliferative responses to inner ear antigens have been implicated in the etiopathogenesis of ASNHL. In the current study, we have extended these autoimmune investigations by determining the frequencies of inner ear specific IFN-gamma producing T cells in peripheral blood mononuclear cells (PBMC) from ASNHL patients and from age- and sex-matched control subjects. ELISPOT analysis showed that 25% of ASNHL patients have significant increased frequencies of inner ear specific IFN-gamma producing T cells in their PBMC. All control subjects were relatively unresponsive. Our results implicate inner ear specific IFN-gamma producing proinflammatory T cells in the pathogenesis of ASNHL.

Adult↗

PubMedDate not supplied

Occult papillary thyroid carcinoma in postmortem species: prevalence at autopsy.

OBJECTIVE: The purpose of this study was to determine the prevalence of occult papillary thyroid cancer (OPTC) in a sample of cadavers from Guatemala, a country in Central America. STUDY DESIGN AND SETTING: This was a cross-sectional study of cadaver samples. We analyzed 150 glands that were removed during autopsy from 150 cadavers (34 women and 116 men) who were admitted to the morgue of the Judicial Bureau between January and March 2000. RESULTS: A total of 17 glands showed macroscopic evidence of disease, but only 3 glands (1 female and 2 males) showed microscopic evidence of malignancy. This corresponded to a 2% prevalence rate (range, 0.4-5.7%). The sex prevalence of OPTC was 2.9% (range, 0.07-15%) for females and 1.7% (range, 0.2-6.1%) for males. No significant difference was noted ( P = .47, exact unconditional test). The male-to-female ratio was 1:1.7. CONCLUSION: We concluded that the prevalence of OPTC in Guatemala is low but comparable to literature reports. Occult papillary thyroid carcinoma appears to have no sex predilection as opposed to the clinically evident papillary thyroid carcinoma, which develops more commonly in females. SIGNIFICANCE: Occult papillary thyroid carcinoma is a much more common pathology than clinically evident thyroid cancer, and the clinical implications still need to be determined.

Adolescent↗

PubMedDate not supplied

Treatment of chronic rhinosinusitis exacerbations due to methicillin-resistant Staphylococcus aureus with mupirocin irrigations.

INTRODUCTION: Chronic rhinosinusitis (CRS) exacerbations due to methicillin-resistant Staphylococcus aureus (MRSA) are routinely encountered. Treatment often involves intravenous antibiotics that provide only transient benefits. Mupirocin has well-recognized antistaphylococcal activity, and its nasal formulation is approved by the Food and Drug Administration for the eradication of nasal colonization with MRSA. OBJECTIVE: The aim of this study was to describe the use of mupirocin nasal irrigations for the treatment of CRS exacerbations due to MRSA. MATERIALS AND METHODS: Charts of patients who received mupirocin nasal irrigations for MRSA exacerbations of CRS between January 2000 and October 2003 were reviewed. RESULTS: Forty-two MRSA-positive cultures were obtained from 24 patients (mean age, 61 years; range, 38-82 years; 15 women and 6 men). Twenty-eight episodes were treated with mupirocin nasal irrigations and doxycycline; 4 were treated with mupirocin nasal irrigations and trimethoprim-sulfamethoxazole, and 7 episodes were treated with mupirocin nasal irrigations alone. Patients were reevaluated at approximately 4 to 6 weeks. Repeat cultures were not obtained in 12 patients (because of clinical and endoscopic resolution). Adequate follow-up was unavailable for 3 patients, and of the 27 repeat cultures, only 1 grew MRSA. Twelve patients had at least one recurrence, with a mean number of episodes of 1.75 (range, 1-8 episodes). The mean follow-up was 11.8 months (range, 3-27 months). CONCLUSIONS: Mupirocin nasal irrigations may avoid the need for intravenous antibiotics, which often provide temporary benefits and entail greater cost and morbidity. Thus, mupirocin nasal irrigations may provide a relatively simple means for the management of MRSA exacerbations of CRS.

Administration, Intranasal↗