F G Kronberg | PubMed Health

PubMed1985

Sinusitis in intensive care unit patients.

The ultimate source of sepsis may be difficult to pinpoint in critically ill patients with multiple possible sources of iatrogenic infection. In the last year, we have been consulted with regard to several febrile intensive care unit patients in whom sinusitis was initially identified by computerized axial tomography done for other reasons. The questions are: 1. are the x-ray findings significant; 2. is this the cause of fever and sepsis; 3. how should the patient be treated for this problem; and 4. can this be prevented. In five patients, sepsis was clearly related to sinusitis. Treatment had included nasal tubes in all six patients, and in addition, five patients had received high doses of corticosteroids while intubated. The sixth patient was a diabetic. Etiology, diagnosis, and management are discussed in detail. We believe that prolonged nasal intubation should be avoided, particularly in patients with decreased resistance to infection. Initial treatment consists of removing intranasal tubes and the administration of broad spectrum or culture specific antibiotics. Surgery is indicated in the event of persistent sepsis or secondary complications. Computerized tomography is an excellent tool for diagnosis and following response to therapy.

Adult↗

PubMed1984

Visual loss associated with orbital and sinus diseases.

Visual loss associated with orbital and sinuses diseases is mainly due to infectious processes, trauma and neoplasm. From 1975 to 1983, we have encountered 34 such cases. The most common cause in our series was infectious processes, either due to aerobic or anaerobic bacteria or fungi (aspergillosis and phycomycosis). Iatrogenic trauma resulting in complete unilateral irreversible blindness was the second most common etiology in the series of cases that came to our attention for several reasons. Three of our patients with complete blindness, even with documented absence of light perception, secondary to infections or mucocele, underwent emergency surgical treatment with successful restoration of vision. Other patients with various degrees of visual loss experienced improvement, often to normal levels, when timely appropriate surgical treatment was applied. Orbital or optic nerve decompression was used according to pathologic findings encountered. High resolution CT scan has been very helpful in precisely pinpointing the lesion. It is also indispensable in the follow-up of orbital abscesses in order to rule out intracranial complications. Blindness with immediate onset secondary to either external or iatrogenic trauma, with rare exceptions, has a dismal prognosis. Early diagnosis and prompt treatment are essential for salvage of vision or even lives of patients affected by such dreadful complications.

Adolescent↗