Holly E Stevens | PubMed Health

PubMed2003

Choosing a computer-assisted surgical system for sinus surgery.

OBJECTIVES: Choosing the correct computer-assisted system for sinus surgery can be a formidable task for surgeons and their institutions. A formal trial of an electromagnetic (InstaTrak, Visualization Technologies Incorporated, Woburn, MA) and an optical (LandmarX by Medtronic-Xomed, Jacksonville, FL) system was conducted over a 10-month period at the St. Paul's Sinus Centre in Vancouver, BC. An objective and subjective evaluation method was used to select the system for use at our institution. METHODS: Thirty-nine patients were operated on by the senior author (A.R.J.) using the InstaTrak (23 patients) or the LandmarX (16 patients). The two groups were balanced in terms of age, gender, number of previous surgeries, and extent of surgery. Estimated blood loss, surgical time, and surgical complications were compared between the groups, with all other variables constant. Nursing and radiology personnel as well as the three surgeons who used both systems at the centre were surveyed on patient safety, ease of use, storage, and accessories. RESULTS: There was no statistical difference in objective surgical data. There was a more pronounced learning curve using the LandmarX as defined by a greater decrease in the duration of surgical time by the end of the trial period. The operating room personnel found the InstaTrak easier to use, whereas the computed tomography technologists preferred the LandmarX. The surgeons found the two systems acceptable in terms of navigational accuracy; however, the InstaTrak was felt to be more user friendly. CONCLUSIONS: The InstaTrak system was chosen for our institution mainly because of its ease of use by the operating room staff and the sinus surgeons.

Adult↗

PubMed2002

Acute bacterial sinusitis in adults: management in the primary care setting.

Sinus disease is inherently associated with viral upper respiratory tract infections and occurs in 90% of individuals with the common cold. Acute bacterial sinusitis occurs in 0.5 to 2% of these individuals. Although the diagnosis of acute bacterial sinusitis is usually based on physical findings, no one sign or symptom is either sensitive or specific for sinusitis. The predictive power can be significantly improved when all signs and symptoms are combined into a clinical impression. Imaging studies have not been shown to be cost effective in the initial assessment and treatment of patients in the primary care setting. Simple plain films may be indicated to resolve the diagnosis in patients with an equivocal history or to follow patients admitted to hospital with severe sinus disease. The initial management of acute sinusitis should be directed toward the relief of symptoms with a 7-day course of decongestants and mucoevacuents. For patients who fail to improve with symptomatic treatment, a 10-day course of amoxicillin is recommended. Second line antibiotics should be initiated if improvement is not seen within 72 to 96 hours.

Adult↗