Thesis (Ph. D.)--University of Chicago, Dept. of Anatomy. / Includes bibliographical references.

Thesis (doctoral)--Albert-Ludwigs-Universität, Freiburg. / Description based on print version record. Includes bibliographical references.

The equine paranasal sinuses are a frequent site of disease. They are anatomically complex structures encased in bone that are difficult to visualize. Because of their complexity and location, accurate diagnosis and treatment of the affected sinus(es) is difficult without a good understanding of their anatomy. Use of 3-D computer models in anatomy education has increased in recent years and shows promise in teaching anatomy of complex structures. The goal of this thesis was to develop a computer program illustrating a 3-D model of the equine paranasal sinuses to aid teaching the anatomy of the paranasal sinuses. A CT scan of a horse’s head was performed and a 3-D reconstruction was generated. The paranasal sinuses were illustrated in the reconstructed images using Adobe Photoshop 6.0. Adobe Flash Professional CS5 was used to create an interactive computer program from the images. The resulting computer program depicts the sinuses and features of the skull at five key points plus or minus nine degrees of rotation.

Thesis (M.Sc.)--University of Alberta, 2010. / A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Master of Science in Medical Sciences, Temporomandibular Disorders/Orofacial Pain. Title from pdf file main screen (viewed on April 23, 2010). Includes bibliographical references.

Introduction: Forensic pathologists may be asked to identify the race group or sex of a cranium of unknown origin. Race group refers to geographic ancestry and sex is biological sex. An analysis of the volumes and measurements of human paranasal sinuses, namely maxillary, ethmoid, sphenoid and frontal sinuses, in dried crania of different race and sex groups (European and Zulu male and female) was undertaken to search for a new improved approach of classifying crania according to race and sex. This anatomical assessment of the human paranasal sinuses identifies race and sex variations in the paranasal sinuses. Variations in paranasal sinus volumes and measurements may mean a variation in anatomical landmarks. The best combination of sinus measurements was selected to classify a cranium according to race group and sex making this research relevant to the field of forensic medicine. Objectives: To compare the paranasal sinus volumes and measurements of dried crania of European and Zulu descent with respect to race group and sex and to develop a method of classifying a cranium according to race group or sex by using dimensions of the paranasal sinuses. Methodology: Documented, cadaver derived, dried crania were obtained from the Raymond A. Dart Collection of Human Skeletons, housed at the School of Anatomical Sciences at the University of the Witwatersrand, Johannesburg, South Africa. Age, race and sex were recorded for each cranium within the collection and hence within the study sample. 26 Adult European crania; 13 male, 13 female. Age range 19-75yrs (mean 49.42yrs) and 27 Adult Zulu crania: 13 male, 14 female. Age range 16-90yrs (mean 40.16yrs) was selected for this study. An additional cranium of unknown origin was also analysed in the research. European crania were from descendants of Europe living in South Africa and Zulu crania were obtained from Zulu patients who were part of the Zulu tribe of South Africa. 53 crania with intact paranasal sinuses (106 individual sinuses for each of the maxillary, ethmoid, sphenoid and frontal sinuses) were studied. In addition, 2 sinuses from the unknown cranium were analysed. The dried crania of European and Zulu origin were assessed by helical, multislice computed tomography using 1mm coronal slices. The area for each slice was obtained by tracing the outline of each slice. A volume was calculated by the CT machine that totaled the slices for each sinus. Measurements of width, length and height were also assessed, as were other craniometrical measurements. Statistical analysis was performed for all European and Zulu male and female sinuses in respect of volumes and measurements. Further statistical analysis searched for classification patterns. In addition, forty patients' scans from the European and Zulu male and female groups in Southern Africa were also assessed. CT scans of 10 adult European males, 10 adult European females, 10 adult Zulu males and 10 adult Zulu females provided 40 pairs of maxillary, ethmoid, sphenoid and frontal sinuses for analysis. Europeans were South African persons of European descent and Zulus were from the Zulu tribe of Kwa Zulu Natal in South Africa. Results: The aim of identifying race and sex differences in this anatomical region is achieved. Significant race and sex variations were found in the European and Zulu, male and female groups when analysing the volumes and measurements of the paranasal sinuses. The very best combinations of classifiable measurements were described and are being put forward as a new tool in human forensic identification studies. The significant sex classification figure of 91.8% by combining ethmoid, sphenoid and frontal paranasal sinus measurements, is a new discovery for using a combination of the sinuses. The significant race classification figure of 95.9 % is an excellent classification figure for classification according to race. This was done using the measurements of maxillary, ethmoid and total distance across the sinuses. All this was achieved by using the measurements of the paranasal sinuses in a European and Zulu, male and female population. Conclusion: Forensic race and sex identification of crania is now possible using a combination of measurements from the paranasal sinuses. A new approach to classifying a cranium into an race or sex group is revealed by way of using a new combination of paranasal sinus measurements. This discovery is of importance to forensic medicine in the realm of identification as it provides a measurable way of assigning race or sex to a cranium within a particular region. Other studies based on other race groups may add further value. What is clear is that the paranasal sinuses are now of established value when assessing race or sex group of a unknown cranium. A new tool for forensic race and sex identification is provided to the armamentarium of the forensic pathologist and associated disciplines.

Chronic rhinosinusitis is a common disorder of chronic inflammation of the upper respiratory tract. It is associated with significant symptoms and impairment of the quality of life of sufferers. Despite recent advances in the medical and surgical management of chronic rhinosinusitis, there remains a population of patients who fail to obtain relief from their symptoms. Chronic inflammation of the mucosa of the nasal cavity and paranasal sinuses is one of the hallmarks of chronic rhinosinusitis. This inflammation is demonstrated by an increased number of chronic inflammatory cells, elevated levels of pro-inflammatory cytokines, increased expression of adhesion molecules and metaplastic changes in the epithelium. The current medical treatments for chronic sinusitis aim to reduce this inflammation and consequently improve symptoms. In recent years, evidence has emerged that macrolide antibiotics have an anti-inflammatory effect that is separate from their anti-bacterial effect. This effect was first described in the treatment of diffuse panbronchiolitis, a disorder of chronic inflammation of the lower respiratory tract. Following the success of macrolides in treating this condition it was trialed in chronic rhinosinusitis. Several open-label trials have subsequently demonstrated a beneficial effect. Laboratory studies have investigated the mechanism of the anti-inflammatory effect of macrolides. These have shown that macrolides effect cytokine production, inflammatory cell apoptosis, expression of adhesion molecules, neutrophil oxidative burst, bacterial virulence and mucociliary function. In this thesis we report a series of experiments designed to further investigate the mechanism of action and clinical effect of macrolides. In vitro studies using whole sections of chronic rhinosinusitis mucosa cultured for 24 hours in macrolide, prednisolone or control showed that macrolide and prednisolone produced significant reductions in the production of interleukin-5, interleukin-8 and granulocyte-macrophage colony stimulating factor. The same cultured specimens also showed a reduction in expression of transforming growth factor-?. No reduction was seen in the expression of the key pro-inflammatory nuclear transcription factor Nuclear factor-?B. In our in vivo experiments, biopsies were taken from chronic rhinosinusitis patients who had received a 3-month course of macrolide. These biopsies showed a reduction in the number of neutrophils present following treatment. There was no reduction in the number of other inflammatory cells or in the expression of TGF-? and NK-?B. We have performed the first ever double-blinded, randomized, placebo-controlled trial of macrolide in the treatment of chronic rhinosinusitis. Patients receiving macrolide showed significant improvements in saccharine transit time, nasal endoscopic scoring and symptom scores following a 12 week course. Patients with low levels of serum immunoglobulin E showed significantly improved outcomes compared to those with high levels. Interleukin-8 levels in nasal lavage fluid were significantly reduced in the patients with low levels of IgE following macrolide treatment. No improvements in any of the objective or subjective outcome measures were seen in the placebo-treated patients. We have performed a series of experiments investigating the anti-inflammatory effect of macrolide antibiotics from 'the bench to the bedside'. These experiments have provided insight into the mechanism of action of macrolides in the laboratory setting and evidence of a beneficial effect in the treatment of chronic rhinosinusitis patients.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 5 uppsatser.

Purpose: Cancers of the sinonasal tract are rare, comprise a diverse group of histologies and are known for their poor prognostic outcomes. The primary aim of this study was to evaluate the 2- and 5-year overall survival (OS) rates in patients treated with radical and palliative intent for sinonasal squamous cell carcinoma (SNSCC). Methods: A retrospective review of medical records of all patients presenting to Cape Town's Groote Schuur Hospital between January 2003 and December 2013 was carried out. All patients with histologically proven squamous cell carcinoma (SCC) of the maxillary sinus and nasoethmoidal complex who underwent treatment at Groote Schuur Hospital and/or iThemba LABS (Laboratory for Accelerator Based Sciences) were included. Fifty-five patients with cancers of the sinonasal tract were identified from the electronic patient system; 23 were excluded either because of different histologies, lack of histology or having initiated treatment outside of Groote Schuur Hospital. The medical records of 32 patients were utilised for final analysis. 2- and 5-year OS was calculated using Kaplan-Meier analysis. Results: The majority (75%) of patients had an ECOG performance status of 1 with facial asymmetry secondary to tumour mass or swelling being the most common presenting symptom (present in 68,75% of cases). 62,50% of cases originated within the maxillary antrum and 56,25% of cases were classified as keratinizing SCC. Twenty-six (81,25%) patients presented with stage IV disease; nodal disease was seen in 13 (40,63%) patients and distant metastasis in 4 (12,50%) patients. Most patients underwent palliative intent treatment with only 11 (34,38%) having radical treatment. The cumulative 2- and 5-year OS from the date of treatment initiation was 26% and 19% respectively. Median OS for the entire cohort was 7,7 months and was statistically significant between intent groups at 5,19 months (95% CI:3.43– 6.95) for palliative compared to 35,45 months (95% CI: 0.00–138.52) for radical patients (c2 = 7.80, p = 0.005). Conclusion: Despite a decline in incidence of disease over the last 30 years and the improved diagnostic and therapeutic modalities available today, the prognosis and survival outcomes for SNSCC remains poor.

No description available.

Descrição: A rinossinusite fúngica (RSF) é uma infecção oportunística, caracterizada pela inflamação da mucosa nasal e dos seios paranasais. É considerada um problema emergente na clínica médica diária, com prevalência aumentada nas últimas décadas, com etiologia nos mais diversos fungos ubíquos. Objetivos: Este trabalho objetivou analisar todos os casos de RSF pertencentes ao banco de dados do Laboratório de Micologia da Irmandade da Santa Casa de Misericórdia de Porto Alegre, no período de 28 anos (1986-2014), relacionando-os com as características clínicas e epidemiológicas. Materiais e métodos: O estudo foi retrospectivo observacional, resultando em uma série de 82 casos, confirmados histopatologicamente e pelos exames micológicos para identificação de fungos, comparados-os com os achados nas imagens radiológicas. Resultados: Foram identificados 54 casos de RSF por aspergilose, com predominância do agente etiológico Aspergillus fumigatus (14/54), e 27 casos de RSF por fungos diferentes do gênero Aspergillus, com superioridade de isolamento de agentes responsáveis por hialohifomicoses (12/27). Configurado, nestes achados, o ineditismo de três casos em nosso meio, com destaque para o primeiro caso de RSF e infecção humana por Trichoderma asperellum. Conclusões: Estes achados representam a maior casuística brasileira identificada, podendo contribuir para uma melhor compreensão epidemiológica, melhorando os critérios de suspeição médica, refletindo na efetividade dos tratamentos, principalmente, no diagnóstico dos casos de RSF invasiva, com altas taxas de mortalidade. / Description: The fungal rhinosinusitis (FRS) is an opportunistic infection characterized by inflammation of the nasal mucosa and sinuses. It is considered an emerging problem in daily medical practice, with prevalence increased in recent decades, with etiology in diverse ubiquitous fungi. Objectives: This study aimed to analyze all cases of RSF belonging to the Mycology Laboratory of the database of the Brotherhood of the Santa Casa of Misericordia Porto Alegre during the period of 28 years (1986-2014), relating them with the clinical and epidemiological characteristics. Methods: The study was observational retrospective, resulting in a series of 82 cases confirmed by histopathological and mycological examinations for identification of fungi, compared them with the findings on radiographs. Results: We identified 54 cases of aspergillosis by RSF, especially the etiologic agent Aspergillus fumigatus (14/54), and 27 cases of RSF different fungi Aspergillus, with insulation superiority of agents responsible for hyalohyphomycosis (12/27). Configured, these findings, the three cases unprecedented in our country, especially the first case of human infection with RSF and Trichoderma asperellum. Conclusions: These findings represent the largest identified Brazilian series and can contribute to a better epidemiological understanding, improving clinical suspicion criteria, reflecting the effectiveness of treatments, mainly in diagnosing cases of invasive RSF, with high mortality rates.