Expert consensus on odontogenic maxillary sinusitis multi-disciplinary treatment

Odontogenic maxillary sinusitis (OMS) is a subtype of maxillary sinusitis (MS). It is actually inflammation of the maxillary sinus that secondary to adjacent infectious maxillary dental lesion. Due to the lack of unique clinical features, OMS is difficult to distinguish from other types of rhinosinusitis. Besides, the characteristic infectious pathogeny of OMS makes it is resistant to conventional therapies of rhinosinusitis. Its current diagnosis and treatment are thus facing great difficulties. The multi-disciplinary cooperation between otolaryngologists and dentists is absolutely urgent to settle these questions and to acquire standardized diagnostic and treatment regimen for OMS. However, this disease has actually received little attention and has been underrepresented by relatively low publication volume and quality. Based on systematically reviewed literature and practical experiences of expert members, our consensus focuses on characteristics, symptoms, classification and diagnosis of OMS, and further put forward multidisciplinary treatment decisions for OMS, as well as the common treatment complications and relative managements. This consensus aims to increase attention to OMS, and optimize the clinical diagnosis and decision-making of OMS, which finally provides evidence-based options for OMS clinical management.

Association of Comorbid Asthma and the Efficacy of Bioabsorbable Steroid-eluting Sinus Stents Implanted After Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis with Nasal Polyps

Objective To identify factors affecting the efficacy of steroid-eluting sinus stents implanted after endoscopic sinus surgery(ESS)in patients with chronic rhinosinusitis with nasal polyps(CRSwNP).Methods We performed a post-hoc analysis of a randomized self-controlled clinical trial on post-operative implantation of bioabsorbable steroid-eluting stents in patients with CRSwNP.Univariate logistic regression analysis was conducted to identify which of the following factors affect the response to post-operative stent implantation:sex,serum eosinophil levels,history of prior surgery,endoscopic scores,and comorbid conditions(asthma and allergic rhinitis).The primary outcome was the rate of post-operative intervention on day 30,and the secondary outcome was the rate of polypoid tissue formation(grades 2–3)on days 14,30,and 90.Results A total of 151 patients with CRSwNP were included in the post-hoc analysis.Asthma was identified as the only risk factor for a poor response to steroid-eluting sinus stents on post-operative day 30,with an odds ratio of 23.71(95%CI,2.81,200.16;P=0.004)for the need for post-operative intervention and 19(95%CI,2.20,164.16;P=0.003)for moderate-to-severe polypoid tissue formation.In addition,the asthmatic group showed higher rates of post-operative intervention and polypoid tissue formation than the non-asthmatic group on post-operative day 30.Blood eosinophil levels were not identified as a risk factor for poor outcomes after stent implantation.Conclusion Comorbid asthma,but not blood eosinophil level,impairs the efficacy of steroid-eluting sinus stents in the short term after ESS in patients with CRSwNP.

Socioeconomic Status Impacts the Prognosis of Chronic Rhinosinusitis Treated by Endoscopic Sinus Surgery:An Observational Cohort Study in Northeast China

Objective To explore the association between socioeconomic status(SES)and postoperative outcomes in patients with chronic sinusitis(CRS)after functional endoscopic sinus surgery(ESS).Methods We conducted an observational cohort study of 1,047 patients with CRS undergoing ESS.Discharged patients were followed up to 72 weeks for all-cause recurrence events.Baseline SES was established based on occupation,education level,and family income of the patients 1 year before the operation.Kaplan–Meier method was used to calculate the recovery rate after ESS,and Cox proportional hazards regression analysis was used to evaluate the relationship between SES and prognosis.Results Patients of middle SES had lower unadjusted all-cause recurrence than those of low or high SES;24-week overall recovery rate was 90.4%[95%confidence interval(CI):89.6%–91.2%]in patients of middle SES,13.5%(95%CI:12.8%–14.2%)in patients of low SES,and 31.7%(95%CI:30.7%–32.7%)in patients of high SES(both log-rank P<0.001).After adjustment for covariates,hazard ratios(HRs)were7.69(95%CI:6.17–9.71,Ptrend<0.001)for all-cause recurrence for low SES versus middle SES,and 6.19(95%CI:4.78–7.93,Ptrend<0.001)for middle SES versus high SES.Conclusion Low SES and high SES were more associated with the worse prognosis of CRS patients after ESS than middle SES.

Study on the Impact of Cognitive Nursing Model on Postoperative Quality of Life in Patients Undergoing Chronic Sinusitis Surgery

Objective:To explore effective nursing programs for surgical patients with chronic sinusitis(CS).Methods:62 CS surgery patients were randomly divided into a research group and a control group with 31 cases in each group.The patients in the research group received cognitive nursing care,while the patients in the control group received routine nursing care.The nursing effects of the two groups were compared.Results:The postoperative quality-of-life scores,health behavior scores,complication rates,and nursing satisfaction scores of the patients in the research group were all better than those of the control group(P<0.05).Conclusion:The cognitive nursing model significantly improves the condition of CS surgery patients,thus it should be popularized.

Low-grade myofibrosarcoma of the maxillary sinus:Two case reports

BACKGROUND Low-grade myofibroblastic sarcoma(LGMS)is an extremely rare tumor characterized by the malignant proliferation of myofibroblasts.LGMS most commonly develops in adults,predominantly in males,in the head and neck region,oral cavity,especially on the tongue,mandible,and larynx.This article presents 2 cases of LGMS localized to the maxillary sinus and provides an overview of the available literature.CASE SUMMARY Two patients with LGMS located in the maxillary sinus underwent surgery at the Department of Head and Neck Surgery.Case 1:A 46-year-old patient was admitted to the clinic with suspected LGMS recurrence in the right maxillary sinus(rT4aN0M0),with symptoms of pain in the suborbital area,watering of the right eye,thick discharge from the right nostril,and augmented facial asymmetry.After open biopsy-confirmed LGMS,the patient underwent expanded maxillectomy of the right side with immediate palate reconstruction using a microvascular skin flap harvested surgically from the middle arm.The patient qualified for adjuvant radiotherapy for the postoperative bed,with an additional margin.Currently,the patient is under 1.5 years of observation with no evidence of disease.Case 2:A 45-year-old man was admitted to our clinic with facial asymmetry,strabismus,exophthalmos,and visual impairment in the right eye.Six months earlier,the patient had undergone partial jaw resection at another hospital for fibromatosis.A contrast-enhanced computed tomography scan revealed a tumor mass in the postoperative log after an earlier procedure.An open biopsy confirmed lowgrade fibrosarcoma(rT4aN0M0).The patient qualified for an extended total right maxillectomy with orbital excision and right hemimandibulectomy with immediate microvascular reconstruction using an anterolateral thigh flap.The patient subsequently underwent adjuvant radiotherapy to the postoperative area.After 9 months,recurrence occurred in the right mandibular arch below the irradiated area.The lesion infiltrated the base of the skull,which warranted the withdrawal of radiotherapy and salvage surgery.The patient qualified for palliative chemotherapy with a regimen of doxorubicin+dacarbazine+cyclophosphamide and palliative radiotherapy for bone metastases.The patient died 26 months after surgical treatment.The cases have been assessed and compared with cases in the literature.CONCLUSION No specific diagnostic criteria or treatment strategies have been developed for LGMS.The treatment used for LGMS is the same as that used for sinonasal cancer radical tumor excision;adjuvant radiotherapy or chemoradiotherapy should also be considered.They have low malignant potential but are highly invasive,tend to recur,and metastasize to distant sites.Patients should undergo regular follow-up examinations to detect recurrence or metastasis at an early stage.Patients should be treated and observed at the highest referral centers.

Use of MLC901 in cerebral venous sinus thrombosis:Three case reports

BACKGROUND Cerebral venous sinus thrombosis(CVT)is rare cause of cerebrovascular disease.The incidence is 0.5%of all stroke.The majority of affected patients are young adults(mean age:35-40 years)with mild to moderate disabilities.Poor outcome with severe disability is seen in 13%of cases.Early diagnosis and treatment are important for good outcomes and preventing complications.Treatment options are limited and mostly based on consensus.NeuroAiD II™(MLC901;Moleac Pte,Ltd,Singapore)has a potential beneficial role in post-stroke recovery,by aiding the natural brain recovery process.CASE SUMMARY MLC901 consists of nine natural herbal ingredients.Studies have shown its safety profile and aid in post stroke recovery.The aim of this case series was to demonstrate the potential role of MLC901 in stroke recovery of patients with cerebral venous sinus thrombosis(CVST)who received MLC901 in addition to standard of care.The prescribed dose of MLC901 is 400 mg/cap two capsules,three times a day.Data from these patients were prospectively collected at baseline and at monthly visits,for a duration of 3 mo.Outcome measures included adherence to therapy,side effects,National Institutes of Health Stroke Scale,Glasgow Coma Scale,modified Rankin Scale,and the Short Orientation-Memory-Concentration Test.MLC901 was well tolerated and no side effects were reported.All patients were stable with improved condition.CONCLUSION This case series highlights the potential therapeutic effects of MLC901 on CVST and provides support for further studies.

Coinfection with hepatic cystic and alveolar echinococcosis with abdominal wall abscess and sinus tract formation:A case report

BACKGROUND Hepatic cystic and alveolar echinococcosis coinfections,particularly with concurrent abscesses and sinus tract formation,are extremely rare.This article presents a case of a patient diagnosed with this unique presentation,discussing the typical imaging manifestations of both echinococcosis types and detailing the diagnosis and surgical treatment experience thereof.CASE SUMMARY A 39-year-old Tibetan woman presented with concurrent hepatic cystic and alveolar echinococcosis,accompanied by abdominal wall abscesses and sinus tract formation.Initial conventional imaging examinations suggested only hepatic cystic echinococcosis,but intraoperative and postoperative pathological examination revealed the coinfection.Following radical resection of the lesions,the patient’s condition improved,and she was discharged soon thereafter.Subsequent outpatient follow-ups confirmed no recurrence of the hydatid lesion and normal surgical wound healing.Though mixed hepatic cystic and alveolar echinococcosis with abdominal wall abscesses and sinus tract formations are rare,the general treatment approach remains consistent with that of simpler infections of alveolar echinococcosis.CONCLUSION Lesions involving the abdominal wall and sinus tract formation,may require radical resection.Long-term prognosis includes albendazole and follow-up examinations.

Frontal Sinus Fractures: Management at the Yalgado Ouedraogo University Hospital Centre (Burkina Faso)

Introduction: Frontal sinus fractures are potentially serious. They are defined as a solution of continuity, open or closed, of one or both bone tables of the frontal sinus. This study aims to report on the management of them at the Yalgado OUEDRAOGO University Hospital Centre. Methodology: It is a descriptive cross-sectional study with retrospective collection from January 01, 2016 to December 31, 2018. Patients with frontal sinus fractures were managed at the Yalgado OUEDRAOGO University Hospital Centre through CT-scan proof. Results: Over three years, a total of 102 cases of frontal sinus fractures were collected with 29.9 years as average age. There were 96 men. Workers in the informal sector and pupils/students represented 58.90% of patients. The residence of the patients was urban in 68.80% of cases and rural in 31.40%. Road traffic accidents (RTAs) happened in 90.20%, and involved 2-wheelers in 98.20%. None of these drivers was wearing a helmet. The type III frontal fracture of Ioannides et al. represented 51.9% of cases. In 89.21% of cases, other facial and/or cranioencephalic injuries were compounded to frontal sinus fractures. No surgical management was observed in 82 (80.39%) patients and surgical management in 20 (19.61%) patients. The outcome was favourable, but sequelae and/or complications were noted in 10 patients who had surgery and 30 patients who did not. Conclusion: These results enforce helmet wearing for all riders of two-wheeled machines. In addition, vaccinations to prevent meningitis in frontal sinus fractures with dural breach should be systematic.

Unusual Presentation of Heart Failure Secondary to Ruptured Aneurysmal Sinus of Valsalva: A Case Report

Sinus of Valsalva Aneurysm (SOVA) arises from an abnormal dilation of the aortic root, leading to enlargement between the aortic annulus and the sinotubular junction. Although often presenting without symptoms, these aneurysms bear the potential for life-threatening complications, primarily from the looming risk of rupture. We present the case of a 42-year-old Malay gentleman with a history of bilateral pedal edema and dyspnea on exertion who was diagnosed with a ruptured sinus of Valsalva aneurysm. The patient underwent successful surgical repair of the aneurysm, leading to symptomatic improvement and favorable outcomes. This case highlights the importance of early diagnosis and prompt surgical intervention in managing this uncommon condition.

Nasal Dermoid Cyst with Sinus Tract Intranasal Bone: A Case Report

Dermoid cysts are benign tumors originating from germ cells, which can form in various locations, including the nasal area in rare cases. They are of unknown exact etiology, but it is suggested that it is due to abnormal tissue migration during early embryonic development. Nasal dermoid cysts albeit rare, can present in various forms such as sinuses, fistulas, or intracranially extending tracts. They can be asymptomatic and incidentally discovered or present with a visible external mass or sinus that is either painful, infected or cosmetically concerning. If nasal dermoid cysts with an intra-nasal bone sinus tract are left untreated, they can lead to life-threatening complications. This report describes the case of a 6-year-old girl with a nasal dermoid cyst connected to a superficial punctum by an intra-nasal tract. She had undergone surgical excision of a nasal swelling previously diagnosed as a dermoid cyst. One year later, she returned to our clinic with a recurrence of the nasal swelling. Imaging tests revealed a nasal dermoid cyst with a tract extending to the nasal tip, without intracranial expansion. The cyst, along with the entire tract, was successfully removed surgically, and the postoperative follow-up indicated no complications. Histopathology confirmed the diagnosis of a dermoid cyst. This case underscores the significance of considering the dermoid tract in nasal cyst cases and the necessity of its complete removal to prevent recurrence.

Evaluation of the Effectiveness and Safety of One-Time Endodontics in the Treatment of Chronic Apical Periodontitis with Sinus Tract in Pediatric Deciduous Teeth

Objective:To observe the effectiveness and safety of one-time endodontics in the treatment of chronic apical periodontitis with sinus tract in pediatric deciduous teeth.Methods:109 cases of children with chronic apical periodontitis with sinus tract in the deciduous teeth treated in our hospital from January 2022 to December 2023 were selected and grouped by the randomized numerical table method,with 54 cases in the experimental group and 55 cases in the control group.The experimental group was treated with one-time endodontics and the control group was treated with conventional endodontics.Results:After the treatment,the total effective rate of treatment was higher in the experimental group than in the control group(P<0.05);the incidence of adverse events was lower in the experimental group than in the control group(P<0.05);the satisfaction of the children's family members was higher in the experimental group than in the control group(P<0.05);the pain duration was lower in the experimental group than in the control group(P<0.05).Conclusion:In the experimental group,children with chronic apical periodontitis with sinus tract of the deciduous teeth were given one-time endodontic treatment,and the results of its implementation were relatively good.

Relationship between dacryoadenitis subtype of idiopathic orbital inflammatory pseudotumor and paranasal sinusitis

AIM：To determine the clinical features of the dacryoadenitis subtype of idiopathic orbital inflammatory pseudotumor and its relationship with paranasal sinusitis.· METHODS：A retrospective analysis of 46 patients who received surgical treatment at the Department of Ophthalmology,Beijing Tongren Hospital,Capital Medical University for the dacryoadenitis subtype of idiopathic orbital inflammatory pseudotumor from October 2010 to December 2012.Each patient underwent magnetic resonance imaging（MRI） of the orbits and the 4paranasal sinuses.Disease status and the level of serum immunoglobulin G4（IgG4） was measured before and6 mo after surgery.· RESULTS：The initial clinical feature of the idiopathic dacryoadenitis type of orbital inflammatory pseudotumor was redness or swelling of the eyelids.Masses were palpated in the area of the lacrimal gland in some patients.Of the 46 patients,16 also suffered from sinusitis（34.8%）,with 14 cases of ethmoid sinusitis,8cases of maxillary sinusitis,9 cases of sphenoid sinusitis,and 8 cases of frontal sinusitis.Of the 16 patients with sinusitis,4 patients had a medical history of rhinitis（range：10mo to 15 y previously）,10 patients had occasional nasal congestion,and 2 patients had no nasal congestion.Thirteen of the 46 patients had elevated serum IgG4 levels.Nine of these 13 patients had MRI signs of sinusitis.All patients（n=46） received oral glucocorticoid treatment for approximately 3mo after surgery.No sign of recurrence was found in the orbital MRI 6mo after surgery.Of the 16 patients with sinusitis,9cases of elevated serum IgG4 levels improved after treatment with decreased serum IgG4 level and 7 cases of normal serum IgG4 levels remained unchanged.· CONCLUSION：Some patients with the dacryoadenitis subtype of idiopathic orbital inflammatory pseudotumor may also suffer from paranasal sinusitis.The incidence of paranasal sinusitis was much higher in patients with IgG4-elevated dacryoadenitis subtype orbital inflammatory pseudotumor than in those with normal IgG4 levels.Dacryoadenitis subtype orbital inflammatory pseudotumor and paranasal sinusitis may both the clinical manifestations of IgG4-related disease involved in different locations.

Systematic Evaluation of Biyuan Tongqiao Granule in the Treatment of Chronic Sinusitis in Children Based on Meta-analysis

[Objectives]To make an evaluation of the efficacy and safety of Biyuan Tongqiao Granule in the treatment of chronic sinusitis in children,and provide evidence-based medical reference for clinical use.[Methods]Databases such as Chinese Biomedical Literature Service System(SinoMed),China Knowledge Infrastructure(CNKI),Wanfang Digital Journal Full-text Database(WF),VIP Database(VIP),EmBase,PubMed,Science Direct,and Cochrane Library were used to collect the clinical randomized controlled trials of Biyuan Tongqiao Granule in children with chronic sinusitis published since the creation of databases.The quality of the included literature was evaluated and the data were extracted.The data was analyzed using Review Manager 5.3 software for meta-analysis,and descriptive analysis was performed for studies that could not be combined.The GRADE method was applied to evaluate the quality of evidence.[Results]A total of 12 studies were included,including 1645 cases of patients.The analysis results show that compared with the control group,Biyuan Tongqiao Granule has an excellent curative effect on children with chronic sinusitis and has a lower incidence of adverse reactions.The GRADE evidence level indicated that the sinus CT scan lesion score was intermediate evidence,and the visual analog score,endoscopic mucosal morphology score,and total effective rate were low-level evidence.[Conclusions]Biyuan Tongqiao Granule has a significant effect in treating chronic sinusitis in children and does not increase the incidence of adverse reactions,but its efficacy and safety need support of more high-quality studies.

Relationship between chronic rhinosinusitis and lower airway diseases: An extensive review

Significant links between allergic rhinitis and asthma have been reported, and the united airway disease hypothesis is supported by numerous findings in epidemiologic, physiologic, pathologic, and immunologic studies. The impact of allergic rhinitis on asthma has been established. On the other hand, the relationship between chronic rhinosinusitis and lung diseases has been under investigation. Chronic rhinosinusitis is a common disease, and the high prevalence of chronic rhinosinusitis in some kinds of lung diseases has been reported. Recent studies suggest that the treatment of chronic rhinosinusitis has beneficial effects in the management of asthma. Here, we present an overview of the current research on the relationship between chronic rhinosinusitis and lower airway diseases including asthma, chronic obstructive pulmonary disease, cystic fibrosis, diffuse panbronchiolitis, primary ciliary dyskinesia, idiopathic bronchiectasis, and allergic bronchopulmonary aspergillosis.

Complications of Sinusitis: About 9 Cases in the Ear Nose &Throat (ENT) Department of the University Hospital Gabriel Touréin Bamako

Objective: This study aims to analyze clinical, paraclinical and therapeutic aspects of sinusitis complications in the Otorhinolaryngology department at the teaching hospital of Gabriel Toure in Bamako. Materials and methods: This descriptive and longitudinal study was conducted on 12 months from March 2012 to February 2013 in 9 cases of sinusitis complications in the department of Otorhinolaryngology at the University Hospital Gabriel Toure in Bamako. Results: The average age of patients was 22.7 years;a median of 19 years within 6 men and 3 women with almost 12.9 days of care seeking duration. The factors of risky were the use of nonsteroid anti-inflammatory drugs NSAID (4 cases), maxillofacial trauma (1 case) and HIV (1 case). Facial pain was the major symptom, such as frontal oedema, rhinorrhea with pus shedding and nasal obstruction. Computer tomography was used for complications specification. Frontal sinusitis was the most encountered with subperiosteal abscess (44.4%). Streptococcus pneumoniae was identified in 3 cases. Medical treatment associated to surgery was conducted on 7 patients. Two cases of death have been registered. Conclusion: The complicated sinusitis is an emergency and dangerous disease requiring specific care by a multidisciplinary staff. Much of complications are commonly encountered despite the antibiotic era.

Analysis of pathogenetic process of fungal rhinosinusitis: Report of two cases

BACKGROUND Fungal rhinosinusitis is an infectious and/or allergic disease caused by fungi in the sinus and nasal cavity. Due to the warm and humid climate in Guangxi Zhuang Autonomous Region, the incidence of fungal rhinosinusitis is higher than that in other provinces. However, its physiological mechanism is not yet clear.Not every patient colonized by fungi develops a fungal infection. To a large extent, the immune status of the patient determines the nature of fungal disease in the nasal passages. The pathologic process of progression from harmless fungal colonization to fungal rhinosinusitis is unclear and has not been reported.CASE SUMMURY We report two patients, one who developed fungal rhinosinusitis 1.5 years after surgery performed to treat an inverted papilloma, and the other with a history of hypertension and cerebral infarction. Both patients recovered from their surgeries. An average time of 2.5 years elapsed from the development of maxillary sinus cysts to the development of fungal rhinosinusitis.CONCLUSION According to these case reports, we speculate that the progression of fungal rhinosinusitis from harmless colonization to disease onset requires approximately one to three years and that the length of the process may be related to underlying diseases, surgical treatment, deficient autoimmune status,and abuse of hormone antibiotics and hormones. Additional data are needed to conduct relevant studies to appropriately prevent and treat fungal rhinosinusitis.

Color Doppler Imaging in the Diagnosis and Follow-up of Carotid Cavernous Sinus Fistulas

This report describes color doppler imaging (CDI) in theevaluation and follow-up of nine patients with carotid cavernous sinusfistulas.The orbits and carotid arteries were examined with CDI.In allcases,the diagnosis was confirmed by angiography.CDI clearlydemonstrated the dilated superior ophthalmic veins (SOVs) with retrogradeflow and low resistance arterial doppler waveform in all nine patients (10eyes).After the study of quantitative hemodynamics,we found that directcarotid cavernous sinus fistulas s...

Correlation between Radiological Staging of Chronic Rhinosinusitis and Revision of Endoscopic Sinus Surgery

Introduction: Chronic rhinosinusitis (CRS) is an inflammatory condition affecting the sinonasal mucosa with duration of more than 12 weeks. Multifactorial aetiology contributes to its refractoriness. Functional endoscopic sinus surgery (FESS) is the most common surgical technique preferred in CRS not responding to medical management, showing high success rates. However, some failure has been noted, requiring revision FESS. CT (Computed Tomography) is a diagnostic tool for CRS, and aids in improving surgical outcomes. Combined with the Lund-Mackay scoring system, CT can help stage the CRS, predicting the need for revision surgery. Methods: In our paper, we aimed to study the relationship between severity of CRS using radiological staging and revision of functional endoscopic sinus surgery, assessing outcome after at least 1 year of follow-up. There was a single centre retrospective study involving 150 patients selected by random sampling, to study the correlation between the severity of chronic rhinosinusitis and revision of functional endoscopic sinus surgery (FESS). The study was conducted in the ENT department of King Hamad University Hospital, Bahrain for a time period of 6 months. Records were scanned and scored using Lund-Mackay system. Lund Mackay score of 10 and above was considered severe. The relation between increased severity with Lund Mackay score on the CT scan and the need for revision sinus surgeries was then determined. Results and Conclusion: This study concludes that LMS score in CT scans can be used to predict the outcomes of primary FESS procedure and the need for revision surgery in the management of CRS.

Misdiagnosis of unroofed coronary sinus syndrome as an ostium primum atrial septal defect by echocardiography:A case report

BACKGROUND Unroofed coronary sinus syndrome(UCSS)is a rare congenital heart disease,which has variable morphologic features and is strongly associated with persistent left superior vena cava(PLSVC).However,it is often difficult to visualize the left-to-right shunt pathway through the CS by transthoracic echocardiography(TTE).CASE SUMMARY A 37-year-old female was admitted to the hepatological surgery department of a hospital with complaint of subxiphoid pain that had started 1 wk prior.Physical examination revealed a grade 3/6 systolic murmur at the left margin of the sternum,between the 2nd and 3rd intercostal cartilage.The patient underwent echocardiography and was diagnosed with ostium primum atrial septal defect(ASD);thus,she was subsequently transferred to the cardiovascular surgery department.A second TTE evaluation before surgery showed type IV UCSS with secundum ASD.Right-heart contrast echocardiography(RHCE)showed that the right atrium and right ventricle were immediately filled with microbubbles,but no microbubble was observed in the CS.Meanwhile,negative filling was observed at the right atrium orifice of the CS and right atrium side of the secundum atrial septal.RHCE identified UCSS combined with secundum ASD but without PLSVC in this patient.CONCLUSION This rare case of UCSS highlights the value of TTE combined with RHCE in confirming UCSS with ASD or PLSVC.

A Possible Association of Staphylococcus Enterotoxin B-induced Asthma and Sinusitis

In order to gain insight into a possible association between chronic sinusitis and asthma, 85 patients with sinusitis and asthma underwent functional endoscopic sinus surgical treatment and serum antibodies and cytokines were measured. The results showed that 51 out of 85 patients with high serum anti-Staphylococcus enterotoxin B （SEB） antibody before treatment obtained satisfactory results for both sinusitis and asthma. The high level of Th2 cytokine IL-4 was down regulated to the levels of normal controls after sinus surgery. Thirty-four out of 85 patients did not show high serum anti-SEB antibody before sinus surgery and did not show much improvement in their asthmatic symptoms although sinusitis symptoms were resolved by sinus surgery. It was concluded that bacterial superantigen SEB （in the sinuses） might play a crucial role in the pathogenesis of lower airway hypersensitivity.