Pirkko Ruoppi

Paranasal Sinus Mucormycosis: a Report of Two Cases

Mucormycosis of the nose and paranasal sinuses is a rare invasive fungal infection, which often has a very fulminant course and characteristic clinical findings. The patients are usually immunocompromised, with diabetic ketoacidosis being the commonest underlying disorder. In some immunocompetent patients, the disease is associated with local predisposing factors, such as chronic sinusitis. Although the prognosis has improved in recent decades, the disease can still be fatal. The underlying disease is an important determinant of prognosis and correction of the metabolic disorder, if present, is essential. Herein we report two cases: one of our patients was immunocompetent but had earlier suffered from polypous rhinosinusitis whereas the other had mild adult-type diabetes. Both patients were successfully treated with surgical debridement and amphotericin B.

Effect of weight reduction on rhinometric measurements in overweight patients with obstructive sleep apnea

Background Elevated nasal resistance and obesity predispose to obstructive sleep apnea (OSA). Weight loss has been shown to result in an alleviation of OSA, but its effect on nasal airflow has not been studied. Methods This study was a prospective, randomized, controlled study with two parallel groups. A total of 52 adult overweight patients (body mass index [BMI], 28–40 kg/m2) with mild obstructive sleep apnea (apnea–hypopnea index {AHI}, 5–15) were randomized into two study groups. The intervention group (n = 26) followed a very low calorie diet with a supervised lifestyle intervention while the control group (n = 26) received routine lifestyle counseling. The changes in BMI, total nasal resistance, total nasal volume, and quality of life scores (Mini Rhinoconjunctivitis Quality of Life Questionnaire, MiniRQLQ) were assessed at baseline and after the intervention at 3 months. Results The reduction in BMI in the intervention group was significantly greater than that achieved by patients in the control group (5.4 kg/m2 versus 0.5 kg/m2). Accordingly, AHI was reduced by 3.2 events/hour in the intervention group and by 1.3 in the control group. However, there were no significant changes in rhinometric measurements despite significant weight loss. There was no correlation between the reduction of BMI and the change in nasal resistance or MiniRQLQ scores. Conclusion Weight reduction does not seem to have any effect on nasal resistance or volume in overweight patients with mild OSA. Patients with OSA and impaired nasal breathing need specific medical or surgical treatment to restore nasal airflow.

Acute Frontal Sinusitis: Etiological Factors and Treatment Outcome

A retrospective analysis of patients with acute frontal sinusitis treated at Kuopio University Hospital between 1981 and 1990 was performed to define etiological factors, clinical course and response to treatment. The study comprised 91 patients, 67 men and 24 women, aged from 9 to 65 years with a mean age for men of 32 years and for women of 29 years. Thirty-nine patients (43%) had previously been suffering from seasonal or chronic rhinitis, which in 22 was allergic, in 15 vasomotoric and in 2 due to intolerance to acetylsalicylic acid. In one case there was a recent and in another an old nasal trauma. Forty-seven patients (52%) were hospitalized, the others treated as outpatients. All received medical treatment. In 49 patients (54%) there was contemporary maxillary sinusitis which was treated with irrigations. Nasal polyps were detected and removed in 18 patients (20%). Anterior ethmoidectomy was made in 11 patients (12%) and trephination of the diseased frontal sinus to avoid complications in 8 patients (9%). No complications occurred. In 5 patients (5%) acute frontal sinusitis recurred once and a chronic course was seen in another 5 patients of whom 3 had chronic allergic and one vasomotor rhinitis.

Kikuchi's Disease: Report of Three Cases and an Overview

We describe, to our knowledge, the first native Finnish patients with Kikuchis histiocytic necrotizing lymphadenitis. The diagnosis was based in all cases on histopathological findings in openbiopsy. The disease was first detected in Japan in 1972, but in Scandinavia, until this decade, there had been no cases reported.

Lactase-induced occupational protein contact dermatitis and allergic rhinoconjunctivitis

Enzymes are high‐molecular‐weight proteins and highly sensitizing occupational allergens used widely in industrial processes. Lactase has been described to cause work‐related respiratory and conjunctival immunoglobulin (Ig)‐E‐mediated sensitizations in workers in the pharmaceutical industry. In these previous reports, allergic rhinoconjunctivitis or asthma was confirmed with prick tests but not by challenge tests. Lactase previously has not been described as a cause of immediate or delayed contact skin reaction. Furthermore, there are no previous reports of lactase‐specific IgE. We report a case of protein contact dermatitis and allergic rhinoconjunctivitis from occupational exposure to lactase in a pharmaceutical worker. The patient exhibited strong positive responses to lactase in prick tests. In an open application test, lactase elicited whealing, and in patch testing, lactase elicited an eczematous reaction. Serum lactase‐specific IgE antibodies were demonstrated in immunospot and radioallergosorbent test assays, and lactase‐IgE‐binding fractions and their specificities were examined in immunoblot and immunoblot inhibition assays. The chamber challenge test was performed to detect the association between lactase sensitization and rhinoconjunctival symptoms. Our results have confirmed the previous observations that lactase can induce occupational IgE‐mediated respiratory and conjunctival sensitizations, but they show that contact skin reactions caused by lactase may also occur.

A rapidly progressing periorbital mass in an infant: Fasciitis Nodularis

Nodular fasciitis is a benign, rapidly growing proliferation of fibroblasts, which is histologically difficult to distinguish from neoplasms. In several reports, as many as half of all cases have been initially misdiagnosed as a fibrosarcoma or some other malignancy. Although the head and neck is a region of predilection in infants and children, only eight periocular lesions have previously been reported in paediatric patients. We present a case of nodular fasciitis which occurred in the periorbital region in a 1½-year-old girl. The process was excised locally in order to perform a biopsy. The mass was initially classified as a sarcoma but subsequently as infantile fibromatosis. Only after a thorough review of the case and four independent pathological consultations was the final diagnosis of nodular fasciitis confirmed. No further treatment was scheduled. Although the primary surgical removal of the tumour was not radical, no recurrence was observed during a 3-year follow-up period.