Wataru Konno

Long-term postoperative control of eosinophilic chronic rhinosinusitis recurrence by inserting a steroid-eluting, sinus-bioabsorbable device reduces the dosage of oral steroid

OBJECTIVE We employed a steroid-eluting, sinus-bioabsorbable device for local treatment after surgery for eosinophilic chronic rhinosinusitis (ECRS). One year later, we investigated its efficacy in suppressing recurrence and reducing the use of oral steroids. METHODS At one year after ECRS surgery, both 18 cases treated with a postoperative steroid-eluting, sinus-bioabsorbable device (Post-ST group) and 25 cases receiving conventional postoperative therapy (Post-Con group) showed significant improvement in the nasal symptoms (nasal obstruction, nasal discharge and olfactory dysfunction), CT score and threshold test (discrimination test). RESULTS The olfactory dysfunction, CT score and threshold test were significantly improved in the Post-ST group compared with the Post-Con group, but the polyp score was not. The mean total number of oral steroid tablets ingested during one year after surgery was 24.3±2.8 tablets in the Post-ST group, which was significant lower than the 36.3±3.7 tablets used in the Post-Con group. CONCLUSION The above results indicate that insertion of a steroid-eluting, sinus-bioabsorbable device after ECRS surgery can reduce the oral steroid intake while maintaining long-term suppression of disease recurrence.

Case Report: Stab Injuries in theNeck Involving the InnominateArtery

Case Report: Stab Injuries in the Neck Involving the Innominate Artery Isolated innominate artery injuries caused by stab wounds are uncommon, but otolaryngologists may still encounter these injuries. The present report describes the case of an 80-yearold woman with a history of rheumatoid arthritis that was referred to our department after sustaining a stab injury to the innominate artery during a suicide attempt. On admission, she was hemodynamically unstable, and injury to the great vessels was suspected. Urgent surgical exploration through anterior neck incision was performed. Thoracic surgeons were consulted, because there was extensive hematoma in the neck and extending to the thorax with continuous active bleeding. A bleeding point was found in the distal part of the innominate artery, and the defect was immediately sutured with a prosthetic patch. Seven weeks after surgery, the patient presented with continuous oozing of blood from a posttraumatic aneurysm in the proximal part of the innominate artery. Emergent surgery was performed to achieve hemostasis and to replace the aneurysmal lesion with an interposition graft. Unfortunately, she expired intraoperatively due to uncontrollable bleeding. Vascular vulnerability based on systemic rheumatoid inflammation caused the outcome to worsen. Otolaryngologists should be aware that stab injury to the neck can result in death, even if the wound appears minor externally. The importance of diagnostic modalities, and cooperation with thoracic surgeons as well as the difficulty in predicting delayed complications followed innominate artery injury are discussed. Isolated innominate artery injuries caused by stab wounds are uncommon, but otolaryngologists may still encounter these injuries. The present report describes the case of an 80-yearold woman with a history of rheumatoid arthritis that was referred to our department after sustaining a stab injury to the innominate artery during a suicide attempt. On admission, she was hemodynamically unstable, and injury to the great vessels was suspected. Urgent surgical exploration through anterior neck incision was performed. Thoracic surgeons were consulted, because there was extensive hematoma in the neck and extending to the thorax with continuous active bleeding. A bleeding point was found in the distal part of the innominate artery, and the defect was immediately sutured with a prosthetic patch. Seven weeks after surgery, the patient presented with continuous oozing of blood from a posttraumatic aneurysm in the proximal part of the innominate artery. Emergent surgery was performed to achieve hemostasis and to replace the aneurysmal lesion with an interposition graft. Unfortunately, she expired intraoperatively due to uncontrollable bleeding. Vascular vulnerability based on systemic rheumatoid inflammation caused the outcome to worsen. Otolaryngologists should be aware that stab injury to the neck can result in death, even if the wound appears minor externally. The importance of diagnostic modalities, and cooperation with thoracic surgeons as well as the difficulty in predicting delayed complications followed innominate artery injury are discussed.