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#91
31.08.2008, 23:23
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Цитата:
Acute sinusitis is usually bacterial in origin. A URI or severe allergic rhinitis leading to obstruction of the ostia and stasis of drainage often precedes it. Haemophilus influenzae and Streptococcus pneumoniae are the organisms most commonly found in adults. In chronic sinusitis, the infecting organisms are variable, and a higher incidence of anaerobic organisms is seen (eg, Bacteroides, Peptostreptococcus, and Fusobacterium species). In children, similar organisms are seen, with the addition of Moraxella catarrhalis. In older children and young adults, Staphylococcus aureus is an occasional finding. In systemically impaired hosts, Candida, Aspergillus, and Phycomycetes may be the cause. Risk factors include the following: diabetes mellitus, cancer, hepatic disease, renal failure, burns, extreme malnutrition, and immunosuppressive diseases. [Ссылки доступны только зарегистрированным пользователям ] 
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. В большинстве случаев острый риносинусит имеет вирусную этиологию. Подтверждение в emedicine|
#92
31.08.2008, 23:37
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The sinuses are normally sterile under physiologic conditions. Purulent sinusitis can occur when ciliary clearance of sinus secretions decreases or when the sinus ostium becomes obstructed, which leads to retention of secretions, negative sinus pressure, and reduction of oxygen partial pressure. This environment is then suitable for growth of pathogenic organisms. Factors that predispose the sinuses to obstruction and decreased ciliary function are allergic, nonallergic, or viral insults, which produce inflammation of the nasal and sinus mucosa and result in ciliary dysmotility and sinus obstruction. Approximately 90% of patients who have viral upper respiratory tract infections (URTIs) have sinus involvement, but only 5-10% of these patients have bacterial superinfection requiring antimicrobial treatment.
[Ссылки доступны только зарегистрированным пользователям ] Ссылка, которую Вы прислали, относится к разделу "скорая помощь" и дает поверхностное представление о синусите, видимо поэтому нет упоминания о вирусной этиологии. Не вижу смысла спорить об этом, поскольку этот момент уже неоднократно обсуждался.
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#93
31.08.2008, 23:45
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Цитата:
 А заодно, внимательно прочтите то, что в предложенной Вами ссылке. ------ Спорить с Вами, действительно, бесполезно.
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#94
31.08.2008, 23:58
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Вы имели в виду прочитать это в Вашей ссылке?
A viral infection associated with the common cold is the most frequent etiology of acute sinusitis. Only a small percentage (as low as 2%) of viral sinusitis cases are complicated by bacterial sinusitis. Если нет весомых доказательств, то спорить конечно бесполезно
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#96
01.09.2008, 00:03
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Одно хорошо, Имедсин будет изучен вдоль и поперек.)))
Цитата:
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#97
01.09.2008, 00:07
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Цитата:
Тут, кажется, нет: [Ссылки доступны только зарегистрированным пользователям ]
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#98
01.09.2008, 00:27
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Вы опустили одно маленькое предложение: Viruses are the most common trigger of acute sinusitis. Rhinovirus, influenza, and parainfluenza viruses are the primary pathogens in 3-15% of patients with acute sinusitis.
В контексте статьи здесь имеется в виду, что из всех возможных вирусов, в 3-15% случаев возбудителями являются риновирус, инфлюенца, параинфлюенца. А если возникнет вопрос, какие еще вирусы вызывают острый риносинусит, то вот ответ: The vast majority of rhinosinusitis episodes are caused by viruses. Most viral upper respiratory infections are caused by rhinovirus, but coronavirus, influenza A and B, parainfluenza, respiratory syncytial virus, adenovirus, and enterovirus are also causative agents. [Ссылки доступны только зарегистрированным пользователям ]
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#99
01.09.2008, 00:33
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<<Acute rhinosinusitis definitions
Term Definition Acute rhinosinusitis Up to 4 weeks of purulent nasal drainage (anterior, posterior, or both) accompanied by nasal obstruction, facial pain-pressure-fullness, or both: ● Purulent nasal discharge is cloudy or colored, in contrast to the clear secretions that typically accompany viral upper respiratory infection, and may be reported by the patient or observed on physical examination ● Nasal obstruction may be reported by the patient as nasal obstruction, congestion, blockage, or stuffiness, or may be diagnosed by physical examination ● Facial pain-pressure-fullness may involve the anterior face, periorbital region, or manifest with headache that is localized or diffuse Viral rhinosinusitis (VRS) Acute rhinosinusitis that is caused by, or is presumed to be caused by, viral infection. A clinician should diagnose VRS when: a. symptoms or signs of acute rhinosinusitis are present less than 10 days and the symptoms are not worsening Acute bacterial rhinosinusitis (ABRS) Acute rhinosinusitis that is caused by, or is presumed to be caused by, bacterial infection. A clinician should diagnose ABRS when: a. symptoms or signs of acute rhinosinusitis are present 10 days or more beyond the onset of upper respiratory symptoms, or b. symptoms or signs of acute rhinosinusitis worsen within 10 days after an initial improvement (double worsening) Transition From Viral to Bacterial Infection Only about 0.5% to 2.0% of VRS episodes are complicated by bacterial infection.48 Although ABRS is often considered a transition from a preceding viral URI, bacterial infection can develop at any time during the course of illness. The concept of a transition, however, is useful for management decisions,38 especially when considering the time course of VRS and which disease patterns are most likely to be associated with bacterial infection. In the first 3 to 4 days of illness VRS cannot be differentiated from an early-onset ABRS, and for that reason only patients with unusually severe presentations or extrasinus manifestations of infection are presumed to have a bacterial illness. Similarly, between 5 and 10 days persistent symptoms are consistent with VRS or may represent the beginning stages of ABRS. In this time period, however, a pattern of initial improvement followed by worsening (“double sickening”) is consistent with ABRS.9,41-42 Beyond 10 days, residual sinus mucosal thickness induced by the virus may persist, usually in the absence of active viral infection, but the probability of confirming a bacterial infection by sinus aspiration is about 60%.49 Gwaltney and colleagues50 studied the time course of signs and symptoms of spontaneous rhinovirus infections (Fig 1). Typical symptoms peak at day 2 to 3 and wane thereafter, but may persist 14 days or longer. Antecedent viral infection can promote ABRS by obstructing sinus drainage during the nasal cycle,51 promoting growth of bacterial pathogens that colonize the nose and nasopharynx (Gwaltney 1996),48 and by depositing nasal bacteria into the sinuses during nose-blowing. Fever is present in some patients with VRS in the first few days of illness (Fig 1) but does not predict bacterial infection as an isolated diagnostic criterion. Fever has a sensitivity and specificity of only about 50% for ABRS.37,38,52 For this reason we did not include fever as a cardinal sign in diagnosing ABRS. Meltzer and co-workers, 9 however, defined a special circumstance of ABRS when purulent nasal discharge for 3 to 4 days was accompanied by high fever. In that document “high fever” was not defined, but the criterion only applied to severe disease with a shorter duration of illness.>>[Ссылки доступны только зарегистрированным пользователям ] Ето не вам, ЕНТ. Просто так. Музыкой навеяло.
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#100
01.09.2008, 00:37
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Цитата:
Вирусная инфекция ( ОРВИ, если угодно ) - действительно, основной триггер синуситов. И с этим никто не спорит. Возбудитель ( если я правильно перевожу, а, если нет, то англоговорящие поправят ) - primary pathogens, причем, в любом контексте.
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#101
01.09.2008, 00:53
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A viral infection associated with the common cold is the most frequent etiology of acute sinusitis.
Вирусная инфекция - самая частая этиология острого синусита. В данном случае триггер = возбудитель Триггером можно назвать переохлаждение, но не микроорганизм.
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#102
01.09.2008, 00:53
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Цитата:
Речь не о тригерах. Ими могут быть в большинстве и вирусы. Различить в первые дни болезни все равно не удастся. Поэтому в первые дни и нерекомендовано назначение антибиотиков. Речь об этиологии острого синусита - а это бактерии. Надеюсь разницу между тригером и этилогией объяснять не нужно.
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#103
01.09.2008, 00:57
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Если в случаях, когда бактериальная инфекция не присоединяется, Вы будете ставить диагноз "просто риносинусит" или "вирусный риносинусит"?
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#104
01.09.2008, 01:01
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[Ссылки доступны только зарегистрированным пользователям ] - эта статья несколько странна в отдельных моментах, и не из профильного раздела. Другие источники не подтверждают написанное в ней. Это как раз тот случай, когда одного источника не всегда достаточно и необходимо, хотя бы для себя, сделать небольшой обзор.
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Линейный вид
