OBJECTIVES-1. To measure the proportion of patients with chronic rhinosinusitis (CRS) who experience clinically significant improvement after endoscopic sinus surgery (ESS) in a prospective, multi-institutional fashion. 2. To identify preoperative characteristics which predict clinically significant improvement in quality of life (QOL) after ESS. STUDY DESIGN-Prospective, multi-institutional cohort study SETTING-Academic tertiary care centers SUBJECTS & METHODS-302patients with CRS from three centers were enrolled between July 2004 and December 2008 and followed for an average of 17.4 months postoperatively. Preoperative patient characteristics, computed tomography (CT) scan, endoscopy score and pre-and postoperative quality of life (QOL) were collected. Univariate and multivariate analyses were performed.

Low-intensity anticoagulation with warfarin prevented cerebral infarction in patients with nonrheumatic atrial fibrillation without producing an excess risk of major hemorrhage. This benefit extended to patients over 70 years of age.

Objectives-To measure the prevalence of and identify clinical characteristics associated with poor olfactory function in a large cohort of patients with chronic rhinosinusitis (CRS).Study Design-Multi-institutional, cross sectional analysis.Methods-An objective measure of olfactory dysfunction, the Smell Identification Test (SIT), demographic data, clinical factors and co-morbidity data were collected from a cohort of 367 patients who presented with CRS at three tertiary care centers. Data was analyzed using univariate and multivariate analyses.Results-Sixty-four percent of men and women aged 18 to 64 had olfactory dysfunction whereas 95% of patients ≥ 65 years had olfactory dysfunction (p<0.001); no significant difference was noted by gender. By multivariate logistic regression analysis, patients with nasal polyposis (OR 2.4, 95% confidence interval (CI) 1.3, 4.2; p=0.003) and patients ≥ 65 years (OR 10.0, 95% CI 2.3, 43.7; p=0.002) were at increased risk of hyposmia. Patients with nasal polyposis (OR 13.2, 95% CI 5.7, 30.7; p<0.001), asthma (OR 4.2, 95% CI 1.8, 9.8; p=0.001), ≥ 65 years (OR 15.6, 95% CI 2.3, 104.9; p=0.005), and smokers (OR 7.6, 95% CI 1.8, 31.6; p=0.005) were at increased risk of anosmia.Conclusions-Poor olfactory function is common in patients with CRS. Age, nasal polyposis, smoking, and asthma were significantly associated with olfactory dysfunction in patients with CRS. Neither prior endoscopic sinus surgery nor a history of allergic rhinitis was associated with olfactory dysfunction. Septal deviation and inferior turbinate hypertrophy were associated with normal olfactory function.

This paper considers an index to assess the success of blinding with application to a clinical trial of disulfiram. The index increases as the success of blinding increases, accounts for uncertain responses, and is scaled to an interval of 0.0 to 1.0, 0.0 being complete lack of blinding and 1.0 being complete blinding.

Epidural supplementation was associated with enhanced survival among patients without metastases before 1.46 years. Epidural anesthesia had no effect on survival of patients with metastases. Additional studies to confirm or refute these findings are warranted.

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Silent cerebral infarction is frequently seen in asymptomatic patients with atrial fibrillation. Age, history of hypertension, active angina, and elevated mean systolic blood pressure were associated with silent infarction at entry. The sample size was too small to determine whether warfarin had an effect on the incidence of silent infarction during the trial. Active angina at baseline was the only significant independent predictor for the later development of symptomatic stroke.

Results suggest oral hygiene ability is decreased among long term care residents, that dexterity tests can help identify patients unable to perform adequate oral self-care, and that these tests could be used to estimate brushing ability among elderly compromised patients.