Fungal rhinosinusitis (FRS) is uncommon and accounts for 6-12% of culture or histologically proven chronic sinusitis. FRS may be acute or chronic. The aim of this paper was to study the histological features that contribute to the diagnosis and sub typing of FRS, using a retrospective review of all paranasal sinus mucosal biopsies from January 2005 to December 2008. The clinical features, predisposing conditions, imaging findings, and extent of the lesion were noted. The slides were reviewed with hematoxylin and eosin, Gomori's methenamine silver, and periodic acid Schiff stains. Culture reports were obtained wherever material was subjected to culture. There were 63 biopsies diagnosed as FRS (45.7%) out of 138 biopsies of chronic sinusitis in the study period. The FRS was classified as allergic in 15 (23.8%), chronic non-invasive (sinus mycetoma) in 1 (1.6%), chronic invasive in 10 (15.87%), granulomatous invasive in 19 (30%), and acute fulminant in 18 (28.5%) biopsies or surgical resections. Predisposing conditions were identified in 19 patients with diabetes mellitus as the commonest. Seventeen of the 18 patients with acute fulminant FRS had predisposing conditions. As per the results, the characteristic histological features were allergic mucin in allergic, fungal ball in chronic non-invasive, sparse inflammation and numerous hyphae in chronic invasive, non caseating granulomas with dense fibrosis in granulomatous invasive, and infarction with suppuration in acute fulminant FRS. Aspergillus sp. was the commonest etiologic agent. To conclude, predisposing risk factors were more common in invasive FRS than in non-invasive sinusitis and Aspergillus species was the most common etiologic agent.
Objective: Patients with preexisting lung cavities are prone to develop fungal masses inside the cavity. Though Aspergillus sp. is the most common fungus colonizing these cavities other fungi may rarely show colonization.
Material and Method:Retrospective study carried out in a tertiary care hospital from 1993 to 2008. All patients diagnosed with a fungal ball on chest radiographs/CT chest with subsequent histological confirmation were analysed. Demographic data, clinical, radiological and surgical findings were retrieved from the medical records. Histopathology slides were reviewed along with special stains for fungi. Fungi were identified on morphology and/or culture.
Results:There were 25 patients in the study period with 20 males and 5 females. A past history of tuberculosis was present in 17 patients. The colonizing fungi were identified as Aspergillus sp. in 20, dematiaceous fungi in 3 and mixed infection (Aspergillus sp. and Candida sp.) in 2. Culture confirmation was available in five specimens, which showed Aspergillus fumigatus in 2, Aspergillus flavus 1, Pseudallescheria boydii 1 and Candida albicans (in mixed infection) in 1.
Conclusion: Fungi other than
A comprehensive and detailed small bowel evaluation became possible since 2001 with the advent of a wireless capsule endoscope that was primarily used for diagnostic purposes. Simultaneously, the development of balloon-assisted enteroscope made detailed evaluation and therapy possible in the deeper small bowel. A novel motorized spiral enteroscope, introduced in 2015, is the most recent addition to the list of device-assisted enteroscopes. The rotational movements of the spiral overtube controlled by the integrated motor are transmitted into a linear force causing forward and backward propulsion of the scope in the bowel. There is emerging evidence about its safety and efficacy in the diagnosis and therapy of various small bowel diseases.
The authors report multiple giant bilateral pseudoaneurysms of pulmonary artery, also known as Rasmussen's aneurysms, which remained silent and unrevealed despite the large size and multiplicity unearthed by fluorine-18 fluorodeoxyglucose positron emission tomography/computerized tomography.
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