This case describes a cerebrovascular accident (CVA) in a 33 year old with carotid and vertebral ... more This case describes a cerebrovascular accident (CVA) in a 33 year old with carotid and vertebral artery stenosis following a presentation of submandibular abscess.
Background: A debate is ongoing on the role of the extent of sinus surgery in disease control in ... more Background: A debate is ongoing on the role of the extent of sinus surgery in disease control in chronic rhinosinusitis (CRS). The newly developed Amsterdam Classification on Completeness of Endoscopic Sinus Surgery (ACCESS) score provides a way to quantify extent of surgery. This study aimed to validate the ACCESS scoring system and to report its interrater agreement compared to the widely used Lund-Mackay (LM) scoring system. Methodology: Forty hand-picked anonymized computed tomography scans of sinuses of patients with varying pathology and degree of previous sinus surgery were independently scored by six rhinologists. Interrater agreement was determined by the intraclass correlation (ICC) statistic. Results: The interrater agreement of the ACCESS score was excellent, comparable to the LM score. The ACCESS interrater agreement was not influenced by degree of opacification or diagnosis. The ACCESS score reliably measured predicted differences induced by sinus surgery. Conclusions: the ACCESS score is an easy-to-use valid tool to assess extent of sinus surgery with an excellent interrater agreement. Further validation in a random group of CRS cases is required.
The European Position Paper on Rhinosinusitis and Nasal Polyps 2012 is the update of similar evid... more The European Position Paper on Rhinosinusitis and Nasal Polyps 2012 is the update of similar evidence based position papers published in 2005 and 2007.The document contains chapters on definitions and classification, we now also proposed definitions for difficult to treat rhinosinusitis, control of disease and better definitions for rhinosinusitis in children. More emphasis is placed on the diagnosis and treatment of acute rhinosinusitis. Throughout the document the terms chronic rhinosinusitis without nasal polyps and chronic rhinosinusitis with nasal polyps are used to further point out differences in pathophysiology and treatment of these two entities. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. Last but not least all available evidence for management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is analyzed and presented and management schemes based on the evidence are proposed.
Retropharyngeal abscesses (RPAs) are extremely uncommon in very early infancy and have specific m... more Retropharyngeal abscesses (RPAs) are extremely uncommon in very early infancy and have specific management challenges.
This case describes a cerebrovascular accident (CVA) in a 33 year old with carotid and vertebral ... more This case describes a cerebrovascular accident (CVA) in a 33 year old with carotid and vertebral artery stenosis following a presentation of submandibular abscess.
Background: A debate is ongoing on the role of the extent of sinus surgery in disease control in ... more Background: A debate is ongoing on the role of the extent of sinus surgery in disease control in chronic rhinosinusitis (CRS). The newly developed Amsterdam Classification on Completeness of Endoscopic Sinus Surgery (ACCESS) score provides a way to quantify extent of surgery. This study aimed to validate the ACCESS scoring system and to report its interrater agreement compared to the widely used Lund-Mackay (LM) scoring system. Methodology: Forty hand-picked anonymized computed tomography scans of sinuses of patients with varying pathology and degree of previous sinus surgery were independently scored by six rhinologists. Interrater agreement was determined by the intraclass correlation (ICC) statistic. Results: The interrater agreement of the ACCESS score was excellent, comparable to the LM score. The ACCESS interrater agreement was not influenced by degree of opacification or diagnosis. The ACCESS score reliably measured predicted differences induced by sinus surgery. Conclusions: the ACCESS score is an easy-to-use valid tool to assess extent of sinus surgery with an excellent interrater agreement. Further validation in a random group of CRS cases is required.
The European Position Paper on Rhinosinusitis and Nasal Polyps 2012 is the update of similar evid... more The European Position Paper on Rhinosinusitis and Nasal Polyps 2012 is the update of similar evidence based position papers published in 2005 and 2007.The document contains chapters on definitions and classification, we now also proposed definitions for difficult to treat rhinosinusitis, control of disease and better definitions for rhinosinusitis in children. More emphasis is placed on the diagnosis and treatment of acute rhinosinusitis. Throughout the document the terms chronic rhinosinusitis without nasal polyps and chronic rhinosinusitis with nasal polyps are used to further point out differences in pathophysiology and treatment of these two entities. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. Last but not least all available evidence for management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is analyzed and presented and management schemes based on the evidence are proposed.
Retropharyngeal abscesses (RPAs) are extremely uncommon in very early infancy and have specific m... more Retropharyngeal abscesses (RPAs) are extremely uncommon in very early infancy and have specific management challenges.
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Papers by M. Raftopulos