Rhinosinusitis: prevention strategies

Risk factors of recurrent sinusitis involve upper respiratory infections, bacterial load of the adenoids, day care attendance and exposure to tobacco smoke as well as sinonasal abnormalities, including septal deviation, choanal atresia, polyps and hypoplasia of sinuses. Furthermore, several systemic disorders can facilitate the development of chronic sinusitis, such as allergic rhinitis, gastro-esophageal reflux disease (GER), cystic fibrosis, primary ciliary dyskinesia, and immunodeficiency diseases. A clinical practice guideline for the management of sinusitis is available only for the acute disease, but does not include for the management of the chronic form (i.e. chronic/recurrent sinusitis) and even less for the prevention strategies. As several studies indicate that the majority of children respond to sequential medical followed by surgical interventions, when needed, the best prevention of recurrence or chronicity is to properly treat acute sinusitis; in addition, children should be removed from larger and crowded day care whenever possible and should not be exposed to cigarette smoke. If allergic rhinitis co-exists, it can be managed with nasal steroids sprays and anti-histamines, although the long-term results are controversial. In case of chronic sinusitis, the strategy of prevention is to assess and to cure the associated conditions.

A rare case of a large lateral meniscal cyst of the knee

Lateral meniscal cysts are usually small asymptomatic lesions, and to find a large cyst with extensive bony changes arising from this cyst is exceedingly rare. These changes are usually erosive defects of the tibia. Dull pain with an associated mass are classical findings. A 47-year-old man developed a symptomatic lateral meniscal cyst that eroded a large part of the lateral tibial plateau. Arthroscopy and arthrotomy with cyst excision was required in this case and led to the amelioration of his symptoms.