小箱子：通过过敏原的完美风暴设置良好的路线
Richard Petty doesn’t normally write laudatory letters about his physicians, but after treatment for chronic rhinosinusitis (CRS), he sat down and penned one to Giuseppe Colasurdo, MD, president of The University of Texas Health Science Center at Houston and then dean of the UTHealth John P. and Kathrine G. McGovern Medical School. In the letter, he commended the skill and professionalism of Martin Citardi, MD, FACS, professor and chair of the Department of Otorhinolaryngology-Head and Neck Surgery at the McGovern Medical School.
Petty, a business process engineer and Lean Six Sigma Black Belt, calculates his pre-Citardi annual expenditure on over-the counter medication and prescriptions at $2,100. Add to that figure another $1,200 for doctor visits, oral steroids and steroid injections and the grand total comes to roughly $3,300 per year. “I’ve had scores of infections and spent thousands of dollars since moving to Houston from San Antonio,” Petty says. “The first ENT I saw after the move described my symptoms as the worst he had ever seen. A sinus infection would feel like a case of the flu. I’d have body aches and chills and horrible splitting headaches, and would miss a couple of days of work.” Petty saw four ENTS and underwent three surgical procedures – two in 2008 and one in 2012 – before being referred to Dr. Citardi in January 2014. He also saw five allergists, one of whom described Houston as “the perfect storm of allergens” for Petty.
这种矢状窦CT显示了不透性的额窦（由黄色箭头指示）。在手术时，额窦充满了保留的分泌物和肿胀的组织。在手术过程中，除去额窦凹陷（由红色箭头指示）的组织阻塞的组织。在解剖过程中，请注意在额叶凹陷的外壁保持组织，以便窦可以恢复正常功能。
“正如一个季节性过敏原倒入一样，另一个季节性过敏也在达到顶峰。我生活在永恒的过敏反应状态，”他说。“即使经过三项手术，我仍在定期感染鼻窦，但他们不再使我完全失望。我可以继续前进并上班。”
Citardi博士在2014年初对Petty进行了修订图引导的功能性内窥镜鼻窦手术。“像Richard一样受益于该手术的患者，用相当典型的临床场景描述，”他说。“大多数人进行了相对较新的鼻窦手术，并且在症状恢复之前做得很好，或者手术后的症状恶化。他们通常有充血和化脓性鼻引流。他们已经收到了多轮抗生素和类固醇，终于被告知他们必须患有这种情况。这些是我们需要看的患者。”
Citardi博士将手术与术后护理的积极进度相结合，包括医疗管理和对腔的密切内窥镜监测，直到完全缓解为止。他说：“鼻窦和鼻手术已经走了很长一段路，但正在进行的医疗管理仍然很重要。”“经过良好的手术后，我们不仅会签约患者。我们关注它们至少两三年，有时甚至更长。通过手术后继续治疗，CRS患者几乎可以预计几乎所有病例。钥匙是长时间内内窥镜检查的继续管理。”
手术后的感染有超过6 -free months instead of the four-to-six-week respites he’d experienced over the previous six years. “I went from 10 to 12 episodes of CRS annually to two,” he says. “To me that’s an enormous success. Over the years I’ve been told that as long as I live in an environment where I’m allergic to so many things, my care would be more about managing the CRS to prevent further infections. I’d heard that same statement from four other doctors, but Dr. Citardi is the first one who delivered it.”
佩蒂在给科拉苏尔多博士的信中写道：“博士Citardi让我觉得自己像个伴侣，而不是要解决的问题。他的极端专业精神充满了朴实的狂热。他增加了我与妻子和孩子的美好时光，提高了我在工作场所的生产力，并提高了我的积极态度。”
Petty says he meant every word he wrote in that letter. “It was well warranted. Dr. Citardi quite literally changed my life.”