Sinus fungal balls: characteristics and management in patients with host factors for invasive infection

BACKGROUND

The characteristics of sinus fungal ball (SFB), classically considered being a non-invasive form of fungal infection, in patients with host factors for invasive fungal infection (IFI) are unknown.

OBJECTIVE

To characterize SFB and their management in patients with host factors for IFI.

METHODOLOGY

Retrospective single-centre study of the clinical, radiology, histology and mycology records of patients treated for SFB between 1997 and 2007. Patients with and without host factors for IFI were compared.

RESULTS

One hundred eighty one patients were classified into two groups: 19 (group 1) with and 162 (group 2) without host fac- tors for IFI. In group 1, SFB were asymptomatic in 26.3% of the cases, ethmoido-sphenoidal sinuses were more frequently involved than in group 2 and fungal culture was positive in 37.5% of the cases. The main species was Aspergillus sp. in both groups. Four cases of complicated SFB were observed, only in patients of group 1. Cure without recurrence was obtained in both groups by endonasal surgery, combined with triazole therapy in complicated forms with osteolysis.

CONCLUSION

In patients with host factors for IFI, SFB more frequently involves deep sinuses and can be complicated by clinical signs suggestive of invasion and radiological signs of osteolysis, with no histological evidence of fungal invasion.

Oxidative stress induces unfolding protein response and inflammation in nasal polyposis

BACKGROUND

Nasal polyposis, a chronic inflammatory disease affecting the upper airways, is a valuable and accessible model to investigate the mechanisms underlying chronic inflammation. The main objective of this study was to investigate a potential involvement of the unfolded protein response (UPR) in the context of oxidative stress and inflammation in nasal epithelial cells from nasal polyps (NP).

METHODS

Epithelial cells from NP (n = 20) and normal mucosa (Controls, n = 15) in primary culture were analyzed by global proteomic approach and cell biology techniques for the glucose-regulated protein 78 (GRP78), the spliced X-box-binding protein 1 (sXBP-1), the glucose-regulated protein 94 (GRP94), and the calreticulin (immunoblot, mass spectrometry, immunocytochemistry).

RESULTS

Proteomics analysis of human nasal epithelial cells in culture revealed the activation of the unfolded protein response in NP. Systematic cell biology and biochemical analysis of two markers (GRP78, sXBP-1) in the presence and absence of oxidative stress in NP showed a susceptibility of the unfolded protein response to oxidative stress compared to controls at least partially linked to an abnormal redox state of the protein disulfide-isomerase 4. This unfolded protein response was correlated with mitochondrial depolarization and secretion of interleukin 8 (IL-8) and leukotriene B4 (LTB4) and was prevented by mitochondrial antioxidant.

CONCLUSIONS

We show the existence of UPR in nasal epithelial cells that is linked to oxidative stress leading to IL-8 and LTB4 secretions. These mechanisms may participate in chronic inflammation in nasal polyposis.

Abnormal respiratory cilia in non-syndromic Leber congenital amaurosis with CEP290 mutations

BACKGROUND

Leber congenital amaurosis (LCA) is the earliest and most severe inherited retinal degeneration. Isolated forms of LCA frequently result from mutation of the CEP290 gene which is expressed in various ciliated tissues.

METHODS

Seven LCA patients with CEP290 mutations were investigated to study otorhinolaryngologic phenotype and respiratory cilia. Nasal biopsies and brushing were performed to study cilia ultrastructure using transmission electron microscopy and ciliary beating using high-speed videomicroscopy, respectively. CEP290 expression in normal nasal epithelium was studied using real-time RT-PCR.

RESULTS

When electron microscopy was feasible (5/7), high levels of respiratory cilia defects were detected. The main defects concerned dynein arms, central complex and/or peripheral microtubules. All patients had a rarefaction of ciliated cells and a variable proportion of short cilia. Frequent but moderate and heterogeneous clinical and ciliary beating abnormalities were found. CEP290 was highly expressed in the neural retina and nasal epithelial cells compared with other tissues.

DISCUSSION

These data provide the first clear demonstration of respiratory cilia ultrastructural defects in LCA patients with CEP290 mutations. The frequency of these findings in LCA patients along with the high expression of CEP290 in nasal epithelium suggest that CEP290 has an important role in the proper development of both the respiratory ciliary structures and the connecting cilia of photoreceptors. The presence of respiratory symptoms in patients could represent additional clinical criteria to direct CEP290 genotyping of patients affected with the genetically heterogeneous cone-rod dystrophy subtype of LCA.

[Sinonasal hemangiopericytoma: review of four cases]

AIM

The aim of this paper is to discuss, through four cases, the characteristics of sinonasal hemangiopericytoma (SNHP) and its diagnostic difficulties.

MATERIALS AND METHODS

Description of four recent, histologically proven cases of SNHP. Bibliographic research was conducted using the following principal key word: "sinonasal hemangiopericytoma".

RESULTS

The four patients complained of non-specific rhino-sinusal symptoms. In each case, physical examination revealed a voluminous unilateral polyploïd tumour of the nasal cavities, documented by CT Scan and MRI. Each patient underwent complete tumour resection by endoscopic sinus surgery. Histological and immunohistochemical examination confirmed SNHP diagnosis, although no specific marker was constantly observed. To date, none of the patients has presented with recurrence.

CONCLUSION

SNHP is of poorly specific clinical and histological presentation. This tumour is difficult to distinguish from solitary fibrous tumour (SFT), with which it is often confused. SNHP is of good prognosis, however lifelong follow-up must be observed.

A 20-year experience of electron microscopy in the diagnosis of primary ciliary dyskinesia

Transmission electron microscopy (TEM) analysis of ciliary ultrastructure is classically used for the diagnosis of primary ciliary dyskinesia (PCD). We report our extensive experience of TEM analysis in a large series of patients in order to evaluate its feasibility and results. TEM analysis performed in 1,149 patients with suspected PCD was retrospectively reviewed. Biopsies (1,450) were obtained from nasal (44%) or bronchial (56%) mucosa in children (66.5%) and adults (33.5%). TEM analysis was feasible in 71.4% of patients and showed a main defect suggestive of PCD in 29.9%. TEM was more feasible in adults than in children, regardless of the biopsy site. Main defects suggestive of PCD were found in 76.9% of patients with sinopulmonary symptoms and in only 0.4% of patients with isolated upper and 0.4% with isolated lower respiratory tract infections. The defect pattern was similar in children and adults, involving dynein arms (81.2%) or central complex (CC) (18.8%). Situs inversus was never observed in PCD patients with CC defect. Kartagener syndrome with normal ciliary ultrastructure was not an exceptional condition (10.2% of PCD). In conclusion, TEM analysis is feasible in most patients and is particularly useful for PCD diagnosis in cases of sinopulmonary syndrome of unknown origin.

Muco-ciliary differentiation of nasal epithelial cells is decreased after wound healing in vitro

BACKGROUND

Epithelial damage and modifications of cell differentiation are frequent in airway diseases with chronic inflammation, in which transforming growth factor-beta1 (TGF-beta1) plays an important role. The aim of this study was to evaluate the differentiation of human nasal epithelial cells (HNEC) after wound healing and the potential effects of TGF-beta1.

METHODS

Basal, mucus, and ciliated cells were characterized by cytokeratin-14, MUC5AC, and betaIV tubulin immunodetection, respectively. Their expression was evaluated in situ in nasal polyps and in an in vitro model of wound healing in primary cultures of HNEC after wound closure, under basal conditions and after TGF-beta1 supplementation. Using RT-PCR, the effects of TGF-beta1 on MUC5AC and DNAI1 genes, specifically transcribed in mucus and ciliated cells, were evaluated.

RESULTS

In situ, high TGF-beta1 expression was associated with low MUC5AC and betaIV tubulin expression. In vitro, under basal conditions, MUC5AC expression remained stable, cytokeratin-14 expression was strong and decreased with time, while betaIV tubulin expression increased. Transforming growth factor-beta1 supplementation downregulated MUC5AC and betaIV tubulin expression as well as MUC5AC and DNAI1 transcripts.

CONCLUSION

After a wound, differentiation into mucus and ciliated cells was possible and partially inhibited in vitro by TGF-beta1, a cytokine that may be involved in epithelial remodeling observed in chronic airway diseases.

Long-term study of fluticasone propionate aqueous nasal spray in acute and maintenance therapy of nasal polyposis

BACKGROUND

Topical steroids are first-line medication to control nasal polyposis (NP), a disease with long-term clinical course.

OBJECTIVE

The aim of this study was to evaluate the efficacy and safety of fluticasone propionate aqueous nasal spray (FPANS) 200 microg twice a day (bd) after 1 month of treatment, and to compare FPANS 200 microg bd and FPANS 200 microg once a day (od) in maintenance and long-term treatment.

METHODS

Double-blind, placebo-controlled, 8-month study with three treatment periods (1-month acute period followed with 1-month maintenance period and 6-month follow-up period) was carried out. Group 1 received FPANS 200 microg bd, during acute, maintenance and follow-up periods, Group 2 received FPANS 200 microg bd during acute period and FPANS 200 microg od during maintenance and follow-up periods, and Group 3 received placebo during acute and maintenance periods and FPANS 200 microg bd during follow-up period. Endpoints were change from baseline in clinic peak nasal inspiratory flow (PNIF), domiciliary evening PNIF, intensity of symptoms and polyposis grade.

RESULTS

After acute period and maintenance periods, FPANS 200 microg bd was significantly more effective than placebo on all endpoints and more effective than FPANS 200 microg od after 1-month maintenance period on clinic PNIF, evening PNIF, obstruction, percentage of days with no sense of smell and percentage of nights with no disturbances. The two doses were similar on other endpoints. After the 6-month follow-up period, there was no difference between the two doses of FPANS at all efficacy endpoints. The safety profile of FPANS did not highlight any new or unanticipated adverse events.

CONCLUSION

The study demonstrated the efficacy of FPANS 200 microg bd in acute treatment and FPANS 200 microg od as a sufficient dose to maintain a long-term efficacy in the treatment for NP.

Rhinitis and epistaxis in patients treated by anti-angiogenic therapy

Anti-angiogenic therapies have a particular drug-related toxicity profile including hypertension, thrombosis, haemorrhages, and proteinuria. Moreover, patients treated by angiogenesis inhibitors present nasal symptoms including symptomatic rhinitis and epistaxis. For the first time, a new entity of "atrophic rhinitis" induced by angiogenesis inhibitors is described and revealed that angiogenesis inhibitors alter the differentiation of nasal epithelium. VEGF may act on epithelial cell proliferation and differentiation in nasal epithelium.