The anti-inflammatory effect of fusafungine during experimentally induced rhinosinusitis in the rabbit

The short-term effects of local intranasal administration of fusafungine were studied for its anti-inflammatory and antimicrobial properties against experimentally induced bacterial rhinosinusitis. The maxillary sinuses of 20 rabbits were infected with encapsulated Streptococcus pneumoniae after mechanical occlusion of each animal's anatomic ostium. Either fusafungine solution or placebo was administered as a nasal spray through the nostrils twice daily for 10 days. Histopathological grading of inflammation, biochemical assay of inflammatory mediators, and the number of bacterial species isolated from the nasal cavities all showed significant recovery from inflammation after fusafungine treatment. The beneficial effects of fusafungine on inflamed sinus mucosa may possibly also be attributable to an initial alleviation of inflammation in the nasal cavity, which permitted entry of the drug to the sinus cavity through a partially reopened ostium. A reciprocal relationship between nasal and sinus reactivity involving generalization of inflammation and recovery was also thought to be of importance. The present findings indicate that local applications of fusafungine may effectively improve clinical conditions producing rhinitis and sinusitis.

Interobserver variations in assessment of antral disease from direct sinoscopic observations compared to video recordings

We tested the reliability of visual clinical sinoscopic observations by using video recordings. An edited video tape was made from the video-recorded bilateral antral sinoscopies of nine patients included in a prospective case series of inflammatory maxillary sinus disease in critically ill patients. An expert panel of four consultant ENT surgeons made individual appraisals of the video using a structured form. They had only been informed in general about the study, but had no further case knowledge in order to avoid all biases. Concordance and interobserver variabilities in the expert panel were compared in pairs. The assessments of the expert panel were compared with the observations of the performer, who was biased through individual case knowledge. Nine patients, either nasotracheally intubated or tracheotomized, had ventilator treatment for more than 7 days. One ENT surgeon performed all sinoscopies and made the direct observations. Satisfactory agreement was found on mucosal alterations. The concordance of recognizing bacterial infection was almost perfect. However, the assessment of redness from a video recording displayed only chance agreement. The differences between kappa statistic values within the expert panel group compared to the comparisons of performer versus expert panel were not significant. The case knowledge of the sinoscopist did not alter the assessments markedly and thus seemed only to have minor influence. Video recording as a method for second opinion was shown to be a useful technique, but will have to be further developed.

[Results of conservative treatment of chronic purulent sinusitis]

Results of conservative treatment 159 patients with chronic purulent maxillary sinusitis has been discussed. In I group (75 sinuses) into sinus has been given clindamycin, in II group (56 sinuses) clindamycin, gentamycin or amikacin with metronidazol, in III group (comparative) others antibiotics. Basic results of bacteriological study and methods of treatment has been presented. In compare with group III statistically better results of treatment has been in group I and II.

Correlation between ciliary beat frequency and the structure of ciliated epithelia in pathologic human nasal mucosa

The structure and function of ciliated epithelium were studied in 44 human nasal mucosa samples using a photoelectric method and scanning electron microscopy (SEM). The ciliary beat frequency (CBF) of cases with recurrent or chronic sinusitis was 9.1 +/- 5.4 Hz. In eight of the samples (18.2%) no ciliary activity was detected. The amount of ciliated cells, the orientation of cilia, epithelial metaplasia, and secretion were found to be explanatory factors accounting for the decreased ciliary activity. Ciliary disorientation and a lack of ciliated cells in SEM correlated with low ciliary activity. In cases where sinusitis secretion was not seen, the CBF was slower than in cases with mucus or mucopurulent secretion. Sinusitis with disoriented cilia, a loss of ciliated cells, and a lack of mucosal secretion is associated with a decreased CBF. This may lead to impaired mucociliary clearance and increase the risk of recurrent and chronic sinusitis.

Effect of systemic pretreatment with betamethasone on the bacterial flora, inflammatory response, and polyp formation in experimentally infected rabbit maxillary sinus mucosa

To investigate possible effects of corticosteroids on polyp formation and local bacterial colonization, pneumococcal sinusitis was experimentally induced in rabbits pretreated with betamethasone or saline. After 7 days, macroscopic polyps were counted post-mortem and on histologic slides after serial sectioning. Histologic sections were also examined with light microscopy. Macroscopic polyps were significantly fewer in animals given betamethasone, while there was no difference regarding the number of microscopic polyps. Ingrowth of pathogenic microorganisms was found in five of eight rabbits given placebo but in none of the animals treated with corticosteroids (P < 0.05). The reduced number of pathogenic strains in these animals may be explained by a better-preserved local host defense. The lower number of macroscopic polyps in the same animals could be because of a delayed mucosal repair and subsequent polyp formation.

Periantral soft-tissue infiltration and its relevance to the early detection of invasive fungal sinusitis: CT and MR findings

PURPOSE

Our goal was to illustrate the relevance of periantral soft-tissue infiltration to the early diagnosis of invasive fungal sinusitis and to describe variations in the appearance of normal periantral soft tissues.

METHODS

We reviewed two cases of pathologically proved invasive maxillary fungal sinusitis in which the sole imaging finding suggestive of invasive disease was periantral soft-tissue infiltration. Variations in the CT appearance of normal periantral soft tissues were studied in 112 patients by assessing the appearance of the fat planes along the anterior and posterior bony antral walls and by noting the presence of infraorbital and distal internal maxillary artery branch vessels within the anterior and posterior periantral fat planes, respectively.

RESULTS

None of the 112 patients had findings that suggested, or that could mimic, soft-tissue infiltration in the anterior periantral soft tissues. In only one (1%) of the 112 patients was there a loss of visibility of the posterior periantral fat plane that was not clearly attributable to the otherwise normal-appearing posterior periantral soft tissues.

CONCLUSION

Infiltration of the periantral fat planes may represent the earliest imaging evidence of invasive fungal disease. When encountered as the sole radiologic finding, periantral soft-tissue infiltration should suggest the possibility of invasive fungal sinusitis in the appropriate clinical setting.

Effects of surgery on mucosal pathologic changes following experimental sinusitis in rabbit

In the present investigation, the regenerative capacity of the infected maxillary sinus mucosa following surgical procedures was studied in a rabbit model. Sinusitis was induced by occluding the ostium with and without the addition of Staphylococcus aureus or Bacteroides fragilis, or by provoking a prolonged bacterial infection with both pathogens. The surgical procedures performed were 1) widening of the natural sinus ostium (middle meatal antrostomy; MMA) and 2) removal of sinus mucosa without ostial interference (modified radical operation; MRO). The histologic features of the entire nose-sinus complex were studied, graded semiquantitatively, and compared with findings in untreated sinusitis, or after surgery only. Whereas MMA and MRO both led to a decrease of the inflammatory features of the sinus mucosa in induced sinusitis, persistent local histopathology was observed in the ostial region following MMA surgery. This indicates the importance of local pathologic changes resulting from interactions of bacterial colonization, inflammation, and surgery in chronic sinusitis.

Maxillary sinus atelectasis with enophthalmos

Chronic maxillary sinusitis may present as atelectasis of the sinus with changes to surrounding structures. Several mechanisms have been proposed for this problem. Chronic obstruction of the sinus ostium, with resultant retention of secretions and osteitic bone resorption, may account for these changes. Enophthalmos is one manifestation that may require corrective treatment. Titanium micromesh reconstruction of the orbital floor, with or without onlay concha cartilage, has reliably resolved the enophthalmos. Reconstruction of the orbital floor and ventilation of the obstructed sinus ostium may be carried out relatively safely in a single operation. The standard endoscopic technique of uncinate removal and middle meatal antrostomy should be modified to prevent orbital penetration. This report reviews our series of 6 patients with this problem, as well as a comprehensive review of the literature. Recommendations for management of both the obstruction and the secondary orbital manifestations are presented.

Early stages in the development of goblet cells in the paranasal sinuses: a multimethodological study in the rabbit

To evaluate the pattern of goblet cell differentiation in sinus mucosa in response to external stimuli, New Zealand White rabbits were subjected to either experimental sinusitis or topical capsalcin application. Sinus mucosa was examined by light microscopy after serial sectioning, whole-mount preparation or immunohistochemistry. The mucosa was also examined by electron microscopy after perfusion fixation or high-pressure freezing. While goblet cells were normally very scarce in the healthy rabbit maxillary sinus mucosa, such cells were frequent after experimental sinusitis or topical capsaicin application. The process of goblet cell differentiation seems to follow a sequential path where serous secretory cells start to produce an increasing amount of mucous granules which appear electron lucent after conventional fixation. Parallel to this shift in secretion production, the cell assumes a bulging appearance after conventional fixation. It is concluded that newly formed goblet cells are recruited from intermediate secretory cell stages rather than from ciliated cells.

Acute sinusitis in the rabbit: a new rhinogenic model

The objective of this study was to create a rhinogenic model of sinusitis using an implanted foreign body in the nasal cavity of the rabbit. The study design was a prospective controlled trial of the experimental design. In this model an obstructing foreign body was placed into the nasal cavity and then impregnated with pathogenic bacteria. This model was studied histologically using whole-mount techniques. Quantitative assessment of the degree of inflammation was made for the maxillary and ethmoid sinus and for overall effect for each animal. Bacteriologic study was performed in a limited number of animals. The results indicated that a significant infection develops in about half of animals. This peaks in intensity between 1 and 2 weeks after implantation and subsequently subsides with some evidence of long-term changes present after 4 weeks. It is concluded that this is a viable and perhaps preferable animal model to study sinusitis. Further investigation is necessary to completely characterize this model.

Conservative treatment of chronic maxillary sinusitis in children. Long-term follow-up

A placebo-controlled prospective study is performed to evaluate conservative treatment of chronic maxillary sinusitis in children. Antibiotic treatment and drainage do not seem to have a permanent curative effect.

Antimicrobial effect on rabbit sinusitis after temporary ostial occlusion

A key precipitating factor in the pathogenesis of acute bacterial sinusitis (ABS) is ostiomeatal obstruction. It has been postulated that ABS cannot resolve until the sinus ostium is patent. The primary purpose of this study is to quantify sinusitis resolution after temporary ostial occlusion in a rabbit model. A secondary aim is to quantify bacterial clearance with and without antimicrobial therapy in Staphylococcus aureus infected sinuses. A blinded, placebo controlled study in 10 New Zealand white rabbits was performed using Merocel as a temporary maxillary sinus ostial obstruction. Computerized tomography (CT) of the maxillary sinuses was obtained before and after bilateral ostial occlusion; sinuses were cultured and then the left sinus was injected with approximately 10(8) cfu/mL S. aureus. CT imaging and sinus cultures were obtained and then the ostial plugs were removed. Serial CT and cultures were done until sinusitis resolved and cultures were negative for S. aureus. Mean CT sinusitis scores increased with ostial obstruction and decreased with ostial plug removal (P < 0.0001 and P < 0.001). Injection of S. aureus did not significantly change mean CT sinusitis scores despite being cultured from 45% of sinuses. Antimicrobial therapy was not significant in reducing mean CT scan sinusitis scores or positive cultures. Resolution of mucosal swelling is more dependent on relief of ostial obstruction rather than antimicrobial therapy in this rabbit model.

Effects of functional endoscopic sinus surgery on maxillary sinus mucosa

OBJECTIVE

To compare the preoperative and postoperative changes on ciliary surface of maxillary sinus mucosa in patients treated with functional endoscopic sinus surgery.

DESIGN

The maxillary mucosa of both the superolateral wall and the ostium were sampled during the operation and 6 to 12 months (mean duration, 7.6 months) after the operation. Ciliary surface was determined using scanning electron microscopy in combination with an image analyzer and was expressed in terms of ciliary area, which is the percentage of mucosal surface occupied by cilia.

SETTING

The samples were taken at a hospital-based clinic. An electron microscopic study was performed at Mie University School of Medicine, Mie, Japan.

PATIENTS

Sixteen patients (20 maxillary sinuses) undergoing functional endoscopic sinus surgery for treatment of chronic sinusitis.

RESULTS

The mean (+/-SD) ciliary area before the surgery was 60.7%+/-28.8% and 39.9%+/-21.5% in the superolateral wall of the maxillary sinus and the ostium of the maxillary sinus, respectively. The ciliary area of the superolateral wall was significantly higher than that of the ostium (P<.001). The mean (+/-SD) postoperative ciliary area value was 74.3%+/-22.6% in the superolateral wall and 51.3%+/-16.1% in the ostium. These postoperative values were significantly higher than the preoperative values (P<.001).

CONCLUSIONS

This study showed that the maxillary sinus mucosa in chronic sinusitis is capable of regeneration, and the damaged ciliated epithelium could return toward normal with the improvement of ventilation and drainage of the maxillary sinus following functional endoscopic sinus surgery.

RANTES is more prevalent in bacterial than in nonbacterial maxillary sinusitis: and P-selectin is preferentially up-regulated in diseased mucosae

OBJECTIVE

To investigate the relationship of the clinical appearance, histological characteristics, bacterial culturing, and messenger RNA (mRNA) expression of RANTES, interleukin 6, and interleukin 12, as well as the occurrence of endothelial adhesion molecules, in inflammatory diseased maxillary sinus mucosa in critically ill patients.

DESIGN

Prospective case series.

SETTING

General intensive care unit and neurosurgical intensive care unit of a tertiary care hospital.

SUBJECTS

Seven critically ill patients, nasotracheally intubated or tracheotomized, who received ventilator treatment for more than 7 days and treatment with antibiotics.

INTERVENTIONS

Bilateral biopsy specimens of antral mucosa were obtained at sinoscopy. Reverse transcriptase-polymerase chain reaction was used to detect the cytokine mRNAs in situ on paraformaldehyde-fixed tissue, and intercellular adhesion molecule 1, vascular cell adhesion molecule 1, E-selectin, and P-selectin were analyzed by immunochemistry on frozen sections. Sampling of secretion and tissue from the antra was performed for bacterial culturing.

RESULTS

Macroscopic and histological appearance varied and showed moderate to pronounced inflammation in 6 antra. All 4 bacterially infected antra showed mRNA RANTES (P=.005). No correlation was found for interleukin 6 and interleukin 12. Up-regulation of P-selectin in all cases and sparse expression of vascular cell adhesion molecule 1 indicate that the inflammation is chronic but nonallergic in type.

CONCLUSION

We find an indication that RANTES is more prevalent in bacterial sinusitis.

Paranasal sinus fungus balls

BACKGROUND

Paranasal sinus fungus balls (mycetomas) are a form of fungal sinus infection distinct from allergic fungal sinusitis, fulminant invasive fungal disease, and paranasal aspergillus granulomas.

METHODS

The Mayo Clinic surgical pathology files of inflammatory sinus specimens from 1984 to 1994 were examined. Twenty-nine paranasal sinus fungus balls were identified. Cases of allergic fungal sinus and invasive fungal disease were excluded.

RESULTS

The fungus ball occurred in 11 men and 18 women, with an age range of 28 to 86 years, mean 64 years. Sinuses involved included maxillary (20 cases), sphenoid (10 cases), ethmoid (9 cases), and frontal (6 cases). In 12 patients, multiple sinuses were involved in a variety of combinations. By culture the most common pathogens were Aspergillus fumigatus and Aspergillus flavus. Treatment was by a variety of surgical procedures. Follow-up in 28 patients showed two recurrences and three deaths due to intracerebral bleed as a complication of surgery. These deaths occurred in patients with sphenoid sinus fungus balls.

CONCLUSIONS

Paranasal sinus fungus balls occurs in an elderly population and have a female predominance. They have a low morbidity and recurrence rate. Death can occur in sphenoid sinus lesions as a complication of surgery.

[Scanning electron microscopic changes of maxillary sinus mucosa before and after functional endoscopic sinus surgery]

We attempted to evaluate postoperative maxillary sinus mucosal changes in 20 maxillary sinuses of 16 patients who underwent functional endoscopic sinus surgery (FESS). Ciliated area of the maxillary sinus mucosa and ostium of maxillary sinus were quantitatively observed by scanning electron microscope and image analysis before and after FESS. In the present study, the number of preoperative ciliated cells of maxillary sinus mucosa and ostium was significantly reduced, goblet cells and microvillous cells were increased, and squamous cell metaplasia observed in part of the maxillary sinuses. Many damaged ciliated cells tend to recover and ciliated area significantly increased at 6-12 months after the surgery. The results showed that the damaged ciliated epithelium could return to normal by the improvement of ventilation and drainage of the maxillary sinus following FESS.

Gram negative sinusitis: a bacteriologic and histologic study in rabbits

Recent investigations of chronic sinusitis that is "recalcitrant" to traditional medical and surgical therapy indicate that gram negative bacteria are frequently involved, most commonly Pseudomonas aeruginosa. Analysis of infection-induced histopathologic changes in the underlying sinus mucosa may provide important insight into the recalcitrant nature of these infections. Therefore, the aim of this investigation is to experimentally induce sinus infection in the rabbit with Pseudomonas aeruginosa, a bacterium commonly associated with "recalcitrant sinusitis," and evaluate the histopathologic findings. A unilateral maxillary sinusitis was induced in 33 New Zealand white rabbits. Histologic analysis at 4, 14, 21, and 28 days revealed a moderate inflammation that persisted throughout the study period. Initial changes included edema, loss of submucosal glands, and ulceration. Fibroplasia and bone remodeling were evident throughout the study. Epithelial plaque formation occurred early in the infection, whereas goblet cell formation was a later change. Experimental sinusitis induced by Pseudomonas aeruginosa causes an intense transmucosal injury. The histopathologic injury and response to Pseudomonas aeruginosa appears to be more intense than that noted on previous investigations of experimental sinusitis using other bacteria. The significant histopathologic changes noted could explain the recalcitrant nature of gram negative sinusitis observed clinically in patients.

Restoration of the mucociliary clearance of the maxillary sinus after endoscopic sinus surgery

BACKGROUND

Whether endoscopic sinus surgery (ESS) restores the mucociliary clearance of the maxillary sinus needs further evaluation.

METHODS

We evaluated the mucociliary clearance of the maxillary sinus by using a radionuclide technique in 12 patients with chronic sinusitis (sinusitis group) and in six patients who had undergone ESS 6 to 14 months after the surgery (post-ESS group). The mucosal cilia taken from the maxillary sinus in 12 patients with sinusitis before and after ESS (paired experiments) were examined by light and electron microscopy.

RESULTS

The radionuclide placed endoscopically in the maxillary sinus in eight patients immediately after ESS maintained 81.2 +/- 16.3% of its radioactivity after 30 minutes. This result was consistent with results in four patients with untreated chronic sinusitis in whom the radionuclide had been instilled by antral puncture (86.9% +/- 3.5%). On the other hand, in six patients in the post-ESS group the radionucleotide maintained only 25.9% +/- 11.6% of its radioactivity, demonstrating statistically significant differences from those of both the sinusitis group without ESS (p < 0.005) and the group 4 days after ESS (p < 0.005). The absence of the cilia in the sinusitis condition was recognized in 35.5% +/- 12.1% (n = 12) of the epithelial cells. On the other hand, the absence of cilia was significantly (p < 0.01) reduced to 5.3% +/- 3.7% of the epithelial cells in the post-ESS condition. Electron microscopic observation also revealed abnormal cilia in the sinusitis condition, whereas the mucosal cilia were regularly arranged in the post-ESS condition.

CONCLUSIONS

The mucociliary clearance of the maxillary sinus disturbed by chronic inflammation was restored by ESS, indicating the clinical effectiveness of ESS for the treatment of chronic sinusitis.

Ciliary ultrastructure in experimental sinusitis

Ultrastructure of respiratory cilia was observed in experimental sinusitis of rabbit maxillary sinuses. Sinus mucosa of 15 rabbits was inoculated with Streptococcus pneumonia bacteria and of 16 rabbits with Bacteroides fragilis bacteria. Specimens were taken during 12 weeks' observation time and they were studied by transmission electron microscopy from the cross-sections. A special emphasis was paid to the number of cilia, the ciliary orientation, the tubular anomalies, the presence of dynein arms and the compound cilia. It seems likely that pneumococcal sinusitis is a more toxic infection to the epithelium causing loss of ciliated cells and cilia than B. fragilis infection. In anaerobic infection ciliary ultrastructure remains normal and dynein arms as well as normal tubular ultrastructure were seen even after 12 weeks' infection.

Aspergillus sinusitis: clinical aspects and treatment outcomes

Seventy-two cases of Aspergillus sinusitis were analyzed during a period of 14 years from January 1980 through October 1993. There were 60 cases of primary type and 12 cases of secondary type. The maxillary and ethmoid sinuses were most commonly affected in both primary and secondary types. The sphenoid sinus was commonly involved in secondary type. Fourteen (23%) cases of primary type and 4 (33%) cases of secondary type demonstrated sinus wall destruction on computed tomography or magnetic resonance images. Seventy percent of primary type and all cases of secondary type showed focal or diffuse areas of increased attenuation in the soft tissue mass on computed tomography scans. Sixteen cases assessed by magnetic resonance imaging showed decreased signal intensities on T1-weighted images and markedly reduced signal intensities on T2-weighted images. Fifty-nine (98%) of 60 cases of primary type were noninvasive, and 1 was invasive. In secondary type, 10 (83%) of 12 patients had noninvasive disease. The most common coexisting disease in secondary aspergillosis was diabetes mellitus. Thickened mucosa with necrotic brownish green material, which was the most common finding in both types, was found in 33 patients with primary type and in 5 with secondary type. Surgery was performed in most cases, among which 4 patients received chemotherapy after surgery with amphotericin B with or without flucytosine. All patients were cured without recurrence during a mean follow-up period of 13 months.

Maxillary sinusitis caused by Ascotricha chartarum Berk. (anamorph Dicyma ampullifera Boul.): a new phaeoid opportunistic human pathogen

The first human infection caused by Ascotricha chartarum of the maxillary sinus is described. The patient, a 35-year-old woman, developed a hard bony swelling on the right cheek. Her maxillary X-ray showed complete opacity of the right maxillary antrum with a shadow of erosion. C.T. scan revealed a radio opaque mass having vacuolated appearance in the antrum. The debris removed from the antrum contained phaeoid fungal elements. At places, softening of the bone was observed. The mucoperiosteum exhibited acute inflammatory reaction and invasion by the pathogen. The pale brown to subhyaline fungal elements in biopsy tissue grew Ascotricha chartarum, a phaeoid ascomycetous fungus in culture. The patient had a smooth recovery when treated with betadine lavage and itraconazole after surgical intervention.

Maxillary sinusitis in Medieval Chichester, England

Maxillary sinusitis is a common medical complaint, affecting more than 30 million people per year in the United States alone. Very little palaeopathological work on this disease has been carried out, probably because of the enclosed nature of the sinuses in intact skulls and the lack of a suitable method for examination. This study tested the hypothesis that maxillary sinusitis was more common in people with leprosy than in people without it in Medieval England. The prevalence of maxillary sinusitis by age and sex was recorded in 133 individuals, some diagnosed as being leprous, derived from a later Medieval (12th to 17th centuries AD) urban hospital population at Chichester, Sussex, England using both macroscopic and endoscopic methods of examination. Of the 133 individuals with one or both sinuses available for examination, 54.9% (73) had evidence of bone change within the sinuses. There was no difference in prevalence between those with leprosy and those without, although clinical studies suggest that over 50% of lepromatous leprous individuals may develop sinusitis. Comparison with another study on Medieval British sites with a 3.6% prevalence (3 of 83) indicates that the prevalence at Chichester is much greater. The problems with diagnosing sinusitis are addressed and reasons behind the high frequency in this study are discussed. Aetiological factors predisposing to maxillary sinusitis are considered with reference to possible environmental conditions prevailing in the later Medieval period in Britain.

Comparative study of the prevalence of maxillary sinusitis in later Medieval urban and rural populations in northern England

Six hundred sixty-three Medieval individuals from Wharram Percy, a rural settlement in the Yorkshire Wolds, and 1,042 individuals from St. Helen-on-the-Walls, a poor parish in the Medieval city of York, were examined in order to test the hypothesis that maxillary sinusitis would be more prevalent in an urban population due to social and environmental conditions characteristic of an industrialized settlement. The results showed that the individuals from St. Helen-on-the-Walls, living in the urban environment, had a greater prevalence of maxillary sinusitis than the rural population; 39% (106) of the individuals from Wharram Percy had evidence of sinusitis compared to 55% (134) of the individuals from St. Helen-on-the-Walls. It is suggested that this pattern may be attributed to occupation and industrial air pollution in the Medieval city of York.

[Paranasal sinus mycetoma with orbital involvement in a patient with AIDS]

A patient with AIDS was hospitalized with a left-sided face swelling and protrusion of the bulbus. After cranial computed tomography and fine-needle aspiration biopsy of the fossa temporalis we diagnosed a mycetoma; localisation and histology made an aspergilloma most probable. Antimycotic therapy led to complete remission of the symptoms. Post mortem we only could culture Candida albicans out of the abscess cavity.

Correlation between preoperative computed tomography and operative findings in functional endoscopic sinus surgery

This study investigated the correlation between diagnostic parameters and surgical findings in patients undergoing functional endoscopic sinus surgery (FESS) for chronic sinusitis. The parameters that were reviewed included the radiologist's report on the computed tomographic (CT) scan, the surgeon's reading of the CT scan, the operative findings, and the histopathology report. A retrospective analysis was conducted of 84 patients with chronic maxillary and ethmoid disease who were treated by the senior author (M.F.P.) over a 5-year period. The average concurrent agreement between the radiologist's CT report and the surgeon's CT interpretation was 92.26% for unilateral ethmoid disease, 83.73% for unilateral maxillary disease, 79.50% for bilateral ethmoid disease, and 64.28% for bilateral maxillary disease. The operative findings compared more closely with the surgeon's CT interpretation. The results of this study underscore the importance of clinical correlation in the surgical management of chronic sinus disease.

Mucociliary activity and histopathology of sinus mucosa in experimental maxillary sinusitis: a comparison of systemic administration of antibiotic and antibiotic delivery by polylactic acid polymer

To evaluate the efficacy of antibiotic delivered by polyactic acid (PLA) polymer in sinusitis, we induced maxillary sinusitis in 32 New Zealand white rabbits by occluding the sinus ostium and inoculating the sinus cavity with Streptococcus pneumoniae. The rabbits were divided into three groups consisting of group 1 (control group, 8 rabbits), which was treated only by reopening the ostium; group 2, which was treated by both reopening the ostium and injecting ampicillin intramuscularly (40 mg/kg/day in three divided doses, 12 rabbits); and group 3 (12 rabbits) in which a piece of PLA-polymer ampicillin (0.326 mg) sheet (1.5 x 1.5 cm) was placed within the sinus after re-establishing ostial patency. The light microscopic findings such as epithelial ulceration, loss of cilia, infiltration of inflammatory cells, and edema were less pronounced in group 2 and minimal in group 3. The electron microscopic findings such as swelling of mitochondria and endoplasmic reticulum and protruded cytoplasm were severest in the control group, followed by groups 2 and 3. The mucociliary transport speed measured at the medial wall of the maxillary sinus was highest in group 3. The results of this study suggest that treatment with PLA-polymer ampicillin may have a better efficacy in maxillary sinusitis than that with systemic administration of ampicillin.

[Odontogenic sinusitis with cutaneous fistulization. A case report]

A 70-year-old male patient presenting with a cutaneous node of the genal region that was first diagnosed as basal cell carcinoma is described. Owing to the following observation, the authors were prompted to a diagnosis of cutaneous odontogenic sinusitis: a) examination of the lesion which emitted pus upon gentle squeezing; b) presence in the vestibular fornix of a large fibrous cord; c) the serious conditions of the mouth and the radiologic results of homolateral sinusitis. The importance of the sinusitis picture, and the necessity to completely remove all bacteria foci prior to surgery on the abdominal aorta the patient was scheduled to undergo, prompted the authors to avulse the cutaneous lesion with tooth extraction, after a "Caldwell-Luc" operation of the homolateral paranasal sinus. Full restitutio ad integrum was achieved.

[Prognosis of the course of puncture-treated maxillary sinusitis by cytological features of the lavage fluid]

The cytological picture of the lavage fluid obtained at puncture treatment of maxillary sinusitis provides a sufficient objective characterization of the inflammation in the sinuses. This makes it easier to predict the disease outcome and progression. The technique is simple and can be performed in any medical institution furnished with clinical laboratory.

Comparison of natural ostiotomy and antibiotic therapy in the treatment of acute maxillary sinusitis in rabbits

The goal of this study was to compare natural ostiotomy and the administration of a systemic antibiotic in the treatment of acute maxillary sinusitis. Maxillary sinusitis was induced in 28 rabbits by blocking the natural ostium with a bone chip and by introducing 0.2 ml of a suspension of Streptococcus pneumoniae (2 x 10(9) cells/ml). The animals were divided into natural ostiotomy and antibiotic therapy groups: the natural ostiotomy group comprised 14 rabbits, in which the bone chip that blocked the natural ostium was removed; and the antibiotic therapy group comprised 14 rabbits treated with systemic antibiotic without reopening the ostium. The sinus mucosa of each group was examined histopathologically 2 weeks and 4 weeks after treatment. There were no significant differences in light microscopic findings between the natural ostiotomy and antibiotic therapy groups. Natural ostiotomy was as effective against acute maxillary sinusitis as the systemic administration of antibiotics. The results of this study suggest that natural ostiotomy and antibiotic therapy may be equally effective in the treatment of acute maxillary sinusitis in rabbits.

Endoscopic and Caldwell-Luc approaches in chronic maxillary sinusitis: a comparative histopathologic study on preoperative and postoperative mucosal morphology

The aim of the present investigation was to study the histopathologic mucosal changes occurring in chronic maxillary sinusitis both preoperative and postoperative to functional endoscopic sinus (FES) surgery and the Caldwell-Luc (C-L) operation. Correlations were also sought between the histopathologic parameters and endoscopic findings, as well as patient symptoms. Sixty sinuses with the FES surgery and 55 sinuses with the C-L procedure were studied. The histologic parameters were graded semiquantitatively and compared preoperatively and postoperatively. The C-L operation reduced almost all parameters, whereas after the FES operation only edema and inflammatory cells were significantly reduced. Fibrosis increased postoperatively with both methods. The number of inflammatory cells was closely correlated to a thickened antral mucosa and to purulent secretion. No valid correlations were found when comparing histology with patient symptoms. All in all, histologic considerations suggest that asthmatic patients with severe sinonasal polyposis might benefit from the C-L procedure.

Interleukin-8 gene expression in chronic sinusitis

PURPOSE

Interleukin-8 (IL-8), a monocyte-derived and macrophage-derived cytokine, displays potent chemotactic activating properties toward neutrophils and thus may contribute to the pathogenesis of chronic sinusitis. The object of this investigation was to show the expression of the IL-8 gene in chronic sinusitis by Northern blot analysis and a reverse transcription-polymerase chain reaction (RT-PCR).

MATERIALS AND METHODS

For Northern blot analysis, RNAs were extracted from maxillary mucosa and nasal polyps from two patients with chronic sinusitis, respectively, and from the inferior turbinate of a nasal allergy patient. For RT-PCR, RNAs were extracted from 11 patients with chronic sinusitis, 8 patients with allergic rhinitis, and 4 patients with hypertrophic rhinitis.

RESULTS

Whereas IL-8 mRNA was expressed in the maxillary mucosa, IL-8 transcript was not detected in the inferior turbinate by Northern blot analysis. IL-8 transcripts were detected in 45% of chronic sinusitis RNAs (5/11) and in 50% of allergic rhinitis RNAs (5/10) by RT-PCR.

CONCLUSION

These data suggest IL-8 may contribute to neutrophil involvement in chronic sinusitis.

Normalization of maxillary sinus mucosa after FESS. A prospective study of chronic sinusitis with nasal polyps

To observe the normalization of antral mucosa after FESS, 71 patients suffering from chronic sinusitis with nasal polyps were enrolled in this study. Pre-operative profiles including history, allergy skin test, and saccharin time test were done. Endoscopic findings of the antral mucosa were divided into 3 groups: polyposis, oedema, and thickening. The time sequence required for normalization of the mucosa was observed through the antromeatal opening. A patient's history of more than seven years, a saccharin time longer than 36 min, and polyposis of antral mucosa are ominous signs for recovery. The most frequent endoscopic finding of maxillary sinusitis is oedema and many of the sinus units (42%) gained complete recovery during the third month. Pre-operative profiles and endoscopic findings during surgery can serve as a reference of recovery time and treatment modality.

Analysis of T cell receptor variability in fresh tumor-infiltrating lymphocytes from human head and neck cancer

In this study, we analyzed T cell receptor (TCR) gene rearrangements in tumor-infiltrating lymphocytes (TIL) freshly obtained from 15 patients with head and neck cancer using the reversely transcribed polymerase chain reaction (RT-PCR) method. These TILs showed preferential expression of V alpha 10, V alpha 8 and V alpha 1, detected in 13 (87%), 11 (73%), and 9 cases (60%), respectively. The TCRV beta gene revealed diversity without preferential usage. The head and neck region is exposed to bacteria and viruses, so it is possible that the tumor site can become infected and accumulate T cells involved in infection and inflammation. Therefore, we also investigated TCR gene usage in T cells infiltrating in chronic sinusitis mucosa to address the question of whether the V alpha 1, V alpha 8, and V alpha 10 subfamilies are characteristic in TIL from squamous cell carcinoma of head and neck. TCR V alpha 10 gene usage was also the most common in V alpha segment in T cells infiltrating the sinus mucosa, but V alpha 1 and V alpha 8 were not detected in the T cells in sinusitis. These results indicate that the V alpha 10 subfamily, the preferred T cell population in both TIL and T cells in inflammatory disease, might be involved mainly in inflammation or infection. On the other hand, V alpha 1 and V alpha 8 appear to be relatively specific populations for antitumor immunity in head and neck cancer.

Transformation of mucosal secretory elements in chronic maxillary sinusitis after endoscopic sinus surgery

To evaluate the secretory element transformation of maxillary sinus mucosa after endoscopic sinus surgery (ESS), I enrolled 20 patients. Five normal antral mucosae were used as controls, and 15 antral mucosae were investigated according to pathologic and secretory patterns. The post-ESS mucosa was evaluated at the 16th week, when gross recovery appeared. Specimens from the rear wall of the antrum were observed under a scanning electron microscope (x2,000). A significant decrease of goblet cells and increase of glands was illustrated in the sinusitis cases, especially the polypoid and purulent groups. In post-ESS cases, the number of goblet cells is about the same as in controls, but the number of gland openings is higher. My conclusions were that 1) the repair of the antral mucosa requires more time than gross recovery and 2) post-ESS follow-up should be longer than 16 weeks to prevent recurrence.

Invasive maxillary aspergillosis in an otherwise healthy individual

Invasive aspergillosis is usually seen in immunocompromised individuals. We report the case of a 56-year-old immunocompetent housewife with Aspergillus niger invading the ethmoid and sphenoid sinuses and extending to the anterior cranial fossa. A. niger grew on three occasions (from the biopsy, mass and dura mater). In spite of medial maxillectomy and ethmoidectomy followed by craniofacial resection and antifungal drugs (amphotericin B) the patient died on tenth post-operative day.

An endoscopic and tomographic evaluation of patients with sinusitis after endoscopic sinus surgery and Caldwell-Luc operation: a comparative study

To evaluate the outcome of surgery using objective methods in patients with sinusitis after endoscopic sinus surgery (ESS) and Caldwell-Luc operation, we randomly selected 37 Caldwell-Luc-operated and 40 ESS-applied cases. Selected patient groups were assessed and compared by endoscopic examination and computed tomography (CT). CT was found to be normal in 12% of Caldwell-Luc-operated sides in comparison to 75% of ESS-applied sides. Endoscopy revealed a patency rate of the windows as 48% in Caldwell-Luc-operated and 86.7% in ESS-applied sides. Fibrosis and abnormal bony changes of the maxillary sinus were encountered in more than half of Caldwell-Luc-operated cases. In conclusion, ESS has a much higher rate of cure compared to the Caldwell-Luc operation if subjective and objective evaluation methods (CT and endoscopy) are applied.

Scanning and transmission electron microscopic findings in cilia from human nasal turbinate and sinus mucosa following respiratory infection

Scanning electron microscopy (SEM) and transmission electron microscopy (TEM) were used to study the ultrastructure of human respiratory cilia in 34 patients with chronic or recurrent respiratory infections and 11 control patients. Specimens of pathological mucosa were taken from 12 maxillary sinuses and 22 middle turbinates. Control tissues were taken from middle turbinates or from sphenoid sinuses during transsphenoidal pituitary surgery. Findings in control tissues or specimens with minimal amounts of pathological findings showed that TEM and SEM findings correlated well. TEM revealed axoneme structure better, while much larger populations of cilia could be studied three-dimensionally with SEM. SEM also was the better study when cilia orientations or lengths were evaluated. Optimal examination of ciliary ultrastructure required both TEM and SEM studies.

[Clinical and biochemical aspects in the treatment of acute maxillary sinusitis with antioxidants]

A trial has been made of traditional versus antioxidant treatment of acute maxillary sinusitides. The patients were injected a mixture consisting of 4 ml emulsion of 10% dibunol liniment and 2 ml of 5% ascorbic acid made by dilution of 10 g dibunol in 30 ml sterile 0.5% novocaine solution. The mixture was introduced into the sinuses 2 times a day, in one of the study groups it was combined with 500,000 U of ampicillin in cases of purulent sinusitis. In catarrhal form the mixture was injected once a day without the antibiotic. Control groups received 4 ml dioxidine in a single dose after the sinus lavage in catarrhal sinusitis and 500,000 U ampicillin plus hydrocortisone emulsion (1 ml in 4 ml solution) 2 times a day in case of purulent sinusitis. All the patients received aevit (one capsule daily). The mean number of manipulations for the study groups were 4.4 +/- 0.4 in catarrhal sinuses and 6.3 +/- 0.5 in purulent sinusitis; in control groups, respectively, 5.9 +/- 0.5 and 10.7 +/- 0.7. Mean duration of treatment reached 5.3 +/- 0.4, 6.2 +/- 0.3 and 7.1 +/- 0.1 in the study groups and 8.5 +/- 0.2, 10.2 +/- 0.4 days in the control groups. Positive response to the treatment with antioxidants was confirmed by positive changes in blood levels of LPO products, activity of lysosomal hydrolases and antioxidant defense enzymes. The results obtained justify the inclusion of antioxidants in the schemes of acute sinusitis treatment.

Cholesterol granuloma in the maxillary sinus

A 35-year-old male complained of recurring headache and nasal obstruction over a 4-year period. A Caldwell-Luc operation was subsequently performed on the left maxillary sinus and a greenish appearing material was removed. Microscopic examination of the tissue specimen showed a granulomatous tissue with typical cholesterol clefts and inflammatory changes consistent with chronic sinusitis. This entity is presented and reviewed.

[Haller's cells: morphologic evaluation and clinico-surgical relevance]

Ethmoidal cells that have developed into the floor of the orbit or into the roof of the maxillary sinus, respectively, are known as Haller's cells. 528 patients, in whom functional endoscopic sinus surgery was performed, were explored regarding the presence of Haller's cells. 43 patients presented with Haller's cells at least on one side (8.14%). CT scans of these patients were evaluated morphometrically measuring the dimensions of the Haller's cells as well as of the maxillary sinus. Further anatomical variations of the paranasal sinuses (concha bullosa, supraorbital cell, agger nasi cell) and the keros type of the ethmoid sinus roof were seen. A highly significant difference could be demonstrated between the incidence of Haller's cells in men (4.9%) and women (11.9%). For the first time it was possible to demonstrate a frequency distribution between Haller's cells deriving from the anterior ethmoidal cells (88%) and those originating from the posterior ethmoidal cells (12%). In 56% Haller's cells were opacified on CT-scan showing a mucosal swelling respectively a retention of secretion during endoscopic surgery.

Natural ostiotomy vs. inferior antrostomy in the management of sinusitis: an animal model

An animal model was used to compare the surgical treatment of chronic sinusitis by opening the natural ostium vs. inferior antrostomy. Fifteen rabbits had surgical occlusion of the natural maxillary sinus ostia to induce sinusitis. At a second operation, the sinuses were entered and in each animal the natural ostia was reopened on one side and an inferior antrostomy was performed on the opposite sinus. Eight weeks after these operations the sinuses were evaluated. No differences were found in antrostomy patency rates, gross evidence of acute or chronic inflammation, or light or electron microscopic findings between sinuses with natural ostiotomy and those with lower antrostomy. The gross appearances and light and electron microscopic findings are discussed.

The effect of ostial opening on experimental maxillary sinusitis in rabbits

Obstruction of the natural ostium is known to be one of the major factors in the pathogenesis of maxillary sinusitis. To explore the therapeutic effect of ostial patency, sinusitis was induced in 32 rabbits by obstruction of the natural ostium and inocculation of Streptococcus pneumoniae. They were divided into two groups: the first ("open") group included 16 rabbits with experimentally induced sinusitis, from which bone chips for obstruction of the natural ostium were removed after a period of 5 days, and the second ("closed") group included 16 rabbits with continuous obstruction of the natural ostium. The induction of sinusitis was found to be successful in all cases, when examined after five days. The amount of nasal and sinus secretion as well as histopathological findings of the sinus mucosa were investigated with light microscopy, scanning and transmission electron microscopy, two and four weeks after induction of sinusitis. The findings were significantly improved in the "open" group.