Endothelial L-selectin ligands in sinus mucosa during chronic maxillary rhinosinusitis

RATIONALE

Chronic rhinosinusitis is characterized by persistent inflammation of the nasal and paranasal mucosa with numerous emigrated leukocytes. L-selectin on leukocytes and its endothelial glycosylated ligands initiate organ-specific leukocyte infiltration into inflamed tissues.

OBJECTIVES

The purpose of this study was to evaluate the endothelial expression of functionally active endothelial L-selectin ligands, sulfated sialyl Lewis x, in maxillary sinus mucosa from patients with chronic rhinosinusitis and from normal control subjects.

METHODS

Maxillary sinus mucosa specimens (116) were obtained surgically and immunohistochemically stained with monoclonal antibodies detecting sialyl Lewis x or sulfated extended core 1 lactosamines. The severity of the inflammation was determined by intraoperative endoscopic findings, computed tomography scans, and histopathologic assessment of the specimens.

MEASUREMENTS AND MAIN RESULTS

The percentage of vessels expressing endothelial sulfated sialyl Lewis x epitopes increased during chronic rhinosinusitis compared with uninflamed control tissue, especially in patients with additional allergic rhinitis, and decreased in specimens from aspirin-intolerant patients with preoperative oral corticosteroid treatment. In addition, the expression level of endothelial sulfated sialyl Lewis x epitopes and the number of mucosal eosinophils correlated with the severity of the inflammation, and decreased in specimens taken 9 months postoperatively compared with intraoperative samples, especially in patients with intranasal corticosteroid treatment.

CONCLUSIONS

Our results suggest that functionally active L-selectin ligands might guide leukocyte traffic into maxillary sinus mucosa preferentially in patients with severe findings of chronic maxillary rhinosinusitis, thus leading to aggravation of the inflammation.

Endoscopic versus Caldwell-Luc approach in chronic maxillary sinusitis: comparison of symptoms at one-year follow-up

The aim of this prospective randomized study was to compare functional endoscopic sinus surgery (FESS) with the standard Caldwell-Luc (C-L) procedure in relieving the symptoms of chronic maxillary sinusitis. One hundred and fifty consecutive adult patients were operated after the failure of treatment with antimicrobials and repeated antral irrigations: 143 patients were available for the follow-up examination, at a median of 12 months after the operation. The patients' global evaluation showed marked improvement in 50.7% of the C-L group and in 76.7% of the FESS group. Overall subjective symptoms deteriorated in 5.5% of C-L operated patients, but not at all in the FESS group. Patients' compliance, asked post-operatively, was 80.2% in C-L patients and 93.0% in FESS patients.

Orientation of human respiratory cilia

Ciliary orientation was studied on the respiratory epithelium of the nasal cavity or the sphenoidal sinus of ten adult nonsmokers without respiratory disease. The ciliary orientation was evaluated from micrographs by measuring the angle between the plane defined by the central tubules and reference line (with a semiautomatic image analyser (IBAS I]. The standard deviation of the angles of cilia population was counted in every field. The standard deviation of the measurements described the ciliary alignment. It varied from 12.1-41.2 degrees. The mean standard deviation was 27.3 +/- 7.4 degrees. 58% of all measured cilia were within +/- 0-20 degrees of the mean and 85% of cilia were within +/- degrees. However, a few cilia or small groups of cilia were found in most fields which differed dramatically from the main orientation. The size of these groups was always less than ten cilia. On the normal respiratory epithelium the standard deviation of ciliary orientation varies between +/- 10-40 degrees (at about 97% probability). For diagnostic conclusions more than 60 cilia should be measured.

Orientation of human respiratory cilia

Ciliary orientation was studied on the respiratory epithelium of the nasal cavity or the sphenoidal sinus of ten adult nonsmokers without respiratory disease. The ciliary orientation was evaluated from micrographs by measuring the angle between the plane defined by the central tubules and reference line (with a semiautomatic image analyser (IBAS I]. The standard deviation of the angles of cilia population was counted in every field. The standard deviation of the measurements described the ciliary alignment. It varied from 12.1-41.2 degrees. The mean standard deviation was 27.3 +/- 7.4 degrees. 58% of all measured cilia were within +/- 0-20 degrees of the mean and 85% of cilia were within +/- degrees. However, a few cilia or small groups of cilia were found in most fields which differed dramatically from the main orientation. The size of these groups was always less than ten cilia. On the normal respiratory epithelium the standard deviation of ciliary orientation varies between +/- 10-40 degrees (at about 97% probability). For diagnostic conclusions more than 60 cilia should be measured.