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Robert C Kern - One of the best experts on this subject based on the ideXlab platform.

  • Chronic Sinusitis with nasal polyps staphylococcal exotoxin immunoglobulin e and cellular inflammation
    American Journal of Rhinology, 2004
    Co-Authors: David B Conley, Anju Tripathi, Anne Marie Ditto, Kathryn J Reid, Leslie C Grammer, Robert C Kern
    Abstract:

    BACKGROUND The etiology of Chronic Sinusitis with nasal polyposis (CS/NP) remains enigmatic. Frequently, Staphylococcus aureus is present in the nose of CS/NP patients, although the significance is unclear. Recent reports have suggested the hypothesis that these bacteria may secrete exotoxins triggering the inflammatory mucosal changes seen in CS/NP. This mechanism of immunopathology has been established in other diseases associated with Staphylococcus colonization and exotoxin secretion such as atopic dermatitis. In atopic dermatitis, the exotoxins incite a local superantigen response in which clonal T-cell activation and massive cytokine release occur in the affected skin. Second, these exotoxins can act as traditional allergens, stimulating a typical immunoglobulin E (IgE) response in the serum, which has been correlated with disease severity. This study is designed to begin the assessment of the hypothesis that a similar mechanism takes place in CS/NP. METHODS Serum was drawn from patients with CS/NP undergoing endoscopic sinus surgery as well as 13 atopic and nonatopic control subjects without Sinusitis. IgE levels to S. aureus exotoxins A (SEA), SE exotoxins B (SEB), and toxic shock syndrome toxin 1 were measured using enzyme-linked immunosorbent assay. Tissue eosinophilia and the presence of lymphocytes on hemotoxylin and eosin-stained sections of polyps were scored by a blinded pathologist and correlated to presence of toxin IgE in the serum. RESULTS Staphylococcal exotoxin (SE)-specific IgE was found in the serum of 5/10 (50%) of the patients with CS/NP. In contrast, 0/13 control patients had IgE to the exotoxins (p = 0.031). Polyp eosinophil, lymphocyte, and mononuclear cell counts were compared in IgE exotoxin-positive and -negative subjects. A trend toward increased eosinophil counts in patients with SE IgE (SE IgE+) was present, but not statistically significant. CONCLUSION These results indicate that a high percentage of CS/NP patients show a systemic IgE response to S. aureus exotoxins in comparison with controls without CS/NP. Although these results are consistent with the actions of Staphylococcus toxins in other diseases, additional work is necessary to establish a local superantigen response in the nasal mucosa of CS/NP patients.

  • Chronic Sinusitis and anosmia pathologic changes in the olfactory mucosa
    Laryngoscope, 2000
    Co-Authors: Robert C Kern
    Abstract:

    Objectives: To evaluate histological changes in the olfactory mucosa of patients with Chronic rhinoSinusitis. These results are analyzed in light of current understanding of the pathophysiology of anosmia secondary to nasal and sinus disease. Study Design: Prospective study of olfaction on patients undergoing sinus surgery for the management of Chronic rhinoSinusitis. Methods: Thirty patients, aged 22 to 39 years, underwent olfactory biopsy at the time of surgery with evaluation by a pathologist. Inflammatory changes were graded as mild (normal), moderate, or severe. Clinical olfactory function was evaluated using the University of Pennsylvania Smell Identification Test (UPSIT). The results correlated with the degree of olfactory dysfunction. Results: Of the 30 patients 19 had unequivocal olfactory mucosa in the biopsy specimen. Eleven had only respiratory or indeterminate mucosa. Nine patients demonstrated normal olfactory mucosa and normal olfactory function (UPSIT >35). Ten patients demonstrated pathological changes in the olfactory mucosa with an influx of lymphocytes, macrophages, and eosinophil% Of these 10 patients, 7 had olfactory deficits as determined by UPSIT. The remaining three patients had normal olfactory function despite moderate Chronic inflammation. These studies indicate that the olfactory mucosa is capable of mounting an inflammatory response similar to that seen in the respiratory mucosa of patients with Chronic Sinusitis. These data suggest that the olfactory deficits in these patients may be the result of inflammatory changes within the olfactory mucosa in addition to any alteration in airflow to the olfactory cleft.

  • candidate s thesis Chronic Sinusitis and anosmia pathologic changes in the olfactory mucosa
    Laryngoscope, 2000
    Co-Authors: Robert C Kern
    Abstract:

    Objectives To evaluate histological changes in the olfactory mucosa of patients with Chronic rhinoSinusitis. These results are analyzed in light of current understanding of the pathophysiology of anosmia secondary to nasal and sinus disease. Study Design Prospective study of olfaction on patients undergoing sinus surgery for the management of Chronic rhinoSinusitis. Methods Thirty patients, aged 22 to 39 years, underwent olfactory biopsy at the time of surgery with evaluation by a pathologist. Inflammatory changes were graded as mild (normal), moderate, or severe. Clinical olfactory function was evaluated using the University of Pennsylvania Smell Identification Test (UPSIT). The results correlated with the degree of olfactory dysfunction. Results Of the 30 patients 19 had unequivocal olfactory mucosa in the biopsy specimen. Eleven had only respiratory or indeterminate mucosa. Nine patients demonstrated normal olfactory mucosa and normal olfactory function (UPSIT >35). Ten patients demonstrated pathological changes in the olfactory mucosa with an influx of lymphocytes, macrophages, and eosinophils. Of these 10 patients, 7 had olfactory deficits as determined by UPSIT. The remaining three patients had normal olfactory function despite moderate Chronic inflammation. These studies indicate that the olfactory mucosa is capable of mounting an inflammatory response similar to that seen in the respiratory mucosa of patients with Chronic Sinusitis. These data suggest that the olfactory deficits in these patients may be the result of inflammatory changes within the olfactory mucosa in addition to any alteration in airflow to the olfactory cleft.

Yasuo Sakakura - One of the best experts on this subject based on the ideXlab platform.

  • immunohistochemical localization of cytokines and cell adhesion molecules in maxillary sinus mucosa in Chronic Sinusitis
    Auris Nasus Larynx, 2000
    Co-Authors: Tsutomu Nonoyama, Eiji Yoshimura, Teruhiko Harada, Jun Shinogi, Yasuo Sakakura
    Abstract:

    Objective: Chronic Sinusitis is a common disease characterized by persistent inflammation of the nasal and paranasal sinus mucosa. Accumulating evidence supports the importance of proinflammatoty cytokines and endothelial cell adhesion molecule (CAM) expression as an initiating process in tissue inflammation. This study was conducted to investigate the localization of major cytokines and CAMs in the maxillary sinus mucosa from patients with Chronic Sinusitis and from normal subjects. Methods: Maxillary sinus mucosal specimens from patients with Chronic Sinusitis (n=10) and from normal subjects (n=6) were immunostained with specific antibodies directed against the cytokines (IL-1α, IL-1β, IL-6, IL-8 and TNF-α) and the CAMs (intercellular adhesion molecule-1, ICAM-1 and vascular CAM-1, VCAM-1). Results: The number of immunoreactive cells for IL-1α, IL-1β, IL-6, IL-8, and TNF-α was increased significantly in patients with Chronic Sinusitis compared with normal controls. Immunoreactivity for ICAM-1 was also increased significantly in patients with Chronic Sinusitis compared with normal controls, whereas VCAM-1 is only minimally expressed or is absent in both groups. Conclusion: These findings indicate that bacterial and/or viral infection may induce functional and morphologic changes in the maxillary sinus mucosa in Chronic Sinusitis through enhanced generation of specific cytokines in conjunction with CAMs.

  • nasal mucociliary transport of Chronic Sinusitis in children
    Archives of Otolaryngology-head & Neck Surgery, 1992
    Co-Authors: Yasuo Sakakura, Teruhiko Harada, Yuichi Majima, Masahiko Hattori, Kotaro Ukai
    Abstract:

    • Nasal mucociliary function is one of the most important and indispensable mechanisms of the respiratory tract, providing protection against the atmospheric environment. We previously found mucociliary dysfunction in the noses of adult patients suffering from Chronic Sinusitis. In this study, using the saccharin method, we determined nasal mucociliary function in normal children and in children with Chronic Sinusitis. The mean (±SD) value of saccharin transit time in the nose was 28.2±19.9 minutes in patients with Chronic Sinusitis, this being significantly slower than that in the control group of children. The incidence of abnormally slow nasal mucociliary transport time (>30 minutes) in patients was significantly higher than in controls of the same age. Mucociliary dysfunction may initiate a vicious cycle of self-mediated inflammation and may be important in recovery from Chronic respiratory inflammation. ( Arch Otolaryngol Head Neck Surg. 1992;118:1234-1237)

Katsunori Fukuda - One of the best experts on this subject based on the ideXlab platform.

  • reduced sialylation of glycoproteins in nasal glands of patients with Chronic Sinusitis
    Acta Oto-laryngologica, 1997
    Co-Authors: Kazuyoshi Ueno, Katsunori Fukuda, Zhen Hai Wang, Yutaka Hanamure, Masahiko Yoshitsugu, Shigeru Furuta, Fumiyuki Uehara, Masaru Ohyama
    Abstract:

    Ueno K, Wang ZH, Hanamure Y, Yoshitsugu M, Fukuda K, Furuta S, Uehara F, Ohyama M. Reduced sialylation of glycoproteins in nasal glands of patients with Chronic Sinusitis. Acta Otolaryngol (Stockh) 1997; 117: 420-423.This study was conducted to investigate the sialylations of glycoproteins in the nasal glands of patients with Chronic Sinusitis. Sialic acids were detected using lectin histochemistry, and the mRNA of sialyltransferase was evaluated by in situ hybridization histochemistry. Sambucus nigra agglutinin (SNA), which recognizes terminal sialic acids, strongly stained the glandular mucous cells of normal subjects, but not those of patients with Chronic Sinusitis. In situ hybridization histochemistry showed that the expression of α2,6 sialyltransferase mRNA was decreased in the secretory cells of patients with Chronic Sinusitis. Our present results suggest that a reduction in sialyltransferase activity at the mRNA level in the nasal glands may lead to the persistence of Chronic Sinusitis.

  • localization of il 1β mrna and cell adhesion molecules in the maxillary sinus mucosa of patients with Chronic Sinusitis
    Laryngoscope, 1994
    Co-Authors: Eiichiro Tokushige, Shoko Katahira, Miharu Ushikai, Kazunori Itoh, Katsunori Fukuda
    Abstract:

    Interleukin-1β (IL-1β) is a predominant cytokine in retained paranasal sinus fluid of Chronic Sinusitis where infiltration by polymorphonuclear neutrophils (PMNs) of nasal and paranasal mucosa is characteristic. The authors investigated the localization of IL-1β messenger RNA (mRNA) in the maxillary sinus mucosa of patients with Chronic Sinusitis, using digoxigenin-labeled oligonucleotide probes. IL-1β mRNA was detected in some extravascular PMNs and small numbers of mononuclear leukocytes but was not detected in other tissue cells or intravascular leukocytes. The expression and distribution of the cell adhesion molecules, intercellular adhesion molecule-1 (ICAM-1) and endothelial-leukocyte adhesion molecule-1 (ELAM-1), were also studied in cultured human mucosal microvascular endothelial cells and in the maxillary sinus mucosa in Chronic Sinusitis by immunohistochemistry using monoclonal antibodies against these cell adhesion molecules. Only ICAM-1 was expressed on cultured human mucosal microvascular endothelial cells without IL-1β stimulation. With IL-1β activation of these cells, ELAM-1 was expressed strongly and the expression of ICAM-1 was enhanced. In the maxillary sinus mucosa, ICAM-1 was strongly and universally expressed on endothelial cells of all small vessels, whereas ELAM-1 was expressed only in the subepithelial region. These findings suggest that IL-1β, one of mediators in Chronic Sinusitis, is produced by PMNs, induces the expression of ICAM-1 and ELAM-1 on endothelial cells, and, thereby, stimulates PMN infiltration in Chronic Sinusitis.

Chenyi Hsu - One of the best experts on this subject based on the ideXlab platform.

  • correlation between bacteriology of the middle meatus and ethmoid sinus in Chronic Sinusitis
    Journal of Laryngology and Otology, 2002
    Co-Authors: Rongsan Jiang, Jenfu Lin, Chenyi Hsu
    Abstract:

    In this study we report on the correlation between the bacteriology of the middle meatusand ethmoid sinus in Chronic Sinusitis. When patients with Chronic Sinusitis underwent functional endoscopicsinus surgery (FESS), swab specimens were taken from the middle meati before surgery. After removing the ethmoid bullae, swab specimens were taken from the ethmoid sinuses. Between November 1998 and February 2001, 186 pairs of middle meatal and ethmoid sinus specimens were collected from 186 patients. No bacteria were cultured from either specimen in 32 patients. The same bacteria were cultured from both specimens in another 60 patients. The culture results differed between the middle meatal and ethmoid sinus specimens in the remaining 94 patients. There was a significant difference between culture rates of 63.4 per cent for middle meatal specimens and 76.3 per cent for the ethmoid sinus specimens. In analysing bacterial species, significantly more aerobic Gram negative bacteria were cultured from the ethmoid sinus specimens than from the middle meatalspecimens. This study shows that the bacteriology of the middle meatus was different from that of the ethmoid sinus. Therefore, the bacteriological findings in the middle meati may not reflect the real bacteriology in Chronic Sinusitis.

  • bacteriology of Chronic Sinusitis after amoxicillin clavulanate potassium therapy
    Otolaryngology-Head and Neck Surgery, 2001
    Co-Authors: Rongsan Jiang, Jinqwen Jang, Chenyi Hsu
    Abstract:

    The bacteriology of Chronic Sinusitis was studied after amoxicillin-clavulanate potassium therapy. Patients with Chronic Sinusitis were randomly divided into 2 groups. In the study group, 90 patients were given a 2-week course of amoxicillin-clavulanate potassium before functional endoscopic sinus surgery. In the control group, 113 patients did not take any antibiotics within 2 weeks before the surgery. Swab specimens were taken from the maxillary and ethmoid sinuses during surgery and sent for aerobic and anaerobic culture. In the study group, the culture rates of maxillary and ethmoid sinuses were 45.6% and 28.9%, respectively. In the control group, the culture rates of maxillary and ethmoid sinuses were 53.1% and 34.5%, respectively. The culture rates between the control group and the study group were not significantly different, either for the maxillary sinus or the ethmoid sinus. This showed that treatment with amoxicillin-clavulanate potassium did not change the bacteriology of Chronic Sinusitis.

  • bacteriology of ethmoid sinus in Chronic Sinusitis
    American Journal of Rhinology, 1997
    Co-Authors: Rongsan Jiang, Chenyi Hsu, Jennfuh Leu
    Abstract:

    This study was designed to study the bacteriology of the ethmoid sinus in Chronic Sinusitis with a new sampling method to decrease nasal contamination. The anterior nose was disinfected with povido...

Kotaro Ukai - One of the best experts on this subject based on the ideXlab platform.

  • nasal mucociliary transport of Chronic Sinusitis in children
    Archives of Otolaryngology-head & Neck Surgery, 1992
    Co-Authors: Yasuo Sakakura, Teruhiko Harada, Yuichi Majima, Masahiko Hattori, Kotaro Ukai
    Abstract:

    • Nasal mucociliary function is one of the most important and indispensable mechanisms of the respiratory tract, providing protection against the atmospheric environment. We previously found mucociliary dysfunction in the noses of adult patients suffering from Chronic Sinusitis. In this study, using the saccharin method, we determined nasal mucociliary function in normal children and in children with Chronic Sinusitis. The mean (±SD) value of saccharin transit time in the nose was 28.2±19.9 minutes in patients with Chronic Sinusitis, this being significantly slower than that in the control group of children. The incidence of abnormally slow nasal mucociliary transport time (>30 minutes) in patients was significantly higher than in controls of the same age. Mucociliary dysfunction may initiate a vicious cycle of self-mediated inflammation and may be important in recovery from Chronic respiratory inflammation. ( Arch Otolaryngol Head Neck Surg. 1992;118:1234-1237)