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Biomedical subjects

C Bachert

Publications and source records attributed to C Bachert.

At least 37 records · Page 2Linked to original sources
PubMed2005

Management of nasal polyposis.

These guidelines are modified from the recent EAACI Position Paper. Nasal polyposis is characterized by an inflammatory process, the factors of which are summarized. Recently, Staphylococcus aureus enterotoxins have been identified to modify the disease. A classification system for polyps, grading systems and epidemiologic data are given, frequent comorbidities are discussed. The diagnostic management is based on endoscopy and CT scanning. A score of severity is proposed. The therapeutic management consists of the medical treatment options, which are given with evidence-based recommendations. Surgical treatment is indicated after failure of medical treatment and commonly performed by endoscopy. Nevertheless medical therapy must be continued after surgery to prevent recurrences. Algorithms of decision are finally proposed [corrected]

Algorithms↗
PubMed2004

Matrix metalloproteinases MMP-7, MMP-9 and their tissue inhibitor TIMP-1: expression in chronic sinusitis vs nasal polyposis.

BACKGROUND: Nasal polyps (NP) are characterized by pseudocyst formation, whereas the mucosa in chronic sinusitis (CS) only shows a limited oedema. Matrix metalloproteinases (MMPs) are a family of endopeptidases able to degrade the extracellular matrix. Differences in histological features between CS and NP might be related to the respective expression of MMPs and their tissue inhibitors (TIMPs). OBJECTIVE: The aim of this study was to investigate MMP-7, MMP-9 and TIMP-1 proteins in NP and CS in comparison with normal mucosa. METHODS: Nasal samples, obtained from controls (n = 10), from NP (n = 8) and from CS (n = 10), were analysed by immunohistochemistry and enzyme-linked immunosorbent assay (ELISA). RESULTS: In NP, compared with controls, staining for MMP-9 and MMP-7 appeared in blood vessels. Matrix metalloproteinase-9-positive inflammatory cells could be detected in increased numbers in pseudocyst formations. Concentrations of MMP-9 protein was found significantly increased in both CS and NP compared with controls, while MMP-7 was significantly increased in NP compared with controls and CS. Tissue inhibitors of metalloproteinase-1 protein was significantly increased in CS and NP when compared with controls. CONCLUSIONS: Chronic sinusitis and NP show different pattern of MMP-7/-9 and TIMP-1 expression. We suggest that this difference in regulation of enzymes is related to the respective tissue remodelling observed in both diseases.

Biomarkers↗
PubMed2004

Objective outcome after functional endoscopic sinus surgery: prediction factors.

OBJECTIVES/HYPOTHESIS: After failure of medical treatment, chronic rhinosinusitis and nasal polyposis require surgical management. However, little is known about the predictive factors for objective outcome after sinus surgery. The aims of the study were to correlate preoperative, intraoperative, and postoperative clinical factors to healing outcome and to establish their respective predictive values. STUDY DESIGN: Prospective study. METHODS: Eighteen patients who had surgery for chronic rhinosinusitis and 18 who had surgery for nasal polyposis at the Ghent University Hospital (Ghent, Belgium) were followed for a 6-month period. In all, 76 operated sides were independently considered. The healing quality was evaluated by endoscopy weekly and then monthly for a period of 6 months. A logistic regression analysis with healing quality at month 6 as outcome was performed on preoperative, intraoperative, and postoperative factors. RESULTS: Previous sinus surgery (P =.0006) and initial disease (P =.0430) were found to be highly predictive for the healing outcome at month 6, patients with nasal polyposis or previous surgery showing significantly worse objective outcome (P =.0034 and P <.0001, respectively). The preoperative computed tomography scan had no predictive value with respect to the extent of surgery (P =.0281). Postoperative parameters had less predictive value. CONCLUSION: Initial disease and its severity as reflected by the extent of surgery and surgical antecedents were the best predictors for the objective outcome at 6 months after sinus surgery. Whereas the first postoperative phase showed similar characteristics for all patients, the healing course differed between patients from month 1 to the end point.

Adult↗
PubMed2004

Persistent rhinitis - allergic or nonallergic?

Although rhinitis has been classified as being either allergic, noninfectious, or "other forms" (nonallergic noninfectious), these categories lack strict classification criteria and often overlap. The term "nonallergic noninfectious rhinitis" is commonly applied to a diagnosis of any nasal condition, in which the symptoms are similar to those seen in allergic rhinitis but an allergic aetiology has been excluded. This group comprises several subgroups with ill-defined pathomechanisms, and includes idiopathic rhinitis, irritative-toxic (occupational) rhinitis, hormonal rhinitis, drug-induced rhinitis, and other forms (non-allergic rhinitis with eosinophilia syndrome [NARES], rhinitis due to physical and chemical factors, food-induced rhinitis, emotion-induced rhinitis, atrophic rhinitis). Unlike allergic rhinitis, there are no specific diagnostic tests and diagnosis is primarily based on a history of reaction to specific irritant-toxic triggering agents (either general or occupational), drugs, infections, and hormonal status, coupled with exclusion of allergic rhinitis and other forms of non-allergic rhinitis by skin prick testing. Accordingly, from a clinical standpoint NARES, irritative-toxic, hormonal, drug-induced and idiopathic rhinitis are possibly the least difficult forms of nonallergic rhinitis to diagnose.

Diagnosis, Differential↗
PubMed2004

Effect of intranasal fluticasone propionate and triamcinolone acetonide on basal and dynamic measures of hypothalamic-pituitary-adrenal-axis activity in healthy volunteers.

BACKGROUND: Most published studies show that intranasal corticosteroids have no effect on the hypothalamic-pituitary-adrenal (HPA) axis, but there have been isolated reports to the contrary, contradicting accumulated knowledge on pharmacokinetics. OBJECTIVE: To re-evaluate the effect of fluticasone propionate aqueous nasal spray (FPANS) and triamcinolone acetonide (TAA) aqueous nasal spray on the HPA axis using an improved study design. METHODS: Twenty-three healthy volunteers were randomized in a double-blind, three-way crossover study. The study comprised a 4-day placebo run-in phase followed by three 4-day treatment periods (placebo, FPANS (200 microg once daily) or TAA aqueous nasal spray (220 microg once daily)), separated by 7-14 days washout intervals. Before the first, and on the last day of each treatment period, 12-h overnight urine was collected to assess cortisol excretion and cortisol creatinine ratio. Approximately 26 h after the last administration of study medication, volunteers underwent stimulation with 0.5 microg adrenocorticotropic hormone (ACTH). Serum cortisol concentrations were measured before and 20 and 30 min after injection. Blood and urine samples were analysed for cortisol by liquid chromatography tandem mass spectrometry. RESULTS: Compared with placebo, EP or TAA had no significant effect on mean overnight (12 h) urinary cortisol excretion, and did not significantly suppress the overnight geometric mean urinary cortisol/creatinine excretion ratio. Values for serum cortisol before and after ACTH simulation showed no significant suppression, although there was a slight blunting of the HPA-axis response following TAA treatment. CONCLUSION: This study confirms that there are no detectable effects on the HPA axis following short-term intranasal FP or TAA at their recommended dosages.

Administration, Intranasal↗
PubMed2004

Interleukin-5 receptors on human lung eosinophils after segmental allergen challenge.

BACKGROUND: IL-5 is a specific cytokine for eosinophil accumulation, activation and prolongation of survival and can be recovered in elevated concentrations from the bronchoalveolar compartment in atopic asthma following allergen challenge. OBJECTIVE: The action of IL-5 is mediated via the specific IL-5 receptor-alpha (IL-5Ralpha). Although in vitro data suggest that IL-5R expression is regulated by cytokines such as IL-3, IL-5 and GM-CSF, IL-5R regulation in vivo and its kinetics following allergen provocation are incompletely understood. METHODS: We investigated IL-5R regulation in vivo following segmental allergen provocation (SAP) with an individually standardized dose of allergen in 12 patients with atopic asthma. Lavage was performed 10 min and 18 h (eight patients) and 10 min and 42 h (eight patients) after allergen challenge. In addition to differential cell counts, IL-5Ralpha was measured by flow cytometry and IL-5 concentrations in bronchoalveolar lavage (BAL) fluid were determined by ELISA. RESULTS: IL-5Ralpha expression decreased significantly on peripheral blood and on BAL eosinophils 18 and 42 h after SAP. In contrast, IL-5 concentrations increased significantly in BAL fluid 18 and 42 h after SAP. In four and two patients, respectively, there were detectable IL-5 concentrations in serum 18 or 42 h after allergen exposure. CONCLUSIONS: Although there was no correlation between IL-5 concentrations and IL-5Ralpha expression on eosinophils in BAL, our data support previous in vitro and in vivo findings of a negative feedback mechanism between IL-5 concentrations and IL-5Ralpha expression on eosinophils.

Adult↗
PubMed2004

Macrophage mannose receptor in chronic sinus disease.

BACKGROUND: The role of infectious agents in the onset and maintenance of chronic sinus disease is still not fully understood. Macrophage mannose receptor (MMR), an innate pattern recognizing receptor, capable of phagocytosis of invaders and signal transduction for proinflammatory mechanisms, might be of importance in immune interactions in chronic sinus disease. OBJECTIVE: We examined the MMR in sinonasal airway mucosa to evaluate its possible role in chronic rhinosinusitis (CS) and nasal polyposis (NPs). METHODS: Surgical samples from patients with sinonasal disease were investigated with real-time RT-PCR for quantification of MMR mRNA expression, and the presence and location of MMR-positive cells was analysed by immunohistochemistry. RESULTS: Quantification of MMR mRNA showed a statistically significant higher expression in NPs compared to CS without NP and controls. Immunohistochemistry revealed expression of MMR in all tissue samples; however, in NP we found an enhanced positive cellular staining including cell aggregates. CONCLUSIONS: We could demonstrate for the first time that the expression of MMR is significantly upregulated in NP compared to patients with CS without NP or turbinate tissue of controls. Macrophages expressing MMR, accumulated in cell aggregates in NPs, play a possible key role in pathogen-macrophage interaction in NP disease.

Adult↗
PubMed2003

Enhanced soluble interleukin-5 receptor alpha expression in nasal polyposis.

BACKGROUND: Alternative splicing of the interleukin-5 receptor alpha (IL-5Ralpha)-subunit leads to the generation of a signalling, membrane-anchored (TM) isoform, or a secreted [soluble (SOL)], antagonistic variant. Given the key role of IL-5 in eosinophil function, we investigated SOL IL-5Ralpha expression pattern in an eosinophil-associated disease such as nasal polyposis (NP). METHODS: An SOL IL-5Ralpha enzyme-linked immunosorbent assay and quantitative real-time polymerase chain reaction (PCR) were established and applied in serum, nasal secretion and nasal tissue of controls (n = 12), and NP patients (n = 42) with or without asthma. RESULTS: Analysis of serum, nasal secretion, and nasal tissue samples revealed that SOL IL-5Ralpha protein concentrations were significantly increased in NP vs control tissue. Within the NP group, there was a significant up-regulation of SOL IL-5Ralpha in patients with systemic airway disease. These findings were confirmed at the mRNA level, using an optimized real-time reverse-transcriptase PCR procedure. CONCLUSIONS: This report demonstrates SOL IL-5Ralpha transcript and protein up-regulation in NP. Soluble IL-5Ralpha differentiates nasal polyps with or without concomitant asthma. As SOL IL-5Ralpha is strongly up-regulated for disease and has antagonistic properties in vitro, our studies shed new light on the mechanisms of specific immunomodulatory therapies, such as anti-IL-5.

Adult↗
PubMed2003

Human beta-defensins and toll-like receptors in the upper airway.

BACKGROUND: Measurement of innate markers in nasal mucosa, tonsils and adenoids might lead to new views about the role of innate immunity in the upper airway. In this study, the expression of human beta-defensins (HBD) 2 and 3 and toll-like receptors (TLR) 2 and 4 in various upper airway diseases was investigated. METHODS: Surgical samples from patients with tonsillar disease (n = 18), hypertrophic adenoids (n = 10) and sinonasal disease (n = 30) (chronic sinusitis, nasal polyps, turbinate mucosa as controls) were investigated by immunohistochemistry. Quantification of HBD-2 and 3 mRNA, TLR-2 and 4 mRNA expression was performed by real-time polymerase chain reaction (PCR). RESULTS: Immunohistochemistry revealed a strong expression of HBD-2 in tonsillar tissue. Quantification of HBD-2 and HBD-3 mRNA showed a more than tenfold higher expression in tonsillar tissue than in adenoids, whereas in nasal biopsies, only negligible defensin expression could be measured. No significant differences were found for TLR-4 between the various tissues, whereas TLR-2 expression in adenoids was significantly lower compared with other tissues. CONCLUSION: These results demonstrate a strong defensin expression in tonsillar tissue compared with nasal and paranasal mucosa and adenoids. Toll-like receptor expression in all these tissues illustrates a possibly important immunological sentinel function of upper airway mucosa.

Adenoidectomy↗
PubMed2003

The WHO ARIA (allergic rhinitis and its impact on asthma) initiative.

The ARIA working group, in collaboration with the WHO in Geneva, recently published a state-of-the-art review and recommendations derived from it on the link between rhinitis and asthma. Rhinitis is the most frequent manifestation of allergic disease in humans and is often linked to other atopic diseases such as food allergy, atopic dermatitis or asthma, and may furthermore have an impact on the sinuses. ARIA focuses on one of the most important of the mentioned issues, the link between upper and lower airways in allergic disease. To facilitate understanding between the otorhinolaryngologist and the pulmonologist, the classification of rhinitis has been adapted to that of asthma, and the terms 'intermittent' and 'persistent' allergic rhinitis have been introduced. Elaborate guidelines for the diagnosis and assessment of the severity of disease are provided, and detailed recommendations for the management of rhinitis and asthma are suggested with a special focus on specific immunotherapy.

Asthma↗
PubMed2003

Vision impairment as presenting symptom of a sphenoidal mucocele.

We present a case of a 27-year-old woman with a sphenoid mucocele, presenting with bilateral visual disturbance and pituitary gland dysfunction but without nasal or sinus complaints. We would like to emphasize the importance of early diagnosis and prompt surgical treatment.

Adult↗
PubMed2002

[Steroid sprays in non-infectious rhinitis and sinusitis. Proper and regular spraying does not damage the nasal mucosa].

Glucocorticoids are an effective therapeutic option for most forms of non-infectious rhinitis and sinusitis. In Germany, dexamethasone, beclomethasone diproprionate, flunisolide, fluocortin butyl ester, budesonide, fluticasone proprionate, triamcinolone acetonide and mometasone furoate are available for nasal application. The action of these drugs is mediated by cytoplasmic receptors (glucocorticoid receptors). In addition, receptor-independent immediate effects are also known. To ensure optimal efficacy of corticoid sprays, detailed patient instruction is of importance, with particular emphasis being placed on the correct spraying technique and regular application. Modern preparations are associated with very few side effects. There is no evidence that mucosal atrophy occurs.

Administration, Intranasal↗
PubMed2002

Up-regulation of IL-18 in allergic rhinitis.

BACKGROUND: This paper reports a study on the concentrations of the pro-inflammatory cytokines IL-18 and IL-1beta in nasal secretions of allergic rhinitis patients in relation to ECP and nasal symptoms. METHODS: We measured IL-18 and IL-1beta concentrations using ELISA, and eosinophilic cationic protein (ECP) using the CAP system, in nasal secretions of 15 seasonal allergic rhinitis (SAR) patients at six visits throughout the pollen season. Pollen exposure, nasal and ocular symptoms were monitored daily. Furthermore, we measured IL-18, IL-1beta and ECP concentrations in nasal secretions of 19 controls and 20 symptomatic persistent allergic rhinitis (PAR) patients with house dust mite allergy. RESULTS: In SAR, the increase of IL-18, IL-1beta and ECP paralleled the pollen flight with a time delay. IL-18 and IL-1beta significantly increased during the pollen season compared to baseline, and differently from ECP, remained elevated until 4 weeks after the season. In PAR, the concentrations of IL-18 and ECP, but not IL-1beta, were significantly higher compared to controls, with IL-18 concentrations also being significantly higher than in SAR. CONCLUSION: This is the first study to demonstrate the up-regulation of IL-18 in nasal secretions in allergic rhinitis. The persistence of elevated IL-18 concentrations until after the season and the high concentrations in PAR compared to SAR suggests its role in persistent allergic inflammation.

Adult↗