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Biomedical subjects

J M Bernstein

Publications and source records attributed to J M Bernstein.

At least 145 records · Page 8Linked to original sources
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The middle ear mucosal immune system in otitis media with effusion.

The mucous membrane of the middle ear cavity in otitis media with effusion has a number of immunobiological mechanisms capable of defending the organ. A humoral immune mechanism, with all the attributes of a local mucosal immune system, appears to be present and capable of preventing viral and bacterial access to middle ear tissue. Putative cells of a cell-mediated immune response also appear to be present, and the distribution of T cells and B cells and T-helper and T-suppressor cells is described. The exact role of these cells in either cell-mediated immunity or delayed hypersensitivity remains to be defined in otitis media. Lymphocyte--macrophage interaction is briefly described and may represent an important aspect of immune modulation in the middle ear in otitis media with effusion. Finally, the effect of middle ear supernatants on natural killer cell activity is discussed. Serous effusions appear to augment natural killer cell activity of peripheral blood lymphocytes.

Antibody Formation↗
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Oxygen consumption of middle ear and peripheral blood neutrophils in acute suppurative otitis media.

Using an oxygen electrode, oxygen consumption has been measured in peripheral blood neutrophils and the corresponding middle ear fluid neutrophils of 26 patients with acute suppurative otitis media. The data suggest that the middle ear fluid neutrophil is functional and is capable of producing an adequate oxygen burst in response to membrane stimulation by opsonized zymosan particles. Some middle ear neutrophils are actually capable of producing a greater respiratory burst than their counterparts in the peripheral blood. However, middle ear neutrophils do not show the increased metabolic activity at 40 degrees C, which blood neutrophils regularly displayed compared with tests performed at 37 degrees C. It is believed that this temperature (40 degrees C) is more physiological during infection and might explain why middle ear neutrophils may not always be capable of destroying bacteria, even though they are present in adequate numbers in the middle ear fluid in some cases of acute suppurative otitis media. Further studies are needed to determine the nature of the defect(s) present in middle ear neutrophil at 40 degrees C.

Adolescent↗
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Stenotrophomonas maltophilia infection and colonization in the intensive care units of two community hospitals: A study of 143 patients.

STUDY OBJECTIVE: To study the epidemiology of Stenotrophomonas maltophilia infections in the intensive care units (ICUs) of community general hospitals. DESIGN: Retrospective chart review of 143 patients with cultures positive for S. maltophilia over a 2-year period. SETTING: Intensive care units of 2 community general hospitals. RESULTS: Patients with S. maltophilia infection or colonization were elderly (mean age 62.4 years), intubated for a mean of 11.8 days, and had a mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 16.6. A tracheostomy was present in 22.4%, and underlying chronic respiratory disease and malignancy were found in 25.9% and 15.4%, respectively. Only 2 patients (1.4%) were neutropenic. Most isolates (89.5%) were from the respiratory tract and were part of a polymicrobial culture in 52. 5% of patients. Only a slightly higher APACHE II score (mean = 18.0, SD 7.8 vs mean = 15.6, SD 6.2, P = 0.052) differentiated patients with infection from those with colonization. All but 2 patients were exposed to antibiotics before their positive culture. Crude mortality rate was 41.3% overall and was significantly higher in those with an APACHE II score of 15 or more (48.8% vs 30.5%, P = 0. 028). CONCLUSION: S. maltophilia is emerging as an important cause of nosocomial infection, especially pneumonia, in ICUs of community general hospitals. Patients tend to be elderly, intubated for a mean of about 12 days, have high APACHE II scores, and frequently have a tracheostomy or underlying chronic respiratory disease. In contrast to earlier reports, neutropenia and underlying malignancy are uncommon in our ICU population. We found prior antibiotic exposure was almost universal and similar to previous reports, but use of imipenem was much less common in our community hospital patients. Patients with a high APACHE II score should be considered infected rather than colonized, but differentiation of infection from colonization remains problematic. Isolation of S. maltophilia from a patient carries a crude mortality rate of 41.3%, and patients with an APACHE II score of 15 or more have a significantly higher mortality rate than those with lesser scores, approaching 50%. Trimethoprim-sulfamethoxazole (TMP-SMX) remains the drug of choice for infections caused by S. maltophilia.

Aged↗
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Biological mediators of inflammation im middle ear effusions.

Four biological mediators of inflammation have been found in middle ear effusions from patients with otitis media with effusion. They are chemotactic factor(s), macrophage inhibition factor(s), activated complement and prostaglandins. The potential role of these mediators has been discussed in relation to their potential for maintaining inflammation in the middle ear cleft after Eustachian tube dysfunction.

Animals↗
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Mucosubstances in otitis media with effusion.

Histochemical localization of sialomucins and sulfated polysaccharides have been demonstrated in the mucous membrane of the middle ear in different middle ear effusions. Inasmuch as a more neutral stain with alcian blue-PAS is still present after treatment with neuraminidase, it is strongly suggested that neutral polysaccharides coexist with neuraminic acid in the middle ear glycoproteins. Sulfated polysaccharides are present only in the mucoid effusions. The use of precise nomenclature for mucosubstances is strongly recommended and is outlined. The nature of the specificity of the histochemical stains is discussed.

Alcian Blue↗
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Antibody coated bacteria in otitis media with effusions.

The significance of bacterial isolates of coagulase negative Staphylococcus epidermidis and Corynebacterium species in middle ear fluids remains controversial. This study was undertaken to evaluate the possible role of these organisms in different effusions. Cultures were obtained from the external cartilaginous ear, bony canal, tympanic membrane, middle ear fluids, tonsils and nasopharynx of 93 patients at the time of myringotomy for otitis media with effusion. Isolates of coagulase negative staphylococci from the middle ear, external ear and posterior aural skin were evaluated in regard to antibiotic sensitivity, biochemical tests and phage typing. Furthermore, in another series of patients in whom these organisms were isolated, specific antibody activity in both middle ear washings and corresponding sera were measured, using the technique of indirect immunofluorescence. The results suggest that the isolates from the middle ear and ear canal are not always identical. There is some evidence that specific IgM and IgG as well as IgA responses to these organisms are present in middle ear washings and not in corresponding serum. These results suggest that coagulase negative Staphylococcus and Corynebacterium species in middle ear effusions may not be contaminants from the external canal and that a local immune response may be produced by these organisms. Whether or not these organisms represent etiologic agents responsible for otitis media with effusion cannot be ascertained from this data. One very interesting point is the presence of IgF coating of organisms in some effusions.

Adolescent↗
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Mucosal immune system: implications in otitis media with effusion.

The ontogeny of the mucosal immune system as it relates to the development of lymphoid tissue in the respiratory tract and the gastrointestinal tract has been studied quite extensively over the past few years. It is apparent now that the bronchus-associated lymphoid tissue and gut-associated lymphoid tissue are the major sources of immunocompetent precursor B lymphocytes. After the induction of antigens in the respiratory tract or the gastrointestinal tract, precursor lymphoid cells in these sites are preferentially activated to undergo significant proliferation. Such antigen-sensitized cells eventually migrate to other mucosa sites, such as mammary glands, genital tract, conjuctiva, etc. Recent evidence has suggested that the immunocompetent tissue observed in the middle ear cleft during otitis media with effusion may function as an extension of the mucosal immune system in the upper respiratory tract. The implications of these observations relative to middle ear disease are discussed.

Antibody Formation↗
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The kallikrein-kinin system in otitis media with effusion.

The kallikrein-kinin system was studied in middle ear effusions from 28 ears suffering from otitis media with either a purulent, mucopurulent, serous or seromucinous, or mucoid effusion. Kinin, kininogen, kininase, kallikrein, prekallikrein, and protein were measured in these secretions. The findings suggest that the concentration of kinin is greatest in the serous and seromucinous effusions and lowest in the mucoid effusion. This is also true for kininogen and total protein. These studies suggest that the vasoactive polypeptide system is present in most middle ear effusions and that the concentration of the components of this system are different for different effusions.

Humans↗
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The significance of lysosomal enzymes in middle ear effusions.

Although lysosomal enzymes have been demonstrated in middle ear effusions by several investigations, the exact source of these enzymes and the role they play in the maintenance and progression of otitis media with effusion have not been thoroughly studied. The source of lysosomal enzymes in middle ear fluids and their possible role in the inflammatory process in otitis media with effusion are explored.

Child↗
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The role of IgE-mediated hypersensitivity in otitis media with effusion.

Forty-one children with recurrent otitis media with effusion (OME) were evaluated for IgE mediated allergy by critical analysis of history, physical findings, skin testing for selected antigens, and laboratory determination of total IgE and radioallergosorbent testing (RAST) for six inhalant and two food allergens. The children were divided into an allergic and nonallergic group. The allergic group clearly had higher total IgE in their serum. There was an elevation of middle ear effusion (MEE) IgE in 5 of 20 allergic cases. In three of these five patients or 15% of the allergic group, the IgE/mg protein was higher in the MEE than in the corresponding serum, suggesting the possibility of local production of IgE. Specific IgE antibody as measured by RAST was noted in 9 of 20 MEE and 5 of 20 nasal washings in the allergic group and in only 2 of 21 MEE and in 10 nasal washings of the nonallergic group. Nasal IgE was substantially increased in three patients of the allergic group; however, the corresponding MEE IgE was not increased in proportion to the nasal IgE. The MEE RAST was positive in 22% of the allergic group and in less than 1% of the nonallergic group. Nasal RAST was positive in 20% of the allergic group and in none of the nonallergic group. We conclude that IgE-mediated allergic reactions may play a role in the pathogenesis of OME in only about 15% of children defined as allergic on the basis of clinical and laboratory evidence. Allergy investigation as a diagnostic procedure in children with recurrent OME, but without a history of allergy on the basis of history, family history, or laboratory testing is likely to be nonproductive.

Adolescent↗
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Chemotactic activity in middle ear effusions.

A study of chemotactic activity in different middle ear effusions (MEE) was undertaken using a technique that has overcome some of the pitfills of previous chemotactic investigations on MEE. In the present study, neutrophils were made to migrate upwards toward a chemotactic gradient. Chemotactic activity was differentiated from increased random migration by the use of a two-filter paper system. The study indicated that directed migration or chemotaxis was present in 65% of purulent effusions, in approximately 25% to 30% of serous and seromucinous effusions, but in less than 20% of mucoid effusions. Chemotactic agents in MEE have been discussed. Chemotactic activity for neutrophils may be an important part of the inflammatory response in otitis media with effusion (OME) and responsible for the elimination of bacteria and other foreign particles. On the other hand, prolonged chemotactic activity owing to immunologic or nonimmunologic mechanisms may be responsible for the release of lysosomal enzymes and the subsequent maintenance of an inflammatory response in middle ear tissue. The exact mechanism and nature of the underlying chemotactic response for leukocytes in OME remain to be determined.

Adolescent↗
PubMedDate not supplied

The role of coagulase-negative staphylococci in chronic otitis media with effusion.

Twenty-eight middle ear effusions from 27 patients with chronic otitis media with effusion were studied for the presence of bacteria. The most common isolates were coagulase-negative staphylococci. However, biochemical and antibiotic sensitivity patterns demonstrated that these organisms represented a heterogenous group. At least three subtypes of coagulase-negative staphylococci were identified from the middle ear effusions, and in only one instance was the isolate from the ear canal identical with that of the middle ear effusion. The data presented suggest that coagulase-negative staphylococci from the middle ear effusions may not be contaminants; however, it cannot be determined from this study whether these organisms play a role as pathogens or as the result of indolent colonization.

Adolescent↗
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Bacteriologic findings from the nose, ethmoid, and bloodstream during endoscopic surgery for chronic rhinosinusitis: implications for antibiotic therapy.

This study addresses the bacterial flora of chronic rhinosinusitis at the time of endoscopic sinus surgery. We used the consensus definition of chronic rhinosinusitis as the presence of paranasal sinus inflammation present for greater than 12 weeks. In our patient study group, all cases of chronic rhinosinusitis had failed to respond to antibiotic therapy and had not been treated previously with surgery. By microscopic examination, chronic inflammatory changes were confirmed in the resected sinus lining of all study patients. Intraoperative cultures were obtained from the nasal vestibule, the middle meatus, ethmoid lining, and peripheral blood during and after the endoscopic procedure. We found approximately 30% of the patients with sterile sinuses, 50% with coagulase-negative staphylococci, and the remainder with a mixed group of "nonpathogenic" organisms. Anaerobes were conspicuously rare. The blood cultures were positive in 7% of cases and were consistent with an organism of the operative site. This is the first time bacteremia has been reported in association with endoscopic sinus surgery. The results suggest that chronic rhinosinusitis is not a bacterial disease, but rather the result of chronic inflammation produced by a previous acute inflammation. The incidence of positive blood cultures, while relatively low and cleared quickly, should alert the physician for the possible need for prophylactic antibiotics in patients with cardiac, prosthetic, or systemic conditions that could lead to metastatic infection.

Antibiotic Prophylaxis↗
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Clinical impedance audiometry.

This manuscript has attempted to briefly outline the most important areas of clinical impedance audiometry. The author has emphasized the use of impedance audiometry in differentiating different types of middle ear pathology and utilizing the stapedial reflex in the determination of malingering as well as an overall test of the normal function of the auditory nervous system from the inner ear to brain stem. Finally, the use of Eustachian tube function can also be utilized by the trained audiologist in determining whether or not there is Eustachian tube dysfunction. It is important to again emphasize that impedance audiometry is objective and does not involve the cooperation of the patient. Thus in the autistic child and in the child who is uncooperative, it is of particular help to the clinical otologist and audiologist. In patients who are malingering the stapedial reflex may assist in determining a valid response in routine autiometry. Finally, with special types of tests which have not been discussed in this manuscript, such as stapedial reflex decay, one may be able to determine the presence of an early acoustic neurinoma.

Acoustic Impedance Tests↗
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Eustachian tube dysfunction in children with ragweed hayfever during natural pollen exposure.

The role of upper respiratory allergy in the pathogenesis of otitis media with effusion (OME) is an interesting but still unresolved issue. In order to investigate this further, fifteen children with ragweed hayfever were studied for the development of eustachian tube obstruction (ETO), utilizing the nine-step pressure-swallow test, prior to, during, and after seasonal exposure to ragweed pollen. Daily symptom-medication diaries were maintained and serial physical examinations were performed. ETO was found in 60% of the ragweed sensitive children during natural pollen exposure. The development of ETO was found to correlate with ragweed skin test wheal size and daily patient symptom-medication scores (SMS) during pollen exposure. Treatment of hayfever symptoms with pseudoephedrine and/or chlorpheniramine did not prevent most patients from developing ETO. Despite the prevalence of ETO in the study group, only one child developed evidence of middle ear effusion. These findings suggest that children with ragweed hayfever develop eustachian tube (ET) dysfunction during natural pollen exposure. Seasonal allergy induced ETO is not, however, by itself sufficient to produce middle ear effusion.

Child↗