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Biomedical subjects

S Frenkiel

Publications and source records attributed to S Frenkiel.

At least 37 records · Page 2Linked to original sources
PubMed1999

Endoscopic repair of cerebrospinal fluid rhinorrhea: is it the treatment of choice?

Between 1991 and 1998, 12 patients with cerebrospinal fluid rhinorrhea were operated on using the intranasal endoscopic approach. The procedure was successful in 10 cases. The endoscopic approach failed in two patients who had larger bony defects and herniating meningoencephaloceles. This paper analyzes the case material with respect to the etiology and site of leakage. The value of computed tomography and magnetic resonance imaging for preoperative localization of the leak is discussed. The technique of underlay fascia graft is described and discussion ensues regarding potential pitfalls that may lead to failure of leak closure.

Adult↗
PubMed1998

Th-2 type cytokine receptors in allergic rhinitis and in response to topical steroids.

OBJECTIVES: Th-2 type cytokine production (interleukin-4 [IL-4] and interleukin-5 [IL-5]) has been demonstrated to play a significant role in the pathophysiology of allergic rhinitis (AR), and the treatment of AR with topical corticosteroids has been shown to reduce the expression of Th-2 type cytokines in vivo. However, the contribution and expression of Th-2 type cytokine receptors in AR and their response to corticosteroid treatment remain to be clarified. Objectives of the current study are 1. To examine the expression of the cytokine IL-4 and IL-5 receptors (IL-4R and IL-5R) in a nasal allergen challenge model and to contrast this with the expression of the receptor for the Th-1 type cytokine, interferon-gamma receptor (IFN-gammaR), and 2. to examine the effects of pretreatment with topical corticosteroid before allergen challenge on the expression of these same receptors. STUDY DESIGN: Randomized prospective study involving 14 ragweed-allergic subjects evenly divided between placebo and corticosteroid pretreatment. METHODS: Immunocytochemistry (alkaline phosphatase-antialkaline phosphatase labeling [APAAP] technique) was used to stain nasal biopsy specimens before and after allergen challenge. Antibodies used included anti-CD3, CD4, CD8, MBP, IL-4R, IL-5R, and IFN-gammaR. RESULTS: Following allergen challenge, we observed a significant increase in the Th-2 type cytokine receptors (IL-4R and IL-5R; P < .05), as well as a significant decrease in the expression of the Th-1 type cytokine receptor (IFN-gammaR; P < .05). Pretreatment with topical corticosteroids before nasal allergen challenge resulted in decreased expression of IL-4R (P < .05) and IL-5R (P < .05) and increased expression of IFN-gammaR (P <.05). Further, IL-4R and IL-5R expression correlated with eosinophil infiltration in the tissues. CONCLUSIONS: We have demonstrated that in AR, cytokine receptors for IL-4, IL-5, and IFN-gamma follow a similar pattern to their ligands. In addition, pretreatment with topical corticosteroids was shown to alter the cytokine receptor expression pattern from a Th-2 profile more toward a Th-1 profile.

Administration, Topical↗
PubMed1998

Expression of IgE heavy chain transcripts in the sinus mucosa of atopic and nonatopic patients with chronic sinusitis.

We have recently shown the increased mRNA expression of interleukin (IL)-4 and IL-13 in sinus biopsies from allergic subjects with chronic sinusitis (ACS), whereas only IL-13 mRNA was elevated in biopsies obtained from nonallergic subjects with chronic sinusitis (NCS). In the lymph nodes and spleen, these cytokines may promote IgE production through transcriptional activation of the germline IgE heavy chain promoter, an event which precedes immunoglobulin isotype switching to IgE in B cells. We hypothesized that local expression of IL-4 and/or IL-13 might act by inducing germline IgE heavy chain transcript expression locally in the sinus mucosa of chronic sinusitis patients. Mucosal sinus biopsies were obtained from 13 patients with ACS, 12 subjects with NCS, and 11 normal control individuals. The numbers of B cells in the sinus mucosa were studied by immunocytochemistry with anti-CD20 monoclonal antibodies. In situ hybridization was performed using antisense radiolabeled riboprobes complementary to the IgE epsilon -heavy chain germline (Iepsilon) and heavy chain constant region (Cepsilon) gene transcripts. Riboprobes specific for the IgG gamma-heavy chain constant region (Cgamma) were used as an isotype control. Immunocytochemical analysis indicated augmented numbers of CD20-positive B cells in the biopsies obtained from ACS patients compared with NCS subjects (P < 0.05) and normal control subjects (P < 0.01). Statistically significant increases were observed in the numbers of cells expressing Iepsilon and Cepsilon transcripts in the sinus mucosa of ACS patients compared with those with NCS (P < 0. 001) and normal controls (P < 0.001), while Cgamma RNA expression did not differ significantly between the groups. In three randomly selected ACS biopsies, 92-100% of cells expressing Cepsilon transcripts and 100% of Iepsilon RNA-positive cells coexpressed CD20 immunoreactivity. Cells expressing Cepsilon transcripts were also significantly increased in NCS compared with normal controls (P < 0. 05). The results of this study suggest that local IgE class switching occurs in the pathogenesis of ACS and that ACS and NCS are both associated with increased expression of Cepsilon transcripts.

Adult↗
PubMed1998

Interleukin-4, interleukin-5, and granulocyte-macrophage colony-stimulating factor receptor expression in chronic sinusitis and response to topical steroids.

Chronic sinusitis and its associated eosinophilic infiltrate are believed to be mediated, at least in part, by the upregulation of Th-2 cytokines, including interleukin-4, interleukin-5, and granulocyte-macrophage colony-stimulating factor (GM-CSF). Interleukin-4 is involved in IgE production and in eosinophil recruitment through upregulation of vascular cell adhesion molecule-1. Interleukin-5 and GM-CSF are involved in eosinophil growth and survival. The aim of this study was to investigate the expression of receptors for these cytokines in the sinus mucosa of subjects with chronic sinusitis. Using the technique of in situ hybridization to detect specific cytokine receptor messenger RNA, we studied the sinus mucosa of subjects with nonallergic chronic sinusitis, subjects with allergic chronic sinusitis, subjects with allergic chronic sinusitis treated with topical steroids, and normal controls. Our data demonstrate higher expression of interleukin-4 receptor in subjects with allergic chronic sinusitis than in controls (p < 0.001) and higher expression of interleukin-5 receptor in both subjects with nonallergic chronic sinusitis and subjects with allergic chronic sinusitis than in controls (p < 0.001, p < 0.001). The expression of interleukin-4 receptor and interleukin-5 receptor was higher in subjects with allergic chronic sinusitis than in subjects with nonallergic chronic sinusitis (p < 0.001). GM-CSF receptor expression was also found to be higher in subjects with allergic chronic sinusitis and subjects with nonallergic chronic sinusitis than in controls (p < 0.001, p < 0.001). In contrast to interleukin-4 receptor and interleukin-5 receptor, however, expression of GM-CSF receptor was higher in subjects with nonallergic chronic sinusitis than in subjects with allergic chronic sinusitis (p < 0.001). In subjects with allergic chronic sinusitis treated with topical corticosteroids, the expression of interleukin-4 receptor and interleukin-5 receptor messenger RNA levels was significantly lower than levels in patients with allergic chronic sinusitis who were not taking topical steroids (p < 0.001, p < 0.001). Steroid treatment had no effect on GM-CSF receptor messenger RNA expression. In conclusion, our data support a role for Th-2 cytokine receptors in the pathophysiology of chronic sinusitis. Further, our data lend support to the theory that differential activation of distinct cytokine pathways mediates inflammation in chronic sinusitis depending on whether there is associated allergy. Finally, treatment with topical corticosteroids has been demonstrated in chronic sinusitis to downregulate receptors for interleukin-4 and interleukin-5.

Administration, Topical↗
PubMed1998

Sinonasal schneiderian papilloma.

OBJECTIVE: Schneiderian papilloma of the paranasal sinuses is a locally aggressive benign epithelial tumour with malignant potential. METHOD: A retrospective analysis of 72 patients as seen at our institution from 1978 to 1997 was conducted. RESULTS: The most frequent symptoms at time of presentation were nasal obstruction, presence of a nasal mass, and nasal discharge. The most common sites of involvement were the maxillary antrum (58.3%), lateral nasal wall (41.7%) and ethmoid sinus (37.5%). Histologic examination confirmed all 72 instances of schneiderian papilloma, with 55/72 (76.4%) being of the inverted type, 13/72 (18.1%) being the fungiform type, and 4/72 (5.5%) being the cylindrical type. An associated malignancy or potential premalignant condition was present in 15 patients (20.8%), with 8 (11.1%) exhibiting dysplastic changes, 4 patients (5.5%) found to have carcinoma in situ, and 3 patients (4.2%) found to have invasive carcinoma. Conservative surgical excision was performed in 37 (51.4%) with more radical surgery, including lateral rhinotomy and medial maxillectomy performed in 35 (48.6%) patients. Recurrence was seen in 17/37 (45.9%) patients treated conservatively compared to 0/35 (0.0%) patients treated aggressively. CONCLUSIONS: Our results indicate that more aggressive surgery is associated with a more definitive treatment and significantly less recurrence and, as such, is the management of choice in cases of schneiderian papilloma. Furthermore, our results indicate the need for long-term follow-up, and the applicability of sinus endoscopy in doing so.

Adult↗
PubMed1998

Human nasal ciliary-beat frequency in normal and chronic sinusitis subjects.

OBJECTIVE: Ciliary-beat frequency (CBF) is an important factor influencing mucociliary flow in the respiratory tract. A significant correlation exists between CBF and mucus transport time (MTT), which suggests that CBF is the main factor in nasal mucociliary clearance in healthy individuals. Mucociliary clearance is influenced by the temperature of the inspired air and decreases at temperatures below 33 degrees C. It is unknown whether CBF varies in different sites within the nasal chamber and exactly how CBF is altered in disease states such as chronic sinusitis (CS) and nasal polyposis (NP). Our study was conducted in an attempt to answer these questions. METHOD: CBF was measured in nasal biopsies from eight normal control subjects: 6 CS and 8 NP patients. Biopsies from the regions of the maxillary, ethmoid, frontal, and sphenoid sinus ostia were also obtained. The material was analyzed using a computerized image-processing system. RESULTS: Our data demonstrated a significant decrease in CBF at 22 degrees C compared to at 35 degrees C for all sinus biopsies (p < .05). We found no statistical difference between the CBF of biopsies from the regions of the various sinus ostia. A comparison between the patients with CS and normal controls again revealed no significant difference in CBF, a finding which contradicts previously published reports. Surprisingly, an increase in CBF was observed in NP patients compared to control and CS patients (p < .05). CONCLUSIONS: We conclude that our technique is a viable model for studying sinonasal CBF in the human. Our data suggest that a mechanism other than decreased CBF may account for the decreased mucociliary clearance observed in chronic sinusitis.

Adult↗
PubMed1998

One-year outcome analysis of functional endoscopic sinus surgery for chronic sinusitis.

OBJECTIVE: This study was conducted to assess treatment results in patients undergoing functional endoscopic sinus surgery for chronic sinusitis, with evaluation of prognostic indicators of success and failure. METHOD: The study included 393 patients who underwent endoscopic sinus surgery for chronic sinusitis over a 4-year period. The diagnosis of chronic sinusitis was based on ongoing symptomatology for greater than 3 months and the presence of mucosal disease on computerized tomography (CT). A retrospective analysis was done looking at patient data, presenting symptoms, CT findings, operative reports, pathology reports, and outcome at 6- and 12-month follow-up. The prognostic significance of selected factors was evaluated using chi-square analysis. RESULTS: A positive history for asthma, allergy, and ASA triad was present in 29.5%, 34.6%, and 10.9% of patients, respectively. Previous sinus surgery was done in 31.9%, and 15.7% of patients were smokers. The most common presenting complaint was nasal congestion/obstruction, followed by facial pain/headaches and olfactory disturbance. A positive outcome was achieved in 80.5% of patients at 6 months and in 69.7% at 12-month follow-up. Revision surgery within a year was needed in 4.1% of patients. Factors affecting outcome included asthma, smoking, polyposis, previous surgery, and pansinusitis. CONCLUSIONS: Extent of disease, as reflected by polyposis, pansinusitis, and premorbid history, is the most important determinant of outcome. Concomitant changes in ciliary motility secondary to asthma or smoking further impede surgical outcome. Future studies focusing on the disease process of chronic sinusitis are needed.

Adolescent↗
PubMed1998

Monocyte chemotactic protein expression in allergy and non-allergy-associated chronic sinusitis.

OBJECTIVE: Chronic sinusitis (CS) is characterized by inflammatory mucosal thickening and polyp formation with a predominantly eosinophilic infiltrate. Chemokines are a novel group of inflammatory mediators capable of attracting specific inflammatory cell populations. Monocyte chemotactic proteins (MCP) are a subfamily of chemokines (MCP-1, MCP-2, MCP-3, and MCP-4) that share a number of functional properties including chemotactic activity for eosinophils. The purpose of this study was to investigate the expression of the MCP family of chemokines in allergy and non-allergy-associated chronic sinusitis using the technique of immunocytochemistry. METHOD: We examined the expression of MCP-1, MCP-3, and MCP-4 in biopsies from the ethmoid sinuses of patients with CS and normal controls. RESULTS: MCPs were localized to the epithelial cells and a subset of inflammatory cells within the mucosa. The expression of both MCP-3 and MCP-4 immunoreactivity were significantly increased in patients with both allergy and non-allergy-associated CS compared to normal controls (p < .001). There was no significant difference in the expression of MCP-1 in nasal biopsies from individuals with CS and normals. The level of expression of MCP-3 and MCP-4 correlated with eosinophil (p < .001) and CD4-positive T-cell infiltrate (p < .001) but not with CD8-positive T-cell infiltration. CONCLUSIONS: Our data suggest biologic redundancy in the expression of eosinophil chemoattractants in CS and a potential role for MCP-3 and MCP-4, but not MCP-1, in the pathophysiology of this disorder. Further, chemokines may be a common link between the eosinophilia of allergy-associated and non-allergy-associated CS, a finding that may have therapeutic implications.

Adult↗
PubMed1997

IL-4 and IL-13 expression in chronic sinusitis: relationship with cellular infiltrate and effect of topical corticosteroid treatment.

OBJECTIVE: Chronic sinusitis with allergy (ACS) and without allergy (NCS) are inflammatory diseases with considerable morbidity. The present study was undertaken to investigate, by in situ hybridization, the expression of IL-13 and IL-4 mRNA in sinus biopsy sections. METHOD: Specimens were obtained from subjects with NCS (n = 12), ACS (n = 13), ACS on steroid therapy (n = 11), and normal controls (n = 11). The composition of the inflammatory infiltrate was also examined in all cases. RESULTS: The number of cells expressing IL-4 and IL-13 transcripts was significantly higher in subjects with ACS compared to normal controls. In contrast, the numbers of IL-13 but not IL-4 mRNA-positive cells were increased in the NCS subjects compared to the normal controls. IL-4 and IL-13 mRNA expression was suppressed in ACS subjects on topical steroid therapy compared to untreated patients. There was no significant difference in the numbers of eosinophils between the ACS subjects treated with steroids and those who were not treated, but the steroid-treated patients demonstrated significantly higher numbers of CD8+ cells in the sinus mucosa. Increased numbers of CD8+ cells were also observed in subjects with NCS compared with ACS subjects and normal controls. CONCLUSIONS: These results demonstrate that increased IL-13 expression is an important feature of allergic and nonallergic patients with chronic sinusitis. Furthermore, our data indicate that IL-13 and IL-4 are under differential regulation in NCS subjects.

Adolescent↗
PubMed1997

Paraseptal structural changes and chronic sinus disease in relation to the deviated septum.

OBJECTIVE: This study was conducted to evaluate the use of computerized tomography in the delineation of the ostiomeatal complex to enhance the endoscopic surgeon's understanding of associated and contributing anatomic features. METHODS: The ostiomeatal complex region (OMC) was prospectively evaluated in 122 consecutive patients as a function of the degree of nasal-septal deviation. This data was correlated with paranasal sinus disease, lateral nasal-wall findings, and middle-turbinate abnormalities. RESULTS: Patients with increasing nasal-septal deviations were associated with a higher incidence of OMC obstruction (p < .05). OMC obstruction in the direction of septal angulation was attributable to nasal septal deformity. However, contralateral OMC obstruction was related to middle-turbinate and lateral nasal-wall abnormalities, which appeared with increased frequency on the side opposite to the septal deviation (p < .05). Furthermore, an increased incidence and severity of sinus disease was noted with increasing septal deviation (p < .05). CONCLUSION: Increasing angles of septal deviation are associated with bilateral sinus disease and contralateral middle turbinate abnormalities and ethmoid bulla prominence.

Abnormalities, Multiple↗
PubMed1996

Development of a standardized proforma for reporting computerized tomographic images of the paranasal sinuses.

The complex regional anatomy of the paranasal sinuses has only recently been elucidated through the use of modern imaging techniques. The advent of computerized tomography in the delineation of sinonasal pathology and anatomic variation has proven invaluable to the otolaryngologist in preoperative planning for functional endoscopic sinus surgery (FESS). Frequently, the radiologic reporting schemes for these studies are not standardized, and in many respects have been found to be inadequate. This study attempts to develop a simple reporting proforma that the head and neck radiologist can routinely use in order to facilitate the presentation of CT scan findings in evaluating sinus, nasal, or upper airway pathology. Over 100 CT sinus reports that had previously been reported were re-read according to this reporting scheme and were analyzed in order to determine whether any significant discrepancies existed. These differences were then classified according to their incidental, minor, and major surgical significance. It is hoped that through the development of a standardized proforma, the complementary relationship between preoperative imaging and endoscopic intervention can be consolidated and further enhanced.

Adolescent↗
PubMed1996

Parotidectomy for the treatment of chronic recurrent parotitis.

OBJECTIVE: To assess the success of superficial parotidectomy in the treatment of chronic parotitis (a potentially debilitating disease heralded by recurrent painful swellings) and purulent sialorrhea. DESIGN: A retrospective review. METHODS: Ten patients who were managed by superficial parotidectomy after failure of all conservative measures at the Department of Otolaryngology, McGill University were studied. RESULTS: Eight had complete resolution of their disease, and two had minor persistence on follow-up. None of them had permanent facial nerve injury. CONCLUSION: We therefore advocate superficial parotidectomy for this condition on failure of conservative measures.

Adolescent↗
PubMed1996

Upregulation of Th-2 cytokine receptors in atopy- and nonatopy-associated chronic sinusitis.

OBJECTIVE: This study was conducted to investigate the expression of alpha IL5 and alpha GM-CSF receptors (alpha IL5r and alpha GM-CSFr) mRNA in the paranasal sinus mucosa of atopic and nonatopic subjects with chronic sinusitis compared to controls. DESIGN: This was a prospective study of patients presenting with the diagnosis of chronic sinusitis of at least 6 months' duration. METHOD: Fourteen patients with stable chronic sinusitis (7 atopic, 7 nonatopic) and 7 controls were included, from whom sinus mucosal biopsies were obtained and examined for membrane-bound alpha IL5r and alpha GM-CSFr mRNA using in situ hybridization. RESULTS: There was a significant difference in the number of cells expressing alpha IL5r mRNA per high-power field in both atopic and nonatopic subjects compared to controls, and in the number of cells expressing alpha GM-CSFr mRNA in both atopic and nonatopic subjects compared with controls. The number of alpha IL5r mRNA-positive cells was significantly greater in the atopic versus nonatopic groups, whereas alpha GM-CSFr mRNA-positive cells were greater in number in the nonatopic versus atopic groups. CONCLUSION: Both alpha IL5r and alpha GM-CSFr are upregulated in chronic sinusitis, suggesting that increases in both Th-2 cytokines and their receptors may be important in the pathology of the disease. Furthermore, the predominant associations of alpha IL5r with atopic chronic sinusitis and alpha GM-CSFr with nonatopic chronic sinusitis suggest that the chronic inflammation in this condition may arise from differential activation of distinct cytokine pathways depending on whether or not there is associated atopy.

Biopsy↗
PubMed1995

Effects and management of barometric change on cavities in the head and neck.

Changes in atmospheric pressure may result in barotrauma to a variety of head and neck structures including the middle and inner ears, the sinus cavities, the teeth and some cranial nerves. This article outlines the pathophysiology of these injuries and suggestions are offered for prevention and treatment.

Atmospheric Pressure↗
PubMed1994

Viral implications in the formation of multicentric inverting papilloma.

There is growing information to support a viral etiology in inverting papilloma formation. Evidence for this hypothesis comes from clinical findings of multicentricity, high recurrence rates, identification of human papilloma virus (HPV), and the presence of viral-like particles within the tumour tissue. Four cases of multicentric inverting papilloma are presented. In one patient, a squamous papilloma (wart) of the nasal vestibule recurred as an inverting papilloma. Another patient also had a cutaneous wart on the right index finger. These cases and others from the literature are discussed with respect to a viral mode of transmission.

Adolescent↗