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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↗
PubMed2006

Assessment of symptomatic patients after endoscopic sinus surgery with special reference to the frontal sinus: comparative radiologic analysis.

PURPOSE: To reveal the role of potential risk factors in frontal recess dissection (FRD), middle turbinate resection (MTR), sinonasal polyposis, and extension of disease in postoperative frontal sinus opacification by determining radiologic changes after endoscopic sinus surgery (ESS) in symptomatic cases using computed tomography (CT). STUDY DESIGN: Retrospective analysis of prospectively collected data from symptomatic patients after ESS. METHODS: Postoperative CT scans were taken in all symptomatic patients during their least symptomatic period or after maximal medical therapy. The radiologic findings of each sinus were compared, and the outcome of ESS was statistically evaluated. Furthermore, FRD, MTR, sinonasal polyposis, and extension of disease were analyzed for postoperative frontal sinus opacification. RESULTS: In our study, 101 sinuses of 61 symptomatic patients were examined. A significant improvement in opacification in all sinuses was detected postoperatively. Multivariate analysis of all potential risk factors revealed that postoperative frontal sinus opacification was affected only by sinonasal polyposis (odds ratio [OR] 3.32; 95% confidence interval [CI] 1.04-10.58) and extension of disease (OR 16.93; 95% CI 4.33-66.23). CONCLUSIONS: Our study revealed that surgical procedures such as FRD and/or MTR may not directly affect postoperative frontal sinus opacification. On the contrary, sinonasal polyposis and extension of disease seemed to be the main risk factors of this issue.

Adolescent↗
PubMed1997

Endoscopic sinus surgery or Caldwell-Luc operation in the treatment of chronic and recurrent maxillary sinusitis.

The treatment of chronic and recurrent maxillary sinusitis has been changed in recent years. The radical Caldwell-Luc approach has increasingly been replaced by more conservative functional endoscopic sinus surgery (FESS). In the central hospital of Central Finland between 1991 and 1992, 260 patients (424 sinuses) suffering from chronic or recurrent maxillary sinusitis were operated on. Patients were classed into three groups according to the patient history of sinusitis. The plain sinus films (occipitomental projections) were evaluated. Complication rate and the need for reoperations were evaluated retrospectively after a mean follow-up time of 3.8 years. Patients in the Caldwell-Luc group had more serious disease than in the FESS or antrostomy group. The plain sinus films taken preoperatively showed more opacification in maxillary sinuses in the Caldwell-Luc group than in the FESS or antrostomy group. Complication rate was 4.4% in the Caldwell-Luc group and 2.6% in the FESS group. No serious complications existed in the whole material. Patients treated with Caldwell-Luc operation in 1991 and 1992 needed reoperation in 7/96 cases (7.3%) and 3/63 cases (4.8%), respectively. In the FESS group, patients operated 1991 and 1992 needed reoperation in 3/11 cases (27%) and 13/72 cases (18%), respectively.

Adult↗
PubMed2003

Allergic fungal sinusitis. A naso-sinusal specific hyperreactivity for an infectious disease?

Allergic fungal sinusitis (AFS) is a rare disease of naso-sinusal complex affecting mainly young, immunocompetent adults who complain of chronic rhinitis and/or recurrent nasal polyposis despite medical and/or surgical treatment. Aim of the study is to analyse, from an allergological and otorhinolaryngological point of view, patients affected by the so-called "allergic fungal sinusitis" in order to better define the relationship between fungi present in naso-sinusal secretions and the host's immunoreactivity. From February 2001 to January 2002, 24 selected patients (13 male 11 female) age range 25-65 years (mean 45), with chronic rhinosinusitis, with a positive fungal examination of nasal secretion, underwent allergological evaluation. All patients were positive for diagnostic criteria of allergic fungal sinusitis and, in all patients, nasal lavage was performed for microscopic examination by fluorescence. Samples were then cultured on Sabouraud growth media for identification of the fungus. Skin prick tests (SPT) were then performed with the 15 main inhalant allergens and twelve fungal allergens (Bracco). The total IgE serum level (PRIST), the specific fungal IgE and the eosinophilic cationic protein were then investigated by means of an immuno-fluorine enzymatic method. Finally, a nasal provocation test was carried out with diluted solutions (1/100, 1/10) and with a pure solution of fungal allergens, selected according to microbiological examination of nasal secretion of each subject. Prick tests were positive for seasonal and perennial allergens in 5 patients (21%), while prick tests with fungi were positive in only 4 patients (16.6%). Total IgE levels were higher than in normals (200 KU/l) in 6 patients (25%) (mean 364.74 KU/l). In another 18 patients, total IgE were normal. Specific IgE levels for the tested fungi and eosinophilic cationic protein levels were within normal range in all patients. Nasal provocation test was negative in all patients. Presence of fungi in nasal secretions of patients with AFS does not appear to be correlated with an allergic status to the isolated fungus. A role for IgE in either the aetiology or the pathophysiology of allergic fungal sinusitis in unlikely, and probably the diagnostic criteria for allergic fungal sinusitis should not include type I hypersensitivity, since no confirmed evidence exists that IgE-mediated type I hypersensitivity is involved in the pathophysiology of allergic fungal sinusitis.

Acute Disease↗
PubMed2004

[Joint therapy of a dural arteriovenous fistula in the transverse-sigmoid sinus using surgical excision and direct sinus packing: a case report].

Combined therapy of direct sinus packing and surgical excision for intracranial dural arteriovenous fistula (dAVF) has not been reported in the literature. A 53-year-old male was admitted to our hospital due to sudden onset of seizure and consciousness disturbance. Plain CT scan showed subcortical hematoma in the right temporal lobe. Cerebral angiography revealed dAVF involved in the right transverse and sigmoid sinuses. The lesion was associated with retrograde venous drainage into the right cerebellum, temporal, and occipital lobes. Positron emission tomography (PET) showed typical findings of venous hypertension in the involved areas. MRI also demonstrated a high intensity lesion in the medulla oblongata, suggesting critical venous congestion. First, we aimed to pack the involved sinus through a minor craniotomy, but cannulation into the sinus was impossible probably because of a marked fibrosis in the involved sinus. Then, we completely exposed the involved sinus through craniotomy. Through a microcatheter inserted into the sinus, the lower part of the sigmoid sinus was directly packed, and the remaining lesion was excised. Postoperative course was uneventful. Disappearance of dAVF resolved the findings on PET and MRI. Combined therapy would be a safe, non-invasive, and useful option for patients with a complex intracranial dAVF.

Central Nervous System Vascular Malformations↗
PubMed1989

[The existence of sinusitis in rabbits and the use of bromhexine as a mucolytic nose drop in the treatment of sinusitis].

To make an experimental sinusitis, 38 maxillary sinus ostia of 19 rabbits were closed by silicon plastic and 24 hours later 10(8)-10(10) germs/ml. of Streptococcus pneumoniae type C III were given to the antrums of sinuses. 5 days later all the rabbits showed sinusitis clinically, radiologically, bacteriologically and histopathologically. Viscous, purulent secretions collected in the antrums of sinuses. We thought that the medical treatment of sinuses which had drainage treatment necessitated to decrease the viscosity of secretions. Because of this bromhexine as a mucolytic nose drop was investigated for the first time for the treatment of sinusitis in two groups of rabbits. As a result of the study bromhexine as a nose drop in the eradication of sinus infections was seen a useful drug.

Administration, Intranasal↗
PubMed1996

[Unusual spontaneous dural cavernous sinus fistula between right external carotid artery and left cavernous sinus--a case report].

A 64 year-old female had left exophthalmos which resulted from a spontaneous dural cavernous sinus fistula between the right external carotid artery and left cavernous sinus. The left cavernous sinus was fed directly from internal maxillary branches of right external carotid artery with the sparing of right cavernous sinus and intracavernous sinus. Symptoms and signs of dural cavernous sinus fistula developed slowly in the left eye only. Although this kind of spontaneou dural cavernous sinus fistula is very rare. The possibility of arterial feeding from contralateral carotid artery should not be ignored in any patient that is suffered from dural cavernous sinus fistula while angiographic study is performed.

Arteriovenous Fistula↗
PubMed1977

[Studies on the differential diagnosis of carotid sinus syndrome and sick sinus syndrome (author's transl)].

55 patients suffering from syncopes or dizziness were investigated by atrial pacing and carotid sinus reflex. In 17 pts. the only pathologic finding was a prolonged sinus node recovery time, in 8 pts. a pathologic carotid sinus reflex. In 7 pts. both pathologic findings were present, a prolonged sinus node recovery time and a pathologic carotid sinus reflex. In 3 pts. suffering from atrial fibrillation in addition a pathologic carotid sinus reflex was found. In 20 pts. the findings were normal. It is concluded that sick sinus syndrome and carotid sinus syndrome are different diseases, which can be separated clearly.

Aged↗
PubMed1990

CT of the paranasal sinuses: study of a control series in relation to endoscopic sinus surgery.

A control series of biplane CT scans of the paranasal sinuses, derived from patients examined for orbital tumours, is described. The scans were assessed for the presence of anatomical variants in the middle meatus, said to contribute to meatal stenosis, and for signs of asymptomatic infection revealed by the presence of clouding or mucosal thickening in the sinuses. Of the anatomical variants, only concha bullosa (pneumatisation of the middle turbinate) was associated with a high incidence of infection in the sinuses (85 per cent). Evidence of asymptomatic sinus infection was as high as 39 per cent overall, the highest incidence occurring in the ethmoid cells (28 per cent). Isolated ethmoid clouding on CT was observed in 15 per cent and is likely to be found in as many as one in seven of the adult population in the UK. It is concluded that in the majority of patients clouding confined to a few ethmoid cells shown on CT is without clinical significance. The evidence from the control series did not support the concept that most sinus infection starts in the middle meatus. The presence of a large reservoir of quiescent or chronic sinus infection in the control group suggests that in most instances sinusitis derives from a recrudescence of this pre-existing infection.

Endoscopy↗
PubMed1999

Infratentorial subdural empyema, pituitary abscess, and septic cavernous sinus thrombophlebitis secondary to paranasal sinusitis: case report.

OBJECTIVE AND IMPORTANCE: Infratentorial empyema, pituitary abscess, and septic cavernous sinus thrombophlebitis are all rare and potentially lethal conditions. The occurrence of all three in a single patient has not previously been described. We present such a case occurring in a young, otherwise healthy man. CLINICAL PRESENTATION: A 26-year-old man with a remote history of sinusitis developed rapidly progressive headache, fever, right eye pain, swelling, proptosis, and visual impairment. Magnetic resonance imaging demonstrated diffuse pansinusitis, including sphenoid sinusitis, and extension of inflammation and infection into the adjacent cavernous sinuses, pituitary gland, and posterior fossa. INTERVENTION: Urgent drainage of the ethmoid and maxillary sinuses was performed; pus was not identified. The patient continued to deteriorate clinically with worsening of visual acuity. Computed tomography of the head performed the next day revealed worsening hydrocephalus and an enlarging posterior fossa subdural empyema. Urgent ventricular drainage and evacuation of the empyema was performed, and subsequently, the patient's clinical course improved. The microbiology results revealed alpha hemolytic streptococcus and coagulase-negative staphylococcus species. The patient survived but during the follow-up period had a blind right eye and pituitary insufficiency. CONCLUSION: Paranasal sinusitis can have devastating intracranial sequelae. Involvement of the adjacent pituitary gland and cavernous sinuses can result in serious neurological morbidity or mortality, and retrograde spread of infection through the basal venous system can result in subdural or parenchymal brain involvement. A high index of suspicion and aggressive medical and surgical treatment are crucial for patient survival, but the morbidity rate remains high. Our patient survived but lost anterior pituitary function and vision in his right eye.

Abscess↗
PubMedDate not supplied

Chronic sinusitis complicating sinus lift surgery.

Sinusitis has been reported as a complication of sinus lift surgery with antral bone augmentation. The procedure involves the creation of a submucoperiosteal pocket in the floor of the maxillary sinus for placement of a graft consisting of autogenous, allogenic, or alloplastic material. This can result in inadvertent tearing of the mucoperiosteal flap with extrusion of graft material into the antrum. Obstruction of the sinus outflow tract by mucosal edema and particulate graft material may result in sinusitis. We will discuss the clinical presentation and management of 14 cases of chronic sinusitis following sinus lift surgery with alloplastic hydroxyapatite (HA) augmentation of the maxillary antrum.

Adult↗
PubMed1975

Comparative histochemical and electron microscopic studies of the sinus and venous walls of the human spleen with special reference to the sinus-venous connections.

Sinus and venous walls of normal human spleens were studied with enzyme histochemical and electron microscopic methods. Particular attention was paid to the connections between sinuses and veins. Histochemically the sinus lining cells revealed a distinct naphthol-AS-acetate-esterase activity but no reaction for alkaline phosphatase. Venous endothelial cells were positive for the latter but negative for the former enzyme. In the sinus-venous junctional area there were no endothelial cells with reactivity for both enzymes. Electron microscopically both the sinus lining cells and the venous endothelial cells could be clearly characterized and therefore easily distinguished from one another on morphological grounds. There were no clear ultrastrural indications of transitional forms between sinus lining cells and venous endothelial cells in the sinus-venous area. According to these findings, sinus lining cells represent a specialized endothelium, but one with practically no morphological similarities to the venous endothelium.

Alkaline Phosphatase↗
PubMed1999

Neurohistology of the sinus tarsi and sinus tarsi syndrome.

The purpose of this study was to clarify the neural anatomy of the sinus tarsi. The nerve endings of the synovium in the sinus tarsi were examined. The synovial membrane in the sinus tarsi was excised in 20 patients with sinus tarsi syndrome (20 feet) and in 2 feet from subjects without symptoms (controls). In 15 of the 20 patients and the two controls, the excised synovial membrane was studied histologically with staining by a modified Gairns gold chloride method. Numerous neural elements were observed in the sinus tarsi in all examined synovium. There were abundant free nerve endings and three types of mechanoreceptors: Pacinian corpuscles, Golgi corpuscles, and Ruffini corpuscles. Macroscopic observation and histological examination, using hematoxylin and eosin, in the other 5 patients revealed chronic synovitis in the sinus tarsi. Our findings suggest that the sinus tarsi is not only a talocalcaneal joint space but a source of nociceptive and proprioceptive information on the movement of the foot and ankle. Sinus tarsi syndrome may result from disorders of nociception and proprioception in the foot.

Adolescent↗
PubMed1993

Age-related changes of sinus node function and autonomic regulation in subjects without sinus node disease--assessment by pharmacologic autonomic blockade.

To assess the relationship between aging and autonomic regulation of sinus node function, 56 subjects of various ages (range 14-75 years, mean 43 +/- 19 years) without sinus node disease were studied. Heart rate, corrected sinus node recovery time and sinoatrial conduction time were measured before (basic) and after (intrinsic) pharmacologic autonomic blockade (propranolol + atropine i.v.). Percent chronotropies of the above parameters were calculated by a modified Jordan's method. Basic heart rate and basic corrected sinus node recovery time did not vary with age (r = -0.15, r = 0.08, respectively), while basic sinoatrial conduction time tended to increase with age (r = 0.32, p < 0.05). Intrinsic heart rate decreased (r = -0.76, p < 0.001), and intrinsic corrected sinus node recovery time and intrinsic sinoatrial conduction time both increased with age (r = 0.55, p < 0.001; r = 0.56, p < 0.001, respectively). The younger the subject, the more negative the percent chronotropies of the above parameters were, and the percent chronotropies correlated positively with age (r = 0.68, p < 0.001; r = 0.52, p < 0.001 and r = 0.34, p < 0.05, respectively). In conclusion, intrinsic sinus node functions deteriorated with age. Furthermore, parasympathetic tone on the sinus node functions decreased with age, which may compensate for age-related deterioration of intrinsic sinus node function.

Adolescent↗
PubMed1994

The diagnostic significance of real sinus node automaticity depression in symptomatic sinus bradycardia.

Atrial overdrive pacing was performed, before and after autonomic blockade, in 42 consecutive patients (32 males and 10 females, mean age 46 +/- 11 years) with symptomatic sinus bradycardia. Patients were divided into two groups: Group I, 23 patients (mean age 43 +/- 8 years) with normal intrinsic heart rate (IHR) and normal intrinsic corrected sinus node recovery time (intrinsic CSNRT < 425 ms) and Group II, 19 patients (mean age 49 +/- 13 years) with abnormal intrinsic sinus node automaticity identified after autonomic blockade by abnormal IHR and/or by abnormal intrinsic CSNRT (> 425 ms). In addition to sinus cycle length, IHR, maximal CSNRT and sinoatrial conduction time (SACT) the real sinus node automaticity depression (SAD) was also evaluated, calculated after autonomic blockade (intrinsic CSNRT-SACT). Not all patients with an abnormal IHR showed abnormally prolonged CSNRT and not all patients with normal IHR had normal CSNRT. Among Group I (normal IHR) in 19 patients the real SAD was < 300 ms, while among Group II in 8 of 11 patients showing abnormal IHR the real SAD was > 300 ms. The abnormal value of SAD (> 300 ms) observed not only in patients with abnormal IHR and/or abnormally prolonged intrinsic CSNRT but also in several patients with normal IHR, increases the sensitivity of testing and may allow to detect even latent organic sinus node dysfunction. In conclusion, a synopsis of IHR, intrinsic CSNRT and intrinsic SACT with real SAD may be useful to estimate more accurately the degree of the impairment of intrinsic sinus node automaticity helping to differentiate the organic sinus node dysfunction from the autonomic one.

Adult↗
PubMedDate not supplied

[Incidence of non-tumor anomalies of the facial sinuses on x-ray computed tomography of the brain of asymptomatic patients. Clinical and radiologic correlations between involvements of ethmoid cells and other sinus cavities].

Two hundred ninety five consecutive brain CT examinations of asymptomatic adults were studied prospectively for detection of nontumoral paranasal sinus abnormalities. CT alterations were found in 104 cases (35.3%), localized to the ethmoid cells in 83 cases, the maxillary sinuses in 56 cases, the sphenoid sinuses in 19 cases, and the frontal sinuses in 18 cases. The relationships between ethmoid cells disease and alterations of the large paranasal cavities are analysed, and the association with previous sinusitis or rhinitis is evaluated. Frontal sinus disease is associated in more than two-thirds of the cases with pathologic meatic and/or unciform ethmoid cells, but such an association could not be demonstrated for the other cavities.

Adolescent↗
PubMed1990

Na/K-ATPase in rabbit paranasal sinus mucosa during induced sinusitis.

Sinusitis was produced in rabbits, after which animals were separated into three groups: allergic sinusitis, induced purulent sinusitis, and spontaneous purulent sinusitis. Mucosal specimens were taken from these animals and normal controls. Na/K-ATPase was localized cytochemically and its activity studied in order to define the energy metabolism of secretion. The Na/K-ATPase reaction was unable to be clearly distinguished in either the allergic sinusitis specimens or the normal mucosa. In both purulent sinusitis groups, an intensive reaction was observed in the subepithelial glands and a weak reaction was found in the goblet cells. The Na/K-ATPase activity in the purulent sinusitis groups was significantly higher than that in the normal control group. The increased Na/K-ATPase activity may be an affect of hyperactivity of the secretory cells.

Animals↗
PubMed1983

Allergic Aspergillus sinusitis: a newly recognized form of sinusitis.

The clinical and pathologic features of seven cases of a newly recognized form of chronic sinusitis are described. Most patients were young adults with a history of asthma, and all had chronic nasal polyps. Radiographically, there was opacification of multiple sinuses. Recurrent sinusitis was common, and several patients underwent numerous surgical drainage procedures. Histologically, a distinct mucinous material containing eosinophils, Charcot-Leyden crystals, and fungal hyphae was found in tissue resected from the sinuses. We believe that these findings constitute a distinct clinicopathologic entity that we term allergic Aspergillus sinusitis. This condition shares similar histopathologic features with allergic bronchopulmonary aspergillosis (ABPA) but affects the paranasal sinuses rather than the lung. Implications for therapy of this form of sinusitis and its possible relationship to allergic lung diseases are discussed.

Adolescent↗