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Role of the dermonecrotic toxin of Bordetella bronchiseptica in the pathogenesis of respiratory disease in swine.

Bordetella bronchiseptica is one of the etiologic agents causing atrophic rhinitis and pneumonia in swine. It produces several purported virulence factors, including the dermonecrotic toxin (DNT), which has been implicated in the turbinate atrophy seen in cases of atrophic rhinitis. The purpose of these experiments was to clarify the role of this toxin in respiratory disease by comparing the pathogenicity in swine of two isogenic dnt mutants to their virulent DNT(+) parent strains. Two separate experiments were performed, one with each of the mutant-parent pairs. One-week-old cesarean-derived, colostrum-deprived pigs were inoculated intranasally with the parent strain, the dnt mutant strain, or phosphate-buffered saline. Weekly nasal washes were performed to monitor colonization of the nasal cavity, and the pigs were euthanized 4 weeks after inoculation to determine colonization of tissues and to examine the respiratory tract for pathology. There was evidence that colonization of the upper respiratory tract, but not the lower respiratory tract, was slightly greater for the parent strains than for the dnt mutants. Moderate turbinate atrophy and bronchopneumonia were found in most pigs given the parent strains, while there was no turbinate atrophy or pneumonia in pigs challenged with the dnt mutant strains. Therefore, production of DNT by B. bronchiseptica is necessary to produce the lesions of turbinate atrophy and bronchopneumonia in pigs infected with this organism.

Animals↗

Nasal pressure-volume relationships determined with acoustic rhinometry.

Partitioning of ventilation has been hypothesized to be related to nasal pressure-volume relationships, relationships that have been difficult to measure. Regional differences in nasal passage pressure-volume relationships are likely because the nasal valve and anterior turbinate are structurally different, but both are altered by agents that alter vascular tone. This study determined nasal volume-to-pressure ratio (NVPR) on six healthy nonsmoking subjects by measuring nasal volume by using acoustic rhinometry at pressures ranging between -14 and +14 cmH2O on 3 days: baseline, after intranasal decongestion (oxymetazoline), and congestion (histamine). NVPR was lower in the nasal valve (0.07 +/- 0.01 cm3/cmH2O) than in the anterior portion of the turbinates (0.29 +/- 0.05 cm3/cmH2O; P < 0.005). Oxymetazoline decongestion decreased NVPR in the nasal valve by 23% and NVPR in the anterior portion of the turbinates by 47%. Histamine did not alter NVPR at either site. Nasal resistance changes correlated with changes in nasal valve and anterior turbinate volume. In summary, regional differences in nasal pressure-volume relationships exist and changes occur with pharmacologically induced vascular decongestion.

Acoustic Stimulation↗

Antimicrobial defensin peptides of the human nasal mucosa.

Defensins, a prominent group of antimicrobial peptides, are an important component of the innate immune response, particularly at mucosal surfaces that are vulnerable to colonization by potential pathogens. The present study was undertaken to investigate the expression of defensins in inferior turbinate mucosa of normal subjects and inferior turbinate mucosa and nasal polyps of patients with chronic sinusitis. Expression of beta-defensin 1 and 2 and alpha-defensin 5 and 6 messenger RNAs (mRNAs) was investigated by reverse transcriptase-polymerase chain reaction, and their expression level was semiquantitatively evaluated by dot blot hybridization. Immunohistochemical analysis was used for detection of alpha-defensins 1, 2, and 3 in tissue sections. Beta-defensin 1 mRNA was expressed in all tissue samples, at levels that did not differ significantly. Beta-defensin 2 mRNA was detected in the turbinate mucosa and nasal polyps of patients with chronic sinusitis, but not in normal mucosa. Its expression level was significantly higher in nasal polyps than in turbinate mucosa. Alpha-defensin 5 and 6 mRNAs were not expressed in any tissues, but alpha-defensins 1, 2, and 3 were detected in all tissue samples obtained from patients with chronic sinusitis. These results suggest that beta-defensin 1 may play a constitutive role in nasal defenses, whereas alpha-defensins 1, 2, and 3 and beta-defensin 2 may be induced in response to local infection or inflammation.

Adult↗

Isolated chronic maxillary sinusitis of non-dental origin does not correlate per se with ipsilateral intranasal structural abnormalities.

A case series of 35 patients with isolated chronic maxillary sinusitis of inflammatory non-dental origin was retrospectively reviewed to determine the correlation of ipsilateral intranasal structural abnormalities. The records were examined for computed tomographic, nasal endoscopic, and intraoperative findings. The incidence of ipsilateral and contralateral intranasal structural abnormalities at the ostiomeatal complex region, including conchae bullosae, Haller cells, paradoxical middle turbinates, and septal deviations, was determined. Nineteen of 35 patients (54%) had ipsilateral abnormalities and 16 (46%) did not. Of the 19 patients with ipsilateral abnormalities, 4 had Haller cells, 4 had conchae bullosae, 2 had paradoxical middle turbinates, and 12 had septal deviations. (Two patients had multiple ipsilateral factors.) Of the 16 patients with contralateral abnormalities, 4 had Haller cells, 3 had conchae bullosae, 2 had paradoxical middle turbinates, and 9 had septal deviations. Ten patients had only contralateral abnormalities, and 6 had no identifiable anatomic abnormality. The difference between the incidences of ipsilateral and contralateral abnormalities in this series of 35 patients with isolated chronic maxillary sinusitis was not statistically significant when the factors were analyzed as a group or by individual factor (range in odds ratios for the various factors, 1 to 1.54; range in p values for the various factors, .25 to 1). Thus, the data show that ipsilateral structural abnormalities at the ostiomeatal complex region, including conchae bullosae, Haller cells, paradoxical middle turbinates, and septal deviations, did not correlate per se with isolated chronic maxillary sinusitis that was not attributable to dental disease.

Chronic Disease↗

Incidence of frontal sinusitis following partial middle turbinectomy.

The role of partial middle turbinate resection as an adjunct to endoscopic sinus surgery is controversial. Recent literature suggests that middle turbinate resection may have a detrimental effect on the frontal sinus. A retrospective analysis of 155 consecutive patients undergoing partial middle turbinate resection utilizing the technique of the senior author (J.A.D.) for either sinusitis or nasal obstruction was conducted. The data reveal a low rate of frontal sinusitis following partial middle turbinectomy (10%). None of the patients undergoing partial middle turbinectomy for nasal obstruction developed frontal sinusitis postoperatively. No major complications were encountered. Frontal sinusitis following middle turbinectomy was often associated with preoperative comorbidity such as asthma, nasal polyps, severe disease score on computed tomography, or diseased middle turbinates. The authors conclude that partial middle turbinectomy for treatment of sinusitis and nasal obstruction has a low incidence of postoperative frontal sinusitis. Development of frontal sinusitis may be predictable on the basis of several comorbid factors.

Adolescent↗

Swiftlase inferior turbinoplasty.

The hypertrophied inferior turbinates are responsible for nasal obstruction in patients with chronic rhinitis. Several methods have been applied to solve this problem. Recently, laser methods have produced good results. We present the management of 387 patients with hypertrophy of the inferior turbinates mucosa, using CO2 laser in combination with the Swiftlase apparatus. CO2 laser energy delivered through the Swiftlase apparatus provides a char-free ablation of a superficial tissue layer. Swiftlase is easily installed onto the existing CO2 laser units and provides a high-power density. The 1-year postoperative follow-up revealed good results in 261 (81%) of 321 patients, thus establishing CO2 laser in combination with the Swiftlase apparatus as a promising new approach for the management of inferior turbinate hypertrophy. CO2 laser energy delivered through the Swiftlase apparatus offers a treatment modality capable of achieving excellent results in hypertrophy of the inferior turbinates with minimal morbidity.

Adolescent↗

Increased expression of IL-4, IL-5, IFN-gamma, IL-6, IL-8, and TGF-beta mRNAs in maxillary mucosa of patients with chronic sinusitis.

This study aimed to investigate expression of various cytokine mRNAs, including IL-6, IL-8, TGF-beta, IL-4, IL-5, and IFN-gamma in maxillary sinus mucosa of patients with chronic sinusitis. Maxillary sinus mucosae of six patients with chronic sinusitis and turbinate mucosae of six healthy subjects were obtained. We performed RT-PCR and Southern blot to examine gene expression of the cytokines IL-6, IL-8, TGF-beta, IL-4, IL-5, and IFN-gamma in maxillary sinus mucosa and compared the results with cytokine gene expressions in normal turbinate mucosa. IL-6, IL-8, TGF-beta, IL-4, IL-5, and IFN-gamma mRNAs were expressed more frequently in maxillary sinus mucosa from patients with chronic sinusitis than in normal turbinate mucosa. All the maxillary sinus mucosa specimens revealed relatively higher mean density ratio for each cytokine investigated than did normal turbinate mucosa. IL-6, IL-8, TGF-beta, IL-4, IL-5, and IFN-gamma mRNAs were expressed simultaneously in maxillary sinus mucosa of chronic sinusitis. These cytokines may be responsible for recruitment of inflammatory cells and for mucosal thickening in chronic sinusitis, and thus chronicity of the disease.

Adult↗

Modified method of submucosal turbinectomy: mucosal flap method.

Sixteen patients with nasal obstructions were treated by use of a new technique of submucosal turbinectomy (mucosal flap method) which can reduce a large volume of the turbinate without leaving any mucosal defect. Subjective nasal obstruction showed improvement in all of the cases at 1 month after operation, and objective nasal obstruction examined with rhinomanometry was improved in 13 out of 16 sides of the noses (8 cases). Mucosal flaps were made from the turbinate mucosa facing the common meatus. After excision of the turbinate bone with the mucosa, the bone stump and mucosal defect were covered with the newly repositioned mucosal flap. It is considered that this mucosal flap method can reduce a large volume of the turbinate without leaving any mucosal defect.

Adolescent↗

The embryonic development of the human ethmoid labyrinth from 8-40 weeks.

The embryonic development of the human ethmoid labyrinth was studied in 24 fetal heads aged between 8 and 40 weeks of gestation under light microscopy. The uncinate process was identifiable at 8 weeks of gestation on the laterosuperior portion of the inferior turbinate; however, at this stage of development, the ethmoid bulla was not apparent. The ethmoid bulla developed on the lateral wall of the middle meatus by 12 weeks of gestation. By 14 weeks, the primordial ethmoid infundibulum and primordial maxillary sinus were seen developing between the uncinate process and the ethmoid bulla. It was obvious that the anterior and middle ethmoid cells developed from the ethmoid bulla. By 22 weeks of gestation, the first cell of the anterior ethmoid group was evident in the anterior-inferior portion of the ethmoid bulla. By 23 weeks of gestation, the first cell of the middle ethmoid group was visible in the superior portion of the ethmoid bulla. Pneumatization of the middle turbinate occurred as part of normal development of the ethmoid labyrinth. By 32 weeks of gestation, the ostium for the development of the middle turbinate cell was seen in the superior-interior portion of the middle turbinate. These observations provide new insight into the development of the ethmoid labyrinth and have important implications for the understanding of normal anatomy and developmental variants of the ethmoid labyrinth.

Embryonic and Fetal Development↗

Technical problems with protein extraction of chemokines featuring RANTES.

Chemokines are known to be one of the sources for eosinophilic tissue infiltration in eosinophilic inflammation. Detection of beta-chemokines such as RANTES was possible in nasal tissue with or without eosinophilic infiltration. The concentration of chemokines which has been measured in the same tissue differs often in the literature. Aim of this study was to compare the different techniques of protein extraction and help to understand and interpret the investigation on RANTES secretion. Tissue of nasal polyps, inferior and middle turbinate was cut into halves and every half on its own pulverized using liquid nitrogen. The protein extraction was performed either with citric acid solution (pH 2.5) or phosphate buffered saline (PBS). The samples were then lyophilized. The concentration of RANTES was measured by a specific double sandwich ELISA. Using the citric acid technique the average concentration of RANTES in middle turbinates was 1.3 ng/mg, in inferior turbinates 1.6 ng/mg and in polyps 2.6 ng/mg tissue, using the PBS technique respectively 0.6 ng/mg, 0.5 ng/mg and 0.8 ng/mg tissue. Our data revealed a mismatch of 3.3:1 for polyps (citric acid: PBS), 3.2:1 for inferior and 2.2:1 for middle turbinates, respectively. Consequent comparison between the results of different techniques was not possible. Of special interest was also the fact that different techniques had different efficiencies of protein extraction in different tissues. Present statements on RANTES concentrations as a prognostic factor in nasal tissues need a technically careful standardization as far as this study shows.

Cells, Cultured↗

[Correlation between objective criteria and subjective evaluation of symptoms in chronic rhinosinusitis].

INTRODUCTION: We evaluated the possible correlations between the extent of inflammatory infiltration of the nasal mucosa caused by mechanical irritation (septal deviation and hypertrophy of the middle turbinate) and nasal airway resistance measured by rhinomanometry and acoustic rhinometry. Subjective evaluation of the nasal obstruction, rhinorrhoea and headache was done by visual analogic scale and compared with the inflammation. PATIENTS AND METHODS: 40 patients with a more than 18 months' history of chronic rhinosinusitis associated with septal deviation and/or hypertrophy of the middle turbinate were included in the study. The density of inflammatory cells (graded from + to +3, where + means few and +3 abundant inflammatory cells) in the mucosa of the middle turbinate was evaluated histopathologically. RESULTS: We found a significant correlation between subjective intensity of nasal obstruction and inflammation (mainly lymphocytes) of the middle turbinate mucosa and the value of nasal airway resistance measured by rhinomanometry. No correlation was found between the other parameters studied. CONCLUSION: Mechanical stimulation at the level of turbinoseptal contact causes inflammation in the mucosa which correlates with both subjective nasal airway resistance and rhinomanometry values.

Adolescent↗

Histopathological verification of clinical indications to partial inferior turbinectomy.

Surgical treatment in cases where disturbances of the nasal patency causes changes in the nasal inferior turbinates is controversial. The authors performed light- and electron microscopy and morphometric examinations of the mucous membrane of the nasal inferior turbinates obtained after partial inferior turbinectomy in patients with vasomotor and perennial allergic rhinitis and compensation hypertrophy of the nasal inferior turbinate accompanied by nasal deviation of the septum. In specimens obtained from patients with vasomotor rhinitis, a small number of glands and fibrosis of the lamina propria was observed. In specimens obtained from perennial allergic rhinitis patients, plenty of glands and large oedema was observed. In the group with compensatory hypertrophy of the inferior turbinate, normal glands and fibred areas around the vessels were observed. The largest histopathological changes of degeneration and hypertrophy of the nasal mucosa were observed in vasomotor rhinitis patients. Histopathological examination of nasal mucosa slides confirmed the usefulness of a partial inferior turbinectomy, but only in vasomotor rhinitis patients.

Adult↗

[Histopathological verifications clinical indications in the inferior turbinoplasty].

Surgical treatment in cases of disturbances of nasal patency caused changes in the nasal inferior turbinates are controversial. The authors performed the microscopic (light microscope) and morphometric examinations of mucous membrane of the nasal inferior turbinates obtained after inferior turbinoplasty in patients with vasomotor and perennial allergic rhinitis and compensation hypertrophy of nasal inferior turbinate accompanied of nasal deviation septum. Analysing of morphologic changes in mucous membrane of the nasal inferior turbinates verified of clinic indications to inferior turbinoplasty.

Case-Control Studies↗

[The secretion of chemokine RANTES in epithelial cells of nasal polyps and its significance].

OBJECTIVE: To investigate the effect of RANTES(regulated upon activation, normal T cell expressed and secreted) on chemotaxis, migration and accumulation of eosinophils in nasal polyps during epithelial immune responses. METHODS: The epithelial cells were obtained from nasal polyps and inferior turbinates in patients with snoring, and cultured for 24 and 48 hours with IL-1 beta(25 micrograms/L, 50 micrograms/L). RANTES was measured in the culture supernatant by ELISA. RESULTS: 1. On incubation with IL-1 beta, the epithelial cells from inferior turbinate and nasal polyps released 1.5-10 fold and 10-20 fold greater amounts of RANTES respectively than unstimulated samples. Significant increase in levels of RANTES was found in both groups(P < 0.001); 2. There was no difference between nasal polyp and inferior turbinate before incubation with IL-1 beta(P > 0.05) in the level of RANTES. After IL-1 beta stimulation, the concentration of RANTES was higher in polyp than in inferior turbinate (P < 0.001); 3. The expression of RANTES in both groups was dose-dependent and time-dependent upon stimulation of IL-1 beta. CONCLUSION: The epithelial cells of nasal mucosa are active end-organs, capable of releasing chemokine RANTES. In nasal polyps, RANTES has chemotactic activity for eosinophils and other inflammatory cells. It could affect the chemotaxis and eosinophil function and may play an important role in polyp formation.

Adult↗

A radiological anatomic study of the cribriform plate compared with constant structures.

BACKGROUND: Understanding of the anterior skull base anatomy is crucial to avoid intracranial violations during endoscopic surgery. The aims of this study were to define the normative data about cribriform plate depth and the relationship between this dimension and the measurements of the adjacent anatomical structures such as middle turbinate length, maximal vertical orbital height and distance between the ethmoid roof and the nasal floor. PATIENTS AND METHODS: Paranasal computerized tomographic scans of 136 healthy adults were included into the study. The cribriform plate depth compared to the ethmoid roof and the adjacent anatomical structures mentioned above were measured bilaterally. RESULTS: The maximal vertical orbital height was detected as the most constant anatomic measurement. We found the mean level difference between the ethmoid roof and the cribriform plate as 6.1 +/- 2.3 (range 1-12 mm) on the left side and 6.1 +/- 2.2 (1-15 mm) on the right side. The middle turbinate was significantly longer in the Keros Type I group than in the other groups (p<0.05). Furthermore, the distance between the ethmoid roof and the nasal floor was lowest in the Keros Type I group (p<0.01). The distance between the ethmoid roof and the nasal floor was statistically higher in Keros group 3 among all groups (p<0.01). The deeper the cribriform plate, the higher the nasal cavity. CONCLUSION: To the best of our knowledge, our study has a unique feature by including the data of the constant anatomical structures comparing with the cribriform plate depth. Since in the group with excessive cribriform plate depth, the middle turbinate was short, care should be taken especially during middle turbinate resections.

Adolescent↗

Expression of interleukin-5, interleukin-8, and interleukin-10 mRNA in the osteomeatal complex in nasal polyposis.

BACKGROUND: Several cytokines are expressed in chronic sinusitis with and without underlying allergy. Their local production and regulation in the osteomeatal complex, the key area of paranasal sinuses, still is not fully understood. This study was performed to investigate differences of cytokine messenger RNA (mRNA) expression between the medial and the lateral part of the middle turbinate and anterior ethmoid mucosa of allergic and nonallergic patients. METHODS: Using the LightCycler system for real-time reverse-transcription polymerase chain reaction, we investigated the content of interleukin (IL)-5, IL-8, and IL-10 mRNA in tissue samples from middle turbinates and anterior ethmoids of 18 patients with chronic sinusitis and nasal polyps. Inferior turbinate mucosa of six control subjects without sinusitis and allergy served as control. RESULTS: IL-5 mRNA was detectable in 32 (60%) of 54 samples (two of six controls) in significant different amounts between the various locations (p < or = 0.001). Anterior ethmoid mucosa (0.96+/-0.99) expressed the highest amount of IL-5 mRNA followed by the lateral (0.37+/-0.54) and the medial portion of the middle turbinate (0.12+/-0.29) with no difference between allergic and nonallergic subgroups. IL-8 was detected in significant higher amounts in all three origins with no significant difference in concentrations between the examined locations as compared with controls. Patients expressed either IL-5 or IL-8 or both cytokine mRNA. IL-10 was expressed in all three specimens from five of eight allergic patients. All five individuals with clinical symptoms of allergy at the time of operation expressed IL-10 in at least one specimen. CONCLUSION: IL-5 cytokine expression in the osteomeatal complex is linked to the presence of nasal polyps, whereas IL-8 is up-regulated without distinct correlation to nasal polyps. IL-10 expression was detectable in five of eight allergic patients.

Adult↗

[Expression and distribution of aquaporin-5 in human nasal polyps].

OBJECTIVE: To investigate the distribution and expression of aquaporin-5 (AQP-5) in nasal polyps and explore the role of AQP-5 in the formation of nasal polyps and the normal function of AQP-5 in the inferior turbinate. METHOD: AQP-5 were studied in 30 samples nasal polyps and 12 samples of inferior turbinates with immunochemistric staing. RESULT: The level of AQP-5 positive cells in the serous cells from nasal polyps were lesser than that from inferior turbinate, and the level of AQP-5 positive cells in the blood vessel endothelium from nasal polyps were more than that from inferior turbinate. CONCLUSION: AQP-5 may play the role in both the formation of nasal polyps and the function of normal nasal mucous membrane.

Adolescent↗

[Combination application of radiofrequency ablation in nasal operation].

OBJECTIVE: To investigate the clinical efficacy of radiofrequency ablation in treating the inferior turbinates hypertrophic and allergic rhinitis after septoplasty or nasal polypectomy. METHOD: Ninety-one patients with nasal septum deviation or nasal polyp with inferior turbinates hypertrophic and(or) allergic rhinitis were underwent septoplasty or nasal polypectomy. Sixty-two cases of 91 patients with inferior turbinates hypertrophic or allergic rhinitis underwent radiofrequency ablation, 29 cases did not. The preoperative and postoperative nasal obstructions were investigated by visual analogue scale (VAS). Allergic rhinitis symptoms were assessed by 1997s Haikou standard. RESULT: The nasal obstruction and allergic symptom of 62 patients who underwent radiofrequency ablation were improved in 3 months postoperatively. VAS improved from (89.5+/-8.7) % to (26.2+/-8.7) % (left side) and (90.3+/-10.5) % to (32.1+/-10.3) % (right side) (P < 0.01). In control group: VAS improved from (90.5+/-8.0) % to (39.2+/-8.9) % (left side) and (89.9+/-11.5) % to (48.1+/-8.1) % (right side) (P <0.01). However, the mean of postoperative nasal obstruction VAS in radiofrequency ablation group is significantly higher than that in control group (P <0.01). CONCLUSION: Combination application of radiofrequency ablation in nasal operation to cure the inferior turbinates hypertrophic and allergic rhinitis is a safe, effective and less traumatic method.

Adolescent↗