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ABSTRACT: Chronic rhinosinusitis (CRS) with eosinophilic infiltration is a type of intractable rhinosinusitis often associated with asthma. The oxidants are well known to induce aggravate asthma. Heme oxygenase-1 (HO-1), a cytoprotective enzyme against oxidant, has been extensively studied in airway diseases. However, no study that observed HO-1 in both epithelial and subepithelial tissues of CRS has been reported.
Part of each specimen derived from the nasal polyps of CRS with and without eosinophilic infiltration was promptly fixed for hematoxylin-eosin staining and immunohistochemical analysis for HO-1 and macrophages.
We found that the expression of HO-1 in the epithelial layers of CRS without eosinophilic infiltration was significantly enhanced as compared with that of CRS with eosinophilic infiltration. On the other hand, the number of macrophages with HO-1 positive reactions was significantly greater in CRS with eosinophilic infiltration compared with CRS without eosinophilic infiltration.
Our study suggests that both a reduction of HO-1 expression in epithelial cells and an increase of infiltration of macrophages positive for HO-1 are related to the epithelial damage of CRS with eosinophilic infiltration.
Auris, nasus, larynx 11/2011; 39(4):387-92. · 0.58 Impact Factor
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ABSTRACT: Co-mobidity of asthma is known to result in a poor prognosis of post-endoscopic sinus surgery (post-ESS). Bacterial infection may play a key role in recurrent pathophysiology of sinusitis in post-ESS.
Forty-two patients with CRS associated with asthma undergoing ESS were enrolled. Bacterial culture was performed from the sinus cavity at the time of acute infectious episodes. Recurrence of sinonasal disease was analyzed in terms of steroid responsiveness and peak expiratory flow (PEF).
Totally 75 aspirates were obtained during post-ESS; 2 repeat aspirates from 10 patients, 3 from 5 patients, and 4 from 2 patients. Only 6 specimens (8.0%) obtained from 5 patients (11.9%) showed no growth whereas 83 isolates were recovered from 69 specimens. Sixteen patients had at least one episode of a significant decline of PEF. All except one patient complained of symptoms and signs of upper respiratory infections prior to a depression of PEF. Positive culture was obtained in 10 out of 11 patients examined at the time of acute exacerbation of CRS.
Bacterial infection may play a critical role of recurrent polyps and refractory symptoms during post-ESS follow-up. Moreover, worsening of sinusitis accompanies asthma exacerbation.
Auris, nasus, larynx 01/2011; 38(4):469-73. · 0.58 Impact Factor
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ABSTRACT: The link between nasal and bronchial disease has been studied extensively for chronic rhinosinusitis and asthma. The concept of "united airway allergy" has become widely accepted in the past decade. We evaluated the relationship between the upper and lower airways during follow-up after endoscopic sinus surgery by monitoring sinonasal and pulmonary functions.
Thirty-nine subjects with chronic rhinosinusitis associated with bronchial asthma were entered in this study. A self smell test using stick-type odorant materials was carried out daily to evaluate postoperative recurrence of sinonasal disease. Each patient was assessed for peak expiratory flow (PEF) 3 times daily.
The average (+/- SD) scores of initial symptoms were 8.3 +/- 2.2, which was significantly decreased to 1.5 +/- 1.4 by 3 months after operation. During postoperative follow-up, 25 of 39 patients showed no decrease in PEF, whereas the other 14 patients had at least 1 episode of a significant decline in PEF. In the postoperative course, with respect to the self smell test, 24 patients showed no aggravation of smell, but 15 patients had episode(s) of decreased olfaction. Twelve patients demonstrated worsening on the smell test concomitant with a decreased PEF. A discrepancy between olfactory acuity and pulmonary function was recognized in 5 patients. There were 22 patients with a good prognosis of parameters of both the upper and lower airways.
Daily monitoring of both upper and lower respiratory tract functions clearly revealed dual relationships, indicating that worsening of sinusitis accompanies asthma exacerbation. Appropriate measures of the upper and lower airways following endoscopic sinus surgery can be used to predict patient outcome.
The Annals of otology, rhinology, and laryngology 11/2010; 119(11):749-54. · 1.05 Impact Factor
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ABSTRACT: Chronic rhinosinusitis (CRS) with nasal polyps is characterized by eosinophilic infiltration. This study hypothesized that the aggregation of the mucosal pathology during remodeling is related to infiltrating eosinophils in patients with such nasal polyps.
To clarify the pathogenetic role of eosinophils in patients with CRS with nasal polyps, this study investigated the relationship between epithelial damage or basement membrane (BM) thickening and the epithelial infiltration of eosinophils in these nasal polyps.
The number of eosinophils that infiltrated into the epithelial and subepithelial layers of sinonasal tissues was counted. The staging of epithelial damage allowed the quantification of epithelial loss.
Both epithelial damage and BM thickness in CRS, which were correlated with the number of infiltrated eosinophils, were significantly greater than in the control group. Neither parameter showed significant differences between the asthma and non-asthma groups. There was a significantly correlation in the eosinophilic infiltration between the subepithelial and epithelial layers.
It is suggested that eosinophils that infiltrate into both the epithelial and subepithelial layers play a part in the process of mucosal remodeling of CRS with nasal polyps.
Rhinology 09/2009; 47(3):275-9. · 1.32 Impact Factor
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ABSTRACT: The clinical efficacy and cost effectiveness of oral antimicrobial prophylaxis with levofloxacin (LVFX) on endoscopic sinus surgery (ESS) was evaluated.
Ninety-three patients undergoing ESS were prospectively enrolled in the present study. The patients were randomly divided into 2 groups, LVFX and flomoxef (FMOX). Two hundred milligrams of LVFX was orally given 2 hours before the start of surgery and 6 hours after the end of surgery, which was followed by the administration of 200 mg every 12 hours for 2 days. One gram of FMOX was dissolved in 100 ml of physiological saline and given intravenously at the induction of anesthesia and 6 hours after the end of surgery, followed by infusion twice daily for 2 days.
There were no statistically significant differences between 2 groups in terms of age, sex, systemic complications, surgical procedures, the duration of the operation, the length of hospitalization, the amount of blood loss, body temperature, or the number of white blood cells or C-reactive protein. Although no statistical significance was observed in the bacterial resistance between the two antibiotics, LVFX seems to show a low rate of resistance pattern change as compared to FMOX. The present study demonstrated that no patients treated with LVFX or FMOX were afflicted with postsurgical infection.
Oral administration of LVFX is a simple, cost-effective and safe alternative to intravenous prophylaxis in ESS based on clinical efficacy and bacteriological study.
American journal of otolaryngology 07/2009; 31(5):360-3. · 0.77 Impact Factor
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ABSTRACT: Eosinophilic chronic rhinosinusitis (CRS) is characterized by the accumulation of numerous eosinophils in the sinus mucosa and nasal polyps, which are frequently difficult to control, even with surgery. The present study was designed to evaluate the expression and localization of eotaxins, which are well known to be potent and selective chemoattractants for eosinophils in CRS.
Randomized study.
The patients were classified into eosinophilic and noneosinophilic groups. Histopathological profiles of the nasal polyp were observed with hematoxylin-eosin staining. Eotaxin-1, -2, and -3 were immunohistochemically stained in the nasal polyps. Furthermore, the protein content of eotaxin subtypes inside the nasal polyp and sinus effusion was measured using enzyme-linked immunosorbent assay (ELISA).
In the nasal polyps, immunoreactivities of the eotaxin subfamily, eotaxin-1, -2, and -3, were noted in most of the infiltrating eosinophils, as well as in other inflammatory cells, epithelial cells, and endothelial cells. Compared with noneosinophilic CRS groups, eosinophilic CRS groups had a significant expression of eotaxins in their eosinophils. The eotaxin concentrations of nasal polyp and sinus effusion as measured by ELISA were significantly increased in the eosinophilic CRS group compared to the noneosinophilic CRS group.
The present findings suggest that enhanced eotaxin family production by eosinophils results in the recruitment of eosinophils into the tissue by a self-amplifying process. Laryngoscope, 2009.
The Laryngoscope 04/2009; 119(6):1053-9. · 1.75 Impact Factor
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ABSTRACT: We previously reported on the clinical effectiveness of functional inferior turbinosurgery utilizing modified vidian neurectomy, the resection of the posterior nasal nerve (PNN), combined with inferior turbinoplasty. In order to prevent re-innervation of the PNN after resection and to avoid postoperative massive hemorrhage--presumably resulting from insufficient fixation and unexpected exposure of the bony or cartilaginous fragments covered on the resected neurovascular bundle containing the sphenopalatine vessels and the PNN--we designed a surgical technique during which a vascular clip was used in order to provide traction of the mucoperiosteal flap. Then we compared it with the previous procedure (without the use of the clip). The injury and defects of the mucoperiosteal flap were evaluated by the degree of exposure to the bony or cartilaginous fragments and scored on a scale of 0 to 2 points. The defects of the mucoperiosteal flap were reduced by using a vascular clip. The average score of the defects was 0.97 +/- 0.73 (n = 64) in the conventional procedure without any manipulation and 0.27 +/- 0.45 (n = 60) in the procedure using a vascular clip. The difference observed between the two gropups was statistically significant (p < 0.001). These results demonstrated that this is a safe technique to prevent injury and defects of the mucoperiosteal flap in gaining access to expose the PNN. This should promote early wound healing, reduce the chance of recurrence and of postoperative massive hemorrhage.
Rhinology 04/2009; 47(1):45-7. · 1.32 Impact Factor
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ABSTRACT: The underlying pathophysiological mechanisms of the posterior nasal nerve (PNN) resection involved the suppression of the secretogogue motor and the inhibition of neurogenic inflammation induced by parasympathetic and sensory denervation.
The study was designed to clarify the underlying mechanisms of the resection of the PNN.
Ten patients with allergic rhinitis and non-allergic chronic rhinitis were enrolled in the study. Clinical symptoms were evaluated before and after administration of oxitropium bromide aerosol, and after the PNN resection. Biopsy specimens from the inferior turbinate mucosa obtained from five patients before and after resection of the PNN were examined.
The application of oxitropium bromide resulted in a significant reduction of both watery rhinorrhea and nasal obstruction, but not sneezing or postnasal drip. Resection of the PNN also significantly improved both rhinorrhea and nasal obstruction. Morphometric analysis of the density of the nasal gland showed a significant reduction, whereas no significant change was recognized in the density of the vessels. A significant reduction in the number of infiltrating neutrophils, eosinophils, and lymphocytes was recognized.
Acta oto-laryngologica 06/2008; 128(12):1337-41. · 0.98 Impact Factor
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Acta Clinica Croatica; Vol.48 No.1.
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Acta Clinica Croatica; Vol.48 No.1.
