RESUMEN
BACKGROUND: Chronic Rhinosinusitis is currently classified into eosinophilic and non-eosinophilic, according to the histologic quantification of the number of eosinophils in nasal mucosa biopsy. There is a lack of unanimous histopathologic criteria and methodology for this classification and no consensus regarding a cut-off point for Eosinophils per High power field. METHODOLOGY: A systematic electronic search was performed on BVS, PUBMED, PUBMED PMC, SCOPUS, WEB OF SCIENCE, EMBASE, COCHRANE and PROQUEST databases looking for studies that reported a cut point for classification of Eosinophilic Chronic Rhinosinusitis (eCRS), and data concerning methodology of classification was extracted. RESULTS: We identified 142 studies that reported 29 different cut-off values for classification of eCRS, and different methods of histologic analysis. Out of these studies 13 reported their own methodology to establish the cut-off point, and used different reference standards as polyp recurrence, asthma and allergy, immunocytochemistry, quality of life index, standard deviation of the control population and cluster analysis. CONCLUSIONS: Further studies are needed to determine a precise cut-off point, especially international multicentered cluster analysis. Moreover, methodologic standardization of biopsy and analysis is needed to certify comparable results. Multiple biopsy sites, densest cellular infiltration area examination and oral steroids restriction at least four weeks before sampling are advisable.
Asunto(s)
Pólipos Nasales , Rinitis , Sinusitis , Enfermedad Crónica , Eosinófilos/patología , Humanos , Pólipos Nasales/patología , Calidad de Vida , Rinitis/diagnóstico , Rinitis/patología , Sinusitis/diagnóstico , Sinusitis/patologíaAsunto(s)
Aspirina/efectos adversos , Pólipos Nasales/patología , Mucosa Respiratoria/metabolismo , Enfermedades Respiratorias/etiología , Enfermedades Respiratorias/metabolismo , Rinitis/etiología , Rinitis/metabolismo , Sinusitis/etiología , Sinusitis/metabolismo , Biomarcadores , Enfermedad Crónica , Progresión de la Enfermedad , Susceptibilidad a Enfermedades , Humanos , Mucosa Respiratoria/patología , Enfermedades Respiratorias/patología , Rinitis/patología , Sinusitis/patologíaRESUMEN
BACKGROUND: Chronic rhinosinusitis (CRS) is a frequently observed condition in patients with immunodeficiency secondary to tumor necrosis factor alpha inhibitors (TNFαis). The histologic features of CRS caused by TNFαis have yet to be determined and may have important implications in understanding the pathophysiology of the disease process. METHODS: A structured histopathology report was used to analyze sinus tissue removed during functional endoscopic sinus surgery (FESS). These structured histopathology variables were compared among patients with CRS on TNFαi (CRSαi), CRS without nasal polyps (CRSsNP) patients, and CRS with nasal polyps (CRSwNP) patients. RESULTS: Eighteen CRSαi, 91 CRSwNP, and 113 CRSsNP patients undergoing FESS were analyzed. Compared to CRSsNP, CRSαi patients exhibited increased mucosal ulceration (16.7% vs 0.9%, p < 0.008), increased fibrosis (100% vs 34.5%, p < 0.001), and increased presence of Charcot-Leiden crystals (16.7% vs 0%, p < 0.002). Compared to CRSwNP, CRSαi patients demonstrated increased fibrosis (100% vs 54.9%, p < 0.001), decreased presence of subepithelial edema (44.4% vs 69.2% p < 0.043), decreased eosinophil aggregates (22.2% vs 47.3% p < 0.042), and fewer eosinophils per high-power field (44.4% vs 73.6%, p < 0.017). CONCLUSION: CRSαi exhibits structured histopathology more similar to CRSsNP. In the appropriate clinical context, it may be reasonable that the medical regimen for these patients be focused on a more antineutrophilic, macrolide-based approach. This study provides insight into the inflammatory environment of patients with CRSαi and may have implications for disease management.
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Inmunosupresores/efectos adversos , Rinitis/inducido químicamente , Sinusitis/inducido químicamente , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Enfermedad Crónica , Endoscopía , Femenino , Humanos , Inflamación , Masculino , Persona de Mediana Edad , Pólipos Nasales/patología , Pólipos Nasales/cirugía , Senos Paranasales/patología , Fenotipo , Rinitis/patología , Rinitis/cirugía , Sinusitis/patología , Sinusitis/cirugíaRESUMEN
BACKGROUND: There remains considerable variation in the extent of sinonasal preservation during the approach for endoscopic transsphenoidal hypophysectomy (TSH). We advocate for a minimally destructive approach utilizing turbinate lateralization, small posterior septectomy, no ethmoidectomy, and preservation of nasoseptal flap (NSF) pedicles bilaterally. Due to these factors, this approach may affect the rates of postoperative rhinosinusitis. The objective of this study is to define the rates of postoperative rhinosinusitis in patients undergoing this approach. METHODS: Single institution, retrospective chart review of patients undergoing TSH from 2005 to 2018. RESULTS: A total of 415 patients were identified and 14% developed an episode of postoperative rhinosinusitis within 3 months. These patients were significantly more likely to have had a history of recurrent acute or chronic rhinosinusitis. Most cases were sphenoethmoidal sinusitis managed with 1 to 2 courses of antibiotics. Of patients with postoperative rhinosinusitis, most did not undergo NSF. Average follow-up was 38 months. Six patients (1.4%) underwent post-TSH functional endoscopic sinus surgery (FESS). Average time from TSH to FESS was 26.3 months. Two of these patients had a history of prior chronic rhinosinusitis without polyposis. Two patients underwent revision TSH for recurrent tumor as the primary indication for surgery at time of FESS. Twenty-two-item Sino-Nasal Outcome Test (SNOT-22) scores generally increased immediately postoperatively, but frequently decreased below preoperative level by the time of last follow-up, regardless of whether patients developed rhinosinusitis. CONCLUSION: Sinonasal preservation during TSH is associated with a low rate of postoperative rhinosinusitis requiring FESS and excellent long-term patient reported outcomes. We continue to advocate for sinonasal preservation during pituitary surgery.
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Hipofisectomía/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Cirugía Endoscópica por Orificios Naturales/efectos adversos , Complicaciones Posoperatorias/cirugía , Rinitis/cirugía , Sinusitis/cirugía , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/patología , Estudios Retrospectivos , Rinitis/etiología , Rinitis/patología , Prueba de Resultado Sino-Nasal , Sinusitis/etiología , Sinusitis/patología , Seno Esfenoidal/cirugía , Colgajos Quirúrgicos/cirugía , Resultado del TratamientoAsunto(s)
Pólipos Nasales , Rinitis , Sinusitis , Enfermedad Crónica , Matriz Extracelular , Humanos , Mucosa Nasal , Pólipos Nasales/patología , Rinitis/patología , Sinusitis/patologíaRESUMEN
BACKGROUND: Precision medicine is an up-to-date strategy aimed at individualizing precise pathophysiological mechanisms. Thus, precision medicine is the basis for personalized medicine, inasmuch as it seeks to define the most appropriate treatment for each patient. Nasal cytology requires only an optical microscope, stains, glasses, and nasal cytology curettes. The procedure may last very few minutes using quick staining and, therefore, it can be considered a reliable point-of-care test in the office setting. METHODS: Cross-sectional study that included 5030 outpatients with nasal disorders: 2612 males and 2418 females, with a mean age of 36.8 ± 17.1 years, who were attended to within a 5-year period. The patients were subdivided according to skin prick-test and nasal cytology results into subjects with allergic rhinitis or non-allergic rhinitis. Cellular forms were further subdivided based on their cytotype: NARNE (> 50% of neutrophils with absence of spores and bacteria); NARES (> 20% of eosinophils); NARMA (> 10% of mast cells); and NARESMA (> 20% of eosinophils and > 10% of mast cells). RESULTS: 453 subjects (9%) had negative nasal cytology, 1056 (21%) had allergic rhinitis, 538 (10.7%) had NARES, 493 (9.8%) had nasal polyposis, 251 (5%) had rhinosinusitis, 221 (4.4%) had NARESMA 201 (4%) had infectious rhinitis, 131 (2.6%) had NARMA, 89 (1.8%) had NARNE, with the remaining subjects having a miscellaneous inflammatory/infectious profile. CONCLUSIONS: Nasal cytology provides quick information about phenotype and endotype and can be repeated during follow-up to assess post-treatment changes.
Antecedentes: La medicina de precisión es una estrategia actualizada que apunta a individualizar los mecanismos fisiopatológicos precisos. Entonces, la medicina de precisión es la base de la medicina personalizada, como definir el tratamiento apropiado en cada paciente. La citología nasal solo necesita un microscopio óptico, tinturas, gafas y curetas. El procedimiento puede durar muy pocos minutos usando tinción rápida, por lo tanto, se puede considerar una prueba confiable en el punto de atención en el consultorio. Métodos: Estudio transversal que incluyó 5030 pacientes ambulatorios con trastornos nasales: 2612 hombres y 2418 mujeres, edad promedio de 36.8 ± 17.1 años, quienes fueron atendidos en un periodo de cinco años. Los pacientes se subdividieron conforme a la prueba cutánea y la citología nasal en sujetos con rinitis alérgica y con rinitis no alérgica. Las formas celulares se subdividieron en función del citotipo: rinitis no alérgica con predominio de infiltración eosinofílica (NARNE, neutrófilos > 50 % con esporas y bacterias ausentes); rinitis no alérgica con eosinófilos (NARES, eosinófilos > 20%); rinitis no alérgica con predominio de infiltrado de mastocitos (NARMA, mastocitos > 10 %) y rinitis no alérgica con eosinófilos y mastocitos (NARESMA, eosinófilos > 20 % y mastocitos > 10 %). Resultados: 453 (9 %) sujetos tuvieron citología negativa a nasal, 1056 (21 %) rinitis alérgica, 538 (10.7%) NARES, 493 (9.8%) poliposis nasal, 251 (5%) rinosinusitis, 221 (4.4%) NARESMA, 201 (4%) rinitis infecciosa; 131 (2.6%) NARMA y 89 (1.8%) NARNE; los sujetos restantes tenían un perfil inflamatorio-infeccioso misceláneo. Conclusiones: La citología nasal proporciona información rápida sobre el fenotipo y endotipo y puede repetirse en el seguimiento para evaluar los cambios posteriores al tratamiento.
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Nariz/patología , Pruebas en el Punto de Atención , Medicina de Precisión/métodos , Rinitis/patología , Adulto , Estudios Transversales , Femenino , Humanos , MasculinoRESUMEN
BACKGROUND: Nasal cytology in a easy-to apply method to differentiate rhinitis phenotypes from a physiopathogenic and diagnostic perspective. There are controversies about the relationship between clinical severity of rhinitis and inflammatory patterns expressed in the nasal cytology. OBJECTIVES: To study the characteristic of the eosinophil and neutrophil patterns in the nasal scraping for Allergic Rhinitis (AR) and Non Allergic Rhinitis (NAR) and its relationship with the clinical grades of rhinitis established by the Allergic Rhinitis and its Impact on Asthama Guideline (ARIA) Methods: In a observational, cross-sectional study we included patients aged 5 to 18 years presenting symptoms of either allergic (AR) or non- allergic rinitis (NAR) without asthma. Cytology was performed by analyzing nasal scraping obtained from the mucosal surface of the inferior turbinate and samples were stained using thr hematoxylin and eosin stain procedure. Inflammatory patterns between AR and NAR and between clinical grades of rhinitis classified by ARIA guide were compared. RESULTS: A total of 231 patients were included. Patients with AR exhibited higher percentage of eosinophils in nasal cytology than those with NAR (p = 0.0012) but no differences were observed in neutrophil count (p = 0.4011). No differences in the percentage of eosinophils and neutrophils between different grades of AR (p = 0.7342 and p = 0.0797 respectively) and NAR (p = 0.1010 and p = 0.1422 respectively) were observed. CONCLUSION: Eosinophil count in the nasal cytology was useful to differentiate rhinitis with a positive allergen skin test from rhinitis with negative skin test, but as neutrophils count, does not help to distinguish clinical grades of AR and NAR as classified by ARIA.
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Eosinófilos/patología , Mucosa Nasal/patología , Neutrófilos/patología , Rinitis/patología , Adolescente , Niño , Preescolar , Estudios de Cohortes , Estudios Transversales , Técnicas Citológicas , Femenino , Humanos , Masculino , Valor Predictivo de las Pruebas , Rinitis/diagnóstico , Índice de Severidad de la Enfermedad , Pruebas CutáneasAsunto(s)
Pólipos Nasales/tratamiento farmacológico , Rinitis/tratamiento farmacológico , Rinitis/patología , Sinusitis/tratamiento farmacológico , Sinusitis/patología , Verapamilo/uso terapéutico , Estudios de Casos y Controles , Enfermedad Crónica , Humanos , Factores Inmunológicos/administración & dosificación , Factores Inmunológicos/efectos adversos , Factores Inmunológicos/uso terapéutico , Verapamilo/administración & dosificación , Verapamilo/efectos adversosRESUMEN
INTRODUCTION: Antibiotics are frequently used for the treatment of rhinosinusitis. Concerns have been raised regarding the adverse effects of antibiotics and growing resistance. The lack of development of new antibiotic compounds has increased the necessity for exploration of non-antibiotic compounds that have antibacterial activity. Amlodipine is a non-antibiotic compound with anti-inflammatory activity. OBJECTIVE: In this study we aimed to investigate the potential role of amlodipine in the treatment of rhinosinusitis by evaluating its effects on tissue oxidative status, mucosal histology and inflammation. METHODS: Fifteen adult albino guinea pigs were inoculated with Staphylococcus aureus and treated with saline, cefazolin sodium, or amlodipine for 7 days. The control group was composed by five healthy guinea pigs. Animals were sacrificed after the treatment. Histopathological changes were identified using Hematoxylin-Eosin staining. Inflammation was assessed by Polymorphonuclear Leukocyte infiltration density. Tissue levels of antioxidants (superoxide dismutase, glutathione) and an oxidative product (malondialdehyde) were determined. RESULTS: In rhinosinusitis induced animals, amlodipine reduced loss of cilia, lamina propria edema and collagen deposition compared to placebo (saline) and although not superior to cefazolin, amlodipine decreased polymorphonuclear leukocyte infiltration. The superoxide dismutase activity and glutathione levels were reduced, whereas the malondialdehyde levels were increased significantly in all three-treatment groups compared to the control group. Amlodipine treated group showed significantly increased superoxide dismutase and glutathione levels and decreased malondialdehyde levels compared to all treatment groups. CONCLUSION: The non-antibiotic compound amlodipine may have a role in acute rhinosinusitis treatment through tissue protective, antioxidant and anti-inflammatory mechanisms.
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Amlodipino/farmacología , Antiinflamatorios/farmacología , Rinitis/tratamiento farmacológico , Sinusitis/tratamiento farmacológico , Amlodipino/uso terapéutico , Animales , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Antiinflamatorios/uso terapéutico , Cefazolina/farmacología , Cefazolina/uso terapéutico , Ensayo de Inmunoadsorción Enzimática , Glutatión/análisis , Glutatión/efectos de los fármacos , Cobayas , Malondialdehído/análisis , Mucosa Nasal/efectos de los fármacos , Mucosa Nasal/patología , Distribución Aleatoria , Valores de Referencia , Reproducibilidad de los Resultados , Rinitis/microbiología , Rinitis/patología , Sinusitis/microbiología , Sinusitis/patología , Staphylococcus aureus , Superóxido Dismutasa/análisis , Superóxido Dismutasa/efectos de los fármacos , Resultado del TratamientoRESUMEN
INTRODUCTION: For decades, animals have been used in sinonasal experimental models, and the practice has increased substantially in the last few years. This study aimed to assess the pathogenesis of infectious process and medication efficiency to treat rhinosinusitis. OBJECTIVE: To evaluate the efficiency of the proposed experimental model to induce an acute bacterial sinonasal infectious process through histological analysis and sinus secretion cultures. METHODS: This was an experimental study with 22 New Zealand rabbits, divided into: group A (six rabbits), group B (seven rabbits), group C (seven rabbits), and group D (control group with two rabbits). Rhinosinusitis was induced by the insertion of a synthetic sponge into the right nasal cavity of 20 animals (study groups), followed by the instillation of bacterial strains (50% Staphylococcus sp. and 50% Streptococcus sp.). The groups were euthanized within 10 days (group A), 17 days (group B), and 30 days (groups C and D). RESULTS: All the rabbits of the study group developed acute bacterial rhinosinusitis, which was diagnosed through macroscopic evaluation, histological analysis, and sinus secretion culture. CONCLUSION: The proposed model is technically simple to perform, it is similar to the rhinogenic model in human beings, and it is highly efficient to reproduce an acute bacterial sinus infection.
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Modelos Animales de Enfermedad , Rinitis/microbiología , Sinusitis/microbiología , Enfermedad Aguda , Animales , Femenino , Masculino , Conejos , Rinitis/patología , Sinusitis/patologíaRESUMEN
Introduction: For decades, animals have been used in sinonasal experimental models, and the practice has increased substantially in the last few years. This study aimed to assess the pathogenesis of infectious process and medication efficiency to treat rhinosinusitis. Objective: To evaluate the efficiency of the proposed experimental model to induce an acute bacterial sinonasal infectious process through histological analysis and sinus secretion cultures. Methods: This was an experimental study with 22 New Zealand rabbits, divided into: group A (six rabbits), group B (seven rabbits), group C (seven rabbits), and group D (control group with two rabbits). Rhinosinusitis was induced by the insertion of a synthetic sponge into the right nasal cavity of 20 animals (study groups), followed by the instillation of bacterial strains (50% Staphylococcus sp. and 50% Streptococcus sp.). The groups were euthanized within 10 days (group A), 17 days (group B), and 30 days (groups C and D). Results: All the rabbits of the study group developed acute bacterial rhinosinusitis, which was diagnosed through macroscopic evaluation, histological analysis, and sinus secretion culture. Conclusion: The proposed model is technically simple to perform, it is similar to the rhinogenic model in human beings, and it is highly efficient to reproduce an acute bacterial sinus infection. .
Introdução: A realização de modelos experimentais nasossinusais em animais vem sendo realizada há décadas, com substancial aumento nos últimos anos. Tem como objetivos identificar as alterações fisiopatológicas ocasionadas pelo processo infeccioso sinusal e avaliar a eficácia de medicamentos no tratamento da rinossinusite. Objetivo: Avaliar a eficácia do modelo experimental proposto para a indução de um processo infeccioso nasossinusal agudo bacteriano, utilizando parâmetros histopatológicos e cultura da secreção sinusal. Método: Estudo experimental com 22 coelhos da raça Nova Zelândia, divididos em: grupo A (6 coelhos), grupo B (7 coelhos), grupo C (7 coelhos) e grupo D (controle com 2 coelhos).Induzido quadro de rinossinusite através da inserção de esponja sintética nas fossas nasais direita dos 20 coelhos (grupos de estudo), seguido por instilação de toxoide bacteriano (50% estreptocócico, 50% estafilocócico). Os grupos foram sacrificados com 10 dias (grupo A), 17 dias (grupo B) e 30 dias (grupos C e D). Resultados: Todos os coelhos do grupo de estudo apresentaram quadro de rinossinusite aguda bacteriana, através da identificação macroscópica, análise histológica e cultura das secreções. Conclusão: O modelo proposto apresenta simplicidade técnica para sua execução, similaridade ao quadro rinogênico que acomete os humanos e é altamente eficaz na produção de um quadro infeccioso bacteriano agudo sinusal. .
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Animales , Femenino , Masculino , Conejos , Modelos Animales de Enfermedad , Rinitis/microbiología , Sinusitis/microbiología , Enfermedad Aguda , Rinitis/patología , Sinusitis/patologíaRESUMEN
PURPOSE: Evaluate and compare two different experimental techniques of maxillary sinus ostium occlusion using N-butyl cyanoacrylate in developing chronic histological findings without the inoculation of pathogenic bacteria among rabbits. METHODS: In a randomized study, sixteen New Zealand rabbits were assigned for occlusion of the right maxillary sinus through a transmaxillary approach or through the roof of the nasal cavity. The contralateral sinus served as a control. After 12 weeks, the animals were sacrificed for blinded histopathological analysis of the maxillary sinus mucosa. RESULTS: Histopathological changes consistent with CRS were found in eight (100%) of the maxillary sinuses approached transmaxillary and three of those through the roof of the nasal cavity (37.5%), p 0.008 and 0.250, respectively, comparing with the control side. Chronic mucosal changes were significantly better induced using the transmaxillary approach (p 0.026). CONCLUSION: It is possible to induce a model of chronic sinusitis among rabbits with transmaxillary sinus occlusion without bacterial inoculation. This model can be replicated for future cellular studies.
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Modelos Animales de Enfermedad , Seno Maxilar/patología , Cavidad Nasal/patología , Rinitis/patología , Sinusitis/patología , Animales , Biopsia , Enfermedad Crónica , Enbucrilato , Masculino , Seno Maxilar/cirugía , Cavidad Nasal/cirugía , Mucosa Nasal/patología , Conejos , Valores de Referencia , Reproducibilidad de los Resultados , Rinitis/etiología , Sinusitis/etiología , Factores de TiempoRESUMEN
PURPOSE: Evaluate and compare two different experimental techniques of maxillary sinus ostium occlusion using N-butyl cyanoacrylate in developing chronic histological findings without the inoculation of pathogenic bacteria among rabbits. METHODS: In a randomized study, sixteen New Zealand rabbits were assigned for occlusion of the right maxillary sinus through a transmaxillary approach or through the roof of the nasal cavity. The contralateral sinus served as a control. After 12 weeks, the animals were sacrificed for blinded histopathological analysis of the maxillary sinus mucosa. RESULTS: Histopathological changes consistent with CRS were found in eight (100%) of the maxillary sinuses approached transmaxillary and three of those through the roof of the nasal cavity (37.5%), p 0.008 and 0.250, respectively, comparing with the control side. Chronic mucosal changes were significantly better induced using the transmaxillary approach (p 0.026). CONCLUSION: It is possible to induce a model of chronic sinusitis among rabbits with transmaxillary sinus occlusion without bacterial inoculation. This model can be replicated for future cellular studies. .
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Animales , Masculino , Conejos , Modelos Animales de Enfermedad , Seno Maxilar/patología , Cavidad Nasal/patología , Rinitis/patología , Sinusitis/patología , Biopsia , Enfermedad Crónica , Enbucrilato , Seno Maxilar/cirugía , Cavidad Nasal/cirugía , Mucosa Nasal/patología , Valores de Referencia , Reproducibilidad de los Resultados , Rinitis/etiología , Sinusitis/etiología , Factores de TiempoRESUMEN
BACKGROUND: Besides sensorineural factors, conductive impediments likely contribute to olfactory losses in chronic rhinosinusitis (CRS) patients, yet no conclusive evidence exists. We aimed to examine possible conductive factors using computational fluid dynamics (CFD) models. METHODS: A total of 29 CRS patients were assessed via odorant detection thresholds (ODTs), rhinomanometry (nasal resistance [NR]), acoustic rhinometry (minimum-cross-sectional area [MCA]) and computed tomography (CT) staging. CFD simulations of nasal airflow and odorant absorption to olfactory region were carried out based on individual CTs. Biopsies of olfactory epithelium (OE) were collected, cryosectioned, stained, and scored for erosion. RESULTS: Significant correlations to ODTs were found for 3 variables: odor absorption in the olfactory region (r = -0.60, p < 0.01), MCA (r = -0.40, p < 0.05), and CT staging (r = 0.42, p < 0.05). However, significant findings were limited to ODTs of the highly soluble l-carvone. Multiple regression analysis revealed that these variables combined, with the addition of NR, can account for 65% of the total variance in ODTs. CT staging correlated significantly with OE erosion (r = 0.77, p < 0.01) and can replace the latter in the regression with comparable outcomes. Partial correlations suggest the contributions of both conductive and sensorineural variables are more prominent if adjusted for the effects of the other. Olfactory loss and inflammatory factors have strong bilateral involvement, whereas conductive factors are independent between sides. As validation, CFD-simulated NRs significantly correlated with rhinomanometrically assessed NRs (r = 0.60, p < 0.01). CONCLUSION: Both conductive and sensorineural mechanisms can contribute to olfactory losses in CRS. CFD modeling provides critical guidance in understanding the role of conductive impediments in olfactory dysfunction in CRS.
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Hidrodinámica , Modelos Biológicos , Rinitis/fisiopatología , Sinusitis/fisiopatología , Adulto , Biopsia , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Odorantes , Mucosa Olfatoria/patología , Rinitis/patología , Rinomanometría , Umbral Sensorial , Sinusitis/patología , Adulto JovenRESUMEN
Conidiobolomycosis and pythiosis are important diseases of sheep in midwestern Brazil. Veterinary practitioners consider it difficult to differentiate between these diseases because they have similar clinical features. In this study, 186 sheep were subjected to necropsy examination over a 6-year period. Thirty (16.1%) cases of rhinitis in sheep that were caused by Conidiobolus lamprauges (n = 15) or Pythium insidiosum (n = 15) were investigated further. The lesions of C. lamprauges infection were mainly rhinopharyngeal (86.7%), localized to the ethmoidal region and associated with exophthalmos. The lesions appear as a white to yellow, firm mass that microscopically appears as a granulomatous inflammatory reaction with numerous giant cells. In contrast, P. insidiosum infection is associated with rhinofacial (93.3%) lesions that mainly involve the frontal region and hard palate and appear as an irregular, friable, yellow to red mass. Microscopically, pythiosis presents as diffuse necrotizing eosinophilic rhinitis. Immunohistochemistry using polyclonal antisera raised specifically against the two organisms was used to confirm the identity of the infectious agent in each disease. This study reports the first immunohistochemical diagnosis of conidiobolomycosis and the first description of a rhinopharyngeal lesion caused by P. insidiosum in sheep.
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Pitiosis/veterinaria , Infecciones del Sistema Respiratorio/patología , Rinitis/patología , Enfermedades de las Ovejas/patología , Cigomicosis/veterinaria , Animales , Conidiobolus , Inmunohistoquímica , Pitiosis/patología , Pythium , Infecciones del Sistema Respiratorio/microbiología , Rinitis/microbiología , Ovinos , Enfermedades de las Ovejas/microbiología , Oveja Doméstica , Cigomicosis/patologíaRESUMEN
UNLABELLED: MMPs (metalloproteinases) and their inhibitor TIMP (tissue inhibitor of metalloproteinases) are important in tissue remodeling and have been implicated in nasal polyp pathophysiology. The objective of the present study was to evaluate gene expression of MMP-1, MMP-2, MMP-9 and TIMP-1 gene expression in nasal polyps and compare them with normal nasal mucosa. Since MMPs could induce a more prominent tissue edema, we also assessed if these gene expressions could be related to a more extensive disease. For the experimental study, 30 nasal polyp samples from patients with CRSwNP (Chronic Rhinosinusitis with Nasal Polyposis) and 19 middle turbinates (MT) from controls were obtained. Gene expression of MMP-1, MMP-2, MMP-9 and TIMP-1 was assessed by qRT-PCR. The expressions of these genes were compared between nasal polyps and controls and correlated to each individual Lund-Mackay score, MMP-1, MMP-2 and MMP-9 were significantly more expressed in nasal polyps than in controls (P < 0.005, P < 0.0001 and P < 0.05 respectively). No expression of TIMP-1 mRNA was detected. There was no correlation between disease extension evaluated by the Lund-Mackay score and MMPs gene expression. The present results demonstrate that there is a significantly higher mRNA gene expression of MMP-1, MMP-2 and MMP-9 in patients with CRSwNP than controls. However, no correlation was observed between MMPs gene expression and sinonasal CT scan extension. LEVEL OF EVIDENCE: 2c.
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Metaloproteinasa 1 de la Matriz/genética , Metaloproteinasa 2 de la Matriz/genética , Metaloproteinasa 9 de la Matriz/genética , Pólipos Nasales/genética , Pólipos Nasales/patología , Rinitis/genética , Rinitis/patología , Sinusitis/genética , Sinusitis/patología , Inhibidor Tisular de Metaloproteinasa-1/genética , Adolescente , Adulto , Enfermedad Crónica , Endoscopía , Femenino , Expresión Génica/genética , Humanos , Masculino , Persona de Mediana Edad , Mucosa Nasal/metabolismo , Mucosa Nasal/patología , Mucosa Nasal/cirugía , Pólipos Nasales/cirugía , ARN Mensajero/genética , Reacción en Cadena en Tiempo Real de la Polimerasa , Valores de Referencia , Rinitis/cirugía , Sinusitis/cirugía , Estadística como Asunto , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
BACKGROUND: NF-ĸB is an essential transcription factor strongly associated to inflammatory response in chronic rhinosinusitis with nasal polyps (CRSwNP). DHMEQ is a NF-ĸB inhibitor that has been previously described with a greatpotential indecreasing inflammation in diseases other than CRSwNP. The aim of study isto evaluate the ability of DHMEQ to reducethe inflammatory recruiters on CRSwNP and to compare its anti-inflammatory profile as a single-agent or in association with fluticasone propionate (FP). METHODS: nasal polyp fibroblasts were cultured in TNF-α enriched media. Cells were submitted to three different concentrations (1, 10 and 100nM) of either FP, DHMEQ or both. Inflammatory response was accessed by VCAM-1, ICAM-1 and RANTES expression (by RTQ-PCR) and protein levels by ELISA. Nuclear translocation of NF-ĸB was also evaluated. RESULTS: both FP and DHMEQ inhibited inflammatory recruiters' production and NF-ĸB nuclear translocation. Interestingly, the anti-inflammatory effect from the association steroids plus DHMEQ was more intense than of each drug in separate. CONCLUSION: DHMEQ seems efficient in modulating the inflammatory process in CRSwNP. The synergic anti-inflammatory effect of DHMEQ and steroids may be a promising strategy to be explored, particularly in the setting of steroid-resistant NP.
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Benzamidas/farmacología , Ciclohexanonas/farmacología , Citocinas/metabolismo , Fibroblastos/metabolismo , FN-kappa B/antagonistas & inhibidores , Pólipos Nasales/patología , Transporte Activo de Núcleo Celular/efectos de los fármacos , Androstadienos/farmacología , Antiinflamatorios/farmacología , Supervivencia Celular/efectos de los fármacos , Células Cultivadas , Quimiocina CCL5/genética , Quimiocina CCL5/metabolismo , Fibroblastos/efectos de los fármacos , Fluticasona , Expresión Génica/efectos de los fármacos , Humanos , Mediadores de Inflamación/metabolismo , Molécula 1 de Adhesión Intercelular/genética , Molécula 1 de Adhesión Intercelular/metabolismo , FN-kappa B/metabolismo , Rinitis/patología , Sinusitis/patología , Factor de Necrosis Tumoral alfa/farmacología , Molécula 1 de Adhesión Celular Vascular/genética , Molécula 1 de Adhesión Celular Vascular/metabolismoRESUMEN
UNLABELLED: The nasal histopathology of HTLV-1 carriers with chronic rhinitis is unknown. OBJECTIVE: To describe the histopathological features of HTLV-1 carriers with chronic rhinitis. MATERIALS AND METHODS: Biopsies of nasal mucosa of ten HTLV-1 carriers with chronic rhinitis (eight patients with allergic rhinitis and two patients with non-allergic rhinitis) were studied using a light microscope. Samples from ten patients with allergic rhinitis not infected with HTLV-1 were used as controls. RESULTS: Subepithelial fibrosis was more pronounced in patients with allergic rhinitis infected with HTLV-1 (p=0.01), while the basement membrane thickness was greater in controls (p=0.03). There was a trend towards less eosinophilia and edema among those infected with HTLV-1, without statistical significance (p=0.2). For the lymphocytic infiltrate, there was no difference between infected and not infected patients with allergic rhinitis (p=1.0). Subepithelial fibrosis associated to moderate or small number of lymphocytes were found in the two HTLV-1 carriers with non-allergic rhinitis. CONCLUSIONS: This study suggests HTLV-1 may modify the histopathology of allergic rhinitis, especially by promoting subepithelial fibrosis, and may be related to chronic non-allergic rhinitis with lymphocytic infiltrate.
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Infecciones por HTLV-I/patología , Rinitis/patología , Adulto , Estudios de Casos y Controles , Enfermedad Crónica , Femenino , Fibrosis , Infecciones por HTLV-I/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Mucosa Nasal/patología , Rinitis/complicaciones , Adulto JovenRESUMEN
Introducción: El estudio histopatológico de muestras obtenidas mediante cirugía endoscópica nasosinusal (CENS) es rutinaria en muchos centros hospitalarios, sin embargo, los reportes de sus resultados y el análisis de su real utilidad clínica son escasos en la literatura publicada. Objetivos: Describir y analizar el estudio de la anatomía patológica obtenida mediante CENS y conocer la correlación entre el diagnóstico clínico y la histopatología. Material y método: Se realizó un estudio descriptivo retrospectivo mediante revisión de fichas clínicas y recolección de datos anatomopatológicos, intervenciones por CENS en el Hospital Clínico Universidad de Chile. Resultados: El mayor porcentaje de los resultados histopatológicos fueron diferentes formas de rinosinusutis crónica (RSC) representando 65,67 por ciento (RSC simple, alérgica, poliposa alérgica y no alérgica). Entre los hallazgos con menor frecuencia destacan: papiloma invertido (4,9(0) por ciento), pólipo antrocoanal (9,31(0) por ciento), rinosinusitis fúngica no invasiva (2,45(0) por ciento) y 7 casos de patología maligna. Con respecto a la correlación clínica e histopatológica, se encontró para RSC una concordancia del 92,15 por ciento, para RSC poliposa del 95,94 por ciento y en pólipos antrocoanales 85,71 por ciento. Conclusiones: La mayoría de los resultados obtenidos fueron distintas formas de inflamación crónica de la mucosa nasosinusal. Se encontró una fuerte correlación entre el diagnóstico clínico y la histopatología, sin embargo, la aparición no excepcional de patología maligna inclina la conducta hacia el uso rutinario de solicitud de biopsia.
Introduction: Histopathological examination of samples obtained by endoscopic sinus surgery (ESS) is routine in many hospitals, however, results reports and effective analysis of its clinical utility are scarce in the literature. Aim: To describe and analyze the pathological study in ESS. Furthermore, recognize the correlation between histopathology and clinical diagnosis. Material and method: A cross-sectional study by reviewing medical records and collecting data from ESS interventions in the University of Chile Clinical Hospital was performed. Results: Most of the diagnoses were different forms of chronic rinosinusutis (CRS), representing 65.67 percent(simple, allergic and polypoid). Among the most common are unusual findings: inverted papilloma (4.9 percent), antrochoanal polyp (9.31 percent), fungal non-invasive rhinosinusitis (2.45 percent) and 7 cases of malignancy. Clinical and histopathologic correlation found for CRS was 92.15 percent 95.94 percent in nasal polyposis and 85.71percent in antrochoanal polyps. Conclusions: Most of the results were different forms of chronic inflammation of the sinus mucosa. A strong correlation between clinical diagnosis and histopathology was found, however, the onset of not exceptional malignant disease suggest the routine use of biopsy.
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Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano de 80 o más Años , Endoscopía/métodos , Enfermedades Nasales/cirugía , Enfermedades Nasales/patología , Biopsia , Enfermedades Nasales/epidemiología , Estudios Retrospectivos , Estudios Transversales , Rinitis/patología , Sinusitis/patología , Valor Predictivo de las PruebasRESUMEN
A histopatologia nasal de portadores do HTLV-1 com rinite crônica é desconhecida. OBJETIVO: Descrever aspectos histopatológicos de portadores do HTLV-1 com rinite crônica. CASUÍSTICA E MÉTODOS: Amostras de mucosa nasal de 10 portadores do HTLV-1 com rinite crônica, sendo oito com rinite alérgica e dois com rinite não alérgica, foram estudadas por microscopia de luz. Amostras de 10 pacientes com rinite alérgica não infectados pelo HTLV-1 serviram como controle. RESULTADOS: Fibrose subepitelial foi maior nos pacientes com rinite alérgica infectados pelo HTLV-1 (p=0,01), enquanto o espessamento da membrana basal foi maior nos controles (p=0,03). Houve tendência a menor eosinofilia e edema entre os infectados pelo HTLV-1, sem significância estatística (p=0,2). Para o infiltrado linfocítico, não houve diferença entre os pacientes com rinite alérgica infectados e não infectados (p=1,0). Fibrose subepitelial com infiltrado linfocítico de intensidade leve a moderada foram os achados encontrados nos dois portadores do HTLV-1 com rinite não alérgica. CONCLUSÕES: O estudo sugere que a infecção pelo HTLV-1 pode modificar a histopatologia da rinite alérgica, sobretudo por maior fibrose, e pode estar relacionada a uma rinite crônica não alérgica com infiltrado linfocítico.
The nasal histopathology of HTLV-1 carriers with chronic rhinitis is unknown. OBJECTIVE: To describe the histopathological features of HTLV-1 carriers with chronic rhinitis. MATERIALS AND METHODS: Biopsies of nasal mucosa of ten HTLV-1 carriers with chronic rhinitis (eight patients with allergic rhinitis and two patients with non-allergic rhinitis) were studied using a light microscope. Samples from ten patients with allergic rhinitis not infected with HTLV-1 were used as controls. RESULTS: Subepithelial fibrosis was more pronounced in patients with allergic rhinitis infected with HTLV-1 (p=0.01), while the basement membrane thickness was greater in controls (p=0.03). There was a trend towards less eosinophilia and edema among those infected with HTLV-1, without statistical significance (p=0.2). For the lymphocytic infiltrate, there was no difference between infected and not infected patients with allergic rhinitis (p=1.0). Subepithelial fibrosis associated to moderate or small number of lymphocytes were found in the two HTLV-1 carriers with non-allergic rhinitis. CONCLUSIONS: This study suggests HTLV-1 may modify the histopathology of allergic rhinitis, especially by promoting subepithelial fibrosis, and may be related to chronic non-allergic rhinitis with lymphocytic infiltrate.