Association between plasma inflammatory mediators and histological endotypes of nasal polyps / 中华耳鼻咽喉头颈外科杂志

Objective: To compare the clinical characteristics and plasma inflammatory markers levels in different endotypes of chronic rhinosinusitis with nasal polyps (CRSwNP), and to explore the plasma biomarkers associated with endotypes of CRSwNP. Methods: A total of 74 CRSwNP patients (male/female: 41/33; average age: 40 years) and 40 control subjects underwent septoplasty in Tongji Hospital from January 2015 to December 2017 were enrolled in this study. The demographic and clinical features of all subjects including age, gender, past history, visual analogue scale (VAS) and CT scores were recorded. Patients with CRSwNP were divided into EoshighNeuhigh, EoshighNeulow, EoslowNeuhigh and EoslowNeulow four endotypes according to the eosinophil (Eos) percentage and neutrophil (Neu) count of nasal polyps tissue. Preoperative blood routine was performed and the levels of 27 biomarkers in plasma were measured by Bio-Plex suspension chip method. The clinical characteristics and the level of serum biomarkers of patients with different endotypes were compared. SPSS 18.0 software was used for statistical analysis. Results: There was no difference in the clinical features including gender ratio, age, course of disease, VAS score, endoscopy and CT score among EoshighNeuhigh, EoshighNeulow, EoslowNeuhigh and EoslowNeulow CRSwNP patients. Compared with EoslowNeuhigh and EoslowNeulow CRSwNP patients, patients with EoshighNeuhigh and EoshighNeulow endotype demonstrated a higher prevalence of atopy, allergic rhinitis and asthma comorbidity, and increased peripheral blood eosinophil absolute count and percentage (all P<0.05). However, there was no significant difference between EoshighNeuhigh and EoshighNeulow CRSwNP. Plasma levels of all 27 mediators including type 1 cytokines (IL-12 and IFN-γ), type 2 cytokines (IL-4, IL-5 and IL-13), type 3 cytokines (IL-17A), pro-inflammatory cytokines (IL-6 and TNF-α) and tissue remodeling-related markers (bFGF, VEGF and PDGF-BB) demonstrated no significant difference among all endotypes of CRSwNP (all P>0.05). Conclusions: Eoshigh and Eoslow CRSwNP patients display significant differences regarding the prevalence of atopy, allergic rhinitis and asthma comorbidity, peripheral blood eosinophil absolute count and percentage, but the clinical characteristics, blood cellular and biological markers can not effectively distinguish four endotypes of CRSwNP. Further studies are warranted to dig out the potential objective, convenient and reliable markers associated with endotypes in patients with CRSwNP.

Expression of CD8+Treg cells in chronic rhinosinusitis and its correlation with eosinophilic infiltration / 中华耳鼻咽喉头颈外科杂志

Objective: To detect the percentages of CD8+Treg cells in the nasal mucosa and peripheral blood of chronic rhinosinusitis (CRS) and to explore their correlation with eosinophilic infiltration. Methods: Thirty-three chronic rhinosinusitis with polyp (CRSwNP), 26 chronic rhinosinusitis without polyp (CRSsNP) and 27 control patients who were collected with the nose mucosal tissue and peripheral blood in the Third Affiliated Hospital of Sun Yat-sen University from March 2017 to October 2018 were selected, including 59 males and 27 females, aging from 18 to 72 years. Hematoxylin and eosin (HE) staining was used to observe the number of eosinophils in the nasal tissues and to classify the CRS into eosinophilic CRS (ECRS) and non-eosinophilic CRS (Non-ECRS). Flow cytometry was used to detect the percentages of CD4+ and CD8+T cells in lymphocytes of nasal mucosa and peripheral blood. The percentages of CD8+Foxp3+Treg cells, CD8+Foxp3-IL-10+Treg cells, CD8+IFN-γ+T cells (Tc1), CD8+IL-4+T cells (Tc2) and CD8+IL-17A+T cells (Tc17) in lymphocytes of nasal mucosa and peripheral blood were also tested. Besides, the percentages of Foxp3+TGF-β+Treg cells and Foxp3+IL-10+Treg cells in CD8+T cells were determined. All data were represented by M (IQR). GraphPad 7.0 and SPSS 16.0 were used for illustration and statistical analysis. Results: The percentage of CD8+T cells (37.75%(17.35%)) was higher than that of CD4+T cells (4.72%(4.29%)) in nasal mucosa (Z=-5.70, P<0.001), while lower (23.60%(9.33%)) than that of CD4+T cells (44.05% (10.93%)) in peripheral blood (t=9.72, P<0.001). CRSwNP patients possessed the highest Tc2 (1.82% (1.22%)) and Tc17 (1.93% (2.32%)) percentages than CRSsNP (Tc2: 0.84% (0.79%); Tc17: 0.54% (1.04%)) and control (Tc2: 1.09% (0.92%); Tc17: 0.47% (0.51%), both P<0.05) patients. While, CRSwNP patients possessed the lowest CD8+Foxp3+Treg cells percentage (0.10% (0.32%)) than CRSsNP (0.43% (1.45%)) and control (0.48% (0.83%), Z value was -2.24, -2.22, respectively, P value was 0.025, 0.027, respectively). The percentages of Foxp3+TGF-β+Treg cells and Foxp3+IL-10+Treg cells of CD8+T cells in nasal mucosa in CRSwNP were also lower than controls (Z value was 1.46, 0.49, respectively, both P=0.001). Moreover, the percentage of CD8+Foxp3-IL-10+Treg cells of CD8+T cells was decreased in nasal mucosa of CRSwNP patients (0.14% (0.28%)) when compared with that of CRSsNP (0.89% (0.81%), Z=0.61, P=0.03). ECRS patients had the lower percentages of CD8+Foxp3+Treg cells (0.07% (0.44%)) and CD8+Foxp3-IL-10+Treg cells (0.13% (0.21%)) than Non-ECRS patients (CD8+Foxp3+Treg cells: 0.53% (0.75%); CD8+Foxp3-IL-10+Treg cells: 0.29% (0.76%), t value was 2.14, 2.78, respectively, both P<0.05). The percentage of CD8+Foxp3+Treg cells and the ratio of CD8+Foxp3-IL-10+T per CD8+T cells were negatively correlated with the percentage of eosinophils in CRS patients(R2 value was 0.56, 0.78, respectively, both P<0.001). There was no significant difference in the distribution of CD8+Fxop3+Treg cells and CD8+Fxop3-IL-10+Treg cells in peripheral blood among different groups. Conclusion: The percentages of CD8+Treg cells decrease in CRSwNP patients, especially in ECRS patients, which are opposite to that of Tc2 and Tc17, and negatively correlate with the eosinophils percentage. This indicates that the decrease in the ratio of CD8+Treg cell may be associated with the immune-imbalance and eosinophilic infiltration in nasal mucosa of CRS patients.

Tumor Inflamatorio de Pott: reporte de un caso y revisión de la literatura / Pott's puffy tumor: a case report and review of the literature

INTRODUCCIÓN: El Tumor inflamatorio de Pott es una complicación rara de una patología frecuente, como son los cuadros infecciosos sinusales, cada vez más inusual por el uso extendido de antibióticos de amplio espectro, es más frecuente en la población adolescente por la neumatización similar al adulto. Se presenta como un aumento de volumen blando a nivel frontal con una osteomielitis del hueso frontal y un absceso subperióstico. MATERIALES Y MÉTODOS: En este trabajo, se presenta una revisión bibliográfica del tema y un caso de un paciente de 9 años, quien cursó con un cuadro infeccioso sinusal, que posterior desarrollo un aumento de volumen frontal, mostrando las imágenes perioperatorias e intraoperatorias. DISCUSIÓN Y CONCLUSIÓN: El absceso subperióstico secundario a la sinusitis, es una complicación rara. Sin embargo, se debe pensar en el diagnostico en pacientes de evolución tórpida y/o que presentan sintomatología neurológica, como convulsiones, se debe completar el estudio con neuroimagen contrastada.

INTRODUCTION: Pott's inflammatory tumor is a rare complication of a frequent pathology, such as sinus infections, increasingly unusual due to the use of broad-spectrum antibiotics, it is more frequent in the adolescent population due to pneumatization similar to that of adults. It presents as an increase in volume at a frontal level with osteomyelitis of the frontal bone and a subperiosteal abscess. ;MATERIAL AND METHODS: In this work, we present a bibliographic review and a case of a 9-year-old patient, who presented with an infectious sinus, which later developed an increase in frontal volume, the perioperative and intraoperative images are shown. DISCUSSION AND CONCLUSION: Subperiosteal abscess secondary to sinusitis is a rare complication. However, the diagnosis should be considered in patients with torpid evolution and / or who present neurological symptoms, such as seizures, the study must be completed with a contrast brain image.

Micronucleus count in nasal epithelial cells from patients with chronic rhinosinusitis and polyps / Contagem de micronúcleos em células epiteliais nasais de pacientes com rinossinusite crônica e pólipos

Abstract Introduction: Chronic rhinosinusitis with nasal polyps, a prevalent disease affecting around 2% of the world population, is characterized by symptomatic inflammation of the nasal mucosa and impairment of quality of life. Chronic rhinosinusitis with nasal polyps has a multifactorial etiology, involving a dysfunctional host response to environmental factors. Thus, inflammatory models may be useful to shed light on the pathophysiology of this disease. Micronucleus count has been used to screen DNA damage in various tissues. Objective: To investigate the association between frequency of micronucleus in exfoliated cells from the nasal cavity of patients with chronic rhinosinusitis with nasal polyps and disease severity. Methods: This cross-sectional study included 21 patients with chronic rhinosinusitis with nasal polyps and 19 controls without disease. None of the participants were smokers. Results: Mean micronucleus count was 3.690 per 1000 cells (±2.165) in individuals with vs. 1.237 per 1000 cells (±0.806) in controls; (Student's t test = 4.653, p< 0.001). Nasal surgery in the past 5 years and aspirin-exacerbated respiratory disease were not associated with nicronucleus count (p= 0.251). Conclusion: Micronucleus count seems to be linked to chronic rhinosinusitis with nasal polyps, providing a new perspective for the evaluation of this disorder.

Resumo Introdução: A rinossinusite crônica com pólipos nasais, doença prevalente que afeta cerca de 2% da população mundial, é caracterizada por inflamação sintomática da mucosa nasal e comprometimento da qualidade de vida. A rinossinusite crônica com pólipos nasais tem etiologia multifatorial, envolvendo resposta disfuncional do hospedeiro a fatores ambientais. Assim, modelos inflamatórios podem ser úteis para esclarecer a fisiopatologia dessa doença. A contagem de micronúcleos tem sido usada para rastrear danos no DNA em vários tecidos. Objetivo: Investigar a associação entre a frequência de micronúcleos em células esfoliadas da cavidade nasal de pacientes com rinossinusite crônica com pólipos nasais e a gravidade da doença. Método: Estudo transversal que incluiu 21 pacientes com rinossinusite crônica com pólipos nasais e 19 controles sem doença. Nenhum dos participantes era fumante. Resultados: A contagem média de micronúcleos foi de 3,690 por 1.000 células (± 2,165) nos indivíduos doentes e 1,237 por 1.000 células (± 0,806) nos controles (teste t de Student = 4,653; p < 0,001). A cirurgia nasal nos últimos 5 anos e a doença respiratória exacerbada por aspirina não foram associadas à contagem de micronúcleos (p = 0,251). Conclusão: A contagem de micronúcleos parece estar ligada à rinossinusite crônica com pólipos nasais, proporcionando uma nova perspectiva para a avaliação dessa doença.

Infección rino-sinusal por Exserohilum rostratum en un niño con leucemia mieloide aguda / Sinus infection caused by Exserohilum rostratum in a pediatric patient with acute myeloid leukemia

Resumen Los episodios de neutropenia febril son cuadros graves, que requieren un estudio etiológico exhaustivo y un inicio rápido de antimicrobianos. Dentro de los posibles microorganismos causales se encuentran los de origen fúngico, los que, dependiendo de su grado de invasión tisular, pueden llegar a presentar una alta mortalidad. Presentamos el caso de un niño con una leucemia mieloide aguda, que tras su quimioterapia de inducción, presentó un episodio de neutropenia febril, con una infección rino-sinusal por Exserohilum rostratum, hongo filamentoso que raramente se asocia a cuadros patológicos. Se inició rápidamente terapia antifúngica, lo cual, asociado a un aseo quirúrgico precoz, lograron una respuesta clínica favorable, sin complicaciones. Luego del seguimiento, y tras recibir profilaxis secundaria durante los episodios de neutropenia, no ha vuelto a presentar nuevas lesiones ni compromiso rino-sinusal.

Abstract The episodes of febrile neutropenia are severe cases that require an exhaustive etiological study and a quick start of antimicrobial agents. Within the possible microorganisms, fungal origins are also found, and depending on its tissue invasion, they can reach a high mortality rate. A case of a pediatric patient who suffered from acute myeloid leukemia is reported, and after his induction chemotherapy, the patient showed an episode of febrile neutropenia, which matches a rhinosinusal infection caused by Exserohilum rostratum, a filamentous fungi that is uncommonly associated with pathological cases. An antifungal therapy and an early surgical treatment were started, which lead to a positive response, without complications to the patient. After the monitoring and receiving secondary prophylaxis during the episodes of neutropenia, the patient hasn't presented new injuries nor rhinosinusal damage.

Relation between chronic rhinosinusitis and gastroesophageal reflux in adults: systematic review / Relação entre rinossinusite crônica e refluxo gastroesofágico em adultos: revisão sistemática

Abstract Introduction: The relationship between gastroesophageal reflux disease (GERD) and chronic rhinosinusitis (CRS) is still a controversial issue in literature. Objective: A systematic review of the association between these two diseases in adult patients. Methods: Systematic review in PubMed and Cochrane Database with articles published between 1951 and 2015. We included all articles that specifically studied the relationship between CRS and GERD. Results: Of the 436 articles found, only 12 met the inclusion criteria. Eight cross-sectional articles suggest a relation between CRS and GERD, especially on CRS that is refractory to clinical or surgical treatment. However, the groups are small and methodologies are different. Four other longitudinal studies have assessed the effect of treatment with proton pump inhibitors (PPIs) on the improvement of symptoms of CRS, but the results were conflicting. Conclusions: There seems to be relative prevalence of reflux with intractable CRS. There is still a lack of controlled studies with a significant number of patients to confirm this hypothesis. Few studies specifically assess the impact of treatment of reflux on symptom improvement in patients with CRS.

Resumo Introdução: A relação entre a Doença do Refluxo Gastroesofágico (DRGE) e a Rinossinusite Crônica (RSC) ainda é tema de controvérsia em literatura. Objetivo: Revisão sistemática sobre a associação entre essas duas doenças em pacientes adultos. Método: Revisão sistemática no Pubmed e Cochrane Database com os artigos publicados entre 1951 e 2015. Foram incluídos todos os artigos que estudassem especificamente a relação entre RSC e DRGE. Resultados: Dos 436 artigos encontrados, apenas 12 satisfaziam os critérios de inclusão. Oito artigos transversais sugerem relação da RSC com a DRGE, especialmente sobre a RSC refratária a tratamento clínico ou cirúrgico prévio. No entanto, os grupos são pequenos e as metodologias são muito diferentes. Outros quatro estudos longitudinais avaliaram o efeito do tratamento com Inibidores de Bomba de Prótons (IBP) sobre a melhora a dos sintomas de RSC, porém os resultados foram discordantes. Conclusões: Parece haver relação de prevalência de refluxo e RSC de difícil controle. Ainda faltam estudos controlados com um número expressivo de pacientes para que se confirme essa hipótese. São escassos os estudos que avaliem especificamente o impacto do tratamento de refluxo na melhora dos sintomas em pacientes com RSC.

Distinct characteristics of nasal polyps with and without eosinophilia / Diferenças nas características de pólipos nasais com e sem eosinofilia

Abstract Introduction Eosinophilic and noneosinophilic Nasal polyps (NPs) are different subtypes of NPs and require different treatment methods. Objective To compare the histologic characteristics, mRNA and protein expression between Nasal Polyps with and without eosinophilia. Methods NPs tissues were obtained from eighty-six NPs patients during surgery. Eosinophilic and noneosinophilic NPs were distinguished according to immunochemical results of the specimen. The histological, mRNA and protein expression features were compared between the two groups. Results In eosinophilic NPs, we observed a significantly higher GATA-3, IL-5, IL-4, IL-13 mRNA and protein expression. In noneosinophilic NPs, IL-17, IL-23 and RORc mRNA and protein expression were increased. Immunohistochemistry tests showed, more mast cells and less neutrophils in eosinophilic NPs compared with noneosinophilic NPs. Eosinophilic NPs patient presented more severe symptom scores when compared to noneosinophilic NPs. Conclusion We demonstrate for the first time that Th2 is the predominant reaction in eosinophilic NPs while Th17 is the predominant reaction in noneosinophilic NPs. Our study may provide new treatment strategy for NPs.

Resumo Introdução Pólipos nasais (PNs) eosinofílicos e não eosinofílicos são diferentes subtipos de PNs e requerem diferentes métodos de tratamento. Objetivo Comparar as características histológicas e a expressão de mRNAs e proteínas entre PNs com e sem eosinofilia. Método Amostras de PNs foram obtidos de 86 pacientes durante a cirurgia. PNs eosinofílicos e não eosinofílicos foram diferenciados segundo os resultados imunoistoquímicos de cada amostra. As características histológicas e de expressão de mRNAs e de proteínas foram comparadas entre os dois grupos. Resultados Em PNs eosinofílicos, observamos uma expressão significativamente maior dos mRNAs e proteínas GATA-3, IL-5, IL-4 e IL-13. Nos PNs não eosinofílicos, aumentou a expressão dos mRNAs e das proteínas IL-17, IL-23 e RORc. Nos testes imunoistoquímicos, observamos maior número de mastócitos e menor número de neutrófilos nos PNs eosinofílicos, em comparação com PNs não eosinofílicos. Os pacientes com PNs eosinofílicos obtiveram escores de sintomas mais graves vs. PNs não eosinofílicos. Conclusão Demonstramos, pela primeira vez, uma reação Th2 predominante em PNs eosinofílicos e uma reação Th17 predominante em PNs não eosinofílicos. Nosso estudo pode proporcionar novas estratégias terapêuticas para a rinossinusite crônica.

Abscesso subperiosteal com extensão epidural devido à rinossinusite aguda em criança de dez anos / Subperiosteal abscess with epidural extension due to acute rhinosinusitis in a ten-year-old child

RESUMO A rinossinusite aguda é uma das afecções mais prevalentes das vias aéreas superiores. Fatores anatômicos presentes em crianças e jovens propiciam o aparecimento de complicações orbitárias. Embora mais raras, as complicações intracranianas das rinossinusites perfazem um grau alto de letalidade, são mais comuns em pacientes acima de sete anos, e devem ser tratadas por uma equipe multidisciplinar.

ABSTRACT Acute rhinosinusitis is one of the most prevalent diseases of the upper airways. Anatomical factors present in children and young people allow for the onset of orbital complications. Although rare, intracranial complications of sinusitis account for a high degree of lethality, are more common in patients over the age of seven, and should be treated by a multidisciplinary team.

Osteomielitis del maxilar secundaria a rinosinusitis en la infancia: Caso clínico / Maxillary osteomyelitis secondary to rhinosinusitis in children: Case report

La rinosinusitis es una patología muy frecuente en la infancia. Entre sus complicaciones, se encuentra la osteomielitis, rara complicación que, cuando se presenta, ocurre, principalmente, en lactantes y niños pequeños. El agente etiológico más frecuente es el Staphylococcus aureus. Clínicamente, se manifiesta con fiebre alta, edema de párpado inferior, rinorrea unilateral y edema palatino ipsilateral; luego se agrega un absceso sobre el área maxilar yuxtanasal y/o sobre los alvéolos dentarios. Secundariamente, pueden desarrollarse secuestros, expulsiones espontáneas de piezas dentarias y trayectos fistulosos, así como complicaciones orbitarias y endocraneales. El diagnóstico es, sobre todo, clínico; se confirma con tomografia computada. El tratamiento es médico quirúrgico. Se presenta un niño de 5 años de edad con rinosinusitis complicada con osteomielitis del hueso maxilar, cuyo germen responsable fue el Staphylococcus aureus meticilino resistente.

Rhinosinusitis is a very common childhood condition. Osteomyelitis is an unusual complication, which mainly occurs in toddlers and young children. The most frequent etiologic agent is Staphylococcus aureus. Iniatially, it is characterized by fever, low eyelid edema, unilateral rhinorrhea and ipsilateral palatine edema. Subsequently, abscesses develop in the maxillar yuxtanasal and/or the dental alveolar area. Secondary, it can be complicated by sequestrations, spontaneous expulsion of dental pieces and/or fistula, as well as orbital and intracranial complications. The diagnosis is based on clinical findings and is confirmed by computed tomography findings. The treatment is clinical and surgical. Here we report a five year old child, with rhinosinusitis complicated by osteomyelitis of maxillary bone, mediated by a methicillin-resistant Staphylococcus aureus infection.

Abordagem cirúrgica de abscesso orbitário subperiosteal associado à fratura de órbita / Surgical approach of orbitalsubperiosteal abscess associated with the orbital fracture

As cavidades orbitárias com os espaços aéreos da face e a ocorrência de infecções advindas de sinusites para a órbita são frequentes especialmente devido à proximidade. Acometem mais comumente crianças com estado nutricional debilitado. Clinicamente apresentam os sinais flogísticos, além de deficit visual, diplopia, oftalmoplegia e proptose. Podem evoluir com complicações graves, como trombose do seio cavernoso e abscesso intracraniano. Estas infecções podem ser classificadas de acordo com sua gravidade. Os exames de imagem de escolha para o diagnóstico e planejamento dos casos são cortes axiais e coronais de tomografia computadorizada. O tratamento deve ser compatível com a gravidade do caso e reação do organismo à antibioticoterapia. O objetivo deste artigo é relatar um caso clínico de paciente pediátrico que após trauma em face foi acometido por fratura em rebordo orbitário superior e desenvolveu posteriormente abscesso orbitário subperiosteal, discutindo os critérios clínicos e imaginológicos para o diagnóstico e a devida condução do caso.

The proximity of the orbital cavities to the air spaces of the face results in the occurrence of orbital infections resulting from sinusitis. Children with debilitated nutritional status are especially vulnerable. Clinically presents the inflammatory signs, and visual acuity deficit, diplopia, ophthalmoplegia and proptosis. Might also lead to severe complications such as cavernous sinus thrombosis and intracranial abscess. These infections can be classified according to their severity. Imaging tests of choice for the diagnosis and planning of cases include axial and coronal cuts of computed tomography. Treatment should be compatible with the severity of the case, taking into account the side effects of the antibiotics used. The objective of this paper is to report a case of a pediatric patient who sustained facial trauma resulting in fracture of the upper orbital rim and subsequently developed orbital subperiosteal abscess. We discuss the clinical and imaging criteria for successful diagnosis and treatment.

Recirculação de muco como causa de insucesso cirúrgico no tratamento da rinossinusite crônica / Mucus recirculation as a cause of surgical failure in the treatment of chronic rhinosinusitis

Uma das causas do insucesso da cirurgia endoscópica, com persistência da rinossinusite crônica, é o fenômeno da recirculação de muco. O muco retorna ao seio maxilar por uma antrostomia que não inclua o óstio natural de drenagem. Comumente, tal fenômeno é subdiagnosticado. O objetivo deste trabalho é relatar um caso clássico de uma paciente que realizou tratamento cirúrgico para rinossinusite crônica, sem sucesso devido à recirculação de muco, bem como discutir seus principais aspectos. Identificar a recirculação de muco em pacientes com rinossinusite crônica recalcitrante, especialmente em pacientes já operados, é muito importante, e seu tratamento cirúrgico pode resolver o problema (AU)

One of the causes of failure of endoscopic surgery, with persistent chronic rhinosinusitis, is the mucus recirculation phenomenon. The mucus returns to the maxillary sinus by a antrostomy that does not include natural ostium drainage. Commonly, such a phenomenon is underdiagnosed. The aim of this study is to report a classic case of a patient who underwent surgical treatment for chronic rhinosinusitis without success due to the recirculation of mucus, as well as discuss its key aspects. Identify the mucus recirculation in patients with recalcitrant chronic rhinosinusitis, especially in patients already operated, is very important and its surgical treatment can resolve the issue (AU)

Osteitis and mucosal inflammation in a rabbit model of sinusitis / Osteíte e inflamação mucosa em um modelo experimental de rinossinusite

INTRODUCTION: Several experimental studies have shown osteitis after the onset of sinusitis, supporting the idea that bone involvement could participate in the dissemination and perpetuation of this inflammatory disease. However, procedures commonly performed for the induction of sinusitis, such as antrostomies, can trigger sinusitis by themselves. OBJECTIVE: To evaluate osteitis in an animal model of sinusitis that does not violate the sinus directly and verify whether this is limited to the induction side, or if it affects the contralateral side. METHODS: Experimental study in which sinusitis was produced by inserting an obstructing sponge into the nasal cavity of 20 rabbits. After defined intervals, the animals were euthanized and maxillary sinus samples were removed for semi-quantitative histological analysis of mucosa and bone. RESULTS: Signs of bone and mucosal inflammation were observed, affecting both the induction and contralateral sides. Statistical analysis showed correlation between the intensity of osteitis on both sides, but not between mucosal and bone inflammation on the same side, supporting the theory that inflammation can spread through bone structures, regardless of mucosal inflammation. CONCLUSION: This study demonstrated that in an animal model of sinusitis that does not disturb the sinus directly osteitis occurs in the affected sinus and that it also affects the contralateral side. .

INTRODUÇÃO: Diversos estudos experimentais evidenciam osteíte após estabelecimento de sinusite, corroborando para a ideia de que o envolvimento ósseo poderia participar na disseminação e perpetuação do processo inflamatório. Porém procedimentos realizados para indução da doença nestes modelos, como antrostomias, podem, por si só, desencadear osteíte. OBJETIVO: Avaliar osteíte em um modelo de rinossinusite em que não ocorre manipulação sinusal e verificar se esta é limitada ao lado de indução, ou se acomete o lado contralateral. MÉTODO: Estudo experimental em que induziu-se rinossinusite em 20 coelhos, por meio de obliteração temporária com esponja de uma das cavidades nasais. Amostras de tecido sinusal foram submetidas à análise histológica semiquantitativa, após sacrifício dos animais em intervalos regulares. RESULTADOS: Foram observados sinais de inflamação óssea e mucosa mais intensa no lado de indução, mas também contralateral. Testes estatísticos evidenciaram correlação entre a osteíte de ambos os lados, porém não entre inflamação óssea e mucosa de um mesmo lado, apoiando a teoria de que a inflamação poderia se disseminar através do tecido ósseo, independente da inflamação mucosa. CONCLUSÃO: O presente estudo evidenciou a existência de osteíte, tanto no lado de indução quanto no contralateral, em modelo experimental em que não ocorre manipulação sinusal. .

Managment of orbital complications of sinusitis / Tratamento das complicações orbitais da sinusite

Purpose: We reported on the clinical approaches of ophthalmology and otorhinolaryngology departments in the treatment of the orbital complications of sinusitis. We also included an in-depth literature review. Methods: We retrospectively reviewed the medical files of 51 patients from January 2008 to January 2014. The records were evaluated for age, gender, type of orbital complications, symptoms, predisposing factors, imaging studies, medical and surgical management, culture results, and follow-up information. SPSS version 15.0 software (Statistical Analysis, The Statistical Package for Social Sciences Inc, Chicago, IL) was used for the statistical analysis. Results: Fifty-one patients met the criteria, with available medical records, for the study (29 male, 22 female). Thirty-two (62.7%) were diagnosed with preseptal cellulitis and 19 (37.3%) with postseptal cellulitis. After a detailed evaluation, 15 were diagnosed with a subperiosteal abscess (SPA), and 4 were diagnosed with orbital cellulitis. The age and gender was similar for the two groups. Five patients with medial SPA were treated with endoscopic sinus surgery, one patient with inferior SPA was treated with external surgery, and six patients with other localizations were treated with a combination of endoscopic sinus surgery and external surgery. All patients presented with periorbital erythema and edema. The length of hospitalization and duration of symptoms were similar in both groups. Visual acuity was between 1/10 to 10/10 (mean 7/10) and statistically significant for preseptal and postseptal cellulitis groups (p<0.001). All patients received intravenous antibiotics upon the first day of admission. Conclusion: Orbital complications of acute sinusitis required intensive follow-up and a multidisciplinary approach. A contrast-enhanced paranasal sinus computerized tomography (CT) scan can detect the extent of the infection. An initial trial of intravenosus (IV) antibiotics ...

Objetivo: Relatamos abordagens clínicas dos departamentos de oftalmologia e otorrinolaringologia para tratar complicações orbitais da sinusite. Uma revisão em profundidade literatura é discutida. Métodos: Foram analisados retrospectivamente os prontuários de 51 pacientes no período de janeiro de 2008 a janeiro de 2014. Os registros foram avaliados quanto à idade, sexo, tipo de complicação orbital, sintomas, fatores predisponentes, estudos de imagem, tratamento médico e cirúrgico, resultados da cultura microbiológica e seguimento. Foi utilizado o programa SPSS versão 15.0 (Statistical Analysis, The Statistical Package for Social Sciences Inc, Chicago, IL) para a análise estatística. Resultados: Cinquenta e um pacientes preencheram os critérios, com os registros médicos disponíveis, para o estudo (29 do sexo masculino, 22 do sexo feminino). Trinta e dois (62,7%) foram diagnosticados com celulite presseptal e 19 (37,3%), com celulite posseptal. Depois de uma avaliação detalhada, 15 foram diagnosticados como abscesso subperiosteal (SPA), 4 eram celulite orbitária. A idade e sexo foi similar para ambos os grupos. Cinco pacientes com abscesso subperiosteal medial foram tratados com cirurgia endoscópica, um paciente com abscessso subperiosteal inferior foi tratado com cirurgia externa, 6 pacientes com outras localizações foram tratados com a combinação de cirurgia endoscópica e cirurgia externo. Todos os pacientes apresentaram eritema e edema periorbital. Tempo de internação hospitalar e a duração dos sintomas foi similar em ambos os grupos. A acuidade visual foi entre 1/10 a 10/10 (média de 7/10) e estatisticamente significante para os grupos celulite presseptal e posseptal (p<0,001). Todos os pacientes receberam antibióticos por via intravenosa, no primeiro dia ...

Main causes and diagnostic evaluation in patients with primary complaint of olfactory disturbances / Principais causas e avaliação diagnóstica em pacientes com queixa primária de distúrbio olfatório

INTRODUCTION: Establishing a diagnosis in patients with olfactory disturbances has always been challenging for physicians.One reason for this is the rarity of some of the diseases that affect this sense, such as Kallmann's syndrome and post-viral olfactory loss. OBJECTIVE: To identify the major causes of olfactory disturbances and to describe the diagnostic evaluation in outpatients attended to at an ambulatory clinic specialized in olfaction disorders. METHODS: A retrospective analysis was performed in outpatients with primary olfactory complaint attended to between June 1, 2011 and September 30, 2013 in a center specialized in olfactory disorders. Patient history, nasofibroscopy, and the University of Pennsylvania Smell Identification Test (UPSIT) comprised the examination. RESULTS: Sixty-two patients were evaluated. The major causes were chronic rhinosinusitis (31%); rhinitis, primarily the allergic type (19%); post-viral olfactory loss (13%); and post-traumatic loss (8%). UPSIT scores were statistically different among different etiologies (p = 0.01). CONCLUSIONS: The major diagnoses that should be part of the physician assessment when a patient complains of olfactory disturbance are chronic rhinosinusitis with and without polyps, allergic rhinitis, post-viral olfactory loss, and post-traumatic loss. .

INTRODUÇÃO: Estabelecer um diagnóstico em pacientes com distúrbios olfatórios foi sempre um desafio aos médicos. Uma das razões para isso é a raridade de algumas doenças que afetam esse sentido como a Síndrome de Kallmann e a perda olfatória pós-viral. OBJETIVO: Identificar as principais causas das doenças olfatórias e descrever sua condução diagnóstica em um ambulatório direcionado a esses distúrbios. MÉTODO: Análise retrospectiva de pacientes ambulatoriais com queixa olfatória primária atendida entre 1º de junho de 2011 e 30 de setembro de 2013 em centro especializado. História clínica, nasofibroscopia e o Teste de Identificação do Olfato da Universidade da Pensilvânia (UPSIT) compuseram a avaliação. Sempre que necessário, foram solicitadas tomografia de seios paranasais e ressonância magnética de crânio. RESULTADOS: Sessenta e dois pacientes foram avaliados. As causas mais comuns encontradas foram respectivamente: rinossinusite crônica (31%), rinites (19%), principalmente a rinite alérgica, perda olfatória pós-viral (13%) e pós-traumática (8%). As pontuações no UPSIT foram estatisticamente diferentes entre as cinco principais causas (p = 0,01). CONCLUSÕES: Os principais diagnósticos que devem fazer parte na investigação médica diante de um paciente com queixa olfatória são: rinossinusite crônica com e sem polipose nasal, rinite alérgica, perda olfatória pós-viral e pós-traumática. .

Aspectos tomográficos da órbita aguda infecciosa: revisão de literatura / Tomographic findings of acute infections of the orbit: literature review

As doenças que acometem a órbita de forma aguda e não traumática por vezes não são conhecidas por médicos em centros de emergência. Essas condições são decorrentes de diversos fatores, como desordens imunológicas, congênitas, infecciosas, vasculares, entre outras. As causas infecciosas correspondem a mais de 50% de todos os casos e requer rápido diagnóstico e conduta para minimização de sequelas. A tomografia computadorizada (TC) é o exame de imagem de primeira linha nesses casos, sendo geralmente disponível nos centros de emergência e capaz de fornecer auxílio diagnóstico de forma rápida, precisa e eficaz. Esse artigo de revisão visa descrever os principais aspectos tomográficos da órbita aguda infecciosa, correlacionando-os com os dados da literatura.

The acute and nontraumatic diseases that involve the orbit are often little known by most physicians. These conditions are due to several factors, such as immune disorders, congenital, infections, vascular, among others disorders. The infectious causes correspond to more than 50% of all cases and require rapid diagnosis and management in order to minimize sequels. Computed tomography (CT) is the first line imaging method on these cases, generally being available in emergency centers and capable to provide an accurate, quick and effective diagnostic information. This review article aims to describe the main tomographic findings in acute orbit infections, correlating them with the literature data.