A comparative study of artificial intelligence nasal polyp classification based on whole-slide imaging and JESREC diagnostic criteria / 中华耳鼻咽喉头颈外科杂志

Objective: To explore the types and clinical characteristics of chronic rhinosinusitis with nasal polyps (CRSwNP) based on artificial intelligence and whole-slide imaging (WSI), and to explore the consistency of the diagnostic criteria of the Japanese epidemiological survey of refractory eosinophilic chronic rhinosinusitis (JESREC) in Chinese CRSwNP patients. Methods: The data of 136 patients with CRSwNP (101 males and 35 females, aging 14 to 70 years) who underwent endoscopic sinus surgery from 2018 to 2019 in the Department of Otorhinolaryngology Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-sen University were analysed retrospectively. The preoperative clinical characteristics of patients were collected, such as visual analogue scale (VAS) of nasal symptoms, peripheral blood inflammatory cell count, total immunoglobulin E (IgE), Lund-Kennedy score and Lund-Mackay score. The proportion of inflammatory cells such as eosinophils, lymphocytes, plasma cells and neutrophils were calculated on the WSI of each patient through artificial intelligence chronic rhinosinusitis evaluation platform 2.0 (AICEP 2.0), and the specific type of nasal polyps was then obtained as eosinophilic CRSwNP (eCRSwNP) or non-eosinophilic CRSwNP (non-eCRSwNP). In addition, the JESREC diagnostic criteria was used to classify the nasal polyps, and the classification results were compared with the current gold standard for nasal polyps diagnosis (pathological diagnosis based on WSI). The accuracy, sensitivity and specificity of the diagnostic criteria of JESREC were evaluated. The data were expressed in M (Q1, Q3) and statistically analyzed by SPSS 17.0. Results: There was no significant difference between eCRSwNP and non-eCRSwNP in age distribution, gender, time of onset, total VAS score, Lund-Kennedy score or Lund-Mackay score. However, there was a significant difference in the ratio of nasal polyp inflammatory cells (eosinophils 40.5% (22.8%, 54.7%) vs 2.5% (1.0%, 5.3%), neutrophils 0.3% (0.1%, 0.7%) vs 1.3% (0.5%, 3.6%), lymphocytes 49.9% (39.3%, 65.9%) vs 82.0% (72.8%, 87.5%), plasma cells 5.1% (3.6%, 10.5%) vs 13.0% (7.4%, 16.3%), χ2 value was 9.91, 4.66, 8.28, 5.06, respectively, all P<0.05). In addition, eCRSwNP had a significantly higher level of proportion of allergic symptoms (nasal itching and sneezing), asthma, peripheral blood eosinophil and total IgE (all P<0.05). The overall accuracy, sensitivity and specificity of the JESREC diagnostic criteria was 74.3%, 81.3% and 64.3%, respectively. Conclusions: The eCRSwNP based on artificial intelligence and WSI has significant high level of allergic symptoms, asthma, peripheral blood eosinophils and total IgE, and the percentages of inflammatory cells in nasal polyps are different from that of non-eCRSwNP. The JESREC diagnostic criteria has good consistency in our research.

Different concentrations of specialized pro-resolving mediators in eosinophilic and non-eosinophilic chronic rhinosinusitis with nasal polyps / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the difference of concentrations of specialized pro-resolving mediators (SPMs) derived from fatty acids in eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP) and non-eosinophilic chronic rhinosinusitis with nasal polyps (nECRSwNP). Methods: A total of 36 patients with bilateral chronic rhinosinusitis with nasal polyps (CRSwNP) who underwent endoscopic nasal surgeries in Peking Union Medical College Hospital from May 2019 to September 2020 were enrolled, including 27 males and 9 females, with the age from 13 to 67 years. There were 23 cases of ECRSwNP and 13 cases of nECRSwNP. At the same time, 12 control subjects were enrolled. The concentrations of multiple SPMs, including lipoxins (LXA4 and LXB4), resolvins (RvD1, RvD2, RvD3, RvD5 and RvE1), protectins (PDX) and maresins (Mar-1) in nasal polyps with different histological subtypes and normal nasal mucosa were analyzed using liquid chromatography-tandem mass spectrometry. The concentrations of SPMs between groups were compared using Mann-Whitney U test. Spearman's rank correlation coefficient was used to measure the correlation between the concentrations of SPMs in nasal polyps and tissue eosinophil counts. Results: The concentrations of RvD2, RvD3, RvD5, LXA4, LXB4, Mar-1 and PDX in ECRSwNP group were significantly higher than that in controls (Z value was -2.276, -2.313, -3.371, -2.094, -2.051, -3.104 and -2.294, respectively, all P<0.05). The concentrations of RvD2, RvD5, Mar-1 and PDX in ECRSwNP group were significantly higher than those in nECRSwNP group (Z value was -2.175, -2.289, -2.243 and -2.124, respectively, all P<0.05). There was no significant difference in all these SPMs between nECRSwNP and controls (all P>0.05). The concentrations of RvD2, RvD3, RvD5, LXB4, Mar-1 and PDX in nasal polyps correlated positively with tissue eosinophil counts (r value was 0.443, 0.436, 0.371, 0.502, 0.340 and 0.386, respectively, all P<0.05). Conclusions: A varienty of SPMs are elevated in ECRSwNP. Dysregulation of fatty acid metabolism might play an important role in the chronic inflammation of ECRSwNP.

Anatomical Variations of the Middle Turbinate Concha Bullosa and its Relationship with Chronic Sinusitis: A Prospective Radiologic Study

Abstract Introduction A pneumatized turbinate, also called concha bullosa, is a normal anatomical variant of the paranasal sinus region. Depending on the site of pneumatization, the concha is classified into extensive, bulbous or lamellar type. The middle turbinate concha bullosa has been implicated as a possible etiological factor in chronic sinusitis. Objectives The aim of this study was to investigate the anatomical variations of the concha bullosa, based on paranasal sinus imaging, and its possible association with sinusitis. Methods This prospective descriptive study was performed at the Department of ENT and Head Neck Surgery over a period of one year, from 2016 to 2017. We studied the computed tomography scans of the nose and paranasal sinuses- in axial, coronal and sagittal planes-of patients who had symptoms of nasal obstruction, or headache and features of chronic sinusitis. Results Out of the 202 scans studied, the prevalence of concha bullosa was 31.7%. The concha was bilateral in 35 (54.7%) patients and unilateral in 29 (45.3%) patients. Out of 99 conchae, 54 were on the right side and 45 were on left side. Ipsilateral sinusitiswas found in 40.4% of the sides in the scans of subjectswith concha. There was no statistically significant association between any type of middle turbinate concha with sinusitis, but sinusitis was more predominant with the extensive type of concha (p > 0.05). Conclusion Multiple air cells, mucocele, pyocele and inflammatory mucosal thickenings in the concha are relatively rare. Detailed knowledge of anatomic variations of the concha bullosa is imperative for the radiologists and the operating surgeons.

The Imaging Appearance of Sinus Mycetoma: A Case Series / El Aspecto Imagenológico del Micetoma Sinusal: Serie de Casos

Sinus mycetoma is a dense accumulation of hyphae that form a rounded mass within the mucosal confines of a paranasal sinus. The aim of this study was to present a case series of three patients with maxillary sinus mycetoma and to describe their radiographic presentations. Three cases are presented. The first two, a 44-year-old woman and an 88 year-old man, both diabetics, were referred to maxillofacial treatment by other specialties. They both had a bad odor of unknown origin on the facial level and their respective computerized tomographies revealed a unilateral opacification of the maxillary sinus with a region of greater radio-opacity. The third case is a 31-year-old woman with a history of a severe facial trauma who had undergone surgery and for whom orthognathic surgery had been planned to correct side effects. In addition to the orthognathic surgery, the removal of the lesion that appeared opacified in the pre-surgery scan was planned. She showed opacification of the maxillary sinus and during the intraoperative stage, tissue of a whitish-gray appearance was detected on the maxillary sinus. The lesion was completely removed and the result of the histopathological study was sinus mycetoma. The patients evolved favorably and the symptomatology disappeared completely. The growing occurrence of mycetoma and the lack of information on it make publicizing this pathology fundamental so it can be considered as a differential imaging, clinical, and pathological diagnosis and in that way receive adequate and opportune treatment.

El micetoma sinusal es una patología de origen fúngico, que afecta a pacientes inmunocomprometidos, capaz de desorientar en su diagnóstico por su clínica y expresión imagenológica particular. El objetivo de este estudio es presentar una serie de tres casos con micetoma en el seno maxilar y describir su presentación imagenológica. Se presentan tres casos. Los dos primeros, una mujer de 44 años y un hombre de 88 años, ambos diabéticos y derivados a atención maxilofacial por otras especialidades. Coincidía un mal olor expelido de origen desconocido a nivel facial y en sus respectivas tomografías computarizadas se observó velamiento unilateral del seno maxilar con una zona de mayor hiperdensidad. El tercer caso corresponde a una mujer de 31 años con antecedente de trauma facial severo operado, a la cual se le planificó cirugía ortognática para corregir secuelas. En conjunto con la cirugía ortognática, se planificó la biopsia excisional de una lesión hiperdensa que se presentó en el escáner pre-quirúrgico; en el intraoperatorio se pesquisó tejido de aspecto blanquecino grisáceo en el seno maxilar. A todos los pacientes se les realizó la exéresis total de la lesión y el estudio histopatológico dio como resultado micetoma sinusal. Los pacientes evolucionaron favorablemente, desapareciendo por completo la sintomatología. La creciente incidencia del micetoma y el desconocimiento sobre el mismo hacen que sea fundamental la difusión de esta patología para ser considerada como diagnóstico diferencial clínico y patológico, y realizar así un tratamiento adecuado y oportuno.

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. .

Evaluation of the ability of an experimental model to induce bacterial rhinosinusitis in rabbits, / Avaliação da capacidade de um modelo experimental para indução de rinossinusite bacteriana em coelhos,

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. .

An experimental model of chronic rhinosinusitis in rabbits without bacterial inoculation

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. .

Correlación diagnóstico clínico e histopatológico en cirugía endoscópica nasosinusal / Clinical and histopathological correlation in endoscopic sinus surgery

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.

Trichosporon inkin, an unusual agent of fungal sinusitis: A report from south India.

The aetiology of fungal sinusitis is diverse and changing. Aspergillus species has been the most common cause for fungal sinusitis, especially in dry and hot regions like India. Trichosporon species as a cause for fungal sinusitis has been very rarely reported the world over. Here, we report a rare case of allergic fungal sinusitis caused by Trichosporon inkin in a 28-year-old immunocompetent woman. Bilateral nasal obstruction, nasal discharge and loss of smell were her presenting complaints. Diagnostic nasal endoscopy showed bilateral multiple polyps. Functional endoscopic sinus surgery was performed and many polyps were removed. Based on mycological and histopathological studies, the pathogen was identified as T. inkin.

Factores pronósticos para cirugía endoscópica funcional en rinusinusitis crónica: una revisión de la literatura actual / Prognostic factors for functional endoscopic surgery in chronic rhinosinusitis: a review of current literature / Fatores prognósticos para cirurgia endoscópica funcional en rinossinusite crônica: uma revisão da literatura atual

La rinusinusitis crónica es una patología bastante frecuente en la consulta diaria tanto de medicina general como a nivel de otorrinolaringología. Su entendimiento, adecuado diagnóstico y manejo preciso son de gran relevancia pues se encuentra dentro de una de las enfermedades que mas causa limitación en los pacientes y por lo tanto ocupa los primeros lugares dentro de las causas de ausentismo laboral. Dentro de sus opciones de manejo se encuentra la cirugía endoscópica funcional hasta el momento con altas tasas de éxito. A pesar de esto los pacientes con rinusinusitis recurrente sometidos a múltiples procedimientos quirúrgicos constituyen un dilema diario en la práctica clínica. Por todo lo anterior es de vital importancia conocer los factores prequirúgicos que puedan predecir de alguna manera el pronóstico postoperatorio del paciente. El objetivo de este artículo fue realizar una revisión de la literatura actual de los factores pronóstico para cirugía endoscópica en pacientes con rinusinusitis crónica (RSC)...

Chronic rhinosinusitis is a very frequent pathology in the daily consultation both at the general medicine and otorrhinolaryngology level. Its understanding, appropriate diagnosis and accurate management are of critical relevance since it is one of the most disabling diseases for the patients thus holding one of the first places as a cause of absenteeism form work. Among its management options there is the functional endoscopic surgery with high success rates up to now. In spite of this, patients with recurrent rhinosinusitis undergoing multiple surgical procedures are a daily dilemma in the clinical practice. For the aforementioned reasons, it is of vital importance to know the pre-surgical factors which can predict in some way the post-operatory prognosis for the patient. The objective of this paper was to perform a review of the current literature about the prognostic factors for the endoscopic surgery in patients with chronic rhinosinusitis (CRS)...

A rinossinusite crônica é uma patologia bastante frequente na consulta diária tanto de medicina geral como de otorrinolaringologia. Seu entendimento, adequado, diagnóstico e tratamento adequado são de grande relevância pois encontra-se dentro de una das doenças que mas causa limitação nos pacientes e portanto ocupa os primeiros lugares dentro de las causas de faltas ao trabalho. Dentro de suas opções de tratamento encontra-se cirurgia endoscópica funcional até o momento com altas taxas de sucesso. Apesar disso os pacientes com rinossinusite recorrente submetidos a múltiplos procedimentos cirúrgicos constituem um dilema diário na prática clínica. Por tudo isso é de vital importância conhecer os fatores pré-cirúrgicos que possam predizer de alguma maneira o prognóstico pós-operatório do paciente. O objetivo deste artigo foi realizar uma revisão da literatura atual dos fatores prognóstico para cirurgia endoscópica em pacientes com rinossinusite crônica (RSC)...

Schizophyllum commune sinusitis in an immunocompetent host.

Schizophyllum commune is widely distributed in the nature, but it rarely causes human infection. We have isolated this mould in a 46-year-old immunocompetent, non-diabetic patient with chronic sinusitis, previously treated with multiple antibiotics and topical steroid nasal drops with no response. Materials obtained from the nasal sinus during the endoscopic surgery, on KOH mount and histopathological study revealed broad septed hyaline hyphae. Growth on the Sabouraud's dextrose agar and potato dextrose agar produced white moulds with microscopic and macroscopic characters of S. commune. Till date there are few reports of S. commune sinusitis in immunocompetent individuals Worldwide. This is the first reported case in India to the best of our knowledge.

Rinossinusites / Rhinosinusitis

A rinossinusite é uma doença frequente na prática diária de clínicos gerais, pediatras, alergologistas, pneumologistas e otorrinolaringologistas. Embora tenha baixa mortalidade e alta morbidade, há situações específicas que precisam ser reconhecidas, em que as complicações podem colocar a vida do paciente em risco. Por ser abordada por diversas especialidades e ter formas variadas de apresentações, é importante definir uma classificação comum a fim de estabelecer diagnósticos mais precisos, racionalizar a solicitação de exames complementares e instituir tratamentos adequados. Dessa forma, haverá uma redução nos custos do tratamento, nas complicações e nas formas crônicas da doença, garantindo uma melhor qualidade de vida para o paciente.

Patogenia e inmunoterapia en la sinusitis alérgica fúngica (SAF) / Pathogeny and immunotherapy of allergic fungal sinusitis

Allergic fungal sinusitis is an atopic condition close related to fungus allergens that initiate a chronic inflammation dependent of the IgE system and LTCD4-TH2 cells whose cytokines and chemokines induced the clinical symptoms. Specific immunotherapy is recommended to avoid the recurrences and to improve the benefits of the surgical procedures of the affected sinuses. We suggest that Bipolaris sp Drechslera sp extracts must be included in the skin testing of the atopic patients suffering rhinosinusal symptoms as well as those who reveal intense response to fungal allergens in general.

Remodelamento das vias aéreas inferiores e superiores: [revisão] / Remodeling of the lower and upper airways: [revision]

Remodelamento pode ser definido como modelar novamente ou de forma diferente, reconstruir. Trata-se de um aspecto crítico do processo de reparação de lesões em todos os órgãos, representando um evento dinâmico de produção e degradação de matriz, em reação a inflamação, levando à reconstrução normal do tecido ou à formação de um tecido patológico. OBJETIVO E MÉTODO: Comparar os dados existentes em literatura entre o remodelamento de vias aéreas inferiores e superiores. RESULTADO: Asma é uma doença inflamatória crônica associada a remodelamento de vias aéreas. Na rinite alérgica, outra doença inflamatória crônica, o remodelamento é ainda pouco entendido. Apesar de a inflamação ser similar na rinite alérgica e asma, a extensão patológica do remodelamento nasal, assim como sua repercussão clínica, pode ser diferente dos brônquios. CONCLUSÃO: O remodelamento nas vias aéreas superiores ocorre em menor intensidade que nas vias inferiores, mas é aparente que a estrutura da mucosa nasal de pacientes com rinite não é normal.

Remodeling is defined as modeling again or differently, as reconstructing. Remodeling is a critical aspect of wound repair in all organs; it represents a dynamic process that associates the production and degradation of matrix in reaction to inflammation. This leads to normal reconstruction or a pathologic process. AIM AND METHODS: To compare data in the current literature on upper and lower airways. RESULTS: Asthma is a chronic inflammatory disease associated with abnormal airways remodeling. In allergic rhinitis, another chronic inflammatory disease, remodeling is still poorly understood. Even though inflammation is similar in allergic rhinitis and asthma, the pathologic extent of nasal remodeling, as well as its clinical consequences, might be different from those in bronchi. CONCLUSION: Remodeling occurs less in upper airways compared to lower airways; it is apparent, however, that the structure of the rhinitic nose is not normal.

Estudo comparativo entre diversas técnicas de confecção de modelo experimental de sinusite inflamatória em coelhos / Comparative study of several sinusitis experimental modelling techniques in rabbits

A criação de modelos de estudo das rinossinusites é necessária para compreensão de seus aspectos fisiopatológicos. OBJETIVO: Sugerimos neste estudo estabelecer um modelo experimental fidedigno, reproduzível e consistente para a rinossinusite inflamatória sem uso de inoculação de agentes infecciosos em coelhos. Tipo de Estudo: Experimental. MATERIAL E MÉTODO: Foram utilizados 20 coelhos neste estudo. Os animais foram submetidos a 4 intervenções diferentes: colocação de tampão de esponja unilateral, obliteração unilateral de óstio nasal com cianoacrilato, instilação unilateral de antígenos em seio maxilar e instilação de sangue em cavidade maxilar unilateral. Os animais foram acompanhados até 15 dias do início do estudo e ao final do período de seguimento foram anestesiados e sacrificados. Os seios maxilares foram avaliados histologicamente e os resultados comparados com os seios maxilares contralaterais para controle e entre os grupos de intervenção. RESULTADOS: Todos os animais do estudo desenvolveram rinorréia amarelada unilateral até o 15º dia de acompanhamento. Apenas os animais que receberam sangue não apresentaram alterações histológicas compatíveis com rinossinusite purulenta. CONCLUSÕES: O uso de esponja e cola para obstrução do óstio meatal e a aplicação de toxóide são eficientes como produtores de modelo de rinossinusite. A aplicação de sangue no antro não produz os mesmos resultados.

Experimental models for clinical studies of rhinosinusitis are needed. AIM: to define a reliable, solid and reproducible experimental model for inflammatory rhinosinusitis with no innoculation of infectious agents in rabbits. Study design: Experimental. MATERIAL AND METHOD: Twenty 20 rabbits were divided into 4 groups submitted to 4 different interventions: the placement of a unilateral nasal fossa sponge, unilateral obliteration of the nasal ostium with cyanoacrylate, unilateral placement of antigens in the maxillary cavity and unilateral placement of blood in the maxillary cavity. The animals were monitored for 15 days and then anesthetized and sacrificed; the maxillary sinuses were evaluated histologicaly and results were compared with controls and between the intervention groups. CONCLUSION: Sponje and glue as agents of meatal obstruction and toxoid aplied in the antrum are efficient as methods for rhinosinusitis modeling. Blood was not efficient in producing sinusitis.

Computed tomography findings in chronic rhinosinusitis patients with and without allergy.

The purpose of this study was to compare the paranasal sinus mucosal thickenings, bony changes consistent with chronic sinusitis, and bony anatomic variations detected by computed tomography (CT) in chronic rhinosinusitis patients with and without allergy. Three hundred and thirty-nine patients with chronic rhinosinusitis were analyzed for their allergic status by performing skin prick test. Two hundred and thirteen patients (62.8%) had at least one positive skin prick test (allergic patients, male/female: 85/128, mean age: 29.1 +/- 1.2). One hundred and twenty-six patients (37.2%) were included in the non-allergic group (male/female: 53/73, mean age: 31 +/- 2.2). Maxillary mucosal thickening and frontal hypoplasy were significantly more common in allergic chronic rhinosinusitis patients. Moreover, pneumatized uncinate process is apparently more common in the allergic group than non-allergic group, and statistical analysis revealed marginal significance (p = 0.0535). In conclusion CT findings of allergic chronic rhinosinusitis patients are comparable to the CT findings of chronic rhinosinusitis patients without allergy. However, presence of maxillary mucosal thickening, frontal hypoplasia or pneumatized uncinate process in the CT scan of a patient with chronic rhinosinusitis could be of clinical significance, and might guide the otolaryngologist for the evaluation of the presence of allergy.

Alterações incidentais dos seios da face na tomografia computadorizada do crânio e órbitas em crianças / Incidental paranasal sinuses abnormalities in pediatric patients using computed tomography of the head and orbits

OBJETIVO: Avaliar a prevalência e as características das alterações tomográficas incidentais dos seios da face em crianças sem quadro clínico de rinossinusite. MATERIAIS E MÉTODOS: Foram estudados pacientes entre zero e 18 anos de idade, submetidos a tomografia computadorizada do crânio ou órbitas por indicações não relacionadas a doença sinusal. RESULTADOS: Foram incluídas 64 crianças (idade média = 5,7 anos; desvio-padrão = 3,9). Achados incidentais nos seios da face ocorreram em 46 casos (72 por cento). Na maioria (25/46) as alterações eram discretas e o espessamento mucoso foi o achado incidental mais comum. Opacificação completa ou nível líquido foram observados em 12 crianças. Mais de um seio foi afetado em 33 pacientes, ocorrendo com maior freqüência nos seios maxilares, seguidos dos etmoidais. O acometimento bilateral e simétrico foi comum. As anormalidades ocorreram com maior prevalência, intensidade e extensão em crianças abaixo de três anos de idade. CONCLUSÃO: A prevalência de alterações tomográficas incidentais em crianças sem quadro clínico de rinossinusite é alta, predominando as definidas como discretas. A alteração mais encontrada é o espessamento mucoso. Achados incidentais moderados e acentuados tendem a ocorrer em crianças com menos de três anos de idade.