ABSTRACT
Introduction: Chronic rhinosinusitis (CRS) is treated with both surgical and medication options. However, long term data on patient outcomes is rare. In a real world clinical environment, our objective was to identify CRS patients, gather patient characteristics, and follow symptoms over one year. Patients and methods: This observational study enrolled patients with CRS. Primary clinical markers included atopy testing, serum IgE, and complete blood counts. A sinus computerized tomography (CT) scan was performed serially. Patients were enrolled into medical treatment Arm A and into surgical treatment Arm B. Symptom scores were calculated using the chronic sinusitis survey (CSS). Results: Atopy testing was positive in 67%. IgE levels or atopy did not correlate with CSS scores. A 23% decrease in total CSS scores was noted in Arm A at one year (P=.01). Arm B demonstrated a 38% reduction in total CSS scores at 3 months (P=.02) only. CT evidence of CRS was found in 74% of patients. However, CT scores did not change significantly over 12 months. Conclusions: No correlation was found between serum IgE levels or atopy versus CSS scores. CT scan scores did not change significantly over 12 months in either treatment group. A reduction of CSS scores was seen in both treatment groups; however a rebound effect was suggested in the surgical arm. Our study demonstrates the disconnection between clinical markers, radiographic evidence and response to therapy in CRS in a common clinical setting. It exemplifies the need for controlled studies with years of chronic rhinosinusitis outcome analysis (AU)
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Subject(s)
Humans , Rhinitis, Allergic, Perennial/therapy , Sinusitis/therapy , Prospective Studies , Treatment Outcome , Immunoglobulin E/analysis , Hypersensitivity, Immediate/complications , EndoscopyABSTRACT
INTRODUCTION: Chronic rhinosinusitis (CRS) is treated with both surgical and medication options. However, long term data on patient outcomes is rare. In a real world clinical environment, our objective was to identify CRS patients, gather patient characteristics, and follow symptoms over one year. PATIENTS AND METHODS: This observational study enrolled patients with CRS, primary clinical makers included atopy testing, serum lgE, and complete blood counts. A sinus computerized tomography (CT) scan was performed serially. Patients were enrolled into medical treatment Arm A and into surgical treatment Arm B. Symptom scores were calculated using the chronic sinusitis survey (CSS). RESULTS: Atopy testing was positive in 67%. lgE levels or atopy did not correlate with CSS scores A 23% decrease in total CSS scores was noted in Arm A at one year (p =.01). Arm B demonstrated a 38% reduction in total CSS scores at 3 months (p =.02) only. CT evidence of CRS was found in 74% of patients. However, CT scores did not change significantly over 12 months. CONCLUSIONS: No correlation was found between serum lgE levels or atopy versus CSS scores. CT scan scores did not change significantly over 12 months in either treatment group. A reduction of CSS scores was seen in both treatment groups: however a rebound effect was suggest in the surgical arm. Our study demonstrates the disconnection common clinical setting. It exemplifies the need for controlled studies with years of chronic rhinosinusitis outcome analysis.
Subject(s)
Adrenal Cortex Hormones/therapeutic use , Endoscopy , Paranasal Sinuses/pathology , Rhinitis/therapy , Sinusitis/therapy , Chronic Disease , Disease Progression , Female , Follow-Up Studies , Humans , Immunoglobulin E/blood , Male , Middle Aged , Paranasal Sinuses/diagnostic imaging , Paranasal Sinuses/drug effects , Paranasal Sinuses/surgery , Prospective Studies , Rhinitis/blood , Rhinitis/physiopathology , Sinusitis/blood , Sinusitis/physiopathology , Skin Tests , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Trigeminal motoneurons (Mo5), mesencephalic trigeminal neurons (Me5), supratrigeminal neurons (Su5), and intertrigeminal neurons (I5) are important constituents of the neural circuitry responsible for jaw movements. Glutamate neurotransmission, mediated by ionotropic and metabotropic glutamate receptors (mGluRs), is critical for the production of jaw movements. To better understand the role of mGluR-mediated modulation of these neurons during early postnatal development, we conducted a series of experiments to illustrate the ontogeny of mGluRs 1, 5 (group I) and mGluRs 2, 3 (group II) in Mo5, Me5, Su5, and I5 neurons using receptor immunohistochemistry. Results demonstrate that the temporal expression of mGluRs is differentially regulated between, and within these trigeminal nuclei. The localization of group I and II mGluRs in these nuclei suggests a role for these receptors in mediating glutamatergic neurotransmission in brainstem circuits responsible for oral-motor behaviors.
