Does recurrent sinusitis lead to a sinusitis remodeling of the upper airways in asthmatic children with chronic rhinitis?

BACKGROUND: There is a growing recognition that some patients with long-standing asthma may possess a component of irreversible airflow obstruction due to airway remodeling. The underlying chronic inflammation has been implicated as the cause of this process. In the upper airways, the inflammation presents itself with symptoms of chronic rhinitis, leading to recurrent sinusitis, in some patients. OBJECTIVE: We attempted to determine if any changes that might be considered remodeling had occurred in the nasopharynx and paranasal sinuses of asthmatic children with recurrent sinusitis. METHODS: Computerized-tomography (CT) scanning of the nasopharynx and paranasal sinuses was investigated retrospectively. RESULTS: Sixty-six asthmatic patients with chronic rhinitis and recurrent sinusitis were analyzed in this respect. Their mean age was 7.41 +/- 2.91 years (26 female, 39 male). In 89% (n = 59) of the patients, tomography findings were abnormal. Among these subjects, sinusal-mucosal thickening was present in 75% (n = 44), and concha hypertrophy was present in 51% (n = 30). Adenoid hypertrophy was present in 20% (n = 12), and septum deviation was present in 17% (n = 10). CT findings were normal in 11% (n = 7). CONCLUSION: In most of the asthmatic children having chronic rhinitis and recurrent sinusitis, the upper respiratory tract underwent a series of changes, which might be assessed as remodeling. Thus, tomography of the upper-respiratory tract may provide some useful information about the state of the disease, and to what extent the treatment can relieve symptoms of the sinus disease and the concomitant asthma.

Hematuria with mumps infection.

Two cases with macroscopic hematuria as complication of acute mumps infection is reported. The patients have neither been vaccinated against mumps nor had mumps infection earlier. Macroscopic hematuria resolved spontaneously and renal functions did not deteriorate in both the patients. Although mumps has a benign course, mild and rarely severe renal involvement may occur. Therefore, renal functions in patients with hematuria and mumps should be followed closely.

Varicella vaccination in children with steroid-sensitive nephrotic syndrome.

We have studied serological and clinical response to live, attenuated varicella zoster virus (VZV) vaccine (Varilrix, SmithKline Beecham) in 20 patients with steroid-sensitive nephrotic syndrome (SSNS) in remission and 22 normal controls who had no history of varicella and no detectable antibody to VZV. Nephrotic patients included 15 boys and 5 girls, with a mean age of 4.7 years (range 2-11.4 years). The controls were healthy age-matched children (13 girls and 9 boys). Seventeen patients with SSNS (85%) and 19 healthy controls (86%) seroconverted 8 weeks after vaccination. One patient with SSNS had a relapse 20 days after vaccination, and 1 child in the control group had a rash. Two years after vaccination, antibodies to VZV were detected in 12 of 17 responders, 2 of 3 non-responders, and 13 of 22 controls. Within 2 years of vaccination, 3 of the vaccine responder children with SSNS had a mild varicella infection. Two responder and 1 non-responder nephrotic children and 9 controls were lost to long-term follow-up. Our results show that immunization with a single dose of VZV vaccine is safe and effective in children with SSNS in remission.