Multidisciplinary approach to the therapy of chronic sinusitis.

Twenty patients with maxillary sinusitis were treated with cefotetan (1 g, i.m.) twice a day. Samples of blood and maxillary sinus mucous membrane were taken in eight patients 2 h after dosing during the third day of therapy to evaluate drug concentration. Results show the excellent clinical and bacteriological effectiveness of cefotetan, as well as its high tissue penetration.

The morphological basis for the effect of substance P on mucociliary activity in rabbit maxillary sinus.

The mucociliary (m.c.) activity in rabbit maxillary sinus is accelerated by the neuropeptide substance P (SP). The morphological basis for this mechanism was investigated by immunocytochemistry using monoclonal antibodies directed against SP. SP-like immunoreactivity was found in nerve fibres in the subepithelial layer of the sinus mucosa, in the maxillary nerve, and in nerve endings close to nerve cell bodies in the sphenopalatine ganglion. Thus, there is morphological evidence in the rabbit that SP plays a role in the regulation of m.c. activity. The results also support the view that the rabbit maxillary sinus is a suitable experimental model for studying SP effects in the airway mucosa.

[Determination of aerosol deposition in the maxillary sinus]. / Depositionsnachweis von Aerosolen in der Kieferhöhle.

The penetration of aerosol into the maxillary sinus depends on the function of the maxillary ostium. Exact findings regarding the velocity of the air flow in the maxillary sinus can be gained by anemometry under optical control of the position of the thermistor. The penetration of aerosol (Patent Blue) can be observed even with a partially closed ostium, and deposit can be documented by photographs. The resorptive process on the mucosa - using fluorescent aerosols - can be visualized by direct excision under UV microscopy. Finally, it is pointed out that the aerosol has a therapeutic value in chronic sinusitis maxillaris even with only partial patency of the ostium.

Healthy and diseased epithelium of the oral and maxillary sinus mucosa studied by X-ray microanalysis.

Concentrations of Na, Mg, P, S, Cl, K, and Ca in healthy and pathologically transformed epithelial cells of oral cavity and maxillary sinus mucosa in man were measured by X-ray microanalysis. Biopsies from normal mucosa, irradiated and clinically cured squamous cell carcinoma, mucoepidermoid carcinoma from the oral cavity, and polyposis in the maxillary sinus were prepared by rapid freezing and cryosectioning. In normal mucosa, nuclei and cytoplasm of basal, intermediate and apical epithelial cells were analyzed. A slight decrease in the concentration of Na, Mg, P and Cl was found towards the apical cells. The concentration of Na in the nuclei of the different cell layers parallelled that of P. The elemental composition of the pathologically transformed cells differed markedly from that of the cells of healthy oral mucosa (higher Na and Cl). In the irradiated squamous cell carcinoma the concentrations of Mg and K were extremely low.

Studies on the penetration of lymecycline into the paranasal sinus in man.

Concentration of lymecycline, a lipophilic tetracycline, in the human sinusal mucosa tissue, as measured by the "punch method" technique are fairly high. The median value of all examined pieces of mucosa amounts to 1.2 mcg/g.

A pharmacokinetic study of bacampicillin in patients with chronic maxillary sinusitis.

The penetration of ampicillin into sinus mucosa and secretion after oral bacampicillin was studied in 30 patients subjected to radical maxillary sinus surgery. Bacampicillin in a dose of 1200 mg was administered orally before the operation and the concentrations in serum, sinus mucosa and secretion were assayed. The mean serum concentration (+/- SEM) reached its maximum of 13.4 +/- 1.2 micrograms/ml in about one hour. The mean concentrations in the secretion and mucosa after two to five hours were 1.6 +/- 0.5 micrograms/ml and 1.6 +/- 0.4 micrograms/ml respectively. The clinical course of the patients was mostly uneventful. Adverse effects probably caused by the drug were found in two cases.

Quantitative histology of the maxillary sinus.

The entire mucosa from 10 normal maxillary sinuses was removed post-mortem and stained by the PAS-alcian blue whole-mount method. The density of goblet cells and of mucous glands was investigated. The median density of goblet cells was 170 cells/field, corresponding to 9,600 cells per mm2, with wide individual variations, but there were no significant differences in density between the various walls. The density of goblet cells was somewhat higher than in the nose. Glands were very scarce and small in the maxillary sinus. Their median density in most walls was 0.15-0.20 gland/mm2, but in the medial wall significantly higher, 0.5 gland/mm2. The lower density of glands in the maxilly sinus than in the nose, where it is 8-9 glands/mm2, is in complete agreement with lesser requirement of the antral mucosa for moistening, cleaning, and warming of the air. Quantitative histological studies of normal mucosa will form the basis for studies of abnormal mucosa.

Antibiotic concentrations in maxillary sinus secretions and in the sinus mucosa.

In maxillary sinusitis, the blood circulation is supposed to be impaired in the oedematous sinus mucosa, and in such cases the transport of antibiotics into the maxillary sinus should be reduced. To prove the accuracy of this assumption a comparison has been made between the concentrations of penicillin and doxycycline (Vibramycin, Pfizer) in sinus mucosa and secretions and the serum concentrations in patients under treatment with these antibiotics. Measureable concentrations of penicillin (greater than 0.2 mug/ml) were reached in the secretions only if the serum concentration was high (greater than 4-5 mug/ml). In contrast, measurable concentrations of doxycycline were achieved in both mucosa and secretions in all patients treated with this antibiotic. This must depend on the fact that doxycycline, due to its optimal lipid solubility, was able to penetrate poorly vascularized tissue. In most cases, the concentrations of doxycycline far exceeded the minimum inhibitory concentrations of the isolated organisms, and in some cases the local concentrations were higher than those found in the serum. The clinical response to doxycycline was good and correlated well to the laboratory data.

Visualization of doxycycline in lung tissue and sinus secretions by fluorescent techniques.

The two studies which are reviewed in this paper demonstrate the value of fluorescent microscopic observations in the studying of the distribution of antibiotics in lung tissue and in sinus secretions. In the lung tissue study, the standard microbiologic assay data on doxycycline concentrations in respiratory tissue take on greater meaning when one is able to visualize the relative distribution of doxycycline-derived fluorescence among bronchiolar, vascular and parenchymal sites. In the sinus secretions study, doxycycline was shown to pass into the sinus secretions in concentrations, in most instances, which are significantly greater than the relevant MICs. These therapeutic levels were achieved and assayed in sinus secretions, even though a corresponding fluorescence was not always demonstrated. When fluorescence was shown, the wide homogeneous distribution of doxycycline throughout the aspirate of purulent maxillary sinus mucus was striking. Fluorescent microscopy can provide a dynamic visualization of doxycycline's presence in human tissue and secretions. Fluorescent microscopy, together with standard microbiological assay methods, affords both qualitative and quantitive data on the drug's biologic activity.