[The influence of local and combined acute suppurative Highmore maxillary sinusitis on the serum lactoferrin and interleukin-8 levels in the children].

The objective of the present study was to estimate the influence of isolated and combined acute suppurative Highmore maxillary sinusitis on the serum lactoferrin (LF) and interleukin-8 (IL-8) levels in the children. A total of 70 children at the age varying from 4 to 15 years were available for the examination. Twenty of them constituted the control group, 29 presented with acute suppurative Highmore maxillary sinusitis, in 21 cildren this condition was combined with frontitis, ethmoiditis, otitis, and adenoiditis. Serum lactoferrin and interleukin-8 levels were measured by solid phase enzyme-linked immunoassay. It was shown that all the aforementioned forms of rhinosinusitis were associated with a significant increase of the serum LF level, an universal factor inactivating the propagation of bacterial, viral, and fungal pathogens. The level of IL-8 known to activate chemotaxis was increased only in the children presenting with combined forms of suppurative Highmore maxillary sinusitis. It is concluded that this difference can be used for the purpose of dufferential diagnostics of different forms of suppurative maxillary sinusitis.

Can summary nitrite+nitrate content serve as an indicator of NO synthesis intensity in body tissues?

Studies with the use of a highly specific enzymatic sensor demonstrated that, contrary to the common opinion, normally nitrate is in fact not present in the most important physiological fluids. NO metabolites in the amniotic fluid and semen are mainly presented by NO donor compounds. Therefore, the intensity of NO synthesis can be evaluated by the total content of all its metabolites, but not by the widely used summary nitrite+nitrate content.

The association between paranasal computerized tomography scans and symptoms and signs in a general practice population with acute maxillary sinusitis.

The objective of this study was to evaluate the association between changes revealed by computerized tomography scan (CT) and symptoms, signs, and bacteriological diagnoses in a general practice population who had been diagnosed with acute maxillary sinusitis (AMS). This study was designed as a prospective cohort study in Danish general practice in cooperation with the otorhinolaryngology and neuroradiology departments at Aalborg County Hospital. One hundred and seventy-four patients, aged 18-65 years, suspected of having AMS were included. The strongest associations were with purulent nasal discharge, preceding upper respiratory tract infection, maxillary toothache and oedema over the maxillary sinuses. Self-reported previous sinusitis was negatively associated with sinus infection. There was a strong association between increasing values of C-reactive protein (CRP) and erythrocyte sedimentation rate and changes on the CT scan. CT scans contributed only little to the final diagnosis, whereas increased CRP values and elevated erythrocyte sedimentation rates were more reliable indicators of inflammation in the sinuses.

Symptoms and signs in culture-proven acute maxillary sinusitis in a general practice population.

The objective of this study was to assess symptoms and signs in patients with maxillary sinusitis and a bacteriological diagnosis obtained by sinus aspiration or lavage. Designed as a prospective cohort study in general practice, the study included 174 patients, aged 18-65 years, suspected of having acute maxillary sinusitis by their general practitioner. The main outcome measures were the independent association of symptoms, signs, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) concentration and confirmed infection with the predominant bacterial pathogens Streptococcus pneumoniae and Haemophilus influenzae. The predominant organisms found in patients with acute maxillary sinusitis were S. pneumoniae and H. influenzae. Body temperature >38 degrees C and maxillary toothache were significantly associated with the presence of S. pneumoniae and H. influenzae. Positive bacteriological culture results were significantly associated with increasing ESR and CRP values. None of the symptoms and signs, with the exception of body temperature >38 degrees C and maxillary toothache, were particularly sensitive indicators of the specific aetiology in patients with acute maxillary sinusitis. Elevated ESR and CRP values were significantly associated with positive bacteriological culture results. On the other hand, absence of these symptoms and signs did not exclude the presence of acute maxillary sinusitis.

Evaluating the reproducibility of sinus lavages with a saline solution administered directly in the maxillary sinus of patients after endoscopic sinus surgery.

INTRODUCTION: Chronic sinusitis is recognized as having a strong inflammatory component, and failures of endoscopic sinus surgery (ESS) are frequently attributed to persistent inflammation. A test that would allow rhinologists to evaluate the inflammatory state of a patient's sinuses would be helpful to evaluate cases refractory to therapy, determine appropriate medical therapy, and monitor the response to therapy. OBJECTIVES: The goal of this preliminary research is to assess the optimal method of collection and the reproducibility and specificity of sinus lavages. METHOD: Twelve patients who had undergone ESS were recruited. They were divided into two groups according to the persistence of their symptoms and the recurrence of acute sinusitis after ESS. The subjects were seen twice. Three successive lavages were collected from each maxillary sinus and were analyzed by cell count. RESULTS: Intrasession cell counts were most reproducible (Spearman rank correlation .7 for eosinophils and .6 for neutrophils) for the second lavage. Intersession cell counts were highly reproducible for eosinophils (r = .7) for the second lavage. The two-tailed t-test did not reveal any statistically significant differences between the good and the poor outcome groups. CONCLUSION: Assessment of eosinophil cell counts on sinus lavage is a feasible and reproducible method to evaluate the inflammatory state of a patient's sinuses in patients who have undergone ESS.

Serum and mucosal nitric oxide levels and efficacy of sodium nitroprussid in experimentally induced acute sinusitis.

Experimental acute sinusitis was induced in 21 New Zealand hybrid rabbits by occluding the ostium and inoculating them with Streptococcus pneumonia. While a group of rabbits with sinusitis was left untreated, two other groups were administered parenteral sodium nitroprussid (SNP) and oral levofloxacin for ten days. While staphylococci species, non-hemolytic streptococcus and contaminated flora were isolated from the sinuses of controls, Streptococcus pneumonia was re-isolated in two of six untreated rabbits, in one of six SNP administered rabbits and none of the levofloxacin treated rabbits. Serum and maxillary sinus mucosal nitric oxide (NO) levels were correlated. While the mean maxillary sinus NO level of controls was significantly higher than that of untreated rabbits, the mean maxillary sinus and serum NO levels were significantly higher in SNP administered rabbits than in the others. Although goblet cell hyperplasia and squamous cell metaplasia were detected in some slides, edema and neutrophil infiltration were the prominent findings. The most severe inflammatory changes were found in the untreated sinusitis group on the third and fifth days. The earliest improvement was observed in the levofloxacin treated rabbits. It was concluded that NO level is decreased during acute sinusitis and that SNP administration hastens the bacteriological and histological recovery.

Serum and Mucosal Nitric Oxide Levels and Efficacy of Sodium Nitroprussid in Experimentally Induced Acute Sinusitis

Experimental acute sinusitis was induced in 21 New Zealand hybrid rabbits by occluding the ostium and inoculating them with Streptococcus pneumonia. While a group of rabbits with sinusitis was left untreated, two other groups were administered parenteral sodium nitroprussid (SNP) and oral levofloxacin for ten days. While staphylococci species, non-hemolytic streptococcus and contaminated flora were isolated from the sinuses of controls, Streptococcus pneumonia was re-isolated in two of six untreated rabbits, in one of six SNP administered rabbits and none of the levofloxacin treated rabbits. Serum and maxillary sinus mucosal nitric oxide (NO) levels were correlated. While the mean maxillary sinus NO level of controls was significantly higher than that of untreated rabbits, the mean maxillary sinus and serum NO levels were significantly higher in SNP administered rabbits than in the others. Although goblet cell hyperplasia and squamous cell metaplasia were detected in some slides, edema and neutrophil infiltration were the prominent findings. The most severe inflammatory changes were found in the untreated sinusitis group on the third and fifth days. The earliest improvement was observed in the levofloxacin treated rabbits. It was concluded that NO level is decreased during acute sinusitis and that SNP administration hastens the bacteriological and histological recovery.

Diagnostic accuracy of acute maxillary sinusitis in adults in primary care.

OBJECTIVE: To evaluate the diagnostic value of symptoms and signs used in diagnosing acute community-acquired maxillary sinusitis (ACAMS), and to find useful clinical predictors for diagnosing it in adults in primary care. DESIGN: Prospective study in the study group and retrospective study in the reference group. SETTING: One primary care centre in the study group and another in the reference group. SUBJECTS: 50 adults with prolonged upper respiratory tract infection > or = 7 days) or self-suspected maxillary sinusitis. As a reference group, an analysis of records and diagnoses made by GP of 45 adult patients with the same inclusion criteria from another primary care clinic. MAIN OUTCOME MEASURES: The signs and symptoms associated with the diagnosis of ACAMS by GP and otorhinolaryngologist. The value of CRP, ultrasound and peak nasal expiratory flow in the diagnosis. RESULTS: Neither ultrasound nor any of the clinical signs increased the accuracy of diagnosis. Peak nasal expiratory flow below the normal range was associated with the diagnosis of ACAMS (p = 0.03). The presence of an otorhinolaryngologist had an influence on GP practice when compared with the reference group. CONCLUSION: The diagnosis of ACAMS is difficult with the available clinical methods. Peak nasal expiratory flow needs further study. New diagnostic means are needed.

[Clinical criteria for acute maxillary sinusitis in general practice]. / Klinisk kriterium for sinuitis maxillaris acuta i almen praksis.

The purpose of the investigation was to examine the diagnostic value of various symptoms, clinical findings, erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) in acute maxillary sinusitis using the aspiration of purulent or mucopurulent from the sinus of a patient with a pathological CT-scanning as the golden standard. Of 174 patients with suspected acute maxillary sinusitis seen in general practice we found 70% to have a pathological CT-scanning and 53% to have pus or mucous pus in the sinus aspirate. Only the ESR and CRP level were found to be significantly and independently associated with a positive diagnosis as defined by the golden standard. A clinical criterion based on either an elevated ESR and/or CRP level in a patient with pain related to the maxillary sinus region had sensitivity of 0.82, a specificity of 0.57, a positive predictive value of 0.68 and a negative predictive value of 0.75, and was diagnostically superior to the clinical examination. The investigation also confirms that this disease is most likely overdiagnosed in general practice.

Trace elements in chronic sinusitis.

Trace elements are indispensable for life and play an important role in the immunological system. Since it is believed that serum trace element values decrease in chronic infections, 43 patients with chronic sinusitis were evaluated for Zn, Mg and Cu levels. While all trace elements were found to be within normal ranges, Cu values were found to be significantly lower than in a control group of 20 age- and sex-matched volunteers. The reasons for this are unclear in the present study.

[Use of correlation analysis of clinical and laboratory data in the treatment of patients with chronic suppurative maxillary sinusitis]. / Primenenie korreliatsionnogo analiza klinicheskikh i laboratornykh dannykh pri lechenii bol'nykh khronicheskim gnoinym gaimoritom.

In order to objectivize clinical and laboratory data, we applied P. V. Terentyev's method of correlation analysis as modified by A. N. Zosimov when examining 60 adolescents with chronic purulent maxillary sinusitis. This approach was necessary to choose an adequate method for evaluating the therapeutic efficacy. Analysis of correlations between clinical parameters, blood profile and immune data demonstrated different relationships before and after therapy. The mathematical and graphical models proposed make it possible to evaluate objectively each type of treatment, the results being in agreement with clinical observations. These models can help predict the course of disease.

[Genetic aspects of the frequency of occurrence of suppurative highmoritis]. / Geneticheskie aspekty chastoty vozniknoveniia gnoinykh gaimoritov.

One hundred and fifty patients with chronic suppurative maxillary sinusitis (89 men and 61 women), aged 15 to 50 years, were examined. A potential correlation between the incidence of the disease and blood genetic markers (ABO-H blood group and Rh-factor) was investigated. No correlation was found between the incidence and ABO-H in that group of patients as a whole. The patients with documented staphylococcal nature of suppurative maxillary sinusitis belonged for the most part to the A (II) - Rh (D) + blood group.