Search

The article presents the cross-sectional study on the correlation between macrophage inflammatory protein-I (MIP) alpha production and eosinophil infiltration in chronic rhinosinusitis with nasal polyps (NP). The study involved nonatopic and atopic NP patients and healthy subjects as controls and flow cytometry for measuring nasal secretions. The results reportedly revealed that NP patients have more MIP alpha concentrations, suggesting that it is useful for assessing eosinophil inflammation.

Background: Patients with allergic rhinitis when challenged with allergen develop various types of nasal response, such as an immediate nasal response (INR), late nasal response (LNR), dual late nasal response (DLNR), or delayed nasal response (DYNR), probably because of different hypersensitivity mechanisms. This study was designed to investigate the cytological changes in the nasal secretions (NSs) during the DYNR, beginning 24‐32 hours, reaching maximum at 32‐36 hours, and resolving within 56 hours after the nasal provocation tests (NPTs) with allergens. Methods: In 45 allergic rhinitis patients developing 45 positive DYNRs (p < 0.01), the NPTs and the phosphate-buffered saline (PBS) controls were repeated and supplemented with cytological examination of the NSs and determination of interferon (IFN)γ and IL-4 in nasal lavage fluid (NLF). Results: The repeated DYNR (p < 0.001) was accompanied by significant changes (p < 0.05) in the counts of neutrophils, monocytes, lymphocytes, epithelial and goblet cells, and, to a limited extent, of plasma cells and platelets in the NSs and increased concentrations of IFN-γ but not of IL-4, in NLF between 24 and 48 hours after the NPT. No significant cytological changes were found in NSs during the PBS controls (p > 0.1). Conclusion: The DYNR is associated with cytological profiles in the NS different from those observed during the INR or LNR. The significant count changes of neutrophils, monocytes, lymphocytes, epithelial and goblet cells in NSs, and increased IFN-γ but not of IL-4 concentrations in the NLF, suggest a possible involvement of the cell-mediated hypersensitivity in the DYNR. These results also emphasize the diagnostic value of NPTs combined with cytological examination of the NSs in patients with nasal allergy. [ABSTRACT FROM AUTHOR]

Objectives: Donor sites for free mucosal grafts for endoscopic endonasal reconstruction of the skull base have traditionally included the middle turbinate, the inferior turbinate, and the nasal septum. The aim of this study was to demonstrate a free mucoperiosteal graft from the nasal cavity floor as a simple alternative donor site for mucosal grafts. Methods: In a cadaver study with clinical correlation, we performed endoscopic endonasal harvest of the nasal floor free mucosal graft on two sides of a cadaveric nasal cavity. We also describe the cases of two patients in whom a nasal floor free mucosal graft was used to repair a skull base defect. Results: The harvest of a nasal floor free mucosal graft is a quick, potentially less morbid method of obtaining free mucosal grafts. In the cases examined, use of this graft carried minimal morbidity and allowed for successful reconstruction of a skull base defect. Conclusions: Harvest of nasal floor mucosa is a technically simple method of obtaining free mucoperiosteum for reconstruction of the skull base. [ABSTRACT FROM AUTHOR]

We present a unique anatomic cause of encephalocele, and describe appropriate diagnosis. Two patients underwent stereotactic image-guided sinus surgery for presumed chronic rhinosinusitis with intraoperative findings of a sinus encephalocele. The first patient underwent a conservative 2-stage management that included an initial cerebrospinal fluid (CSF) leak repair followed by encephalocele resection. The second patient underwent a 1-stage encephalocele resection and CSF leak repair with a septal graft. The sinus surgeon needs to consider the possibility of encephalocele when the ethmoid, sphenoid, or, rarely, frontal sinuses present with an isolated opacification that does not improve with conservative medical therapy. [ABSTRACT FROM AUTHOR]

Background: Exosomes are nanovesicles of endocytic origin released by cells and present in human body fluids such as plasma, breast milk, and bronchoalveolar lavage fluid. These vesicles take part in communication between cells. Recently, it was shown that exosomes contain both mRNA and microRNA. This RNA can be shuttled between cells (exosomal shuttle RNA), which is a new route of communication between cells. The aim of this study was to determine whether nasal secretions harbor exosomes and furthermore, whether these exosomes contain RNA. Methods: Human nasal lavage fluid (NLF) underwent centrifugation and filtration to discard cells and debris, followed by a final ultracentrifugation at 120,000 × g to pellet the exosomes. Exosomes were detected using electron microscopy (EM), flow cytometry, and Western blot. RNA was extracted and analyzed using a Bioanalyzer. Results: Exosomes were visualized as 40-80 nm, CD63+ vesicles using EM. Flow cytometry of exosomes using anti-major histocompatibility complex class II beads revealed exosomes positive for the tetraspanins CD9, CD63, and CD81. Western blot confirmed the presence of exosomal protein and absence of proteins from the endoplasmic reticulum (ER), because the exosomes were positive for Tsg101, but negative for the ER marker, calnexin. Bioanalyzer analysis revealed that, these exosomes contain RNA. Conclusion: This study shows for the first time that NLF contains exosomes and that these exosomes contain RNA. Further characterization of the exosomal RNA and proteins may provide important information about communication in the nose and potentially provide a source of biomarkers for upper airway diseases. [ABSTRACT FROM AUTHOR]

Objectives: We report novel mutations in the POU3F4 gene resulting in congenital X-linked deafness DFN3, and describe the results of cochlear implantation in 4 boys (3 siblings) followed for an average of 3.5 years. Methods: The diagnosis of DFN3 was made in infant boys on the basis of the radiologic criteria of an underdeveloped modiolus, a wide cochlear fossette, and the presence of all cochlear turns. The POU3F4 gene was sequenced. A standard, transmastoid, facial recess approach was used for cochlear implantation. A lumbar drain was placed before the operation. Results: The identified mutations in the POU3F4 gene were novel (p.R167X in the 3 siblings) or recently reported (p.S310del). A high-flow cerebrospinal fluid leak through the cochleostomy was encountered in each patient and was ultimately controlled. Although the implants functioned properly, the auditory perceptual abilities did not progress past sound detection in the 3 siblings, or past closed-set word identification in the non-sibling, who achieved better speech perception with contralateral amplification. Three boys (2 siblings) show signs of other learning disorders; 1 boy was too young for a complete assessment. Conclusions: Preoperative gene mutation analysis in DFN3 patients who are considering cochlear implantation may help in long-term counseling and in avoidance of postoperative complications. Limited auditory perception and language acquisition may result. Amplification may sometimes be a better alternative than cochlear implantation, despite the severity of the hearing loss. [ABSTRACT FROM AUTHOR]

The article compares the Equid herpesvirus 1 (EHV-1) glycoprotein B (gB) gene copies per 1 million nucleated nasal cells, per swab, per 1 microliter of extracted deoxyribonucleic acid (DNA), and per 1 nanogram of DNA in measuring the viral load of nasal secretions of naturally and infected horses using real-time polymerase chain reaction (PCR). Viral loads of artifically and naturally infected horses had positive correlation between the four methods. Nucleic acids from both groups at various time points were almost the same.

Chronic subdural hematoma as a complication of lumbar drain placement for the management of iatrogenic cerebrospinal fluid (CSF) leak has not been previously documented in the literature. We describe such a case in a 69-year-old man who presented with right nasal obstruction secondary to an inverted papilloma involving the paranasal sinuses. The patient underwent endoscopic sinus surgery, which included a medial maxillectomy. Surgery was complicated by a small CSF leak, which was repaired intraoperatively. Five days later, the patient experienced CSF rhinorrhea, and a lumbar drain was inserted. He developed overdrainage symptoms but was well when he was discharged. However, 22 days later he returned with right hemiparesis. Computed tomography of the brain showed a left frontoparietal subdural hematoma with a mass effect. The neurosurgical team performed an emergency drainage procedure, and the patient experienced a complete neurologic recovery. We discuss the pitfalls of lumbar drainage, the possible pathophysiology of overdrainage, and the lessons learned from this case. [ABSTRACT FROM AUTHOR]

Clinical images from high-resolution computed tomography (HRCT) of a 35-year-old woman presented with a 1-month history of a clear, watery, left nasal discharge on bending forward and diagnosed with spontaneous cerebrospinal fluid (CSF) rhinorrhea from the left sphenoid sinus defect are presented.

The article discusses the case of a 43-year-old woman presented with recurrent sinus infections and postnasal drip. Computed tomography (CT) detected a fluid level in the right maxillary sinus. Mucopurulent drainage on the right lateral nasopharyngeal wall was revealed by examination of the nasopharynx through the left nasal airway that was carried out at the time of functional endoscopic sinus surgery. The condition of the patient was reported to improve after the operation and was treated with antibiotics based on culture and sensitivities.