Significance of lysosomal proteases; cathepsins B and H in maxillary mucosa and nasal polyp with non-atopic chronic inflammation

Tissue extracts from maxillary mucosa (MM) and nasal polyp (NP) with non-atopic chronic inflammation were applied to DEAE-Sepharose, and hydrolytic activity of lysosomal proteases (cathepsins B and H) was measured by the fluorometric assay. Hydrolytic activity of cathepsins B and H in MM, of which cathepsin B was a major one, was about 3.5 times as high as that in NP. Protein composition resembled in both extracts except for several apparent protein bands with high molecular weight observed in NP. These results suggest that in MM with chronic inflammation, mucosal destruction induced by excess lysosomal granuloproteases overwhelming protease inhibitors would occur, being much related to the formation of its irreversible lesion.     

A study of infiltrated cells in the maxillary mucosa in nasal allergy and chronic sinusitis

The cloudiness of the maxillary sinus in Waters-view is 37% in patients with nasal allergy. The pathogenesis of this cloudiness has not fully understood yet; is it due to the type- I allergic reaction, or secondary maxillary sinusitis? To clarify the pathology, we studied the infiltrated cells in 37 mucosae of the maxillary sinus in which X-ray revealed an abnormal shadow. Samples were also taken from 9 antrums with chronic sinusitis, and 18 and 4 nasal mucosae form the inferior turbinate with nasal allergy and sinusitis, respectively. Each specimen were fixed with Carnoy solution and formalin, and were stained with Hematoxylin & Eosin, and with Alcian blue & Safranin. Numbers of formalin sensitive and resistant mast cells and eosinophils were determined in the epithelium, and superficial and deep layers of the lamina propria, respectively. The population of both mast cells in each compartment was not different between nasal allergy and maxillary sinusitis both in the nasal and maxillary mucosae. The number of eosinophils in the maxillary and nasal epithelial significantly increased in nasal allergy compared with sinusitis. These results suggested that type-I allergic reaction might occur in the maxillary mucosa as well as nasal mucosa in patients with nasal allergy.     

Application of YAMIK sinus catheter for patients with paranasal sinusitis with and without nasal allergy

Purpose: YAMIK sinus catheter (YAMIK) has already been reported to be a useful therapeutic device for sinusitis cases. The purpose of this study was to compare the effectiveness of YAMIK in sinusitis cases with and without nasal allergy in order to contribute toward establishing its indication. Methods: YAMIK was tried in 10 chronic sinusitis cases complicated with nasal allergy and 20 cases without nasal allergy. Clinical symptoms, endoscopic findings and pathological opacification in X-ray photographs were compared in these cases with and without nasal allergy. Results: No significant differences were seen in the effectiveness of YAMIK between cases with and without nasal allergy. Conclusion: These findings suggest that YANIK is useful and applicable even in sinusitis cases complicated with nasal allergy.     

Sympathomimetics in nasal allergy

The effect of a topically administered alpha-adrenoceptor agonist (phenylpropanolamine) after allergen challenge was evaluated in a placebo-controlled double-blind crossover study in 10 subjects with allergic rhinitis in an asymptomatic period. The nasal airway resistance was objectively measured by anterior rhinomanometry after nasal allergen challenge. The degree of nasal blockage, secretion and the number of sneezes were registered in a score. Nasal airway resistance and the degree of blockage were found to be significantly reduced. Thus, alpha-adrenoceptor agonists might be used topically for symptomatic treatment of allergic rhinitis comprising mucosal congestion.     

Hypoxia in paranasal sinuses of patients with chronic sinusitis with or without the complication of nasal allergy

OBJECTIVE: In order to elucidate the pathogenesis of the radiologic opacity of the sinuses frequently observed in patients with allergic rhinitis, the mechanisms underlying their sinus mucosal swelling were studied clinically. MATERIAL AND METHODS: We confirmed the presence of hypoxia in inflamed sinuses and obstruction of the sinus ostium in operated patients with chronic sinusitis by digitally monitoring the oxygen tension. The possibility of radiologic sinus shadow was also investigated after transient obstruction of the natural ostium. RESULTS: The oxygen tension was significantly lower in inflamed than non-inflamed sinuses (p < 0.01), irrespective of the presence or absence of allergic rhinitis. In 54.5% of patients without sinusitis, transient obstruction of the middle meatus by gauze packing resulted in the appearance of a pathologic sinus shadow on radiograms obtained after septoplasty and turbinotomy. In both allergic and non-allergic rhinitis, thick opacity was the most frequently encountered pattern (p < 0.01). CONCLUSION: Our study revealed that in the absence of a primary allergic reaction in the sinus mucosa, blocking of the middle meatus and ostium by allergic swelling of the nasal mucosa may induce hypoxia and secondary mucosal swelling in the sinuses.     

Proteolytic activity and serum protease inhibitors in nasal secretions from adult patients with common colds

Proteolytic activity and concentrations of serum protease inhibitors were measured in nasal secretions collected from 14 adult patients (6 males and 8 females) with common colds. Elastase concentration and fibrinolytic activity increased about three days after the onset of the colds, and there was a significant correlation between both values (p less than 0.01). Trypsin-like protease activity was very low. Of all serum protease inhibitors, inter-alpha-trypsin inhibitor could not be detected, and alpha 2-macroglobulin could be detected in only two cases. Variation of alpha 1-antitrypsin value was very similar to that of alpha 1-antichymotrypsin, and there was a significant correlation between alpha 1-antitrypsin and elastase (p less than 0.001). Phoretic patterns of crossed immuneelectrophoresis revealed the presence of alpha 1-antitrypsin-protease complex. alpha-protease inhibitors are major serum protease inhibitors in nasal secretions of persons with colds, and inhibit excess proteolytic activity of serine proteases. This protection is considered to be one of the major factors in preventing irreversible mucosal change.     

Lysosomal thiol proteases (cathepsin B-like proteases) in serous middle ear effusions from adult patients

Hydrolytic activity of cathepsins B, H and trypsin-like proteases was measured in 38 serous middle ear effusion (MEE) samples. The concentrations of (alpha 1-AT) and alpha 2-macroglobulin (alpha 2-M) were also quantitated. The mean value of cathepsin B activity was 25.0 +/- 20.7 RFU and that of cathepsin H was 14.3 +/- 3.0--both significantly higher than those in plasma (1.8 +/- 0.4 RFU, 1.2 +/- 0.3 RFU, p less than 0.005). Very low trypsin-like protease activity could be observed. The mean concentrations of alpha 1-AT and alpha 2-M were 368 +/- 94.8 mg/dl and 57.5 +/- 57.3 mg/dl. The bulk of alpha 1-AT in MEEs was occupied by free alpha 1-AT, which can saturate exogenous trypsin. Due to the very low molar concentration of alpha 2-M in MEEs, thiol proteases (mainly cathepsin B) could be a possible major factor inflicting proteolytic injury on the middle ear mucosa and reflecting the severity of the inflammatory process.     

鼻腔解剖变异与慢性鼻窦炎关系的研究

目的:评价鼻腔HRCT检查及临床应用价值.方法:应用Philips SR-7000螺旋CT扫描仪对106例鼻疾病患者行冠状位及横断位HRCT扫描,层厚3mm,层间距5mm.其中12例层厚3mm,层间距3mm.结果:本组病例慢性鼻窦炎患者占92%,扫描显示鼻中隔偏曲占81.6%,中鼻甲气化占52.0%,中鼻甲反向弯曲占22.4%,Haller气房占44.8%,筛泡过度气化占50.0%,钩突偏曲占21.4%.扫描层间距为5mm,窦口鼻道复合体显示率为49.6%.层间距3mm为100%.结论:窦口道复合体变异与慢性鼻窦炎的发生相关,鼻窦HRCT冠状位扫描是显示该区域最佳影像学技术,对功能性鼻内窥镜手术具有指导价值.