Ultrastructural changes of mast cells in the nasal mucosa in patients with pollinosis

The ultrastructural changes of mast cells in nasal mucosa taken from patients with pollinosis during pollen season were observed by electron microscopy. The main features of degranulation were as follows: 1. swelling of granules with lower electron density; 2. disappearance of the perigranular membrane; 3. vacuoles found in cytoplasm of the mast cells. It is suggested that the mast cells in the nasal mucosa play a more important role in nasal allergy.     

Differentiation and proliferation of mast cells in nasal mucosa]

We determined the distribution of mast cells in nasal mucosa and studied their proliferation. Inferior turbinate mucosa was sampled in 13 patients with allergic rhinitis (allergic group) and 5 without (non allergic group) and stained immunohistochemically using anti mast cell tryptase antibody, anti-c-kit antibody, anti-PCNA antibody, and anti mast cell chymase antibody. Tissue sections stained with anti tryptase antibody revealed a higher degree of infiltration of tryptase-positive cells, i.e., mast cells, in the allergic group than in non allergic group. In the allergic group, the number of tryptase-positive cells, c-kit-positive cells, and PCNA-positive cells was significantly greater in the epithelium and shallow lamina propria than that in the deep lamina propria. Tryptase-positive, c-kit-positive cells, i.e., c-kit-positive mast cells, and tryptase-positive, PCNA-positive cells, i.e., PCNA-positive mast cells, were also abundunt in the epithelium and shallow lamina propria. The stem cell factor and c-kit receptor are reported to play a primary role in mast cell differentiation and proliferation. PCNA-positive cells represent actively proliferating cells. Based on the above, we concluded that mast cells in the epithelium and shallow lamina propria in the allergic group differentiated and proliferated more actively than those in the deep lamina propria.     

Ultrastructure of nasal and paranasal mucosa in patients with chronic polypous rhinosinusitis

Electron microscopic study of operative samples of nasal and paranasal mucosa from patients with chronic polypous rhinosinusitis has discovered changes in the mucosa typical for inflammation and ultrastructural changes. Epithelial layer underwent destruction. Adequate function of the remaining ciliary cells is doubtful even in minimal changes of their ciliary apparatus. The absence of the specialized contacts between the epithelyocytes indicates dysfunction of the selective ionic permeability. There was overgrowth of the reticular fibers of the basal membrane. Plasma cells exhibited marked dilation of the cysterns of the rough endoplasmic reticulum probably because of active accumulation of immunoglobulins or their precursors.     

The significance of nasal eosinophils and mast cells in children with nasal symptoms

Nasal smears from children with symptoms of nasal obstruction and/or discharge were examined for the presence of eosinophils, mucus-containing cells and mast cells. The presence of more than one eosinophil or any mast cells was significantly associated with atopy as determined by immediate hypersensitivity on skin prick testing. Twelve children with markedly increased numbers of nasal smear mast cells are described. In these children symptoms frequently commenced in the first 6 months of life. Nasal eosinophilia was not noted in any of the cases. Nasal smear mastocytosis was associated with significant perennial symptoms and would be missed if nasal smears are examined only for eosinophilia.     

Clinical value of bacteriological examinations of nasal and paranasal mucosa in patients with chronic sinusitis

Although many investigations on the bacteriology of chronic sinusitis have been reported, there is still much discussion about the physiological flora of the nose and paranasal sinuses, the role of the various aerobic and anaerobic “pathogenic” bacteria, and the influence of the anatomical location from which samples for bacteriology are taken. We conducted a qualitative and semi-quantitative bacteriological examination of patients with chronic sinusitis undergoing a transnasal sinus operation (patient group), and of patients without chronic sinusitis undergoing a septoplasty (control group). In both groups brush smears of the inferior nasal turbinate and biopsies of the middle nasal turbinate were taken, with additional biopsies of the maxillary sinus and ethmoidal bulla in the chronic sinusitis group . In both groups coagulase-negative staphylococci were identified in almost all samples. Staphylococcus aureus was found in 22% (middle turbinate) to 33% (inferior turbinate) of the samples from the control group and in 33% (maxillary sinus, middle turbinate) to 50% (inferior turbinate) of the samples from the patient group. Other (pathogenic) aerobic bacteria were found much more rarely and only slight distinctions between control and patient group were observed. The concentrations of the different bacterial species (colony-forming units) were comparable in both groups. Strictly anaerobic bacteria and fungi were not identified. Only small discrepancies between the various methods and/or locations of sampling were found. Based on our bacteriological findings a differentiation between patients with and without chronic sinusitis was not possible. These results shed doubt on the clinical value of bacteriological examinations of nasal and paranasal mucosa in patients with chronic sinusitis. Received: 19 September 2000 / Accepted: 10 April 2001     

炎性细胞在变应性鼻炎患者鼻黏膜中的观察

目的 探讨变应性鼻炎患者鼻黏膜组织中炎性细胞的变化及与变应性鼻炎的关系。方法 选择55例发作期变应性鼻炎患者及123例健康者，采用刮匙在下鼻甲黏膜处刮拭涂片，用Wright染色，进行细胞学检测，并进行统行学分析。结果变应性鼻炎发作期患者黏膜细胞发生了显著变化，中性粒细胞及嗜酸粒细胞的数量显著增加（P〈0．001），淋巴细胞明显增加（P〈0.05），而脱落上皮细胞显著减少（P〈0．001）。结论 炎性细胞是变应性鼻炎发病机制中诸多因素之一，深入了解这一作用对于指导临床治疗有重要的意义。     

Clinical value of bacteriological examinations of nasal and paranasal mucosa in patients with chronic rhinosinusitis

Introduction. In the literature, contradictory statements regarding the physiological flora of the nose and paranasal sinuses, the role of aerobic and anaerobic ‘pathogenic’ bacteria, and the influence of the sample technique and location can be found. The aim of this study was to examine the reliability of bacteriological examinations of the nasal and paranasal mucosa in patients with chronic rhinosinusitis. Methods. Patients with and without chronic rhinosinusitis undergoing a functional endoscopic sinus surgery (FESS) or a septoplasty were examined. Nasal brushes of the inferior turbinate and mucosal biopsies of the middle turbinate were taken in both groups. Mucosal biopsies of the ethmoidal bulla and maxillary sinus were taken in only the chronic rhinosinusitis group. Results. In both groups, coagulase‐negative Staphylococci were found in all samples. Staphylococcus aureus was found in 22% (middle turbinate) and 33% (inferior turbinate) of all samples in the control group and in 33% (maxillary sinus) and 50% (inferior turbinate) in the patient group. Other aerobic bacteria were found in low percentages in both groups. No strictly anaerobic bacteria and no significant differences between both groups and the different samples were found. Conclusions. A differentiation between patients with and without chronic sinusitis was not possible.     

鼻腔黏膜病变与年龄及当地气候变化规律的调查

目的　探讨鼻黏膜病变与年龄及当地气候变化的规律。方法　对符合入选条件的患者进行登记编号,每月随访1次,前鼻镜和/或鼻内镜观察患者鼻腔黏膜病变部位和病情变化。利用SPSS17.0软件对记录数据进行Spearman相关性分析。结果　成功随访259例,记录有病变患者555人次,病变部位957处。气流对鼻腔黏膜损伤好发于10月至次年4月,4月后发病患者减少,8月后患者逐渐增加,11月、12月患者明显增加（P＜0.05）。2～12岁儿童、40～80岁中老年人发病率较高,13～39岁发病率较低（P＜0.05）。与湿度呈负相关（P＜0.05）。损伤部位以鼻中隔Little区黏膜最高,其次依次为下鼻甲、鼻中隔偏曲凹面、鼻中隔偏曲凸面、下鼻道、中鼻道、中鼻甲及嗅裂。结论　鼻腔黏膜损伤与年龄、季节有关,可能与鼻腔气流作用相关     

Vidian nerve resection in chronic hypertrophic non allergic rhinitis: effects on histamine content, number and rate of degranulation processes of mast cells in nasal mucosa

The effects of Vidian nerve resection on the histamine content, number and rate of degranulation processes of mast cells in the respiratory tract of the nasal mucosa in patients with intractable chronic hypertrophic non-allergic rhinitis (CHNAR) have been investigated at various times after surgery. Preliminary data are also presented on the effects of Vidian nerve stimulation on the same parameters. The Vidian nerve was stimulated during surgery before resection. After neurotomy the histamine content was significantly lower than before but the values became less low with the passing of time. The number of mast cells per microscopic field and their degranulation index were significantly lower after surgery than before it. Stimulation determines a significant reduction in the number of mast cells per microscopic field and a parallel reduction in histamine content. These data establish a relationship between cholinergic activity and secretory response of mast cells and demonstrate a role of the parasympathetic nerve supply in the pathogenesis of CHNAR. The great reduction in the number of mast cells and histamine content also suggests that the parasympathetic nerve supply could play a role in the regulation of histamine synthesis and uptake.     

Inhibitory effect of erythromycin on interleukin-8 secretion from exudative cells in the nasal discharge of patients with chronic sinusitis

OBJECTIVES: The mechanism of the efficacy of long-term low-dose macrolide therapy for chronic sinusitis is not fully understood. The authors studied the inhibitory effect of erythromycin on interleukin-8 (IL-8) secretion from exudative cells in the nasal discharge of patients with chronic sinusitis. STUDY DESIGN AND METHODS: Exudative cells in the nasal discharge were isolated from six patients with nonallergic chronic sinusitis. The cells, more than 90% of which were neutrophils, were incubated with or without erythromycin in the presence of 10 micrograms/mL of lipopolysaccharide. The IL-8 concentrations in the culture supernatants were measured by enzyme-linked immunoassay. RESULTS: The amount of secreted IL-8 in the absence of erythromycin was 682 +/- 226 pg/10(6) cells/24 h. The IL-8 secretion was significantly reduced to 66 +/- 15% and 46 +/- 13% of the control in the presence of 10(-6) and 10(-5) M of erythromycin, respectively. CONCLUSION: Erythromycin may act as a biologic modulator that inhibits IL-8 secretion from exudative cells and thereby blocks the vicious circle of neutrophil recruitment and IL-8 generation in the inflammatory site in chronic sinusitis.     

Amoxicillin concentrations in nasal secretions of patients with acute uncomplicated sinusitis and in paranasal sinus mucosa of patients with chronic sinusitis

In this prospective randomized clinical study a total of 59 patients of both sexes (above 18 years of age) were enrolled. Thirty patients with acute sinusitis were randomly allocated to two treatment groups, one group receiving 1000 mg amoxicillin every 12h for 10 days and the other group receiving 500 mg amoxicillin every 8 h for 10 days. The median concentration of amoxicillin in nasal secretions was 2.34 µg/ml in the 12-h administration group and 1.95 µg/ml in the 8-h administration group. Median bioavailability of antibiotic at 8-24h did not show any statistical differences between the two treatment schemes [probability (Z) = 0.2]. Twenty-nine patients with chronic sinusitis were then randomly allocated to three groups, with patients receiving 1000 mg amoxicillin at 12, 8 or 6 h before nasal and/or sinus surgery was carried out. The mean amoxicillin concentrations in mucosal tissues removed intraoperatively ranged from 0.69 to 0.99 µ/g sample. Statistical evaluation by analysis of variance did not show any statistically significant differences among the three treatment groups [probability (F) = 0.1705]. In all cases of acute and chronic sinusitis, amoxicillin concentrations exceeded minimum inhibitory concentration values for pathogens common in sinusitis. Our results indicate that 1000 mg amoxicillin administered twice daily produces tissue concentrations high enough to be clinically effective in patients with either acute or chronic sinusitis.     

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.     

慢性鼻窦炎内窥镜手术前后鼻窦粘膜的组织学研究

通过对30例慢性鼻窦炎内窥镜鼻窦手术前后的鼻窦粘膜进行扫描电镜和透射电镜的定量研究以及组织形态的定量研究，结果发现：术前上皮结构紊乱，上皮细胞脱落，细胞表面纤毛肿胀、倒伏、断裂及脱落；杯状细胞增多；细胞内线粒体减少、肿胀。术后的上皮细胞排列整齐，纤毛数量增多，均匀；细胞内线粒体增加，其形状因子、长短袖比等计量参数与术前比较均有显著性差异（P＜0．05）。作者认为，从组织学角度来看，内窥镜鼻窦手术清除病灶彻底，解除了窦口鼻道复合体的阻塞，因此对手术后鼻窦上皮的功能恢复十分有利。另外，组织形态学研究用于对鼻窦手术后疗效的评价，也是一种较新的和较客观的方法。     

Relationship between infiltrating cells and adhesion molecules in the nasal mucosa of patients with allergic rhinitis

Antigen-induced changes of cell adhesion molecules and their relationships to infiltrating cells were investigated immunohistochemically in nasal mucosa of perennial allergic rhinitis patients. An increased expression of E-selectin and VCAM-1 was noted on the vascular endothelium of the nasal mucosa 15-25 h after the topical antigen challenge. Although there was no increased expression of ICAM-1, we noted a positive correlation between the expression of E-selectin and ICAM-1. The expression of E-selectin and VCAM-1 as well as ICAM-1 was revealed to be correlated with the number of EG2-positive cells and CD4-positive cells, but not with elastase-positive cells. These findings suggest that all these adhesion molecules play a role in the topical influxes of eosinophils and CD4-positive cells in allergic nasal mucosa.