难治性鼻-鼻窦炎黏膜胶原纤维沉积的研究

目的本研究观察难治性鼻-鼻窦炎（difficult-to-treat rhinosinusitis,DTRS）的鼻窦黏膜胶原纤维沉积程度,同时还探讨其与TGF-β1、嗜酸性粒细胞及影像学表现的关系。方法根据患者就诊时临床特点和纳入标准将51例慢性鼻-鼻窦炎患者分为难治组（12例）、复发组（14例）、初治组（15例）和对照组（10例）。术前对所有研究对象行血常规和鼻内镜检查,同时对术前鼻窦CT行LundMackay评分;术中取黏膜组织进行Masson染色、HE染色和ELISA检测。结果①难治组的黏膜胶原纤维面积百分比高于复发组、初治组和对照组;②胶原纤维面积百分比与TGF-β1浓度、黏膜嗜酸性粒细胞计数和Lund-Mackay评分均有相关性;而与全血嗜酸性粒细胞计数无相关性。结论①鼻窦黏膜纤维组织增生可能是DTRS病理特征之一,可能与发病有关;②TGF-β1高表达、黏膜嗜酸性粒细胞浸润丰富和高Lund-Mackay评分可能是胶原纤维沉积的危险因素。     

Surgical Management of Rhinosinusitis in Onco-Hematological Patients

Objectives

In onco-hematological diseases, the incidence of paranasal sinuses infection dramatically increase and requires a combination of medical and surgical therapy. Balloon dilatation surgery (DS) is a minimally invasive, tissue preserving procedure. The study evaluates the results of DS for rhinosinusitis in immunocompromised patients.

Methods

A retrospective chart review was conducted in 110 hematologic patients with rhinosinusitis. Twenty-five patients were treated with DS technique and 85 patients with endoscopic sinus surgery (ESS). We considered the type of anesthesia and the extent of intra- and postoperative bleeding. Patients underwent Sino-Nasal Outcome Test (SNOT-20) to evaluate changes in subjective symptoms and global patient assessment (GPA) questionnaire to value patient satisfaction.

Results

Local anesthesia was employed in 8 cases of DS and in 15 of ESS. In 50 ESS patients, an anterior nasal packing was placed and in 12 cases a repacking was necessary. In the DS group, nasal packing was required in 8 cases and in 2 cases a repacking was placed (P=0.019 and P=0.422, respectively). The SNOT-20 change score showed significant improvement of health status in both groups. However the DS group showed a major improvement in 3 voices: need to blow nose, runny nose, and facial pain/pressure. The 3-month follow-up GPA questionnaire showed an higher satisfaction of DS group.

Conclusion

Balloon DS represents a potentially low aggressive treatment and appears to be relatively safe and effective in onco-hematologic patients. All these remarks may lead the surgeon to consider a larger number of candidates for surgical procedure.     

In vitro studies and safety assessment of Doppler ultrasound as a diagnostic tool in rhinosinusitis

We have previously proposed the use of Doppler ultrasound to noninvasively stage a sinus infection. In this study, we first investigated the acoustic properties of nonpurulent and mucopurulent sinus secretions. The density, viscosity, speed of sound and attenuation of 18 samples of sinus fluid were examined. We then assessed the safety of the method by determining the temperature increase when ultrasound is transmitted through a bone sample of the same thickness as the anterior wall of the maxillary sinus. As a measure of the probability to generate acoustic streaming, we determined the ratio of sound attenuation over the viscosity of the sinus fluid and compared this with the value obtained from acoustic streaming measurements on a model system. The results indicated that detectable levels of acoustic streaming can be generated in serous sinus fluid, which has a low viscosity, but is very unlikely in mucopurulent secretions. The attenuation of the mucopurulent sinus fluid was 10 times higher than that of the serous cyst fluid, but the viscosity of the mucopurulent secretion was a thousand times higher than that of serous fluid. The safety experiments gave a temperature increase of the bone of <1.5°C at I(spta) of 640 mW/cm(2), below the temperature increase considered to be harmful by the World Federation for Ultrasound in Medicine and Biology.     

Emerging therapeutic options in fulminant invasive rhinocerebral mucormycosis

Objective

Five cases of rhinocerebral mucormycosis (RCM) with different courses of illness and outcomes also due to different therapeutical strategies including Posaconazole as a new therapeutic option are described. Predisposing conditions for RCM are diabetes mellitus and immunosuppression. Diagnosis is often delayed because patients complain about nonspecific symptoms of acute rhinosinusitis, and initial CT imaging is unimpressive. Progressive disease, however, leads to early orbital and cerebral invasion. Due to the lack of typical clinical signs, diagnosis relies on histopathology. Therapy consists of the management of predisposing factors, radical surgical intervention and systemic antifungal therapy.

Methods

We describe five cases of RCM with different comorbidities and outcomes.

Results

RCM remains a diagnostic and therapeutic challenge because it begins with nonspecific symptoms and ends as fulminant disease with high mortality. Here, systemic treatment with Posaconazole appears to be a more effective alternative to amphotericin.

Conclusion

If a patient is suspected having RCM, improvement of predisposing diseases, radical surgical debridement and effective systemic antifungal therapy must be instituted immediately.     

长期小剂量克拉霉素在治疗儿童慢性鼻鼻窦炎中的作用

目的探讨长期使用小剂量克拉霉素治疗儿童慢性鼻-鼻窦炎（chronic rhinosius-itis,CRS）的临床疗效。方法采用随机对照将74例诊断为CRS儿童分为常规治疗（38例）和克拉霉素治疗（36例）两组,常规治疗组采用喷鼻剂糠酸莫米松喷鼻和碱性盐水行鼻腔冲洗;克拉霉素组采用上述方法加用克拉霉素,疗程为12周。采用视觉模拟量表（visual analog scale,VAS）评估其症状,鼻内镜观察评估鼻腔,分别安排在治疗前,治疗后4、8和12周。鼻窦CT采用Lund-Mackay评分法,分别安排在治疗前和治疗后12周。结果两组病例经过4周治疗后,其症状VAS总分和鼻内镜评分均较治疗前明显下降（P〈0.05）,但两组间差异无显著性意义（P〉0.05）;经过8周治疗,两组病例症状VAS总分和鼻内镜评分均较治疗前和治疗4周明显下降（P〈0.01）,且克拉霉素组疗效明显优于常规治疗组（P〈0.01）;至治疗后12周,两组病例症状VAS总分和鼻内镜评分均较治疗前、治疗4周和治疗8周明显下降（P〈0.01）,鼻窦CT评分也较治疗前明显下降（P〈0.01）,两组间疗效差异亦有显著性意义（P〈0.01）。结论长期小剂量克拉霉素应用治疗儿童CRS近期有着较好的疗效,是一种安全有效的治疗选择。     

A randomized, prospective, double-blind study on the efficacy of dead sea salt nasal irrigations

OBJECTIVE: The objective of this randomized, prospective, double-blind study was to compare nasal irrigation using hypertonic Dead Sea salt (DSS) solution with hypertonic saline in the treatment of chronic rhinosinusitis and improvement of quality of life (QOL). METHODS: With Institutional Review Board approval, 42 adults seeking treatment for chronic rhinosinusitis in a tertiary university-affiliated medical center were studied. After history and endonasal examination, computed tomography imaging, and QOL survey (Standardized Rhinoconjunctivitis Quality of Life Questionnaire [RQLQ(S)]), patients were randomized to self-administered hypertonic saline spray and irrigation twice daily or hypertonic DSS spray and irrigation. Patients were reassessed weekly and at 1 month. RESULTS: Both groups had similar symptoms and RQLQ(S) scores before treatment and had significant improvement after treatment. However, the DSS patients had significantly better symptom relief and only the DSS group showed improved RQLQ(S) scores. CONCLUSIONS: We present a short-term study providing level I evidence on the superiority of DSS over saline nasal irrigation for treatment of chronic rhinosinusitis.     

Rhinosinusitis in cystic fibrosis: not a simple story

OBJECTIVE: Chronic inflammation of sinuses and nasal mucosa is found in 74-100% patients suffering from cystic fibrosis, whereas nasal polyps in 6-44% patients. The aim of this paper is to assess rhinosinusitis types taking into account the forms of cystic fibrosis and the kind of CFTR gene mutation. MATERIAL AND METHODS: The author presents material of 126 cystic fibrosis patients, 90 with typical clinical features and 36 with atypical phenotype. Genetic tests were carried out to determine the genotype of CFTR gene. The sample was divided into four groups according to the genotype effect on the chloride canal function. Cytological examination of nasal mucosa was carried out in all the patients. RESULTS: In 71.5% of patients with cystic fibrosis, infectious chronic non-specific rhinosinusitis was found. Other types of rhinosinusitis--acute infectious, chronic allergic and non-allergic with eosinophilia were found in 21.4% of patients, whereas in 7.1% of patients no clinical symptoms of rhinosinusitis were found. Nasal polyps were found in 23 (18.3%) patients with cystic fibrosis: in 21 patients with a typical form and in 2 patients with an atypical form. Nasal polyps were more frequent in groups with the genotype consisting of both "strong" mutations than in the group with unknown or "mild" mutations. CONCLUSION: Rhinosinusitis in cystic fibrosis patients is not homogenous pathology. Infectious chronic non-specific rhinosinusitis is found the most frequently, but other forms of rhinosinusitis appear quite often and they require proper treatment.     

药物治疗慢性鼻-鼻窦炎嗅觉障碍的疗效观察

目的观察药物治疗慢性鼻-鼻窦炎嗅觉障碍的疗效。方法对本院2006年1月～2008年8月26例慢性鼻-鼻窦炎（不伴鼻息肉）嗅觉障碍患者进行回顾性分析。减充血剂、抗炎、抗感染、黏液促排药物治疗20例,在此基础上给予全身激素及营养神经治疗5例,全身激素、营养神经及抗病毒治疗1例。治疗前后行嗅觉测试、鼻窦CT和鼻内镜检查。结果本组26患者中24例治愈,治愈率92.00%,平均治疗时间25.64 d。结论以嗅觉障碍为主诉的慢性鼻-鼻窦炎,根据病因,选择正确的治疗方案,可获满意治疗效果。     

Diversities of allergic pathologies and their modifiers: Report from the second DGAKI-JSA meeting

In October 2021, researchers from the German Society of Allergy and Clinical Immunology (DGAKI) and from the Japanese Society of Allergology (JSA) focused their attention on the pathological conditions and modifiers of various allergic diseases. Topics included 1) the pathophysiology of IgE/mast cell-mediated allergic diseases; 2) the diagnosis and prevention of IgE/mast cell-mediated diseases; 3) the pathophysiology, diagnosis, and treatment of eosinophilic airway diseases; and 4) host–pathogen interaction and allergic diseases. This report summarizes the panel discussions, which highlighted the importance of recognizing the diversity of genetics, immunological mechanisms, and modifying factors underlying allergic diseases.     

慢性鼻-鼻窦炎的发病机制及诊疗进展

慢性鼻-鼻窦炎(CRS)是耳鼻咽喉头颈外科的多因素疾病。根据患者症状、鼻内镜检查以及鼻窦CT扫描,CRS的诊断比较明确,但其病理机制却较复杂,治疗方式的选择也不完全一样。临床上应该更多地考虑内在的病理机制类型,采取针对性的治疗方式,以达到最好的治疗效果。