Central Retinal Artery Occlusion in Rhino-Orbital-Cerebral Mucormycosis: An Inflammatory-Prothrombotic State.

PURPOSE: The aim was to evaluate patient profiles of rhino-orbital-cerebral mucormycosis (ROCM) cases with central retinal artery occlusion (CRAO) postcoronavirus disease 2019. DESIGN: A nonrandomized retrospective case-control study. METHODS: The ROCM cases presenting with CRAO were compared with a control ROCM group without CRAO at a tertiary care center. Demography, systemic status, clinical features, histopathology, imaging, and blood profile were assessed for any specific risk factors. RESULTS: A total of 12 patients were seen in the CRAO group and 16 in the non-CRAO group. The male-to-female ratio was 3:1 with a mean age of 49.5 years. In the CRAO group, 75% had diabetes mellitus with mean hemoglobin A1c of 9.03%, and 66.7% had received steroid treatment. All cases were histopathologically confirmed positive for mucor. There was a significant difference in mean D-dimer and serum ferritin between the 2 groups, with higher level in the CRAO group. All patients with CRAO had light perception-negative vision, with total ophthalmoplegia and proptosis seen in 66.7% of cases. Four patients had orbital apex involvement, 5 had cavernous sinus involvement, and 8 had intracranial involvement in the CRAO group. CONCLUSIONS: Inflammatory markers D-dimer and serum ferritin were significantly associated with CRAO, suggestive of hyperinflammatory and hypercoagulable state. A high index of suspicion should be maintained in cases with elevated markers and prophylactic anticoagulants can be started to prevent CRAO in a subset of patients.

[Effect of cycloxygenase 2 inhibitor on levels of prostaglandin E2 in plasma and in local infiltrated fluid after functional endoscopic sinus surgery].

OBJECTIVE: To examine the time course and clinical relevance of changes in prostaglandin E2 (PGE2) to pain and outcome in surgical drainage, and circulating blood after functional endoscopic sinus surgery (FESS). METHODS: Thirty-seven patients scheduled to undergo FESS were randomized to receive celecoxib 400 mg(n=16) one hour before anesthesia induction and celecoxib 200 mg, q12 h for five consecutive days after surgery or nothing for patients in control group(n=21). Surgical site drainage and venous blood were collected up to 48 hours after surgery to test PGE2 level. Plasma levels of thromboxane A2 (TXA2) and prostacyclin (PGI2) were also tested for the same time course. RESULTS: For control patients, PGE2 level was elevated in both surgical site and circulating blood, which reached a peak concentration 6 h(177.5 ± 142.2 ng/L) and 48 h (64.5 ± 21.4 ng/L)respectively after FESS. For patients in celecoxib group, a significant reduction of surgical drainage PGE2(peak level 106.2 ± 33.4 ng/L at 6 h) and plasma PGE2 (peak level 44.7 ± 30.2 ng/L at 48 h) was observed(P<0.05). Pain scores 6 h and 48 h after surgery were positively correlated with surgical drainage PGE2 level, correlation coefficient being 0.333 (P=0.044) and 0.353(P=0.032) respectively. Celecoxib did not affect the ratio of plasma TXA2 to PGI2. CONCLUSION: Upregulation of PGE2 in surgical site after surgery was crucial in inflammatory response and postoperative pain. Cycloxygenase-2 inhibitor could significantly reduce surgical drainage and plasma PGE2 concentration.

Acute phase protein concentrations in dogs with nasal disease.

The concentrations of C-reactive protein (CRP), serum amyloid A, haptoglobin (Hp) and α(1)-acid glycoprotein were measured in dogs with clinical signs of nasal disease and compared with those of healthy dogs in order to determine the expression of these proteins in cases of canine nasal disease. A significant difference (P<0.001) between the symptomatic group and the control group was found for both CRP and Hp. Among the animals with nasal disease, a significant intergroup difference (P<0.05) was found in the expression of Hp between dogs with aspergillosis and those with chronic rhinitis.

Comparison of serologic evaluation via agar gel immunodiffusion and fungal culture of tissue for diagnosis of nasal aspergillosis in dogs.

OBJECTIVE: To compare the sensitivity and specificity of serologic evaluation and fungal culture of tissue for diagnosis of nasal aspergillosis in dogs. DESIGN: Prospective study. ANIMALS: 58 dogs with nasal discharge and 26 healthy dogs. PROCEDURES: Dogs with nasal discharge were anesthetized and underwent computed tomography and rhinoscopy; nasal tissues were collected for histologic examination and fungal culture. Sera were assessed for antibodies against Aspergillus spp (healthy dog sera were used as negative control specimens). Nasal aspergillosis was diagnosed in dogs that had at least 2 of the following findings: computed tomographic characteristics consistent with aspergillosis, fungal plaques detected during rhinoscopy, and histologically detectable fungal hyphae in nasal tissue. Histologic characteristics of malignancy were diagnostic for neoplasia. Without evidence of neoplasia or fungal disease, nonfungal rhinitis was diagnosed. RESULTS: Among the 58 dogs, 21 had nasal aspergillosis, 25 had nonfungal rhinitis, and 12 had nasal neoplasia. Fourteen aspergillosis-affected dogs and 1 dog with nonfungal rhinitis had serum antibodies against Aspergillus spp. Fungal culture results were positive for Aspergillus spp only for 17 dogs with aspergillosis. With regard to aspergillosis diagnosis, sensitivity, specificity, and positive and negative predictive values were 67%, 98%, 93%, and 84%, respectively, for serum anti-Aspergillus antibody determination and 81%, 100%, 100%, and 90%, respectively, for fungal culture. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that seropositivity for Aspergillus spp and identification of Aspergillus spp in cultures of nasal tissue are highly suggestive of nasal aspergillosis in dogs; however, negative test results do not rule out nasal aspergillosis.

Nasal septum perforation of welders.

During the periodic physical checkups in 1997-2000, the authors have found eleven cases of nasal septum perforation among 2,869 welders in Ulsan, Korea. They have not suffered from diseases and conditions that could cause septum perforation such as tuberculosis, syphilis, and long-term use of topical corticosteroids. And also they did not have trauma history and surgical experiences on their nasal septum. To investigate the cause of septum perforation we reviewed the past history of pre-employment, the results of annual working environment survey and the material safety data sheets of welding rods and steels with which they have dealt. We also analyzed the concentration of several metals of welding fume and the concentration of blood and urinary chromium. In the result, we assumed that the nasal septum perforation of welders was due to chronic exposure to low-level hexavalent chromium.

Carbohydrates expressed on Aspergillus fumigatus induce in vivo allergic Th2-type response.

BACKGROUND: The mould Aspergillus fumigatus (Af) causes several forms of Th2-biased diseases such as Type I respiratory allergies. This mould contains abundant carbohydrates including glucan, chitin and galactomannan. However, little is known on whether these carbohydrates directly drive Th2 responses in vivo. OBJECTIVE: We sought to determine the relative role of carbohydrates expressed on crude extracts of Af in the induction of Th2-type antibody production and local eosinophila in mice. METHODS: Carbohydrates on native Af were destroyed by sodium metaperiodate under mild conditions. CBA/J mice were sensitized intranasally with native, periodate-treated or mock-treated Af. Histologic changes and production of Af-specific IgE, IgG1 and IgG2a, as well as serum total IgE were determined. Inhibition ELISA for Af-specific IgE was performed using periodate-treated Af as an inhibitor. RESULTS: Mice sensitized with periodate-treated Af displayed significant decreases in both total and specific IgE levels in comparison to mice sensitized with native or mock-treated Af. Furthermore, sensitization and subsequent challenge with periodate-treated Af significantly reduced the degree of eosinophil recruitment into the nasal mucosa, compared to the controls. On the other hand, competitive inhibition showed that periodate-treated Af could inhibit binding between native Af and specific IgE in a similar manner to that of native and mock-treated Af. CONCLUSION: These results suggest that carbohydrates on Af play a key role as internal adjuvants in inducing the allergic Th2-type response and are not the targets of the induced IgE response.

The effect on arterial blood gases and heart rate of bilateral nasal packing.

In order to elucidate the blood gas and heart rate changes caused by bilateral nasal packing, 21 healthy subjects who had had septoplasty or septorhinoplasty were investigated with pre- and post-operative blood gas measurements and 24-h Holter monitoring. Nasal packing caused a significant decrease in O2 saturation (P < 0.05), a borderline decrease in PO2 (P = 0.09), insignificant changes in PCO2, pH and HCO3 (P > 0.05), a significant increase in minimum and mean heart rates (P < 0.05) and insignificant changes in maximum heart rates; however, further research is necessary to elucidate the direct cause-and-effect relationship. No serious arrhythmias were observed. Although these changes may be within normal levels for healthy subjects, they may have serious consequences for patients with cardiopulmonary diseases.

Peripheral eosinophilia in the diagnosis of chronic rhinosinusitis.

PURPOSE: To determine the relationship between peripheral blood eosinophilia and chronic rhinosinusitis. MATERIALS AND METHODS: A retrospective review was conducted of consecutive operative cases during 1 calendar year. The preoperative complete blood count (CBC) were tabulated for three groups of patients: those undergoing endoscopic sinus surgery, those undergoing septoplasty with turbinate reduction alone, and a nonrhinologic control group. Statistical analysis was performed to determine differences in the components of the CBC among these three groups of patients and to identify significant associations between abnormal peripheral eosinophil counts and these diagnoses. RESULTS: A total of 87, 32, and 92 patients were identified for the endoscopic sinus surgery (ESS), septoplasty, and control groups, respectively. Significant differences in the percentages of eosinophils, lymphocytes, and neutrophils were noted among the three groups (P <.05). Comparison among groups indicated that ESS patients had significantly higher percent peripheral eosinophilia when compared with both the control group and septoplasty group (P <.001 and P =.010, respectively); no significant difference was noted between the septoplasty group and the control group (P =.627). The sensitivity and specificity of the peripheral eosinophil count for chronic sinusitis were 49.4% and 84.7%, respectively. CONCLUSIONS: The peripheral eosinophil count in chronic sinusitis is elevated compared with both a nonrhinologic control group and a group of patients with septal deviation. Furthermore, abnormally elevated eosinophil counts are associated with chronic sinusitis but not chronic rhinitis alone. However, this association is not strong enough to be used in the diagnosis of chronic sinusitis because of poor sensitivity.

Nocturnal oxymetry in patients with total nasal packing.

Nocturnal oxymetry was recorded in ten otherwise healthy patients undergoing different types of nasal surgery with total nasal packing. Postoperative nocturnal oxymetry was worse than preoperative one in seven patients and judged as abnormal in four. These results indicate that in otherwise healthy subjects, nasal surgery and total nasal packing induce immediate significant changes in nocturnal breathing.

Experimental infection of dogs with the nasal mite Pneumonyssoides caninum.

A successful experimental transmission of the canine nasal mite, Pneumonyssoides caninum, is described. Some 11 weeks after repeated systemic ivermectin treatment, four Beagles were inoculated via the right nostril with 20 P. caninum mites of different sexes and life stages, obtained at the necropsy of an infected dog. The inoculated dogs and a matching uninoculated control were observed for clinical signs for 14 weeks and then euthanised. Vague upper respiratory signs and a transient minor increase in the number of eosinophils in peripheral blood were recorded in the inoculated dogs. At necropsy 4-12 P. caninum mites were found in the nasal cavities and sinuses of the inoculated dogs, but none in the control. In three out of the four infected dogs mites were found in both the right and left nasal cavities and sinuses of the skull. Since in no case more mites than the number used for inoculation were detected it is not clear if the mites managed to reproduce in the dogs. Inflammatory lesions were seen most consistently in the olfactory mucosa, respiratory mucosa and tonsils, and growth of opportunistic bacteria was observed in the tonsils of the infected dogs. The inflammatory lesions seen in the olfactory mucosa may explain why dogs infected with P. caninum sometimes appear to suffer from impaired scenting ability.

Serum IgE levels and its clinical correlation with varying patterns of bronchial asthma and nasal allergy.

In a study of 847 cases of bronchial asthma and nasal allergy frequent association with raised serum IgE was noticed. Degree of atopy (as judged by skin allergy tests), age, sex and duration of disease tended to influence IgE levels in asthmatics. Both extrinsic and intrinsic varieties of asthma showed similar raised serum IgE levels. In subjects with nasal allergy alone, the values were considerably lower but still much higher than found in control patients.

Evaluation of allergen-specific IgE antibodies by MAST for the diagnosis of nasal allergy.

Multiple-antigen simultaneous test (MAST) is a new system for detecting allergen-specific IgE antibodies. Multiple antigens can be examined simultaneously in a short period of time by this method. The purpose of this study is to evaluate the usefulness of this method and to compare the results of MAST with those of RAST and intradermal skin test using 133 serum samples obtained from patients with nasal allergy. The positive rates of the main allergens detected by the MAST system are 56% for Japanese cedar, 31 for Dermatophagoides farinae (DF), 30% for Dermatophagoides pteronyssinus (DP), 27% for house dust (HD), and 27% for timothy grass. The positive rates of food allergens are very low. An average of 3.5 different allergens can be simultaneously detected in one serum. We have compared MAST and RAST with respect to nine allergens: HD, DF, cat, Japanese cedar, timothy, bahia, sweet vernal, velvet, and ragweed. There are statistically significant correlations between MAST and RAST for all allergens except ragweed, the correlation coefficients in the eight allergens are greater than r = 0.60, and total agreements exceed over 70%. Similarly, there also is a good correlation between MAST and skin test for the allergens: HD, cat, Japanese cedar, timothy grass, and ragweed. These results indicate the clinical usefulness of the MAST system for detecting specific IgE antibodies in patients with nasal allergy.

Clinical significance of atrial natriuretic peptide in different diseases of the nose.

Atrial natriuretic peptide (ANP) levels of nasal secretion and blood plasma were measured in 40 patients with chronic nasal conditions and 20 healthy subjects by a sensitive radioimmunoassay. In the healthy subjects, the mean blood ANP level was lower than, but not parallel with, the mean nasal ANP level (p less than 0.05). Among the patients, the blood ANP levels were higher in those with nasal polyposis, atrophic rhinitis and nasal allergy, while lower in simple rhinitis and recurrent epistaxis, than in the control group. Apart from nasal polyposis, all the patients were found to have a lower level of nasal ANP. The conclusion is that the nose may be capable of producing ANP independently from the plasma level. In patients with chronic nasal obstructive disease, the endocrine function of the heart is affected also. The relationship of the plasma and nasal ANP may help to explain some rhinological abnormalities.

Experimental nasal obstruction and changes in the arterial blood gases.

This is a controlled animal experiment in which the effect of chronic nasal obstruction on the arterial blood gases was studied. Sixty female New Zealand Albino rabbits, in groups of 3 litter mates were assigned to 3 groups: control, unilateral nasal obstruction, and bilateral nasal obstruction. Nasal obstruction was produced using coagulating electro-cautery and the values of pO2, pCO2 and pH in the arterial blood were studied. In animals with unilateral nasal obstruction the blood gas values were similar to those in the control group. In animals with bilateral nasal obstruction there was a marked fall in pO2 and a marked increase in pCO2. These changes were statistically significant, but there was no significant change in arterial pH in any of the obstructed groups.