Resveratrol prevents development of eosinophilic rhinosinusitis with nasal polyps in a mouse model.

BACKGROUND: Since the recent establishment of a murine model of eosinophilic chronic rhinosinusitis with nasal polyps (CRSwNP), both the development of new drugs for treatment or prevention of eosinophilic CRSwNP and elucidation of their pathogenesis have been feasible. We investigated the therapeutic effects of resveratrol on CRSwNP and its mechanism of action using a murine model. METHODS: After induction of eosinophilic CRSwNP, the therapeutic effects of resveratrol were tested and compared with those of triamcinolone acetonide. Histopathologic changes were evaluated using hematoxylin and eosin for overall inflammation, Sirius red for eosinophils, and Masson's trichrome stain for collagen. The expression levels of the interleukin (IL)-4, IL-5, prostaglandin D synthase, and leukotriene C4 synthase genes were assessed by quantitative real-time PCR. Cyclooxygense-2 and 5-lipoxygense levels were evaluated by immunohistochemical staining and Western blot analysis. RESULTS: The degree of eosinophilic infiltration and subepithelial fibrosis was significantly decreased by administration of high-dose resveratrol, the potency of which was similar to that of triamcinolone acetonide. The expression levels of the IL-4, IL-5, prostaglandin D synthase, and leukotriene C4 synthase genes were significantly decreased by administration of low- or high-dose resveratrol. The production of 5-lipoxygenase was strongly inhibited by high-dose resveratrol. CONCLUSIONS: Resveratrol may be useful for the prevention of eosinophilic CRSwNP. A key mechanism of its action is believed to be its anti-inflammatory effect, particularly on eosinophils, by inhibiting the lipoxygenase pathway.

Characteristics and risk factors of mucosal cysts in the paranasal sinuses.

BACKGROUND: Though mucosal cysts in the paranasal sinuses (PSMCs) are common findings on radiographic images, the nature of PSMCs and risk factors for the development of PSMCs have not yet been determined. The aim of this study was to evaluate the characteristics of PSMCs using brain magnetic resonance (MR) imaging. METHODOLOGY/PRINCIPAL: A total of 6831 subjects who underwent health checkup including brain MR imaging were included in this study. The characteristics of PSMCs, including their location, number and size, as well as the presence of obstruction of the sinus ostium and sinusitis, were analysed using brain MR images. Structured questionnaires and medical records were reviewed to evaluate the smoking status and comorbid medical conditions. RESULTS: The overall prevalence of PSMCs was 7.4% and was significantly higher in females than in males. PSMCs were most commonly found in the maxillary sinus, most of which were located unilaterally as a solitary cyst. Large cysts were associated with obstruction of the sinus ostium and subsequent sinusitis. Smoking was a single important risk factor for developing PSMCs. No significant associations were found between symptoms (nasal/respiratory) and the presence of PSMCs. CONCLUSIONS: The prevalence of PSMCs was 7.4% and decreased with age. Large cysts may lead to obstruction of the sinus and subsequent sinusitis. Smoking was an important risk factor for PSMCs, and the total amount of smoking correlated with cyst size. Most subjects were asymptomatic, and specific treatment was not performed.

Clinical Implication of Tests for Prostate-specific Antigen in Brain-dead Organ Donors.

BACKGROUND: Although cancer screening tests are not mentioned under brain-dead organ donor care guidelines in Korea, we assessed the level of prostate-specific antigen (PSA), an important prostate cancer marker, and performed prostate biopsies when needed in brain-dead organ donors. We believe that insisting on a screening test for cancer diagnosis in donors' organs is important. MATERIALS AND METHODS: Data were collected between January 2010 and July 2015 from Ajou University Hospital. We retrospectively analyzed the PSA levels and prostate biopsy results in 111 male brain-dead organ donors (mean age, 48.4 years). RESULTS: The mean PSA level was 7.395 ng/mL (range, 0.062 to 61.780; reference, 0 to 4 ng/mL). Ultrasonography or computed tomographic examination did not reveal prostate cancer, and a rectal examination was not performed. After checking the PSA levels, prostate biopsies were performed in 16 patients based on the recommendations of a urologist, and 4 patients (3.6% of 111) were diagnosed with prostate cancer. All cancers involved adenocarcinomas (acinar type) histopathologically. In 2 patients, the Gleason score was 6 (3 + 3), whereas the other 2 showed a score of 7 (3 + 4). Among the patients diagnosed with prostate cancer, 1 donated his liver and corneas, and the remaining 3 could not donate. CONCLUSION: Well-defined cancer screening tests are needed in Korea. Additionally, when the probability of organ transplantation-induced cancer metastasis is low or a recipient is at a high risk owing to not receiving organs, the law should allow organ donation even if prostate cancer is diagnosed in the donor.

The effect of regular salbutamol on lung function and bronchial responsiveness in patients with primary ciliary dyskinesia.

STUDY OBJECTIVE: There is growing evidence that regular beta(2)-agonist use in patients with asthma is associated with decreased airway caliber and increased bronchial responsiveness. The aim of this study was to determine whether regular treatment with beta(2)-agonists induces changes in lung function and bronchial responsiveness in patients with primary ciliary dyskinesia. DESIGN: A randomized, double-blind, placebo-controlled, crossover study. PATIENTS: Nineteen children with primary ciliary dyskinesia. INTERVENTIONS: Subjects received inhaled salbutamol or identical placebo (2 x 100 microg qid) for periods of 6 weeks with a wash-out period of 4 weeks. MEASUREMENTS AND RESULTS: FEV(1) was measured before and 3 weeks and 6 weeks after salbutamol or placebo treatment. High-dose methacholine inhalation tests were performed before and 6 weeks after each treatment. The provocative concentration of methacholine producing a 20% fall in FEV(1) (PC(20)) and maximal airway narrowing (MDeltaFFEV(1)) was measured. No significant change in FEV(1) was observed during the salbutamol or placebo periods. No significant differences in the parameters of bronchial responsiveness (PC(20) and MDeltaFFEV(1)) were noted as the result of either salbutamol or placebo treatment. CONCLUSION: Our data have shown that salbutamol, inhaled regularly for 6 weeks, did not cause either a decline in lung function or an increase in bronchial responsiveness in subjects with primary ciliary dyskinesia.

Expression of the MAGE 3 gene product in squamous cell carcinomas of the head and neck.

BACKGROUND: The melanoma antigen (MAGE) 3 gene may be a useful tumor specific marker since it is expressed in a variety of cancers. MATERIALS & METHOD: The expression and intracellular location of MAGE 3 gene product were investigated in 40 squamous cell carcinomas, 2 tumor lines, 20 benign diseases, and 20 normal tissues of the head and neck. Immunohistochemical staining with anti-MAGE 3 mAb 57B was conducted from fresh frozen specimens. Correlations between MAGE 3 expression and clinicopathological parameters were also evaluated. RESULTS: The MAGE 3 gene product was detected in squamous cell carcinomas (18/40, 45%) and in tumor cell lines (2/2, 100%), but not in benign diseases and normal tissues. No significant correlation was drawn between MAGE 3 expression and clinical parameters including clinical stages and metastasis. CONCLUSION: These results show MAGE 3 antigen could represent a potential target for immunotherapy in head and neck squamous cell carcinomas.

Measurements of cross-sectional area of the nasal cavity by acoustic rhinometry and CT scanning.

The authors aimed to evaluate the validity and characteristics of acoustic rhinometic tests by comparing the results with those of computed tomography (CT) of the nasal cavity. Cross-sectional areas along the nasal cavity were measured by acoustic rhinometry (AR) and CT of the nasal cavity in 30 normal subjects. Cross-sectional areas measured by each technique showed a statistically significant correlation. The two measurements showed a better linear correlation in the anterior part of the nasal cavity up to 24 mm from the nostril than in the posterior part of the nasal cavity beyond that point. Mean cross-sectional areas measured by AR were constantly less than those measured by CT of the nasal cavity up to 33 mm from the nostril, whereas areas measured by AR were greater than those measured by CT scans beyond that point.

Mucociliary activity and ultrastructural abnormalities of regenerated sinus mucosa in rabbits.

The purpose of this study was to observe histologic findings in the regenerated maxillary sinus mucosa and restoration of ciliary activity by measuring the speed of mucociliary transport after complete surgical removal of the maxillary sinus mucosa. The maxillary sinuses of 32 rabbits were opened anteriorly and one side of the sinus mucosa of each animal was completely removed. In 16 animals, the natural ostia were widened, and, in another 16 animals, the natural ostia were left undisturbed. The contralateral, sham-operated sinus was used as a control for each animal. The animals of each group were reanesthetized and the maxillary sinuses were reopened at planned intervals. The speed of mucociliary transport toward the maxillary ostium, determined by India ink particle movement, was reduced to 6.4 mm/min, whereas it was 10.8 mm/min in the control side. Beating cilia were observed in 16% by dark-field microscopy, in contrast to 66% in the control sinus. Pseudostratified columnar epithelia without cilia were present in 12%, with the remaining consisting of pseudostratified ciliated columnar epithelia (88%). Light microscopic examination showed increase in submucosal fibrotic proliferation, decrease in submucosal glands, and infiltration of inflammatory cells. Under transmission electron microscopy, abnormal cilia such as compound cilia or edematous cilia were frequently found in the regenerated specimens. These observations suggest that mucociliary clearance of the regenerated sinus mucosa may be significantly diminished compared with that of the original mucosa.

Mucociliary activity and histopathology of sinus mucosa in experimental maxillary sinusitis: a comparison of systemic administration of antibiotic and antibiotic delivery by polylactic acid polymer.

To evaluate the efficacy of antibiotic delivered by polyactic acid (PLA) polymer in sinusitis, we induced maxillary sinusitis in 32 New Zealand white rabbits by occluding the sinus ostium and inoculating the sinus cavity with Streptococcus pneumoniae. The rabbits were divided into three groups consisting of group 1 (control group, 8 rabbits), which was treated only by reopening the ostium; group 2, which was treated by both reopening the ostium and injecting ampicillin intramuscularly (40 mg/kg/day in three divided doses, 12 rabbits); and group 3 (12 rabbits) in which a piece of PLA-polymer ampicillin (0.326 mg) sheet (1.5 x 1.5 cm) was placed within the sinus after re-establishing ostial patency. The light microscopic findings such as epithelial ulceration, loss of cilia, infiltration of inflammatory cells, and edema were less pronounced in group 2 and minimal in group 3. The electron microscopic findings such as swelling of mitochondria and endoplasmic reticulum and protruded cytoplasm were severest in the control group, followed by groups 2 and 3. The mucociliary transport speed measured at the medial wall of the maxillary sinus was highest in group 3. The results of this study suggest that treatment with PLA-polymer ampicillin may have a better efficacy in maxillary sinusitis than that with systemic administration of ampicillin.

Surgical management of congenital aural atresia.

Congenital aural atresia is a relatively common anomaly in otology. It requires an early assessment of hearing status and an early evaluation of the degree of atresia. Its surgical management is aimed at obtaining hearing gain and at establishing appropriate auditory canal status for the application of hearing aids. The authors analyzed the preoperative otologic findings, surgical findings, postoperative complications, and postoperative hearing results of 25 ears in 21 patients with congenital aural atresia. From January 1987 to February 1992, 24 of these ears were surgically corrected by anterior approach; the remaining 1 was corrected by transmastoid approach. Postoperative audiologic follow-up ranged from 8 months to 4 years (N = 21). A new modification of anterior approach is introduced. The final average air-bone gap was 30 dB, in contrast to preoperative 53 dB (N = 21). The final air-bone gap was improved to a level within 30 dB in 52% of the patients. Meatal stenosis was the most frequent postoperative complication and was seen in 12 patients in primary operation (N = 25). There was no postoperative facial nerve palsy and no sensorineural hearing loss. There was little difference in postoperative hearing among the various types of congenital aural atresia and the type of tympanoplasty that had been performed.

Endoscopic removal of the antral portion of antrochoanal polyp by powered instrumentation.

OBJECTIVES: To introduce a new surgical technique for endoscopic removal of the antral portion of antrochoanal polyp (ACP) by powered instrumentation and to determine its efficacy by measures of relevant patient outcome. STUDY DESIGN: Prospective study in 28 patients undergoing endoscopic sinus surgery for ACP by our surgical technique. METHODS: Improvements of clinical symptoms and endoscopic and computed tomographic findings were evaluated postoperatively with a follow-up period ranging from 12 to 52 months. All symptom scores on a 100-mm visual analogue scale before operation were compared with those at the last visit after operation. Postoperative endoscopic and computed tomographic findings were graded using a three-point scale ranging from 0 to 2. In surgical technique, the antral portion of ACP was identified through the enlarged ostium under intranasal endoscopy and removed by a blade of powered instrumentation that was inserted through the canine fossa. RESULTS: Symptom scores were all significantly reduced postoperatively. All but one patient showed improvement in clinical symptoms and endoscopic and computed tomographic findings during the follow-up period. There were no major complications specific to this technique. CONCLUSION: Our technique provides an attractive alternative to other methods for removing the antral portion of an ACP and is associated with excellent outcomes and minimal morbidities.

Effects of beta-toxin of Staphylococcus aureus on ciliary activity of nasal epithelial cells.

OBJECTIVES: To investigate the in vitro effects of staphylococcal beta-toxin on ciliary activity and the in vivo effects on sinusitis induction. STUDY DESIGN: The in vitro effects of staphylococcal beta-toxin on ciliary activity were investigated at different concentrations and exposure times. Experimental sinusitis was induced in rabbits with application of beta-toxin and confirmed 7 days later. METHODS: Ciliated epithelial cells were taken from the maxillary sinus mucosa of 10 rabbits. Five culture dishes from each rabbit were used for the experimental group, and one culture dish from each rabbit was used for the control group. In the experimental group, ciliary beat frequency (CBF) was measured at concentrations of 0.1, 1, 2, 5 and 10 U/mL of beta-toxin using a video-computerized analysis technique, while in the control group, culture medium containing no toxin was used. CBF was measured 1, 2, 4, 6, 8, 12, 24, and 48 hours after administration of beta-toxin. To induce experimental sinusitis, 2 U/mL of beta-toxin was percutaneously applied to the maxillary sinus of 10 rabbits without occlusion of the natural ostium, while normal saline was percutaneously applied to the right-side maxillary sinus of 4 rabbits in the control group. At 7 days, mucosal membranes were taken from the inferomedial wall of the maxillary sinus for light microscopic study. RESULTS: CBF dropped significantly after an 8-hour incubation at 2, 5, and 10 U/mL of beta-toxin. No ciliary activity was observed after a 24-hour incubation at 2 and 5 U/mL and a 12-hour incubation at 10 U/mL of beta-toxin. Mucoid, purulent discharge was observed in the maxillary sinuses of the beta-toxin-applied group. Prominent epithelial disruption and infiltration of inflammatory cells into the epithelium and lamina propria were observed in the beta-toxin-applied group. CONCLUSIONS: Staphylococcal beta-toxin may reduce ciliary activity and induce sinusitis without occlusion of the natural ostium of the maxillary sinus in rabbits This study provides another animal model of sinusitis for understanding the pathogenesis of sinusitis induced by bacterial exotoxins.

Effects of phenylephrine on ciliary beat in human nasal respiratory epithelium: quantitative measurement by video-computerized analysis.

The in vitro effects of phenylephrine solution on ciliary beat frequency (CBF) in terms of different concentrations and exposure times were investigated using a video-computerized analysis technique. Nasal epithelial cells were taken from inferior turbinate of 10 volunteers by scraping the nasal mucosa with a cytology brush. CBF was measured in five different concentrations including 0.125%, 0.25%, 0.5%, 1%, and 2.5%. Each specimen was incubated in different solution for 6 days and CBF was measured at 30 minutes, 1 hour, 2 hours, 4 hours, 8 hours, 12 hours, 1 day, 2 days, 3 days, 4 days, 5 days, and 6 days. CBF decreased significantly after 12-hour incubation in 0.125% phenylephrine solution and after 8-hour incubation in 0.25% phenylephrine solution, both clinically used concentrations. There were significant decreases in CBF after incubation in 0.5% phenylephrine for 2 hours, in 1% for 1 hour, and in 2.5% for 30 minutes (P < 0.05, repeated measure analysis of variance [ANOVA]). CBF of the nasal respiratory ciliated cells significantly decreased with increasing concentrations of phenylephrine solution and with increasing incubation times at the same concentration (P < 0.05, repeated measure ANOVA). The results of this study suggest that phenylephrine may inhibit ciliary beat in vitro by its pharmacological effect at lower concentrations than clinically used ones.

Effects of alpha-toxin of Staphylococcus aureus on the ciliary activity and ultrastructure of human nasal ciliated epithelial cells.

OBJECTIVE: The in vitro effects of staphylococcal alpha-toxin on ciliary activity were investigated at different concentrations and exposure times. STUDY DESIGN: Ciliated epithelial cells of the sphenoid sinus were taken from patients operated on for pituitary tumors. Video-computerized analysis technique and transmission electron microscopy were used to analyze the effects of the toxin on ciliary activity. METHODS: Ciliary beat frequency (CBF) was measured in four different concentrations of alpha-toxin including 0.1, 1, 10, and 50 microg/mL. CBF was measured at 2, 4, 6, 12, 24, and 48 hours after administration of the toxin. To observe reversibility of the reduced ciliary activity, after 24-hour incubation in the media containing 10 microg/mL of alpha-toxin, the media were replaced with alpha-toxin-free media. The tissues were also processed for transmission electron microscopy to observe ultrastructural changes of the epithelial cells. RESULTS: CBF increased significantly at 2-hour incubation and then decreased significantly after 12-hour incubation in 10 microg/mL of alpha-toxin (P< .05, repeated-measures ANOVA). The transmission electron microscopic findings showed mitochondrial swelling and a slight protrusion of the plasma membrane of the cilia. In toxin-free media, loss of ciliary activity was not recovered. CONCLUSIONS: CBF increased at first, but with increasing incubation time ciliary movements decreased gradually and stopped eventually. This loss of CBF may be an irreversible change associated with ultrastructural changes in the mitochondria and the plasma membrane of the cilia.

Regulation of mucociliary motility by nitric oxide and expression of nitric oxide synthase in the human sinus epithelial cells.

OBJECTIVES: This study was performed to investigate the changes in ciliary beat frequency (CBF) after treatment with Larginine in the human sinus mucosa and to determine the distribution of inducible nitric oxide synthase (iNOS) and endothelial nitric oxide synthase (eNOS) in the healthy sinus mucosa. STUDY DESIGN/METHODS: CBF was measured in the sphenoid sinus mucosa of 12 patients who underwent trans-septal trans-sphenoidal hypophysectomy for the treatment of pituitary gland tumor. CBF was measured over 24 hours in Dulbecco's modified Eagle's medium (DMEM) after treatment with L-arginine, its inactive spatial isomer D-arginine, or an NOS inhibitor, N(G)-nitro-L-arginine methyl ester (L-NAME). DMEM without treatment with these materials was used as a control. Other pieces of the mucosa were exposed to L-NAME and its inactive spatial isomer D-NAME after preincubation with L-arginine. The specimens were immunohistochemically stained for iNOS and eNOS. RESULTS: CBF increased 24 hours after treatment with L-arginine as compared with control groups. CBF increased in proportion to the increasing concentrations of L-arginine. There was no significant change after treatment with D-arginine or L-NAME. CBF increased after treatment with L-arginine at 30 minutes and maintained for 24 hours. L-NAME inhibited the increase in CBF by L-arginine, but D-NAME showed no such effect. Immunoreactivity to both iNOS and eNOS was frequently observed in the ciliated epithelial cells and was stronger to eNOS than to iNOS. CONCLUSIONS: From the results of this study it is suggested that nitric oxide (NO) produced by iNOS and eNOS using L-arginine may increase CBF in the healthy sinus mucosa and that NO may have a regulatory function in ciliary motility in the human sinus mucosa.

Changes of nasal function after temperature-controlled radiofrequency tissue volume reduction for the turbinate.

OBJECTIVES: Temperature-controlled and temperature-monitored radiofrequency tissue volume reduction (RFTVR) for the turbinate is a new treatment modality for nasal obstruction secondary to turbinate hypertrophy. We compared the nasal functions after the treatment ofRFTVR and laser vaporizing turbinoplasty (LVT) using subjective symptom scores and objective tests. STUDY DESIGN: Prospective, randomized clinical trial. METHODS: Twenty-four patients with nasal obstruction secondary to inferior turbinate hypertrophy were prospectively evaluated from March 1999 to October 1999 at Seoul National University Hospital (Seoul, Korea). Sixteen patients were treated with RFTVR, and eight patients with LVT. The preoperative and postoperative nasal functions were investigated by visual analogue scale of symptoms, butanol threshold test, saccharine test, acoustic rhinometry, rhinomanometry, and ciliary beat frequency. RESULTS: At 8 weeks postoperatively, the severity and the frequency of nasal obstruction improved subjectively in 81.3% and 93.8% of RFTVR group and in 87.5% and 87.5% of LVT group, respectively. Significant improvement of nasal symptoms began from 2 to 3 days after the operation in the RFTVR group, whereas there was significant improvement of nasal symptoms at 8 weeks after operation in the LVT group. However, objective nasal functions including nasal volume and total nasal resistance were significantly improved at 8 weeks after surgery in both groups. Among patients reporting symptoms of hyposmia, 55.6% of RFTVR group and 63.6% of LVT group showed improved olfaction. Saccharin transit time and ciliary beat frequency were preserved after RFTVR CONCLUSION: RFTVR for the turbinate may be useful as an alternative approach for the treatment of chronic turbinate hypertrophy.

Traumatic pseudoaneurysm of the intracavernous ICA presenting with massive epistaxis: imaging diagnosis and endovascular treatment.

Traumatic pseudoaneurysm of the intracavernous internal carotid artery (ICA) is a very rare cause of epistaxis but is a life-threatening clinical situation when left untreated. The authors have experienced four cases of traumatic pseudoaneurysm involving the intracavernous ICA. Delayed massive epistaxes developed 1 to 8 months after trauma and initial transient epistaxis in all four patients. Three of the cases were successfully managed by the detachable balloon occlusion (DBO) of the ICA along with the aneurysm openings. In one case, a large pseudoaneurysm destroying a large area of the central skull base with peripheral blood clot was demonstrated on computed tomography, magnetic resonance imaging, and angiography; this patient died due to massive epistaxis before the trial of DBO. Imaging findings of pseudoaneurysms involving the intracavernous ICA in the four cases are described, and the role of endovascular treatment is discussed.

Effects of mucokinetic drugs on rheological properties of reconstituted human nasal mucus.

OBJECTIVE: To investigate the effects of mucokinetic drugs on the rheological properties of human nasal mucus in patients with chronic sinusitis. DESIGN: We reconstituted human nasal mucus obtained from 74 patients with chronic sinusitis and determined the effects of 4 mucokinetic drugs, including acetylcysteine, deoxynuclease I, 2% sodium bicarbonate, and a combination product containing tyloxapol (Alevaire), on rheological properties of reconstituted human nasal mucus (RHNM). We used 5% RHNM dissolved in phosphate-buffered solution as the optimal buffer and concentration of RHNM for the study because it showed a viscoelastic response similar to that of freshly collected nasal mucus from patients with chronic sinusitis. METHODS: Four experiments were performed to determine the influence of each drug on dynamic viscosity and elasticity of 5% RHNM. Distilled water was used as a control. RESULTS: Acetylcysteine and deoxynuclease I significantly decreased both dynamic viscosity and elastic modulus, while distilled water had no effect on rheological properties of 5% RHNM in vitro. Alevaire significantly reduced both dynamic viscosity and elastic modulus. Sodium bicarbonate significantly reduced elastic modulus but not dynamic viscosity. Reduction of elastic modulus by Alevaire was significantly greater than that by sodium bicarbonate, while there was no difference in reduction of dynamic viscosity between them. CONCLUSION: Our results indicate that RHNM may be useful for studying the topical effects of various drugs on nasal mucus from patients with chronic sinusitis.

Aspergillus sinusitis: clinical aspects and treatment outcomes.

Seventy-two cases of Aspergillus sinusitis were analyzed during a period of 14 years from January 1980 through October 1993. There were 60 cases of primary type and 12 cases of secondary type. The maxillary and ethmoid sinuses were most commonly affected in both primary and secondary types. The sphenoid sinus was commonly involved in secondary type. Fourteen (23%) cases of primary type and 4 (33%) cases of secondary type demonstrated sinus wall destruction on computed tomography or magnetic resonance images. Seventy percent of primary type and all cases of secondary type showed focal or diffuse areas of increased attenuation in the soft tissue mass on computed tomography scans. Sixteen cases assessed by magnetic resonance imaging showed decreased signal intensities on T1-weighted images and markedly reduced signal intensities on T2-weighted images. Fifty-nine (98%) of 60 cases of primary type were noninvasive, and 1 was invasive. In secondary type, 10 (83%) of 12 patients had noninvasive disease. The most common coexisting disease in secondary aspergillosis was diabetes mellitus. Thickened mucosa with necrotic brownish green material, which was the most common finding in both types, was found in 33 patients with primary type and in 5 with secondary type. Surgery was performed in most cases, among which 4 patients received chemotherapy after surgery with amphotericin B with or without flucytosine. All patients were cured without recurrence during a mean follow-up period of 13 months.

Hypertonic saline decreases ciliary movement in human nasal epithelium in vitro.

Various saline solution formulae are frequently used in patients with rhinosinusitis. Osmolarity affects ciliary beat frequency (CBF); however, little is known about the effects of saline solutions on ciliary activity of nasal epithelial cells. The aim of this study was to assess whether CBF of normal turbinate mucosa is affected by hypertonic, isotonic, or hypotonic saline solution in vitro and whether histologic changes are associated with the alteration of ciliary movement. We assessed variations of CBF after exposure to 0.06%, 0.12%, 0.9%, 3.0%, or 7.0% saline solutions and histologic changes were examined by transmission electron microscopy. Isotonic and hypotonic solutions produced no ciliary slowing; however, ciliostasis was observed within a few minutes in 3.0% or 7.0% solution. The histologic changes demonstrated that the ciliary slowing might be attributed to epithelial damage by fluid transport toward the surrounding medium. In conclusion, hypertonic saline solutions decrease CBF and disrupt nasal epithelial cells in vitro.

Horseradish peroxidase permeability across rat nasal mucosa in selective stimulation of substance P innervation with capsaicin.

To investigate the physiological role of substance P innervation (SPI) in the nasal mucosa from inhaled irritant macromolecules, SPI in the rat nasal mucosa was selectively stimulated with capsaicin and the degree of horseradish peroxidase (HRP) permeability across the nasal epithelium was evaluated by enzyme immunoassay or by histochemical electron microscopy. The serum level of HRP was reduced significantly in capsaicin-administered rats compared to control rats along the time course with quantitative analysis of the enzyme immunoassay. Control rats showed heavy permeation of HRP across the epithelium, but capsaicin-administered rats showed weak permeation of HRP across the epithelium with histochemical electron microscopy. The epithelial lining and its tight junctions were left intact as judged by electron microscopy. In conclusion, selective stimulation of SPI of the rat nasal mucosa with capsaicin decreased the epithelial absorption permeability to HRP without compromising the epithelial integrity. These findings imply that the physiological role of capsaicin-sensitive SPI in the rat mucosa is to protect the airway from inhaled irritant macromolecules.