One hundred and fifty-five patients with complaints indicating acute sinusitis were examined and their symptoms and signs registered. The final diagnosis--maxillary sinus empyema versus not empyema--was established by means of antral aspiration. A computer-based analysis of clinical data demonstrated the significance of the clinical examination. Local symptoms such as pain and purulent rhinorrhea with unilateral predominance were particularly guiding, even in bilateral cases, while nasal obstruction, tenderness during percussion, and affected general condition were not. With an overall reliability of about 85%, appropriate therapy can be suggested based on the clinical findings alone.
By antral aspiration, 200 sinus secretions were obtained from the same number of adult patients with maxillary sinusitis. The bacteriological findings were related to the character of the secretions as well as to the duration of symptoms, previous antibacterial treatment and possible dental genesis. Pathogens were isolated in 87% of 54 patients with untreated acute sinus empyema, Streptococcus pneumoniae being the most prevalent (57%). In 47 cases of treatment failure Haemophilus influenzae predominated and was found in 60% of the purulent secretions. In all, 11% of the 47 cases showed growth of beta-lactamase-producing H. influenzae, corresponding to 18% of all H. influenzae in this group. Staphylococcus aureus and anaerobic bacteria were infrequent findings except in purulent sinus secretion from patients with a long history. In contrast to patients with sinus empyema, no pathogens were found in the majority of 37 patients with non-purulent sinusitis.
Complement receptors, CR1 and CR3, on neutrophils increase their cellular spontaneously at 37 degrees C or after mechanical stress during the cell preparation. We have established a cell preparation procedure and a cytofluorometric immunoassay method to evaluate the receptor expression in vivo in this study. The expression of CR1 and CR3 was studied after haemolysis in NH4Cl at different temperatures and incubation intervals. It was shown that cell preparation and receptor analysis must be performed at 15 degrees C or lower to avoid up-regulation of the receptor structures. Two minutes' incubation at 20 degrees C was sufficient to modulate the cells in this regard. Granulocytes from healthy blood donors were analysed and the mean fluorescence intensity (MFI), which reflects the number of receptors on the cell surface, showed a normal distribution for the CR1 (n = 158) and CR3 (n = 76) expression in the healthy population. The MFI of the two receptors showed a correlation (r = 0.71). Granulocytes from all donors could be modulated at 37 degrees C to a similar degree for both receptors (r = 0.76), despite the fact that they are supposed to be mobilized from different intracellular pools. A group of patients with localized inflammatory processes, such as sinusitis, differed from the healthy controls. In this group, the CR1 expression was not normally distributed, but 15 out of 26 patients (58%) had granulocytes with a CR1 expression exceeding the mean +/- SD of the normal population.
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