Chronic rhinosinusitis (CRS) affects 5-12% of the world’s adult population. Chronic rhinosinusitis with nasal polyps (CRSwNP) accounts for 25-30% of all cases of CRS. CRSwNP-associated inflammatory process in nasal mucosa and paranasal sinuses depends on the characteristics of local immunity, including expression of a number of cytokines. The aim of this work was to investigate the parameters of local immunity in various clinical forms of CRSwNP. In this work, the concentrations of pro-inflammatory cytokines, i.e., interleukin-1β (IL-1β) and IL-8, antimicrobial function of neutrophils from the nasal cavity was evaluated, along with histological and immunohistochemical studies of polyposis tissue. The study included 4 groups of patients: a control group of practically healthy individuals, patients with CRSwNP, clinical cases with chronic purulent rhinosinusitis and nasal polyps (CPRSwNP), and patients with CRSwNP complicated by bronchial asthma (CRSwNP + BA), including the cases with asthmatic triad (CRSwNP + intolerance to NSAIDs + BA). The patients were classified on the basis of their clinical characteristics and severity of the course of the disease. Interleukin-1β (IL-1β) and IL-8 concentrations in nasal secretions were determined by enzyme-linked immunosorbent assay (ELISA). To assess functional activity of neutrophils, a lysosomal cationic test was used on the smears from mucous surface of inferior turbinate. Histological examination of the polypous tissue biopsies was performed in slices stained with Carazzi’s hematoxylin and eosin. IL-1β and IL-8 location in the polypous tissue were detected by indirect immunohistochemistry. In all groups of the patients, IL-1β and IL-8 concentrations exceeded those in the control group. The levels of IL-1β in the groups with CPRSwNP, CRSwNP + BA were significantly increased as compared with the CRSwNP group. IL-8 concentrations in the CRSwNP and CPRSwNP groups were significantly higher than in the CRSwNP + BA group. When analyzing antimicrobial function of neutrophils, the decreased average values of cytochemical coefficient were shown in CPRSwNP and CRSwNP + BA groups, compared with the control group and CRSwNP. In all clinical forms of CPMS, complex histopathological changes were observed, including leukocyte infiltration, fibrosis, edema, and collagen depositions. In addition, the integrity of epithelial layer was found to be damaged in polyposis, epithelial metaplasia is detected as well as increased mucus production. These disorders lead to a decrease in muco-ciliary clearance in nasal cavity. The most significant pathomorphological changes occur in CRSwNP + BA, especially in cases of asthmatic triad. According to immunohistochemical data, in various forms of CRSwNP, IL-1β- and IL-8-positive leukocytes, predominantly macrophages, are detected in the polypous tissue both subepithelially and in the connective tissue stroma of the polyps. Changed concentrations of pro-inflammatory cytokines in nasal secretion of the patients, altered antimicrobial activity of mucosal neutrophils, and characteristic pathomorphological disorders in polypous tissue of patients with CRSwNP are associated with severity of inflammatory process and clinical course of the disease. The results obtained are essential to understanding the mechanisms of pathogenesis in various subgroups of CRSwNP, assessing severity of the disease and efficiency of the treatment applied.
Parietal edema/edematous syndrome, appearing in isolation in the paranasal sinuses, is the most common radiographic finding. However, the transformation of the syndrome into polypous tissue, the relationship with the formation of clinical forms of rhinosinusitis are poorly understood. Objective. To reveal the relationship of edematous syndrome of the mucous membrane of the paranasal sinuses with meteorological elements (humidity, temperature, precipitation, wind speed). Describe the mechanism of the pathogenetic relationship between increased water vapor pressure and edematous syndrome of paranasal sinuses. Materials and methods. The study included 504 people who performed computed tomography in the units of Saint Petersburg City Hospital No. 40 in 2019, of which 243 were men, 261 were women. Age from 33 to 56 years old, mean age 46.45 ± 1.87. On each of the three selected days of the month, 14 patients were determined (methods of random sampling) who underwent CT of paranasal sinuses. Results. The processes of condensation in the sinuses were evaluated using a computer thermotechnical calculation. A connection was found between the edematous syndrome of the mucous membrane of the paranasal sinuses and meteorological elements (moderate correlation between relative humidity and the presence of edema, a strong correlation between the average wind speed and edema of paranasal sinuses). The mechanism of pathogenetic connection of increased water vapor pressure with edematous syndrome of paranasal sinuses is described. The main types of pathological processes were identified: film condensation with a dew point on the mucosal surface, interstitial condensation with a dew point in the thickness of tissues, and various combinations thereof.
Objective: Identify the diagnostic signs for chronic rhinosinusitis with nasal polyps (CRSwNP & resistant forms) with multimorbid cardiovascular pathology (MCVP) (coronary artery disease (CAd), hypertension, metabolic syndrome (MS). Identify effectiveness of photodynamic therapy in CRSwNP treatment. Design and methods: The study included 75 patients (mean age 35,8±7,93, 39,2% - female,60,8% - male) with CRSwNP and MCVP divided into 3 groups by simple random sampling. Patients in group 1 (n = 27) received standard therapy CRSwNP, hypertension, CAd, NPMd, 8-weeks anti- bacterial and leukotriene receptor antagonists treatment. Surgical interventions history of the last 5 five years: from 1 to 2. Patients in group 2 (n = 28) received standard therapy CRSwNP, hypertension, CAd, NPMd, 8-weeks antibacterial and leukotriene receptor antagonists treatment. Surgical inter- ventions history of the last 5 five years: more than 3. Patients of group 3 (n = 20) received standard therapy CRSwNP, hypertension, CAd, NPMd, 8-weeks antibacterial treatment, 8-weeks leukotriene receptor antagonists treatment and sessions of photodynamic therapy of the paranasal sinuses. Surgical interventions history of the last 5 five years: more than 3. used in the study: complex psychological test methods, ENT and laboratory-instrumental evaluation of the cardiovascular system. Results: depres- sion was detected in 46,3%, 71,9%, 58,3% of patients, (first, second, third groups). Types «non-dipper» and «night-peaker» found in patients 2nd and 3rd groups- corresponds with (CRSwNP & resistant forms). Bone transformation zone as a result of chronic inflammation within the ethmoidal labyrinth and maxillary sinuses identified in the second and third patients group (85% of cases). The use of pho- todynamic therapy in the resistant CRSwNP forms treatment improves the functional indicators of the nasal cavity and paranasal sinuses. Conclusions: Patients with CRSwNP have symptoms of depression and «non-dipper» and «night-peaker» patterns. All CRSwNP patients are defined trigger points with areas of chronic osteitis and odontogenic osteomyelitis. The use of photodynamic therapy for CRSwNP treatment, reduces the number of CRSwNP recurrence.
Chronic polypous rhinosinusitis (CPR) is an immune disease based of the chronic inflammation and remodelling of the nasal mucosa and paranasal sinuses. The objective of the work is to study morphological changes of the polypous tissue removed from the nasal cavity and paranasal sinuses to determine the structural features characteristic for CPR pathogenesis. The authors examined 84 persons with CPR. The first group included 44 patients in which CPR was not combined with bronchial asthma (BA). The second group comprised 40 patients with CPR with BA. All the patients underwent endonasal polypectomy. The histological material was processed according to the standard method to obtain histological preparations. In cases of CPR combined with BA the basal membrane thickening was observed, as well as the expressed oedema of the mucous membrane layer and the mucous gland hyperplasia with cysts generation against the background of the expressed infiltration with eosinophil granulocytes and plasma cells. Without BA, the basal membrane had no clear structure, the cellular infiltration was presented mainly by lymphocytes and neutrophils, and, to a lesser extent, by eosinophils granulocytes and plasma cells.
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