Chronic rhinosinusitis (CRS) is an inflammatory disorder with numerous predisposing factors, including genetics, anatomic anomalies, bacteria, and fungus. CRS with nasal polyps can be distinguished by an eosinophilic type inflammation with a high concentration of IgE. Recent studies have implicated exposure to superantigens derived from Staphylococcus aureus and Alternaria as possible causes for the pahophysiology of nasal polyps. Superantigens are microbial toxins that bind to human leukocyte antigen class II histocompatibility molecules on antigen-presenting cells and T cell receptors on T cells simultaneously, bypassing classical antigen specificity. T lymphocyte sensitization to superantigen with production of the T-helper 2 cytokines has been proposed as a key step in the initiation of nasal polyps. This review summarize the current evidence for an active role of fungal and bacterial superantigens in CRS with nasal polyps. However, therapeutic approaches are so far limited and empirical, and need further improvement.
Alternaria ; Antigen-Presenting Cells ; Bacteria ; Cytokines ; Eosinophils ; Fungi ; Histocompatibility ; Humans ; Immunoglobulin E ; Inflammation ; Leukocytes ; Lymphocytes ; Nasal Polyps ; Polyps ; Receptors, Antigen, T-Cell ; Sensitivity and Specificity ; Sinusitis ; Staphylococcus aureus ; Superantigens ; T-Lymphocytes

Macular hemorrhage which result from breaks of Bruch's membrane or from choroidal neovascularization can develop in high degenerative myopia, but its occurrence after photorefractive surgery has rarely been reported. We experienced a case of macular hemorrhage after laser in situ keratomileusis[LASIK]:A 28-year-old female patient with high myopia of -16.5 diopters, who had received successful LASIK operation on her left eye.complained of a sudden drop in vision 20 days postoperatively.On fundus examination, macular hemorrhages were detected on her left eye.Eventually the hemorrhages resolved, but more than 2 lines of her best corrected visual acuity were lost.During follow-up, a new hemorrhagic lesion was incidently found on the other eye. This case demonstrates that macular hemorrhages may develop after LASIK in eyes with high degenerative myopia, and lead to a permanent reduction in visual acuity.We should be alert to any potential retinal pathology in patients having refractive surgery.
Adult ; Bruch Membrane ; Choroidal Neovascularization ; Female ; Follow-Up Studies ; Hemorrhage* ; Humans ; Keratomileusis, Laser In Situ* ; Myopia ; Myopia, Degenerative ; Pathology ; Refractive Surgical Procedures ; Retinaldehyde ; Visual Acuity

Chronic rhinosinusitis (CRS) is a very common condition but it's pathogenesis is not completely understood. Although, fungi have been suggested to play an important role in the pathogenesis of CRS, there is a significant controversy among rhinologist. The host defense mechanisms against fungi are numerous ranges from innate immunity to adaptive immunity. Fungal biofilms and superantigens are clearly present on the sinus mucosa of CRS patients; they are interacting with the host immune system in perpetuating chronic inflammation. Fungi also play as an inducer of marked inflammatory reaction by enhancing the production of chemical mediators from respiratory mucosa and inflammatory cells. However, the inability to reduce symptoms and sings of CRS inflammation by antifungal treatment means that the hypothesis that fungi play a role in a majority of the cases of CRS has to be rejected. However, there are not many arguments to suggest a causative role of fungi in CRS and due to the intrinsic or induced change in immunity of CRS patients, fungi might have a disease-modifying role.
Adaptive Immunity ; Biofilms ; Defense Mechanisms ; Fungi* ; Humans ; Immune System ; Immunity, Innate ; Inflammation ; Mucous Membrane ; Respiratory Mucosa ; Sinusitis ; Superantigens

Chronic rhinosinusitis (CRS) is a very common condition but it's pathogenesis is not completely understood. Although, fungi have been suggested to play an important role in the pathogenesis of CRS, there is a significant controversy among rhinologist. The host defense mechanisms against fungi are numerous ranges from innate immunity to adaptive immunity. Fungal biofilms and superantigens are clearly present on the sinus mucosa of CRS patients; they are interacting with the host immune system in perpetuating chronic inflammation. Fungi also play as an inducer of marked inflammatory reaction by enhancing the production of chemical mediators from respiratory mucosa and inflammatory cells. However, the inability to reduce symptoms and sings of CRS inflammation by antifungal treatment means that the hypothesis that fungi play a role in a majority of the cases of CRS has to be rejected. However, there are not many arguments to suggest a causative role of fungi in CRS and due to the intrinsic or induced change in immunity of CRS patients, fungi might have a disease-modifying role.
Adaptive Immunity ; Biofilms ; Defense Mechanisms ; Fungi* ; Humans ; Immune System ; Immunity, Innate ; Inflammation ; Mucous Membrane ; Respiratory Mucosa ; Sinusitis ; Superantigens

No abstract available.

Fungal rhinosinusitis was once considered a rare disorder but is now reported with increasing frequency throughout the world. This entity is now thought to comprise five subtypes. Acute invasive fungal rhinosinusitis, chronic invasive fungal rhinosinusitis, and chronic granulomatous invasive fungal rhinosinusitis make up the invasive group, whereas noninvasive fungal rhinosinusitis is composed of fungal ball and fungus related eosinophilic rhinosinusitis including allergic fungal rhinosinusitis (AFRS). These five subtypes are distinct entities with different clinical, histological, and radiologic features. The diagnosis of each category is important for optimum therapy and predicting the course. However, consensus on terminology, pathogenesis, and optimal management is lacking. The distinction of granulomatous from chronic invasive type is not beyond controversy as both types have a chronic course and predominant orbital involvement. AFRS, eosinophilic fungal rhinosinusitis, and esinophilic mucin rhinosinusitis are imprecise and require better definition. The clear differentiation and definition of categories of fungal rhinosinusitis is related to the development of a management protocol of each category. Prompt diagnosis and initiation of appropriate therapy are essential to avoid a protracted or fatal outcome.
Consensus ; Eosinophils ; Fatal Outcome ; Fungi ; Mucins ; Orbit

Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of the nasal and paranasal sinus mucosa. Generally CRS can classify depend on the presence of polyps or eosinophilic infiltration. Eosinophils have immune-modulatory effects on the inflammatory response of CRS and eosinophilia has been noted to be a marker for more extensive disease. Eosinophilic CRS (ECRS) is a clinical entity of chronic inflammation accompanied by numerous infiltrations of eosinophils in sinonasal tissues. The purpose of this review is to define and characterize the potential subcategories of ECRS and to discuss pathophysiology for targeted treatment modalities. Although it is difficult to differentiate one form of ECRS from another, genetic and molecular study will lead to unreveal the immunologic mechanism and pathogenesis of ECRS.
Eosinophilia ; Eosinophils ; Inflammation ; Mucous Membrane ; Polyps

Three-dimensional surgical accuracy between virtually planned and actual surgical movements of the maxilla in two-jaw orthognathic surgery.

Three-dimensional surgical accuracy between virtually planned and actual surgical movements of the maxilla in two-jaw orthognathic surgery.

BACKGROUND AND OBJECTIVES: Airway epithelial cells contribute to the pathogenesis of air disease by their interaction with inhalant pathogenic extracts. Airborne fungi interact with nasal epithelial cell and enhance the production of inflammatory cytokines. Glucocorticosteroids (GCs) have been used therapeutically for nasal polyps and allergic disease with potent anti-inflammatory effects. The purpose of this study was to investigate the inhibitory effect of GCs on fungi induced nasal epithelial cell activation. MATERIALS AND METHODS: The epithelial cells of nasal polyps were obtained from patients and stimulated with Alternaria. To evaluate the anti-inflammatory effects of GCs, Alternaria was pretreated with GCs (triamcinolone, dexamethasone, and budesonide) and cultured with epithelial cells. Interleukin-8 (IL-8) and granulocyte-macrophage colony stimulating factor (GM-CSF) were measured to determine the activation of epithelial cells. Reverse transcriptase-polymerase chain reaction (RT-PCR) test for protease-activated receptors (PARs) mRNA expression in nasal epithelial cells were performed. RESULTS: Alternaria enhanced the production of IL-8 and GM-CSF from nasal epithelial cells. GCs inhibited the activation of nasal epithelial cells, but the PAR2 and PAR3 mRNA expression were not suppressed by GCs. CONCLUSION: These data suggest that GCs inhibit the production of chemical mediators by Alternaria, but anti-inflammatory effect of GCs are not associated with PARs.
Adrenal Cortex Hormones* ; Alternaria ; Colony-Stimulating Factors ; Cytokines ; Dexamethasone ; Epithelial Cells* ; Fungi ; Granulocyte-Macrophage Colony-Stimulating Factor ; Humans ; Interleukin-8 ; Nasal Polyps* ; Receptors, Proteinase-Activated ; RNA, Messenger