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

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

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

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.

A 50-year-old woman visited our hospital for two palpable masses on her sternal and left upper abdominal areas. She had augmentation mammoplasty 12 years prior. Based on the physical examination, the mass in the sternal area was firm, movable, and round. The size of the mass was approximately 3.0x3.0x1.0 cm3. The mass in the upper-left abdomen showed similar characteristics, with a size of approximately 10.0x15.0x1.5 cm3. Ultrasonography revealed a 3.9x1.0x3.4 cm3 hypoechoic lesion in the sternal area. On enhanced-mode computed tomography, a rupture of the left breast implant was noted. Both masses had similar densities as the implant. After rupture of the breast implant, surgery was performed under general anesthesia. Using an inframammary approach, both breast implants and masses were removed using the site of the previous mammoplasty incision. Intraoperative findings revealed that the left breast implant was ruptured and the masses consisted of implant gel components. After surgery, the patient's recovery was uneventful. The patient was discharged without any problem on hospital day 9.
Abdomen ; Anesthesia, General ; Breast Implants* ; Female ; Humans ; Mammaplasty ; Middle Aged ; Physical Examination ; Rupture ; Silicone Gels* ; Ultrasonography