Sinus tumors of Rocky Mountain bighorn sheep: investigation of an infectious etiology

2013 Spring.Includes bibliographical references.Rocky Mountain bighorn sheep are an icon in Colorado. As our state animal, bighorn sheep are a well-recognized symbol of the wildlife, wildlands, and wilderness-centric people that Colorado is famous for. Efforts to manage and conserve this species are a priority in Colorado and throughout western North America. As part of those efforts a great deal of research has been conducted to understand bighorn sheep respiratory disease, the leading infectious cause of death in these animals. In the process of investigating respiratory disease in bighorn sheep in Colorado, we discovered a surprisingly high occurrence of sinus tumors within the upper respiratory tracts of many animals. This disease had not been described previously and became the focus of work for this dissertation. Here, I have compiled our findings regarding the characterization of bighorn sheep sinus tumors and the results of our efforts to identify an infectious etiology for this disease. Through the examination of naturally-occurring cases, we identified characteristic histologic and gross features of bighorn sheep sinus tumors to define this disease. We also analyzed factors associated with sinus tumors at a population level. The results of this study suggest that bighorn sheep sinus tumors are an infectious disease, maintained within specific geographic areas corresponding to distinct populations of animals. Our results also suggest a role for bighorn sheep sinus tumors in predisposing animals to secondary infections by bacterial agents that can cause pneumonia. To specifically test the hypothesis that bighorn sheep sinus tumors are a transmissible disease, we experimentally inoculated bighorn sheep and domestic sheep lambs with a cell-free filtrate derived from a naturally-occurring bighorn sheep sinus tumor and its associated exudates. Within 18 months post-inoculation we demonstrated transmission of the disease to both bighorn sheep and domestic sheep species, supporting our hypothesis that bighorn sheep sinus tumors represent an infectious process. This experiment also provided an opportunity to examine tumors early in development, further characterize the cells comprising the tumors, and suggest mechanisms for pathogenesis. With evidence that bighorn sheep sinus tumors are caused by an infectious agent, we also attempted to identify a specific etiology for this disease. We primarily used PCR methods with degenerate PCR primers to evaluate samples from bighorn sheep sinus lining tissues for the presence of herpesviruses and retroviruses, which are well-known causes of infectious tumors. We successfully identified the presence of herpesviral and (likely endogenous) retroviral sequences in our samples, but we were unable to find an association between these viruses and the occurrence of sinus tumors. Based on similarities between bighorn sheep sinus tumors and oncogenic retroviral diseases of domestic sheep and goats, we specifically screened our samples for the presence of Jaagsiekte sheep retrovirus (JSRV), and enzootic nasal tumor viruses (ENTV-1 and ENTV-2). We successfully identified ENTV-2-specific sequences from some of our samples, but an association between this virus and bighorn sheep sinus tumors was not clear. We found an association between ENTV-2 and early tumor cases, but not well-defined tumors. While our PCR data alone did not definitively identify ENTV-2 as the cause of bighorn sheep sinus tumors, our histologic, histochemical, and immunohistochemical results have helped us to develop a hypothesis for the pathogenesis of bighorn sheep sinus tumors, and provided additional support for the hypothesis that this disease is caused by ENTV-2. Our working hypothesis for the pathogenesis of bighorn sheep sinus tumors is that epithelial cells of the sinus lining are infected by ENTV-2, but that uninfected periosteal pluripotent cells are stimulated to replicate, resulting in predominantly stromal tumors. This hypothesis is based on histologic observations, histochemical stains used to differentiate cell types, and IHC results specifically identifying the presence of ENTV antigen within surface epithelial cells of experimentally-induced tumors, but not within the predominating stromal cells of the tumors. These results help to explain why detection of the virus is uncommon in well-developed stromal tumors, but more easily detected in early tumor cases with less stromal proliferation. Additional research will help to further elucidate the pathogenesis of bighorn sheep sinus tumors, and the potential role that tumors may play in predisposing bighorn sheep to fatal respiratory disease. The definitive identification of an etiologic agent for bighorn sheep sinus tumors, and the development of an antemortem diagnostic assay will greatly enhance efforts to understand and manage this disease

European position paper on rhinosinusitis and nasal polyps 2020

The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise . The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included

European Position Paper on Rhinosinusitis and Nasal Polyps 2020

The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise. The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included.Peer reviewe

The Nose as a Route for Therapy: Part 1. Pharmacotherapy

This article reviews nasal structure and function in the light of intranasal pharmacotherapy. The nose provides an accessible, fast route for local treatment of nose and sinus diseases, with lower doses than are necessary systemically and few adverse effects. It can also be used for other medications as it has sufficient surface area protected from local damage by mucociliary clearance, absence of digestive enzymes, responsive blood flow, and provides a rapid route to the central nervous system.Peer reviewe

An investigation into the literature regarding nasal allergy with special reference to the therapeutic value of Zinc ionisation - a report on 120 personal cases

1. A review of the literature on nasal allergy has been made with special reference to zinc ionisation therapy.2. Mention has been made of the methods of investigating a case of nasal allergy and the results of various forms of treatment are liven.3. The technique of zinc ionisation is described and the details requirin`, particular attention are mentioned.4. Zinc ionisation acts by coagulating the surface epithelium with a subsequent regeneration of healthy epithelium, and by reducing oedema in the nose as a result of fibrosis in the submucosa.5. Zinc ionisation may be used for any form of nasal allergy. The results of 120 cases treated are given in full. These show 30.92% personally 3 cures , 42.73; great improvements , 15.45 %, improvements ,and 10.90% failures.6. No untoward effects have been noted in a total of 492 ionisations.7. The cases which have failed to respond to zinc ionisation are described and commented upon.8. Zinc ionisation has no effect at all upon purulent nasal discharge.9. An outline of the treatment to be adopted. in any particular case of nasal allergy is given

Diagnostic accuracy of maxillary periapical pathology perforating the sinus floor: a comparison of pantomograph and CBCT images

>Magister Scientiae - MScPeriapical lesions are fairly common pathology associated with the apex of a non-vital tooth. Some chronic lesions develop without an acute phase with no recollection of previous symptoms. It is known that maxillary odontogenic infections can breach the sinus floor with succeeding complications. Pantomography, a widespread conventional radiographic technique, provides a generalized view of the maxillofacial region. Advanced modalities like CBCT may facilitate in navigating complex anatomy, which would otherwise be obscured

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

European Position Paper on Rhinosinusitis and Nasal Polyps 2020

The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise . The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com

Rhinosinusitis

This book highlights five different sections of rhinosinusitis, namely allergic rhinitis, sinusitis, dental-related sinusitis, one airway disease, and surgical techniques in sino-nasal diseases. It incorporates new clinical and research developments as well as future perspectives in the ever-expanding upper and lower airway problems. I dedicate this book to those who provide continued research, high-quality clinical observations, and care, as well as selfless teaching and publications to advance knowledge in airway problems. ENT surgeons, rhinologists, allergologists, immunologists, pulmonologists, postgraduates, researches, trainees, and general practitioners with special interest in one airway disease will find this book useful and interesting