A Comparison of the Bacterial Culture Results of Maxillary Sinus Mucosa and Pus Collections for Chronic Maxillary Rhinosinusitis

Objective: Although maxillary antral taps are the standard for collecting pus for bacterial culture, they sometimes reveal no growth. Intraoperative mucosal cultures are another method to collect pathogen samples. This study compared aerobic bacterial cultures from maxillary sinus mucosa and pus collected from chronic maxillary rhinosinusitis patients. Methods: A prospective study of 22 chronic maxillary rhinosinusitis patients was conducted. Antral pus and mucosa collected during endoscopic sinus surgery were immediately sent to a microbiological laboratory. The degree of concordance between maxillary sinus mucosa aerobic bacterial cultures and pus cultures was then analyzed. Results: Twenty-seven specimens were obtained for the cultures. The proportions of positive mucosal and pus cultures were 40.74% and 51.85%, respectively. The common aerobic pathogens from the two culture techniques were Pseudomonas aeruginosa and Staphylococcus aureus. A concordance between the pus and mucosal cultures was demonstrated by 19 out of 27 specimens (70.37%). Compared with the pus cultures, the mucosal cultures had a specificity of 84.62% (95% CI, 54.55%-98.08%), a sensitivity of 57.14% (95% CI, 28.86%-82.34%), a predictive value of a positive result of 80% (95% CI, 50.83%-93.93%), and a predictive value of a negative result of 64.71% (95% CI, 48.96%-77.80%). Conclusion: Similar pathogenic bacteria were recovered from the mucosa and pus. Given the high degree of similarity of the bacteria found, the good concordance rate, and the high specificity and positive predictive value of the mucosal cultures compared with the pus cultures, mucosal cultures should be a reference standard and an option when pus is unavailable, especially with immunocompromised patients

A Comparison of the Bacterial Culture Results of Maxillary Sinus Mucosa and Pus Collections for Chronic Maxillary Rhinosinusitis

Objective: Although maxillary antral taps are the standard for collecting pus for culture, they sometimes reveal no growth. Intraoperative mucosal cultures are another method to collect pathogen samples. This study compared aerobic bacterial cultures from mucosa and pus from chronic maxillary rhinosinusitis patients. Methods: A prospective study of 22 chronic maxillary rhinosinusitis patients was conducted. Antral pus and mucosa collected during endoscopic sinus surgery were immediately sent to a microbiological laboratory. The degree of concordance between maxillary sinus mucosa aerobic bacterial cultures and pus cultures was then analyzed. Results: Twenty-seven specimens were obtained for the cultures. The proportions of positive mucosal and pus cultures were 40.74% and 51.85%, respectively. The common aerobic pathogens from the two culture techniques were Pseudomonas aeruginosa and Staphylococcus aureus. A concordance between the pus and mucosal cultures was demonstrated by 19 out of 27 specimens (70.37%). Compared with the pus cultures, the mucosal cultures had a specificity of 84.62% (95% CI, 54.55%-98.08%), a sensitivity of 57.14% (95% CI, 28.86%-82.34%), a predictive value of a positive result of 80% (95% CI, 50.83%-93.93%), and a predictive value of a negative result of 64.71% (95% CI, 48.96%-77.80%). Conclusion: Similar pathogenic bacteria were recovered from the mucosa and pus. Given the high degree of similarity of the bacteria found, the good concordance rate, and the high specificity and positive predictive value of the mucosal cultures compared with the pus cultures, mucosal cultures should be a reference standard and an option when pus is unavailable, especially with immunocompromised patients

Aberrant antigenic expression in extranodal NK/T-cell lymphoma: a multi-parameter study from Thailand

<p>Abstract</p> <p>Background</p> <p>Extranodal NK/T-cell lymphoma, nasal type (ENKTL) is not common worldwide, but it is the most common T- and NK-cell lymphomas in many Asian countries. Immunophenotypic profiles were studied based on limited series. The authors, therefore, studied on ENKTL according to characterize immunophenotypic profiles as well as the distribution of EBV subtype and LMP-1 gene deletion.</p> <p>Methods</p> <p>By using tissue microarray (TMA), immunohistochemical study and EBV encoded RNA (EBER) in situ hybridization were performed. T-cell receptor (TCR) gene rearrangement, EBV subtyping, and LMP-1 gene deletion were studied on the available cases.</p> <p>Results</p> <p>There were 22 cases eligible for TMA. ENKTL were positive for CD3 (91%), CD5 (9%), CD7 (32%), CD4 (14%), CD56 (82%), TIA-1 (100%), granzyme B (95%), perforin (86%), CD45 (83%), CD30 (75%), Oct2 (25%), and IRF4/MUM1 (33%). None of them was positive for βF1, CD8, or CD57. TCR gene rearrangement was negative in all 18 tested cases. EBV was subtype A in all 15 tested cases, with 87% deleted LMP-1 gene. Cases lacking perforin expression demonstrated a significantly poorer survival outcome (p = 0.008).</p> <p>Conclusions</p> <p>The present study demonstrated TIA-1 and EBER as the two most sensitive markers. There were a few CD3 and/or CD56 negative cases noted. Interestingly, losses of CD45 and/or CD7 were not uncommon while Oct2 and IRF4/MUM1 could be positive in a subset of cases. Based on the present study in conjunction with the literature review, determination of PCR-based TCR gene rearrangement analysis might not be a useful technique for making diagnosis of ENKTL.</p

Endotyping of Chronic Rhinosinusitis With and Without Polyp Using Transcription Factor Analysis

Inflammation of the nose and paranasal sinus or rhinosinusitis (RS) is a significant global health problem that is both very common and very costly to treat. Previous reports reveal variability in histology and mechanism of inflammation in patients with chronic rhinosinusitis with and without polyp (CRScNP and CRSsNP, respectively). There are various methods and hypothesis that try to explain this variability. Accordingly, the aim of this study was to investigate the incidence of each type of sinonasal inflammation among patients diagnosed with CRScNP or CRSsNP using transcription factor analysis (TFA). This study included mucosa specimens from nose/paranasal sinuses from patients with chronic rhinitis (CR), CRSsNP, or CRScNP that were obtained at the Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand during the June 2009 to May 2012 study period. TFA was employed to measure the following transcription factors: T-box transcription factor (T-bet) for Th1, GATA binding protein 3 (GATA-3) for Th2, retinoic acid-related orphan receptor C (RORC) for Th17, and forkhead box P3 (FOXP3) for Treg. Forty-one subjects (22 males, 19 females) were enrolled, with a mean age of 45.93 ± 13 years. Twenty-six patients were diagnosed with CRScNP, 7 with CRSsNP, and 8 with CR (controls). The majority of CRScNP specimens (76.9%) had eosinophil count greater than 100 cells/high-power field (HPF). Mean eosinophil count was 930.08 ± 1,399 cells/HPF (range: 17–5,570). Th2 transcription factor (GATA-3) was statistically significantly higher in the CRScNP group than in the CRS and control groups (p &lt; 0.001); whereas, Treg transcription factor (FOXP3) was statistically significantly lower in the CRScNP group than in the CRSsNP and control groups (p &lt; 0.001). The transcription factors for Th1 and Th17 (T-bet and RORC, respectively) were not significantly different among the three groups. The result of transcription factor analysis revealed hyperfunction of Th2 in patients with CRScNP, which might result in hypereosinophilic infliltration in the polyps. One explanation for this finding is the decreased activity of Treg. Although environment-host interaction is the most probable hypothesis, the etiology of aberrant adaptive immunity needs to be elucidated

Factors Affecting Unfavourable Results from a Sinonasal Inverted Papilloma Surgery

Objective: Sinonasal inverted papilloma (SNIP) is the most common nasal benign tumor, but locally invasive. The standard treatment is to identify origins of the tumor and total removal. Unfavourable results are finding postoperative residual or recurrent tumors. The aim of this study is to determine factors affecting postoperative residual or recurrent tumors and a rate of getting postoperative residual or recurrent tumors from SNIP surgeries. Methods: A retrospective study in patients with SNIPs was conducted. Relationships between demographic data, tumor sites, tumor stages by Krouse classification, surgical approaches, surgeons’ experience, using microdebrider assisted surgery, operative time, intraoperative blood loss, histopathology, Epstein Barr virus (EBV), human papillomavirus (HPV) infection, time to detect tumor after surgery and unfavourable results were evaluated. HPV and EBV were detected by in situ hybridization. Results: 73 patients were included in this study. Unfavourable results were found in 27 patients (36.99%). 50% of patients received unfavourable results after postoperative duration of 115 months. 5 years of a disease-free survival rate was 64.3% (95% CI: 51.9% to 76.7%). The patients with external surgical approaches got worse results than those with endoscopic sinus surgery (p = 0.01, a hazard ratio of 3.88, 95% CI: 1.39 to 10.87). The patients operated without using microdebrider assisted surgery got worse results than those with using the device (p < 0.001, an adjusted hazard ratio of 5.09, 95% CI: 2.08 to 12.45). The patients with abnormal pathological changes (tissue dysplasia and malignant transformation) had worse results than those without changes (p = 0.02, an adjusted hazard ratio of 3.42, 95% CI: 1.24 to 9.38).   Conclusion: Non-endoscopic nasal surgery, non-using microdebrider assisted surgery, and abnormal pathological changes may be some of the causes of unfavourable results from SNIP surgeries. Long postsurgical surveillance should be done, because of 36.99% of patients received unfavourable results from SNIP surgeries