Convergence of two major pathophysiologic mechanisms in nasal polyposis: immune response to Staphylococcus aureus and airway remodeling

This review is addressed two pathophysiologic mechanisms implicated in the pathogenesis of nasal polyposis: the unique remodeling process found in nasal polyp tissue and the immune response of patients with nasal polyposis to Staphylococcus aureus.\ud \ud These two theories converge to the same direction in different aspects, including decreased extracellular matrix production, impaired T regulation and favoring of a Th2 immune response.\ud \ud In patients with nasal polyposis, an exaggerated immune response to Staphylococcus aureus may aggravate the airway remodeling process

Orbital decompression in exophthalmos by combined external and endonasal endoscopic approach

A reducao da proptose na oftalmopatia por doenca Graves pode ser obtida atraves de varias tecnicas. A descompressao endonasal auxiliada por endoscopio pode ser utilizada isoladamente ou combinada com outras tecnicas. Com o objetivo de avaliar o efeito da descompressao orbital por via externa e endoscopica endonasal, 15 pacientes portadores de proptose por doenca de Basedow-Graves foram submetidos a 17 descompressoes orbitais. Por acesso cutaneo foram removidas a parede ossea lateral e a porcao medial ao canal infra-orbital da parede inferior da orbita e por acesso endonasal auxiliado por endoscopio foi removida a parede medial da orbita. No periodo que variou de seis a 18 meses de acompanhamento pos-operatorio foi observada uma reducao media da proptose de 6,00 mm, um paciente apresentou diplopia pos-operatoria (6 por cento) e nao houve piora na acuidade visual. Concluindo, a tecnica de descompressao orbital por via externa e endonasal auxiliada por endoscopia mostrou-se segura e eficaz na reducao da proptose e com baixa morbidadeBV UNIFESP: Teses e dissertaçõe

Correção do nariz desviado utilizando spreader graft no lado convexo do desvio Deviated nose correction by using the spreader graft in the convex side

O nariz desviado é resultado de um conjunto de alterações anatômicas e por isso existe um grande número de técnicas para sua correção, sendo que um único método não deve ser utilizado em todos os casos. OBJETIVO: Avaliar um novo método para a correção destas deformidades, o uso do spreader graft no lado convexo do nariz desviado. FORMA DE ESTUDO: Prospectivo. MATERIAL E MÉTODO: Seis pacientes com nariz desviado foram submetidos à rinoplastia com colocação de spreader graft no lado convexo do desvio nasal e acompanhados por um período de 2 anos. RESULTADOS: Todos os pacientes apresentaram melhora da estética facial. Conclusão: Este estudo mostrou ser possível utilizar o spreader graft no lado convexo do desvio nasal em casos específicos.<br>A deviated nose is the result of a set of anatomical abnormalities, and for this reason there are many methods for correcting such defects. Therefore we should not use only one single method in all cases of nasal deformities. AIM: In this prospective study we propose a new method using a spreader graft on the convex side of the deviated nose. METHODS: We performed rhinoplasty in six patients by inserting a spreader graft in the convex side of the deviated nose and followed them for two years. RESULTS: All six patients presented an improvement in the external appearance of their noses. Conclusions: This study showed that in some particular cases, the spreader graft technique can be used successfully to correct deviated noses

Role of imbalance of eicosanoid pathways and staphylococcal superantigens in chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is a multifactorial disease of the upper airways with a high prevalence (approximately 11%) in the general population. Different immune and inflammatory mechanisms are involved in its pathogenesis. Alterations in the arachidonic acid pathway (leading to an imbalanced production of eicosanoids) have been linked to the pathophysiology of different diseases especially nasal polyposis, asthma, and aspirin-exacerbated respiratory disease. Furthermore, viral and bacterial infections have been identified as important factors amplifying the pro-inflammatory reactions in these pathologies. This review summarizes the impact of an imbalance in the eicosanoid pathway and the effect of Staphylococcus aureus enterotoxins on the regulation of the pro-inflammatory network in CRS and their translation into disease severity.Flemish Research Board (FWO Post-doctoral mandate)European UnionSão Paulo State Military Police-Health Department, BrazilFlemish Scientific Research Board FWOInteruniversity Attraction Poles ProgramUniv Ghent, Dept Otorhinolaryngol, Upper Airways Res Lab, B-9000 Ghent, BelgiumJagiellonian Univ, Sch Med, Dept Med, Krakow, PolandUniversidade Federal de São Paulo, Dept Otorhinolaryngol, São Paulo, BrazilMedex, Bielsko Biala, PolandUniversidade Federal de São Paulo, Dept Otorhinolaryngol, São Paulo, BrazilFlemish Research Board (FWO Post-doctoral mandate): FWO08-PDO-117European Union: 17Flemish Scientific Research Board FWO: A12/5-HB-KH3Flemish Scientific Research Board FWO: G.0436.04Interuniversity Attraction Poles Program: IAP P6/35Web of Scienc

Three-dimensional cell culture for the study of nasal polyps

Objectives: Three-dimensional (3D) cell cultures have many applications such as stem cell biology research, new drug discovery, cancer, and Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). This disease is characterized by a significant impact on quality of life and productivity. The diversity of factors that act in the progression of CRSwNP point to the creation of a cell culture model that allows the integration of different cell types with extracellular matrix. This work aimed to create a cell culture model in 3 dimensions (spheroids) for the study of Nasal Polyposis. Methods: Nasal polyp tissue from patients diagnosed with CRSwNP was mechanically dissociated using tweezers and a scalpel and the solution containing cells and small aggregates of nasal polyps was transferred to a Petri dish containing 5 mL of culture medium at the concentration of 106 cells/mL. Results: The spheroids were cultivated for 20 days, fixed and analyzed using confocal microscopy. In a 3D culture environment, the spheroids were formed both by clustering cells and from small tissue fragments. In the cultures analyzed, the ciliary beat was present from the dissociation of the cells up to 20 days in culture. Conclusion: Our findings also point to these characteristics showing the environment generated in our study, the cells remained differentiated for a longer time and with ciliary beating. Thus, this work shows that nasal polyp-derived cells can be maintained in a 3D environment, enabling better strategies for understanding CRSwNP in situations similar to those found in vivo. Level of evidence: Laboratory studies

Convergence of two major pathophysiologic mechanisms in nasal polyposis: immune response to Staphylococcus aureus and airway remodeling

Abstract This review is addressed two pathophysiologic mechanisms implicated in the pathogenesis of nasal polyposis: the unique remodeling process found in nasal polyp tissue and the immune response of patients with nasal polyposis to Staphylococcus aureus. These two theories converge to the same direction in different aspects, including decreased extracellular matrix production, impaired T regulation and favoring of a Th2 immune response. In patients with nasal polyposis, an exaggerated immune response to Staphylococcus aureus may aggravate the airway remodeling process

Convergence of two major pathophysiologic mechanisms in nasal polyposis: immune response to Staphylococcus aureus and airway remodeling

Abstract This review is addressed two pathophysiologic mechanisms implicated in the pathogenesis of nasal polyposis: the unique remodeling process found in nasal polyp tissue and the immune response of patients with nasal polyposis to Staphylococcus aureus. These two theories converge to the same direction in different aspects, including decreased extracellular matrix production, impaired T regulation and favoring of a Th2 immune response. In patients with nasal polyposis, an exaggerated immune response to Staphylococcus aureus may aggravate the airway remodeling process

Complicações rinossinusais após descompressão orbital em técnica externa e endonasal combinada Sinus complications after orbital decompression by combined external and endonasal technique

Muitas técnicas de descompressão orbital têm sido utilizadas no tratamento da oftalmopatia por Graves. Recentemente, introduziu-se a cirurgia endoscópica endonasal na descompressão de órbita, como técnica isolada ou combinada com as já existentes, acreditando proporcionar melhor visão da parede medial da órbita e menor incidência de infecção bacteriana quando a parede medial é acessada por endoscópio. OBJETIVO: Avaliar as complicações após a descompressão orbital por técnica combinada assistida por endoscopia na prevenção de infecção rinossinusal. FORMA DE ESTUDO: Clínico Prospectivo. MATERIAL E MÉTODO: 16 pacientes 18 órbitas foram submetidos à descompressão orbital no Setor de Órbita do Departamento de Oftalmologia da Escola Paulista de Medicina UNIFESP. RESULTADOS: Quatro pacientes, durante o acompanhamento por tomografia no pós-operatório, apresentaram velamento do seio maxilar ou frontal, sem sintomatologia. CONCLUSÃO: A descompressão orbital por via externa combinada com a via endonasal auxiliada por endoscopia mostrou-se eficaz na prevenção de sinusite clinicamente manifesta e suas complicações, embora no acompanhamento tomográfico 22% dos pacientes apresentaram velamento do seio maxilar ou frontal.<br>Many techniques of orbital decompression have been used in the treatment of Graves ophthalmopathy. Recently endonasal endoscope surgery was introduced in the orbital decompression, as an isolated technique, or combined with existing techniques hopefully to give better visualization of medial wall and a lower incidence infection when the medial wall is acessed. AIM: To evaluate orbital decompression combined with endoscope in prevention of bacterial infection, we relate three cases of assyntomatic patients with computer tomography control of facial sinus presenting opacification of maxillary or frontal sinus. STUDY DESIGN: Clinical Prospective. MATERIAL AND METHOD: 16 patients with 18 orbita procedures underwent orbital decompression, in the Ophthalmology Department at the Escola Paulista de Medicina-UNIFESP an orbital decompression was obtained by combined technique using endonasal access with an endoscope. RESULTS: Four patients during postoperative CT scan presented assymtomatic opacification of the maxillary or frontal sinuses. CONCLUSION: A combination of endoscopy in orbital decompression by external approach showed the effectiveness in prevention of sinusitis clinically manifested and its complications, although a longer time of follow-up is needed to understand better radiological findings 22% presented opacification of the sinuses and their consequences

Nasal Polyp-Derived Mesenchymal Stromal Cells Exhibit Lack of Immune-Associated Molecules and High Levels of Stem/Progenitor Cells Markers

Mesenchymal stromal cells (MSCs) are considered adult progenitor stem cells and have been studied in a multitude of tissues. In this context, the microenvironment of nasal polyp tissue has several inflammatory cells, but their stroma compartment remains little elucidated. Hence, we isolated MSCs from nasal polyps Polyp-MSCs (PO-MSCs) and compared their molecular features and gene expression pattern with bone marrow-derived MSCs (BM-MSCs). Initially, both PO-MSCs and BM-MSCs were isolated, cultivated, and submitted to morphologic, differentiation, phenotypic, immunosuppressive, and gene expression assays. Compared to BM-MSCs, PO-MSCs showed normal morphology and similar osteogenic/ adipogenic differentiation potential, but their immunophenotyping showed lack of immune-associated molecules (e. g., CD117, HLA-DR, PDL-1, and PDL2), which was linked with less immunoregulatory abilities such as (i) inhibition of lymphocytes proliferation and (ii) regulatory T cell expansion. Furthermore, we detected in the PO-MSCs a distinct gene expression profile in comparison with BM-MSCs. PO-MSC expressed higher levels of progenitor stem cells specific markers (e. g., CD133 and ABCB1), while BM-MSCs showed elevated expression of cytokines and growth factors (e. g., FGF10, KDR, and GDF6). The gene ontology analysis showed that the differentially modulated genes in PO-MSC were related with matrix remodeling process and hexose and glucose transport. For BM-MSCs, the highly expressed genes were associated with behavior, angiogenesis, blood vessel morphogenesis, cell-cell signaling, and regulation of response to external stimulus. Thus, these results suggest that PO-MSCs, while sharing similar aspects with BM-MSCs, express a different profile of molecules, which presumably can be implicated in the development of nasal polyp tissue.Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq)Univ Fed Sao Paulo, Dept Otolaryngol Head & Neck Surg, ENT Res Lab, Sao Paulo, BrazilUniv Antwerp, Dept Biomed Sci, PPES Lab Proteinchem, Prote Epigenet Signaling, Antwerp, BelgiumUniv Fed Sao Paulo, Div Nephrol, Dept Med, Sao Paulo, BrazilUniv Sao Paulo, Inst Biomed Sci, Dept Immunol, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Otolaryngol Head & Neck Surg, ENT Res Lab, Sao Paulo, BrazilUniv Fed Sao Paulo, Div Nephrol, Dept Med, Sao Paulo, BrazilFAPESP: 12/02270-2Web of Scienc

Osteodistrofias do Osso Temporal: Revisão dos Conceitos Atuais, Manifestações Clínicas e Opções Terapêuticas Osteodysplasia of the Temporal Bone: Up-date Concepts, Clinical Presentations and Therapeutic Options

Sob a designação de osteodistrofias do osso temporal, podemos encontrar uma série de doenças que apresentam em comum a desorganização da arquitetura ou da composição do tecido ósseo. A otospongiose é, com larga margem, a osteodistrofia mais comum nessa localização e suas alterações, repercussões clínicas e tratamentos são amplamente discutidos na literatura. Entretanto, formas menos freqüentes, como a displasia fibrosa e a osteogênese imperfeita, não são entidades raras e merecem atenção. Este artigo tem como objetivo discutir essas formas menos comuns de osteodistrofia do temporal através de uma revisão sobre os conceitos atuais dessas entidades, da apresentação de três exemplos clínicos e a discussão sobre opções de tratamento.<br>Osteodysplasia of the temporal bone included a significant amount of osseous diseases sharing bone matrix structural and composition damage. Otospongiosis is, by far, the most frequent form of this involvement in the temporal bone. Nevertheless, fibrous dysplasia and osteogenesis imperfecta are not rare and deserve attention. In this article, the authors present a discussion about the recent concepts of those less frequent forms of osteodysplasia of temporal bone, its options of treatment, illustrated with three clinical cases