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1.  The impact of intraoperative saline irrigations on bacterial load within the maxillary sinus 
Saline irrigations are routinely employed during endoscopic sinus surgery to remove mucous and debris from the sinus cavities. What is unknown is whether this results in a quantitative reduction in pathologic bacteria within the sinus mucosa. The objectives of this study were to quantify the amount of 5 different bacteria (Staphylococcus aureus, Haemophilus influenzae, Pseudomonas aeruginosa, coagulase-negative Staphylococcus (CNS), and Streptococcus pneumoniae) within the maxillary sinus and to determine the impact of saline irrigations on bacterial counts.
Twenty patients with chronic rhinosinusitis were prospectively enrolled. After bilateral maxillary antrostomies, biopsies were taken of the maxillary sinus mucosa prior to any irrigation. In each patient, the left maxillary sinus was then irrigated with 250 cc of normal saline (NS) with a pressurized pulse-irrigation device and the right side was irrigated with 250 cc of NS using a 30-cc syringe attached to a curved suction tip. Repeat maxillary sinus mucosal biopsies were then taken from each side. Each biopsy was analyzed using quantitative polymerase chain reaction to determine the presence and amount of each of the bacteria.
Saline irrigations were found to significantly reduce the amount of S. aureus, P. aeruginosa, and S. pneumoniae found within the maxillary sinus mucosa. No difference was found for H. influenzae or CNS. No difference in bacterial load reduction was able to be shown between the pressurized saline flushes and manual saline rinse methods.
Intraoperative saline irrigations are able to significantly reduce the amount of potentially pathogenic bacteria within the diseased sinus mucosa.
PMCID: PMC4390042  PMID: 22287465
maxillary sinus; endoscopic sinus surgery; bacteria; polymerase chain reaction; saline irrigations; hydrodebrider; in-traoperative irrigations; bacterial load
2.  Epigenetics of Chronic Rhinosinusitis and the Role of the Eosinophil 
One theory for the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP) involves aberration in the expression of genes that maintain the sinonasal innate immune system. We propose that the alteration in gene expression seen in CRSwNP is a result of oxidative byproducts of eosinophils. Activated eosinophils and neutrophils may lead to the production of hypobromous acid (HOBr) and hypochlorous acid (HOCL) and the post-translational modification product 5-bromocytosine (5BrC) and 5 chlorocytosine (CIC) respectively. 5BrC and CIC may cause aberrant methylation of cytosine during DNA replication and mimic the endogenous methylation signal associated with gene silencing. We propose to use gas chromatography-mass spectrometry (GC-MS) to identify the presence of 5BrC and CIC in CRSwNP patients.
Patients with CRSwNP undergoing endoscopic sinus surgery were prospectively recruited into this study. Using GC-MS tissue specimens were analyzed for the presence of 5BrC, CIC and methylated cytosine.
Tissue specimens from 14 patients with CRSwNP and 3 normal controls were processed using GC-MS. CRSwNP specimens demonstrate elevated levels of 5BrC and CIC compared to normal controls.
Eosinophils, which are predominantly found in CRSwNP, may lead to DNA modification and gene silencing via 5BrC and aberrant methylation patterns and may help explain the pathogenesis of CRSwNP.
PMCID: PMC4241761  PMID: 22311846
3.  Temporal lobe abscess in a patient with isolated sphenoiditis 
Allergy & Rhinology  2011;2(1):40-42.
A 74-year-old immunocompetent man admitted for severe retro-orbital headache was diagnosed with isolated sphenoiditis. At the time of scheduled surgery, the patient was mildly obtunded, and a head CT revealed a temporal lobe abscess. The patient underwent a left temporal craniectomy and a bilateral endoscopic sphenoid sinusotomy, which revealed gross fungal debris. The patient made a full recovery with resolution of abscess and sinus findings. Suspicion for intracranial infection should be raised in any sinus patient with neurological changes. Early diagnosis with imaging studies is extremely important for surgical drainage before permanent neurological sequelae.
PMCID: PMC3390129  PMID: 22852114
Abcess; allergic sinusitis; fungal infection; headache; sinonasal; sphenoiditis; temporal lobe
4.  Superantigens and chronic rhinosinusitis: Skewing of T-cell receptor Vβ-distributions in polyp-derived CD4+ and CD8+ T cells 
American journal of rhinology  2006;20(5):534-539.
Recent studies have suggested that Staphylococcus aureus secrete superantigenic toxins that play a role in the etiology of chronic rhinosinusitis with nasal polyposis (CRSwNP). Twenty S. aureus superantigens (SAg’s) have been identified, each of which bind the Vβ-region of the T-cell receptor (TCR) outside the peptide-binding site. Approximately 50 distinct Vβ-domains exist in the human repertoire, and distinct SAg’s will bind only particular domains generating a pattern of Vβ-enrichment in lymphocytes dependent on the binding characteristics of a given toxin. The aim of this study was to analyze the pattern of Vβ-expression in polyp-derived lymphocytes from CRSwNP patients.
Polyps were harvested from 20 patients with CRSwNP and 3 patients with antrochoanal polyps. Flow cytometry was used to analyze the Vβ-repertoire of polyp-derived CD4+ and CD8+ lymphocytes. Data were analyzed in light of the known skewing associated with SAg exposure in vivo and in vitro. Skewing was defined as a percentage of Vβ-expression >2 SD of that seen in normal blood.
Seven of 20 subjects exhibited skewing in Vβ-domains with strong associations with S. aureus SAg’s. The three antrochoanal polyps failed to show any significant Vβ-skewing.
This study establishes evidence of S. aureus SAg–T-cell interactions in polyp lymphocytes of 35% of CRSwNP patients. Although these results are consistent with intranasal exposure of polyp lymphocytes to SAg’s, additional study is necessary to establish the role of these toxins in disease pathogenesis.
PMCID: PMC2802273  PMID: 17063750

Results 1-4 (4)