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Biomedical subjects

R J Salib

Publications and source records attributed to R J Salib.

12 recordsLinked to original sources

Nasal lavage fluid concentrations of eotaxin-1 (CCL11) in naturally occurring allergic rhinitis: relationship to disease activity, nasal luminal eosinophil influx, and plasma protein exudation.

BACKGROUND: Eotaxin-1 (CCL11) is a CC chemokine whose nasal eosinophilic chemotactic activity in vivo and in vitro has been demonstrated primarily using nasal allergen challenge models. The extension of these challenge findings to the in vivo setting has been limited. OBJECTIVE: To obtain nasal lavage fluid from volunteers with perennial and seasonal (in- and out-of-season) allergic rhinitis (AR) and non-atopic non-rhinitic controls for the measurement of eotaxin-1 concentrations and to relate these findings to the symptomatic disease severity, the percentage of lavage eosinophils, and to alpha(2)-macroglobulin (alpha(2)-MG) lavage concentrations, as a marker of vascular permeability and an index of airway inflammation. METHODS: Thirty-seven volunteers with AR (16 seasonal and 21 perennial) and 20 non-atopic non-rhinitic volunteers were recruited and phenotyped. Nasal lavage fluid was obtained by standardized protocol. The nasal lavage fluid concentrations of eotaxin and alpha(2)-MG were measured by ELISA, and differential cell counts performed on cytospins. RESULTS: Eotaxin-1 nasal lavage fluid concentrations were significantly higher in both the perennial and seasonal (in-season) AR groups compared with the controls, and significantly related to the severity of symptom expression and to the percentage of lavage eosinophils. The lavage eosinophil counts were significantly higher in both the symptomatic rhinitis groups compared with the control groups and correlated with the lavage concentrations of alpha(2)-MG. alpha(2)-MG levels were significantly increased in seasonal (in-season) rhinitics compared with both non-atopic controls and seasonal (out-of-season) rhinitics. A significant correlation was observed between the levels of alpha(2)-MG and levels of eotaxin in the symptomatic allergic rhinitic groups. CONCLUSIONS: This study clearly demonstrates the relevance of eotaxin-1 to the pathogenesis of naturally occurring AR.

Adult↗

The novel use of the human nasal epithelial cell line RPMI 2650 as an in vitro model to study the influence of allergens and cytokines on transforming growth factor-beta gene expression and protein release.

BACKGROUND: The epithelial accumulation of mast cells is a feature of allergic rhinitis and this has been linked to the expression of the known mast cell chemoattractant transforming growth factor-beta (TGF-beta) at this site. Little is known concerning the regulation of TGF-beta gene expression or protein release by nasal epithelial cells. To address this we have utilized the RPMI 2650 human nasal epithelial cell line, which has some features that closely resemble normal nasal epithelium and has been reported to secrete a TGF-beta-like molecule. OBJECTIVES: To investigate the regulation of TGF-beta gene expression and protein secretion in RPMI 2650 nasal epithelial cells following exposure to allergens (house dust mite (HDM) and grass pollen) and mast cell associated T-helper type 2 (Th2) cytokines (IL-4, IL-13, and TNF-alpha). Methods Light and scanning electron microscopy was used to evaluate the morphology of RPMI 2650 cells in culture, enzyme-linked immunosorbent assay was used to investigate their TGF-beta secretory capacity and the identification of the TGF-beta isotype(s) involved, flow cytometry was used to demonstrate the presence of TGF-beta receptors on the RPMI 2650 cells, and the quantitative real-time TaqMan PCR was used to measure TGF-beta gene expression. RESULTS: TGF-beta(2) was identified as the main isotype secreted by the RPMI 2650 cells. HDM allergens and TNF-alpha increased both TGF-beta gene expression and protein release from these cells, whereas grass pollen, IL-4, and IL-13 were without effect. CONCLUSIONS: The RPMI 2650 nasal epithelial cell line represents a valid in vitro model to evaluate the regulation of TGF-beta biology. In this system HDM allergens have stimulatory activity that is fundamentally different from that of grass pollen allergens, and the Th2 cytokines IL-4 and IL-13 are without effect. The ability of TNF-alpha to up-regulate both TGF-beta gene expression and protein release indicates that mast cell-epithelial interactions concerning TGF-beta are bi-directional and this may be fundamental to epithelial immunoregulation. The availability of a model system, such as the RPMI 2650 cells, will enable the early evaluation of future novel and targeted interventions directed toward the aberrant responses of upper airway structural cells.

Allergens↗

KTP laser fine fenestra stapedotomy with vein graft interposition in the surgical management of otosclerosis.

Otosclerosis is an hereditary disease of bone derived from the embryonic otic capsule. The exact aetiopathogenesis remains unclear. It can be associated with significant disability due to hearing impairment. Medical and surgical treatments, with varying degrees of effectiveness and complication rates, are available. The surgical method for the correction of the conductive hearing loss associated with otosclerosis continues to undergo technical refinement with the aim of improving results and minimising complications. The surgical technique of fine fenestra stapedotomy is well established. Here, we describe a new modification of this technique involving the use of a KTP laser. Based on the retrospective review of the results and complication rates of over 200 consecutive cases, we would like to recommend the technique of KTP laser fine fenestra stapedotomy in the surgical management of otosclerosis.

Humans↗

Allergic rhinitis: past, present and the future.

Allergic rhinitis represents a global health issue affecting between 10% to 25% of the world population, with increasing prevalence over the last decade. Although often trivialized by patients and doctors, allergic rhinitis is a significant cause of morbidity, in addition to its substantial economic impact. While allergic rhinitis is an inflammatory disorder of the upper airways, inflammation alone is insufficient to explain the chronic nature of the disease. An exciting concept which has recently emerged in asthma concerns the role of the bronchial epithelium as a key regulator of airway inflammatory and remodelling responses in asthma. It has been shown by our group that the disruption and alteration in the function of the lower airway epithelium in asthma leads to the generation of a variety of stimuli that lead to the restructuring of the airway wall. This raises interesting questions regarding a similar role for the upper airway epithelium in allergic rhinitis. This review aims to interpret past and current research into allergic rhinitis, and to address specific areas where future research is warranted, particularly in relation to the possibility of an altered upper airway epithelial phenotype in allergic rhinitis.

Asthma↗

Remodelling of the upper airways in allergic rhinitis: is it a feature of the disease?

The traditional viewpoint that inflammation, owing to a genetic T-helper type 2 (Th2)-directed imbalance, is the cause of allergic rhinitis has meant that the potential coexistence of other genetic defects and the relevance of any airway remodelling changes to disease pathogenesis and persistence have received scant attention, and as such remain controversial areas. This is particularly so in view of the limited published work in this field, which has so far reported markedly conflicting findings. This review endeavours to outline what is known about the nature of the remodelling response within the upper airway in allergic rhinitis, in addition to highlighting specific areas where further research is warranted.

Capillary Permeability↗

The crucial role of imaging in detection of facial nerve haemangiomas.

Facial nerve haemangioma is a rare benign neoplasm accounting for 0.7 per cent of all tumours involving the temporal bone. The diagnosis of a facial nerve tumour is often missed or delayed. Early diagnosis is imperative as it influences the eventual outcome for facial nerve function. Prognosis is related to the size of the tumour, the severity and the duration of pre-operative paralysis. The definitive diagnosis of a facial nerve tumour rests exclusively with high resolution imaging of the temporal bone using enhanced magnetic resonance imaging (MRI) and thin-sectioned computed tomography (CT). This case emphasizes the crucial role that high quality imaging can play in the diagnosis of facial nerve tumours, and elegantly illustrates the imaging features of facial nerve haemangiomas.

Adult↗

Sinusitis in the hypoplastic maxillary antrum: the crucial role of radiology in diagnosis and management.

Maxillary sinus hypoplasia (MSH) is occasionally encountered in otorhinolaryngological practice. The hypoplastic sinus is liable to mucus retention, and cases of MSH usually present as a persistent maxillary sinusitis. Endoscopic surgery has been recommended as an effective treatment for the sinus infection. However, MSH is associated with anomalies of the lateral nasal wall which, if not recognized pre-operatively, can lead to inadvertent surgical damage to the orbit. Although some of these abnormalities can be evident endoscopically, the role of imaging in diagnosis and identification of important surgical landmarks is paramount. A posteriorly placed middle meatal antrostomy is recommended as the surgical treatment of choice.

Adult↗

Antrochoanal polyp presenting with obstructive sleep apnoea and cachexia.

A rare presentation of an antrochoanal polyp is reported. A 14-year-old boy presented with obstructive sleep apnoea and subnormal growth velocity for height and weight over a 1-year period. Examination revealed a post-nasal mass which following removal was confirmed histopathologically as an antrochoanal polyp. Relief of the airway obstruction was promptly followed by catch-up growth and subsequent normal growth velocities. The possible mechanisms underlying the cachexia are explored including the possible association with the obstructive sleep apnoea.

Adolescent↗

Chronic cerebrospinal fluid leak into skull base causing intramedullary osteolysis.

We present the rare case of a 74-year-old woman with extensive intramedullary osteolysis of the petroclival skull base straddling both sides of the basi-occiput and basi-sphenoid. She presented with clinical features of recurrent spontaneous cerebrospinal fluid (CSF) otorrhoea despite three previous attempts at repair of the CSF leak. Recent advances in imaging techniques enable accurate radiological diagnosis of skull base lesions. We performed T1- and T2-weighted magnetic resonance (MR) images, a fluid attenuated inversion recovery (FLAIR) sequence MR, and a diffusion scan to study the characteristics of the skull base pathology. This revealed extensive osteolysis, with cystic spaces within the clivus and the petrous pyramid extending also to the basi-occiput. The leak was sealed using the technique of subtotal petrosectomy with obliteration of the eustachian tube and blind pit closure of the ear canal. The patient has been followed up for six months with no recurrence of symptoms.

Aged↗

Surgical emphysema following dental treatment.

Surgical emphysema is a relatively rare complication of dental surgery. Many cases go unrecognized or are misdiagnosed. Although the majority of cases resolve spontaneously, some can lead to potentially life-threatening complications requiring emergency intervention. A case of surgical emphysema following a routine restorative dental procedure is presented. The differential diagnosis and management of this condition is discussed.

Anaphylaxis↗