RANTES IS MORE PREVALENT IN BACTERIAL THAN IN NONBACTERIAL MAXILLARY SINUSITIS - AND P-SELECTIN IS PREFERENTIALLY UP-REGULATED IN DISEASED MUCOSAE

Objective: To investigate the relationship of the clinical appearance, histological characteristics, bacterial culturing, and messenger RNA (mRNA) expression of RANTES, interleukin 6, and interleukin 12, as wel l as the occurrence of endothelial adhesion molecules, in inflammatory diseased maxillary sinus mucosa in critically ill patients. Design: P rospective case series. Setting: General intensive care unit and neuro surgical intensive care unit of a tertiary care hospital. Subjects: Se ven critically ill patients, nasotracheally intubated or tracheotomize d, who received ventilator treatment for more than 7 days and treatmen t with antibiotics. Interventions: Bilateral biopsy specimens of antra l mucosa were obtained at sinoscopy. Reverse transcriptase-polymerase chain reaction was used to detect the cytokine mRNAs in situ on parafo rmaldehyde-fixed tissue, and intercellular adhesion molecule 1, vascul ar cell adhesion molecule I, E-selectin, and P-selectin were analyzed by immunochemistry on frozen sections. Sampling of secretion and tissu e from the antra was performed for bacterial culturing. Results: Macro scopic and histological appearance varied and showed moderate to prono unced inflammation in 6 antra. All 4 bacterially infected antra showed mRNA RANTES (P=.005). No correlation was found for interleukin 6 and interleukin 12. Up-regulation of P-selectin in all cases and sparse ex pression of vascular cell adhesion molecule 1 indicate that the inflam mation is chronic but nonallergic in type. Conclusion: We find an indi cation that RANTES is more prevalent in bacterial sinusitis.