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Background: Ciliary dyskinesia (CD) is a low incidence genetic illness, that presents with a wide clinical spectrum. Also, there are transitory conditions that present with ciliary anomalies, secondary to infectious diseases of the airways., Aim: To descube clinical and ultrastructural findings and clinical and therapeutic evolution of these patients., Patients and Methods: Retrospective review of medical records and electron microscopy findings of 33 patients (aged 1 to 21 years, 14 females) with ultrastructural diagnosis of CD. To obtain follow up information, a telephone survey was done., Results: In 30 patients (90%) the inner dynein arm (IDA) was absent in 50 or more percent of the cilia. Twenty two (66%) had absence of the outer dynein arm. Before diagnosis of CD, 19 patients (57%) presented recurrent otitis media, 25 patients (77%), three or more episodes of rhinosinusitis and 18 patients (56%) had recurrent pneumonia. Middle ear ventilation tubes were placed in 19 patients (57%), and during its use, 12 (68%) remained without othorrea. Sixteen patients (48%) with recurrent episodes of rhinosinusitis required adenoidectomy Seven (21%) required a functional endoscopic sinus surgery (FESS), and 6 (86%) improved after FESS., Conclusions: Our patients with CD presented recurrent infections in different airway locations. In those with a diagnosis of CD and recurrent otológica! and rhinosinusal infections, IDA was absent in a high percentage of cilia. FESS and the use of ventilation tubes may have a beneficial role in a subgroup of patients with CD.

Primay ciliary dyskinesia is a rare autosomal recessive disorder, characterized by abnormal ciliary structure and function and chronic lung, sinus and middle ear disease. A 45-year-old man with a history of recurrent respiratory infections, which was developped in the adult age, and was presented with moderate clinical involvement, and spermatic hypomotility in seminogram. Diagnosis and differential diagnosis was based on the typical clinical picture and the electron microscopical demonstration of ultrastructural abnormalities. We found abnormal number of cilia on the bronchial mucosa cells and the ciliary structure was abnormal too. We observed abnormally short dynein arms and defective radial spokes.

Background: Primary ciliary dyskinesia is characterized by a congenital alteration of the ciliary ultrastructure and function. As a consequence, their respiratory tract sweeping action is lost and recurrent respiratory infections ensue., Aim: To analyze a clinical series of patients with primary ciliary dyskinesia, their clinical and laboratory features., Patients and Methods: A retrospective review of patients with primary ciliary dyskinesia seen a University Hospital, between 1994 and 1998. Bronchial biopsies were obtained with 3.6 mm diameter Olympus fibrobronchoscope, using a cayman type forceps. Ultrastructural alterations of respiratory tract ciliated cells were recorded., Results: Six patients (four male) aged 9 months to 13 years old were reviewed. Three patients had situs inversus. All had repeated bouts of obstructive bronchitis and pneumonia, five had sinusitis, four atelectasis, three recurrent otitis and three had bronchiectasis. Cystic fibrosis and immunological alterations were ruled out in five children. Ultrastructural analysis revealed absence of dynein arms in three cases, absence of the internal dynein arm in one, additional peripheral microtubules and absence of dynein arms in one case., Conclusions: Primary ciliary dyskinesia must be considered in the differential diagnosis of recurrent respiratory infections. Ultrastructural analysis of ciliary structure can be done in bronchial biopsies obtained through bronchoscopy.

Immotile cilia syndrome is associated with different ciliary defects, although the clinical presentation is similar in every case. A study was made of a 36-year-old woman with recurrent respiratory infections since birth, chronic sinusitis and chronic bronchitis with bronchiectasias. Her medical history included a tubaric pregnancy and two miscarriages. Nasal mucociliary transport was investigated on two occasions at a 1-year interval using an isotopic technique. Ciliary ultrastructure was studied by electron microscopy after obtaining two biopsies from the inferior and middle turbinates separated by a 1-year interval. The sweat test and blood immunoglobulins were normal. The absence of mucociliary transport was verified on both occasions. An abnormality was observed in 30% of the cilia in the form of semicircular ciliary cross-sections, with only 7 pairs of peripheral microtubules. The central pair was normal. We termed this anomaly "incomplete ciliary axonema" and believe that it could be another cause of immotile cilia syndrome.

A study was conducted of the clinical manifestations and ultrastructure in a series of seven patients with repeated pulmonary infections and infertility (3 cases with primary ciliary dyskinesia [PCD] and 4 with the young syndrome [YS]). Clinical and functional respiratory changes were more marked among cases of PCD. The seminogram showed azoospermia in cases with YS and hypospermia with marked hypomotility in cases with PCD. A nasal mucosa biopsy specimen was obtained from all patients to perform a transmission electron microscopy (EM) investigation. Patients with YS did not have pathognomonic ultrastructural changes, whereas patients with PCD had a large number of ciliary abnormalities (23.3% +/- 1.5%); 14% +/- 7% of them corresponded to nonspecific ciliary changes and the remaining abnormalities to congenital ciliary changes (ciliary disorientation in three cases, defective radial spokes in one case and microtubule transposition in one case). EM is a useful technique which is recommended for the differential diagnosis in this group of patients.

Ciliary dyskinesia syndrome or immotile cilia syndrome, is a congenital defect in the ultrastructure of cilia, which result in a clinical expression diverse: recurrent respiratory infections, recurrent otitis media, infertility in the adult male, and half of those situs inversus. A case of ciliary dyskinesia syndrome is presented, who suffered of recurrent pneumonia and relapsing secretory otitis media.

We investigated the relationship between ciliary dyskinesia--commonly referred to as inmotile cilia syndrome--and sterility. In the past two years, we have accurately diagnosed 6 new cases of a total of 20 suspected as having this condition. To make the diagnosis, complete clinical, radiological, ultrastructural and spermatic work up was performed. All males in the fertile age were found to be sterile with spermatozoides with no motility. Sterility may initially go undetected in these patients due to early intense ORL and respiratory symptoms they present. However, mild forms of this disease entity may be asymptomatic and patients may consult for sterility with a clinical picture of scantily florid chronic bronchitis like that of smokers. Coincidental situs inversus may be useful in making the diagnosis.