title: Kartagener's syndrome: review of a case series.
abstract: BACKGROUND
  Kartagener Syndrome (KS) is a rare autosomal recessive genetic disorder, resulting in a group of clinical manifestations, including bronchiectasis, chronic pansinusitis and situs inversus.
  
  
  METHODS
  We hereby reviewed eight cases of this rare entity selected from patients attending our outpatients Respiratory Unit since 2006. Samples of respiratory epithelium were obtained with the method of nasal brushing and sent to a specialized center in order to be studied with electron microscopy. At least 50 cross sections of different cilia from different cells were observed in each specimen to study the axonemal structure. Electron micrographs were taken at a magnification of X 50,000 to determine the orientation of the cilia and at a magnification of X 110,000 to study the axonemal pattern. The incidence of abnormal cilia was expressed as a percentage.
  
  
  RESULTS
  We observed different ultrastructural defects in our KS patients, including absence of outer dynein arms, absence of outer and inner dynein arms, and absence of the central pair with transposition of a peripheral doublet into the central position. Patient's follow up lasted till 2014, however two patients with more severe clinical behavior died before.
  
  
  CONCLUSIONS
  This is a review of a case series, yet our data has shown that nasal brushing with ultrastructural pathological differentiation may be useful to identify patients with high risk and to develop more complex clinical presentations.
authors.affiliation: Pulmonology Unit, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Ciancio
authors.affiliation: Department of Human Pathology and Oncology (Division of Pathology), University of Siena, Siena, Italy.
authors.forename: Maria Margherita
authors.initials: MM
authors.lastname: de Santi
authors.affiliation: Pulmonology Unit, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Campisi
authors.affiliation: Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Amato
authors.affiliation: Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Di Martino
authors.affiliation: Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Maria
keywords: Dinein arms; Kartagener’s syndome; Nasal brushing; Primary ciliary dyskinesia; Situs inversus; Transmission electron microscopy