[Adaptive desensitization for acetylsalicylic acid hypersensitivity: A success story?]. / Adaptive Desaktivierung bei ASS-Hypersensitivität: Eine Erfolgsgeschichte?

BACKGROUND: Adaptive desensitization still remains the only causative therapy for acetylsalicylic acid (ASA) hypersensitivity and is carried out nearly worldwide. To date there are hardly any data available on disease development under current desensitization therapy and longitudinal data in particular are missing. STUDY DESIGN: Out of a large collective of patients with proven hypersensitivity to ASA, 194 patients with initiated desensitization treatment were observed for periods up to 5 years (average 32 months). RESULTS: Patients with immediate reactions to systemic challenge tests revealed a response rate of 77% after 12 months of therapy. In this period 12% reached complete remission, 38% showed a clear reduction in symptoms, 32% reached partial remission, 13% remained unchanged and 5% suffered from disease progression. CONCLUSION: Adaptive desensitization therapy for hypersensitivity to ASA has been shown to be an effective causative therapy and chronic hyperplastic sinusitis as well as bronchial asthma could be improved. For the determination of maintenance dosages and required time periods more data are needed.

[Respiratory epithelial adenomatoid hamartoma of the nose and nasal sinuses : a rare differential diagnosis of nasal polyposis]. / Respiratorische epitheliale adenomatoide Hamartome der Nase und der Nasennebenhöhlen : Seltene Differenzialdiagnose der Polyposis nasi.

INTRODUCTION: Hamartomas are benign tumor-like lesions resulting from incorrectly differentiated germplasm and can manifest in different organ systems. In the nasal cavity and the sinuses these lesions are rare. Only few data on etiology, epidemiology and clinical significance of these tumors exist to date. MATERIALS AND METHODS: In a retrospective study, material from patients treated in the Clinic for Otorhinolaryngology, Head and Neck Surgery of the Ulm Military Hospital was screened on the incidence and clinical courses of respiratory epithelial adenomatoid hamartomas (REAH) of the nose and nasal cavity. Furthermore, for cases of REAH, formalin-fixated paraffin-embedded tissue samples were re-evaluated and examined for human papillomavirus (HPV) DNA by PCR. RESULTS: Tissue samples from 8145 surgical interventions on the nose and nasal sinuses from 2003 to 2012 were included. A total of 22 patients (3 female, 19 male; median age 57.5 years) diagnosed with REAH could be identified. Major complaints were nasal blockage (91 %), sinusitis (82 %), rhinorrhea (36 %) and cephalgia (23 %). Nasal endoscopy showed polyps in 68 % of patients. Native nasal sinus CT scans revealed no indications of REAH. Intraoperatively, hamartomas were found in 12 patients originating from the ethmoid bone, in 8 from the middle meatus or infundibulum and in 2 from the olfactory cleft. Macroscopic and histological examination showed compact lesions sized between 4 and 25 mm in the largest diameter containing homologous tissue, without signs of dysplasia or malignancy. HPV DNA was not identified in any case. CONCLUSION: REAH of the nasal cavity and sinuses are rare benign local tissue lesions, usually without any autonomous proliferation. Clinical signs and findings correspond to those in polypoid pansinusitis. Only with single-sided or olfactory cleft location might CT scans provide indication of a tumorous lesion. For differentiation from true neoplasms, surgical resection and histopathological clarification is indicated. On the basis of current knowledge, complete surgical resection is adequate therapy.

Tophaceous gout of the thoracic spine presenting as back pain and fever.

Spinal gout has been reported only rarely. We describe a 59-year-old man with a history of gout, who was receiving chronic immunosuppressive therapy after a renal transplant and who presented with fever and back pain. After an extensive work-up and biopsy, the diagnosis was thoracic tophaceous gout. The pain and fever responded to prednisone and allopurinol. Tophaceous gout is a rare cause of fever and back pain but should be considered in the differential diagnosis in the appropriate clinical setting.

Polyarteritis nodosa presenting as acute myocardial infarction with coronary dissection.

Coronary manifestations of polyarteritis nodosa (PAN) are rarely identified pre-mortem. We report a 51-year-old female with PAN causing a coronary dissection and new lesions developing over the next 5 days. PAN should be added to the list of differential diagnoses for spontaneous coronary dissections.

Temporal arteritis and sensorineural hearing loss.

OBJECTIVES: The association of temporal arteritis and sensorineural hearing loss is a rare occurrence. We present four cases with both these disorders. METHODS: A 10-year retrospective review of all cases seen at the Geisinger Medical Center showed 271 cases of temporal arteritis and four cases with concomitant sensorineural hearing loss. The four cases were identified, obtained, and extensively reviewed. Patients ranged in age from 59 to 76 years and presented with sensorineural hearing loss and signs, symptoms, and biopsy evidence of temporal arteritis. The response to therapy and clinical course of each case are discussed. RESULTS: In three patients, the hearing loss preceded the diagnosis of giant cell arteritis by 2 days to 2 months. In one case, the hearing loss was noted concurrently with systemic features of giant cell arteritis. All cases were treated with corticosteroids and had full or partial return of hearing. CONCLUSIONS: Sensorineural hearing loss can be a preceding or concurrent symptom of temporal arteritis. Recognition and treatment may lead to partial or full recovery. It is not certain whether the time from onset of hearing loss to diagnosis to institution of therapy influences recovery.