The SWI/SNF complex in eosinophilic and non eosinophilic chronic rhinosinusitis.

INTRODUCTION: Chronic rhinosinusitis (CRS) can be classified as eosinophilic (eCRS) or non-eosinophilic (neCRS) based on infiltration type. The SWI/SNF complex may be involved in the pathophysiology of CRS. AIM: To assess the expression of the SWI/SNF complex in both CRS groups; to correlate blood eosinophil count (BEC), and histopathology eosinophil count (HPEC) with the SWI/SNF expression level in eCRS and neCRS. MATERIALS AND METHODS: The study population consisted of 96 patients (68 eCRS, 28 neCRS). Immunohistochemical staining was performed on sinonasal mucosa for assessment of SWI/SNF protein expression. Type of tissue infiltration was assessed in samples obtained from examined groups (HPEC). The diagnostic value of eCRS was 10 cells/HPF (high power field). Complete blood count was analysed in order to calculate BEC. RESULTS: BEC and HPEC correlated negatively with all the SWI/SNF subunits. HPEC and BEC correlated positively with clinical findings (L-M and SNOT-22), while SWI/SNF correlated negatively with clinical findings (L-M and SNOT-22). CONCLUSIONS: The SWI/SNF was observed in both eCRS and neCRS, with lower expression in former. The meaning of its negative correlation with BEC, HPEC and clinical findings in eCRS group remains to be understood.

Combined minimally invasive surgical management of a nasal dermoid sinus cyst affecting the frontal sinus: literature review and new classification.

INTRODUCTION: Nasal dermoid sinus cysts (NDSCs) are the most common lesions associated with midline craniofacial anomalies, in the majority of cases diagnosed during childhood. NDSCs affecting the frontal sinus are rare. AIM: To demonstrate the clinical, radiological and diagnostic pitfalls of NDSCs affecting the frontal sinus. MATERIAL AND METHODS: A retrospective analysis of NDSCs affecting the frontal sinus with a literature review and a novel classification is presented. RESULTS: We present a rare and complex case of an NDSC in an adult patient that affected the frontal sinus. Endoscopic-assisted open rhinoplasty with endoscopic sinus surgery - Draf type 2B approach - was performed as an effective removal method of choice. A literature review supports our report. CONCLUSIONS: NDSCs affecting the frontal sinus can mimic complications of sinusitis. A minimally invasive combined technique of endoscopic-assisted open rhinoplasty with endoscopic sinus surgery - Draf type 2B frontal sinus approach - is recommended for treatment.

Role of Vitamin D and Its Receptors in the Pathophysiology of Chronic Rhinosinusitis.

OBJECTIVES: Chronic rhinosinusitis (CRS) is a disease that represents a challenging therapeutic problem. Vitamin D and its receptors (VDR) are involved in the regulation of the immune system and may play role in CRS. Objectives of this study were to assess the relationships between the total concentration of vitamin D (25VD3) in sera, vitamin D receptor (VDR) expression, 1α-hydroxylase expression, and clinical data, including age, gender, Sino-Nasal Outcome Test (SNOT-22), computerized tomography (CT) scan, allergy status, and vitamin D supplementation in CRS patients with (CRSwNP) and without nasal polyps (CRSsNP), and in a control group. METHODS: The studied group comprised 52 patients with CRS without nasal polyps (sNP), 55 with CRS with nasal polyps (wNP), and 59 in the control group. The endpoints were determined by appropriate methods. We conducted immunohistochemical staining of gathered tissue from the ostiomeatal complex for determination of VDR and 1α-hydroxylase. Analytical results were compared with clinical data as already noted. RESULTS: A decrease in VDR nuclear staining occurred in CRS patients as compared to controls. Insignificant differences were observed in 1α-hydroxylase, expression in all studied groups, while VDR and cytochrome CYP27B1 protein expression (1α-hydroxylase) correlated with clinical data. CONCLUSIONS: The data provide evidence that indicates that vitamin D and its receptor and enzymes may play a role in CRS.

Presurgical evaluation of retroauricular subcutaneous tissue thickness in BAHA surgery.

OBJECTIVE: A growing population of implanted patients benefit from the Bone-Anchored Hearing Aid (BAHA). An important step in the surgery is subcutaneous tissue reduction. The proper preparation of the implant site depends on relevant tissue removal, which is combined with incision, surgical technique, and preliminary retroauricular tissue thickness. STUDY DESIGN: Prospective analysis. SETTING: Authors attempt to measure the retroauricular subcutaneous tissue thickness and try to trace the correlation between retroauricular subcutaneous tissue thickness with objective parameters such as sex, height, weight, and age. PATIENTS: Group of hundred randomly selected patients were enrolled in the study. INTERVENTION(S): Standard ultrasound with liner transducer probe was applied to measure the tissue thickness. MAIN OUTCOME MEASURES: Sex, weight, height, and age were correlated with retroauricular tissue thickness; results also were calculated for body mass index. RESULTS: The retroauricular subcutaneous tissue thickness ranged between 2.0 and 11.0 mm with the mean value of 5.25 mm. Statistical validation revealed strong correlation with weight and body mass index. Statistical difference was found between retroauricular subcutaneous tissue thickness and sex, confirming women to have thinner subcutaneous tissue than men. The age of the patient also was predictive but without the linear correlation. Conducted measurements revealed no association between retroauricular subcutaneous tissue thickness and height of the patients enrolled in the study. CONCLUSION: Our results provide a predictive value during preoperative counseling of patients and planning the surgery. Basic information obtained during the examination can help choose the optimal implantation technique. The ultrasound examination applied in the study turned to be an easy and reliable method to assess the retroauricular tissue thickness before the surgery.

Comparison of positron emission tomography/computed tomography imaging and ultrasound in surveillance of head and neck cancer - The 3-year experience of the ENT Department in Poznan.

BACKGROUND: Posttreatment surveillance for the local and regional recurrence of the head and neck squamous cell carcinoma often requires a multimodality techniques that include PET combined with CT, MRI, US. AIM: The purpose of this study is to compare the diagnostic performance of two imaging techniques (PET/CT and US), and their combined use for the detection of a subclinical regional recurrence in patients after HNSCC treatment. MATERIALS AND METHODS: 83 patients after completion of the HNSCC treatment underwent both US and PET/CT on the mean follow-up of 14 months after initial treatment. RESULTS: The sensitivity and specificity of PET/CT were 86% and 82%, respectively; US values reached 81% and 87%, respectively. PPV was 79% for PET/CT, and 83% for US. NPV was 89% for PET/CT, and 85% for US. The overall accuracy for PET/CT and US was 84% for both methods. CONCLUSION: US could be regarded as complementary to PET/CT as the procedures with highest sensitivity, specificity and NPV for detecting subclinical regional recurrences after HNSCC treatment.

[The systems of classification of laryngo-tracheal stenosis]. / Systemy klasyfikacji zwezen krtaniowo-tchawiczych.

Laryngo-tracheal stenosis (LTS) is a relatively rare disease, which develops in very heterogenous group of patients. Careful diagnostics and classification are essential for planning the following treatment and assessing its results. To classify and treat LTS, endoscopic and imaging techniques are required. In this publication basing on the literature review different systems of LTS classifications are described in details. Additionally basing on our clinical experience the probe of choosing the best classification for Polish ENT and thoracosurgery departments was undertaken. In our opinion the use of complex grading systems is unreal in everyday work by Polish ENT surgeons and thoracosurgeons. We suggest to implement the Cotton's system and Medical Research Council dyspnea scale as the optimal way to classify and asses the outcomes of LTS treatment. The former system is well known and widely advocated in Poland, the latter requires a modicum of time from the physician. Both scales, as a combination of subjective and objective parameters show a strong correlation and therefore complement each other.

[The reasons of laryngo-tracheal stenosis: a review of literature and analysis of 124 patients]. / Przyczyny zwezen krtaniowo-tchawiczych na podstawie przegladu literatury i doswiadczen wlasnych.

Laryngo-tracheal stenosis (LTS) is a relatively rare disease, caused usually by iatrogenic reasons (intubation, tracheotomy, radiotherapy and surgery of the larynx and trachea) or by trauma. However they may be caused by another rare diseases effecting the wall of the larynx and trachea (primary stenosis) or by compression of pathological process near by (secondary stenosis). Among the primary stenosis except iatrogenic and posttraumatic there are also: congenital, postinfective (tuberculosis, syphilis, scleroma, diphtheria, histoplasmosis and the other), in connective tissue diseases (Wegener's granulomatosis, relapsing polychondritis), in blister diseases (pemphigoid cicarticans, epidermolysis bullosa hereditaria), in amyloidosis, in sarcoidosis and tracheobronchopathia osteochondroplastica. Secondary stenosis may be effected by thyroid diseases, diseases of the big blood vessels of the thorax, hypertrophic thymus, enlargement of the lymph nodes near by the trachea, tumors and cysts of the neck and mediastinium, retrotracheal abscess and cold abscess in vertebral column tuberculosis. If the reason of stenosis is unknown, the stenosis is called idiopathic. In this publication basing on the literature review the reasons of LTS were described in details. We also present our clinical experience concerning 124 patients. The authors underline, that in most of patients the reason of LTS can be find after taking the history of a patient. However, in the cases, when the reason is not clear, a lot of specific examination should be done to find another rare reason, and only after exclusion it the diagnosis of idiopathic LTS can be established.

[Utility of PET/CT in evaluation of haed and neck carcinoma--preliminary report on the basis of presented cases]. / Zastosowanie PET/CT w diagnostyce nowotworów glowy i szyi--doniesienie wstepne w oparciu o prezentacje przypadków.

18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) offers advantages over PET alone, which is limited by poor anatomic localization and CT alone, which provides morphologic data only. Fusion of PET and CT images allows for precise target delineation for head and neck cancer compared with CT alone. The aim of this article is to evaluate the effect of the use of PET/CT in patients with head and neck cancer. We present four patients whose management was influenced by the implementation of combined PET/CT imaging. We conclude that PET/CT allows detection of recurrent neoplasm, carcinoma of unknown origin, second primary sites, distant metastases, tumor surveillance, staging, and planning radiation therapy.

[Head and neck amyloidosis]. / Amyloidoza w obrebie glowy i szyi.

INTRODUCTION: Amyloid is a pathological protein which can accumulate in almost every tissue, consequently resulting in illness (amyloidosis). Amyloid has a red color when the slice preparation is stained with Congo red staining and under polarized light exhibits a characteristic apple-green color. Over 26 different proteins, that can form amyloid, have been described. AL, AA and ATTR amyloidosis are the most frequent type of amyloidosis. Head and neck is a rare region for amyloidosis, which can be localized and/or systemic. Early diagnosis and precise classification of the amyloidosis is essential for treatment planning. Various treatment strategies: antinflammatory management, chemotherapy, immunotherapy, surgery, gene therapy, to name just a few, are already readily available or are currently being explored or researched. MATERIAL AND METHODS: Three cases are presented here: an elderly women with tongue and neck tumor and two patients with laryngeal tumors. The biopsy of the lingual and laryngeal tumor and ultrasonography in the first case have been performed in the ENT-Department and Ambulance. RESULTS: In the Internal Medicine Department the patient with lingual and neck tumor, due to symptoms such as: swallowing disorders, dysartria, painful joints swelling and carpal syndrome in anamnesis, previously underwent an examination in order to rule out scleroderma. The investigation appeared to be negative. The histopathology investigation of the lingual tumor identified amyloidosis. USG has not revealed any significant findings. The two patients with laryngeal tumor, except for hoarseness, has not manifested other symptoms suggesting general illness. The biopsy established that there was localized amyloidosis. CONCLUSION: Diagnosis of amyloidosis and its correct classification continue to pose a great challenge. Two factors play a pivotal role in the identification of local or systemic amyloidosis: the local and/or systemic manifestation and Congo red staining as a gold diagnostic standard.

[Intranasal meningocele presenting as a nasal polyp--case report]. / Wewnatrznosowa przepuklina oponowa imitujaca polip nosa--opis przynpadku.

Intranasal meningocele occurs rarely. It is difficult to diagnose because its appearance resembles common polyps. If it coexists with other inborn cranio-facial malformation they are easier to diagnose. In the case investigated by us, the 32 year-old woman's ailments suggested intranasal polyps and we discovered the meningocele localized intranasal on the right. The CT scan of the nasal sinuses is the most reliable examination for the developing diagnosis. The CT findings revealed the meningocele protruding from the anterior cranial fosse through the lamina cribrosa to the right nasal cavity. During the operation the meningocele was removed and the durra mater was sutured. The bony-mucosal lesion was covered with composite graft taken from bony part of nasal septum and mucosal part of the inferior turbinate. The graft has been incorporated into the surrounding tissue. Neither a cerebrospinal fluid leak nor any other complications have been reported within the past 6 years. Therefore, we consider this a successful procedure.

Histological structure of the nasal cartilages and their perichondrial envelope. I. The septal and lobular cartilage.

The cellular elements and extracellular matrix of the nasal septal cartilage and the lateral crus of the lobular cartilage were studied in serial coronal sections of five human cadaver noses. To discern the various tissue components, the sections were stained according to the methods of Mallory-Cason, Azan, Herovici, Verhoeff-van Gieson, and Lawson as well as by immunohistochemistry to demonstrate the presence of collagen type I and II. A characteristic gradual transition of the chondrocytes was observed in both septal and lobular cartilage: from numerous small flat cells oriented parallel to the surface of the cartilage to less numerous larger ovaloid cells oriented perpendicular to the surface. This difference between the peripheral and central zones of the cartilage was particularly marked in lobular cartilage. Both septal and lobular cartilage have a high density of type II collagen but almost none of type I. The peripheral zones of the matrix showed a higher density of collagen than the central zone. This difference was more pronounced in septal than lobular cartilage. The high density of type II collagen in septal cartilage, particularly in the peripheral zones, suggests that one of the primary tasks of the septum is providing stiffness to the external nose. That idea is consistent with findings from our study of the perichondrial envelope.

Histological structure of the nasal cartilages and their perichondrial envelope. II. The perichondrial envelope of the septal and lobular cartilage.

The perichondrial envelopes of the septal cartilage and the lateral crus of the lobular cartilage were studied in serial coronal sections of five human noses. To differentiate between the various tissue components, the sections were stained according to Mallory-Cason, Azan, Herovici, Verhoeff-van Gieson, and Lawson. Collagen types I and II were immunohistochemically stained. The results demonstrated that the perichondrium of the septal cartilage and the lateral crus of the lobular cartilage consists of a homogeneous layer of type I collagen fibers and elastic fibers. The elastic fibers have a network-like arrangement and are most numerous in the perichondrium of the lateral crus of the lobular cartilage. Clearly distinguishable zones in the perichondrial envelopes could not be observed. The perichondrium on the outside of the lateral crus of the lobular cartilage and the triangular cartilage is significantly thicker than the inner perichondrium. It is speculated that these morphological characteristics of the perichondrial envelopes are related to functional differences between the cartilages. The mobility of the lateral crus of the lobular cartilage requires a higher content of elastic fibers in its perichondrium than the more rigid septal cartilage. A thicker outer perichondrium of the lateral crus of the lobular cartilage and the triangular cartilage may be related to muscular forces that are exerted on the outer side of the cartilages only.

[A rare case of Holmes-Adie syndrome in a 60-year-old patient with a chronic cough cured in a laryngological way]. / Rzadki przypadek zespolu Holmesa-Adiego u szescdziesiqcioletniej chorej leczonej laryngologicznie z powodu przewleklego kaszlu.

UNLABELLED: The case of a 60-year-old woman with a chronic dry cough which lasted for 4 years is presented. The patient underwent thorough diagnostics. Clinical examination and laboratory tests excluded pathology in the upper and lower airways, which could have been the cause of the cough. An ophthalmological examination revealed a tonic pupil with dissociation of a close light. Neurological findings showed reduced deep tendon reflexes. The above mentioned findings were accompanied by abnormalities of autonomic function, such as orthostatic hypotension and bradycardia while performing the Valsalva maneuver during respiration. Both clinical examination and diagnostic tests made it possible to establish a rare case of Holmes-Adie syndrome. CONCLUSION: The presence of a dry chronic cough occurring in a patient without pathology in the upper and lower airways indicates the necessity for ophthalomlogical and neurological examination in order to confirm the existence of Holmes-Adie syndrome.

[Esthesioneuroblastoma of nasal cavity and ethmoid sinus]. / Esthesioneuroblastoma jamy nosowej i zatok sitowych.

This paper presents a rarely occurring tumor of nasal cavity and ethmoid sinus (esthesioneuroblastoma--2nd grade of the pathological grading system proposed by Hyams). It was observed in a woman aged 68. Moreover, there were described surgical therapy and repair of cerebral spinal fluid leaks using composite bone/mucosal graft of the lower turbinate as a donor material. The treatment was successful.