BILATERAL CAROTID BODY PARAGANGLIOMAS - LITERATURE REVIEW AND COMMENTS IN A PATIENT WITH NO SIGNS OF MEN SYNDROME.

Paragangliomas are rare neuroendocrine slow-growing tumors, often asymptomatic, that originate from embryonic neural crest cell. In the head and neck area, the most common location is the carotid body, followed, with decreasing frequency, in jugular, tympanic and vagal sites. Bilateral carotid body tumors are extremely rare. Aim: To present the most important features of carotid body paragangliomas, illustrating the clinical characteristics, associated with a thorough analysis of the diagnostic imaging elements, but also the current therapeutic strategies, with respective anatomical, surgical considerations and potential complications that can occur. Surgical resection is the main line of treatment. The complex anatomy of the cervical region and the close relationships of carotid body paragangliomas with carotid vessels and cranial nerves, as well as its intense vascularization makes the surgical intervention a real challenge even for an experienced surgeon. Discussion: Starts from a bilateral carotid paraganglioma in a 35-year-old male, with painless lateral neck swelling, accidentally discovered by his barber about two years ago. Diagnosis was suspected on the basis of history, clinical and radiological findings. "Wait and scan" strategy plus endocrinologic assessment for MEN syndromes were considered the optimal therapeutic approach in this case.

Bromelain's penetration into the blood and sinonasal mucosa in patients with chronic rhinosinusitis.

SUMMARY: The aim of this research is to investigate penetration of Bromelain into sinonasal mucosa in patients with chronic rhinosinusitis (CRS) versus a control group. Bromelain is derived from pineapple (Ananas comosus) and has various pharmacological effects. 40 patients (20 patients and 20 controls) were enrolled in the study. Bromelain 500 mg tablet twice daily was administered for 30 days. We scored bromelain presence in turbinate and ethmoid mucosas and in the serum of both the groups. Bromelain has an excellent distribution from blood to rhinosinusal mucosa. Its diffusion ability may allow the use of bromelain as an anti-inflammatory agent in paranasal sinus pathologies.

MP-AzeFlu provides rapid and effective allergic rhinitis control: results of a non-interventional study in Romania.

BACKGROUND: Allergic Rhinitis and its Impact on Asthma (ARIA) and the European Union (EU) recommend a shift to guide allergic rhinitis (AR) treatment decisions from symptom severity to disease control, using a simple visual analogue scale (VAS). Using this VAS we assessed, in a real-life study in Romania, the effectiveness of MP-AzeFlu nasal spray. METHODOLOGY: In this multi-centre, prospective, non-interventional study, 253 patients (over 11 years old) with moderate-to-severe AR were prescribed MP-AzeFlu and assessed their symptoms on a VAS (0 (not at all bothersome) to 100 mm (very bothersome)) on Days 0, 1, 3, 7 and 14. The proportion of patients who achieved a defined VAS score cut-off for well-controlled (38 mm) AR were also calculated. Patients perception of disease control was assessed on Day 3. RESULTS: MP-AzeFlu use was associated with a mean (standard deviation) VAS score reduction from 78.4 (15.1) mm at baseline to 14.7 (15.1) mm on the last day. Effectiveness was consistent irrespective of disease severity, phenotype or patient age. 83.4% of patients achieved the smaller than 39 mm well-controlled VAS score cut-off by last day and 95.2% considered their symptoms to be well- or partly controlled at Day 3. CONCLUSIONS: MP-AzeFlu provided rapid, effective and sustained AR symptom control in a real-life setting in Romania, irrespective of severity, phenotype or patient age, aligning with ARIA and EU recommendations and supporting the position of MP-AzeFlu as the drug of choice for the treatment of moderate-to-severe AR.

Regenerative potential of human schneiderian membrane: progenitor cells and epithelial-mesenchymal transition.

An innate osteogenic potential of the Schneiderian membrane (SM) is progressively assessed in studies ranging from non-human species to human subjects. It has relevance for endosteal placement and osseointegration. Nestin-expressing osteogenic progenitor cells are allegedly involved in bone formation and remodelling. Nestin phenotype was not assessed previously in human SM. We therefore aimed to fill that particular gap in the literature. Bioptic samples of human adult SM were obtained during surgery from eight adult patients, operated for non-malignant pathologies. Immunohistochemistry on paraffin-embedded tissue samples used primary antibodies against nestin, CD45, CD146, cytokeratin 7 (CK7), and alpha-smooth muscle actin (α-SMA). Nestin expression was consistently found in endothelial cells, and was scarcely encountered in pericytes, putative stromal stem/progenitor cells, as well as in glandular epithelial cells. Moreover, woven bone formation in the periosteal layer of the SM can also be regarded as evidence of the osteogenic potential of this membrane. Nestin and CD45 expression in cells of the primary bone supports the osteogenic potential of SM nestin-expressing cells and a possible involvement of hematopoietic stem cells in maxillary sinus floor remodeling. CD146, a known inducer of epithelial-mesenchymal transition (EMT), was expressed in epithelia, as was CK7. Isolated stromal cells were found expressing CD146, CK7 and α-SMA, suggesting that regenerative processes happening in the SM may also involve processes of EMT which generate stem/progenitor cells. This study provides additional evidence for the regenerative potential of the Schneiderian membrane and identifies potential roles for cells of its stem niche in osteogenesis.

Are HMGB1 protein expression and secretion markers of upper airways inflammatory diseases?

Taking into account the mechanisms at the origin of the airways inflammatory pathologies, our attention has been recently addressed to the study of HMGB1, a protein belonging to the group of alarmins. Alarmins are those molecules which in homeostatic conditions carry out specific metabolic and/or structural functions; furthermore, after a direct trauma or an infection, these molecules are released in the extracellular milieu becoming there activators of the innate immunity and powerful inflammatory factors. In a previous research we found in patients affected with chronic rhinosinusitis with/without nasal polyposis (CRSwNP) an increased expression of this protein in the nucleus of nasal mucosa epithelial cells. HMGB1 was overexpressed also as focal subepithelial infiltration and in the inflammatory cells of patients in comparison with controls. These results suggested a possible pathogenetic role of HMGB1 in CRSwNP. The aim of the present study was to investigate if the expression and localization (nuclear, cytoplasmic and extracellular) of the HMGB1 protein-cytokine is somehow related to the severity and complexity of the histological and clinical picture. We noticed values which have around statistical significance between nuclear HMGB1 and eosinophils infiltrate (p=0.0607) and between nuclear HMGB1 and inflammatory infiltrate (P=0.0524). Even more significant was the correlation between extra-cellular HMGB1 expression and the presence of allergic-hyper reactive conditions such as asthma, allergic rhinitis, NSADs intolerance, antibiotic allergy. HMGB1 was significantly more expressed in the nucleus (p=0.0499) and in the intercellular space (p=0.0380) in allergic patients than in non-allergic subjects and as extra-cellular infiltrate in patients with NSADs intolerance (p=0.0022). These results confirm the role of HMGB1 in the pathogenesis of chronic rhinosinusitis with/without nasal polyposis; besides the higher extra-cellular expression in patients with a more severe clinical and inflammatory picture and the presence of associated co-morbidities suggests to seek for new compounds: these compounds, decreasing the extra-cellular release of this alarmin through a scavenger mechanism, could keep under control the inflammatory process without interfering with the nuclear transcriptional messengers.

Tinnitus in elderly population: clinic correlations and impact upon QoL.

INTRODUCTION: Tinnitus is a common health problem that affects between 10 - 30% of the population, approximately 3 - 4% presenting to the doctor at least once in their life. There are many causes that lead to tinnitus in elderly population, including otology, metabolic, neurologic or cardiovascular conditions. The aim of this study was to determine the association of tinnitus with these chronic comorbidities among elderly community and its impact upon their quality of life. MATERIALS AND METHODS: We performed a clinical retrospective study on 471 ENT patients hospitalized for various diseases, up to 60 years old, for a period of 24 months. All subjects were assessed for subjective tinnitus, neuro-vascular comorbidities and QoL by use of the brief version of the World Health Organization QoL instrument. RESULTS: Tinnitus was reported in 114 patients, giving a prevalence of 24,2%. Variables like gender, residence, economic status, alcohol or smoking were not significantly associated with tinnitus. On the other hand, otic and sinonasal pathology, dizziness, hypertension, arteriosclerosis or diabetes were significantly correlated. All patients with tinnitus presented a more negative perception of their overall health and a poorer QoL, compared to those without. CONCLUSIONS: Tinnitus is a common pathology among elderly community. Its association with chronic treatable health comorbidities reduces QoL and highlights the need of cooping strategies among this group population.

[Endoscopic surgery for benign rhino-sinusal tumors]. / Chirurgia endoscopica a tumorilor benigne rinosinusale.

OBJECTIVES: Evaluation of the efficiency for endoscopical transnasal surgical techniques of rhino-sinusal benign tumors. MATERIAL AND METHOD: Retrospective study underwent between January 2005 - January 2006 in ENT&HNS Department "Sf. Maria" Bucharest, including 31 consecutive patients diagnosed with rhino-sinusal benign tumors. The patients underwent endoscopical surgical resections, with a follow-up period ranging between 14-26 months (average of 17,2 months). RESULTS: We present the results achieved during the study over a group of patients with benign tumors from which 14 cases were inverted papillomas (45,16%), 7 cases of haemangiomas (22,58%), 3 cases of neurofibromas, and 3 cases of juvenile angiofibromas (each representing 9,67%), 2 cases of ossifying fibromas, and 2 cases of ameloblastomas (each representing 6,45%). The surgical procedures were performed under general anesthesia by the same surgeon. In the follow-up period, the patients were evaluated endoscopically and radiologicaly. The recurrence rate was 12,90% (4 cases) that required combined endoscopic and open approach: 2 cases of inverted papillomas and 2 cases of ossifying fibromas. CONCLUSIONS: Endoscopic transnasal approach of benign rhino-sinusal tumors is a successful surgical method, with the advantage of no esthetics impairments, reduced hospitalization, and preservation of the patient's quality of life, with medium and long term results comparable with open surgery.

The importance of the olfactory sense in the human behavior and evolution.

Not long ago it was believed that the human olfactory sense had a low importance, a vision which turned into the exploration of the environment. Recent studies have shown that, despite the weak representation of the olfactory receptor common in other species too, the cortical areas of integration of the olfactory sensations are very large and have important interconnections with memory, language, and neuro-vegetative areas. In humans, olfaction has a small contribution in identifying objects or other people, but plays an important social and emotional part. People learn to love or to hate certain foods or objects only by appreciating their odor and this proved to be a very important economic factor. The most significant role of olfactory signals in humans appears to be the modulation of their behavior and interpersonal relationships, of their affiliation to certain groups or social classes, having a major influence in their tastes and personality. signal that will be sent to the specialized areas in their tastes and personality.

The role of p53, PCNA and Ki-67 as outcome predictors in the treatment of laryngeal cancer.

The aim of our study was to determine the importance of p53, PCNA and Ki-67, evaluated by immunohistochemistry, in the treatment and prediction of the laryngeal carcinoma. Out of a total of 319 patients with laryngeal carcinoma that underwent surgery in our department between 1999 and 2007, we performed a retrospective study on 71 cases who benefited by immunohistochemical guidance before the beginning of the treatment. All these patients have been followed-up two to five years after surgery. The values of p53, PCNA and Ki-67 are strongly correlated with the histological grading, by means of descriptive statistics (confidence level 95%); the mean values of these three markers corresponding to each HP grade. A highly statistical significant positive correlation (r = 0.84, p < 0.001 ) between the values of p53 and PCNA was observed. The values of p53, PCNA and Ki-67 in the patients from this study are strongly correlated with the absence of the loco-regional lymph node metastases, by means of descriptive statistics (confidence level 95%). Ki-67 only is correlated significantly to the presence of lymphatic metastases in the regional lymph nodes (stage N1, N2 or N3 TNM). P53 and PCNA are not correlated significantly with the presence of the metastases in the regional lymph nodes.

Impact of smoking on the immunological profile of patients with laryngeal carcinoma.

Immunity plays an important role in the prognosis and the natural development of cancer. Previous studies have shown that the presence of tumor in the body could modify the immune response leading to immunosuppression. The aim of this study was to evaluate the immunological changes of patients with larynx squamous cell carcinoma undergoing potentially curative surgery. We assessed the serum levels of cytokines (IL-1, IL-2, IL-4, IL-6, IL-8, IL-10, IFN-gamma, TNF-alpha, GM-CSF), chemokines (MCP-1 and MIP-1alpha) and growth factors (VEGF and bFGF) in laryngeal cancer patients before, during and after surgery. We have used a novel multianalyte XMap profiling technology that allows simultaneous measurement of multiple parameters in small volumes of samples. To investigate the changes in immune mediators' profile induced by tumor resection, we assessed the culture supernatants of the peripheral blood mononuclear cells (PBMC) derived from the patients, before and after surgery. The results suggested a predominance of a Th2 type of immune response associated with the presence of the tumor (especially in the case of heavy smokers who smoke more than 40 pack-years). However, shifts towards a Th1 type of immune response as well as an improvement of monocyte functions were noticed after surgery.

[CSF leaks--diagnostic and therapeutic approach]. / Fistulele de LCR ale rinobazei, aspecte diagnostico-terapeutice actuale.

The paper presents the classification of the CSF leaks and their etiology. The authors insist on the post surgical causes and on the modem diagnostic procedures such as 2 transferrin and trace protein determination and high resolution CT. They also present their own experience in repairing defects from the anterior skull base under endoscopic control. A lot of 20 patients with CSF leak is presented and the types of approach are discussed. If the defect is in the sphenoid sinus the obliterative techniques are preferred. The ethmoidal roof defects are covered with onlay or underlay procedures depending on their dimensions. The results are compared with those from the literature. The authors conclude that the CSF leaks in the anterior and middle skull base are mainly due to trauma or iatrogenic. A clear diagnostic algorithms and a correct selection of the cases suitable for endoscopic approach are required.

[Laryngo-tracheal trauma. Problems in management]. / Traumatismele laringo-traheale. Probleme de management.

It is presented the experience of Department of ENT&HNS from "Santa Maria Hospital" Bucharest in treating 85 patients with laryngo-tracheal trauma during a period of 10 years. The author presents the causes of these kind of trauma and insists on endoscopic and iatrogenic laryngotracheal trauma with an increasing number in the last years. Presenting the lot of patients the author insists on the therapeutic approach which is divided in 4 types of maneuvers depending on the etiology, the localisation and the extension of the lesions. An ancient controversy is debated--that of prolonged orotracheal intubation vs tracheostomy followed by tracheal intubation. The conclusion is that such types of laryngotracheal trauma require a team management (ENT, pneumology and thoracic surgeon) in order to prevent the stenotic and fibrous sequelae which are difficult to treat.

[An extensive left subperiosteal frontotemporal orbital abscess and left suppurative pansinusitis with an odontogenic origin]. / Abces orbitar fuzat frontotemporal subperiostal stâng si pansinuzita supurata stânga cu punct de plecare odontogen.

A 28-years-old patient with pansinusitis and orbital abscesses to odontogenic infection origin were present. Treatment, complication and evolution are discussed.