Fungal colonization of the respiratory tract in allogeneic and autologous hematopoietic stem cell transplant recipients: a study of 573 transplanted patients.

BACKGROUND: Fungal colonization and infections remain a major cause of infection morbidity and mortality following hematopoietic stem cell transplantation (HSCT) in patients with hematological malignancies. The aim of this study was to analyze the spectrum of fungal microflora of the respiratory tract (oral cavity, pharynx, epiglottis, and sputum) in patients undergoing HSCT and to evaluate the relationship between HSCT type and incidence of mycotic colonization and infections. MATERIAL/METHODS: Retrospective analysis of fungal isolates collected from the respiratory tract (oral cavity, pharynx, epiglottis, and sputum) of 573 patients undergoing HSCT was performed. RESULTS: The overall rate of fungal colonization in patients undergoing HSCT was 8.7%. Patients undergoing allogeneic HSCT were statistically significantly more often colonized (12.95%) compared to autologous HSCT recipients (4.7%). Colonizing cultures were mainly C. albicans and C. krusei, and sporadically C. glabrata, C. famata, Aspergillus spp. and Saccharomyces cerevisiae. C. albicans was the most frequent species found in isolates from the pharynx, sputum, and oral cavity collected from patients undergoing HSCT. Aspergillosis was more common after allogeneic than after autologous HSCT. The pharynx was the most frequently colonized site. CONCLUSIONS: Allogeneic HSCT recipients are more susceptible to fungal infections compared to the autologous group. Selection of species during prophylaxis and antifungal therapy requires developing more effective prevention and treatment strategies based on new antifungal drugs and microbe-specific diagnoses.

[Cochlea development in infants with central nervous system impairment occurring as an effect of perinatal asphyxia]. / Rozwój slimaka u niemowlat ze zmianami w obrebie osrodkowego ukladu nerwowego powstalymi w nastepstwie asfiksji okoloporodowej.

UNLABELLED: Asphyxia in neonates with inadequate blood-inner ear barrier function causes damage to the inner ear included the degeneration of outer hair cells of the organ of Corti and oedematous changes in stria vascularis. The major consequences in the central nervous system (CNS) are found to be hypoxic-ischemic encephalopathy (HIE) in term newborns, peri- (PVH) or intraventricular hemorrhages (IVH) and periventricular leucomalacia (PVL) in preterm neonates. THE AIM OF THE STUDY: was to carry out the objective assessment of the cochlea development using CEOAEs in infants with CNS impairment occurring as an effect of perinatal asphyxia, imaged during trans-fontanel ultrasonography. MATERIAL AND METHODS: To the investigation 36 infants with HIE, IVH or PVL were included, the control group encompassed 32 born at term, health children. In all children three times otoscopic examination and CEOAEs recordings were performed: after birth, in 3rd and in 6th month of life using Otodynamics Otoacoustic Analyser ILO-88 in Quick Screen version. Perinatal anamnesis, general pediatric status, results of trans-fontanel ultrasonography and biochemical test results were taken into account in statistical analyses. RESULTS: The mean amplitudes of CEOAEs in the first days of life were significantly reduced in InvG comparing to control babies. In half-octave frequency bandwidth analysis significant reduction of S/N Ratio at 1,5­4 kHz in InvG was observed. 3 and 6 months later the recorded responses significantly increased, they didn't reach values of CG but no statistical differences between groups were observed. CONCLUSION: In conclusion, the outer hair cells activity in first days of life is reduced in newborns with CNS impairment and perinatal asphyxia in anamnesis comparing to health children. The maturation of the cochlea is intensive during first 3 months of life, later only subtle changes in CEOAEs are observed.

Assessment of hearing organ activity in a group of neonates with central nervous system impairment.

OBJECTIVE: Hypoxic-ischemic encephalopathy, primary subarachnoid hemorrhage in term newborns as well as periventricular leukomalacia and intraventricular hemorrhage in premature newborns are the major consequences of perinatal asphyxia. Intrauterine hypoxia and labor prolongation can also affect the hearing organ in newborns causing reversible or irreversible changes in the cochlea, brainstem or cortex. The aim of the study was to carry out the objective assessment of the cochlea and hearing pathway activity using CEOAEs and ABR; to find relationships between hearing status and parameters effecting on nervous system in neonates with central nervous system impairment occurring following perinatal asphyxia. METHODS: To the investigation 36 newborns with hypoxic-ischemic encephalopathy, periventricular leukomalacia or intraventricular hemorrhage were included. The control group encompassed 32 health newborns matched as to the age. In all newborns otoscopic examination, CEOAEs after birth and CEOAEs with ABR 3 months later were performed. Perinatal anamnesis, general pediatric status, results of trans-fontanel ultrasonography and biochemical test results were taken into account in statistical analyses. RESULTS: The mean amplitudes of CEOAEs in the first days of life were significantly reduced in investigation group comparing to control babies. 3months later the recorded responses significantly increased but did not reach values of control group. No differences were found between latencies of waves I and II. ABR latencies of waves III, IV, V and interpeak latencies I-III, III-V, I-V were delayed in investigation group when compared to control patients. Also morphology of ABR recordings in investigation group has slightly changed. Perinatal aspyxia leading to hypercapnia, low gestational age, prolonged artificial ventilation and meningitis were the main risk factors related to disturbances in ABR recordings. CONCLUSIONS: The combined use of CEOAEs and ABR in neonates with central nervous system impairment involvement revealed the existence of abnormalities in cochlear micromechanics and retrocochlear auditory pathway. Etiology seems to be multifactoral.

[Assessment of retrocochlear hearing pathway activity in infants with central nervous system impairment occurring as an effect of perinatal asphyxia]. / Ocena funkcji pozaslimakowej czesci drogi sluchowej u niemowlat ze zmianami w obrebie osrodkowego ukladu nerwowego powstalymi na skutek asfiksji okoloporodowej.

INTRODUCTION: The most often changes in the central nervous system (CNS) occurring as an effect of perinatal asphyxia are found to be hypoxic-ischemic encephalopathy (HIE) in term newborns, peri- (PVH) or intraventricular hemorrhages (IVH) and periventricular leukomalacia (PVL) in preterm neonates. Chronic hypoxia is considered to affect the brainstem in infants, especially nuclei of the hearing pathway are vulnerable to low oxygen level. The aim of the study was to carry out the objective assessment of the retrocochlear hearing pathway activity using ABR in infants with CNS impairment occurring as an effect of perinatal asphyxia, imaged during trans-fontanel ultrasonography. MATERIAL AND METHODS: To the investigation 36 infants with HIE, IVH or PVL were included, the control group encompassed 32 born at term, health children. ABR recordings were performed in 3 months old children using Nicolet Spirit System for clicks of 85 and 80 dB nHL. RESULTS: No differences were found between latencies of waves I and II. ABR latencies of waves III, IV, V and interpeak latencies I-III, III-V, I-V were significantly delayed in InvG when compared to control patients. In conclusion, the brainstem activity in infants with CNS involvement as an effect of perinatal asphyxia is lower comparing to health children. Subclinical abnormalities as prolonged synaptic transmission of electric signal in retrocochlear auditory pathway were revealed.

[Extramedullary plasmacytoma of the neck--case report]. / Szpiczak plazmocytowy odosobniony pozakostny w obrebie szyi--opis przypadku.

Extramedullary plasmacytoma (EMP) is a rare neoplasm which belongs to non-Hodgkin's lymphomas, which is characterized by monoclonal, neoplastic proliferation of B-type lymphocytes in the soft tissues. The most common location for EMP to occur is the nasopharynx and paranasal sinuses. Treatment is efficacious with surgery, radiotherapy or combination these two methods. This report presents a case of EMP of the neck in 63-year-old patient, diagnosed and treated in ENT Department of Medical University of Silesia in Zabrze. On the basis of physical examination and radiologic studies the extensiveness of the tumour was determined and the surgical procedures were undertaken. Diagnosis was established on the basis of histopatological and immunohistochemical postoperative examinations as well as radiologic studies and trepanobiopsy. Surgery was followed by radiotherapy. 6 months later because of progression and dissemination of the disease chemotherapy and hematological treatment were performed. Patient remains in laryngological, oncological and transplantological follow-up.

[Parapharyngeal oncocytoma of the parotid gland--case report]. / Przypadek gruczolaka kwasochlonnego slinianki przyusznej penetrujacego do przestrzeni przygardlowej.

Oncocytoma is a rare, benign salivary gland tumour with slowly course. It usually occurs in the parotid gland, seldom in submandibular gland. This report presents a case of parapharyngeal oncocytoma of the left parotid gland in 77-year-old patient, treated in 2nd ENT Department of Medical University of Silesia in Zabrze. On the basis of physical examination and preoperative radiologic studies (computed tomography scan of nasopharynx, magnetic resonance imaging, Doppler ultrasonography of carotid and vertebral arteries) the extensiveness of the tumour was determined and the surgical procedure was undertaken. The removal of a whole tumour was performed through a cervical--transpharyngeal approach with midline mandibulotomy. A follow-up of 30 months hasn't revealed any recurrence of the oncocytoma.

[Septal nasal chondroma--a case report]. / Chrzestniak przegrody nosa--opis przypadku.

INTRODUCTION: Cartilaginous tumors of the head and neck are rare. The most frequent site is larynx and spheno-ethmoidal area. Chondroma of the nasal septum is very rare. Since its first description in the literature in 1842, only about 140 cases have been reported. The symptoms of nasal septum chondroma are nasal obstruction, headache and epistaxis. The treatment of choice is wide surgical excision. AIM: The aim of our study was to show own, very rare case of septal nasal chondroma. MATERIAL AND METHODS: We described a case of septal nasal chondroma in the 39-year-old female. She reported nasal obstruction, headache of the frontal area for about 10 years. The CT examination showed the tumor mass in the right nasal cavity extending to the maxillary sinus and right orbit. The tumor was removed via the lateral rhinotomy. Histopathological examination revealed chondroma. No recurrence was noticed after 2 years of follow-up. CONCLUSIONS: Chondroma should be taken into consideration during the differential diagnosis of the septal nasal tumors.

[Hearing evaluation in chronic renal failure children]. / Ocena narzadu sluchu u dzieci z przewlekla niewydolnoscia nerek.

UNLABELLED: Chronic renal failure (CRF) causes a lot of systemic side-effects, among them: neurological and otological complications. In present study hearing evaluation was made in young patients, using distortion product otoacoustic emissions (DPOAEs) and auditory brainstem responses (ABR). THE AIM OF STUDY: (1) objective assessment of hearing organ activity in CRF children, (2) localization of hearing organ part involved in CRF, (3) establishing best parameters of ipsilateral stimulation in DPOAEs for clinical use. MATERIALS AND METHODS: Hearing acuity was assessed in 22 CRF children ranging in age from 9 to 17 years and 18 healthy children ranging in age from 10 to 18 years. At first pure tone audiometry and tympanometry were evaluate. Only patients with normal middle ear condition and hearing threshold better than 30 dB HL were put forward further investigations. Objective assessment of hearing condition included: (1) DPOAEs using DP-gram format. Two simultaneous pure-tone signals (primaries) were presented to the ear at two different frequencies (f1 and f2, where f2 > f1) and the 2f1-f2 were analyzed. Five pairs of non equal level and L2 were used L1 and L2: panel A1: L1 = 65 and L2 = 60 dB SPL, panel A2: L1 = 63 and L2 = 55 dB SPL, panel A3: L1 = 59 and L2 = 45 dB SPL, panel A4: L1 = 55 and L2 = 35 dB SPL, panel A5: L1 = 51 and L2 = 25 dB SPL; (2) ABR investigation using click stimulus, at 90 dB nHL level. Wave I, III, V latencies and intervals I-III, III-V, I-V were evaluated. Our results reviled significantly lower mean DPOAEs amplitudes in CRF children when compare to healthy children, at all frequencies measured. No differences in ABR evaluation were observed. Most optimal DPOAEs parameters in clinical use seem to be panel A1, A2 and A3 of level L1 and L2.

[Evaluation of cochlear function in children with chronic renal failure]. / Ocena funkcji slimaka u dzieci z przewlekla niewydolnoscia nerek.

UNLABELLED: In present study cochlear function was evaluate in young chronic renal failure (CRF) patients using distortion product otoacoustic emissions (DPOAEs). THE AIM OF STUDY: (a) objective assessment of cochlear function in CRF children, (b) establishing best parameters of ipsilateral stimulation in DPOAEs (DP-gram format) for clinical use. Hearing acuity was assessed in 19 CRF children and 18 healthy children. At first pure tone audiometry and tympanometry were evaluate. Only patients with normal middle ear condition and hearing threshold better than 30 dB HL were put forward further investigations. Objective assessment of cochlear function included DPOAEs using DP-gram format. Our results reviled significantly lower mean DPOAE amplitudes in CRF children when compare to healthy children, at all frequencies measured. Most optimal DP-gram parameters in clinical use seems to be level L1 and L2 equal respectively: 65 and 60 dB SPL; 63 and 55 dB SPL; 59 and 45 dB SPL.

[Assessment of cochlea activity in a group of newborns with central nervous system impairment as an effect of perinatal asphyxia using click-evoked otoacoustic emissions (CEOAEs)]. / Ocena funkcji slimaka za pomocq emisji otoakustycznej wywolanej trzaskiem (CEOAEs) u noworodków z niedotlenienienem oklporodowym i nastepowymi zmianami w obrebie osrodkowego ukladu nerwowego.

During adaptation of newborn to extra-uterine environment dramatic changes in functioning in the inner organs and the entire human body is observed. Complicated or premature birth as well as complicated course of a perinatal period may cause reversible or irreversible damage of various tissues, organs or systems, and, consequently, their dysfunction. The most often changes in the central nervous system (CNS) in newborns occurring as an effect of perinatal asphyxia are found to be ischemic-hypoxic encephalopathy (IHE), periventricular leucomalacia (PVL) and intraventricular hemorrhages (IVH). Chronic hypoxia is considered to affect the hearing organ in newborns. Reversible or irreversible changes within the cochlea, brainstem or cortex may result in perceptive hearing losses. The aim of the study was to carry out the objective assessment of the cochlea activity using CEOAEs in neonates with CNS impairment occurring following perinatal asphyxia. To the investigation 16 newborns with IHE, PVL or IVH were included. The control group encompassed the health newborns matched as to the age. Perinatal anamnesis, general pediatric status, results of trans-fontanel ultrasonography and biochemical test results were taken into account in statistical analyses. In all newborns otoscopic examination and CEOAEs after birth and 3 months later were performed. CEOAEs in session 1 were significantly reduced in the investigated group comparing to control babies but 3 months later no differences between groups were observed. The outer hair cells activity in first days of life is reduced in newborns with asphyxia in anamnesis but with time no differences in cochlea development are observed.