Hyaluronan synthases and hyaluronidases in nasal polyps.

Nasal polyps (NPs) are benign lesions of nasal and paranasal sinuses mucosa affecting 1-4 % of all adults. Nasal polyposis affects the quality of patient's life as it causes nasal obstruction, postnasal drainage, purulent nasal discharge, hyposmia or anosmia, chronic sinusitis, facial pain and snoring. Without treatment, the disease can alter the craniofacial skeleton in cases of extended growth of polyps. The development of NPs is caused by the hyperplasia of nasal or paranasal sinuses mucosa, and edema of extracellular matrix. This is usually the result of high concentration of high molecular mass hyaluronan (HA) which is either overproduced or accumulated from blood supply. The size of HA presents high diversity and, especially in pathologic conditions, chains of low molecular mass can be observed. In NPs, chains of about 200 kDa have been identified and considered to be responsible for the inflammation. The purpose of the present study was the investigation, in NPs and normal nasal mucosa (NM), of the expression of the wild-type and alternatively spliced forms of hyaluronidases, their immunolocalization, and the expression of HA synthases to examine the isoform(s) responsible for the increased amounts of HA in NPs. Hyaluronidases' presence was examined on mRNA (RT-PCR analysis) and protein (immunohistochemistry) levels. Hyaluronan synthases' presence was examined on mRNA levels. Hyaluronidases were localized in the cytoplasm of epithelial and inflammatory cells, as well as in the matrix. On mRNA level, it was found that hyal-1-wt was decreased in NPs compared to NM and hyal-1-v3, -v4 and -v5 were substantially increased. Moreover, HAS2 and HAS3 were the only hyaluronan synthases detected, the expression of which was almost similar in NPs and NM. Overall, the results of the present study support that hyaluronidases are the main enzymes responsible for the decreased size of hyaluronan observed in NPs; thus they behave as inflammatory agents. Therefore, they could be a potential target for the design of a more advanced treatment for nasal polyposis.

Expression and distribution of aggrecanases in human larynx: ADAMTS-5/aggrecanase-2 is the main aggrecanase in laryngeal carcinoma.

Members of the ADAMTS family of proteases degrade proteoglycans and thereby have the potential to alter tissue architecture and regulate cellular functions. Aggrecanases are the main enzymes responsible for aggrecan degradation, due to their specific cleavage pattern. In this study, the expression status, the macromolecular organization and localization of ADAMTS-1, ADAMTS-4/aggrecanase-1 and ADAMTS-5/aggrecanase-2 in human normal larynx and laryngeal squamous cell carcinoma (LSCC) were investigated. On mRNA level, the results showed that ADAMTS-4 was the highest expressed enzyme in normal larynx, whereas ADAMTS-5 was the main aggrecanase in LSCC presenting a stage-related increase up to stage III (8-fold higher expression compared to normal), and thereafter decreased in stage IV. Accordingly, immunohistochemical analysis showed that ADAMTS-5, but not ADAMTS-4, was highly expressed by carcinoma cells. Sequential extraction revealed an altered distribution and organization of multiple molecular forms (latent, activated and fragmented forms) of the enzymes within the cancerous and their corresponding macroscopically normal laryngeal tissues, compared to the normal ones. Importantly, these analyses indicated that critical macromolecular changes occurred from the earliest LSCC stages not only in malignant parts of the tissue but also in areas that were not in proximity to carcinoma cells and appeared otherwise normal. Overall, the results of the present study show that ADAMTS-5/aggrecanase-2 is the main aggrecanase present in laryngeal carcinoma suggesting a critical role for the enzyme in aggrecan degradation and laryngeal tissue destruction during tumor progression.

Factors influencing quality of life after total laryngectomy: a study of 92 patients.

BACKGROUND AND OBJECTIVES: Total laryngectomy is a radical surgery for advanced laryngeal cancer. In the present study we evaluate the influencing factors for long term quality of life of 92 laryngectomees. PATIENTS AND METHODS: 92 patients who underwent laryngectomy for laryngeal cancer in the University Hospital of Patras, Greece were evaluated using a modified version of the EORTC-QOL-C30 questionnaire. The patients were distributed into 6 groups based on time elapsed between surgical treatment and completion of the questionnaire, ranging from 2 years for group 1 to 9-10 years for group 6. RESULTS: The mean value of psychological status (p=0.01), smelling disorders (p=0.032), mood change (p=0.003) were statistically significant in regard to the patient's overall view of their life postsurgically. Coexisting illness (defined as diabetes, hypertension or prostate disease which required medication on daily basis or hospitalization more than two times a year) was also significantly affecting (p=0.021) the patient's oral communication skills. CONCLUSION: Quality of life is affected by functional disabilities and the psychological state of the patients. No statistically significant improvement over time was noted in our series.

Necrotizing fasciitis of the head and neck: report of 5 cases and review of the literature.

BACKGROUND: Necrotizing fasciitis (NF) is a severe, rapidly spreading soft tissue infection of polymicrobial origin. This condition most frequently affects thorax, abdominal wall, extremities, perineum and groin, but according to recent literature the head and neck area is also involved with increasing frequency. PATIENTS AND METHODS: Five cases of head and neck NF were detected among patients who were admitted at the Department of Otorhinolaryngology-Head and Neck Surgery of the University Hospital of Patras, Patras, Greece, over a 5-years period. Various parameters including patients' health status, co-morbidity, etiology, microbiology, affected area, antibiotic therapy, hospital stay, surgical treatment and complications were considered. CONCLUSIONS: The management of NF should comprise of hemodynamic and respiratory evaluation and monitoring, broad-spectrum i.v. antimicrobial therapy, surgical debridement and nutritional support. Close postoperative management of NF patients remains of paramount importance.

Voice restoration after total laryngectomy using provox 2 (generation II) prosthesis.

BACKGROUND AND OBJECTIVES: Voice restoration after total laryngectomy is of outmost importance for patient and a therapeutic challenge for the surgeon and speech pathologist. Among various rehabilitation methods prosthetic voice yields nowadays the best results. PATIENTS AND METHODS: A total of 12 patients underwent laryngectomy at the Department of Otorhinolaryngology, University Hospital, Patras, Greece, between February 2006 and May 2007. All patients had advanced laryngeal squamous cell carcinoma. Eight patients had primary voice prosthesis inserted and four patients had a tracheo-esophageal puncture (TEP) carried out as a secondary procedure. RESULTS: The majority of the patients (80%) from both the primary insertion or the secondary insertion group, developed good and understood speech using the prosthesis. No significant difference in quality of speech was found between the two subgroups. Four patients required replacement of the prosthesis at intervals of 8 and 10 months after insertion, because of salivary leakage and granulation formation around the fistula, while 3 patients developed a mild mucositis and tracheitis due to postoperative radiotherapy. DISCUSSION: TEP puncture and prosthesis insertion is a relatively simple, safe and effective surgical procedure for voice restoration after laryngectomy. Provox 2 (generation II) voice prosthesis is a new and useful modified device that has overcome the previous prosthesis drawbacks, is well tolerated by the patients and can be easily changed via the front-loading technique.

Cystic thymoma coexisting with vascular dysplasia.

We report the case of a 23-year-old female patient, who was admitted to our hospital because of aggravating pain in the right shoulder, right chest and ear accompanied by cough and dyspnea. Imaging revealed a soft tissue mass in the mediastinum in close relation with an additional large mass extending in the right upper thorax, right axilla and neck. The tissue obtained during surgery showed the former mass to be a cystic thymoma, being in contact with an extensive vascular dysplasia. The characteristic clinical presentation, the contribution of imaging, the results of operation, and the follow-up are rather unique. The review of the literature did not reveal similar cases.

A new perspective in learning pattern generation for teaching neural networks.

This article deals with the Learning Patterns (LPs)' generation, a major aspect of Feed-Forward Artificial Neural Networks (FANNs)' learning process. Currently, more work is done to understand the mechanisms and improve the speed, learning accuracy, and implementation features of FANNs' teaching algorithms, though little is done towards the development of enhanced techniques that would extract experts' knowledge (from examples, rules, etc.) and obtain standardised LPs that would improve this learning process. A new approach in generating LPs is thereby introduced, that is used to train a new Medical Decision Support System (MDSS) based on FANNs, and its performance is analysed and compared with previous methods. It can handle incomplete data archives, individually boost any particular dataum special characteristics, and its application induces the FANNs to show better convergent facets. The efficiency of the resulting MDSS was thoroughly tested by pulmonologists and haematologists using medical data archives of a regional hospital.

Lateral neck abscess caused by Streptococcus bovis in a patient with undiagnosed colon cancer.

Bacteraemia or endocarditis caused by Streptococcus bovis, a non-enterococcal group D streptococcus, is a very common finding in patients suffering from intestinal tumours or other colon diseases. A case of a patient with a laternal neck abscess caused by S. bovis is reported. During the treatment the patient was found to have colonic malignant lesions. The problems in the appropriate diagnosis and the possible correlation between these two clinical entities are presented and discussed.

Evaluation of TATI and CYFRA 21-1 in patients with head and neck squamous cell carcinoma.

This preliminary nonrandomized study was conducted to evaluate the clinical usefulness of TATI and CYFRA 21-1 as tumor markers in head and neck squamous cell carcinoma. Serum levels of these markers were measured from 122 subjects of a tertiary-care university hospital, divided into four groups: (1) normal individuals and patients with (2) inflammatory pathology, (3) benign tumors and (4) squamous cell carcinoma of the head and neck. Serum samples were collected before and after treatment, with a mean follow-up period of 12 months. The cutoff level, sensitivity, specificity and likelihood ratio of a positive and negative test were: 21 microg/l, 66.6%, 93.75%, 10.6 and 0.35 for TATI; 3.3 microg/l, 28.5%, 95%, 5.7 and 0.75 for CYFRA 21-1, respectively. Both markers presented elevated mean values and statistically significant differences in the cancer patient group compared with the other groups. Significant differences were also observed between the stage of disease and tumor differentiation. TATI levels seem to relate positively to the course of disease during the follow-up period. Although CYFRA 21-1 values presented significant differences, the majority of them were under the cutoff level. We conclude that TATI seems to play a role in the clinical evaluation of head and neck squamous cell carcinoma, while the usefulness of CYFRA 21-1 is limited.

Periapical abscesses: causal bacteria and antibiotic sensitivity.

The purpose of this study was to investigate the aerobic and anaerobic flora of periapical abscesses and evaluate their susceptibility to various antibiotics. In 52 patients, with a diagnosis of periapical abscesses, pus cultures were taken. Forty-two aerobes and 122 anaerobes were revealed, with 2 or more than 2 anaerobic strains isolated in 36 patients. Infections were purely aerobic in 6%, purely anaerobic in 17% and mixed in 75%, while in 2% of the specimens there was no growth of microorganisms. Among anaerobes, microorganisms from the Bacteroides group (38.5%), Peptostreptococcus spp. (24.6%), Peptococcus spp. (13.9%), and Fusobacterium spp. (4.1%), predominated in all cultures. Among aerobes the most prevalent bacteria were streptococci (47.6%) followed by staphylococci (35.6%) while Enterobacteriaceae were isolated in 4.8% of specimens. Selected susceptibility tests performed on several anaerobic species revealed that nitroimidazole derivatives, chloramphenicol and clindamycin retain their broad spectrum killing activity against anaerobes, followed by cefoxitin and moxalactam. Of the newer quinolones, ofloxacin was the most effective. It is evident that the high isolation rate of anaerobic bacteria should influence empiric therapeutic decisions.

Reduced variance in the latency and amplitude of the fifth wave of auditory brain stem response after normalization for head size.

The value of the Auditory Brain Stem Response (ABR) in the assessment and detection of neurological disorders could be considerably enhanced if the normative standards of ABR characteristic parameters take into account all other systematic sources of variance. The present study attempts to take into account the influence of head size on latency and amplitude of the ABR components. We examined amplitude and latency as a function of head size in 40 normal male subjects (age 20-40 years). Significant negative correlation was found between amplitude and head radius. The experimental data were fitted using a theoretical curve of the potential on the surface of a three-concentric sphere model representing the human head. The fitted curve of amplitude versus radius can be applied to normative data in order to substantially reduce dispersion and consequently increase the diagnostic value of this parameter. Moreover, a substantial effect of radius on wave V latency was detected. Normalization of the latencies with reference to the head radius, assuming that the latter is proportional to the length of brain stem, resulted in a significant reduction in the standard deviation of these data as compared to the original.

Cefuroxime axetil in the treatment of acute otitis media in children.

Cefuroxime axetil was evaluated for clinical efficacy and tolerance in the treatment of acute otitis media in children. Fifty-five children, 5.0 to 10.8 years, were randomly assigned to receive 250mg cefuroxime axetil every 12 hours or 50mg/kg/day amoxicillin in three divided doses. Both treatment schemes lasted for 10 days. Acute otitis media was diagnosed by the presence of erythema and/or opacity with bulging of the tympanic membrane. A tympanogram was obtained upon enrollment to the study, as well as within 2 days after completion of therapy. Fifty-one children completed the treatment protocol. The cure rate was 74.1% for cefuroxime axetil and 75.0% for amoxicillin. Clinical improvement was noted in 25.9% of children treated with cefuroxime axetil and in 25.0% of those treated with amoxicillin. There was no clinical failure in the two treatment groups. None of the children experienced relapse of acute otitis media during the month following completion of therapy. The findings indicate that cefuroxime axetil given twice daily has comparable efficacy to amoxicillin given three times daily in the treatment of children with acute otitis media.

Pharmacokinetic study of cefaclor in chronic maxillary sinusitis.

The pharmacokinetics of the maxillary sinus fluid were studied in 42 patients (26 males and 16 females), suffering from chronic maxillary sinusitis, after oral administration of 0.5g or 1g cefaclor. A thin plastic catheter, for sinus secretion sampling, was inserted in the sinus cavity and remained in place throughout the study. Sinus fluid levels of cefaclor (0.5g), measured by agar and well-diffusion microbiological method, ranged between 0.17-0.19, 0.28-0.42, 0.18-0.22 and 0.12-0.16 microgram/ml at 2, 4, 6 and 8 hour intervals respectively. Levels ranging between 0.15-0.26, 0.37-0.90, 0.23-0.27 and 0.16-0.19 microgram/ml were found after the administration of 1g cefaclor at the same time intervals respectively. Higher levels were found in purulent nasal material than in cystic fluid aspirates.

Cross-sectional anatomy of the nose and paranasal sinuses. A correlative study of computer tomographic images and cryosections.

Anatomic relations in the nose and paranasal sinuses have been studied in computer tomographic images and cryosections, to highlight some details that are of importance for the functional nasal surgeon. From three heads the sections were obtained in three perpendicular planes (coronal, axial and sagittal). The most interesting sections are depicted in three ways: a computer tomographic image, the surface photography of the tissue block in the microtome and a stained section of 20 microns. A number of interesting relations that are clearly depicted are discussed.

Tumours of the head and neck in children. A clinico-pathological analysis of 1,007 cases.

Tumours of the head and neck in children are uncommon, representing only 2-3% of all head and neck tumours. During the twenty year period 1964-1983, 12,876 childhood tumours were submitted for pathological diagnosis. Of these 1,007 (7.8%) were in the head and neck region, and it is this group that has been analysed. 30.6% (308 cases) were malignant neoplasms, 27.8% (280 cases) were benign neoplasms, 24.2% (244 cases) presented as tumour-like conditions and 17.4 (175 cases) were dysplasias arising from embryonal remnants. The overall sex ratio was 1.5:1 in favour of males. Lymphomas accounted for 15.9% overall (52.3% of the malignant neoplasms). Of benign tumours, haemangiomas were the most frequent (38.5%) and of the tumour-like conditions, dermoid and epidermoid cysts accounted for 36.1%. Of the embryonal remnant dysplasias, thyroglossal duct cysts accounted for 71.4%.