Lysyl oxidase-like 1 polymorphisms in a southwestern Greek cataract population with pseudoexfoliation syndrome.

PURPOSE: The aim of this study was to determine the possible association of rs1048661 and rs3825942 single nucleotide polymorphisms (SNPs) in the lysyl oxidase-like 1 (LOXL1) gene of cataract patients from southwestern Greece with pseudoexfoliation (PEX) syndrome. PATIENTS AND METHODS: Ninety-three patients with PEX syndrome and 74 without PEX syndrome were recruited with the principal diagnosis being cataract. LOXL1 SNPs, rs1048661 and rs3825942, were genotyped by using polymerase chain reaction. RESULTS: The G allele of rs1048661 was found in 96.7% in the PEX group as compared to 80.5% of non-PEX alleles (P=19×10(-4); Odds ratio [OR] =5.37; 95% confidence interval [CI] =1.68-17.12). Similarly, the G allele of rs3825942 was found in 72.1% of the PEX group as compared to 41.8% of non-PEX alleles (P=4×10(-5); OR =3.78; 95% CI =1.98-7.23). The T and A allele frequencies of rs1048661 and rs3825942, respectively, were underrepresented in the PEX group patients as compared to non-PEX group. CONCLUSION: Our data confirm previously reported association between LOXL1 polymorphisms and PEX syndrome in a southwestern Greek population. A significant association was found for the G allele of rs1048661 and rs3825942 demonstrating that the GG haplotype is a high-risk factor for the development of PEX syndrome.

Dorsalis Pedis Free Flap: The Salvage Option following Failure of the Radial Forearm Flap in Total Lower Lip Reconstruction.

Reconstruction after resection of large tumors of the lower lip requires the use of free flaps in order to restore the shape and the function of the lip, with the free radial forearm flap being the most popular. In this study we describe our experience in using the dorsalis pedis free flap as a salvage option in reconstruction of total lower lip defect in a patient with an extended lower lip carcinoma after failure of the radial forearm free flap, that was initially used. The flap was integrated excellently and on the followup the patient was free of disease and fully satisfied with the aesthetic and functional result.

Androgen receptor in laryngeal carcinoma: could there be an androgen-refractory tumor?

Androgen receptors (ARs) which are implicated in the pathogenesis of several malignancies can also be a possible downstream effector in laryngeal cancer. In the present study, 97 invasive squamous laryngeal carcinomas were studied by immunohistochemistry for protein expression of AR. Androgen receptors were expressed in 52.6% of tumor specimens, suggesting their implication in the pathogenesis of this tumor. Our study's aim was to investigate the hypothetical scenario of an androgen refractory laryngeal carcinoma where androgen receptors can be activated by nodal molecules in the course of an Epithelial-to-mesenchymal transition (EMT) phenomenon. In line with this we correlated AR expression with the expression of ILK, p-Akt, E-cadherin, ß-catenin in our sample as well as with tumor grade and TNM stage. A reverse correlation between nuclear AR and cytoplasmic ILK expression was evidenced, indicating an interaction of those molecules in laryngeal carcinoma. Finally in our material, in those carcinomas that were expressing ARs, stronger nuclear expression of the receptor was characterized by poorer cell differentiation and correlated with the acquisition of EMT features like E-cadherin loss and ß-catenin translocation raising a question whether activated ARs can drive an EMT procedure.

The chondroitin/dermatan sulfate synthesizing and modifying enzymes in laryngeal cancer: expressional and epigenetic studies.

BACKGROUND: Significant biochemical changes are observed in glycosaminoglycans in squamous cell laryngeal carcinoma. The most characteristics are in chondroitin/dermatan sulfate fine structure and proportion, which might be due to differential expression of the enzymes involved in their biosynthesis. The aim of the present work was the investigation in expressional and epigenetic level of the enzymes involved in chondroitin/dermatan sulfate biosynthesis in laryngeal cancer. METHODS: Tissues subjected to total RNA and DNA isolation, and protein extraction. The techniques used in this study were RT-PCR analysis, western blotting and methylation specific PCR. RESULTS: We identified that many enzymes were expressed in the cancerous specimens intensively. Dermatan sulfate epimerase was expressed exclusively in the cancerous parts and in minor amounts in healthy tissues; in the macroscopically normal samples it was not detected. Furthermore, chondroitin synthase I and chondroitin polymerizing factor were strongly expressed in the cancerous parts compared to the corresponding normal tissues. Sulfotransferases, like chondroitin 6 sulfotransferase 3, were highly expressed mainly in healthy specimens. CONCLUSIONS: The study of the various chondroitin/dermatan synthesizing enzymes revealed that they were differentially expressed in cancer, in human laryngeal cartilage, leading to specific chondroitin/dermatan structures which contributed to proteoglycan formation with specific features. The expression of the examined enzymes correlated with the glycosaminoglycan profile observed in previous studies.

Exfoliation syndrome related to sensorineural hearing loss.

BACKGROUND: To investigate the relationship between exfoliation syndrome and sensorineural hearing loss. METHODS: A prospective study was designed. Patients with evidence of ocular exfoliation syndrome (study group) and individuals without any clinical signs of exfoliation syndrome (control group) were selected. Cases and controls were chosen to have similar demographic characteristics. Study and control group subjects with a history of conditions affecting hearing function were excluded. Pure-tone audiometry was performed in all participants in both groups and hearing thresholds were measured at frequencies of 0.25, 0.5, 1, 2, 4 and 8 kHz (kilohertz) for each ear. RESULTS: A total of 69 subjects participated in the study. The study group included 47 subjects and the control group 22. There was no significant difference in mean age (P = 0.985) and gender (P = 0.378) between groups. Mean pure-tone hearing thresholds were significantly higher in study group at frequencies of 4 kHz (P = 0.004) and 8 kHz (P = 0.001), but not at frequencies of 0.25, 0.5, 1 and 2 kHz. The greatest difference in the comparison of mean hearing thresholds between study and control group was noted at 8 kHz. CONCLUSIONS: The above results are in accordance with previous studies and provide additional evidence of the association between exfoliation syndrome and sensorineural hearing loss at high frequencies. Particular effect was shown on the highest frequency of 8 kHz. These findings may support the systemic nature of exfoliation syndrome.

Differential beta-catenin expression between glottic and supraglottic laryngeal carcinoma.

Glottic carcinomas present with a favorable prognosis comparing to supraglottic. This fact is mainly attributed to differences in anatomical, histological and embryological aspects. It is possible that differential molecular anatomy between the two distinct anatomical entities contributes to this clinical observation as well. The current study intended to evaluate, by immunohistochemistry in paraffin-embedded tissue samples from 97 invasive squamous laryngeal carcinomas, the possible differential expression of crucial molecules for malignant cell's function such as integrin-linked kinase, phosphorylated Akt, E-cadherin, beta-catenin, androgen receptor, estrogen receptor-beta and vimentin between glottic and supraglottic laryngeal carcinomas. We documented a correlation of supraglottic laryngeal carcinomas with high grade (p = 0.001) and enhanced tumor TNM stage (p < 0.001). The supraglottic location was correlated with the abolishment of beta-catenin from the membrane (p = 0.025). However, the diverse anatomical locations are not characterized by statistically significant differential expression of ILK, p-Akt, AR, ER-beta, E-cadherin and vimentin. Our results show that it is possible that molecular factors, such as beta-catenin, are differently expressed in glottic and supraglottic carcinomas, leading to the distinct clinical behavior of those tumors.

Taste function evaluation after tonsillectomy: a prospective study of 60 patients.

Tonsillectomy is regarded as a safe procedure, with post-operative taste disturbances rarely reported. The aim of this study was to access taste function after tonsillectomy in a series of 60 patients. Sixty patients (age range 14-40 years; mean 24.4 years; median 21 years; STD 7.7 years), 24 males and 36 females, underwent bilateral tonsillectomy at the University Hospital of Patras, Greece. All patients were diagnosed with recurrent tonsillitis and randomly assigned to two groups. The first group consisted of 27 patients, who underwent tonsillectomy using scissors and raspatory with electrocautery for coagulation. The remaining 33 patients underwent tonsillectomy using pressure-assisted tissue-welding technology. Chemogustometry was used to evaluate the patients' taste function on the first postoperative day and succeedingly, 15 days and 1 month postoperatively. Three different quantities of tastant were used in each test. Taste recognition in posterior tongue regions proved to be more affected compared with anterior tongue regions in the first postoperative day. Bitter and sour tastes were more affected than those of sweet and salty. Succeeding tests yielded near normal results for all patients except two, with one patient achieving normal taste function 1 month postoperatively and the other still facing taste disorders 1 month after tonsillectomy. The results indicate that Tonsillectomy entails a temporary reduction in taste function. This finding should be attributed to direct or indirect intraoperative damage of the glossopharyngeal nerve or unintentional extension of the lingual nerve by application of the tongue retractor. No significant difference was noted between the two operative techniques evaluated in our study. In most cases taste function returns to preoperative levels within 2 weeks postoperatively. Post-tonsillectomy taste disturbances are uncommon, and patients should be informed of this possibility.

Survival after laryngectomy: a review of 133 patients with laryngeal carcinoma.

Survival trends in survival for laryngeal cancer in Europe are varied. Five-year survival varied around 60-64% but numbers below 50% have been commonly reported. The aim of this study was to assess the factors influencing survival in patients with laryngeal cancer in our region. A total of 128 male and 5 female patients with larynx cancer (91 glottic and 42 supraglottic) were treated at Patras University Hospital between March 1992 and August 2004. Except 3, all were smokers and 56 (41%) heavy alcohol users. Postsurgical staging showed that most had been classified at stages III (38%) and IV (49%). By histology, 31 tumors were classified as poorly differentiated, 78 as moderately differentiated and 23 as well differentiated. All patients underwent laryngectomy with extension of the procedure where appropriate. Also, a total of 45 patients received adjuvant therapy (either chemotherapy or radiotherapy). Farmers, construction workers, professional drivers and mechanics and coffee shop and bar employees account for more than 70% of patients. Results showed that 64 (48.1%) patients died during the follow-up, 58 (43.6%) of them died from cause related to their disease. With a median follow-up of 25 months, the 5-year disease-free survival (DFS) was 53% and the 5-year overall survival (OS) was 45%. Significant prognostic factors for OS included patient age, advanced staging, heavy alcohol use and poor tumor differentiation while for DFS affected mainly by poor tumor differentiation. We conclude that the disease stage at presentation, tumor grade and alcohol consumption prove to be important predictors for the OS as well as the DFS in our series.

Bilateral ossification of the auricles: an unusual entity and review of the literature.

BACKGROUND: True ossification of the auricle with cartilage replacement by bone, is a very rare clinical entity and can result in an entirely rigid auricle. CASE PRESENTATION: We present a rare case of bilateral ossification of the auricles in a 75-years old man with profound progressive rigidity of both auricles. His main complaint was a mild discomfort during resting making sleeping unpleasant without any other serious symptoms. His medical history was significant for predisposing factors for this condition such as, Addison's disease and diabetes mellitus. Excisional biopsy was performed confirming the ossified nature of the auricles. Further treatment deemed unnecessary in our case due to his mild clinical picture. CONCLUSION: True auricular ossification is a quite rare clinical entity with unclear pathogenesis and one should have in mind that there is always the possibility of a serious co-existed disease like endocrinopathy.

Estrogen receptor-beta expression in human laryngeal carcinoma: correlation with the expression of epithelial-mesenchymal transition specific biomarkers.

Laryngeal carcinoma is a malignancy of the respiratory tract with a significantly higher male to female ratio, suggesting involvement of gender-depended factors in the pathogenesis. Estrogen influences the pathological processes of hormone-dependent cancers, such as breast, prostate and ovarian cancers, through its receptors, estrogen receptor-alpha (ER-alpha) and -beta (ER-beta). While ER-alpha promotes cell proliferation, recent studies indicate that ER-beta is protective against carcinoma progression into an invasive state. However, it is unclear whether ER-beta plays a role in laryngeal cancer. In the present study we examined the expression of ER-beta in 80 invasive human squamous laryngeal carcinomas by immunohistochemistry and correlated ER-beta expression with markers of epithelial-mesenchymal transition (EMT). ER-beta was expressed in 83% of tumour specimens where it was localized in the nuclei of tumour cells. The expression of ER-beta correlated positively with the maintenance of E-cadherin and beta-catenin at cell junctions and negatively with the loss of E-cadherin, nuclear translocation of beta-catenin and increased TNM stage. We concluded that estrogen receptor-beta expression is documented in laryngeal cancer indicating a possible role in the pathogenesis of this malignancy. It is suggested that ER-beta could protect tumour cells from acquiring aggressive EMT features such as E-cadherin downregulation and nuclear beta-catenin activation.

Low COX2 in tumor and upregulation in stroma mark laryngeal squamous cell carcinoma progression.

OBJECTIVES/HYPOTHESIS: Invasive squamous cell carcinomas (SCC) of the larynx, like most solid tumors, are surrounded by a reactive stroma, in which cancer associated fibroblasts (CAFs) are the predominant cell type. This mesenchymal reaction may affect cancer progression multiply. The proinflammatory enzyme cyclooxygenase-2 (COX-2) has been correlated with head and neck cancer. This study aims to explore the impact of epithelial and stromal COX-2 expression on SCC behavior. STUDY DESIGN: Retrospective case review study performed in a tertiary health center institution. METHODS: Double immunohistochemistry of COX-2 and the CAF marker alpha-smooth muscle actin (alpha-SMA) was utilized in 97 laryngeal cancer patients. Follow-up data were collected in 52 cases. RESULTS: Low COX-2 immunostaining in cancer cells was associated with advanced grade (P = .044) and shorter recurrence-free period (P = .035). CAF expression was positively correlated with the grade of the infiltrating tumor (P = .030). CONCLUSIONS: In laryngeal SCCs, COX-2 may exert its deleterious effect by alterations in the tumor microenvironment. CAF-derived, COX-2-mediated paracrine influences on malignant cells possibly facilitate cancer progression. Overlooking the stromal remodeling could account for unsuccessful treatments of epithelial neoplasms.

Tuberculosis of the parotid gland.

Tuberculosis (Tbc) presented as an isolated parotid mass is rare. Preoperative diagnosis is difficult and the symptomatology is nonspecific. In the majority of the cases an initial diagnosis of a parotid tumor, often a pleomorphic adenoma, is made. We present a 35-year old woman with a six months duration right parotid lump. The mass was firm and nontender without ipsilateral cervical lymphadenopathy, suggesting a parotid neoplasm. The computerized tomography scan showed an intraparotideal tumor resembling a pleomorphic adenoma and thus the patient underwent to a superficial parotidectomy. Fine needle aspiration biopsy was performed but it was not diagnostic. Histological examination revealed an intraparotideal lymph node with changes of granulomatous lymphadenopathy type, like those demonstrated in the tuberculosis and sarcoidosis. Ziehl-Nielsen staining was negative, while the tuberculin skin test (PPD, 5 IU) was positive. The patient's treatment regimen consisted of a 2-month initial phase of isoniazid, rifampin, pyrazinamide and ethambutol followed by a 7 month continuation phase of isoniazid and rifampin. Postoperatively, there was only a mild paresis of the facial nerve resolved a week after. Parotid Tbc is very rare but should be considered as a differential diagnosis of parotid lumps. Fine needle aspiration biopsy (FNAB) is of outmost importance for diagnosis, since the treatment of this entity is primarily conservative. However, surgery could be both therapeutic and diagnostic, especially when other diagnostic examinations fail.

Retinoid X receptor overexpression desensitizes laryngeal epithelium to carcinogenic effects associated with epidermal growth factor receptor upregulation.

OBJECTIVE: Squamous cell carcinomas (SCCs) of the larynx are sequelae of hyperplastic and dysplastic lesions. Epidermal growth factor receptor (EGFR) is found frequently overexpressed in SCCs of the head and neck, although its regulatory role is not fully elucidated. Conversely, retinoid X receptor alpha (RXRalpha) mediates the reversing effects of retinoids on head and neck carcinogenesis. We examined the expression of EGFR in relation to the progress of laryngeal tumorigenesis and how this association is modulated by concurrent RXR presence. DESIGN: A retrospective study. SETTING: A basic research anatomy laboratory, operating within a tertiary care institution. MATERIALS: Tissue samples from 129 patients with premalignant or malignant laryngeal lesions. METHOD: Paraffin-section immunohistochemistry. MAIN OUTCOME MEASURES: EGFR immunoreactivity in relation to histopathology progression, in both the presence and absence of RXR immunoexpression. RESULTS: EGFR was upregulated along the epithelial deterioration toward neoplasia (p < .001) but was unaffected by tumour grade. In RXRalpha-positive cases, a markedly stronger induction of EGFR occurred with malignant transformation compared with the epithelia immunonegative for the nuclear receptor. CONCLUSION: This study suggests that RXRalpha confers to squamous cells a shielding effect against excessive mitogenic stimulation, which might be EGFR dependent. RXR-positive patients manifesting resistance to anti-EGFR agents could benefit from rexinoid administration.

Impaired mucociliary clearance in allergic rhinitis patients is related to a predisposition to rhinosinusitis.

Although mucociliary clearance has been shown to be impaired in patients with allergic rhinitis and chronic rhinosinusitis, its exact role in relation to a predisposition to rhinosinusitis is unknown. To investigate this possible association, we conducted a prospective study of 125 patients with allergic rhinitis. Of this group, 23 patients were classified as being sinusitis-prone based on their history of antibiotic consumption for the treatment of rhinosinusitis; the remaining 102 patients were deemed to be not sinusitis-prone. The saccharine test was used to evaluate mucociliary clearance in all patients. Several variables-age, sex, smoking habits, rhinitis severity, and medication history-were examined. We found that the sinusitis-prone patients had a significantly greater mucociliary clearance time than did those who were not prone (median: 15 and 12 min, respectively; p = 0.02). No other statistically significant differences were seen between the 2 groups with respect to any other variables that might have affected mucociliary clearance. We conclude that impaired mucociliary clearance in allergic rhinitis patients is associated with a predisposition to rhinosinusitis.

Oculoauriculovertebral complex with an atypical cause of obstructive sleep apnea.

Oculoauriculovertebral spectrum (OAVS) is a birth defect of unknown etiology, often causing obstructive sleep apnea, due to unilateral retrognathia. We describe an adolescent sleep apnea patient, with usual and unusual signs of OAVS. Apart from mandibular hypoplasia, microtia, external auditory canal atresia and cervical vertebrae anomalies, skull base asymmetry was also noted, resulting in aberrant anatomy of the tympanic cavity, and nasopharyngeal obstruction, which was the main source of the patient's apneas. The extended craniofacial abnormalities manifested here, suggest a broader developmental impairment, exceeding the 1st and 2nd branchial arch malformation theory, which is the principal hypothesis for OAVS etiology.

Integrin-linked kinase cytoplasmic and nuclear expression in laryngeal carcinomas.

Integrin-linked kinase (ILK) has been implicated in the development and progression of several human malignancies. Previous in vitro studies also implicate ILK in the activation of Akt and beta-catenin as well as in the regulation of E-cadherin expression. However, the role of ILK in human laryngeal cancer and its possible in vivo downstream effectors in the disease are currently unknown. We examined by immunohistochemistry the protein expression of ILK, phosphorylated-Akt (p-Akt), E-cadherin, and beta-catenin in 97 invasive squamous laryngeal carcinomas. Increased cytoplasmic and nuclear expression of ILK and p-Akt decreased membranous expression of E-cadherin and nuclear accumulation of beta-catenin was found in 87.6%, 85.6%, 71.1%, and 43.3% of cases, respectively. Our results suggest that ILK expression may be implicated in human laryngeal carcinoma and its localization in the nucleus possibly proposes novel nuclear functions of this molecule. In addition, enhanced ILK expression correlates with activation of Akt but not with downregulation of E-cadherin and activation of beta-catenin. Finally, in our material while activated Akt seems to characterize well-differentiated tumors, loss of E-cadherin and activation of beta-catenin correlated with high grade carcinomas.

Biochemical changes of extracellular proteoglycans in squamous cell laryngeal carcinoma.

Larynx is a complicated organ with peculiar properties, having a noticeable impact in vocal and respiratory physiology. In squamous cell laryngeal carcinoma, the extracellular matrix components underwent significant modifications concerning their fine chemical structure. Degradation of aggrecan is observed, whereas versican and decorin amounts are increased. The expression of aggrecan is almost totally ceased in later cancer stages, whereas decorin is expressed in normal and cancerous samples. But its expression is increased in cancer, being related to cancer stage. However, the expression of versican seems to be characteristic of the tumor, since none or traces expression is observed in normal samples. Chondroitin/dermatan sulfate is the major glycosaminoglycan, but its sulfation shows a shift from C6 position of galactosamine in normal samples to C4 in malignancy. Dermatan sulfate represents minor amounts in normal samples but increases in proportion up to one-fourth of total sulfated glycosaminoglycans in malignancy. In addition, an increase in the amounts of hyaluronan is also observed in malignant samples. Accumulated data demonstrate that tumor progression is closely related to the alteration of the expression and biochemical composition of specific extracellular constituents that describes the mild aggressive phenotype of squamous cell laryngeal carcinoma.

Is mucociliary transport velocity related to symptoms in chronic rhinosinusitis patients?

Mucociliary transport velocity (MTV) measured by rhinoscintigraphy is considered a reliable measure of mucociliary clearance, one of the mechanisms that are distorted in chronic rhinosinusitis (CRS). The aim of this study was to investigate possible correlation of MTV with the severity of patients' symptoms. We have studied thirty-seven CRS patients who completed the 20-item sinonasal outcome test (SNOT-20) form, a reliable measure of health related quality of life and were also examined by rhinoscintigraphy with technetium-99m macroaggregated albumin. Our findings showed that the MTV of our patients ranged from nil to 4.17mm/min with a mean value of 1.74+/-1.055 mm/min. The SNOT-20 scores varied from 0.3 to 3.7 with a mean of 1.6+/-0.922. The correlation between SNOT-20 score and MTV was not statistically significant (Spearman's r=-0.191). In conclusion, although rhinoscintigraphy is widely accepted as a reliable test of mucociliary velocity and clearance, it did not correlate with subjective measures of the severity of CRS.

Glottic versus supraglottic tumors: differential molecular profile.

Glottis and supraglottis, although anatomically interconnected, are embryologically distinct. Moreover, squamous cell carcinomas arising from these subsites, differ in terms of epidemiology, risk factors, clinical behaviour and prognosis. This study aims to explore any possible differences between their molecular profiles. We investigated in the two tumor types, the expression of epidermal growth factor receptor (EGFR), nuclear factor-kappaB (NF-kappaB) and retinoid X receptor alpha (RXRalpha), principal signal transducers associated with cancer, as well as cyclooxygenase-2 (COX-2), an enzyme induced in malignant neoplasms. The clinical material includes tumor specimens from 61 patients with laryngeal cancer of glottic or supraglottic origin. Subsite groups were matched for gender, age and histological grade. Paraffin-section immunohistochemistry was performed, to detect the aforementioned molecules. Staining patterns were membranic and cytoplasmic for EGFR, purely cytoplasmic for COX-2, nuclear for RXRalpha and cytoplasmic, as well as nuclear, for NF-kappaB. Intense EGFR and RXRalpha expression was significantly associated with glottic tumor descent (P = 0.011 and 0.001, respectively). No significant relationship was established between neoplasm location and expressions of NF-kappaB, COX-2. Our results show that tumors emerging from the two laryngeal regions, are different with regard to their molecular constitution. Upregulation of EGFR and RXRalpha in carcinomas of the glottis, might be important in the design of subsite-specific chemotherapeutic approaches.

Lung function measurements in traditional bakers.

BACKGROUND: Respiratory disease is common and amenable to early detection and management in the primary care setting. Spirometric and phlethysmographic evaluation of ventilatory function plays a critical role in the diagnosis, differentiation and management of respiratory illness such as asthma, chronic obstructive pulmonary disease and restrictive disorders. METHODS: Study subjects consisted of 58 workers in the production of bread and 45 salesclerks of bread from the same bakeries. The lung function of employees was checked using a spirometry and body phlethysmography, calculating the indexes Forced expiratory volume 1 sec (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, residual volume (RV), total lung capacity (TLC), and RV/TLC ratio. The percentage of the obstructive and the restrictive impairment both in the bread producers and sellers was also searched as well as the percentage of response in the bronchodilation. RESULTS: Bread producers recorded significantly lower mean lung functions compared with salesclerks, for FEV1, FVC and FEV1/FVC ratio, when observed values were expressed as percentages of predicted normal values. Furthermore the percentage of obstructive impairment among the bread producers was 12.6%, while a percentage of 20.68% of them presented a response in bronchodilation (while the percentage in salesclerks was 6.6% respectively). The percentage of restrictive impairment was similar in both groups (12.6% for bread producers and 11.1% for salesclerks). CONCLUSION: The study concluded that bread producers in traditional bakeries in Greece are at increased risk of developing airway obstruction compared with salesclerks of bread from the same bakeries. A different degree of smoking status and of wheat flour dust exposure may explain this difference. Technical preventive measures such as well ventilated work areas and appropriate respiratory protective devices should be adopted.