[Chlamydia trachomatis and urogenital mycoplasms in nonconococcal urethritis in men].

INTRODUCTION: Nongonococcal urethritis is the most common sexually transmitted infection in men, with vast majority of the etiological agents such as Chlamydia trachomatis, followed by urogenital mycoplasmas. The aim of this study was to determine the prevalence of Chlamydia trachomatis, Ureaplasma urealyticum and Mycoplasma hominis in nongonococcal urethritis in men, and to examine infections associated with these agents. Material and methods 299 sexually active, heterosexual men with nongonococcal urethritis were included into the study. Urethral samples were taken with a dacron swab placed into the urethra up to 2-3 cm. The Direct immunofluorescence technique was performed for identification of Chlamydia trachomatis. Ureaplasma urealyticum and Mycoplasma hominis were detected with Mycoplasma IST assay. RESULTS: Chlamydia trachomatis was detected in 22.75%, Uraeplasma urealyticum in 21.08% and Mycoplasma hominis in 8.02% cases. We found no significant differences in prevalence between Chlamydia trachomatis and Ureaplasma urealyticym (p > 0.05). Monoinfections were found in 51.85% with significantly higher rate (p < 0.01) than associated infections (11.70%). Among associated infections, coinfection of Chlamydia trahomatis and Ureaplasma urealyticum was predominant. Association of Chlamydia trachomatis with urogenital mycoplasmas was significantly higher (p < 0.05) than the one between Ureaplasma urealyticum and Mycoplasma hominis. In 36.45% patients no patogenic microorganisms were detected. CONCLUSION: These results confirmed the etiological role of Chlamydia trachomatis and urogenital mycoplasmas in nongonococcal urethritis with prevalence of 51.85% in monoinfections and 11.70% in associated infections. In 36.45% of cases the etiology of urethritis was not elucidated. These results suggest that more sensitive diagnostic tool should be applied when searching for the derailed etiology of nongonococcal urethritis.

[Effect of topical administration of beclomethasone dipropionate on symptoms of chronic rhinitis]. / Efekti topijske primene beklometazon dipropionata na simptome hronicnog rinitisa.

The aim of this study was to evaluate the effect of topical administration of corticosteroid beclomethasone dipropionate on common nasal symptoms in moderate allergic and non-allergic hyperreactive eosinophilic rhinitis, and in allergic and non-allergic hyperreactive eosinophilic rhinitis associated with bilateral moderate nasal polyposis. The study was prospective and controlled. During the study 106 patients were examined, out of whom 66 were treated, while 40 had no therapy. Beclomethasone diproprionate nasal spray was administered in the daily dose of 400 micrograms. Patients with isolated rhinitis underwent 3 otorhinolaryngologic examinations during the six-week treatment. Patients with nasal polyposis underwent 4 otorhinolaryngologic examinations during six-month treatment. One-week therapy showed highly significant decrease of the average score of symptoms of isolated rhinitis in relation to basal condition. No further significant change was noted after six-week therapy. Six-week therapy of nasal polyposis exerted significantly reduced score of symptoms in relation to basic condition. During further treatment no significant reduction of symptoms was noted. Follow-up period of all control subgroups showed no significant change of symptom scores. Topical therapy with beclomethasone dipropionate represented a significant medication of the first therapeutic line in moderate isolated eosinophilic rhinitis, as well as in moderate bilateral eosinophilic nasal polyposis.

Skin reactivity to vasomotor agents in non-eosinophilic and eosinophilic non-allergic rhinitis.

The aim of this prospective study was to examine skin reactivity to four vasomotor agents and to determine whether non-eosinophilic rhinitis patients differ from patients with eosinophilic rhinitis. Nasal cytology enabled us to classify 74 rhinitis patients into a non-eosinophilic (n = 63) and an eosinophilic group (n = 11). Skin reactivity to intradermal tests with papaverine, metacholine, histamine and compound 48/80 was measured. No significant difference for papaverine, metacholine, histamine and compound 48/80, singly, was found between the non-eosinophilic and eosinophilic group. The frequency of the total pathological skin reactivity to vasomotor agents, singly and in combinations, was greater in the eosinophilic (91 per cent) then in the non-eosinophilic group (78 per cent) but intergroup difference was not significant. These findings suggest that pathologic skin reactivity to vasomotor agents is a feature of non-eosinophilic as well as eosinophilic non-allergic rhinitis patients and indicate that no difference is noticed in the skin reactivity between these groups.

[Intradermal tests with vasomotor agents in chronic noninfectious rhinitis]. / Intradermalni testovi vazomotornim agensima kod hronicnog, neinfektivnog rinitisa.

The aim of this prospective study was to examine the skin reactivity to four vasomotor agents in chronic, non-infectious rhinitis patients, and to determine whether non-allergic rhinitis (NAR) patients differ from allergic rhinitis (AR) patients. Seventy four patients with NAR and 44 with AR were subjected to intradermal testing with papaverine (5 mg/ml), metacholine (0.02, 0.2 and 2.0 mg/ml), histamine (0.01, 0.1, 1.0 and 10.0 micrograms/ml), compound 48/80 (0.01, 0.1, 1.0 and 10.0 micrograms/ml) and saline. It was found that the frequency of pathological skin reactivity to papaverine in the patients with NAR (25/74) was significantly greater (p = 5.0 x 10(-3)) then in the patients with AR (4/44). No significant inter-group difference in skin reactivity to metacholine, histamine, compound 48/80 and saline was observed. The frequency of the total pathological skin reactivity to vasomotor agents, singly and in combinations, in patients with NAR (80%) was significantly greater (p = 0.03) than in patients with AR (61%). These findings suggested that the pathological skin reactivity to papaverine, metacholine, histamine and compound 48/80 was a feature of chronic, non-infectious rhinitis patients and it was more frequently associated with non-allergic than with the allergic etiology of rhinitis.

[Chronic rhinitis--effect of topical administration of corticosteroids on eosinophilic leukocytes]. / Hronicni rinitis--efekti lokalne primene kortikosteroidnih lekova na eozinofilne leukocite.

Clinical manifestation of chronic rhinitis is due to local release of mediators from inflammatory cells. Eosinophil leukocytes are important in pathogenesis of nasal hypersensitivity as well as nasal hyperreactivity [1, 2]. The aim of the study was to follow-up the effect of local corticosteroid treatment on a number of eosinophils in nasal secretion of patients with chronic rhinitis. The study was prospective and controlled. A total number of 88 subjects was included in the study. Patients with chronic rhinitis who were treated with local corticosteroids (63) constituted the experimental group (37 with isolated allergic rhinitis, 10 with isolated nonallergic noninfective hyperreactive rhinitis, 10 with allergic rhinitis associated with nasal polyposis and 6 with nonallergic noninfective hyperreactive rhinitis associated with nasal polyposis). There were 25 patients with chronic rhinitis in the control group (18 with isolated allergic rhinitis, 2 with isolated nonallergic noninfective hyperreactive rhinitis, 3 with allergic rhinitis associated with nasal polyposis, and 2 with nonallergic noninfective, hyperreactive rhinitis associated with nasal polyposis). During the treatment with beclomethasone dipropionate aqueous nasal spray (daily dose was 400 micrograms during 6 weeks for isolated rhinitis and 6 months for associated forms of rhinitis), control examinations were regulary performed. The first control was after one week, the second after six weeks, the third after three months and the fourth after six months. The same control was carried out in the control group of patients who were without therapy. Cytological examination of nasal secretions included brush method of collecting secretions, staining smears with Leishman's stain and light microscopic scrutinising of nasal smear magnified up to 1000 times. The results of the study demonstrated the highly significant decrease in the number of eosinophils after the therapy in patients with isolated allergic rhinitis (x2(FR) = 71,121, DF = 2, p < 0.01), in patients with isolated hyperreactive rhinitis (x2(FR) = 19,050, DF = 2, p < 0.01), in patients with allergic rhinitis associated with nasal polyposis (x2(FR) = 26,730, DF = 3, p < 0.01), as well as in patients with hyperreactive rhinitis associated with nasal polyposis (x2(FR) = 17,000, DF = 3, p < 0.01). There were no significant differences in control group of patients, neither in subgroup with allergic rhinitis (x2(FR) = 2,528, DF = 2, p > 0.05) nor in subgroup with hyperreactive rhinitis associated with nasal polyposis (x2(FR) = 0.250, DF = 2, p > 0.05) (Table 2). Local corticosteroids have the potential to influence the regulation of eosinophil apoptosis. The induction of apoptosis by beclomethasone dipropionate treatment is an efficient way to remove eosinophil leukocytes from inflammatory sites [8]. The locally used corticosteroids in chronic rhinitis reduced significantly the number of eosinophils in nasal secretion. This result proves immunomodulatory effects of these medicaments in the pathogenesis of chronic rhinitis.

[Juvenile angiofibroma of the nasopharynx--clinical diagnosis and therapy]. / Juvenilni angiofibrom nazofarinksa--iskustva u klinickoj dijagnostici i lecenju.

Juvenile nasopharyngeal angiofibroma is an infrequent epipharyngeal tumour necessitating particular diagnostic and therapeutic procedures in comparison to other benign epipharyngeal tumours due to its expansive growth tendency. Our retrospective study is aimed at presenting clinical casuistry of the tumour in order to evaluate modern diagnostic and therapeutic possibilities. The study included 13 male patients, aged 13-24 years, who were hospitalized, diagnostically assessed and surgically treated at the Institute of Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia over the period 1990-June 2001. The following parameters were analyzed: sex, age groups, preoperative symptoms of the disease, diagnostic methods, embolization, local tumour spreading, number and time of tumour relapses and surgical approach.

[Rhabdomyosarcomas in the naso-paranasal area]. / Rabdomiosarkomi nazoparanazalne regije.

The nasoparanasal region rhabdomyosarcoma belongs to the group of the rare malignant diseases, however it nevertheless represents major diagnostic and therapeutic problem. The study is aimed at presenting clinical casuistry of the nasoparanasal region rhabdomyosarcoma in adults and children, for the purpose of assessment of modern diagnostic and therapeutic possibilities. The study was retrospective and included the patients with evidenced and pathohistologically verified rhabdomyosarcoma of the nasoparanasal region diagnosed and treated at the Institute of Otorhinolaryngology and Maxillofacial Surgery of the Clinical Centre of Serbia, during the period 1988-2001, and subsequently at the Institute of Oncology in Belgrade. The total of 9 patients aged 3-50 years (median 15) were assessed, with the female to male ratio being 4:5. Seven patients were previously hospitalized in other health institutions. The following parameters were analyzed: sex, age group, number of hospitalizations, diagnostic procedures, histological tumour types, mode of treatment and disease outcome. In 7 patients, the tumour spread beyond the nasoparanasal region--in 6 into the orbit, in 5 into the epipharynx, in 3 intracranially, in 1 into the pterygopalatine pit and in another 1 into the parapharyngeal space. Regional lymph nodes were affected only in one patient, while distant bone metastases were evidenced on another one. Embryonal type of the rhabdomyosarcoma was verified in 7 patients, while two had the alveolar type. In the affected children mean survival was significantly longer (76.3 months) in comparison to the one observed in adults (11.5 months). Therapeutic procedure included combined application of the chemotherapeutic protocols (adjusted with respect to the age group and stage of the disease) and radiotherapy. Radical surgical procedures were applied on in case of stage I tumours, and they may also be used in rest-relapse cases subsequent to the applied chemo-, i.e., radiotherapy.