[Peripheral blood cell count and inflammation-based markers in chronic rhinosinusitis]. / Zellzahl und Entzündungsparameter im peripheren Blut bei chronischer Rhinosinusitis.

OBJECTIVE: The aim of this study was to verify whether the following peripheral blood cell count and inflammation-based markers differ between various types of chronic rhinosinusitis (CRS): neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR) and platelet-to-lymphocyte ratio (PLR), as well as erythrocyte sedimentation rate (ESR) and C­reactive protein (CRP) levels. MATERIALS AND METHODS: In all, 386 patients had complete peripheral blood count, ESR, CRP and nasal cytology. The severity of CRS symptoms was assessed using three-stage Lund-Mackay computed tomography (CT) scores. The participants were stratified based on the results of nasal cytology and by the presence of nasal polyps (NP). The inflammation-based markers were calculated by dividing the cell numbers of the different cell types by numbers of the other cell types. RESULTS AND CONCLUSIONS: Blood leukocyte and neutrophil counts were higher in neutrophilic CRS. Differences between patients with CRS with nasal polyps (NP) and CRS without NP were significant for blood leukocytes, neutrophils, monocytes, eosinophils, CRP, NLR and MLR values. In CRS with NP, peripheral blood leukocyte, neutrophil, monocyte and eosinophil counts, as well as CRP, NLR and MLR values were higher than in CRS without NP. Our results show that all individuals with CRS could benefit from the analysis of blood counts and inflammation-based markers at the beginning of their evaluation. High levels of inflammation-based markers might guide the clinician towards planning more radical CRS therapy and use of systemic anti-inflammatory medication.

Induced sputum eicosanoids during aspirin bronchial challenge of asthmatic patients with aspirin hypersensitivity.

BACKGROUND: Altered metabolism of eicosanoids is a characteristic finding in aspirin-exacerbated respiratory disease (AERD). Bronchial challenge with lysyl-aspirin can be used as a confirmatory diagnostic test for this clinical condition. Induced sputum allows to measure mediators of asthmatic inflammation in bronchial secretions. OBJECTIVES: To investigate the influence of inhaled lysyl-aspirin on sputum supernatant concentration of eicosanoids during the bronchial challenge test. Subjects with asthma hypersensitive to nonsteroidal anti-inflammatory drugs were compared with aspirin-tolerant asthmatic controls. METHODS: Induced sputum was collected before and following bronchial challenge with lysyl-aspirin. Sputum differential cell count and sputum supernatant concentrations of selected lipoxygenases products: 5-,12-,15-hydroxyeicosatetraenoic acid, cysteinyl leukotrienes, leukotriene B4 , 11-dehydro-thromboxane B2 , and prostaglandins E2 , D2 , and F2α and their metabolites, were measured using validated methods of chromatography-mass spectrometry. RESULTS: Aspirin precipitated bronchoconstriction in all AERD subjects, but in none of the aspirin-tolerant asthmatics. Phenotypes of asthma based on the sputum cytology did not differ between the groups. Baseline sputum eosinophilia correlated with a higher leukotriene D4 (LTD4 ) and leukotriene E4 (LTE4 ) concentrations. LTC4 , PGE2 , and 11-dehydro-TXB2 did not differ between the groups, but levels of LTD4 , LTE4 , and PGD2 were significantly higher in AERD group. Following the challenge, LTD4 and LTE4 increased, while PGE2 and LTB4 decreased in AERD subjects only. CONCLUSIONS: During the bronchial challenge, decrease in PGE2 and its metabolite is accompanied by a surge in bronchoconstrictory cysteinyl leukotrienes produced at the expense of LTB4 in AERD subjects. Bronchial PGE2 inhibition in AERD seems specific and sensitive to a low dose of aspirin.

A case of respiratory epithelial adenomatoid hamartoma of the sinonasal tract.

Respiratory epithelial adenomatoid hamartoma is a rare, non-neoplastic tumour characterised by an abnormal mixture of tissues that are indigenous to the region. REAH are shiny, polypoid, exophytic masses with a rubbery to firm texture. They may arise and co-exist in the setting of inflammatory polyps. We present a case of a 49-year-old patient who was referred to the department with a clinical diagnosis of chronic nasal sinusitis. Results of post-op histopathological examination show a mild change of the respiratory epithelium requiring, among others, differentiation from inverted papilloma and adenoid carcinoma.

The presence of B7-H4+ macrophages and CD25+CD4+ and FOXP3+ regulatory T cells in the microenvironment of nasal polyps - a preliminary report.

The nasal polyp (NP) seems to represent the end-stage of longstanding inflammation in patients with chronic rhinosinusitis. The aim of our study has been to evaluate the presence of two regulatory cell populations in the microenvironment of NP: CD4+CD25high Foxp3+ (Treg) cells and B7-H4-expressing macrophages. Treg cells are actively able to inhibit T lymphocytes, while the population of B7-H4-expressing macrophages has recently been described as characterized by a regulatory function similar to that of Treg cells. For our study, we evaluated 14 NP tissue samples. The samples were divided into two main groups, eosinophilic (NP) and lymphocytic (NP), according to the predominant type of immune cell infiltration. The presence of Treg cells and B7-H4 positive macrophages in the samples was analyzed by FACS. Treg cells and B7-H4-expressing macrophages were identified in all the examined nasal polyps. The percentages of both Treg cells and of B7H4 positive cells found in the eosinophilic nasal polyps were higher than those found in the lymphocytic nasal polyps. Treg cells and B7H4+ macrophage subpopulations were present in the NP microenvironment and the alterations in their percentages were related to a distinct pattern of immune cell infiltration.

A giant cranial aneurysmal bone cyst associated with fibrous dysplasia.

An aneurysmal bone cyst (ABC) is a rare, benign fibro-osseous lesion, considered a vascular phenomenon secondary to fibrous dysplasia or a giant-cell tumour, and occurs mainly in long bones and vertebrae. In this case report a 16-year-old male presented with massive epistaxis. He was admitted with a 3-year history of chronic rhinitis, headaches, right ocular pain and recurrent epistaxis. CT scans showed a predominantly cystic, expansive mass obstructing both nasal cavities, extending to all paranasal sinuses and both orbits, with evidence of anterior cranial fossa skull base destruction. The patient underwent a craniofacial resection of the tumour performed with an external approach and an immediate reconstruction of the dural defect. Histology confirmed the lesion was an ABC associated with fibrous dysplasia. The patient's recovery was complete. A large facial aneurysmal bone cyst can damage the facial skeleton and skull base, and requires excision by a combined external approach.

Sphenoid sinus pyocele with intracranial extension managed under endoscopic guidance: a report of an extremely rare case.

OBJECTIVES: Sphenoid pyoceles with intracranial extension are extremely rare lesions that can mimic tumours and usually cause ophthalmological symptoms. Their infectious nature mandates urgent surgical decompression since pyoceles can cause intracranial and orbital complications. CASE REPORT: A 16-year-old male presented with intense headache and dizziness lasting three days. On admission, the patient gave a five-year history of chronic rhinitis, nasal congestion, and progressively worsening headaches. Ophthalmological examination was normal. CT and MR scans disclosed distension of the sphenoid sinus by a pyocele 55 mm in diameter, extending to the presellar region through the eroded cribriform plate. The patient underwent an endoscopic transnasal sphenoethmoidectomy. After surgery he reported improvement in all preoperative symptoms and was asymptomatic at 3-months follow-up. CONCLUSIONS: A huge sphenoid sinus pyocele with intracranial extension may cause no ophthalmological symptoms. It can be safely managed using endoscopic techniques.

[Transient evoked otoacustic emission in children with juvenile idiopatic arthritis]. / Otoemisja akustyczna wywolana trzaskiem u dzieci z mlodzienczym idiopatycznym zapaleniem stawów.

Juvenile idiopathic arthritis (JCA) is an inflammatory systemic disease of connective tissue which etiology is still unknown. Progressive arthritis is the basic symptom, with pain, oedema, stiffness and movement impediment are typical for. Chronic process of arthritis might be accompanied by rheumatoid nodes, pericarditis, myocarditis, changes in the lungs and kidney, which appear with various frequency and indicates on systemic form of disease. The incudo-malleolar and incudo-stapedial joints are synovial in type. It should be expected that these joints might be affected by rheumatoid changes similar to those observed in joints in other parts of the body. Copeman was the first who described transient conductive hearing loss in patients with exacerbated rheumatoid process--and he called it oto-arthritis. He stressed that it was the consequence of the rheumatoid lesions in joints of ear ossicules. In adult patients with JCA in 60% of cases the perceptive hearing-loss is observed possibly because of the chronic course of the disease and its farmacological treatment. The aim of the study was the assessment of the functional state of the peripheral part of hearing organ on the basis of TEOAE. This study was preceded by examination of hearing with pure tone audiometry, speech audiometry, high frequency audiometry and impedance audiometry. The analysis of results was done in correllation to form of JCA and its activity. The research was carried out on the group of 45 children suffering from JCA; 14 boys and 31 girls between 5-18 years of age. In all children from experimental group the examination was performed in the active phase of disease process. Mean duration of the disease was 33.5 month. In all children TEOAE was obtained no matter on the form of JCA. Children with systematicus form of JCA--more aggressive type than others--have the recordings of TEOAE with small amplitude and narrow range of frequency. Those results show that rheumatoid lesions in conductive mechanism of the middle ear are insufficient for the development of the conductive hearing loss. As a results of chronic pathological process destructions of hearing organ may lead to the cochlear lesions and this way to perceptive hearing loss.

Osteoma of the sphenoid sinus.

OBJECTIVE: Only twenty cases of osteomas of the sphenoid sinus have been reported. This tumour causes progressively worsening headaches and visual disturbance and should be resected when symptomatic or fast-growing. In selected cases, endoscopic sinus surgery offers an effective alternative to open procedures. CASE REPORT: The authors report a case of sphenoid osteoma in a 19-year old woman. Computed tomography performed because of complaints of progressively worsening headaches identified a large osteoma of the sphenoid sinus. The clinical features and radiological assessment of the disease are presented together with a review of the literature. RESULTS: The endoscopic technique used for resection of the tumour gave a very good result. CONCLUSION: Sphenoid osteoma is an extremely rare lesion which can be approached endoscopically in selected cases.

Endoscopic removal of air gun pellet in the sphenoid sinus.

THE OBJECTIVE: The presence of an isolated foreign body in the sphenoid sinus is a rare finding, and a retained projectile in this sinus is even more uncommon. CASE REPORT: The authors report the case of a 15-year-old male that was shot in the face with an air gun but was nevertheless able to seek for medical help. The anatomical considerations of the gunshot injury are made, and radiological assessment of the foreign body is presented. THE RESULT AND CONCLUSION: The projectile could be successfully removed with an endoscopic technique, no short or long term sequelae occurred.

The effect of hormonal factors on the hearing organ in women, after surgical castration. Preliminary report.

BACKGROUND: Estrogens have not only direct and beneficial effect on relaxation of the arteries increasing the blood flow in the blood vessels, but also their level of secretion has considerable effect on synthesis of acetylcholine a neurotransmitter indispensable for appropriate functioning of the hearing organ. The aim of this study is analysis of the effect of hormones on the hearing organ in women who underwent surgical castration. MATERIAL: The study included 40 females, aged between 32 55 years who had undergone an operative treatment mainly because of uterine myoma. A group of 50 women aged between 32 50 years with appropriate hormone level comprised the control group. METHOD: Each woman investigated underwent the following examinations: gynaecological, otolaryngological and laboratory tests, such as: evaluation of levels of estradiol (E) and folliculin stimulating hormone (FSH). The assessment of hearing was carried out using tone and speech audiometry, tympanometry, test registration of auditory brain stem responses (ABR) and otoacoustic emissions (EOAE). The examinations mentioned above are performed in women as initial examinations before surgical treatment and as follow-up examinations 1, 3 and 12 months after the surgery. RESULTS: The results presented in this paper include initial examinations and follow-ups 3 months after the surgical treatment taking into consideration the correlation with the results of laboratory tests and the results obtained in the control group.

[Video-roentgen cinematographic evaluation of pharyngeal phase disorders during swallowing in patients after partial laryngectomy due to localized supraglottic cancer]. / Wideorentgenokinematograficzna ocena zaburzen fazy gardlowej aktu polykania u chorych po operacjach czesciowego usuniecia krtani z powodu raka o lokalizacji nadglosniowej.

Videorentgenocinematographic examinations of swallowing were conducted on 81 patients after partial laryngectomy and on 35 subjects being a control group. Resection of piriform recess, a part of base of the tongue, the hyoid bone or its part is the factor that causes intensified difficulty during swallowing and increase in the frequency of the occurrence of aspiration. The results of videorentgenocinematographic examinations indicate that the shape and mobility of the tongue and the mobility of remaining after the surgery parts of the larynx have the greatest influence on the efficient swallowing in patients who have undergone partial laryngectomy due to cancer initially located in the supraglottic area. The larynx mobility is closely related to the remaining of the hyoid bone. The importance of remaining the possibly non-deformed structure and mobility of the tongue during partial laryngectomy involves the issue of reconstruction of defects occurred during the surgery. Videorentgenocinematographic examinations confirm the effectiveness of the method involving reconstruction of defects in a part of the base of the tongue with a vascular pedicle flap of the submandibular gland.

[Manometric analysis of the oral and pharyngeal phases of the act of swallowing]. / Badania manometryczne fazy ustnej i gardlowej aktu polykania.

Manometric analysis of swallowing was conducted on 35 subjects, aged 44 to 60. The course of physiological changes in pressure during oral and pharyngeal phase of swallowing was analysed. To objectify the evaluation of analysed phenomena, parameters that include both pressure values inside pharynx and oesophagus and time dependences connected with changes in their value were used as proposed by the authors of this paper and as applied by other authors involved with these issues.

[Objective evaluation of the influence of the tongue base reconstruction on the swallowing disorders]. / Obiektywna ocena wplywu rekonstrukcji nasady jezyka na zaburzenia aktu polykania.

Laryngographic, manometric and videorentgenocinematographic examinations of swallowing were conducted on 54 patients after partial laryngectomy and on 35 subjects being a control group. Resection of a part of the base of the tongue is the factor that causes intensified difficulty during swallowing and increase in the frequency of the occurrence of aspiration. The results of manometric and videorentgenocinematographic examinations indicate that the shape and mobility of the tongue has the greatest influence on the efficient swallowing in patients who have undergone partial laryngectomy due to cancer initially located in the supraglottic area. The importance of remaining the possibly non-deformed structure and mobility of the tongue during partial laryngectomy involves the issue of reconstruction of defects occurred during the surgery. Both manometric and videorentgenocinematographic examinations confirm the effectiveness of the method involving reconstruction of defects in a part of the base of the tongue with a graft of angio-pedunculated submandibular gland. The study of effectiveness of glottis or neoglottis performed with the use of laryngograph showed no relation between glottis/neoglottis occlusion effectiveness index and intensified swallowing disorders. This shows the lack of compensating option in swallowing disorders with the help of a mechanism based on an efficient glottis or neoglottis occlusion alone.

[Objective evaluation of the influence of the hyoid bone resection on the disorders in the act of swallowing]. / Obiektywna ocena wplywu resekcji kosci gnykowej na zaburzenia aktu polykania.

Laryngographic, manometric and videorentgenocinematographic examinations of swallowing were conducted on 49 patients after partial laryngectomy and on 35 subjects being a control group. The results of examinations indicate that the mobility of remaining after the surgery parts of the larynx have the great influence on the efficient swallowing. The larynx mobility is closely related to the remaining of the hyoid bone. Resection of the hyoid bone or its part is the factor that causes intensified difficulty during swallowing and increase in the frequency of the occurrence of aspiration. The study of effectiveness of glottis or neoglottis performed with the use of laryngograph showed no relation between glottis/neoglottis occlusion effectiveness index and intensified swallowing disorders. This shows the lack of compensating option in swallowing disorders with the help of an mechanism based on an efficient glottis or neoglottis occlusion alone.

[Videorentgenocinematographic analysis of pharyngeal phase in the act of swallowing]. / Badania wideorentgenokinematograficzne fazy gardlowej aktu polykania.

The course of the pharyngeal phase was analysed in physiological conditions. The mobility of anatomical structures taking part in the phase was evaluated, taking into consideration the time sequence in which the elements of the phase followed. To objectify the evaluation of the analysed phenomena, authors of this paper proposed and used linear and time parameters also used by other authors involved with these issues.

[The development of concept of partial surgery of the larynx due to supraglottic cancer]. / Rozwój koncepcji zastosowania operacji czesciowego usuniecia krtani z powodu raka o pierwotnej lokalizacji w pietrze nadglosniowym.

It has been shown the conception of partial surgery of the larynx due to cancer primary develops in the supraglottic. The evolution of this method which is a consequence of progress in anatomical and embryological knowledge as well as technical possibilities of surgeons has been introduced. The modern methods of partial removal of larynx let resume physiological function of larynx with oncological security.

[Effectiveness coefficient for laryngographic closure of the glottis as a way of evaluating airway protection against aspiration of gastric contents]. / Wskaznik skutecznosci zwarcia glosni (w.s.z.g.) jako sposób oceny zabezpieczenia dróg oddechowych przed aspiracja tresci pokarmowej.

Laryngographic examination was conducted on 35 men aged 45 to 65 with good hearing and proper pronunciation. Based on the examination, the proposed by the authors of this paper laryngographic closure effectiveness coefficient of the glottis (LCEC) was calculated as a way for evaluating protection of airways against the aspiration of food. Glottis occlusion serves an essential function as a mechanism protecting airways, especially in patients who have undergone horizontal supraglottic laryngectomy. The examination was conducted with the purpose of obtaining numerical values of LCEC, which will be treated as results of the controlled group during the examination of swallowing disorders in patients with partial laryngectomy.

[Evaluation of airway protection against aspiration of gastric contents in patients after partial laryngectomy using the laryngographic closure effectiveness coefficient of the glottis/neoglottis]. / Ocena zabezpieczenia dróg oddechowych przed aspiracja tresci pokarmowej u chorych po operacjach czesciowego usuniecia krtani za pomoca wspólczynnika skutecznosci zwarcia glosni/neoglosni (w.s.z.g.).

Laryngographic examinations were conducted on 97 patients who had undergone partial laryngectomy and on 35 subjects being a control group. The study of effectiveness of glottis or neoglottis performed with the use of laryngograph showed no relation between glottis/neoglottis occlusion effectiveness index and intensified swallowing disorders. This shows the lack of compensating option in swallowing disorders with the help of a mechanism based on an efficient glottis or neoglottis occlusion alone.