The effect of passive smoking on bacterial colonisation of the upper airways and selected laboratory parameters in children.

Exposure to tobacco smoke is associated with a higher risk of respiratory tract diseases. The aim of this study was to determine the influence of passive smoking on selected characteristics of children with adenoid hypertrophy. Sixty-one children with adenoid hypertrophy were enrolled in the prospective study. Differences in bacterial colonisation of middle nasal meatus and nasopharynx and changes in selected laboratory immune and inflammatory markers according to the tobacco smoke exposure were analysed. Exposure to tobacco smoke was associated with significantly higher colonisation of pathogenic bacteria and polymicrobial growth of pathogenic bacteria (≥ 2 bacteria) in middle nasal meatus compared to non-exposed children (P = 0.045, P = 0.032, respectively). Identification of pathogenic bacteria in the middle nasal meatus did not correlate with isolation of pathogenic bacteria in the nasopharynx in either group of children. Parameters of humoral immunity in serum, IgA and IgG, were detected at higher concentrations in children exposed to tobacco smoke (P = 0.047, P = 0.031, respectively). Differences in selected parameters of cellular immunity in peripheral blood according to passive smoking were not observed. Tobacco smoke exposure is related to increased colonisation by pathogenic bacteria in middle nasal meatus and elevation of IgA and IgG in peripheral blood, but does not seem to influence markers of cellular immunity parameters in children with adenoid hypertrophy. Avoidance of passive smoking could be recommended as a universal preventive strategy against microbial colonisation of the upper airways and development of various inflammatory diseases in children, e.g. adenoid hypertrophy.

The effect of adenotomy, allergy and smoking on microbial colonization of upper aerodigestive tract in children.

AIM: To evaluate microbial colonization of upper aerodigestive tract in children and to investigate the influence of adenoid hypertrophy, allergy and exposition to cigarette smoke on presence of pathogens. METHODS: In 43 children with adenoid hypertrophy and 17 healthy children bacterial culture was performed by a swab from middle nasal meatus, nasopharynx and tonsils. The effect of adenotomy, presence of allergy and exposure to passive smoking on bacterial colonization were investigated. RESULTS: Identification of potentially pathogenic bacteria in upper aerodigestive tract was significantly higher in children with adenoid hypertrophy compare to control group. Adenotomy was associated with significantly decreased colonization by potential pathogens. Allergy was diagnosed in 33 % children with adenoid hypertrophy. Presence of allergy and exposure to tobacco smoke were associated with significantly more often colonization by potentially pathogenic bacteria in the upper aerodigestive tract. CONCLUSION: Increased colonization of upper aerodigestive tract by potential pathogens and their significant decrease after adenotomy indicate the role of pathogenic bacteria in the etiopathogenesis of adenoid hypertrophy. Allergy and tobacco smoke exposure are related to increased colonization by potentially pathogenic bacteria in the upper aerodigestive tract.

Papillary Carcinoma of Thyroid Gland in a Two-year-old Child.

BACKGROUND: Thyroid nodules are less common among children than among adults. By contrast, thyroid nodules are more often malignant in childhood than in adulthood. In children, 26% of thyroid nodules are malignant, while in adults the corresponding value is 5-10%. Risk factors for developing thyroid nodules in children are female sex, post-pubertal age, previous or co-existing thyroid disease, previous irradiation of the neck, and a family history of thyroid disease. In children younger than 10 years, when no risk factors are present, the incidence rates are practically negligible. CASE REPORT: A two-year-old girl presented with a right thyroid mass. Laboratory evaluation revealed normal levels of triiodothyronine and thyroid-stimulating hormone. Thyroid ultrasonography revealed a 4.8 × 3.2 × 2.5 cm nonhomogenous nodule. The patient underwent right hemithyroidectomy. The pathology was consistent with papillary thyroid carcinoma; therefore, total thyroidectomy and selective neck dissection were performed. CONCLUSIONS: We report a very rare case of papillary thyroid carcinoma in a two-year-old child with no risk factors. The detection of a thyroid nodule in such a young child with no pre-disposing risk factors does not exclude the possibility of thyroid carcinoma and warrants careful evaluation and appropriate therapy.

Surfactant proteins A and D are related to severity of the disease, pathogenic bacteria and comorbidity in patients with chronic rhinosinusitis with and without nasal polyps.

BACKGROUND: Surfactant proteins (SP) A and D play a critical role in the innate defence of respiratory mucosa. Although numerous studies have focused on the importance of surfactant in the lower airways, relatively little is known about its role in the upper respiratory system. METHODS: The prospective study was conducted with 61 subjects divided into patients with chronic rhinosinusitis with nasal polyps (CRSwNP), with chronic rhinosinusitis without nasal polyps (CRSsNP) and healthy controls. SP-A and SP-D were detected in nasal lavage fluid (NALF) by ELISA and in nasal mucosa by immunohistochemical staining. Severity of the diseases assessed by preoperative CT score, presence of comorbidity (allergy and bronchial asthma) and bacterial culture from the middle nasal meatus was evaluated. RESULTS: In nasal mucosa, SPs were localised in ciliated cells of the surface epithelium and serous acini of the submucosal glands. Stronger expression of SPs in submucosal glands was observed in CRSwNP and CRSsNP groups in comparison with controls. In patients with CRSsNP and more severe form of the disease, higher levels of SP-A and SP-D in NALF and stronger immunoreactivity of these proteins in nasal mucosa were detected. Identification of pathogenic bacteria was associated with higher levels of SP-A and SP-D in NALF and nasal mucosa in patients with CRSsNP and control group. Presence of allergy was associated with stronger expression of SP-A in submucosal glands in all CRS patients and with decreased levels of both SPs in NALF in CRSsNP patients. CONCLUSIONS: Surfactant proteins A and D play an important role in innate host defence of upper respiratory tract. Different expression of these proteins in patients with chronic rhinosinusitis indicates possible novel target of therapy in these patients.

Total thyroidectomy: safe and adequate treatment for papillary microcarcinoma of the thyroid gland.

Total thyroidectomy: safe and adequate treatment for papillary microcarcinoma of the thyroid gland. OBJECTIVE: The purpose of this study was to evaluate the incidence of and surgical approach in patients with papillary thyroid microcarcinoma (PTMC; thyroid cancer s10 mm) when these patients underwent surgery for presumed benign thyroid conditions. MATERIAL AND METHODS: Between January 2006 and December 2013, 1460 adult patients underwent partial or total thyroidectomy for presumed benign thyroid conditions in the Department of Otorhinolaryngology, Head and Neck Surgery, Comenius University, Jessenius Faculty of Medicine, University Hospital in Martin, Slovakia. Of this population, 78 patients with incidental PTMC were further studied. RESULTS: Incidental papillary microcarcinoma was more frequently detected in patients with multinodular goitre (P = 0.034) or Hashimoto's thyroiditis (P=0.00 13) than in patients with other thyroid diseases. Multifocal and bilateral occurance of PTMC was identified in 26% and 18% of patients, respectively. The initial surgical procedure was -hemithyroidectomy in 23% of patients. All patients initially treated with hemithyroidectomy underwent completion thyroidectomy 10-32 days (median 19 ±7 days) after initial surgery. There were no significant differences in postoperative complications (recurrent laryngeal nerve injury, hypoparathyroidism) between patients with hemithyroidectomy and patients with total thyroidectomy at the first operation (P = 0.647). Completion surgery in patients with hemithyroidectomy was not followed by a significant increase in the incidence of complications (P=0.228). CONCLUSION: Incidental PTMC is more often detected in patients that undergo surgery for multinodular goitre and Hashimoto's thyroiditis. Total thyroidectomy constitutes a safe and adequate surgical approach in patients with PTMC.

[Malignant tumors of thyroid gland]. / Malígne nádory stítnej zlazy.

AIM: The incidence of thyroid cancer has been increasing. The aim of this work was to determine risk factors, diagnostic methods and extent of surgical treatment of malignant goiter. MATERIAL AND METHODS: The authors retrospectively analyzed patients who were surgically treated for thyroid disease at the Department of Otorhinolaryngology, Head and Neck Surgery, Comenius University, Jessenius Faculty of Medicine, Teaching Hospital in Martin, Slovakia, from the January 1st, 2006 to December 31st, 2013, for thyroid disease. The incidence, risk factors of malignant thyroid tumors, indication for surgery and its complications were evaluated. RESULTS: A total of 1,620 adult patients were surgically treated for thyroid disease at the Department of ENT, Head and Neck Surgery, CU JMF, UH in Martin, Slovakia, between 2006- 2013. Malignant tumors were identified in 238 patients (15%). Microcarcinoma (incidentally detected malignant tumor 1 cm) occurred in 78 cases (5%). Malignant thyroid tumor was more common in younger patients (p = 0.002). Newly created and larger nodules positively correlated with the occurrence of malignancy (p = 0.003, p = 0.041, resp.). Gender, family history of thyroid disorder, previous radiation therapy, and previous malignancy did not affect the incidence of malignant tumor of thyroid gland. High sensitivity and specificity in the dia-gnosis of malignant thyroid nodule was observed using aspiration cytology (75%, 97%, resp.) and intraoperative histopathological examination (88%, 100%, resp.). CONCLUSION: Malignant tumor of thyroid gland is more common in younger patients with newly developed nodule. The risk factors of malignancy increase with the size of the thyroid nodule. Aspiration cytology and peroperative histopathology have high sensitivity and specificity in the dia-gnosis of malignant thyroid tumor; therefore, they should be a standard method in the dia-gnosis of nodular goiter. The method of choice in the treatment of thyroid malignancy is total thyroidectomy.

Comorbidity has no impact on eosinophil inflammation in the upper airways or on severity of the sinonasal disease in patients with nasal polyps.

OBJECTIVE: The study was designed to determine whether there is an association between the comorbidity as atopy, bronchial asthma, aspirin intolerance and eosinophil infiltration of the upper airways, severity of the sinonasal disease and rate of revision sinus surgery in patients with nasal polyps. MATERIAL AND METHODS: One hundred and fifty patients were enrolled in the prospective study. Differences in CT score, rate of revision surgery, concentration of eotaxin and eosinophil cationic protein in nasal lavage fluid (NALF) and distribution of eosinophils in NALF and nasal tissue in patients with chronic rhinosinusitis with nasal polyps (CRSwNP), chronic rhinosinusitis without nasal polyps (CRSsNP) and control group were investigated. We focused on the relationship between presence of comorbidity (atopy, bronchial asthma and aspirin intolerance) and severity of the disease, the need of revision surgery and markers of eosinophil inflammation in upper airways in patients with CRSwNP. RESULTS: Patients with CRSwNP had more severe form of the sinonasal disease, higher rate of revision FESS and significant higher presence of markers of eosinophil inflammation in NALF and nasal tissue than patients with CRSsNP (P < 0.05). Atopic and non-atopic asthma as well as aspirin sensitivity significantly more often coexisted with CRSwNP. Comorbidity did not influence eosinophil infiltration or severity of the disease in patients with CRSwNP. CONCLUSION: Presence of comorbidity (atopy, bronchial asthma and aspirin intolerance) has no impact on severity of the disease or eosinophil content in the upper airways in patients with CRSwNP.

Pulmonary surfactant in the airway physiology: a direct relaxing effect on the smooth muscle.

Beside alveoli, surface active material plays an important role in the airway physiology. In the upper airways it primarily serves in local defense. Lower airway surfactant stabilizes peripheral airways, provides the transport and defense, has barrier and anti-edematous functions, and possesses direct relaxant effect on the smooth muscle. We tested in vitro the effect of two surfactant preparations Curosurf® and Alveofact® on the precontracted smooth muscle of intra- and extra-pulmonary airways. Relaxation was more pronounced for lung tissue strip containing bronchial smooth muscle as the primary site of surfactant effect. The study does not confirm the participation of ATP-dependent potassium channels and cAMP-regulated epithelial chloride channels known as CFTR chloride channels, or nitric oxide involvement in contractile response of smooth muscle to surfactant.By controlling wall thickness and airway diameter, pulmonary surfactant is an important component of airway physiology. Thus, surfactant dysfunction may be included in pathophysiology of asthma, COPD, or other diseases with bronchial obstruction.

Kuttner tumor.

OBJECTIVE: Kuttner tumor or chronic sclerosing sialadenitis is a benign inflammatory condition of the salivary gland. Clinically, it produces a firm swelling of the gland and may be difficult to distinguish from neoplasia. This is an under-recognized entity in the surgical pathology and cytology literature. We describe our experience with Kuttner tumor. METHODS: Retrospectively, we analyzed a group of 7 patients with chronic sclerosing sialadenitis treated from January 1999 to March 2010 at the Department of Otorhinolaryngology, FD Roosevelt Faculty Hospital in Banska Bystrica, Slovakia. The authors evaluated age and sex distribution, patient's history, diagnostic procedures, extent and success of surgical treatment and postoperative complications. RESULTS: Four patients with chronic sclerosing sialadenitis were male and 3 were female. The mean age of patients was 55 years (ranging from 43 to 70 years). Submandibular gland was affected in 6 cases (85.7 %), involvement of both parotid glands was found in one patient (14.3 %). All patients in our study group were treated surgically. In 6 cases submandibular gland extirpation was performed via standard transcervical approach. Total parotidectomy with facial nerve preservation was realized in one patient with bilateral involvement of parotid glands. CONCLUSION: Chronic sclerosing sialadenitis is a condition that is perhaps more common than thought but usually mis-recognised as it is only after excision of the gland that the correct diagnosis is made (Tab. 1, Ref. 17).