[The place of otorhinolaryngology in modern medicine].

This publication is devoted to the peculiar features of the development of otorhinolaryngology as an integral component of modern medical science and practice and the place it now occupies among other disciplines. Much attention is given to the formation of the scientific views of focal infections with special reference to tonsillitis, the role of immune pathology an allergic reactions in etiology and pathogenesis of ENT diseases. Also considered is the problem of the elaboration of the new surgical methods and their application for the treatment of ENT pathology.

A case of infection-associated antiproteinase-3-negative cytoplasmic antineutrophil cytoplasmic antibody pauci-immune focal necrotizing glomerulonephritis.

We present the case of a man with Gram-negative sepsis and exposure to oral silica who developed pauci-immune focal necrotizing glomerulonephritis (PI-FNGN) in the setting of a subacute polymicrobial central venous line (CVL) infection. He developed a cytoplasmic antineutrophil cytoplasmic autoantibody (C-ANCA) that was antiproteinase-3 (PR-3) and antimyeloperoxidase (MPO) antibody negative. We believe this is the first reported case of Gram-negative sepsis-associated PI-FNGN. Chronic silica exposure is a leading environmental risk factor in the development of ANCA vasculitis. Oral silica is a common pharmaceutical additive and its bioavailability is being recognized. Oral silica, therefore, may also be a risk for development of autoreactivity. The PI-FNGN resolved with antibiotic therapy alone. The C-ANCA titer declined as the PI-FNGN resolved. The case supports experimental and observational research that environmental exposures act as adjuvants for an immune response and also provide epigenetic triggers for autoreactivity. The C-ANCA was negative for PR-3, its major antigen. C-ANCA antigen specificity may depend on the pathogenesis of the underlying disease, potentially elicited by a cross-reaction of an antibody to foreign and self target antigen sequence homology or alternatively elicited by antigenic epitope spread.

Immunoglobulin and CD8⁺ T-cell distribution in histologically distinctive tonsils of individuals with tonsillar focal infection.

CONCLUSION: This study demonstrated that the common immunological mechanism, which involves aberration of immunoglobulin and T-cell distribution in histologically distinctive tonsils, may be associated with the pathogenesis of tonsillar focal infection. OBJECTIVES: Tonsillar focal infection comprises a group of relatively common diseases combined with chronic tonsillar infection, is associated with unusual immune responses in tonsils, and may cause lesions in another distant target organ. This study aimed to investigate the distribution of inflammatory T cells and T-cell regulatory elements, such as programmed cell death-1 (PD-1) and Fork head box protein 3 (Foxp3), immunoglobulin production, and histological characteristics in tonsils from patients with tonsillar focal infection. METHODS: Immunohistochemistry and reverse transcription-polymerase chain reaction (PCR) were used to compare the expression of CD8(+) T cells, immunoglobulins, and cytokines associated with immunoglobulin production in the tonsils of patients with IgA nephropathy (IgAN), palmoplantar pustulosis (PPP), rheumatoid arthritis (RA), and chronic tonsillitis. RESULTS: The overexpression of CD8(+) T cells combined with decreased expression of Foxp3 and PD-1 and the aberration of immunoglobulin production, which may be due to the elevated expression of activation-induced deaminase (AID), B-cell-activating factor of the TNF family (BAFF), supporting isotype switching, and B-cell survival in the histologically distinctive tonsils.

[The Posner-Schlossmann syndrome and allergy]. / Syndrome de Posner Schlossmann et allergie.

In 13 cases of Posner Schlossmann Syndrome, the authors have performed a systematic and full allergologic investigation. They were able to demonstrate in all cases an atopic constitution. The immunity tests in vivo associated with a rhinomanometric inhalation of the responsible allergen have shown positive responses to the pneumallergens and to the streptococcus hemolyticus by the way of a focal infection. In almost all cases secondary syndromic reactions were present. Specific desensitization carefully managed, closely supervised, makes possible in early detected cases the attacks to become less frequent and eventually to disappear.

[Immunogenicity characteristics of a microorganism population from the pathological foci in chronic inflammatory diseases of the upper respiratory tracts]. / Kharakteristika immunogennosti populiatsii mikroorganizmov patologicheskogo ochaga pri khronicheskikh vospalitel'nykh zabolevaniiakh verkhnikh dykhatel'nykh putei.

The staphylococcal population isolated from the pathologic focus in patients with chronic infectious inflammatory diseases of the upper respiratory tract has been found to be heterogeneous in immune response it induces in the body. The action of immune serum in vivo and in vitro leads rather quickly to quantitative changes in the surface antigenic structures of microbial cells, disappearing in the absence of contact with antibodies. The data obtained in this study indicate that the immunogenicity of microbes easily changes under the influence of immune response, which permits them to evade the immunologic control. It is quite probable that such processes play an essential role in the formation of chronic inflammatory diseases.

[Effect of infection foci and preexisting pathology on immunological shifts and the course of the disease in myocardial infarct patients]. / O vliianii ochagov infektsii i predshestvuiushchei patologii na immunologicheskie sdvigi i techenie zabolevaniia u bol'nykh infarktom miokarda.

The course of the disease and the dunamics of immunologic shifts were compared in 277 patients suffering from myocardial infarction, 87 of whom had foci of infection and chronic infectious-allergic diseases while 190 had no complications. In patients of the first group the disease was usually of a lingering character and anticardiac antibodies were found in circulation for lengthy periods of time. The incidence of chronic tonsillitis and odontogenous infectious foci was higher among patients with myocardial infarction complicated by the postinfarction syndrome than among those with a noncomplicated course of the disease (in 12 out of 20 and in 3 out of 20 patients, respectively).

[The effect of antibodies to microorganisms in a focus of purulent inflammation]. / Vliianie antitel na mikroorganizmy v ochage gnoinogo vospaleniia.

The rats were infected with a suspension of dissociated or agglutinated Pseudomonas aeruginosa [correction of B. pynocyaneus]. Infection with the agglutinated agent drastically improved the clinical course, lowered the indices of the process generalization (mortality, metastatic foci, spread in the internal organs); no hemorrhages, necrosis or abscesses were noted. A rapid (within the first day) death of almost all agglutinated bacteria in the primary focus was observed, this not being due to phagocytosis or complement-dependent lysis.

[The interaction of neutrophilic granulocytes with Candida albicans fungi in the formation of mycotic foci under conditions of immunodepression]. / Vzaimodeistvie neitrofil'nykh granulotsitov s gribami Candida albicans pri formirovanii mikoticheskikh ochagov v usloviiakh immunodepressii.

In the electron-microscopic study of the interaction of neutrophil granulocytes with the fungal species C. albicans in the process of the formation of mycotic foci in mice under the conditions of cyclophosphamide-induced immunosuppression, mouse leukocytes have been found to retain their capacity for migration to the focus of inflammation and for the phagocytosis of fungal cells. At the same time the fungicidal activity of leukocytes is decreased, which is manifested by the prevalence of viable fungal cells with the partially digested cell wall in the cytoplasm of leukocytes.

[A clinico-laboratory assessment of the efficacy of an Augmentin suspension in treating children with suppurative-inflammatory diseases caused by opportunistic bacteria]. / Kliniko-laboratornaia otsenka éffektivnosti Augmentin-suspenzii pri lechenii detei s gnoino-vospalitel'nymi zabolevaniiami, vyzvannymi uslovno-patogennymi bakteriiami.

Augmentin suspension (amoxycillin+clavulanic acid) was estimated in clinico-laboratory studies with respect to children suffering from pyoinflammatory diseases of various localization and its high efficacy was shown. Good and satisfactory results were recorded in 96.3 per cent of the cases in the treatment (monotherapy) and afterwards in the patients, adverse reactions such as nausea and vomiting being recorded only in 1 patient. The therapy with augmentin led to normalization of the microflora of the upper respiratory tract mucosa and a 1.5-fold increase in the neutrophil engulfment index.

[Factors in the development of chronic infection foci in the nasopharynx]. / Vyvchennia faktoriv rozvytku khronichnykh vohnyshch infektsiï v nosohlottsi.

Antigens were studied of HLA system in always ailing patients presenting with the formed chronic focus of infection in the tonsils. A total of 56 patients with chronic decompensated tonsillitis who were assigned for tonsillectomy by clinical indications were examined together with 53 essentially healthy subjects. Tonsillitis patients revealed HLA-antigens B7, A1, associations A10B7, more frequently than controls, the difference being statistically significant. The data obtained are helpful in identification of risk groups in relation to formation in recurrent respiratory diseases of chronic focal pathology in the nasopharynx.

[The correction of immunity in adolescents and children with focal staphylococcal diseases]. / Korektsiia imunitetu u pidlitkiv i ditei z vohnyshchevymy stafilokokovymy zakhvoriuvanniamy.

The aim of the work done was to improve treatment options for focal Staphylococcus-induced diseases in adolescents and children with the aid of adsorbed staphylococcal anatoxin (ASA) concurrently with low-intensive EHF therapy. Overall fifty patients aged 3 to 17 years with Staphylococcus infection in tonsils, nose, ears were kept under medical surveillance. ASA and EHF therapies were instituted according to the developed schemes of such therapies. Positive dynamics was shown of clinical picture and parameters characterizing humoral and cell-mediated immunity. There were no unfavourable side-effects. The proposed mode of treatment can, we believe, be widely used in a clinical setting.

IgA production and tonsillar focal infection in IgA nephropathy.

IgA nephropathy (IgAN), the common primary glomerulonephritis, is a tonsillar focal infection characterized by the qualitative abnormality of IgA in circulation and IgA deposition in the renal mesangium. Mesangial deposition of IgA, which is composed predominantly of poorly galactosylated polymeric IgA1 (pIgA1), seems to be the initiating event in the pathogenesis of IgAN. The origin of poorly galactosylated IgA, however, remains unclear. Recent studies suggest that the mesangial polymeric IgA1 deposition could be derived from mucosally primed plasma cells. B cells may undergo IgA class switching to acquire the expression of IgA via T-cell-dependent or T-cell-independent pathways in mucosa-associated lymphoid tissue and then differentiate to IgA plasma cells or home in on systemic sites. Dendritic cells, including plasmacytoid dendritic cells and another type of antigen-retaining cell, follicular dendritic cells, have an irreplaceable role in IgA class-switch mechanisms by producing IgA-inducing signals. Furthermore, an increased number of pIgA1-secreting plasma cells in the bone marrow and tonsil, as well as increased IgA class switching, have been found in IgAN, providing a link between the mucosal immunity and IgAN. The favorable effect of tonsillectomy on patients with IgAN showed that tonsillar focal infection may be closely related to pIgA1 deposition in glomerular mesangium of patients with IgAN and at least a part of pIgA1 may originate from affected tonsils. Therefore, the indication for tonsillectomy should be considered in patients with IgA nephropathy, especially at a mild or early stage, to prevent future renal deterioration. In this paper, we focus on IgA class switching and the role of tonsils with focal infection in IgAN.

Tonsil-related skin diseases and possible involvement of T cell co-stimulation in chronic focal infection.

Some inflammatory skin diseases are known to be related to tonsil focal infection at their onset. Administration of antibiotics is adequate treatment in most acute or subacute cases. However, chronic focal infections in the tonsils could cause chronic skin diseases like pustulosis palmaris et plantaris (PPP), and it is our frequent experience that tonsillectomy leads to a dramatic and persistent improvement of PPP skin lesions. The expression of inducible co-stimulator (ICOS), a co-stimulatory receptor on activated T cells, was significantly higher in tonsil tissues from PPP patients than in tonsil tissues from non-PPP patients. Moreover, ICOS expression in tonsil tissues from 3 patients with psoriasis vulgaris that was strongly suspected to be related to tonsil focal infection was also high, suggesting that the activation of T cells via ICOS costimulation in focal infections likely triggers inflammation associated with tonsil-related skin diseases. PPP is notable today for paradoxically induced skin lesions in patients treated with TNF-α antagonists for rheumatoid arthritis, Crohn's disease, psoriasis and psoriatic arthritis. It is important to clarify the immunological milieu in PPP not only for the treatment approach but also for understanding these unexpected reactions.

Triggering role of focal infection in the induction of extra-palmoplantar lesions and pustulotic arthro-osteitis associated with palmoplantar pustulosis.

Palmoplantar pustulosis (PPP) is a chronic inflammatory disorder characterized by sterile pustules predominantly involving the palms and soles of middle-aged women. Whether PPP is the acral type of pustular psoriasis or a distinct entity has long been discussed; however, the clinical features of PPP are really heterogeneous and different between Asians and Caucasians, which may depend on the race with backgrounds of different HLAs. PPP is closely related with psoriasis, but considered to be a distinct entity in Japan. Although the pathogenesis of PPP is still poorly understood, PPP is a representative skin disorder showing a close relationship with focal infections such as tonsillitis, chronic sinusitis, and dental infection. In particular, tonsillitis often triggers or deteriorates PPP. In Japanese patients, regions other than the palms and soles are occasionally affected manifesting scaly erythemas which resemble psoriasis, and solitary pustules are also seen. Some of these extra-palmoplantar lesions are induced by the Koebner phenomenon or occur after focal infections. Further, arthralgia is also induced on the sternum, clavics, sacroiliac joints, and upper ribs following focal infections. This paper makes a focus on the triggering role of focal infection in the induction of extra-palmoplantar lesions as well as arthralgia (putulotic arthro-osteitis).