RESUMO
Eustachian tube dysfunction is a frequent pathology of middle-ear ventilation, leading to many more or less disabling otologic symptoms. Severity varies from simple otitis media with effusion to aggressive chronic otitis or cholesteatoma. First-line treatment is medical, but surgery can also be proposed. It consists in balloon dilation of the Eustachian tube, in order to increase ventilation and improve symptoms. It is performed in second-line in patients with Eustachian tube dysfunction confirmed by tubomanometry, after failure of local drug treatment. It can be performed under general or local anesthesia but it is mandatory to use a medical device with market authorization for this indication. The main aim of this surgical note is to describe the technique of balloon dilation in the treatment of Eustachian tube dysfunction and the three balloon models with CE label and market authorization currently available in France and in Europe. Balloon dilation of the Eustachian tube appears to be a promising option to restore natural middle-ear ventilation in patients with chronic obstructive Eustachian tube dysfunction.
Assuntos
Otopatias , Tuba Auditiva , Otite Média , Humanos , Dilatação , Cateterismo/métodos , Otopatias/cirurgia , Otite Média/terapiaRESUMO
The 70-kb pYV plasmid of Yersinia enterocolitica directs the synthesis and secretion of several virulence determinants called Yops. These proteins are produced during the invasion of the host tissues and induce a strong antibody response. The yop genes are transcribed from strong promoters activated by a common transcription activator. Recombinant Y. enterocolitica strains expressing the B subunit of the cholera toxin were constructed from a yopH-ctxB operon fusion. Integration of the gene ctxB in the pYV plasmid itself, by a double crossing over, ensured its stability in the infecting bacteria. Oral inoculation of recombinant bacteria in mice elicited serum and intestinal antibody responses and resulted in protection of the immunized mice against a cholera toxin challenge. Secretory immunoglobulin A antibodies against the cholera toxin B subunit occurred not only in the intestines but also in the respiratory tract.
Assuntos
Proteínas da Membrana Bacteriana Externa/genética , Toxina da Cólera/imunologia , Proteínas Tirosina Fosfatases , Proteínas Recombinantes de Fusão/imunologia , Yersinia enterocolitica/genética , Administração Oral , Animais , Toxina da Cólera/genética , Feminino , Imunização , Imunoglobulina A Secretora/biossíntese , Memória Imunológica , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Óperon , Plasmídeos , Yersinia enterocolitica/imunologiaRESUMO
Rabbit polyclonal antisera were raised against the pYV-encoded outer membrane protein P1 of five Yersinia enterocolitica strains belonging to serogroups O:3, O:5,27, O:8, and O:9. Analysis of these strains with the sera showed that P1 presented at least six different antigenic factors. Two of the serum specimens were chosen to test the P1 agglutinability of 797 strains isolated from various sources. This technique appeared to be more reliable than autoagglutination and Ca2+ dependency to monitor the presence of the pYV plasmid. Hence, we propose this P1-mediated agglutination as a new and easy virulence test.
Assuntos
Testes de Aglutinação/métodos , Plasmídeos , Yersinia enterocolitica/genética , Anticorpos Antibacterianos , Estudos de Avaliação como Assunto , Humanos , Sorotipagem , Virulência/genética , Yersinia enterocolitica/classificação , Yersinia enterocolitica/isolamento & purificaçãoRESUMO
Growth of yersiniae is restricted at 37 degrees C in the absence of calcium ions. This phenomenon correlates with the massive release of a set of proteins called Yops. Growth restriction and Yops production are governed by a 70 kb plasmid called pYV. yop genes are distributed throughout pYV and constitute a thermoactivated regulon controlled by the gene virF. The transcription activator VirF is a member of a new family of regulators including those of the arabinose and rhamnose operons as well as a regulator of enteric colonization pili. The role of calcium ions on the release of Yops remains largely unknown.
Assuntos
Proteínas de Bactérias/genética , Genes Reguladores , Yersinia/genética , Aderência Bacteriana , Proteínas da Membrana Bacteriana Externa/análise , Proteínas de Bactérias/biossíntese , Cálcio/fisiologia , Regulação Bacteriana da Expressão Gênica , Genes Reguladores/fisiologia , Yersinia/patogenicidadeRESUMO
The replication genes (rep) of the virulence plasmid pYVe439-80 of Yersinia enterocolitica were localized and characterized by restriction endonuclease analysis. Comparison with pIB1, a virulence plasmid of Y. pseudotuberculosis, indicates that while the plasmids carry homologous rep genes their location with respect to the highly conserved 'calcium region' is different. This replication function is thermosensitive. Mini-derivatives of pYVe439-80 appear to be rather unstable. The region of pYVe439-80 containing homology to the incD determinant of F was shown to contain a plasmid-stabilization system (par). The region encoding par was characterized by restriction endonuclease analysis. pIB1 contained an homologous par region but located differently. The pYV plasmids thus underwent rearrangements during their divergent evolution. While the positions of rep and par in the two plasmids are inverted with respect to the surrounding loci, our determination of the orientation of each locus rules out the hypothesis of a simple inversion of a quadrant of pYV. The gene encoding YOP5, a 26 kDa protein encoded by pIB1, was cloned on a mobilizable vector and introduced in Y. enterocolitica W22708 containing pYVe227 (indistinguishable from pYVe439-80), mutated in the homologous gene. The recombinant Y. enterocolitica secreted YOP5. Hence, the transcriptional activation and secretion systems of pYVe227 act on a yop gene from pIB1 and on its product, indicating that these systems are interchangeable.