Treatment with a neutrophil elastase inhibitor and ofloxacin reduces P. aeruginosa burden in a mouse model of chronic suppurative otitis media.

Chronic suppurative otitis media (CSOM) is a widespread, debilitating problem with poorly understood immunology. Here, we assess the host response to middle ear infection over the course of a month post-infection in a mouse model of CSOM and in human subjects with the disease. Using multiparameter flow cytometry and a binomial generalized linear machine learning model, we identified Ly6G, a surface marker of mature neutrophils, as the most informative factor of host response driving disease in the CSOM mouse model. Consistent with this, neutrophils were the most abundant cell type in infected mice and Ly6G expression tracked with the course of infection. Moreover, neutrophil-specific immunomodulatory treatment using the neutrophil elastase inhibitor GW 311616A significantly reduces bacterial burden relative to ofloxacin-only treated animals in this model. The levels of dsDNA in middle ear effusion samples are elevated in both humans and mice with CSOM and decreased during treatment, suggesting that dsDNA may serve as a molecular biomarker of treatment response. Together these data strongly implicate neutrophils in the ineffective immune response to P. aeruginosa infection in CSOM and suggest that immunomodulatory strategies may benefit drug-tolerant infections for chronic biofilm-mediated disease.

Comparing audiometric parameters between crushed and intact cartilage tympanoplasty: a double-blinded, randomised, controlled trial study.

OBJECTIVE: To investigate hearing and the take rate of crushed cartilage grafts in tympanoplasty. METHODS: In this double-blinded, randomised, controlled trial, 46 patients with tympanic membrane perforation were enrolled. A conchal cartilage graft was used for reconstruction in both intervention and control groups. In the intervention group, crushed cartilage was used. The success rate and hearing results were ascertained every four months over a one-year follow-up period. RESULTS: A total of 36 patients - 20 in the intervention group and 16 in the control group - completed one year of follow up. There were no statistically significant differences between the two groups in mean air-bone gap, bone conduction threshold, speech discrimination score or speech reception threshold. CONCLUSION: The reduction in living cells after crushed cartilage tympanoplasty may decrease the rigidity and the volume of the graft, but may not necessarily improve the hearing results.

Nasal vestibular huge keratoacanthoma: an unusual site.

Keratoacanthoma (KA) is a rapidly growing, low-grade neoplasm of pilo-sebaceous and hair follicle units which most often appears on the sun-exposed skin of the middle aged and older persons with multiple or localized occurrence. This tumor is dome-shaped nodule with a central keratinous plug. The etiology of this tumor is not obvious. Exposure to excessive sunlight is the most frequently noted responsible factor in the etiology of KA. About 80% of the tumors occur on the face. The histological features of the KA are often very similar to those of a cutaneous squamous cell carcinoma; however, the tumor structure usually provides a basis for their difference. There are many unusual cases of keratoacanthoma reported regarding site, size or other specifications. In this study, we excised a mass of nasal vestibule, a site far away sun-exposure. To our knowledge, this is the first case of nasal vestibular keratoacanthoma. For a clinician and a pathologist it is important to consider a benign lesion like Keratoacanthoma (KA) in the differential diagnosis of ulcerated nasal lesions and pay attention to differ it from Squamous Cell Carcinoma (SCC) which has a different and aggressive management.

ENT manifestations in Iranian patients with primary antibody deficiencies.

OBJECTIVE: One hundred and nine patients with primary antibody deficiencies were selected in order to determine the frequency of ENT complications. METHOD: Demographic information and ENT medical histories were collected for each patient. Duration of study for each patient was divided into two periods of before diagnosis and after diagnosis and the initiation of treatment. RESULTS: Eighty-two of 109 patients (75.2 per cent) experienced ENT infections during the course of the disease (63: otitis media, 75: sinusitis and nine: mastoiditis). At the time of diagnosis, 52 (47.7 per cent) out of 109 patients presented with an ENT symptom. The frequencies of episodes were 27 for sinusitis and 25 for otitis media (one complicated with mastoiditis). After immunoglobulin replacement therapy the incidence of otitis media was reduced from 1.75 before treatment to 0.39 after treatment per patient per year (p = 0.008). The incidence of sinusitis also significantly decreased from 2.38 to 0.78 (p value = 0.011). CONCLUSION: ENT infections are common medical problems in primary antibody deficiency patients. Persistent and recurrent ENT infections should be suspected as originating from a possible underlying immunodeficiency.

Surgical management of aneurismal dilation of vein and pseudoaneurysm complicating hemodialysis arteriovenuos fistula.

BACKGROUND: Pseudoaneurysm (PS) and aneurismal dilation of vein (ADV) are recognized complications of arteriovenous fistulas (AVF) in patients on hemodialysis. We present our experience about surgical management of these complications, which resulted in AVF preservation for continuing hemodialysis. MATERIAL AND METHODS: Twenty-two patients underwent surgical repair of an aneurismal dilation of vein or a pseudoaneurysm arising from a native AVF. In 14 patients the aneurismal dilation of vein arose from the venous limb of AVF and in eight patients the pseudoaneurysm arose from an arteriovenous anastomotic site in the antecubital and anterior part of arm. The mean follow-up period was 15 months. Clamp Aneurysm Repair (CAR) was performed to repair the aneurismal dilation of venous limb of AVF and Tourniquet Aneurysm Repair (TAR) was performed to repair PS that arose from AVF in the antecubital and anterior part of arm. RESULTS: In eight of the 14 patients with aneurismal dilation of vein, who underwent CAR procedure, vascular access was preserved. In three patients with aneurismal dilation of vein in snuffbox and one in forearm, the AVF had failed due to prior venous thrombosis of AVF. In two of 14 patients, there was no need for preservation of AVF because of renal transplantation. The technical success rate and patency rate during follow up period in CAR method was 100%. In seven of eight patients with psudoaneurysm in the antecubital and anterior part of arm, who underwent TAR procedure, the AVF remained patent. The technical success rate in TAR method was 87.5%, and the patency rate was 87.5%. Overall, technical success rate was 95.45% and patency rate was 93.75%. During the 15 months of follow up period hemodialysis program through the repaired AVF sustained as desired. CONCLUSIONS: The surgical methods used in our study could effectively repair the aneurismal dilation of vein and psudoaneurysm arising from a native AVF, and it lead to preservation of the AVF patency for continuing hemodialysis. These methods are technically feasible, safe and cost-effective procedures. It does not require dissection and additional incision for control of the vein and artery proximal and distal to the aneurismal dilation of vein and pseudoaneurysm; result in shorter time of procedure without complications.

Distribution of primary immunodeficiency disorders diagnosed in the Children's Medical Center in Iran.

Primary immunodeficiency disorders include a variety of diseases that render patients more susceptible to infections. To determine the percentage of different primary immunodeficiency disorders diagnosed in the Children's Medical Center Hospital affiliated to Tehran University of Medical Sciences in Iran, we retrospectively reviewed the charts of the patients being referred to our hospital for immunologic evaluation of recurrent infections during a 20 year period. Among these patients, antibody deficiencies were the most frequent ones and were found in 52.6% of patients (n = 130). T-cell disorders, phagocytic disorders and complement deficiencies were found to be present in 24.69% (n = 61). 22.2% (n = 55) and 0.4% (n = 1) respectively. On the whole, common variable immunodeficiency was the most frequent disorder (n = 65), followed by ataxia telangiectasia (n = 39), X-linked agammaglobulinemia (n = 33), chronic granulomatous disease (n = 29) and selective IgA deficiency (n = 20). This study reveals that antibody deficiencies are the most common type of disorders as shown in other studies. A comparative study shows some differences between our results and other registries. This article also indicates that immunodeficiency disorders should be considered in patients with recurrent infections.