Nasal cytology can predict clinical efficacy of subcutaneous immunotherapy in intermittent allergic rhinitis.

Introduction: Allergen immunotherapy (AIT) is the only disease-modifying treatment option available for patients with IgE-mediated allergic rhinitis. The identification of specific biomarkers, which may predict response to AIT, is currently an active field of research in the aspect of recommended personalization of medicine. Aim: To assess the changes in rhinological parameters in intermittent allergic rhinitis (IAR) patients resulting from subcutaneous immunotherapy (SCIT). Material and methods: Forty-two patients (female: 19; 45%) with IAR qualified for subcutaneous immunotherapy were enrolled in this study. Fourteen (33.3%) patients were desensitized with grass pollen allergen extracts, 12 (28.6%) with tree pollen allergen extracts, and 16 (38.1%) with grass and tree pollen allergen extracts. The patients were evaluated before AIT during the pollen season and in the next pollen season after introduction of subcutaneous immunotherapy. On both occasions, determination of total nasal symptom score (TNSS), rhinomanometry and nasal cytology were performed. Results: All examined parameters significantly improved after one course of allergen immunotherapy: the percentage of eosinophils in nasal mucosa, TNSS and nasal resistance decreased, whereas the nasal flow rate increased. The decrease in percentage of nasal eosinophils significantly correlated with improvement in TNSS (rs = 0.39, p < 0.05) and was the highest in the subgroup sensitive to grass pollen (44.5 (40-52)). Conclusions: The rhinological assessment confirmed high effectiveness of SCIT in intermittent allergic rhinitis. A high percentage of eosinophils in nasal cytology before subcutaneous immunotherapy can predict its clinical efficacy for intermittent allergic rhinitis, especially in grass pollen allergy.

sCD48 is elevated in non-allergic but not in allergic persistent rhinitis.

BACKGROUND: CD48 is a costimulatory receptor of the immune response. Interactions between CD48 and CD244 (2B4) on mast cells and eosinophils suggest that these cells can act synergistically in the 'allergic effector unit' to promote inflammation. This report explores the role of CD48 in persistent allergic (PAR) and non-allergic rhinitis (NAR). METHODS: In this study, serum was obtained from 70 subjects (45 female, 64%; mean age, 36; range 18-70 years) to estimate the levels of sCD48 and two eosinophils-related parameters, ECP and eotaxin-1/CCL11. Twenty patients with PAR, 15 patients with NAR, and 35 healthy controls were included. The intensity of rhinitis symptoms was estimated by the Total Nasal Symptom Score. We also assessed the fractional exhaled nitric oxide bronchial and nasal fractions (FeNO) and neutrophil to lymphocyte (NLR) and eosinophil to lymphocyte (ELR) ratios. RESULTS: Significantly higher sCD48 serum levels were observed in the NAR group than in the PAR and control groups, and significant correlations were found between the serum level of sCD48 and the number and percentage of eosinophils. ECP and eotaxin-1/CCL11 serum levels were also found to be significantly higher in the NAR group. CONCLUSIONS: CD48 may be involved in eosinophilic pathophysiological reactions in non-allergic rhinitis.

Elevated Serum Level of CD48 in Patients with Intermittent Allergic Rhinitis.

BACKGROUND: In the pathogenesis of intermittent allergic rhinitis (IAR), the inflammatory reaction is of importance. CD48, belonging to the CD2 family, participates in mast cell-stimulating cross-talk, facilitates the formation of the mast cell/eosinophil effector unit, and is expressed by eosinophils. OBJECTIVES: To assess the serum level of soluble form of CD48 (sCD48) in patients with IAR during and out of the pollen season and correlate with the disease severity and with eosinophil-related parameters. MATERIALS AND METHODS: Sixty-three patients (female: 79%; mean age: 30.58) were included to the study. Forty-five patients were assessed during the pollen season and other 42 patients during out of the pollen season. Twenty-four patients (female: 37.50%; mean age: 27.90) were evaluated twice, during the pollen season and out of the pollen season. sCD48, ECP, eotaxin-1/CCL11 serum levels together with complete blood count, and fractional exhaled nitric oxide bronchial and nasal fraction (FeNO) were performed. The severity of symptoms was assessed using the Total Nasal Symptom Score (TNSS), and neutrophil-to-lymphocyte (NLR) and eosinophil-to-lymphocyte (ELR) ratios were calculated. RESULTS: sCD48 serum level, FeNO nasal and bronchial fractions, and TNSS were significantly higher in the IAR group in the pollen season compared with out of the pollen season. Differences in ECP, eotaxin-1/CCL11 serum levels, and NLR and ELR were not significant between season and out of the season. No correlations were found between sCD48 and eosinophil-related parameters. CONCLUSIONS: sCD48 may be a biomarker to the exacerbation phase in patients with IAR. One can assume that CD48 participates in the pathogenesis of IAR.

Serum levels of interleukin 33 and its receptor ST2 in patients treated with subcutaneous allergen immunotherapy in intermittent allergic rhinitis.

INTRODUCTION: Interleukin 33 (IL-33) is a pleiotropic cytokine involved in pathological processes in seasonal allergic rhinitis. IL-33 binds to ST2 receptor, which is highly expressed on mast cells and selectively on Th2 cells. Information is lacking on the role of IL-33/ST2 axis in allergen subcutaneous immunotherapy. AIM OF THE STUDY: To determine if allergen immunotherapy changes the IL-33/ST2l axis in seasonal allergic rhinitis patients. MATERIAL AND METHODS: 40 patients with intermittent allergic rhinitis sensitive to grass and/or tree pollen were studied. Among these, 10 patients were longitudinally assessed in the follow-up visit after completing the first course of immunotherapy. Twenty-two healthy subjects were included as controls. Immunotherapy was applied according to a perennial schedule comprising up-building and maintenance phases. Serum levels of ST2/IL-33 R and IL-33 were measured by ELISA (R&D Systems). RESULTS: Serum levels of IL-33 significantly rose after the first course of immunotherapy and reached the controls levels. Serum levels of ST2 were comparable before the pollen season and after the first course of immunotherapy. CONCLUSIONS: Increase in serum levels of IL-33 after the first course of immunotherapy may suggest it is too short period to prevent the expected raise in serum IL-33 levels in the pollen season, and longer treatment is required to observe significant changes of this cytokine. ST2 serum levels are independent of immunotherapy and pollen season.

The Effect of Antileukotrienes on the Results of Postoperative Treatment of Paranasal Sinuses in Patients with Non-Steroidal Anti-Inflammatory Drug-Exacerbated Respiratory Disease.

BACKGROUND: Based on endoscopic examination, chronic rhinosinusitis (CRS) is divided into chronic inflammation with (CRSwNP) or without nasal polyps (CRSsNP). On the basis of the pathomechanism of inflammation, CRS is divided into endotypes. Eosinophilic CRSwNP with coexisting bronchial asthma and hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs) is a real therapeutic challenge. AIM: Comparative analysis of the results of treatment of patients with CRSwNP, bronchial asthma, or hypersensitivity to NSAIDs (NSAID-exacerbated respiratory disease, NERD), using antileukotrienes (leukotriene receptor antagonists, LTRAs) or intranasal glucocorticoids or both drugs together after endoscopic sinus surgery (ESS). MATERIAL AND METHODS: 33 patients (11 male, 33%) with NERD divided into three groups treated with LTRAs or intranasal glucocorticoids or both drugs together were assessed in terms of general well-being, state of pathological changes, and olfactory disorders using the following tools: Sino-Nasal Outcome Test, Visual Analogue Scale, Brief Identification Smell Test, and Lund-Kennedy score before and at 12 months after surgery. CT assessments were made prior to surgery using the Lund-MacKay scale. RESULTS: Comparable efficacy of treatment with nasal steroids and antileukotrienes was found after 12 months of observation of patients. CONCLUSIONS: The results suggest comparable efficacy of treatment with nasal steroids and antileukotrienes in patients with NERD after ESS. Treatment with montelukast and mometasone has not been shown to be superior to both drugs administered separately.

Female and male orbit asymmetry: Digital analysis.

BACKGROUND: Standard anthropometric methods applied to measurements of the skull differentials are laden with mistakes stemming from the way the measuring devices are built and from a lack of experience on the part of the researchers. To increase objectivity, digital imaging measurements via computer systems were introduced. OBJECTIVES: The aim of this research was to assess the asymmetry of the male and female orbit with the application of the new graphic methods: raster graphics and vector graphics. MATERIAL AND METHODS: The examination was conducted on 184 well-preserved skulls. The photos were taken by a digital camera with high definition. Orbit asymmetry was examined by determining the distance between the centers of gravity of both orbits and the frontal median line d1 and d2. Then angles α and ß were appointed. They are defined as angles between the line that runs through craniometrical points mf and ek on the right side (angle α) and on the left side (angle ß), and the frontal median line at their crossing point. Distances r2 and r1, which are allocated points between the frontal median lines (LPP), were also set. RESULTS: Angles α and ß were also analyzed while comparing the skulls of both genders. Statistically significant differences were only observed in male skulls. However, differences for both genders were noted in parameters d1 and d2. No statistically significant differences were discovered between men and women for parameters r1 and r2. The groups of women and men were merged, being treated as a population; which resulted in the conclusion that there are no statistically significant differences between these parameters. CONCLUSIONS: The skull's asymmetry connected to gender and the asymmetry of the right and left sides of examined craniums can be used in criminal examinations as well as in facial reconstructive surgeries.

Bacterial Infections and Osteoclastogenesis Regulators in Men and Women with Cholesteatoma.

One of the most distinct features of middle ear cholesteatoma is bone destruction. Aetiology of cholesteatoma is thought to be multifactorial. Endotoxins produced by bacteria are thought to initiate the inflammation process in the middle ear leading to cholesteatoma. There are physiological differences in bone metabolism between men and women. The aim of our study was the immunohistochemical evaluation of the contents of two key components of the OPG/RANK/RANKL triad-RANKL and OPG in cholesteatoma, to analyse if there are any differences between the sexes and to evaluate the bacteria species isolated from cholesteatoma just before surgical treatment and to evaluate their plausible influence on the expression of OPG and RANKL in cholesteatoma. Twenty-one adult patients with acquired cholesteatoma who underwent surgery were analysed. There were no statistically significant differences in the expression of both regulators of osteoclastogenesis between the sexes. In 38.1 % patients cholesteatoma was not infected, whereas in 61.9 % patients various bacterial infections or mycosis were found. The most frequently isolated species was Pseudomonas aeruginosa (14.29 % infections) followed by Staphylococcus aureus (9.52 % infections). There were no statistically significant differences in expression of both OPG and RANKL between uninfected and infected cholesteatomas.

Upper Respiratory Tract Diseases in Athletes in Different Sports Disciplines.

Upper respiratory tract diseases in athletes are a very common medical problem. Training conditions in different sports disciplines increase the risk of upper respiratory disease. Epidemiological evidence suggests that heavy acute or chronic exercise is related to an increased incidence of upper respiratory tract infections in athletes. Regular physical exercise at high intensity may lead to transient immunosuppression due to high prevalence of allergic diseases in athletes. Regardless of the cause they can exclude athletes from the training program and significantly impair their performance. In the present work, the most common upper respiratory tract diseases in athletes taking into account the disciplines in which they most often occur were presented. The focus was laid on symptoms, diagnostic methods and pharmacotherapy. Moreover, preventive procedures which can help reduce the occurrence of upper respiratory tract disease in athletes were presented. Management according to anti-doping rules, criteria for return to training and competition as an important issues of athlete's health were discussed.

Orbital Opening Shape and Its Alphanumerical Classification.

BACKGROUND: Orbit is the one of the most complicated areas of the facial part of cranium. The anthropological analysis of the orbits comprises basic measurement characterizing their shape: width and height. Classic anthropometric methods used to measure the skull variability are burdened with mistakes resulting from construction of measuring devices as well as from researcher's experience. OBJECTIVES: The purpose of our research was to introduce a metric classification of the orbital opening. MATERIAL AND METHODS: The study was carried out on 184 skulls. In our study we suggest introducing a classification of the orbital opening shape by calculating a functional for the 15 categories of the orbit shape. Shape categories have been arranged following the increasing value of the functionals. Each shape category of the orbital opening, according to the Piasecki's descriptive classification, was assigned a letter from the alphabet. RESULTS: We have observed a greater number of symmetrical skulls in the female group (29.11%) than in the male (23.81%). In both groups the symmetry type AA was the most frequent, it corresponds to the value of functional comprised in the interval from 0 to 1,30. According to the Piasecki's descriptive classification it was the oval elongated type. CONCLUSIONS: Our alphanumerical classification based on the value of functional and on the orbit outline assigned to the value is an objective and useful method of the orbital opening shape analysis.

Bronchial asthma control after argon plasma coagulation turbinectomy in patients with chronic rhinitis.

Bronchial asthma is frequently accompanied by chronic rhinitis. It has been observed that effective treatment of rhinitis may reduce asthma symptoms. The aim of the study was the evaluation of the control of bronchial asthma symptoms in patients with chronic rhinitis after argon plasma coagulation turbinectomy (APCt). The effect of APCt was assessed in 47 adults with drug-resistant chronic rhinitis and bronchial asthma 3-month post-procedure. Changes of asthma symptoms were scored using Asthma Control Test (ACT). Subjective improvement of nasal congestion 3 months after APCt was observed in 87% and of rhinorrhoea in 75% patients. Rhinomanometry showed 219 ± 19 cm³/s increase of flow and 0.75 ± 0.06 Pa/cm³/s reduction of resistance. The prevalence of patients with insufficient bronchial asthma control decreased from 79 to 4%. The decrease was associated with diminished frequency of eosinophils >20% in nasal cytology from 83% pre-procedure to 28% in the follow-up. The percentage of eosinophils >20% in cytology before APCt increased the chance for asthma control improvement by 22.8 times. Reduction in symptoms of drug-resistant rhinitis after APCt is followed by significant improvement of asthma control. The most beneficial therapeutic effects of APCt are noted in patients with a high rate of eosinophils in nasal cytology.

Factors that favor the occurrence of cough in patients treated with ramipril--a pharmacoepidemiological study.

BACKGROUND: Dry cough is a common cause for the discontinuation of ramipril treatment. The aim of this pharmacoepidemiological study was to assess the incidence of ramipril-related cough among the Polish population and to characterize patients at risk of experiencing the adverse effect of cough during ramipril treatment. MATERIAL/METHODS: This was a prospective observational study involving 10,380 patients treated with ramipril for a period of no longer than 8 weeks, consisting of 3 visits: baseline, first follow-up (after 4-8 weeks) and second follow-up visit (after 4-8 weeks of cessation of ramipril, conducted only for evaluating coughing patients). RESULTS: The incidence of ramipril-related cough was 7.1%. Logistic regression analysis identified female sex (OR=1.35), cigarette smoking (OR=2.50), chronic obstructive pulmonary disease (OR=1.70), asthma (OR=1.60) and previous history of tuberculosis (OR=6.20) to be significantly and independently associated with the onset of ramipril-related cough. Coughing subsided within a period of 2-20 days after ramipril was discontinued. In all patients reporting the appearance of cough within the first 5 days after therapy initiation, the adverse effect subsided after therapy discontinuation. If cough appeared within 6-10 days, it subsided after discontinuation in 81.6% of subjects. Cough persisted in 30.4% of those reporting later onset. CONCLUSIONS: 1. Female sex, cigarette smoking, COPD, asthma, and previous history of tuberculosis increase the risk of ramipril-related cough. 2. The later the cough occurs during treatment, the less often the drug is the causative agent and the cough and also less likely to disappear after discontinuation of ramipril.

Epistaxis as the reason for premature discontinuation of clopidogrel after percutaneous coronary angioplasty with stent implantation.

BACKGROUND: Haemorrhagic complications, including epistaxis, are the main reason for discontinuation of antiplatelet therapy in patients after stent implantation which increases risk of in-stent thrombosis. AIM: To evaluate the incidence of bleeding complications leading to premature discontinuation of antiplatelet therapy in patients after percutaneous coronary intervention (PCI) with stent implantation. METHODS: A total of 3250 patients (males 64%, mean age 62 ± 10 years) after PCI with stent implantation and without indications for chronic anticoagulation or the use of low molecular weight heparin participated in the survey. RESULTS: Antiplatelet therapy after discharge from hospital was continued by 98.5% of patients. Antiplatelet therapy, according to the current standards (clopidogrel with acetylsalicylic acid [ASA]), was used by 86.3% of the respondents and 8.4% of patients used clopidogrel without ASA. A 90.0% of patients after bare metal stent (BMS) implantation and 94.9% after drug-eluting stent (DES) implantation (p < 0.001) continued clopidogrel therapy for more than a month. The 12-month period of clopidogrel treatment was completed by 52.4% of patients after BMS implantation and by 68.9% after DES implantation (p < 0.001). Epistaxis occurred in 6.2% of patients. The incidence of epistaxis was similar in patients taking clopidogrel (4.7%) or ASA (4.6%) alone and in patients taking both drugs (5.8%). Episodes of epistaxis generally did not occur during the first month of antiplatelet therapy after DES implantation and were followed by discontinuation of clopidogrel therapy by 20.9% of patients with this bleeding complication. Factors favouring the occurrence of epistaxis included hypertension (OR = 2.22), chronic kidney disease (OR = 2.85) and liver cirrhosis (OR = 2.53). Epistaxis occurred in 12.1% of the patients who prematurely discontinued clopidogrel (OR = 2.43). CONCLUSIONS: 1. The occurrence of epistaxis is followed by premature discontinuation of clopidogrel therapy by one fifth of patients after coronary angioplasty and DES implantation. 2. Nosebleeds are more common in subjects with hypertension, chronic kidney disease and liver cirrhosis.

[Long-term results after argon plasma coagulation (APC) inferior turbinates reduction]. / Wyniki odlegle konchoplastyki z uzyciem plazmy argonowej (APC).

Interior turbinate hypertrophy is one of the major causes of nasal airway obstruction. Medical treatment often produces insufficient improvements. In these cases, surgical reduction of inferior turbinates can be proposed. Authors analyzed long-term results of argon plasma coagulation (APC) for inferior turbinates reduction in patients with chronic nasal obstruction. Rhinomanometric parameters, clearance of saccharine test results and cytological examination were statistically analyzed in 70 patients after 3 month and in 47 after 12 month after surgery. Five patients received a second operation. Only patients with first degree in T/S (turbinate/septum) nasal septum deviation were enrolled in both groups. Every patients were treated ineffectively with nasal drops. All patients received topical anesthesia. The procedure of APC were easy to perform end we did not experience postoperative bleeding. Rhinomanometric measurement demonstrated a significant nasal flow at 3 and 12 month after APC. Before 3 and 12 month after surgery the values for resistance shoved significant difference. There were no changes in saccharine transit - time during the follow-up period. At 3 postoperative month, the nasal stuffiness had improved 62 (88%) patients. At 12 month after surgery, the nasal stuffines had improved 34 (73%) patients. APC was shown to effectively reduce the symptom of nasal obstruction without any complications. Argon Plasma Coagulation should be an alternative method in treating the patients with hyperplastic inferior turbinate.

[A 20-year retrospective histoclinical analysis of parotid gland tumors in the ENT Department AM in Katowice]. / Analiza histokliniczna guzów slinianek przyusznych u chorych operowanych w okresie 20 lat w Klinice Laryngologii SlAM w Katowicach.

INTRODUCTION: Salivary gland neoplasms represent the diverse group of tumours encountered by the head and neck surgeons. MATERIAL AND METHODS: The study is analysis of 531 patients with parotid gland tumours in patients treated in ENT Department during 1986-2006. We analysed surgical treatment and intraoperative tumour stage. The results of histological diagnosis were presented. RESULTS: The frequency of incidence of benign neoplasm was 80%. The most frequent tumour was pleomorphic adenoma--75% and adenolymphoma--16%. Malignant tumours constituted 20% of all gland tumours. Mucoepidermoid (27%) and adenoid cyst (22%) carcinomas were the most common malignant tumour. Tumour stages T3-T4 was in 90%.

[The histo-clinical analysis of 95 malignant neoplasms of parotid gland]. / Analiza histokliniczna 95 nowotworów zlosliwych slinianek przyusznych.

INTRODUCTION: Malignant tumors constituted 25% of all gland tumors, the most frequently in parotid gland. MATERIAL AND METHODS: The study is analysis of 436 patients with parotid gland tumors who underwent surgery in ENT Department. The results of histopatological diagnosis are presented. We analysed surgical treatment, intraoperative tumor stage and accuracy of fine - needle aspiration cytology in diagnosis. RESULTS: Malignant tumors constituted 22% of all gland tumors. Mucoepidermoid (27%) and adenoid cyst (22%) carcinomas were the most common malignant tumor. Tumor stage T3-T4 was in 88,5% cases. Accuracy of fine-needle aspiration cytology in diagnosis of parotid tumors is 81,2%.

[Analysis of 216 cases of pleomorphic adenoma of the parotid gland]. / Analiza kliniczna 216 przypadków gruczolaków wielopostaciowych slinianki przyusznej.

Pleomorphic adenoma is the most frequent benign tumour of the salivary glands. The most common localization is the parotid gland. The authors present a clinical analysis of the group of 216 patients, who was treated in ENT Department and who was diagnosed as pleomorphic adenoma. The frequency of incidence of mixed tumours is 50.70% of all 426 cases of parotid gland's tumours. In 92, 13% cases the tumours was localized in the superficial part, only in 7.87% in deep part of the gland. Sixteen patient was operated on because of the recurrence of mixed tumours. In one case we observed the syndrome of the auriculotemporal nerve. The temporary paresis of facial nerve after operation occurred in 19 patients. We don't noticed the incidence of salivary fistula in our material.

[Argon plasma coagulation (APC) for interior turbinates reduction]. / Konchoplastyka z uzyciem plazmy argonowej (APC).

Authors analyze results of argon plasma coagulation (APC) for interior turbinates reduction in patients with chronic nasal obstruction treated ineffectively with nasal drops. Rhinomanometric parameters, clearance of saccharine test results and cytological examinations were statistically analyzed in 70 patients with bilateral hypertrophy of turbinates treated in ENT Department of Medical University of Silesia in Katowice in years 2000-2001. Control group consists of 30 patients without breathing problems. The obtained results confirmed high effectiveness of APC for interior turbinates reduction. Only patients with first degree in T/S (turbinate/septum) nasal septum deviation were enrolled in both groups.

[Adenolymphoma of parotid gland--analysis of 75 cases]. / Gruczolaki limfatyczne slinianki przyusznej--analiza 75 przypadków.

The authors present a clinical analysis of the group of 75 patients, who was treated in Department of Otolaryngology in the years 1986-2000 and who was diagnosed as adenolymphoma. The frequency of incidence of Warthin's tumour is 17,6% of all 426 cases of parotid gland's tumours. In 72 cases (96%) the tumour was localized in the superficial part, only in 3 cases (4%)--in the deep part of the gland. In one patient we observed recurrence of adenolymphoma. In one case adenolymphoma coexisted with carcinoma planoepitheliale of parotid gland.

[Ectopic thyroid glad--a case report]. / Odszczepiona tkanka tarczycowa--opis przypadku.

Authors have described the case of 67 years women with an anterior midline neck tumor. The tumor was surgically excited and the microscope examination revealed thyroid tissue with colloid goiter. One must consider a midline ectopic thyroid gland in the differential diagnosis of masses in the neck.

[Middle ear tuberculosis behind an intact tympanic membrane--a case report]. / Gruzlicze zapalenie ucha srodkowego przy nieuszkodzonej blonie bebenkowej--opis przypadku.

An extremely rare case of the 21 years women with the tuberculosis of the tympanic cavity behind the intact tympanic membrane was presented. The authors have described the clinical picture, diagnosis difficulties and ways of therapy. A surgical treatment and antituberculosis treatment was satisfactory.