Differential expression of tumor necrosis factor α, interleukin 1ß, nuclear factor κB in nasal mucosa among chronic rhinosinusitis patients with and without polyps.

INTRODUCTION: The pathogenesis of nasal polyps is still not fully understood. AIM: To analyze the topography and intensity of interleukin 1ß (IL-1ß), tumor necrosis factor α (TNF-α), cyclooxygenase 2 (COX-2), nitric oxide synthase 2 (NOS-2), and nuclear factor-κB (NF-κB) expressions in eosinophilic and neutrophilic polyps and in normal nasal mucosa. MATERIAL AND METHODS: The study included specimens from 20 patients with eosinophilic polyps (more than 10% of eosinophils in inflammatory infiltrate), 20 individuals with neutrophilic polyps (predominance of neutrophils and less than 10% of eosinophils), and samples of normal nasal mucosa from 10 controls. The expressions of studied proteins in vascular endothelial cells, epithelial, stromal and glandular cells were determined immunohistochemically with specific monoclonal antibodies. RESULTS: Irrespective of the cellular type, the intensity of expressions in eosinophilic and neutrophilic polyps was significantly higher than in the normal mucosa. Eosinophilic polyps were characterized by stronger expressions of TNF-α (in all cellular types), IL-1ß (in endothelial, glandular and epithelial cells), NF-κB (in stromal and epithelial cells), COX-2 (in glandular and stromal cells), and NOS-2 (in endothelial and stromal cells). In contrast, neutrophilic polyps showed significantly stronger expressions of COX-2 (in epithelial and endothelial cells) and NOS-2 (in glandular and epithelial cells). In both phenotypes, the strongest expressions of all studied markers were documented in vascular endothelial cells. CONCLUSIONS: Inflammatory markers are involved in pathogenesis of both eosinophilic and neutrophilic polyps. Endothelial defects can play an important role in the development of nasal polyps.

IMPACT OF GENISTEIN AND PHYTIC ACID ON THE VIABILITY AND PROLIFERATION ACTIVITY OF NASAL POLYPS' CELLS IN AN IN VITRO MODEL.

In developed countries, chronic rhinosinusitis with nasal polyps is one of the diseases that diminish patients' quality of life most significantly. Treatment of that often incurable disease is based on the steroids and surgery in patients who had failed thorough conservative management. It appears that the introduction of new treatment agents suppressing inflammation process and inhibiting cells' proliferation would be a valuable therapeutic option. The aim of the present study was to evaluate the in vitro effect of genistein and phytic acid on the viability and growth rate of fibroblasts derived from nasal polyps. Cells were incubated with various concentrations of genistein (5-500 µM) and phytic acid (100-20,000 µM). After 72 h incubation, cells survivability and cells' growth rate were estimated by combination of WST-1 and LDH methods. QRT-PCR technique was used to determine the expression of histone H3, BCL-2, BAX and P53 genes. Caspase-8 and -9 expressions were evaluated by ELISA assay. Genistein and phytic acid significantly and in dose-specific manner decreased nasal polyps fibroblasts survivability and growth rate. Both agents in similar way decreased cell proliferation as measured by the expression of histone H3. They induce apoptotic machinery by modulating the expression of BCL-2, BAX and caspase-8 activity. Genistein and phytic acid have significant potential for a therapeutic role in the treatment of chronic rhinosinusitis.

ANTIPROLIFERATIVE AND CYTOTOXIC EFFECT OF SELECTED VITAMIN D ANALOGS ON NASAL POLYPS FIBROBLASTS AND OTHER CELLS WITH HIGHER PROLIFERATIVE POTENTIAL.

Besides well-known effect on bone and mineral metabolism vitamin D is involved in essential non-calcemic regulatory mechanisms, such as cellular proliferation, differentiation and apoptosis in various cell types. Major limitation for therapeutic use of calcitriol, a hormonally active form of vitamin D, is its calcemic and phosphatemic action. Recently, more selective vitamin D analogs which retain clinically useful activities with reduced toxicity have been designed. The aim of the present study was to evaluate the in vitro effect of vitamin D analogs on proliferation rate and survivability of cells with increased proliferative activity. The effect of calcitriol, PRI-2191, PRI-1890, PRI-1906 and PRI-2205 was examined. The experiments were performed on cultures derived from nasal polyps and cancer cells lines (SNB-19, C32 and SH-4). Cultures were incubated 72 h with tested compounds, each at the concentration of 0.025, 0.25, 2.5 and 25 µg/mL. The cytotoxic effect of vitamin D analogs and their influence on growth rate were determined using WST-1 assay. RT-QPCR technique was used to evaluate the expression of anti-apoptotic BCL-2 and pro-apoptotic BAX gene. Each of the tested compounds presented significant effect at the concentrations above 0.25 µg/mL. The strongest inhibition of the growth rate and decrease in cell survivability was observed after treatment with PRI-1890 and PRI-2191. Stimulation with calcitriol and other vitamin D analogs led to decrease BCL-2/BAX mRNA ratio in each cell lines. The apparent pro-apoptotic action revealed PRI-2191 followed by PRI-1890. It might be hypothesized that vitamin D analogs supplementation may provide therapeutic benefits not only in oncological patients but also in chronic rhinosinusitis.

Microarray analysis of NF-κB-dependent genes in chronic rhinosinusitis with nasal polyps.

BACKGROUND: The inflammatory process underlying nasal polyposis is induced and perpetuated by the enhanced activity of several agents including transcription factors. It has recently been demonstrated that one of them, named nuclear factor-kappa B (NF-κB), is implicated in the regulation of multiple pro-inflammatory genes. OBJECTIVES: The aim of the study was to identify using microarray technology which NF-κB-dependent genes are activated in nasal polyp (NP) samples compared to the control mucosa. MATERIAL AND METHODS: The transcriptional activity of genes was analyzed using an oligonucleotide microarray on 15 NPs and 8 cases of normal nasal mucosa. RESULTS: Gene expression patterns obtained in NPs were significantly different from those in normal mucosa. NPs and control cases clustered separately, each of them with large homogeneity in gene expression. Among 582 human NF-κB-dependent genes 25 showed a significantly higher expression in NPs compared to the control. The largest increase focused on gene encoding TFF3 (a 5-fold higher expression) followed by NOS2A (5x), SERPINA1 (4x), UCP2 (4x), OXTR (4x) and IL8 (3x) (p<0.05). In healthy mucosa 19 genes presented increased transcription activity compared to NPs. The most significantly enhanced levels were shown LTF gene (20 fold) followed by KRT6B (7x), LYZ (7x), SD11B2 (5x) and MMP3 (4x) (p<0.05). CONCLUSIONS: DNA microarray technology highlights the involvement of many unsuspected pathologic pathways which could be involved in NP growth. The identification of novel disease-related genes may help to understand the biology of NPs and elaborate new targeted therapy.

A microarray study of gene expression profiles in nasal polyps.

OBJECTIVE: Nasal polyposis (NP) is a multifactorial disease manifesting in chronic inflammation of upper respiratory tract of unknown etiology. We studied mRNA gene expression profiles in NP compared with normal mucosa as well as pointed at genes characteristic of different expression in examined tissues. MATERIAL AND METHODS: Fifty-three patients with NP (36 eosinophilic and 17 neutrophilic NP) were included into the study. Transcriptional activity of genes was analyzed using oligonucleotide microarray in 17 NP and 8 cases of normal nasal mucosa. A study of mRNA expression of selected genes was performed using QRT-PCR. RESULTS: We identified 556 genes, which were differentially expressed between the studied and the control group. Among them 217 showed significantly higher expression, whereas 339 lower expression in NP than in controls. The microarray and QRT-PCR results were compatible for 7 of 8 evaluated genes. In NP strongly significant higher transcriptional activity of MMP10, NOS2A, ALOX15 and IL-8 genes was observed. In the control group, significantly higher expression of DMBT1, ALOX12 and LTF genes was detected. CONCLUSION: The analysis of gene expression in inflammatory changed nasal polyp tissues may become a supplementary method in diagnostics and treatment. Molecular alterations may indicate changes during the clinical course of the disease.

Influence of vitamin D(3) analogues in combination with budesonid R on proliferation of nasal polyp fibroblasts.

UNLABELLED: Vitamin D (VD) and its different analogues, besides their classic role as regulators of calcium and phosphor homeostasis, have emerged as a large family of antiproliferative agents. Such properties suggested VD potential as a therapy for chronic inflammatory diseases, including nasal polyposis (NP). NP growth involves both an inflammatory process and the proliferation of fibroblast as an important factor inducing aberrations in the phenotype of the epithelium. The aim of this study was to investigate the possible influence of 1alpha,25-dihydroxyvitamin D(3) (calcitriol) and 1alpha,24(R)-dihydroxyvitamin D(3) (tacalcitol) in monotherapy and in combination with budesonid R (BR) on NP fibroblast proliferation. MATERIAL AND METHODS: The study involved 26 samples of NP. NP cells were cultured on 96-well plates beginning with a concentration of 5 x 10(3) cells per well with RPMI 1640 medium supplemented with antibiotics and 10% foetal bovine serum. After the fourth to sixth passage the medium was replaced with a nutrient medium with calcitriol or tacalcitol in a defined concentration (from 10(-9) M to 10(-3) M) alone or in combination with BR in 1:1, 1:3 or 3:1 ratios, each at concentrations from 10(-5) M to 10(-3) M. RESULTS: Growth inhibition of nasal fibroblasts exposed to calcitriol or tacalcitol was noted. Significant antiproliferating activity was observed at calcitriol concentrations of 10(-4) M and 10(-3) M after 48 h, and at a concentration of 10(-3) M after 72 h with the percentage of proliferating cells reduced to 30% compared to the control samples (P < 0.05). In cells treated with tacalcitol the maximal effect was seen at 10(-4) M after 48 h and at 10(-3)M after 72 h with a 60% inhibition with respect to the control (P < 0.05). The inhibition of fibroblast proliferation reached the maximal level when they were exposed to calcitriol: BR (1 : 1) or tacalcitol: BR (1 : 1), each at a concentration of 10(-4) M, after 72 h (82% and 69%, respectively). CONCLUSIONS: The antiproliferative activity of calcitriol and tacalcitol in NP cultures was confirmed. Because of its lower toxicity and higher activity tacalcitol seems to be the more promising agent in NP therapy, both as a single medication and in treatment protocols with BR.

[Diversity of nasal polyps in microarray technology research]. / Zróznicowanie polipów nosa w badaniach technika mikromacierzy oligonukleotydowych.

UNLABELLED: Nasal polyps, according to many authors, generate as a result of chronic inflammation process with activation of cytokines, immunological reaction mediators that regulate proliferation, differentiation and cell apoptosis. Clarifying molecular mechanisms present in those disturbances may have diagnostic and prognostic value in evaluation of recurrence, dynamics and differentiation of nasal polyps as well as in their therapy. AIM: The aim of the work was an analysis of nasal polyps on the basis of molecular, histopathological and clinical picture as well as comparing differentiated genes transcription in nasal polyps and proper nasal mucosa. MATERIAL AND METHOD: Oligonucleotide array with HGU 133A - Affymetrix were used to analyze the expression of 22,283 genes in nasal polyp tissues from 17 patients. The control group consisted of 8 tissue samples from patients after nasal septoplasty surgery. RESULTS: All the samples could be classified to nasal polyps group or proper mucosa group, it reflected significant differences in genes profile expression in both groups. The evaluation of 22,283 genes transcriptions showed that in most cases nasal polyps tissue reflect classification connected with dominant inflammation cells infiltration. The data obtained let distinguish subgroups connected with clinical condition of the patients. The subgroup with massive nasal and sinus polyposis, eosinophilia and differentiated lower respiratory airways hyperactivity and the subgroup without eosinophilia infiltration may be distinguished. The data obtained suggest that molecular mechanisms may influence on the promotion and kind of inflammation process as well as the clinical course of nasal polyps.

Evaluation of hearing organ in patients with Turner syndrome.

UNLABELLED: Hearing loss and middle ear diseases are often reported in some of Turner patients. In most of the reports hearing organ was evaluated with the use of subjective methods. The aim of the work was subjective and objective evaluation of hearing organ with an attempt to set the correlation between the results and the genotype of the patients with Turner syndrome (Ts). MATERIAL: 51 Ts patients aged 14.3 years on average. There were 29 girls with monosomy X and 22 having mosaicism. A detailed medical history was taken in each case with attention given to the hearing loss risk factors. METHOD: Physical ENT examination, hearing evaluation: pure tone audiometry, impedance audiometry, distortion products otoacoustic emissions (DPOAEs), brain auditory evoked potentials (BAEP). The control group consisted of 30 healthy patients. RESULTS: Recurrent acute otitis media was reported by 19.6% of Ts patients. Pure tone audiometry was improper in 36.3% ears; conductive hearing loss was present in 11.7% ears, mixed hearing loss in 5.9% ears and the moderate sensorineural hearing loss in 18.6% ears. Impedance audiometry was impaired in 14.7% of the cases. DPOAE disturbances were present in 41.4% of Ts patients, BAEP was improper in 52.0%. The percentage of the disturbances in DOPAEs and in BAEP in patients with mosaicism was 45.4 and 40.9% while in patients with monosomy 68.9 and 62%. CONCLUSIONS: Ts patients present predisposition to hearing disturbances. The disturbances seem to be connected with middle ear infections and with sensorineural hearing losses. Hearing loss in Ts women is not clinically apparent in most of the cases; this fact reflects the need of early evaluation and further monitoring of hearing organ in those patients. Sensorineural hearing loss seems to prevail in patients with 45,X genotype, so perhaps attention should be paid to this subgroup of Ts patients.

Co-expression of the TGF-beta1 and TGF- beta2 isoforms in nasal polyps and in healthy mucosa.

BACKGROUND: The formation of nasal polyps is connected with a chronic inflammatory process with the activation of different cytokines. TGF-ss induces fibrosis and acts as a chemoattractant and proliferation factor for fibroblasts. The aim of the study was to evaluate the expression profiles of the genes coding TGF-ss isoforms in nasal polyps with predominately eosinophilic and neutrophilic infiltration and in healthy mucosa and to assess their mutual correlation with the levels of gene transcription. MATERIAL/METHODS: The study group consisted of 24 patients with nasal polyposis. On the basis of the histopathological evaluation there were 16 eosinophilic and 8 neutrophilic polyps. The control group constituted 9 healthy patients. The expression profiles of the genes coding the TGF-ss isoforms were detected using real-time RT-QPCR. RESULTS: TGF-beta1 and TGF-beta2 mRNAs were revealed in 10 patients with eosinophilic polyps. TGF-beta1 transcriptional activity was accompanied by TGF-beta2 transcriptional activity in nasal polyps. TGF-beta2 gene expression in tissues without mRNA for TGF-beta1 was silenced. There was positive correlation between the expressions of the TGF-beta1 and TGF-beta2 isoforms in nasal polyps. TGF-beta1 mRNA was present at higher levels in all control samples than in eosinophilic polyps. An increased TGF-beta1 mRNA expression was accompanied by an increased TGF-beta2 mRNA expression in healthy mucosa. TGF-beta3 showed the most intensive transcriptional activity among the TGF-ss isoforms in both nasal polyps and control tissues. There was no correlation between TGF-beta3 and TGF-beta1 nor between TGF-beta3 and TGF-beta2 transcriptional activity in nasal polyps and normal tissue.

[Can the placebo be the cure?]. / Czy placebo moze byc lekiem?

Effect of placebo still brings out questionable views and opinions, despite achievements of modern medicine. Placebo has been a component of healing process since the beginning of our history. Given consciously or unconsciously is responsible for the success of medicine before randomized clinical trials. This article reviews the short history of placebos and gives series of examples of the effects and advocates a more rigorous approach to their understanding. The role and meaning of placebos in the clinical trials have been presented since its power has been discovered in the 1955. But we still know little about placebos. For that reason there is a necessity to study the effect of placebo with the same rigor that has been applied to other treatment. According to some authors, this effect particularly concerns psychological and neurological diseases with signs of restlessness, pain and depression. In these cases, effect of placebos may often exemplify as well as distort the evaluation of treatment and efficacy of the drug. Those being engaged in clinical trials must recognize and manage the reality of placebos rather than the attempt to eliminate or disparage them.

[Sepsis in the sphenoiditis patient]. / Posocznica u pacjentki z zapaleniem zatoki klinowej.

INTRODUCTION: We present a case of sepsis caused by isolated sphenoiditis. MATERIAL AND METHOD: The case being described concerns 61-year-old woman treated at the Department of Occupational Diseases of Wroclaw Medical University due to body temperature maintaining for 2 months at above 38 degrees C, leucocytosis reaching 14-16 thousand and weight loss of about 4 kg. Detailed diagnostics did not confirm the preliminary diagnosis of system or neoplastic disease. Bacteriological blood examination revealed the presence of staphylococcus aureus susceptible to Vancomycin and Tienam. The attempt of pharmacological treatment did not produced the expected effect. NMR examination of the facial skeleton proved partial shadowing of the Sphenoidal sinus. The patient was admitted for surgical treatment. After the sphenoidal sinus was cut open, mucopurulent contents was found inside. During microbiological examination, staphylococcus aureus with identical susceptibility was cultured from the mucopurulent contents. After 3-week guided antibiotic therapy, permanent temperature regression and permanent improvement of the patient's condition were achieved. RESULTS: Surgical treatment combined with intensive antibiotic therapy caused the complete regression of symptoms. CONCLUSION: Isolated sphenoiditis occurs rarely but it still is a serious diagnostic and therapeutic problem. Diagnosis delay and disease progress may lead to life-threatening complications.

[The profile of expression of transforming growth factor beta1 and TGFbetaRI, TGFbetaRII and TGFbetaRIII genes in nasal polyps]. / Profil ekspresji genów kodujacych TGF-beta1 i jego receptory TGFbetaRI, TGFbetaRII i TGFbetaRIII w polipach nosa.

BACKGROUND: Transforming growth factor beta (TGF-beta) plays an important role in cells proliferation and differentiation as well as in local immunological response. OBJECTIVES: An evaluation of genes expression profile for TGF-beta1 and its receptors TGF-betaRI, TGF-beta RII and TGF-beta betaRIII as well as their potential role in the pathogenesis of nasal polyps in eosynophilic and neutrophilic polyps and in normal nasal mucosa. MATERIAL: Material consisted of 22 patients. Nasal polyps were removed during standard polypectomy or FESS. In the histopathological evaluation there were 16 eosynophilic polyps and 5 neutrophilic ones. The control group consisted of 8 healthy patients from whom healthy nasal mucosa was taken during nasal septoplasty. METHODS: The expression of the genes coding TGF-beta and its receptors was evaluated with the use of RT-PCR technique. RESULTS: TGF-beta1 mRNA was present in 10 eosynophilic polyps out of 16. In neutrophilic polyps group (n = 6) mRNA TGFbeta-1 was present in 3 samples. TGFbeta-1 isoform was present in all the tissues of the control group. It was significantly larger expression of TGFbeta-1 gene in normal mucosa in comparison with eosinophilic and neutrophilic polyps (p < 0.05). The expression of genes coding TGFbetaRI, TGF-betaRII and TGF-betaRIII receptors was obtained in all the polyps and healthy tissues. There was no significant differences in the transcription activity of the receptors in polyps and in the healthy tissue. CONCLUSIONS: Considering regulative function of TGFbeta1 in inflammation processes, its low concentration in nasal polyps tissue may influence on migration and survival of inflammation cells. The high expression of genes coding TGFbetaRI, TGF-betaRII and TGF-betaRIII receptors in all the polyps and healthy tissues, show readiness to transduction of TGFbeta. It may suggest that, less intensive TGFbeta1 expression in nasal polyps may be connected with the presence of other than first TGFbeta isoforms. This problem needs further investigations to set precise role of individual TGFbeta isoforms and other growth factors in the pathogenesis of NSP as their interactions with local cytokines. It may help to work out more effective and specific therapeutic methods in nasal polyps therapy.

[The change of proliferative potential of fibroblasts derived of nasal polyps in vitro cultured, influenced by derivatives vitamins D]. / Zmiany potencjalu proliferacyjnego fibroblastów pochodzacych z polipów nosowych, w hodowlach in vitro, pod wplywem pochodnych wit. D.

INTRODUCTION: Recurrent polyposis in the same patient resulting in the necessity of repeated surgeries forced to search for new pharmacological therapeutic methods. At present, locally acting glycocorticosteroids have the greatest value in the treatment of nasal polyposis. Polyps grow is connected with inflammation process and proliferation of fibroblasts. OBJECTIVE: An evaluation of calcitriol and tacalcitol influence on proliferation of fibroblasts extracted from nasal polyps. MATERIAL: consisted of 9 tissue samples coming from nasal polyps sampled during polypectomies. The testing was performed on the polyps fibroblasts after the sixth passage after the primary culture was established. Three days after the culture was started the cells were poured with nutrient medium without serum added and after further 24 hours was replaced by nutrient medium with takalcitol and calcitriol in the defined concentrations. The expression of the genes coding histone H3 was evaluated with the use of RT-PCR technique. RESULTS: Tacalcitiol and calcitriol in vitro decrease proliferation of fibroblasts sampled from nasal polyps. Inhibition is most effective for the concentration of 10-4M. Tacalcitiol and calcitriol also inhibit level of histone H3 gene expression. CONCLUSION: Experimental data suggest tacalcitiol to be more effective in the same concentration. Present studies may indicate the direction of further investigation in the potential pharmacological treatment on nasal polyps.

[Haemangiopericytoma of the nasal cavity as a cause of recurrent epistaxis--case report]. / Haemangiopericytoma nosa jako przyczyna nawracajacych krwawien--opis przypadku.

A case of haemangiopericytoma of the nasal septum in 73-year-old female admitted to the Department of Otolaryngology of Wroclaw Medical University with a history of recurrent epistaxis and progressive right monolateral nasal respiratory obstruction is reported. On admission presented smooth, cyanotic, easily bleeding lesion in the nasal cavity on the right. Nose CT scans identified presence of a soft-tissue mass arising from the nasal septum. She was treated with a complete surgical resection of the mass. The diagnosis was established based on the careful histopathological examination. Haemangiopericytomas are rare soft-tissue neoplastic lesions, occurring mainly in adults, originating from pericytes and primarily arising in the lower extremities and retroperitoneum. Haemangiopericytomas of head and neck are very unusual and comprise about 15 to 30%; of these, approximately 5% occur in the sinonasal area. Authors have presented etiology, symptomatology, histopathological features, differential diagnoses, diagnostic and therapeutic management. Malignant and benign clinical course have been described.

[RANTES expression in nasal polyps fibroblasts; spontaneously and after stimulation with lipopolisaccharides (LPS) and phytohemagglutinin (PHA)]. / Ekspresja chemokiny RANTES w fibroblastach pochodzacych z polipów nosowych; samoistna i po stymulacji lipopolisacharydami (LPS) i fitohematoksylina (PHA).

INTRODUCTION: According to the results of research carried out by a number of authors, one of the main mechanisms of the generation of polyps is local inflammatory processes accompanied by immune system disorders. It has recently been shown that a number of differentiation factors and inflammatory mediators may be involved in the growth of nasal polyps. RANTES is a eosinophil chemoattractant factor likely could play an important role in a chronic inflammatory response in the nasal tissue that subsequently leads to the development of nasal polyps. OBJECTIVE: The objective of this study was detection of the chemokine RANTES in nasal polyps fibroblasts and researching influence of stimulation with lipopolisaccharides and phytohemagglutinin for RANTES expression in cultured nasal fibroblasts in vitro. METHODS: Nasal polyps were obtained from 17 subjects (9 atopic and 8 nonatopic) during polypectomy. RANTES was measured by immunofluorescence method. RESULTS: Intensive granular luminescence was observed in all cytoplasm of cells with the exception of nucleus. Immunoreactive RANTES was found to be present in 70% of cells. We not find increase percentage of positive RANTES fibroblasts after stimulation with lipopolisaccharides and phytohemagglutinin. RANTES expression was similar in the both: atopic and nonatopic polyps. CONCLUSIONS: This study demonstrates that cultured fibroblasts derived from both atopic and nonatopic patients release RANTES spontaneously and after stimulation with lipopolisaccharides and phytohemagglutinin. This observation and the finding that RANTES is present in nasal polyps fibroblasts suggest that this chemokine may be an important mediator of eosinophil in both atopic and nonatopic nasal polyposis. More research needs to expand on chemotactic factors such as RANTES and their interplay with other local cytokines.

[Diagnostic and treatment in nasal polyps of children treated in Wroclaw ENT department in the years 1991-2001]. / Diagnostyka i leczenie polipów nosa u dzieci hospitalizowanych w Klinice otolaryngologii we Wroclawiu w latach 1991-2001.

BACKGROUND: Nasal polyposis is not often observed in children and usually follows general chronic diseases or disorders of cilliary structure or function and occurs mostly after 10 years of age. This is why in children clinical changes qualified as nasal polyposis should always be verified as congenital diseases or neoplasmatic changes. CASE REPORT: The population: of children treated in the years 1991-2001 in the Wroclaw ENT Department with initial diagnosis of nasal polyposis was presented. Material consisted of 52 children admitted in the years of 1991-2001 to Wroclaw ENT Department with already diagnosed nasal polyposis. In each case medical history was collected together with routine physical ENT examination complemented with fiberoendoscopic examination of the nose end epipharynx. In 7 children with initial diagnosis of nasal polyposis hypertrophy of pharyngeal tonsil with vasomotor rhinitis was diagnosed. Those children underwent adenectomy. Remaining group of 45 children aged from 2 to 16 years was analysed. Surgical treatment (polypectomy, FESS) was performed in 44 children. There was antrochoanal polyp in 10 cases (20,4%), monolateral choanal atresy in 1 case, foreign body of nasal cavity in 1 case and neoplasmatic tumour diagnosed in 5 cases. CONCLUSIONS: The diagnostic difficulties in nasal polyposis in children, except neoplasm, are reflected by the cases with initial diagnosis of nasal polyp and finally diagnosed as foreign body with inflammatory reaction or monolateral choanal atresy. Endoscopic examination of nasal cavity together with radiological diagnostic should be ordered routinely in the unclear cases.

Trace elements in nasal polyps.

The reason why nasal polyps occur has not been explained yet. In the literature, the role of immunological factors are considered and broadly discussed, but there is no information on the role of microelements in the pathogenesis of nasal sinusal polyposis. In this study, concentrations of Cu, Se, Zn, and Pb in tissue of nasal polyps were determined. The tissue samples were taken from 41 patients during polypectomia procedures, whereas healthy tissue from nasal mucosa was sampled from 10 patients during endonasal surgery. The concentrations of the elements were determined by atomic absorption spectrometry. It was found that the concentrations of all the elements were signifcantly lower in polyp tissues than in healthy nasal mucosa. The reasons for this are unclear in the present study.

[Cytological examination of nasal polyps smears]. / Badanie cytologiczne wymazów z polipów nosowych.

Cytological evaluation of smears taken from the surface of nasal polyps were presented. 30 patients were examined. In 60% of the smears the prevalence of neutrophils were noticed. The metaplasia of stratified squamous cell epithelium, lesion of cell's nuclei and blurring of cytoplasm were observed in this cases. In 23 cytograms predominance of eosinophils were found. In cytograms with predominance of eosinophils, numerous stratified columnar epithelium were present. According to cytological examination the polyps were divided to neutrophil and eosinophil type. Cytograms taken from eosinophil polyps resembling smears from atopic rhinitis. In the case of neutrophil polyps the changes in cytograms characteristic for chronic rhinitis were found.

[Electrophysiologic tests of the auditory apparatus and vestibular organ in Usher syndrome]. / Badania elektrofizjologiczne narzadu sluchu i przedsionkowego w zespole Ushera.

Usher syndrome is a congenital autosomal dominant inherited disease characterised by hearing, balance and vision problems. The aim of the work was an evaluation of hearing and vestibular organ in the chosen group of patients with Usher syndrome diagnosed. Material consisted of 10 persons (5 males and 5 females) aged from 16 to 46 years with Usher syndrome diagnosed. All the patients have been in constant ENT and Ophthalmology Clinics' care. Complex hearing and balance organ, including posturography, as well as complex ophthalmologic examination were performed in each case. Medium or severe perceptive cochlear hearing loss, proper function of vestibular organ and slight elevation of stabilograms parameters were found in 6 cases. In 4 cases there were severe bilateral hearing loss, lack of vestibular function and considerable worsening of stabilograms parameters. In ophthalmologic examination in all the cases there was bilateral symmetrical dystrophy of the retina of various intensification. We concluded that hearing and balance organ examination in Usher syndrome can state accessory diagnostic aspect that might help to distinguish subtypes of the syndrome. In this way audiologic and otoneurologic tests could help to define prognosis of the disease in the individual cases. A necessity of close co-operation of genetics, ophthalmologists and ENT doctors as well as psychologists was stressed.

[Bacterial flora as a potential etiopathogenic factor for nasal polyps]. / Flora bakteryjna jako potencjalny czynnik etiopatogenetyczny polipów nosa.

Nasal polyps develop in patients with disturbed local homeostasis of nasal mucosa. Research of Bernstein and Stoop showed the influence of inflammation of nasal mucosa on growth of nasal polyps. Bacterial and viral infections play significant role in development and intensification of inflammatory and immunological process. Many bacteria produce factors which damage cilia cells, cause dyskinesis of cilia and destroy respiratory epithelium. Disturbed muco-ciliar cleaning permits bacteria to penetrate through mucous layer and facilitate their adhesion and colonization on the cells of respiratory epithelium. Adhesion and successive colonization with bacteria multiplication can lead to inflammatory process. Nose swabs results were different in each examined group. The aim of this work was to define bacterial flora in patients with nasal polyps and in patients after polypectomia and to compare it to bacterial flora in healthy patients. Nose swabs were performed in 51 patients with nasal polyps before polypectomia and additional in 15 patients after polypectomia. 25 healthy medical students were a control group. The patients were divided into two groups: I. patients with nasal eosinophilic polyps, II. patients with nasal neutrophilic polyps. In the group of patients with both neutrophilic and eosinophilic polyps dominating bacterial flora included bacteria which usually are the cause of inflammation. In the group of patients after polypectomia bacterial flora was not different from that which was found in patients with polyps.