[Bone anchored hearing aids (BAHA) used for treatment of conductive hypoacusis--current problems in Poland]. / Aktualne problemy protezowania niedosluchów przewodzeniowych aparatami zakotwiczonymi w kosci skroniowej (BAHA) w Polsce.

Basic principles, indications and limitations of BAHA implantation as well as different kinds of operation techniques are presented. The beginning and the development of BAHA use in Poland are mentioned together with some difficulties in broadening of this kind of implantation.

Smell impairment in workers occupationally exposed to cadmium.

ENT and olfactometric examinations were carried out on 73 workers at an electrochemical plant involved in the production of cadmium-nickel batteries, where cadmium fumes were emitted into the workplace. Exposure levels exceeded the maximum allowable concentrations by about 1-2 times. The controls included 43 non-exposed, age- and cigarette-smoking-matched people. The olfactometric tests were carried out by the blast injection method, using natural coffee, aniseed, lemon and mint oils; two threshold measurements were assessed: maximum perceptible odour (MPO) and minimum identifiable odour (MIO). In addition, blood chemistries and urinalysis were carried out. The study revealed the smell lesion in 45.2% of the exposed group vs 4.6% of the controls. A statistically significant correlation between olfactory dysfunction and cadmium concentrations in the blood and urine was found; however, no correlation with the duration of employment was observed. It seems most likely that cigarette smoking, which is a considerable source of cadmium, may intensify this dysfunction, hence heavy smokers should not work in conditions of cadmium exposure.

Assessment of smell and taste in patients with allergic rhinitis.

We examined the senses of smell and taste in 240 patients with verified hypersensitivity reactions of the respiratory tract. Olfactometry was performed according to Elsberg and Levy's method and followed by electrogustometry. The examinations revealed that the incidence of smell and taste disorders in patients with allergic rhinitis is 21.4% and 31.2%, respectively. No significant relationships between smell and taste dysfunction were found. We evaluated statistically positive correlations between the olfactory and gustatory thresholds compared with 78 qualitative and quantitative factors assessed in the study. There was a statistically significant relationship between the olfactory thresholds and levels of eosinophils in blood and in nasal discharge. acid reaction of the nasal mucosa, coexisting nasal polyps and X-ray changes in the ethmoid sinuses. There was a positive influence of pharmacotherapy as well as specific desensitization and surgery on the impairment of the sense of smell in allergic rhinitis.

[The treatment of tracheal stenosis in Wegener's granulomatosis by laser surgery]. / Leczenie zwezenia tchawicy w przebiegu choroby Wegenera za pomoca lasera.

A case of Wegener's disease is described. In eight years of remission a patient, treated with cyclophosphamid and steroids demonstrated sterosis of the trachea and upper way obstruction. We have performed carbon dioxide laser photoresection of granulotion mucosis and scars with an excellent results.

[Approach to acute non-inflammatory increase in the circumference of the neck]. / Problem naglego niezapalnego powiekszania sie obwodu szyi.

We describe a case of spontaneous rupture of a left common carotid artery aneurysm during coughing which had lead to the demise of the patient despite a surgical intervention. This case is correlated with three cases of cervical haematomas which also presented with an acute increase in the neck circumference. Based on the literature and our own experience, we discuss the diagnostic and surgical approach to patients suspected of having aneurysms of the great vessels of the neck.

Olfactory disorders induced by cadmium exposure: a clinical study.

The evaluation of olfaction is not only widely applied and undeniably valuable in clinical diagnostics but it is also of interest to industrial medicine. It should be borne in mind that in certain workplaces, particularly in the chemical industry, the olfactory receptor has to act as an organ which warns the worker against threatening intoxication, and this is possible only when it functions properly. Cadmium, as a highly toxic metal, found widely in industry and in the environment, is frequently included in the list of chemicals known to cause olfactory impairment. The purpose of this study was to evaluate olfaction in workers occupationally exposed to cadmium. The correlation between olfaction and concentrations of cadmium in urine, blood and in the workplace air as well as employment duration was examined in workers of the "CENTRA" S.A., an electrochemical plant in Poznan. In this plant cadmium-nickel batteries are produced, and there is chronic occupational exposure to cadmium in quantities exceeding maximum allowable concentration (MAC). A group of 73 workers aged 20 to 60 years (42.0 +/- 18.0), employed from 4 to 24 years (12.5 +/- 8.5) were examined. Of the 73 workers who completed the evaluation, 53 people (72.7%) were smokers (10-40 cigarettes per day). In addition to medical history, medical and ENT examinations, blood and urine tests were taken and olfactometry performed. Olfactometry was performed according to Elsberg and Levy's method, modified by Pruszewicz, in which natural coffee as well as aniseed, lemon and mint oils were used. The quantitative and qualitative olfactory disorders were evaluated on the basis of the established odor detection threshold (ODT) and odor identification threshold (OIT). The examinations revealed numerous cases of hyposmia (26.0%) and parosmia (17.8%) and one case of anosmia (1.4%). In the majority of people with olfactory disorders, hypertrophic changes in the nasal mucosa, dependent on the duration of employment, were identified. Statistically significant relationship between olfactory impairment and cadmium concentration in blood, urine and the workplace air was observed. However, such a relationship was not found in regard to the duration of employment. The study indicated the need to carry out routine olfactometries. The results of these examinations could be the ground to perform certain preventive and therapeutic procedures.

[Tracheal strictures in the course of Wegener's disease]. / Zwezenia tchawicy w przebiegu choroby Wegenera.

Two cases of tracheal strictures in the course of Wegener's disease are described. One patient died two months after tracheotomy, the other was successfully treated only by megachemotherapy (cyclophosphamide and steroids).

[Warthin's tumors with atypical location]. / Guzy Warthina o nietypowej lokalizacji.

This article addresses etiology, pathogenesis and histology of papillary cystadenoma lymphomatosum (Warthin's tumor). Described are two cases of tumors with this histopathological characteristics with unusual locations. The first patient presented with a discrete lesion located in the nasopharynx, and the second with multiple post-infectious nodules located in the parotid glands bilaterally. The approach to the diagnosis and treatment of these cases is discussed.

[Surgical treatment of hearing loss in blue sclera syndrome]. / Operacyjna poprawa sluchu w zespole niebieskich twardówek.

Etiological theories given in literature, patomechanism and otosclerosis-reminding traits of the blue scleras syndrome are discussed in this paper. The operative methods of repairing conductive hypoacusia in familial blue scleras syndrome based on own research are described. The audiological results of hearing loss surgical treatment in this case are presented.

Morphology of brain stem lesion and bera findings after 60Co irradiation.

Ionizing rays, utilized in radiological diagnostics and oncological therapy affect the central nervous system and may injure auditory pathways and cause hearing disturbances which vary in intensity. On the basis of a stereotactic atlas of the brain of a guinea pig, the trapezoid and geniculate bodies were identified in the skull X-ray pictures. The irradiated region was found to have 10 x 6 x 5 mm in dimensions and to be situated at the depth of 11 mm away from the animals occiput. After introductory recording of the potentials obtained from the brain stems (BERA), the stems of 60 guinea pigs were irradiated in the groups with the doses of 5, 10, 20 Gy. The hearing potentials from the brain stems were recorded on the 1st, 4th, 10th, 21st and 84th day after irradiation. The findings of measurements of hearing potentials were compared with the morphologic picture of the brain stems in the examined animals.

Multiple enhancer elements mediate induction of c-fos in vascular smooth muscle cells.

Previous work from this and other laboratories has demonstrated that the vasoconstrictor peptide angiotensin II results in hypertrophy of rat aortic smooth muscle cells that is associated with an increase in transcription of the early growth response gene c-fos. To explore the molecular mechanism responsible for c-fos induction in rat aortic smooth muscle cells, we used a series of reporter constructs linked to the chloramphenicol acetyl transferase gene in transient transfection experiments in rat aortic smooth muscle cells. Constructs containing both the serum response element and cAMP response element exhibited a 20-fold increase in chloramphenicol acetyl transferase activity in response to either serum or angiotensin II, whereas no increase was seen in vehicle-treated cells. Mutations in either the serum response element or cAMP response element alone, which have been demonstrated to inactivate these elements in other cell types, had no effect on chloramphenicol acetyl transferase inducibility. In contrast, if both elements were mutated, inducibility was almost abolished. Electrophoretic mobility shift assays with oligonucleotides corresponding to either serum response element or cAMP response element demonstrated that these oligonucleotides are capable of forming specific complexes with proteins from rat aortic smooth muscle cell nuclear extracts. One of the proteins binding to the serum response element is the previously described serum response factor, since it was supershifted by a monospecific antibody. These studies demonstrate that c-fox induction in smooth muscle occurs by a dual mechanism that can activate transcription via the serum response element or cAMP response element. These elements appear to act equally and independently, involving a distinct set of transacting factors.

[Meningiomas of the middle ear]. / Oponiaki ucha srodkowego.

The histological structure of meningiomas as well as symptomatology, diagnostics and treatment of those tumors originally localized in the temporal bone is discussed on the basis of literature. A case of a histologically confirmed intratympanic meningioma in a 43-year-old woman is presented. The original symptoms of the tumor imitated the symptoms of the chronic otitis media. Two operations of the ear were performed and the tumor which was completely removed has not given any symptoms of metastasis for six years.

[A case of congenital unilateral absence of maxillary and frontal sinuses]. / Przypadek wrodzonego jednostronnego braku zatok szczekowej i czolowej.

The paper presents individual evolution of frontal and maxillary sinuses at man as well as presents the case of congenital unilateral absence of maxillary and frontal sinuses at 54 years old woman during treatment of upper airways infection. The only symptom found in physical examination was lowered infraorbital margin. Before and after treatment the patient did not claim any complaints.

[Thrombosis of the sigmoid sinus and transverse sinus with an unusual course]. / Zakrzep zatoki esowatej i poprzecznej o nietypowym przebiegu.

A case of intracranial complication in patient with cephalgia and short period of the temperature without signs of sharpening chronic otitis is reported. At the time of the operation epidural abscess of fossa cranial posterior, perisinusal abscess and thrombus of sigmoid sinus, abscess in transverse sinus were found.

[The application and usage of the bone-anchored hearing aids (BAHA)]. / Zastosowanie zakotwiczonych aparatów sluchowych na przewodnictwo kostne (BAHA).

This article describes the mode of operation of temporal bone-anchored hearing aids (BAHA) based on the phenomenon of osseointegration, and the otiatric and audiologic criteria used in the selection of patients for implantation of this device. The technical details of the two-step implantation of a titanium anchor for BAHA within the mastoid process are described. The difficulties associated with this procedure are analyzed based on our own experience with implants placed in 3 patients.

Angiotensin II type 1 receptor-mediated stimulation of c-fos gene expression in astroglial cultures.

Angiotensin II (ANG II) stimulates plasminogen activator inhibitor 1 (PAI-1) gene expression in astroglial cells prepared from rat brains. In this study, we investigated whether c-fos gene expression may be involved in this cellular action of ANG II. Incubation of astroglial cultures with ANG II caused a time- and dose-dependent transient stimulation of the steady-state levels of c-fos mRNA, with a maximal stimulation of 50-fold observed with 100 nM ANG II within 30-45 min. This stimulation was completely abolished by the presence of the type 1 ANG II (AT1) receptor antagonist losartan but not by the type 2 ANG II receptor blocker PD-123177. Depolarization of brain cell cultures with 50 mM K+ also caused a 100-fold increase in c-fos mRNA levels, an effect partially blocked by losartan. These observations show that AT1 receptor activation stimulates expression of the c-fos gene, which may act as a third messenger in the regulation of cellular actions of ANG II, including PAI-1 gene expression in astroglial cells.

The cellular and physiological actions of insulin in the central nervous system.

Insulin is a peptide hormone involved in the regulation of glucose homeostasis. Its synthesis and function in the peripheral tissues have been extensively studied and well understood. In contrast, demonstration of insulin in the brain has raised questions concerning its origin and physiological significance. In spite of extensive studies, the source of insulin present in the brain has not yet been conclusively identified. Evidence exists in support of both peripheral and central origins of this hormone in the brain. Recognized physiological effects of insulin in the central nervous system (CNS) include regulation of food intake, control of glucose uptake and trophic actions on neuronal and glial cells. These actions of insulin are mediated by insulin receptor resembling closely that in peripheral tissues and coupled with tyrosine kinase signal transduction pathway. In this review we will discuss theories concerning the origin of insulin in the CNS. In addition, we will present current information on both cellular and physiological effects of this hormone in the brain.

Angiotensin-II induction of plasminogen activator inhibitor-1 gene expression in astroglial cells of normotensive and spontaneously hypertensive rat brain.

Angiotensin-II (AII) stimulates plasminogen activator inhibitor-1 (PAI-1) gene transcription, translation, and protein secretion from astroglial cells derived from normotensive [Wistar-Kyoto (WKY)] rat brain, an effect mediated by AII type 1 (AT1) receptors. Since abnormal expression of the brain AII system has been demonstrated in spontaneously hypertensive (SH) rats, we investigated the regulation of PAI-1 gene expression by AII in astroglial cells from the brains of these animals. AII caused an increase in PAI-1 gene expression in SH rat astroglia in a manner similar to that observed in WKY-derived cultures. However, both the basal and AII-stimulated levels of PAI-1 mRNA in SH rat astroglia were only 20% of those observed in WKY rat astroglial cultures. Consequently, there was a significant reduction in the de novo synthesis and secretion of PAI-1 from astroglia of SH rat brain. The reduced synthesis and secretion of PAI-1 from SH rat brain astroglia was associated with lower numbers of AT1 receptors in these cells. However, the steady state levels of AT1 receptor mRNA were comparable in both WKY and SH rat astroglia. This reduction in AII-modulated PAI-1 levels in SH rat astroglia is consistent with a proposed role of these interactions in the development of hypertension in these animals.

Angiotensin II stimulation of plasminogen activator inhibitor-1 gene expression in astroglial cells from the brain.

In this study, we investigated the mechanism of angiotensin II (Ang II) induced secretion of plasminogen activator inhibitor-1 (PAI-1) from astroglial cells prepared from 21-day-old rat brain. Competition-inhibition experiments with the use of selective antagonists for Ang II receptor subtypes indicated that astroglial cells contain chiefly Ang II type 1 (AT1) receptors. The interaction of Ang II with AT1 receptors resulted in a time- and concentration-dependent stimulation of PAI-1 gene expression. A maximal, 20-fold induction of PAI-1 messenger RNA (mRNA) steady-state levels was observed with 10 nM Ang II. This effect of Ang II was blocked by DuP753, an AT1 receptor antagonist, but not by PD123177, an AT2 receptor antagonist. Raise in PAI-1 mRNA levels was followed by an elevation in PAI-1 concentration in culture media reaching its maximum after 24 h. Interaction of Ang II with AT1 receptors also resulted in a time- and concentration-dependent stimulation of inositol phospholipid (IP) hydrolysis. A maximal, 3- to 5-fold stimulation of IP hydrolysis was observed with 10 nM Ang II. The time course experiments indicated that Ang II-induced stimulation of IP hydrolysis precedes the stimulation of PAI-1 mRNA. This suggested that activation of phospholipase C, IP hydrolysis system and possibly protein kinase C (PKC) may mediate Ang II's effect on PAI-1 mRNA. Direct stimulation of PKC by phorbol ester, phorbol 12,13-dibutyrate (PDB), resulted in a time- and concentration-dependent elevation of PAI-1 mRNA levels, similar to that caused by Ang II (maximal stimulation of 20-fold with 100 nM PDB for 4 h). This effect was totally blocked by the protein kinase C inhibitor, H7. In addition, Ang II stimulation of PAI-1 mRNA was also blocked by H7. In contrast, Ang II did not elevate PAI-1 mRNA levels in astroglial cultures from neonatal rat brains. However, treatment of neonatal cultures with PDB increased levels of this mRNA species. These observations indicate that the coupling of AT1 receptors with IP hydrolysis and PKC activation may be important for Ang II stimulation of PAI-1 gene expression. The lack of Ang II's effect on PAI-1 mRNA in neonatal astroglia may be explained either by a low coupling efficiency between AT1 receptors and the second messenger system, or by a low AT1 to AT2 receptor level ratio.