Frontal sinus and recess osteomas: an endonasal endoscopic approach.

BACKGROUND: Over the last decade, there has been an increase in the use of the endonasal endoscopic approach for removing frontal sinus and frontal recess osteomas. This study aimed to describe an endoscopic endonasal treatment of osteomas without the need for an external approach. MATERIALS AND METHODS: We performed a retrospective analysis of patients that had received operations over a 5-year period in a single center. RESULTS: Twenty-nine patients underwent endoscopic osteoma resections. The osteomas were graded according to the Chiu and Kennedy grading system: 12 had type I, 2 had type II, 13 had type III, and 2 had type IV osteomas. The most common indication for surgery was frontal pain. Removal of the osteoma was incomplete in three patients. Of these, one underwent successful transnasal reoperation, and the other two had tumors that extended near the mid-orbital line and were attached to the orbital roof. Based on an 11-point scale (0--no pain, 10--maximum pain), the mean pain intensity decreased from 7.5 before surgery to 3.3 (p < 0.005) after surgery for patients that underwent surgery due to frontal pain. CONCLUSION: We found that exclusively transnasal endoscopic resections of frontal sinus osteomas were safe. However, this approach can be inadequate under some conditions. An auxiliary external approach may be required when the frontal ostium is narrow and/or when tumors are extensively attached to the orbital roof, and grow close to the midorbital point.

The effect of methylprednisolone on proliferation of PBMCs obtained from steroid-sensitive and steroid-resistant rheumatoid arthritis patients.

OBJECTIVE: Glucocorticoids (GCs) are among the most frequently used drugs for the treatment of rheumatoid arthritis (RA). Unfortunately, up to 30% of patients with RA fail to respond to the treatment. We investigated the hypothesis that patients with RA who did not respond to GC treatment have steroid-resistant peripheral blood mononuclear cells (PBMCs). METHODS: Forty-four patients with RA were enrolled in the study. PBMCs were isolated from blood samples. The effect of methylprednisolone (MP) on the proliferation of stimulated cells was measured. After taking the blood samples, 10 days of MP therapy (20 mg i.v.) was started, in order to classify the patients into either a GC-sensitive (RA/GCS) or a GC-resistant (RA/GCR) group. RESULTS: A quarter of our patients did not show any improvement after short-term GC therapy and were assigned to the RA/GCR group. The inhibition of PBMC proliferation after MP treatment was significantly lower in the RA/GCR as compared to the RA/GCS group. CONCLUSION: Based on the close relationship between clinically observed GC resistance and a diminished response of PBMCs to MP treatment, we conclude that measurement of the steroid sensitivity of PBMCs may be a useful tool in predicting the therapeutic effect of GC in patients with RA.

Trunk sway measures of postural stability during clinical balance tests: effects of a unilateral vestibular deficit.

This research evaluated whether quantified measures of trunk sway during clinical balance tasks are sensitive enough to identify a balance disorder and possibly specific enough to distinguish between different types of balance disorder. We used a light-weight, easy to attach, body-worn apparatus to measure trunk angular velocities in the roll and pitch planes during a number of stance and gait tasks similar to those of the Tinetti and CTSIB protocols. The tasks included standing on one or two legs both eyes-open and closed on a foam or firm support-surface, walking eight tandem steps, walking five steps while horizontally rotating or pitching the head, walking over low barriers, and up and down stairs. Tasks were sought, which when quantified might provide optimal screening for a balance pathology by comparing the test results of 15 patients with a well defined acute balance deficit (sudden unilateral vestibular loss (UVL)) with those of 26 patients with less severe chronic balance problems caused by a cerebellar-pontine-angle-tumour (CPAT) prior to surgery, and with those of 88 age- and sex-matched healthy subjects. The UVL patients demonstrated significantly greater than normal trunk sway for all two-legged stance tasks especially those performed with eyes closed on a foam support surface. Sway was also greater for walking while rotating or pitching the head, and for walking eight tandem steps on a foam support surface. Interestingly, the patients could perform gait tasks such as walking over barriers almost normally, however took longer. CPAT patients had trunk sway values intermediate between those of UVL patients and normals. A combination of trunk sway amplitude measurements (roll angle and pitch velocity) from the stance tasks of standing on two legs eyes closed on a foam support, standing eyes open on a normal support surface, as well as from the gait tasks of walking five steps while rotating, or pitching the head, and walking eight tandem steps on foam permitted a 97% correct recognition of a normal subject and a 93% correct recognition of an acute vestibular loss patient. Just over 50% of CPAT patients could be classified into a group with intermediate balance deficits, the rest were classified as normal. Our results indicate that measuring trunk sway in the form of roll angle and pitch angular velocity during five simple clinical tests of equilibrium, four of which probe both stance and gait control under more difficult sensory conditions, can reliably and quantitatively distinguish patients with a well defined balance deficit from healthy controls. Further, refinement of these trunk sway measuring techniques may be required if functions such as preliminary diagnosis rather than screening are to be attempted.

[Endoscopic intranasal microsurgery in the management of cerebrospinal fluid rhinorrhea]. / Zastosowanie endoskopowej mikrochirurgii wewnatrznosowej w leczeniu plynotoku nosowego.

The surgical management of cerebrospinal fluid rhinorrhoea has changed significantly after the introduction of functional endoscopic sinus surgery in the management of chronic rhinosinusitis. It gave the excellent visualization and atraumatic surgical technique in the management of eight cases of cerebrospinal fluid leaks treated in Department of Otolaryngology Medical University of Warsaw. Five of them were grafted with a pedicled middle turbinate mucosal flap. In the next three cases cerebrospinal fluid leaks came from sphenoid sinus and were stopped by free autograft of temporal fascia or abdominal fat. The indications and the advantages of the endoscopic management of cerebrospinal fluid leaks were discussed.

Extent of pathological changes in the paranasal sinuses of patients with cystic fibrosis: CT analysis.

The aim of the study was to define the characteristic changes revealed by computed tomography (CT) examination of the paranasal sinuses in patients with cystic fibrosis (CF). The group of 30 CF patients was evaluated in the outpatient clinic of the Department of Otorhinolaryngology, Medical University of Warsaw, from 1996 to 1998. The control group consisted of 30 patients with chronic rhinosinusitis (CRS). CT scans were obtained from both groups of patients, and findings revealed more advanced pathological changes in the CF than CRS group. The extensive inflammatory process observed in CT scans of CF patients resulted in the impairment of frontal and maxillary sinus development, destruction of bony structures, and medial projection of the lateral nasal wall.

Trunk sway measures of postural stability during clinical balance tests: effects of age.

BACKGROUND: The major disadvantage of current clinical tests that screen for balance disorders is a reliance on an examiner's subjective assessment of equilibrium control. To overcome this disadvantage we investigated, using quantified measures of trunk sway, age-related differences of normal subjects for commonly used clinical balance tests. METHODS: Three age groups were tested: young (15-25 years; n = 48), middle-aged (45-55 years; n = 50) and elderly (65-75 years; n = 49). Each subject performed a series of fourteen tasks similar to those included in the Tinetti and Clinical Test of Sensory Interaction in Balance protocols. The test battery comprised stance and gait tasks performed under normal, altered visual (eyes closed), and altered proprioceptive (foam support surface) conditions. Quantification of trunk sway was performed using a system that measured trunk angular velocity and position in the roll (lateral) and pitch (fore-aft) planes at the level of the lower back. Ranges of sway amplitude and velocity were examined for age-differences with ANOVA techniques. RESULTS: A comparison between age groups showed several differences. Elderly subjects were distinguished from both middle-aged and young subjects by the range of trunk angular sway and angular velocity because both were greater in roll and pitch planes for stance and stance-related tasks (tandem walking). The most significant age group differences (F = 30, p <.0001) were found for standing on one leg on a normal floor or on a foam support surface with eyes open. Next in significance was walking eight tandem steps on a normal floor (F = 13, p <.0001). For gait tasks, such as walking five steps while rotating or pitching the head or with eyes closed, pitch and roll velocity ranges were influenced by age with middle-aged subjects showing the smallest ranges followed by elderly subjects and then young subjects (F = 12, p <.0001). Walking over a set of low barriers also yielded significant differences between age groups for duration and angular sway. In contrast, task duration was the only variable significantly influenced when walking up and down a set of stairs. An interesting finding for all tasks was the different spread of values for each population. Population distributions were skewed for all ages and broadened with age. CONCLUSIONS: Accurate measurement of trunk angular sway during stance and gait tasks provides a simple way of reliably measuring changes in balance stability with age and could prove useful when screening for balance disorders of those prone to fall.

[Use of intratympanic gentamycin for the treatment of Meniere's disease]. / Transtympanalne podawanie gentamycyny w chorobie Meniere'a.

The ablation treatment of Meniere's disease by intratympanic streptomycin applications was first reported by Schuknecht in 1957. Streptomycin and gentamycin are the most frequent aminoglycosides used for the Meniere's disease treatment. Gentamycin is responsible for the damage of vestibular dark cells causing the impairment of endolymph production. This method gives the possibility for the control of the vertigo with a potential hearing preservation. Fifteen patients with unilateral Meniere's disease who had not responded to conventional therapy, were treated by intratympanic gentamycin injections. The hearing status and the caloric test were staged before and after treatment according to the AAO-HNS guidelines. Overall results after minimum 1 year follow-up in this group were as shown below: complete vertigo control--5 patients, substantial vertigo control--8 patients, complete relief of tinnitus--10, relief of aural fullness--12 patients, hearing loss--none. According to presented results, intratympanic injections of gentamycin is the useful alternative to the surgery. This method should be consider in every patient with the unilateral Meniere's disease, who had not responded to the conventional treatment.

[Paranasal sinuses CT scans analysis of patients with cystic fibrosis]. / Analiza obrazów tomografii komputerowej zatok przynosowych u chorych z mukowiscydoza.

Thirty patients with cystic fibrosis (CF) were diagnosed of the otolaryngological outpatient clinic, a part of Department of Otorhinolaryngology Medical Academy in Warsaw, in 1996-1998. The control group was formed by thirty patients with chronic rhinosinusitis (CRS). Computed tomography (CT) scans were estimated in all cases. Results showed, that inflammatory changes are more advanced in patients with cystic fibrosis than in patients with chronic rhinosinusitis. The high progression of inflammatory changes in patients with cystic fibrosis, observed in CT scans, caused: disturbed development of a frontal and maxillary sinuses, destruction of bony structures formed the lateral wall of the nasal cavity, medical bulging of the lateral nasal wall.

[The great investigators of the ear anatomy]. / Wielcy badacze anatomii ucha.

There was presented the galaxy of famous anatomists which had investigated the structure of the ear and the temporal bone. There were shown the anatomical parts of the ear, which were named from the names of their discoverers.

[Evaluation of the results of surgical treatment of patient with paranasal sinusitis and cystic fibrosis]. / Ocena wyników leczenia operacyjnego przewleklego zapalenia zatok przynosowych u pacjentów z mukowiscydoza.

30 patients diagnosed from cystic fibrosis in the Department of Otorhinolaryngology, the Medical University in Warsaw in 1996-1998 participated in this study. In whole group of patients the advanced inflammatory changes in paranasal sinuses were found. In 7 cases endoscopic surgery of paranasal sinuses has been performed. The follow up has been kept by 2 years. In 2 cases reappearance of symptoms and nasal polyps observed after few months post the operation. In the remaining number of patients we noticed the satisfactory result of the treatment and the improvement of the life quality. A good nasal patency and recovery od smell were gained.

High levels of IL-17 in rheumatoid arthritis patients: IL-15 triggers in vitro IL-17 production via cyclosporin A-sensitive mechanism.

Recent data suggest that IL-15 plays an important role in the pathogenesis of rheumatoid arthritis. In the present study, we hypothesized that elevated in the joints of rheumatoid arthritis, but not osteoarthritis, patients, IL-15 may exert its proinflammatory properties via the induction of IL-17, a cytokine known to stimulate synoviocytes to release several mediators of inflammation including IL-6, IL-8, GM-CSF and PGE2. To test this hypothesis, we first measured the levels of IL-17 and IL-15 using specific ELISA and found that synovial fluids of patients with rheumatoid arthritis, but not with osteoarthritis, contain high levels of these cytokines. A strong correlation between IL-15 and IL-17 levels in synovial fluids was observed. Among tested factors, LPS and TNF-alpha failed, IL-15 and IL-2 were equipotent, and PMA + ionomycin was far more efficient in the induction of IL-17 secretion by PBMCs isolated from healthy blood donors. Interestingly, synovial fluid cells, in contrast to PBMCs isolated from patients with rheumatoid arthritis, but not osteoarthritis, respond to PMA + ionomycin with much lower, comparable to IL-15-triggered IL-17 secretion. Moreover, PMA + ionomycin-triggered IL-17 secretion is completely or partially blocked in the presence of low doses of cyclosporin A or high doses of methylprednisolone, respectively. IL-15-triggered IL-17 secretion by PBMCs was completely inhibited by these drugs. Thus, our results suggest for the first time that IL-15 may represent a physiological trigger that via cyclosporin A and steroid sensitive pathways leads to the overproduction of IL-17 in the joints of rheumatoid arthritis patients.

Protein kinase c-dependent pathway is critical for the production of pro-inflammatory cytokines (TNF-alpha, IL-1beta, IL-6).

The authors hypothesized that certain PKC isoforms play an important role in the induction of pro-inflammatory cytokine (TNF-alpha, IL-1beta, IL-6) synthesis. To test this hypothesis, the cytosol-to-membrane translocation of select PKC isoforms with tested cytokine production in human monocytes cultured in vitro was correlated. It is reported that in monocytes treated with phorbol ester (PMA), translocation of PKC isoforms alpha, betaII, delta and epsilon precede cytokine synthesis. Moreover, specific inhibition of PKC translocation that occurs in the presence of Calphostin C is reflected in downstream events: lack of MAP kinases phosphorylation, loss of DNA binding ability by AP-1 transcription factor, and the reduction of pro-inflammatory cytokine synthesis. Thus, the cytosol-to-membrane translocation of PKC isoforms alpha, betaII, delta and epsilon with the subsequent activation of: (1) MAP kinases; and (2) AP-1 transcription factor, may represent critical steps in the induction of signalling cascade leading to TNF-alpha, IL-1beta, IL-6 synthesis in human monocytes.

[Profound bilateral sensorineural hearing loss: a result of viral infections]. / Gleboki obustronny niedosluch odbiorczy--nastepstwo kolejnych infekcji wirusowych.

A patient is presented with profound bilateral sensorineural hearing loss, as a result of viral infections. The extensive clinical diagnosis was carried out. The findings of multiple audiological and immunological tests helped to fix the proper treatment and the period of its application. In consequence, the hearing in the right ear showed a significant improvement, but the left ear wasn't recovering. The inflammatory process occurred much earlier in the left ear and caused the indivertible hearing loss.

Regulation of ICE activity and ICE isoforms by LPS.

Interleukin 1 beta (IL-1 beta) is a highly inducible proinflammatory cytokine. It is processed to its mature, secreted 17-kDa form by a cysteine endoprotease; the interleukin 1 beta converting enzyme (ICE). Regulation of IL-1 beta levels can be achieved both at transcriptional and translational level and in particular at the posttranslational, ICE catalysed, level. Thus, we examined ICE activity in rats under conditions of systemic stimulation by intraperitoneal (i.p.) injections of lipopolysaccharide (LPS) from E. coli, which are known to dramatically alter IL-1 beta mRNA and protein levels. ICE mRNA levels and endoprotease activity have also been found to be differentially regulated in the rat adrenal gland and rat brain after i.p. injections of LPS. An induction in ICE mRNA levels could be seen in the adrenal gland, the pituitary and in the hypothalamus after LPS treatment as measured by reverse transcription-polymerase chain reaction (RT-PCR), whereas the ICE endoprotease activity was increased in the pituitary and decreased in the hippocampus and in the adrenal gland. The discrepancy between increased mRNA level for ICE and decreased enzyme activity in the adrenals might be explained by the induction of ICE isoforms, some of which might be inhibitory for the enzyme activity and induced by LPS, yielding as a net effect a suppression of ICE activity.

[Ethmoiditis with orbital complications in children]. / Powiklania oczodolowe w przebiegu ostrego zapalenia zatok przynosowych u dzieci.

Five ethmoiditis cases with orbital complications in children aged 3.5 to 6 years were analysed. All were treated at almost at the same time in Warsaw hospitals in October 1994. Among the five presented cases, four were treated surgically. The value of CT examination in diagnosing ethmoiditis is stressed by the authors.

Modified expression of c-Fos and c-Jun proteins and production of interleukin-1 beta in patients with rheumatoid arthritis.

OBJECTIVE: To examine the relationship between the expression of c-Fos and c-Jun proteins and the METHODS: The expression of c-Fos and c-Jun proteins and the production of IL-1 beta in the PBMC of 11 patients with active RA was determine by Western blots and ELISA techniques, respectively. RESULTS: The spontaneous expression of c-Fos protein and the production of IL-1 beta was higher in RA patients. Under LPS treatment, the PBMC of both RA patients and healthy subjects produced similar high levels of IL-1 beta without any significant changes in the expression of c-Fos and c-Jun proteins. By contrast, PMA-induced production of IL-1 beta was impaired in RA patients and was preceded by the disregulated expression of c-Fos and c-Jun proteins when compared with healthy donors. CONCLUSION: It can be postulated that in some RA patients the spontaneously high production of IL-1 beta may be associated with the up-regulated expression of c-Fos protein in PBMC. On the other hand the impairment of IL-1 beta production in RA induced by the PKC-dependent pathway, may be related to disturbances in c-Fos and c-Jun protein expression. This dysfunction seems to be compensated by some unknown mechanisms implicated in LPS signalling, which is known to involve not only the PKC-mediated pathway.

Recombinant tumor necrosis factor alpha inhibits growth of methylcholanthrene-induced sarcoma and enhances natural killer activity of tumor-infiltrating lymphocytes in aging rats.

The effect of recombinant human tumor necrosis factor alpha (rHuTNF-alpha) on the growth of immunogenic, methylcholanthrene-induced sarcoma (MC-Sa) and natural killer (NK) cell activity of tumor-infiltrating lymphocytes (TIL) in adult and aging rats was investigated. In both groups of animals the growth of transplantable MC-Sa was markedly and similarly inhibited by multiple intratumoral (i.t.) injections of rHuTNF-alpha. This effect was accompanied by stimulation of NK activity of tumor-infiltrating lymphocytes in adult as well as in aging rats. Studies in vitro demonstrated additionally that rHuTNF-alpha was a potent stimulator of NK but not of ADCC (antibody-dependent cellular cytotoxicity) activity of spleen lymphocytes from healthy animals. Our results indicate that the antitumor effect of TNF-alpha is comparable in adult and in aging rats bearing immunogenic MC-Sa. The inhibition of MC-Sa growth may be attributed not only to the TNF-alpha-induced necrosis of the neoplastic tissue but also to the in vivo stimulatory effect of this cytokine upon the NK-type function of lymphocytes infiltrating the tumor mass.

Interleukin 1 expression is inducible by nerve growth factor in PC12 pheochromocytoma cells.

Expression of the cytokine interleukin 1 alpha (IL-1 alpha) was demonstrated in the rat PC12 pheochromocytoma cell line by (i) immunohistochemistry using rabbit polyclonal antisera raised against the recombinant murine IL-1 alpha, (ii) an ELISA, and (iii) a specific cell conversion bioassay based on the use of LBRM33-1A5 cells. IL-1 alpha mRNA was demonstrated in the PC12 cells, by PCR amplification. Constitutive expression of IL-1 alpha in PC12 cells was demonstrated in all experiments, although the cellular levels of IL-1 alpha-like immunoreactivity varied. The expression of IL-1 alpha, as studied at the mRNA level, was inducible by mouse nerve growth factor (7S NGF), and the gene product level was inducible in a dose- and time-dependent fashion by 7S NGF. The maximum induction corresponds to a 600% increase in IL-1 alpha-like immunoreactivity above the expression level found in noninduced cells and occurred after a 3-day incubation of the cells with NGF at 0.75 micrograms/ml of culture medium. The significance of the ability of NGF to induce IL-1 expression lies in the fact that IL-1 itself also acts as a growth factor that promotes glial proliferation and, even more importantly, IL-1 itself induces the expression of NGF at peripheral nerve injury [Lindholm, D., Heumann, R., Meyer, M. & Thoenen, H. (1987) Nature (London) 330, 658-659].

Methylcholanthrene-induced tumors in adult and in aging rats: infiltrating cells and their ADCC activity.

In our previous studies we found that the slower growth of syngeneic, immunogenic MC-induced sarcoma (MC-Sa) in aging rats was followed by the higher activity of spleen lymphocytes in ADCC assay. The purpose of the present paper was to study infiltrating cells of immunogenic and non-immunogenic MC-Sa and to estimate in situ ADCC activity in relation to the growth of MC-Sa transplants in adult and aging rats. It was found that MC-Sa's were infiltrated mainly by lymphocytes. Among cells infiltrating tumor the high percentage of cells with Fc receptor was present. During progressive tumor growth the percentage of infiltrating cells and also FcR+ cells significantly decreased within immunogenic MC-Sa, but did not change in the case of the non-immunogenic MC-Sa. In cell infiltrates of both tumors no differences between adult and aging rats were observed. At early stages of the tumor growth the cells active in ADCC assay were present within both MC-Sa. The slower growth of immunogenic MC-Sa in aging rats compared with adults was connected with longer maintenance of ADCC activity in situ. In the case of non-immunogenic MC-Sa, which grew at similar rate in both groups of rats, no differences in ADCC activity between adult and aging animals were observed. It is suggested that in situ ADCC activity may be one of the mechanisms responsible for the slower growth of immunogenic MC-Sa in aging rats.