In vitro culture Muller cell model to study the role of inverted internal limiting membrane flap technique in macular hole closure.

Inverted internal limiting membrane (ILM) flap may constitute a scaffold for Muller cells whose migration and proliferation on its surface begin the process of macular hole closure. The goal of the study was to establish an in vitro model of the interaction between ILM and the Muller cells. Vitrectomy with inverted ILM flap was performed in 23 patients due to a full-thickness macular hole (FTMH). After dissection of the inverted flap, the area of ILM peeling was extended and material was collected for cell culture experiments. Muller cells cultured on adherent cell plates showed significantly better growth than on suspension plates. Our results reveal that the presence of the ILM can overcome the growth inhibitory effect of the non-adhesive surface. Moreover, the ILM appears to be the optimal growth surface under normoxia conditions mimicking the microenvironment after vitrectomy and hypoxia which is natural state for Muller cells. The closure rate of FTMH was 100%. Our study revealed that in non-adhesive culture conditions patient derived ILM constitutes an optimal growth surface for Muller cells. We have demonstrated that the ILM effectively stimulates attachment, proliferation, and survival of Müller cells in conditions of normoxia which is the case after vitrectomy. The results strongly advocate for the use of inverted ILM flap method in macular hole closure surgeries.

Central serous chorioretinopathy induced by drugs metabolized by cytochrome P450 3A4.

The purpose of this study was investigate whether replacing or discontinuing drugs that are inhibitors or substrates of cytochrome P450 3A4 (CYP3A4) may improve the clinical course of central serous chorioretinopathy (CSC). A retrospective observational study included 43 patients with active CSC. Twenty seven patients (32 eyes, group 1) were using drugs that act as substrates or inhibitors of CYP3A4. In 25 of these 27 patients, treatments including steroids, calcium channel blockers, anticoagulants, statins, beta-adrenolytics, angiotensin receptor antagonists, antidepressants, muscarinic receptor antagonists, phosphodiesterase type 5 inhibitors, and others were discontinued or replaced with medications not affecting CYP3A4. Sixteen patients (19 eyes, group 2) not using any medication that affects CYP3A4, were given eplerenone, rifampicin, or laser treatment. Main outcomes measures were assessed by functional and anatomical images obtained using multimodal imaging techniques. The average follow-up time was 12 months. In group I after discontinuing or replacing substrates or inhibitors of CYP3A4, improvements were observed in 18 patients (22 eyes). None of the patients that were using drugs affecting CYP3A4 improved with eplerenone therapy, however, all 18 patients improved after discontinuing the drugs. All these drugs had a blocking effect on eplerenone therapy. Best corrected visual acuity (BCVA) improved in 14 eyes, remained unchanged in 5 eyes, and worsened in 3 eyes. In 21 of the 22 eyes, subretinal fluid absorption was observed with optical coherence tomography (OCT). Mean central retinal thickness decreased from 361 µm to 219 µm. One patient (2 eyes) was unable to change treatment (due to neoplasm), one patient (1 eye) did not agree to change or stop treatment, and seven patients (7 eyes) were lost to follow-up. Of the 16 patients (19 eyes) who were treated with eplerenone, rifampicin, or laser, improvements were observed in 14 patients (16 eyes), two patients (2 eyes) were lost to follow-up, and CSC worsened in 1 eye. We concluded that patients with CSC should not take substrates or inhibitors of CYP3A4. These drugs should be replaced with alternatives that act through other metabolic pathways.

Early identification of hearing impairment in patients with type 1 diabetes mellitus.

OBJECTIVE: The aim of this study was to evaluate the cochlear micromechanics and central auditory function in patients with type I diabetes mellitus and to identify the site of possible dysfunction. METHODS: Cochlear activity was evaluated by recording distortion product otoacoustic emissions (DPOAEs). DPOAEs were performed using an ILO 92 Otodynamics Analyser. Functional changes in the retrocochlear auditory pathway were evaluated by auditory brainstem responses (ABRs). DPOAEs and ABRs were measured in 42 normally hearing patients with type 1 diabetes mellitus aged 21 to 42 years, and 33 age- and sex-matched nondiabetic control subjects. RESULTS: Both of the groups (diabetic and control) had normal and undifferentiated results in tonal and impedance audiometry. ABR peripheral transmission time (wave I) and central transmission time (interpeak latencies I-V) were significantly delayed in the diabetic compared with normal subjects, and the mean amplitudes of various DPOAEs were significantly reduced in the diabetic patients compared with the control subjects. CONCLUSIONS: Combined use of different procedures for monitoring central and peripheral portions of the auditory pathway in diabetic patients showed alterations in cochlear micromechanics and the retrocochlear auditory pathway. Hearing impairment in diabetic patients is usually mild and subclinical, and can be detected early by accurate and objective audiometric methods.

[Evaluation of dynamic changes in hearing impairment in subjects exposed to noise while testing for transient evoked otoacoustic emission]. / Ocena dynamiki rozwoju uszkodzenia slluchu u górników narazonych na halas przy uzyciu badania emisji otoakustycznej wywolanej trzaskiem.

A group of 74 miners, aged 19-35 years, exposed to industrial noise at average level of 82-88 dBA for 1.5 to 15 years were examined by means of otoacoustic emission (TEOAE). The group was divided into three subgroups, depending on the duration of noise exposure. The results obtained in miners were compared to the results of the control group nonexposed to noise at the workplace. Otoacoustic emission was weaker in subjects exposed to noise. Significant differences in responses were found in subgroups II and III as compared to controls. The results were compared to the data reported by other authors. The role of otoacoustic emission in providing information about dynamics changes in hearing impairment, depending on the duration of noise exposure, in subjects exposed to industrial noise, was emphasised.

[Preliminary assessment of transient evoked acoustic emissions (TEOAE) in newborns depending on selected parameters of delivery complications with particular analysis of newborns with hypotrophy]. / Wstepna ocena emisji otoakustycznej wywolanej trzaskiem (TEOAE) u noworodków w zaleznosci od wybranych parametrów zaburzen okoloporodowych ze szczególnym uwzglednieniem noworodków z cechami hipotrofii wewnatrzmacicznej.

OBJECTIVES: Transient evoked otoacoustic emission (TEOAE) is accepted as a good and universal test for screening of the cochlea function in newborns. This method is particularly useful in the newborn group with risk-factors of hearing losses. Early identification of the cochlear pathology gives possibility of supplying with hearing aid instrument and rehabilitation. MATERIAL AND METHODS: In this study 300 newborns was tested with TEOAE, besides such parameters as birth mass, Apgar scale, bilirubinemy were analysed. Then the same results of the newborns with hypotrophy consisted of 40 subjects were analysed. RESULTS: The study did not indicate any tendency of changing TEOAE in particular parts within the cochlea in newborns with hypotrophy. Hypotrophy does not seem to influence the cochlea function monitored by TEOAE half-octave band analysis.

[Assessment of otoacoustic emission usefulness for early detection of hearing impairment caused by noise]. / Ocena przydatnosci pomiarów emisji otoakustycznej wywolanej trzaskiem w wykrywaniu wczesnych ubytków sluchu spowodowanych halasem.

74 miners, aged 19-35, exposed to industrial noise were examined by means of otoacoustic emission (TEOAE). The group was divided into 3 subgroups depending on the time of noise exposure. Significant weakening of otoacoustic emission in all subgroups was observed, even in subgroup with the shortest time of noise exposition and normal audiogram. The results were confirmed by others authors. Otoacoustic emission (TEOAE) could be very useful in early detection of hearing impairment cause by noise. 74 miners, aged 19-35, exposed to industrial noise were examined by means of otoacoustic emission (TEOAE). The group was divided into 3 subgroups depending on the time of noise exposure. Significant weakening of otoacoustic emission in all subgroups was observed, even in subgroup with the shortest time of noise exposition and normal audiogram. The results were confirmed by others authors. Otoacoustic emission (TEOAE) could be very useful in early detection of hearing impairment cause by noise.

[A case of preserved otoacoustic emissions in a child with unilateral idiopathic severe sensorineural hearing loss]. / Przypadek zachowanych otoemisji akustycznych u dziecka z jednostronnym, idiopatycznym, glebokim niedosluchem odbiorczym.

In this study there is presented a case of unilateral, idiopathic, severe sensorineural hearing loss in a child. The inner ear pathology has been confirmed by tonal and impedance audiometry, and brainstem evoked response audiometry. Simultaneously in the same ear normal otoacoustic emission (SOAE, TEOAE, DPOAE) has been recorded. MRI did not reveal any pathology in internal ear canal and cerebellopontine angle. The presented case suggests that there is a possibility of existence of the normal outer hair cell function with simultaneous inner ear cell disorder or first neuron pathology. Similar cases of idiopathic sensorineural hearing losses with preserved otoacoustic emissions in children were described by Katona (1993), Welz-Mueller (1993) and Konradsson (1996).

[A case of laryngomucocele coexisted with pleomorphic adenoma of the larynx]. / Rzadki przypadek laryngomucocele z jednoczesnym wystapieniem gruczolaka wielopostaciowego krtani.

Benign pleomorphic adenomas of the larynx are very rare. Review of the literature showed about 20 cases of this tumours. We present a case of benign mixed tumor located in the false vocal cord and coexisted with laryngomucocele. The tumor was removed by endoscopic laser resection. To our knowledge it is the second published in literature case of benign plemorphic adenoma of the larynx in which treatment was performed by using CO2 laser surgery.

[The 2f1-f2 DPOAE amplitudes and latencies in the groups of older people with presbyacusis and young people with normal hearing]. / Ocena amplitud i latencji 2f1-f2 DPOAE w grupie osób starszych z presbyacusis oraz osób mlodych z prawidlowym sluchem.

Otoacoustic emissions have been shown to be useful as indicators of the cochlear function. One of the most valuable techniques is distortion product otoacoustic emission recording (DPOAE), mostly 2f1-f2 distortion, which is described as being present regularly and indicating the strongest connection with hearing level. DPOAE amplitudes are analysed as relating to the frequency (DP-gram) or to the signal levels (input-output function). Another feature of DPOAE providing many details with regard to cochlear mechanics seems to be the assessment of 2f1-f2 DPOAE latencies. In the present study 2f1-f2 DPOAE amplitudes and latencies were analysed and compared in two groups: the elderly with presbyacousis and the young with normal hearing level. All measurements were taken using Otodynamics ILO 92 system. DPOAE latencies were recorded by phase gradient method with fixed-f1 and swept-f2 signal. The following signal parameters were used: f2 ranging from 732 to 6396 Hz, signal levels L1 = L2 = 70 dB SPL, f2/f1 ratio ranging from 1.18 to 1.25. According to the mathematical formula y = 1.412 + exp(7.685-0.7698*ln(f2)) 2f1-f2 DPOAE latencies were calculated in the group of young people at f2 = 1.0 kHz; 2.0 kHz; 3.0 kHz; 4.0 kHz; 5.0 kHz; 6.0 kHz as follows: 12.08 ms; 7.67 ms; 5.99 ms; 5.08 ms; 4.50 ms; 4.10 ms. The analogous analysis revealed the following results in the group of the elderly: y = 2.402 + exp(9.293-1.019*ln(f2)) and calculated latencies--11.9 ms; 7.09 ms; 5.50 ms; 4.71 ms; 4.24 ms; 3.93 ms. The greater differentiation of the latencies measured in low frequency band was observed in the elderly while in the young subjects in mid and high frequency bands. The 2f1-f2 DPOAE amplitudes recorded for the whole frequency band were significantly higher in the young people than in the elderly. No correlation was observed between latencies and amplitudes in both investigated groups.

[Otoacoustic emission nonlinear distortions in musicians with absolute and relative pitch]. / Otoemisje znieksztalcen nieliniowych u muzyków ze sluchem absolutnym i relatywnym.

In the presented study an analysis was performed of the properties of the cochlea using Distortion Product Otoacoustic Emissions (DPOAE). 52 musicians were examined, aged 17-31 years, with systematic musical training longer than 10 years, and 30 non-musicians without musical experience, aged 18-30 years. Then all musicians were tested with Rakowski's test to divide them into the absolute pitch possessors (APP) and relative pitch possessors (RPP). DPOAE recorded in musicians were statistically higher than in nonmusicians for f2 = 1.0, 2.0 and 4.0 kHz for signal intensities generally ranged from 45 to 55 dB SPL. Analogous comparison between APP and RPP showed higher DPOAE for f2 = 2.0 and 4.0 kHz in APP but the differences were not statistically significant. Simultaneously no significant differentiations were observed between investigated groups for highest signal intensities in the whole frequency band. The study suggests that systematic musical training influences the cochlear mechanics assessed by DPOAE and the greatest differences concern the active processes within the cochlea. The continuation seems to be justified.

[A case of gigantic pleomorphic adenoma of the parotid gland]. / Przypadek olbrzymiego gruczolaka wielopostaciowego slinianki przyusznej.

The case of big size pleomorphic adenoma of the partoid gland was presented. Attention was paid on the necessity of the surgical treatment of pleomorphic adenomas by superficial or total parotidectomies. Possibility of the post operative complications avoidance, even in such big cases was emphasized.

[Evaluation of cochlear function by means of otoacoustic emission in children treated with cytostatic drugs in the course of bone marrow proliferative diseases]. / Ocena funkcji slimaka za pomoca otoemisji akustycznej u dzieci leczonych cytostatykami w przebiegu chorób rozrostowych ukladu krwiotwórczego.

The aim of study was cochlear function estimation by means otoacoustic emission in children treated by leukaemia cytostatic drugs in course of the bone marrow proliferative diseases. The children after treatment of acute lymphoblastic leukemia or nongranulomatic malignant lymphoma according to BFM programme were examined in this study. Audiologic examination of children included tonal audiometry, tympanometry and otoacoustic emission as well. The results were compared to the findings of control group consisted of healthy children have never suffered from ear diseases and have never used ototoxic drugs. No significant differences in tonal audiometry and TEOAE were observed. Aggressive treatment of leukaemia does not result in hearing loss.

[Assessment of usefulness of PCNA and protein p53 in subjects with laryngeal cancer with local recurrence]. / Ocena przydatnosci oznaczania markera PCNA i bialka P53 u chorych na raka krtani ze wznowa miejscowa.

The authors estimated PCNA and P53 in subjects with laryngeal cancer in whom local or nodal recurrences were observed. The study included 54 patients from Upper Silesia in age 37-79 years (mean 57 +/- 8.8). The mean value of the PCNA index in subjects with local recurrence (LR) was 24.2% +/- 12.1 while in subjects without LR 22.1% +/- 9.4 (p > 0.05). Additionally, 21 subjects were separated from the investigated group in whom no lymph node metastases were found during laryngectomy. Among these subjects in 16 LR was observed (PCNA index was 30.9% +/- 12.5) while in remaining 5 subjects, in whom LR did not develop, PCNA index was 21.7% +/- 11.2. Analysis of the P53 index in subjects with LR revealed significantly higher values (19.2% +/- 9.1) in comparison to cases without LR (13.2% +/- 6.3). Our study revealed usefulness of the P53 and PCNA as markers which could support the histological diagnostic process describing biology of the cancer cells. The demonstrated increase of PCNA and P53 index in patients with LR might be useful in prediction of LR.

[Precancerous states of the larynx: analysis of mono- and polyclonality of the cells with high proliferative index (p53, PCNA)]. / Stany przedrakowe krtani--analiza mono- i poliklonalnosci komórek o wysokim indeksie proliferacyjnym (p53, PCNA).

The aim of the study was analysis of relationship between proliferation index (PCNA) and protein p53 content in dysplastic laryngeal epithelium and the degree of dysplasia, age of patients and smoking. The study population consisted of 45 patients (mean age 57.7 +/- 6.2) with chronic laryngitis. It was revealed epithelial dysplasia varying in intensity in 36 patients and epithelial hyperplasia without dysplasia (acanthosis) in 9 patients--control group. Mean value of p53 protein index was 8.91 +/- 7.43% in dysplastic epithelium and 3.67 +/- 3.4 in hyperplastic epithelium without dysplasia. The difference was statistically significant (p = 0.007). P53 content significantly differed between groups with grade I and grade II dysplasia (p = 0.03) and between groups with grade I and grade III dysplasia (p = 0.03). The difference was found between groups with grade II and III dysplasia and group with hyperplasia without dysplasia. The analysis of the correlation between degree of dysplasia and value of PCNA index showed absence of differences. There was no relationship between smoking, age of patients and Value of p53 and PCNA index.

[The prospective analysis of laryngeal cancer growth dynamics in compliance with evaluation of DNA content and ploidy in cytologic material]. / Ocena prospektywna dynamiki rozrostu raka krtani z uwzglednieniem badania ploidii i zawartosci DNA w materiale cytologicznym.

The aim of this study was evaluation of DNA ploidy in the cytological samples from patients with laryngeal cancer and comparison a type of DNA ploidy with histological grading (G) and staging of neoplasmatic process. The examinations were performed on 47 patients operated due to laryngeal cancer (3 women, 44 men, mean age 58). Cytological material was collected from squamous carcinoma tissue by imprinting method. Slides were staining by Feulgen method in order to quantitative analysis of DNA by static cytophotometry. In studied material, aneuploid, polyploid and hypoploid tumors were found in 22 patients and diploid tumors were found in 25 cases. Analysis of DNA ploidy type distribution in correlation to G feature showed:--diploid type were dominated in G1 and G2 tumors,--aneuploid and polyploid type were dominated in G3 tumors. Hypoploid and polyploid tumors were appeared in patients with metastases to cervical lymph nodes more frequently than in patients without metastases. Analysis of DNA ploidy complete traditional histopathological diagnosis of laryngeal cancer and may be useful in predicting metastases to cervical lymph nodes.

[Assessment of utility of nm 23 antigen as a metastatic potential marker in laryngeal cancers: preliminary study]. / Ocena przydatnosci oznaczania antygenu nm 23 jako markera potencjalu przerzutowego raków krtani--doniesienie wstepne.

The aim of the study was the analysis of the utility of nm 23 protein in prediction of cervical lymph node metastases in patients with laryngeal cancer. A preliminary study was performed in 35 patients with laryngeal cancer with cervical lymph node metastases, which were confirmed by histopathologist. The control group consisted of 30 patients with laryngeal cancer without cervical lymph node metastases. In statistical analysis T and N were taken into account. In the investigated group with metastases the presence of positive immunostaining was found in 11% of cases while in the control group in 20%. The analysis of the presence of nm 23 protein revealed a weak usefulness of this marker as a factor which predicts the presence of the cervical metastases.

[Assessment of usefulness of PCNA and oncoprotein p53 staining in prediction of the recurrences in subjects operated on for laryngeal carcinoma]. / Ocena przydatnosci oznaczania atygenu proliferacyjnego PCNA i bialka p53 w przewidywaniu wznów u chorych operowanych z powodu raka krtani.

The authors estimated PCNA and P53 in subjects with laryngeal cancer with local or nodal recurrences. The study concerned 54 patients from Upper Silesia aged 37-79 (mean 57 +/- 8.8). The mean value of the PCNA index in subjects with local recurrence (LR) was 24.2% +/- 12.1 while in subjects without LR 22.1% +/- 9.4 (p > 0.05). Additionally, 21 subjects in whom no lymph node metastases were found during laryngectomy were separated from the investigated group. In 16 of them local recurrences were observed and the mean value of PCNA index was 30.9% +/- 12.5. In remaining 5 subjects in whom local recurrences were not developed the mean value of PCNA index was 21.7% +/- 11.2. The analysis of the P53 index in subjects with LR revealed significantly higher values (19.2% +/- 9.1) in comparison with cases without LR (13.2% +/- 6.3). The assessment of the mean values of PCNA and P53 index depending on T, N or stage as well as nodal recurrence did not reveal any statistical significance. Our study revealed usefulness of the P53 and PCNA as markers which could support the histological diagnostic process describing biology of the cancer cells. The demonstrated increase of PCNA and P53 index in patients with LR might be useful in prediction of LR.

[Monitoring of neurophysiologic modalities during surgery for cerebellopontine angle tumors. Personal experiments]. / Monitorowanie neurofizjologicznych modalnosci w trakcie zabiegów operacyjnych guzów kata mostowo-mózdzkowego. Doswiadczenia wlasne.

The purpose of intraoperative monitoring of many modalities is to save some structures of the nervous system being at risk of damaging during surgical procedures. In cerebellopontine angle (cpa) tumour cases these nervous system structures can include cranial nerves (trigeminal, facial, cochlear, accessory), motor and sensory tracts localised within brainstem, and other. Continuous registration of somatosensory and auditory evoked potentials as well as electromyography of masseter muscle, orbicular muscle of eye and trapezius muscle during procedure is the method of brainstem, cochlear tract and cranial nerves status evaluation. Direct stimulation of cranial nerves within posterior fossa using bipolar electrode is the method of facial, trigeminal and accessory nerves localisation, especially in patients with large tumours. In Department of Neurosurgery Silesian University School of Medicine for intraoperative monitoring of many modalities in cpa lesion cases Nocolet Viking IV D unit with special IOM software is employed. Authors presented own experience in such method and effect in treatment of group of 15 patients operated with electrophysiological intraoperative monitoring.

Short-term experience with early steroid withdrawal in African-American renal transplant recipients.

There are limited data on the results of early steroid withdrawal (ESW) in African-American (AA) renal allograft recipients. We examined short-term transplant outcomes in a retrospective, non-concurrent cohort study of 40 AAs who did not (ESW group), and 33 who did [steroid maintenance (SM) group] receive maintenance steroids after day 4 post-transplant. Patients received thymoglobulin (ATG) induction, mycophenolate mofetil, and tacrolimus or sirolimus. Data were analyzed using survival analysis methods and regression models. Patients in the ESW group were older, had lower current panel reactive antibody and fewer re-transplants, and received fewer doses of ATG. One-year graft survival and acute rejection (AR) rates were 100% and 13% in the ESW group and 97% and 15% in the SM group. After controlling for confounders, at 1 year, ESW was not associated with higher risk of graft loss, AR, or worse graft function, but was associated with less weight gain. The SM group had higher cholesterol levels at 3 months and higher risk of post-transplant diabetes mellitus. We did not observe any cases of subclinical rejection. This study suggests that ESW under modern immunosuppression is safe over the short term in at least a subset of AA recipients with risk profiles similar to those studied herein, and could be associated with improved outcomes.