[Peripheral blood cell count and inflammation-based markers in chronic rhinosinusitis]. / Zellzahl und Entzündungsparameter im peripheren Blut bei chronischer Rhinosinusitis.

OBJECTIVE: The aim of this study was to verify whether the following peripheral blood cell count and inflammation-based markers differ between various types of chronic rhinosinusitis (CRS): neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR) and platelet-to-lymphocyte ratio (PLR), as well as erythrocyte sedimentation rate (ESR) and C­reactive protein (CRP) levels. MATERIALS AND METHODS: In all, 386 patients had complete peripheral blood count, ESR, CRP and nasal cytology. The severity of CRS symptoms was assessed using three-stage Lund-Mackay computed tomography (CT) scores. The participants were stratified based on the results of nasal cytology and by the presence of nasal polyps (NP). The inflammation-based markers were calculated by dividing the cell numbers of the different cell types by numbers of the other cell types. RESULTS AND CONCLUSIONS: Blood leukocyte and neutrophil counts were higher in neutrophilic CRS. Differences between patients with CRS with nasal polyps (NP) and CRS without NP were significant for blood leukocytes, neutrophils, monocytes, eosinophils, CRP, NLR and MLR values. In CRS with NP, peripheral blood leukocyte, neutrophil, monocyte and eosinophil counts, as well as CRP, NLR and MLR values were higher than in CRS without NP. Our results show that all individuals with CRS could benefit from the analysis of blood counts and inflammation-based markers at the beginning of their evaluation. High levels of inflammation-based markers might guide the clinician towards planning more radical CRS therapy and use of systemic anti-inflammatory medication.

Induced sputum eicosanoids during aspirin bronchial challenge of asthmatic patients with aspirin hypersensitivity.

BACKGROUND: Altered metabolism of eicosanoids is a characteristic finding in aspirin-exacerbated respiratory disease (AERD). Bronchial challenge with lysyl-aspirin can be used as a confirmatory diagnostic test for this clinical condition. Induced sputum allows to measure mediators of asthmatic inflammation in bronchial secretions. OBJECTIVES: To investigate the influence of inhaled lysyl-aspirin on sputum supernatant concentration of eicosanoids during the bronchial challenge test. Subjects with asthma hypersensitive to nonsteroidal anti-inflammatory drugs were compared with aspirin-tolerant asthmatic controls. METHODS: Induced sputum was collected before and following bronchial challenge with lysyl-aspirin. Sputum differential cell count and sputum supernatant concentrations of selected lipoxygenases products: 5-,12-,15-hydroxyeicosatetraenoic acid, cysteinyl leukotrienes, leukotriene B4 , 11-dehydro-thromboxane B2 , and prostaglandins E2 , D2 , and F2α and their metabolites, were measured using validated methods of chromatography-mass spectrometry. RESULTS: Aspirin precipitated bronchoconstriction in all AERD subjects, but in none of the aspirin-tolerant asthmatics. Phenotypes of asthma based on the sputum cytology did not differ between the groups. Baseline sputum eosinophilia correlated with a higher leukotriene D4 (LTD4 ) and leukotriene E4 (LTE4 ) concentrations. LTC4 , PGE2 , and 11-dehydro-TXB2 did not differ between the groups, but levels of LTD4 , LTE4 , and PGD2 were significantly higher in AERD group. Following the challenge, LTD4 and LTE4 increased, while PGE2 and LTB4 decreased in AERD subjects only. CONCLUSIONS: During the bronchial challenge, decrease in PGE2 and its metabolite is accompanied by a surge in bronchoconstrictory cysteinyl leukotrienes produced at the expense of LTB4 in AERD subjects. Bronchial PGE2 inhibition in AERD seems specific and sensitive to a low dose of aspirin.

A case of respiratory epithelial adenomatoid hamartoma of the sinonasal tract.

Respiratory epithelial adenomatoid hamartoma is a rare, non-neoplastic tumour characterised by an abnormal mixture of tissues that are indigenous to the region. REAH are shiny, polypoid, exophytic masses with a rubbery to firm texture. They may arise and co-exist in the setting of inflammatory polyps. We present a case of a 49-year-old patient who was referred to the department with a clinical diagnosis of chronic nasal sinusitis. Results of post-op histopathological examination show a mild change of the respiratory epithelium requiring, among others, differentiation from inverted papilloma and adenoid carcinoma.

A giant cranial aneurysmal bone cyst associated with fibrous dysplasia.

An aneurysmal bone cyst (ABC) is a rare, benign fibro-osseous lesion, considered a vascular phenomenon secondary to fibrous dysplasia or a giant-cell tumour, and occurs mainly in long bones and vertebrae. In this case report a 16-year-old male presented with massive epistaxis. He was admitted with a 3-year history of chronic rhinitis, headaches, right ocular pain and recurrent epistaxis. CT scans showed a predominantly cystic, expansive mass obstructing both nasal cavities, extending to all paranasal sinuses and both orbits, with evidence of anterior cranial fossa skull base destruction. The patient underwent a craniofacial resection of the tumour performed with an external approach and an immediate reconstruction of the dural defect. Histology confirmed the lesion was an ABC associated with fibrous dysplasia. The patient's recovery was complete. A large facial aneurysmal bone cyst can damage the facial skeleton and skull base, and requires excision by a combined external approach.

Sphenoid sinus pyocele with intracranial extension managed under endoscopic guidance: a report of an extremely rare case.

OBJECTIVES: Sphenoid pyoceles with intracranial extension are extremely rare lesions that can mimic tumours and usually cause ophthalmological symptoms. Their infectious nature mandates urgent surgical decompression since pyoceles can cause intracranial and orbital complications. CASE REPORT: A 16-year-old male presented with intense headache and dizziness lasting three days. On admission, the patient gave a five-year history of chronic rhinitis, nasal congestion, and progressively worsening headaches. Ophthalmological examination was normal. CT and MR scans disclosed distension of the sphenoid sinus by a pyocele 55 mm in diameter, extending to the presellar region through the eroded cribriform plate. The patient underwent an endoscopic transnasal sphenoethmoidectomy. After surgery he reported improvement in all preoperative symptoms and was asymptomatic at 3-months follow-up. CONCLUSIONS: A huge sphenoid sinus pyocele with intracranial extension may cause no ophthalmological symptoms. It can be safely managed using endoscopic techniques.

[Transient evoked otoacustic emission in children with juvenile idiopatic arthritis]. / Otoemisja akustyczna wywolana trzaskiem u dzieci z mlodzienczym idiopatycznym zapaleniem stawów.

Juvenile idiopathic arthritis (JCA) is an inflammatory systemic disease of connective tissue which etiology is still unknown. Progressive arthritis is the basic symptom, with pain, oedema, stiffness and movement impediment are typical for. Chronic process of arthritis might be accompanied by rheumatoid nodes, pericarditis, myocarditis, changes in the lungs and kidney, which appear with various frequency and indicates on systemic form of disease. The incudo-malleolar and incudo-stapedial joints are synovial in type. It should be expected that these joints might be affected by rheumatoid changes similar to those observed in joints in other parts of the body. Copeman was the first who described transient conductive hearing loss in patients with exacerbated rheumatoid process--and he called it oto-arthritis. He stressed that it was the consequence of the rheumatoid lesions in joints of ear ossicules. In adult patients with JCA in 60% of cases the perceptive hearing-loss is observed possibly because of the chronic course of the disease and its farmacological treatment. The aim of the study was the assessment of the functional state of the peripheral part of hearing organ on the basis of TEOAE. This study was preceded by examination of hearing with pure tone audiometry, speech audiometry, high frequency audiometry and impedance audiometry. The analysis of results was done in correllation to form of JCA and its activity. The research was carried out on the group of 45 children suffering from JCA; 14 boys and 31 girls between 5-18 years of age. In all children from experimental group the examination was performed in the active phase of disease process. Mean duration of the disease was 33.5 month. In all children TEOAE was obtained no matter on the form of JCA. Children with systematicus form of JCA--more aggressive type than others--have the recordings of TEOAE with small amplitude and narrow range of frequency. Those results show that rheumatoid lesions in conductive mechanism of the middle ear are insufficient for the development of the conductive hearing loss. As a results of chronic pathological process destructions of hearing organ may lead to the cochlear lesions and this way to perceptive hearing loss.

Endoscopic removal of air gun pellet in the sphenoid sinus.

THE OBJECTIVE: The presence of an isolated foreign body in the sphenoid sinus is a rare finding, and a retained projectile in this sinus is even more uncommon. CASE REPORT: The authors report the case of a 15-year-old male that was shot in the face with an air gun but was nevertheless able to seek for medical help. The anatomical considerations of the gunshot injury are made, and radiological assessment of the foreign body is presented. THE RESULT AND CONCLUSION: The projectile could be successfully removed with an endoscopic technique, no short or long term sequelae occurred.

Osteoma of the sphenoid sinus.

OBJECTIVE: Only twenty cases of osteomas of the sphenoid sinus have been reported. This tumour causes progressively worsening headaches and visual disturbance and should be resected when symptomatic or fast-growing. In selected cases, endoscopic sinus surgery offers an effective alternative to open procedures. CASE REPORT: The authors report a case of sphenoid osteoma in a 19-year old woman. Computed tomography performed because of complaints of progressively worsening headaches identified a large osteoma of the sphenoid sinus. The clinical features and radiological assessment of the disease are presented together with a review of the literature. RESULTS: The endoscopic technique used for resection of the tumour gave a very good result. CONCLUSION: Sphenoid osteoma is an extremely rare lesion which can be approached endoscopically in selected cases.

Hyaloid vessels of the human fetal eye. A scanning electron microscopic study of corrosion casts.

OBJECTIVE: Microscopic investigation of the hyaloid vascular system in 5-month-old human fetuses. METHODS: Corrosion casting and light and scanning electron microscopy. RESULTS: The hyaloid artery ramifies into a tuft of vasa hyaloidea propria, which communicates with the posterior portion of the tunica vasculosa lentis, characterized by a network of anastomosing vessels. They further pass to the lateral portion of the tunica, acquiring a nonanastomosing palisadelike array and drain into the vessels of the ciliary processes or, after bending over the edge of the developing iris, drain into the outer choriocapillaris. The tunica vasculosa lentis vessels also communicate with the pupillary membrane, a system of vascular arcades arranged in several interconnected tiers, supplied by the terminal branches of the long posterior ciliary arteries. In tunica vasculosa lentis, arterioles seem to pass directly into veins, without forming a capillary bed. CONCLUSIONS: At the investigated developmental stage, the fully developed hyaloid system enters its subsequent involution, and the vessels nourishing the vitreous have already involuted. The system is generally similar to that observed in other mammals.

The effect of hormonal factors on the hearing organ in women, after surgical castration. Preliminary report.

BACKGROUND: Estrogens have not only direct and beneficial effect on relaxation of the arteries increasing the blood flow in the blood vessels, but also their level of secretion has considerable effect on synthesis of acetylcholine a neurotransmitter indispensable for appropriate functioning of the hearing organ. The aim of this study is analysis of the effect of hormones on the hearing organ in women who underwent surgical castration. MATERIAL: The study included 40 females, aged between 32 55 years who had undergone an operative treatment mainly because of uterine myoma. A group of 50 women aged between 32 50 years with appropriate hormone level comprised the control group. METHOD: Each woman investigated underwent the following examinations: gynaecological, otolaryngological and laboratory tests, such as: evaluation of levels of estradiol (E) and folliculin stimulating hormone (FSH). The assessment of hearing was carried out using tone and speech audiometry, tympanometry, test registration of auditory brain stem responses (ABR) and otoacoustic emissions (EOAE). The examinations mentioned above are performed in women as initial examinations before surgical treatment and as follow-up examinations 1, 3 and 12 months after the surgery. RESULTS: The results presented in this paper include initial examinations and follow-ups 3 months after the surgical treatment taking into consideration the correlation with the results of laboratory tests and the results obtained in the control group.

Microvasculature of the dorsal mucosa of human fetal tongue: a SEM study of corrosion casts.

The vasculature of the dorsal mucosa of the tongue was investigated in 18-21 week human fetuses by corrosion casting and scanning electron microscopy. Microvascular systems of the fungiform, foliate and circumvallate papillae, albeit less complex, showed similarity to those described in children, while the capillary networks of the filiform papillae were not yet fully developed, having either a knot-like or cone-like form instead of the corolla-like pattern typical of the postnatal period. Morphological features suggesting angiogenesis included both capillary outgrowths characteristic of vascular sprouting and tiny holes in the vascular walls regarded as evidence of intussusceptive capillary growth. The subpapillary vascular network supplying and draining the papillary vessels was composed of the more superficial capillary bed and the deeper plexus of larger arterioles and venules.

Effectiveness of classical chordectomy in the treatment of cancer of the glottis.

From 1980 to 1992, 85 patients diagnosed with tumour of the glottis, localized exclusively in the vocal cord area, had undergone surgery. A 90% 5-year survival rate without recurrences had been obtained. Taking into account the cases of life-saving surgery, the percentage of the 5-year survivals amounted to 94%. Considerably better results were obtained by the excision of the entire vocal cord and not just one of its sections (1/2, 2/3 etc.). The degree of deformation of the voice following chordectomy was assessed by means of acoustic and laryngographic methods (Laryngograph Processor PCLX). A 13% rate of irregularity in the functioning of the neoglottis, following surgery, was observed. The Jitter-Shimmer co-efficients were established. The results of the deformation of the voice following chordectomy were presented on the J-S scale and compared with other partial surgeries performed on patients with tumours of the glottis. All of the acoustic and laryngographic findings were presented in the from of mean values most representative of chordectomy.

Acoustic assessment of voice signal deformation after partial surgery of the larynx.

OBJECTIVE: The main objective of the present study was to assess the degree of voice signal impairment among patients who had undergone partial surgery of the larynx due to cancer of this organ. Such on evaluation may be helpful in the selection of the optimal surgical technique for the treatment of tumors displaying a varying degree of local advancement. METHODS: A prospective examination was carried out among 128 patients. Additionally a comparative study of the control group consisting of 36 healthy males was carried out. Acoustic tests were carried out in an echo-free chamber. The temporal changes in the value of acoustic pressure of the uttered text were registered. The 'distance' between the normal speech signal and the pathological voice has been established. RESULTS: The values of the fundamental frequency increase together with an increase of the range of resection of anatomical structures. The biggest differences in the value of results describing the distance from the standard were observed after hemilaryngectomy. The shortest distance from the acoustic standard was observed after chordectomy. No significant differences in the degree of voice signal impairment among patients who had undergone extended chordectomy and hemilaryngectomy were observed. CONCLUSION: The above findings can be of help in arriving at an optimum solution in cases of partial surgery of the larynx. The problem is particularly important in situations where there is the choice between different types of surgery.

Hyalinizing clear cell carcinoma of salivary gland. A case report.

Authors describe a case of hyalinizing clear cell carcinoma of the parotid gland in a 65-year-old female. Morphological characteristics of clear cell tumors of salivary glands are then discussed.

Ossification of human thyroid cartilage. Scanning electron microscopic study.

The architecture of the cartilage already developed within ossified areas have shown apparent differences not only depending on their location within cartilage territory but also due to their chemical composition. The cartilage areas exhibiting a markedly advanced ossification process have shown rather high concentration level of Ca, P and Si.

Blood vascular organization of the walls of vermiform appendix from human fetus. Examination of vascular corrosion casts in SEM.

Ten human vermiform appendices obtained from fetal corpses (160.0-240.0 mm of CRL) were examined using injection-micro corrosion method. Blood vascular bed reproduced with this method was observed with scanning electron microscope (SEM). Blood vascular bed structure of foetal appendix has been described, simultaneously with produced by them plexuses and organisation of microcirculation in a wall of the appendix. Collected results have been compared with data of other authors who conducted similar research on adult human appendices and appendices of several animal species.

Angiomorphology of the retrobulbar part of the optic nerve. A scanning electron microscopy of vascular casts.

The presented study was carried out on the fetal specimens of the eye-ball, together with the retrobulbar part of the optic nerve which were obtained from 15 human fetuses aged 16-20 weeks of the intrauterine life. The vascular casts were prepared by injection of low-viscosity resin Mercox which afterwards were analyzed in a scanning electron microscope (SEM). The technique employed allowed the authors to describe both the vascular pattern of the optic nerve as well as the network of arterial vessels which formed the Zinn and Haller's circle. The own original findings are compared with results obtained by other authors on the vasculature of the optic nerve in mammals and humans in different periods of the life.

Microvasculature of the human fetal laryngeal anterior commissure.

The vascular pattern of the injected with Mercox human fetal larynges, especially of the anterior commissure and surrounding it area, was analysed within the horizontal and frontal sections under a light microscope. The main result of our study was confirmation of existence of the avascular "plane zero" situated above the anterior commissure, which separates that structure from the supraglottic tier. That finding i.e. avascular separation between teh middle and upper laryngeal compartments, already present in the fetal period, has clinical implications as far as the spread of neoplastic process within the larynx is cancerued.

Microvasculature of the human fetal extra-ocular muscles. A SEM corrosion casts.

In the light of already known differences on the vascular patterns between slow and fast contracing skeletal and extra-ocular muscles (EOM) which has been described in both mammals and man we were interested to see if same of these features are presented in the human EOM during the second half of the gestation. Therefore the microvasculature bed of EOM was studied by SEM of vascular corrosion casting technique. 15 human embryos at 16-20 week of gestation, after spontaneous abortion, were used for this study. The vasculature bed of the all EOM studied is composed of two layers i.e. the orbital and the global. The orbital layer, in all specimens examined, has shown a relatively higher number of transverse anastomoses than the global one, although the capillary vessels were arranged similarly on the both sides.