[Ear aid in Myanmar]. / Ohrenhilfe in Myanmar.

As the example of a small team working in Myanmar since 2010 has demonstrated, it is possible to achieve sustainable success in medical education and training in foreign countries with relatively little effort, in this case in middle ear surgery. The main requirements are outstanding communication within the team as well as with the authorities, organizations, and colleagues on site. Equally important is mindful and respectful work in the hosting country and the consideration of cultural particularities. Essential contributing factors for long-term success are intercultural exchange, interpersonal relationships, and especially the motivation of colleagues on site, which together create a foundation of trust. This trust combined with regular exchange visits enables constant professional development according to the current needs.

[Repeated dual-probe pH monitoring as a diagnostic tool to control therapy for laryngopharyngeal reflux]. / Therapiekontrolle bei laryngopharyngealem Reflux durch wiederholte 2-Kanal-pH-Metrie.

OBJECTIVES: The most effective current treatment option for patients suffering from laryngopharyngeal reflux (LPR) is the use of proton pump inhibitors (PPIs). Compared to other PPIs, esomeprazole seems to provide best 24-h control of intragastric acid. However, some patients remain resistant to medical acid suppression with PPIs. The aim of this investigation was to identify the number of non-responders among patients suffering from LPR being treated by esomeprazole 40 mg once daily (officially approved maximum dosage). PATIENTS AND METHODS: Between June 2004 and January 2006, 27 patients suffering from LPR diagnosed by dual-probe pH monitoring were treated with esomeprazole 40 mg once daily. After 13-54 days (mean 28 days) while still under PPI-treatment, the 24-h pH-study was repeated in order to control the effectiveness of therapy. Patients with at least a reduction of the reflux area index (RAI) compared to the result before treatment were categorized as responders. Furthermore, the number of patients with a measurable reduction of proximal reflux episodes under PPI-treatment was quantified. RESULTS: Repeated pH monitoring during PPI therapy revealed a reduction of the RAI in 22 of 27 patients. Five patients, however, showed a higher RAI despite medical treatment (19%). In 13 patients (48%), treatment with 40 mg esomeprazole once daily reduced the RAI to a normal value (<6.3). In 18 of 27 patients, the number of proximal reflux episodes has decreased (67%). CONCLUSION: In a number of patients suffering from LPR, treatment with esomeprazole 40 mg once daily did not provide any measurable proximal acid reduction. Repeated pH monitoring during treatment is an adequate diagnostic tool to control the therapeutic effect of PPIs objectively and to identify non-responders at an early point.

Primary structure of a proteinase inhibitor released from goat serum inter-alpha-trypsin inhibitor.

An acid-resistant trypsin inhibitor was released from goat serum inter-alpha-trypsin inhibitor and isolated by affinity chromatography. The primary structure of the inhibitor was established and the inhibitory properties were estimated. The inhibitor designed gIK-14 was characterized as a serine proteinase inhibitor from the family of the double-headed Kunitz-type inhibitors as suggested.

Immunocytochemical and biochemical identification of angiotensin II in human nasal tissue.

Angiotensin II (ANG II) was identified immunocytochemically and biochemically in biopsy samples of human nasal tissue. Staining for ANG II was predominantly found in structures similar to a string of pearls with consecutive short varicose areas, which is characteristic for neuronal tissue. The localization of ANG II in neurons was confirmed by positive staining of adjacent tissue sections with a specific antibody to neurofilament or doublestaining with both antibodies in one section. Likewise, ANG II-like material was also determined radioimmunologically in nasal tissue extracts. The concentrations of ANG II varied form 1.28 to 332.78 fmol/g wet tissue weight with an average concentration of 79.61+/-44.09 fmol ANG II/g wet tissue weight (mean+/-SEM, n=7). The ANG II-immunoreactive material was further characterized biochemically by HPLC on a reversed phase C(18) column in an acetonitrile and methanol gradient as Ile(5)-ANG II and ANG II metabolites such as Ile(4)-ANG III, Ile(3)-ANG II(3-8)hexapeptide and Ile(2)-ANG II(4-8)pentapeptide.

Nasal interleukin-5, immunoglobulin E, eosinophilic cationic protein, and soluble intercellular adhesion molecule-1 in chronic sinusitis, allergic rhinitis, and nasal polyposis.

OBJECTIVE: To compare concentrations of interleukin-5 (IL-5), immunoglobulin E (IgE), eosinophilic cationic protein (ECP), and soluble intercellular adhesion molecule-1 (sICAM-1) in nasal secretion and serum of patients with chronic nonallergic sinusitis, allergic rhinitis, and nonallergic nasal polyposis to obtain information about the pathogenesis of these diseases. METHODS: Nasal secretion and serum were analyzed by routine enzyme-linked immunosorbent assay techniques. Nineteen patients with chronic nonallergic sinusitis, 24 patients with seasonal allergic rhinitis, and 18 patients with nonallergic nasal polyposis were included in the study. Eight healthy, nonallergic probands served as control subjects. RESULTS: Significantly elevated concentrations of IL-5 (5-fold, P < .05) and IgE (15-fold, P < .01) were detected in nasal secretion of patients with allergic rhinitis (IL-5, 51.8 +/- 13.2 pg/mL; IgE, 41.9 +/- 20.9 kU/L) or nonallergic nasal polyposis (IL-5, 57.9 +/- 36.9 pg(mL; IgE, 40.5 +/- 20.2 kU/L) compared with controls (IL-5, 10.6 +/- 7.8 pg/mL; IgE, 2.8 +/- 0.5 kU/L) or with patients with chronic nonallergic sinusitis (IL-5, 16.5 +/- 13.2 pg/mL; IgE, 5.4 +/- 3.1 kU/L). There were no significant differences between patients with allergic rhinitis and those with nonallergic nasal polyposis. Concentrations of ECP were significantly elevated (sixfold, P < .01) in patients with allergic rhinitis (297.8 ng/mL +/- 173.1) compared with controls (52.4 +/- 28.0 ng/mL) or patients with chronic nonallergic sinusitis (44.8 +/- 40.1 ng/mL), whereas twofold higher concentrations (not significant) of ECP were observed in patients with nonallergic nasal polyposis (107.1 +/- 26.6 ng/mL). Significantly elevated concentrations of sICAM-1 in nasal secretion (threefold, P < .05) were detected only in patients with chronic nonallergic sinusitis (79.4 +/- 45.6 ng/mL). The elevated sICAM-1 nasal secretion values in this group correlated significantly (P < .05) to the serum values. CONCLUSIONS: Equally elevated concentrations of IL-5 and IgE in patients with allergic rhinitis and nonallergic nasal polyposis implicated similar pathogenic processes in both diseases. Whereas the pathogenesis of allergic rhinitis is IgE-specific, the pathogenesis of nasal polyps is not as clear. IL-5 was suggested to play a pivotal role in tissue eosinophilia, which was confirmed by data in the present study. Elevated concentrations of ECP were suggested to result from tissue eosinophilia--a characteristic of both diseases. Elevated concentrations of sICAM-1 in patients with chronic nonallergic sinusitis pointed to its key role in the recruitment of neutrophils into the inflamed tissue, whereas an important role in eosinophil recruitment was ruled out.

Immunohistological expression of interleukin 16 in human tonsils.

BACKGROUND: Interleukin 16 (IL-16) acts highly chemotactic on CD4-bearing cells. Besides chemotaxis, IL-16 has numerous immunomodulatory effects, and not only on T cells. OBJECTIVE: To determine IL-16 expression in human tonsils. METHODS: Tonsillar follicles were immunohistologically characterized to elicit a possible cellular source of IL-16 expression. RESULTS: The mantle zone of immature and mature B cells was CD22 immunoreactive (ir), whereas the germinal center of activated B cells was CD23-ir. Plasma cells that were CD38-ir were observed extrafollicularly beneath the epithelium and within the germinal center. T cells were found most frequently in the extrafollicular space, with a majority of CD4 cells. CD68-ir macrophages were predominantly found within the germinal center. Immunostaining of anti-IL-16 revealed strong cytoplasmatic reactivity of extrafollicular cells and of cells at the outer rim of the mantle zone. Numerous cells adherent to the stratified squamous epithelium were IL-16-ir as well. Double immunostaining identified CD4(+) T cells as the major cellular source of IL-16 expression. Furthermore, a population of CD22(+) B cells at the outer rim of the mantle zone expressed IL-16 as well. CONCLUSIONS: Interleukin 16 was mainly expressed in a typical CD4-like pattern in human tonsils. Our data strongly suggest that CD4(+) lymphocytes constitute the major cellular source for IL-16. We hypothesize that the double-immunostained CD4-ir and IL-16-ir cells represent activated T cells. Because CD22(+) B cells at the outer rim of the mantle zone expressed IL-16 as well, we conclude that this area might constitute the locus of IL-16-mediated B-cell differentiation.

Overexpression of tenascin in cholesteatoma and external auditory meatal skin compared to retroauricular epidermis.

In the present study the distribution of tenascin in cholesteatoma was immunohistochemically investigated. The results were compared with those in external auditory meatal skin and in retroauricular skin of healthy controls. The staining pattern was additionally correlated to the degree of cell proliferation as detected by the monoclonal antibody MIB-1 (Ki-67 antigen). Retroauricular skin showed a limited distribution of tenascin in the papillary dermis and a sparse reactivity of MIB-1 in only a few epithelial cells. External auditory meatal skin revealed a more pronounced reaction for tenascin and MIB-1. In contrast, cholesteatoma tissue exhibited an abundant and continuous expression of tenascin covering the whole stroma compartment. This coincided with a significant increase of MIB-1-positive cells in the basal and suprabasal epithelial layers. Doublestaining experiments revealed most prominent stromal tenascin-expression in areas with marked signs for epithelial proliferation. This suggests that tenascin is selectively increased in response to epidermal hyperproliferation. This matrix protein thus shows a quantitatively and qualitatively enhanced expression under pathological conditions. Moreover, the abundant reactivity for tenascin in the cholesteatoma provides evidence of a deregulated cell-matrix interaction involved in the hyperproliferative process of cholesteatoma formation.

Allergic rhinitis does not constitute a risk factor for obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome (OSAS) is a condition characterized by recurrent episodes of obstruction of the upper airway. The aim of this study was to evaluate whether nasal obstruction due to allergic rhinitis constitutes a risk factor for OSAS. Patients (n = 119) presenting typical symptoms of sleep apnea were tested for OSAS using polysomnography. Additionally all patients were tested in vivo and in vitro (including nasal eosinophilic cationic protein) for allergic rhinitis. Examination for allergic rhinitis revealed that 88.3% of all patients had no allergic rhinitis, whereas only 11.7% were diagnosed as allergic. No significant differences in sleeping parameters were observed between allergic and non-allergic patients. Comparison of parameters indicative of relevant OSAS (apnea-hypopnea index [AHI] > 10) revealed that 60% of non-allergic patients had relevant OSAS, compared to only 50% of allergic patients. Investigation of allergic subgroups revealed similar results: no significant differences in sleeping parameters or elevated rates of relevant OSAS parameters were observed, especially in perennial allergic rhinitis due to house dust mites. No elevated rates of allergic rhinitis were observed in the studied cohort of patients suffering from sleep apnea or OSAS. Furthermore, no significant differences in sleeping behavior or polysomnography parameters were found on comparing allergic and non-allergic patients. In summary, our data rule out allergic rhinitis as a major risk factor for OSAS.

Nasopharyngeal epignathus causing nasal airway blocking in a 4-year old child.

Congenital oral teratoma or epignathus is a very rare lesion, especially in older children. We report on a 4-year old female infant presenting with nasal blocking, little watery discharge and recurrent otitis. First adenoids were suspected. An endoscopic examination of the nose and nasopharynx demonstrated an irregular mass in the nasopharynx, covered partly by mucosa. A MRI-scan (T1-weighted) showed fat-intensity. Histological examination revealed a teratomatous malformation. Although rare, teratoma should be included in the differential diagnosis of a nasopharyngeal mass in the paediatric age group.

[Determination of intercellular adhesion molecule-1 (ICAM-1) in nasal secretions of patients with rhinitis]. / Determinación de la molécula de adhesión intercelular-1 (ICAM-1) en la secreción nasal en pacientes con rinitis.

Intercellular adhesion molecule-1 (ICAM-1) is an integrin involved in the regulation of cell migration and activation in various tissues. ICAM-1 expression has been shown to be associated closely with cell infiltration in allergic diseases. We analyzed the possible participation of soluble ICAM-1 (sICAM-1) in the pathogenesis of various diseases of the nasal mucosa by measuring sICAM-1 levels in nasal secretions using sandwich ELISA. Soluble ICAM-1 levels in patients with allergic rhinitis and nasal polyposis did not increase with respect to healthy controls, but patients with chronic sinusitis had higher sICAM-1 levels. Soluble ICAM-1 levels also increased in patients with allergic rhinitis after a provocation test with the specific allergen. These results show that ICAM-1 is involved in the pathogenesis of chronic sinusitis and allergic rhinitis.

[Treatment of nasal polyposis with systemic and local corticoids]. / Tratamiento de la poliposis nasal mediante aplicación sistémica y local de corticosteroides.

Surgical or medical treatment of nasal polyposis still is a challenge in otorhinolaryngology. A study was made of the effectiveness of combined local and systemic, steroid treatment. Thirty-seven patients with different grades of nasal polyposis received a combination of systemic (methylprednisolone oral 10 days) and local (inhaled budesonide, day 8 to day 28) steroids. Therapeutic effects were measured using nasal endoscopy with a four-stage system for grading nasal fossa involvement and a symptomatic scale of none, mild, moderate, and severe. The mean endoscopic score decreased from 1.14 on day 1 to 0.14 on day 28 and the symptom score from 2.8 to 1.2. The results show than nasal polyposis can be treated successfully with combined local and systemic steroid treatment.

[Acoustic rhinometry: determination of early and late-phase reactions in allergic rhinitis]. / Rinometría acústica: determinación de la fase temprana y tardía en la rinitis alérgica.

Allergic rhinitis is characterized by morphological changes in the nasal cavity that produce airway obstruction. Acoustic rhinometry (AR) was used to analyze changes in the nasal airways of 10 patients with allergic rhinitis who underwent a nasal provocation test with 1000 biological units of specific allergen. Acoustic rhinometry was carried out 10, 20, 30, 45, and 60 minutes, and 2 and 8 hours after exposure to allergen. The parameters analyzed were minimal cross-sectional area (MCA) and a new parameter, volume A (VA), obtained by integration of the distance/area graph surrounding the anterior part of the lower turbinate. The early-phase reaction after exposure to allergen was a 10-30% reduction of MCA and VA compared with baseline value. The late-phase reaction was one-third as strong. The contralateral MCA and VA were affected only minimally in the early-phase reaction, but a symmetrical response was observed in the late-phase reaction. VA changes were more evident than MCA changes. The results show that acoustic rhinometry is suitable for measuring local changes following exposure to nasal antigens, particularly if both VA and MCA are evaluated.

[Determination of the diagnostic efficacy of the multi-RAST test (Phadiotop) in allergic rhinitis]. / Determinación de la eficacia diagnóstica de multi-RAST-test (Phadiotop) en la rinitis alérgica.

Diagnosis of IgE mediated allergic rhinitis is based on medical history. Prick-test (of the skin) and determination of increased IgE levels by serum (PRIST and RAST) as well as intranasal provocation test. To search the potential diagnostic value of a multi-RAST test (Phadiotop) in serum and nasal fluids, 508 with rhinitis were studied: In 267 patients nasal allergy was confirmed by the above mentioned tests. Phadiotop revealed a sensitivity of 98.1% in serum and 79.0% in nasal fluid. Specificity of Phadiotop was 95.9% in serum and 97.5% in nasal fluid. Our results show that the determination of Phadiotop can be considered as a very sensitive screening test for allergy detection.