Elimelech Deutsch

Transnasal endoscopic management of choanal atresia

Since 1755, when Roederer first described choanal atresia, more than 350 papers have been published dealing with the various aspects of this entity. Many surgical techniques have been used to treat the malformation, each with its advantages and disadvantages. Endoscopic transnasal repair of choanal atresia provides excellent visualization and enables accurate surgery to be performed on patients of all ages and even on newborn infants. Described are two newborn infants, one with bilateral choanal atresia and the other with bilateral choanal stenosis, successfully treated by endoscopic transnasal repair, with a 12 month follow-up. The technique of endoscopic choanal repair is described, emphasizing it as a highly successful, short and safe procedure with swift recovery and short hospitalization.

Functional endoscopic sinus surgery of orbital subperiosteal abscess in children.

Subperiosteal abscess of the orbit (SPA) should be considered an important part of the group of orbital complications following acute sinusitis. This situation requires early surgical intervention to avoid visual loss or ophthalmoplegia. Six cases of children with SPA of the orbit treated successfully by Functional Endoscopic Sinus Surgery (FESS) are reviewed. The importance of ophthalmological examination, nasal endoscopy and CT scan is emphasized concerning the management protocol. The major advantage of FESS is the avoidance of external ethmoidectomy with the resultant scar. FESS is demonstrated as a safe and convenient procedure with excellent post operative recovery of the patients.

Transient expression of human interleukin-2 and interferon-γ genes is regulated by interaction between distinct cell subsets

The level of transient expression of human IL-2 and IFN-gamma genes, we show, is regulated by dynamic interaction between two functionally distinct cell populations. One is able to express these genes, while the other, bearing one of several specific surface markers, actively inhibits their expression. Defined cell subsets were isolated from PBMC and tonsil cells using immunomagnetic beads coated with monoclonal antibodies directed against surface markers. Depletion of CD8, CD11a (Leu15), or Leu8 subsets led to a pronounced superinduction of IL-2 and IFN-gamma gene expression when the remaining cell population was stimulated with mitogen (PHA) or antigen (SEB). Thus, a 10-fold increase in production of IFN-gamma was observed after removal of CD11a (Leu15) cells constituting only a small percentage of the total cell population. By contrast, depletion of cells expressing CD19, a B cell marker, did not yield any superinduction. Conversely, CD8, CD11a (Leu15), or Leu8 cell subsets, but not CD19 cells, each inhibited the induction of IL-2 and IFN-gamma gene expression almost completely in depleted or total cell populations from which they were derived. Gene expression occurring within one cell subset could be effectively inhibited by cells from a second subset. Introduction of inhibitory cells (Leu8) into a population that actively expressed IL-2 and IFN-gamma mRNA resulted in an immediate cessation of gene expression. This suppression involves a soluble mediator, since the culture medium in which such cells were activated exerted a similarly effective inhibition.

Regulation of human interleukin-2 and interferon-gamma gene expression by suppressor T lymphocytes

Concomitant with induction of inlerleukin‐2 (IL‐2) and interferon‐gamma (IFN‐γ) gene expression in human tonsil cells, milogenic stimulation induces a transient activation of cells able to effectively suppress expression of these genes. Induction of IL‐2 and IFN‐y genes largely precedes appearance of suppressor cell activity, allowing expression of both genes to occur before strong down‐regulation is exerted by activated suppressor cells. Suppressive activity induced in one cell population can inhibit IL‐2 and IFN‐γ gene expression in another population from the same donor. The distinct nature of suppressor cells is supported by the absence of down‐regulation of IL‐2 gene expression in a helper cell line. M LA‐144: yet, in these cells, negative control can be expressed when active suppressor cells are introduced. Our findings support the concept that actual levels of IL‐2 and IFN‐γ gene activity are regulated to a large extent by the differential kinetics of activation of suppressor cells on one hand and of cells expressing the IL‐2 and IFN‐γ genes on the other.

Synchronous Bilateral Oncocytoma of the Parotid Glands

A case of synchronous bilateral oncocytoma arising in the parotid salivary gland is presented and the literature is reviewed. The oncocytoma forms a small group of neoplastic diseases in the parotid gland and synchronous bilateral tumors are relatively rare. According to the available literature this is the fourth case reported.

Down-regulation of human tumor necrosis factor-β gene expression by cells with suppressive activity

Human TNF-beta (lymphotoxin) gene expression is down-regulated by immunosuppression. Induction of TNF-beta mRNA in lymphoid cells is greatly enhanced by gamma-irradiation, cyclophosphamide and cimetidine, agents that each inhibit activation of suppressive cells. The level of TNF-beta mRNA expressed in response to stimulation, whether by mitogen or antigen, is reduced strongly by concomitant activation of suppressive cell subsets. Removal of CD8 or CD11b cells leads to a pronounced superinduction of TNF-beta mRNA in the depleted cell population. Induction of TNF-beta mRNA precedes appearance of suppressive cell activity, allowing for temporary expression. The TNF-beta gene is as sensitive as IFN-gamma and IL-2 genes to suppression. Hence, three genes characteristically expressed in Th1 cells, encoding IL-2, IFN-gamma, and TNF-beta, are similarly regulated by cell-mediated suppression. Actual levels of TNF-beta during an immune response are determined by the balance between activities of expressing and suppressing cell subsets, both transiently manifested.

Waardenburg syndrome with associated multiple anomalies

A 4 1/2-year-old girl presenting characteristics of Waardenburgs syndrome with associated multiple defects is described. The patient presents all the obvious signs of the syndrome with the exception of the white forelock (poliosis), but with additional anomalies like: syndactyly, absence of the fourth left toe, bilateral preauricular sinus and dacrocystitis. It is the second case of Waardenburgs syndrome reported by us during the last 20 years.

Giant Cell Tumor of the Temporal Bone

True giant cell tumor of the temporal bone is a rare entity. This is only the 15th case documented in the English literature. It is interesting because of its presenting symptoms similar to those of e

Cytokine Evaluation in Throat Infections

Inflammatory cytokines have been shown to play an important role in the pathogenesis of various inflammatory processes. In throat infections, intracellular inflammatory cytokines have been detected from the sites of inflammation. The present study aimed to evaluate serum cytokine levels of patients with throat infections and correlate them to the inflammatory parameters and type of inflammation. Significantly higher inflammatory cytokine levels (interleukin [IL]–6 >7 pg/mL, IL-1 >1β pg/mL, tumor necrosis factor a >1 pg/mL) were detected in most of the patients as opposed to healthy controls. Clinical parameters of infection (fever >38°C, leukocytosis >11,000 white blood cells per cubic millimeter, polymorphonuclear neutrophils >75%) were significantly correlated with high levels of inflammatory cytokines: mainly IL-6 and tumor necrosis factor α, and to a lesser degree with IL-1β. No correlation, however, was found between the type of inflammation and cytokine levels. The present study indicates a role of inflammatory cytokines in the pathogenesis of throat infections and the need for an anti-inflammatory and anticytokine therapeutic approach.

Hyperuricemia: A possible etiologic factor in chronic recurrent parotitis†

Chronic recurrent parotitis is a common salivary gland disease. It is often associated with such clinical conditions as antecedent pyogenic infections, mumps, debilitation, intense fluid restriction and drugs.