Eugeniusz Czecior

Analysis of procalcitonin and CRP concentrations in serum of patients with chronic spontaneous urticaria

BackgroundOur previous findings showed the importance of analysing the peripheral markers of acute phase response (APR) activation, C-reactive protein (CRP) and IL-6 in the context of urticaria activity and severity. However, these biomarkers do not reliably differentiate between APR to infectious and the disease severity.AimIn order to investigate a possible association between the immune-inflammatory activation markers CRP and procalcitonin (PCT).MethodsSerum PCT and CRP concentrations were measured in patients with CU of varying severity as well as in healthy subjects.ResultsSerum PCT and CRP concentrations were significantly increased in more severe CU patients when compared to healthy controls and mild CU, and within the CU population there was a significant correlation between concentrations of PCT and CRP. Serum PCT concentrations remained within normal ranges in most CU patients and were only slightly elevated in some severe CU cases.ConclusionsPCT serum concentration may be only slightly elevated in some cases of severe CU. Upregulation of PCT synthesis accompanied by parallel changes in CRP concentration reflects a low-grade systemic inflammatory response in CU. PCT should be considered as a better marker than CRP to distinguish between APR to infection and an active non-specific urticarial inflammation.

Sarcoidosis and its otolaryngological implications.

Sarcoidosis and its aetiopathogenesis, epidemiology and diagnostic procedures (including the Kveim reaction) are presented in this paper. The clinical manifestations of this disease, especially in otolaryngological organs, including the larynx, salivary glands, nose and paranasal sinuses, are described. Treatment procedures, including surgical interventions and prognosis, are also discussed.

Effect of tonsillectomy on the level of exhaled nitric oxide (NO) in patients with recurrent tonsillitis

BACKGROUND Increased expression of inducible nitric oxide synthase in inflamed tonsils has been reported. Our preliminary observation was the first to demonstrate that increased exhaled NO level may occur in patients with tonsillitis. OBJECTIVE To extend the observation scope, the same group of patients was examined for NO exhaled after tonsillectomy. MATERIALS AND METHODS Exhaled oral NO level was measured with Niox Mino(®) analyzer, six-seven months after tonsillectomy in 27 non-atopic patients who suffered from recurrent tonsillitis and in 35 healthy non-atopic subjects. RESULTS After tonsillectomy, exhaled NO levels were significantly reduced as compared to the preoperative period values and did not differ significantly from those of the healthy subjects. CONCLUSIONS The results support a finding of the elevated exhaled NO consequent to NO production in chronically inflamed tonsils, but whether NO plays any role in the pathogenesis of tonsillitis or is merely a by-product of another process, needs to be determined.

Current view on nasal polyps management in Samter's triad patients

UNLABELLED The nasal polyps associated with Samters triad are often very extensive, difficult to treat, with great tendency to recurrence. In this paper the current opinion on nasal polyps management in aspirin triad patients was presented. PATHOGENESIS Opinions on pathogenesis of these disease was remembered as well as its epidemiology. DIAGNOSTIC METHODS The available diagnostic methods were presented. Treatment options: The available preservative treatment options was analyzed including aspirin desensitization. The role of surgical treatment, functional endoscopic sinus surgery was analyzed.

Ocena wybranych biomateriałów do rekonstrukcji perforacji przegrody nosa

INTRODUCTION The septal nasal perforation is an important problem for the laryngologists and plastic surgeons. The reasons of septal nasal perforations are injuries, neoplasm, self-mutilation, chronic rhinitis, allergy, Wegener granuloma, sarcoidosis, tuberculosis, toxic metals (arsenic, chrome), some drugs (steroids), narcotizing agents (cocaine) and complications after endoscopic and septal nasal operations. The surgical treatment, especially in the cases of large septal perforation, is often difficult because of the atrophy of nasal mucosa and lack of suitable material for reconstruction. In the surgical treatment many of methods and reconstructive materials have been used. The following autogenous tissues were used in the reconstruction of septal perforation: alloderm, temporal fascia, septal and auricle cartilage, cranial periosteum, perichondrium, ethmoidal and hip bone. The defect of such materials is progressive resorption. For many years the suitable synthetic material for septal nasal reconstruction has been searched for. Among the biomaterials the following have been used without success: Dacron, porous polyethylene, dolomite, bioglass. The rejection of synthetic material was the reason of failure. The aim of our study was to evaluate two different biomaterials with proper mechanical and biological features for nasal cartilage replacement. MATERIAL AND METHODS We studied two types of biomaterials: biostable terpolymer PTFE/PVDF/PP and resorbable copolymer of glycolide and L-lactide (PGLA). The pilot studies were performed on two experimental animals (rabbits). The animals were operated in the general anesthesia. The biomaterials were implanted in the rabbit auricular cartilage because of its similarity to the septum and easy surgical access. Subperichondrically 1 x 1 cm fragment of the cartilage was removed. This fragment was then replaced with the biomaterial. The rabbits were painlessly sacrificed after 4 months of observation. RESULTS A very good integration of PGLA implant with auricular cartilage was observed. In the histological examination the lack of excessive inflammatory reaction as well as no cartilage necrosis were observed. CONCLUSIONS 4 months after implantation of PGLA in the rabbit auricular cartilage very good macroscopic and histological results were achieved.Summary Introduction The septal nasal perforation is an important problem for the laryngologists and plastic surgeons. The reasons of septal nasal perforations are injuries, neoplasm, self-mutilation, chronic rhinitis, allergy, Wegener granuloma, sarcoidosis, tuberculosis, toxic metals (arsenic, chrome), some drugs (steroids), narcotizing agents (cocaine) and complications after endoscopic and septal nasal operations. The surgical treatment, especially in the cases of large septal perforation, is often difficult because of the atrophy of nasal mucosa and lack of suitable material for reconstruction. In the surgical treatment many of methods and reconstructive materials have been used. The following autogenous tissues were used in the reconstruction of septal perforation: alloderm, temporal fascia, septal and auricle cartilage, cranial periosteum, perichondrium, ethmoidal and hip bone. The defect of such materials is progressive resorption. For many years the suitable synthetic material for septal nasal reconstruction has been searched for. Among the biomaterials the following have been used without success: Dacron, porous polyethylene, dolomite, bioglass. The rejection of synthetic material was the reason of failure. The aim of our study was to evaluate two different biomaterials with proper mechanical and biological features for nasal cartilage replacement. Material and methods We studied two types of biomaterials: biostable terpolymer PTFE/PVDF/PP and resorbable copolymer of glycolide and L-lactide (PGLA). The pilot studies were performed on two experimental animals (rabbits). The animals were operated in the general anesthesia. The biomaterials were implanted in the rabbit auricular cartilage because of its similarity to the septum and easy surgical access. Subperichondrically 1 x 1 cm fragment of the cartilage was removed. This fragment was then replaced with the biomaterial. The rabbits were painlessly sacrificed after 4 months of observation. Results A very good integration of PGLA implant with auricular cartilage was observed. In the histological examination the lack of excessive inflammatory reaction as well as no cartilage necrosis were observed. Conclusions 4 months after implantation of PGLA in the rabbit auricular cartilage very good macroscopic and histological results were achieved.

Frequency of IgE-dependent hypersensitivity to moulds in patients with chronic rhinosinusitis with polyps.

Introduction The complicated etiology of chronic sinusitis with polyps and frequent allergy to mould is established. Aim We aimed to investigate the frequency of the IgE-dependent hypersensitivity in this group of patients and prove the need of surgery in allergic chronic rhinosinusitis patients. Material and methods Forty-two patients (19 females, 23 males) aged 34–73 years (55 ±12.6 years), with chronic sinusitis with polyps were included into the study. Functional endoscopic sinus surgery, laryngological examination, sinus computed tomography scans, and smear from maxillary sinus for microbiological examination were done in all patients. Skin prick tests with common perennial and seasonal inhalant allergens, tIgE and sIgE against moulds were required. Results Thirty-two of 42 patients (71.4%) were allergic to at least one inhalant allergen. A mean concentration of total IgE was 241.2 ±186.3 kU/l (35.0–708.0 kU/l) and was lower in patients with fungal culture found in sinus mucin than in patients without fungal presence 75.1 ±54.6 kU/l vs. 284.3 ±204.1 kU/l. We found no difference in the number of positive skin prick tests in a group with and without fungal culture. None of patients with fungal culture found in sinuses presented a detectable level of mold sIgE. All patients with fungal vegetation in sinuses required at least two polypectomy procedures. Conclusions The total IgE concentration was significantly lower in patients with fungal presence in sinuses. Nasal polyps occurred more frequently in patients with fungal presence in sinuses.

Late Dysphagia and Dyspnea as Complications of Esophagogastroduodenoscopy in Delayed Pressure Urticaria: Case Report

Delayed pressure urticaria (DPU) is characterized by swelling in the area of sustained pressure on the skin. The reported case was a potentially life-threatening complication due to mucosal edema following esophagogastroduodenoscopy (EGD). A 37-year-old man, suffering from severe DPU and chronic spontaneous urticaria, had undergone EGD due to dyspeptic symptoms. A few hours after the EGD procedure, the patient showed both dysphagia and dyspnea. A physical examination indicated massive tongue base and pharynx edema. We suggest that these symptoms were most likely due to the pressure exerted by EGD. No other apparent origins such as angioedema or late-phase allergic reaction to drugs were identified. One should be aware of the increased risk of developing airway and gastrointestinal obstruction during medical procedures associated with compression, such as EGD or endotracheal intubation, in DPU patients.

Reconstruction of the larynx after a resection of a huge chondrosarcoma

Chondrosarcoma of the larynx is a rare condition of still unknown pathogenesis. This tumor occurs usually between the sixth and seventh decade of life. Forty five years old patient was admitted to the ENT Department in Zabrze for a diagnosis of a slow growing tumor from about 3 years. The great unmovable tumor 2.5 cm/3 cm/3 cm was arising from the cricoid cartilage. The hist-pat result of the biopsy was cartilage. The patient did not agree on the proposed surgical treatment. After one year, in the MRI examination, the tumor sized 46 mm/37 mm/39 mm was found. The patient was again qualified for the operation and agreed for the proposed treatment. In general anesthesia, the tumor together with the part of trachea, cricoids and thyroid cartilages was resected. After excision the reconstruction was performed. During 10 months of the follow-up the patient remains free of the disease.

Exhaled nitric oxide in patients with early glottic cancer.

Nitric oxide (NO) may contribute to the mutagenic processes and has been extensively studied as a noninvasive marker of neoplastic processes occurring in the airways. It has been suggested that an increased expression of inducible NO synthase might appear as an important molecular event involved in the early stage of laryngeal carcinogenesis. The aim of this study was to determine NO levels in the exhaled air of patients with early stage glottic carcinoma. Exhaled bronchial NO was measured using a Niox Mino analyzer in 28 patients with squamous cell glottic carcinoma (T1–T2N0M0) and in 30 healthy controls. There were no significant differences in exhaled NO level between the healthy controls and T1–T2N0M0 patients with glottic cancer or between the subgroups (T1 vs. T2). It seems that early glottic cancer is not associated with significant changes in the exhaled NO level. Early diagnosis of cancer is desirable, however this study does not prove that exhaled NO may be a useful biomarker in patients with early stage squamous cell glottic carcinoma.

240 Mold Sensitization in Chronic Rhinosinusitis Patients.

Background It is estimated that about 10% of the population have IgE antibodies to common inhalant molds. Exposure to fungal allergens could be linked to the presence and persistence of asthma, rhinitis and atopic dermatitis. Mold sensitization is a risk factor for development and deterioration of upper airway allergy, especially chronic rhinosinusitis. We addressed the incidence of mold allergy measured as specific IgE to molds and skin prick tests in chronic sinusitis patients. We assessed prevalence of allergic reactions to mould among surgery treated chronic sinusitis patients. Methods A group of 28 chronic sinusitis patients after surgery were included into the study. Routine medical examination, skin prick tests with common inhaled allergens and extended mold panel (Alternaria alternate, Cladosporium herbarium, Aspergilus fumigatus, Candida albicans, Mucor mucedo, Botrytis cinerea, Rhisopus nigricans, Penicilliumi notatum, Fusarum moniliforme Pullularia pullulans (Allergopharma, Germany), tIgE, asIgE measurement were performed (Phadia, Sweden). All investigated patients were consulted by laryngologist and mycological examination was performed. Results We found that sensitization to at least one allergen was present in 43.8(14/32) of sinusitis patients. The most prevalent was sensitization to house dust mite Dermatophagoides pt., found in 21.8 % (7/32) patients. Positive results of skin prick tests with Candida albicans we observed in 18.8% (6/32), with Alternaria alternate in 15,6% (5/32), Cladosporium herbarium in 6,3% (2/32), Aspergilus fumigatus in 3,13 % (1/32). None of investigated patients presented sensitization to other mold allergens. Microbiological methods demonstrated fungal infection only in 2 patients. Conclusions Almost half of chronic sinusitis patients presented sensitization to at least one allergen. Fungal allergy is relatively rare in chronic sinusitis patients.