Fiorella R

Allergic and non-allergic rhinitis in swimmers: clinical and cytological aspects

Background Rhinitis, either allergic or non-allergic, is frequent in athletes, particularly in swimmers. In this latter case, exposure to chlorine in swimming pools seems to play a relevant role, since it can exacerbate a pre-existing allergic rhinitis (AR) or produce a non-specific irritation. The aim of this study was to detail the clinical and cytological characteristics of rhinitis in swimmers, and to assess the possible role of chlorine-induced symptoms. Methods Elite swimmers with rhinitis symptoms underwent a complete diagnostic work-up, including allergy testing, nasal cytology and anterior rhinomanometry. Those evaluations were repeated after 1 month of use of a nasal clip during swimming. A matched group of asymptomatic swimmers was also studied. A total of 74 swimmers (54 symptomatic and 20 controls), with an age range of 9–21 years, were studied. In the control group, only mild and non-specific findings were observed, and only two had a positive skin test. Results In the symptomatic group, 24 (44%) had AR, and 19 (35%) had a predominant neutrophilic inflammation. The use of a nose clip reduced cellular infiltration and nasal resistances only in the subjects with neutrophilic rhinitis, whereas a clinical improvement was seen also in AR. Conclusion A neutrophilic rhinitis occurs in a large proportion of swimmers. This seems to be irritative in its nature and can be prevented by avoiding the direct contact with chlorinated water.

When allergic rhinitis is not only allergic.

Background In clinical practice it can be observed that some patients with seasonal allergic rhinitis (AR) continue to have symptoms even when the exposure to allergens is expected to be low or absent. We studied the clinical and cytological characteristics of these atypical forms of (AR) in a large population of patients. Methods Consecutive patients with symptoms of rhinitis and with positive skin test to pollens only were interviewed for the duration of symptoms, correlation with sensitization pattern, and presence of reactivity to nonspecific stimuli. All underwent rhinoscopy and nasal scraping for cytology. Results Five hundred nineteen patients with AR were studied. Of these 519 patients 60 (11.5%) had an atypical or mixed form of rhinitis, with symptoms independent of the exposure and also elicited by nonspecific stimuli. These patients clearly differed from typical forms, especially for the nasal inflammation. They had a greater number of eosinophils and mast cells out of season (p < 0.05). Moreover, these atypical forms had, more frequently, asthma and eosinophilic polyps. Conclusion In ∼12% of patients with AR, other mechanisms of inflammation seem to intervene. Nasal cytology can be helpful in discriminating these atypical forms.

Nasal inflammation in vernal keratoconjunctivitis

REFERENCES 1. Kumagai N, Fukuda K, Fujitsu Y, Seki K, Nishida T. Treatment of corneal lesions in individuals with vernal keratoconjunctivitis. Allergol Int 2005;54:51-9. 2. Fukushima A, Ozaki A, Fukata K, Ishida W, Ueno H. Ag-specific recognition, activation, and effector function of T cells in the conjunctiva with experimental immune-mediated blepharoconjunctivitis. Invest Ophthalmol Vis Sci 2003;44:4366-74. 3. Magone MT, Chan CC, Rizzo LV, Kozhich AT, Whitcup SM. A novel murine model of allergic conjunctivitis. Clin Immunol Immunopathol 1998;87:75-84. 4. Trocmé SD, Gleich GJ, Kephart GM, Zieske JD. Eosinophil granule major basic protein inhibition of corneal epithelial wound healing. Invest Ophthalmol Vis Sci 1994;35:3051-6. 5. Kumagai N, Fukuda K, Ishimura Y, Nishida T. Synergistic induction of eotaxin expression in human keratocytes by TNF-a and IL-4 or IL-13. Invest Ophthalmol Vis Sci 2000;41:1448-53. 6. Fukuda K, Fujitsu Y, Seki K, Kumagai N, Nishida T. Differential expression of thymusand activation-regulated chemokine (CCL17) and macrophage-derived chemokine (CCL22) by human fibroblasts from cornea, skin, and lung. J Allergy Clin Immunol 2003;111:520-6. 7. Kumagai N, Fukuda K, Fujitsu Y, Yamamoto K, Nishida T. Role of structural cells of the cornea and conjunctiva in the pathogenesis of vernal keratoconjunctivitis. Prog Retin Eye Res 2006;25:165-87. 8. Garcia-Zepeda EA, Rothenberg ME, Ownbey RT, Celestin J, Leder P, Luster AD. Human eotaxin is a specific chemoattractant for eosinophil cells and provides a new mechanism to explain tissue eosinophilia. Nat Med 1996;2:449-56. 9. Imai T, Baba M, Nishimura M, Kakizaki M, Takagi S, Yoshie O. The T cell-directed CC chemokine TARC is a highly specific biological ligand for CC chemokine receptor 4. J Biol Chem 1997;272:15036-42.

Indications for frontolateral laryngectomy and prognostic factors of failure

Abstract The aim of this study was a retrospective analysis of the oncological results in a group of patients treated by frontolateral laryngectomy using clinical and histopathological correlations in order to review the indications for surgery. In all, 150 patients underwent frontolateral laryngectomy as described by Leroux-Robert. All were staged according to the 1992 UICC TNM classification. Factors examined were clinical T, histopathological T, tumor infiltration of the anterior commissure and the vocal cord muscle, survival without disease and the percentage of local relapses. Twenty-one patients had local relapses (14%), while four patients developed second primary tumors (2.7%). Among the different correlations examined, microscopic infiltration of the anterior commissure was related to a greater number of local relapses (25.5% vs 5%) and a 55% survival with with no evidence of disease (NED). The crude 5-year NED survival was 66% and was influenced by second primary tumors and metastases (7.4%) and non-oncological diseases (14.6%). These data show the need for a re-evaluation of the indications for frontolateral laryngectomy because subtotal reconstructive laryngectomy could be performed more safely in the more advanced cases. In contrast, cases with more limited tumors might be better treated by laser for a more functional and cost-beneficial result.

Molecular Biopathology of Metaplastic, Dysplastic, and Neoplastic Laryngeal Epithelium

In a large series of more than 100 cases of laryngeal carcinomas, the presence of steroid hormone receptors was demonstrated in the cytosol and in the nuclear fraction. Their presence was confirmed by the identification of estrogen receptor isophorms and by the detection of hormone-related proteins such as ER-D5. EGFr, and cathepsin D. These molecules were also variably expressed in normal, hyperplastic, and dysplastic epithelium. These data suggest a possible role of hormone receptors during laryngeal carcinogenesis. Finally, the presence of an Angiotensin II receptor was studied in neoplastic and preneoplastic laryngeal epithelium.

Multiple masses on the tongue of a patient with generalized mucocutaneous lesions.

Luca Pastore and colleagues discuss the differential diagnosis and management of a 62-year-old man who presented with a 6-cm fungating mass on the dorsum of the tongue.

Studio di prevalenza sulle micosi otorinolaringoiatriche in un campione di immigrati in Puglia

Introduzione : i continui flussi migratori in Puglia hanno posto una serie di problemi sul piano sanitario, inizialmente limitati alla gestione dell’emergenza ma subito estesi alla sorveglianza epidemiologica per la prevenzione di patologie infettive che possono essere importate da queste popolazioni. In tale ambito e stata condotta un’indagine anche sulla presenza di miceti che colonizzano il distretto otorinolaringoiatrico, con particolare riferimento ai funghi dimorfi, recentemente segnalati anche in Medio Oriente ma normalmente endemici in America e Africa. Metodi : l’indagine e stata condotta su un campione di 297 Kurdi, sbarcati ad Otranto (LE), maschi, eta 15 - 35 anni (media 23 anni). Ciascun soggetto e stato sottoposto ad una visita otorinolaringoiatrica e al prelievo, mediante tampone sterile, del secreto orofaringeo, nasale e auricolare, per la ricerca di lieviti, muffe e funghi dimorfi. Risultati : dei 297 soggetti esaminati, 70 (23.6%) sono risultati positivi per miceti (45 lieviti, 25 muffe) di cui 36 (51.4%) in sede nasale, 30 (42.9%) in sede orofaringea e 4 (5.7%) in sede auricolare. Tra i lieviti, Candida albicans e risultata la specie piu frequente (66.7%), isolata esclusivamente a livello orofaringeo; tra le muffe Penicillium spp. (56%) riscontrato solo a livello nasale. La ricerca di funghi dimorfi e risultata negativa. Conclusioni : la prevalente colonizzazione di muffe a livello nasale e di lieviti a livello orofaringeo conferma la sede di elezione da parte di questi microrganismi. Tuttavia, e interessante sottolineare che in sede nasale il genere Penicillium e risultato predominante rispetto al genere Aspergillus, contrariamente ai dati di letteratura. Inoltre, i funghi dimorfi non sono stati mai isolati anche se l’area geografica di provenienza e stata introdotta tra quelle endemiche per questi miceti. In conclusione, la nostra indagine evidenzia che l’incidenza delle positivita per miceti non si discosta da quella tipica di popolazioni ad elevato livello socio sanitario, nonostante le avverse condizioni di viaggio.