Krzysztof Oleś

Aspirin provocation increases 8-iso-PGE2 in exhaled breath condensate of aspirin-hypersensitive asthmatics

BACKGROUND Isoprostanes are bioactive compounds formed by non-enzymatic oxidation of polyunsaturated fatty acids, mostly arachidonic, and markers of free radical generation during inflammation. In aspirin exacerbated respiratory disease (AERD), asthmatic symptoms are precipitated by ingestion of non-steroid anti-inflammatory drugs capable for pharmacologic inhibition of cyclooxygenase-1 isoenzyme. We investigated whether aspirin-provoked bronchoconstriction is accompanied by changes of isoprostanes in exhaled breath condensate (EBC). METHODS EBC was collected from 28 AERD subjects and 25 aspirin-tolerant asthmatics before and after inhalatory aspirin challenge. Concentrations of 8-iso-PGF2α, 8-iso-PGE2, and prostaglandin E2 were measured using gas chromatography/mass spectrometry. Leukotriene E4 was measured by immunoassay in urine samples collected before and after the challenge. RESULTS Before the challenge, exhaled 8-iso-PGF2α, 8-iso-PGE2, and PGE2 levels did not differ between the study groups. 8-iso-PGE2 level increased in AERD group only (p=0.014) as a result of the aspirin challenge. Urinary LTE4 was elevated in AERD, both in baseline and post-challenge samples. Post-challenge airways 8-iso-PGE2 correlated positively with urinary LTE4 level (p=0.046), whereas it correlated negatively with the provocative dose of aspirin (p=0.027). CONCLUSION A significant increase of exhaled 8-iso-PGE2 after inhalatory challenge with aspirin was selective and not present for the other isoprostane measured. This is a novel finding in AERD, suggesting that inhibition of cyclooxygenase may elicit 8-iso-PGE2 production in a specific mechanism, contributing to bronchoconstriction and systemic overproduction of cysteinyl leukotrienes.

Endoskopowe leczenie chorych z izolowanymi stanami patologicznymi zatoki klinowej

Summary Introduction Cases of isolated lesions of the sphenoid sinus are rare. For descriptive purposes, clinicians divide them into inflammatory and non-inflammatory with prevalence of the former. Symptoms of the sphenoid sinus disease are difficult to characterise, the most common of them being vague headache and visual disturbances. Thorough preoperative evaluation of the lesion is essential – nasal endoscopy must be performed and computerised tomography or magnetic resonance imaging results analysed. The purpose of the study is to present the assessment of endoscopic surgery outcome in the own group of patients with isolated sphenoid disease. Material and methods Clinical data of 22 subjects were analysed retrospectively. There were 5 patients with bacterial sinusitis, 6 with fungal sinusitis, 4 with allergic thickening of the mucous membrane with no evidence of bacterial or fungal infection, 2 with mucocele, 1 with sphenoid osteoma, 1 with inverted papilloma, 1 with a foreign body and 2 with cerebral fluid fistula. Each patient had preoperative nasal endoscopy and CT/MRI imaging performed. Then they underwent endoscopic transnasal sphenoethmoidectomy with removal of the lesion or closure of the fistula. The sphenoid sinus was approached through its front wall. Results The patients’ postoperative course was uneventful. They noted improvement in all preoperative symptoms, except for bilateral oculomotor nerve paralysis in one individual, and were asymptomatic to ophthalmological examination. Conclusions Isolated lesions of the sphenoid sinus, even very rare tumours like those presented here, can be in most cases safely approached and removed endoscopically. All risks of the method must be considered prior to the operation. High frequency of fungal sinusitis should be noted.

Reoperacje w przebiegu otitis media chronica cholesteatomatosa

Summary Introduction Chronic cholesteatoma otitis media, apart from destruction of bones and possibility of otogenous complications, is characterized by possibility of recurrence of the disease after non radical treatment or presence of risk factors. Aim This paper intends to analyze changes typical for cholesteatoma, observed during otosurgery including the results of bacteriological investigations. Material and methods Nearly 450 otosurgeries were performed in Department of Otolaryngology at Jagiellonian University 2004–2007. Analysis refers to patients reoperated on chronic cholesteatoma otitis media. Results 47 reoperations in the course of chronic choleateatoma otitis media were performed. Bacteriological analysis was provided in 21 cases. The most common bacteria were Stahylococcus aureus and Pseudomonas aeruginosa. Biofilms were not observed in specimens. Conclusions The recurrence of the process should be expected in patients with cholesteatoma. They require regular, periodical follow-up examination.INTRODUCTION Chronic cholesteatoma otitis media, apart from destruction of bones and possibility of otogenous complications, is characterized by possibility of recurrence of the disease after non radical treatment or presence of risk factors. AIM This paper intends to analyze changes typical for cholesteatoma, observed during otosurgery including the results of bacteriological investigations. MATERIAL AND METHODS Nearly 450 otosurgeries were performed in Department of Otolaryngology at Jagiellonian University 2004-2007. Analysis refers to patients reoperated on chronic cholesteatoma otitis media. RESULTS 47 reoperations in the course of chronic choleateatoma otitis media were performed. Bacteriological analysis was provided in 21 cases. The most common bacteria were Staphylococcus aureus and Pseudomonas aeruginosa. Biofilms were not observed in specimens. CONCLUSIONS The recurrence of the process should be expected in patients with cholesteatoma. They require regular, periodical follow-up examination.

Endoskopowe leczenie chorych z kostniakami zatok przynosowych – doświadczenie własne ☆

Summary Osteomas are relatively common, benign, slow-growing, often asymptomatic neoplasms of the paranasal sinuses, occurring mainly in frontal and ethmoid sinuses. Surgical removal is done if they extend beyond the boundaries of the sinus, keep enlarging, are localised in the region adjacent to the nasofrontal duct, or if signs of chronic sinusitis are present and, irrespective of their size, in symptomatic tumours. Progressive headaches and chronic inflammation of the adjacent mucous membrane are most common symptoms. Endoscopic surgery plays an important role in management of ethmoid, sphenoid and frontal osteomas. Aim The aim of the paper was to report own experience in endoscopic treatment of patients with osteomas of the paranasal sinuses. Material and methods 6 patients with osteomas of paranasal sinuses were included in the group, mean age 36 years (range 15–52). Most common involvement was ethmoid cells (3). There were also patients with frontal, maxillary and sphenoid osteoma. All tumours were removed under endoscopic giudance. Frontoethmoidectomy was performed to remove ethmoid and frontal osteomas. Antrotomy was used in case of maxillary involvement and sphenoethmoidectomy in the patient with sphenoid sinus osteoma. Sphenoid sinus was approached through its anterior wall with a Stammberger punch. All the tumours were removed using fine forceps. Results No post-operative complications were observed. No recurrences were noted. All patients remain asymptomatic. Conclusions Resection of small and medium size osteomas of the paranasal sinuses can be safely and radically performed using endoscopic techniques. It allows their radical resection and very good cosmetic effects.

Induced sputum supernatant bioactive lipid mediators can identify subtypes of asthma.

Induced sputum (IS) allows to measure mediators of asthmatic inflammation in bronchial secretions. The specific role of induced sputum supernatant (ISS) endogenous bioactive lipid mediators in subtypes of asthma is not well understood.

Endoskopowe leczenie chorych z wewnątrzczaszkowymi powikłaniami zapalenia zatok

Summary Introduction Intracranial complications of sinusitis (cerebral, epidural, and subdural abscesses, meningitis, and dural sinus thrombophlebitis) remain a challenging and current topic. Although they are nowadays relatively rare, prompt recognition of these disease states is important to prevent permanent neurological deficit or fatality. Infection may spread hematogenously or by direct extension. Patients with complications require surgery to remove the focus of infection from the sinuses and drain the abscess. Recently, endoscopic frontal and sphenoid sinus surgery has emerged as the preferred technique for the treatment of the most advanced and complicated chronic sinusitis. Material and methods Records of 7 patients aged from 13 to 65 (mean 30.6) years treated in our department for intracranial complications between January 2002 and September 2006 were analysed retrospectively. The diagnosis of meningitis was established in 2 patients, in one case with accompanying bilateral oculomotor nerve palsy. Cavernous sinus thrombosis, frontal abscess with hemiplegia, cerebral oedema, bilateral oculomotor nerve palsy and retrobulbar optic nerve neuritis with blindness was diagnosed each in one individual. 5 endoscopic bilateral frontosphenoethmoidectomies and 2 endoscopic sphenoethmoidectomies were performed. In one case a frontosphenoethmoidectomy was combined with craniotomy. Results All preoperative symptoms subsided in 4 operated individuals. Vision improved in the patient with bilateral retrobulbar optic nerve neuritis. In patients with hemiplegia and bilateral oculomotor nerve palsy the symptoms persisted. No complications of the surgery were observed. Conclusions Surgical treatment of the focus of infection in the sinuses can be accomplished endoscopically via an intranasal approach with less morbidity, easy identification of anatomical structures, physiological drainage of the sinuses and superior cosmetic effects.

Spontaneous cerebrospinal fluid leak at the clivus

We present a case report of a 60-year-old woman with a spontaneous cerebrospinal fluid leak at the clivus, obesity and no history of trauma. Follow-up imaging scans confirmed enlargement of the defect within the posterior clival framework to the size of 16 × 9 × 4 mm with a suspected meningocerebral hernia. The surgeons used the “two nostrils – four hands” endoscopic operating technique. The patient reported a history of cerebrospinal fluid leaks lasting for 3 years, with increasingly shorter leak-free periods and an increasing incidence of inflammatory complications. The patient recovered without complications, and she was discharged 14 days after the surgery. Good local outcome and improved patient condition were achieved postoperatively.

Immunoglobulin G4-related disease (IgG4-RD) in the orbit: mucosa-associated lymphoid tissue (MALT)-type lymphomas.

Background MALT lymphomas were classified for differential diagnostics of IgG4-dependent disease due to their exceptional predilection to intraorbital localization. Therefore, the goal of our studies was large retrospective analysis of patients diagnosed with MALT lymphomas within the orbital tissues, since no such studies have been conducted in Poland. Material/Methods The starting study population consisted of 167 patients with isolated infiltrative tumor diseases within the orbital region treated at the Department of Otolaryngology, Head and Neck Surgery of the Medical College Jagiellonian University in Cracow. The immunohistochemical assays using anti-IgG, anti-IgG4 and anti-CD138 antibodies were used to estimate the IgG4+/CD138+ and IgG4+/IgG+ ratios. Results Of all the studied and analyzed patients, a final group of 19 patients with orbital MALT lymphomas was selected to undergo diagnostic examinations for IgG4-related disease. Detailed analysis and diagnostic screening for IgG4-related disease was performed and results meeting the criteria of IgG4-dependent disease were obtained in 10 out of 19 patients with the diagnosis of MALT tumor established on the basis of immunohistochemical assays. Conclusions MALT lymphomas are the most common of all lymphomas occurring within orbital tissues. In this study, results consistent with the criteria of IgG4-related disease were obtained in approximately 50% patients with immunohistochemical diagnosis of orbital MALT lymphoma.

Endoskopowe leczenie olbrzymich kostniaków podstawy czaszki

Summary Introduction Osteomas are relatively common, benign, slow-growing neoplasms. Mainly occurring in frontal and ethmoid sinuses. Endoscopic surgery plays an important role in management of ethmoid, sphenoid and frontal osteomas. Aim We discuss our experiences in endoscopic treatment of giant osteomas. Results In giant osteomas Draf III or Lothrop approaches are prefered. Periostium of the orbit was intact in all cases. Discharge of cerebrospinal liquid was not observed. Conclusions Size of tumor determines type of surgical aprroach. Endoscopic surgery is more and more popular way in surgical treatment of giant osteomas.

Optymalizacja leczenia chorych z perlakiem ucha środkowego

Summary Background The chronic otitis media is a frequent condition in ENT practice. The presence of cholesteatoma can lead to the destruction of bony structures in the middle ear spaces to a different extent. Aim We discuss the way of the patients’ treatment with the chronic cholesteatoma otitis media that were operated on for the first time. Material and methods We analyze the patients with the chronic cholesteatoma otitis media who were diagnosed, operated on and followed up in our Department between 2006 and 2009. 410 operations on ears were performed in that period of time. We discuss the extent of cholesteatoma, the hearing impairment, the type of otosurgery and the distant results of performed therapy. Results We discuss 44 patients operated on chronic cholesteatomatoma otitis media for the first time. It constitutes ca. 10% of all middle ear operations performed in analyzed period of time and 40% of all individuals operated on cholesteatoma. Conclusions There is a group of patients with the chronic cholesteatoma otitis media that have no hearing improvement after the reoperation. The main aim of the therapy in this group is to remove the pathology and therefore obtain the ‘dry ear’ and prevent against otogenous complications.