Paweł Stręk

Aspirin desensitization in patients with aspirin-induced and aspirin-tolerant asthma: A double-blind study

BACKGROUNDnNumerous open trials have demonstrated the beneficial clinical effects of aspirin desensitization (AD) in patients with aspirin-induced asthma (AIA). These beneficial effects might be attributable to aspirins potent anti-inflammatory properties, but that supposition requires further corroboration.nnnOBJECTIVEnWe sought to compare the clinical and biochemical responses to chronic oral AD in 20 patients with AIA and 14 patients with aspirin-tolerant asthma (ATA). All of the patients had chronic rhinosinusitis and nasal polyposis, and these responses were investigated in a pilot, double-blind, placebo-controlled study.nnnMETHODSnTwelve patients with AIA and 6 patients with ATA were randomly assigned to receive 624 mg of aspirin, and 8 patients with AIA and 8 patients with ATA received placebo. Both aspirin and placebo were administered once daily for 6 months. Nasal symptoms, Sino-Nasal Outcome Test (SNOT20) scores, peak nasal inspiratory flows, Asthma Control Questionnaire scores, spirometric parameters, peak expiratory flows, blood eosinophilia, and corticosteroid doses were assessed on a monthly basis. Levels of urinary leukotriene E4 and the stable plasma prostaglandin (PG) D2 metabolite 9α,11β-PGF2 were evaluated at baseline and after 1, 3, 5, and 6 months.nnnRESULTSnOnly the patients with AIA subjected to AD reported improvements in smell and reductions in sneezing and nasal blockade. The SNOT20 and Asthma Control Questionnaire scores of these patients decreased, and their peak nasal inspiratory flows increased. The dosages of inhaled corticosteroids were reduced. There were no changes in leukotriene E(4) or 9α,11β-PGF(2) levels after AD.nnnCONCLUSIONnThe clinically beneficial effects of AD on nasal and bronchial symptoms occurred only in the patients with AIA.

A possible correlation between vertebral artery insufficiency and degenerative changes in the cervical spine

Abstract We studied 130 patients, aged 20 to 81 years, with symptoms of tinnitus, vertigo or dizziness. Radiological examinations revealed degenerative changes in the cervical spines of all patients such as discopathy or osteophytes. Head and neck and neurological examinations ruled out other symptoms apart from vertebrobasilar artery flow insufficiency. The vertebrobasilar arteries were examined by means of a color Doppler ultrasonograph using duplex scanning. The correlation coefficient (CC) defining the relationship between the number of patients with abnormal blood flow and the total number of patients with radiologically confirmed changes in the cervical spine was 41.5%. When patients were separated by age, the value of the CC coefficient increased proportionally according to age, changing from 0 to 79.1%. Use of the Doppler ultrasonograph was found to be a safe and non-invasive diagnostic method that enabled us to assess the influence of degenerative changes in the cervical spine on hemodynamic disturbances in the inner ear and brain stem. Our findings demonstrated a pathological decrease of vertebral artery flow velocity in relationship to degenerative changes in the cervical spine.

The analysis of RCAS1 and DFF-45 expression in nasal polyps with respect to immune cells infiltration

BackgroundNasal polyp constitutes a benign growth process in the nasal and sinus mucosa. RCAS1 (receptor-binding cancer antigen expressed on SiSo cells) is a protein expressed mainly by various human cancer cells. It is not only the marker of cancer process and its expression can also be observed in physiological processes. It is responsible for the regulation of immune cells activity. DFF45 (DNA fragmenting factor) has been described as a substrate for caspase-3. DFF45 seems to play an important role in the onset of apoptotic process by acting probably through the regulation of DNA fragmentation. The aim of the study was to evaluate the ability of nasal polyps to regulate the cytotoxic immune response and to determine their resistance to apoptosis.ResultsThe higher RCAS1 level was identified in lymphocytic nasal polyps, the medium one in eosinophilic while the lowest was identified in neutrophilic. DFF-45 expression was higher in eosinophilic than in neutrophilic and lymphocytic nasal polyps.ConclusionThe changes in DFF-45 level in nasal polyps might indicate a different resistance to apoptosis mediated by immune cells. The alterations in RCAS1 expression indicate that nasal polyps have the ability to regulate the cytotoxic immune response.The breaking of resistance to immune mediated apoptosis in nasal polyps might have a new therapeutic impact.

Induced sputum eicosanoids during aspirin bronchial challenge of asthmatic patients with aspirin hypersensitivity

Altered metabolism of eicosanoids is a characteristic finding in aspirin‐exacerbated respiratory disease (AERD). Bronchial challenge with lysyl‐aspirin can be used as a confirmatory diagnostic test for this clinical condition. Induced sputum allows to measure mediators of asthmatic inflammation in bronchial secretions.

The evaluation of metallothionein expression in nasal polyps with respect to immune cell presence and activity

BackgroundThe expression of metallothionein (MT) is involved in acquiring resistance to immune-mediated apoptosis; it is also a negative regulator of the immune response. Nasal polyps are typified by a resistance to immune-mediated apoptosis as well as by excessive immune cell infiltration. RCAS1 (receptor-binding cancer antigen expressed on SiSo cells) is a membrane protein capable of inducing the apoptosis of CTLs and NK cells. The aim of the present study has been to explore the expression of metallothionein with respect to immune cell presence and immune cell activity. In our study, we identified immune cells using CD4 and CD68 antigen expression and evaluated their activity using CD25 antigen expression. We then analyzed metallothionein, RCAS1, CD25, CD4, and CD68 in a sampling of 50 nasal polyps using the immunohistochemistry method. We were able to divide the nasal polyps into three main groups according to their predominant immune cell infiltration: eosinophilic nasal polyps (21 cases), lymphocytic nasal polyps (17 cases), and neutrophilic nasal polyps (12 cases).ResultsIn the present study, statistically significant differences between the MT expression in the epithelium and that in the stroma of the nasal polyps along with the accompanying alterations in activation markers on immune cells were found and the number of macrophages in both the eosinophilic and the lymphocytic nasal polyps was assessed. RCAS1-expressing macrophages were found only in the eosinophilic nasal polyps.ConclusionMT expression seems to favor the survival of nasal polyp epithelial cells in the adjacent area of increasingly cytotoxic immune activity. RCAS1-expressing macrophages seem to participate in creating the immune suppressive microenvironment and so help to sustain local inflammation.

Acoustic assessment of voice signal deformation after partial surgery of the larynx

OBJECTIVEnThe main objective of the present study was to assess the degree of voice signal impairment among patients who had undergone partial surgery of the larynx due to cancer of this organ. Such on evaluation may be helpful in the selection of the optimal surgical technique for the treatment of tumors displaying a varying degree of local advancement.nnnMETHODSnA prospective examination was carried out among 128 patients. Additionally a comparative study of the control group consisting of 36 healthy males was carried out. Acoustic tests were carried out in an echo-free chamber. The temporal changes in the value of acoustic pressure of the uttered text were registered. The distance between the normal speech signal and the pathological voice has been established.nnnRESULTSnThe values of the fundamental frequency increase together with an increase of the range of resection of anatomical structures. The biggest differences in the value of results describing the distance from the standard were observed after hemilaryngectomy. The shortest distance from the acoustic standard was observed after chordectomy. No significant differences in the degree of voice signal impairment among patients who had undergone extended chordectomy and hemilaryngectomy were observed.nnnCONCLUSIONnThe above findings can be of help in arriving at an optimum solution in cases of partial surgery of the larynx. The problem is particularly important in situations where there is the choice between different types of surgery.

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

BACKGROUNDnIsoprostanes 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).nnnMETHODSnEBC 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.nnnRESULTSnBefore 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).nnnCONCLUSIONnA 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.

Tinnitus pitch and minimum masking levels in different etiologies.

Abstract Objective: We sought to determine whether the results of audiological tests and tinnitus characteristics, particularly tinnitus pitch and minimum masking level (MML), depend on tinnitus etiology, and what other etiology-specific tinnitus characteristics there are. Design: The patients answered questions concerning tinnitus laterality, duration, character, aggravation, alleviation, previous treatment, and circumstances of onset. The results of tympanometry, pure-tone audiometry, distortion-product otoacoustic emissions, tinnitus likeness spectrum, MML, and uncomfortable loudness level were evaluated. Study sample: Patients with several tinnitus etiological factors were excluded. The remaining participants were divided into groups according to medical history: acute acoustic trauma: 67 ears; chronic acoustic trauma: 82; prolonged use of oral estrogen and progesterone contraceptives: 46; Ménières disease: 25; congenital hearing loss: 19; sensorineural sudden deafness: 40; dull head trauma: 19; viral labyrinthitis: 53; stroke: 6; presbycusis: 152. Data of 509 ears were analysed. Results: Tinnitus pitch was highest in patients with acute acoustic trauma and lowest in patients receiving estrogen and progesterone. MML was lowest after acute acoustic trauma and in congenital hearing loss, and highest after a stroke and in the case of presbytinnitus. Conclusions: Tinnitus pitch and MML are etiology dependent.

Bony wall damage in the region of the middle and posterior cranial fossa observed during otosurgery

Summary Background Bony wall damages in the region of the middle and posterior cranial fossa are usually observed in cases of chronic otitis media. These defects can also be congenital, post-traumatic, iatrogenic or due to tumors. They can potentially lead to the development of intracranial complications. Material/Methods We analyzed patients who were diagnosed as having bony wall damage in the region of the middle and/or posterior cranial fossa. We also discuss methods of reconstruction during otosurgery. The analysis involves patients who underwent middle ear operations in the Department of Otolaryngology at the Jagiellonian University of Krakow between 2004 and 2008; 495 otosurgeries were performed during this period of time. Results In 70% of patients the reason for otosurgery was chronic otitis media. In 20%, bone defects occurred simultaneously with otosclerosis. Less than 10% underwent otosurgery for other reasons. Bony wall damage in the region of the middle and posterior cranial fossa were diagnosed in 46 patients who underwent surgery. In patients with bony wall damage, otogenic intracranial complications were described in 14 cases. Conclusions The performed reconstruction methods for bony wall damage, which used the fascia, strengthened with the pedicle muscle flap for larger defects and with either bone lamella or cartilage in specific cases, proved successful. Nearly 80% of bony wall damages in the region of the middle and posterior cranial fossa remain asymptomatic and are discovered incidentally during middle ear surgery. The above observations emphasize the significant role of pre-operative imaging diagnostics.

Determinants of Change in Air-Bone Gap and Bone Conduction in Patients Operated on for Chronic Otitis Media.

Background Middle ear surgery aims to eliminate pathology from the middle ear, improve drainage and ventilation of the postoperative cavity, and reconstruct the tympanic membrane and ossicles. The aim of this work is to define the factors that affect ABG (air-bone gap) and bone conduction in the patients operated on due to chronic otitis media. Material/Methods A prospective analysis of patients operated on due to diseases of the middle ear during 2009–2012 was carried out. The cases of patients operated on for the first time due to chronic otitis media were analyzed. The analysis encompassed patients who had undergone middle ear surgery. The patients were divided into several groups taking into account the abnormalities of the middle ear mucous and damage of the ossicular chain observed during otosurgery. Results A significant hearing improvement was observed in patients with type 2 tympanoplasty in the course of chronic cholesteatoma otitis media and in patients with simple chronic inflammatory process in whom a PORP was used in the reconstruction. Granulation tissue was an unfavorable factor of hearing improvement following tympanoplasty. A significant improvement of bone conduction was observed in the patients with dry perforation without other lesions in the middle ear. The elimination of granulation lesions was a positive factor for the future improvement of the function of the inner ear. Conclusions The presence of granuloma-related lesions in the middle ear spaces is likely to impede hearing improvement. Damage to the ossicular chain rules out the possibility of bone conduction improvement after surgery. The prognosis on tube-related simple chronic otitis media after myringoplasty, with the preserved continuity of the ossicular chain, consists of closing the ABG and leads to significant improvement of bone conduction.