Ron Eliashar

Ingestion of caustic substances: a 15-year experience

Objective: The objective of this study was to analyze the circumstance, demographic features, clinical findings, and complications of caustic ingestion in relation to the type and amount of caustic substance.

Computerized Navigation for Surgery of the Lower Jaw: Comparison of 2 Navigation Systems

PURPOSEnTo evaluate the accuracy and applicability of 2 computerized navigation systems for surgery of the lower jaw.nnnPATIENTS AND METHODSnTwo patients diagnosed with a mucoepidermoid carcinoma of the lower jaw were prepared for tumor resection applying 2 different computerized navigation systems: the Image-Guided Implantology (IGI) system (DenX Advanced Dental Systems, Moshav Ora, Israel), which is specialized for dental implant surgery and the LandmarX system (Medtronic Xomed, Inc, Jacksonville, FL), which is designed for ear, nose, and throat surgery. Intraoperative accuracy of navigation of each of the systems was evaluated from the precision of targeting of distinctive anatomical landmarks in the mandible, including a preoperatively placed titanium screw.nnnRESULTSnThe navigational error of the IGI system was less than 0.5 mm, while that of the LandmarX system was between 3 mm and 4 mm. Tumor resection was performed with the guidance of the IGI system, and resulted in complete resection with tumor-free margins.nnnCONCLUSIONSnThe mobile nature of the lower jaw complicates its synchronization during surgery with the preacquired imaging data. The accuracy of navigation based on tracking of the patients head is compromised by asynchronous movements of the mandible during surgery. Direct tracking of the lower jaw, via a teeth-mounted sensor frame, is superior to its indirect tracking. The teeth also provide a more secure basis for the fiducial markers than soft tissue attachment. We conclude that a computerized navigation system using a teeth-mounted sensor frame and teeth-supported fiducial markers enables more accurate navigation for surgery of the lower jaw.

OK‐432 Therapy for Cervical Lymphangioma

Objective: To describe our experience with sclerosing treatment of lymphangiomas in the head and neck region by intralesional injections of OK‐432.

Packing in Endoscopic Sinus Surgery: Is it Really Required?

OBJECTIVE: The aim of this study was to evaluate the routine use of packing or local hemostatic agents in endoscopic sinus surgery (ESS). METHODS: Packing and/or hemostatic agents were used only when necessary in 100 consecutive adult ESS patients in a tertiary academic hospital. Necessity for packing the nose after excessive bleeding was analyzed in relation to demographic characteristics, medical history, previous surgeries, current surgical procedure, type of anesthesia, and amount of intraoperative bleeding. RESULTS: Three patients who required packing because of other reasons (such as bolstering of mucosa) were excluded from the study. The remaining 97 patients included 61 males and 36 females between the ages of 16 to 86 (mean 44). Forty-nine patients underwent only ESS, 40 ESSs associated with nasal polypectomy, and 8 underwent other endoscopic procedures. Fifty-four underwent the operation under general anesthesia and 43 under local anesthesia. Intraoperative blood loss was less than 30 mL in 82 patients (85%), 30 to 50 mL in 11 (11%), and more than 50 mL in 4 (4%). In 89 patients (92%), packing or a hemostatic agent was not used. No patient had bleeding complications postoperatively. A comparison between patients who required packing to those who did not showed that the only statistically significant associations related to general anesthesia (P = 0.0082) and to the amount of intraoperative bleeding (P < 0.001). CONCLUSIONS: Most ESS procedures can be managed without packing or any other hemostatic measures. Local anesthesia, use of local vasoconstrictors, and careful operative technique minimize the need for nose packing, thus reducing patients discomfort, postoperative complications, and cost of surgery. EBM rating: C-4

Physical interactions between mast cells and eosinophils: a novel mechanism enhancing eosinophil survival in vitro

To cite this article: Elishmereni M, Alenius HT, Bradding P, Mizrahi S, Shikotra A, Minai‐Fleminger Y, Mankuta D, Eliashar R, Zabucchi G, Levi‐Schaffer F. Physical interactions between mast cells and eosinophils: a novel mechanism enhancing eosinophil survival in vitro. Allergy 2011; 66: 376–385.

CD48 Is an Allergen and IL-3-Induced Activation Molecule on Eosinophils

Eosinophils are involved in a variety of allergic, parasitic, malignant, and idiopathic disorders by releasing a variety of factors including specific granule proteins, lipid mediators, and proinflammatory and immunoregulatory cytokines and chemokines. In addition, they interact with various cell types in the inflamed tissue. Yet, the mechanism of eosinophil activation is still poorly understood. Recently, we described the expression and function of the CD2-subfamily of receptors and especially 2B4 on human eosinophils. In this study we focus on CD48, the high-affinity ligand of 2B4. CD48 is a GPI-anchored protein involved in cellular activation, costimulation, and adhesion, but has not been studied on eosinophils. We demonstrate that human eosinophils from atopic asthmatics display enhanced levels of CD48 expression and that IL-3 up-regulates CD48 expression. Furthermore, cross-linking CD48 on human eosinophils triggers release of eosinophil granule proteins. Assessment of CD48 expression in a murine model of experimental asthma revealed that CD48 is induced by allergen challenge and partially regulated by IL-3. Additionally, anti-IL-3 reduces CD48 expression and the degree of airway inflammation. Thus, CD48 is an IL-3-induced activating receptor on eosinophils, likely involved in promoting allergic inflammation.

Physical interactions between mast cells and eosinophils: a novel mechanism enhancing eosinophil survival in vitro.

To cite this article: Elishmereni M, Alenius HT, Bradding P, Mizrahi S, Shikotra A, Minai‐Fleminger Y, Mankuta D, Eliashar R, Zabucchi G, Levi‐Schaffer F. Physical interactions between mast cells and eosinophils: a novel mechanism enhancing eosinophil survival in vitro. Allergy 2011; 66: 376–385.

WOUND-HEALING MODULATION IN UPPER AIRWAY STENOSIS—MYTHS AND FACTS

Wound healing plays a major role in the development of acquired subglottic stenosis. Pharmacologic treatment of subglottic stenosis must address both physiologic and pathologic healing processes. The relevant Pubmed and Ovid databases from 1960 to 2007 were systematically searched. Several modulating agents have been tested. Most of them were poorly investigated. Three modalities were thoroughly studied—steroids and antibiotics, mitomycin, and antireflux medications. However, there are conflicting data regarding their role in preventing and treating subglottic stenosis. Current data support to some extent the textbook suggestions of antibiotics, steroids, and antireflux treatment. As no other treatment options exist, we recommend using these modalities for pharmacologic modulation of subglottic stenosis. Mitomycin should still be considered as an unproven treatment; its use may be considered as an adjunct.

The role of the eosinophil in nasal diseases.

Purpose of reviewThe eosinophil is involved in physiologic and pathologic processes, such as asthma, parasitic diseases, granulomatous disorders, fibrosis, malignant tumors and several sino-nasal diseases. Recent developmentsRecent data on the structure and function of the eosinophil provides additional information regarding the pathophysiology and the treatment options of these diseases. In this paper the most recently acquired data on the role of the eosinophil in allergic rhinitis (with or without bronchial asthma), chronic sinusitis (with or without nasal polyposis) and allergic fungal sinusitis are reviewed. SummaryThe data provides evidence regarding the pivotal role of the eosinophil in sino-nasal diseases. Possible ways to target the eosinophils are discussed.

Hypoxia modulates human eosinophil function

BackgroundEosinophils are involved in various inflammatory processes including allergic inflammation during which angiogenesis has been documented. Angiogenesis is most likely connected to the hypoxia which characterizes inflamed tissues. Eosinophils produce VEGF and are pro-angiogenic. However, to the best of our knowledge no study has been performed to verify the existence of a direct link between eosinophils, hypoxia and angiogenesis in allergic inflammation.ObjectiveTo characterize eosinophil function and angiogenic potential under hypoxic conditions.MethodsHuman peripheral blood eosinophils were cultured in normoxic or hypoxic conditions with or without cytokines. Viability and apoptosis were assessed by Annexin V/PI staining. Anti- or pro-apoptotic protein levels, HIF-1α levels and MAPK phosphorylation were analyzed by immunoblot analysis. Angiogenic mediator release was evaluated by ELISA.ResultsHypoxic eosinophils were more viable than normoxic ones after up to three days. In addition in hypoxia, anti-apoptotic Bcl-XL protein levels increased more than pro-apoptotic Bax levels. Hypoxia increased VEGF and IL-8 release. In hypoxic eosinophils high levels of HIF-1α were observed, particularly in the presence of GM-CSF. MAPK, particularly ERK1/2 inhibitors, decreased hypoxia-mediated VEGF release and HIF-1α expression.ConclusionEosinophils respond to hypoxia by up-regulation of survival and of some of their pro-angiogenic functions indicating a correlation between eosinophilic inflammation and angiogenesis.