Viktor Chrobok

Pneumococcal capsular polysaccharides conjugated to protein D for prevention of acute otitis media caused by both Streptococcus pneumoniae and non-typable Haemophilus influenzae: a randomised double-blind efficacy study

Summary Background Acute otitis media is one of the most commonly-diagnosed childhood infections. This study assessed the efficacy of a novel vaccine that contained polysaccharides from 11 different Streptococcus pneumoniae serotypes each conjugated to Haemophilus influenzae -derived protein D in prevention of acute otitis media. Methods 4968 infants were randomly assigned to receive either pneumococcal protein D conjugate or hepatitis A vaccine at the ages of 3, 4, 5, and 12–15 months and were followed-up until the end of the second year of life. Middle-ear fluid was obtained for bacteriological culture and serotyping in children who presented with abnormal tympanic membrane or presence of middle-ear effusion, plus two predefined clinical symptoms. The primary endpoint was protective efficacy against the first episode of acute otitis media caused by vaccine pneumococcal serotypes. Analysis was per protocol. Findings From 2 weeks after the third dose to 24–27 months of age, 333 clinical episodes of acute otitis media were recorded in the protein D conjugate group (n=2455) and 499 in the control group (n=2452), giving a significant (33·6% [95% CI 20·8–44·3]) reduction in the overall incidence of acute otitis media. Vaccine efficacy was shown for episodes of acute otitis media caused by pneumococcal vaccine serotypes (52·6% [35·0–65·5] for the first episode and 57·6% [41·4–69·3] for any episode). Efficacy was also shown against episodes of acute otitis media caused by non-typable H influenzae (35·3% [1·8–57·4]). The vaccine reduced frequency of infection from vaccine-related cross-reactive pneumococcal serotypes by 65·5%, but did not significantly change the number of episodes caused by other non-vaccine serotypes. Interpretation These results confirm that using the H influenzae -derived protein D as a carrier protein for pneumococcal polysaccharides not only allowed protection against pneumococcal otitis, but also against acute otitis media due to non-typable H influenzae . Whether this approach would also allow improved protection against lower respiratory tract infections warrants further investigation.

Anterior orbital meningoencephalocele

Basal and syncipital meningoceles and meningoencephaloceles are relatively rare. Otorhinolaryngologists, neurologists, and ophthalmologists should know all the details concerning their incidence, diagnosis, and differential diagnosis. Incorrect interpretation of formations propagating especially into the nasal cavity or the paranasal sinuses and, rarely, into the orbit or the nasopharynx, can lead to serious complications.

Medialization Thyroplasty with a Customized Silicone Implant: Clinical Experience

The authors implemented medialization thyroplasty with a customized silicone implant in a total of 43 operations (36 patients) in 1999–2003. In 5 of these patients, the medialization thyroplasty was combined with cricothyroid subluxation (3 cases) or adduction of arytenoid cartilage (3 cases). One patient received medialization thyroplasty, cricothyroid subluxation and adduction of arytenoid cartilage. Postoperatively 36 patients reported substantial reduction of their complaints, 5 patients found their voice improved and only 2 patients (5.6%) stated that their voice had not changed. The subjective evaluation was consistent with the findings of laryngoscopy and the preoperative and postoperative phonation parameters (maximum phonation time, maximum sound pressure level, jitter and shimmer). Average maximum phonation time was 6.5 s before surgery and 12.5 s after surgery. Maximum vocal sound pressure level was, on average, about 4 dB higher after surgery. Jitter was reduced from 5.3 to 3.7% and shimmer from 32.3 to 18.6%. The differences between presurgical and postsurgical parameters in our study were all statistically significant, indicating voice improvement. Medialization thyroplasty with a silicone implant was proven to be a successful and safe surgical method for the treatment of vocal fold paralysis.

Growth Curves, Measurement and Three-Dimensional Reconstruction in the Histopathology of Temporal Bones

The paper consists of three parts, in which the opportunities for measurement in histopathology of the temporal bone are shown. Measurement of size and distance (1D measurement) is used for determining the growth curves during the fetal period. Measurement of area (2D measurement) shows a difference in volume of mesenchymal tissue in the middle ear cavity between the groups with and without kidney pathology during the prenatal period. A computer 3D reconstruction of malformations of the middle and inner ears can be applied in understanding the pathology of the hearing organ. The first part concerns the application of measurements of size and distance to a set of 121 temporal bones from 71 fetuses. For evaluation, the following parameters were collected from the histological samples: the height and width of the stapes, the height of the vestibule, the length of the macula sacculi, the length of the macula utriculi, and the height and width of the cochlea. Regression analysis was applied to the data set to determine the relationship of the growth curves of particular structures. The data for growth curves from 36 aborted, presumably normal fetuses, are used. So the growth curves show the normal development of these structures. The Mitscherlich model was found to be the most satisfying for the growth curve in the fetal period. The amount of mesenchymal tissue in the middle ear (2D measurement) was determined after computer digitalization (Lucia) of the samples’ area of the middle ear cavity. Statistical tests confirmed a larger amount of this tissue in the group of samples obtained from fetuses with pathological kidney findings (agenesis of kidneys, Potter’s sequence), in comparison with a group of spontaneously aborted fetuses without kidney damage.The 3D computer reconstruction of the temporal bone, the third topic, was created using our own Medicus software written for the project. In a sample of bone without pathology, reconstruction enabled assessment of basic anatomical structures and two temporal bones show malformation of the stapes (VATER syndrome) and the cochlea (trisomy 21).

Reconstruction of an orbital floor fracture in a 4-year-old child.

The authors present a case of a 4-year-old girl with an orbital floor fracture. During surgery absorbable collagenous mesh (Pelvicol) was placed between the bone wall and the orbital periosteum. Pelvicol was selected as a natural xenogeneic tissue (porcine dermis) ready for first use in the reconstruction of the orbital floor fracture. The patient has fully recovered without any symptoms.