Inducible nitric oxide synthase expression in various laryngeal lesions in relation to carcinogenesis,angiogenesis, and patients’ prognosis

Conclusions: The inducible nitric oxide synthase (iNOS) expression leading to vascular endothelial growth factor (VEGF) overexpression may be useful as a factor for predicting recurrence after initial treatment and prognosis in laryngeal squamous cell carcinoma (SCC). Objective: We analyzed expression of iNOS, p53, and VEGF in various laryngeal lesions. Materials and methods: The study samples consisted of 63 SCC, 20 dysplasia, 7 polyp, and 5 normal epithelium of the larynx. The expression of iNOS, p53, and VEGF was identified by immunohistological methods. Results: No positive immunostaining for iNOS, p53, and VEGF was observed in normal epithelium and polyps. In contrast, with the progression from mild/moderate dysplasia to severe dysplasia to carcinoma, their expression levels increased. In dysplasia, there was a significant positive correlation among expression of iNOS, p53, and VEGF. In SCC, iNOS expression correlated with VEGF overexpression and microvessel density, but not with p53 overexpression. In SCC, the expression of iNOS and VEGF significantly increased in patients who developed local recurrence and/or metastases after initial treatments. Kaplan–Meier analysis showed that disease-free survival was significantly shorter in patients with iNOS or VEGF expression. Multivariate analysis showed expression of iNOS and VEGF as independent indicators for poor disease-free survival.     

Epidemiological analysis of patients cure in frame of emergency in ORL clinic in Warsaw, stepińiska 15/21 in 1996

Study the epidemiological and clinical features of patients attending the emergency in the Clinic during 12 months to think whether the emergency is still needed as a one of method of curing. 4892 patients attended the emergency. Parameters analyzed were: age, sex, hour and day of arrival, place of living, initial signs, hospitalization and surgical services. The most frequent reasons for coming to the emergency were: ear disease (32.2%--middle ear otitis), nose disease (662 patients), bleeding nose (559 patients). The most frequent reason for hospitalization were swallowed foreign body (16.5%), tumor of the larynx and pharynx (16%), vestibulary nerve (12.9%). Emergency is an important sector of hospital activity, with a mean 55 per day (week-days), 87 per day (week-end and out of job days). The majority men disease were facial traumas, women were disease of vestibulary nerve, sudden hearing loss. However, 33% of the consultation in the emergency apper to be real medical emergencies, others could be appropriately provided by a general practitioner.     

Aleukämische,in Lymphosarkom übergehende Lymphadenose

Zusammenfassung Auf dem Boden einer aleukämischen Lymphadenose kommt es zur Entwicklung eines Lymphosarkoms der Tonsille. Die histologische Untersuchung der Felsenbeine deckt eine Otosklerose als Ursache der klinisch nachgewiesenen Schwerhörigkeit auf.Mit 2 Textabbildungen.     

Tinnitus and hearing loss in 15–16-year-old students: Mental health symptoms,substance use,and exposure in school

The current study assessed the responses from a survey titled ‘Life and Health – Young People 2005’, completed by 2878 15–16-year-old adolescents in mainstream schools in the county of Örebro, Sweden. Thirty-nine percent of students with hearing loss (slight, mild, or moderate) and 6% of students with normal hearing reported tinnitus often or always during the past three months. Almost no gender difference was observed among students with normal-hearing reporting tinnitus (boys 6.3%, girls 5.6%); however, a gender difference was noticed among hard-of-hearing (HH) students (boys 50%, girls 28%). Adolescents with both hearing loss and tinnitus reported considerably higher scores for mental health symptoms, substance use, and school problems than other students. Anxiety in the past three months, male gender, and alcohol consumption in the past year were associated with tinnitus in HH students; irritation and anxiety in the past three months, disability, use of illicit drugs, and truancy predicted tinnitus in the normal-hearing group. Consequently, students with a hearing loss and tinnitus are at high risk and should be monitored for subsequent problems.     

Interleukin 5, IL6, IL12, IFN-γ, RANTES and Fractalkine in human nasal polyps, turbinate mucosa and serum

Polyps are considered to develop as an end result of an inflammatory process. Cytokines and chemokines in the respiratory mucosa may be a key to polyp pathophysiology. The main objective was to identify IL-5, IL-6, IL-12, RANTES, IFN- and Fractalkine in humans on the protein level in nasal polyps and mucosa from the inferior turbinate (IT). Furthermore, the cytokines and chemokines RANTES and Fractalkine were analyzed in plasma. Tissue homogenates and plasma from 13 patients were analyzed by the ELISA technique. All the patients had longstanding nasal/paranasal polyposis. Fractalkine was detected in polyps and IT in two different patients. IL-5 was expressed in polyps and IT. IL-6 was expressed in all patients with a higher level in polyps than IT. IL-12 was present in plasma, polyps and IT, though at an increased level in polyps. RANTES was present at a higher level in plasma than in polyps and IT. IFN- was detectable in polyps and IT. Fractalkine is detected in nasal polyps, which is a new observation. The overall results indicate a mixed T_H1/T_H2 cytokine profile in nasal polyps. RANTES and IL-12 are strongly present in plasma, suggesting an ongoing inflammatory drive. IL-6 and IL-12 are up-regulated in polyps versus the IT. Up-regulation of IL-6 may be explained by increased fibroblast activity dependant on an ongoing local inflammation possibly initiated by an infection. IL-5, RANTES and IFN- are equally represented in polyps and IT, indicating equilibrium between the nasal polyps and surrounding tissue, and that an up-regulation of cytokines in the polyp indicates a potential for polyp growth.     

Juvenile nasopharyngeal angiofibromas in Denmark 1981–2003: diagnosis,incidence, and treatment

Conclusions. Juvenile nasopharyngeal angiofibroma (JNA) is a rare tumor in young males, with a non-negligible potential for recurrence. Preoperative embolization is a safe procedure that diminishes the peroperative blood loss and the need for blood transfusion. The endoscopic approach was used with good results in JNA stage I and II (Chandler). Objectives. To estimate the incidence rate of JNA in the Danish population and to describe symptoms and treatment. Patients and methods. This was a national retrospective cohort study. All cases of JNA diagnosed in Denmark from 1981 to 2003 were identified. Data were extracted from medical records. Results. Forty-five male (no female) JNA cases were identified. In 43 cases, clinical data were recovered. Median age was 15 years. The incidence rate in Denmark was 0.4 cases per million inhabitants per year and 3.7 cases per million males (aged 10–24) per year. All patients underwent surgery, and the endoscopic approach was increasingly being used. The embolization procedure proved to be safe and decreased the intraoperative blood loss statistically to 650 ml in the embolized group from an average of 1200 ml in the non-embolized group (p<0.05). Similarly, the need for peroperative blood transfusion was reduced (p<0.005). The primary recurrence rate was 23% and no patients died.     

Biofilms in Ear,Nose, and Throat Infections: How Important are They?

BACKGROUND: Biofilms present a new challenging concept in sustaining chronic, common antibiotic-resistant ear, nose, and throat (ENT) infections. They are communities of sessile bacteria embedded in a matrix of extracellular polymeric substances of their own synthesis that adhere to a foreign body or a mucosal surface with impaired host defense. The aim of this paper is to review the literature on ENT diseases that can be attributed to biofilm formation and to discuss options for future treatment. MATERIALS AND METHODS: Literature review from Medline and database sources. Electronic links and related books were also included. STUDY SELECTION: Controlled clinical trials, animal models, ex vivo models, laboratory studies, retrospective studies, and systematic reviews. DATA SYNTHESIS: Biofilm formation is a dynamic five-step process guided by interbacterial communicating systems. Bacteria in biofilms express different genes and have markedly different phenotypes from their planktonic counterparts. Detachment of cells, production of endotoxin, increased resistance to the host immune system, and provision of a niche for the generation of resistant organisms are biofilm processes that could initiate the infection process. Effective prevention and management strategies include interruption of quorum sensing, inhibition of related genes, disruption of the protective extrapolymer matrix, macrolides (clarithromycin and erythromycin), and mechanical debridement of the biofilm-bearing tissues. With regard to medical indwelling devices, surface treatment of fluoroplastic grommets and redesign of cochlear implants could minimize initial microbial colonization. CONCLUSION: As the role of biofilms in human infection becomes better defined, ENT surgeons should be prepared to deal with their unique and tenacious nature.     

Vocal fold medialization in children: injection laryngoplasty, thyroplasty, or nerve reinnervation?

OBJECTIVE: To review surgical interventions for pediatric unilateral vocal fold immobility (UVFI). DESIGN: Retrospective medical chart review. SETTING: Two tertiary academic centers. PATIENTS: All children who underwent vocal fold medialization for dysphonia, with or without aspiration, from January 2004 to September 2006. INTERVENTIONS: Injection laryngoplasty, ansa cervicalis-recurrent laryngeal nerve anastomosis, or thyroplasty. MAIN OUTCOME MEASURES: Age, sex, intervention, etiology, time from onset of UVFI to surgery, subjective success in improving voice, subjective duration of improvement, and complications. RESULTS: Twenty-seven procedures were performed in 15 patients (mean age, 10.6 years). Nineteen injection laryngoplasties, 3 thyroplasties (1 bilateral), 2 ansa cervicalis-recurrent laryngeal nerve reinnervation procedures, 1 adduction arytenoidopexy, and 1 cricothyroid joint subluxation were performed. Causes of UVFI included thoracic surgery in 6 cases (40%), prolonged intubation in 4 (26%), central nervous system neoplasm in 3 (20%), unknown etiology in 1 (7%), and anoxic brain injury in 1 (7%). The mean duration from onset of symptoms to treatment was 47 months. There was 1 surgical complication (postoperative aspiration pneumonia following thyroplasty while the patient was under local anesthesia). Parents reported a satisfactory outcome in all cases. CONCLUSIONS: Injection laryngoplasty, thyroplasty, and nerve reinnervation can be performed in pediatric patients with good outcomes and an acceptable safety profile. This article describes the experiences of 2 institutions with phonosurgery for UVFI in children and provides insight into the advantages and disadvantages of each procedure. Prospective studies, with validated quality-of-life measurements, are needed to greater clarify the role of different types of phonosurgery in children with UVFI.     

Honey in otorhinolaryngology: when, why and how?

In this review of the literature devoted to the use of honey, the authors analyse the composition, indications, benefits and adverse effects of this product in otorhinolaryngology and head and neck surgery. Published data indicate that honey applied topically to skin and mucosal wounds and/or burns and administered orally as antitussive medication (after the first year of life) is highly effective with no adverse effects. The physiological action of honey is the result of various mechanisms (osmotic, detersion, bactericidal action). Various medicinal honeys are available worldwide, but only one has Food and Drug Administration approval for the treatment of wounds. After the first year of life, the use of food honey appears to be as effective as medicinal honey, while decreasing the overall cost of treatment.     

Effects of Japanese herbal medicine,Juzen-taiho-to,in otitis-prone children – a preliminary study

Conclusion: Juzen-taiho-to (JTT, TJ-48), a Japanese herbal medicine that improves immune function, was found to be effective in otitis-prone in children. Objective: To evaluate the efficacy of JTT against intractable and recurrent infections in immature immune systems, we administered JTT to otitis-prone infants and investigated clinical changes before and during JTT administration. Subjects and methods: Twenty-four otitis-prone infants were administered JTT at 0.10–0.14 g/kg/day twice a day for 3 months. We compared clinical course, such as frequency of acute otitis media (AOM), duration of fever and antibiotics administration, and hospital visits for the periods before and during JTT administration. Results: Medication compliance rate was 87.5%, and administration of JTT led to remission in 95.2% patients. No apparent side effects were observed. The frequency of AOM decreased significantly (Wilcoxon signed rank test, p=0.000) with JTT. The duration of fever (p=0.000) and administration of antibiotics (p=0.001), as well as the number of hospital visits (p=0.001) and emergent hospital visits (p=0.000) showed significant decreases after JTT administration. After the end of the JTT period, 14 of 21 (66.7%) patients started to take it again, as they experienced purulent otitis media and/or other infections after discontinuation. The frequency of AOM increased significantly after stopping JTT (p=0.004) and decreased again with JTT resumption (p=0.005).