Endoscopic surgery of the orbit

Thanks to continuous improvement of instrumentarium, methods of imaging and intraoperative neuronavigation, endoscopic techniques are increasingly used for management of intraorbital pathologies. The aim of the study was to present, basing on own experience, the virtues and limitations of endoscopic transnasal surgery in the diagnosis and treatment of orbital pathologies. This article contains a review of endoscopic treatment of lacrimal duct stenosis, evacuation of inflammatory lesions and benign tumors penetrating the orbit from the adjacent sinuses, management of primary intraorbital tumors, Graves-Basedov orbitopathy and posttraumatic lesions of the optic nerves. Both own experience and data from the relevant literature indicate that intraorbital inflammatory lesions can nowadays be effectively treated by means of endoscopy whereas purely endoscopic removal of intraorbital tumor still remains rare because is technically demanding and requires high experience in this type of surgery. In case of malignancies endoscopy may be used for diagnostic purposes and/or as a method supporting conventional external surgical approaches.     

BRCA1 mutations and colorectal cancer in Poland

Evidence to date that germline mutations in the tumor suppressor gene BRCA1 increase the incidence of colorectal cancer is mixed, and both positive and negative results have been reported. To establish whether or not inherited variation in BRCA1 influences the risk of colorectal cancer, we genotyped 2,398 unselected patients with colorectal cancer and 4,570 controls from Poland for three BRCA1 founder mutations (C61G, 4153delA and 5382insC). A BRCA1 mutation was present in 0.42% of unselected cases of colorectal cancer and in 0.48% of controls (OR = 0.8; P = 0.8). The mutation frequency was slightly higher (0.93%) in 321 cases who reported a family history of colon cancer in a first- or second-degree relative (OR = 1.9; P = 0.5). A BRCA1 mutation was also seen in excess (0.82%) in 851 cases who were diagnosed with colorectal cancer at age 60 or earlier (OR = 1.7; P = 0.3). The mean age at onset in carriers was 7 years younger than in non-carriers (57.0 years vs. 64.0) and the difference was significant (P = 0.05). This study suggests that BRCA1 mutations may be associated with early-onset of colorectal cancer.     

Occupational asthma due to manganese exposure: a case report

Manganese belongs to a group of agents called "transitional metals" that are known to induce occupational asthma. However, well-documented cases of manganese-induced asthma have been lacking thus far. We have discussed a case of a 42-year-old non-smoking welder with work-related dyspnea. A number of clinical procedures were performed including clinical examination, routine laboratory tests, total serum IgE, skin prick tests to common aeroallergens and manganese nitrate, resting spirometry test, histamine challenge, and a single-blind, placebo-controlled specific inhalation challenge with 0.1% manganese chloride solution. Clinical findings and laboratory test results remained normal but a significant bronchial hyperreactivity was found. During the specific inhalation challenge, dyspnea and a significant decrease in forced expiratory volume (FEV1) were observed. An increased proportion of eosinophils and basophils in induced sputum could also be noted at 4 and 24 h after the challenge. The argument for recognizing the condition as occupational asthma was a positive clinical response to the specific challenge test as well as the morphological changes found in induced sputum. To our knowledge, this is the first well-documented case of manganese-induced occupational asthma.     

Elevated levels of anti‐endotoxin antibodies in patients with bilateral idiopathic acute anterior uveitis

Purpose: Endotoxins have been proved to be responsible for acute anterior uveitis (AAU) in animals in a well‐established experimental model of endotoxin‐induced uveitis (EIU). The purpose of our study was the detection of antibodies against endotoxins of selected enterobacteria in the serum of patients with idiopathic AAU and searching for correlations between the levels of these antibodies and the presence of HLA‐B27 antigen as well as characteristic signs of EIU such as bilaterality and the absence of spontaneous recurrences of the disease. Methods: Reactions of serum IgG antibodies with lipopolysaccharides (LPSs) of Escherichia coli O1, E. coli O10, E. coli O111, E. coli J5, and Klebsiella pneumoniae O3 were determined for 60 patients with idiopathic AAU and 40 healthy volunteers. The presence of HLA‐B27 antigen in patients was determined. Documentation of the frequency of recurrences of AAU during a follow‐up period of 8 years was collected. Results: We have observed that the sera of patients with a first attack of AAU reacted stronger with the LPS of K. pneumoniae O3 than the sera of patients with relapse of the disease. Patients with bilateral AAU had markedly higher levels of antibodies against four of the five used LPSs than patients with one eye involved. A multiply comparison showed higher levels of IgG reacting with LPS of E. coli O111 in patients with bilateral eye inflammation admitted with the first attack of AAU comparing to controls. The incidence of recurrent form of AAU was significantly increased in HLA‐B27‐positive patients compared to HLA‐B27‐negative patients. However, we found in HLA‐B27 carriers that those with the bilateral form of AAU had over three times smaller risk of recurrence and showed stronger immunization by endotoxins than patients with unilateral inflammation. Conclusion: Our results suggest a potential role of endotoxins in the aetiology of the nonrecurrent bilateral form of AAU. We suggest that not only HLA‐B27 status but also determination of number of involved eyes may be useful to assess the risk of recurrence of the idiopathic AAU.