Inactivation of the Antifungal and Immunomodulatory Properties of Human Cathelicidin LL-37 by Aspartic Proteases Produced by the Pathogenic Yeast Candida albicans

Constant cross talk between Candida albicans yeast cells and their human host determines the outcome of fungal colonization and, eventually, the progress of infectious disease (candidiasis). An effective weapon used by C. albicans to cope with the host defense system is the release of 10 distinct secreted aspartic proteases (SAPs). Here, we validate a hypothesis that neutrophils and epithelial cells use the antimicrobial peptide LL-37 to inactivate C. albicans at sites of candidal infection and that C. albicans uses SAPs to effectively degrade LL-37. LL-37 is cleaved into multiple products by SAP1 to -4, SAP8, and SAP9, and this proteolytic processing is correlated with the gradual decrease in the antifungal activity of LL-37. Moreover, a major intermediate of LL-37 cleavage—the LL-25 peptide—is antifungal but devoid of the immunomodulatory properties of LL-37. In contrast to LL-37, LL-25 did not affect the generation of reactive oxygen species by neutrophils upon treatment with phorbol esters. Stimulating neutrophils with LL-25 (rather than LL-37) significantly decreased calcium flux and interleukin-8 production, resulting in lower chemotactic activity of the peptide against neutrophils, which may decrease the recruitment of neutrophils to infection foci. LL-25 also lost the function of LL-37 as an inhibitor of neutrophil apoptosis, thereby reducing the life span of these defense cells. This study indicates that C. albicans can effectively use aspartic proteases to destroy the antimicrobial and immunomodulatory properties of LL-37, thus enabling the pathogen to survive and propagate.     

Vascular malformation of the head and neck--diagnosis and treatment

Vascular malformations are the most common anomalies appearing from birth to any adulthood. They are not clinically and morphologically homogenous group. They may occur at different place but most often in the subcutaneous or submucous space in the oral cavity, pharynx, the paranasal sinuses and nose. The aim of this study was to present the difficulties in diagnosis and treatment of head and neck vascular malformations in patients hospitalized in ENT Department University of Lodz from 2001 to 2006. From 17 patients with vascular malformations we choose four to careful evaluation. Two patients had neck vascular malformation, two had the paranasal and nose sinuses tumors. Presented lesions were categorized as "low-flow" vascular malformation. In two cases there was vascular and lymphatic malformation, deeply located in the neck. In two cases arisen in the nose and the paranasal sinuses, there were capillary and cavernous types. We pointed out the clinical signs and diagnostic problems in deep vascular tumors and bleeding risk concerning treatment procedure. Even a needle biopsy and radiological imagining did not confirm the preoperative diagnosis. CT and MRI is recommended to delineate the extend the lesion, and evaluation of its special anatomical location, surrounding arteries, vessels and important neck structure prior to surgery. In the paranasal and nose tumor CT could show bone destructions as well. CONCLUSIONS: Surgical careful excision has been favorable in depth neck laying and extended paranasal and nose vascular malformation. Because of the risk of bleeding careful hemostasis are important challenges in the surgical removal, so embolization is preferred in some cases.     

Endoscopic management of osteomas of the paranasal sinuses--own experience

Osteomas are relatively common, benign, slow-growing, often asymptomatic neoplasms of the paranasal sinuses, occurring mainly in frontal and ethmoid sinuses. Surgical removal is done if they extend beyond the boundaries of the sinus, keep enlarging, are localised in the region adjacent to the nasofrontal duct, or if signs of chronic sinusitis are present and, irrespective of their size, in symptomatic tumours. Progressive headaches and chronic inflammation of the adjacent mucous membrane are most common symptoms. Endoscopic surgery plays an important role in management of ethmoid, sphenoid and frontal osteomas. Aim. The aim of the paper was to report own experience in endoscopic treatment of patients with osteomas of the paranasal sinuses. Material and methods. 6 patients with osteomas of paranasal sinuses were included in the group, mean age 36 years (range 15-52). Most common involvement was ethmoid cells (3). There were also patients with frontal, maxillary and sphenoid osteoma. All tumours were removed under endoscopic giudance. Frontoethmoidectomy was performed to remove ethmoid and frontal osteomas. Antrotomy was used in case of maxillary involvement and sphenoethmoidectomy in the patient with sphenoid sinus osteoma. Sphenoid sinus was approached through its anterior wall with a Stammberger punch. All the tumours were removed using fine forceps. Results. No post-operative complications were observed. No recurrences were noted. All patients remain asymptomatic. Conclusions. Resection of small and medium size osteomas of the paranasal sinuses can be safely and radically performed using endoscopic techniques. It allows their radical resection and very good cosmetic effects.     

Ejaculatory Disorders in Men With Urethral Stricture and Impact of Urethroplasty on the Ejaculatory Function: A Systematic Review

Background

Urethral stricture may disturb both micturition and semen emission. Urethroplasty, despite the restoration of a proper urethral patency, may not eliminate the accompanying ejaculatory dysfunction (EjD).

Evaluation of tracheal stenosis: comparison between computed tomography virtual tracheobronchoscopy with multiplanar reformatting,flexible tracheofiberoscopy and intra-operative findings

The aim of the study was to evaluate and compare various helical CT display modes [virtual endoscopy (VE)] and multiplanar reformations (MPR), conventional flexible tracheobronchoscopy (FT) and intra-operative (IO) findings in patients with tracheal stenosis and to analyze the advantage of MPR and VE in diagnosis and treatment planning and in postoperative follow-up. Thirty-seven patients with tracheal stenosis underwent standard neck and chest CT followed by MPR and VE. Results were correlated with the results of FT and IO findings. Thirty-three of the 37 stenoses were correctly graded and measured adequately using VE. Complete correlation among CT, fiberoptic tracheoscopy, and surgery of stenosis grading, stenosis length and length of planned resection segment of the trachea was noted between 33 of 37 patients with tracheal stenosis. Correlation between VE and IO was noted in 35 of 37 patients and between FT and VE was noted in 33 of 37 patients with tracheal stenosis. The sensitivity of VE was 94–97%, specificity was 100% with comparison to IO findings. The sensitivity and accuracy of MPR was 86–89% and specificity was 100% with comparison to FT findings. The results of the study indicate that VE is an excellent, consistent, and objective technique. VE with MPR is very useful in diagnostic evaluation and treatment planning in patients with tracheal stenosis.     

Dynastab S: A new concept for high energy fractures of the distal tibia

Background. High energy fractures of the distal tibia ("pylon fractures") usually result in severe reduction of the range of motion of the superior ankle joint. If there is severe soft tissue trauma coexisting with the fractures, the possibilities for surgical treatment are limited. Our study examined the suitability of the DYNASTAB S external fixator (for ankle joint stabilization). Material and methods. We studied 25 adult patients (15 men, 10 women), treated from April 2001 to March 2003, to whom the DYNASTAB-S stabilizer was applied for an average of 10.5 weeks. Results. In all patients bone union was achieved, with a good range of motion in the talo-crural joint. All patients tolerated the applied treatment well. The average hospital stay was 9 days. There were 2 cases of transient inflammatory reaction of the skin around the screws, and 1 case of algodystrophy syndrome, which resolved after physical treatment combined with pharmacotherapy. Conclusions. The Dynastab S external fixator is very successful in the treatment of fractures with poor prognosis in traditional methods of conservative and surgical treatment, providing bone union and good functional efficiency of the superior ankle joint. The use of the mechanical joint imitating the movement of the injured ankle joint allows for early joint rehabilitation without loss of stability of the fracture. Adaptation of the device to the operated limb is excellent. The Dynastab S external fixator can be recommended for wider use in the treatment of pylon fractures.