Does Helicobacter Pylori Infection Increase the Levels of Exhaled Nitric Oxide?

It has been suggested that H. pylori infection upregulates iNOS expresion and synthesis of nitric oxide (NO). In order to extend the scope, exhaled NO in H. pylori-infected patients with chronic gastritis was investigated. Exhaled oral NO level was measured with Niox Mino® analyzer, twice before and six-seven months after successful H. pylori eradication therapy in 26 patients with gastritis and in 16 healthy non-atopic subjects. Exhaled NO was significantly increased in H. pylori-infected patients with chronic gastritis as compared with the healthy subjects. Following eradication the levels were significantly reduced compared to the basal level before the therapy and did not differ significantly from those of the healthy subjects. It seems that H. pylori-associated gastritis is accompanied by an increased level of exhaled NO, resulting probably from the locally increased NO production.

Analysis of procalcitonin and CRP concentrations in serum of patients with chronic spontaneous urticaria

Background

Our previous findings showed the importance of analysing the peripheral markers of acute phase response (APR) activation, C-reactive protein (CRP) and IL-6 in the context of urticaria activity and severity. However, these biomarkers do not reliably differentiate between APR to infectious and the disease severity.

Aim

In order to investigate a possible association between the immune-inflammatory activation markers CRP and procalcitonin (PCT).

Methods

Serum PCT and CRP concentrations were measured in patients with CU of varying severity as well as in healthy subjects.

Results

Serum PCT and CRP concentrations were significantly increased in more severe CU patients when compared to healthy controls and mild CU, and within the CU population there was a significant correlation between concentrations of PCT and CRP. Serum PCT concentrations remained within normal ranges in most CU patients and were only slightly elevated in some severe CU cases.

Conclusions

PCT serum concentration may be only slightly elevated in some cases of severe CU. Upregulation of PCT synthesis accompanied by parallel changes in CRP concentration reflects a low-grade systemic inflammatory response in CU. PCT should be considered as a better marker than CRP to distinguish between APR to infection and an active non-specific urticarial inflammation.

Acute phase inflammatory markers in patients with non-steroidal anti-inflammatory drugs (NSAIDs)-induced acute urticaria/angioedema and after aspirin challenge

BACKGROUND

Active chronic urticaria, identified as a mast cell- and basophil-dependent inflammatory disorder of the skin is able to elicit acute phase response (APR). However, systemic inflammatory response in different types of urticaria is poorly characterized.

AIM

To determine APR pattern in a clearly defined group of patients with acute urticaria and/or angioedema - induced by NSAIDs.

METHODS

Plasma IL-6 and serum C-reactive protein (CRP) concentrations were studied in 17 patients with NSAIDs-induced acute urticaria/angioedema (NSAIDsAU) and in 20 healthy controls. Eleven patients who used NSAIDs were presented at the emergency room with acute urticaria/angioedema while the remaining six manifested the symptoms during the aspirin challenge test. Patients were examined in a dynamic manner: during the acute phase, and next, after subsidence of the symptoms.

RESULTS

CRP and IL-6 concentrations increased significantly in patients with NSAIDsAU as compared with their asymptomatic period and the healthy subjects. In addition, NSAIDsAU patients showed elevated concentration of the biomarkers following aspirin provocation with the baseline values recovered in the asymptomatic period.

CONCLUSION

These results indicate that an acute systemic inflammatory response is activated in patients with NSAIDs-induced urticaria and/or angioedema. The study supports the evidence proving that up-regulation of CRP and IL-6 in urticaria/angioedema does not necessarily reflect any concomitant infection or other inflammatory processes, but may be due to the disease itself.

The Blood Urokinase System in Patients with Seasonal Allergic Rhinitis and Concomitant Seasonal Asthma during Pollen Season

It is well known that the fibrinolytic system actively participates in inflammatory processes. To investigate the role of the urokinase system in atopic allergy, we assessed circulating levels of urokinase-type plasminogen activator (uPA) and its soluble receptor (suPAR) in patients with pollen allergy suffering from allergic rhinitis and asthma during a period of natural pollens exposure. Plasma concentrations of uPA and suPAR were measured in 19 patients sensitized to grass and rye pollens (12 men and 7 women, 18 to 30 years old) who had seasonal allergic rhinitis and concomitant seasonal asthma symptoms, and 23 age- and sex-matched healthy controls, using THE enzyme-linked immunosorbent assay (ELISA) method. There were no significant differences in plasma concentrations of uPA and suPAR between patients and the control subjects. Seasonal allergic airway inflammation is not associated with enhanced release of uPA and suPAR into the systemic circulation.

Effect of tonsillectomy on the level of exhaled nitric oxide (NO) in patients with recurrent tonsillitis

BACKGROUND

Increased expression of inducible nitric oxide synthase in inflamed tonsils has been reported. Our preliminary observation was the first to demonstrate that increased exhaled NO level may occur in patients with tonsillitis.

OBJECTIVE

To extend the observation scope, the same group of patients was examined for NO exhaled after tonsillectomy.

MATERIALS AND METHODS

Exhaled oral NO level was measured with Niox Mino(®) analyzer, six-seven months after tonsillectomy in 27 non-atopic patients who suffered from recurrent tonsillitis and in 35 healthy non-atopic subjects.

RESULTS

After tonsillectomy, exhaled NO levels were significantly reduced as compared to the preoperative period values and did not differ significantly from those of the healthy subjects.

CONCLUSIONS

The results support a finding of the elevated exhaled NO consequent to NO production in chronically inflamed tonsils, but whether NO plays any role in the pathogenesis of tonsillitis or is merely a by-product of another process, needs to be determined.

Administration of low doses of tumor necrosis factor-alpha protects rat liver from ischaemic damage and reperfusion injury

Liver ischaemia and reperfusion (IR) injury is a significant clinical problem. The aim of our study was to investigate the protective effect of tumor necrosis factor-alpha (TNF-alpha) on rat liver ischaemia-reperfusion injury. A TNF-alpha dose of 3 microg/kg body weight was injected into rats that had undergone partial (70%) ischaemia and reperfusion. The activities of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), total blood antioxidant level (using the FRAP test), and the concentrations of TNF-alpha, myeloperoxidase (MPO) and malondialdehyde (MDA) in liver homogenates after 1, 6, and 72 hours of reperfusion were measured. It was demonstrated that, rats subjected to IR, the administration of small doses of TNF-alpha significantly reduced ALT and AST activities after 60- minute liver ischaemia and 1 or 6 hour of reperfusion. The strongest reductions in ALT and AST activities were seen after 1 hour of reperfusion (30% and 35%, respectively). Exogenous TNF-alpha reduced the release of this cytokine in all observed periods, with the greatest reduction observed after 1 hour of reperfusion. Decreases in MPO concentration (by 40-45% in all periods of observation), as a marker of hepatic neutrophil infiltration, and in MDA concentration, the end-product of lipid peroxidation (by 55-60% at all time points), accompanied the reduction of TNF-alpha release. The administration of TNF-alpha to the rats after IR did not alter total plasma antioxidant potential, as assayed by the FRAP test, after 1 hour of reperfusion; however, at the later times a marked increase (approximately 40-50%) occurred. We demonstrated that intraperitoneal injections of small doses of TNF-alpha protect rat livers from IR injury. The mechanism of this protection is related to reductions in the release of TNF-alpha during IR after injection of this cytokine, resulting in reductions in oxidative stress and inflammation during the later phase of reperfusion.

Sleep study in patients with overweight and obesity

Obstructive sleep apnea syndrome (OSAS) is a disorder characterized by repetitive collapse of the pharyngeal airway during sleep, which leads to oxygen desaturation, sleep fragmentation and daytime somnolence. Obesity is one of the most important risk factor for the development of OSAS. The exact mechanisms responsible for the relationship between obesity and OSAS are still unclear. The fat deposits in the pharynx region as well as the reduction in the lung volume have been considered as factors that might be responsible for the increase of the upper airway collapsibility. The aim of our study was to evaluate the correlation between the Body Mass Index (BMI) and sleep study parameters in overweight and obese patients suffering from breathing disturbances during sleep. We studied a group of 106 consecutive obese or overweight patients with a primary complaint of snoring or other breathing disturbances during sleep. In all cases, BMI and sleep studies (PolyMESAM) were examined. We evaluated relationship between the BMI and sleep study parameters such as Respiratory Disturbance Index (RDI), Apnea Index (AI), Desaturation Index (DI) and Average of Lowest Saturation (LSAT). The results showed the lack of significant statistical correlations between BMI and all the sleep parameters studied in the overweight patients and the statistical positive correlation between the BMI and RDI in the obese cases. We conclude that BMI determination may be considered as a simple, yet important predictor, of the OSAS in the group of obese patients.

Comparison of the efficacy and tolerability of amoxycillin/clavulanic acid 875 mg b.i.d. with cefuroxime 500 mg b.i.d. in the treatment of chronic and acute exacerbation of chronic sinusitis in adults

The efficacy and safety of amoxycillin/clavulanic acid (AMX/CA) (875/125 mg b.i.d. for 14 days) were compared with that of cefuroxime axetil (500 mg b.i.d. for 14 days) in a multicenter, open, parallel-group, randomized clinical trial in 206 adults with chronic or acute exacerbation of chronic sinusitis. Clinical response was similar, with 95% of AMX/CA-, and 88% of cefuroxime-treated, clinically evaluable patients cured (95% confidence interval; -0.6% to +15%). In bacteriologically evaluable patients, cure rates, defined as eradication of the original pathogen with or without re-colonization with non-pathogenic flora, were also similar, with 65% of AMX/CA- and 68% of cefuroxime-treated patients cured (95% confidence interval; -18% to +15%). However, clinical relapse was significantly higher in the cefuroxime group: 7% (7/89) of clinically evaluable patients, compared with 0% (0/98) in the AMX/CA (p=0.0049) group. A similar incidence of possible or definite adverse events related to the study drug was reported for both treatments (AMX/CA 4.4%, cefuroxime 4.3%), the most frequent being diarrhea. Four adverse events were recorded as serious or life-threatening with only one considered related to the study drug (urticaria, cefuroxime). AMX/CA 875/125 mg b.i.d. for 14 days is as effective and well tolerated as cefuroxime axetil 500 mg b.i.d. for 14 days in the treatment of chronic, or acute exacerbation of chronic sinusitis, but is associated with a significantly lower clinical relapse rate.

[The orbito-zygomatic craniotomy in the treatment of giant tumor penetrating from maxillary-ethmoidal region to the anterior cranial fossa]

The orbitozygomatic craniotomy was presented in resection of giant tumour of maxillary-ethmoidal region, orbital cavity and anterior cranial fossa. As a result of this approach the possibility of whole tumour resection was obtained. Also, easy closure of anterior fossa and avoidance of the facial deformation was achieved.

Recurrent laryngeal nerve palsy after thyroid cancer surgery: a laryngological and surgical problem

Recurrent laryngeal nerve paralysis is one of the most frequent complications after thyroid surgery due to goiter and cancers. A higher probability of this complication occurs after secondary procedure of the thyroid and in malignant cases. The symptoms may differ and depend on many factors. Generally, patients need careful ENT and surgical care including diagnosis and treatment. Four hundred and sixty-six patients who underwent thyroid operation due to cancer were analyzed. The group was composed of 227 papillary carcinoma, 87 follicular carcinoma, 51 medullary carcinoma, and 101 anaplastic carcinoma. Two hundred and fifty-three total thyroidectomies, 82 lobectomies and subtotal second lobe operations, 91 subtotal thyroidectomies, and 40 biopsies (wedge resections) were performed. In all 426 total and subtotal thyroidectomies an attempt to identify the recurrent laryngeal nerves was carried out. For 360 patients (77%) the surgical procedure was primary and for 106 patients (23%) the operation was secondary. Preoperative and postoperative laryngoscopic examinations were performed in all patients. Every patient with palsy underwent special laryngological procedures if needed (tracheotomy, phoniatric rehabilitation, conservative treatment and surgery in lack of improvement). The rate of postoperative vocal cord paralysis was 4.7%. The permanent palsy rate was 3.5%. In 1.2% recovery was observed. Of the 4.7% palsy rate, 3.2% concerned unilateral palsy and 1.5% bilateral pathology. Using the chi2 test, no significant differences between the rate of unilateral and bilateral paralysis and between temporary and permanent paralysis were found. On the basis of our material and results, identification the recurrent laryngeal nerves should be mandatory at surgery, thereby avoiding paralysis. Special laryngological procedures and surgical care from the beginning of paralysis are necessary for patients with vocal cord palsy. It allows to diagnose and treat patients with quite good results.

[Giant osteoma of the paranasal sinuses passing into the anterior cranial fossa]

A case of giant osteoma of paranasal sinus passing into anterior cranial fossa was presented. The frontal craniotomy in order to removing this tumor was applied. In any case of such tumor the CT seems to be a necessary examination.

[An influence of combined treatment of laryngeal cancer on thyroid gland activity]

The aim of the research work was to estimate the risk of functional complications arising within thyroid after radiotherapy, when thyroid of patients being ill with carcinoma of head and neck area skin was afflicted with radiation beam as well as to examine whether the circadian rhythmand concentration of hypophysis and thyroid hormones are dependent on combined treatment. The group contained 18 pilot patients treated with combined method, which were examined for concentration and circadian rhythm of TSH, T3, T4, fT3, fT4 three times: before commencement of treatment, one month and six months after completion of treatment. Results of circadian rhythm and concentration of thyroid hormones examinations proved that in case of all hormones the circadian rhythm exist which undergoes a dysrrythmia after one month and six months from completion of combined treatment.

[Reconstructive methods in the surgery of defects of the floor of the mouth and the tongue due to carcinoma]

A retrospective analysis of patients with tongue, floor of the mouth and tonsil carcinoma treated in II ENT Department University School of Medicine in Zabrze between 1994 and 1996 was undertaken. 32 male and 10 female underwent operation of the oropharynx. The visor flap, mandibulotomy or peroral approach was used. In 32 cases mandibulotomy, in 2 cases visor flap and in 3 cases peroral approach was performed. The usefulness of bone grafts from iliac ala, skin flaps and part of the tongue applied to replace the defect after extensive operation of the oropharynx was analysed and presented. In 2 patients partial mandibulectomy was performed. In 2 patients defect was replaced with iliac crest. Good graft's vitality, availability and function were emphasized.

[Hearing aid fitting in children treated at the Phoniatric Outpatient Clinic in Zabrze in years 1986-1990]

The purpose of this study was to evaluate the hearing aid fitting of 179 regularly controlled, hearing-disabled children from the Silesian area, first time admitted to Phoniatric Outpatient Clinic in Zabrze in years 1986-1990. The mean age of provision of a hearing aid was high. Children were supplied with hearing aids at mean age of 4,9 years (losses > 60 dB) and of 9,3 years (losses < or = 60 dB). There was a delay from 8,4 up to 12,5 months (losses < or = 60 dB) between the age of fitting and the issue of the hearing aid. It was also stated that the total amount of children wearing their aids binaurally decreased significantly from 118 to 74 during 5 years' period. As for the utilisation of hearing aids, prevalence of full-time users (57.9%) was demonstrated in confrontation to non-users (5.6%).

[A new water manometer for the measurement of pressure during swallowing]

A new pneumohydraulic water manometer for measuring pressure generated in the pharynx and oesophagus during swallowing was presented. It consists of measuring and pneumatic parts and a computer.

[The results of treatment of esophageal burns admitted to the 2nd ENT clinic in Zabrze]

The authors presented a 4 cases of esophageal scar tissue stenosis due to burns. The results of treatment in 3 patients were successful. One patient needs periodical dilatation. Therapeutic problems were discussed.

[The case of myoepithelioma of the parotid gland]

Myoepithelioma of the parotid gland occurs relatively rarely. In the literature was described only 33 cases of this tumors. It's growth's slow and distension. Basing upon the case of 48-year old woman, the authors discuss the difficulties of diagnostic, treatment and the course of the disease.

[Sedlacek-Kambic-Tucker reconstruction after partial laryngectomy (preliminary report)]

The three cases of simultaneous reconstruction after some partial laryngectomies in patients with laryngeal cancer were presented. The indications to those operations were defined and the surgical technique was introduced. The important advantages from this technique was pointed out. Also a very good functional results and possibility of early extubation were emphasized. The possibility of some postoperative complications after this reconstruction were suggested. Based on our experience and literature the procedure was found as a good and useful surgical method.

[Sternocleidomastoid musculocutaneous flaps for reconstruction of defects after head and neck neoplasm surgery (preliminary report)]

Sternocleidomastoid myocutaneous flaps have been used for reconstructive procedures in 6 oncologic patients. In two of them, flaps were used after pharyngolaryngectomy. Healing was successful and feeding tube removed 14 days after operation. In the other cases, flaps was used for reconstruction of defects of the floor of mouth tongue and lateral wall of pharynx. The flap healed primarily in three out of four cases. All patients underwent radiotherapy.

[The fasciocutaneous deltopectoral flap in skin defect reconstruction after pharyngolaryngectomy]

The case of skin defect reconstruction after pharyngolaryngectomy with simultaneous removal of cancer recidivism from tracheostomal region was presented. The method of preparation and suturing of the deltopectoral flap in place of skin defect was introduced. The defect after flap removal was covered by epidermis from the high. The simplicity of the procedure and high vitality of the flap, despite of the irradiation was emphasized.

[A case of a large parapharyngeal tumor removed by medial mandibulectomy]

In the paper by the authors the case of big size pleomorphic adenoma of the parapharyngeal space was presented. The tumors was taken out without any difficulties by transcervical approach with splitting mandibulae and cutting the muscles of the mouth bottom with wide exposure of the parapharyngeal space. This way of operations is considered and proved us a practicable method concerning the localization of the tumor.

[A study of erythrocyte oxidative enzyme activity in patients with laryngeal cancer before and after treatment with a selenium preparation CEROSEL]

The preliminary results of activity changes of antioxidant enzymes (glutathione peroxidase, catalase and superoxide dismutase) in erythrocyte in 19 patients with laryngeal cancer were presented. Enzymes activity in patients was signified three times: before surgery, before and after radiotherapy. During Co-60-therapy patients received leaven preparation of selenium CE-ROSEL in dose 100 micrograms Se/day. Obtained results showed increase of enzymes activity after CE-ROSEL supplementation. This changes are probably the result of selenium influence on protected mechanism before the free radicals.

[Gentamycin as a cause of hearing impairment in children treated at the Phoniatric Outpatient Clinic in Zabrze between 1987-1992]

Medical history was analyzed in an attempt to identify the etiology of 748 hard-of-hearing children treated at the Phoniatric Out-Patient Clinic in Zabrze between 1987-1992. In 198 cases, gentamicin was the major cause of bilateral sensorineural hearing loss. Ninety children had a hearing loss of less than 60 dB and 108 above 60 dB. The results obtained in our study are comparable to those of other authors.

[The case of malignant oncocytoma of the parotid gland]

Malignant oncocytoma of the parotid gland occurs relatively rarely. Basing upon the case of 48-years old man, the authors discuss the difficulties of diagnostic, treatment and the course of the disease.

[About the matter of injury to the superior laryngeal nerve during strumectomy]

The attention is paid to the frequently overlooked in clinical practice problem of diagnosis and strumectomy, in the light of literature data on peripheral nerve regeneration. The authors point to important causes of frequent failures in the treatment of such complications. They conclude that at the present level of knowledge, the only practical way to avoid the aforementioned complication is the change of surgical technique in routine strumectomy.