Prognostic factors in the endoscopic treatment of sinonasal polyposis

Uvod: Nosno-sinusna polipoza je hronično inflamatorno oboljenje sluznice nosa i paranazalnih sinusa koje dovodi do nastanka polipoidnih formacija u šupljini nosa. Smatra se podgrupom hroničnog rinosinuzitisa, a često se javlja u sklopu različitih oboljenja kao što su astma, intolerancija aspirina i cistična fibroza. Ranija istraživanja su pokazala da je prisustvo polipa u nosu povezano sa težom formom bolesti. Prema novijim istraživanjima, nosno-sinusna polipoza može dovesti do značajnih ograničenja u fizičkim, emocionalnim i socijalnim aspektima života obolelih. Stoga, osim kliničkih merenja težine bolesti na osnovu intenziteta simptoma, nalaza endoskopije nosa i kompjuterizovane tomografije (CT) paranazalnih sinusa, važan dodatni aspekt u globalnoj evaluaciji bolesnika predstavlja merenje kvaliteta života u vezi sa zdravljem. Neuspeh medikamentoznog tretmana u lečenju nosno-sinusne polipoze zahteva hirurško lečenje. Stopa uspešnosti funkcionalne endoskopske sinusne hirurgije (FESS) u lečenju hroničnog rinosinuzitisa i polipoze nosa je prema podacima iz literature 76-97,5%. Posle hirurškog lečenja 2,5-24% bolesnika i dalje ima simptome. Neuspeh u hirurškom lečenju se obično pripisuje anatomskim abnormalnostima, alergiji, astmi, recidivu polipoze, intoleranciji aspirina, cilijarnoj disfunkciji i drugim sistemskim oboljenjima. Iz navedenih razloga, jedan od glavnih ciljeva u novijim istraživanjima predstavlja pronalaženje potencijalnih prognostičkih faktora za rezultate hirurškog lečenja. Cilj: Proceniti terapijski efekat FESS-a u lečenju bolesnika sa nosno-sinusnom polipozom i ispitati prognostički značaj pojedinih faktora i komorbiditeta za rezultate lečenja. Materijal i metode: Ovom prospektivnom studijom je obuhvaćeno 85 bolesnika sa nosno-sinusnom polipozom (≥18 godina) koji su lečeni endoskopskom sinusnom hirurgijom posle neuspeha medikamentoznog tretmana. Simptome bolesnika smo grupisali kao major i minor faktore, a njihov intenzitet je prikazan pomoću vizuelne analogne skale (VAS). Kvalitet života je prikazan pomoću generičkog upitnika SF-36. Objektivni status bolesnika je prikazan kao endoskopski i CT skor. Bolesnici su evaluirani u okviru cele grupe i odgovarajućih podgrupa, koristeći demografske faktore, kliničke faktore i komorbiditete kao dihotomne varijable (pol, godine života, prethodno hirurško lečenje, alergija, astma, intolerancija aspirina)...Introduction: Sino-nasal polyposis is a chronic inflammatory disease of the mucous membrane of the nose and paranasal sinuses, which leads to the forming of polypoid formations inside the nasal cavity. It is considered to be a subgroup of chronic rhinosinusitis, and it often appears related to variuos diseases such as asthma, intolerance to aspirin and cystic fibrosis. Earlier research indicated that the presence of polyps in the nose is related to a more serious form of disease. According to later research sino-nasal polyposis can lead to significant limitations regarding physical, emotional and social aspects of patients’ lives. Therefore, besides clinical evaluation of the seriousness of disease based on the intensity of symptoms, nasal endoscopy findings and computerized tomography (CT) of paranasal sinuses, the important additional aspect in the global evaluation of a patient is the evaluation of the quality of life regarding health. The failure of medicamentous treatment of sino-nasal polyposis requires surgical treatment. The success rate of functional endoscopic sinus surgery (FESS) in treatment of chronic rhinosinusitis and nasal polyposis, according to literature data, is 76-97,5%. After surgical treatment 2,5-24% patiens continue to have symptoms. The failure of surgical treatment is usually ascribed to anatomical abnormalities, allergy, asthma, recurrency of polyposis, intolerance to aspirin, ciliary dysfunction and other system diseases. Due to aforementioned reasons, one of the primary goals in the recent research is discovering the potential prognostic factors for the outcome of surgical treatment. Outcomes: The evaluation of therapeutic effect of FESS in the treatment of patients with sino-nasal polyposis and the examining of prognostic significance of certain factors and comorbidities for the outcomes of treatment. Material and methods: This prospective study has comprised 85 patients with sinonasal polyposis (age ≥18) who were treated by endoscopic sinus surgery after the failure of medicamentous treatment. We have grouped the patients’ symptoms into major and minor factors, and their intensity is presented by means of visual analogous scale (VAS). The quality of life is presented by general health survey SF-36. The objective status of patients is presented as endoscopic and CT score..

Middle ear tuberculosis: Diagnostic criteria

Introduction. Tuberculous otitis is a diagnostic problem due to the difficulty to obtain microbiological, histomorphological and cytological confirmation of the disease. Objective. Our objective was to compare clinical and radiological characteristic and development of otogenic complications in patients with tuberculous otitis and otitis with cholesteatoma as the most destructive form of chronic nonspecific otitis in the purpose of establishing the diagnostic criteria for tuberculous otitis. Methods. Medical records of 12 patients with tuberculous otitis and 163 patients with cholesteatoma treated at the Institute of Otorhinolaryngology and Maxillofacial Surgery in Belgrade during the eight-year period were analyzed. All of the patients underwent otomicroscopic, audiological and radiological examination of the thorax and temporal bone, microbiological examination of the secretion and histomorphological examination of the tissue taken during middle ear surgery. Statistical analysis was done using χ2 test with Yates correction. Results. Otogenic complication as facial palsy and sensorineural hearing loss were more frequent in tuberculous otitis patients, than in cholesteatoma. Also, fistulas of the labyrinth and facial canal bone destruction were also more frequent in tuberculous otitis than in cholesteatoma. A larger extent of temporal bone destruction was noticed on CT scans of the temporal bone in half of the patents with tuberculous otitis. Coexistence with miliary pulmonary tuberculosis was detected in one third of the patients. There were no microbiological or histomorphological confirmations of the disease, except in one case with positive Ziehl-Neelsen staining. Conclusion. Tuberculous otitis media should be considered in patients with serious otogenic complications and with shorter duration of ear discharge, and in association with diagnosed miliary pulmonary tuberculosis and extensive temporal bone destruction. Polymerase chain reaction still is not reliable for diagnosis

Meningoencephalitis as a complication of acute otitis media in a 11-year-old child

Introduction. Acute otitis media is a very common disease in the early childhood age, with typical symptoms such as otalgia and fever. Otogenic complications are divided into extracranial and intracranial. Although the introduction of antibiotics has significantly reduced the incidence of intracranial complications, they are still present. Clinical picture usually develops fast, with the predominance of neurologic symptoms. Case outline. An 11-year-old boy was admitted to a tertiary health care children’s hospital because of fever, agitation, altered behavior and disorder of consciousness. Based on the anamnesis, clinical examination, CT, MRI, and lumbar puncture, it has been established that it is a case of meningoencephalitis as complications of acute otitis media. Besides intense antibiotic and symptomatic therapy, surgical treatment too was conducted as well. Firstly, mastoidectomy with the implantation of ventilation tube was done, followed by radical tympanomastoidectomy, because there was no improvement. The treatment was followed by numerous complications, such as toxic hepatitis, mycoplasma pneumoniae infection, and hemolytic anemia. The treatment lasted for 71 days, and the patient was discharged from the hospital in a good general condition, without the focal motor failure. Conclusion. Meningoencephalitis is unusual and rare complication of acute otitis media that requires urgent diagnostic procedure and multidisciplinary approach to the treatment. Surgical treatment of the ear that caused complications should not be postponed, and the choice of surgical method must be adapted to each patient individually. Hospital treatment of these patients is often prolonged and auditory and neurological sequelae are substantial and require long-term treatment

Impact of rhinosinusal polyposis on CT score in patients with chronic rhinosinustis

Background/Aim. Chronic sinusitis is a disease characterized with mucosal inflammatoion of nasal and paranasal sinuses for at least 12 weeks. In order to assess the extent and severity of inflammatory changes in paranasal sinuses CT score according to Lund-Mackay is the most commonly used. Recent studies show the possibility of existing different subtipes of chronic rhinosinusitis, pointing out the presence of nasal polyps and their influence on the severity of chronic rhinosinusitis. The aim of this research was to examine the influence of sinonasal polyposis on the extensity of inflammatory changes on computerized tomography (CT), evaluated by the Lund-Mackay CT score. Methods. A prospective study compared the Lund-Mackay CT score values between the patients with chronic rhinosinusitis associated with nasal polyps and those without them. We determined mean values of the total CT score in both groups of the patients, as well as mean values of CT score for each group of sinuses and ostiomeatal complexes. Results. The study included 90 patients, 47 males and 43 females, 45-year old on average, diagnosed with chronic rhinosinusitis on the basis of diagnostic algorithm. The group with uncomplicated chronic rhinosinusitis (without nasal polyps) consisted of 30 patients and the group with complicated chronic rhinosinusitis (with nasal polyps) of 60 patients. Observing these two groups of patients revealed statistically highly important intergroup difference in CT score for each group of sinuses and ostiomeatal complexes. The mean value of total CT score in the group with uncomplicated chronic rhinosinusitis was 4.37 while in the group with complicated chronic rhinosinusitis it was 16.05 (p < 0.01). Conclusion. Chronic rhinosinusitis complicated by sinonasal polyposis is characterized with more extensive inflammatory changes on CT and, consequently, with higher CT score for each group of sinuses and ostiomeatal complexes, as well as higher total CT score

Comparison of Effects of Endogenous and Exogenous Excitatory Amino Acids on Retzius Nerve Cells of the Leech

In this paper we examine the effects of L-aspartate, L-glutamate, and $-N-oxalylamino-L-alanine (Lathyrus toxin) on Retzius nerve cells of the leech Haemopis sanguisuga. The goal was to compare the electrophysiological effects of endogenous vs. exogenous amino acids, known as potent neurotoxins, through the mechanism of excitotoxicity. We used classical intracellular recordings on Retzius nerve cells in isolated ganglia of the leech, and plotted dose-response curves to compare potencies. Our results show that Lathyrus toxin is more than 200 times more potent in depolarizing the membrane potential on our model than L-aspartate and L-glutamate, which are approximately equipotent

ОРИГИНАЛНИ РАД / ORIGINAL ARTICLE � UDC: 616.284-002.5-07 Middle Ear Tuberculosis: Diagnostic Criteria

Introduction Tuberculous otitis is a diagnostic problem due to the difficulty to obtain microbiological, histomorphological and cytological confirmation of the disease. Objective Our objective was to compare clinical and radiological characteristic and development of otogenic complications in patients with tuberculous otitis and otitis with cholesteatoma as the most destructive form of chronic nonspecific otitis in the purpose of establishing the diagnostic criteria for tuberculous otitis

The Impact of Cytokines on Health-Related Quality of Life in Adolescents with Allergic Rhinitis

Background: Frequent episodes of nasal symptoms are the usual clinical manifestations (CM) of allergic rhinitis (AR) and have a significant negative impact on health-related quality of life (HRQoL) in adolescents. The purpose of this cross-sectional study was to test the hypothesis that cytokines in nasal mucus may be associated with HRQoL in adolescents with AR. Methods: European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L), “The Adolescent Rhinoconjunctivitis Quality of Life Questionnaire” (AdolRQLQ) and the Total 4 Symptom Score (T4SS) scoring system were administered to 113 adolescents with AR, nonallergic rhinitis (NAR) and to healthy control subjects. Nasal secretions were sampled and tested for 13 cytokines using a multiplex flow cytometric bead assay. Results: The AR group had significantly lower EQ-5D-3L (0.661 ± 0.267 vs. 0.943 ± 0.088; p p p = 0.002), IL-6 (p = 0.031), IL-8 (p p = 0.013) and IL-18 (p = 0.014) compared to the control group, and IL-1β, IL-6, IL17-A and IL-18 were significantly (p < 0.050) increased with disease progression. Cytokines IL-1β, IL-6, as well as severe CM, were identified as significant predictors of lower HRQoL in adolescents with AR. Conclusions: This study identified IL-1β, IL-6, as well as severe CM, as predictors of lower HRQoL in adolescents with AR. However, these results should only serve as a starting point for additional confirmation research