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Olszewska E, De Vito A, O’Connor-Reina C, Heiser C, Baptista P, Kotecha B, Vanderveken O, Vicini C. Consensus Statements among European Sleep Surgery Experts on Snoring and Obstructive Sleep Apnea: Part 2 Decision-Making in Surgical Management and Peri-Operative Considerations. J Clin Med 2024; 13:2083. [PMID: 38610848 PMCID: PMC11012596 DOI: 10.3390/jcm13072083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Reaching consensus on decision-making in surgical management and peri-operative considerations regarding snoring and obstructive sleep apnea (OSA) among sleep surgeons is critical in the management of patients with such conditions, where there is a large degree of variability. Methods: A set of statements was developed based on the literature and circulated among eight panel members of European experts, utilizing the Delphi method. Responses were provided as agree and disagree on each statement, and the comments were used to assess the level of consensus and develop a revised version. The new version, with the level of consensus and anonymized comments, was sent to each panel member as the second round. This was repeated for a total of five rounds. Results: The final set included a total of 71 statements: 29 stand-alone and 11 with 42 sub-statements. On the 33 statements regarding decision-making in surgical management, there was 60.6%, 27.3%, and 6.1% consensus among all eight, seven, and six panelists, respectively. On the 38 statements regarding the peri-operative considerations, there was 55.3%, 18.4%, and 15.8% consensus among all eight, seven, and six panelists, respectively. Conclusions: These results indicate the need for an expanded review of the literature and discussion to enhance consensus among the sleep surgeons that consider surgical management in patients with snoring and OSA.
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Affiliation(s)
- Ewa Olszewska
- Department of Otolaryngology, Sleep Apnea Surgery Center, Medical University of Bialystok, 15-276 Bialystok, Poland
| | - Andrea De Vito
- Department of Surgery, Morgagni-Pierantoni Hospital, Health Local Agency of Romagna, 47121 Forlì, Italy
| | | | - Clemens Heiser
- Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium; (C.H.); (O.V.)
- Department of Otorhinolaryngology/Head and Neck Surgery, Klinikum Rechts der Isar, Technical University of Munich, 80333 Munich, Germany
| | - Peter Baptista
- Clinica Universidad da Navarra, Departmento de Orl, 31008 Pamplona, Spain;
| | - Bhik Kotecha
- Nuffield Health Brentwood, Essex, Brentwood CM15 8EH, UK;
- UME Health, 17 Harley Street, London W1G 9QH, UK
| | - Olivier Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium; (C.H.); (O.V.)
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, 2650 Antwerp, Belgium
| | - Claudio Vicini
- GVM Care & Research ENT Consultant, GVM Primus Medica Center, GVM San Pier Damiano Hospital, 48018 Faenza, Italy;
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Olszewska E, De Vito A, Baptista P, Heiser C, O’Connor-Reina C, Kotecha B, Vanderveken O, Vicini C. Consensus Statements among European Sleep Surgery Experts on Snoring and Obstructive Sleep Apnea: Part 1 Definitions and Diagnosis. J Clin Med 2024; 13:502. [PMID: 38256636 PMCID: PMC10816926 DOI: 10.3390/jcm13020502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
Seeking consensus on definitions and diagnosis of snoring and obstructive sleep apnea (OSA) among sleep surgeons is important, particularly in this relatively new field with variability in knowledge and practices. A set of statements was developed based on the literature and circulated among eight panel members of European experts, utilizing the Delphi method. Responses in agreement and disagreement on each statement and the comments were used to assess the level of consensus and develop a revised version. The new version with the level of consensus and anonymized comments was sent to each panel member as the second round. This was repeated a total of five rounds. The total number of statements included in the initial set was 112. In the first round, of all eight panelists, the percentage of questions that had consensus among the eight, seven, and six panelists were 45%, 4.5%, and 7.1%, respectively. In the final set of statements consisting of 99, the percentage of questions that had consensus among the 8, 7, and 6 panelists went up to 66.7%, 24.2%, and 6.1%, respectively. Delphi's method demonstrated an efficient method of interaction among experts and the establishment of consensus on a specific set of statements.
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Affiliation(s)
- Ewa Olszewska
- Department of Otolaryngology, Sleep Apnea Surgery Center, Medical University of Bialystok, 15-276 Bialystok, Poland
| | - Andrea De Vito
- Department of Surgery, Morgagni-Pierantoni Hospital, Health Local Agency of Romagna, 47121 Forlì, Italy;
| | - Peter Baptista
- Clinica Universidad da Navarra, Departmento de Orl, 31008 Pamplona, Spain;
| | - Clemens Heiser
- Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium; (C.H.); (O.V.)
- Department of Otorhinolaryngology/Head and Neck Surgery, Klinikum Rechts der Isar, Technical University of Munich, 80333 Munich, Germany
| | | | - Bhik Kotecha
- Nuffield Health Brentwood, Essex, Brentwood CM15 8EH, UK;
- UME Health, 17 Harley Street, London W1G 9QH, UK
| | - Olivier Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium; (C.H.); (O.V.)
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, 2650 Antwerp, Belgium
| | - Claudio Vicini
- GVM Care & Research ENT Consultant, GVM Primus Medica Center, GVM San Pier Damiano Hospital, 48018 Faenza, Italy;
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De Vito A, Olszewska E, Kotecha B, Thuler E, Casale M, Cammaroto G, Vicini C, Vanderveken OM. A Critical Analysis of Pharyngeal Patterns of Collapse in Obstructive Sleep Apnea: Beyond the Endoscopic Classification Systems. J Clin Med 2023; 13:165. [PMID: 38202171 PMCID: PMC10779773 DOI: 10.3390/jcm13010165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/17/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: Drug-Induced Sleep Endoscopy (DISE) enables the three-dimensional and dynamic visualization of the upper airway (UA) during sleep, which is useful in selecting the best treatment option for obstructive sleep apnea (OSA) patients, particularly for surgical procedures. Despite international consensus statements or position papers, a universally accepted DISE methodology and classification system remain a controversial open question. (2) Methods: A review of the English scientific literature on DISE related to endoscopic classification systems and surgical outcome predictors (3) Results: Of the 105 articles, 47 were included in the analysis based on their content's relevance to the searched keywords. (4) Conclusions: A final report and scoring classification system is not universally accepted; the most internationally applied endoscopic classification system during DISE does not cover all patterns of events that occur simultaneously during the endoscopic examination, highlighting that several configurations of collapse and obstruction at different UA levels could be observed during DISE, which should be described in detail if DISE has to be considered in the decision-making process for the UA surgical treatment in OSA patients and if DISE has to have a role as a predictive factor for surgical outcomes analysis.
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Affiliation(s)
- Andrea De Vito
- ENT Unit, Department of Surgery, Ravenna-Lugo Hospitals, Health Local Agency of Romagna, 48121 Ravenna, Italy;
- ENT Unit, Department of Surgery, Forlì—Faenza Hospitals, Health Local Agency of Romagna, 47122 Forlì, Italy
| | - Ewa Olszewska
- Department of Otolaryngology, Medical University of Bialystok, 15-328 Bialystok, Poland;
| | - Bhik Kotecha
- Queens Hospital, Barking Harvering and Redbridge University Hospitals NHS Trust, Rom Vally Way, Romford RM1 2BA, UK;
| | - Eric Thuler
- Sleep Surgery Division, OHNS Department, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Manuele Casale
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy;
| | - Giovanni Cammaroto
- ENT Unit, Department of Surgery, Forlì—Faenza Hospitals, Health Local Agency of Romagna, 47122 Forlì, Italy
| | - Claudio Vicini
- ENT Unit, Faenza Hospital, Villa Maria Group, 48018 Faenza, Italy;
| | - Olivier M. Vanderveken
- Department of Otorhinolaryngology-Head and Neck Surgery, Antwerp University Hospital (UZA), 2650 Antwerp, Belgium;
- Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
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Łuczak MW, Dżaman K, Zaręba Ł, Czerwaty K, Siewiera J, Głuszko A, Olszewska E, Brzost J, Kantor I, Szczepański MJ, Ludwig N. HMGB1 Carried by Small Extracellular Vesicles Potentially Plays a Role in Promoting Acquired Middle Ear Cholesteatoma. Diagnostics (Basel) 2023; 13:3469. [PMID: 37998605 PMCID: PMC10669961 DOI: 10.3390/diagnostics13223469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/07/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023] Open
Abstract
Cholesteatoma is a specific medical condition involving the abnormal, non-cancerous growth of skin-like tissue in the middle ear, potentially leading to a collection of debris and even infections. The receptor for advanced glycation (RAGE) and its ligand, high-mobility box 1 (HMGB1), are both known to be overexpressed in cholesteatoma and play a potential role in the pathogenesis of the disease. In this study, we investigated the role of small extracellular vesicles (sEVs) in carrying HMGB1 and inducing disease-promoting effects in cholesteatoma. No significant differences in the concentration of isolated sEVs in the plasma of cholesteatoma patients (n = 17) and controls (n = 22) were found (p > 0.05); however, cholesteatoma-derived sEVs carried significantly higher levels of HMGB1 (p < 0.05). In comparison to sEVs isolated from the plasma of controls, cholesteatoma-derived sEVs significantly enhanced keratinocyte proliferation and IL-6 production (p < 0.05), potentially by engaging multiple activation pathways including MAPKp44/p42, STAT3, and the NF-κB pathway. Thus, HMGB1(+) sEVs emerge as a novel factor potentially promoting cholesteatoma progression.
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Affiliation(s)
- Michał W. Łuczak
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI 02906, USA;
- Department of Biochemistry, Medical University of Warsaw, 02-097 Warsaw, Poland; (Ł.Z.); (A.G.)
| | - Karolina Dżaman
- Department of Otolaryngology, Centre of Postgraduate Medical Education, 02-097 Warsaw, Poland; (K.D.); (K.C.); (I.K.)
| | - Łukasz Zaręba
- Department of Biochemistry, Medical University of Warsaw, 02-097 Warsaw, Poland; (Ł.Z.); (A.G.)
| | - Katarzyna Czerwaty
- Department of Otolaryngology, Centre of Postgraduate Medical Education, 02-097 Warsaw, Poland; (K.D.); (K.C.); (I.K.)
| | - Jacek Siewiera
- Department of Hyperbaric Medicine, Military Institute of Medicine-National Research Institute, 00-902 Warsaw, Poland;
| | - Alicja Głuszko
- Department of Biochemistry, Medical University of Warsaw, 02-097 Warsaw, Poland; (Ł.Z.); (A.G.)
| | - Ewa Olszewska
- Department of Otolaryngology, Medical University of Bialystok, 15-276 Bialystok, Poland;
| | - Jacek Brzost
- Department of Otolaryngology, The Children’s Memorial Health Institute, 00-328 Warsaw, Poland;
| | - Ireneusz Kantor
- Department of Otolaryngology, Centre of Postgraduate Medical Education, 02-097 Warsaw, Poland; (K.D.); (K.C.); (I.K.)
| | - Mirosław J. Szczepański
- Department of Biochemistry, Medical University of Warsaw, 02-097 Warsaw, Poland; (Ł.Z.); (A.G.)
- Department of Otolaryngology, Centre of Postgraduate Medical Education, 02-097 Warsaw, Poland; (K.D.); (K.C.); (I.K.)
| | - Nils Ludwig
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
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5
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Polecka A, Olszewska N, Danielski Ł, Olszewska E. Association between Obstructive Sleep Apnea and Heart Failure in Adults-A Systematic Review. J Clin Med 2023; 12:6139. [PMID: 37834783 PMCID: PMC10573908 DOI: 10.3390/jcm12196139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Heart failure (HF) patients commonly experience obstructive sleep apnea (OSA), which may worsen their condition. We reviewed a diverse range of studies to investigate the prevalence of OSA in HF patients, the effects of positive airway pressure (PAP) treatment, and the potential impact of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and sacubitril/valsartan on OSA outcomes. METHODS We analyzed case-control, observational studies, and randomized controlled trials. Prevalence rates, PAP treatment, and HF pharmacotherapy were assessed. RESULTS Numerous studies revealed a high prevalence of OSA in HF patients, particularly with preserved ejection fraction. PAP treatment consistently improved an apnea-hypopnea index, left ventricular ejection fraction, oxygen saturation, and overall quality of life. Emerging evidence suggests that SGLT2i and sacubitril/valsartan might influence OSA outcomes through weight loss, improved metabolic profiles, and potential direct effects on upper airway muscles. CONCLUSIONS The complex interplay between OSA and HF necessitates a multifaceted approach. PAP treatment has shown promising results in improving OSA symptoms and HF parameters. Additionally, recent investigations into the effects of HF pharmacotherapy on OSA suggest their potential as adjunctive therapy. This review provides insights for clinicians and researchers, highlighting the importance of addressing OSA and HF in patient management strategies.
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Affiliation(s)
- Agnieszka Polecka
- Doctoral School of the Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Natalia Olszewska
- Student Research Group, Department of Otolaryngology, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Łukasz Danielski
- Student Research Group, Department of Otolaryngology, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Ewa Olszewska
- Sleep Apnea Surgery Center, Department of Otolaryngology, Medical University of Bialystok, 15-089 Bialystok, Poland
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Rutkowska J, Kasacka I, Rogowski M, Olszewska E. Immunohistochemical Identification and Assessment of the Location of Immunoproteasome Subunits LMP2 and LMP7 in Acquired Cholesteatoma. Int J Mol Sci 2023; 24:14137. [PMID: 37762439 PMCID: PMC10531666 DOI: 10.3390/ijms241814137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Cholesteatoma, accompanied by chronic inflammatory response, is characterized by invasive growth and osteolytic activity. As specific proteasome isoforms, the immunoproteasomes serve as an important modulator of inflammatory responses. The aim of the present study was to determine the biological activity of cholesteatoma through the analysis of the expression and localization of immunoproteasome subunits of low molecule weight protein (LMP) 2 and LMP7. Cholesteatoma specimens were obtained from 15 adults who underwent ear surgery due to acquired attic cholesteatoma. Normal skin specimens were taken from retro-auricular skin incisions from the same patients. The specimens were stained with anti-LMP7 antibody, using immunohistochemistry techniques based on the binding of biotinylated secondary antibody with the enzyme-labeled streptavidin and the Envision FLEX system. In all specimens of cholesteatoma, the immunohistochemical reaction with the antibody against the LMP2 was positive, in both the cytoplasm of the cholesteatoma matrix and the perimatrix. A negative reaction with anti-LMP2 was observed in the cytoplasm and nuclei of control skin cells. A positive nuclear and cytoplasmic immunohistochemical reaction with anti-LMP7 has been demonstrated in numerous cells, in both the matrix and perimatrix of cholesteatoma. We present evidence of the presence of expressions of LMP2 and LMP7 within cholesteatoma tissue. Our results might bring new information concerning immunoproteasome-dependent pathophysiologic mechanisms in cholesteatoma.
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Affiliation(s)
- Justyna Rutkowska
- Department of Otolaryngology, Medical University of Bialystok, 15-089 Białystok, Poland; (M.R.); (E.O.)
| | - Irena Kasacka
- Department of Histology and Cytophysiology, Medical University of Bialystok, 15-089 Białystok, Poland;
| | - Marek Rogowski
- Department of Otolaryngology, Medical University of Bialystok, 15-089 Białystok, Poland; (M.R.); (E.O.)
| | - Ewa Olszewska
- Department of Otolaryngology, Medical University of Bialystok, 15-089 Białystok, Poland; (M.R.); (E.O.)
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Fiedorczuk P, Olszewska E, Polecka A, Walasek M, Mroczko B, Kulczyńska-Przybik A. Investigating the Role of Serum and Plasma IL-6, IL-8, IL-10, TNF-alpha, CRP, and S100B Concentrations in Obstructive Sleep Apnea Diagnosis. Int J Mol Sci 2023; 24:13875. [PMID: 37762178 PMCID: PMC10530258 DOI: 10.3390/ijms241813875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a prevalent and underdiagnosed condition associated with cardiovascular diseases, depression, accidents, and stroke. There is an increasing need for alternative diagnostic tools beyond overnight sleep studies that measure the Apnea/Hypopnea Index (AHI). In this single-center, case-control study, we evaluated serum and plasma concentrations of IL-6, IL-8, IL-10, TNF-α, CRP, and S100B in 80 subjects, including 52 OSA patients (27 moderate [15 ≤ AHI ˂ 30], 25 severe [AHI ≥ 30]) and 28 non-OSA controls (AHI 0-5). Participants with OSA showed approximately 2 times higher median concentrations of CRP in plasma, and IL-6 in serum, as well as 1.3 to 1.7 times higher concentrations of TNF-α and IL-8 in plasma compared with the control group. Receiver Operator Characteristic (ROC) curve analysis was performed to evaluate the predictive capabilities of these serum and plasma biomarkers in distinguishing between the OSA and control groups, revealing varying sensitivity and specificity. In summary, in this study, serum and plasma biomarkers CRP, S100B, IL-6, TNF-α, and IL-8 have been shown to be elevated in patients with OSA, correlated positively with disease severity, age, and BMI. These results support the potential role of these biomarkers in diagnosing OSA, supplementing traditional methods such as overnight sleep studies.
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Affiliation(s)
- Piotr Fiedorczuk
- Department of Otolaryngology, Medical University of Bialystok, 15-089 Bialystok, Poland; (P.F.); (M.W.)
| | - Ewa Olszewska
- Department of Otolaryngology, Medical University of Bialystok, 15-089 Bialystok, Poland; (P.F.); (M.W.)
| | - Agnieszka Polecka
- Doctoral School of the Medical, University of Bialystok, 15-089 Bialystok, Poland;
| | - Marzena Walasek
- Department of Otolaryngology, Medical University of Bialystok, 15-089 Bialystok, Poland; (P.F.); (M.W.)
| | - Barbara Mroczko
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok 15-089 Bialystok, Poland; (B.M.); (A.K.-P.)
| | - Agnieszka Kulczyńska-Przybik
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok 15-089 Bialystok, Poland; (B.M.); (A.K.-P.)
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8
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Fiedorczuk P, Olszewska E, Rogalska J, Brzóska MM. Osteoprotegerin, Chitinase 3-like Protein 1, and Cardiotrophin-1 as Potential Biomarkers of Obstructive Sleep Apnea in Adults-A Case-Control Study. Int J Mol Sci 2023; 24:ijms24032607. [PMID: 36768925 PMCID: PMC9916736 DOI: 10.3390/ijms24032607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/15/2023] [Accepted: 01/28/2023] [Indexed: 02/03/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a prevalent, underdiagnosed disease and is considered a risk factor for cardiovascular diseases, depression, accidents, and stroke. Recent clinical practice guidelines for OSA expressed the need for a new clinical tool that establishes the Apnea-Hypopnea Index (AHI) to determine the disease burden. The serum and plasma concentrations of Osteoprotegerin (OPG), Chitinase 3-like protein 1 (YKL-40), and Cardiotrophin-1 (CT-1) in 80 subjects-52 OSA patients, 27 moderate (15 ≤ AHI ˂ 30) and 25 severe (AHI ≥ 30), and 28 non-OSA controls (AHI 0-5)-were determined. Moreover, the Total Oxidative Status (TOS), Total Antioxidative Status (TAS), and Oxidative Stress Index (OSI) were assessed in the serum and plasma to evaluate whether the severity of OSA and the concentrations of OPG, YKL-40, and CT-1 correlate with the oxidative/reductive status. The serum and plasma concentrations of YKL-40 and CT-1 were higher in the OSA group, whereas the serum and plasma concentrations of OPG were lower compared to the control group. The concentrations of OPG, YKL-40, and CT-1 in the serum and plasma correlated with AHI; however, a better correlation of the concentrations was obtained for the above-mentioned proteins in the plasma. The concentrations of YKL-40 and CT-1 in the serum and OPG in the plasma show better diagnostic capabilities for moderate and severe OSA than the concentrations of YKL-40 and CT-1 in the plasma and the concentrations of OPG in the serum.
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Affiliation(s)
- Piotr Fiedorczuk
- Department of Otolaryngology, Medical University of Bialystok, 15-089 Bialystok, Poland
- Correspondence: ; Tel.: +48-663-751-516
| | - Ewa Olszewska
- Department of Otolaryngology, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Joanna Rogalska
- Department of Toxicology, Medical University of Bialystok, 15-089 Bialystok, Poland
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9
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Olszewska E, Pietrewicz TM, Świderska M, Jamiołkowski J, Chabowski A. A Case-Control Study on the Changes in High-Sensitivity C-Reactive Protein and Tumor Necrosis Factor-Alpha Levels with Surgical Treatment of OSAS. Int J Mol Sci 2022; 23:ijms232214116. [PMID: 36430593 PMCID: PMC9699588 DOI: 10.3390/ijms232214116] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/05/2022] [Accepted: 11/10/2022] [Indexed: 11/18/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a common but underdiagnosed condition with significant health and economic implications for society. Inflammatory mediators are proposed to be associated with the presence and severity of OSAS and contribute to morbidity and mortality. This paper details a prospective non-randomized case control study of a cohort of subjects, who underwent surgical treatment of OSAS and were enrolled to assess the sleep parameters and blood levels of selected inflammatory markers at pre-operative and post-operative time points, also comparing them to the levels in a control group. A total of 25 study subjects and 18 control subjects were enrolled. Median values and interquartile range (IQR) of the apnea-hypopnea index (AHI) in the study group pre-operatively and post-operatively were 34 (18.5-45.5) and 13.3 (7.5-27.3), while in the control group 1.4 (1.0-2.1) per hour. The mean (IQR) hs-CRP levels (mg/L) were 1.782 (0.941-5.594) and 1.980 (0.990-5.445) in the study group, pre-operatively and post-operatively, respectively, while 0.891 (0.767-1.436) in the control group. The mean (IQR) TNF-α levels (pg/mL) were 7.999 (6.137-9.216) and 6.614 (5.534-7.460) pre-and post-operatively, respectively, and were 6.000 (5.026-6.823) in the control group. Results demonstrated that both inflammatory markers, hs-CRP and TNF-α, are higher in subjects with OSAS compared to the controls, and their levels decrease, but are still higher than the controls, after successful surgical treatment. Further analysis including the body mass index and age demonstrated that these changes were significant for TNF-α, but not hs-CRP.
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Affiliation(s)
- Ewa Olszewska
- Department of Otolaryngology, Medical University of Bialystok, 15-089 Bialystok, Poland
- Correspondence:
| | | | - Magdalena Świderska
- Department of Physiology, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Jacek Jamiołkowski
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Adrian Chabowski
- Department of Physiology, Medical University of Bialystok, 15-089 Bialystok, Poland
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10
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Olszewska E, Vasilenok N, Polecka A, Stróżyński A, Olszewska N, Rogowski M, Fiedorczuk P. Long-term outcomes of pharyngoplasty for Obstructive Sleep Apnea Syndrome. Otolaryngol Pol 2022; 76:18-25. [DOI: 10.5604/01.3001.0015.7672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b>Introduction: </b> Pharyngoplasty techniques for the treatment of obstructive sleep apnea syndrome (OSAS) have evolved, which improved the understanding of the anatomy, patient selection, and adoption of functional approaches. </br></br> <b>Aim:</b> To analyze long-term results of pharyngoplasty in OSAS patients. </br></br> <b>Material and methods:</b> Between 2007 and 2021, a total of 234 adult patients with OSAS who had previously failed positive airway pressure (PAP) therapy underwent sleep surgery. Of this group, 75 patients met the criteria of a minimum 5-year follow-up. To date, 25 patients completed the follow-up study protocol, including the medical history, visual analog scale (VAS) for snoring loudness, body mass index (BMI), endoscopy of the upper airways, type III sleep study, and standardized questionnaires including Epworth Sleepiness Scale (ESS) and EQ-5D-5L Euro – Quality of Life Questionnaire. </br></br> <b>Results:</b> The average period of follow-up was 96.80 ± 30.20 months. The mean age of participants was 54.6 ± 14.02 and the mean BMI 30.28 ± 2.74. Patients underwent uvulopalatopharyngoplasty (n = 21) and expansion sphincterpharyngoplasty (n = 4) between 2008–2015. A long-term improvement in sleep parameters was observed for the mean AHI (29.84 ± 20.06before and 19.45 ± 18.53 after surgery, p = 0.0294), and the median VAS (8.13 before and 3.78 after surgery), mean oxygen saturation during sleep 94,5% (IQR 93.0–95.25), and the median ESS score was 6.17 ± 4.57. The majority of patients reported subjective long-term improvement in sleep quality and a reduction of snoring. </br></br> <b>Conclusions:</b> In OSAS patients who failed PAP therapy, pharyngoplasty may provide a long-term improvement in upper airway obstruction during sleep.
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Affiliation(s)
- Ewa Olszewska
- Department of Otolaryngology, Medical University of Bialystok, Bialystok, Poland
| | - Nataliya Vasilenok
- Doctoral School of the Medical University of Bialystok, Bialystok, Poland
| | | | | | | | - Marek Rogowski
- Department of Otolaryngology, Medical University of Bialystok, Bialystok, Poland
| | - Piotr Fiedorczuk
- Doctoral School of the Medical University of Bialystok, Bialystok, Poland
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Olszewska E, Rogalska J, Brzóska MM. The Association of Oxidative Stress in the Uvular Mucosa with Obstructive Sleep Apnea Syndrome: A Clinical Study. J Clin Med 2021; 10:jcm10051132. [PMID: 33800385 PMCID: PMC7962821 DOI: 10.3390/jcm10051132] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/26/2021] [Accepted: 03/05/2021] [Indexed: 12/29/2022] Open
Abstract
The hypothesis that individuals with obstructive sleep apnea syndrome (OSAS) demonstrate oxidative stress in the uvular mucosa that correlates with OSAS occurrence was investigated. A total of 128 participants (mean age 45.8, mean body mass index 30.7, female–male ratio 1:20) were divided into the non-OSAS group (apnea–hypopnea index—AHI < 5) and OSAS-group (AHI ≥ 5), in which mild (5 ≤ AHI < 15), moderate (15 ≤ AHI < 30), and severe (AHI ≥ 30) sub-groups were distinguished. Laryngological examination, Epworth Sleep Scale questionnaire, and home sleep study were performed to obtain AHI, mean oxygen saturation, and lowest oxygen saturation. Total oxidative status (TOS) and total antioxidative status (TAS) were assayed in the uvular mucosa taken during palatoplasty or palatopharyngoplasty. The severity of oxidative stress was expressed as oxidative stress index (OSI). Oxidative/reductive imbalance was noted in the mucosa of the uvula of OSAS individuals, and TAS of the uvular mucosa negatively correlated with the severity of this syndrome. TOS and OSI in the mild, moderate, and severe OSAS were higher than in the non-OSAS group, whereas TAS of the uvular mucosa in the OSAS group was lower compared to the non-OSAS group. In conclusion, oxidative stress in the uvular mucosa is associated with the occurrence of OSAS.
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Affiliation(s)
- Ewa Olszewska
- Department of Otolaryngology, Medical University of Bialystok, 15-089 Bialystok, Poland
- Correspondence:
| | - Joanna Rogalska
- Department of Toxicology, Medical University of Bialystok, 15-089 Bialystok, Poland; (J.R.); (M.M.B.)
| | - Małgorzata M. Brzóska
- Department of Toxicology, Medical University of Bialystok, 15-089 Bialystok, Poland; (J.R.); (M.M.B.)
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Pang KP, Montevecchi F, Vicini C, Carrasco‐Llatas M, Baptista PM, Olszewska E, Braverman I, Kishore S, Chandra S, Yang HC, Chan YH, Pang SB, Pang KA, Pang EB, Rotenberg B. Does nasal surgery improve multilevel surgical outcome in obstructive sleep apnea: A multicenter study on 735 patients. Laryngoscope Investig Otolaryngol 2020; 5:1233-1239. [PMID: 33364416 PMCID: PMC7752065 DOI: 10.1002/lio2.452] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/20/2020] [Accepted: 08/24/2020] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Does nasal surgery affect multilevel surgical success outcome. METHODS Prospective eight country nonrandomized trial of 735 obstructive sleep apnea (OSA) patients, who had multilevel palate and/or tongue surgery, divided into two groups, with or without nose surgery. RESULTS There were 575 patients in nose group, 160 patients in no nose group. The mean age for nose group 44.6 ± 11.4, no nose group 44.2 ± 11.8. Mean preoperative BMI for nose group 27.5 ± 3.6, no nose group 27.5 ± 4.1, mean postoperative BMI nose group 26.3 ± 3.7, no nose group 27.1 ± 3.8 (P = .006). Mean preoperative AHI nose group 32.7 ± 19.4, no nose group 34.3 ± 25.0 (P = .377); and mean postoperative AHI nose group 13.5 ± 10.2, no nose group 17.1 ± 16.0 (P = .001). Mean preoperative ESS nose group was 11.3 ± 4.7, no nose group was 10.4 ± 5.4 (P = .051); and mean postoperative ESS nose group was 5.3 ± 3.2, no nose group was 6.7 ± 2.8 (P = .001). The nose group had higher percentage change (adjusted for age, gender, BMI) in AHI (33.7%, 95% CI 14% to 53.5%) compared to the no nose group (P = .001); the nose group also had more percentage change in ESS (37%, 95% CI 23.6% to 50.3%) compared to the no nose group (P < .001). Change in BMI did not affect AHI nor ESS change (Cohen effect 0.03 and 0.14, respectively). AHI change in both groups were also statistically significant in the mild OSA (P = .008) and the severe OSA (P = .01). Success rate of surgery for the nose group 68.2%, while the no nose group 55.0% (P = .002). CONCLUSION Combining nose surgery in multilevel surgery improves surgical success. LEVEL OF EVIDENCE IIC.
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Affiliation(s)
- Kenny P. Pang
- OtolaryngologyAsia Sleep Centre, ParagonSingaporeSingapore
| | | | | | | | | | - Ewa Olszewska
- Sleep Apnea Surgery Center, ENTMedical University of BialystokBiałystokPoland
| | - Itzhak Braverman
- Otolaryngology Head and Neck Surgery, Hillel Yaffe Medical CenterTechnion Faculty MedicineHaifaIsrael
| | | | | | - Hyung Chae Yang
- OtolaryngologyChonnam National University Medical SchoolGwangjuSouth Korea
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of MedicineNational University SingaporeSingaporeSingapore
| | - Scott B. Pang
- OtolaryngologyAsia Sleep Centre, ParagonSingaporeSingapore
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13
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Fiedorczuk P, Stróżyński A, Olszewska E. Is the Oxidative Stress in Obstructive Sleep Apnea Associated With Cardiovascular Complications?-Systematic Review. J Clin Med 2020; 9:jcm9113734. [PMID: 33233796 PMCID: PMC7699884 DOI: 10.3390/jcm9113734] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 12/18/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a prevalent, underdiagnosed disease and is considered an independent risk factor for cardiovascular disease. The exact mechanism of cardiovascular complications (CVC) development as a complication of OSA is not entirely understood. Oxidative stress is suspected to be the essential factor in initiating various comorbidities in OSA. Biomarkers of nonenzymatic lipid and protein peroxidation, DNA repair and antioxidant capabilities measured in serum, plasma and urine are frequently used to assess the presence of oxidative stress. We conducted a systematic review and quality assessment of available observational analytic studies to determine whether there is an association between oxidative stress and OSA in patients with prevalent CV disease compared to (a) patients with prevalent CV disease but no OSA, (b) patients with prevalent CV disease and less severe OSA and (c) patients with OSA and no overt CV disease. This systematic review demonstrated that, while oxidative stress is associated with OSA, there was no clear difference in the severity of oxidative stress between OSA patients with or without cardiovascular complications.
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Affiliation(s)
- Piotr Fiedorczuk
- Doctoral School of the Medical University of Bialystok, 15-328 Białystok, Poland;
| | | | - Ewa Olszewska
- Department of Otolaryngology Medical University of Bialystok, 15-328 Białystok, Poland
- Correspondence: ; Tel.: +48-(85)-831-8696
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14
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Pang KP, Baptista PM, Olszewska E, Braverman I, Carrasco-Llatas M, Kishore S, Chandra S, Yang HC, Chan YH, Pang KA, Pang EB, Rotenberg B. SLEEP-GOAL: A multicenter success criteria outcome study on 302 obstructive sleep apnoea (OSA) patients. Med J Malaysia 2020; 75:117-123. [PMID: 32281591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To demonstrate SLEEP-GOAL as a more holistic and comprehensive success criterion for Obstructive Sleep Apnoea (OSA) treatment. METHODS A prospective 7-country clinical trial of 302 OSA patients, who met the selection criteria, and underwent nose, palate and/or tongue surgery. Pre- and post-operative data were recorded and analysed based on both the Sher criteria (apnoea hypopnea index, AHI reduction 50% and <20) and the SLEEP-GOAL. RESULTS There were 229 males and 73 females, mean age of 42.4±17.3 years, mean BMI 27.9±4.2. The mean VAS score improved from 7.7±1.4 to 2.5±1.7 (p<0.05), mean Epworth score (ESS) improved from 12.2±4.6 to 4.9±2.8 (p<0.05), mean body mass index (BMI) decreased from 27.9±4.2 to 26.1±3.7 (p>0.05), gross weight decreased from 81.9±14.3kg to 76.6±13.3kg. The mean AHI decreased 33.4±18.9 to 14.6±11.0 (p<0.05), mean lowest oxygen saturation (LSAT) improved 79.4±9.2% to 86.9±5.9% (p<0.05), and mean duration of oxygen <90% decreased from 32.6±8.9 minutes to 7.3±2.1 minutes (p<0.05). The overall success rate (302 patients) based on the Sher criteria was 66.2%. Crosstabulation of respective major/minor criteria fulfilment, based on fulfilment of two major and two minor or better, the success rate (based on SLEEP-GOAL) was 69.8%. Based solely on the Sher criteria, 63 patients who had significant blood pressure reduction, 29 patients who had BMI reduction and 66 patients who had clinically significant decrease in duration of oxygen <90% would have been misclassified as "failures". CONCLUSION AHI as a single parameter is unreliable. Assessing true success outcomes of OSA treatment, requires comprehensive and holistic parameters, reflecting true end-organ injury/function; the SLEEP-GOAL meets these requirements.
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Affiliation(s)
- K P Pang
- Asia Sleep Centre, Department of Otolaryngology, Paragon, Singapore,.
| | - P M Baptista
- Clinica Universidad de Navarra, Department of Otolaryngology, Pamplona, Navarra, Spain
| | - E Olszewska
- Medical University of Bialystok, ENT Department, Poland
| | - I Braverman
- Hillel Yaffe Medical Center, Technion Faculty Medicine, Department of Otolaryngology Head and Neck Surgery, Haifa, Israel
| | | | - S Kishore
- Nova Specialty Hospital, Otolaryngology Department, Hyderabad, India
| | - S Chandra
- Belle Vue Clinic & Hospital, ENT Department, Kolkata, India
| | - H C Yang
- Chonnam National University Hospital, Otolaryngology Department, Korea
| | - Y H Chan
- National University Singapore, School of Medicine, Biostatistics Unit, Singapore
| | - K A Pang
- Asia Sleep Centre, Department of Otolaryngology, Paragon, Singapore
| | - E B Pang
- University of Glasgow, Medicine Faculty, Scotland
| | - B Rotenberg
- Western University, Otolaryngology Department, London, Ontario, Canada
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15
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Abstract
Introduction Sleep is a physiological state essential for proper functioning of the body. One of the reasons for sleep disorders is obstructive sleep apnea syndrome (OSAS). Aim: The aim of this research is histological evaluation of the mucous membrane of the soft palate in patients affected by various forms of OSAS. Material and method: The studied group consisted of patients with sleep-related breathing disorder in the form of primary snoring or OSAS. People with chronic tonsillitis, without a history of sleep-related breathing disorders, were included in the comparative group. Fragments of the mucous membrane of the uvula (study group) and the glossopalatine arch (comparative group) were taken for histological examination during surgery. Using histological, histochemical and immunohistochemical methods, we assessed the presence and severity of inflammation (CD3, CD20, CD68), the structure of nerve fibers (S-100) and the size of blood vessels (CD34) in the examined tissue. Results: Patients with OSAS developed a local inflammatory process in the oropharyngeal tissues (stronger expression of CD3, CD20, CD68 in people with OSAS). The exacerbation of the immunohistochemical reaction with CD3 correlated with the phase of OSAS. We found a higher degree of fibrosis and a higher expression of CD34 and S-100 receptors in subjects with OSAS compared to snoring patients and patients from the comparative group. Discussion: Due to chronic tissue vibration, snoring most likely leads to damage to the nerve fibers in the soft palate, which can intensify episodes of shallow breathing during sleep and increase the occurrences of apnea.
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Affiliation(s)
- Justyna Panek
- Klinika Otolaryngologii, Uniwersytet Medyczny w Białymstoku
| | - Joanna Reszeć
- Zakład Patomorfologii Lekarskiej, Uniwersytet Medyczny w Białymstoku
| | - Marek Rogowski
- Klinika Otolaryngologii, Uniwersytet Medyczny w Białymstoku
| | - Ewa Olszewska
- Klinika Otolaryngologii, Uniwersytet Medyczny w Białymstoku
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16
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Pang KP, Baptista PM, Olszewska E, Braverman I, Carrasco-Llatas M, Kishore S, Chandra S, Yang HC, Wang CMZ, Chan YH, Pang KA, Pang EB, Rotenberg B. Does drug-induced sleep endoscopy affect surgical outcome? A multicenter study of 326 obstructive sleep apnea patients. Laryngoscope 2019; 130:551-555. [PMID: 30993741 DOI: 10.1002/lary.27987] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/27/2019] [Accepted: 03/18/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVES/HYPOTHESIS Our objective was to determine whether drug-induced sleep apnea (DISE) affects the successfulness of the surgical outcome. STUDY DESIGN Prospective, seven-country, nonrandomized trial. METHODS There were 326 consecutive obstructive sleep apnea (OSA) patients who had nose, palate, and/or tongue surgery included in the study. DISE was performed in only one group. RESULTS There were 170 patients in the DISE group and 156 patients in no-DISE group. The mean preoperative body mass index (BMI) for the DISE group was 27.6 ± 4.6, whereas in the no-DISE group it was 28.1 ± 3.9 (P = .23). The mean preoperative systolic blood pressure (SBP) for the DISE group was 130.4 ± 16.7, whereas in the no-DISE group it was 142.9 ± 15.5 (P < .001). The mean preoperative diastolic blood pressure (DBP) for the DISE group was 81.4 ± 9.7, whereas in the no-DISE group it was 89.1 ± 9.7 (P < .001). The mean preoperative apnea-hypopnea index (AHI) for the DISE group was 32.6 ± 18.8, whereas in the no-DISE group it was 33.7 ± 19.6 (P = .61). The mean postoperative AHI for the DISE group was 15.9 ± 12.6, whereas in the no-DISE group it was 13.2 ± 8.8 (P = .023). The age-, gender-, BMI-adjusted percentage change in AHI for the DISE group was -48.4 ± 31.9, whereas in the no-DISE group it was -59.8 ± 18.6 (P < .001). The age-, gender-, and BMI-adjusted success rate for the DISE group was 66.5%, whereas in the no-DISE group it was 80.8% (P = .004). The age-, gender-, and BMI-adjusted change in SBP for the DISE group was -6.1 ± 8.6, whereas in the no-DISE group it was -13.3 ± 11.1 (P < .001). The age-, gender-, and BMI-adjusted change in DBP in the DISE group was -5.2 ± 12.1, whereas in the no-DISE group it was -12.4 ± 11.7 (P < .001). The mean age- and gender-adjusted change in BMI for the DISE group was -4.6 ± 12.9, whereas in the no-DISE group it was -6.3 ± 18.5 (P = .34). The Cohen effect of BMI on the overall AHI, lowest oxygen saturation, and blood pressure changes was 0.08. CONCLUSIONS DISE may not significantly affect surgical success in OSA. LEVEL OF EVIDENCE 2c Laryngoscope, 130:551-555, 2020.
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Affiliation(s)
- Kenny P Pang
- Otolaryngology Department, Asia Sleep Centre, Paragon, Singapore
| | - Peter M Baptista
- Otolaryngology Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Ewa Olszewska
- Ear, Nose, and Throat Department, Medical University of Bialystok, Bialystok, Poland
| | - Itzhak Braverman
- Department of Otolaryngology-Head and Neck Surgery, Hillel Yaffe Medical Center, Technion Faculty Medicine, Haifa, Israel
| | | | - Srivinas Kishore
- Otolaryngology Department, Nova Specialty Hospital, Hyderabad, India
| | - Sudipta Chandra
- Ear, Nose, and Throat Department, Belle Vue Clinic and Hospital, Kolkata, India
| | - Hyung Chae Yang
- Otolaryngology Department, Chonnam National University Hospital, Gwangju, South Korea
| | | | - Yiong Huak Chan
- Biostatistics Unit, School of Medicine, National University Singapore, Singapore
| | - Kathleen A Pang
- Otolaryngology Department, Asia Sleep Centre, Paragon, Singapore
| | - Edward B Pang
- Medicine Faculty, University of Glasgow, Glasgow, United Kingdom
| | - Brian Rotenberg
- Otolaryngology Department, Western University, London, Ontario, Canada
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Olszewska E, Woodson BT. Palatal anatomy for sleep apnea surgery. Laryngoscope Investig Otolaryngol 2019; 4:181-187. [PMID: 30828637 PMCID: PMC6383450 DOI: 10.1002/lio2.238] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/07/2018] [Accepted: 11/23/2018] [Indexed: 12/25/2022] Open
Abstract
The goal of this review is to advance the understanding of the muscular and soft tissue palatal anatomy as it relates to palatal surgery for sleep apnea and the phenotypic variations that generate the shape and collapsibility of the retropalatal airway. Anatomically, the soft palate has both a proximal and distal segments separated by the palatal genu. The proximal palatal segment has a variable angle from the hard palate (ie, alpha angle) determined by the position and length of the levator veli palatini muscle. The palatopharyngeus muscle (PP) is a major defining element of the palate and lateral pharyngeal wall and forms the medial wall of the lateral palatal space. It is composed of two divisions: the longitudinal palatopharyngeus fasciculi which acts to elevate the pharynx and depress the soft palate and the transverse palatopharyngeus fascicle (Passavant's ridge) which function is a nasopharyngeal sphincter. The lateral palatal space incorporates the supra-tonsilar fat, and is bounded by muscles that determine the structure of the palate and associated lateral pharyngeal walls. Understanding of palatal muscles and pharyngeal airway phenotypes provides insight into the steps and mechanisms of pharyngoplasty procedures. Level of Evidence N/A.
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Affiliation(s)
- Ewa Olszewska
- Sleep Apnea Surgery Centre Department of Otolaryngology, Medical University of Bialystok Bialystok Poland
| | - B Tucker Woodson
- Division of Sleep Medicine and Surgery Department of Otolaryngology Medical College Wisconsin Milwaukee Wisconsin U.S.A
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Abstract
Cholesteatoma is a serious otolaryngologic condition that to date remains an important problem and poses a challenge to otolaryngologists around the world. To improve the approach pertaining to the diagnosis and management of middle ear cholesteatoma, clear, clinically applicable, and useful definition and classification of cholesteatoma are required. This review aimed to evaluate the current and most accepted descriptions and opinions concerning cholesteatoma. A review of the literature concerning different definitions and classifications of cholesteatoma was used in the preparation of the Cholesteatoma Guidelines, a project implemented by the European Academy of Otology - Neuro-otology.
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Affiliation(s)
- Justyna Rutkowska
- Department of Otolaryngology, Medical University of Bialystok, Bialystok, Poland.
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19
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Abstract
This manuscript intends to review types, pathogenesis, associated risk factors, and potential methods of prevention and treatment of the retraction pockets in adults and children. The importance of retraction pockets (RP) lies in loss of original histological and anatomical structure which is associated with development of ossicular chain erosion, cho¬lesteatoma formation and potentially life threatening complications of cholesteatoma. The trans-mucosal exchange each gas in the middle ear (ME) is towards equalizing its partial pressures with the partial pressure in the environ¬ment. MEs that have abnormalities in the volume and ventilation pathways in the epitympanic may be more suscep¬tible to retraction pockets. Sustained pressure differences and/or inflammation leads to destruction of collagen fibers in the lamina propria. Inflammatory mediators and cytokines lead to release of collagenases result in viscoelastic properties of the lamina propria. The process of changes in the tympanic membrane structure may evolve to the cho¬lesteatoma formation. There are many different staging systems that clinicians prioritize in their decision making in the management of RP. The authors discuss the management possibilities in different clinical situations: RP without and with ongoing or intermittent evidence of Eustachian Tube Dysfunction (ETD), presence of adenoid hypertrophy or re-growth of adenoids, presence or absence of effusion, invisible depth of RP without effusion. invisible depth of RP with effusion, ongoing RP after VT insertion, and finally suspicion of cholesteatoma in a deep RP with ME effusion. A decision algorithm regarding the management of TM retraction and retraction pockets is provided.
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Affiliation(s)
- Alper Cuneyt
- Pediatric Otolaryngology Fellowship Program Children’s Hospital of Pittsburgh of UPMC University of Pittsburgh School of Medicine Pittsburgh, PA, U.S.A
| | - Ewa Olszewska
- Klinika Otolaryngologii AM w Białymstoku Kierownik Kliniki: prof. dr hab. med. M. Rogowski
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Yung M, Tono T, Olszewska E, Yamamoto Y, Sudhoff H, Sakagami M, Mulder J, Kojima H, İncesulu A, Trabalzini F, Özgirgin N. EAONO/JOS Joint Consensus Statements on the Definitions, Classification and Staging of Middle Ear Cholesteatoma. J Int Adv Otol 2017; 13:1-8. [PMID: 28059056 DOI: 10.5152/iao.2017.3363] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The European Academy of Otology and Neurotology (EAONO) has previously published a consensus document on the definitions and classification of cholesteatoma. It was based on the Delphi consensus methodology involving the broad EAONO membership. At the same time, the Japanese Otological Society (JOS) had been working independently on the "Classification and Staging of Cholesteatoma." EAONO and JOS then decided to collaborate and produce a joint consensus document. The EAONO/JOS joint consensus on "Definitions, Classification and Staging of Middle Ear Cholesteatoma" was formally presented at the 10th International Conference on Cholesteatoma and Ear Surgery in Edinburgh, June 5-8, 2016. The international otology community who attended the consensus session was given the chance to debate and give their support or disapproval. The statements on the "Definitions of Cholesteatoma" received 89% approval. The "Classification of Cholesteatoma" received almost universal approval (98%). The "EAONO/JOS Staging System on Middle Ear Cholesteatoma" had a majority of approval (75%). Some international otologists wanted to see more prognostic factors being incorporated in the staging system. In response to this, the EAONO/JOS steering group plans to set up an "International Otology Outcome Working Group" to work on a minimum common otology data set that the international otology community can use to evaluate their surgical outcome. This will generate a large database and help identify relevant prognostic factors that can be incorporated into the staging system in future revisions.
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Affiliation(s)
- Matthew Yung
- The Ipswich Hospital NHS Trust, Heath Road, Suffolk, United Kingdom IP4 5PD.
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21
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Abstract
Chronic ear disease with cholesteatoma is characterized by an intrusion of keratinizing stratified squamous epithelium into the middle ear manifesting bone resorption at the interface of the perimatrix. The aim of our study was to investigate the markers of a catabolic process associated with several chronic inflammatory states. We assessed the level of catabolism of glycoconjugates in assays of cholesteatoma extracts, quantifying two lysosomal exoglycosidases: alpha-mannosidase (alpha-MAN) and beta-galactosidase (beta-GAL). Cholesteatomas (n = 15) and normal adult postauricular skin served as controls (n = 15) were collected from the patients during surgery owing to chronic otitis media. To assess exoglycosidase activity, release of p-nitrophenol from p-nitrophenol derivatives of alpha-mannose and beta-galactose was used. In 13 of 15 specimens, we observed significantly higher activity of investigated enzymes in cholesteatoma tissue compared with control tissue (postauricular skin). The mean activity of alpha-MAN from the cholesteatoma cells was 1.76 +/- 1.10 nkat/g wet tissue and 0.61 +/- 0.21 nkat/g wet tissue in the control probes. The mean activity of beta-GAL from the cholesteatoma cells was 1.77 +/- 1.07 nkat/g wet tissue and 0.87 +/- 0.20 nkat/g wet tissue in the control probes. Catabolic reactions involving glycoproteins, glycolipids, and proteoglycans may play a role in cholesteatoma-related bone resorption. The present data indicating that the lysosomal exoglycosidases alpha-MAN and beta-GAL are significantly and consistently elevated suggest the need to further correlations assessment between levels of alpha-MAN and beta-GAL and cholesteatoma behavior. Further research should also evaluate the relative importance of these particular exoglycosidases in manifesting bone resorption in considering the spectrum of identified inflammatory mediators.
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Affiliation(s)
- Ewa Olszewska
- Department od Otolaryngology, Medical University of Bialystok, Bialystok, Poland.
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Olszewska E, Matulka M, Mroczko B, Pryczynicz A, Kemona A, Szmitkowski M, Mierzwinski J, Pietrewicz T. Diagnostic value of matrix metalloproteinase 9 and tissue inhibitor of matrix metalloproteinases 1 in cholesteatoma. Histol Histopathol 2015; 31:307-15. [PMID: 26490574 DOI: 10.14670/hh-11-677] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Matrix metalloproteinase 9 (MMP-9), able to degrade type IV collagen, plays a key role in inflammatory cell migration as well as in the destructive behaviour of cholesteatoma. The aim of our study was to compare the expression of MMP-9 and TIMP-1 in cholesteatoma tissue and in the concentrations in serum and plasma concentrations. MATERIAL AND METHODS Twenty five adult patients suffering from cholesteatoma (a study group) were included in the study. A comparison group consisted of 25 adult patients admitted to hospital due to nasal septum deviation. MM-9 and TIMP-1 serum and plasma concentrations as well as proteins' expressions in cholesteatoma tissues (study group) and normal retroauricular skin specimens (control group) were evaluated. MMP-9 and TIMP-1 concentrations were measured using enzyme-linked immunosorbent assay (ELISA). Cholesteatoma tissues and normal retroauricular skin specimens were evaluated immunohistochemically. RESULTS In the study and a comparison groups, MMP-9 and TIMP-1 concentrations were similar with no significant difference within the groups. In cholesteatoma tissues, the expression of the investigated enzyme and its inhibitor was higher than in normal skin specimens, limited mostly to cholesteatoma perimatrix. CONCLUSION Cholesteatoma may be limited to the middle ear or parts of the temporal bones. Our findings suggest better clinical usefulness of MMP-9 and TIMP-1 expression in cholesteatoma tissues than either serum or plasma levels of these proteins. It might suggest that the higher the expression of MMP-9 the stronger the inflammation -accompanied cholesteatoma.
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Affiliation(s)
- Ewa Olszewska
- Department of Otolaryngology, Medical University of Bialystok, Poland.
| | - Marlena Matulka
- Department of Otolaryngology, Medical University of Bialystok, Poland
| | - Barbara Mroczko
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, Poland
| | - Anna Pryczynicz
- Department of General Pathomorphology, Medical University of Bialystok, Poland
| | - Andrzej Kemona
- Department of General Pathomorphology, Medical University of Bialystok, Poland
| | - Maciej Szmitkowski
- Department of Biochemical Diagnostics, Medical University of Bialystok, Poland
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Abstract
Development of a consensus on the definitions and classification of cholesteatoma is essential for scientific community to exchange information on clinical studies and compare their outcomes. The aim of the study is to reach a consensus among members of the European Academy of Otology and Neurotology (EAONO) regarding the definitions and classification related to cholesteatoma. A set of statements was developed by the authors utilizing the literature on the definition and classification of cholesteatoma. A questionnaire was sent to the members of the EAONO, inviting them to state if they are in agreement with each of the statements and if not, then to provide comments or suggestions for revision. Responses were evaluated and modified using online questionnaire and survey software based on the Delphi technique, a cyclical process of gathering information, summarizing, and re-submitting the revised statements to the same target population until a consensus is reached. Target agreement among the responders was set at a minimum of 80%, and the cycle of revision and re-submission of the statements were repeated until a consensus was reached on a majority of the statements. A steering group has been established to evaluate the results of the survey and worked via the process of cognitive debriefing. Out of 364 EAONO members, 123 responded to the first consensus cycle, 77 to the second cycle, and 53 to the third cycle. After three cycles, all statements concerning cholesteatoma definitions reached the target of 80% consensus. However, a consensus on the classification of cholesteatoma could not be achieved. The steering group excluded four statements of cholesteatoma definition and established a consensus on cholesteatoma classification. A consensus on cholesteatoma definitions was reached among the members of the EAONO. The final revision on consensus statements for cholesteatoma definition and classification has been made via the process of cognitive debriefing of the steering group.
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Affiliation(s)
- Ewa Olszewska
- Department of Otolaryngology, Medical University of Bialystok, Bialystok, Poland.
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Olszewski S, Olszewska E, Popko J, Poskrobko E, Sierakowski S, Zwierz K. Fibroblast-Like Synovial Cells in Rheumatoid Arthritis--the Impact of Infliximab on Hexosaminidase Activity. ADV CLIN EXP MED 2015; 24:807-13. [PMID: 26768631 DOI: 10.17219/acem/27302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The effect of multiple infusions of infliximab (INF), a chimeric anti-tumor necrosis factor alpha antibody, on the concentration of hexosaminidase (HEX) activity in a synovial cell culture derived from human synovial inflamed fluid obtained from patients suffering from rheumatoid arthritis (RA) has been evaluated. OBJECTIVES The aim of this study was to prove INF efficacy in RA. MATERIAL AND METHODS Inflamed synovial fluid was taken from RA patients (a study group) and patients who had undergone knee trauma within 7 days (a control group). The following solutions of infliximab were used: 40, 60 and 140 µg/mL. Determination of the concentration of HEX activity in cell cultures was performed after 24, 48, 72 and 96 h of infliximab administration. To identify synoviocytes in cell culture immunohistochemical staining with vimentin and pancytokeratin was performed. RESULTS A predominance of fibroblast-like synovial cells has been observed in the study group. In the control group the concentration of HEX activity without adding infliximab to the cell culture was 283.00 nkat/mL. After 96 h of incubation with infliximab, the concentrations of HEX activity in cultured synoviocytes according to infliximab doses of 40, 60 and 140 µg/mL were respectively: 280.00, 271.50 and 293.50 nkat/mL. In the study group, the concentration of HEX activity without adding infliximab to the cell culture was 542.27 nkat/mL. The final concentrations of HEX activity of cultured fibroblast-like synovial cells measured after 96 h of incubation with infliximab were: 471.72, 498.27 and 556.72 nkat/mL, according to infliximab doses of 40, 60 and 140 µg/mL. In all groups (besides the infliximab concentration of 140 µg/mL after 96 h of incubation), the level of concentration of HEX activity was significantly higher in the study group compared to the control group, irrespective of infliximab concentration and time of infliximab incubation. CONCLUSIONS Infliximab changes the concentration of HEX activity depending on the drug dose and time of administration.
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Affiliation(s)
| | - Ewa Olszewska
- Department of Otolaryngology, Medical University of Bialystok, Poland
| | - Janusz Popko
- Department of Pediatric Orthopedics, Medical University of Bialystok, Poland
| | | | - Stanisław Sierakowski
- Department of Rheumatology and Internal Diseases, Medical University of Bialystok, Poland
| | - Krzysztof Zwierz
- Medical College of the Universal Education Society, Łomża, Poland
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Erchak N, Olszewska E, Kalvinsh I, Liepinsh E, Belyakov S, Sobolev A, Arsenyan P. Synthesis of Pentacoordinated Si-(Morpholiniomethyl)Silanates*. Chem Heterocycl Compd (N Y) 2014. [DOI: 10.1007/s10593-014-1617-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lends A, Olszewska E, Belyakov S, Erchak N, Liepinsh E. NMR and Quantum-Chemical Studies of Electrostatically Stabilized 1-(N,N-Substituted-aminiomethyl)spirobi[3-oxo(2,5-dioxa-1-silacyclopentan)]ates (ES-Silanates). Heteroatom Chem 2014. [DOI: 10.1002/hc.21203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Alons Lends
- Latvian Institute of Organic Synthesis; Aizkraukles 21 LV 1006 Riga Latvia
| | - Ewa Olszewska
- Department of Organic and Applied Chemistry; Institute of Chemistry; Siedlce University; 08-110 Siedlce Poland
| | - Sergey Belyakov
- Latvian Institute of Organic Synthesis; Aizkraukles 21 LV 1006 Riga Latvia
| | - Nikolai Erchak
- Department of Organic and Applied Chemistry; Institute of Chemistry; Siedlce University; 08-110 Siedlce Poland
| | - Edvards Liepinsh
- Latvian Institute of Organic Synthesis; Aizkraukles 21 LV 1006 Riga Latvia
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Sieśkiewicz A, Reszeć J, Piszczatowski B, Olszewska E, Klimiuk PA, Chyczewski L, Rogowski M. Intraoperative bleeding during endoscopic sinus surgery and microvascular density of the nasal mucosa. Adv Med Sci 2014; 59:132-5. [PMID: 24797989 DOI: 10.1016/j.advms.2013.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 10/24/2013] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the correlation between quality of the surgical field, intraoperative bleeding during endoscopic sinus surgery (ESS) and the density of microvasculature of the nasal mucosa. MATERIAL/METHODS Nasal mucosa of 30 patients, operated for chronic rhinosinusitis, was biopsied to assess expression of CD34 antigen on vascular endothelium. Quality of surgical field was evaluated with Fromm-Boezaart scale at mean arterial pressure (MAP) of 70-80 mmHg. If at this MAP surgical field quality was not satisfactory further reduction of hemodynamic parameters was performed until 'bloodless surgical field' (grade 2 or lower) was achieved. The rate of intraoperative bleeding was calculated from the ratio of total blood loss and the operative time. The extent of the disease was assessed according to computed tomography findings using Lund-Mackay staging system. RESULTS Significant positive correlation (Spearman correlation test; p<0.05) was found between CD34 antigen expression and quality of surgical field at MAP between 70 and 80 mmHg as well as the rate of intraoperative bleeding. More intense reduction of MAP was necessary to achieve 'bloodless surgical field' in patients with high CD34 expression than in those with moderate and low expression. Lund-Mackay score correlated with quality of surgical field but not with the rate of intraoperative bleeding. CONCLUSION During ESS, it is microvascular density of the nasal mucosa rather than the extent of the disease that contributes to the intensity of intraoperative bleeding, although both factors negatively influence the quality of surgical field.
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Affiliation(s)
- Andrzej Sieśkiewicz
- Department of Otolaryngology, Medical University of Bialystok, Bialystok, Poland.
| | - Joanna Reszeć
- Department of Pathomorphology, Medical University of Bialystok, Bialystok, Poland
| | | | - Ewa Olszewska
- Department of Otolaryngology, Medical University of Bialystok, Bialystok, Poland
| | | | - Lech Chyczewski
- Department of Pathomorphology, Medical University of Bialystok, Bialystok, Poland
| | - Marek Rogowski
- Department of Otolaryngology, Medical University of Bialystok, Bialystok, Poland
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Sieśkiewicz A, Piszczatowski B, Olszewska E, Lukasiewicz A, Tarasow E, Rogowski M. Minimally invasive transnasal medial maxillectomy for treatment of maxillary sinus and orbital pathologies. Acta Otolaryngol 2014; 134:290-5. [PMID: 24328734 DOI: 10.3109/00016489.2013.857786] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Minimally invasive transnasal medial maxillectomy with preservation of the nasolacrimal duct may provide an alternative method for surgical treatment of selected maxillary sinus and inferior orbit pathology if more extensive endonasal or external approach procedures are to be avoided. OBJECTIVES To present a modification of the transnasal endoscopic approach to the maxillary sinus leading through its medial wall, anteriorly to the nasolacrimal duct that considerably improves access to the antero-inferior part of the maxillary sinus and entire orbital floor. To discuss indications for the procedure along with surgical outcome after at least 12 months of follow-up. METHODS A total of 22 selected patients with extensive/refractory inflammatory maxillary sinus disease that could not be cleared completely through middle meatal antrostomy or pathologies of the inferior orbit that required uncompromised access to the orbital floor were operated with this method. The effectiveness of the treatment was evaluated through clinical symptomatology and endoscopic examination to confirm eradication of the disease. RESULTS The presented method allowed for good overall symptom control and eradication of disease confirmed endoscopically in about 90% of cases with an inflammatory type of disease. The visualized reach within the maxillary sinus with commercially available endoscopic instruments was conspicuously improved as compared with middle meatal antrostomy.
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Affiliation(s)
- Andrzej Sieśkiewicz
- Department of Otolaryngology Head and Neck Surgery, Medical University of Bialystok , Bialystok , Poland
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Chojnowska S, Minarowska A, Waszkiewicz N, Kępka A, Zalewska-Szajda B, Gościk E, Kowal K, Olszewska E, Konarzewska-Duchnowska E, Minarowski Ł, Zwierz K, Ładny JR, Szajda SD. The activity of N-acetyl-β-d-hexosaminidase A and B and β-glucuronidase in nasal polyps and hypertrophic nasal concha. Otolaryngol Pol 2013; 68:20-4. [PMID: 24484945 DOI: 10.1016/j.otpol.2013.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 06/01/2013] [Accepted: 06/17/2013] [Indexed: 11/30/2022]
Abstract
UNLABELLED Nasal polyps and hypertrophic lower nasal conchae are common disorders of nasal cavity. The majority of etiopathogenetic theories indicate inflammatory background of polyps and hypertrophic concha. N-acetyl-β-D-hexosaminidase and β-glucuronidase are lysosomal exoglycosidases revealing accelerated activity in inflammatory processes. AIM The aim of the study was to evaluate the catabolism of glycoconjugates in nasal polyps and hypertrophic nasal concha basing on the activity of N-acetyl-β-D-hexosaminidase (HEX) and β-glucuronidase (GLU). MATERIAL AND METHODS Material consisted of nasal polyps taken from 40 patients during polypectomy in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and hypertrophic lower nasal conchae taken from 20 patients during mucotomy. The activity of HEX, HEX A, HEX B and GLU in supernatant of homogenates of nasal polyps and hypertrophic lower nasal concha tissues has been estimated using colorimetric method. RESULTS Statistically significant decrease has been observed in concentration of the activity (per 1mg of tissue) of HEX (p<0.05), HEX B (p<0.001) and specific activity (per 1mg of protein) of HEX B (p<0.001) in nasal polyps tissue in comparison to hypertrophic lower nasal conchae tissue. CONCLUSIONS Decrease in the activity and specific activity concentration of the majority of examined lysosomal exoglycosidases (increasing in inflammations) in comparison to hypertrophic lower nasal conchae suggests electrolytes disorders and questions the inflammatory background of nasal polyps.
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Affiliation(s)
- Sylwia Chojnowska
- Medical Institute, College of Computer Science and Business Administration, Łomża, Poland.
| | - Alina Minarowska
- Department of Surgical Nursing, Medical University of Bialystok, Poland
| | | | - Alina Kępka
- Department of Biochemistry, Radioimmunology and Experimental Medicine, The Children's Memorial Health Institute, Warsaw, Poland
| | | | - Elżbieta Gościk
- Department of Paediatric Radiology, Medical University of Białystok, Poland
| | - Krzysztof Kowal
- Department of Allergology and Internal Medicine, Medical University of Białystok, Poland
| | - Ewa Olszewska
- Department of Otolaryngology, Medical University of Białystok, Poland
| | | | - Łukasz Minarowski
- Department of Lung Diseases and Tuberculosis, Medical University of Bialystok, Poland
| | - Krzysztof Zwierz
- Medical College of the Universal Education Society, Łomża, Poland
| | - Jerzy Robert Ładny
- Department of Emergency Medicine and Disasters, Medical University of Białystok, Poland
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Olszewska E, Jakimowicz-Rudy J, Rogowski M. Catabolism of Mannosidase and Fucosidase in Cholesteatoma. Otolaryngol Head Neck Surg 2012. [DOI: 10.1177/0194599812451426a238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To determine the level of glycoconjugates catabolism by marking α-mannosidase (MAN) and α-fucosidase (FUC) activity in cholesteatoma and serum. Method: Middle ear cholesteatomas (Chol), normal skin specimens (C) and serum of cholesteatoma patients and serum from healthy volunteers were included in the study. The concentration of lysosomal exoglycosidases activity was assessed on the basis of p-nitrophenol release from the derivatives of the substrate (MAN from mannose and FUC from fucose). Results: Mean concentration of MAN activity in Chol was 8.31112 pKat/mL in comparison with C (2.621048 pKat/mL). Pearson correlation (MAN activity) was r = 0.26321. Mean activity concentration of FUC in Chol was 10.03288 pKat/mL in comparison with C: 2.723152 pKat/mL. The average concentration of MAN activity in serum from cholesteatoma patients was 3.05712 pKat/mL, compared to the concentration of MAN activity in the control serum 2.73244 pKat/mL. The average concentration of FUC activity in serum of cholesteatoma patients was 5.40336 pKat/mL and significantly higher in comparison with the FUC activity concentrations in C 3.51976 pKat/mL. Conclusion: There is an increase of glycocojugates catabolism due to the significantly higher concentration of MAN and FUC activity in cholesteatoma. The increased concentration of MAN and FUC activity in serum of cholesteatoma patients might suggest the role of those enzymes in the pathogenesis of chronic otitis media with cholesteatoma.
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Abstract
HIV (human immunodeficiency virus) infection may produce no clinical symptoms for 10 years on average. However, after many years of infection most people develop symptoms that indicate progression of the disease. There are no regular characteristic symptoms or early stage, and no logical sequence of AIDS indicator disorders has been observed. People who are not aware of the infection are referred to physicians of various specializations, including otolaryngologists. It is on their knowledge about HIV infections, among other factors, that early diagnosis of the disease depends. Appropriate and quick introduction of anti-retroviral drugs may let a person with HIV live decades longer.
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Affiliation(s)
- Ireneusz Rzewnicki
- Department of Otolaryngology, Medical University of Bialystok, Bialystok, Poland.
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Abstract
BACKGROUND The diagnostic process and the surgical procedures in patients with snoring and obstructive sleep apnea syndrome (OSAS) are crucial. The aim of this study was to assess the efficacy of surgical treatment in snoring and OSAS patients. MATERIAL/METHODS A precise laryngological examination and screening polysomnography (Poly-Mesam) were performed in all patients with mild, moderate and severe OSAS before and 6 months after surgery. The patients completed questionnaires concerning their complaints. We included patients qualified to septoplasty, laser-assisted uvulopalatoplasty (LAUP), uvulopalatopharyngoplasty (UPPP) and radiofrequency-induced thermotherapy of the tongue base (RITT). Outcome evaluation of surgery was performed on the basis of data received from follow-up laryngological examinations, selected parameters obtained from the Poly-Mesam test and follow-up questionnaires. RESULTS In most cases we observed improvement, defined as decreasing some sleep parameters, such as a respiratory disturbance index (RDI), by more than 50%, decreasing the loudness of snoring, decreasing the number of hypopneas, and obtaining better blood saturation values. After UPPP we noticed changes in retropalatal space, soft palate dimensions and uvula-posterior pharyngeal wall distance. In the postoperative period we did not observe severe complications. In some cases we found short-lived palatal deficiency after UPPP. Patients after RITT experienced discomfort and throat pain lasting from 2 to 4 days. In 2 patients we observed swelling of the tongue base, which decreased after few days. CONCLUSIONS Surgery in OSAS contributes to normalization of some sleep parameters. The majority of patients experienced improvement after surgery.
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Affiliation(s)
- Ewa Olszewska
- Department of Otolaryngology, Medical University of Bialystok, Bialystok, Poland.
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Sieskiewicz A, Lyson T, Olszewska E, Chlabicz M, Buonamassa S, Rogowski M. Isolated sphenoid sinus pathologies--the problem of delayed diagnosis. Med Sci Monit 2011; 17:CR180-CR184. [PMID: 21358607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Isolated sphenoid sinus pathologies are relatively rare. In the majority of cases, symptoms do not arise in the early stages of the disease or are non-specific, therefore making diagnosis difficult. The aim of this study was to investigate the diagnostic process and the reasons for development of complications in patients with isolated sphenoid sinus pathology. MATERIAL/METHODS The clinical data and observation charts of 32 patients were investigated to determine how long the main symptoms of sphenoid pathology had been present before the patients were referred for medical treatment, and the time that elapsed from the first ambulatory medical assessment to the initial diagnosis. RESULTS Complaints and symptoms of sphenoid sinus pathology had been present for 10.2 months before the diagnosis was established. Although the duration of complaints in "ORL" (diagnosed by otorhinolaryngologist) and "non-ORL" (diagnosed by other specialists) group of patients was similar (10.8 and 9.5 months on average, respectively), unexpectedly, in the "non-ORL" group of patients, the time necessary for making the initial diagnosis was actually shorter than in the "ORL" group (1.8 vs 4.1 months). At the time of hospital admission, endoscopic examination revealed no abnormalities in 31.2% of patients. In 28.1% of patients the pathological process in the sphenoid sinus was diagnosed only after the onset of complications. CONCLUSIONS The occult character of the disease and the lack of severe and specific symptoms, rather than the delay in getting extensive diagnostic tests, are responsible for the delayed diagnosis and treatment.
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Affiliation(s)
- Andrzej Sieskiewicz
- Department of Otolaryngology Head and Neck Surgery, Medical University of Bialystok, Bialystok, Poland.
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Chlabicz M, Sieśkiewicz A, Rózańska-Kudelska M, Olszewska E, Roszkowska-Jakimiec W, Rogowski M. [Cathepsin D activity in chronic rhinosinusitis with nasal polyps]. Otolaryngol Pol 2011; 64:299-301. [PMID: 21166140 DOI: 10.1016/s0030-6657(10)70610-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED Nasal polyposis affects about 1 to 4% of the population. Polyps develop in oedematous and inflammated mucous membrane. In spite of the intensive research the pathomechanism of their development is not fully understood. The majority of the theories concerning the development of nasal polyps emphasize the role of the inflammatory process causing the rupture of the epithelium and the basal membrane. Cathepsin D is one of important mediators of inflammatory processes, that may be involved in the pathogenesis of nasal polyposis. THE AIM OF THE STUDY was to establish the role of the cathepsin D in the pathogenesis of nasal polyps. MATHERIAL AND METHOD: Tissues were taken from 39 patients treated with endoscopic sinus surgery due to chronic rhinosinusitis with polyps. The activity of the cathepsin D was assesed with spectrofotometric method using the specific inhibitor (pepstatin) in tissue of nasal polyps, in oedematous and the inflammated mucous membrane of the nasal conchae and the samples of mucous membrane taken from the nasal septum. RESULTS Statistically significant difference in cathepsin D activity between polypoid tissue, inflammated mucosa and the mucous membrane of the nasal septum was detected (t-student test, p < 0.05). No difference in the activity of this enzyme was observed between the polypoid tissue and the inflammated mucosa. CONCLUSION Increased activity of the cathepsin D in nasal polyps and inflammatory changed mucosa confirm the important role of the cathepsin D in inflammatory processes leading to damage and subsequent remodeling of mucous membrane. We believe that further research on the activity of other proteolytic enzymes is necessary to demonstrate the differences between the inflammable changed mucous membrane and nasal polyps.
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Abstract
Background Isolated sphenoid sinus pathologies are relatively rare. In the majority of cases, symptoms do not arise in the early stages of the disease or are non-specific, therefore making diagnosis difficult. The aim of this study was to investigate the diagnostic process and the reasons for development of complications in patients with isolated sphenoid sinus pathology. Material/Methods The clinical data and observation charts of 32 patients were investigated to determine how long the main symptoms of sphenoid pathology had been present before the patients were referred for medical treatment, and the time that elapsed from the first ambulatory medical assessment to the initial diagnosis. Results Complaints and symptoms of sphenoid sinus pathology had been present for 10.2 months before the diagnosis was established. Although the duration of complaints in “ORL” (diagnosed by otorhinolaryngologist) and “non-ORL” (diagnosed by other specialists) group of patients was similar (10.8 and 9.5 months on average, respectively), unexpectedly, in the “non-ORL” group of patients, the time necessary for making the initial diagnosis was actually shorter than in the “ORL” group (1.8 vs 4.1 months). At the time of hospital admission, endoscopic examination revealed no abnormalities in 31.2% of patients. In 28.1% of patients the pathological process in the sphenoid sinus was diagnosed only after the onset of complications. Conclusions The occult character of the disease and the lack of severe and specific symptoms, rather than the delay in getting extensive diagnostic tests, are responsible for the delayed diagnosis and treatment.
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Affiliation(s)
- Andrzej Sieskiewicz
- Department of Otolaryngology Head and Neck Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Tomasz Lyson
- Department of Neurosurgery, Medical University of Bialystok, Bialystok, Poland
| | - Ewa Olszewska
- Department of Otolaryngology Head and Neck Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Magdalena Chlabicz
- Department of Otolaryngology Head and Neck Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Simona Buonamassa
- Department of Neurosurgery, Queen’s Hospital NHS Trust Romford, Essex, U.K
| | - Marek Rogowski
- Department of Neurosurgery, Medical University of Bialystok, Bialystok, Poland
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Chilimoniuk M, Olszewska E, Maksimowicz T. [Taxan induction chemotherapy and concomitant chemoradiotherapy with cisplatin in patients with locally advanced head and neck cancer--early results]. Pol Merkur Lekarski 2010; 29:357-360. [PMID: 21298984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
UNLABELLED The growing number of patients with head and neck cancer is a reason to search for new effective treatment strategies. Results of treatment for locally advanced squamous cell head and neck cancer with surgery and/or radiotherapy are still unsatisfactory. During last decade concomitant chemoradiotherapy became a new standard in this group of patients. The treatment method is charged of high toxicity and real therapeutic advantages are obtained by limited number of patients. Intensive clinical investigations on novel therapeutic strategies are in progress. One of them is the combination of induction chemotherapy with taxan (TPF) and concomitant chemoradiotherapy join with cisplatin. The aim of the study was to estimate the treatment tolerance and early term results with combination of induction chemotherapy with TPF and concomitant chemoradiotherapy join with cisplatin in patients with locally advanced, squamous cell carcinoma of head and neck. MATERIAL AND METHODS Patients with locally advanced oropharyngeal and larynx cancer treated in the Institute of Oncology in Bialystok at the Department of Radiotherapy II from latter half of 2009 year were included in the study. The treatment protocol consisted of 3 courses of induction chemotherapy TPF (Taxotere 75 mg/m2, DDP 100 mg/m2, 5-Fluorouracyl 1000 mg/m2 every 3 weeks) and conventionally fractionated radiotherapy (Df=2 Gy, 5 x weekly) to total dose of 66-72 Gy and for neck cervical lymph nodes up to 60-66 Gy with concomitant of cisplatin 100 mg/m2 every 3 weeks. Early reactions were estimated according to EORTC/RTOG scales, and chemotherapy tolerance was evaluated according to the CTC scale. Twelve patients with homogenous criteria were included in the study. RESULTS The treatment tolerance was acceptable. However several adverse reactions were present. The main adverse effect was the extensive mucosal reaction. Neutropenia and anemia were also observed in most of the patients. Some patients complained of diarrhea, vomiting and nausea in mild or moderate intensity which were persisted temporarily. CONCLUSIONS Induction chemotherapy TPF and concomitant radiochemotherapy with cisplatin in patients with locally advanced head and neck cancer in III-IV clinical stages came out as the treatment of high efficacy.
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Piszczatowski B, Sieśkiewicz A, Rutkowska J, Rogowski M, Rózańska-Kudelska M, Olszewska E. [The influence of endoscopic treatment of isolated, small inflammatory lesions of sphenoid sinus on headache sensation]. Otolaryngol Pol 2010; 64:165-70. [PMID: 20731207 DOI: 10.1016/s0030-6657(10)70054-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED One of the most frequent complaint in patients with isolated sphenoiditis is headache. In large proportion of these patients no pathologic findings are revealed in sphenoethmoidal recess endoscopicaly thus discrimination between sinus originated and primary headache in such cases may be especially difficult. THE AIM OF THIS STUDY Was the assessment of the influence of endoscopic treatment of isolated, small inflammatory sphenoid sinus lesions on headache sensation. MATERIAL AND METHOD 13 patients suffering from headache, with CT-diagnosed isolated, small inflammatory lesions of sphenoid sinus such as mucosal thickening, polypoid tissue and cysts were treated endoscopicaly. Headache was assessed on the basis of five-grade scale before surgery, 1 month after surgery and after the observation period that varied between 5 to 40 months. RESULTS In the first postoperative month the improvement in their headache was declared by 84.6% of patients, but after longer observation the success rate lowered to 61.5%. The improvement was observed both in patient whose the only complaint was headache and in patients with negative endoscopic findings. CONCLUSIONS Small isolated sphenoid sinus lesions constitute a group of specific pathologies of paranasal sinuses, which is still difficult to diagnose despite of technological advancement. The treatment of these lesions remains controversial. Decision as to operative treatment should be taken cautiously since headache in great proportion of these patient is not sinus originated. Further multicenter studies on the basis of larger group of patients are necessary to delineate the indications for surgical intervention in patients with small isolated inflammatory sphenoid sinus lesions.
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Erchak NP, Olszewska E, Lukevics* E. Methanolysis of 2-furylsilane. Chem Heterocycl Compd (N Y) 2010. [DOI: 10.1007/s10593-010-0555-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Olszewski S, Rutkowska J, Popko J, Dabrowska K, Bielawski T, Olszewska E. [The pirymethamine influence on hexosoaminidase gene expression in synovial cell culture--preliminary report]. Pol Merkur Lekarski 2010; 28:112-116. [PMID: 20369738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
UNLABELLED Inflammation process is leading to increasing of synovial fluid and value of its pressure. Moreover, the impairment of vascular flow within synovial membrane and increased permeability of blood vessels were described. The activity of lysosomal enzymes, such as N-acetyl-beta-glucosaminidase (HEX), was increased in patients with rheumatoid arthritis in comparison to health synovial fluid. It is supposed, that HEX takes part in joint destruction. The using of HEX inhibitors in synovial cell culture and evaluation of HEX mRNA expression before and after the adding of inhibitor may contribute in showing the new ways of understanding pathogenetic pathways of motion organ disorders. THE AIM of the study was to evaluate the expression of HEXA and HEXB genes in the synovial cell culture derived from human synovial inflammatory fluid obtained from patients suffered from rheumatoid arthritis. MATERIAL AND METHODS The inflamed synovial fluid was taken from patients suffered from rheumatoid arthritis. The following solutions of potential inhibitor--pyrimethamine were used: 20 microg/ml, 10 microg/ml, 3 microg/ml and 1.5 microg/ml. Two separate control groups were established: control group 1 where only 0.6% of ethanol was added to the synovial cell culture; control group 2 where only 0.5% DMSO was added to the synovial cell culture. The relative quantitative real-time reverse transcriptase polymerase chain reaction (RT-PCR) was carried out. RESULTS. The difference in HEXA and HEXB expression was observed in synoviocytes obtained in synovial cell culture. Five time higher relative HEXA expression was determined after applying 3 microg/ml of pirymethamine compared with the control 1. The highest concentration of pirymethamine (10 and 20 microg/ml) caused the least elevation of HEXA expression. The slight decreased of HEXB expression was observed under the concentration of pirymethamine: 1.3 and 3 microg/ml. CONCLUSIONS. Pyrimethamine contributes to regulating the HEX gene expression from synovial cells. The change in gene expression level is dependent on the concentration of the pirymethamine. Our preliminary data don't let us establish the concentration of pyrimethamine that may significantly inhibit HEXA and HEXB expression. Further study may be conducted to put new insight into the pathogenesis of joint destruction in the course of rheumatoid arthritis.
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Affiliation(s)
- Sławomir Olszewski
- Uniwersytet Medyczny w Białymstoku: Klinika Ortopedii i Traumatologii Dzieciecej.
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Olszewska E, Kosztyła-Hojna B, Borzym-Kluczyk M, Rogowski M, Rutkowska J, Zukowska M, Waniewska E, Jakimowicz-Rudy J, Sieśkiewicz A. [Possible involvement of hexosaminidase in vocal polyps--preliminary report]. Pol Merkur Lekarski 2009; 27:463-465. [PMID: 20120707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
UNLABELLED Vocal fold polyp is usually a result of the injury of the vocal cords. It often appears after vocal overuse or misuse causing trauma in vocal fold mid-membranous and wound formation. THE AIM OF THE STUDY was to assess the activity of hexosaminidase in vocal fold polyps in the comparison to the control tissue. MATERIAL AND METHODS Vocal polyps (n=8) were collected from 8 patients during direct laryngoscopy. Specimens of normal vocal folds were obtained from 8 cadavers (n=8) served as controls. Specimens were immediately frozen in -80 degrees C. To assess hexosaminidase activity, release of p-nitrophenol from p-nitrophenol derivatives was used. RESULTS We observed statistical differences between the activity of investigated enzyme in all vocal folds specimens compared with that in normal tissue homogenates. However the activity of HEX achieved a low level. Mean release of HEX from the activated cells in vocal fold specimens was 1.073 nkat/g wet tissue compared with 0.766 nkat/g wet tissue in normal cadaveric vocal fold homogenates. CONCLUSIONS Low activity of HEX in vocal fold polyps suggests that inflammation may not be a primary factor in the development of the disease and other mechanism should likely be considered in the pathogenesis of vocal fold polyps.
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Affiliation(s)
- Ewa Olszewska
- Uniwersytet Medyczny w Białymstoku, Klinika Otolaryngologii.
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Sieśkiewicz A, Kochanowicz J, Rutkowska J, Rogowski M, Olszewska E. [The evaluation of olfactory dysfunction after the operation of ruptured anterior communicating artery aneurysm]. Pol Merkur Lekarski 2009; 27:302-304. [PMID: 19928658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
UNLABELLED Although the frequency of smell disorders after the operations of the anterior communicating artery aneurysm depends to a large degree on the used surgical approach, several independent of surgery factors may contribute to the postoperative smell tests outcome. THE AIM OF OUR STUDIES: The evaluation of the sense of smell in patients who underwent the operation of ruptured anterior communicating artery aneurysm using pterional approach. MATERIAL AND METHODS In the retrospective studies the results of smell test of the group of 21 patients operated for ruptured anterior communicating artery aneurysm and 21 healthy volunteers of control group were compared. The patients suffering from neurodegenerative, metabolic and endocrynological disorders, as well as those with rhinoscopic symptoms of rhinosinusitis and with decreased nasal potency confirmed by anterior rhinomanometry were excluded from the study. RESULTS During the operations it was possible to anatomically retain olfactory nerves in all operated patients. Severe smell disorders (severe hyposmia and anosmia) were detected in 1 (4.7%) patient of the control group and in 6 (28.5%) patients of postoperative group. The mean composite olfactory score in Cain test of the postoperative group was 4.53, and in the control group 5.47 points. The difference did not reach statistic significance (Mann-Whitney test, p = 0.068). CONCLUSIONS Although pterional approach to anterior communicating artery is relatively low traumatic to olfactory tract, the subarachnoid hemorrhage may have an unfavorable effect on postoperative olfactory nerve functioning. Considering the fact, that in spite of thorough examination of the patients, we were not able to exclude from the studied groups all the patients with preoperatively impaired smell, it seems reasonable to perform similar smell test studies in the prospective way.
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Olszewska E, Borzym-Kluczyk M, Rzewnicki I, Rutkowska J, Knas M, Rogowski M, Waniewska E, Wielgosz R. Hexosaminidase as a new potential marker for larynx cancer. Clin Biochem 2009; 42:1187-9. [DOI: 10.1016/j.clinbiochem.2009.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 02/22/2009] [Accepted: 03/01/2009] [Indexed: 10/21/2022]
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Abstract
UNLABELLED Treatment of the advanced form of rhinophyma causing severe nasal deformity and nasal breathing impairment is reserved mainly for surgical methods. Laser techniques among them play particular role. The aim of the study was to present short series of patients suffering from severe form of rhinophyma, who were treated with CO2 laser, emphasizing the advantages and disadvantages of the method used. MATERIAL AND METHOD Three male patients, aged 51-69, with advanced form of rhinophyma were treated in our clinic with CO2 laser. The total removal of pathologic tissue was performed during 2-3 sessions of laser therapy with an interval 4-8 weeks in-between. RESULTS The follow-up ranged from 4-12 months. Satisfactory cosmetic and functional result was achieved in all patients. Full reepithelization of the wound took place within 4-6 weeks. Intensive bleeding from dilated vessels during the procedure that required bipolar electrocautery occurred in two cases. There were no postoperative complication in the studied group. CONCLUSIONS The CO2 laser is relatively save and precise surgical tool for rhinophyma ablation. If the resection is not to aggressive, healing process is quick and without excessive scaring. Unfortunately the "dry field" conditions are not always possible to achieve during operation, due to limited coagulative properties of the CO2 laser towards dilated blood vessels. In advanced stages of rhinophyma to increase safety of the procedure, several sessions of the laser therapy might be necessary to remove all the hypertrophic tissue.
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Sieśkiewicz A, Rogowski M, Olszewska E. [Selected applications of diode laser in laryngological surgery]. Otolaryngol Pol 2008; 62:549-52. [PMID: 19004255 DOI: 10.1016/s0030-6657(08)70312-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED Diode laser due to emitted wavelength and achieved tissue effect appear to be universal tool for broad range of applications in laryngological surgery. The aim of the study was to present variety of applications of this type of laser in the treatment of selected pathologies of the nose, pharynx and oral cavity. MATERIAL AND METHOD 45 patients with various pathologies of the nose, pharynx and oral cavity were subjected to diode laser treatment under control of endoscopes and video routing system. In the studied group diode laser was used for hyperplastic turbinates treatment, correction of concha bullosa and septum deformations, ablation of nasal polyps and synechiae inside nasal cavity including cicatrical stenoses in the orifice of common lacrimal canalliculus, coagulation of vascular hemorrhagic diathesis, ablation of bleeding granulomas and polyps and treatment of vascular malformations. Results. Endoscopic diode laser surgery enabled for precise and save removal of the pathology accompanied only by minimal intraoperative bleeding. Healing and reepithelization process were normal and even in large postoperative defects do not exceeded 12 weeks. Postoperative complications in the form of cicatrix and synechiae were found in 3 patients. CONCLUSIONS Various pathologies may be treated effectively with diode laser if appropriate laser beam parameters and surgical technique is applied.
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Kosztyła-Hojna B, Rogowski M, Olszewska E, Kasperuk J. [Voice quality evaluation in patients with obstructive sleep apnea syndrome treated with uvulopalatopharyngoplasty (UPPP)]. Pol Merkur Lekarski 2008; 25:46-50. [PMID: 18839614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
MATERIAL AND METHODS The evaluation of voice quality of 22 patients with obstructive sleep apnea syndrome (OSAS), who underwent uvulopalatopharyngoplasty (UPPP), was performed. The voice quality was assessed before the operation, and 1 month and 6-months after the procedure. The grade of dysphonia was determined on a six-grade dysphonia scale according to the Union of European Phoniatricians. Maximum phonation time (MPT) was analyzed. The acoustic examination of voice was performed determining fundamental frequency (F0) value and shimmer, jitter and NHR acoustic parameters. Formants analysis of voice was made estimating the level of F1, F2, F3 and F4 formants. RESULTS Registered hearing dysphonia directly after the surgery was transient. The surgery did not significantly change F0 and jitter parameters that decrease the grade intensification of dysphonia. The reduction of maximum phonation time, changes in jitter and NHR acoustic parameters as well as the reduction of F3 and F4 formants confirmed the occurrence of open nasality directly after UPPP. CONCLUSION Registered voice quality and timbre disturbance after UPPP were periodic.
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Borzym-Kluczyk M, Olszewska E, Radziejewska I, Lewszuk A, Zwierz K. Isoenzymes of N-acetyl-β-hexosaminidase in human pleomorphic adenoma and healthy salivary glands: a preliminary study. Clin Chem Lab Med 2008; 46:131-6. [DOI: 10.1515/cclm.2008.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Olszewska E, Wagner M, Goon P, Shamaa A, Upile T, Rogowski M, Steinstaesser L, Sudhoff HH. Melanocyte localization and distribution in human cholesteatoma. Histol Histopathol 2007; 23:291-6. [PMID: 18072086 DOI: 10.14670/hh-23.291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Melanocytes in skin are derived from the neural crest and colonize the epidermis in the first trimester of gestation. Melanocytes have been observed in the nasopharyngeal, inner ear and oral mucosa and should therefore be present in the middle ear mucosa. AIMS To identify and determine the distribution of melanocytes in human cholesteatoma and normal meatal skin in Caucasian adults. MATERIAL AND METHODS Human cholesteatoma (n=18) and normal meatal skin samples (n=10) were investigated immunohistochemically with anti-HMB-45 and MART-1 antibodies. Localization and distribution of melanocytes were assessed in the epidermis and cholesteatoma using an automatic analyzing system. RESULTS Regular skin exhibited melanocytes within the epidermis and accounted for 10% of the total cell number. They occurred partly as membrane-bound clusters. Cholesteatoma matrix melanocytes were observed in the basal layer and exhibited an oval or roundmorphology. Decreased numbers of melanocytes in the basal layer correlated with keratinization within cholesteatoma samples. Melanocytes revealed monomorphous nuclei, abundant cytoplasm containing particles of melanin. Found adjacent to glands and blood vessels, melanocytes were also scattered among the mesenchymal cells. Accounting for 2-6% of the total cell number within the squamous epithelium, melanocyte density was significantly lower in cholesteatoma tissue than in skin. CONCLUSIONS The melanocyte distribution pattern was different when comparing the epithelia of skin and cholesteatoma. The presence of melanocytes in cholesteatoma may be due to an ingrowth, consequently controlled by keratinocyte-derived signals. In terms of the pathogenesis of cholesteatoma, neither squamous metaplasia nor melanocyte metaplasia can be excluded by our data.
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Affiliation(s)
- Ewa Olszewska
- Department of Otorhinolaryngology Head and Neck Surgery, University of Bochum, Bochum, Germany.
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Abstract
Cholesteatoma is a destructive disease characterized by the progressive expansion of keratinizing squamous epithelium in the middle ear and mastoid, and chronic inflammatory reaction of the subepithelial connective tissue. N-Acetyl-beta-d-hexosaminidase (HEX) catalyzes the release of terminal non-reducing N-acetyl-d-hexosamine residues acting on glucosides and galactosides in glycoproteins, G(M2)-gangliosides and glycosaminoglycans (GAGs). In this study the activities of HEX were measured in cholesteatoma tissue and in normal skin to demonstrate a possible role of HEX in bone resorption in the area adjacent to cholesteatoma. Cholesteatomas (n = 21) and normal adult retroauricular skin (controls, n = 21), were collected from patients during surgery due to chronic otitis media. In 20 of 21 specimens a significantly higher activity of HEX was observed in cholesteatoma tissue compared with that in normal skin. Mean release of HEX from the activated cells was 68.55 +/- 30.77 nkat/g wet tissue in cholesteatoma and 31.79 +/- 10.02 nkat/g wet tissue in skin specimens. It may explain the process of bone resorption in the area adjacent to cholesteatoma, i.e. ossicles or temporal bone. This study suggests that drugs inhibiting HEX activity, such as iminocyclitols, may be useful in cholesteatoma treatment.
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Sieśkiewicz A, Walenczak I, Olszewska E, Luczaj J, Rogowski M. [The assessment of nasal surgery and uvulopalatopharyngoplasy (UPPP) in the treatment of patients with mild and moderate obstructive sleep apnea (OSA)]. Pol Merkur Lekarski 2007; 22:130-3. [PMID: 17598658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
UNLABELLED The role of nasal patency in the pathogenesis of OSA is not fully understood. There are conflicting data in the literature considering the influence of the nasal resistance on RDI. The aim of the study was to assess if the surgical procedures aimed at increasing nasal patency performed simultaneously with UPPP (uvulopalatopharyngoplasty) may improve it's effectiveness. MATERIAL AND METHODS 20 patients with mild to moderate OSA (RDI < 30) were qualified for the study. Their BMI was less than 30, and total nasal resistance assessed by anterior rhinomanometry exceeded 0,45 kPa/l/s in each patient. The UPPP and nasal surgery (septoplasty, mucoplasty or CO2 laser mucotomy) were performed as a one surgical procedure in all patients. RESULTS The effectiveness of simultaneously performed UPPP and nasal surgery reached 55% in the group of unselected mild to moderate OSA patients. Snoring volume decreased to the level that did not disturb sleep of others in 75% of patients. CONCLUSIONS Nasal surgery minimally increased the effectiveness of UPPP in the treatment of unselected mild to moderate OSA patients. These surgical procedures caused noticeable decrease of snoring volume that was corroborated both subjectively and objectively. At the same time snoring was more reduced than RDI in studied group of patients.
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Borzym-Kluczyk M, Radziejewska I, Olszewska E, Szajda S, Knaś M, Zwierz K. Statistical evaluation of the isoform patterns of N-acetyl-beta-hexosaminidase from human renal cancer tissue separated by isoelectrofocusing. Clin Biochem 2007; 40:403-6. [PMID: 17303102 DOI: 10.1016/j.clinbiochem.2006.11.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Revised: 10/30/2006] [Accepted: 11/09/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Isoenzymes of HEX from human renal carcinoma and neighbouring macroscopically normal renal tissue can show different patterns on isoelectrofocusing gels. The aim of our work was to elaborate the method for statistical evaluation of differences. DESIGN AND METHODS Isoenzymes of N-acetyl-beta-hexosaminidase were separated from renal (control and cancerous) tissues of 15 patients. Isoenzymes were electrofocused in Multiphor II, with ampholine pH 3.5-9.0 (2%) and then evaluated densitometrically and analysed statistically. RESULTS A similar pattern in activity of isoforms of isoenzymes A and B in normal and cancerous renal tissue was observed. CONCLUSIONS The proposed method of statistical evaluation of differences in isoforms of N-acetyl-beta-glucosaminidase can also be adapted to estimate the isoforms of other enzymes in different tissues.
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Affiliation(s)
- Malgorzata Borzym-Kluczyk
- Department of Pharmaceutical Biochemistry, Medical University, Mickiewicza 2A, 15-230 Białystok, Poland.
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