Hereditary hemorrhagic telangiectasia-laser treatment of epistaxis

Hereditary hemorrhagic telangiectasia (HHT) is a rare, autosomal dominant disorder characterized by recurrent epistaxis, telangiectasias, and multiorgan vascular dysplasia. Various modalities exist for the treatment of HHT-related chronic epistaxis, although no method is preferred over another. The aim of this study was to review the effectiveness of diode laser photocoagulation in the treatment of epistaxis in patients with HHT. The study included 17 patients (7 men, 10 women) treated with diode laser photocoagulation from year 2008 to 2012. All patients met the Curaçao criteria for a diagnosis of HHT. Patients were followed for 1 year. Treatment success was assessed using a custom questionnaire and total blood counts. After laser photocoagulation, the frequency and intensity of bleeds were reduced significantly and average hemoglobin concentrations improved at the 4-month assessment. After laser treatment, no patient required septodermoplasty; therefore, we suggest that every patient with HHT should be treated with laser photocoagulation. Diode laser treatment is a simple and effective procedure that should be considered when treating HHT.

Clinical Implications of Nasal Septal Deformities

The first attempts to systematize septal distortions have been given by Cottle who defined four groups of septal deformities: subluxation, large spurs, caudal deflection and tension septum. Fortunately, the variations of the septal deformities show a certain order, thus enabling more precise classification. Mladina was the first to make user-friendly classification of septal deformities in six basic types. He also described the seventh type, named "Passali deformity", which presents individually, but is always a well-defined combination between some of the previous six types. Mladina types of septal deformities (SD) are divided in two main groups: so called "vertical" deformities (types 1, 2, 3 and 4), and "horizontal" ones (types 5 and 6). This classification was immediately well accepted by rhinologists worldwide and started to be cited from the very beginning. Since then it has been continuously cited increasingly more often, thus making Mladina classification a gold standard whenever clinical researches on nasal septum are concerned. More than forty clinical studies based on this classification have been performed to date. It is extremely important to make a strict distinction between the types of SD since all of them play some specific role in the nasal and general physiology in man.

The two holes syndrome

BACKGROUND

Defects in the fontanel region of the lateral nasal wall have been described in the literature as "accessory" or "secondary" ostia. The authors consider them a sign of chronic maxillary sinusitis. Along with mucus recirculation between the natural ostium and the fontanel defect, we call it the Two Holes Syndrome. The aim of this study was to determine the incidence of fontanel defects in patients with chronic rhinosinusitis (CRS) and in healthy subjects.

METHODS

Eighty-eight hundred seventy-nine outpatients with CRS were examined by means of nasal fiberendoscopy. The control group consisted of 1442 healthy volunteers with no previous history of CRS.

RESULTS

Defect in the posterior fontanel was found in 1713/8879 CRS patients (19.3%). It was bilateral in 1165 cases (68.03%). Defect in the anterior fontanel was found in 54 patients (0.61%). The circulating mucus ring was identified in 162 patients with fontanel defects (9.17%). The defect in the posterior fontanel was found in 7/1442 healthy volunteers (0.48%). It was never bilateral, the circulating mucus was not observed and defect in the anterior fontanel was not found.

CONCLUSION

Posterior fontanel defects were found more frequently in CRS patients than in healthy subjects. These defects have been clinically related to chronic infection of the maxillary sinus and should not be called "accessory" or "secondary" ostia. CRS with defects of the fontanel region and mucus recirculation can promote a number of health disturbances (chronic postnasal drip, headache, and cough). We named this entity the Two Holes Syndrome.

Involvement of p16 and PTCH in pathogenesis of melanoma and basal cell carcinoma

The involvement of two tumor suppressors p16 and Ptch in pathogenesis of cutaneous melanomas and basal cell carcinomas (BCCs) was studied through expression of Ptch and p16 and genetic alterations in 9p21 region (p16) and in 9q22.3 region (PTCH) of chromosome 9. Immunohistochemical analyses of paraffin-embedded tissues with Ptch and p16 antibodies, typing for 9q22-q31 and 9p21 region with polymorphic markers and p16 and Ptch mutation detection was done. Higher expression of p16 and Ptch in melanoma and BCC of the skin was frequently detected in studied cases. However, allelic loss of PTCH region occurs more frequently in BCCs than loss of heterozygosity of p16 region. Both types of tumors, BCCs and melanomas, suggest involvement of Hh-Gli signaling pathway, but using different mechanisms.

Biofilm in nasal polyps

INTRODUCTION

Bacterial biofilms are involved in many human bacterial infectious processes and in chronic rhinosinusitis as well. The aim of this study was to determine whether biofilm exists in nasal polyps, both in diffuse nasal polyposis (DNP) and antrochoanal polyps (ACP).

METHOD

Tissue samples were taken from seven patients suffering from DNP and three patients suffering from ACP, based on the defined patient inclusion and exclusion criteria. After the preparation, the tissue samples were analyzed by means of scanning electron microscopy (SEM) for signs of biofilm formation.

RESULTS

Signs of biofilm presence were found in all DNP patients. In ACP cases, biofilm was found in the stalk and nasal, polypoid part of the ACP, whereas there were no signs of biofilm on diseased mucosa of the posterior wall of the maxillary sinus.

CONCLUSIONS

Our preliminary study showed a possible role of bacterial biofilm in pathogenesis and maintenance of both DNP and ACP. There are no obvious differences in the SEM appearance of biofilms in DNP and ACP. Future research is needed to explain why biofilm is present in cases of diffuse nasal polyposis and at the nasal part of ACP, but not on the maxillary sinus part of ACP.

Lethal injuries among the members of the 4th Guardian Brigade of Croatian Army during the 1991-1995 war

OBJECTIVE

We analyzed the causes of deaths among the members of the 4th Guardian Brigade (GB) of the Croatian Army during the war in Croatia from 1991 to 1995: the site of the lethal injuries, the type of wounds, and estimated the severity of injuries with lethal outcome according to the Abbreviated Injury Scale.

METHODS

This was a retrospective study using the files and data obtained from 4th GB, Croatian Ministry of Defense, and Croatian Ministry of War Veterans.

RESULTS

During the War in Croatia from 1991 to 1995, 182 members of 4th GB were killed. One hundred fifteen (63.2%) suffered lethal injuries caused by shell fragments, 47 (25.8%) soldiers had gunshot wounds, and 20 ( 11.0%) died in traffic accidents. Mean Abbreviated Injury Scale for killed soldiers was 7.61 +/- 1.27.

CONCLUSION

During the war in Croatia, the leading causes of death were mines and explosions, and, in a minor proportion, gunshot wounds.

Inverted sinonasal papilloma--a report of 31 cases and review of the literature

Inverted papilloma is an epithelial neoplasm of the lateral nasal wall and adjacent sinuses characterized by a marked propensity for recurrence and a significant association with carcinoma. In this retrospective study we present 31 cases treated by our departments between 1982 and 1999. The aim was to compare our results to those of other authors especially regarding surgical management. The male to female ratio of these patients was 2:1 and most patients were in the 6th and 7th decades of life. Conservative surgery was used in most cases as the initial treatment. The overall recurrence rate was low and there were 3 cases associated with carcinoma. We conclude that the results of conservative surgery in selected cases are comparable to those using radical methods. A review of the literature is presented and particular attention is dedicated to the literature concerning analysis of p53 expression, HPV and Epstein-Barr infection and apoptosis in inverted papilloma.

Videofluoroscopy of the swallowing act after partial supraglottic laryngectomy by CO(2) laser

The evaluation of functional deglutition in patients after partial supraglottic laryngectomy by CO(2) laser was performed by videofluoroscopy of the swallowing act. We studied 20 patients in PA and LL projections, and the swallowing act, at 25 frames per s, was captured on videotape. Aspiration was found in six patients, four of whom had manifest clinical symptoms of aspiration. Four patients had post-deglutitive, one intra-deglutitive and one both intra- and post-deglutitive aspiration. Other swallowing disturbances or structural deformities were not detected. Dynamic radiological studies of swallowing, such as videofluoroscopy of the swallowing act, can provide valuable information regarding functional results after surgical procedures in the upper aerodigestive tract. Our encouraging results prove the validity of partial supraglottic laryngectomy by CO(2) laser as a method of treatment for carcinoma of the larynx.

Nasal polyps in children

During the 1980-1995 period, 957 patients were admitted for nasal polyposis, 59 (6.2%) of them children. Results were analyzed with respect to localization of the polyps, allergy, histologic picture, bacteriologic tests, radiologic findings of paranasal sinuses, cytology of nasal mucosa, therapeutic approach, and tendency to relapse. Forty children (22 boys and 18 girls) were analyzed. Their mean age was 11.1 years. Unilateral polyposis was found in 29, and bilateral in 11 children. Antrochoanal polyps (ACP) were found in 30, bilateral nasal polyps in 5, polyps in maxillary sinus in 5, and allergy in 8 children. Inflammation of the maxillary sinus was present in 93% of children with ACP. Their correlation between ACP and inflammation in maxillary sinus suggested that edema of the sinus mucosa have led to protrusion through the ostium and formation of the nasal polyp.

Detection and genotyping of Borrelia burgdorferi sensu lato by polymerase chain reaction

AIM

To isolate and genotype Borrelia burgdorferi genospecies in serum samples of Croatian patients with erythema migrans.

METHODS

DNA isolates from sera of patients with erythema migrans were analyzed by nested polymerase chain reaction (PCR), amplifying a segment of flagellin gene with primers encompassing the conserved region of the gene. To screen PCR products for heterogeneity, we performed single-stranded conformation polymorphism (SSCP) analysis. The samples showing differences in SSCP patterns were sequenced, and the sequence compared in the GeneBank for sequence homology with known Borrelia burgdorferi genospecies. We also constructed phylogenetic tree of all known borrelial sequences.

RESULTS

The nested PCR method using specially designed flagellin gene primers, achieved the sensitivity of 10 genome copies (0.01 pg of purified Borrelia burgdorferi DNA from culture) by dilution analysis. The assay specificity was confirmed by amplification of a part of the flagellin gene from different bacterial species. The primer pairs successfully amplified only Borrelia burgdorferi flagellin gene. The genome of Borrelia burgdorferi sensu lato was detected in the sera of all 10 tested patients with erythema migrans. Sequence data and phylogenetic analysis confirmed that all amplified samples belonged to Borrelia afzelii genospecies.

CONCLUSION

Phylogenetic tree analysis placed the borrelial isolates together with Borrelia afzelii sequences into a single group. This finding was additionally supported by sequence homology analysis, which produced a homology score of 99%. In patients with erythema migrans who come from the northwest Croatia, an endemic area for Lyme borreliosis, Borrelia afzelii was the cause of skin manifestations of Lyme borreliosis.

Lingual thyroid

Lingual thyroid is one of the rarest anomalies of thyroid origin. It is located in the midline of the base of the tongue. Lingual thyroid répresents ectopic, i.e. accessory thyroid tissue. It develops from the epithelium of the thyroglossal duct that has not obliterated properly, and it is sometimes the only thyroid tissue. Beside two cases presented, the embryology, symptomatology, diagnostic and therapeutic procedures, the literature reports of lingual thyroid are reviewed.