Systemic sclerosis and its oral health implications

Systemic sclerosis (SSc) is a chronic, generalized disorder of the connective tissue. It is characterized by immune disorders, abnormalities of morphology and functions of small blood vessels, and the presence of inflammatory process. The pathogenesis of this disorder has not yet been fully understood. The classification criteria were established by The American College of Rheumatology (ACR). A number of clinical types are distinguished due to the diversity of the clinical picture. These types are characterized by a different course, presence of organ complications and prognosis. Connective tissue disorders are interdisciplinary conditions and, therefore, the subject of interest of different medical specialties, including dentistry. The oral cavity may be the place of pathological manifestations within soft and hard tissues. Such manifestations are the results or the primary symptom of systemic diseases. The relationship between the health of the oral cavity and systemic diseases has been frequently reported in the literature. Lesions in the oral cavity in patients with SSc are discussed in detail in the present paper. Management includes the administration of drugs that prevent tissue ischemia and post-ischemic consequences as well as drugs that inhibit inflammatory-immune processes and excessive collagen production.

Kikuchi-Fujimoto disease as a rare cause of lymphadenopathy--two cases report and review of current literature

Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a benign and self-limited disease, characterized typically by enlargement of regional lymph nodes accompanied by fever. KFD affects predominantly young adult females of Asian origin and is rarely seen in European countries, where it may cause diagnostic difficulties. Two cases of KFD in a 33 and 27-year-old woman with mild fever, malaise, lymphadenopathy initially misdiagnosed for indolent non-Hodgkin's lymphoma was presented. The definitive diagnosis was established on the basis of histopathological examination of totally excised cervical lymph nodes. The propriety diagnosis allowed us to avoid inappropriate chemotherapy. The disease course in our patient was uneventful during the 1.5 and 12-year follow-up period. The clinical presentations, complications as well as current concepts on pathogenesis, diagnosis and treatment of the Kikuchi-Fujimoto disease was briefly reviewed in this paper. The need of a long-term follow-up of patients with Kikuchi-Fujimoto disease was emphasized.

[Biodegradation of tracheal carbon implant in animal experiment]

INTRODUCTION

The radical treatment of tracheal stenosis comprises segmental resection and its reconstruction. The most successful type of reconstruction is the "end to end" technique. In cases with large tracheal defects (over 6 cm) this kind of reconstruction is impossible. From many years the adequate biomaterial is searched for the tracheal reconstruction. Most of the implanted biomaterials undergo biodegradation process.

AIM

The aim of the study was to analyze the biodegradation process in carbon fibers of prosthesis implanted in tracheal defects in animal experiment.

MATERIAL AND METHODS

We studied the prosthesis implanted in tracheal defects in sheep. The prosthesis were built with composite biomaterial composed of carbon fibers and polisulfone. The observation period was 1, 2, 3, 4, 6, 8, 24 and 38 weeks. In the morphometric evaluations the breadth, curve width, fullness factor and mean grey level of carbon fibers were assessed.

RESULTS

The results showed that carbon fibers undergo progressively degradation in animal environment. The width gradually decreased. The mean grey level in the first three weeks decreased, but in the next period it increased. Conclusion. The carbon fibers of segmental tracheal prosthesis undergo gradually degradation process in biological environment expressed by decreasing of their dimensions connected with the lost of irregularities and changes of structure density.

[Treatment of invasive rhinosinusitis--the case report]

The frequency of fungal etiology of sinusitis contains between 9 and 49 % according to different authors. Fungal rhinosinusitis has been divided into noninvasive and invasive forms. Noninvasive infections include fungus ball (mycetoma) and allergic fungal rhinosinusitis. Invasive infections include acute (or fulminates) fungal rhinosinusitis and invasive chronic rhinosinusitis. The case of chronic invasive rhinosinusitis was presented. Patient performed surgery--Functional Endoscopic Sinus Surgery and paranasal sinuses operation from subcranial approach. Surgery procedures were followed by antifungal pharmacotherapy (Orungal and Worykonazol). The presented case of fungal invasive chronic rhinosinusitis was treated according to recommended procedures with surgery followed by adequate antifungal farmacotherapy. In this case we have reached a successful outcome.

[Immunohistochemical assessment of molecule Ki67 in nasal polyps tissue]

Immunohistochemical assessment of proliferation marker--Ki67 in nasal polyps tissue and in healthy nasal mucosa was performed. There was no statistical significance difference between percentage of Ki67 positive cells in nasal polyps and nasal mucosa. These cells were observed mainly in epithelial layer and few in subepithelial layer. In examined group Ki67 expression was higher in planoepithelial metaplasia. Assessment of cells proliferation processes could be sensitive and early indicator of neoplasmatic transformation. Examined subgroup in witch Ki67 expression was also higher, was subgroup with eosinophilic infiltrations. Cells proliferation processes in nasal polyps tissue are very important occurrence and require further examinations.

[Surgical treatment of chronic sinusitis in children]

INTRODUCTION

Chronic sinusitis presents important problem in children. General approach in chronic sinusitis in children consists of: findings the proper diagnosis, optimal pharmacotherapy (oral or intravenous antibiotics), treatment coexisting allergic or systemic diseases and considering employing surgical treatment. The main surgical procedures in the treatment of chronic sinusitis in children are adenoidectomy and functional endoscopic sinus surgery (FESS).

MATERIAL AND METHODS

32 children with chronic sinusitis treated in ENT Department Silesian Medical University in Zabrze in the years 2000-2005 were presented in this study. 26 patients were treated surgically and 6 children by pharmacotherapy. In the surgically treated patients we performed 10 Functional Endoscopic Sinus Surgery, 4 unilateral and 8 bilateral sinusoscopy of maxillary sinus, and in 4 cases we removed choanal polyps.

RESULTS

In the group of 26 surgically treated children we did not observed the recurrence of symptoms in the 24 months follow-up period.

[Strategy of the sinonasal tumors treatment]

INTRODUCTION

The sinonasal tumors belong to rare diseases. They state 0.2-0.8% of all the malignant neoplasms and about 3% of head and neck tumors. These tumors are two times frequent observed in men than in women, mainly between 50 and 70 years old. In the sinonasal complex besides the primary are seen also the metastatic tumors. They state about 1% of all tumors (kidney, testum, breast, pulmonary).

AIM

The aim of our study was to retrospective analysis of the sinonasal tumors, treated in the ENT Department Silesian Medical University in Zabrze. The special attention was carried on the preoperative diagnostics and proper qualification to the surgical treatment.

MATERIAL AND METHODS

26 patients treated in the ENT Department Silesian Medical University in Zabrze between 2000 and 2006 suffered from the sinonasal tumors were retrospectively analyzed.

RESULTS

In the histological examination in 4 patients the benign neoplasm and in 22 patients malignant tumors were diagnosed. 24 patients were surgically treated (2 patients were not qualify to surgery because of the general diseases). On the basis of the CT and MRI examination as well as the description of the surgical procedure we stated that in 13 cases the primary localization of neoplasm was the maxillary sinus, in 5 cases ethmoidal cells, in 3 nasal cavity. In one patient the estimation of primary tumor localization was not possible, because of the very large extension of the neoplasm. The choice of the surgical procedure was depend on the tumor extension and localization. In 19 cases lateral rhinotomy with different modifications was performed. In one case the cranial incision was done. In 8 patients with the infiltration of lateral nasal wall the medial maxillectomy were performed. In 8 other patients upper maxillary resection were done. In two cases the total maxillectomy were performed, in the next two lower maxillary resection. All the patients were postoperatively treated by radiotherapy.

Sleep study in patients with overweight and obesity

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

The nasal airway evaluation in morbid obesity

The aim of the present study was to evaluate objectively the nasal patency in the obese patients. A total of 18 morbidly obese patients were recruited for the study. All of them were surgically treated because of morbid obesity using Bilo-Pancreatic Diversion (BPD) or Laparoscopic Gastric Banding (LGB) methods. The patients were free of nasal abnormalities, such as septum deviation, polyps, nasal concha hypertrophy and paranasal sinus diseases. This group comprised 10 men and 8 women aged from 17 to 54. The mean Body Mass Index (BMI) was 51.6 kg/m(2), ranged from 34.7 to 61.8 kg/m(2). In all of the patients the nasal patency was examined by active anterior rhinomanometry according International Standardization Rhinomanometric Committee using air pressure 75, 100 and 150 dPa. The results were compared to the healthy control group. The correlation between BMI and nasal airflow pressure was also examined. We found that inspiration values for 75, 100 and 150 dPa as well as the expiration values for 100 and 150 dPa in standard method and expiration values for 100 and 150 dPa in Broms method using anterior rhinomanometry in morbidly obese patients were statistically significant higher in comparison with the healthy controls. No statistical significant correlation between BMI of obese patients and the airflow pressure values was found. We conclude that in the morbid obesity the nasal patency is reduced as compared to the healthy controls.

[Treatment of otosclerosis in children]

Between 1994 and 2004 in the ENT Department Silesian Medical University Zabrze 330 stapedotomy were performed in patients suffered from otosclerosis. In this group of patient's 16 stapedotomies in 13 children aged from 9 to 17 years were performed. 4.85% of all the patients with otosclerosis treated in our Department were children. The purpose of this study was to analyze the audiologic results of stapedotomies in children. The postoperative evaluations were performed in the period from 6 months to 8 years after the surgical treatment. In the hearing state evaluation we analyzed the change of the air-bone gap, an average air conduction hearing improvement, the rate of percentage hearing improvement and an average hearing loss by Bell Telephone Laboratories. In all the operated children we observed the decrease of the air conduction hearing level. Stapedotomy was successful (postoperative air bone gap within 10 dB) in 62.5% of the cases. In 5 cases the air bone gap was lower than 20 dB (31.25%). In one case it was greater then 20 dB. The air bone gap closure was at the average of 4.39 dB level. The results were comparable with the other authors. Stapedotomy can be an effective procedure for correcting conducting hearing losses due to the otosclerosis in the pediatric patients.

[The rare case of sinonasal osteosarcoma in a 22-year-old patient (case report)]

Sarcomas of head and neck are very rare and comprise about 10 to 15% of all malignant nonepithelial neoplasms. A case of 22-year old patient with sinonasal osteosarcoma was presented. The authors stressed the significance of CT in the diagnostic procedures. The preoperative symptoms, histological character of the tumor and postoperative status were shown and discussed. Patient was treated by combined method: the surgical excision and radio-chemotherapy. The 24 months follow-up period was free of symptoms.

[Tuberculosis within the laryngologic organs]

Tuberculosis, considering entry of infection, most frequent concerns the lungs. Rarely we observed extrapulmonary cases of tuberculosis within the bones, joints, urogenital organs and lymph nodes as well as within the head and neck region--larynx, nose and paranasal sinuses, middle ear, pharynx, tonsils, tongue, parotid glands and central nervous system. The diagnosis of head and neck tuberculosis is based on patient's examination as well as on the bacteriologic and histologic study of the biopsy specimen.

AIM

The aim of the study was to show our own, very rare cases of head and neck tuberculosis.

MATERIAL AND METHODS

We showed our own experience in the diagnosis and treatment of patients suffer from head and neck tuberculosis. 7 cases of head and neck tuberculosis (4 laryngeal, 2 sinonasal and 1 middle ear) were treated from 1986 to 2004 in the II ENT Department Silesian Medical University in Zabrze. In all the cases the diagnosis was based on the histological examination of the tissue specimen. All of the patients were suspected of the neoplastic disease. We assessed good long-term results after the conservative treatment (sometimes completed by surgery).

CONCLUSIONS

Tuberculosis of the head and neck region should be taken into consideration during the differential diagnosis of neoplastic diseases.

[The case of extensive fungal sinusitis in a 72 years old man]

The case of extensive, invasive fungal sinusitis in 72 years old man was presented in this paper. The surgical treatment was performed in this patient--rightsided maxillectomy with orbitotomy. Results of histological and mycological examinations of postoperative material shoved evidence of Aspergillus Fumigatus. The additional pharmacotherapy with Amphotericin B and Orungal was attached. Despite of such aggressive treatment patient died 9 months after the last operation.

[Malignant transformation of giant jugular chemodectoma]

Chemodectoma is a very rare neoplasm classified on the border of the benign and malignant tumours. A case of a large paraganglioma was presented. The method of choice in treatment these tumors should consist of surgery and radiation therapy postoperatively.

[Hearing evaluation in patients suffering from hypercholesterolemia]

The negative influence of hypercholesterolemia on the blood vessels condition and following degeneration lesions of the organs is well known. The aim of our study was to estimate the lipid balance disorders influence on the small blood vessels of the brain and inner ear in the patients with hypercholesterolemia and hypertriglyceridemia on the base of the audiometric, ABR and TEOAE evaluations. In our study we observed no statistical significant differences between the mean auditory thresholds in the study and control groups as well as statistical negative correlation between cholesterol serum level and amplitudes of TEOAE. In the ABR evaluation we stated the prolonged latency of the wave III and V as well as I-III and III-V interpeaklatencies in the patients with hyperlipidemia in comparison with the control group.

[Surgical treatment of acquired external auditory canal atresia]

Acquired atresia of the external auditory canal is a relatively rare disease, that can be the result of the recurrent external otitis, chronic media otitis, ear trauma, neoplasms or iatrogenic complications. The surgical treatment results after operation in the 7 patients with acquired external auditory canal atresia were presented. The mean age of the patients was 34.1 and the female to male ratio was 2:5. In 6 cases we performed transcanal operation. The meatus atresia was removed and then the stenotic canal was widened by removing the skin and fibrous tissue. We especially focused our attention on the state of the anterior angle of the tympanic membrane. The bony canal was widened by burr in cases with bony overhangs. The bony canal walls were lined with pediculate or free skin grafts. In cases of tympanic membrane perforation we performed myringoplasty with temporal muscle fascia or tragus perichondrium. The follow-up period was from 8 to 39 months. The hearing improvement with primary closure of air bone gap within 20 dB was achieved in 43% of cases. In 28% of the patients recurrent atresia developed. The early surgical treatment is recommended in all the cases because cholesteatoma behind the atresia was found in 28% of patients.

[Stapedectomy in the treatment of otosclerosis in children]

In the years 1994-2000 in the Laryngology Department Silesian Medical Academy in Zabrze 167 stapedectomy were performed in 143 patients with otosclerosis. In this group of patients 11 stapedectomies in 8 children aged from 9 to 17 years were performed. 5.6% of all the patients with otosclerosis treated in our Department were children. The purpose of this study was to analyze the audiologic results of stapedectomies in children. The postoperative evaluations were performed in the period from 6 months to 6 years after the surgical treatment. In the estimation of the hearing state we analyzed the change of the air-bone gap, an average air conduction hearing improvement, the rate of percentage hearing improvement and an average hearing loss by Bell Telephone Laboratories. In all the operated children we observed the decrease of the air conduction hearing level. Stapedectomy was successful (postoperative air bone gap within 10 dB of the preoperative bone conduction) in 63.6% of the patients. In 3 cases the air bone gap was lower than 20 dB (27.3%). In one case it was greater then 20 dB. The air bone gap closure was at the average of 5.75 dB level. The results were comparable with the other authors. Stapedectomy can be an effective procedure for correcting conducting hearing losses due to the otosclerosis in the pediatric patients.

[Esthesioneuroblastoma: staging system and methods of treatment]

A rare neoplasm of the nose and paranasal sinuses--esthesioneuroblastoma was characterised. New staging system, diagnostics and therapeutic methods were analyzed. Diagnostic difficulties in esthesioneuroblastoma recognition were emphasized. The interesting case report confirming this problem was shown. Value of the immunohistochemical examinations was emphasized.

[A case of tongue neoplasm in a 15-year old patient treated with immunosuppressants for renal insufficiency]

The case of lingual cancer in the 25-years old man treated in 2nd ENT Department Silesian Medical Academy in Zabrze was presented in this paper. The patient has been treated from 1989 due to chronic pyelonephritis finished with the renal insufficiency. In 1991 the renal graft was performed and in 1993 graftectomy due to its rejection. In 1991-1993 the long-term immunosuppression was taking including medicines like Cyclosporin, Imuran, Azatioprin and Encorton. The aim of this study was to consider the influence of immunosuppression therapy on lingual cancer appearance in our patient.

Concentration of s-ICAM-1 in nasal polyps tissue

INTRODUCTION

Polyps are a nasal condition considered to be inflammatory in nature. Pathophysiology of that disorder is not fully known. The role of ICAM-1 in inflammatory and immune response through its involvement in leukocyte adhesion dependent phenomena is proved to be important. The aim of the study was to establish the role of sICAM-1 in the inflammatory process in nasal polyps.

MATERIAL AND METHODS

27 patients (23 males and 4 females) with nasal polyposis and 12 (7 males and 5 females) controls with septal deviation were included in the study. All patients underwent routine surgical treatment (polypectomy, septoplasty). The collected tissues of polyps and nasal mucosa were homogenized, placed in 0.04M EDTA and centrifuged. sICAM-1 concentration in supernatant of polyps and nasal mucosa tissue were determined with the ELISA method (Genzyme, UK).

RESULTS

In the polyps tissue we found a significantly higher concentration of sICAM-1 compared to the nasal mucosa of healthy subjects (6.74 +/- 5.31 ng/ml vs 0.28 +/- 0.13 ng/ml; p < 0.001). The elevated concentration of sICAM-1 was positively correlated with total tissue eosinophil count (r = 0.51; p < 0.01) and the duration of the disease (r = 0.628; p < 0.001). No correlation was found between sICAM concentration and the age of the patients subjected to examination.

CONCLUSIONS

The increased level of sICAM-1 in polyps tissue indicates the role of the molecule in the development of chronic inflammation and probably in the patophysiology of nasal polyps.

[The role of imperfect fungi in etiopathogenesis of allergic rhinitis]

In this paper the role of imperfect fungi in etiopathogenesis of perennial rhinitis was examined. In a group of 26 patients the concentration of total IgE and IgE specific of Candida albicans, Aspergillus fumigatus, Alternaria alternata, Mucor racemosus and Cladosporum herbarum was signified. Oversensibility to imperfect fungi was confirmed in 30.8% of patients: to Candida albicans in 3.8%, to Aspergillus fumigatus in 11.5%, to Alternaria alternata in 3.8%, to Mucor racemosus in 7.6% and to Cladosporum herbarum in 3.8%.

[Rhinomanometry of nasal patency in children with complete and secondary cleft palate]

The authors evaluated the morphology of nasal cavities and nasal patency using active anterior rhinomanometry in 94 children (mean age 10.2 years). Complete bilateral primary and secondary cleft palate was confirmed in 28 children (29.8%), unilateral in 66 children (70.2%), where complete right-side primary and secondary cleft palate was observed in 19 children (28.8%) and complete left side primary and secondary cleft palate in 47 children (71.2%). Measurement methods were used according to Rhinomanometric Standardization Committee. Significant relationship between nasal patency examined using active anterior rhinomanometry and complete cleft palate was confirmed. High, symmetric resistance of nasal airflow was observed in children with complete bilateral primary and secondary cleft palate. Children with complete unilateral primary and secondary cleft palate were found to have asymmetric nasal airflow, higher on the cleft side. In this group mean nasal airflow resistance was higher on non-cleft side than in population without defects, whereas on clefted side it is approximal to population without defects. In children with complete bilateral primary and secondary cleft palate mean resistances distribution was symmetric but higher than in population without defects.

[The evaluation of the phase angle in the tympanometric examination of the middle ear in a healthy population]

The results of phase angle estimations in 62 middle ears in healthy peoples were presented. Examinations were performed using multifrequency middle ear analyser with probe tone frequency from 250 to 2000 Hz. Own laboratory norms were estimated for the peak value and phase angle value in resonance frequency of middle ears. Obtained results were compared with other authors examinations. No significant statistical corellations between peak value of phase angles and probe tone frequency of impedancemeter were found.

[Impedance measurements of the middle ear volume with tympanic membrane perforation]

The measurement principles of pneumatic spaces of the middle ear were presented in this paper. According to the literature the controversial opinions of other authors were analysed. On the base of two cases changes of the middle ear volume in pathological states were presented. The value of middle ear volume estimation preoperatively was emphasized.