Olfactory ensheathing cells (OECs) join olfactory axons in their entrance to the central nervous system, representing a unique population of glial cells with functions in olfactory neurogenesis, axonal growth and olfactory bulb formation. Olfactory ensheathing cells have a great potential to induce repair for neural injuries, in central nervous system and peripheral nervous system, existing numerous experimental and clinical studies lately, reporting beneficial effects in anatomical and functional recovery. Studies are also conducted in order to establish possible pro-regenerative effects of the OECs, their potential in tissue repair and ability to modulate the immune system. The aim of this paper was to review the properties of olfactory ensheathing cells and their potential therapeutic role in regenerative medicine.
Chronic rhinosinusitis is a very common medical condition that affects nasal and paranasal sinuses mucosa in both adults and children. Its pathology, however, still remains unclear and researchers focus more and more on the role of nitric oxide (NO), a free radical produced in normal conditions by the paranasal sinuses epithelium in healthy patients, in the development of this disease. NO’s role in the upper airway disease is not completely known, but it appears to act like a first-line host defence agent, maintaining the sinuses sterile due to its antiviral and bacteriostatic properties and by increasing mucociliary clearance. NO levels in the exhaled air of patients with CRS are lower than in healthy patients. One explanation for this might be the sinus obstruction that occurs in CRS because subjects with complete sinus opacification have the lowest levels. Furthermore, NO levels decrease after CRS treatments, suggesting that its measurement might help in monitoring the patient’s response to therapy. In this review, we discuss the NO synthesis in the respiratory tract, its involvement in airway pathology, its role in the pathogenesis of CRS and the current clinical uses for NO in CRS and several other airway diseases.
BACKGROUND. The ostiomeatal complex (OMC) is the anatomical region situated between the middle turbinate and the lateral nasal wall, at the level of the middle meatus. Common anatomical variations of OMC are concha bullosa, hypertrophy of the uncinate process and of the bulla ethmoidalis and Haller’s cell. Our study was aimed to investigate the prevalence of these conditions and their relations to different symptoms.
MATERIAL AND METHODS. The study is a retrospective descriptive study based on 256 files of patients who were hospitalized and treated for OMC pathology in our clinic between January 2009 and January 2014. The data acquired were included into Excel Worksheets and statistically analyzed using GraphPad Software.
RESULTS. The most common finding was concha bullosa (63.67%), followed by hypertrophy of the bulla ethmoidalis (10.93%) and of the uncinate process (10.15%). Haller’s cell was found in only 3% of cases. The most common symptom for all patients was nasal obstruction, followed by nasal discharge. The majority of symptoms improved after functional endoscopic sinus surgery for OMC drainage.
CONCLUSION. OMC pathology is a frequent indication for functional endoscopic sinus surgery. The most common condition that determines blockage of OMC and need for surgical treatment is concha bullosa. The most common complaint of patients with OMC pathology is nasal obstruction.
BACKGROUND. Olfaction is one the most important senses; however, even nowadays it is incompletely known in humans from an anatomical and physiological point of view, but also as concerns the assessment methods and treatment. The main causes for acquired olfactory dysfunctions involve inflammatory pathology (local or general) and head trauma. Olfactory impairment after traumatic head injury (THI) is more frequent than believed. Today there are a number of tests for assessing the loss of smell, but more studies are needed in order to establish standardized protocols for patients with such pathology after THI. This uncertainty is more and more exploited by malingerers.
OBJECTIVE. The aim of the paper was to find in literature the necessary information in order to permit a correct management of a patient with olfactory impairment after head trauma and to establish new protocols that may help identify malingerers when medico-legal implications exists.
MATERIAL AND METHODS. We studied an amount of works and studies in order to highlight the diagnosis options specialist have, if such a case is encountered (olfactory loss after THI).
RESULTS. Recent studies show that great progress has been made, but more scientific research is needed. Specialists still search correlation between all diagnosis methods.
CONCLUSION. Olfactory disorders are an important topic given their importance in patient quality of life, but also for the medico-legal implications.
BACKGROUND. Innate immunity represents the first way of protection against different pathogenic agents. Recently, it has been a permanent interest regarding an innate immune molecule, that is known as palate, lung, nasal epithelial clone (PLUNC). PLUNC is a specific result found in the airways, of approximately 25 kDa, whose encoding is realized by adjacent genes located within a region of 300 kb in chromosome 20; these proteins must be detected predominantly in the superior respiratory tract.
MATERIAL AND METHODS. We performed a prospective clinical study on 34 patients with chronic rhinosinusitis and 10 controls, in order to investigate the expression of this protein in nasal tissue of patients affected by chronic rhinosinusitis. We tested the correlation between the existence of this disease and PLUNC proteins positivity.
RESULTS. 100% of controls have a+++ rated PLUNC proteins positivity, while cases have a lower percentage of positivity. There were no differences statistically significant between patients with CRSwNP and those with CRSsNP.
CONCLUSION. As a response to different irritating agents (bacteria, viruses, chemical factors), nasal mucosa will react by producing PLUNC proteins. PLUNC proteins have a defensive role in the upper airways mucosa.
BACKGROUND. Ultrasonography has been used in rhinology for diagnosing trauma lesions (fractures, hemosinus), second opinion in tumoral pathology, screening for sinusitis, but on a small scale and with future prospects of cost efficiency.
OBJECTIVE. We hope to grow awareness of the possible use of ultrasound in screening for nasal and paranasal sinuses pathology at the level of ENT emergency departments.
MATERIAL AND METHODS. We describe the technique for ultrasound examination of this region, emphasizing the need for a profound anatomical knowledge characteristic for ENT specialists. Any specialist having access to an ultrasound machine is encouraged to experiment with this imaging procedure. Two cases benefited from the use of ultrasonography in order to receive a better management and a swift treatment. One case presented with a maxillary sinus tumor and another with a paranasal tumor neighbouring the orbit.
CONCLUSION. Ultrasonography of nasal and paranasal sinuses permits serial examination without irradiating the patient; it could be implemented as an addition to FAST-like protocols at the level of emergency departments in order to screen for occult head and neck pathology prior to conventional radiology and CT imaging and thus reducing costs
BACKGORUND. Simulation models have slowly been gaining a place in training and surgical skills, before attending the operating theatre. This paper presents a model that allows the trainee to practise the functional endoscopic sinus surgery (FESS) training in a safe, non-patient facing environment.
MATERIAL AND METHODS. The method can be practised away from the operating theatre and the skills developed can then be transferred to the operating theatre. To create our FESS simulator, we use a cardboard tube and sheet, scissors, markers, cutter, foam, needles, catheters, plasticine, an inflatable balloon, a 10g lumbar puncture needle, one 5 cc syringe, two Blakesley forceps (straight and angled) and a 0° and 30° Hopkins rigid optics. In this simulator you can practise a puncture of the inferior turbinate, the endoscopic depth, remove a polyp, balloon dilation, a partial ethmoidectomy.
RESULTS. We describe a cheap and easy to build FESS training model, which allows the resident to practise this technique in a risk-free environment, while guaranteeing the reproducibility of the technique under similar conditions.
CONCLUSION. The high cost of digital simulators does not allow possible spreading this technology in every department. For that reason, the purpose of this paper is the acquisition of a set of skills that allow the resident to go to the operating room with clear concepts about the basic techniques.
Chronic rhinosinusitis (CRS), fairly common disease in the field of otorhinolaryngology, is the focal point of thorough study of the pathophysiology and treatment strategies for a favourable evolution of patients with this problem. Although there have been important advances in the treatment of CRS, signs and symptoms still remain long after functional endoscopic sinus surgery (FESS), indicating the persistence of the biofilm infection on the sinus mucosa. This review aims to highlight the relationship between bacterial biofilm and CRS, and also the available treatment strategies of the latter.
Background. The increased incidence of accidental or non-accidental ingestion of corrosive substances or drug compounds leading to postcaustic esophagitis represents a major public health issue. The treatment of postcaustic esophagitides is difficult and long lasting, calling for a complex team trained in this borderline pathology: gastroenterologist, general surgeon, otorhinolaryngologist, anesthesiologist, psychiatrist. In cases when preventive treatment has failed, the only effective therapy remains the surgical one.
Material and methods. Our study involved an analysis of the cases treated and/or operated in the Department of General and Esophageal Surgery of the “Sfanta Maria” Hospital in Bucharest, between 1981-2014; respectively 195 patients who benefited from reconstructive esophageal interventions. Of the selected patients, 191 were operated for corrosive pathology produced by ingestion of caustic soda and only four cases by ingestion of acids. The lesion balance showed that, besides the esophagus, the oropharynx (28 patients), the larynx (7 patients) and the stomach (31 patients) had been affected by the corrosion process, requiring particular surgical solutions. The bypass reconstruction (preserving the esophagus) was the standard treatment, esophagectomy having been performed in only 4 patients.
Results. The main remote postoperative complaint was feeding inability, a consequence of various causes: cervical anastomosis stenosis, motor dysfunctions of the graft or of the laryngopharyngeal complex, over-time alteration of the graft, technical vices or the degradation of intra-abdominal assemblies, traumatic injuries of the presternal substituent.
Conclusion. One of the most important moments during the esophageal reconstruction surgery remains the duration of the cervical anastomosis, since the postoperative complication rate and the remote functional outcome depend on it. Minimizing postoperative risks and complications requires a complete mastery of surgical methods, of the small technical “artifices” and of the necessary therapeutic refinements adapted to each individual case.
Background. Few studies approached the process of blood vessels formation in the Schneiderian membrane. We aimed at investigating by immunohistochemistry the processes that are responsible for forming new blood vessels in the human Schneiderian membrane.
Material and methods. We applied CD31 and CD34 markers on bioptic samples gathered from eight adult patients negative for malignant pathologies. Filopodia-projecting endothelial tip cells (ETCs) were found and indicated processes of sprouting angiogenesis. Also, CD31-expressing monocyte-derived cells were found being involved in processes of vasculogenesis. These cells were projecting filopodia, thus being assessed as endothelial progenitor tip cells (EpTCs). Aggregates of CD31+ EpTCs were also analyzed. Further stages of lumen acquisition and large diameter vessels formation, specific for vasculogenesis, were evaluated.
Results. It resulted that, specifically within the maxillary sinus mucosa, vascular remodelling is equally ensured by adult vasculogenesis and sprouting angiogenesis.
Conclusion. This is, to our knowledge, the first evidence of adult vasculogenesis in the maxillary sinus mucosa, supported by bona fide bone marrow-derived CD31+ cells. The guidance mechanism of EpTCs protrusions needs further investigations for finding similarities, or dissimilarities, with the endothelial tip cells prolongations.