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The role of inflammatory mediators in the pathogenesis of nasal polyposis: Literature review


Nasal polyposis represents a late stage of long-lasting inflammation of the sinonasal mucosa, characterized by increased inflammatory cells infiltration and anomalous tissue remodelling. A wide range of chemical mediators such as cytokines, chemokines, cell adhesion molecules are involved in the pathomechanism of nasal polyposis, but their significance has not been completely clarified.

Eosinophils are the dominant inflammatory cell population in nasal polyposis and are thought to be the central effector cells responsible for the onset and maintenance of the inflammatory process. Persistent inflammation of the sinonasal mucosa can lead to structural changes, such as epithelial damage, thickened basement membrane, stromal edema, formation of pseudocysts. This review summarizes prior and current knowledge regarding the involvement of the inflammatory process in the pathogenesis of nasal polyposis.

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“Cahul” ozonated mineral water in the treatment of experimentally induced chronic rhinosinusitis


BACKGROUND. Chronic maxillary sinusitis is a frequently encountered pathology, resistant to treatment, which can cause significant economic losses. Considering these aspects, it is necessary to develop new methods of treatment.

OBJECTIVE. The purpose of this study was to assess the therapeutic efficacy of the “Cahul” ozonated mineral water in the treatment of experimentally induced chronic rhinosinusitis and its action on the mucosa of the maxillary sinus.

MATERIAL AND METHODS. The experimental study was conducted on a group of 14 chinchilla rabbits, aged between 8 and 12 months, weighing 2.5-3.0 kg, kept in vivarium conditions. In the first stage of the study, chronic rhinosinusitis was induced. 3 months after, maxillary antrostomy in the medial wall was performed on all animals included in the study; the intervention was performed under general anesthesia. The rabbits were divided into two groups. The rabbits enrolled in the study group underwent daily inhalations and maxillary sinus lavage with the “Cahul” ozonated mineral water. In the control group, inhalations and lavage were performed with 0.9% NaCl solution. Efficacy of the treatment was assessed observing the clinical character of the pathology. On days 2, 5 and 9 of the experiment, endoscopic and histological examinations were performed.

RESULTS. On the ninth day of treatment, if in the study group the appearance of the sinus mucosa was almost normal, in the control group, the histological examination revealed: epithelial hyperplasia, cylindrical cell hyperplasia, thickening of the basement membrane and lymphocyte infiltration. Mucosal fragments harvested after 5 days revealed submucosal fibrosis, leukocyte infiltration in the control group being more pronounced than in the study group.

CONCLUSION. Maxillary sinus lavage with the “Cahul” ozonated mineral water improves mucociliary clearance and stimulates regeneration of affected cells.

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Schneiderian membrane adult vasculogenesis evaluated by CD31 and CD34 expression and morphological arrangement


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.

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The role of PLUNC proteins in the etiopathogeny of chronic rhinosinusitis


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.

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Case report. Cystic lesions of the maxilla – clinical considerations and differential diagnosis


Cystic lesions of the maxilla are benign entities with both odontogenic and non-odontogenic origins. The maxillary cyst is a benign tumor of the bones of the jaw, which has a membrane and contains a fluid, semi-solid or mixed (liquid / semi-gaseous) material. These often lead to deformities in the jaw area. Cases are specific by framing pathological rarity, etiology, pathogenesis and clinical symptoms.

Considering the large entity of cystic formations that can be found in the maxilla region, we selected two patients with cystic formations of the upper jaw, which were part of different pathological etiology categories, with special rarity occurring, evolutionary appearance and difficult to classify in terms of pathognomonic signs.

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Nasolacrimal duct obstruction: the relationship with nasal allergy


Nasolacrimal duct obstruction (NLDO) is a common event in clinical practice. The authors, all members of the Italian Society of Rhinology, analysed 100 cases from different ENT Departments. The causes of NLDO, according to the etiology, can be divided into two classes: idiopathic primary acquired nasolacrimal duct obstruction and secondary. The aim of the study was to describe an association between the sign and symptoms of chronic rhinosinusitis and a complaint of epiphora.

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Fourth mandibular molar in a pediatric patient – Case report


Background. Supernumerary teeth are described as an excess of the normal teeth number of 20 deciduous and 32 permanent teeth and can occur in any dental region.

Material and methods. The authors present the case of a 12-year-old female child with a paramolar in the maxilla, discovered accidentally during an orthopantomogram, emphasising the treatment modality and the complications that can appear.

Conclusion. Supernumerary teeth can be present in any region of the oral cavity. Both practitioners and clinicians should be aware of the various types of paramolars and make a treatment plan after an accurate clinical and radiographic examination.

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The treatment of gingival recessions - Our experience


OBJECTIVE. The purpose of this study was to compare the options for treatment of Miller’s Class I and Class II gingival recessions using coronally advanced flap (CAF) and platelet-rich fibrin membrane (PRFm) with CAF and connective tissue graft (CTG).

MATERIAL AND METHODS. A surgical treatment was carried out on 30 subjects (23 women and 7 men), with a total of 118 symmetrical recessions of Class I and Class II by Miller on different places of the jaws, using two different methods. On one side of the jaw was held a plastic covering of the recessions with CAF in combination with PRFm (test group), and on the other side – CAF in combination with connective tissue graft (control group). The clinical evaluation includes: gingival recession depth (GRD), probing pocket depth (PPD), clinical attachment level (CAL), keratinized gingival width (KGW), gingival thickness (GTH), mean percent of root coverage (RC %). The results were observed six months postoperatively.

RESULTS. The average values for the GRD measured six months postoperatively for the control group were 0.37±0.36 mm and 0.70±0.41 mm for the test group. The results for CAL for the control group were 2.01±0.44 mm and 2.28±0.50 mm for the test group, while the mean percentage of root coverage (RC %) was 90.29±9.05% for the control group and 80.48±10.19% for the test group. The values for GTH were 1.04±0.16mm for the control group and 0.92±0.09 mm for the test group.

CONCLUSION. Both compared methods show good results in terms of all evaluated parameters. The group treated with CAF + CTG showed better results with a statistically significant difference for the RC% and the average values for GRD, GTH and CAL. The results of our study demonstrate a good potential for PRFm used in the treatment of Miller’s Class I and Class II gingival recessions.

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Case report. A rare case of triple-hit diffuse large B-cell lymphoma of the parotid gland in a patient with Sjogren’s syndrome


BACKGROUND. Primary malignant lymphomas of the salivary gland are rare, accounting for 2% of salivary gland tumors and 5% of all extranodal lymphomas. The clinical presentation is not particularly characteristic, a feature that usually leads to diagnostic and treatment delays.

CASE REPORT. We report a case of a parotid gland triple-hit diffuse large B-cell (DLBCL) lymphoma associated with follicular lymphoma in a 76-year-old female patient with a unique personal history, which included a diagnosis of Sjogren Syndrome and exposure to a toxic working environment with pesticides. Diffuse large B-cell lymphomas are uncommon given the fact that most lymphoid malignancies are low-grade lymphomas, with MALT (mucosa associated lymphoid tissue) lymphomas being the most common. Triple-hit DLBCL are extremely rare and the diagnosis can be challenging. Parotidectomy, as the first step, must be followed by histopathology and immunohistochemistry for final diagnosis and treatment.

CONCLUSION. This case highlights the fact that B-cell lymphoma in the salivary gland can be unrecognized due to unspecific symptoms and requires immunohistochemistry studies for confirmation. It is important to recognize triple-hit lymphoma due to its worse prognosis and differentiated treatment. Patients with Sjogren syndrome have additional risk factors for progression to lymphoma.

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Endoscopic approach of sinonasal inverted papilloma – our 15 years’ experience on 162 cases


BACKGROUND. Inverted papilloma is a benign tumor of the nose and sinuses, with a high risk of recurrence and malignant degeneration. The inverted papilloma is a slow growing tumor that can be approached through an endoscopic or external approach, depending on its stage.

OBJECTIVE. The aims of the study are to identify the particularities of diagnosis of the inverted papilloma, to establish the correct steps in surgical treatment of this tumor and to open the access for other steps of treatment.

MATERIAL AND METHODS. The authors present their experience in managing the sinonasal inverted papilloma in a 15-year retrospective clinical study, which included 162 patients. The preoperative protocol consisted in clinical examination, nasal endoscopy, radiologic imaging (CT scan) and biopsy with histopathology results and immunohistochemistry findings. Surgical removal of the inverted papilloma was performed by endoscopic techniques, according to the stage of the tumor. We were interested in the recurrence rate of the tumor and its malignancy after a long-term follow-up.

RESULTS. In our series, we included 162 patients and we had 26 (16.04%) recurrences and 12 (7.40%) malignant degenerations. All our patients were diagnosed in Krouse stages I, II and III and underwent endoscopic resection of the tumor.

CONCLUSION. In order not to have any leftover tumor (the most important factor of recurrence and malignant transformation), it is mandatory to have a complete diagnosis of the inverted papilloma, a precise surgical technique and a rigorous followup. In some cases, the surgical treatment is associated with other type of treatment (antiviral, antiangiogenetic).

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