Biomedical subjects
B Petruson
Publications and source records attributed to B Petruson.
Insulinlike growth factor I immunoreactivity in nasal polyps.
Nasal polyps from 15 patients were all found to express increased insulinlike growth factor I immunoreactivity. A hypothesis for the formation of nasal polyps is described: macrophages, seen in allergic and infectious reactions, produce and release growth factors, tentatively including insulinlike growth factor I. In enclosed paranasal sinuses this results in an accumulation of insulinlike growth factor I stimulating the growth of both epithelium and blood vessels in the sinuses. The mucosa increasingly bulges out through the ostium after having filled out the sinusity. Continuing growth stimulation is supplied by the inflammatory reaction, endothelial cells in the polyp, and activated macrophages inside or outside the polyp.
A lateral rhinotomy approach to transsphenoidal hypophysectomy.
The transsphenoidal approach to the sella turcica is nowadays more often used than the transcranial. The disadvantages of the transantral and transseptal approaches are a narrow and distant operative field and various complications. A fluoroscope often has to be used for orientation. With our lateral rhinotomy technique, no fluoroscope is needed as the whole sphenoid can be inspected. Furthermore, the operative field is wide and closer to the surgeon, few instruments are needed, bleeding is easily controlled, the anterior wall of the sella can be properly sealed, CSF rhinorrhoea prevented and the sphenoidal mucosa restored. The whole operation can be performed within 2 h. Fifty-seven patients were operated upon with good results and few complications.
Improvement of the nasal airflow by the nasal dilator Nozovent.
The lateral wall of the nostril is considered as the functional unit in the regulation of the nasal resistance causing more than half of the total resistance. In 16 test-subjects both nostrils were dilated with a plastic nasal device, Nozovent, and the airflow through the nose was measured with and without the device. In each object the mean value of ten inspirations at 150 Pa was calculated. Before the application the mean value of the subjects was 0.68 l/sec and with the device 0.84 l/sec. The improvement of airflow was comparable with that of treatment with nose-drops. The device ought to be helpful in patients with or without collapsing ala nasi during the night to increase nasal airflow when sleeping.
Nasal mucosal changes in children with frequent infections.
Children with frequent recurrent respiratory tract infections and constant mucopurulent secretion from the nose were thoroughly examined, including bacteriologic and immunologic analyses. Biopsy specimens from the nasal mucosa were investigated by light and electron microscopy. Eight different histopathologic factors were distinguished and evaluated in relation to the continual nasal discharge. The mucus production was increased, due to an increased number of goblet cells or submucosal glands. The mucus transport was impaired owing to a decreased number of ciliated cells or different deficiencies in the structure of the cilia. The secretion of periciliary fluid was altered due to dysfunction of microvilli-equipped cells and the availability of tissue fluid due to vascular changes. Leakage of tissue fluid partly reflects deficiencies in the epithelial lining. Purulent discharge was observed from microabscesses. Reactive changes in the nasal mucosa are described and discussed in relation to treatment schedules aimed at reducing short- and long-term discomfort and complications.
Humoral immunity in nasal mucosa of patients with common variable immunodeficiency.
Humoral immunodeficiency, as reflected by the low serum immunoglobulin (Ig) concentrations in adult patients with common variable immunodeficiency (CVID), was even more severely expressed at the B-cell level in their nasal mucosa. No Ig-producing cells could be detected by immunohistochemistry in 11 of 19 mucosal specimens. The epithelial distribution of secretory component (SC) was normal in all specimens, but a sign of SC-dependent IgM transport was seen in only three. Epithelial IgA was completely lacking. All patients had had recurrent lower respiratory tract infections and 16 had recurrent or chronic infections of the upper respiratory tract. A previous report indicated that the intestinal mucosa is a privileged site for maturation of B cells in patients with CVID; the present study shows that this does not hold true for the nasal mucosa. This difference in B-cell maturation may in part explain the preferential susceptibility to infections in the respiratory tract of patients with CVID.
Survival after surgical treatment in maxillary neoplasms of epithelial origin.
During 1968-1979, 55 cases of epithelial neoplasms originating from the maxillary antrum were diagnosed and treated within the referral area of 1.5 million inhabitants. A majority of the patients were operated upon after pre-operative irradiation therapy (40-50 Gy). No significant difference in survival rate was found between patients operated on by total maxillectomy, including orbital exenteration, and patients subjected to partial maxillectomy. Patients with tumours not completely removed during primary surgery and patients with glandular involvement had a poor prognosis despite additional surgery and radiotherapy. The prognosis for the remaining patients was considerably better, with a 5-year survival rate of 60 per cent.
Haemostatic disorders in habitual nose-bleeders.
Ninety-one habitual nose-bleeders were screened for haemostatic disorders. 46 screening results in 38 nose-bleeders were outside the normal range. After extended investigation, it was found that 25 (27 per cent) habitual nose-bleeders had haemostatic disorders, all except one in the primary haemostasis. The disorders found could be classified as mild bleeding disorders (MBD) and compared to the estimated frequency of MBD in the population there was an increased incidence of haemostatic disorders in the habitual nose-bleeders. Abnormal vessels in the nasal mucosa were present in 85 per cent of the investigated nose-bleeders, equally distributed between nose-bleeders with and without haemostatic disorders. This indicates that abnormal vessels and haemostatic disorders in habitual nose-bleeders, it is possible to detect previously unknown but clinically important disorders.
Immunohistochemical study of nasal mucosa in patients with common variable immunodeficiency.
The presence of immunoglobulin (Ig)-producing cells was studied immunohistochemically in nasal mucosa obtained from adult patients with common variable immunodeficiency. In 11 of 19 biopsy specimens no such cells could be detected and with one exception very few appeared in the others. Distinct sign of epithelial IgM transport mediated by secretory component (SC) was seen in three specimens although the epithelial distribution of SC appeared normal in all cases. All patients had recurrent lower respiratory tract infections and 16 had recurrent infections of the upper respiratory tract. The localization of the infections primarily to the respiratory tract might be explained by the fact that the immunodeficiency, as reflected by the low serum Ig concentrations, was still more severely expressed at the B cell level in the nasal mucosa.
Immunohistochemical study of nasal mucosa in patients with selective IgA deficiency.
Fifteen nasal biopsy specimens from adult patients with selective IgA deficiency were examined in a 'blind' immunohistochemical study for the presence of immunocytes producing various immunoglobulin (Ig) classes. Three groups of patients could be identified. One group had a predominance of IgG- and IgM-producing cells in their nasal mucosa, a second group revealed mainly IgG- and IgD-producing cells, and a third group had very few mucosal immunocytes. The clinical examinations showed that upper respiratory tract infections were most common in patients with few immunocytes while such infections were least common in patients with predominance of IgG and IgM immunocytes. Our results indicated that IgM, in contrast to IgD, acts as a compensatory secretory Ig in some patients with selective IgA deficiency.
The clinical condition of IgA-deficient patients is related to the proportion of IgD- and IgM-producing cells in their nasal mucosa.
Nasal biopsy specimens from 15 adult patients with selective IgA deficiency but normal IgG-subclass levels were examined by immunohistochemistry for the presence of immunocytes producing various Ig isotypes. The mucosal samples were completely IgA-deficient except in two cases where 0.9% and 8.4% IgA cells were found, respectively (normal, 69.8%). Numerous IgG- (mainly IgG1-) producing cells were present in 10 samples; in five of these there were additional IgM- but virtually no IgD-producing cells, whereas in the other five a marked dominance of the IgD over the IgM isotype was seen. The latter category of patients had more upper airways infections (recurrent acute rhinosinusitis, otitis media, and tonsillitis) than the former, who had no recurrent upper respiratory tract infections except one patient with recurrent acute rhinosinusitis. The five remaining samples, which contained very few Ig-producing cells, were derived from patients with even more frequent infections than those showing IgD predominance. Our results indicate that IgM acts as a compensatory secretory Ig in the upper respiratory tract of some IgA-deficient subjects. However, immunoregulatory events favouring local IgD responses apparently do not support mucosal defence satisfactorily, either because local production of IgM is hampered or because IgD (which is not a secretory Ig) blocks complement-dependent reactions mediated by IgG and IgM antibodies within the mucosa.
Somatomedin C in pathogenesis of malignant exophthalmos of endocrine origin.
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Transection of varicose vessels in the nasal mucosa of patients with recurrent epistaxis. A 2-year follow-up.
Twenty-two patients with recurrent nose bleeds and varicose vessels on the nasal septum were subjected to transection of the vessels and followed-up for 2 years. One month after the operation, it was not possible to identify the original vessels. In other locations new varicose vessels began to appear after 1 month, and at the end of the follow-up period were observed on 9 out of 10 operated sides. The transection resulted in an immediate decrease in the frequency of nose bleeds and at the end of the control period 12 (55%) of the patients had had less than 4 bleeds during the previous year in spite of the observed rapid formation of new vessels. Mucosal atrophy with symptoms of increased nasal crusting occurred in 3 patients. Transection of varicose vessels in patients with nose bleeds leads to a decrease in the number of bleeds.
Occurrence of epistaxis in habitual nose-bleeders and analysis of some etiological factors.
The occurrence of epistaxis in 121 habitual nose-bleeders has been analysed together with the importance of different etiological factors. Heredity for recurrent nose-bleeds was noted by 42% of the bleeders, which was significantly more than in the control group (p less than 0.001). The start of the nose-bleeds was mostly spontaneous. Both common cold and stress or tiredness were frequently experienced before the occurrence of the nose-bleeds. The blood pressure distribution of the habitual nose-bleeders did not differ from that of the population samples used for comparison. Diseases reported by the habitual bleeders were few, and the blood routine tests revealed only few diseases that could be related to the recurrent nose-bleeds.
Reconstruction of the anterior nasal septum by transplantation.
Different implantation materials have been used for reconstruction of the infrastructures of the nose. Preserved allografts from the nasal septum or autografts from costal cartilage are regarded as the best. A new technique for reconstruction of the anterior septum has been used in 14 patients during 1979-1982. A pocket (13-18 mm X 22-27 mm) was first prepared between the mucous membranes from the nasal spine to the dorsum of the nose. With a piece of 1 mm thick Silastic as a model a cartilage graft was taken from the superior part of the auricle. The perichondrium on both sides was preserved to permit a good revascularisation, keep the cartilage viable and prevent resorption. The graft was kept in place in the pocket with Silastic splint on each side of the septum for two weeks. In none of the patients was any resorption noted.
Infections of the nose and paranasal sinuses in adult patients with immunodeficiency.
Twenty-two patients with common variable immunodeficiency (CVID) and 18 patients with selective IgA deficiency were examined with respect to previous and present infections of the upper respiratory tract (URT), especially of the nose and paranasal sinuses. Recurrent acute rhinosinusitis was common in both groups of patients, but the development of chronic rhinosinusitis was only found in patients with CVID, indicating the more severe nature of this condition compared with selective IgA deficiency. The infections of the URT occurred several years before the appearance of lower respiratory tract (LRT) infections. Once the infections of the LRT had started, the patients had a tendency to neglect the symptoms from the URT. Early detection of antibody deficiency syndromes is of vital importance for prevention of repeated and chronic infections often causing tissue damage in the respiratory tract.
Goblet cell number in the nasal mucosa relates to cell-mediated immunity in patients with antibody deficiency syndromes.
Histopathological changes in the nasal mucosa were studied in biopsies from the inferior turbinate in 22 patients with common variable immunodeficiency (CVID) and 16 patients with selective IgA deficiency. Most patients with CVID had fewer goblet cells than the healthy controls (p less than 0.001), whereas patients with selective IgA deficiency often had manyfold increased numbers (p less than 0.001). The number of goblet cells showed a significant (p less than 0.001) relationship to the cell-mediated immune function. Patients with lowered cell-mediated immune function, as measured by in vivo and in vitro tests, showed reduced numbers or lack of goblet cells. These patients had an increased number of subepithelial, seromucous gland acini compared with healthy controls (p less than 0.01) and patients with selective IgA deficiency (p less than 0.05). The production of mucus may be a compensatory mechanism, participating in the protection of the mucosal surface of the antibody-deficient patient. The increase in the number of goblet cells, but not of subepithelial, seromucous gland acini seems dependent on the cell-mediated immune system.
Nasal mucosa changes after exposure to dicumylperoxide.
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