Search PubMed⌕ Search

Biomedical subjects

L Klimek

Publications and source records attributed to L Klimek.

At least 55 records · Page 3Linked to original sources
PubMed1999

The effect of short-term immunotherapy with molecular standardized grass and rye allergens on eosinophil cationic protein and tryptase in nasal secretions.

BACKGROUND: Activation of mast cells and eosinophils under pollen exposure can be inhibited by specific immunotherapy. OBJECTIVE: The effect of short-term immunotherapy with 7 preseasonal injections of molecular standardized allergens from grass and rye pollen on eosinophil cationic protein (ECP) and tryptase levels in nasal secretions has been compared with symptomatic drug treatment in an open, randomized study with 48 patients. METHODS: Nasal reactivity and mediator levels in nasal secretions were measured at baseline, before season, in season, and after season. RESULTS: Symptom scores in the immunotherapy group were 134.5 (95% CI, 65 to 336) versus 386. 0 (95% CI, 185 to 563), significantly lower as in the drug-treated group. ECP and tryptase levels increased significantly during natural allergen exposition. The seasonal levels in the immunotherapy group were significantly lower than in the drug-treated group with 272.1 ng/mL (252.0 to 293.9 ng/mL; immunotherapy) versus 470.4 ng/mL (SEM, 435.6 to 508.0 ng/mL; drugs) for ECP and with 8.73 ng/mL (SEM, 8.20 to 9.29 ng/mL) versus 17.47 ng/mL (16.42 to 18.60 ng/mL) for tryptase (all, P <.001). The ECP level induced by nasal provocation was 105.6 ng/mL (99.0 to 112.6 ng/mL) versus 180.4 ng/mL (169.2 to 192.4 ng/mL), significantly lower (P <.001) in the immunotherapy group, as was the tryptase level with 12.12 ng/mL (11.53 to 12.75 ng/mL) versus 8.19 ng/mL (7. 79 to 8.62 ng/mL; P <.001) at the after-season visit. CONCLUSION: Short-term immunotherapy is able to reduce tryptase and ECP in nasal secretions more effectively than drug treatment in patients with allergic rhinitis.

Adolescent↗
PubMed1999

Norm values for eosinophil cationic protein in nasal secretions: influence of specimen collection.

BACKGROUND: Eosinophil granulocytes play an important role in allergic inflammation of the nasal mucosa. Eosinophil cationic protein (ECP) is a specific eosinophil granule protein released upon activation of these cells. ECP concentration in nasal secretions has been demonstrated to be a good marker for the activity of eosinophilic nasal mucosal inflammation. The clinical use of such a marker requires defined values which are regarded as pathological or within normal range. In analyses of nasal secretion samples, the sampling method has an important influence on the data obtained. OBJECTIVE: We investigated ECP levels in nasal secretions (NS) of healthy volunteers obtained by seven different methods of sample collection to define norm values and to evaluate the clinical use of the different methods. METHODS: A total of 839 healthy individuals were evaluated using blowing the nose (Bl: n = 82), suction (Suc: n = 69), Okuda microsuction technique (MSuc: n = 93), absorbent cotton wool samplers (CWS: n = 156), rubber-foam samplers (RFS: n = 193), nasal lavage (Lav: n = 112) and nasal spray washing (NSW: n = 134). RESULTS: Missing values occurred in more than 60% in Bl, Suc and MSuc, so that no norm range was defined for these methods. Norm range for ECP in NS was 5-46 ng/mL for CWS, 7-41 ng/mL for RFS, 4-51 ng/mL for NSW, and 3-31 ng/mL for Lav. CONCLUSIONS: When comparing seven different methods used in this study to collect nasal secretions and determine ECP levels, the method based upon absorption or nasal washing was the best.

Adolescent↗
PubMed1999

Short-term preseasonal birch pollen allergoid immunotherapy influences symptoms, specific nasal provocation and cytokine levels in nasal secretions, but not peripheral T-cell responses, in patients with allergic rhinitis.

BACKGROUND: [corrected] Birch pollen allergic rhinitis can be sufficiently treated with specific subcutaneous allergoid immunotherapy (IT). However, little is known about the clinical and immunological effects of short-term therapy protocols. OBJECTIVE: To investigate the clinical efficacy of a birch pollen allergoid IT using seven preseasonal injections and to evaluate immunological parameters that might explain clinical findings. METHODS: Thirty-seven patients were included into the study and randomized to either a symptomatic treatment or allergoid IT plus symptomatic treatment. Patients were examined during the pre-IT season, at two extraseasonal visits both before and after IT and during the post-IT season. At each visit, nasal secretion samples were taken and analysed for levels of IL-4, IL-5 and IFNgamma. In addition, short-term birch-specific T-cell lines (TCLs) were cultured from peripheral blood mononuclear cells of 10 patients of the IT group, both before and after IT, and the ratios of lymphocyte subpopulations were determined. Cytokine production by TCLs (IL-4, IL-5, IFNgamma, IL-10) and proliferation of TCLs in response to stimulation with birch pollen allergen were measured. RESULTS: It was possible to evaluate 27 patients in accordance with the study protocol. Clinical symptoms and medication intake were reduced as a result of the IT as were nasal secretion levels of IL-5 (P = 0.007). IFNgamma was increased in nasal secretions (P = 0.01), while IL-4 was not measurable in most samples. No effect was found on proliferation of birch pollen-reactive TCLs, cytokine production by TCLs and the frequency and ratio of CD4+ and CD8bright or CD45RA+ and CD45RO+ cells in peripheral blood (all P > 0.05). Conclusion Preseasonal IT with a birch pollen allergoid is clinically effective in allergic rhinitis and influences cytokine production in the nose, but does not modulate the measured responses of peripheral blood T cells.

Allergens↗
PubMed1999

Sequential therapy with azelastine in seasonal allergic rhinitis. Deutsche Rhinitis Studiengruppe (German Rhinitis Study Group).

A sequential therapy treatment with azelastine (Allergodil) in seasonal allergic rhinitis is introduced. In the critical early stage, treatment begins with a combination of azelastine tablets (azelastine hydrochloride, CAS 79307-93-0) and azelastine nasal spray (azelastine, CAS 58581-89-8), and after five days only the nasal spray is administered. This sequential therapy model aims at achieving the quickest and most complete effect without reducing the tolerability. The investigation was carried out as a randomized, controlled double-blind phase IV study of parallel group design with 300 patients during 14 days. In the first five days, one group was given one puff (0.14 mg) of azelastine nasal spray twice daily and one 2 mg tablet of azelastine at night. The other group received nasal spray and a placebo tablet. Beginning on day six, both groups received nasal spray only. Both treatments proved to be effective; the combination therapy, however, was significantly more effective beginning as early as the first treatment. The superiority of the combination therapy increased until day five. Thereafter, the two curves grew closer together; however, the superiority of the combination treatment remained. The tolerability of both treatments was similar.

Adolescent↗
PubMed1999

[Anosmia caused by inhaled hazardous substances. Significance for expert assessment general practice].

BACKGROUND: Both environmental and occupational pollutants can affect the functional integrity of the olfactory epithelium or even destroy olfactory tissue. However, occupational hyposmia and anosmia have not been included into the list of occupational diseases. Therefore, compensation of occupationally induced smell disorders is difficult. OBJECTIVE: To evaluate patients with toxic hyposmia for the pollutants involved and to discuss consequences for occupational and environmental medicine. METHODS: A total of 19 patients were evaluated in our departments between 1993 and 1997 for olfactory disorders related to environmental or occupational pollutants. The charts of these patients were retrospectically analyzed and the causative pollutants compared with the literature. RESULTS: A chronical exposure to mixtures of metal dusts and steam, volatile organic substances, and anorganic gases were the most common pollutants involved in occupational dysosmia. Only one case of acute development of an anosmia due to exposure to CO and combustion gases was documented. CONCLUSIONS: Olfactory disorders are underestimated in occupational and environmental medicine. Relevance of olfactotoxic substances for occupational medicine can be postulated in metal and chemical workers, in welding and disinfection. The list of occupational diseases should be completed by olfactory hyposmia and anosmia.

Adult↗
PubMed1999

[Significance of eosinophilic granulocytes in relation to allergy and aspirin intolerance in patients with sinusitis polyposa].

BACKGROUND: The development of nasal polyps might be influenced by different factors such as mucosal inflammation. Infiltration with eosinophils is a common finding, although in largely different quantitis. PATIENTS AND METHODS: We investigated 58 patients suffering from nasal polyps who were assigned for endonasal sinus surgery based on endoscopic and CT findings. Out of these patients, 52% have already had sinus surgery and had recurrent polyps. All patients were subjected to both, allergy testing and a functional in vitro test for aspirin intolerance. During surgery, tissue samples were gained and send for histological examination with special respect to eosinophil infiltration. RESULTS: Eosinophil infiltration was observed in 66% of all patients. 37 patients (64%) exhibited aspirin intolerance only, four (7%) had a positive allergy test only, in 9 patients (15%) both, allergy and aspirin intolerance were diagnosed. Allergy and aspirin intolerance were accompanied by eosinophil tissue infiltration. Eosinophil infiltration was more common and more severe if allergy and aspirin intolerance were found together compared with the tissue eosinophilia in patients with either one entity. CONCLUSION: This study confirms the importance of eosinophil infiltration in the pathogenesis of severe or recurrent nasal polyps based on allergy and aspirin intolerance. A coincidance of allergy and aspirin intolerance was found in an unexpected high number of patients.

Adult↗
PubMed1999

A passive-marker-based optical system for computer-aided surgery in otorhinolaryngology: development and first clinical experiences.

OBJECTIVES: To develop a new type of optical computer-aided surgery (CAS) device that overcomes some of the restrictions of common systems and to examine its accuracy and usability under laboratory and intraoperative conditions. STUDY DESIGN: Prospective study using laboratory experiments and intraoperative data collection. METHODS: An optical CAS system applying passive optical markers for coordinate determination was developed. Laboratory accuracy measurements were obtained on a Plexiglas model with known coordinates of fiducial markers, before and after predefined table movements. Intraoperative accuracy measurements were recorded from 24 patients undergoing endonasal surgery of the paranasal sinuses with two different referencing techniques (fiducial markers and mouthpiece). RESULTS: The system demonstrated laboratory accuracy to within 0.86 mm (SD = 0.94 mm). After table movements, the accuracy decreased to 1.12 mm (SD = 0.99 mm), 1.05 mm (SD = 0.96 mm), 1.15 mm (SD = 1.04 mm), and 1.54 mm (SD = 1.25 mm), respectively, in four different positions. Intraoperative accuracy was within 1.14 mm (SD = 0.57 mm) (fiducial markers) and 2.66 mm (SD = 1.89 mm) (mouthpiece) (P < .05). One of the main advantages of the new technology was the possibility of using any common instrument or endoscope by adapting a marker array. CONCLUSIONS: Passive-marker technology has been demonstrated to be useful for optical position determination in computer-aided surgery.

Adult↗
PubMed1999

Does cocaine still have a role in nasal surgery?

Endonasal surgery is already very common and its importance is increasing. Successful anaesthesia in endonasal sinus surgery is of critical importance for the success of the procedure and many surgeons prefer to use cocaine for this purpose. However, there is a great body of evidence that suggests that use of cocaine, even in experienced hands, can cause rapid, unexpected and severe toxic reactions. Therefore, its use in endonasal surgery can no longer be recommended, especially since better tolerated alternatives are available for topical and infiltration anaesthesia. These alternatives include lidocaine (lignocaine) and tetracaine (pantocaine) in combination with epinephrine (adrenaline), naphazoline or oxymetazoline.

Absorption↗
PubMed1999

[Methods for monitoring of therapeutic efficacy in immunotherapy of allergic rhinitis].

Efficacy monitoring of immunotherapy (IT) is performed to adjust the therapy according to the patient's reactions, to collect data for scientific studies and to evaluate the efficacy of IT. A decrease of allergy symptoms and of drug use are the main parameters. For this, allergy diaries are most suitable. Pollen exposition should be monitored with Burkhard traps. Wheal and flare reactions in skin tests can be measured by visual inspection with quantification of the diameter on transparent foils or by means of laser scanners. Nasal provocation testing leads to subjective and objective (rhinomanometry, acoustic rhinometry) results. A change in the threshold concentration of allergen, which is needed to provoke a positive test reaction, can be used to evaluate the success of an IT. Additionally, systemic or local side-effects should be carefully revealed. Cytologic measures can be achieved by nasal lavages. Cotton samplers, cytology brushes and suction techniques are used to collect cells and nasal secretions. Early and late allergic reactions can be evaluated. Specific cell activation markers like ECP or tryptase are useful parameters in nasal secretions. T-lymphocyte subpopulations and T-cell-lymphokine-profiles can be detected. During IT, a change from a dominating TH2-cytokine-profile to a dominating TH1-cytokine-profile can be seen. For the reason of their expense, those methods are restricted to scientific investigations and only rarely used for routine diagnostics.

Biomarkers↗
PubMed1999

[Short-term immunotherapy--a survey of current studies].

Immunotherapy (IT) plays a central role in the therapy of allergic rhinitis as it was proved to be causal and preventive. IT induces humoral and cellular changes in the immune system, a reduction of symptoms and a prophylactic effect regarding a possible expansion of the allergene spectrum and of involved organ systems. Regular therapeutic schedules include allergen injections starting immediately after the pollen season and ending just before the expected beginning of a season. Additionally, perseasonal and perennial therapy schemes have been used. In all these, a phase of dose-increase is followed by an individually adjusted steady-state preservation-phase. In perseasonal and perennial scheme the injections are given during the pollen season. The preseasonal shortterm-immunotherapy is another schedule. The increase of the injected allergen-dose is made very fast (most commonly during seven weeks), so that the phase of dose-increase is shortened considerably, and a preservation-phase does not take place. This shortterm-immunotherapy has been developed for patients who consult their doctor shortly before the start of the pollen season. The preseasonal shortterm-immunotherapy has been shown to be efficient regarding allergic rhinitis caused by grass-, rye-, birch-, hazel- and alder-pollen. Clinical and experimental data of two placebo-controlled trials and one open study are presented and the role of this new immunotherapy approach is discussed.

Adult↗
PubMed1999

[Theories on the mode of action of desensitization].

Specific immunotherapy (SIT) has been practised successfully for about 80 years. In classic immunotherapy, an allergen-extract is repeatedly injected subcutaneously in increasing doses. A large number of clinically controlled studies have proved the efficacy of this kind of immunotherapy, while its mode of action is not precisely known yet. A successful SIT leads to an impairment of allergic symptoms (symptom score), and a concordant decrease in drug use. Furthermore, a reduced reactivity in specific dermal, nasal and bronchial provocation tests is induced as well as a diminished unspecific reagibility in the affected tissues. Several studies showed reduced values for allergen-specific IgE (serum) that followed an initial increase. A reduced immigration of eosinophils was found, both after provocation with allergen and during the pollen season, as well as diminished values of markers for the activity of eosinophils, e.g. eosinophil cationic protein (ECP). Also, a reduced allergen-induced histamine-liberation from mast cells and basophils has been reported. The underlying mechanism for these effects of SIT might be a reorientation of the allergen-induced lymphokine-production to a dominant TH1-cytokine-profile. Because the relation between the quantity of IL-4 and its regulator IFN-gamma controls the extent of IgE-synthesis by B-cells, the reorientation leads to a diminished production of IgE. IFN-gamma inhibits the differentiation of TH2-cells; by this less TH2-cells are present to help B-cells to produce IgE-antibodies, and to induce the differentiation of mast cells and basophils as well as immigration, differentiation and activation of eosinophils. Thus, the positive effects of SIT can be explained by the reorientation T-cell lymphokine profile. The mechanism under discussion for explaining this reorientation include: 1) an increased differentiation of allergen-specific CD4+ precursor-cells or a reorientation of established TH2-cells to the production of IFN-gamma, 2) the differentiation of IFN-gamma-producing CD8+ T-cells and of T-cells with receptors for T-cell-antigenes of the gamma, delta-type; and 3) the induction of an energy in TH2-cells.

Allergens↗
PubMed1999

[Therapeutic measures for anaphylactic reactions in the course of allergen-specific immunotherapy].

Allergologic emergencies that are caused by an overwhelming immunologic systemic reaction during immunotherapy are guessed to occur in 1:1,000,000 to 1:100,000. These anaphylactic or anaphylactoid reactions are induced by the liberation of different mediators. The symptoms are determined by the kind, the quantity and the relation of these mediators and by the individual predisposition. In general, these symptoms can be detected on the skin, the lungs, the cardiovascular system and the gastrointestinal tract. The early treatment of circulatory and pulmonary disturbances is decisive for the prognosis of the patient. The severity of symptoms is graded from 1 to 4. An adequate therapy has to be given immediately according to the severity of the symptoms in a step-wise approach. Initially, an interruption of the allergen exposition is important, as is an oxygen supply and placement of intravenous accesses. In the specific drug-therapy a few substances have proved to be reliable. Catecholamines (adrenaline, dopamine, noradrenaline), histamine-antagonists, glucocorticosteroids, theophylline and volume substitutes belong to this group, but not the intravenous application of calcium.

Anaphylaxis↗
PubMed1998

Virtual reality: preparation and execution of sinus surgery.

Endonasal sinus surgery requires a great deal of training before it can be performed adequately. Due to the complex and variable anatomy and the proximity of important structures, severe complications are possible, even for experienced surgeons. The nasal endoscopy simulator (NES) is an interactive training system for nasal endoscopy and endonasal sinus surgery that combines computer graphics and virtual reality (VR) techniques. This system consists of a graphics workstation, a tracking system for measuring the position of the endoscope and surgical instruments in space, a head model, image data sets of the nasal cavity and paranasal sinus area, and complementary software. The current NES is a visual and auditory VR system that provides both educational and planning options for sinus surgery. The usual resistance when touching relevant anatomical structures is not provided by this release. Therefore, a "force feedback system" is implemented that allows for such a response. VR simulation will become an important part of surgical education and planning for individual sinus surgery procedures. The ongoing development of the NES will lead to an improved educational environment for residents in training and practitioners.

Computer Graphics↗
PubMed1998

Development of computer-aided surgery for otorhinolaryngology.

Computer-aided surgery (CAS) describes a method that allows intraoperative navigation in the surgical field based on digital image data such as computed tomography, magnetic resonance imaging, and others. A computer processes the image data in real time and is intraoperatively connected to a measuring system for coordinate determination. CAS has been used in ENT surgery since 1986, and we developed several generations of CAS systems. A passive robot arm was employed in the first approach. Then electromechanical and infrared optical coordinate-measuring devices followed. CAS was applied to several fields of otorhinolaryngologic surgery, including the paranasal sinuses, the orbit, the rhino- and otobasis, and others. CAS was found to be particularly useful for acoustic neuroma removal, paranasal sinus surgery in cases of massive disease or revision surgery, decompression of the orbit or optic nerve, extraction of deep-seated foreign bodies, stereotaxy-like biopsies, and educational purposes. CAS in its current state of development is a useful tool that can be applied routinely; however, further technical developments are necessary.

Diagnostic Imaging↗
PubMed1998

Indications for computer-assisted surgery in otorhinolaryngology.

Indications for the use of computer-assisted surgery (CAS) in otorhinolaryngology can be grouped into several domains including the following: difficult cases involving the anterior, middle, and posterior skull base, especially the rhinobasis or laterobasis, and diseases of the petrous bone, the infratemporal fossa, the retromaxillar space, and the orbit; extended paranasal sinus surgery and revision cases with surgically altered anatomic landmarks; and use for educational purposes where CAS can provide better instruction in surgical anatomy by relating the surgical field to radiological sectional images. A new field for CAS is surgery of the inferior neck soft tissues or pathologic processes reaching into the upper mediastinum.

Humans↗
PubMed1998

Clinical validation of a new olfactory test.

A new approach to clinical olfactometry is presented using nasal sprays. A special dosage valve was used to standardize an aerosol size to 40 microns. For evaluation a 6 x 6 matrix (substance/olfactory quality) with verbal associative clues was used according to test psychological findings. Validation took place in three steps after determining smell-associated thresholds in preliminary examinations. Recognition of different aromas administered either by spraying into the open mouth from a distance of 5 cm using nasal sprays or sniffing opened bottles was compared in 50 subjectively normosmic subjects. Findings showed that the correspondence between the two procedures was relatively high, with global identification of odorous substances as high as 98.4% in the spray test. The number of substances used was next reduced to those six substances providing the most reproducible results in an investigation with 56 normosmic and 55 hyposmic subjects. Verbal associative clues were also tested. In a last step 50 patients with hyposmia of various origin and 110 normosmic subjects were tested, allowing previous results to be reproduced regardless of the cause of hyposmia. The spray test was shown to be easily performed and was suitable as a screening test, with a sensitivity of 88% and a specificity of 100%.

Administration, Intranasal↗