Biomedical subjects
Publications and source records attributed to L Klimek.
Otitis media with effusion is one of the most common otologic diseases encountered by the clinician. This is primarily a pediatric problem although it can be seen in all age groups. The etiology, diagnosis, and treatment of this disorder will be discussed in this manuscript.
A prospective study was carried out to evaluate the sensitivity of ultrasonography in diagnosis of peritonsillar abscess (Quinsy). In 1986 through 1989 all cases of doubtful peritonsillitis were subjected to B-mode ultrasonography of tonsils before tonsillectomy was carried out. 36 patients were included in this clinical study. In cases of clinically uncertain peritonsillar abscesses the sensitivity of the method was 82%. However, only four false positive cases ("abscess in the scan but no pus during surgery") occurred.
A new clinical odour test was developed and validated in a clinical trial including 50 healthy volunteers as well as 35 patients suffering from smell disorders. The aromas were incorporated in an inert gas under disclosure from oxygen, avoiding impairment caused by oxidative transformation. Conventional smell test by Elsberg bottles was used as standard. The spray test proved to be equally effective in discriminating subjects suffering from smell disorders as the standard procedure. Moreover the spray test is feasible and long term constance of the substances is guaranteed.
Numerous techniques have been described for surgical decompression in endocrine orbitopathy. Irrespective of the approach chosen, the procedure might involve hazards to important vessels and nerves near the base of the skull. When the optic nerve is compressed and relief of pressure at the orbital apex is necessary, the internal carotid artery and the cavernous sinus are at risk as well as the optic nerve itself. Although the use of modern optical instruments such as operating microscopes and endoscopes is now standard practice for this form of surgery, adequate topographical orientation is not achieved in every case. For this reason a computer-assisted locating device developed in this department has been employed by us in 7 cases of endocrine orbitopathy where surgical decompression was required. By using computer-tomographic or MR-tomographic image data, the positions of structures at risk can be plotted to within 0.6 mm. Used in conjunction with an operating microscope and with endoscopic techniques, the system proved helpful in all cases.
In a monocentric placebo-controlled double-blind study with two-period cross-over the anti-obstructive effect of azelastine nasal spray was evaluated. Nasal provocation with histamine or specific allergen respectively was performed before the pollen season in 28 patients with a history of seasonal allergic rhinitis. Efficacy was documented by rhinomanometry, acoustic rhinometry, rhinoscopy and symptom score. Acoustic rhinometry showed a statistically significant lesser decrease in nasal cavity volume in favour of azelastine after histamine provocation (p < 0.05). Reduction in nasal flow as determined by rhinomanometry confirmed this tendency (p < 0.1) after allergen provocation. The analysis of the patients' symptom scores clearly indicated the superior efficacy of azelastine as compared to placebo, especially for nasal obstruction after provocation with both histamine (p = 0.005) and allergen (p < 0.02).
This study was designed to investigate subacute effects of long-term exposure of both healthy and chronically inflamed human respiratory mucosa to ozone. Functional and metabolic effects on ciliary beat frequency (CBF), release of interleukin 8 (IL-8), interleukin 4 (IL-4), and gamma interferon (g-INF), as well as cellular viability and cytotoxicity, were monitored. Cell cultures of 60 specimens (healthy mucosa: n = 30, inflamed mucosa: n = 30) were exposed to synthetic air and to ozone-enriched synthetic air in different concentrations of 100, 500, and 1000 micrograms/m3. Continuous expositions were performed using an air/liquid interface cell culture technique for a period of 4 weeks. CBF was monitored using video-interference contrast microscopy and cytokine release was quantified by enzyme immunoassays. Cellular viability and cytotoxicity were controlled by measuring lactate dehydrogenase activity, cytosolic activity of esterases, and by staining of nuclear DNA. Synthetic air had no influence on CBF during the 4 weeks of exposure. IL-8 release was continuously diminished in unaffected and in chronically inflamed mucosa. Within the first week of continuous exposure with any ozone concentration neither CBF nor release of IL-8 were affected in healthy or in inflamed mucosa. During the second and the following weeks of exposure CBF and the release of IL-8 were reduced in both tissues. Release of IL-4 or g-INF were not detectable at any time during the 4 weeks of ozone exposure. At higher ozone concentrations of 500 and 1000 micrograms/m3 there was an increase of cytotoxicity which was greater in chronically inflamed than in healthy mucosa. In conclusion, ozone had no measurable effect on those parameters measured in human upper respiratory epithelium after one week of in vitro exposure to different concentrations, but did after longer periods of exposure. Chronically inflamed mucosa had a tendency toward a higher susceptibility to intermediate and high concentrations of ozone that did not reach a level of statistical significance under the conditions used in this study.
A controlled prospective study on 31 patients with nasal polyps was performed to evaluate the time course of olfactory function after endonasal surgery. A modified Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory function test was used to measure olfactory threshold, odor identification ability, and odor discrimination ability. The test was performed in all patients 1-3 days before surgery (V1), 7-10 days after surgery (V2), and after 1 (V3), 2 (V4), 3 (V5), and 6 (V6) months. Mean olfactory threshold in the CCCRC butanol test was 4.19 at V1 (= moderate hyposmia). At V2, it decreased to 3.46 (= severe hyposmia), before increasing to 5.16 at V3 and 5.22 at V4 (= mild hyposmia). After the second postoperative month, olfactory threshold decreased again until the end of the study: 5.13 at V5 and 4.87 at V6 (= moderate hyposmia). The time course for odor identification ability and odor discrimination ability showed comparable results. This study demonstrates that olfactory function is impaired in patients with nasal polyps. Endonasal sinus surgery might improve olfactory function with best results within 3 months after surgery.
Nasal polyps affect approximately 4% of the population in the western world. The etiology of this disease is unknown, although inflammatory mechanisms may play an important role. In preceding studies we and others have shown that besides H1-antagonism, azelastine influences the immigration and activation of inflammatory cells. In this open label study in 16 patients with nasal polyps and perennial mite-allergic rhinitis, the effect of azelastine nasal spray twice daily 0.14 mg to each nostril on recurrence of nasal polyposis after endonasal surgery was evaluated. One patient dropped out after 3 months, unwilling to take further medication. Clinical and laboratory data of 15 patients were recorded over 25 weeks in a total of seven visits. Of these one patient needed nasal budesonide during the 4 weeks between visits 3 and 4. All other patients did not take any steroids before inclusion into the trial or during the 6-month observation period. Concentrations of eosinophil cationic protein (ECP) for eosinophils, myeloperoxidase (MPO) for neutrophils and tryptase for mast cells were determined in nasal secretions before and after eight and 25 weeks of treatment using double antibody radioimmunoassays, because these have been demonstrated to be good inflammatory markers in nasal diseases. Mean concentrations of MPO decreased from 2724 ng/mL to 1610 ng/mL (p = 0.0015) over the entire treatment period. ECP decreased from 458 ng/mL to 264 ng/mL (p = 0.0342). Tryptase decreased from 37.9 ng/mL to 22.4 ng/mL (p = 0.0574). These data were consistent with a significant decrease in clinical symptoms. Thus, azelastine seems to have an inhibitory effect on eosinophil and neutrophil activation in patients with nasal polyps and mite allergy.