Biomedical subjects

Heinz Stammberger

Publications and source records attributed to Heinz Stammberger.

11 recordsLinked to original sources

PubMed2006

Nasal IL-5 levels determine the response to anti-IL-5 treatment in patients with nasal polyps.

BACKGROUND: Chronic rhinosinusitis with nasal polyps is characterized by an eosinophilic inflammation and high IL-5 levels. OBJECTIVES: Antagonizing the effect of IL-5 is a potential new treatment strategy in patients with nasal polyps. METHODS: In a double-blind, placebo-controlled, randomized, 2-center safety and pharmacokinetic study, 24 subjects with bilateral nasal polyps were randomized to receive a single intravenous infusion of reslizumab, a humanized anti-human IL-5 mAb, at 3 mg/kg or 1 mg/kg or placebo. We evaluated the safety and pharmacokinetics of reslizumab, and biologic activity was assessed by means of endoscopic evaluation of polyp size, symptoms, peripheral eosinophil counts, peripheral and local IL-5 levels, eotaxin levels, and eosinophil cationic protein levels. RESULTS: We demonstrated that a single injection of reslizumab up to 3 mg/kg is safe and well tolerated. Blood eosinophil numbers and concentrations of eosinophil cationic protein were reduced up to 8 weeks after treatment in serum and nasal secretions. Individual nasal polyp scores improved only in half of the treated patients for 4 weeks. Responders had increased IL-5 concentrations in nasal secretions at baseline compared with nonresponders, and logistic regression analysis revealed that increased nasal IL-5 levels (>40 pg/mL) predict the response to anti-IL-5 treatment. CONCLUSION: A single injection of anti-IL-5 reduces the size of nasal polyps for 4 weeks in half of the patients, and nasal IL-5 levels predict the response to anti-IL-5 treatment. CLINICAL IMPLICATIONS: Intravenous administration of a humanized anti-human IL-5 mAb is safe and reduces the size of nasal polyps in half of the patients.

Adolescent↗

PubMed2005

5-Oxo-6,8,11,14-eicosatetraenoic acid is a potent chemoattractant for human basophils.

BACKGROUND: 5-Oxo-6,8,11,14-eicosatetraenoic acid (5-oxo-ETE) is a chemoattractant for eosinophils and neutrophils, and the messenger RNA for its receptor, the oxo-eicosatetraenoic acid receptor (OXE), has been detected in several tissues. OBJECTIVES: This study aimed at clarifying the role of 5-oxo-ETE in the regulation of basophil function. METHODS: Basophil responses were determined in assays of flow-cytometric shape change, Ca(2+) flux, chemotaxis, and histamine release. Messenger RNA for OXE was detected by real-time PCR. RESULTS: We observed that human eosinophils were 3 to 10 times more sensitive to 5-oxo-ETE than neutrophils in flow-cytometric shape change and Ca(2+) flux assays, as estimated from the half-maximal responses of the cells. Basophils responded to 5-oxo-ETE in the shape change assay with a sensitivity similar to that of eosinophils. 5-Oxo-ETE was a weak inducer of Ca(2+) flux in basophils and did not cause histamine release but was a highly effective chemoattractant for basophils in the low nanomolar concentration range in a pertussis toxin-sensitive manner. In agreement with these functional studies, the messenger RNA for the 5-oxo-ETE receptor, OXE, was detectable in basophils as in monocytes, eosinophils, and neutrophils, but not in fibroblasts. Specimens from sinus mucosa, tonsils, and adenoids also contained detectable levels of messenger RNA for OXE. CONCLUSION: Our data suggest that 5-oxo-ETE is potentially involved in the regulation of basophil recruitment and might hence be a useful therapeutic target in atopic disease.

Arachidonic Acids↗

PubMed2005

Endoscopic resection of juvenile angiofibromas--long term results.

OBJECTIVE: To evaluate the long term outcome after endoscopic endonasal resection of juvenile nasopharyngeal angiofibromas (JNA). METHODS: Retrospective study of a series of 21 consecutive patients undergoing endoscopic resection of JNA (type I - IIIa according to Fisch) at two Hospital Centers between 1993 and 2002. Mean follow-up was 51.7 months (range 5-120). Extension to the medial aspect of infratemporal fossa and retromaxillary space was no contraindication against an endonasal endoscopic approach. In three cases of type IIIa tumours a computer assisted intraoperative guiding system was applied (ENTrak, GE Medical, Lawrence, USA). RESULTS: Fifteen patients (71.4%) were free of disease after one endoscopic resection. Three patients (14.3%) had an unmistakable recurrence with the need for further treatment at 6, 14, and 23 months, respectively. Two of the three recurrent tumours have been successfully resected endoscopically, one case was treated with gamma knife. In three patients (14.3%) postoperative MRI showed localized enhanced signal, presumably minimal persistent tumour tissue. Without further treatment all of these patients remained free of symptoms and MRI follow up showed no tumour growth over three, five and ten years, respectively. No postoperative long term sequela was observed. CONCLUSIONS: Resection of nasopharyngeal angiofibromas type I-IIIa can be safely achieved endoscopically. The advantage of this minimally invasive technique is avoidance of external scars and low morbidity. The intraoperative computer assisted guiding system ENTrak was highly accurate and provided substantial help in selected cases.

Adolescent↗

PubMed2003

Case report of bilateral cervical chondrocutaneous branchial remnants.

Cervical chondrocutaneous branchial remnants are rare and not well known lesions. Histologically the lesion per definition presents as a Choristoma. Choristoma is the pathohistological term for a developmental tumor-like anomaly consisting of tissues foreign to the site at which it is located. Treatment is complete surgical removal as promptly as possible in order to get an exact histopathological diagnosis. A case of a 4-month-old boy with cervical chondrocutaneous branchial remnants anterior to the sternocleidomastoid muscles on both sides is presented. According to literature search this appears to be the second case published on such a bilateral lesion.

Abnormalities, Multiple↗

PubMed2003

'Eosinophilic fungal rhinosinusitis': a common disorder in Europe?

OBJECTIVES/HYPOTHESIS: The traditional criteria for the diagnosis of allergic fungal sinusitis include chronic rhinosinusitis, "allergic mucin" (mucus containing clusters of eosinophils), and detection of fungi by means of histological examination or culture. In 1999, a group of Mayo Clinic researchers, with a novel method of mucus collection and fungal culturing technique, were able to find fungi in 96% of patients with chronic rhinosinusitis. Immunoglobulin E-mediated hypersensitivity to fungal allergens was not evident in the majority of their patients. Because the presence of eosinophils in the allergic mucin, not a type I hypersensitivity, is probably the common denominator in the pathophysiology of allergic fungal sinusitis, the Mayo Clinic group proposed a change in terminology from allergic fungal sinusitis to eosinophilic fungal rhinosinusitis. Using new techniques of culturing fungi from nasal secretion, as well as preservation and histological examination of mucus, we investigated the incidence of "eosinophilic fungal rhinosinusitis" in our patient population. STUDY DESIGN METHODS: In an open prospective study nasal mucus from patients with chronic rhinosinusitis as well as from healthy volunteers was cultured for fungi. In patients, who underwent functional endoscopic sinus surgery, nasal mucus was investigated histologically to detect fungi and eosinophils within the mucus. RESULTS: Fungal cultures were positive in 84 of 92 patients with chronic rhinosinusitis (91.3%). In all, 290 positive cultures grew 33 different genera, with 3.2 species per patient, on average. Fungal cultures from a control group of healthy volunteers yielded positive results in 21 of 23 (91.3%). Histologically, fungal elements were found in 28 of 37 patients (75.5%) and eosinophilic mucin in 35 of 37 patients (94.6%). Neither fungi nor eosinophils were present in 2 of 37 patients (5.4%). CONCLUSIONS: Our data show that the postulated criteria of allergic fungal sinusitis are present in the majority of patients with chronic rhinosinusitis. Either those criteria will be found to be invalid and need to be changed or, indeed, "eosinophilic fungal rhinosinusitis" exists in the majority of patients with chronic rhinosinusitis. Based on our results, fungi and eosinophilic mucin appear to be a standard component of nasal mucus in patients with chronic rhinosinusitis.

Chronic Disease↗

PubMed2003

Pneumatization of turbinates.

OBJECTIVES: To present unusual computed tomography (CT) findings concerning huge pneumatization of turbinates and paranasal sinuses in one patient. In current world literature the authors only found nine reports of pneumatization of inferior turbinates, which, therefore, must be considered an extremely rare anatomical finding. STUDY DESIGN: Case report and literature review. METHODS: Computed tomography findings in a 35-year-old white woman with nasal obstruction are presented; and the authors describe this additional case of pneumatization of an inferior turbinate, as well as other variants. The literature and nomenclature are reviewed. RESULTS: Besides the rare anatomical finding of a pneumatized inferior turbinate, in addition, both patient middle and superior turbinates were pneumatized bilaterally. Frontal and sphenoid sinuses were huge, with pneumatization of the crista galli and the posterior parts of the septum. The floor of the orbit presented with an orbitoethmoid (Haller) cell on one side. Thus, five of the six turbinates present were pneumatized. To the authors' knowledge, no other case of such extreme pneumatization has been published in world literature to date. CONCLUSIONS: Whereas pneumatization of the ethmoturbinals is a frequent finding on sinus computed tomography scans, pneumatization of the maxilloturbinal remains an extremely rare anatomical variant. Pneumatization of ethmoid cells and secondary sinuses is considered an active achievement of nasal and sinus mucosa during fetal development and adolescence. The underlying mechanisms of this process are not yet understood. The inferior turbinate is the least likely to present with pneumatization. In clinical practice, the pneumatization status should well be studied on the scans before any sinus and turbinate surgery is undertaken.

Adult↗

PubMed2003

Bipolaris spicifera causes fungus balls of the sinuses and triggers polypoid chronic rhinosinusitis in an immunocompetent patient.

We report the rare case of a 19-year-old immunocompetent male suffering both from fungus balls of the sinuses and from chronic rhinosinusitis with massive polyposis. Endoscopic sinus surgery revealed grayish brown necrotic masses embedded in viscous eosinophilic mucus. Inoculated onto petri dishes, these masses as well as the mucus grew a dark pigmented fungus, which was identified as Bipolaris spicifera.

Adult↗

PubMed2002

Nasalance changes after functional endoscopic sinus surgery.

Forty adult patients diagnosed with chronic rhinosinusitis who underwent functional endoscopic sinus surgery (FESS), were analyzed with respect to postoperative resonatory voice changes. For evaluation the patients were asked about their subjective impression of voice changes using a questionnaire. An objective assessment was performed by determining the so-called nasalance using the Nasometer (Kay Elemetrics), preoperatively, on the immediate postoperative follow-up (2 days after surgery), and approximately 1 month after surgery. The mean nasalance values increased significantly one month after FESS whereas the immediate postoperative control (2 days after surgery) showed a decrease of nasalance. Although FESS is a minimally invasive procedure, it can change the acoustic characteristics of the vocal tract in the long term and produce a significant increase in nasality. The authors strongly recommend that clinicians inform all patients, in particular voice professionals, about the possible effects of endonasal sinus surgery on voice quality.

Adolescent↗

PubMed2002

Image guided surgery of paranasal sinuses and anterior skull base--five years experience with the InstaTrak-System.

We report on our experience with navigational tools in paranasal sinus and anterior skull base surgery, especially with electromagnetic guidance systems. During the last five years we operated over 80 selected cases with the InstaTrak system from VTI (Lawrence, MS, USA). Applicability and user friendliness were explored. The InstaTrak 3500 employs a Sun Workstation and is a frameless and free-arm and navigation system. Two different suction devices, used as sensors (receivers), and one transmitter are interconnected to this workstation. The position of the tip of the aspirator is displayed as a pair of crosshairs on the screen in axial, coronal and sagittal planes of the patient's CT-scan on the computerscreen online. Our results showed high accuracy-level, usually better than one millimeter and a setup-time less than ten minutes, on average. No additional personnel is required in the OR. We believe that the system enhances efficacy in selected cases like revision surgery, tumor surgery or difficult anterior skull base surgery. However, one should consider that medicolegal responsibility stays always with the surgeon and not with any navigation system.

Austria↗

PubMedDate not supplied

Pre and post functional endoscopic sinus surgery nasal cavity volume assessment by acoustic rhinometry.

UNLABELLED: Acoustic rhinometry is an objective method to determine nasal cavity geometry. The technique is based on sound wave reflexion analysis in the nasal cavity, and determines crossectional areas as a function of distance as well as volume. AIM: The purpose of this study is to analyse nasal cavity volume changes caused by functional endoscopic sinus surgery (FESS) in adults with chronic rhinosinusitis by acoustic rhinometry, and to correlate these changes with improvements in the sensation of nasal obstruction. MATERIAL AND METHOD: Forty patients aged from 18 to 73 years were prospectively evaluated between August and October 1999 at the Graz University Hospital, Austria. All patients were diagnosed with chronic rhinosinusitis, and undertook acoustic rhinometry before and after FESS. SCIENTIFIC DESIGN: A clinical prospective study. RESULTS: The nasal cavity total volume increased significantly after surgery. Nasal obstruction was improved in 88% of the patients, 20% with partial improvement and 68% with total improvement. There was no correlation between volume increase and improvement of the sensation of nasal obstruction. CONCLUSION: Total nasal cavity volume significantly increased after surgery; however, there was no correlation between volume increase and improvements of nasal obstruction. No significant pre or postoperative increase in total nasal cavity volume after decongestion were observed.

Adolescent↗

PubMedDate not supplied

Fungi: a normal content of human nasal mucus.

BACKGROUND: In recent studies, we showed that 91.3% of both CRS patients and healthy controls grew positive fungal cultures out of their nasal mucus, which therefore appears to be a common finding within the adult population. However, it still was unknown as of when fungi could be cultured from nasal mucus in human beings. We attempted to ascertain this point of time in the nasal mucus of neonates. METHODS: We examined nasal mucus from 30 neonates immediately after birth, on the 1st and 4th day postpartum and after 2 and 4 months of life. The samples obtained with sterile cotton swabs were cultured on agar plates. Fungal cultures were identified either conventionally by microscopy or with molecular techniques. To prove possible contamination during birth, mucus of the maternal birth canal was examined as well. RESULTS: In 6 of 30 (20%) of our neonates we found positive fungal cultures immediately after birth in (3 of them Candida albicans) most likely because of contamination passing the maternal birth canal. In 2 of 29 (7%) of our neonates, positive fungal cultures were obtained on the 1st day postpartum, and in 4 of 26 (15%) positive fungal cultures were obtained on the 4th day, all limited to 1 day only and without clinical symptoms of colonization. After the 2nd month of life, examination of nasal mucus yielded positive fungal cultures in 8 of 11 (72%), and after 4 months examination of nasal mucus yielded positive fungal cultures in 17 of 18 (94%) of our babies, with a wide array of different species. CONCLUSION: Fungi can be cultured from nasal mucus as soon as contact with the environmental air exists but they are not persistent in the 1st day of life. However, after 4 months, the situation is similar to the one in adults: fungal cultures can be obtained from almost everyone's nose. Therefore, fungi must be considered a normal content of nasal mucus.

Age Factors↗