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Biomedical subjects

M Wayoff

Publications and source records attributed to M Wayoff.

At least 19 recordsLinked to original sources
PubMed1992

[Medicolegal implications of sinus surgery].

Possible sinus surgery complications are reviewed. The difficult anatomy and its relationship with the orbit, the optic nerve and the olfactory fossa are the main reason of complication. However by technical improvement of imaging and endoscopy, as well as by surgical skill refinement the complication rate decreases. In the patient's interest, and to avoid medico-legal suits, some recommendations are suggested.

Diagnostic Imaging↗
PubMed1992

[Local immunologic system of the nose and paranasal sinuses].

The mucus membranes of the nasal chambers may be compared to a local immune system which has been called the NALT. The submucosa contains a lymphoid infiltration of T-helpers, T-suppressors and a set of plasma cells capable of synthetizing four IgG subgroups, IgM, IgA and IgD. The IgA plasma cells are most numerous. There is no local synthesis of IgE. Macrophages and langerhans' giant cells are present. The epithelium is an immunological entity which is composed, in addition to secretory cells, of uliated cells, lymphocytes, and M cells. The epithelium is able to synthesize secretory component and allows the transport of IgA and IgM into the secretions. The NALT has multiple immunological functions: antigenic information, humoral immune response, and expression of local cellular immunity. Modifications in T lymphocyte subpopulations are observed in allergic rhinitis. Secreted interleukins modify the local efflux and affluence of effector cells (mastocytes and eosinophils). Abnormalities of the NALT are characteristic of deficiency in humoral IgA and IgG subgroups. The possible presence of alterations of cellular immunity in chronic rhinosinusitis has been suggested.

Humans↗
PubMed1992

NARES: a model of inflammation caused by activated eosinophils?

Twenty patients were selected on the basis of perennial rhinitis, the absence of allergy and with an eosinophil count higher than 20% of total leucocytes in nasal secretions (NARES). Nasal endoscopy with biopsies from the middle turbinate and sinus CT were performed. Biopsies were processed for histological examination and for immunofluorescence. The clinical progress during treatment was scrutinized. An acute congestive aspect of the nasal mucosa was noted in 4 cases, and micropolyposis in 9 cases. Sinus CT showed opacity of the ethmoidal cells in 87% of cases (maxillary sinuses: 75%; frontal sinus: 46%; sphenoidal sinus: 31%). An eosinophilic infiltrate of the nasal mucosa was constituted in 9 cases: In 6 cases, the cells expressed the Fc epsilon RII receptor, recognized by the monoclonal antibody Bb10. Anti-H1 drugs usually failed to result in a clinical improvement and local eosinophilia was not changed. Local corticoids were more effective but not sufficient in some cases, so that oral corticotherapy was needed. Ethmoidectomy was performed in three cases. NARES seems to evolve in three stages: (1) migration of eosinophils from the vessels to the secretions; (2) retention of eosinophils in the mucosa which might be linked to activation of unknown origin; (3) nasal polyposis. Numerous interactions between irritation of the epithelium, release of substance P, and eosinophils, lead to the hypothesis of a neurogenic origin of NARES.

Adult↗
PubMed1992

Incidence of medico-surgical treatment for nasal polyps on the development of associated asthma.

The surgical treatment of nasal polyps (in asthmatic patients) is still controversial today because of the contradictory, inconsistent, and unforeseen results reported in the literature. The 50 patients included in this study (mean age 49 years, range 25-67 years) came for a check-up on an average of 18 months (lower limit 12 months, upper limit 40 months) after a radical endoscopic intranasal ethmoidectomy. Thirty patients suffered from polyps and bronchial hyperreactivity; 12 patients in this group also suffered from aspirin intolerance. Twenty patients suffered from nasal polyps alone, and served as a control series. The following parameters were methodically noted relative to the date of ethmoidectomy: 1) the frequency of attacks and possible intervals of respiratory difficulty, pre- and postoperatively; 2) the basic treatment for the asthma, and the difference in size of the therapeutic doses necessary and/or the elimination of one or more therapeutic classes; 3) bronchospasticity, evaluated pre- and postoperatively by auscultation for wheezing and peak flow measurements. A bronchial challenge with carbamyl choline and a four-doses aspirin challenge over two days (10 mg, 50 mg, 100 mg, 400 mg) were carried out pre-and postoperatively in the absence of contra-indications. Ninety-one per cent of the patients have improved and now live in less discomfort. The factors studied show a lower frequency of attacks, a distinct decrease of respiratory difficulty, less need for anti-asthmatic medication and especially less oral corticoids, and a marked improvement in functional respiratory test. The carbamyl choline test confirms these data and even shows the totally reversible nature of nonspecific bronchial hyperreactivity in 30% of these patients. This series is too limited for us to say that intolerance to aspirin is reversible; perhaps only the reactivity threshold changes. In the 20 subjects with nasal polyps alone, no case of asthma have been recorded since the operation. Improvement of the asthmatic condition may be partly dependent upon a global diagnosis and treatment of the patient by the pneumo-immunoallergologist and the ENT-specialist. However, the nature of the surgical act seems to be of prime importance, and we must insist on the need for a radical marsupialization of the paranasal sinuses.

Aspirin↗
PubMed1992

[Hypersensitivity accidents to thrombin following the use of biological glues].

Biological adhesives are made of human plasma and bovine heterologous proteins. These entail a poorly documented risk of sensitization. We report about two allergic accidents caused by the injection of Tissucol in the pituitary mucosa of patients suffering from the Rendu-Osler-Weber disease. The clinical picture of the first case was that of a serum sickness, and leukocytoclastic vasculitis was demonstrated. The second case was a delayed hypersensitivity accident, which was confirmed by the subsequent allergological investigation. Although the responsibility of thrombin seems to be evidenced in these two cases, it nevertheless remains exceptional. However, the risk of sensitization following repeated injections of heterologous proteins in a mucosa with a particularly high immunological responsiveness must be well-known. The increasing use of these biological products will probably result in a growing number of accidents, and we must now contemplate the possibility of screening this sensitization before using biological adhesive. Finally, the possibility of latent sensitization by the ingestion of beef must also be considered.

Aged↗
PubMed1992

[Quantitative cytology of nasal secretions collected by lavage and blowing. Nasal cytometry].

The authors propose a method, simple and practical, for quantitative cytological analysis of nasal secretions. A representative sample of secretions was collected in each nasal cavity by the washing-blowing technic. Homogenization using mucolytics was the first step in the laboratory. After cytocentrifugation and May-Grundwald-Giemsa staining, the light microscope (x 100) was used for the differential leukocyte count. The two factors Friedman's test (sample and experimentation) showed no analytic variability of the measure (p less than 0.05) for the analysed parameters. 534 specimens were obtained on 254 patients and 13 control subjects. All the parameters could be analysed for the two nasal cavities on 127 patients (47.6%), for only one nasal cavity on 62 patients (23.2%), at all 189 positive results (70.8%). The mean volume collected after a 7 ml washing-blowing test was 5 ml. The total leukocyte count varied between 6,833 +/- 1,424 and 44,638 +/- 31,226 per ml in the control group, between 125,246 +/- 36,108 and 498,245 +/- 367,328 per ml in the patient group. The mean eosinophil count varied between 0.3 +/- 0.2% and 1.3 +/- 0.8% in the control group, between 15.1 +/- 2.4% and 18.2 +/- 2.6% in the patient group. The neutrophil count was over 90% in the control group, between 75 and 80% in the patient group. The mean lymphocyte count was about 5% in the two groups, the monocyte count about 1%. So the washing-blowing technic enables a quantitative analysis of nasal secretions. Nasal cytometry seems to be an interesting method for studying the inflammatory secretory cells compartment.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1992

[Cytometry of nasal secretory eosinophilia].

Nasal secretory eosinophilia was evaluated in inflammatory chronic rhinitis by a cytometric method. Thirteen control subjects and 97 patients (nasal polyps = 44; chronic sinusitis = 26; chronic rhinitis = 27) took part in this study. Secretory eosinophilia was low in the control group (0.3 +/- 0.2 to 1.3 + 0.8%), compared to: 13.8 +/- 8.2 to 15 +/- 7.6% in idiopathic chronic rhinitis, 16.3 +/- 7.3 to 22.7 +/- 10.2% in perennial allergic rhinitis, 18.5 +/- 6 to 25.3 +/- 6.1% in nasal polyps, 23.1 +/- 1.1 to 25.9 +/- 8.6% in nasal polyps with asthma, 27.3 +/- 7.1 to 30.3 +/- 7.8% in aspirin triad. The NARES syndrome was clearly individualized with a secretory eosinophilia between 48 +/- 16.9 and 58.8 +/- 10.7%. Nasal cytometry is a new method that confirms the role of secretory eosinophilia as an interesting marker in the study of inflammatory chronic rhinitis. Nevertheless reference values would be established only after a better knowledge of cell kinetics in nasal secretion under normal and pathological conditions.

Chronic Disease↗
PubMed1991

Immunohistologic analysis of the cholesteatoma matrix in children.

The immunohistological characteristics of retraction pockets, cholesteatoma matrix and granulomatous tissue were compared in 14 samples from pediatric cholesteatoma. The junction between epidermis and the middle ear mucosa appeared as the most inflammatory area, displaying the characteristics of delayed type hypersensitivity. CD1 + Langerhans cells were observed in all epidermic areas, but expressed class II molecules only in the vicinity of polymorphonuclear infiltrates. Numerous mast cells and IgA producing cells were also observed, suggesting that defenses from the mucosal immune system are summoned and contribute to the pathogenesis of cholesteatoma.

Adolescent↗