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Biomedical subjects

R Jankowski

Publications and source records attributed to R Jankowski.

At least 73 records · Page 4Linked to original sources
PubMed1992

[Spontaneous subarachnoid hemorrhage in pregnancy].

Subarachnoid haemorrhage from an intracranial aneurysm or arteriovenous malformation is a grave complication of pregnancy. The authors analyzed 11 cases of verified subarachnoid haemorrhage during pregnancy from 10 identified and 1 unidentified cerebral vascular malformation. The aneurysms were responsible for subarachnoid haemorrhage in 6, and arteriovenous malformation in 4 patients. We conclude that the decision to operate after subarachnoid haemorrhage during pregnancy should be based upon neurosurgical principles, whereas cesarean delivery should be done in every pregnant patient with subarachnoid haemorrhage.

Adult↗
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↗
PubMed1992

[Conservative operative procedure in surgery of the spine].

An operative treatment within the spine due to the traumatic, neoplastic, vascular or other indications frequently result in complications as disturbance of the shape, flexibility, strength, mobility of the spine and injury of neural structures of a various degree. These complications may be prevented by minimizing surgical injury to the bone, ligaments, nerves and vessels and by adequate intra- and postoperative stabilization of the spine. The management will be effective only if the level, range and type of injury as well as spine tolerance against mechanical loads is diagnosed accurately. The authors included case reports.

Adult↗
PubMed1991

[Insufficiency of ethmoidectomy in the treatment of nasal polyposis].

The authors report 100 ethmoidectomies performed on 50 patients between 01/87 and 09/89. 75% have been treated anteriorly by systemic corticosteroids. 65% have had prior sinus surgery. Follow-up time ranged from 12 to 34 months (mean: 18 months). A regular treatment with intranasal steroid sprays was taken post-operatively by 96% of patients until three months and 48% until 18 months. 72% of patients considered the symptoms relief as satisfactorily (score of satisfaction greater than 8/10). Severe nasal obstruction, noted in 88% cases pre-operatively, reappeared in 26% 18 months post-operatively. Anosmia, encountered in 72% pre-operatively, disappeared post-operatively in one half of the cases with a good conservation of olfaction 18 months later. Anterior and/or posterior rhinorrhea, sneezing were also satisfactorily controlled. Results on facial pain were not significant. Endoscopic evaluation was performed by a physician who was not the surgeon. A normoplastic mucosa covered the ethmoid cavities in 40%. Localized oedema was observed in 38%. An asymptomatic recurrence, discovered on endoscopic examination, was present in 11%. The symptomatic recurrence rate was 11%. A CTscan control, performed the day of the endoscopic examination and analysed few weeks later, reinforced the degree of objectivity. A complete marsupialization of the ethmoid labyrinth without any remaining cell was confirmed in only 30%. Frequence and aspects of the opacities in the great sinuses were the same pre- and post-operatively. So, this study shows that the insufficiencies of the ethmoidectomy are 1) the difficulty to perform a complete marsupialization of the ethmoid 2) persistent opacities in the great sinuses 3) persistence of the mucosa disease after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Cortex Hormones↗
PubMed1991

[Rhino-sinusal immunology].

Nose and sinus pathology is frequently related to a chronic inflammation, the mechanisms of which involve different cell types that form the MALT, or effector cells. B-lymphocytes are three times more numerous than the T-lymphocytes, where the CD4+ cells predominate over the CD8+ cells. IgA's are mainly secreted by the plasmocytes. In IgA deficiency, a relative increase in IgG or IgD plasmocytes has been recorded. Antigenic information is obtained from cells presenting the antigen. Langerhans-like cells have been described. Two different populations of mast cells have been identified, whilst on the contrary eosinophilic cells are normally absent. The particularities of capillary vascularization and the extent of the nerve fibre network contribute to the creation of a micro-environment interacting with the lymphocytes. The phenomena of cellular interaction are described through the dynamic evolution of the IgE-dependent response in allergic rhinitis.

Humans↗
PubMed1991

[Clinical and pathogenic aspects of NARES (non-allergic rhinitis with eosinophilic syndrome)].

Non-allergic rhinitis with eosinophilic syndrome (NARES) accounts for 14% of rhinitis. It is defined by a syndrome of nasal hyper-reactivity over more than three months, the absence of any atopic factor, and an eosinophilia of nasal secretions 20% greater than the leukocytes. The main features are evidenced by the authors on the basis of 20 observations. The symptoms are significantly more marked than in other forms of rhinitis. Olfactive disorders occur very frequently. The symptoms often fail to respond to anti-histamines and even corticoids. The frequency of a micropolyposis starting in the meatus is confirmed by endoscopy and a CT-scan reveals the frequency of hyperplasia of the sinusal mucosa (affecting first and foremost the ethmoid cells). Hyperadrenergy is frequently evidenced by papavenire IDR and by the isoprenaline IV test. Two cases revealed the coexistence of an intolerance to aspirin and a bronchial hyper-reactivity, evidenced by the Carbachol test. The histological and immunofluorescent examination of the pituitary mucosa evidenced an eosinophilic infiltration in 40% of cases. This infiltrate is often labelled by the BB10 monoclonal antibody. The evolution of NARES appears to involve three stages: secretory eosinophilia with a healthy mucosa, eosinophilic mucosa infiltration, and in situ activation of the eosinophils. An evolution towards an eosinophilic PNS and then a triad was observed in two cases. Hopothèses are put forward by the authors to explain the local nasal influx of eosinophils.

Chronic Disease↗
PubMed1990

Drug assay in ground tissues: example of ketoprofen diffusion into tonsillar tissue.

Ketoprofen was assayed in tissues of surgical patients after mechanical grinding of the tissue in liquid nitrogen; the fine powder obtained allowed the drug to be determined by HPLC in the same way as for liquid samples. The method was applied to the study of ketoprofen diffusion into the tonsillar tissue of 15 patients after a single intramuscular injection of ketoprofen (100 mg). A correction was made for blood contamination after hemoglobin determination.

Adolescent↗
PubMed1990

[Which approach should be chosen for inverted nasosinusal papilloma?].

Inverted papillomas are a benign tumors arising from the external wall of the nasal cavity. Sinus extension is easy to evaluate pre-operatively by using the CT-scan. Lateral rhinotomy is therefore not the only way to removing these tumors. Vestibular and endonasal approaches can be considered. Surgical treatment must however remove the tumor tissue completely since recurrence results directly from insufficiency and must be completed by an histological analysis of the whole tissue after its removal in view of its frequent association with carcinoma.

Humans↗
PubMed1990

[Immunohistology of polyps of the nose and paranasal sinuses. Physiopathologic value].

The pathophysiology of nasal polyposis is yet unclear, but chronic disturbances of the inflammatory pathways may be suspected. Immunological investigations were performed in 3 series of patients: 37 with nasal polyps, 22 with chronic sinusitis, and 15 controls with healthy nasal and sinusal mucosa. Patients with nasal polyps had up to ten times more eosinophil density than patients with sinusitis or healthy mucosa. The average of mast cells and IgE or IgA, M, G plasma cells were not different in the various group. Deposited immune complexes were always absent. These results gave us the opportunity to discuss recent pathogenic theories.

Adolescent↗
PubMed1989

[NARES syndrome. A developing link in the Fernand-Widal triad].

The NARES is a new entity in rhinology. The incidence is more than 15% among all types of rhinitis. The clinical picture is a somewhat variable nasal hyper-reactivity, with frequent hyposmia. Three cases are recorded, which fit for classical criteria of diagnosis: negative allergic tests, more than 20% of local eosinophilia. The authors point out the absence of variation of eosinophilia after nasal challenge with an extract of house dust mite D. Ptéronyssinus. Nasal endoscopy and the computerized tomography show a propensity towards micropolyposis in 2 cases. A bronchial hyper-reactivity to carbamylcholine is detected twice. A cutaneous intolerance to aspirin is proved in one case. A state of adrenergic hyper-reactivity is established in the three patients. The authors suggest that NARES is precursor of the aspirin triad. A dysfunction of the autonomic nervous system, characterized by an adrenergic hyper-reactivity, leads to a neurogenic inflammation of the nasal mucosa. Eosinophils are attracted, and infiltrate the mucosa. Then the eosinophil-derived chemical mediators maintain a chronic inflammatory state. The best therapeutical means are discussed.

Adult↗
PubMed1989

Immunohistological characteristics of nasal polyps. A comparison with healthy mucosa and chronic sinusitis.

Immunohistological investigations were performed on a series of samples from 37 patients with nasal polyps, 22 with chronic sinusitis, and 15 controls with healthy nasal and sinusal mucosa. Mean numbers of plasma- and mast cells were not different in the various groups. Immunoglobulin isotypes were always predominantly IgA and IgM; IgE were scarce. Deposited immune complexes were always absent. A statistically significant difference, however, was observed in the number of eosinophils within the mucosa. Patients with nasal polyps had up to ten times more eosinophils per surface unit than patients with sinusitis or healthy mucosa.

Adolescent↗
PubMed1987

[New tympanomastoid repair in open technics: Galea's flap].

After an anatomical review, the authors describe the method for obtaining the temporo-parietal facial flap and its particularities in the rehabilitation of the canal down technic. The main indications of this flap are: the rehabilitation of unstable cavities, a Palva's flap alternation, a solution to the filling up after petrectomy or enlarged canal down technic.

Ear, Middle↗