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The nasal cavity displays immune tolerance to commensal bacteria under homeostatic conditions, which is rapidly converted to a pro-inflammatory response upon infection. Yet, the factors that control this conversion are still largely unknown. Here, we provide evidence that Fc gamma receptor III (FcγRIII) stimulation breaks immune tolerance to bacteria in the human nasal cavity through activation of nasal epithelial cells, which are the first line of defense against invading microbes. While under steady-state conditions human nasal epithelial cells were completely non-responsive to Gram-negative bacteria P. aeruginosa or TLR4 ligand LPS, IgG opsonization of bacteria, as occurs upon infection, strongly induced production of pro-inflammatory agents such as IL-6 and IL-8. This breaking of tolerance to bacteria was completely dependent on FcγRIII, which amplified cytokine gene transcription through cross-talk with TLR4. In addition, we identified that epithelial cells from patients suffering from chronic rhinosinusitis with nasal polyps do not display LPS tolerance, thereby providing an explanation for the disturbed host defense responses of these patients. Taken together, these data are the first to identify FcγR expression on nasal epithelial cells, as well as to identify its important role in controlling the balance between tolerance and inflammation in the nasal cavity.

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BACKGROUND: We previously found that allergic rhinitis patients with an isolated pollen sensitization responded more strongly to a nasal provocation with grass pollen (GP) than patients who had an additional house dust mite (HDM) sensitization. To elucidate this phenomenon, we investigated the dynamics of Foxp3+CD4+ T lymphocytes in allergic rhinitis patients with distinct allergen sensitizations. METHODS: Three groups of allergic rhinitis patients with skin prick test confirmed allergic sensitizations were investigated and compared to 14 healthy controls: 14 subjects with an isolated grass pollen sensitization (Mono-GP); 9 subjects with isolated housedust mite sensitization (Mono-HDM); 29 subjects with grass pollen and house dust mite sensitization (poly-sensitized). Subjects in the Mono-GP group were challenged with grass pollen extract, subjects in the Mono-HDM group were challenged with house dust mite extract, subjects in the poly-sensitized group and the healthy controls were randomly challenged with either grass pollen or house dust mite. Nasal biopsies were taken before and after nasal provocation. We compared the distribution of FoxP3+CD4+ cells in nasal biopsies before and after nasal provocation using immunohistochemistry. RESULTS: There was no difference in the number of FoxP3+CD4+ cells between healthy and the three allergic groups at baseline.Nasal provocation did result in an increase in eosinophils in the three allergic groups, but did not result in a change in the number of FoxP3+CD4+ cells in any of the groups or induced differences between any of the groups. CONCLUSION: Clinical differences in the response between mono-GP and multiple-sensitized allergic individuals are not related to differences in the number of regulatory T cells in the nasal mucosa.

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The temperature was recorded during drilling through fresh human cadaveric fingers with thermocouples built in the tips of Kirschner wires. High temperatures up to 190 degrees C were measured. This may contribute to osteonecrosis around the wires and to loosening and infections.

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In a retrospective study the results of 203 interphalangeal and metacarpophalangeal arthrodeses performed between 1977 and 1990 were reviewed. Eighty-three percent of the cases involved severe hand injuries. Two fixation techniques were used. During the early period, 143 arthrodeses were performed with percutaneous Kirschner wires, combined with either interosseous wiring or plaster of Paris. From 1987 to 1990, 60 arthrodeses were performed with the use of tension band fixation. In the Kirschner wire group 18% of the patients had pin-track infections, and in 15% rearthrodeses were necessary. In the tension band group 2% of the patients had an infection, and in 5% rearthrodeses were performed. Both the infection rate and the rearthrodeses rate were significantly lower in the tension band group than in the Kirschner wire group. Judging from this study, the tension band fixation technique is the method of choice for arthrodeses of the small finger joints.

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A group of 46 patients, with stage-1 malignant melanoma of intermediate thickness and histologically proven negative regional lymph nodes, was retrospectively reviewed. The aim of our study was to determine whether the prognosis of these patients had been worsened by the regional lymph-node dissections. There was no influence on the survival or disease-free interval.

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From 1972 to 1983 105 patients were admitted with a dislocated supracondylar fracture of the humerus. The average follow-up was five years. In general the functional results of treatment were good. The anatomical results were less satisfactory, and most times concerned varus deformities of the elbow, which did not influence the elbow function. Lesions of arteries and nerves only occurred in seriously dislocated fractures. The isolated nerve injuries were reversible. Two patients developed a Volkmann's ischemic contracture; their case history is discussed. In 24 cases a second reduction was performed and/or a new therapy instituted. Closed reduction with plaster necessitated alteration of the therapy in 10 out of 23 cases. Based on this experience and the long average duration of hospitalization of 14 days, closed reduction under general anaesthesia with percutaneous K-wire fixation seems to be the treatment of choice.

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