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Indexed/Abstracted in: EMBASE, Scopus
Online ISSN 1827-188X
Lenzi A., Zaghis A. *, Zerboni R. **
Ospedale Civile di Legnano Presidio Ospedaliero di Magenta *Dipartimento di Scienze Otorinolaringoiatriche e **Istituto di Scienze Dermatologiche IRCCS Ospedale Maggiore Policlinico, Milano
Background. In this study the authors aimed to evaluate the general and local immune status of a group of patients suffering from recurrent phlogistic episodes in the atticoantromastoid surgical cavity to establish whether a possible alteration of the defence immune mechanisms might be responsible for the periodic recidivation and the lack of response to treatment.
Methods. Out of a series of 97 patients suffering from recurrent phlogistic episodes of the atticoantromastoid surgical cavity, a group of 30 patients was identified in whom secretive pousse were particularly frequent and difficult to overcome. The general immune situation and local immune conditions of each patient were assessed to establish whether immune deficiencies might interfere with microbial factors leading to inflammatory recidivation.
Results. The determination of C3-C4 complement fractions and the assay of immunoglobulins were normal in all patients, as was the cytofluorimetric study of peripheral T lymphocytes. The cutaneous response to a multitest showed 6 hypoergic subjects but none who were, anergic. A significant concordance was found between the microorganisms isolated from auricular secretions and cell-mediated, hyposensitivity to the antigens tested. Epicutaneous tests for lhe usual local otological drugs and common haptens (GIRDCA standard series) only revealed three patients who were sensitive to chloramphenicol. Immunohistochemical tests performed on re-epitheliased tissue from the surgical cavity, removed by biopsy, showed numerous CD-positive cells (Langerhans cells), predominantly T-lymphocyte (CD3+) perivascular infiltration, HLA-D at the level of the Langerhans cells, T-lymphocytes and endothelial cells of the dermal plexus.
Conclusions. The results obtained show that the inflammatory sequelae in radicalised patients appear to stem from local disreactivity (cell-mediated sensitivity) in the absence of general immunological alterations.