Archives of oto-rhino-laryngology最新文献

Carbonic anhydrase activity was demonstrated cytochemically on an ultrastructural level in the vestibular end organs of the guinea pig. Reaction product was found in the dark cells, transitional cells, cells of the planum semilunatum and supporting cells. In the dark cells, reaction product was observed in the cytoplasm as well as in the basal infoldings. Reaction product was also observed in the basal infoldings of the transitional cells and the cells of the planum semilunatum. The globular structures inside the supporting cells, transitional cells and the cells of the planum semilunatum were also surrounded by the reaction product. These findings suggest that carbonic anhydrase may have different functions, such as water and ion transport, respiration, nutrition and calcium carbonate deposition in the vestibular end organs.

The authors report their experiences after operating on 279 patients with unilateral acoustic neuromas between 1976 and 1988, with 258 cases managed by the translabyrinthine approach and 21 cases by the middle fossa approach. The authors emphasize the necessity for total removal in order to avoid recurrences.

The best approach to parathyroid removal in primary hyperparathyroidism (HPT) is still a major topic in neck surgery. The present report reviews our experiences with 71 patients operated by parathyroidectomy (PTX) between 1978 and 1987. Preoperative computed tomography, sonographic and double-tracer subtraction scanning examination allowed a precise assessment of the number and the topography of the diseased glands. Consequently, 65 patients underwent partial "selective" PTX, with removal of one or two glands, while 6 patients underwent subtotal PTX. The surgical results can be summarized as follows: full success in 67 cases (94.4%); persistent hypercalcemic syndrome in 3 cases (4.2%); recurrence of HPT in 1 case (1.4%). One case of persistent hypercalcemia was solved by reoperation. Thus, the total success rate was definitively assessed at 95.8%. As a complication of surgery a long-lasting postoperative hypocalcemic syndrome was observed in only 2 patients following subtotal parathyroidectomy. Our overall findings show that an attentive preoperative study by means of modern imaging techniques usually allows a "selective" partial PTX with good results and a low risk of complications.

The central projections of fibers from the vestibular nerve were studied in 19 chinchillas after horseradish peroxidase labelling. In addition, the limits of the vestibular nuclei and the anatomical characteristics of their neurons were also studied. All five vestibular nuclei received primary afferents, but there were extensive areas of them that received very little or no projections at all, such as the rostral part of the superior vestibular nucleus, the dorsocaudal part of the lateral vestibular nucleus, the caudal half of the medial vestibular nucleus and the caudalmost aspect of the dorsal vestibular nucleus.

This study demonstrates the initial changes affecting the sensory hair-cell plasma membranes in the vestibular end organs of gentamicin-treated guinea pigs by using a ruthenium red staining technique. First, 0.1 ml of a solution containing 5 mg gentamicin sulfate was injected into the middle ear. After 7 days, the sensory hair cell cilia were observed to be degenerating. The various stages of this degeneration process were classified into two types: the decrease in glycocalyx was designated type I fusion, while type II fusion was characterized by a bleb formation of the plasma membrane of the sensory hair cells, followed by a decrease in glycocalyx. The latter mechanism allowed plasma membrane contact, with subsequent fusion of the plasma membrane of neighboring sensory hair-cell cilia. The material also illustrates the degeneration of ciliary actin filaments. These findings suggest that the aminoglycoside affects both the glycocalyx and the plasma membrane, and that the decrease in glycocalyx may be the first sign of sensory hair-cell fusion.

Fifty-three patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN) were treated with a combined modality treatment consisting of three cycles of induction chemotherapy before definitive surgery and/or radiotherapy. Two additional cycles of the same chemotherapy were given after local-regional therapy. The chemotherapeutic regimen included cisplatinum 100 mg/m2 on day 1, 5-fluorouracil 1000 mg/m2 as a continuous infusion on days 2-6, bleomycin 15 units i.m. on days 15 and 29, mitomycin C 4 mg/m2 i.v. on day 22 and hydroxyurea 1000 mg/m2 p.o. on days 23-27. Each cycle was repeated every 42 days. Forty-nine patients are evaluable for response. There were 37 men and 12 women, with a median age of 58 years (range 18-75 years) and performance status of 80 (range 40-90). Sixteen patients (33%) demonstrated a complete response, 20 (41%) a partial response, yielding a 74% response rate to induction chemotherapy; 12 (24%) patients had stable disease and 1 (2%) progressive disease. The actuarial survival of those patients who completed the whole treatment program was 65% at 2 years and 47% at 3 years. Toxicities included nausea and vomiting (66%). anemia (34%), leukocytopenia (54%), thrombocytopenia (22%), stomatitis (36%), diarrhea (10%), alopecia (78%), hear impairment (4%) and transient creatinine elevation (2%). The results of the present study showed that induction chemotherapy with the above regimen produced a high rate of complete responses and can be safely combined with local-regional therapy to improve local tumor control and increase disease-free survival in patients with locally advanced SCCHN.

Laryngotracheal stenosis in children is difficult to manage, especially in cases of acquired lesions. Of 317 cases reviewed, 75 surgical cases are reported here: 28 were congenital and 47 acquired, mostly due to endotracheal intubation. A large variety of laryngotracheoplasty techniques have been used in reconstruction, depending on the age and status of the patient, the size of the laryngeal lumen, the exact site of the stenosis and any associated anomalies. The three main techniques used have been described by Evans, Cotton, and Rethi. Stenting relied on Silastic rolls, Montgomery T-tubes and Aboulker Teflon prostheses. The results in 65 patients showed a decannulation rate of 92% in cases of congenital stenosis and 80% in acquired ones. Improvements in therapy still seem necessary in order to reduce the cannulation time following treatment and the sequelae producing dysphonia.

A review of over a century of publication on laryngeal stenosis reveals much about the aetiology and treatment. The earlier aetiologies of infection and in particular diphtheria of the early part of the twentieth century have given way to more complex and insidious causes. Trauma, particularly from intubation by endotracheal, tracheal or nasogastric tubes, is now the primary cause of simple and complex laryngeal stenosis. The treatments over the past century have been varied and ingenious, ranging from simple dilatation and intubation of the 1800s to galvanocautery, endoscopic scar incision and heated bougienage of the early twentieth century. By the 1930s and 1940s the concept of laryngofissure, scar excision, stenting and skin grafting was the accepted approach to laryngeal stenosis. More recently endoscopic approaches, local flap placement and laser surgery have been advocated. The open approach, however, has stood the test of time. This review presents a comprehensive bibliography and from the reading of these texts a method of classification is presented. This classification is coupled to available modern treatments as described in the literature and so gives the surgeon the available options for the stenosis encountered. The choice remains with the surgeon; however, as in most complex clinical problems there is usually a safe, reliable, dependable procedure, and it is the author's opinion, from this literature review, that the open laryngofissure procedure fulfils these criteria.

We have studied two postmortem human laryngeal specimens after the injection of collagen. The first larynx was removed 14 days after injection, while the second was examined 5 months after injection. The specimens are described macroscopically and microscopically. Excellent tolerance to the collagen was noted, with virtually no inflammatory reaction seen. The collagen injected seems to have been colonized progressively by the host cells and by neovessels. These findings coincide closely with those observed in animal models. In comparison to the inflammatory granulomas found after injections with Teflon, the absence of inflammatory reactions following the use of collagen does at least contribute to justifying its continued application clinically.

In a retrospective study of 2568 patients with peripheral facial palsies seen during a 10-year period, 106 (8.2%) of 1293 patients (50.4%) with Bell's palsy suffered a recurrence. A recurrence at the same side of the face was called a "recurrent" one, but was considered to be an "alternating" one at the other side. Ninety-eight patients (52 men, 46 women) were studied for this report. Of these patients, 70% suffered from a second attack of Bell's palsy within 10 years of the first attack. Fourteen patients had more than one recurrence. Of some note, 33 of the 98 patients had their second palsy in the last months of the year. Recovery of facial function after a recurrent palsy was worse in 39.6% and was 32.1% after an alternating palsy. The recovery after multiple palsies appears to be worse than after a single palsy.