Archives of oto-rhino-laryngology最新文献

Since 1950 many animal radiotracer experiments have been performed to study inner ear kinetics. For the most part in these studies, radionuclides were applied systemically, following which a discontinuous probing of inner ear fluids or of inner ear tissues was done. Two techniques have been developed in the Section for Experimental Otorhinolaryngology of the University of Würzburg. These have been adapted to the direct and continuous measurements of inner ear efflux kinetics for several hour periods. For this purpose, only a tiny amount of radiotracer need be applied directly to the inner ear. Experiments were done on the anesthetized guinea pig as an animal model. In the first technique, a collimator-detector system is focused precisely on the cochlea, which had been quickly resealed after application of the radionuclide bolus via two small holes in the basal turn of the cochlea. The second technique makes use of a perilymph cycling system, whereby a small outer volume includes a microcuvette with a so-called artificial round window. By this latter cycling technique, perilymph clearance kinetics of all kinds of radiotracers--with the exception of tritium labelled ones--can be measured. Calculations from clearance kinetics show that quite small particles with particle weights up to 100, such as the chlorine anion and the potassium cation, as well as urea, glycerol, pyruvate, and lactate, exhibit perilymphatic half-lives varying from 45 to 60 min. These half-live data are plausible in regard to cochlear blood flow measured previously via an independent technique developed by Angelborg et al.(ABSTRACT TRUNCATED AT 250 WORDS)

Verrucous carcinoma of the larynx is quite distinct from well-differentiated squamous cell carcinoma has a characteristic morphology and specific clinical behavior. It accounts for approximately 1%-2% of all laryngeal carcinomas. However, difficulties are encountered clinically in separating verrucous carcinomas from keratoses, verruca vulgaris and squamous cell carcinomas with a verrucous appearance. Between 1962 and 1982, 1504 patients with squamous cell carcinomas of the larynx were diagnosed and treated by staff physicians in the Department of Otolaryngology--Head and Neck Surgery, Washington University in St. Louis. Fifteen of these patients (1%) had verrucous carcinomas. These cases were studied in order to clarify any diagnostic problems, trace the biologic behavior of the tumors and report the results of the treatment used. Of these 15 patients, we were able to follow up 8. The latter had been treated only with surgery and none of them had received radiotherapy. One death occurred, but the patient died of other causes and remained free of cancer. Reports in the literature describe a high rate of recurrence of verrucous carcinomas following radiotherapy with occasional anaplastic transformation of tumors. No patients in our series developed a metastasis in the neck, indicating that neck dissection is not justified for patients with these neoplasms even though clinically enlarged neck nodes may be present.

The cochlear blood flow of normal adult guinea pigs was measured by a laser Doppler flowmeter. The validity of this flowmeter was ascertained by its specificity for blood flow and its sensitivity to blood flow changes. Angiotensin II was infused into the animals and asphyxia was induced. The responses of the cochlear blood flow showed a close correlation with those of the systolic blood pressure. These results suggest a passive aspect in the physiology of cochlear blood circulation. On the other hand, there was a negative correlation between the responses of auricular skin blood flow and those of systolic blood pressure to a certain dose range of angiotensin II. To clarify the specific details of inner ear blood flow, further studies of the hemodynamics of the inner ear blood circulation should be continued under various experimental conditions.

Twenty cases of intrapetrous lesions were studied by a 1.5 T magnetic resonance (MR) unit. In all cases, comparisons were made between MR, CT and clinical findings. Our present material included 9 cholesteatomas, 1 cholesterol cyst, 3 primary epidermoid carcinomas, 2 metastatic neoplasms, 1 glomus jugulare tumor and 4 facial neurinomas. Gadolinium was injected in 7 cases and seemed to be the best method for studying the intrapetrous tumors. MR permitted accurate topographic study and assessment of tumoral extension, as well as a ready demonstration of tumor vascularity. The present findings also showed that MR is not capable of defining small bony detail or calcifications.

Rhabdomyoma is a rare tumor of skeletal muscle origin which can occur in different localizations. The head and neck region is a site of predilection for the adult type. Its absolutely benign behavior makes correct diagnosis crucial. In this study, a case of an extracardiac rhabdomyoma of the larynx was found to recur 12 years after initial treatment. Following its surgical removal, histology showed typical patterns of an adult type of rhabdomyoma with focal cross-striations. Immunocytochemically, all applied muscular markers were positive. Electron microscopy revealed muscular filaments with cross-striations and glycogen granules. These findings showed that immunocytochemistry plays an important role in differential diagnosis and the need for possible further treatment.

Lipid A is a covalently bound component of gram-negative bacterial lipopolysaccharides and is the biologically active component in endotoxin. In order to detect and quantitate lipid A in middle ear effusions (MEE) from patients with otitis media with effusion (OME), antisera against lipid A were produced in mice by repeated immunization with conjugates using lipid A from Salmonella minnesota Re595 and bovine serum albumin. As a result, a competitive enzyme-linked immunosorbent assay (ELISA) was developed that was specific for lipid A. From the ELISA results, 10 out of 15 samples from the serous type MEE (mean, 13.57 +/- 2.17 micrograms/ml) and 5 out of 6 from the mucoid type MEE (17.73 +/- 4.34 micrograms/ml) were positive. These findings indicate that lipid A may contribute to the pathogenesis of both types of human OME.

Differences in prognosis between salivary gland mucoepidermoid tumors and acinic cell tumors were compared by means of conventional histopathological grading and nuclear DNA content which was assessed cytochemically by a scanning cytophotometric procedure. The mucoepidermoid tumors were found to show a stronger correlation between histopathological grading and prognosis than did the acinic cell tumors. By using DNA quantification, valuable additional information could be obtained for predicting the behavior of the mucoepidermoid tumors, whereas there was no correlation between DNA content and prognosis for the acinic cell tumors. Regarding the relatively "benign" clinical course of most mucoepidermoid tumors, the term "tumor"--as proposed by the World Health Organization's classification--seems appropriate. In contrast, the more severe clinical courses of the acinic cell tumors justify the use of the term "carcinoma" instead.

We describe here a technique for reconstruction of the external ear based upon an autogenous costal cartilage graft which is inserted into a cutaneous pocket dissected in the auricular area. Three subsequent procedures are then performed: rotation of the ear-lobe; reconstruction of the tragus; and elevation of the auricle. The ideal age for reconstruction is about 7 years. This technique was originally described by Brent, who has a very extensive experience with this kind of surgery. Skin deficiencies can be overcome by using either a temporo-parietal fascial flap or a skin expander.

A microfluorometric method was used to determine the nuclear DNA content in the nasopharyngeal carcinomas (NPC) of 25 patients treated before 1983. Eleven patients are still alive with no evidence of disease (NED), while the rest died of their disease (DOD). All of the patients received a cycle of radiotherapy, while some also received chemotherapy or neck dissections. The neoplastic cells studied were taken from the original biopsy blocks, deparaffinized, isolated by enzymatic treatment and mechanical fragmentation, and then Feulgen-stained. The cytofluorometric measurement was carried out by a microphotometer equipped for fluorescence excitation and connected to a computer. This method allowed us to construct a histogram of the DNA content in the neoplastic cells. Different neoplastic classes were identified and represent the heteroclonality of the tumor, which can be expressed by the heteroclonality index (HCT). From the collected data it appears that the NED patients all had a low HTC (less than 1) and only 7 of the DOD patients had low HTCs (less than 1). Six of the DOD patients with a low HTC were in advanced stages of their tumor at the time of diagnosis, while the remaining patient did not complete his treatment. Our results show that the DNA analysis of the NPC cell population may offer a useful tool in predicting the biological behavior of this tumor and also improving its treatment.