Archives of oto-rhino-laryngology最新文献

Dissociated human nasal epithelial cells from nasal polyps were cultured in Ham's F12-DME 1/1 supplemented with NU-serum 10%, choleratoxin (10 ng/ml), retinoic acid (10(-7) M) and antibiotics. In monolayer cultures, the epithelial cells grew to confluency on collagen gels, became squamous, and lost their cilia within 2-6 weeks. In suspension cultures, epithelial cell sheaths formed stable vesicles and aggregates. These maintained a respiratory-type morphology and normal ciliary activity for over 6 months. When deciliated, squamous cells from monolayer cultures were brought in suspension, a respiratory-type morphology with cilia reappeared. This in vitro ciliogenesis resulted in normal and coordinated ciliary activity observed for more than 5 months.

Fiberoptic bronchoscopy was carried out in 17 consecutive AIDS patients with suspected opportunistic infections. A total number of 23 bronchoscopies were performed and a comparison was made about the effectiveness of the available diagnostic techniques, which included bronchoalveolar lavage, transbronchial lung biopsy and bronchial brushings. The most common cause of pulmonary parenchymal disease was Pneumocystis carinii (7 patients). In 6 of these HIV-positive patients the detection of infection was decisive in making a diagnosis of AIDS. The most effective procedure for diagnosing P. carinii pneumonia was transbronchial lung biopsy (5 patients), while bronchoalveolar lavage and bronchial brushings showed P. carinii and 5 and 4 patients respectively. Complications were minor and occurred only in those patients subjected to transbronchial biopsy. Our findings showed that transbronchial biopsy has the highest yield in the diagnosis of P. carinii infection. When all diagnostic components of the bronchoscopic procedures are carried out, very few cases with these infections should be missed.

We report a retrospective study of 161 cases of vestibular or epilaryngeal cancer treated by horizontal laryngectomy. The different factors affecting prognosis were analyzed statistically. Three groups were distinguished according to the size and primary site of the tumor: (1) a group with a very poor prognosis, which included patients with large tumors of the epilarynx; (2) a group with an average prognosis, which included small tumors of the epilarynx and large tumors with their primary site in the vestibule; (3) a group with a favorable prognosis which included tumors classified as T1 or T2 that were initially located in the vestibule.

The authors report their surgical experiences with 55 extensive tumours of the pharyngoesophageal junction. Thirty-three of these cases were managed by circular pharyngolaryngectomy, total oesophagectomy with stripping and left coloplasty, and 22 were treated with circular pharyngolaryngectomy with free intestinal transplants. A comparative study of the post-operative courses of the patients and their oncological and functional outcomes shows the advantages, disadvantages and indications of these two techniques.

The necessity for direct observation of the pharyngeal outlet of the normal or pathological eustachian tube has always stimulated research for suitable diagnostic instruments. As the result of various investigation procedures currently available, we performed a series of endoscopic screenings using both the Hopkins telescope and the fiberoptic rhinopharyngolaryngoscope. The present study aimed at evaluating and demonstrating the morphological and dynamic functional condition of the pharyngeal outlet of the tube. The present investigation was carried out on 60 males and females, ranging in age from 4 to 70 years. Inspection of the pharyngeal outlet of the tube and its adjoining region enabled us to document some of the various causes for tubal dysfunction. By visualizing tubal movements, endoscopy also made it possible to perform a dynamic study of tubal functions. However, the investigation procedure utilized did not allow us to record any significant differences between the two diagnostic instruments used, except that the fiberscope can be more easily handled, whereas the photographs taken with the telescope are of better quality.

The records of 14 patients who have benefited from intralaryngeal injections of ZCI collagen for at least 3-4 years were reviewed. All patients still living were evaluated. Qualitative phonatory measurements included laryngostroboscopy and frequency voice analysis, while quantitative studies included maximum phonation times and phonatory quotients. The absence of both local and general inflammatory reactions was observed in these patients, confirming the excellent host tolerance of ZCI collagen and the stability of the functional results achieved.

Various conservative and surgical procedures are available for the management of aggressive hemangiomas in infancy and childhood. One of them is magnesium seeding, a treatment modality developed more than 90 years ago but neglected for a long time. The technique consists of implanting 0.5- to 1-mm-thick wires of 99.8% pure magnesium into the tumor mass. During repeated courses oxidation of the metal results in fibrosis and cicatricial transformation of the tumor. Indications, technique and results are discussed.

The olivocochlear innervation has been postulated to regulate active mechanical processes in the mammalian cochlea. Histochemical studies led to the suggestion that a subpopulation of these efferent nerves, which predominantly terminate on outer hair cells (OHCs), are gamma-aminobutyric acid (GABA)-ergic. By means of two monoclonal antibodies, we were able to visualize GABAA-receptor immunoreactivity at the basal pole of isolated sensory cells. Both subunits of the GABAA receptor, the alpha- and beta-subunit, are known to form the transmembranous GABA/benzodiazepine-receptor complex and were present on OHCs. In addition, these inhibitory receptors were more numerous in the apical turns of the cochlea, indicating another criterion for distinguishing the apical from basal turns of the cochlea. These results support the concept that a subpopulation of axosomatic synapses at the basal pole of OHCs liberate the inhibitory neurotransmitter GABA into the synaptic cleft. Binding of the transmitter to these newly observed subsynaptic receptors is possibly followed by a change in OHC motility and a subsequent modulation of the movement of the basilar membrane.

Different techniques and materials used in the surgery of chronic otitis media have been evaluated in a large clinical experience at Semmelweis University, Budapest. Data from 1572 operations performed during the last 5 years (1983-1988) are summarized. In the 870 non-cholesteatomatous processes (55.3%), mastoidectomies and tympanoplasties were performed, with the latter primarily using temporalis fascia and cortical bone. Out of the 250 cholesteatoma cases (15.9%), one-fourth was solved by a primary wall-up technique followed by a second stage revision and tympanoplasty within 1.5 years later.

Tympanoplasty can cause a sensorineural hearing loss by a mechanism of acoustic trauma. Although this lesion appears to be relatively infrequent in clinical practice, we believe that its low apparent incidence is caused when clinicians fail to assess the auditory frequencies above 8000 Hz. Twenty-four patients with normal bone-conduction audiometric thresholds scheduled for tympanoplasty were assessed with an electro-stimulation, bone-conduction high-frequency audiometer which can measure hearing frequencies up to 20 kHz before and after surgery. A measurable hearing loss was found in the upper limits of the audible frequencies in 9 patients (37.5%), and was considered important in 4 of them (16.7%). This hearing loss was recorded above the upper frequency limit of conventional audiometers. The findings in this study indicate that drilling of the temporal bone can impair the hearing level in the high frequencies in a significant number of patients. High-frequency audiometry is a very sensitive tool to assess any damage caused to the inner ear by surgical procedures carried out in the middle ear and temporal bone.