Archives of oto-rhino-laryngology最新文献

To date it has not been possible to work out a standard quantification for single photon emission computed tomography (SPECT). Only one mathematical model has received general recognition, but the theoretical preconditions for this model are not fulfilled by iodine-amphetamine kinetics. A practical solution is offered by semiquantitative analysis. We have developed three computer programs for this analysis for perfusion and cerebral function studies of the symmetrically arranged brain.

Findings in recent years have stressed the importance of research on the target organ in IgE-mediated allergies of the respiratory tract. In this review we have focussed on the nasal secretions (NS) as a contract medium between allergens and the respiratory mucosa. Our findings have demonstrated that NS show different allergen extraction activities in relation to different conditions. Whereas NS of allergic and inflamed noses extracted allergens very rapidly, NS of normal noses showed no extraction activity. Furthermore, it could be demonstrated that the IgE specificities in NS are comparable with those in the serum of individual patients not indicating a local IgE synthesis. The presence and function of basophilic cells and eosinophils and their mediators are discussed in the light of recent studies.

The epidermal Langerhans' cells play an important role in immunological reactions resulting from chronic inflammations of the skin. Recently, S-100 protein, one of the nervous-system-specific proteins, has been shown to be a useful marker for the epidermal Langerhans' cells. We investigated the localization of Langerhans' cells in human cholesteatoma specimens by means of an immunohistochemical method for detecting S-100 protein. A large number of Langerhans' cells containing S-100 protein immunoreactivity were found in the epithelium of the cholesteatoma and also in the subepithelial region. This immunoreactivity was detected both in the cytoplasm of the Langerhans' cells and their dendritic processes along their entire lengths. The number of S-100 positive Langerhans' cells in cholesteatoma associated with otorrhea increased significantly as compared with normal epithelium from the external auditory canal and tympanic membrane, while no increase in the number of S-100-positive cells was recognized in cholesteatoma without otorrhea. The S-100-positive dendritic cells in the cholesteatoma revealed longer and more complexly branched processes than those in normal tissues. These findings suggest that the Langerhans' cells within the cholesteatomatous lesion are responsible for generating and maintaining the chronic immunological reactions in this disease.

Due to the fact that the temporal bone has broad segments of bone anterior to and behind the internal auditory canal which are empty of functionally important structures, a broad exposure of the cerebellopontine angle may be obtained from above. This technique is adequate for the management of acoustic neurinomas up to 3 cm in diameter. A low postoperative morbidity and a high percentage of hearing preservation with total tumor removal were obtained in a series of 190 cases. This report underlines the advantages of the procedure and points to various other indications.

An acute pneumococcal maxillary sinusitis was induced in New Zealand white rabbits by unilateral obstruction of the sinus ostium and then injecting 10(8) Streptococcus pneumoniae into the sinus. After subjecting this bacterial strain to one animal passage, the bacteria were reisolated in nine of ten infected maxillary sinuses. All rabbits developed a unilateral purulent sinusitis, while a non-purulent sinusitis could be induced by occlusion only of the maxillary ostium. By using a non-diffusable tracer, microspheres labelled with Sn113, blood flow measurements were performed on these sinuses. These studies showed that the blood flow of the infected sinuses was significantly higher than on the control side. However, in chronic sinusitis (with a blocked ostium), the blood flow did not differ significantly from that on the control side. Biochemical studies in the animals with purulent sinusitis demonstrated that lactate concentration in the mucosa was significantly higher as compared to the control side. The glucose concentration was significantly lower in the mucosa of the infected side, as was the ATP content of the sinus mucosa in purulent sinusitis. These results indicate an increased glycolysis as well as a relative energy depletion in the sinus mucosa in purulent sinusitis, which could result in an impaired epithelial function.

As the transfusion risks to which patients are exposed are gradually understood, every effort is being made to find both a valid and safe alternative to homologous blood transfusions. Bearing this in mind, the most sensible solution appears to be the practice of a self-donor procedure with normovolemic hemodilution prior to elective surgery. However, even repeated bloodlettings do not modify the oxygen delivery to tissues since, with a reduction in the hemoglobin content of the circulating blood, there is a corresponding increase in oxygen availability. Since the reduction of circulating erythrocytes brings with it a reduction in blood viscosity, there is in turn an improvement in the microcirculation. The generally better tissue oxygenation, the reduction of the blood's viscosity and the increased circulatory perfusion all also favor a prophylaxis against deep vein thrombosis. We have currently performed 72 surgical procedures for head and neck neoplasms that were undertaken at the Clinical ENT Division of Treviso Hospital precisely with the normovolemic hemodilution described above. The self-donor transfusion technique was adopted with the help of the hospital's transfusion service. We have analyzed the data relative to this method and have found that the normovolemic hemodilution represents the treatment of choice in surgery-induced stress, particularly since this approach allows a better tissue oxygenation.

Many infants with tracheotomies remain cannulated for prolonged periods while the underlying cause of airway obstruction is either treated or natural resolution is awaited (usually by growth). To enable these children to enjoy a relatively normal family environment despite a tracheotomy, it is desirable that they should be managed at home for at least part of the time. For the past 8 years we have routinely used soft polyvinyl chloride paediatric tracheotomy tubes (Shiley) in our patients. These tubes have proved to be relatively resistant to obstruction with secretions and are changed at 1- to 2-week intervals. They can be modified by making a series of three to four 2-mm through-and-through fenestrations around the shoulder in order to improve speech production and facilitate decannulation. Parents are tutored in tracheotomy care, which includes tube changing, humidification and suction. They are then permitted to take their child home from hospital when they are considered to be competent. Twenty-eight children (13 boys, 15 girls) with a mean age of 14.5 weeks (range 1-525 weeks) at the time of tracheotomy have been managed at home using this system. The median period of hospitalisation was 12 weeks (range 5-75 weeks), and the median duration of home management was 94 weeks (range 13-394 weeks). Sixteen patients have been successfully decannulated, 11 remain cannulated and 1 died at home from sudden infant death syndrome. Despite supportive measures, the majority of the children developed intermittent chest infections.(ABSTRACT TRUNCATED AT 250 WORDS)

The adherence to and the absorption from nasal mucosal epithelium of type b and non-typeable strains of Hemophilus influenzae were studied in guinea pigs. H. influenzae bacteria were administered to the nose as 4 x 10(7) organisms in 1.0 ml saline. The outer membrane vesicles (OMV) of H. influenzae were used in the absorption study. Scanning electron microscopic studies showed that H. influenzae cells attached to both ciliated and non-ciliated cells of the nasal mucosa. Histological studies showed that OMV were absorbed through the nasal mucosa, mainly from ciliated cells. Further, penetration of OMV through the nasal mucosa of immunized animals was reduced when compared with that of non-immunized ones.

The carbohydrate contents of the guinea pig endolymphatic sac were investigated by the use of lectins. The lumen of the endolymphatic sac was filled with stainable precipitate containing N-acetyl glucosamine, mannose, glucose, galactose and fucose. N-Acetyl galactosamine was also detected but in minute amounts. This composition corresponded to other areas in the inner ear, such as the cupula, the otolithic membrane and the tectorial membrane. The function of these carbohydrates may play an important role in preventing the lumen of the endolymphatic sac from collapsing as well as in regulating transepithelial fluid transport.

Eye movements were recorded using DC-electro-oculography in 20 healthy subjects during sinusoidal voluntary head movements and during similar voluntary head movements with minimized cervical input. The eye movements during these conditions were compared to the vestibulo-ocular reflex (VOR), to the cervico-ocular reaction (COR) and to the active COR (i.e., voluntary stabilization of the head in space while the trunk was moved sinusoidally). Each subject sat with eyes covered on a rotating chair. Sinusoidal movements having an amplitude of +/- 20 degrees and either 0.1 or 0.2 Hz were performed. Voluntary head movements and head movements with minimized cervical input showed no difference in the gain of the slow-phase velocity of the nystagmus, the saccadic activity (cumulated amplitude/time) and the maximum eye deviation. The distribution of saccades around the reversal of head movement in space represents the only significant difference between these conditions. While the saccades appear promptly after reversal during sinusoidal voluntary head movement, they appear during voluntary head movement with minimized cervical input just before the reversal of head movement in space. The direction of saccades always depends on the displacement of the head related to the trunk and is due to cervical input and/or central influences.