bluuebunny/crossref_metadata_2025 huggingface dataset:
Nonmyeloablative transplantation with or without alemtuzumab: comparison between 2 prospective studies in patients with lymphoproliferative disorders
Authors: Pérez-Simón José A. , Kottaridis Panagiotis D. , Martino Rodrigo , Craddock Charles , Caballero Dolores , Chopra Raj , Garcı́a-Conde Javier , Milligan Don W. , Schey Stephen , Urbano-Ispizua Alvaro , Parker Anne , Leon Angel , Yong Kwee , Sureda Ana , Hunter Ann , Sierra Jordi , Goldstone Anthony H. , Linch David C. , Miguel Jesus F. San , Mackinnon Stephen
Published: October 2002

Although nonmyeloablative conditioning regimen transplantations (NMTs) induce engraftment of allogeneic stem cells with a low spectrum of toxicity, graft-versus-host disease (GVHD) remains a significant cause of morbidity and mortality. In vivo T-cell depletion, using alemtuzumab, has been shown to reduce the incidence of GVHD. However, this type of maneuver, although reducing GVHD, may have an adverse impact on disease response, because NMTs exhibit their antitumor activity by relying on a graft-versus-malignancy effect. To explore the efficacy of alemtuzumab compared with methotrexate (MTX) for GVHD prophylaxis, we have compared the results in 129 recipients of a sibling NMT enrolled in 2 prospective studies for chronic lymphoproliferative disorders. Both NMTs were based on the same combination of fludarabine and melphalan, but the United Kingdom regimen (group A) used cyclosporin A plus alemtuzumab, whereas the Spanish regimen (group B) used cyclosporin A plus MTX for GVHD prophylaxis. Patients receiving alemtuzumab had a higher incidence of cytomegalovirus (CMV) reactivation (85% versus 24%,P < .001) and a significantly lower incidence of acute GVHD (21.7% versus 45.1%, P = .006) and chronic GVHD (5% versus 66.7%, P < .001). Twenty-one percent of patients in group A and 67.5% in group B had complete or partial responses 3 months after transplantation (P < .001). Eighteen patients in group A received donor lymphocyte infusions (DLIs) to achieve disease control. At last follow-up there was no difference in disease status between the groups with 71% versus 67.5% (P = .43) of patients showing complete or partial responses in groups A and B, respectively. No significant differences were observed in event-free or overall survival between the 2 groups. In conclusion, alemtuzumab significantly reduced GVHD but its use was associated with a higher incidence of CMV reactivation. Patients receiving alemtuzumab often required DLIs to achieve similar tumor control but the incidence of GVHD was not significantly increased after DLI.
Mice expressing a neutrophil elastase mutation derived from patients with severe congenital neutropenia have normal granulopoiesis
Authors: Grenda David S. , Johnson Sonja E. , Mayer Jill R. , McLemore Morgan L. , Benson Kathleen F. , Horwitz Marshall , Link Daniel C.
Published: October 2002

Severe congenital neutropenia (SCN) is a syndrome characterized by an isolated block in granulocytic differentiation and an increased risk of developing acute myeloid leukemia (AML). Recent studies have demonstrated that the majority of patients with SCN and cyclic neutropenia, a related disorder characterized by periodic oscillations in the number of circulating neutrophils, have heterozygous germline mutations in the ELA2 gene encoding neutrophil elastase (NE). To test the hypothesis that these mutations are causative for SCN, we generated transgenic mice carrying a targeted mutation of theirEla2 gene (“V72M”) reproducing a mutation found in 2 unrelated patients with SCN, one of whom developed AML. Expression of mutant NE mRNA and enzymatically active protein was confirmed. Mice heterozygous and homozygous for the V72M allele have normal numbers of circulating neutrophils, and no accumulation of myeloid precursors in the bone marrow was observed. Serial blood analysis found no evidence of cycling in any of the major hematopoietic lineages. Rates of apoptosis following cytokine deprivation were similar in wild-type and mutant neutrophils, as were the frequency and cytokine responsiveness of myeloid progenitors. The stress granulopoiesis response, as measured by neutrophil recovery after cyclophosphamide-induced myelosuppression, was normal. To define the leukemogenic potential of V72M NE, a tumor watch was established. To date, no cases of leukemia have been detected. Collectively, these data suggest that expression of V72M NE is not sufficient to induce an SCN phenotype or leukemia in mice.
Chronic graft-versus-host disease after allogeneic blood stem cell transplantation: long-term results of a randomized study
Authors: Mohty Mohamad , Kuentz Mathieu , Michallet Mauricette , Bourhis Jean-Henri , Milpied Noël , Sutton Laurent , Jouet Jean-Pierre , Attal Michel , Bordigoni Pierre , Cahn Jean-Yves , Boiron Jean-Michel , Blaise Didier
Published: October 2002

The use of peripheral blood stem cells (PBSCs) is rapidly growing in the allogeneic transplantation setting as an alternative to bone marrow (BM). We previously reported a higher incidence of chronic graft-versus-host disease (cGVHD) associated with allogeneic PBSC transplantation in a randomized trial. In this follow-up report, we analyzed the evolution of cGVHD in the patients (n = 101) enrolled on this study. At a median follow-up of 45 months (range, 31-57 months), we found that the 3-year cumulative incidence of cGVHD was 65% (95% confidence interval [CI] 51%-78%) in the PBSC group and 36% (95% CI 23%-49%) in the BM group (P = .004). We also found that extensive cGVHD was more frequent in the PBSC group (44% [95% CI 30%-58%] vs 17% [95% CI 7%-27%];P = .004). The prevalence of cGVHD was always higher in the PBSC arm. Ocular involvement was more frequent in PBSC recipients (P = .02). Cutaneous and liver involvement was similar among BM and PBSC recipients. Chronic GVHD required multiple courses of immunosuppressive therapy in addition to cyclosporine and corticosteroids during longer periods (P = .03). Altogether, this translated into longer periods of hospitalization after transplantation in the PBSC group (P = .04). Finally, we also confirm that cGVHD after PBSC transplantation is associated with an antileukemic effect that is at least as potent as after BM. However, to date, this has not translated into a survival difference, possibly due to the early-stage leukemic status of these patients or to the relatively small size of the study population.
Binding of Sp1 to the proximal promoter links constitutive expression of the human uPA gene and invasive potential of PC3 cells
Authors: Ibañez-Tallon Inés , Ferrai Carmelo , Longobardi Elena , Facetti Ileana , Blasi Francesco , Crippa Massimo P.
Published: October 2002

Activated transcription of the urokinase-type plasminogen activator (uPA) gene depends on the enhancer, located approximately 2 kb from the start of transcription. The proximal promoter, driving basal transcription, contains a GC-/GA-rich sequence immediately upstream of the TATA box. We have investigated the role played by this element in the transcription of the uPA gene in HeLa and PC3 cells, which do not express or constitutively express the gene, respectively. This region binds either Sp1 or Sp3, as monomers or multimers, but not a combination of the 2 proteins. The more efficient binding of Sp1 to the proximal promoter in PC3 cells is correlated to its phosphorylation state. Polymerase chain reaction (PCR)–coupled, chromatin immunoprecipitation experiments with anti-Sp1 antibodies indeed show an enrichment of proximal promoter sequences in PC3 cells and support the observed difference in transcription levels from proximal promoter constructs in HeLa versus PC3 cells. Furthermore, overexpression of Sp1 increases transcription from the reporter construct in HeLa cells, whereas in PC3 cells, overexpression of Sp3 does not reduce transcription from the same construct, indicating that the Sp1/Sp3 balance cannot be shifted. We conclude that the GC-/GA-rich element of the uPA regulatory region is an independent functional element, regulated by Sp family proteins. Phosphorylation of Sp1 determines the presence in vivo and the functionality of this element in PC3 cells. Thus, the cellular context determines the relevance of the GC-/GA-rich region in uPA gene transcription, which contributes to constitutive gene expression, related, in turn, to the invasive phenotype.
Quercetin 3,7-dimethyl ether: a vasorelaxant flavonoid isolated from Croton schiedeanus Schlecht
Authors: Guerrero M F , Puebla P , Carrón R , Martín M L , Román L San
Published: October 2002

The vasorelaxant profile of quercetin 3,7-dimethyl ether, a flavonoid isolated from Croton schiedeanus Schlecht (Euphorbiaceae), was assessed in aortic rings isolated from Wistar rats. To gain insight into its structure-activity relationship, we compared this substance with quercetin 3,4′,7- trimethyl ether (ayanin), another flavonoid isolated from this plant, quercetin 3,3′,4′,7-tetramethyl ether, a flavonoid synthesized by us, and quercetin. In addition we examined the interaction of quercetin 3,7-dimethyl ether with the nitric oxide (NO)/cyclic guanosine monophosphate (cGMP) pathway. According to their pEC50 values (concentration producing a 50% inhibition of the maximal contractile response) to phenylephrine-induced precontraction in rat isolated aorta, the potency order was quercetin 3,7-dimethyl ether > quercetin > quercetin 3,4′,7-trimethyl ether > quercetin 3,3′,4′,7-tetramethyl ether (4.70 ± 0.18; 3.96 ± 0.07; 3.64 ± 0.02; 3.11 ± 0.16). The relaxant effect of quercetin 3,7-dimethyl ether was significantly decreased by the removal of endothelium as well as by methylene blue, an inhibitor of guanylyl cyclase, and by NG-nitro-L-arginine methyl ester hydrochloride (L-NAME), an NO-synthase inhibitor. Therefore, quercetin 3,7-dimethyl ether has a NO/cGMP pathway-related profile, with increased vasorelaxant activity due to hydroxylation at positions 3 and 4 of the B ring. In addition, methylation at positions 3 and 7 with respect to quercetin of the C and A rings, respectively, seems to further enhance the vasorelaxant activity of quercetin 3,7-dimethyl ether.
A case of extramedullary plasmacytoma arising from the nasal septum
Authors: Hidaka Hiroshi , Ikeda Katsuhisa , Oshima Takeshi , Ohtani Haruo , Suzuki Hideaki , Takasaka Tomonori
Published: October 2002

A rare case of extramedullary plasmacytoma arising from the nasal septum with localized amyloid deposition is reported. A 75-year-old woman presented with a history of post-nasal discharge and nasal obstruction for several months. Endonasal endoscopic observation revealed the presence of a mass arising from her nasal septum with an extension to the nasopharynx. No cervical lymph nodes were palpable. The biopsy specimen was diagnosed as a plasmacytoma (IgG, lambda-light chain type). Both serum myeloma-protein and urine Bence-Jones protein were negative. Bone marrow biopsy, a chest radiograph, total body skeletal survey and 67Ga- and 99mTc-scintigrams showed no other systemic lesions. These findings confirmed the diagnosis of extramedullary plasmacytoma in the nasal septum. The patient received irradiation of 40 Gy without clinically detectable reduction of tumour size. The patient eventually underwent complete resection of the tumour by KTP/532 laser under endonasal endoscopic control. Pathologically, the tumour mass was composed mainly of amyloid deposition with a marked reduction of tumour cells. This indicated the radiosensitiveness of tumour cells, which was clinically masked by the increased amyloid deposition. The clinical presentation, pathological features and surgical procedures are described with a review of the literature.
All nasal polyps need histological examination: an audit-based appraisal of clinical practice
Authors: Diamantopoulos Ioannis I. , Jones Nick S. , Lowe James
Published: October 2002

Case details were reviewed from 2021 patients treated surgically for nasal polyposis between 1991 and 1999, seen by six surgeons serving a catchment population of 805 000. The aim of this study was to determine the incidence of discrepancies between clinical and histological diagnosis. Twenty-two patients (1.1 per cent) were identified as having a lesion that differed histologically from the clinical diagnosis made at the time of surgery and which altered their further management. Amongst them were 11 cases of inverted papilloma, two of Wegener’s granulomatosis, and two of sarcoid. The rest of the cases comprised three of squamous cell carcinoma, one of adenocarcinoma, one of myeloma, one of angiofibroma and one of microcystic papillary adenoma. In this series, the occurrence of malignancy, inverted papilloma, or other clinically significant pathology among the group of patients with otherwise clinically unsuspected histology justifies sending nasal polyps for routine pathologic examination. A cost–benefit analysis showed that, on the basis of 250 cases per year, the cost of laboratory and pathological services would be £12.000, in comparison with the estimated average medicolegal cost of £51.000 per year incurred as a result of a delay in diagnosis together with the pain and suffering which would result given the case mix in this series.
Intra-laryngeal endoprosthesis: an alternative therapeutic approach to surgical procedures of laryngeal exclusion
Authors: Debry Christian , Charles Xavier , Frenot Marc , Gentine André
Published: October 2002

The uncertain results of aryepiglottopexy in our personal experience led us to develop, for patients with aspirations associated with the risk of severe pneumonitis, three types of intralaryngeal endoprostheses (ILEP) under the systematic cover of a tracheostomy. From September 1997 to May 1999, seven protheses were implanted in six patients. It was not possible to restore the full range of laryngeal functions, i.e. deglutition, phonation and respiration. However, our results, that were obtained with an intracricoidal prothesis closed at its upper end or equipped with a phonatory valve, are quite encouraging, even more so when in association with early alimentary re-education and support continuation of our trial. These ILEPs are simple to place, well tolerated, efficacious in preventing deglutition pneumonitis and easy to remove. Furthermore, the reversibility of this bloodless procedure facilitates the monitoring of a possible recovery of the laryngeal functions.
Bacterial penetration into tonsillar surface epithelium during infectious mononucleosis
Authors: Räisänen Simo , Myklebust Reidar , Bye Helga-Marie , Stenfors Lars-Eric
Published: October 2002

Bacterial penetration into epithelial cells, scraped from the palatine tonsils of 14 patients (10 males, four females; median age 16 years) with current infectious mononucleosis and concomitant membranous tonsillitis, was studied using the transmission electron microscopic (TEM) technique. Bacteria were seen to adhere to and penetrate the epithelial cells, some of which were completely filled with bacteria. This finding suggests intracellular proliferation of bacteria. Epstein – Barr virus, the causative agent of infectious mononucleosis, especially when associated with growth of β-haemolytic streptococci on the palatine tonsils, induces bacterial penetration into tonsillar tissue, that in turn might be a causative mechanism in the development of peritonsillar abscess.
Sensorineural hearing loss caused by a high jugular bulb
Authors: Tsunoda Atsunobu
Published: October 2002

A 15 – year – old female presented with sensorineural hearing loss related to a high jugular bulb. She noticed temporary worsening of her right hearing with mild dizziness when her neck was compressed whereas she noticed no change in her left hearing. An audiogram showed temporary worsening of low tone bone – conduction on such occasions. A large jugular bulb covering the right round window was observed through the perforation. Computed tomography (CT) revealed a large jugular bulb obliterating the round window niche. Deterioration of bone conduction during neck compression was thought to be caused by the protrusion of the jugular bulb into the inner ear via the round window.
This case suggested the possibility of sensorineural hearing loss due to the jugular bulb. As in the present case, jugular bulb or vein -related ear disorders should be examined by neck compression.
Misplaced parotid glands: bilateral agenesis of parotid glands associated with bilateral accessory parotid tissue
Authors: Flax-Goldenberg Renee , Peled Nathan , Goldenberg David , Zvi Joachims Henry
Published: October 2002

Agenesis of the parotid is a rare entity. It is usually unilateral but bilateral cases have been described as a rare cause of xerostomia. Accessory parotid tissue is also uncommon and is not normally associated with aplasia of the parotid gland. The embryological, histological, clinical and radiological findings of these two entities will be discussed in addition to the report of an obscure case of bilateral parotid agenesis together with bilateral accessory parotid tissue.
Bilateral cerebrospinal fluid rhinorrhoea
Authors: Ramsden James D. , Corbridge Rogan , Bates Grant
Published: October 2002

Cerebrospinal fluid (CSF) rhinorrhoea is leakage of fluid from the subarachnoid space to the frontal, sphenoidal or ethmoidal sinuses, and may occur spontaneously. The authors present the first reported case of bilateral spontaneous CSF rhinorrhoea. Bony defects on both sides of the cribriform plate were identified using endoscopic and radiological techniques, and the CSF fistula was closed endoscopically. The aetiology, diagnosis and contemporary surgical treatment of spontaneous CSF leaks is discussed. Endoscopic repair was successful in this case, and in view of the high success and low reported complication rates this surgical approach should be considered for treatment of spontaneous CSF rhinorrhoea.
Hoarseness due to leech ingestion
Authors: Al-Hadrani A. , Debry C. , Faucon F. , Fingerhut A.
Published: October 2002

This paper presents a case of hoarseness caused by the pharyngolaryngeal localization of a leech. This pathological lesion is extremely rare in western European countries, but is more frequent in endemic areas. Possibly lethal dyspnoea, haemoptysis or haematemesis can be the revealing symptoms. When the diagnosis is suspected simple examination under anaesthesia and removal of the leech will effect a cure.
A benign parathyroid cyst presenting with hoarse voice
Authors: Sen P. , Flower N. , Papesch M. , Davis A. , Spedding A. V.
Published: October 2002

Parathyroid tumours and cysts are rare and, when presenting as neck masses, can be clinically misdiagnosed as thyroid lesions. Symptoms may be caused by compression of the surrounding structures or hormonal overactivity. This paper describes a patient with recurrent hoarseness owing to the pressure effects of a parathyroid cyst on the recurrent laryngeal nerve.
Immune response and immunopathology of the inner ear: an update
Authors: Berrocal Jose Ramon Garcia , Ramirez-Camacho Rafael
Published: October 2002

Immune-mediated inner-ear disease includes clinical conditions associated with unilateral or bilateral rapidly progressive forms of sensorineural hearing loss. A systemic autoimmune disorder can be present in less than one-third of cases. Because of the lack of well defined detection methods to identify immune-mediated processes within the inner ear, and the fact that the human inner ear is not amenable to diagnostic biopsy, there has been great interest in developing animal models. Experimental models of sterile and virus-induced labyrinthitis support the participation of the immune system in the aetiopathogenesis of inner-ear disorders: interleukin-2 emanates from the endolymphatic sac and assists in changing the spiral modiolar vein, as in the expression of intercellular adhesion molecule 1, which allows the egress of immune cells from the circulation. The formation of a fibro-osseous matrix ultimately results in degeneration of the inner ear. These investigations have allowed us to alter the immune response for the purpose of regulating its intensity and the subsequent damage to patients.
Semi-invasive allergic aspergillosis of the paranasal sinuses
Authors: Oyarzabal M. F. , Chevretton E. B. , Hay R. J.
Published: October 2002

Aspergillosis of the nose and paranasal sinuses has classically been divided into four types: allergic, non-invasive, invasive and fulminant. Recent reports have suggested that a semi-invasive form with bone destruction and erosion, but without fungal tissue invasion, may occur. We present a case of allergic non-invasive aspergillosis of the paranasal sinuses with associated bone destruction extending into the orbit and anterior cranial fossa, in a non-immunocompromised patient. Surgical debridement combined with a prolonged course of oral itraconazole has resulted in long-term resolution with no evidence of recurrence of disease five years later.
Desmoplastic fibroma of the temporal bone
Authors: Dutt Sunil N. , Mirza Showkat , Irving Richard M. , Jones E. L.
Published: October 2002

An unusual case of a desmoplastic fibroma of the temporal bone is presented. Although classified benign, this intraosseous lesion exhibits local aggressiveness and has a high potential for recurrence. This rare condition occurs predominantly in the mandible and in the long bones and is seldom seen in the calvarium. Here we add another case to the previously described eight in the skull and this is the fourth such case reported in the temporal bone. The clinical features, radiology, histopathology and the therapeutic considerations of this lesion in a 72-year-old female are discussed. In addition, a literature review of all the cases affecting the skull bones is presented.
Study of surfactant level in cases of primary atrophic rhinitis
Authors: Sayed Ramadan Hashem , Abou-Elhamd Kamal-Eldin A. , Abdel-Kader Mohamed , Saleem Tahia Hashem
Published: October 2002

The surfactant system of the nose was examined biochemically in control cases and compared to cases of primary atrophic rhinitis. The study group included 25 cases with primary atrophic rhinitis compared to 10 normal volunteers. Biochemical analysis of the nasal aspirate in these cases revealed the presence of phospholipids constituting surfactant with phosphatidylcholine constituting 75.35 per cent of the total phospholipids. Biochemical analysis of the nasal aspirate in cases with primary atrophic rhinitis revealed a significant decrease in the total phospholipids compared to normal cases and also a significant change in the phospholipid profile. Thus significant biochemical changes in the surfactant system of the nose is an evident and early finding in cases of primary atrophic rhinitis. This suggests a possible role for surfactant deficiency in the aetiopathogenesis of cases of primary atrophic rhinitis.
Superior laryngeal nerve preservation in peri-apical surgery by mobilization of the viscerovertebral angle
Authors: El-Guindy A. , Abdel-Aziz M.
Published: October 2002

Iatrogenic lesions of the superior laryngeal nerve (SLN) are much more common than is generally recognized. Since injury to this nerve may cause transient or even persistent changes either in quality of voice or in deglutition, an attempt should be made to localize and identify the nerve during surgery. This study included 74 patients who underwent surgical dissection near the thyroid apex in the neck. Effective prevention of SLN injury during surgery was achieved by anatomical localization of the nerve in the viscerovertebral angle and its functional identification with the nerve stimulator. Post-operative analysis consisted of subjective interview, rigid laryngoscopy, acoustic analysis, laryngeal videostroboscopy and cricothyroid electromyography. Four patients complained of post-operative voice changes; two were diagnosed as SLN injury (2.4 per cent), one as reflux laryngitis and the fourth as intubation granuloma. Surgical access to the SLN in the periapical area may be achieved through mobilization of the viscerovertebral angle. The use of a nerve stimulator during difficult situations should keep SLN injury at a minimum.
Unusual presentations of isolated sphenoid fungal sinusitis
Authors: Shaw Chi-Kee Leslie , McCleave Michael , Wormald Peter John
Published: October 2002

Isolated sphenoid fungal sinusitis is a rare and often difficult to diagnose condition as the presenting symptoms are often vague and non-specific. In this series each case has a different clinical presentation with a different causative fungus. Although isolated fungal sphenoid sinusitis is usually seen in immunocompromised individuals, two of the three cases presented were immunocompetent. The fungi were Pseudallescheria boydii, Aspergillus fumigatus and Schizophyllum commune. In order to illustrate the great diversity of clinical signs, each case is individually presented. The characteristic radiological signs and the clinical management of each case are also presented. The danger signs of associated pathology are discussed with particular reference to an associated squamous carcinoma in one case. Surgical options and chemotherapy are discussed. Isolated sphenoid fungal sinusitis is a rare condition that if undiagnosed may result in considerable morbidity and even mortality of patients.
A unique parotid adenocarcinoma
Authors: Hill D. S. , Ellis G. L. , Gatland D. J.
Published: October 2002

A large number of different types of benign and malignant tumours of the salivary glands are recognized, and rare and unusual variants arise from time to time that can be difficult to interpret. We report an apparently unique parotid neoplasm that does not fit any of the currently recognized diagnostic groups and can best be termed lymphadenocarcinoma. Clinical and pathological features are described, and its possible relationship to recognized tumour types is examined.
Contact endoscopy of the larynx: a quantitative study
Authors: Wardrop Peter J. C. , Sim Stephanie , McLaren Kathryn
Published: October 2002

Contact endoscopy is a technique of obtaining detailed magnified images of living epithelium, using a modified glass rod lens endoscope placed on the surface of the tissue. The technique has been extensively described in gynaecological, and more recently, laryngeal and nasal tissues. However, no quantitative studies of its diagnostic accuracy yet exist. A prospective partially blinded controlled study of eight cases with a variety of laryngeal pathologies is described. A single pathologist with no knowledge of the ultimate histological diagnoses successfully identified six of eight laryngeal pathologies on contact endoscopic findings, while the other two cases were identified to a degree of accuracy that was sufficient to positively identify the need for standard tissue biopsy. The advantages and disadvantages of the technique are described, along with suggestions for its role in clinical practice.
Salivary gland choristoma of the middle ear: case treated with KTP laser
Authors: Supiyaphun Pakpoom , Snidvongs Kornkiat , Shuangshoti Shanob
Published: October 2002

Salivary gland choristoma of the middle ear is rare. It consists of non-malignant, non-growing, normal salivary gland tissue in the middle ear. It is a developmental abnormality that occurs around the proximal part of the second branchial arch before the fourth month of intrauterine life.

The authors found the 25th recorded case in our centre and another 24 reported cases from a review of the literature between 1961 and 1999. Intratympanic salivary gland choristoma frequently occurs during the first and second decades of life and with a female preponderance (56 per cent). Nearly all the patients (96 per cent) in our review presented with a hearing loss, that had begun since birth, in infancy, or during childhood. Tinnitus (28 per cent), and serous otitis media (24 per cent) were also commonly present. One case complained of otorrhoea. Intratympanic and extratympanic anomalies were found in 96.2 per cent and 34.6 per cent of cases respectively. Of these anomalies, ossicular chain (88.5 per cent), facial nerve (65.4 per cent), middle-ear muscles (30.8 per cent) and labyrinthine windows (23 per cent) were the four most common sites. Therefore, salivary gland choristoma may represent a manifestation of a congenital ear anomaly.

Diagnosis of salivary gland choristoma is generally not documented pre-operatively, but is based on surgical biopsy and histopathological investigations. Treatment of this rare lesion depends on the size, location and extent of the mass, degree of anatomical abnormality and expertise of the surgeon. In difficult cases where the mass is attached to the dehiscent or inferiorly placed facial nerve, only biopsy is recommended. However, complete surgical removal is advocated for a mass that is easy to remove. KTP laser use via a 200 micron fibreoptic light carrier can facilitate removal especially in cases with ossicular chain involvement.
Mesenchymal chondrosarcoma of the maxilla
Authors: Chidambaram A. , Sanville P.
Published: October 2002

Mesenchymal chondrosarcoma (MC) is a rare tumour, with a predilection for the head and neck region. We describe a case of mesenchymal chondrosarcoma arising in the right maxilla extending to the basi-sphenoid. Its computed tomography (CT) and magnetic resonance imaging (MRI) and histopathological features and the management are presented. We also reviewed the literature of reported cases involving the maxilla.
Screening for vestibular schwannoma: magnetic resonance imaging findings and management
Authors: Dawes Patrick J.D. , Mehta Deepak , Arullendran Puveendran
Published: October 2002

We report the contrast-enhanced magnetic resonance imaging (MRIg) findings from a series of 1139 patients who underwent screening to exclude a diagnosis of vestibular schwannoma. An acoustico-facial nerve bundle tumour was found in 3.1 per cent of patients imaged and vestibular schwannoma incidence is estimated at 1.4 per 100 000 population per annum. MRIg showed an abnormality in 14 per cent of patients; about one third of the findings may have accounted for the presenting symptom(s). A small number of patients had unexpected pathology revealed that required onward referral for further active management.
Submasseteric abscess
Authors: Balatsouras Dimitrios G. , Kloutsos Georgios M. , Protopapas Dionysis , Korres Stavros , Economou Constantinos
Published: October 2002

The masseteric space is an important tissue compartment of the neck, but disease in it is difficult to diagnose and treat. In this paper a case of a young adult male with an abscess of the submasseteric space is presented. Diagnosis was established by computed tomography (CT) of the neck, but the severity of the lesion was not accurately estimated. Surgical intervention was performed and a large quantity of pus was drained. A detailed medical history and clinical examination of the patient as well as CT are important tools in the accurate diagnosis and efficient treatment of the disease.
Papillary squamous cell carcinoma of the larynx
Authors: Ereño Cosme , López José I , Sánchez José M. , Bilbao Francisco J.
Published: October 2002

A case of papillary squamous cell carcinoma of the larynx in a 50-year-old man is reported. The lesion was located in the supraglottic region and grossly presented a characteristic finger-like pattern of growth. The tumour pursued an indolent clinical course, and the patient is well and free of disease after 47 months of follow-up. The present paper recapitulates the macro- and microscopic features of this rare neoplasm and stresses its differential diagnosis with other exophytic squamous cell carcinomas of the region.
Rhinophycomycosis
Authors: Thakar  , Baruah  , Kumar  , Sharma
Published: October 2002

Rhinophycomycosis, a subcutaneous fungal infection, is less uncommon than many other frequently cited granulomatous lesions of the paranasal sinuses. Four illustrative cases are presented with their characteristic clinical, radiological and histopathological features. The initial origin of the swelling was always in the region of the nasal vestibule and ala. The therapeutic response to potassium iodide, ketaconazole and fluconazole was dramatic and sustained.
Chondrosarcoma of the thyroid cartilage
Authors: Uygur Kemal , Tüz Mustafa , Dogru Harun , Sari Aliye
Published: October 2002

Sarcomas of the larynx are extremely rare neoplasms that account for approximately one per cent of all tumours of this organ. We present a case of laryngeal chondrosarcoma originating from thyroid cartilage, characterized by an unusual long clinical course over 15 years without laryngeal symptoms or duplication of metastases, treated at the Süleyman Demirel University Medical Faculty, Ear, Nose and Throat (ENT) department.
Classification of haemorrhage following tonsillectomy
Authors: Windfuhr  , Seehafer
Published: October 2002

To date there exists no sensible way of classifying the intensity of haemorrhage following tonsillectomy, though this is a prerequisite when comparing the results presented in literature. We evaluated the incidence of post-operative haemorrhage according to our classification in 602 patients who underwent tonsillectomy at our department in 1999. In 21 patients a grade 1 (spontaneous cessation) bleeding occurred. One patient had a grade 2 (infiltration anaesthesia), 14 patients had a grade 3 bleeding (treatment under general anaesthesia) with one patient receiving a blood transfusion. Two patients had a grade 4 bleeding (ligature of the external carotid artery). There was no patient with grade 5 bleeding (lethal outcome). Grades 1 and 3 had the same incidence rates. Primary haemorrhage (<24 hours) can be expected in the majority of patients undergoing tonsillectomy. Secondary haemorrhage is rare and can be life-threatening.
Peri-orbital surgical emphysema following functional endoscopic sinus surgery, during extubation
Authors: Tzifa K. T. , Skinner D. W.
Published: October 2002

We present a case of peri-orbital surgical emphysema following functional endoscopic sinus surgery (FESS), due to extubation with simultaneous manual inhalation with a closed expiratory valve. This complication has not been previously reported in association with general anaesthetic and FESS. Patients undergoing FESS are advised against nose blowing. However, we recommend that the anaesthetist working with a surgeon who performs FESS should also be warned not to use manual inhalation with a closed expiratory valve while extubating, as this can cause peri-orbital surgical emphysema.
Use of the auricular composite graft in nasal reconstruction
Authors: Raghavan U. , Jones N. S.
Published: October 2002

We present our experience using conchal composite grafts in major and minor nasal reconstruction. We believe that composite grafts have an important and under-utilized role as an adjunct to the paramedian forehead flap on total and subtotal nasal reconstruction, as well as in providing an internal lining and support in stenosis of the nasal vestibule. The use of a composite conchal graft as an inner lining and support is often preferential to a septal composite or hinge flap that often results in a septal perforation with its associated morbidity.

We recognize that a composite conchal graft used for reconstruction of the alar margin provides a suboptimal result after several months. This is because it is not always possible to replace a whole aesthetic subunit and whilst the site the graft is harvested from often allows the correct contour to be chosen, the quality of skin is often different and this can be seen after several weeks when any post-operative oedema has settled.
Osseo-integration in Paget’s disease: the bone-anchored hearing aid in the rehabilitation of Pagetic deafness
Authors: Uppal Harpreet S. , D’Souza Alwyn R. , Proops David W.
Published: October 2002

The first report of a patient with gross Paget’s disease and progressive hearing loss who successfully underwent hearing rehabilitation with an osseo-integrated hearing aid is presented. The otological manifestations of Paget’s disease and the principles of osseo-integration are discussed. The use of a bone-anchored hearing aid (BAHA) in selected patients with Paget’s disease can provide useful amplification and hearing rehabilitation.
Synovial sarcoma in the retropharyngeal space
Authors: Nadig S. K. , Love M. H. S. , Brooker D. S. , Hall S. J.
Published: October 2002

Synovial sarcoma is an aggressive mesenchymal tumour, rarely occurring in the head and neck. Management guidelines are by extrapolation of management of sarcomas in the extremities. We present a case involving the retropharyngeal space in a 20-year-old male. Analysis of more data on head and neck synovial sarcoma is necessary to make meaningful management recommendations.
Second malignancies in early stage laryngeal carcinoma patients treated with radiotherapy
Authors: Holland John M. , Arsanjani Amir , Liem Benny J. , Hoffelt S. Christopher , Cohen James I. , Stevens Kenneth R.
Published: October 2002

A retrospective review of 240 patients with T1/T2 squamous cell carcinomas of the larynx was performed. Seventy-two per cent had glottic primaries, 27 per cent had supraglottic tumours and one per cent had subglottic disease. Sixty-nine per cent presented with T1 disease and 31 per cent had T2 staged tumours. All patients were treated with definitive radiotherapy between 1973 and 1997.

With a median follow-up of 68 months, 68 patients (28 per cent) have developed 72 other cancers. Ten of 68 presented with synchronous primaries (15 per cent). Thirty per cent of glottic patients and 25 per cent of the supraglottic/subglottic patients developed second cancers. The most frequent second malignancy was lung cancer: 28/72 (39 per cent). Fifteen patients developed second head and neck cancers (21 per cent). Other second primary sites included oesophagus (eight), prostate (six), colorectal (five), breast (two) and others (eight). The median time from radiotherapy until the development of a second cancer was 31 months. The Kaplan-Meier survival estimate at five years was significantly less for those patients developing second cancers (55 per cent) compared to those not developing second malignancies (70 per cent), (p<0.05). The median survival from the development of a second cancer was 14 months. More died as a result of a second cancer (41 patients) than their primary laryngeal cancer (40 patients). Second cancers are common and deadly in patients with early stage laryngeal carcinoma.
Computed tomography and ultrasonographic evaluation of metastatic cervical lymph nodes with surgicoclinicopathologic correlation
Authors: Sarvanan K. , Bapuraj J. Rajiv , Sharma Suresh C. , Radotra B. D. , Khandelwal N. , Suri S.
Published: October 2002

The detection of cervical lymph nodal metastasis and carotid artery invasion by metastatic lymph nodes is an important issue in the management of head and neck malignancies. This study compared the evaluation of metastasis by palpation, ultrasonography (USG) and computed tomography (CT) in patients with known head and neck malignancies.

Twenty-five consecutive patients with head and neck malignancy were prospectively evaluated for the presence of cervical lymphadenopathy and carotid artery invasion. All patients underwent clinical examination (palpation), USG and CT examination. A modified CT criteria was employed which yielded acceptable results for the detection of metastatic nodes. Radical neck dissection was performed for 26 neck sides, and the results of pre-operative evaluation were confirmed by the surgical and histopathological findings.

Palpation, ultrasound and CT have comparable sensitivity in the determination of metastasis involving cervical lymph nodes. Thus palpation should be employed as the primary method of assessment of secondaries in the neck.

However, palpation is less sensitive than CT and USG in the detection of carotid artery involvement, hence the clinical suspicion of arterial invasion should be confirmed by either CT or USG which have similar accuracy in the detection of carotid artery invasion.
How I do it; securing a full thickness skin graft
Authors: Lancaster J. L. , Karagama Y. G.
Published: October 2002

The authors present a novel way of securing a full thickness skin graft (Wolfe graft) that we believe is not only time saving but also helps to create a dressing that exerts an equal pressure over all areas of the graft.
Parotid mass as an early sign of Kaposi’s sarcoma associated with human herpesvirus 8 infection
Authors: Puxeddu Roberto , Parodo Giuseppina , Locci Francesca , Puxeddu Ilaria , Manconi Paolo Emilio , Ferreli Caterina
Published: October 2002

Kaposi’s sarcoma of an intraparotid lymph node is extremely rare in non-immunocompromised human immuno-1 deficiency virus (HIV)-negative patients. We report a case of a left parotid mass as an early sign of Kaposi’s sarcoma-associated human herpesvirus 8 (HHV-8) infection in a 57-year-old patient. After subtotal parotidectomy and histopathological diagnosis of lymph node localization of Kaposi’s sarcoma, an accurate dermatological investigation revealed a solitary small lesion in the left foot. Chemotherapy with five cycles of vincristine gave a temporary response of the cutaneous lesion. Seven months later, a few small, firm, purplish-red lesions appeared in different areas of the body, but no adjuvant treatment was accepted by the patient since the lesions occasionally disappeared or remained stable in size. At four years follow-up, there has been no recurrence in the parotid region, and the patient is alive with cutaneous disease but in good general health. The problems related to the diagnosis, the management strategy of such a rare condition and the prognosis are also discussed.
Does clinical assistant experience in ENT influence general practitioner referral rates to hospital?
Authors: Bhalla R. K. , Unwin D. , Jones T. M. , Lesser T.
Published: October 2002

Referral rates from individual partners within two demographically matched general practices to the local ENT service were gathered prospectively over a six-year period. The study was designed to determine if extra training in one practice altered these rates. A single partner from one practice attended otolaryngology clinics for regular training over a three-year period. This was funded by the local Family Practitioners’ Committee. The funding enabled a locum to cover this partner’s clinical commitment whilst he attended the specialist clinics for continued ENT training. The aim of this study was to identify whether the provision of continued ENT training and education to general practitioners (GPs) influenced referral patterns to specialist clinics.
Effect of KTP laser on implants used in middle-ear surgery
Authors: Gerlinger I. , Pytel J. , Liktor B. , Lujber L.
Published: October 2002

The present study is intended to explore the effects of the KTP laser on various types of implant, used in middle-ear surgery. A laboratory study was undertaken to evaluate the interaction between the KTP laser (KTP-532 Orion Laser, Laserscope, UK) and individual middle-ear implants. A variety of middle-ear implants were used: a silicone sheet, Teflon® , hydroxylapatite, ionomeric cement, gold and titanium prostheses as well as gelfoam. Following exposure to the laser, these implants were studied by direct inspection using an operating microscope.

The KTP laser induced no detectable alteration in any of the implants when they were clean and dry. However, in the presence of fresh blood, under the influence of the energy of the absorbed laser, the silicone burnt and melted and the Teflon® piston was vaporized. Likewise, a few tiny holes appeared on the surface of the ionomeric implant and then the prosthesis deformed. The hydroxylapatite implant broke into two pieces. However, no detectable alteration could be observed on gold or titanium pistons, even in the presence of blood.

The authors conclude, that in the presence of blood, interaction between the KTP laser and both silicone and hydroxylapatite implants needs to be avoided. Teflon® prostheses can be cautiously vaporized. Gold and titanium prostheses were unaffected by laser even in the presence of blood.
Origin of multicellular organisms as an inevitable consequence of dynamical systems
Authors: Furusawa Chikara , Kaneko Kunihiko
Published: October 2002

The origin of multicellular organisms is studied by considering a cell system that satisfies minimal conditions, that is, a system of interacting cells with intracellular biochemical dynamics, and potentiality in reproduction. Three basic features in multicellular organisms—cellular diversification, robust developmental process, and emergence of germ‐line cells—are found to be general properties of such a system. Irrespective of the details of the model, such features appear when there are complex oscillatory dynamics of intracellular chemical concentrations. Cells differentiate from totipotent stem cells into other cell types due to instability in the intracellular dynamics with cell–cell interactions, as explained by our isologous diversification theory (Furusawa and Kaneko, 1998a; Kaneko and Yomo, 1997). This developmental process is shown to be stable with respect to perturbations, such as molecular fluctuations and removal of some cells. By further imposing an adequate cell‐type‐dependent adhesion force, some cells are released, from which the next generation cell colony is formed, and a multicellular organism life‐cycle emerges without any finely tuned mechanisms. This recursive production of multicellular units is stabilized if released cells are few in number, implying the separation of germ cell lines. Furthermore, such an organism with a variety of cellular states and robust development is found to maintain a larger growth speed as an ensemble by achieving a cooperative use of resources, compared to simple cells without differentiation. Our results suggest that the emergence of multicellular organisms is not a “difficult problem” in evolution, but rather is a natural consequence of a cell colony that can grow continuously. Anat Rec 268:327–342, 2002. © 2002 Wiley‐Liss, Inc.
Epithelial–mesenchymal transitions: A mesodermal cell strategy for evolutive innovation in Metazoans
Authors: Pérez‐Pomares José M. , Muñoz‐Chápuli Ramón
Published: October 2002

Epithelial–mesenchymal transitions (EMTs) are well known processes in which new mesenchyme is locally generated from epithelia. During the development of the vertebrate embryo, EMTs are a source of mesenchyme in diverse places and stages through embryonic morphogenesis, especially in mesodermal domains. In the present work we consider the embryo as a two‐state system in which epithelium and mesenchyme represent the stable and unstable states, respectively. We think that a pattern of recurrent oscillations between the plasticity and exploratory behaviour of the mesenchyme and the stability of the epithelia can be recognized in the embryogenesis of vertebrates and, probably, in most tripoblastic Metazoans. Mesoderm, in particular, might be regarded as a cell layer able to oscillate between epithelial and mesenchymal states. The cellular and molecular mechanisms that enable these recurrent oscillations between stable (epithelial) and unstable (mesenchymal) states during embryogenesis provide the mesoderm with a large plasticity, an extended potential for innovation, and a better control of the three‐dimensional (3D) body organization. In this scenario, it is conceivable that the origin of the mesoderm itself might be related to ancestral mechanisms regulating cell adhesion and detachment. We conclude that EMTs played a key role in the evolution of Metazoans, and are involved in the pathological and reparative processes of adult organisms. Anat Rec 268:343–351, 2002. © 2002 Wiley‐Liss, Inc.