bluuebunny/crossref_metadata_2025 huggingface dataset:
Single Isolated Cotton-Wool Spots
Authors: Remky Andreas , Arend Oliver
Published: April 2003

The presence of isolated cotton-wool spots in normal fundi may indicate serious systemic disease. In this presentation 4 patients were examined for blurred vision or scotomas with sudden onset. Two of them were pregnant. Funduscopic examination revealed soft-appearing white spots in the temporal arcades in 3 patients and in the papillomacular bundle in 1 patient. Due to the lack of other fundus lesions 3 of the patients were initially treated for toxoplasmosis. The patients were seronegative for typical viral (HIV), antinuclear antibodies, bacterial infections, or toxoplasmosis. Blood pressures, glycosylated hemoglobin and blood counts were in the normal range. At the follow-up examinations subjective symptoms had improved and the spots disappeared or were smaller and showed more distinct borders, and no new lesions were detected. These cases suggest that isolated cotton-wool spots may occur without serious systemic disease in otherwise healthy subjects and the spots may be misinterpreted as acute inflammatory retinochoroidal lesions.
Melanocytoma of the Left Optic NerveHead and Right Retrobulbar Optic Neuropathy Compressed by a Tuberculum sellae Meningioma
Authors: Shinoda Kazuo , Hayasaka Seiji , Nagaki Yasunori , Kadoi Chiharu , Kurimoto Masanori , Okada Eikichi
Published: April 2003

A 40-year-old woman had a highly pigmented, slightly elevated tumor on the left optic disc. She had no visual disturbance in the left eye. The tumor was stationary for 5 years. At age 45 years, she complained of decreased visual acuity in the right eye. Magnetic resonance imaging showed a right-shifted homogeneous lesion at the tuberculum sellae. Histopathologic study of the excised lesion revealed interlacing bundles of spindle-shaped fibroblast-like cells with whorl formation. We believe that a relationship between melanocytoma of the optic nerve head and a tuberculum sellae meningioma may exist rather than a chance occurrence, as previously suggested by others.
Ritleng Intubation Set: A New System for Lacrimal Pathway Intubation
Authors: Müllner K.
Published: April 2003

Silicone tubing of the lacrimal pathway is used after lacrimal pathway injuries or canalicular stenosis. This procedure is often complicated by the so-called accordeon phenomenon. Far the last 3 years we have used a new system for lacrimal intubation: the Ritleng intubation set. It consists of a silcone tube which is connected to a polypropylene tube and a specially designed stainless probe for lacrimal insertion. Due to the smooth connection of the polypropylene tube and the silicone tube intubation can be performed easily and without the so-called accordeon phenomenon. In case of congenital or acquired lacrimal stenosis probing and silicone intubation can be performed in one step. We used this set in 19 lacrimal lacerations of the lacrimal pathway and in 7 cases of congenital and 12 cases of acquired lacrimal stenosis. With this specially designed lacrimal intubation set lacerated canaliculi can be quickly reapproximated. It allows probing of the lacrimal system and intubation in one procedure. In this report the technique and indications will be described and discussed.
Extracapsular Cataract Extraction with Posterior Chamber Lens Implantation in Capsular Glaucoma
Authors: Arici Mustafa Kemal , Topalkara Ayşen , Demırcan Süleyman , Erdoğan Haydar , Güler Cenap
Published: April 2003

Purpose: To evaluate intraocular pressure (IOP) control after extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (PCIOL) implantation in patients with capsular glaucoma (CG) and coexisting cataract. Methods: This prospective study included 20 patients (20 eyes) having CG and cataract whose IOPs were under 22 mm Hg and controlled with antiglaucoma medication. All patients had ECCE with PCIOL implantation and the follow-up period was at least 18 months. IOP was measured postoperatively at 3, 6, 9, 12 and 18 months and compared with preoperative IOP. Results: Following the cataract extraction, PCIOL implantation produced a statistically significant reduction in IOP at all time points compared with the preoperative IOP during the study period (p < 0.001). The mean preoperative IOP was 18.25 ± 1.83 mm Hg; postoperatively at 1 month, it was 13.45 ± 2.06 mm Hg; at 3 months 14.80 ± 2.50 mm Hg; at 6 months 15.35 ± 1.27 mm Hg, at 12 months 14.85 ± 1.87 mm Hg and at 18 months 15.15 ± 1.42 mm Hg (p < 0.0008). The mean reduction in IOP was 16.98% from baseline at 18 months postoperatively. The mean number of antiglaucoma medication was reduced from 1.35/eye preoperatively to 0.60/eye postoperatively at 18 months (p < 0.0007). Conclusion: The result of our study revealed that ECCE with PCIOL implantation may be a reliable choice in controlling IOP in patients with CG.
Effect of Beta-Blocker Eyedrops on Corneal Epithelial Barrier Function
Authors: Niiya Akiko , Yokoi Norihiko , Matsumoto Yasuhiro , Komuro Aoi , Ishibashi Takeshi , Tomii Satoshi , He Jiucheng , Kinoshita Shigeru
Published: April 2003

To investigate the long-term effect of a topically applied β-blocker on human corneal epithelium, the corneal epithelial barrier function and the superficial cell area of the corneal epithelium were evaluated. Seventeen normal healthy volunteers (without medication), 7 cataract patients (treated with pyrenoxine eyedrops) and 7 glaucoma or ocular hypertension patients (treated with 0.5% timolol maleate) were assigned to this study. The eyedrops had been used on a daily basis for at least 3 months. In the evaluation of corneal epithelial barrier function, fluorescein uptake was measured using a slitlamp fluorophotometer after application of 3 μl of 0.5% fluorescein for 10 min. In the evaluation of the superficial cell area, the central corneal epithelium was measured by tandem scanning confocal microscopy (TSCM). The healthy control and timolol groups were compared. Corneal fluorescein uptake in the healthy control, pyrenoxine and timolol groups was 20.3 ± 3.2, 21.5 ± 4.0 and 76.2 ± 30.0 ng/ml (mean ± standard error), respectively. There was a significantly higher fluorescein uptake in the timolol group compared to the pyrenoxine group (p = 0.0088) and the healthy control group (p = 0.0055). TSCM showed no significant difference in the superficial cell areas of the corneal epithelium between the healthy control and timolol groups. β-Blocker eyedrops decreased the corneal epithelial barrier function. Their application was not accompanied by any biomicroscopic change in the superficial cell area.
Influence of Human Immunodeficiency Virus Status on the Clinical History of Herpes simplex Keratitis
Authors: Pramod N.P. , Hari R. , Sudhamathi K. , Ananadakannan K. , Thyagarajan S.P.
Published: April 2003

Human immunodeficiency virus (HIV) infection is associated with a wide spectrum of systemic and ocular infectious diseases. Little is known about its association with herpes simplex keratitis (HSK) in this geographical region (South India). A retrospective study was undertaken to analyze this association in a cohort of 30 virologically proven recurrent HSK cases. Laboratory methods included herpes simplex virus (HSV) isolation, HSV antigen detection and tear secretory IgA or HSV DNA detection while commercial ELISA kits detected HIV infection. The rationale behind the HIV screening was to assess the role of HIV with increased HSK recurrences. Confirmed HIV seropositivity was 16.7% in recurrent HSK cases as against 3.3% in the matched first-episode HSK cases (p < 0.05, Fisher’s exact test). Our observations on the features of herpetic keratitis in HIV-proven patients, though based on a small number of cases, raise the question whether the immunological abnormalities associated with HIV/AIDS may affect the clinical course of HSK.
Intubation of the Lacrimal Pathways under Endoscopic Control
Authors: Komínek Pavel , Červenka Stanislav , Novák Václav
Published: April 2003

Described herein is a new modification of the lacrimal pathway intubation in children with efferent lacrimal pathway obstruction. For removal of the intubation set probe without olive tips from the inferior nasal meatus, a special titanium loop is used. An endoscopic technique allows us a basically more considerate performance of this procedure and to speed it up. The risk of iatrogenic damage to the mucous membrane of the inferior meatus is, thus, reduced too. From April 1994 to June 1998, lacrimal pathway intubation was performed in 235 children 283 times. Infraction of the inferior concha was performed 27 times. Insertion of a probe submucously into the inferior nasal meatus was found 35 times and the probe was released by focused incision of the mucous membrane.
Visual Acuity Disturbances in Chronic Renal Failure
Authors: Tomazzoli L. , De Natale R. , Lupo A. , Parolini B.
Published: April 2003

Patients affected by chronic renal failure often complain of blurred vision when submitted to hemodialysis. Refraction, visual acuity and lens transparency have been evaluated in 36 eyes of 18 patients who underwent hemodialysis, before and after the treatment. Student’s t test did not prove any statistically significant difference between the considered parameters. However, a change in refraction was noted in 64% of the eyes, always in hyperopic mean. Corrective glasses had to be changed to ensure the same visual acuity as before the hemodialytic treatment. Particular care must be taken in lens prescription in those patients who could undergo dialysis for chronic renal failure.
Clinical Diagnosis of Chronic Canaliculitis by 20-MHz Ultrasound
Authors: Tost Frank , Bruder Ralf , Clemens Stefan
Published: April 2003

The practical value of high-resolution ultrasound (transducer frequency of 20 MHz) in the study of the lacrimal canaliculi has been proven. It can also be used in the clinical diagnosis of chronic canaliculitis. If the classic symptoms are absent, the clinical diagnosis is often inaccurate, and treatment is insufficient. Representative images of normal cases and of chronic canaliculitis illustrate the potential of high-resolution ultrasound. In our patient, 20-MHz scanner images revealed pathological findings which were invisible during slitlamp examination. Ultrasonic images of chronic canaliculitis showed ectasia of the canaliculus and sulfur grains. High-resolution ultrasonic examination of the lacrimal drainage system demonstrated that the 20-MHz scanner used was able to show concrements (sulfur grains), measuring 1–2 mm in diameter. Such more reflective structures (like sulfur grains) are a pathognomonic sign of chronic canaliculitis. Our report confirms the efficiency of 20-MHz sonography in the diagnosis of canaliculitis without any side effects.
Pattern Dystrophy of the Retinal Pigment Epithelium in Crohn’s Disease
Authors: De Franceschi P. , Costagliola C. , Soreca E. , Di Meo A. , Giacoia A. , Romano A.
Published: April 2003

The authors describe a case of bilateral pattern dystrophy of the retinal pigment epithelium in a man with Crohn’s disease. The patient was examined every 6 months over a follow-up of 30 months. The right eye presented a macroreticular dystrophy while in the left eye a butterfly pattern dystrophy was diagnosed. During the follow-up period the retinal lesion changed; in the right eye the lesion increased in size, while in the left eye the morphology of the lesion passed from the butterfly to Sjögren’s type. This report adds a new ocular manifestation of Crohn’s disease, emphasizing the importance of the ophthalmological follow-up in the recognition of posterior segment complications associated with this inflammatory bowel disease.
Advances in the Use of Glass-Ionomeric Cement
Authors: Weber B.P. , Philipps B. , Strauchmann B. , Lenarz T.
Published: April 2003

The objective of this study was to develop a method of cement microapplication using glass-ionomeric cement. The results of an experimental study to design a microapplication method of glass-ionomeric cement (Ionocem®) are presented. Typical middle ear implant materials, as well as human temporal bones and middle ear ossicles, were used to test the efficiency of this application method. Two different versions of Ionocem®, low and normal viscosity, were tested under different temperatures and with several application tools. Sufficient processing time could be achieved by cooling the cement down to 4°C. A subcutaneous insulin syringe with a milled-off tip proved to be cost-effective, efficient and versatile. Using this instrument, durable and secure cementation between the parts tested could be achieved. This method may be of significant importance in otologic research and microsurgical routine. In part 2, experimental animal results will follow, as the method portrayed was used to secure parts of a totally implantable middle ear hearing device.
Peritonsillar Abscess Associated with Infectious Mononucleosis
Authors: Arkkila Eva , Sipilä Jukka , Laurikainen Esa , Suonpää Jouko
Published: April 2003

Infectious mononucleosis (IM) is characterized as a viral disease; thus, no antibiotic treatment is recommended. However, some of these patients tend to develop a long-lasting, painful disease, which can be relieved by antibiotic administration. Due to this bed-side knowledge, we re-evaluated 928 patients with peritonsillar abscess (PA), treated during a 5.5-year period in the Department of Otorhinolaryngology of Turku University Central Hospital. Of these patients 15 (1.6%) also had infectious mononucleosis (IM). During this period, 64 patients with severe pharyngeal IM were treated in our department and thus the proportion of PA in patients with IM was 23.4%. A control of 15 age- and sex-matched patients with PA but without mononucleosis was formed in order to evaluate the possible differences in patient history, clinical symptoms and findings. Such differences were small and did not affect the chosen treatment of PA, abscess tonsillectomy. There was no peri- or postoperative difference in complications or recovery, but the hospitalization time was longer in IM patients with PA (3.1 days) than in patients with PA only (2.4 days). IM patients referred to ENT departments make a special group of patients, who may also need surgical treatment.
Long-Term Fate of Plastipore in the Middle Ear
Authors: El-Seifi Alaa , Fouad Bassem
Published: April 2003

Four Plastipore prostheses, removed at revision surgery 7–10 years after implantation, have been examined. The gross appearance of the prostheses was preserved. The prostheses were surrounded by a fibrous tissue capsule and showed fibrous tissue ingrowth localized in peripheral zones. Foreign-body giant cells and macrophages were detected in small numbers. Histologic evidence of breakdown of the prostheses, in the form of microdisintegration of the walls of micropores, was detected on a small scale. Compared to the massive foreign-body reactions reported in short-term studies, the tissue reaction apparently subsides with time and becomes insignificant. Strict criteria for insertion should be regarded.
Projection Neurons in the Superior Olivary Complex of the Rat Auditory Brainstem: A Double Retrograde Tracing Study
Authors: Riemann Randolf , Reuss Stefan
Published: April 2003

The superior olivary complex (SOC), a group of interrelated brainstem nuclei, sends efferents to a variety of neuronal structures including the cochlea and the inferior colliculus (IC). In the present study conducted in rats, we sought to investigate whether single SOC efferent neurons project to both cochlea and IC. These neurons were identified by retrograde axonal transport of the neuronal tracers fluoro-gold upon application to the cochlea and cholera toxin B subunit injected into the central nucleus of the IC. Projections to the cochlea were found to stem predominantly from the ipsilateral lateral superior olive (LSO) and medial superior olive (MSO) as well as from the bilateral superior paraolivary nucleus (SPO), dorsal periolivary groups (DPO) and the medial nucleus of the trapezoid body (MNTB). Neurons innervating the IC were seen in the bilateral LSO and DPO, in the SPO predominantly ipsilateral, as well as in the ipsilateral MSO and MNTB. We further observed that some neurons in the ipsilateral LSO, and a considerable part of those of the SPO were double-labeled. However, cells projecting to either IC or cochlea were much more numerous than double-labeled neurons.
Patients’ and Cohabitants’ Reports on Snoring and Daytime Sleepiness, 1–8 Years after Surgical Treatment of Snoring
Authors: Hagert Britt , Wahren Lis Karin , Wikblad Karin , Ödkvist Lars
Published: April 2003

A follow-up study was performed with the aim to evaluate all individuals surgically treated by the uvulopalatopharyngoplasty (UPPP) or laser uvulopalatoplasty (LUPP) method from a whole county in Sweden, 1–8 years after surgery, by assessing snoring occurrence and daytime sleepiness, as experienced by the patients and their cohabitants. Questionnaires were mailed to all operated people (n = 457) and were returned by 91% (346 men, 69 women) preoperatively diagnosed as habitual snorers (n = 255), cases of obstructive sleep apnea syndrome (n = 110) and unspecified snorers (n = 48). In addition 345 bedpartners participated. For outcome of surgery, no significant differences in diagnoses or sex were found. Improvement in snoring occurrence was reported by 89.6% of the patients, confirmed by 92% of the cohabitants (r = 0.84, p < 0.01). The remaining snoring occurrence was significantly dependent on the surgical method and the time after operation. Excessive daytime sleepiness (EDS) was experienced by 73.3% of the patients compared to 67% reported by the cohabitants. Of 415 patients operated on, 18% were free from snoring and 25% were free from EDS. Individuals with a shorter time since surgery reported less snoring. The UPPP method gave a significantly better result than LUPP for the symptom ‘snoring’.
Myringosclerosis Develops within 9 h of Myringotomy
Authors: Mattsson Cecilia , Johansson Cathrine , Hellström Sten
Published: April 2003

The aim of the present experimental study was to elucidate the temporal development of myringosclerosis. Twenty-four Sprague-Dawley rats were myringotomized bilaterally. At 3, 6, 9, 12, 18, 24, 30, 36, 48, 60, 72 and 84 h after the myringotomy, 2 animals at each time were examined otomicroscopically and thereafter sacrificed. The pars flaccida and pars tensa were excised and prepared for light- and electron-microscopic studies. Otomicroscopically, myringosclerosis was visible in the pars tensa 24 h after myringotomy, whereas no sclerotic lesions were noted in the pars flaccida. Histologically, sclerotic lesions were present in the pars tensa and pars flaccida 9 and 12 h, respectively, after myringotomy. The pars flaccida responds promptly with an inflammatory reaction characterized by abundant macrophages. Myringosclerosis develops promptly after myringotomy and its establishment is related to an inflammatory reaction.
Hyalinizing Clear Cell Carcinoma of the Oral Cavity and of the Parotid Gland
Authors: Rinaldo Alessandra , McLaren Kathryn M. , Boccato Paolo , Maran ArnoldG.D.
Published: April 2003

Hyalinizing clear cell carcinoma (HCCC) is a rare, recently described tumor of salivary gland origin. Differential diagnosis includes benign lesions as clear cell change in a pleomorphic adenoma or in oncocytoma and malignant tumors – i.e. epithelial-myoepithelial carcinoma, polymorphous low-grade adenocarcinoma, mucoepidermoid carcinoma, clear cell acinic carcinoma, clear cell squamous carcinoma, clear cell malignant melanoma, clear cell odontogenic carcinoma, clear cell rhabdomyosarcoma, sebaceous carcinoma and metastasis of renal carcinoma. A favorable prognosis after wide local excision has been evidenced. Three new cases of HCCC (2 in the oral cavity and 1 in the parotid gland) are presented.
Transcranial Cortical Magnetic Stimulation of Lower-Lip Mimetic Muscles: Effect of Coil Position on Motor Evoked Potentials
Authors: Rödel R. , Laskawi R. , Markus H.
Published: April 2003

The effect of the coil position along the interaural line on motor evoked potentials of lower-lip muscles to cortical transcranial magnetic stimulation was investigated in 17 healthy subjects. Using a figure-8-shaped coil, we observed ipsi- and contralateral middle-latency motor evoked potentials in all subjects, when the coil was centered within an area between 4 and 13 cm lateral to the vertex. Maximal responses (mean amplitude 1.4 ± 0.8 mV contralateral, 0.7 ± 0.5 mV ipsilateral) with shortest mean onset latencies (11.3 ± 1.6 ms contralateral, 12.1 ± 2.8 ms ipsilateral) were obtained at a stimulus position of 10 cm lateral to the vertex. Cortical maps of mean amplitude and mean response duration showed inverse U-shaped configuration. Furthermore, we observed an additional polyphasic and mostly bilateral response in 16 of the 17 subjects.
Clinical Design and Evaluation of the Prototype of a New Digital Audioprosthesis for Profound Hearing Loss: Speech Recognition Aspects
Authors: Urquiza R. , Ruiz-Rico R. , Tejero C. , Gago A.
Published: April 2003

The design and implementation of the prototype of a digital hearing aid and its computerized fitting interface, followed by a basic preliminary clinical evaluation concerning speech recognition aspects, is reported. The final device is particularly destined to those patients suffering sensorineural hearing losses with recruitment and problems for speech recognition. The prototype is based on the digital signal processor TMS320C30. The host is a personal computer. The primary concept of the processing strategy is the ‘integral treatment of acoustic information’ within the remaining auditory field of the patient leading to minimum modification of the signal profile. The processing stages include linear amplification, specially designed AD conversion, real fast Fourier transform, 128 multiband single treatment (compression threshold and magnitude of compression), inverse fast Fourier transform, and DA conversion. Compression parameters and pure-tone audiometry data are entered by the computerized fitting interface which also provides real time information of input and output spectral profile. The preliminary clinical evaluation here reported corresponds to a series of 13 patients and it is focused on speech recognition performances. Ten patients had sensorineural hearing loss. Three subjects served as controls. All subjects were studied by an extensive audiological protocol. In 6 patients the prototype improved the maximum intelligibility with respect to unaided hearing reaching levels in the range of 90–100%. In 4 patients using conventional hearing aids, the prototype improved the maximum intelligibility with respect to the previous aided hearing. Values reached the same range as in the former 6 patients. Straightening of the speech audiometry curves was observed in those patients with recruitment. Two controls with previously normal speech recognition showed no worsening and others with conductive deafness reported additional improvement of the responses in noisy conditions with respect to the audioprosthesis in use.
Middle Cranial Fossa Approach to the Internal Auditory Meatus:A Chinese Temporal Bone Study
Authors: Low W.K.
Published: April 2003

Most techniques applied in the middle cranial fossa approach to the internal auditory meatus were based on anatomic studies in Caucasians. As racial differences in the cranium exist, this paper evaluated the applicability of these techniques in Chinese patients. This paper also evaluated the usefulness of the 30-degree-angled rigid endoscope in identifying the superior semicircular canal (SSC). Thirty Chinese temporal bones were dissected. It was found that, like in Caucasian patients, (1) constant relation exists between the geniculate ganglion and SSC, and (2) the internal auditory meatus of each specimen was situated within a 60-degree angle anterior to the SSC. However, the orientation of the arcuate eminence and its relationship to the SSC in Chinese differed from Caucasians. The endoscope was found to be useful in aiding early identification of the SSC and in differentiating it from surrounding air cells. In conclusion, some recommended landmarks used in hearing preservation via the middle cranial fossa approach may not apply to Chinese patients. The endoscope has the potential to enhance the chances of hearing preservation.
Active Nonlinear Mechanics of the Organof C orti Including the Stereocilia-Tectorial Membrane Complex
Authors: Böhnke Frank , von Mikusch-Buchberg Jutta , Arnold Wolfgang
Published: April 2003

There is a large amount of knowledge about the different components of the organ of Corti (OC), but little is known about how these components act together in vivo. To clarify the complex mechanical behavior of the OC, anatomic results are carefully analyzed and used to develop a finite element model of a short section of OC, which includes 8 outer hair cells (OHC) and their supporting structures. The modal analysis shows the frequency-dependent phase reversal of the radial stereocilia displacement. The transient computation confirms the amplification of OC displacements when the ability of the OHC to contract and elongate is considered. The inclusion of a nonlinear function describing the mechanoelectrical transduction in OHC amplifies and distorts the displacement of the OC when it is stimulated by a sinusoidal input pressure function. These results are in agreement with other psychoacoustic, electrophysiologic and otoacoustic measurements.
Electric-Acoustic Stimulation of the Auditory System
Authors: vonIlberg C. , Kiefer J. , Tillein J. , Pfenningdorff T. , Hartmann R. , Stürzebecher E. , Klinke R.
Published: April 2003

Various devices have been developed to overcome the widespread phenomenon of different degrees of hearing deficits between mild and profound hearing loss. Basically, we differentiate between acoustic stimulation (hearing aids), restricted to cases with a partially functioning cochlear receptor, and electrical stimulation (cochlear implants), stimulating the auditory nerve directly in cases with profound or total hearing loss. For the first time, animal data have been collected that indicate the possibility of nearly interference-free use of both stimulation types simultaneously. In addition, we have gathered the first clinical patient experience, which confirms the encouraging results. Future implications for patients with severe high-frequency hearing loss are discussed.
Determining the Pathway of the Blink Reflex through Transcutaneous Electrical Stimulation of the Facial Nerve over the Stylomastoid Foramen
Authors: Nakamura Katsuhiko , Sakamaki Koichiro , Sizuku Haruhiko , Koike Yasuo
Published: April 2003

The afferent pathway of the late response (R2 component) of the blink reflex in response to transcutaneous electrical stimulation of the facial nerve over the stylomastoid foramen remains uncertain. The two major hypotheses regarding the afferent pathway of R2 are that it may consist of either the trigemino-facial or the facio-facial reflex. This study was performed to determine the afferent pathway of R2. Ninety-one patients with acute unilateral peripheral facial palsy and 21 controls were studied. The degree of facial nerve damage was classified into three groups: mild, moderate, and severe according to their electroneurographic value. In each group, the appearance rate, latency, and area under the curve of contralateral R2 elicited by electrical stimulation of the injured facial nerve over the stylomastoid foramen were measured and compared with those of controls. The contralateral R2 parameters did not differ between the patient groups and the controls. The results indicate that the afferent pathway of R2 is mediated not only through the facial nerve. We conclude that the auriculotemporal nerve (V3) and the great auricular nerve (C2, C3) may also contribute to the afferent pathway of R2.
Clinical Diagnosis of an Unusual Cause of a Cutaneous Neck Mass
Authors: Low W.K.
Published: April 2003

A case of migrating ingested fish bone presenting as an unresolving inflamed neck mass is reported. The clinical features of this rare but easily misdiagnosed entity are discussed. The diagnosis must be suspected in a patient with an unresolving inflamed cutaneous lesion (especially one with a punctum), tenderness of the lesion elicited on swallowing and the presence of a palpable subcutaneous fistula tract. In such a patient, a history of recent foreign body ingestion must be actively sought. An accurate early diagnosis of this easily treatable condition is desirable as it could avert unnecessary delays, inconveniences, anxiety, costs, investigations and surgery.
Direct Carotid Cavernous Fistulaafter Submucous Resection of theNasal Septum
Authors: Bizri Abdul Rahman , Al-Ajam Mohammad , Zaytoun George , Al-Kutoubi Aghiad
Published: April 2003

A carotid cavernous fistula (CCF) is an abnormal arteriovenous anastomosis between the carotid artery and the cavernous sinus. Etiologies of this condition reported in the literature so far include facial trauma, rupture of an intracavernous aneurysm of the carotid artery, Ehler-Danlos syndrome and fibromuscular dysplasia of the cerebral arteries. Such fistulae were reported as complications of rhinoplasty, transsphenoidal surgery, embolization of cavernous sinus meningioma, and rhinocerebral mucormycosis. CCF may also occur spontaneously in children or as a congenital malformation. However, to our knowledge, submucous resection of the nasal septum has not been reported before to cause direct carotid-cavernous fistula. CT and angiographic findings are presented and a review of the literature for reported causes of CCF is made as well as a brief discussion of the possible pathophysiology.
Periodic Alternating Nystagmus and Congenital Nystagmus: Similarities in Possibly Inherited Cases
Authors: Ito Ken , Murofushi Toshihisa , Mizuno Masahiro
Published: April 2003

In this paper, 2 patients, a daughter with periodic alternating nystagmus and a mother with congenital fixation nystagmus, are presented, and the similarities of the two disorders are discussed, not only in the eye movements, but also in their underlying abnormalities. The literature was reviewed, and the link between periodic alternating and congenital fixation nystagmus, which had been suggested based on circumstantial evidence, may be confirmed by our cases. The possible evidence of inheritance suggests that the two disorders share common abnormalities in visual processing.
Epithelial Changes in Seasonal Allergic Rhinitis throughout the Year: Evidence of Coexistent Air Pollution and Local Secretory IgA Deficiency?
Authors: Glück Ulrich , Gebbers Jan-Olaf
Published: April 2003

To determine possible epithelial changes in seasonal allergic rhinitis, we examined epithelial cells in cytology swab preparations of 38 non-smoking patients, exclusively sensitized to grass pollen, throughout the year, and surgical material of 8 patients. Cytologically, we found a marked goblet cell hyperplasia during the period of grass pollen exposure, while meta- and dysplasia were found throughout the year. Immunohistochemically, a lack of secretroy IgA in the altered epithelium was detected. These results were not obtained in the control group of 60 healthy non-smokers. Since we have recently found the same epithelial changes of meta- and dysplasia in smokers, these findings may point to non-specific toxic damage of the nasal epithelium possibly caused by other air pollutants. The altered epithelium may lead to an impairment of the local secretory IgA defence system and thereby to an increased allergen uptake.
Saccular Laryngeal Cysts
Authors: Kinnunen Ilpo , Klemi Pekka , Grenman Reidar
Published: April 2003

Supraglottic laryngeal cysts are benign lesions that usually are easily recognized and simply managed. Among these lesions saccular cysts are uncommon, usually large, anomalies of the larynx and can cause severe airway obstruction and even death. Three patients with a saccular cyst were successfully treated by endoscopic CO2-laser excision of their lesions. Before microlaryngoscopy and laser procedure, an urgent tracheostomy was required in 1 of our cases.
Ossifying Lipoma Independent of Bone Tissue
Authors: Kameyama Kaori , Akasaka Yoshikiyo , Miyazaki Hiromichi , Hata Jun-ichi
Published: April 2003

A 46-year-old Japanese male was referred to a local hospital because of a firm, nontender mass on his neck. On physical examination, the tumor was soft, well demarcated, 3 × 2 cm in size and located in the submucosal region. It was entirely separate from the vertebrae. The resected tumor was shown to be a lipoma with focal ossification. Ossifying lipomas are rare, and the cases which are independent of bone even more so. A literature review revealed that ossifying lipoma independent of bone tissue has been reported in only 8 cases, and, interestingly, all of them occurred in the head and neck region.
Nonsurgical Treatment of Advanced Metastatic Cervical Disease in Cancer of the Larynx
Authors: Petruzzelli Guy J. , Emami Bahman
Published: April 2003

Historically, patients with advanced cervical adenopathy (N2 or N3) have between a 20 and 30% chance of surviving their disease at 5 years from treatment. Despite attempts at more aggressive surgical resection, including resection and reconstruction of the carotid artery, patients with advanced cervical adenopathy remain at the highest risk for the development of local recurrences and distant metastases. This chapter will review the current limitations of surgical resectability for advanced neck disease, discuss the evolution of combined chemoradiation therapy for these patients, and finally present promising recent technological advances in radiation oncology which will have significant impact on the treatment of these patients.
Malignant Salivary Gland Tumors in Quito, Ecuador
Authors: Pacheco-Ojeda Luis , Domeisen Hannes , Narvaez Mercedes , Tixi Ricardo , Vivar Nicolás
Published: April 2003

Objectives: Malignant salivary gland tumors (MSGT) are uncommon. Age-standardized incidence rates are 0.5 and 0.3 per 100,000 in Quito, Ecuador; and 1.0 and 0.7 per 100,000 in the USA (SEER Program), for males and females, respectively. The goal of this study was to review a 16-year experience of a major general hospital in the treatment of these lesions. Patients and Methods: From 1982 to 1998, 308 salivary gland tumors were surgically treated at the Hospital ‘Carlos Andrade Marin’ of the Ecuadorian Institute of Social Security in Quito, Ecuador, an Andean city of approximately 2 million inhabitants. Malignant lesions were found in 58 cases (19%): 37 out of 194 parotid gland tumors (19%), 7 out of 86 submandibular tumors (8%) and 14 out of 28 minor salivary gland tumors (50%). Adenoid cystic carcinoma and mucoepidermoid carcinoma were the most common histologic types. Twenty-two cases were classified as stage I, 13 as stage II, 1 as stage III and 20 as stage IV (UICC TNM staging classification). Thirty-one (53%) patients were treated by surgery alone; postoperative radiation therapy was additionally given to 22 (38%), and surgery, radiotherapy and chemotherapy were applied in 5 cases (9%). Results: Local (LR) and/or regional recurrences were detected in 13 patients (22%). Twelve patients (21%) developed distant metastasis (DM; 2 in more than one site): 7 in the lungs, 2 in the brain, 2 in the bone and 1 each in the liver, subcutaneous tissue and pleura. Thirty-five patients are alive, 33 disease free. Twenty-three patients are deceased: 6 with LR, 7 with DM, 3 with both LR and DM, 1 with locoregional recurrence and DM, 2 with a second neoplasm, 3 with intercurrent disease and 1 from unknown causes. Five- and 10-year overall survival rates were 75 and 68%, respectively. There were no significant differences in mortality according to the site of the primary tumor or histologic type, but stage and involved surgical margins were important prognostic factors (p = 0.006 and 0.003). Conclusions: The surgical or multimodality treatment of MSGT has provided a good locoregional control (78%) and 68% 10-year survival in a series of patients treated at the oncology department of a general hospital in Quito, Ecuador. Stage and involved surgical margins were significant prognostic factors.
Nasal Challenge Activates the Mucociliary Transport System on Not Only the Ipsilateral but also the Contralateral Side of the Nose in Patients with Perennial Allergic Rhinitis
Authors: Mori Shigehito , Fujieda Shigeharu , Kimura Yuichi , Takahashi Noboru , Saito Hitoshi
Published: April 2003

It is controversial whether the mucociliary transport system in the nasal mucosa of persons with allergic rhinitis is upregulated after an allergen challenge in vivo. The aim of this study was to assess the effect of a specific allergen challenge on the mucociliary transport system in allergic rhinitis. We used a challenge of house dust mites or a control substance on one side of the nose of 97 volunteers (54 with allergic rhinitis for house dust mites and 43 without allergies). The mucociliary transport system of the ipsilateral or contralateral side of the nose challenged was evaluated using the saccharin clearance time on the right side of the nose. The saccharin clearance time was significantly shortened after an allergen challenge not only on the ipsilateral (right) side of the nose (from 15.0 ± 11.6 to 10. 9 ± 9.2 min, mean ± SD, p = 0.041) but also on the contralateral (left) side of the nose (from 14.7 ± 10.1 to 8.1 ± 7.9 min, p = 0.013) in the allergic group. A reduction of the saccharin clearance time was also seen in the allergic group after a control challenge [ipsilateral (right) challenge: from 13.0 ± 10.0 to 11.6 ± 10.6 min, contralateral (left) challenge: from 13.5 ± 9.0 to 10.2 ± 10.1 min]. There were no reductions of the saccharin clearance time after an allergen or control challenge in the nonallergic groups. These results suggest that a unilateral nasal challenge accelerates the mucociliary transport system bilaterally in the nose of subjects with a hypersensitivity such as allergic rhinitis.
Is mts1 (S100A4) Gene Involved in the Metastatic Process Modulated by Gamma-Interferon?
Authors: Chiaramonte Raffaella , Fasola Stefano , Lollini Pier Luigi , De Giovanni Carla , Comi Paola
Published: April 2003

This study investigates the involvement of mts1 (S100A4) in the metastatic process. We have evaluated the levels of mts1 gene in murine cancer cells following modulation of the metastatic ability. We report here that modulation of the expression of mts1 gene in cells derived from a breast murine adenocarcinoma (TS/A) did not correlate with metastatic ability either when pretreated in vitro with γ-interferon (γ-IFN) or following transfection with γ-IFN gene. In another series of experiments we treated the cell lines B16-A and B78H1, both derived from B16 melanoma, with γ-IFN. An increased expression of mts1 was found only in B16-A, but not B78H1, correlated with a strong increase in metastatic activity of B16-A clone upon γ-IFN treatment.
Epinephrine Augments Specific T-Cell Responses to Antigen in C57BL/6 (H-2b) Weak-Responder Mice by a CD8+ Lymphocyte-Dependent Mechanism
Authors: Rodberg Gary M. , Kradin Richard L.
Published: April 2003

Stress has been implicated as a factor in the pathogenesis of autoimmune disorders. In order to determine the effect of adrenergic stress on immune responses in vivo, C57BL/6 (B6; H-2b) mice, which respond weakly to hen-egg lysozyme (HEL), were immunized on day 0 with HEL (50–200 µg s.q.) and subsequently injected with epinephrine (EPI; 0.1–0.5 mg/kg s.q.) daily for up to 10 days. Controls included A/J mice (H-2k) which respond strongly to HEL. In some experiments, B6 mice were depleted of CD4+ or CD8+ lymphocytes by monoclonal antibody treatment in vivo, prior to immunization with HEL, and injection with EPI. On day 10, single cell suspensions of draining lymph nodes (LN) and spleen were examined for immune phenotype, proliferative responses to HEL, and lymphokine production. Minimal specific proliferative responses were detected in B6 mice compared to A/J mice. However, lymphocyte proliferation increased in HEL-immunized EPI-treated B6 mice but not in the A/J mice. IL-2-mediated proliferation and IL-2 secretion were both increased in the HEL-immunized EPI-treated B6 mice. The depletion of CD8+ but not CD4+ lymphocytes in vivo abrogated the effects of EPI, whereas adoptive transfer of naive CD8+ splenocytes to the CD8-depleted mice restored specific responses in the HEL-immunized EPI-treated animals. We conclude that EPI augments antigen-specific T-cell responses to HEL in B6 mice by a CD8+ T-cell-dependent mechanism.
Mucosal HIV Infection
Authors: Ullrich Reiner , Schmidt Wolfgang , Zippel Thomas , Schneider Thomas , Zeitz Martin , Riecken Ernst-Otto
Published: April 2003

The gastrointestinal tract is not only a major site of clinical manifestations of the acquired immune deficiency syndrome but also an important compartment for HIV infection at all stages of the disease. In intestinal biopsies HIV has been detected so far mainly in mononuclear cells of the lamina propria but also in epithelial cells. Primary and permanent epithelial cell lines can be productively infected by HIV in vitro and epithelial cell monolayers can rapidly transport HIV by transcytosis. Both phenomena are most effective for cell-associated virus and do not require CD4 expression but seem to involve the interaction of gp120 with galactosyl ceramide. In vivo, productive HIV infection of epithelial cells appears to be rare if it occurs at all. Mucosal HIV infection is highly active at all stages of HIV infection and the gastrointestinal tract is probably a major source of HIV in the body. Highest mucosal HIV production is found rather early in HIV disease and is associated with histological abnormalities and gastrointestinal symptoms. The excessive production of HIV in the intestine appears to be due to transcriptional or translational upregulation and local variations in HIV production correlate with local cytokine levels.
Nonmalabsorptive Mechanisms of Diarrhea in HIV Infection
Authors: Stockmann Martin , Fromm Michael , Riecken Ernst-Otto , Schulzke Jörg-Dieter
Published: April 2003

More than 50% of AIDS patients suffer from diarrhea, the cause of which is unexplained in 15–40%. In 60–85% a potential cause for diarrhea could be found but the pathogenic relevance often remains unclear. In this paper we review the current knowledge about the nonmalabsorptive mechanisms for diarrhea in HIV infection from a pathophysiologic point of view and we show evidence that the diarrhea in advanced HIV infection by HIV per se could be caused by a leak flux mechanism due to an epithelial barrier defect.
Cell Proliferation and Apoptosis of the Glomerular Epithelial Cells in Rats with Puromycin Aminonucleoside Nephrosis
Authors: Shiiki Hideo , Sasaki Yoshihiko , Nishino Toshihiko , Kimura Toshiaki , Kurioka Hideyuki , Fujimoto Shinichi , Dohi Kazuhiro
Published: April 2003

Injury and repair of the glomerular epithelial cells (GECs) play an important role in the pathogenesis of focal segmental glomerulosclerosis (FSGS). To obtain a better understanding of proliferation and apoptosis of GECs, we examined immunohistochemical and in situ hybridization findings in puromycin aminonucleoside nephrosis (PAN) of rats. The minimal-change nephrotic syndrome model (PAN-MCNS) was induced by administering 5 subcutaneous injections of puromycin aminonucleoside (PA; each 1.5 mg/100 g B/W to one group of rats), whereas the FSGS model (PAN-FSGS) was induced by administering an additional 5 injections of PA to another group of rats. The cell kinetics of the GECs were assessed with labeling 5-bromo 2′-deoxyuridine (BrdU) and proliferating cell nuclear antigen (PCNA). To investigate regulation of apoptosis in rats with PAN, we evaluated the expression of p53, Fas antigen, Fas ligand and Bcl-2. Rats with PAN-MCNS exhibited a significantly greater number of BrdU- and PCNA-labeled GECs as compared with control rats. In rats with PAN-FSGS, the number of PCNA-labeled GECs was greater than in rats with PAN-MCNS, but the number of BrdU-labeled GECs was lower. Apoptotic cells were occasionally observed in the sclerotic lesions, with the number being significantly higher in rats with PAN-FSGS than in rats with PAN-MCNS and control. Apoptotic cells were observed in the GECs of PAN-FSGS rats. However, they were negative for p53, Fas antigen, and Fas ligand. Immunohistochemical and in situ hybridization studies revealed a greater intraglomerular overexpression of Bcl-2 protein and bcl-2 mRNA in the PAN-FSGS rats as compared with control rats. These results suggest that insufficient proliferation and apoptosis in GECs may be involved in the progression of FSGS.
Long-Term Telomere Dynamics: Modest Increase of Cell Turnover in HIV-Infected Individuals Followed for up to 14 Years
Authors: Feng Yan-Ru , Biggar Robert J. , Gee Dennis , Norwood David , Zeichner Steven L. , Dimitrov Dimiter S.
Published: April 2003

To quantify the long-term dynamics of telomere lengths and the effect of HIV infection on lymphocyte turnover rates, we measured in a blinded study longitudinal samples from 6 individuals using a highly accurate method based on two-dimensional calibration of DNA sizes. For two uninfected controls followed 8 and 10 years the average telomeric terminal restriction fragment (TRF) shortening rate in peripheral blood mononuclear cells (PBMCs) was 50 and 60 bp/year, respectively, in agreement with previous measurements of cross-sectional samples. The TRF lengths of PBMCs from two slow progressors followed for 14 years declined by a rate of 120 ±10 bp/year, i.e. 2-fold higher than the rate of TRF shortening for uninfected individuals. The rate of TRF shortening was higher in CD8 (140 ±10 bp/year) than in CD4 (100 ±10 bp/year) cells. The CD8 cell TRFs of the two fast progressors shortened faster (240 ±10 bp/year) and the rate of CD4 cell TRF shortening in one of the fast progressors was 160 bp/year. These data suggest that HIV infection causes only a modest increase in the lymphocyte turnover which we speculate could be due to chronic activation of the immune system, and may not result in the exhaustion of its regenerative capacity and immunopathogenesis.
Cellular Immune Response to Retinal S-Antigen and Interphotoreceptor Retinoid-Binding Protein Fragments in Eales’ Disease Patients
Authors: Saxena S. , Rajasingh J. , Biswas S. , Kumar D. , Shinohara T. , Singh V.K.
Published: April 2003

The role of retinal antigens in Eales’ disease was studied in 24 patients and an equal number of healthy controls. Lymphocyte proliferative responses were tested in vitro against native S-antigen, its uveitopathogenic peptides (peptide M and peptide G), yeast histone H3 peptide and uveitopathogenic fragment of interphotoreceptor retinoid-binding protein (IRBP; R16) to establish their role in the pathogenesis of Eales’ disease. Out of 24 Eales’ disease patients, 6 showed significant proliferative response against S-antigen, its uveitogenic fragments or IRBP. None among the controls showed any response to any retinal antigen used in this study. There was no statistically significant difference in the response to purified protein derivative between patients and controls. These results suggest that retinal antigens may play a role in the etiopathogenesis of Eales’ disease. An extraneous agent that could result in exposure of normally sequestered uveitopathogenic antigens of the immune system, leading to an exuberant immune response in the eye may initiate the disease.
CD3+/CD30+ Circulating T Lymphocytes Are Markedly Increased in Older Subjectswith Down’s Syndrome (Tr isomy 21)
Authors: Bertotto A. , Crupi S. , Fabietti G.M. , Troiani S. , Parente C. , Mezzetti D. , Vaccaro R.
Published: April 2003

CD3+/CD30+ circulating T lymphocytes were found to be increased in the blood of individuals with Down’s syndrome (DS; trisomy 21). This finding appears to be related to age as the numbers of CD3+/CD30+ T cells were dramatically enhanced in the circulation of older DS subjects. Since CD30 antigen expression is considered to be a marker of T-helper-2 (Th-2) activation, and Th-2+ cells are associated with certain human pathologies, our data may in some way explain the enhanced susceptibility of DS patients to infections, malignant diseases and autoimmunity.