Ljubljana classification of epithelial hyperplastic laryngeal lesions.
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Epithelial Cells↗
Biomedical subjects
L Michaels
Publications and source records attributed to L Michaels.
[Epidermoid formation in the pathogenesis of congenital cholesteatoma--a current review].
BACKGROUND: Many theories have been suggested regarding the origin, pathogenesis, diagnosis, and incidence of congenital cholesteatoma. REVIEW OF LITERATURE: An overview on the current literature on congenital cholesteatoma of the middle ear is presented. It comprises the possible etiology and pathogenesis of congenital cholesteatoma. Among other theories, germ scattering, metaplasia, ingrowth of meatal epidermis, and reflux of amniotic fluid have been proposed. Special emphasis is put on the epidermoid formation theory, which has been described by Michaels and others. CONCLUSIONS: It is widely accepted that congenital cholesteatomas may originate from the postpartum persistence of epidermoid formations. Nevertheless, a clear transition from epidermoid formation to congenital cholesteatoma has yet to be confirmed.
Cholesteatoma, Middle Ear↗
The epidermoid formation and its affinity to congenital cholesteatoma.
The epidermoid formation was reinvestigated in stained step sections of foetal and neonatal temporal bones to assess its relationship to congenital cholesteatoma. Epidermoid formations were found in 88 of 211 temporal bones (42%) at from 12 weeks gestation to 6 months post-partum. The site was usually near the roof of the anterolateral epitympanum at an average of 389 microns anterior to the anterior edge of the tympanic membrane. Seven epidermoid formations however, were sited on the medial anterosuperior tympanic membrane surface. The mean surface diameter of epidermoid formations was 242 microns. Some were greater than 1500 microns, which approaches the size of small congenital cholesteatomas. They are often in proximity to a developmental epithelial fold which could close off to produce a cyst. These features support the concept that the epidermoid formation is a precursor of the small anterosuperior congenital cholesteatoma.
Cholesteatoma↗
Development and evaluation of a chromatographic procedure for partial purification of substance P with quantitation by an enzyme immunoassay.
We have developed a simple chromatographic procedure for the partial purification of substance P (SP) from acidified plasma and serum samples. We have evaluated a sensitive antigen competition enzyme immunoassay (EIA) for the quantitation of SP. The chromatographic procedure has recovery efficiencies ranging from 94.8 to 125%. The immunoreactivity of unknown amounts of purified SP subjected to the preparative procedure yielded a coefficient of variance of 9.4%. The EIA yielded reproducible standard curves having an interassay (n = 8) correlation coefficient of 0.984. The evaluation of normal adult control serum yielded a mean value of 51 pg/ml (range, 35 to 61 pg/ml). The evaluation of 3.33 x concentrates of serum-derived partially purified SP provided uncorrected SP values of 117 to 201 pg/ml, which fell within the midpoint of the three-decalog standard curve. These studies indicate that both the preparative and quantitative procedures are required for the detection of SP in plasma or serum samples collected from patients with several clinical disorders.
Adult↗
Mediastinal endodermal sinus tumor.
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Adolescent↗
Argyrophilic nucleolar organizer regions in auditory meatal skin and middle ear cholesteatoma.
Comparative silver-staining of argyrophilic nuclear organizer regions (AgNORs) was performed to study the proliferative activity of auditory meatal skin and middle ear cholesteatoma. AgNOR expression patterns were counted by standardized methods in two centres, Bochum and London, and mean numbers of dots per nucleus were calculated. Specimens of normal auditory meatal skin showed 1.54 dots/nucleus (n = 12) in the Bochum study, whereas cholesteatoma had 3.71 dots/nucleus (n = 21). In the London study normal meatal skin showed two dots/nucleus (n = 4), whereas acquired cholesteatoma (n = 8) gave a mean of 4.90 dots/nucleus and congenital cholesteatoma a mean of 4.70 dots/nucleus (n = 2). Our findings confirm the hyperproliferative state of middle ear cholesteatoma, suggest that the congenital variety of cholesteatoma may have a similar activity and indicate that AgNOR staining is a useful technique for assessing cellular proliferation in cholesteatoma and objectifying and quantifying its aggressive behaviour.
Cell Division↗
The Kambic-Gale method of assessment of epithelial hyperplastic lesions of the larynx in comparison with the dysplasia grade method.
Sections of vocal cord biopsies from 47 cases in whom had been previously assessed by a dysplasia grading system at from I to III, were reclassified according to the Ljubljana system. The majority of the Grade I lesions were reclassified as "non-risky", but a small number were put into the risky or even carcinoma in situ groups. While most of the Grade III cases were reclassified as "risky" there were a few who were assigned to a non-risky category. It is suggested that with the Ljubljana histological grading system a more clear-cut separation of cases with risk of developing vocal cord malignancy from those with no such risk, is possible. Attention is drawn to a lesion denoted as "large cell hyperplasia", which is not covered in the grading or Ljubljana categorization of vocal cord lesions. The malpighian cells in this lesion are enlarged to over 30 microm in diameter, and show prominent nucleoli: apoptotic cells are prominent. Evidence is presented that this may be a categorical risk for the development of malignant changes.
Apoptosis↗
The ear in the acquired immunodeficiency syndrome: II. Clinical and audiologic investigation.
Patients with acquired immunodeficiency syndrome (AIDS) were investigated to determine the sites, nature, and severity of any otologic abnormalities. Tinnitus, "muffled" or "echoing" hearing, and vertigo were frequent complaints. Eight percent of the 155 patients studied showed evidence of chronic otitis media, usually with effusion. Mostly mild, but occasionally severe sensorineural hearing loss was found in many, affecting more severely the higher and lower frequencies than the middle range. Almost all patients showed diminished otoacoustic emissions, suggesting cochlear dysfunction resulting from infection or ototoxicity as the basis for the hearing loss. Impairment of the otoacoustic emissions by a subclinical otitis media with effusion cannot, however, be excluded. On the basis of this study it is suggested that the provision of otologic care to patients with AIDS may enhance their quality of life and, by the early detection and treatment of severe otitis media, may even prolong life.
Acoustic Impedance Tests↗
Benign mucosal tumors of the nose and paranasal sinuses.
The histogenesis of benign mucosal tumors of the nose and paranasal sinuses is reviewed in this report. In contradistinction to the view favored in the literature, these comprise three distinct entities. Everted and cylindric cell papillomas are true papillomas, lined by stratified squamous and microcyst-laden, columnar, and oncocytic epithelium, respectively. Inverted papillomas are polyps with marked, patchy squamous metaplasia in ductal and surface epithelium and numerous microcysts containing macrophages in those epithelia. Low-grade squamous carcinoma of the nose and paranasal sinuses may be difficult to distinguish from inverted papilloma. There are no intermediate forms from any one of the three types of benign mucosal tumors of the nose and paranasal sinuses to another. The site of origin of everted papilloma is from the nasal septum or nasal vestibular epithelium. Inverted and cylindric cell papillomas arise on the other hand from the lateral wall of the nose, ethmoid, or maxillary sinuses. Inverted papillomas alone among the three have a strong tendency to recur, and some cases are associated with carcinoma, although the development of malignancy is unusual.
Biopsy↗
Histological study of oxalosis in the eye and adnexa of AIDS patients.
Review of a series of 98 eyes removed at autopsy from 86 AIDS patients identified 12 cases (14%) showing varying degrees of microscopic calcium oxalate deposition. The oxalate crystals were birefringent using polarisation microscopy and were stained histochemically by the silver nitrate-rubeanic acid method (Yasue), a stain considered to be specific for calcium oxalate. In two cases, the deposition was extensive and involved the surface of the ciliary processes, ciliary body and pars plana of the retina, the retinal and optic nerve blood vessel wall, a few retinal pigment cells, and the anterior inner sclera. A lesser degree of intraocular involvement was observed in the remaining 10 cases. In all but two eyes, where a peripheral active area of cytomegalovirus retinitis was present, no other significant microscopical abnormality was found. Clinically, these patients were asymptomatic. At autopsy, oxalate deposits were found in the kidney and/or thyroid in seven of the patients.
Acquired Immunodeficiency Syndrome↗
Histogenesis of papillomas of the nose and paranasal sinuses.
OBJECTIVE: To determine by review of their histogenesis whether papillomas of the nose and paranasal sinuses are three distinct entities or, as has been favored in the literature, three variations of a single entity. METHODS AND PATIENTS: We examined biopsy sections from 191 patients with sinonasal papillomas. Biopsy sections included all types of sinonasal papillomas stained using routine methods and, in some cases, using immunohistochemistry for macrophages (PG-M1) and proliferation antigen (MIB-1). Two cases of inverted papilloma were also examined using transmission electron microscopy. RESULTS: Everted and cylindric cell papillomas are true papillomas, lined by stratified squamous and microcystladen, columnar, oncocytic epithelium, respectively. Inverted papillomas are polyps with marked, patchy squamous metaplasia and numerous microcysts containing macrophages in ductal and surface epithelium. There are no intermediate forms from any one of the three types to another. CONCLUSIONS: Some differences between the three types are already established with regard to sites of origin, tendency to recur, and association with malignancy. It is likely that their etiologies--eg, concerning human papillomavirus infection--will be found to differ, if their distinct histogeneses are considered.
Humans↗
Polymerase chain reaction amplification of herpes simplex viral DNA from the geniculate ganglion of a patient with Bell's palsy.
Bell's palsy is the most common cause of facial paralysis. In this study, we demonstrate the presence of herpes simplex viral type 1 (HSV-1) genomic DNA in the geniculate ganglion of a patient who had Bell's palsy. This association suggests that in this patient, HSV-1 may have caused Bell's palsy. If HSV-1 is a cause of Bell's palsy, treatment with acyclovir may be beneficial. Additional studies should be done to establish the prevalence of HSV-1 as an etiologic agent of Bell's palsy.
Aged↗
Effect of craniotomy and cerebrospinal fluid loss on the inner ear. An experimental study.
Craniotomy with cerebrospinal fluid (CSF) suction was performed on 18 guinea pigs to determine the effects on the inner ear morphology. Six control animals received anaesthesia only and 12 were operated on with a postoperative survival time of 1 or 24 h. The histologic examinations showed no signs of endolymphatic hydrops or injury to other structures in any of the animals. In 11 of the operated animals, red blood corpuscles were demonstrated in the perilymphatic space of the cochlea, the subarachnoid space, and the cochlear aqueduct (CA). After 1 h survival time blood had entered primarily the basal part of the scala tympani, but in the animals of 24 h survival time the blood was more abundant in both the scala tympani and the scala vestibuli indicating flow within the inner ear. The CA thus provides a pathway between the CSF and the whole of the perilymph through which noxious effects could take place.
Animals↗
The ear in the acquired immunodeficiency syndrome: I. Temporal bone histopathologic study.
A postmortem histopathologic investigation of temporal bones of patients with the acquired immunodeficiency syndrome (AIDS) was performed after microslicing, acid decalcification of the slices and paraffin embedding. Histopathologic changes in 49 temporal bones from 25 patients included severe otitis media in five patients (20%), low-grade otitis media in fifteen (60%), labyrinthine cryptococcosis in two, Kaposi's sarcoma deposit in the eighth nerve of one, and cytomegalovirus (CMV) inclusion-bearing cells in the inner and middle ear of six (24%). It was possible to identify the CMV genome by in situ hybridization in only two bones and expression of CMV antigen by immunohistochemistry in none, probably because of prolonged decalcification in acid. The ear is no less susceptible to AIDS-associated diseases than any other organ, and is particularly prone to CMV infection.
AIDS-Related Opportunistic Infections↗
Cochlear dysplasia and meningitis.
Congenital dysplasias of the labyrinth of the inner ear are associated with varying degrees of hearing loss. There is a risk of a fistulous communication between the subarachnoid space and the middle ear cavity in some cases that present either as cerebrospinal fluid otorhinorrhea or as recurrent attacks of meningitis. The types of deformity where such a fistula is likely have not been clearly defined. The authors correlated the hearing state with the imaging assessment in 20 patients with congenital malformation of the labyrinth and, in particular, the cochlea. In addition the postmortem histologic findings from one patient with severe cochlear dysplasia who died from otogenic meningitis are described. The key to the assessment is the basal turn of the cochlea. If the basal turn is present and of normal caliber then some hearing is possible and there is no risk of a major fistula. However, if the basal turn is wider than normal or replaced by an undeveloped sac then there is anacusis and very real risk of fistula. In such cases the deformed labyrinth needs to be packed with fibrofatty tissues after just one attack of meningitis.
Adolescent↗
Condyloma acuminatum and squamous papilloma of the palate.
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Condylomata Acuminata↗
Keratosis of the tympanic membrane and deep external auditory canal. A defect of auditory epithelial migration.
We have previously described the pathways of movement of epithelium on the tympanic membrane, showing that there are two discrete and separate zones. Four cases of keratosis of the tympanic membrane and deep external auditory canal are here reported. All patients complained of tinnitus and other aural symptoms. Sequences of otoscopic photography of daubs of dye placed on the tympanic membrane showed an abnormal anterior movement over the whole tympanic membrane in two cases and complete paralysis of movement in the two others. These findings suggest that the disorder arises from damage to basal epidermal cells caused by inflammation, which is probably due to infection. Treatment is by suction-stripping of keratin from the eardrum. Careful examination of the eardrum under magnification is required in all cases of tinnitus so as to detect this condition.
Aged↗