Consensus Conference on Nasal Polyposis.
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Administration, Intranasal↗
Biomedical subjects
M Tos
Publications and source records attributed to M Tos.
[Developments in the treatment of neurinomas of the acoustic nerve].
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Cohort Studies↗
Cathamenial pneumothorax.
Cathamenial pneumothorax is a relatively low-frequency pathology (approximately 100 cases cited in the literature) characterized by recurrent pneumothorax episodes during the menstruation period. We report on a 34-year-old female patient who had recurrent pneumothorax that did not respond to chest drainage and whose presentation was directly related to the menstruation period. Our patient also had a significant clinical record for pelvic endometriosis. She underwent video-assisted thoracoscopic exploration (VATS) of the pleural cavity and dystrophic parenchymal blebs of the middle lobe were found. An atypical resection of the bollous tissue was performed and pleurodesis completed the intervention. During VATS no ectopic endometriosis foci or diaphragmatic fenestrations (widely considered as a possible cause of this clinical picture) were evidenced.
Adult↗
Cartilage palisade tympanoplasty in sinus and tensa retraction cholesteatoma.
OBJECTIVE: The aim of this study was to investigate whether reconstruction of the eardrum with palisade cartilage technique could prevent retraction of the new eardrum after surgery for sinus and tensa retraction cholesteatoma in children and to investigate the postoperative hearing. STUDY DESIGN: In 32 children aged 5 to 15 years, operated on from June 1995 to October 2000 for cholesteatoma (21 with sinus cholesteatoma and 11 with tensa retraction cholesteatoma) the eardrum was reconstructed with the palisade cartilage technique. Postoperatively, the children were seen as outpatients and were recently reevaluated with otomicroscopy, tympanometry, and audiometry. All patients (100%) were reevaluated on an average of 37 months (range 3-63 months). MAIN OUTCOME MEASURES: Postoperative retractions, perforations, cholesteatoma recurrence, and hearing. RESULTS: At the final examination, posterosuperior retraction was observed in two patients, both operated on for sinus cholesteatoma with reconstruction of the ossicular chain. In those cases, the palisades were not placed in the posterosuperior drilling defect behind the interpositioned incus. All the patients had an intact tympanic membrane at the final follow-up visit. One small perforation was surgically closed during the observation period. No patients developed cholesteatoma during the follow-up period. The postoperative hearing was good, and the hearing did not deteriorate with increasing observation time. CONCLUSIONS: The palisade technique effectively prevented postoperative retraction of the eardrum. The postoperative hearing was good.
Acoustic Impedance Tests↗
Goblet cell density in acute otitis media caused by Moraxella catarrhalis.
HYPOTHESIS AND BACKGROUND: Secretory otitis media is associated with a highly increased goblet cell density, confirming the secretory pathogenesis of this disease. Previous studies have shown that the middle ear goblet cell density, and thus the secretory capacity, are massively increased during experimental acute otitis media and at least 6 months thereafter, conceivably predisposing to the subsequent development of secretory otitis media. These studies used middle ear inoculation of either Streptococcus pneumoniae, nontypeable Haemophilus influenzae, or H. influenzae type b. The present study aimed at determining the goblet cell density during and after acute otitis media caused by Moraxella catarrhalis to clarify whether this bacterium induces an equivalently enhanced secretory capacity. METHODS: Twenty-five 25 rat middle ears were inoculated with M. catarrhalis. Five rats were killed on days 4, 8, 16, 60, and 180 after inoculation, followed by staining, dissection, and whole-mount embedding of the middle ear mucosae. The goblet cell density was determined by counting in 24 fields, covering the entire middle ear. RESULTS: In comparison with 25 normal middle ears, the goblet cell density was significantly increased in almost all counting localities, from day 4 and < or = 2 months after inoculation. The goblet cell density peaked on day 16, subsided thereafter, and in some areas reached a normal level 6 months after the acute incident. Mucosal areas containing goblet cells were consistently enlarged, thus leaving the middle ear with an increased secretory capacity during and 6 months after inoculation. CONCLUSION: The goblet cell density of the middle ear mucosa is increased during acute otitis media caused by M. catarrhalis and up to several months thereafter. This may predispose to the subsequent development of secretory otitis media. However, in comparison with acute otitis media caused by other bacteria, M. catarrhalis induced only modest changes in goblet cell density.
Acute Disease↗
[Vestibular schwannoma. A new interpretation of tumor growth].
INTRODUCTION: The goal of the present paper was to investigate the growth of vestibular schwannoma (VS). MATERIAL AND METHOD: A series of 123 patients with 127 tumours were allocated to the wait and scan group in the period 1973 to 1999. The material was updated three times medio 1993, medio 1996 and medio 1999. Via the Danish national register, data on whether the included patients were alive or dead were collected medio 1999. Three sets of growth results were obtained. RESULTS: The results medio 1993 revealed: tumour growth in 94 tumours (74%), no growth in 23 tumors (18%) and negative growth in 10 tumors (8%). Medio 1996 the results changed to: tumour growth in 104 tumors (82%), no growth in 15 tumours (12%) and negative growth in eight tumours (6%). The growth figures changed again in medio 1999 to: tumour growth in 108 tumours (85%), no growth in 11 tumours (9%) and negative growth in eight tumours (6%). However, the results may also be interpreted in another way: 52 patients (42%) are alive, tumour growth did not demand any intervention, 23 patients (19%) died due to non-tumour related causes and 35 patients (28%) were previously treated and alive by the termination of the third observation period. CONCLUSION: It is concluded that tumour growth is time dependent, surgery at diagnosis is the ultimate solution, however the current study provides a number of arguments in favour of the wait and scan policy.
Adolescent↗
[Vestibular neurectomy in the treatment of Meniere's disease].
INTRODUCTION: A brief history of vestibular neurectomy is given. This treatment was introduced in Denmark by us, based upon our large experience with translabyrinthine removal of vestibular schwannomas. MATERIAL: Includes all patients (43 operations in 42 patients) who had section of the vestibular nerve performed in the period from 1980 to 1996. Mean age was 51 years and the postoperative observation period varied from 2 to 15 years, mean 6.4 years. RESULTS: The vertigo was under control in 88% of the patients. Fourteen patients developed some imbalance after surgery caused by the abolished vestibular function in the ear involved. Thirty-nine patients indicated satisfaction with the operation, 92% retained their preoperative hearing. Only few and slight complications were seen, including two re-operations for CSF leaks and a slight transient facial nerve paresis. DISCUSSION AND CONCLUSIONS: The results are in accordance with those obtained by other authors, and retrosigmoid section of the vestibular nerves is an effective treatment of vertigo refractory to other treatment modalities. In order to reduce the patients' worries about undergoing an intracranial intervention it is important to inform the patients and patients' associations about the good results obtained by this treatment and in particular to inform about the very few complications. Due to the limited number of patients needing this treatment, and the need for surgical experience in order to maintain the favorable results, centralization of the treatment is mandatory.
Adult↗
[The deaf can be hearing--cochlear implantation. The Danish Society of Otolaryngology, Head and Neck Surgery].
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Cochlear Implantation↗
Is the loss of gallstones during laparoscopic cholecystectomy an underestimated complication?
Laparoscopic cholecystectomy entails an increased risk of gallbladder rupture and consequent loss of stones in the abdominal cavity. Herein we report the case of a 51-year-old male patient, who underwent laparoscopic cholecystectomy 2 years before presentation to our hospital. He had experienced tension sensation and epigastric pain since 4 months postoperatively. A well-defined epigastric mass, which was hard and painful on palpation, was detected and later confirmed by ultrasonography and CT scan. Explorative laparotomy revealed a mass in the area of the gastrocolic ligament,resulting from biliary gallstones in conjunction with a perimetral inflammatory reaction. A review of the literature showed that the incidence of gallbladder lesions during laparoscopy is 13-40%. In order to prevent this complication, meticulous isolation of the gallbladder, proper dissection of the cystic duct and artery, and careful extraction through the umbilical access are required. Ligation after the rupture or use of an endo-bag may be helpful. The loss of gallstones and their retention in the abdominal cavity should be noted in the description of the surgical procedure.
Cholecystectomy, Laparoscopic↗
Preliminary results of a new delivery system for gentamicin to the inner ear in patients with Meniere's disease.
Intratympanic gentamicin therapy has gained some clinical popularity in the treatment of vertigo associated with Meniere's disease. This therapeutic modality offers some advantages over traditional surgical treatment. The vestibulotoxic effect of gentamicin is well documented, but there is no general agreement about the dose needed to control vertigo attacks without affecting hearing. In the current preliminary study 27 patients with Meniere's disease refractory to medical management were treated by small doses of gentamicin delivered via microcatheter in the round window niche and administered by an electronic micropump. The patients received a total dose of 0.24-90 mg. The effect on vestibular symptoms resulted in the cessation of vertigo in the 22 patients, control of drop attacks in 4 of 6, and release of aural pressure and fullness in 2 of 4. Significant hearing loss (anacusis) occurred in six patients, slightly related to the flow rate in the pump setting. Different explanations for the loss of hearing are presented. The new delivery system for gentamicin appears to be effective in controlling vertigo, but with an unacceptable negative effect on hearing. The effectiveness and the safety of this new delivery system must be investigated further in controlled studies. However, it opens up the possibility of future novel ways of treating inner ear diseases, such as sudden deafness and tinnitus, as well as for the protection, repair, and regeneration of inner ear sensory cell function in damage due to aging, noise, toxic substances, immune reactions, etc.
Adult↗
Effect of photodynamic therapy on a heterotransplanted human parotid tumor.
To evaluate the effect of photodynamic therapy on human parotid tumors we used tumor specimens obtained from parotid surgery on a consecutive group of patients. The tumors were transplanted into a subcutaneous pocket of nude mice. The original human tumors were pleomorphic adenoma (four), adenolymphoma (one), acinic cell carcinoma (one), sarcoma (one) and low-grade adenocarcinoma (one). The most aggressive growth was seen in the low-grade adenocarcinoma. We re-implanted this tumor on ten mice bilaterally, and treated the tumors with photodynamic therapy (PDT), resulting in a mean depth of tumor necrosis of 5.4 mm (1-10 mm). In three cases we found vital tumor cells in the periphery of the tumor after treatment, with several new blood vessels in the surrounding tissue, indicating a great potential for neo-angiogenesis in this tumor. In order to evaluate the possible nerve damage subsequent to the photodynamic therapy, the ischiadic nerve in 24 lower limbs of nude mice were investigated. In one case only the macroscopical and histological investigation revealed signs of nerve damage. The current study demonstrates that the nude mice implantation model is excellent to investigate growth in both malignant and benign parotid tumors, and to test new therapeutic modalities. Photodynamic therapy seems to have a possible role in the future management of the malignant lesions of the parotid gland, in cases where radical surgery for some reason is not achievable.
Animals↗
Vestibular neurectomy.
A brief history of the vestibular neurectomy is given. This treatment modality was introduced in Denmark by us, using the experiences obtained by the use of translabyrinthine treatment modality for vestibular schwannoma surgery. This paper presents our experiences with this type of surgery (translabyrinthine, retrolabyrinthine and retrosigmoid vestibular nerve section) from 1980 to 1996, including 43 operations in 42 patients. The patients had all been treated with conventional methods without success and were all severely handicapped by their attacks of vertigo. The mean age was 51 years, postoperative observation time between 2 and 15 years, with a mean of 6.4 years. The vertigo was controlled in 88% of the patients, while postoperative imbalance occurred in 14 patients, mainly due to the ablation of the vestibular labyrinth and not by episodic vertigo. A total of 39 patients indicated that they were satisfied with the operation. Six patients were deaf before surgery and 92% of the remaining patients retained their preoperative hearing. Postoperative complications were few, including two re-operations for CSF leaks, one patient with a slight transient facial nerve paresis and one transient VI nerve paresis. The results compare favorably with results from other authors. Retrosigmoid vestibular nerve section is an effective treatment modality to be offered to patients in whom other modalities have failed. Information about the efficacy and leniency of the treatment should be given to the patient's organization in order to diminish the fear of an intracranial intervention. Surgical experience is necessary in order obtain good results, the number of patients needing the operation is small and centralization of the treatment is mandatory.
Adult↗
Recurrence of attic cholesteatoma: different methods of estimating recurrence rates.
One problem in cholesteatoma surgery is recurrence of cholesteatoma, which is reported to vary from 5% to 71%. This great variability can be explained by issues such as the type of cholesteatoma, surgical technique, follow-up rate, length of the postoperative observation period, and statistical method applied. The aim of this study was to illustrate the impact of applying different statistical methods to the same material. Thirty-three children underwent single-stage surgery for attic cholesteatoma during a 15-year period. Thirty patients (94%) attended a re-evaluation. During the observation period of 15 years, recurrence of cholesteatoma occurred in 10 ears. The cumulative total recurrence rate varied from 30% to 67%, depending on the statistical method applied. In conclusion, the choice of statistical method should depend on the number of patients, follow-up rates, length of the postoperative observation period and presence of censored data.
Actuarial Analysis↗
Vestibular schwannoma growth--long-term results.
The growth of vestibular schwannoma (VS) was investigated in a series of 123 patients with 127 tumours during 3 periods: 1973 to 1993 (mean observation period 3.4 years), 1973 to 1996 (mean observation period 3.8 years) and 1973 to 1999 (mean observation period 4.2 years). Three sets of growth results were obtained. At the end of the first period, 94 tumours (74%) exhibited measurable growth, 23 tumours (18%) no measurable growth and 10 tumours (8%) negative growth. Tumour growth was observed in 104 tumours (82%), no tumour growth in 15 tumours (12%) and negative growth in 8 tumours (6%) at the end of the extended observation period. Growth was observed in 108 tumours (85%), no growth in 11 tumours (9%) and negative growth in 8 tumours (6%) subsequent to the third observation period. However, the results can be interpreted in another way: 52 patients (42%) are alive, tumour growth required no intervention; 23 patients (19%) died due to non-tumour-related causes; and 35 patients (28%) were previously treated and alive by the end of the third observation period. Together with other factors, the results reported here should be considered when timing of surgery is to be decided.
Adolescent↗
Cystic vestibular schwannoma--clinical and experimental studies.
The cystic variant of vestibular schwannoma (VS) presents a therapeutic dilemma. Several studies have previously demonstrated that the surgical outcome in this tumour entity is less favourable than that of solid tumours of comparable size. The "wait and scan" policy has not been recommended for these tumours, as the cystic elements expand, causing displacement of the brainstem and compression of the 4th ventricle, resulting in hydrocephalus. The large tumour size at diagnosis and the cystic contents do not support the role of radiosurgery as a therapeutic option. We have previously published the surgical outcome of 23 cystic VS. The present study includes 44 patients (44 cystic tumours) in a series of 773 tumours (5.7%) who underwent surgery in the period 1976 to 1996. This paper presents the neuroradiological and histological features of the tumours, as well as the results of tumour specimen implantation and surgery in athymic nude mice. Therapeutic options are also discussed.
Adult↗
Intracanalicular vestibular schwannoma--therapeutic options.
The growth of purely intrameatal vestibular schwannoma (VS) was investigated in a series of 40 patients with 40 unilateral VS in the period 1973 to 1996 (mean 3.6 years). Twenty-seven tumours (67.5%) revealed growth and 13 tumours (32%) had no measurable growth. Four growth patterns were observed: (i) 15 tumours (37.5%) exhibited constant growth; (ii) 13 tumours (32.5%) had no measurable growth; (iii) 8 tumours (20%) revealed growth subsequent to a no-growth period; and (iv) 4 tumours (10%) manifested different growth patterns during the observation period. The mean diameter growth per year was 3.2 mm. The findings of the present study, especially those achieved in groups B (the non-growing tumours) and C (tumour growth subsequent to a silent period), question the reliability of the results achieved by radiosurgery, as no tumour growth may occur with no intervention.
Adolescent↗
Prevalence of chronic otitis media in a randomly selected population from two communes in southern Vietnam.
The prevalence of chronic otitis media was studied in an urban and a rural community in southern Vietnam in 1995. A total of 3,300 children, aged from 6 months to 10 years, were selected randomly by taking every third child on the vaccination list. In this cross-sectional study, 453 ears were found to have chronic otitis media or sequelae otitidis, giving an overall prevalence of 6.86%. A total of 140 ears had perforations. Various attic changes were found in 73 ears and other chronic tympanic membrane changes, such as atrophy, tympanosclerosis and adhesions, in 219 ears. Cholesteatoma was seen in two ears.
Acoustic Impedance Tests↗
Effect of penicillin on experimental acute otitis media. A histopathological study of goblet cell density, bone modelling dynamics, polyp and adhesion formation.
Clinical studies have shown that the effect of antibiotic treatment on acute otitis media is modest. Experimental acute otitis media induces a number of histopathological changes in the middle ear mucosa. Among these are increased goblet cell density, polyp and adhesion formation, as well as massive osteoneogenesis. To investigate the effect of penicillin administration on these histopathological features, we employed a rat model of acute pneumococcal otitis media. Five of 25 rats were sacrificed on days 4, 8, 16, 90 and 180 post-inoculation, preceded by oral administration of penicillin V 100 mg/kg/day, initiated on day 2 and lasting 5 days. Using a light microscope, qualitative and quantitative histopathology of middle ear goblet cell density, bone-modelling dynamics, polyp and adhesion formation was registered and compared with previous studies of untreated animals. Increase in goblet cell density and new bone formation was reduced significantly by treatment, whereas polyp and adhesion formation was unaffected by penicillin administration. It is concluded that penicillin reduces middle ear secretory capacity and new bone formation during and following acute otitis media, conceivably preventing subsequent development of secretory otitis media, leaving polyp and adhesion formation unchanged.
Acute Disease↗