[On the degree of mineralization of the otosclerotic stapes].
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Biomedical subjects
Publications and source records attributed to S Iurato.
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Thirty-seven patients operated on by total vestibular neurectomy for Ménière's disease underwent follow-up examination for at least 5 years. Vertigo has been controlled in all the patients excepting one who developed Ménière's disease in the opposite ear. Three patients had a total hearing loss. Overall results in this study are comparable to those of other series in the literature. Vestibular neurectomy has been confirmed to be an effective procedure for relieving vertigo in intractable Ménière's disease with a success rate of 90-100% while preserving hearing in most of the patients. The results of vestibular neurectomy are far better than those obtainable with endolymphatic sac surgery.
Middle ear ossicles removed during ear surgery in 40 patients were examined in order to compare the histopathologic changes in children with those observed in adults. Bone resorption, mainly localized at the level of the periosteum and haversian canals in adults, was much more extensive in children. Replacement of bone by fibrous granulation tissue was observed in 60% of children's ossicles and in 27% of those belonging to adults. In children, extensive active resorptive osteitis of the ossicles was frequently associated with intensive round cell infiltration, which seems to play an important role in bone absorption and in the aggressiveness of cholesteatoma.
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The junctions between the cells of the organ of Corti have been investigated with the freeze-fracture method in the chinchilla inner ear. Numerous gap junctions have been found among all the supporting cells, particularly at the level of their basal part. This means that the supporting cells have their cytoplasm electrotonically and metabolically coupled. Gap junctions were not observed between supporting and sensory cells nor between sensory cells and nerve endings. At this level the transmission should be chemically mediated.
The maculae sacculi and utriculi of the chinchilla vestibular labyrinth have been studied by freeze-fracture method. In the replicas extensive zonulae occludentes have been found between sensory and supporting cells at the endolymphatic surface. Gap junctions are located between the supporting cells. Some intramembranous specializations of the synaptic regions are described in both types of the sensory cells.
Two different tissues have been observed in specimens of tympanosclerotic material studied under light and electron microscopy. The first, devoid of cells and blood vessels, is a dense fibrous tissue similar to that already described in fibrous tympanosclerosis. The second resembles a bone tissue, containing osteocytes and vascular channels; it is laid down by metaplasic fibroblasts following the invasion of the first tissue by osteoclasts and blood vessels after its calcification.
The present paper describes the setting-up of a new project, sponsored by the Commission of the European Communities, to promote the study of functional histopathology of the human audio-vestibular organ. The project has the purpose of co-ordinating in Europe morphological research on the hearing and equilibrium organ and promoting the comparison of data from clinical, physiological and morphological studies in the field of hearing and equilibrium impairment. A manual (Iurato et al., 1982) has been prepared with the objectives of (1) stimulating clinicians to participate in the project, (2) encouraging the collection of audiological data for comparison with pathology, and (3) supplying clinicians with the necessary information about the technique of fixation and preparation of the specimens. The fixation procedures for the two major techniques of studying ear pathology: (1) microdissection and electron microscopy, and (2) embedding of the whole block for serial sectioning and light microscopy, are described in detail. Special paragraphs deal with the technique of fixation of the brain and with the technique of removal of the temporal bones and brain at autopsy. The instructions for delivery of the specimens and the publication rules are enclosed in the main body of the manual. Appendix 1 contains a list of the participating laboratories. Appendix 2 deals with autopsy legislation in the different European countries. Appendix 3 contains the sender's data sheet which supplies the instructions for collecting the clinical history of the patient and the audiological and vestibular data.
A review is given of the methods employed in human temporal bone pathology, from the camera lucida drawings of the last century to the sophisticated techniques of today.