Biomedical subjects

T Palva

Publications and source records attributed to T Palva.

At least 217 records · Page 12Linked to original sources

PubMedDate not supplied

Nasal polyposis. Relationships to allergy and acetylsalicyclic acid intolerance.

Allergological, clinical and histological findings in 109 unselected patients, treated for nasal polyps during the period Feb. 1977 to Feb. 1978 are reported. The material was divided into three groups according to clinical findings: 1) Atopy Group; 18 patients with positive history and skin test; 2) ASA Intolerance Group; 25 patients with a definite history of acetylsalicylic acid intolerance; and 3) Intrinsic Disease Group; 66 patients in whom specific etiological factors were not found. On skin testing, positive reactions were obtained in 42 patients. In 23 of the patients, the skin test result agreed with the history. Secretion and tissue eosinophilia, noted in 97 and 102 patients, respectively, correlated in 88% of the patients, whereas correlation with blood eosinophilia was poor (30%). The mean IgE level was 140 in the serum and 731 in the polyp fluid, serum values above 150 occurring in 28 out of 105 patients and fluid values above 150 in 58 out of 84 patients. The predominant histological finding in the polyp biopsies was tissue eosinophilia, which was most abundant in the ASA intolerance group. Squamous metaplasia was seen in 30% but it was marked only in 5 cases. In 10 patients ASA intolerance was confirmed by oral provocation.

Adolescent↗

PubMedDate not supplied

Artifacts in eighth cranial nerve biopsy.

The occurrence of artifactual morphological changes was investigated in human eighth nerve biopsies and corresponding changes were brought about in biopsies from rats by mechanical handling before fixation. At the very site of compression by a pair of forceps the biopsy stained lighter than in its immediate surroundings. Electron microscopy showed denuded and fragmented axons among vesicular debris in the area. Further away the myelin coats were greatly thickened, often to the degree that the axonal canal could no longer be identified. The myelin lamellae showed separation and were occasionally seen in convoluted forms. Also variations in the diameters of the nerve fibres and ruptures of the meylin coats could be produced after mechanical handling.

Animals↗

PubMedDate not supplied

Immunologic aspects of otitis media.

The cellular immune response in otitis media with effusion consisted of granulocytic cells in the majority (60--70%) of cases, while the monocytic-lymphocytic cells formed the bulk of cells present in 20%. A considerable number (15--20%) of serous, seromucinous and mucoid effusions had sparse cellular populations. T-lymphocytes, marked with alpha-naphthyl-acetate-esterase (ANAE) constituted the majority of lymphocytes and were present in effusion liquids in numbers similar to those in blood. Tests with E-rosettes confirmed the results obtained with ANAE stain. The finding that T-lymphocytes are present in normal numbers may link the mucosal damage to the delayed-type hypersensitivity reaction. Another explanation of mucosal damage may be sought in immune complexes, which have recently been found to be present in many sterile middle ear liquids.

Antigens, Bacterial↗

PubMedDate not supplied

Cytotoxic leukocyte reaction.

Blood samples from 49 subjects were submitted to cytotoxic leukocyte tests, which were read double-blind by two laboratory technicians. The results were identical in 78% of the tests and the statistical error of the method was 0.46. In a group of 32 subjects, the cytotoxic test was repeated on 3 consecutive days. Deviations in the results occurred in 18--20% of the tests, the statistical errors varying between 0.38 and 0.43. In a series of serum samples (75 subjects) with positive leukocyte reactions to food antigens, various in vitro procedures were carried out in connection with the cytotoxic test. The following observations were made: In 42 of 58 tests, a positive leukocyte reaction was transferred with the reactive serum to cells from non-reactive subjects. After heating of the reactive serum (56 degrees C, 2 h) and washing of the cells, reactivity was no longer observable in 44 out of 52 tests. Treatment with EDTA consistently blocked expected cytotoxic reactions in 36 tests. DSCG inhibited expected reactions in 45%, antihistamine in 93%, and cortisone in 20% of the tests.

Complement System Proteins↗

PubMedDate not supplied

The prognostic value of Eustachian tube function measurements in tympanoplastic surgery.

The Eustachian tube function was tested preoperatively by sonotubometry and by the negative pressure equalization test in 87 ears subjected to simple myringoplasty, tympanoplasty alone, or tympanoplasty combined with mastoid surgery. The relations between tubal function test results and healing were analysed on average 10 months after the operation. The results indicating absent or partial pressure equalization ability were poorly correlated with the successful outcome of surgery, while sonotubometry showed a good correlation. Pressure equalization may produce such an unphysiological underpressure that many test results are erroneously negative. Sonotubometry is an entirely physiological method and has in this Department replaced the pressure equalization test for routine evaluation of the Eustachian tube function.

Adolescent↗

PubMedDate not supplied

Vestibular nerve findings in 150 neurectomized patients.

Vestibular nerve specimens obtained at neurectomy were studied by light and electron microscopy in 150 patients with various neuro-otological disorders. The vestibular nerve was considered morphologically normal in only 20% of the cases but the changes observed in most cases were interpreted as artifacts or physiological changes of aging. In nearly half of the cases there was excessive fibrosis of the perineurium or endoneurium of the vestibular nerve, or occurrence of glial tissue within or near Scarpa's ganglion. When these changes are of moderate or severe degree, they may be of pathological significance. Severe nerve cell destruction with subsequent fibrosis, indicating primary neuropathy, was found in four cases.

Adult↗

PubMedDate not supplied

The patulous Eustachian tube and chronic middle ear disease.

The function of the Eustachian tube was tested preoperatively by sonotubometry in 100 ears subjected to surgery for chronic ear disease. 36 ears showed no tubal passage for sound during swallowing and the surgical intervention revealed cholesteatoma in 17 of these cases. In 64 cases sonotubometry gave positive results preoperatively and among these cholesteatoma was found in 26 ears. One patient had a continuously patent tube with typical symptoms and only cutting of the tensor veli palatini muscle tendon revealed the symptoms after reconstructive ear surgery. In another patient the tube opened well on swallowing, remained patent for some time, and closed slowly. This finding was unexpected and the patient had no complaints associated with the tubal function. The patulous tube is a rare condition (1-2%) in patients with chronic middle ear disease but should be diagnosed before surgery and followed carefully postoperatively.

Adolescent↗

PubMedDate not supplied

Pitfalls in myringoplasty.

The results of myringoplasty on 172 ears examined after an average follow-up time of 1.5 years are reported. The fascial underlay technique with swing-door plasty was employed in 78% of the cases. The graft take was successful in 150 ears (87%), three of which (2%) later revealed adhesive changes in the middle ear. Three ears were reoperated, the percentage of healed perforations being 89. A high tone hearing loss occurred in two ears and a moderate flat sensorineural hearing loss in another two (2%). Successful graft take was obtained in 92% of the operations performed by specialists and in 59% of the ears operated upon by residents. Successful myringoplasty presupposes acquisition of a faultless surgical technique and strict adherence to it at all phases of surgery.

Hearing Loss, High-Frequency↗

PubMedDate not supplied

Histopathological observations on polyethylene-type materials in chronic ear surgery.

Proplast implants were used in reconstruction of the posterior ear canal wall in one ear and in obliteration of the cavity in two ears. All ears healed well but the canal wall implant became visible in 15 months and had to be removed because of persistant suppuration. The other two implants became visible 3 to 4 years postoperatively. Plastipore TORPs were implanted in two ears undergoing revision surgery. One prosthesis was removed several months later because of infection, and the other 1 year after surgery, as no improvement in hearing had been achieved. Histologically, masses of giant cells were seen in the implants and many cells had engulfed both the vitreous carbon material of Proplast and the white Teflon material of both Proplast and Plastipore. It is concluded that Proplast is unsuitable either for canal wall reconstruction or for cavity obliteration. Plastipore should be used only as a bridge between two ossicles. If the implant must be applied to the tympanic membrane, that end should be fitted with a nonabsorbable bony homograft, which does not cause foreign body reaction.

Biocompatible Materials↗

PubMedDate not supplied

Immune complexes in the middle ear fluid and adenoid tissue in chronic secretory otitis media.

Specimens of middle ear effusion and adenoid tissue were studied for bacteria and pneumococcal capsular antigen in 107 patients with secretory otitis media. 120 of 163 middle ear effusion samples (73.6%) were negative on bacterial culture. Hemophilus influenzae was present in 9.2% and Streptococcus pneumoniae in 1.8%. Hemophilus influenzae was cultured from 44.8% and Streptococcus pneumoniae from 35.5% of 107 adenoid tissue specimens. Free pneumococcal capsular antigen was demonstrated in 10.4% of the middle ear fluids and this figure rose to 23% when antigen was liberated from the immune complexes by heating. The corresponding figures for adenoid tissue suspension were 27.1% and 39%. The adenoid tissue or the lymphoid tissue of the entire oropharynx could act as the source of antigen which could maintain immune complex disease in some patients suffering from secretory otitis media.

Adenoids↗

PubMedDate not supplied

Findings in a pair of temporal bones from a patient with secretory otitis media and chronic middle ear infection.

The histopathological changes in a pair of temporal bones from a 69-year-old woman who had secretory otitis media in the left ear and chronic middle ear infection in the right ear are described. Tympanostomy tubes had been placed in her left ear nine times. The perforation at the grommet showed no ingrowth of squamous epithelium; the fine structure of the tympanic membrane was normal. There were a few mucus strands present in the middle ear, which was lined with a one- to three-cell layer epithelium, where only a few secretory cells were found. In the right ear the thick tympanic membrane showed papillary projections of the squamous epithelium extending from the outer epidermal layer deep into the stroma and close to the collagenous layer of lamina propria. A large marginal perforation was present in the posterior quadrant, but there was no ingrowth of squamous epithelium from the canal into the middle ear. From the anterior margin, a concave veil-like sheet of squamous epithelium had grown onto the incus, chorda tympani and the stapes head. Numerous finger-like projections extended from the margin of this epithelium to the stapedial footplate and the epitympanum. The mucous membrane of the bony portion of the Eustachian tube in both ears was normal to the cartilage level, and the defective ventilation was in all likelihood caused by a dysfunction at the pharyngeal end of the Eustachian tube.

Aged↗

PubMedDate not supplied

Immunohistochemical identification of inflammatory cells in secretory and chronic otitis media and cholesteatoma using monoclonal antibodies.

Monoclonal antibodies (OKT 3,4,6,8 and OKIa) were used in conjunction with the avidin-biotin-peroxidase complex method to classify inflammatory cells in 6 biopsies of the middle ear mucosa in patients with secretory otitis media (SOM) and in 19 middle ear or mastoidal biopsies in patients with chronic otitis media (COM). Mononuclear cell infiltrates under the mucosal epithelium were found to consist mainly of T4 positive (helper-inducer) T-lymphocytes (50-60%). T8 positive (suppressor-cytotoxic) T-lymphocytes accounted for 20-30% of the cells. T4 positive cells were confined to the round cell infiltrates, whereas T8 positive cells were also located under the mucosal epithelium and seemed to penetrate it. There were no differences between SOM or COM with regard to the distribution or localization of T4 and T8 cells. T6 and Ia positive Langerhans cells were found in the ingrowing tympanic membrane squamous epithelium and in the cavity skin. The number and distribution of these T6 positive cells were similar to those observed in the skin. In the thick cholesteatoma epithelium these cells were somewhat unevenly distributed but were more numerous than in other sites studied. The results are indicative of a normal cell-mediated mucosal response to infection.

Antibodies, Monoclonal↗

PubMedDate not supplied

Aspiration cytology in acute otitis media.

One hundred and ninety-three middle ear effusion samples from patients with acute otitis media were studied for cellular content and bacteria. Findings were compared with clinical and radiological data. In samples positive for pathogenic bacteria (Haemophilus, pneumococci) neutrophils predominated, whereas monocytes or phagocytes were more numerous in samples with nonpathogens. Inflammatory cells were more frequent in large than in small mastoid air cell systems. Destruction of cell walls was associated with increase of neutrophils and sclerosis with preponderance of lymphocytes, monocytes and phagocytes.

Acute Disease↗

PubMedDate not supplied

Junctions of squamous epithelium with middle ear mucosa.

Specimens obtained from the middle ear during surgery for cholesteatoma showed either abrupt junctions without metaplasia or junctions of varying width with metaplastic epithelium. Another form of junctional area showed pronounced inflammatory cell reaction with squamous epithelium projections growing into the stroma under the columnar epithelium. Immunofluorescent staining for cytokeratins showed distinct decoration of the columnar and metaplastic epithelia as well as of the basal cells of squamous epithelium. Prekeratin staining showed decoration of both squamous and metaplastic epithelium and no staining of the columnar epithelium. The findings suggest that metaplasia forms part of the migrating front of the squamous epithelium and alone plays no major role in cholesteatoma genesis.

Cholesteatoma↗

PubMedDate not supplied

Hearing preservation in acoustic neurinoma surgery.

In a series of 120 patients with acoustic neurinoma, hearing preservation at removal of the tumour via the suboccipital approach was attempted in 30 ears. Hearing was preserved in 13 ears (43%), but in two, hearing was lost entirely in 3 to 4 years; thus the success rate was 36%. In 9 of the remaining 11 ears useful speech discrimination was present. Audiological tests showed increased retrocochlear loss after surgery. A surgical team should master the methods of both translabyrinthine and suboccipital surgery in order to choose the best approach for each patient.

Acoustic Impedance Tests↗

PubMedDate not supplied

Cholesterol content in middle ear fluid in secretory otitis media.

The total cholesterol content was determined in 36 mucoid and 2 serous middle ear fluid samples (MEF). The hemoglobin was measured in all samples and the cholesterol value representing blood contamination was subtracted from the total cholesterol content of the sample. The values of the remaining cholesterol ranged from 0.1 to 4.7 mg/ml with a mean of 1.8. No correlation was found between cholesterol content and the size of the fluid sample. Nor was cholesterol content related to the status of mastoid pneumatization or clouding of the air cells. The presence of cholesterol in MEF is probably explained by seepage from the capillaries during the negative pressure phase and, in mucus-filled ears with no negative pressure, by disintegration of white blood cells in the fluid.

Cholesterol↗

PubMedDate not supplied

Effect of erythromycin on adenoid bacteria.

Seventy-eight patients with secretory otitis media were given erythromycin ethylsuccinate 50 mg/kg/day, divided into 2 doses, for 7-8 days before undergoing adenoidectomy and tympanostomy. Nasopharyngeal swabs for bacterial culture were obtained before medication and at surgery and the adenoid homogenate was also studied for bacteria. Pneumococci and Branhamella strains became significantly reduced, while Hemophilus influenzae showed no change. Pneumococcus and Branhamella strains partially returned one month after surgery and in part were found in patients who had not had these strains before antimicrobial therapy. Erythromycin ethylsuccinate can sterilize neither the adenoids nor the middle ear space if the causative agent is Hemophilus influenzae.

Adenoidectomy↗

PubMedDate not supplied

Surgical treatment of chronic middle ear disease. 1. Myringoplasty and tympanoplasty.

Results of myringoplasty or tympanoplasty were evaluated in 225 ears followed for at least one year after surgery. Repair of the tympanic membrane with an underlay connective tissue graft (fascia in 90%) was successful in 97% of the ears. One late perforation developed 3 years postoperatively. The average postoperative air-bone gap was 4.8 dB in 88 cases of myringoplasty, the series including three ears with a rigid footplate. Rigid incus and malleus should not be mobilized but subjected to resection and reconstruction. Poor tubal function caused adhesive changes in one ear (1%). In tympanoplasty the average postoperative air-bone gap was 11.3 dB in 100 ears with stapes present and 20.6 dB in 36 ears with only the footplate remaining. Of the 137 tympanoplasty ears, 10 (7%) showed prominent adhesive changes. In 36 ears with cholesteatoma there was one recurrence 3 years later (3%). An air-bone gap of less than 20 dB was postoperatively noted in 94% of the ears undergoing myringoplasty and in 69% of the ears undergoing tympanoplasty.

Ear Diseases↗