Stapes with otosclerotic lesions obtained during stapedectomies were examined with light microscopy, histochemistry, immunochemistry, and electron microscopy to elucidate the cellular mechanism(s) involved in this disease process. Three types of lesions were identified: cellular (spongiotic), fibrotic, and sclerotic. The cellular type is characterized by monocyte, macrophage, osteoblast, and osteoclast recruitment and their activation. Macrophage recruitment is an early event of otosclerosis. The fibrotic type is characterized by extensive fibrosis of the bone, and the sclerotic type is characterized by a paucity of bone cells. Cytochemical results showed a large accumulation of granular substances positive for periodic acid-Schiff stain along the edge of the marrow spaces coinciding with ultrastructural calcospherite deposits, suggesting that glycosaminoglycans are involved in the mineralization process. Acid phosphatase is largely localized in the osteoclasts, but a sporadic diffusion of this enzyme was observed in the demineralizing front of the preotosclerotic lesion. Immunoglobulin G and complement C3 were colocalized in pericapillary tissue, suggesting deposit of immune complex in the spongiotic lesion. This finding indicates a possibility that immune mechanisms are involved in otosclerosis.

Acid Phosphatase↗

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Rehabilitation of the shoulder after radical neck dissection.

After classical radical neck dissection with removal of the sternocleidomastoid muscle and division of the spinal accessory nerve, there are certain disabling or disagreeable musculoskeletal defects. This paper describes the muscular deficiencies and gives a set of exercises which can be counted on to minimize the problems.

Humans↗

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Otosclerotic stapes: morphological and microchemical correlates. An electron microscopic and x-ray analytical investigation.

A total of 32 otosclerotic stapes is thin-sectioned without decalcification and examined using transmission and scanning electron microscopes, with a nondispersive x-ray analyzer attached to the latter. These otosclerotic stapes are classified as spongiotic, sclerotic, or preotosclerotic, accoring to their pathologic characteristics and state of mineralization. Either diffuse or patchy demineralization in the ground substance appears to be the initial stage of otosclerosis, and this area coincides with preotosclerotic lesions (also known as blue mantle) in light microscopy. Therefore, it is interpreted that demineralization precedes the destruction of ground substance in the preotosclerotic lesion. Bone mineral deposits in new otosclerotic bone appear to be related to the collagen fibrils that are embedded in the ground substance. No mineral deposit could be seen without the ground substance deposition; therefore, it is suggested that this ground substance is the single most important factor in the poor mineralization of the otosclerosis. The sclerotic lesions are well mineralized and show a typical pattern of hydroxyapatite by x-ray diffraction study. We could not confirm the notion that the sclerotic lesion is hypermineralized as compared to the normal stapes. The spongiotic lesions are poorly mineralized, with low calcium salt. Using the Ca/P ratio and x-ray diffraction pattern as criteria, it was determined that spongiotic lesions belong to unstable, immature bone.

Bone Marrow↗

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Bilateral hypoglossal nerve paralysis after irradiation therapy.

Cancericidal doses of irradiation therapy to be the head and neck may be followed by paralysis of cranial nerves due to fibrosis of tissue about the nerves and infiltration of the nerves with fibrous tissue. The hypoglossal nerve is particularly prone to this delayed effect of irradiation therapy and a case is presented here in which there was bilateral hypoglossal paresis appearing three years after therapy.

Adult↗

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Surgery of the inferior nasal turbinates.

The inferior turbinates are responsible for nasal obstruction more often than commonly thought. When there is no other obvious cause or nasal obstruction, and when allergic disorder or other medical condition is not responsible, attention should be given to treatment of the inferior turbinates in many instances of nasal obstruction. Such treatment is usually surgical and may consist of submucous resection of the turbinate bone or excision of redundant hyperplastic turbinate tissue, or a combination of the two. Other treatments consist of electrocautery or cryotherapy. Injection of corticosteroids have produced blindness through embolism and, in general, this treatment is discouraged. The paper discusses in some detail which patients are best suited for submucous resection and which for excision of soft tissue. Techniques, which are simple, are also described.

Airway Obstruction↗

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Active otosclerotic foci in the stapes. An electron microscopic study.

A total of 12 undecalcified and decalcified otosclerotic stapes containing active spongiotic lesions were examined using an electron microscope. Evidence of osteolytic osteolysis was seen in all specimens, but osteoclasts were observed in only four. The advancing front in the spongiotic lesion was 'moth-eaten' due to the demineralization of canaliculi and lacunae. The demineralizing process appeared to be initiated by degranulation of lysosomes by the degenerating osteocytes. As bone resorption continued, poorly mineralized new bone was laid down by osteoblasts which showed mitochondrial swelling. The possible implication of this mitochondrial swelling is discussed in relation to the pathology of the otosclerosis.

Ear Ossicles↗

PubMedDate not supplied