[Trimetazidine versus betahistine in vestibular vertigo. A double blind study]. / Trimétazidine contre bétahistine dans les vertiges vestibulaires. Etude en double aveugle.

The efficacy of trimetazidine (60 mg/day) in vertigo was compared with that of betahistine (24 mg/day) in a three-month double-blind study. Included in the study were only patients with peripheral vertigo associated or not with tinnitus or hearing loss, and excluded were those presenting with symptoms related to retrocochlear or central disease. Out of the 40 patients enrolled, 20 suffered from Meniere's disease; 4 patients either dropped out of the study or were non-compliant to therapy and could not be taken into account in the final analysis, which bore on 36 patients (18 treated by trimetazidine and 18 with betahistine). There were no dropouts in the Meniere's disease subgroup (10 receiving trimetazidine and 10 receiving betahistine). Results revealed a better response to therapy with trimetazidine in patients suffering from vertigo, and this was particularly true of the Meniere's disease subgroup (p less than 0.025). Moreover, in the latter subgroup, all patients treated with trimetazidine fully recovered from vertigo spells, while these disappeared completely only in 4 of the patients administered betahistine (p less than 0.005). There was no noticeable difference between the two treatment groups as regards the evolution of the accompanying symptoms and the audiometric or vestibular test results. Clinical acceptability was equally excellent in both treatment groups. Overall, this study allowed to confirm the therapeutical efficacy of trimetazidine in the management of vertigo, as well as establishing the clinical advantage of trimetazidine over betahistine in patients suffering from Meniere's disease.

Morphology of a columellaform stapes.

A columellaform stapes found in male patient 18 years old with a conductive hearing loss, has been examined by SEM and light microscopy. The ossicle was smaller than a normal stapes. The head was linked to the base by a crural plate, probably formed by the fusion of the material of the two crura. Microscopy showed a slightly less interwoven structure of the fibrillar bone present mainly at the cranial aspect of the crural plate. Honeycomb-like bone was confined to the caudal part of the crural plate. Microscopy revealed a cavity in the centre of the stapes at the transition between the base and the plate. During surgery, a bony structure was found linking the posterior side of the head of the stapes to the pyramidal eminence. Post-operative audiograms revealed improved hearing with some residual conductive loss of about 10 dB. This case illustrates that a columellaform stapes may occur without forming part of a syndrome.

A comparative immunohistochemical study of cytokeratin and vimentin expression in middle ear mucosa and cholesteatoma, and in epidermis.

Cytokeratin expression was studied in human middle ear cholesteatoma lesions, using a variety of immunohistological techniques and a wide range of polyclonal antisera and monoclonal antibodies against cytokeratin (CK) subgroups or individual CK polypeptides. The expression of the other cytoskeletal proteins, vimentin and desmin, was also investigated. Middle ear mucosa and epidermal tissues were used as reference tissues. Our investigations also included epithelial structures present in the cholesteatoma perimatrix and in dermal tissues. The results indicate that, compared with epidermal tissues, the expression profile of CKs in cholesteatoma matrix is representative of a hyperproliferative disease. Evaluating the presence of a marker of terminal keratinization - the 56.5 kD acidic CK n degrees 10 - we found supportive evidence of a pronounced retardation of its expression, which did not parallel histological differentiation. In epidermal tissues, the first prickle cell layers are CK10 positive whereas in many cholesteatomas this finding was observed near the stratum granulosum only. Probing the early stages of keratinization - the 58 kD basic CK n degrees 5 and the 50 kD acidic CK n degrees 14 - we regularly observed an extended staining area in the cholesteatoma matrix. In epidermal reference tissues, only the basal and nearest suprabasal layers were convincingly labeled. As a rule, non-epidermal CKs did not belong to the cholesteatoma CK set. However, exceptions to that rule were noticed as a focal or more extended expression of one or more non-epidermal CKs in about half of the cases. Together with the extended CK5 topography, this is further evidence that CK expression is seriously affected by the diseased state. CK expression in the perimatrix is limited to mucous glands, either normal, atrophic or hyperplastic. CKs n degrees 4, 5, 7, 14, 18 and 19, also displayed by middle ear mucosa, were consistently observed. Where ductal arrangements were present, CK10 was also detected, in analogy with the CK10 registration in ductal portions of mucous glands in the external ear canal skin. The absence of CK8 in mucous glands of the perimatrix, however, strongly differentiates these structures from the mucous gland acini and ducti in the external ear canal, where CK8 is systematically expressed. Vimentin staining was restricted to dendritic cells of the matrix (Langerhans cells) and to perimatrix fibroblasts, blood cells and vascular endothelium. Coexpression of CK and vimentin was not observed.

Differentiation of nuclei during keratinization in middle ear cholesteatoma. DNA cytophotometry completed by computerized image analysis.

Quantitative DNA cytophotometric techniques were applied to judge the alteration (differentiation) and ultimate fate of nuclei during keratinization in human middle ear cholesteatoma. Compared with a healthy epidermis, a tendency towards postponed nuclear degradation was noticed. Two patterns governing the loss of DNA are recognized. In one group, the mean nuclear DNA content declines continuously, starting in the nearest suprabasal layers and continuing throughout the prickle and granular cell stages, where the ultimate degeneration of nuclei takes place. This pathway corresponds to that observed in epidermis, but evolves more slowly. In another group of samples, the onset of the DNA decline is delayed to the upper prickle cells, exceptionally to more terminal stages of keratinization. During matrix keratinization, a profound nuclear remodelling takes place, similar to that in epidermal tissues, as far as eu- and heterchromatin DNA and area data are concerned. However, euchromatinization of nuclei in matrix prickle cells is more pronounced than in epidermal tissues. The topography of residual heterochromatic clumps does not reflect a persistent margination as in epidermal nuclei, but is the result of more individualized rearrangements. The changes in karyotype are less elaborate when the complete decline of the nuclear DNA content only occurs during terminal keratinization.

New perspectives in the direct microscopic examination of middle ear effusions.

Detection and identification of bacteria in middle ear effusions from patients with otitis media with effusion requires sensitive bacteriologic techniques. Direct microscopic examination is very important in this respect. Three staining methods--Gram, Giemsa and the fluorescent acridine orange stain--were evaluated and compared by examining 112 middle ear effusions. Purulent effusions showed more bacteria than mucoid, and mucoid effusions showed more bacteria than serous in the direct microscopic examination of the smears. Acridine orange stain proved superior in detecting bacteria compared with Gram and Giemsa stains and distinguished dead from living bacteria. It is even more sensitive in this way than aerobic and anaerobic cultures. Giemsa stain was superior in the identification of inflammatory cells. Acridine orange and Giemsa stains are recommended in the bacteriocytologic examination of middle ear effusions; Gram stain may provide additional information.

The influence of otitis media with effusion on speech and language development and psycho-intellectual behaviour of the preschool child--results of a cross-sectional study in 1,512 children.

To investigate the influence of otitis media with effusion (OME) on the psychological, social and intellectual development of preschool children, a cross-sectional study in 1,512 apparently healthy children, aged 25-80 months, attending kindergarten (infant school) was performed. Tympanometry and evaluation of the various psychological, social and intellectual parameters by the infant school teacher (assisted by a sociologist) were the most important diagnostical tools in this study. It was demonstrated that OME had a negative influence on speech/language development, intelligence, attention at school, activity at school, manual skill and social behaviour of the 2 to 6 year old child. For speech and language the negative influence was most clearly demonstrated in the youngest age group (less than 47 months), for intelligence and activity in the older age groups. Early detection and appropriate treatment of OME are recommended to avoid these complications.

Clinical use of rhinomanometry in children.

To investigate Passive Anterior Rhinomanometry (PAR), several clinical experiments were set up to explore in children aged 3-6 years the nasal resistance in various normal and pathological situations, in order to determine the role of rhinomanometry in clinical situations in young children. It was shown that the nasal cycle in children differs greatly from that in adults, showing a regular undulating pattern of nasal resistance, but without alternating phenomena. There are also quite regular fluctuations with a short period of about 90 s. Physical exercise and changes in body position have also, in children, a definite influence on nasal resistance. PAR in various pathological situations of the nasal cavity gave a wide range of individual results. It was, however, found that children with a nasal septum deviation, with a pronounced nasal edema, and with serous and purulent nasal secretions had a higher nasal resistance than children without nasal pathology. Because of the spontaneous and evoked changes in nasal resistance in children and because of the large standard deviations of nasal resistance values in pathological situations, clinicians should interpret the results of a one-time rhinomanometrical measurement very carefully.

Malignant otolaryngological tumors in children.

The details of 37 children presenting a malignant tumor in the ENT-region (period 1950-1983) are presented and discussed. The prevalence was higher in boys than in girls and the most common tumors were non-Hodgkin lymphoma (n = 14) and rhabdomyosarcoma (n = 13). The most common primary sites were the nasopharynx (9 cases), the paranasal sinuses (7 cases) and the soft tissue in the parotid region (7 cases). In 23 children the presence of a painless tumor was the first symptom, in 11 pain was predominant. Only a minority (5 children) presented a limited tumor; in 20 children there was a local extension of the tumor and in 10 children metastases were present at the first visit. The beneficial role of chemotherapy and the necessity of a good teamwork in the treatment of these children is outlined. Of the 37 children, 14, (38%) are surviving; of these 14 children, 12 are off therapy and cured. It is demonstrated that the prognosis improved considerably since the last 14 years.

[Dyspnea in an occult thyroid carcinoma]. / Dyspnoe bij een frust schildkliercarcinoma.

A non-palpable thyroid carcinoma presenting as a subglottic narrowing with respiratory difficulties.

A quantitative histochemical study of sulphydryl and disulphide content during normal epidermal keratinization.

A quantitative histochemical study was carried out on the distribution of protein thiol and disulphide groups in normal human plantar epidermal tissue. Histochemical demonstration of reactive groups was achieved by addition of N-(4-aminophenyl) maleimide, subsequent diazotization and final coupling with a Nitro Red or chromotropic acid label as first described by Sippel. The quantitative reliability of the method was tested by absorption cytophotometry, and evaluated on the basis of the internal consistency of the results reported. Our histological observations and histophotometric data support accepted views on epidermal keratinization. A limited, though reproducible, amount of disulphide bonds was observed near the basement membrane. The free thiol concentration in basal and prickle cells was low and almost constant, but was higher in the granular cells, where deposition of sulphur-containing proteins on cell membranes is initiated. In Malpighian layers, disulphide cross-links only occurred just beneath the transition zone in thickened cell membranes. The staining pattern of the inner stratum corneum resembled a mosaic and was characterized by a Sharp rise of the disulphide content, which exceeded the decrease in free thiol groups. The free thiol concentration decreased further throughout the cornified layers whilst the disulphide content remained fairly constant. Staining of thiol and disulphide groups together corresponded, within the limits of the standard error, to the sum of the thiol and disulphide concentrations when they were assayed separately in living ahd horny cells. These results confirm that living cells are the main site of free thiol groups, while horny cells are the most prominent of site of disulphide cross-links.

Quantitative determination of free thiol and disulphide groups by a fluorescent maleimide procedure.

To determine the quantitative reliability of thiol histofluorometry, the distribution of protein thiol and disulphide groups was reinvestigated in normal human epidermis, labelled with DACM-3 after cryocutting. Microscopical observations roughly confirmed, that living keratinocytes and inner stratum corneum are the main sites of free thiol groups, while disulphide crosslinks are almost exclusively found in cornified cells. Histofluorometric quantitation led to free--SH, --S--S-- or combined --SH and --S--S-profiles through the different strata, that were not compatible with previous absorption-histophotometric studies and lacked internal consistency. The difficulties reside mainly at the methodological level and may partially be resolved--at least in keratinocytes--by extraction of nonstructural SH-groups in a prerinsing step. Permanent mounting further contribute to the realization of normal fluorescence behaviour, as visualized by the decay curves. DACM-saturation of structural protein reactive groups was only reached after prolonged staining.

[Hundred cases of general anesthesia for laryngoscopy and/or bronchoscopy, in children under five years age (author's transl)]. / Anesthésie générale pour laryngoscopie et/ou bronchoscopie chez l'enfant. Cent cas chez des moins de cinq ans.

The authors describe an anesthetic technique used for endoscopies (laryngo-tracheo-bronchoscopies) in 100 children under five years age. Three different apparatus for jet ventilation are used: manual injection, automatic injection and high frequency positive pressure ventilation. The first apparatus is home made. It allows control of insufflation of O2 by manual compression of a gun type injector. With the second one (Wolf injectomat), injection of O2 or O2/N2O is automatic. The aga bronchovent is used for high frequency positive ventilation with O2.

The temporal bone as route of infection in recurrent meningitis.

Three successive episodes of recurrent meningitis in connection with an infection of the upper respiratory tract appeared to be related to a congenital idiopathic oval window CSF leak. An inner ear dysplasia was the underlying factor and accounted for the deafness and for the absence of signs of acute labyrinthis during these infectious episodes.