Skin affection in rhinoscleroma. A clinical, histological and electron microscopic study on four patients.

Clinical, histological and electron microscopic studies were performed on 4 rhinoscleroma patients with concomitant skin lesions in the upper lip, dorsum of the nose and nasolacrymal sac area. The skin lesions were treated locally. One of the patients was followed up to 16 years. Histologically, the skin lesions showed downward prolongation of the rete pegs. Deep in the dermis, vacuolated Mikulicz cells surrounded by lymphocytes and plasma cells were found. By electron microscopy, numerous small vacuoles containing fine granular material were seen inside Mikulicz cells. A limited number of bacilli were found inside and outside these cells. Two clinical entities of rhinoscleroma are observed in Egypt, an active granulomatous type with possible extranasal extension, and a less active intranasal type with limited mucosal lesions. The skin lesions in rhinoscleroma were found to have an unpredictable course.

Experimental intravenous inoculation of Klebsiella rhinoscleromatis bacilli in albino rats: a histopathological and bacteriological study.

Scleroma, chronic specific granuloma of the nose and upper respiratory tract, is endemic in Egypt and many other countries. The exact pathogenesis of the disease as regards the aetiological role of Klebsiella rhinoscleromatis is contradictory. This work investigated the effect of experimental intravenous injection of K. rhinoscleromatis in albino rats to demonstrate that the micro-organism can fulfil Koch's postulates. Micro-organisms were isolated from biopsy specimens taken from nasal lesions of 10 patients in the granulomatous stage of scleroma. Specimens were subjected to bacteriological and histopathological examinations to confirm the diagnosis. A 100 microl volume of freshly prepared bacterial inoculum containing 10(8) cfu/ml was injected weekly in the tail vein of each of 30 albino rats for 5 consecutive weeks. Biopsy specimens were taken from sacrificed animals and subjected to bacteriological and histopathological examinations. Positive histopathological diagnosis of scleroma was reported in the nose of 66.7% of rats, the larynx of 46.7%, the lungs of 26.7% and liver of 20% of rats. Bacteriological techniques were successful in revealing K. rhinoscleromatis from the nose of 36.7% of rats, the larynx of 30% and the lungs of 20% of rats. Various techniques were carried out to demonstrate the micro-organisms in tissue sections. Two histochemical stains for bacteria were employed: silver and Periodic Acid Schiff (PAS) stains. Immunoperoxidase technique using Klebsiella capsular type 3 antiserum was applied. It gave positive results in 66.7% of the 6 stained liver sections in spite of negative bacteriological cultures. The histiocytic nature of the Mikulicz cells was confirmed using alpha-1 antitrypsin, an immunohistochemical marker of histiocytes, and by studying the ultrastructural features of Mikulicz cells using the transmission electron microscope.

The vomeronasal (Jacobson's) organ in adult humans: frequency of occurrence and enzymatic study.

The vomeronasal system in adult humans has commonly been regarded as absent or vestigial, but recently it was found to be more common than previously reported. In this study, a search for the frequency of occurrence of the vomeronasal organ (VNO) was performed by examining the nasal septae of 200 adult patients. The frequency of occurrence was found to vary according to the method of examination. By anterior rhinoscopy, large pits and even deep grooves lined by glistening mucosa were visible in 16% of the people examined. Using nasal endoscopes this ratio increased to 76%. After receiving informed, written consent, from 13 patients undergoing endonasal surgery under general anaesthesia, one VNO was dissected out. Specimens were examined histologically and histochemically for succinic dehydrogenase and alkaline phosphatase enzymes. One specimen was processed for transmission electron microscopy. Two morphologically distinct cell types were differentiated. One cell type was previously suggested to have some of the features associated with nerve cells and could have a sensory function. A possible function for the VNO is postulated.

The effect of streptomycin and irradiation on rhinoscleroma (electron microscopic study).

Irradiation of scleromatous lesions produces its effect by destroying the organisms, whereas Streptomycin improves the mucosal defence mechanisms. A combination of both lines of treatment seems to be indicated for the arrest of the pathological process.

The effect of cigarette smoke on the vocal cord mucosa of the rabbit: An electron microscopic study.

The effect of whole cigarette smoke on the vocal cord mucosa of the rabbit has been studied with the electron microscope. The epithelium shows variable degrees of hyperplasia, with enlargement of the basal cells. Variable degrees of damage are found in the nerves and muscles in the tunica propria. The relationship between these changes, some endogenous factors in the larynx and the development of cancer are discussed. A possible toxic effect of cigarette smoke on the nerves and muscles of the larynx is mentioned.

The effect of cigarette smoke on the tracheal mucosa of the rabbit. An electron microscopic study.

The effect of whole cigarette smoke on the tracheal mucosa of the rabbit has been studied by the electron microscope. The epithelium shows oedema and disturbed stratification. The cilia are sparse and some show clubbing. The basal cells are active. Large amorphorous bodies and numerous vacuoles are found in the tunica propria. Some damage in the smooth muscles is found. The irritative effect of cigarette smoke on the epithelium is demonstrated. Factors which may explain the rare incidence of malignancy in the trachea are discussed.

Scleroma of the upper respiratory passages: a CT study.

Scleroma is a chronic specific granulomatous disease endemic in Egypt. The nasal cavities were all affected in the 37 patients examined. The paranasal sinuses and nasopharynx were involved in 17 patients, while the larynx and upper trachea were affected in five patients, four of whom were females. Twenty-three patients were in the granulomatous stage; the rest of the patients were in the atrophic and fibrotic stages. The main nasal and nasopharyngeal CT findings were soft tissue masses of variable sizes. The lesions were characteristically homogenous, non-enhancing and had distinct edge definition; adjacent fascial planes were not invaded. The subglottic area was involved in laryngeal and tracheal scleroma. The lesions were mainly in the form of concentric irregular narrowing of the airway. In the trachea, crypt-like irregularities were diagnostic of scleroma. Intra-orbital, intra-cranial and infratemporal parapharyngeal scleromatous masses were detected in one patient.

Laryngotracheal augmentation using titanium mesh.

BACKGROUND: The management of laryngotracheal stenosis is still a serious surgical challenge. The fact that there are currently numerous reconstruction procedures indicates that there is at present no standard treatment. STUDY DESIGN: Titanium mesh was used instead of traditional homografts in reconstruction of the anterior laryngotracheal wall in 12 tracheostomised patients with benign chronic laryngotracheal stenosis. The anterior laryngotracheal wall was split, followed by excision of scar tissue and fixation of the titanium plate at the split end. A Silastic stent was inserted above the tracheostomy tube and fixed in place by running sutures fixed to the skin by buttons. The stent was removed endoscopically six weeks later and a trial of decannulation was undertaken. RESULTS: Endoscopically, good epithelisation was seen on the inner surface of the mesh in 10 cases and decannulation was possible. Four of these patients required endoscopic debulking of granulation tissue. Decannulation was impossible in two cases, one due to excessive granulation tissue and the other due to prolapse of the titanium mesh into the tracheal lumen (the mesh was removed endoscopically and a Montgomery T-tube inserted). CONCLUSION: Titanium mesh was found to be a good alternative for augmentation of the anterior laryngotracheal wall. It offered rigid support, with fewer of the complications reported with other grafts.

Endoscopy of lower respiratory tract scleroma.

Eleven cases of scleroma with lower respiratory tract affection were examined by the flexible and rigid bronchoscopes. The patterns of laryngeal, tracheal and bronchial scleroma as seen through the flexible scope are presented. In the larynx, diffuse and localized forms are found. The trachea was affected by granular or atrophic lesions. Stenosis of the main bronchi was seen in two patients. The present-day treatment of lower respiratory tract scleroma is discussed.

Evaluation of the fluorescent gonococcal test-heated.

In a 1-year evaluation of the indirect fluorescent antibody test for gonorrhea, 16,127 specimens from low-and high-risk groups were examined, and the results were compared with culture, history of exposure to a known patient, and clinical signs and symptoms. The results confirmed the usefulness of the indirect fluorescent antibody test for gonorrhea as a screening procedure, especially for women in the low-risk group. The test is more economic and probably more sensitive than culture for mass screening of asymptomatic women.

Serologic diagnosis of gonococcal infection.

Infection with N. gonorrhoeae stimulates the production of antibodies to many common, species-specific, and type-specific antigens. The L-antigen is an envelop antigen and antibodies to it could be demonstrated by various methods in more than 90% of the patients after the first 10 days of infection. Serologic tests are not yet available in the United States. If and when they become available, they may be recommended for: (1) Screening asymptomatic men and women, (2) Use as an adjunct diagnostic tool in cases of prostatitis, arthritis, disseminated gonococcal infection, and pelvic inflammatory disease, (3) Use (alone or in conjunction with culture) when specimens must be mailed to a central laboratory, when mailing conditions do not allow for incubation within 24-48 hr, or when proper media and qualified bacteriologists are not available.

Human nasal blood vessels after permanent tracheostomy. Electron-microscopic study.

Biopsy specimens from the inferior turbimate of 13 permanently tracheostomized patients were examined by the electron microscope. Variations from the normal were recorded, as proliferation of capillaries, venous congestion and arteriolar contraction. The relation of shunting air away to these changes is discussed.

Gonorrhea screening program in New York State.

Of 171,089 mailed specimens examined for Neisseria gonorrhoeae, 88% were submitted by family planning clinics, physicians in private practice, and other non-VD clinics. To process a large volume of specimen bottles, we developed a swab-oxidase test and demonstrated it to be reliable for the initial screening of all specimens. Our protocol permitted the isolation and confirmation by sugar fermentation of 95% of all presumed N. gonorrhoeae cultures within 1 or 2 days after growth was observed. The results obtained over a 2-year period indicate that the positivity rate is directly related to the lag period between specimen collection and examination. There was no adverse effect of cold weather on the positivity rate, but, irrespective of the season, 3 to 9% of the positive specimens required incubation for 3 days before gonococcal growth appeared.

Modified immunofluorescence test for the serologic diagnosis of gonorrhea (FGT-ABS).

Investigation of the source of false-positive reactions in the Fluorescent Gonococcal Test-Heated (FGT-H) implicated antibodies to antigens common to Neisseria gonorrhoeae and N. meningitidis. Absorption experiments proved that the fluorescence was due to both species-specific and common antigens and that in most cases the common antibodies could be successfully absorbed by a soluble protein extract of N. meningitidis. The value of such an absorption step was examined using sera from 500 women, 73 from bacteriologically confirmed cases of gonorrhea and 427 from bacteriologically and clinically negative cases. The absorption step reduced the false positivity rate by 58% without a significant change in sensitivity. The modified procedure, the Fluorescent Gonococcal Antibody Test-Absorbed (FGT-ABS), has a sensitivity similar to the Fluorescent Gonococcal Test-Heated (FGT-H) but has the advantage of higher specificity.

Detection of antibodies to Neisseria gonorrhoeae by counterimmunoelectrophoresis.

Antigen was partially purified from Neisseria gonorrhoeae B370 saline wash and used to assay human sera for the presence of antibodies to N. gonorrhoeae. The antigen activity as monitored by counterimmunoelectrophoresis (CIE) is resistant to trypsin and papain but sensitive to heat and periodate oxidation. Of the sera from patients with bacteriologically confirmed cases of gonorrhea, 80% were positive by CIE using this antigen preparation. Of the sera in the negative control group 11% were reactive.

Toxofactor associated with Toxoplasma gondii infection is toxic and teratogenic to mice.

A toxin associated with Toxoplasma gondii infection was obtained from the trophozoites and culture medium used to propagate the parasite in cell cultures. The toxin, named Toxofactor (TF), administered parenterally or nonparenterally in adult mice, produces transient symptoms of lethargy, ruffled fur, and body weight loss. Organ changes which accompanied the outward symptoms included hepatosplenomegaly and involuted thymus. TF activity was detected in extracts of the blood, peritoneal fluid, liver, and spleen of infected mice. Severe damage to embryonal and fetal development was induced when TF was administered during pregnancy. Resorption, abortion, and congenital abnormalities were produced, dependent upon the stage of development at the time of exposure. Adult mice which had reacted to and recovered from an initial intraperitoneal injection to TF were protected against a secondary challenge from TF. Fetal development was also protected from damage when TF was used to challenge adults previously exposed to TF. Mouse and rabbit anti-TF sera neutralized TF activity in the adult. In no instance did control mice show any deleterious effect when exposed to soluble cell lysate from the uninfected cell line (BHK-21) used to propagate the organism plus the used medium from these same uninfected cells. TF activity was not attributed to bacterial, myocoplasmal, or viral contamination. TF toxic activity is labile to elevated temperature and high or low pH, which also destroy its protective properties. TF activity was sensitive to trypsin and was obtained in the elution fraction (alpha-methyl-D-mannoside) from affinity chromatography (concanavalin A-Sepharose 4B). Ultrafiltration indicated the molecular weight to be between 50,000 and 100,000. TF, apparently a glycoprotein, was quantitated for activity by a weight loss assay. A unit of activity was defined as the minimum quantity of TF (highest dilution) which produced at least a 10% average body weight loss in adult Nya:NYLAR female mice between days 7 and 12 post-intraperitoneal injection.