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.

The long-term results of the treatment with transtympanic ventilation tubes in children with chronic secretory otitis media.

In the present report we discuss the short-term and long-term results of treatment with transtympanic ventilation tubes in 140 children with chronic secretory otitis media. Important findings are: after 6 months only 40% and after 12 months only 5% of the inserted grommets are still draining. A good clinical result is obtained in 72% after 6 months, and in 52% after 12 months. With a long follow-up, up to 10 years, 71% of the children suffering from chronic secretory otitis media and treated with grommets, can be considered as cured, with or without a small complication. The poorest results are obtained after a follow-up of 2-3 years. Children under 7 years have a better prognosis than older children. There is also a better prognosis in children with serous effusions than in those with a glue ear. We noticed very few complications in our treatment with grommets: no sensorineural hearing loss and a persisting perforation in 2% of the treated ears.

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.

First observations on treatment of cholesteatoma with (N-acetyl)cysteine.

In a series of cholesteatoma patients the benefit of local application of acetylcysteine was demonstrated. Chemical studies and fractional analyses were used to reveal the breakdown of keratin. Histochemically the influence of acetylcysteine on keratin is confirmed.

Scanning electron microscopic studies of the staples in normal and in some pathological and experimental conditions.

By means of the electro-scanning microscope we were able to demonstrate the three-dimensional bony structure of the normal stapes, and the variations in structure of the different stages of otosclerosis. One case of osteopsatyrosis is also discussed. The callus formation in an experimentally fractured footplate is compared with otosclerosis.

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.

The importance of the anaerobic bacteria in paranasal sinusitis.

The anaerobic examination of the material, obtained by 100 antral punctures, in 66 patients with paranasal sinusitis, showed the importance of the anaerobic bacteria. In 33% we found anaerobes: 12% of the cultures were pure anaerobic, 21% were mixed aerobic-anaerobic. The most frequent anaerobe is the Peptostreptococcus. Anaerobic cultures are more frequently found in the unilateral cases of paranasal sinusitis. The presence of anaerobes does not seem to be dependent on the patient's age, the duration of the sinusitis and the previous administration of antibiotics during the last 3 days. In 76% the anaerobes disappeared after the initial antral puncture and washing.

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.

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.

[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.