Arachidonic acid metabolites and sinonasal polyposis. I. Possible prognostic value.

PURPOSE: The etiology of sinonasal polyps is sometimes obscure. This study was undertaken to evaluate the potential role of arachidonic acid metabolites (AAm) on recurrent polyposis. MATERIALS AND METHODS: Tissue production of prostaglandin E2 (PGE2), 6-keto-prostaglandin F1-alpha (PGI2), thromboxane A2 (TxA2), and leukotriene C4 (LTC4) by nasal mucosa was determined by radioimmunoassay in 27 patients with sinonasal polyposis (SNp) and in 10 volunteers. RESULTS: The group of patients with SNp with the evidence of recurrences in postoperative period (Group 1) showed significantly lower PGE2 concentrations than group of patients with SNp recurrences (Group 2). The differences in concentrations of PGI2 in mentioned groups were insignificant. In comparison with other groups, a group of patients who underwent surgery several times for SNp (Group 4) had a higher mean TxA2 concentration. The LTC4 concentrations were the highest in groups of patients where SNp recurrences were observed. When the incidence of polyposis recurrences (within 18 months after surgery) was correlated with the level of LTC4 production at the time of surgery, the rate of recurrence was significantly higher in patients with increased LTC4 level than in those with normal LTC4 levels. CONCLUSIONS: LTC4 might have a prognostic value. The possible role of AAm in occurrence of SNp is apparent and suggests possible role for medical intervention.

Effect of climatic elements on the frequency of secretory otitis media.

A relationship between the number of children hospitalized for secretory otitis media and climatic elements was observed during a 10-year period (1981-1990). The highest correlation was obtained between the number of secretory otitis media cases and the number of sunny hours in a month, followed by that between the number of secretory otitis media cases and the mean monthly temperature and relative air humidity. The largest number of children were hospitalized for secretory otitis media toward the end of winter, and the lowest toward the end of summer (in August and September).

Immunohistochemistry of glomus jugulare and tympanicum tumors.

Glomus jugulare and tympanicum tumors differ from other paragangliomas, especially from aorto-sympathetic, visceral-autonomic and adrenal medulla tumors. They differ not only in their localization, but also in their histologic and clinical pictures. As differentiated from other paragangliomas, these tumors show no argyrophilia. Besides the difference in histochemistry, the glomus jugulare and tympanicum tumors also differ from other paragangliomas in the intensity of their immunohistochemical reaction to particular markers. As differentiated from other paragangliomas that react well to chromogranin with antisera, the chief cells of these tumors are poorly represented with chromogranin as a marker. As distinguished from chromogranin, however, synaptophysin produced a positive reaction, i. e., moderate to maximal reactivity, in all cases under study. Helper cells of these tumors, and likewise other paragangliomas, are well represented by antisera to S-100 protein and glial fibrillary acid protein.

Surgical treatment of Menière's disease--two techniques compared.

Two techniques for surgical treatment of Menière's disease, endolymphatic sac decompression according to Shambough and decompression on the stapes footplate, i. e., platino decompression according to Martin, were compared. A series of 81 patients were hospitalized for treatment, and 20 surgical procedures were performed: platino decompression in eight cases, and endolymphatic sac decompression in 12. None of the eight patients had relapse of the disease after platino decompression, whereas the endolymphatic sac operation was followed by relapse in 6 of the 12 patients. Considering the postoperative values of hearing loss, the considerably lower incidence of relapse, and the technically simple procedure of platino decompression, this technique is recommended as a method of choice for the surgical treatment of Menière's disease.

[Granuloma of the oval window after stapedectomy]. / Granulom fenestre ovalis nakon stapedotomije.

A case report is presented of a female patient who underwent stapedotomy with bad functional results Reoperation revealed a dislocated prosthesis and there was no successful hearing. Besides conduction deafness perceptive deafness occurred as well. The second reoperation disclosed reparative granuloma around the prosthesis, while histological analysis showed foreign-body granuloma. Foreign-body granuloma by stapedectomy is extremely rare and it was the first case in our 810 surgically treated ears.

[Classification of secretory otitis based on cytological analysis of middle ear transudate]. / Tipizacija sekretornog otitisa na temelju citoloske analize transudata iz srednjeg uha.

On the basis of the number of cell elements in the cytologic smear of the transudate from the middle ear, secretory otitis media was divided into four groups providing indication for therapeutic procedures. The first group is characterized by a mass of mucus and very scarce cell elements, suggesting a relatively short duration of illness and the healing by conservative therapy and adenoidectomy. The second group contained somewhat more cell elements in the cytologic smear, suggesting a longer duration of illness and requiring the use of a ventilation tubule in the therapeutic procedure. The third group showed a considerable cell infiltration and the appearance of individual collagenic fibres scattered in disorder in the smear. The transudate is dense, sticky, and dark. Its aspiration from the cavum is not easy. The finding suggests a long duration of illness, requiring a more active approach of the otosurgeon. The fourth group is characterized by a very scarce but dense aspirate from the middle ear. The cytologic smear shows an intense cell infiltration and a mass of collagenic fibres, which speaks for a very long duration of illness and for the necessity, in view of the formation of connective tissue in the middle ear, of an explorative tympanotomy coupled with adhesiolysis and the use of the ventilatory tubule.

[Branchial cyst and fistula of the first branchial cleft. Apropos of a case]. / Kyste branchial et fistule du premier sillon branchial. Présentation d'un cas.

We describe a case of a fistula from the first branchial cleft. At the otorhinolaryngology clinic of the Faculty of Medicine at the University of Zagreb we have operated on more than 100 cases of congenital abnormalities of the branchial arches. However, it is only recently that we had the first case of fistula from the first branchial cleft. We report the clinical aspects and operative course in detail.

Rhinomanometrical findings after septoplasty in children.

40 children of both sexes, aged 5-12, with deviations or fractures of the nasal septum were tested. These children were selected for septoplasty on the basis of anamnestic data, ENT examination and anterior rhinomanometry with and without anamnestic data. The control group consisted of 15 children, of approx. the same age and sex distribution, with normal nose breathing and rhinomanometrical findings. The operated group underwent clinical and rhinomanometrical examination 3 and 12 months after surgery, and the control group 12 months after the initial examination. Septoplasty was performed under general anaesthesia with locally applied vasoconstrictors. The results showed that rhinomanometrical resistances prior to surgery were significantly higher in all the subjects in the operated group than those in the control group. Rhinomanometrical resistances were lower in 29 operated cases 3 months after septoplasty than before septoplasty, and significantly lower in 32 operated cases 12 months after septoplasty. Rhinomanometrical resistances in the operated group 12 months after surgery were a little higher than those in the control group 12 months after the initial examination. Failures and complications after septoplasty are commented upon, as is their influence on rhinomanometrical resistances.

[Effect of radiotherapy on the function of the parotid gland]. / Die Wirkung der Radiotherapie auf die Funktion der Ohrspeicheldrüse.

The incidence of adverse effects on radiotherapy in head and neck cancer is quite common. Some irradiation doses affecting parotid gland have been investigated. 38 irradiated cases and 12 non-irradiated cases constituting the control group have been included in the study. Histologic examination, sialography, scintigraphy and sialometry have been performed in all cases. The impairment of parotid gland is evident in the early stage and is aggravated with time. Glandular function is not reduced significantly by irradiation doses of 2000-3000 r. A marked functional reduction has been noted with irradiation doses of 5000-6000 r., and is variable in each individual. The reduced glandular function was particularly reduced in the early postirradiation period. The subsequent functional improvement is related to the remainder of less affected parenchyma, reduced inflammatory process and rapid growth of goblet cells in the walls of the outlet system compensating mucus deficit.

[The fascia and perichondrium in reconstructive surgery of the middle ear]. / Faszie und Perichondrium in der rekonstruktiven Chirurgie des Mittelohres.

Analysis of 140 patients operated on for chronic otitis media showed that the perichondrium possesses biological qualities similar to those of the fascia, although it is used less often. When using the fascia, perforations occurred in 16% of the operated patients, whereas when using the perichondrium the incidence was 20%. Improved hearing when using the perichondrium was observed in 69%, and when using fascia in 42%. Functional results with the perichondrium were much better than with the fascia.

[Functional results following stapedectomy. A 5-year study]. / Funktionelle Ergebnisse nach der Stapedektomie. Eine fünfjährige Studie.

Results of partial stapedectomy with the formation of small fenestra and the use of teflon piston prostheses in the period of 1980-1984 are shown. Particular attention was paid to the group of patients under 18 years of age representing 3.3% of all operated cases, as well as to patients with combined hearing loss. In both groups, functional results of surgery were very good. Of the total of 284 operated ears, there were 20 reoperations.

[Malignant case of angiofibroma (author's transl)]. / Bösartiger Verlauf eines Angiofibroms

Various opinions about the etiopathogenesis of angiofibroma are mentioned. The authors, however, have not succeeded in confirming the frequently mentioned theory of hormonal formation of these tumours. It appears that surgical therapy is the only efficient way today of providing a clear view and a rapid radical removal of tumours, thus reducing the usually profuse haemorrhage during surgical treatment. Pre-operative ligation of the external carotid artery has no noticable effect on the reduction of haemorrhage during the operation. X-rays have no effect on the growth of the tumours. There is no great difference between the histological picture of a primary tumour and that of its recurrences. The malignant course of an angiofibroma in an adult is described which recurred several times and led to the involvement of the endocranium with a letal ending. The histological picture remained unchanged all the time. A spreading of the tumour was noticed in areas distant from the primary localisation of the tumour which we consider to be due to implantation and which indicates great potential growth of tumour cells of this angiofibroma.