Estrogen receptor-beta is the predominant estrogen receptor subtype in human oral epithelium and salivary glands.

Many studies have shown that the oral mucosa and salivary glands are sensitive to estrogen action. However, the expression of estrogen receptors (ERs) within these tissues is an area of controversy. ERs exist as two subtypes (ERalpha and ERbeta), and we hypothesized that the incongruity between ER expression and estrogen sensitivity may result from differential expression of ER subtypes in oral tissues. To test this hypothesis, we analyzed oral mucosal and salivary gland samples for ERalpha and ERbeta protein expression by immunohistochemistry from a cross-section of patients attending hospital for surgical problems of the head and neck. ERalpha was not detected in oral buccal and gingival epithelium or in salivary glands. In contrast, ERbeta was widely expressed at high levels in all oral tissues studied. Within these tissues, ERbeta was observed primarily in keratinocytes and salivary gland acinar and ductal cells. Our results demonstrating the expression of only the ERbeta subtype within oral tissues may explain the contradictory results from previous studies investigating ER expression in these tissues. Importantly, these results suggest that estrogens may act via ERbeta in oral tissues and explain the effect of hormonal changes on the oral mucosa as well as on saliva secretion and composition.

Electronystagmographic findings in patients with acute cerebral vascular disease and vertigo.

A neurootologist examined 233 successive cases of acute disabling vertigo from the Clinic of Neurology of Turku University Central Hospital. On magnetic resonance imaging (MRI), 24 patients had evidence of acute cerebral or cerebellar brain infarction. The examination scheme included a case history analysis, clinical neurootological examination and electronystagmography (ENG). The audiological examination included pure-tone thresholds and speech audiometry. The ENG analyses were done by two neurootologists who had no information about the aetiology of the diseases. A central disturbance in ENG was observed in 59% (10/17) of the patients with cerebral brain infarction and 71% (5/7) of the patients with cerebellar brain infarction. ENG is not valid as a screening method for the central aetiology of vertigo; imaging of the central nervous system is needed.

Difficult airway in a patient with Marshall-Smith syndrome.

Marshall-Smith syndrome is a rare clinical disorder characterized by accelerated bone maturation, dysmorphic facial features, airway abnormalities and death in early infancy because of respiratory complications. Although patients with Marshall-Smith syndrome have several features with potential anaesthetic problems, previous reports about anaesthetic management of these patients do not exist. We present a case, in which severe hypoxia developed rapidly after routine anaesthesia induction in an eight-month-old male infant with this syndrome. After several unsuccessful attempts the airway was finally secured by blind oral intubation. After 2 weeks, laryngeal anatomy was examined with fibreoptic laryngoscopy which revealed significant laryngomalacia. Laryngoscopy was performed without problems with ketamine anaesthesia and spontaneous breathing. The possibility of a compromised airway should always be borne in mind when anaesthetizing patients with Marshall-Smith syndrome. Anaesthesia maintaining spontaneous breathing is safest for children with this syndrome. If tracheal intubation or muscle relaxation is required, precautions are needed to maintain a patent airway. Muscle relaxants should possibly be avoided before intubation.

Febrile infection changes the expression of IgG Fc receptors and complement receptors in human neutrophils in vivo.

We have examined the expression of the IgG Fc receptors (FcRI, FcRII, FcRIII) and complement receptors (CR1, CR3) in neutrophils from 42 patients with febrile bacterial infection, 20 patients with febrile viral infection and 69 non-febrile healthy individuals. Using receptor-specific MoAbs and immunofluorescence flow cytometry the relative fluorescence intensity (as a measure of receptor number) and the proportion of receptor-positive cells were determined in peripheral blood neutrophils exposed to minimal processing, consisting only of erythrolysis. Both the percentage of FcRI-positive neutrophils and FcRI number per neutrophil were significantly (P < 0.001 and P < 0.0001) increased in bacterial infected patients compared with controls, whereas in viral infected patients only the FcRI percentage was markedly elevated (P < 0.05). In addition, both FcRII and CR1 levels were significantly higher in the bacterial infection group than in the viral infection and control groups (bacterial versus control P < 0.001, bacterial versus viral P < 0.0001). No changes in expression of FcRIII or CR3 were found in the patient groups. The kinetic analysis of receptor expression in bacterial infection patients revealed a shift in the percentage of FcRI-bearing neutrophils towards normal values already on day 2 after the first analysis. On the other hand, the levels of FcRI, FcRII and CR1 remained clearly elevated in these patients during 1 week's follow-up period. We conclude that febrile infection may cause systemic activation of the entire pool of circulating neutrophils, resulting in alterations in cell surface receptor expression, some of which are characteristic of the nature of the infectious agent.

Sleep disorders in patients with severe nasal obstruction due to septal deviation.

The role of nasal obstruction in etiology of the sleep apnea disease is controversial in literature. Forty-six subjects (3 women, 43 men) with severe nasal obstruction due to septal deviation were evaluated. The examination included case history, clinical ORL examination by ENT specialist, rhinomanometry and whole night sleep recording (SCSB, oximetry, EKG). Mean age of the patients was 40.0 years (from 17 to 68 years) and body mass index 26.0 kg/m2 (from 20.3 to 34.6 kg/m2). The chief complaint of the patients was a severe nasal obstruction. Thirty-one patients (67%) had also heavy disturbing snoring, and apnea periods during sleep were reported by 10 cases. The evaluation of the sleep recordings revealed 12 cases with partial upper airway obstruction (26%), 1 case with severe airway obstruction, 1 case with mixed type of obstructive apnea and 3 cases with periodic limb movements. Evaluation of the oxygen desaturation of the blood revealed only 6 cases with significant disturbance (pO2 below 90% level). As a final result we conclude that severe nasal obstruction can lead to breathing disturbance during sleep.

The evaluation and treatment of the neck in carcinoma of the oral cavity.

Locoregional recurrence is the most common cause of failure in the treatment of carcinoma in the oral cavity. The extent of the disease can be evaluated by inspection, endoscopy, palpation, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US). The treatment consists of surgery, radiation, and their combination. The purpose of this study was to evaluate the effect of imaging and active treatment of the neck in patients with oral cancer. Altogether 31 consecutive patients with 32 squamous cell carcinomas in the oral cavity were included. Of the tumors, 5 were T1, 18 were T2, 5 were T3 and 4 were T4. According to CT and US findings, 19 of the patients had a normal lymph node status, whereas 12 patients had enlarged or rim-like enhanced lymph nodes in the neck. Preoperative radiotherapy to the primary site and the neck was given to all except 3 patients. Surgery was carried out in all except 4 patients. A neck dissection was performed in N-positive cases (n = 9) and electively in patients with a high risk of metastases (n = 10). The median follow-up time was 31 months, with the minimum of 11 months, or until death. Seventeen (55%) of the patients experienced a recurrence. In only 1 patient the recurrence appeared initially in the neck, whereas all others had a local recurrence. Later, a distant metastasis was found in 3 patients. The meticulous imaging and active treatment of the neck were successful since only one patient's disease recurred primarily in the neck. The high number of recurrencies at the primary site show the need for intensified therapy.

Prediction of the clinical outcome of acute frontal sinusitis with ventilation measurement of the nasofrontal duct after trephination: a long-term follow-up study.

Acute frontal sinusitis has become an increasing clinical problem in the region that is served by the hospital represented by the authors of this study. The standard surgical treatment protocol after the failure of conservative therapy has been to perform trephination of the involved frontal sinus. More sophisticated procedures have been used in patients with prolonged or recurrent disease. The authors have developed a simple ventilation test of the nasofrontal duct that can be used to determine which patients require further surgery. In a long-term follow-up study of 85 patients, this ventilation test was shown to predict the cases that would heal uneventfully after trephination and the cases that would require further surgery because of an obstructed nasofrontal duct. The findings of this study are of special interest for modern functional endoscopic sinus surgery, the purpose of which is to open up the nasofrontal region.

Correlations between subjective sensation of nasal patency and rhinomanometry in both unilateral and total nasal assessment.

The correlation between rhinomanometry and subjective sensation of nasal obstruction was studied. Patients assessed their nasal airway patency using a visual analogue scale (VAS). The VAS results and rhinomanometry correlated better when unilateral nasal obstruction was evaluated compared to total nasal evaluation. When rhinomanometric data were divided into four clinically relevant grades of obstruction (very patent, normal, obstructed and very obstructed) and the quartiles of the VAS results were compared to these, the agreement was good or fairly good in 75-85% of cases. A similar result was also encountered when, in an experimental study, 30 individuals were asked to breathe through four artificial nose models with a varying inner diameter of 9-3 mm. Again, most subjects assessed these models logically, but in 11% of the cases the subject assessed the narrowest tube as patent or the widest tube as very obstructed. Our results prove the necessity of having some sort of objective method to evaluate nasal patency; if we rely only on the patient's sensation, we may get a misleading picture of his nasal function.

Vestibular neuronitis. An otoneurological evaluation.

Eighty-one cases with vestibular neuronitis were examined. The diagnostic criteria were a sudden onset of vertigo without previous symptoms, spontaneous nystagmus towards the healthy side, totally extinguished caloric responses with 44 degrees C and 30 degrees C water irrigation and no involvement of hearing associated with the onset of the disease. The series was divided into a prospective and a retrospective group. The prospective group A was examined at the acute stage, about 1 month and 1 year afterwards. The retrospective group B fulfilled the same criteria as group A and was examined 1-8 years after the acute stage. The results of the acute stage in group B were analysed from the case history reports, electronystagmo- and audiograms. The preceding and predisposing factors and symptoms were inquired. The examination scheme included the clinical otoneurological examination, the nystagmographic, audiological and clinical neurophysiological measurements and the serological and hematological specimens were collected at the acute stage of group A to examine the role of virus infections in the etiology of vestibular neuronitis. The liquor specimens of 16 cases available in group A were analysed. A recent respiratory infection was reported by 9 cases (27.3 percent) in group A and by 18 cases (37.5 percent) in group B. The serological evidence (increase of IgM-antibodies) was observed in 1 case against influenza A and in 1 case against parainfluenza 3 and the hematological examinations revealed clues of virus infection in 6 cases (18.2 percent) of group A. Cell counts and protein analyses of the liquor specimens were within normal limits. Cases with arterial hypertension under medical control were observed in 15.2 percent of group A and 14.6 percent in group B. These figures do not exceed the age- and sex-correlated prevalence of arterial hypertension in Finnish population. The clinical symptoms included an acute chiefly rotatory vertigo associated with nausea and vomiting without subjective involvement of hearing. The prominent symptoms lessened gradually during the first week and most of the patients were able to their earlier work after one month. The prognosis of the disease was good. The clinical otoneurological findings of the acute stage included spontaneous nystagmus with Frenzel's glasses and disturbances of the vestibulospinal tests. These abnormalities improved markedly during the follow-up period. The results of electronystagmography were characteristic of a pure peripheral vestibular disorder. Nystagmic beats were observed almost regularly in the pendular eye-tracking test at the acute stage examination.(ABSTRACT TRUNCATED AT 400 WORDS)