Myofibromatosis-like hemangiopericytoma metastasizing as differentiated vascular smooth-muscle and myosarcoma. Myopericytes as a subset of "myofibroblasts".

A thyroid hemangiopericytoma that was resected in a 5-year-old boy recurred insidiously in the larynx 8 years later. Marked cicatricial mucosal inflammation prevented a definitive pathologic diagnosis of recurrence until a nodule grew to obstruct the airway 15 years after initial surgery. After excision of the nodule, a larger sarcomatous metastasis was discovered in the upper esophagus and resected, but the patient eventually succumbed to widespread disease at the age of 20 years. The original tumor contained atypical pericytes and bundles of hyalinizing smooth muscle abutting on "staghorn vessels," a pattern similar to infantile myofibromatosis. Desmin immunostaining was negative in the pericytes but positive in smooth-muscle cells dispersed singly as well as in bundles. Both elements reacted strongly for vimentin and the alpha-isoform of actin (alpha-SMA) found in normal smooth muscle and pericytes. A third cell type showing dendritic processes and immunoreactivity for all three antigens was interpreted as a myopericyte. Spindled cells in multiple subsequent mucosal biopsy specimens stained retrospectively also positive for these antigens. Large bundles of vascular smooth muscle surrounded by radiating myocytes characterized the occluding laryngeal nodule. In the esophageal metastasis, which showed no histologic features typical of hemangiopericytoma, numerous mitotically active, small, vimentin+, desmin+, alpha-SMA+ cells often maintained shortened processes and tended to form nodular aggregates about capillaries. Single rows of pericytes accreted to endothelial tubes. Ultrastructurally, some cells contained myofilaments and irregular dense material or showed rare cell junctions and variable investment by a basal lamina.(ABSTRACT TRUNCATED AT 250 WORDS)

Intra-arterial mitomycin C and intravenous bleomycin as induction chemotherapy in advanced head and neck cancer--a phase II study.

Fifty-six patients with previously untreated, unresectable squamous cell carcinomas of the head and neck region were treated with repeated intra-arterial chemotherapy with mitomycin C using a selective or super-selective angiographic technique, and bleomycin given i.v., followed by radical radiotherapy. In addition, restricted tumour-reductive surgery was done in 18 of these patients. The response rate (CR + PR) after completion of the integrated treatment was 89%, with 63% of the patients showing CR. The toxicity of this regimen was, however, far from negligible. The median survival for this series of patients with advanced head and neck cancers is 19 months, and 17 are still alive after 16 + -66 + months.

Malignant melanoma of the nasal cavity and nasopharynx treated with cisplatin and accelerated hyperfractionated radiation.

Primary malignant melanoma of the nasal cavity and paranasal sinuses is an uncommon disease, accounting for only 0.5-2% of all malignant melanomas. The primary treatment has been surgery. The frequency of local recurrence is high and recurrence is also the major determinant of treatment failure. Here we report on six patients with locally advanced disease, four of whom were too advanced for surgery, who were treated with accelerated hyperfractionated radiation in combination with cis-platinum. Three of four patients treated for local recurrent disease achieved a local cure and died of disseminated disease after 9-21 months. One patient given preoperative cisplatin and radiation is still alive with no evidence of disease 34 months after the completion of treatment. The present protocol may be a useful approach to obtain local control with the possibility of long-term cure.

Cineradiography identifies esophageal candidiasis in progressive systemic sclerosis.

Cineradiography of the esophagus showed signs of esophageal candidiasis in 11 out of 71 patients with progressive systemic sclerosis (PSS) - both in diffuse scleroderma and the CREST syndrome. Culture of esophageal brushings confirmed the presence of Candida albicans in eight of these 11 patients. Antimycotic treatment decreased the cineradiographic signs of candidiasis and the degree of dysphagia. Since impaired esophageal motility and treatment with immunosuppressive drugs may predispose to candida esophagitis, and since dysphagia will decrease after antimycotic treatment esophageal mycosis should always be sought in patients with PSS.

Normal gas exchange in the human middle ear.

Different kinds of biological gas pockets and the special character of the middle ear as a gas pocket are discussed. The pattern of gas absorption from the normal middle ear and from ears with blocked Eustachian tubes is presented. The amount of gas leaving the ear by diffusion and the resulting underpressure from this process are determined. The composition of air in the ear is compared to that in experimental gas pockets and the role of the partial pressures of CO2 and O2 in secretory otitis media is discussed.

Diffuse pigmented villonodular synovitis of the temporomandibular joint diagnosed by fine-needle aspiration cytology.

Diffuse pigmented villonodular synovitis is a rare tumor in the temporomandibular joint region. This article deals with a 32-yr-old male who suffered from pain and swelling in the right temporomandibular joint region associated with restricted mouth opening. Computed tomography showed a tumor lateral to the temporomandibular joint. Arthrography revealed a displaced temporomandibular joint disk. Fine-needle aspiration cytology showed characteristic cellular changes, including rounded or oval cells with abundant cytoplasm and intracytoplasmatic hemosiderin deposits and numerous multinucleated giant cells without nuclear atypia. A benign mesenchymal lesion suggestive for pigmented villonodular synovitis was diagnosed and later verified at histologic examination. Fine-needle aspiration cytology seems to be useful for this diagnosis.

Pedunculated intraluminal fibro-lipoma of the oesophagus. Case report.

Only few cases of pedunculated, benign, intraluminal lipomas and fibrolipomas of the oesophagus have been reported. A further case is now added. The diagnosis is often delayed since it is difficult both for the radiologist and the endoscopist to detect the tumour. Symptoms and signs are few and uncharacteristic. The diagnosis could be made earlier and without sophisticated methods if the possibility of a tumour is kept in mind, especially in patients with a dilated oesophagus and a normal opening of the cardia. The value of fiberoptic endoscopy as a valuable tool for early diagnosis is stressed. The therapy is in most cases extirpation through cervical oesophagotomy.

The effect of provoked allergic reaction and histamine on nasal mucosal blood flow in humans.

The allergic reaction in the nasal mucosa is a complex pathophysiological process with several chemical mediators involved. One of the primary mediators is histamine. This investigation was performed to study separately the effects of an allergic reaction and of histamine on the human nasal mucosal blood flow with the 133Xe wash-out method. An allergic reaction was provoked by pollen allergens and blood flow was estimated before and after provocation. In healthy subjects and in subjects with allergic rhinitis and off pollen season, the effect of histamine injected into the mucosa was studied. The allergic reaction decreased the blood flow but histamine had a converse effect in both allergic and normal subjects. This indicates that histamine alone is not responsible for the vascular effects in allergic rhinitis. Different mechanisms responsible for the decreased blood flow in the allergic reaction are discussed.

Voice evaluation before and after laser excision vs. radiotherapy of T1A glottic carcinoma.

Quality of voice after treatment for T1A glottic squamous cell carcinoma was studied in two matched groups of males treated either with CO2 laser cordectomi (n = 18, mean age 65.2 years) or with full dose radiotherapy (n = 18, mean age 65.1 years). All patients had histologically verified invasive squamous cell carcinoma. Fifteen male patients (mean age 63.9 years) without laryngeal disorders were used as controls. Voice recordings prior to treatment, and both at 3 months and at 2 years after completed treatment were analyzed. Acoustic measures of shimmer, jitter, breathiness, harmonic-to-noise ratio and fundamental frequency (F0) average were calculated with the Soundscope program. Two plain measures were also used: time required to read a running speech voice sample, and number of breaths. Perceptual voice analysis was performed blindly by two groups of listeners, Group A (4 experienced listeners) and Group B (4 naive listeners). Group A estimated quality of voice according to a modified GRBAS score, whereas Group B estimated Grade only. We found voice quality both at 3 months and at 2 years after radiotherapy to be significantly better than after laser treatment, as assessed by the acoustic variables breathiness, jitter, F0 average, running speech voice sample reading time and number of breaths. The perceptual variables Grade (Group A and B), Breathiness, Asthenia and Strain were also significantly better after radiotherapy.

Hemifacial spasm. Nerve block with phenol under electromyographic control.

Seven cases of hemifacial spasm are described. Six were operated upon with intra-osseal exposure of the facial nerve. In all 6 cases transient peripheral facial paresis developed. When the paresis disappeared the patients had a recurrence of the spasms. As an alternative to surgical procedures a method for selective nerve block under E. M. G. control with 3% phenol is described and 5 cases have been treated with this method. Ambulatory treatment with deposition of 3% phenol in the main branch of the facial nerve appears to have an equally good effect to the surgical methods hitherto used. Examination with E. M. G. suggested that the hemifacial spasm is of central origin.

Patency of the nasofrontal duct during frontal sinusitis.

In a series of frontal sinuses trephined due to frontal sinusitis the airway resistance of the nasofrontal duct was tested during the healing period as well as in a long-term follow-up study up to one year. The nasofrontal duct was more resistant to passage for air than for saline during the healing period. A high incidence of recurrences was found in cases with high airway resistance of the duct, a prolonged primary healing period and when major nasal pathology was found.

Ameloblastoma of the maxilla. Report of three cases.

Three cases of ameloblastoma of the maxilla are presented. Symptoms, diagnostic procedures and therapy are discussed in relation to these cases. It is stressed that surgery of a maxillary ameloblastoma must be radical from the beginning. Otherwise the tumour may spread to the pterygopalatine fossa, temporal fossa or base of skull. Such tumour extensions are not resectable. The tumour is slowly-growing and a careful follow-up is mandatory.

Caudal musculocutaneous trapezius flaps for reconstruction of soft tissue defects.

To date trapezius flaps have been utilized only to a limited extent in reconstructive surgery. We present the experience we have gained of caudal trapezius flaps in the reconstruction of tissue defects on the neck and shoulders. We have operated on a total of 6 patients. The anatomy of the trapezius muscle and its function are presented in brief. The surgical technique is explained and case studies of 3 patients are presented.

[Immediate relief in malignant respiratory tract neoplasms by endoscopic neodymium-YAG laser treatment]. / Omedelbar lindring vid maligna tumörer i luftvägarna med endoskopisk neodym-YAG-laserbehandling.

Primary and secondary malignant tumours in the central airways can cause obstruction or chronic haemoptyses. Conventional forms of treatment are insufficient. Bronchoscopic Neodymium-YAG laser treatment, hitherto unused in Sweden, can give immediate palliation, Indications and contraindications are given, and the first fourteen patients treated are presented.