Adenoid hypertrophy-​diagnosis and treatment: the new S2k guideline.

Hyperplasia of the pharyngeal tonsils is to be considered pathologic when nasopharyngeal symptoms of mechanical obstruction and/or chronic inflammation occur. Chronic Eustachian tube dysfunction can result in various middle ear diseases such as conductive hearing loss, cholesteatoma, and recurrent acute otitis media. During examination, attention should be paid to the presence of adenoid facies (long face syndrome), with a permanently open mouth and visible tip of the tongue. In the case of severe symptoms and/or failure of conservative treatment, adenoidectomy is usually performed on an outpatient basis. Conventional curettage remains the established standard treatment in Germany. Histologic evaluation is indicated for clinical evidence of mucopolysaccharidoses. Due to the risk of hemorrhage, the preoperative bleeding questionnaire, which is obligatory before every pediatric surgery, is referred to. Recurrence of adenoids is possible despite correct adenoidectomy. Before discharge home, otorhinolaryngologic inspection of the nasopharynx for secondary bleeding should be performed and anesthesiologic clearance obtained.

[Adenoids-diagnosis and treatment: the new German S2k guideline]. / Adenoide Vegetationen ­ Diagnostik und Therapie ­ die neue S2k-Leitlinie.

Hyperplasia of the pharyngeal tonsils is to be considered pathologic when nasopharyngeal symptoms of mechanical obstruction and/or chronic inflammation occur. Chronic Eustachian tube dysfunction can result in various middle ear diseases such as conductive hearing loss, cholesteatoma, and recurrent acute otitis media. During examination, attention should be paid to the presence of adenoid facies (long face syndrome), with a permanently open mouth and visible tip of the tongue. In the case of severe symptoms and/or failure of conservative treatment, adenoidectomy is usually performed on an outpatient basis. Conventional curettage remains the established standard treatment in Germany. Histologic evaluation is indicated for clinical evidence of mucopolysaccharidoses. Due to the risk of hemorrhage, the preoperative bleeding questionnaire, which is obligatory before every pediatric surgery, is referred to. Recurrence of adenoids is possible despite correct adenoidectomy. Before discharge home, otorhinolaryngologic inspection of the nasopharynx for secondary bleeding should be performed and anesthesiologic clearance obtained.

[Glottis injection to improve voice function : Review of more than 500 operations]. / Stimmlippeninjektion zur Stimmverbesserung : Rückblick auf über 500 Operationen.

BACKGROUND: Hoarseness due to insufficient glottal closure can be treated by injection laryngoplasty (augmentation). Vocal fold injections can be performed as an in-office procedure or under general anesthesia. As injection materials have recently improved and different injection approaches are available, injection laryngoplasties are performed much more frequently. OBJECTIVES: Advantages and disadvantages of injection materials, laryngeal approaches, and differential indications are described. MATERIALS AND METHODS: Literature research and experience of more than 500 laryngeal injection procedures are provided. RESULTS AND CONCLUSIONS: Sophisticated use of available injection materials can provide a satisfying improvement of voice function with minimal patient discomfort. Adequate indication is mandatory for a favorable outcome. Further improvement regarding biocompatibility and the duration of injection materials is desirable.

Mechanism of interleukin-2 signaling: mediation of different outcomes by a single receptor and transduction pathway.

The T cell lymphokine, interleukin-2 (IL-2), plays a pivotal role in an immune response by stimulating antigen-activated B lymphocytes to progress through the cell cycle and to differentiate into antibody-secreting cells. An IL-2 inducible B lymphoma line, in which the growth and differentiation responses are uncoupled, provides a model system for dissecting the signaling mechanisms operating in each response. This system was used to show that both signals are initiated by IL-2 binding to a single, unifunctional receptor complex. Moreover, both signals are transduced by a pathway that does not involve any known second messenger system and that can be blocked by a second T cell lymphokine, interleukin 4. These findings suggest that the pleiotrophic effects of IL-2 are determined by different translations of the signal in the nucleus.

Dynamic processing of DOM: Insight from Exometabolomics, Fluorescence Spectroscopy, and Mass Spectrometry.

Dissolved organic matter (DOM) in freshwater environments is an important source of organic carbon, supporting bacterial respiration. Frozen environments cover vast expanses of our planet, with glaciers and ice-sheets storing upwards of six petagrams of organic carbon. It is generally believed that DOM liberated from ice stimulates downstream environments. If true, glacial DOM is an important component of global carbon cycling. However, coupling the release of DOM to microbial activity is challenging due to the molecular complexity of DOM and the metabolic connectivity within microbial communities. Using a single environmentally relevant organism, we demonstrate that processing of compositionally diverse DOM occurs, but, even though glacially derived DOM is chemically labile, it is unable to support sustained respiration. In view of projected changes in glacier DOM export, these findings imply that biogeochemical impacts on downstream environments will depend on the reactivity and heterogeneity of liberated DOM, as well as the timescale.

Herpes simplex virus infection of human fibroblasts and keratinocytes inhibits recognition by cloned CD8+ cytotoxic T lymphocytes.

CD8+ cytotoxic T lymphocytes (CTL) clones with specificity for herpes simplex virus (HSV) were derived from two donors with genital HSV-2 infection. These CTL clones specifically lysed HSV-infected autologous B lymphoblastoid cells, but not HSV-infected fibroblasts. Exogenous peptide loading sensitized both cell types to lysis by an HSV-specific CTL clone of known specificity. HSV infection rendered fibroblasts refractory to peptide sensitization. HSV infection also rendered fibroblasts and keratinocytes insensitive to lysis by allospecific CD8+ CTL clones. Lysis of B lymphoblastoid cells in this system was only slightly reduced by HSV infection. Reduction of fibroblast allospecific lysis was dose and time dependent and was blocked by acyclovir, indicating the involvement of a late HSV gene product. HSV caused a reduction of fibroblast cell surface HLA class I antigen, at least in part due to reduction of synthesis of heavy chain-beta 2 microglobulin heterodimers. These results suggest that HSV-induced blockade of antigen presentation by cutaneous cells to CD8+ CTL may be a mechanism by which HSV limits or evades the immune response of the host.

Synthesis of Sindbis virus complementary DNA by avian myeloblastosis virus RNA-directed DNA polymerase.

Sindbis virus 42 S RNA was efficiently transcribed into complementary DNA (CDNA) by avian myeloblastosis virus alphabeta DNA polymerase using oligo- (dT) or single-stranded calf thymus DNA as primers. Both of the Sindbis virus cDNA products were able to protect 60% of 125I-labeled Sindbis virus RNA, at near equal weight ratios, from RNAase A and T1 digestion. Using hybridization kinetics, the Crt 1/2 value for hybridization of the calf thymus-primed cDNA product with excess Sindbis RNA was determined to be 1.8 9 10-2 mol . s . 1-1. Thes data demonstrate that the Sindbis virus cDNA products are relatively uniform representations of Sindbis virus RNA sequences.

An autoradiographic investigation of the subcortical visual system in chimpanzee.

Based on one adult chimpanzee monocularly injected with radioactive proline, retinofugal fibers were found to terminate bilaterally in the suprachiasmatic, pregeniculate, lateral geniculate, olivary, pretectal and lateral terminal nuclei, and the superior colliculi; the existence of a dorsal terminal nucleus of the accessory optic system is in doubt. In the ipsilateral geniculate nucleus, the fibers terminate in layers 2, 3 and 5; in the contralateral nucleus, they end in layers 1, 4 and 6. Midway through the geniculate nucleus, layers 3 and 4 split medially into two daughter layers each. In the superior colliculi, most of the retinal terminals are aggregated superficially in a band located in the stratum griseum superficiale. The contralateral band is interrupted by gaps; the ipsilateral band has fewer gaps, is slightly thicker and located more deeply. There is a limited second tier of terminals in the contralateral superficial gray.

Complementary laminar terminations of afferents to area 17 originating in area 18 and in the lateral geniculate nucleus in squirrel monkey.

The projections from area 18 and the lateral geniculate nucleus onto area 17 of the squirrel monkey (Saimiri) were investigated with retrograde (horseradish peroxidase) and anterograde (tritiated proline) labelling techniques, and the (Fink-Heimer) silver impregnation method for degenerating axons and their terminals. The association fibers from area 18 terminated in all layers of area 17 except in layer IV and in the lower aspect of layer IIIc. The greatest number of terminals were in layers I, V and VI. The bulk of geniculocortical fibers terminated in layer IV and the lower aspect of layer IIIc; a minority of the geniculocortical fibers terminated in layer VI and the lower aspect of layer IIIb. Thus, the majority of fibers from the two sources investigated terminate in a complementary laminar fashion in area 17. The portion of area 17 on the lateral surface of the hemisphere, where the central visual field is represented, received a less dense projection from the geniculate nucleus than the striate cortex in the calcarine fissure, where the peripheral visual field is represented. Ocular dominance columns were not apparent in the striate cortex. No evidence was found that the lateral geniculate nucleus projects to area 18. The results of combined injections of horseradish peroxidase and tritiated proline in area 17 indicated a point-to-point reciprocity between area 17 and the ipsilateral lateral geniculate nucleus.

Ultrastructure of neurons in the nucleus basalis of Meynert in squirrel monkey.

The nucleus basalis of Meynert in the squirrel monkey exhibits numerous labeled neurons following the retrograde transport of horseradish peroxidase from occipital cortical injection sites. The typically large, often clustered, labeled cells are seen most frequently in association with the fibrous bordering structures of the substantia innominata and in the internal and external laminae of the globus pallidus. Ultrastructurally the copious cytoplasm of nucleus basalis neurons abounds with organelles. Large, vacuolated lipofuscin granules proliferate as a function of age and are not evident in younger monkeys. Approximately 4% of the somal surface is occupied by symmetrical synapses with either flat or pleomorphic vesicles. The remainder is covered mostly by neuroglial processes. Somatic spines bearing synapses are occasionally observed. In the neuropil surrounding nucleus basalis somata, the synapses onto dendrites and spines are mostly asymmetrical with large, round vesicles. Labeled nucleus basalis cells in the substantia innominata immediately lateral to the optic tract are larger and rounder than cells in the internal and external pallidal laminae. However, no remarkable ultrastructural differences were observed between nucleus basalis somata in the substantia innominata and external pallidal lamina, or between horseradish peroxidase-labeled and unlabeled large cells.

Anatomical consequences of long-term monocular eyelid closure on lateral geniculate nucleus and striate cortex in squirrel monkey.

The effects of long-term monocular deprivation on the geniculostriate system in squirrel monkeys were studied with neuroanatomical methods. Four neonates were visually deprived by monocular eyelid suture during their first 10 days of life and survived from 9 to 40 months. In the lateral geniculate nucleus (LGN), deprivation resulted in severe cell size changes. Neurons in the deprived laminae were smaller compared to those in the undeprived laminae. Deprivation left the reciprocal connections between LGN and striate cortex intact: After horseradish peroxidase (HRP) injections into striate cortex, retrogradely transported enzyme labeled a wedge of neurons in deprived and undeprived LGN laminae; anterogradely transported HRP filled preterminal and terminal axons in this wedge. Following 3H-proline injections into the deprived eye for transneuronal transport, autoradiography showed in the ipsilateral striate cortex a silver grain distribution over most of layer IVc similar to that in normal squirrel monkeys, except for a small strip in the anterior calcarine fissure. Here, a few, irregularly spaced "patches" of higher grain density occurred deep in layer IVc. Layer IVc of contralateral area 17 was also uniformly labeled over most of its extent, except for a very few and inconspicuous accumulations of slightly increased silver grains. After visual stimulation of the deprived eye, the 14C-2-deoxyglucose method showed in the contralateral striate cortex some alternating "patches" of higher uptake superimposed on the heavy labeling in layer IVc. Layer IVc in the ipsilateral cortex was more uniformly labeled. Regularly spaced arrays of labeled "puffs" in layers II/III were present in both hemispheres. Cytochrome oxidase staining showed no change in the distribution pattern of the enzyme in the deprived monkeys from the basic pattern of normal adults. No changes in cell sizes were found in layer IVc in cresyl-violet-acetate-stained sections. These results lead to the conclusion that in area 17 of squirrel monkeys there is no distinct segregation of inputs from the two eyes into anatomically discrete ocular dominance columns and they support the view of a predominantly binocular organization of area 17.

Subcortical projections to the occipital and parietal lobes of the chimpanzee brain.

The subcortical sources of afferents to occipital and parietal cortex were studied in two chimpanzees with the aid of retrogradely transported horseradish peroxidase (HRP). In chimpanzee 1, HRP was injected into right cortical areas 17 and 18; chimpanzee 2 received HRP into right areas 17, 18, 19, and 39. The following subcortical structures were found to project to area 17 and/or area 18: locus coeruleus, dorsal raphe nucleus, nucleus annularis, nucleus centralis superior, pontine reticular formation, mesencephalic reticular formation, dorsal hypothalamus, lateral hypothalamus, nucleus basalis of Meynert, nucleus of the diagonal band of Broca, claustrum, nucleus basalis lateralis amygdalae, lateral geniculate nucleus, inferior pulvinar, lateral pulvinar, nucleus limitans, medial magnocellular part of the nucleus ventralis anterior, nucleus paracentralis, and nucleus centralis medialis thalami. Some of these structures may also project to area 19 and/or area 39. The following thalamic nuclei were found to project to area 19 and/or area 39 but not to areas 17 and 18: nucleus lateralis posterior, nucleus centralis lateralis, nucleus medialis dorsalis, nucleus ventralis lateralis, nucleus ventralis anterior nucleus lateralis dorsalis, and nucleus anterior ventralis. In several Instances, the HRP-labeled cells traversed specific nuclear borders, extending uninterruptedly from one classically defined nucleus into another. These results in the chimpanzee largely confirm data from a number of other mammalian taxa on the subcortical sources of afferents to the posterior cortex. Because of the close biological relationship between chimpanzee and man, we feel confident that such projections are also features of the human brain.

Distribution of muscarinic cholinergic receptor proteins m1 to m4 in area 17 of normal and monocularly deprived rhesus monkeys.

Antibodies to muscarinic cholinergic receptor proteins m1 to m4 were used in striate cortex tissue of normal rhesus monkeys to determine the laminar distribution of these proteins with special attention to geniculorecipient layers. The normal patterns were compared to those of monkeys whose ocular dominance system had been altered by visual deprivation. In normal monkeys, immunoreactivity of all four proteins was localized in complex laminar patterns; m1 was densest in layers 2, 3, and 6, followed by layer 5. In contrast, m2 reactivity was densest in lower layer 4C and in 4A; the latter exhibited a honeycomb pattern. Layers 2 and 3 displayed alternating dense and light regions; this pattern was complementary to that of cytochrome oxidase (CytOx). Laminar immunoreactivity for the m3 receptor was similar to the CytOx pattern, including a honeycomb in 4A and a pattern of alternating darker and lighter patches in layers 2/3. Antibody to m4 reacted most densely with layers 1, 2, 3, and 5, layers 2 and 3 exhibited alternating dark and light regions, and layer 4A had a faint honeycomb. Layer 4C was the lightest band. The differential distribution of these four muscarinic receptor subtypes suggests distinct roles in cholinergic modulation of visual processing in the primate striate cortex. Furthermore, all four muscarinic receptors appear to be insensitive to elimination of visual input via monocular occlusion from birth, to deprivation of pattern vision in one eye during a specific time period in adulthood, and to long-term retinal injury.

Competition between an aphakic and an occluded eye for territory in striate cortex of developing rhesus monkeys: cytochrome oxidase histochemistry in layer 4C.

Monkey models were used to examine the effects of competition for cortical territory between two eyes which were deprived simultaneously, but each eye experienced a different type of deprivation. We wanted to determine whether, under this condition of binocular unequal deprivation, the postnatal process of segregation into ocular dominance columns proceeds according to the same rules as those that apply to competition between a deprived and an undeprived fellow eye. Our models involved surgical removal of the natural lens from one eye in newborn rhesus monkeys. The resulting aphakia was corrected optically to a near point with extended-wear contact lenses. The fellow eyes were either left unmanipulated or occluded with opaque contact lenses for varying periods during the day. At the end of the rearing period, some monkeys from each experimental group had either one eye enucleated or sustained injury to the retinal ganglion cells of one eye. The histochemical reaction for cytochrome oxidase was used to reveal the widths of ocular dominance columns in layer 4C of striate cortex in these monkeys. Under all experimental conditions, the axons related to the two eyes occupied segregated fields. The amount of cortical territory related to the aphakic, optically corrected eye depended on the manipulations of the fellow eye. In competition with an unmanipulated fellow eye, the aphakic eye's territory was greatly reduced. In competition with a part-time occluded eye, its territory was reduced to a lesser degree, depending on the duration of the occlusion. In competition with a continuously occluded eye, however, the space related to the aphakic, optically corrected eye was slightly greater than that related to the occluded eye. Since neither the aphakic nor the continuously occluded eye receives normal visual input, they are both impaired. Therefore, they may compete on an almost equal basis for synaptic territory in layer 4C of striate cortex. Moreover, it is likely that activities originating in the aphakic and the continuously occluded eye are asynchronous, and that this condition is sufficient to drive the postnatal segregation of inputs from the two deprived eyes.

Areal and laminar distribution of neurons interconnecting the central visual cortical areas 17, 18, 19, and MT in squirrel monkey (Saimiri).

The retrogradely transported horseradish peroxidase (HRP) method was used to study the areal and laminar distribution of neurons sending their axons to ipsilateral and contralateral visual cortical areas 17, 18, 19, and MT in the squirrel monkey. Further details regarding neuron type (stellate or pyramidal), size class, and spatial grouping of the cells making these corticocortical connections also were obtained. All interareal connections are reciprocal. Ipsilaterally, such connections exist between areas 17 and 18, 17 and MT, 18 and 19, 18 and MT, and 19 and MT. In addition, areas 18, 19, and MT receive association fibers from the ipsilateral frontal eye field; when combined with previous findings, these results indicate the existence of reciprocal connections between area 18 and the frontal eye field and between area MT and the frontal eye field. Each of areas 18, 19, and MT. Area 17 has only weak callosal connections. Both the ipsilateral and the contralateral connections are topographically organized such that they obey a hodological principle of visuotopic connectivity: that is, only representations of the same part of the visual field are interconnected. With regard to layers of origin, the callosal neurons of these visual areas conform to the general concept of corticocortical fibers arising from supragranular layers in that most of them are located in layer IIIb; only a few of them reside at the junction between layers V and VI. On the other hand, for all the visuocortical connections investigated, the anteriormost area of a reciprocally interconnected pair has its association neurons located predominantly in the infragranular layers while the posteriormost area has its association neurons located primarily in layer III. All callosal fibers and most association fibers arise from pyramidal cells. The callosal cells are larger and reside at a deeper level in layer III than neurons with ipsilateral corticocortical connections. However, some of the association cells at the junction of layers V and VI in area 17 which project to area MT are relatively large and may include the solitary cells of Meynert; but medium-sized pyramidal cells also participate in this projection. In area 17, some association neurons in layers IIIb and IIIc which project to area 18, as well as some in layer IIIc which project to area MT, are most likely stellate cells. Several different patterns of cell groupings were observed for the central representation interconnections. Neither ipsilateral area MT nor any of the contralateral visuocortical areas had multiple groupings of labeled neurons. The ipsilateral projections from area 17 to 18, 17 to MT, and 18 to 19 were arranged similarly according to a plan involving separate, multiple loci of origin for cells projecting to a small and isolated subregion of the central representation in the target cortical area; following larger injections, cells throughout the central representation of the projecting cortex were labeled...

Subcortical structures projecting to visual cortical areas in squirrel monkey.

In 17 adult squirrel monkeys (Saimiri), horseradish peroxidase was used as a retrograde tracer substance to reveal the subcortical structures (other than the lateral geniculate nucleus and pulvinar) which project to the occipital lobe, and, in particular, to the central visual field representation in areas, 17, 18, 19, and MT. Evidence is provided that each of areas 17, 18, and MT receives a projection from locus coeruleus, nucleus dorsalis raphae, nucleus annularis, nucleus centralis superior, formation reticularis pontis oralis, nucleus basalis of Meynert, lateral hypothalamus, claustrum, and nuclei paracentralis and centralis medialis thalami. Area 19 receives a projection from all these structures except from the nucleus annularis. Only area MT was determined to be a target of a projection from the nucleus linearis. For technical reasons, only area MT was determined to receive afferent fibers from the nucleus basalis lateralis amygdalae. The results indicate that there is no topographical organization of subcortical inputs to the central visual field representation in individual cortical areas.

Estimation of antigen-responsive T cell frequencies in PBMC from human subjects.

A new method for estimating the frequency of antigen-responsive T cells, using a cell proliferation assay, is described. In this assay, the uptake of tritiated thymidine by peripheral blood mononuclear cells which have been exposed to antigen, is measured for each well on a microtiter plate. Whereas this assay is generally used as part of a limiting dilution assay, here we estimate the frequency of responding cells using a single, carefully chosen cell density. The traditional analysis of such data uses a cut-off to separate wells which contain no responding cells and wells which contain at least one responding cell. The new method uses the scintillation count to estimate the number of responding cells for each well on the plate. We do this by fitting a two-stage model, the first stage being a Poisson model with antigen-specific frequency parameters, and the second stage a linear model with plate-specific parameters.

Distribution of retinofugal and corticofugal axon terminals in the superior colliculus of squirrel monkey.

The distribution of terminal fields of retinocollicular fibers was studied in squirrel monkeys with the autoradiographic technique. The terminals were aggregated into patches which were separated by intervening gaps. The ipsilateral patches were particularly distinct. The patches as well as th gaps ranged in size from 50 to 200 microns. In the most posterior aspect of the contralateral superior colliculus, the gaps were absent, and the terminals formed an uninterrupted sheet. The corresponding portion of the ipsilateral colliculus had no retinal input, in agreement with the concept that this region most likely represented the temporal crescent of the visual field. In the most anterior portion of the superior colliculus where the fovea is known to be represented, the ipsilateral and contralateral projections were sparse but, nevertheless, discernible. There was a partial laminar segregation of terminals. The majority of the terminal fields in the contralateral colliculus was located in the most dorsal tier of the stratum griseum superficiale, whereas the majority of the ipsilateral input was slightly deeper in the same stratum. The distribution of corticocollicular fibers was studied by the autoradiographic technique. The fibers from areas 17 and 18 terminated predominantly in the dorsal portion of the stratum griseum superficiale. Area 19, in contrast, projected to the ventral portion of the stratum griseum superficiale. Thus the terminal fields of axons from the retina, area 17 and area 18, overlap in the superior colliculus, whereas axons arising from area 19 terminate in another substratum.

Peptidergic innervation of the primate meibomian gland.

PURPOSE: To localize and characterize nerves in primate meibomian glands using immunohistochemical staining for neuropeptides and neuronal enzymes. METHODS: Upper eyelids were obtained from seven rhesus monkeys (Macaca mulatta) and one cynomolgous monkey (Macaca fascicularis). The tissues were fixed either by immersion in Zamboni's fixative or by transcardiac perfusion with paraformaldehyde and glutaraldehyde and were then postfixed. Cryostat tissue sections of the lids were stained by immunohistochemistry using rabbit antisera to neuron-specific enolase (NSE), tyrosine hydroxylase (TH), neuropeptide Y (NPY), vasoactive intestinal polypeptide (VIP), calcitonin gene-related peptide (CGRP), and substance P (SP), followed by a fluorescence visualization system. RESULTS: Used as a marker for the overall nerve distribution, NSE antibodies revealed abundant smooth and varicose nerve fibers closely apposed to the basement membranes of acini of the meibomian glands. Numerous nerve fibers near the meibomian gland acini were immunoreactive for NPY and VIP, but nerve fibers containing TH, CGRP, and SP were more sparse in the meibomian glands. Nerve fibers also were visualized in other eyelid structures, including conjunctiva, epidermis, hair follicles, and subconjunctival lymphoid follicles. CONCLUSIONS: The meibomian glands of rhesus and cynomolgous monkeys are richly innervated by diverse nerve fiber types. The immunohistochemical staining suggests a largely parasympathetic origin for this innervation, with relatively smaller contributions from sympathetic and sensory sources. These findings also suggest that meibomian gland secretion is under the control of diverse neurotransmitter-neuromodulator mechanisms.