External auditory canal cholesteatoma and benign necrotising otitis externa: clinical study of 95 cases in the Capital Region of Denmark.

OBJECTIVE: To identify epidemiological and pathophysiological factors, and treatment strategies, in external auditory canal cholesteatoma and benign necrotising otitis externa. METHODS: A retrospective case study was conducted of patients suffering from external auditory canal cholesteatoma and benign necrotising otitis externa admitted to tertiary hospitals, in the Capital Region of Denmark, over a five-year period. RESULTS: Eighty-three patients (95 ears) with external auditory canal cholesteatoma or benign necrotising otitis externa were identified. A minimum incidence rate of 0.97 per 100 000 inhabitants per year was demonstrated. Sixty-eight per cent of cases had a history of smoking. Most lesions (74 per cent) were localised in the floor of the ear canal. Treatment time was 3.2 months for patients who had surgery and 6.0 months for those who received conservative treatment. CONCLUSION: It is suggested that external auditory canal cholesteatoma and benign necrotising otitis externa are in fact the same disease, and therefore the diagnosis of external auditory canal cholesteatoma should be changed to benign necrotising otitis externa. Microangiopathy has a leading role in the aetiology. Surgery should be conducted in most cases.

Branchial cleft anomalies: accuracy of pre-operative diagnosis, clinical presentation and management.

OBJECTIVE: To examine the accuracy of the pre-operative diagnosis of branchial cleft anomalies, and also to describe their occurrence, clinical presentation and management. METHODS: Retrospective review of the records of patients diagnosed with a branchial cleft anomaly between 1997 and 2006. RESULTS: One hundred and twenty-six patients were included. Pre-operative diagnosis had a positive predictive value of 0.856 (95 per cent confidence interval, 0.771-0.918) and a sensitivity of 0.944 (95 per cent confidence interval, 0.869-0.979). These patients' demographic data, investigations, findings and management are presented, along with a possible strategy for dealing with solitary cystic masses in the neck. CONCLUSION: As pre-operative diagnosis has a positive predictive value of 86 per cent, cystic lesions in the neck should be presumed to be carcinomatous until proven otherwise. Branchial fistulae and sinuses seem to be a disease of childhood, while branchial cysts occur mainly in adults. Branchial cleft anomalies are equally frequent in men and women, and equally distributed on the left and right side of the neck.

[Risk of hemorrhage after outpatient versus inpatient tonsillectomy]. / Risiko for efterblødning ved tonsillektomi i dagkirurgisk versus stationaert regi.

INTRODUCTION: This study evaluates the risk of post-tonsillectomy haemorrhage in outpatient surgery compared to conventional inpatient management. MATERIAL AND METHODS: We reviewed 528 tonsillectomies performed at the ENT Department, Rigshospitalet, University of Copenhagen, in the period 1.6.1997 to 31.5.1998. The 264 outpatient tonsillectomies were compared with 264 inpatient procedures. The number of post-operative haemorrhages and the time interval from operation to post-operative bleeding were registered, along with the need for re-operation. Outpatients were discharged 8 hours after surgery, inpatients after 24 hours. RESULTS: Forty-five (8.5%) of 528 tonsillectomies had post-operative haemorrhage complications, 15 (2.8%) patients needed a re-operation. Twenty-five (55%) cases of reactionary haemorrhage occurred < 8 hours after surgery and nine needed a re-operation. Two of three cases of post-operative haemorrhage 8-24 hours after primary surgery were re-operated, whereas four of 17 patients with haemorrhage > 24 hours post-operatively needed another surgery. There were no differences between inpatient and outpatient management. Eighty-nine per cent of all early (0-24 h) post-operative haemorrhages occurred < 8 hours post-operatively. In the time period from 8-24 hours post-operatively there were only three cases of reactionary haemorrhage. The risk of post-operative haemorrhage after discharge was 4.2% and 3.4% after outpatient and inpatient management respectively, a difference of only 0.8%. This makes outpatient tonsillectomy an acceptable alternative to inpatient management.

New modification of hot-water irrigation in the treatment of posterior epistaxis.

BACKGROUND: Tamponade treatment for epistaxis is painful and traumatic to the nasal mucosa, and may necessitate hospitalization for several days. Hot-water irrigation (HWI) was introduced as a treatment of epistaxis more than 100 years ago. In a previous study the treatment proved to be effective, less painful, and less traumatic, and required a shorter hospital stay than tamponade treatment. However, HWI has the risk of aspiration during treatment. To minimize this risk, a special catheter has been designed. OBJECTIVES: To evaluate the modified HWI and to compare the results with tamponade treatment, with respect to patient compliance, effectiveness, recurrence of bleeding, pain, complications, and length of hospital stay. PATIENTS: A total of 122 patients, hospitalized for posterior epistaxis, were randomized to receive either HWI or tamponade treatment. RESULTS: In the HWI group, 31 (55%) of the patients could be discharged from the hospital after the initial treatment only, compared with 29 (44%) of the patients treated with tamponade. Using a 10-cm visual analog scale, the mean pain score during treatment was 4.7 in the HWI group compared with 7.5 in the tamponade group. The mean hospital stay was 2.9 days for the HWI group vs. 4.0 days for the tamponade group. After discharge from the hospital, necrosis or synechia was found on rhinoscopy in 12 patients (40%) in the tamponade group compared with none in the HWI group. CONCLUSIONS: Compared with tamponade treatment, HWI is as effective, requires a significantly shorter hospital stay, is less traumatic to the nose, and is significantly less painful.

Allograft stapes-incus assembly. Long-term results.

In 35 patients with absence of the stapedial arch, with a history of radical surgery, and without ossicles, the head of an allograft stapes was placed on the patients' footplates and an allograft incus body on the top of this. The long-term results of this assembly, judging by different methods of analysis, are still somewhat better than those of 98 ears with approximately the same pathologic condition treated by an allograft incus as the columella between the footplate and fascia. The allograft stapes-incus assembly is an alternative method to the commonly used incudal columella. The allograft stapes has not been resorbed to a significant degree during the years after surgery.

Bilateral sudden deafness and acute acquired toxoplasmosis.

An 18-year-old woman, while suffering from acute acquired toxoplasmosis, experienced sudden deafness and a total loss of vestibular function first in the right ear and three months later also in the left. Following treatment with sulphadiazine and pyrimethamine, hearing was retrieved to such a degree that the patient was enabled to communicate by means of a body-worn hearing aid and lip-reading. Taking the differential diagnostic possibilities into account, we believe that toxoplasmosis was the cause of the severe hearing loss. Since effective treatment seems to be available, we recommend that patients with acute bilateral sensorineural hearing loss of unknown origin are examined for acute toxoplasmosis with a view to instituting chemotherapy.

Partial and total reconstruction of old radical cavities. Long-term results.

Partial reconstruction of old radical cavities was performed in 118 ears with well-epithelialized mastoid cavities but with problematic tympanic cavities. Total reconstruction was performed in 145 ears with chronically discharging cavities. Partial reconstruction included reconstruction of only the tympanic cavity, whereas in total reconstructions both the tympanic cavity and the external auditory canal were rebuilt, in most cases with obliteration of the mastoid cavity. The patients were reexamined several times during observation periods of up to 17 1/2 years (mean, 8 1/2 years) and the long-term results were analyzed. The primary functional results were good but deteriorated with increasing observation time. In 79% of the patients, the ears remained dry following total radical reconstruction.

Selective gastric vagotomy and drainage for duodenal ulcer: a 10-13-year follow-up study.

From 1964 to 1968 selective gastric vagotomy (SGV) and drainage was performed in 174 patients. Of these, 105 patients were followed-up 10-13 years after operation; 56 were dead. Ulcers recurred in 18 patients. The cumulated recurrence rate after 13 years (life table method) was 15% (95% confidence limits: 8-23). The method for drainage was usually either a Heineke-Mikulicz or a Finney pyloroplasty. There was a significantly higher risk of ulcer recurrence in the group that underwent Heineke-Mikulicz drainage procedures. The incidence of dumping and diarrhea had not changed during a five-year follow-up period. Two patients were slightly anemic. No patient was iron-deficient. Apart from two recurrent ulcers, gastroscopic examinations in 36 patients revealed no major changes, and biopsy specimens showed slight to moderate chronic atrophic gastritis in most cases. Visick grading showed 77% of the ulcers in Grade I + II, 19% in Grade VI. It is concluded that SGV has no place in the elective treatment of duodenal ulcer. Two alternatives are suggested.

[Cytochemical study of different stages in the life cycle of Toxoplasma gondii. I. Amylopectin and lipids in endozoites]. / Tsitokhimicheskoe issledovanie raznykh stadii zhiznennogo tsikla Toxoplasma gondii. II. Amilopektin i lipidy v éndozoitakh.

Attempts were made to localize cytochemically acid micopolysaccharides, in addition to sulphate groups of mucosubstances in Toxoplasma endozoites of SS-119 and RH strains with negative results. Amylopectin was found to be the only polysaccharide so far detected in the endozoite stage, using the PAS technique. With RH strain toxoplasmas, the dynamics of amylopectin was followed within 6 days after mouse inoculation. On day 2, toxoplasmas and the host cells of the mouse peritoneal exudate being practically PAS-negative, the amount of amylopectin increased progressively towards day 6. The immune response of the host may be presumably involved in the pattern of this dynamics. Phospholipids were detected in the cytoplasm of intra- and extracellular endozoites of strain SS-119. Little, if any, amount of neutral fat was observed. Of special interest is the increased phospholipid content in the infected host cells.

[Cytochemical study of different stages in the life cycle of Toxoplasma gondii. I. Nucleic acids and proteins in endozoites]. / Tsitokhimicheskoe issledovania raznykh stadii zhiznennogo tsikla Toxoplasma gondii. I. Nukleinovye kisloty i belki v éndozoitakh.

Using the Feulgen technique in addition to the methyl green-pyronin and gallocyanin-chromalum staining, nucleic acids were detected in Toxoplasma gondii of strains SS-119 and RH DNA was revealed in the nuclei of both intracellular and free individuals examined on various days (2--6) after mouse inoculation. A high RNA content in the cytoplasm of endozoites is a most characteristic feature of this stage. However, no definite nucleolus has been demonstrated in the endozoite nucleus. Using the Fast green and Alcian blue techniques, resp., histones were detected in the endozoite nuclei whose locality corresponded to that of Feulgen-positive material. The Acrolein-Schiff method located aldehyde groups of protein in endozoites, the detected stuff being confined mainly to the nuclear and perinuclear areas of the parasite. Tannofilic protein seems to screen the endozoite body, no difference between nuclear and cytoplasmic staining being seen. Tryptophan and tyrosin were not detected in the endozoites of Toxoplasma. The results obtained on Toxoplasma endozoites are compared with the metabolic patterns seen in the host cells of the peritoneal exudate and with previous literature data.