Mast cells in chronic inflammation of the middle ear mucosa.

AIM OF THE STUDY: The number, distribution and degranulation frequency of mast cells have been studied in the middle ear mucosa biopsies of patients with chronic otitis media. MATERIALS AND METHODS: The pathohistological analysis has been performed on 115 biopsy specimens, taken intraoperatively from the different regions of the middle ear cleft in 27 patients with chronic otitis media and in 15 children with otomastoiditis which occurred during the treatment of secretory otitis media. Mast cells were identified on the basis of metachromatic staining for histamine and heparin granules. RESULTS: The findings of this study confirm that the number of mast cells is increased in all areas of middle ear cleft in chronic inflammation of the middle ear mucosa. Mast cells were identified in 108 out of 115 analysed samples. In chronic otitis media of atticoantral and tubotympanic type mast cells were present in 91.5% of samples, the cells with heparin granules were present in 62.2% and degranulation frequency was 37.8%. In secretory otitis media 33 mucosal samples were analysed and all samples contained mast cells with predominance of histamine granules and with de granulation frequency of 81.8%. CONCLUSION: These findings indicate that mast cells have complex function in pathophysiology of chronic inflammation of the middle ear mucosa: it may take part in amplification of inflammation as well as in its limitation. Further studies are needed to clarify the role of histamine and heparin in chronic inflammatory reactions of the middle ear mucosa.

Intraoral glomus tumour. A case report.

A case of an intraoral glomus tumour is presented. The literature pertinent to this intraorally rare pathology is discussed.

[Histological changes of radicular cyst epithelial lining due to chronic inflammation]. / Histoloske promene epitela radiksnih cista uzrokovane hronicnom inflamacijom.

The paper deals with the investigation of the relationship between chronic inflammation in the subepithelial layer and histological changes of the epithelium of radicular cysts. Histological examination of 60 radicular cyst specimens was carried out with the aim to define this relationship. The stratified squamous epithelium with a variety of histological changes was found in 58 specimens. A high degrees of chronic inflammation in the subepithelial layer was also recorded. Histological changes of the epithelium correlated to the degree of inflammation in the subepithelial layer of radicular cysts.

Functional trauma of the vocal folds: classification and management strategies.

Laryngeal trauma may result from accidents, surgical, iatrogenic and functional lesions. Functional trauma is caused by excessive and improper use of the voice and may affect the speaking voice of nonprofessionals, but also the speaking and singing voice of vocal professionals. According to specific etiologic, histologic, laryngoscopic and stroboscopic features various vocal fold changes are included in the functional traumatic group. These are mucous standing, 'nodule-like' lesions (contact edema, contact thickening and vocal nodules), polyps, hematoma, cysts and contact hyperplasia. Management strategies are discussed for each lesion, including drug therapy, voice reeducation and phonosurgery.

[Investigation of immunoglobulin presence and localisation in epithelial lining of radicular cyst walls by ABC immunoperoxidase technique]. / Istrazivanje prisustva i lokalizacije imunoglobulina u epitelu zida radiksnih cista primenom ABC imunoperoksidne tehnike.

Immunoglobulin classes A, G and M in the epithelial lining of radicular cysts are analysed by a new method: ABC immunoperoxidase technique. The obtained results show a high degree of all immunoglobulin classes present in the cyst walls, as well as in the epithelial lining. The findings suggest the important role of immunoglobulin in the processes occurring in the radicular cyst walls.

[Microscopic diagnosis of verrucous carcinoma]. / Znacaj mikroskopske dijagnostike verukoznog karcinoma.

Twelve cases of verrucous carcinoma of the orofacial region were reviewed for their clinical and pathological characteristics. Verrucous carcinoma made 3.5% of all primary epidermoid carcinoma observed during the period of investigation. The tumour occurred chiefly in older patients (from 25 to 81 years, mean age 57.5) and more often in males than in females (9 males: 3 females). The most common site of occurrence was the vermilion surface of the lower lip (seven cases). Macroscopic appearance of lesions was reported as exophytic, warty, and white. Microscopically, the thickened epithelium was well differentiated and stratification was preserved. Rete pegs of carcinoma were broad and blunt; they also appeared to "puch" into underlying tissues. Basement membrane appeared to be intact. Cells of tumours were displayed, and histologic features of the spectrum were generally associated with viral modification. The prognosis in verrucous carcinoma is very good, because of the absence of metastases. Radiotherapy should not be used, since not only local recurrence is common, but also anaplastic changes may occur with corresponding aggressive behaviour and metastasis.

[Incidence of lymphoma cells in the bone marrow and peripheral blood in patients with non-Hodgkin's type lymphoma]. / Ucestalost limfomskih celija u kostnoj srzi i perifernoj krvi obolelih limfoma tipa non-Hodgkin.

The appearance of lymphomatous cells in the bone marrow and peripheral blood in 120 patients with Non-Hodgkin's lymphomas (NHLs), was investigated. The presence of lymphomatous cells in the bone marrow was found in 56.6% ob patients and in the peripheral blood in 23.3% of individuals. Lymphomatous site in the bone marrow was proportionally frequent in the group of patients with the high grade aggressive NHLs in comparison to the low grade group. The finding of the peripheral blood occupation was reversible However no significant statistical difference was found. The results also suggest that lymphomatous invasion of the bone marrow does not obligatory predict the invasion of the peripheral blood. Reverse correlation between the frequent bone marrow and peripheral blood occupation by lymphomatous cells and the mean survival time which was significantly shorter in the patients who exhibited the invasion of any kind, was also found. This means that lymphomatous invasion of the bone marrow and peripheral blood might be a potentially useful parameter of the clinical aggressiveness and the course of the disease.

[Mastocytes in chronic inflammation of middle ear mucosa]. / Mastociti u hronicnoj inflamaciji sluznice supljina srednjeg uva.

INTRODUCTION: Pathohistological studies have shown that in secretory otitis media an increased number of mast cells have been found in mucosa of the middle ear and an increased level of histamine in the cavity of the middle ear. The aim of this study was to analyse the distribution and functional state of mast cells in middle ear mucosa biopsies in patients with chronic otitis media. MATERIAL AND METHODS: The pathohistological analysis was performed on 118 biopsy specimens of mucosa of the middle ear. The samples were taken intraoperatively from 39 patients during the surgical treatment of chronic otitis media with and without cholesteatoma and otomastoiditis. The specimens were taken from mastoid, attic space, promantory and protympanon. All biopsy specimens were prepared for hematoxylin-eozin staining and were identified with PAS method and Lennert Giemsa histamine granules. The Alcian blue-Safranin method was used to identify heparin granules in mast cells. By using the semiquantitative method, distribution of mast cells was marked as rare (+), numerous (+2) and high (+3). Also the number of degranulated cells was identified (Tables 1, 2). RESULTS AND DISCUSSION: The analyses of biopsy specimens of mucosa of the middle ear in chronic otitis media showed that cells were present in all areas of mucosa in a considerably higher number (Table 1). Degranulated cells were frequently found in biopsy specimens of otomastoiditis and contained predominately histamine granules; thus specimens taken from chronic otitis media, with and without cholesteatoma, showed mast cells with heparin granules with low rate degranulation. Pathophysiological examinations of the role of mast cells in the mechanism of chronic inflammation have shown that mast cells display through mediators the biphasic effect. They can participate in the process of deterioration of inflammation, whereby the released mediators cause the processes of tissue destruction, and can stimulate the process of tissue repair. Heparin accelerates the healing process of tympanic membrane perforation, stimulates the proliferation of endothelial cells and supports angiogenesis in the lamina propria of the tympanic membrane. Further studies are needed to clarify the role of histamine and heparin in the pathophysiology of chronic inflammation in chronic otitis media.

[Microscopic analysis of gingival inflammatory infiltrate in periodontal disease]. / Mikroskopska analiza zapaljenskih infiltrata gingive u obolelih od parodontopatije.

Twenty surgically treated patients (aged 14-67) were subject of analysis aiming to found localisation, intensity and cellular structure of gingival inflammatory infiltrate. Results of our research showed following characteristics of inflammatory infiltrate: location--30% superficial, 85% deep (focal) and 30% diffused infiltrate; intensity--15% weak, 40% moderate and 45% strong infiltrate; structure--60% mainly plasmocits, 20% plasmocitis and 20% mixed inflammatory infiltrate. In sulcular epithelium were very often found large amounts of granulocits and lymphocits. It can be concluded that periodotal type of gingival inflammation had local immunologic reaction. This process was mainly located in deep parts of gingival tissue and was also predominantly alterative.

[Melkersson's-Rosenthal's syndrome]. / Melkerson-Rozentalov sindrom.

We examined a patient with Melkersson's-Rosenthal's syndrome who was admitted to the Department of Clinical Neurology for acute cerebral hemispheric ischaemic infarction. The patient presented the typical triad of features that include facial oedema, facial palsy, and fissure of the tongue. He had also manifestations unusual for that age (a 33 year-old man): hypertension, permanent haematuria and advanced cerebral stenoocclusive vascular disease. Immunological measurements have shown sligthly increased levels of both serum immunoglobulin and B lymphocytes, and high levels of histamine in blood. The patient was hypersensitive to certain external antigens (exhaust, fumes, Coca-Cola, fungicide--T.M.T.D.). This case demonstates the complexity of this syndrome and illustrates the necessity of long-term follow-up of such patients.

Uremic pruritus and skin mast cells.

The number of mast cells in the skin was evaluated in 25 patients with end-stage renal failure on different treatment modality (conservative, hemodialysis and peritoneal dialysis). According to the presence of pruritus, uremic patients were divided into two groups: group A, 13 patients with diffuse pruritus, and group B, 12 patients without pruritus. Controls were 6 age- and sex-matched healthy subjects. In comparison with patients without pruritus, patients with pruritus had mainly degranulated, diffusely spread and more numerous mast cells in the skin; significantly higher levels of plasma middle molecular weight substances, serum histamine and PTH and significantly lower serum iron levels. However, no differences were noted in observed parameters between groups on different treatment modalities. Favorable therapeutic effects in patients with pruritus were achieved either with iron supplementation in those with hypoferremia or with antihistamines, mast cell membrane stabilizers and high-permeability membranes.

Sarcoidosis and protein losing enteropathy.

The authors report a case of sarcoidosis associated with protein losing enteropathy. The diagnosis of intrathoracic stage I sarcoidosis was based on x-ray and biopsy of mediastinal lymph nodes. Enteric protein loss was suspected because of edema lasting for 2 yr, hypoproteinemia, decreased concentrations of serum immunoglobulins, and lymphopenia involving mainly T-cells and proved by 51CrCl3 test (21%/120 hr). Lymphography was consistent with granulomatous involvement of retroperitoneal lymph glands while small bowel biopsy showed blunt villi and dilated lacteals. All the pathological parameters normalized after 6 mo of prednisone treatment. In some cases of sarcoidosis, when abdominal lymph glands are involved, cellular and humoral immunologic derangements may be caused or potentiated by excessive enteric protein and lymphocyte loss.

Renovascular hypertension associated with bilateral aldosteronoma.

The authors present a 35-year-old male patient with renovascular hypertension caused by the stenosis of both renal arteries of the right kidney. Two years after the diagnosis of hypertension was made, an endarterectomy was performed but a successful correction of the upper stenotic artery was not achieved. During the next 2 years the hypertensive disease was uncontrollable with antihypertensive medications and gradually entered into a malignant phase. In addition to the atrophy of the right kidney, an adenoma of the left adrenal gland was revealed (19.75 g) which was operated on. Left adrenalectomy had only a transitory benefit on blood pressure level. Five months later an adenoma of the right adrenal gland was diagnosed and together with the ischaemic right kidney was operated on (right adrenalectomy and nephrectomy) which definitely cured the hypertension. The chronological sequence of events and the course of the disease in the patient point to the possibility that long-standing hyper-reninaemia, due to renal ischaemia, may cause the development of multiple bilateral adrenocortical adenomas and that secondary aldosteronism may transform into primary.

Primary bile acid malabsorption. Histologic and immunologic study in three patients.

Three patients are presented with a history of chronic watery diarrhea due to bile acid malabsorption, proved by the tauro-23[75Se]selena-25 homocholic acid test and an unequivocal response to cholestyramine therapy. Fecal fat tests, Schilling tests, and barium studies of the small intestine and colon were all normal. Jejunal biopsies were normal but multiple biopsies of the terminal ileum, performed by retrograde ileoscopy, showed uniform crypt hyperplastic villous atrophy and features of colonic metaplasia with increased mononuclear infiltration of the lamina propria. All 3 patients demonstrated evidence of abnormal immune function, including the presence of serum autoantibodies, circulating immune complexes, and hypocomplementemia. One patient had Sjögren's syndrome. This disorder, which might be immunologically mediated, should be called primary bile acid malabsorption and should be distinguished from other ileal disorders.