The hypertrophy of pharyngeal tonsill in the estimation of XIX-century physicians

The role of such physicians as Rudolph A. Kolliker, Johann N. Czermak, Ludwig Tuerck, Friedrich E. Voltlini, Benjamin B. Loewenberg, Hubert v. Luschka in the building of the science on hypertrophy of pharyngeal tonsil are pointed out first of all. The specific significance of achievements of Wilhelm Meyer (1824-1895) of Copenhagen based on scrupulous examinations is described. In the Polish territories the innovatory were works of Teodor Heryng, Klemens Koehler, W?adys?aw Wróblewski, Jan Sedziak, Teofil Zalewski. The epidemiology, etiology, pathogenesis, anatomo-patological examinations, the role of pharyngeal tonsil on immunity system are presented widely. The influence of hypertrophy of pharyngeal tonsil on general evolution of child, on his intellectual sphere, on speech disorders, on upper respiratory tract disorders, on auditory disorders, on the origination of deaf-mutism, on the origination of reflexogenous neuroses are described in more detail. An important role of anterior rhinoscopy, posterior rhinoscopy, and digital examination in the diagnosis of this illnes are also presented with full particulars.     

Factors associated with long-term complications after repair of mandibular fractures

Educational Objective: At the conclusion of this paper, the participants should be able to identify, compare, and discuss the natural history of complications of mandible fractures and repair. Objectives: To analyze factors affecting the incidence of long‐term complications after the repair of mandible fractures. To determine whether the use of antibiotics at any time in the course of treatment impacted the development of complications. Study Design: Retrospective medical record review. Methods: Medical records for patients with mandibular fractures treated surgically over a 5 year period were reviewed for demographics, history of substance abuse, etiology, location of fracture, any associated facial injury, type and timing of repair, pre‐, peri‐, and postoperative antibiotic treatment, length of hospitalization, and lag time to repair. The development of infectious and other complications after surgery, specifically, the development of abscesses, fistulae, mal/nonunion, hardware exposure, or extrusion, were recorded. Results: Of 273 subjects, 56 fractures were repaired using open reduction internal fixation (ORIF) alone, 112 mandibulomaxillary fixation (MMF), and 105 with a combination of MMF and ORIF. Eighteen (6.6%) patients developed an infectious or related long‐term complication. These included abscess (n = 4), infected hardware (n = 1), mal/nonunion (n = 8), and hardware exposure/extrusion (n = 9). Smoking and alcohol abuse (P = .021) and the use of plating techniques (P = .04) correlated with a higher incidence of long‐term complications. Patient age, sex, location and etiology of fracture, associated facial injury, lag time to repair, length of hospitalization, and the use of antibiotics at any time after injury or repair were unrelated to the development of complications. Conclusions: The development of infection, nonunion, and related complications after the repair of mandibular fractures correlates with a history of tobacco and alcohol use and ORIF of multiple fractures, but there were no statistically significant relationships to patient demographics, fracture site, lag time to repair, length of hospitalization, or the use of antibiotics. In this series, antibiotic therapy appears to have had no impact on the development of postoperative complications.     

Qualitätssicherung eines universellen Neugeborenen-Hörscreenings

Statutory implementation of a universal newborn hearing screening requires a continuous quality assurance monitoring. Therefore, at the Annual Meeting in 2007, the members of the German Society of Phoniatrics and Pediatric Audiology passed a recommendation on measures of quality assurance applied to newborn hearing screening. This recommendation describes the procedures, performance, location, time frame, and technical prerequisites of the screening and of potentially necessary follow-ups, the definition of hearing loss to be detected, the performing and responsible professional groups and their qualifications for the screening, the regulation of repeat and control screenings, the confirmation diagnostics and initiation of therapy, the information of parents, the documentation of screening results, the aims and organization of a tracking system, the tasks of regional screening centers and of a supraregional institution for the quality assurance of the hearing screening, the central collection of person and screening-related quality relevant data, and the accessibility of defined data sets as predisposition for cost analyses and quality reports.     

Carcinomatous meningitis arising from primary nasopharyngeal carcinoma

Carcinomatous meningitis, also known as leptomeningeal metastasis and meningeal carcinomatosis, is the invasion of neoplastic cells into the leptomeninges. Head and neck cancers, especially nasopharyngeal carcinoma, give rise to carcinomatous meningitis very infrequently. In this case report, we present a rare case of carcinomatous meningitis with nasopharyngeal carcinoma as the primary source. In 1987, a 45-year-old white female presented with a few year history of chronic bilateral serous otitis media. She also complained of intermittent diplopia, right facial pain, right-sided headache, and, finally, right facial palsy. The patient was subsequently diagnosed with nasopharyngeal carcinoma by biopsy and treated with radiation as well as chemotherapy. Her neurological symptoms improved, and she did fairly well for several years. However, various neurologic symptoms started to recur, including right facial weakness, right facial numbness in the distribution of all 3 divisions of cranial nerve (CN) V, loss of taste as well as smell, and diplopia. In 1993, magnetic resonance imaging scan of the head revealed recurrence of nasopharyngeal carcinoma with involvement of the ethmoid sinuses as well as extension of the tumor into the frontotemporal leptomeninges. Over the course of the next 3 years, the patient experienced a very gradual decline with involvement of almost all of the CNs (CN I, II, III, V, VI, VII, VIII, IX, X, XII). This case report of carcinomatous meningitis from primary nasopharyngeal carcinoma is one of the few reported in the literature. Although very rare, nasopharyngeal carcinoma can give rise to carcinomatous meningitis, probably by direct invasion of malignant cells. We also review the literature with respect to the diagnosis and treatment of carcinomatosis meningitis.     

鼻咽癌调强适形放疗137例远期疗效及预后因素分析

目的：回顾性分析137例鼻咽癌调强适形放射治疗的远期疗效及预后影响因素。方法：对确诊的初治的无远处转移的137例鼻咽癌患者,采用三维适形调强放射治疗技术。在放疗后1个月按WHO实体瘤疗效评价标准进行近期疗效评价。放疗结束后2年内每3个月复查一次,2年后每6～12个月复查一次,常规进行临床查体、鼻咽镜、CT、B超、MRI、胸片、骨扫描检查,了解鼻咽腔、颈部淋巴结及颅神经情况。采用寿命表法计算总生存率,Kaplan-Meier方法计算无复发生存率、无远处转移生存率、无瘤生存率,用Log—rank检验法对14项可能影响预后的临床因素进行单因素分析,采用Cox风险比例模型做多因素分析,P〈0.05为差异有统计学意义。结果：①1、3、5年总生存率分别为98．5％、90．3％、74．6％,无复发生存率分别为97．0％、81．9％、66．7％无远处转移生存率分别为96．3％、80．5％、56．0％,元瘤生存率分别为95．6％、76．9％、43．8％;②单因素分析显示T分期、N分期、92福州临床分期、联合化疗、颅底骨质破坏、颅神经损伤、咽后淋巴结转移、疗终残留、总放疗时间等对预后的影响有统计学意义（均P〈0．05）;性别、族别、年龄、病理类型、贫血与否对预后的影响无统计学意义（均P〉0．05）;③将T分期、颅底骨质破坏、颅神经损伤、咽后淋巴结转移、N分期、联合化疗、疗终残留、总放疗时间、贫血与否引入Cox模型,结果表明N分期、联合化疗、颅神经损伤、疗终残留、总放疗时间是影响鼻咽癌预后的独立因素（均P〈0．05）。结论：鼻咽癌调强适形放射治疗较常规放疗有明显优势,在相关临床因素中N分期、颅神经损伤、联合化疗、疗终残留、总放疗时间是影响预后的最主要因素。     

Evaluating the effects of oral prednisolone on recovery after tonsillectomy: a prospective, double-blind, randomized trial

OBJECTIVES: To investigate the role of a 7-day course of oral prednisolone on recovery from tonsillectomy. STUDY DESIGN: Double-blind, randomized, placebo-controlled trial of 50 consecutive patients, aged 5 years and older, who had no previous or known contraindications to steroid therapy. METHODS: The patients were randomized at the time of surgery to either a 7-day course of daily placebo or prednisolone (dosage: 10 mg per day in patients aged 5-11 y, 0.5 mg/kg in those aged 12 and older). Age, sex, weight, diagnosis, tonsil size (in cm2), additional adenoidectomy, performing surgeon, method of dissection, length of procedure, total blood loss, intraoperative fluid requirement, and length of hospitalization were documented for each patient. During the first postoperative day, morning pain score, paracetamol use, oral fluid intake, temperature, presence of nausea and vomiting, level of activity (low, moderate, or normal), and type of diet (liquid, soft, or normal) were recorded. RESULTS: The steroid group consisted of a greater number of diathermy dissection cases and had significantly less intraoperative blood loss (P value = .022 and .017, respectively). On postoperative days 4 to 7, the steroid group experienced less nausea and vomiting (P value = .01, .04, .04, and .04, respectively). Paracetamol use was less in the steroid group on days 2, 7, and 8 (P value = .03, .02, and .02, respectively). There was no difference between the two groups for the other data measured. CONCLUSION: A 7-day course of corticosteroids may play a limited role in patients' recovery from tonsillectomy.     

Impact of gland morphology and concomitant thyroid nodules on preoperative localization of parathyroid adenomas

OBJECTIVES: Primary hyperparathyroidism (pHPT) is a common endocrine disease. The aim of this study was to assess the effect of the presence of thyroid nodules, adenoma weight, and ectopic localization on the sensitivity of different imaging studies in patients with hyperparathyroidism. STUDY DESIGN: A series of 125 patients with pHPT who underwent low-frequency ultrasonography, high-frequency ultrasonography, Thallium-Technetium scintigraphy, sestamibi scintigraphy, and combined technique was reviewed retrospectively. Patients were divided in two groups depending on the presence or absence of thyroid nodules. RESULTS: The overall sensitivity of low-frequency ultrasonography, high-frequency ultrasonography, Thallium-Technetium scintigraphy, sestamibi scintigraphy, and combined technique was 69%, 89%, 71%, 86%, and 98%, respectively. The sensitivity of these imaging studies was 94%, 100%, 94%, 96%, and 100%, respectively, in our patients with no thyroid nodules but decreased to 54%, 84%, 54%, 81%, and 79%, respectively, in the presence of thyroid nodules. The parathyroid adenoma weight in true-positive imaging studies was significantly higher than those in false-positive and false-negative imaging studies. The numbers of ectopic parathyroid adenomas were found to be higher in the group of parathyroid adenomas undetected with ultrasonography when compared with ultrasonographically detected adenomas. CONCLUSION: In patients with parathyroid adenoma, the sensitivity of imaging studies correlates with the presence of thyroid nodules, adenoma weight, and ectopic localization.     

Audio-Reflexometry in Testing Hearing of Very Young Children1a

Audio-reflexometry is a method of measuring the levels of hearing through the observation of involuntary reponses resulting from acoustic stimulation. The importance of reflexes in measuring hearing levels has been recognized by pediatricians, audiologists, and otologists. Pupilar responses, eye blinks, rolling of eyes, eyes opening wide, turning of head, Moro reflex and startle reflex have been considered as indicators of auditory responses.

The author, in a study of 124 children from the age of 1–24 months, found that head turning (in part) begins around the age of 2 months. The results and observations indicate that auditory responses could be considered fairly dependable around the age of 3–4 months. At the age of 6 months the responses are even ore dependable. The research also indicates that a meaningful stimulus such as the ‘baby cry test’ signal would serve as a better diagnostic stimulus than other stimuli testing hearing. However, factors such as (1) establishment of rapport, (2) age of the child, (3) acoustic characteristics of the signal, (4) testing environment, (5) instrumentation, (6) method of response, (7) time spent in testing, (8) physical condition of the child, (9) child's co-operativeness, and (10) the examiner's clinical experience, contribute to the validity of hearing thresholds, irrespective of the type of test used.     

Is open surgery for head and neck cancers truly declining?

In the past two decades, major modifications in the way we treat head and neck cancers, due to advances in technology and medical oncology, have led to a decline in the use of open surgery as first-line treatment of cancers arising from several primary tumor sites. The incidence of tobacco- and alcohol-related squamous cell carcinoma of the pharynx and larynx has been steadily decreasing, with a rise in the incidence of human papillomavirus-related oropharyngeal tumors and the use of minimally invasive endoscopic surgery and non-surgical treatment modalities has increased in the treatment of all of these tumors. However, open surgery remains the initial definitive treatment modality for other tumors, including tumors of the skin, oral cavity, sinonasal cavities and skull base, salivary glands, thyroid and sarcomas. Selected group of nasal, paranasal, base of the skull and thyroid tumors are also candidates for minimally invasive procedures. For some indications, the rate of open surgery has actually increased in the past decade, with an increase in the incidence of oral cavity, thyroid and skin cancer, an increase in the number of neck dissections performed, and an increase in salvage surgery and free flap reconstruction. The use of minimally invasive, technology-based surgery—with the use of lasers, operating microscopes, endoscopes, robots and image guidance—has increased. Technology, epidemiology and advances in other domains such as tissue engineering and allotransplantations may further change the domains of competencies for future head and neck surgeons.     

Significance of hemodynamic parameters of blood loss in orthognathic surgery]

INTRODUCTION: The hemodynamic parameters of 95 patients undergoing maxillary or bimaxillary orthognathic surgery in 1996 and 1997 at the Department of OMF Surgery/Plastic Surgery, Krefeld, Germany, were analyzed retrospectivly to study the effect of intraoperative blood loss. MATERIALS AND METHODS: The parameters included the blood loss volume, age, weight and sex of the patients, the mode of osteotomy and the operation time, the surgeon, the average blood pressure, the infusion volume, the anesthesiologist, the thrombocyte counts and their function, the activity of the coagulation factors II, V, VII, VIII, IX, X, XI, XII, XIII and von-Willebrand-factor, and the pathological coagulation factor counts of each patient, the rate of autologous blood donation and the rate of retransfusion. Statistical analysis was done using the Speraman-Rhotest. RESULTS: The average blood loss during maxillary osteotomy was 670 +/- 380 ml and during bimaxillary surgery 1120 +/- 510 ml. Men lost about 300 ml more than women. Operations of more than 3.5 h in length led to a blood loss of 1200 +/- 520 ml as opposed to 670 +/- 310 ml. The average blood loss among various surgeons was between 670 ml and 1180 ml of various anesthesiologists between 730 ml and 1200 ml, without statistical evidence. Some 17.9% of patients showed pathological thrombocytic function concerning medication with aspirin; 34.7% had pathological activities of coagulation factors, but only 2.1% with clinical significance. CONCLUSION: Mode of operation, maxillary or bimaxillary, und length of operation were the most significant factors of intraoperative blood loss. Patients with pathological coagulation had nearly the same rate of blood loss as patients with physiological coagulation. In most cases this was determined by restriction of aspirin. Analysis of the rate of autologous blood retransfusion showed a significant correlation to blood loss in bimaxillary surgery. Maxillary osteotomy led to a retransfusion of only 14.2% of autologous blood unit. This should be reviewed critically especially concerning costs.     

Metallic elements in the perilymph measured with an inductively-coupled plasma atomic emission spectrometer.

Metallic elements in the perilymph of the scala tympani in normal and acoustically overstimulated guinea pigs were measured using a new method, an inductively-coupled plasma atomic emission spectrometry. The concentrations of phosphorus and eight metallic elements, i.e. calcium, copper, iron, potassium, magnesium, sodium, lead and zinc were measured simultaneously in a 2 microliters sample of perilymph. The mean concentration values of calcium, copper, iron, magnesium, phosphorus, lead and zinc were 2.03 mM, 38.5 microM, 69.3 microM, 0.822 mM, 0.851 mM, 43.5 microM and 25.0 microM, respectively. There was no significant effect of acoustic overstimulation on the concentrations of these elements except for magnesium, which decreased significantly after the exposure to a intense sound (2 kHz, 115 dB SPL) for 15 min. This is the first report describing the synchronous determination of metallic poly-elements, including copper, iron, lead and zinc, in the perilymph.     

小儿先天性鼻腔鼻窦肿物的临床诊疗观察

目的 探讨小儿先天性鼻腔鼻窦肿物的诊断及鼻内镜手术治疗的安全性和有效性.方法 回顾性分析上海交通大学医学院附属新华医院收治的24例先天性鼻腔鼻窦肿物患儿的临床资料.术前进行鼻内镜、鼻窦CT和MRI检查,全部病例经鼻内镜下鼻腔鼻窦肿物切除术,术后随访手术疗效.结果 24例中良性占位17例,其中脑膜脑膨出8例、骨化纤维瘤3...     

Inner ear concentrations and ototoxicity of different antibiotics in local and systemic application

The cause of the specific ototoxicity of antibiotics of the aminoglycosid group, like streptomycin, kanamycin, neomycin, gentamicin, may, as we could observe, be looked for in the specific accumulation of these substances both in the endolymph and perilymph of the internal ear. The toxicity may be explained by the high concentration of these antibiotics in the lymphatic fluid and by the fact, that they are retained there for a long time.

In a comparative study with isomolar doses of the toxic aminoglycosid antibiotics, both the extent of sensory (hair) cell damages using the surface preparation technique were evaluated and the antibiotic level was measured. It could be shown that the more toxic the substance, the higher was the concentration in the internal ear. This specific accumulation and toxicity, typical for each substance, could be found both in systemic intramuscular and direct (topical) application to the cochlea.

On the other hand, when other antibiotics were applied, either in a systemic or topical mode, basic differences became apparent. Thus, the neurotoxic polymyxins and tetracyclines, when applied intramuscularly, did not cause any damages to hearing because of their inability to penetrate the internal ear, that is, through the blood-lymph barrier. Topically applied, polymyxin causes severe sensory cell damages and, to a smaller extent, tetracycline, too. Furthermore, chloramphenicol topically applied, will cause sensory cell damages. The pronounced damages caused by the topical application of erythromycin, were also surprising. Only penicillin, independent of its mode of application, showed no internal ear damages, the result being identical with the control tests.     

Sudden deafness: efficacy of a therapeutic protocol

Sudden hearing loss is an entity of unknown cause. Different theories of its etiology and treatment have been proposed. The objective of our report is to evaluate the efficacy of the therapeutic protocol used in our department in patients with sudden hearing loss. We made a retrospective study of 24 patients who had experienced sudden hearing loss from January 1994 to March 1998. We studied the parameters of age, sex, days of hospitalization, vestibular symptoms, otoscopy, personal history, radiology study, and successive audiograms. The treatment protocol consists of low-dose steroids, pentoxyphylline, and carbogen, and a concentration of 5% CO2 and 95% O2. Treatment was effective, with a recovery rate of 83%. The factors of tinnitus or vertigo, the state of hearing in the opposite ear, and age did not influence the recovery of hearing. However, the form of the audiogram and initial hearing were important prognostic factors.     

TGF-β1 CD44V6 bcl-2及p53蛋白在喉鳞状细胞癌组织中的表达及其临床相关性研究

目的：探讨转化生长因子TGF-β1 CD44V6 bcl-2及p53蛋白在喉鳞状细胞癌中的表达与喉鳞状细胞癌患者的病理分级、临床分期和患者生存率间的相互关系，以研究TGF-β1在喉鳞状细胞癌发病机制中的作用。方法：利用免疫组织化学法测定43例喉鳞状细胞癌石蜡切片中TGF-β1、CD44V6、bcl-2及p53蛋白的表达。结果：TGF-β1在病理Ⅰ、Ⅱ、Ⅲ级中阳性表达率分别为86．96％、82．35％和100．00％；CD44V6分别为60．87％、70．59％和100．00％；bcl-2分别为82．61％、94．12％和100．00％；p53分别为26．09％、35．29％和66．67％。结论：①TGF-β1表达与喉鳞状细胞癌的病理分级、临床分期、颈淋巴结转移和患者的3、5年生存率有关，可作为评定喉鳞状细胞癌的进展、预测其转移与预后的指标。②TGF-β1在喉鳞状细胞癌中的表达与CD44V6、bcl-2、p53具有一定的相关性。     

1992～2002年鼻息肉临床医疗技术变化及费用的研究

目的：研究近十年来鼻息肉手术临床医疗技术及医疗费用的变化趋势，以及两者之间的关系。方法：调查近十年来360例鼻息肉手术出院病例临床医疗技术及医疗费用的变化指标，并进行统计分析。结果：麻醉方法及用药、鼻窦CT检查、鼻内镜使用、凝血机制检查、抗生素使用、入出院评估宣教、总住院天数及术前住院天数等均随时间推移而发生了明显变化。结论：随着耳鼻咽喉专科及各相关学科的发展，医疗技术也随之变化，医疗技术的变化对医疗费用必然产生一定影响。     

多平面分期手术对重度阻塞性睡眠呼吸暂停低通气综合征合并代谢综合征患者的影响

目的观察多平面分期手术对重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）合并代谢综合征（metabolic syndrome,MS）患者颈动脉内膜中层厚度（carotid intimamedia thickness,IMT）及代谢指标的影响。方法选择重度OSAHS合并MS患者45例,均行多平面手术治疗,并对其治疗前及治疗后12个月患者呼吸暂停低通气指数（AHI）、体重指数（BMI）、最低血氧饱和度（LSaO2）、血脂总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL—C）、高密度脂蛋白胆固醇（HDL—C）、空腹血糖（FBG）及空腹胰岛素（INS）检查,PSG监测及嗜睡评分（ESS）。结果治疗前两组比较除AHI差异具有统计学意义外（P〈0．05）,其余年龄、BMI、LSaO2、LDL—C、HDL—C、TC、TG、FBG、INS、ESS及IMT的比较差异均无统计学意义（P〉0．05）;所有患者治疗前、后AHI、LSaO2、TC、TG、LDL—C、HDL—C、FBG、INS、ESS及IMT的比较,除FBG差异无统计学意义外（P〉0．05）,其余差异均具有统计学意义（P〈0．05）;有效组IMT、ESS、AHI及LSaO2治疗前后比较差异具有统计学意义（P〈0．05）,无效组IMT值和LSaO2治疗前后比较差异无统计学意义（P〉0．05）,而ESS和AHI治疗前后比较有显著性差异（P〈0．05）。结论多平面手术对重度OSAHS合并有MS患者均有效,提示积极手术干预治疗OSAHS同时也可治疗MS;OSAHS可能是MS病情发展的一个重要因素;经过手术治疗可以逆转或延迟颈动脉粥样硬化的进程。     

Vasculae decompression of the cochlear nerve in tinnitus sufferers

An estimated 40 million Americans suffer from tinnitus, and approximately 20% of these sufferers feel that the quality of their life is significantly impaired by this symptom. Despite thorough evaluation, the underlying etiology in the majority of these patients remains obscure or conjectural. Most of these patients will, however, benefit from consultation and avoidance of caffeine, nicotine, and salt, while others require biofeedback, amplification, masking, and even psychotherapy. On rare occasions, physicians are presented with a patient complaining of unilateral tinnitus of undetermined etiology who, in spite of a thorough evaluation and all conventional therapies, continues to be severely handicapped by that symptom. Early findings suggest that these patients may be suffering from vascular loop compression of the cochlear division of the eighth cranial nerve. When patients are carefully selected, retrosigmoid decompression of that vascular loop has provided gratifying relief.