Immunohistochemical study of vascular endothelial growth factor, angiogenesis and proliferation by Ki67 in Juvenile nasopharyngeal angiofibroma

Juvenile nasopharyngeal angiofibroma [JNA] is a rare highly vascularized neoplasm of the nasopharynx that affects boys and young men. The underlying dysregulated molecular mechanisms remain unclear. The participation of angiogenic growth factors have been suggested. The aim of this study is to assess the expression of vasularization and proliferation in the pathogenesis of juvenile nasopharyngeal angiofibroma and to detect the role of antiangiogenic therapy in the treatment. Formalin fixed paraffin embedded sections of fifteen cases of juvenile nasopharyngeal angiofibroma [primary and recurrent] were studied immunohistochemically by VEGF, CD31 and Ki67 specific antibodies and visualized using light microscope. VEGF-expressing vessels, CD31 positive vessels and proliferating cells were evaluated by the same method. All the patients are adolescent males ranging in age between 12 to 26 years. Most tumors examined classified clinically as stage II or III with only one case as stage I and two cases as stage IV. No correlation between patient's age or tumor stage and VEGF expression, vascular density and Ki67 proliferating cells. The number of CD31 positive vessels varied from 15 to 100 per HPF. The microvascular density [MVD] varied from grade 1 to grade 3 in all the studied cases. The number of proliferating cells [ki67proliferating cells] ranged from 12 to 50 per HPF with median count 24, none of the fibroblastic stromal cells showed any reactivity to the CD31 antibodies contrasting the positive staining of the vascular endothelium. The stroma showed 12 cases [80%] with VEGF stromal positivity, while only the rest 3 cases [20%] with VEGF stromal negativity. Also it showed 7 cases [46.6%] with Ki67 positivity while 8 cases [45.4%] with Ki67 negativity. [40% of the studied cases] with positive VEGF stroma showed high vascular count and high MVD [grade 3] while only 4 cases showed low vascular count and low MVD [grade1] and negative stromal VEGF [5cases] showed [grade 2] MVD. [6 cases] with proliferating Ki67 stromal cells showed grade 3 MVD, while only one case with grade 2 MVD. We observed that cases with positive stromal VEGF showed high number of positive VEGF vessels. In JNA, VEGF is frequently expressed by the stromal cells and vessels and is associated with increased vessel density. VEGF is frequently expressed by stromal cells and blood vessels, associated with proliferation and increased vascular density. VEGF contributes to the strong vascularisation of this benign tumor. Therefore, antiangiogenic therapy might be considered. These findings support the theory that nasopharyngeal angiofibroma represents a vasoproliferative malformation

use of carbon dioxide laser to remoe small submandibular sialoliths

Six cases of small submandibular duct sialoliths were treated using carbon dioxide laser as a surgical dissector. When the laser beam encountered the small submandibular sialolith [3 mm or less], a light scattering effect [flash or burst] was observed thus enabling an almost immediate localization of the stone in the salivary duct or in the surrounding tissue. Stone extirpation is more rapid, with less surgical trauma, using this technique

application of laser in tonsillectomy operation

This study included twenty patients who underwent CO2 laser tonsillectomy between April 1996 and November 1996. Ten cases were operated under general anesthesia and the rest of the cases under local anesthesia. Using such new dramatic tool, laser tonsillectomy proved to be safe, effective and cost effective with minimal intraoperative and postoperative morbidity and complications

Discharging ear and teething

The relation between tooth eruption and otitis media is still a subject of debate. Teething may produce conditions leadings to initiation or exacerbation of otitis media as well as other local and systemic clinical manifestations. Fifty infants [Aged 6-23 months] having acute otitis media during teething were selected. Fifteen healthy infants of similar age and sex distribution were chosen as a control group. Both groups are subjected to full clinical examination including ENT and oral examination. Serum calcium, phosphorus and alkaline phosphatase, estimation of IgG, IgM, T lymphocyte count, and T lymphocyte subset using monoclonal antibodies. Serum calcium, phosphorus and alkaline phosphatase in both groups were within normal range, indicating that neither teething nor otitis media were associated with other systemic disturbances. Humoral immune mechanism has not been shown to play a role in the pathogenesis nor the recurrence of otitis media since IgG and IgM did not differ between patients and control group. However cellular immunity was found to be defective in these infants as manifested by an imbalance in T-cell and T-subsets cells leading to a deficiency in the immunoregulatory function of the immune system in infants having otitis media. Recurrent attacks of acute otitis media in otitis prone children could be attributed to a functional helper T-cells deficiency