Post-rhinoplasty mucous cyst formation of the nasal dorsum.

PROBLEM: Formation of a mucous cyst of the nasal dorsum after rhinoplasty is a rare complication, and a limited number of cases has been reported. Located subcutaneously, mucous cysts are thought to arise from traumatically displaced mucosal remnants. This may well be the result of inadequate surgical technique, and preservation of the mucosal lining, whenever possible, is therefore advocated when performing a rhinoplasty procedure. METHODOLOGY: We report a well-documented case of a patient with a mucous cyst of the nasal dorsum, which developed 40 years after the initial surgery. RESULTS: The cyst was excised through an external rhinoplasty approach. A thin-walled cyst, firmly attached to the bony pyramid, was easily removed from the overlying skin. CONCLUSIONS: Histopathological confirmation of such cysts is emphasized, as well as consideration of the technical aspects of prior surgery, since this may provide insight into risk factors involved.

A fatal case of craniofacial necrotizing fasciitis.

A case of fatal craniofacial necrotizing fasciitis is described in a 72-year-old diabetic woman and management is discussed. Progressive infection of the eyelids occurred with involvement of the right side of the face. Computed tomography revealed soft tissue swelling. Antibiotic treatment was started and debridement performed; histopathology showed acute inflammation and thrombosis of the epidermis and dermis. Despite treatment, scepticemia occurred, resulting in death less than 48 h after presentation. At this time extensive necrosis had developed in the superficial fascia with undermining and gangrene of surrounding tissues. Streptococcus and Staphylococcus were the pathogens involved. Poor prognosis in similar patients has been associated with extensive infection, involvement of the lower face and neck, delayed treatment, advanced age, diabetes and vascular disease.

[Life-threatening angioedema as a side effect of angiotensin-converting-enzyme (ACE) inhibitors]. / Levensbedreigend angio-oedeem als bijwerking van angiotensine-'converting'-enzym (ACE)-remmers.

During the past years, angioedema occurring in association with angiotensin converting enzyme (ACE) inhibitors is seen more and more often. This is due to the increasing use of these drugs for hypertension and congestive heart failure. If the diagnosis is missed and prescription of the ACE inhibitor is prolonged, recurrent and more severe episodes of angioedema may occur. In case of involvement of the upper airway and respiratory distress, the condition may be life-threatening. We demonstrate three such patients, men of 84, 73 and 63 years old. First of all, the airway should be secured. Administration of epinephrine may be indicated. Further use of ACE inhibitors is contraindicated.

Expression of intermediate filament proteins in the adult human vestibular labyrinth.

The immunohistochemical detection of intermediate filament proteins, cytoskeletal constituents that allow the characterization of tissues, was investigated in frozen sections of the chemically fixed, nondecalcified, adult human vestibular labyrinth. Cytokeratins (CKs) were detected in all epithelia (including the sensory epithelia), although substantial differences in the degree of staining between individual cells occurred. The expression of CKs 7, 8, 18, and 19 as detected with our subunit-specific monoclonal antibodies in the vestibular epithelia is typical of "simple" epithelia and is identical to the CK subtypes found in the human cochlea. Although immunostaining for CK 7 was very weak and was limited to certain vestibular wall cells, the other CKs demonstrated a pronounced and rather uniform distribution throughout the different epithelia. All epithelia (including the sensory epithelia) displayed expression of vimentin, thus demonstrating co-expression with CKs. Vimentin was also present in the subepithelial connective tissue fibroblasts and mesothelial lining of the vestibular labyrinth. Neurofilament proteins were detected in all neuronal structures. The intense staining for CKs in the maculae and cristae implies that these sensory organs are rigid structures, a finding that may possibly be of importance in the mechanoelectrical transduction process for the sense of equilibrium.

Expression of intermediate filament proteins in the adult human cochlea.

The immunohistochemical localization of intermediate filament proteins was studied in frozen sections of chemically fixed, nondecalcified adult human cochleas. Cytokeratins were found in all epithelial cells lining the cochlear duct (including most supporting cells of the organ of Corti) but were absent in the hair cells. Neurofilament proteins were present in the nerve endings at the hair cells, in the neural bundles, and in the ganglion cells. Vimentin staining occurred in most of the supporting structures and was roughly complementary to the regions showing cytokeratin staining and neurofilament staining. However, the region of the spiral prominence and outer sulcus, as well as the pillar cells and Deiters' cells in the organ of Corti, showed coexpression of vimentin and cytokeratins. No definite immunostaining was observed with antibodies to desmin and glial fibrillary acidic protein.

Differential immunohistochemical detection of cytokeratins and vimentin in the surgically removed human endolymphatic duct and sac.

Immunohistochemical detection of intermediate filament proteins and different subgroups of cytokeratins (Cks) was used to characterize the epithelium of the surgically removed adult human endolymphatic duct (ED) and sac (ES). The epithelium of the ED and ES demonstrated immunostaining for Cks 7, 8, 14, 17, 18 and 19, a pattern typical of so-called "complex" or "mixed" epithelia. This is a remarkable finding, since this pattern differs strikingly from previously reported data on the adult human cochlea and vestibular labyrinth that demonstrated a Ck pattern typical of "simple" (or single-layered) epithelia. Furthermore, the epithelium of the ED and ES demonstrated co-expression of Cks and vimentin. The present data indicate that the epithelium of the ED and ES exhibits another type of epithelial differentiation and demonstrates a higher degree of complexity than the other epithelia in the adult human inner ear.

Cytokeratin expression in the epithelia of the adult human cochlea.

Epithelia can be characterized by the specific expression pattern of their cytokeratin components. Therefore, we investigated the immunohistochemical expression of different cytokeratin subunits in frozen sections of chemically fixed, non-decalcified, adult human cochleas. The organ of Corti and the marginal cells of the stria vascularis showed reactivity for cytokeratin subunits 8, 18 and 19, whereas the other cochlear epithelia in addition expressed cytokeratin 7. The expression of cytokeratins 7, 8, 18 and 19 by the epithelia of the adult human cochlea is typical of "simple" epithelia. The deviant cytokeratin pattern of the organ of Corti and marginal cells of the stria vascularis may well reflect their differences in functional state and/or differentiation as compared to the other cochlear epithelia.

Progress in temporal bone histopathology. III. An improved technique for immunohistochemical investigation of the adult human inner ear.

A new tissue processing technique is described for immunohistochemistry of the adult human inner ear, avoiding the immuno-compromising step of prolonged decalcification. The procedure allows reliable investigation of frozen sections of the chemically fixed, non-decalcified, adult human cochlea and vestibular sense organs. Preservation of immunoreactivity, combined with satisfying tissue morphology, is illustrated by the immunohistochemical localization of the intermediate filament constituents cytokeratins and neurofilament proteins throughout the membranous labyrinth.