Sialometaplasia arising in the ectopic salivary gland ductal inclusions of multiple intraparotid lymph nodes.

Sialometaplasia, squamous metaplasia of salivary gland lobules, is a benign condition occasionally presenting with lesions clinically simulating malignancy. "Necrotising sialometaplasia", recognised by lobular infarction, necrosis, and simultaneous squamous metaplasia of ducts and acini is a well known condition. There are only a few reports of the "proliferative type of sialometaplasia", which is recognised by a more mature morphology of larger and more irregular metaplastic nests, lacking necrosis. This report describes a unique case of "proliferative sialometaplasia of multiple intraparotid lymph nodes" occurring in a 55 year old woman, presenting with multiple parotid lumps. This interesting case points to the importance of intraparotid lymph nodes as sites for multiple lesions of the parotid region.

TEOAE monitoring of Cisplatin induced ototoxicity in guinea pigs: the protective effect of vitamin B treatment.

OBJECTIVE: To evaluate Cisplatin (CP) induced ototoxicity and the effects of vitamin B treatment on ototoxicity in guinea pigs by using the Transient Evoked Otoacoustic Emission (TEOAE) technique. METHODS: Eleven guinea pigs were divided into two groups and they were tested by TEOAE before and after the experiment. A TEOAE response was regarded as positive when all of the following criteria were met: 1. The mean amplitude of the cochlear response in dB pe SPL should be greater than that of the noise in the external auditory canal; 2. The reproducibility rate of the response should be greater than 50%; 3. The stimulus stability rate should be greater than 65%; 4. The signal to noise ratio of the response in 1, 2, 3, 4 and 5 kHz band frequencies should be greater than 3 dB pe SPL in at least two bands. The first group included five animals that had only CP injections. Six animals in the second group received additional 0.2 ml/kg combined vitamin B preparations for 7 consecutive days. Thereafter, the right and left ears of all animals in both groups were tested by TEOAE. RESULTS: TEOAE responses recorded from 22 ears of 11 guinea pigs before drug administrations showed that the responses with maximum amplitude were originated from the mid-frequency region. Positive TEOAE responses were significantly reduced after CP administrations in both groups when compared with their respective pretreatment results (P<0.01). However, vitamin B injections, in addition to a single large dose of CP, resulted in significantly better TEOAE responses than those obtained after only CP injections (P<0.05). CONCLUSIONS: The routine use of TEOAE monitoring is recommended in clinical CP treatment protocols for the early detection and follow up of ototoxicity. Also, prospective clinical trials are needed in order to validate the protective effects of vitamin B treatment against ototoxicity.

Evaluation of the primary tumour and the metastatic lymph node with or without extracapsular spread by means of argyrophillic nucleolar regions (AgNOR).

Though TNM staging is the most popular clinical system for defining the prognosis of Head and Neck Squamous Cell Carcinoma (HNSCC), different clinical trials of the tumours with the same TNM stage have caused doubts about this system. Extra Capsular Spread (ECS) in a metastatic lymph node is one of the recently defined prognostic factors in HNSCC. The hypothesis of this study was to assess the relationship between the primary tumour of laryngeal and oral cavity squamous cell carcinoma and the metastatic lymph nodes with and without ECS. The argyrophillic Nucleolar Organiser Regions (AgNOR) count was used as an index of the grade of malignancy of the neoplastic tissue. As a result, significantly higher AgNOR counts were obtained in the metastatic lymph nodes with ECS than in the primary tumours, while the lowest AgNOR counts were found in the metastatic lymph nodes without ECS. However, when primary tumours of the metastatic lymph nodes with ECS and the primary tumours of the metastatic lymph nodes without ECS were compared, no significant difference was found.

Metastatic thyroid carcinoma of the mandibule.

A case of metastatic papillary carcinoma to the mandible is presented. Though relatively rare, metastatic tumours of the mandible should be included in the differential diagnosis of the tumours in the parotid region. For the primary site; being in the cervicofacial region, the thyroid gland must be considered by the head and neck surgeon.

Investigation of topical ciprofloxacin ototoxicity in guinea pigs.

Antibiotic eardrops mostly contain potentially ototoxic aminoglycosides. Ciprofloxacin is an alternative, and there is limited experience in its topical use. To investigate the topical ototoxicity of ciprofloxacin, 11 guinea pigs have been operated on. Transbullae silicone drug delivery tubes were placed to both ears of the animals. After the operation the guinea pigs were divided into two groups. The first group of animals received 0.2 ml of 4% gentamicin in one ear and 0.2 ml of 0.9% sodium chloride solution in the other. The second group received 0.2 ml of 0.2% ciprofloxacin in the test ear and 0.2 ml of 0.9% sodium chloride solution in the control ear. All drugs were given once a day on 7 consecutive days. Auditory brainstem response thresholds were recorded using click, 4 and 8 kHz logon stimuli before and after the operation, and after topical drug application. Results were statistically compared using Wilcoxon matched pairs signed-ranks test. Comparison of the thresholds before and after the operation, physiological saline application, as well as ciprofloxacin application yielded no statistically significant differences, whereas application of gentamicin resulted in total hearing loss. The results indicate that topical use of 0.2% ciprofloxacin is not ototoxic in guinea pigs.

High-resolution computed tomographic evaluation of the cochlear capsule in otosclerosis: relationship between densitometry and sensorineural hearing loss.

Otosclerotic cochlear involvement is a rather frequent disease that has not been clearly understood in terms of diagnosis and management. Objective evaluation methods are needed to confirm the clinical diagnosis, investigate the relationship with hearing impairment, and validate the results of treatment. In this study two ear groups with bone conduction hearing loss (BCHL) were investigated with audiometry and high-resolution computed tomography (HRCT). In the first group (n = 22) the diagnosis of fenestral otosclerosis was confirmed at operation; the second group (n = 9) was composed of ears clinically suspicious for purely cochlear involvement. Additionally, a control group (n = 14) of otologically normal ears was also studied. Foci of demineralization were demonstrated in 58% of the ears in the two groups; the sensorineural hearing loss (SNHL) in those ears was significantly worse than in those with normal radiologic findings. Three methods of HRCT densitometry were used to determine the abnormal regions in the cochlear capsule; the results suggested that hypodense regions were consistent with a greater degree of SNHL, in contrast to the hyperdense ones in ears with better cochlear reserves. Agreement was found between the location of the density change and the frequency topography of the SNHL; densitometric values were correlated with the bone conduction thresholds for certain frequencies. It is concluded that the spongiotic foci are responsible for the SNHL, since there was a correlation between their location and the SNHL frequency. The determination of better hearing in those ears with sclerotic foci supports the hypothesis that the sclerotic phase may not be a healing process following the spongiotic phase, and that it can be the first stage of the disease.

Management of parapharyngeal space cysts.

Parapharyngeal space cysts, besides salivary gland origin may be derived from the first and dorsal portions of the second pharyngeal pouches. They are mucosal or epithelial lined structures with no external or visceral opening and always present on the lateral aspects of the nasopharyngeal wall. Two consecutive cases of parapharyngeal space cysts totally excised by transoral and transparotid routes are presented.

Submaxillary hypoglossal neurilemmoma.

Neurilemmomas of the hypoglossal nerve are uncommon neoplasms. A unique case of submaxillary hypoglossal neurilemmoma is presented with radiological and surgical results. Methods of diagnosis and differential diagnosis are discussed.

Lingual thyroid: the diagnostic value of magnetic resonance imaging.

Lingual thyroid is an uncommon developmental aberration of embryogenesis. It may present as a mid-line, non-tender, painless, reddish appearing swelling in the throat. Magnetic resonance imaging (MRI) is a relatively new diagnostic method for this condition. Two cases of lingual thyroid are reviewed with their MRI's and surgical results.

Swollen neck in children: a report of two cases.

Two cases of swollen neck during straining, coughing, or crying caused by internal jugular vein dilatation that were diagnosed by ultrasonography and computed tomography are presented. With a review of the literature the aetiology and diagnostic procedure are discussed.

Metastatic renal carcinoma to the parotid gland.

A case of renal carcinoma metastatic to the left parotid gland is presented. A 60-year-old male patient developed a painful mass in his left parotid region one and a half years after he had undergone a left nephrectomy operation for renal carcinoma. The mass was excised surgically. The histopathological diagnosis was metastatic renal carcinoma. From a review of the literature, it is apparent that unlike most of the cases reported, this one had a very aggressive nature. The clinical presentation of the metastasis, and the factors determining the prognosis in cases of metastatic renal carcinoma to the head and neck are discussed.