Auditory brainstem latencies in type I (insulin-dependent) diabetic patients.

INTRODUCTION: This study was undertaken to compare auditory brainstem response latencies in insulin-dependent diabetics, and to compare these findings with metabolic control, microangiopathy, neuropathy, and the duration of diabetes. METHODS: Auditory brainstem latencies were studied in 53 type I diabetic patients and 42 randomly selected nondiabetic control subjects, aged between 20 and 40 years. Three different stimulus repetition rates (10, 30, and 50 Hz) were used. All subjects had normal hearing ability. RESULTS: Wave V latencies were longer in diabetic patients when compared with those of control subjects at all repetition rates. At repetition rates of 10 and 50 Hz, diabetic patients had a prolonged I-V interwave latency, and at a repetition rate of 50 Hz, diabetics had a longer III-V interwave latency than control subjects. These findings indicate a central disturbance in the auditory pathway. Microvascular complications (retinopathy, nephropathy) and the duration of diabetes were associated with the prolongation of auditory brainstem latencies. In contrast, poor metabolic control (high fasting blood glucose and glycated hemoglobin A1c) at the time of the present study was only marginally associated with prolonged auditory brainstem latencies. The changes in auditory brainstem latencies associated with diabetic neuropathy (measured with five cardiac autonomic nervous function tests) appeared simultaneously with microvascular complications and in patients with diabetes of long duration, and thus a causative role of diabetic neuropathy in the pathogenesis of prolonged auditory brainstem latencies remains unsolved. CONCLUSION: Delayed auditory brainstem latencies in type I diabetic patients are probably caused by the long duration of diabetes and the microvascular complications associated with it.

Jaw fractures in children.

From a total of 350 jaw fractures treated in 1980-1984 at Kuopio University Central Hospital, 20% were in children. These injuries were evaluated retrospectively regarding age, sex, incidence and etiology. Forty-five of the patients were boys and 25 girls. The frequency of maxillary and mandibular fractures in 70 young patients was 28.6%. The most common type of bone fractures was fracture of the alveolar process, which was prevalent in persons with mixed dentition. Before the age of 7 years, falls from height were the common causes of jaw fractures. The major cause of the jaw fractures in children from 7 to 15 years old was road accidents (47.1%), especially in boys. Most of these were cycling accidents, only a few patients were victims of automobile accidents. In addition, about one third (25.7%) of the patients were treated in the hospital because of multiple injuries to other organs.

Extranodal head and neck non-Hodgkin's lymphomas in children in Finland.

During the 20-year period from 1961 to 1980, 17 cases of extranodal head and neck non-Hodgkin's lymphoma in children under 15 years of age were diagnosed in Finland. Eight cases had tumours in tonsils or nasopharyngeal adenoids and 9 cases lymphomas of other sites of the head and neck. The age-adjusted annual incidence rate for all cases was 0.69 and for tumours of the pharyngeal lymphatic tissue 0.35 per 10(6) children. Seven of the 17 tumours were undifferentiated lymphomas (Burkitt's and non-Burkitt's types) and 5 lymphoblastic lymphomas. The overall 5-year disease-free survival rate was 37%. Five of the 9 patients with tonsillar or adenoid lymphomas were disease-free more than 5 years.

Detection of human papillomavirus (HPV) DNA in oral squamous cell carcinomas by in situ hybridization and polymerase chain reaction.

A series of 156 formalin-fixed, paraffin-embedded biopsies from 40 patients with surgically-treated oral squamous cell carcinomas was analysed for the presence of human papillomavirus (HPV) infection by histopathological evaluation, in situ DNA hybridization and polymerase chain reaction (PCR). Epithelial changes suggesting a HPV lesion within, or adjacent to, the carcinoma lesions were found in 16 out of 40 patients (40%). Morphological signs of a flat HPV lesion were found in four cases (10%), those of inverted type in three cases (7.5%), and those of papillary type in nine cases (22.5%). HPV DNA was demonstrated in one of the lesions by in situ hybridization with biotin-labelled DNA cocktail probe containing HPV types 6, 11, 16 and 18. With the PCR technique, samples from 11 (27.5%) of the 40 patients proved to contain HPV DNA. Of these, HPV 6 was demonstrated in one case, HPV 16 in ten cases and HPV 18 in one case. HPV DNA was exclusively detected in the biopsies showing carcinoma tissue or its adjacent precancer lesions. No viral DNA was found in the biopsies derived from the tumour-free resection margins. These results provide further evidence to support the concept of HPV involvement in the aetiology of oral squamous cell carcinomas, most probably acting synergistically with other carcinogens.

Human papillomavirus (HPV) type 6 and 16 DNA sequences in bronchial squamous cell carcinomas demonstrated by in situ DNA hybridization.

A series of 131 routinely processed, paraffin-embedded biopsy specimens derived from the same number of patients with a bronchial squamous cell carcinoma were analyzed using in situ DNA-hybridization technique with a probe cocktail containing 35S-labeled human papillomavirus (HPV) DNA of types 6, 11, 16, 18, and 30. The 12 carcinomas shown to contain HPV DNA by the probe cocktail were subjected to in situ hybridization with the specific HPV DNA probes applied separately under high stringency conditions. HPV DNA could be found in 9 of these carcinomas; 2 cases contained HPV 6 DNA and 7 hybridized with HPV 16 DNA. The role of HPV in the development of bronchial squamous cell carcinoma is discussed in the light of the previously established morphologic evidence as well as the increasing number of reports on malignant transformation of the respiratory tract HPV lesions. The present findings of HPV DNA sequences provide further support to the concept of HPV as a potential causative agent of some bronchial squamous cell carcinomas, possibly acting synergistically with chemical or physical carcinogens. As in the genital tract, it seems clear that a respiratory tract infection by "low-risk" HPV types 6 and 11 by no means excludes the possibility of malignancy, so far ascribed almost exclusively to the "high-risk" type HPV 16.

Human papillomavirus type 11 DNA in squamous cell carcinomas and pre-existing multiple laryngeal papillomas.

The case histories of 4 patients are presented, who developed an invasive squamous cell carcinoma from pre-existing multiple laryngeal papillomatosis (two juvenile-onset and two adult-onset) during a long latency period. A series of 14 routinely processed, paraffin-embedded biopsies obtained from these patients (including both benign papillomas and carcinomas) were analysed using in situ DNA-hybridization technique with 35S-labelled Human papillomavirus (HPV) DNA probes of HPV types, 6, 11, 16, 18 and 30. The lesions were also assessed by indirect immunoperoxidase (IP-PAP) technique to demonstrate the expression of HPV structural proteins. On light microscopy, morphology was consistent with HPV infection in all 14 biopsies. HPV antigen expression could not be demonstrated in any of the papillomas or carcinomas, however. HPV 11 DNA was present in high copy numbers in both the benign and malignant lesions of 2 patients, both presenting with the juvenile-onset disease. The present findings provide support for the role of HPV as an etiological agent in laryngeal squamous cell carcinoma, most probably acting synergistically with chemical or physical carcinogens (one patient received irradiation and 2 others were smokers). It seems clear that an infection by the 'low risk' HPV types 6 and 11 by no means excludes the possibility of developing a laryngeal malignancy, so far ascribed to the 'high risk' type HPV 16 only.

Oral cancer in children under 15 years of age. A clinicopathological and virological study.

11 malignant tumours of the oral region in children under 15 years of age were diagnosed in Finland during the 20-year period from 1961 to 1980; the age adjusted annual incidence rate being 0.31 per 1,000,000 children. 5 cases were intraoral cancer and 5 cases malignant tumours of the major salivary glands. The formalin-fixed tumours were studied using the in situ DNA hybridization technique for Adenovirus, group II, Epstein-Barr and human papillomavirus, type 16. For the first time, evidence was provided for the presence of Epstein-Barr virus in a malignant salivary gland tumour, implicating a possible etiological role for this virus in salivary gland neoplasms.

Squamous cell carcinoma of the tongue in children.

Only 14 case reports of squamous cell carcinoma of the tongue in children under 15 years of age had been published until 1980. One was reported in Finland as a second tumor in a patient with retinoblastoma. According to the Finnish Cancer Registry, which covers the whole population, three cases of squamous cell carcinoma of the tongue in children under 15 years of age have been diagnosed in Finland during the 20 years from 1961 to 1980; the age-adjusted annual incidence rate being 0.13 per 1,000,000 children per year. According to the available material, the prognosis of squamous cell carcinoma of the tongue in children is poor. The treatment has followed the guidelines for adults.

Immunocompetent cell reaction in prognostic evaluation of squamous cell carcinoma of the lip.

An intimate interplay between the host factors and the tumour seems to be operative in lip cancer, and is undoubtedly capable of modifying the clinical course of the disease. A series of 70 patients with squamous cell carcinoma of the lip was assessed by light microscopy and using histochemical staining for acid alpha-naphthyl acetate esterase to demonstrate the morphological manifestations of tumour-host reactivity. The factors analysed include stromal reactions; intensity of the immunocompetent cell infiltrate including mast cells, and the subpopulations, i.e. B or T lymphocytes and mononuclear phagocytes (MPS cells). B lymphocytes far outnumbered the T and MPS cells in all the infiltrates studied, the percentages of the latter two cell types being inversely related to the intensity of the infiltrate, however. The cell composition in the infiltrates lacked statistically demonstrable effect on the frequency of metastases and the 5-year survival, as did the stromal mast cell reaction, too.

Finnish approach to the treatment of acute otitis media. Report of the Finnish Consensus Conference.

The theme of the first consensus conference to be held in Finland was the treatment of acute otitis media. The statements and recommendations accepted by the conference, which was organized according to the National Institutes of Health model, are presented in this report. On the basis of scientific knowledge, clinical experience, and conditions in Finland, the conference delegates concluded that penicillin V, in large doses, is still the drug of first choice in this disease. The importance of surgical drainage of the middle ear was stressed, as was the necessity of careful follow-up of the patient until the condition is completely healed. Decongestants were considered rather useless. In the prevention of recurrent attacks, adenoidectomy but not tonsillectomy was regarded as being of help, tympanostomy of probable benefit, antimicrobial (sulfonamide) prophylaxis worth considering in selected cases, but the effect of pneumococcal vaccination poor. The conference delegates agreed that uncomplicated acute otitis media should, as before, usually be treated by physicians taking care of children at the primary health care level.

Human papillomavirus DNA in squamous cell carcinomas of the larynx demonstrated by in situ DNA hybridization.

A series of 116 consecutive laryngeal squamous cell carcinomas were analyzed using an in situ DNA hybridization technique with 35S-labelled human papillomavirus (HPV) DNA probes to demonstrate the DNA of HPV types 6, 11, 16 and 30, in routinely processed, paraffin-embedded biopsies. The lesions were also assessed on light microscopy for HPV-suggestive morphological features, and by indirect immunoperoxidase (IP-PAP) technique to demonstrate the expression of HPV structural proteins (viral antigens). A total of 15/116 (12.9%) of the tumors were shown to contain the DNA of at least one HPV type. HPV 11 was the most frequent DNA type, found in 9/116 (7.8%) of the lesions, followed by HPV 16 (5.2%), and HPV 6 (4.3%). Noteworthy is the failure to disclose the recently described HPV type 30 DNA (suggested to be specific for laryngeal carcinomas) in any of the 116 carcinomas studied. Double infections (more than one HPV type) were disclosed in 5 (33.3% of the HPV DNA-positive) carcinomas: HPV 6 and 11, 1 case; HPV 6 and 16, 2 cases, and HPV 11 and 16, 2 cases. Light microscopic morphology was HPV-suggestive in 6 (40%) of the 15 HPV DNA-positive lesions, but HPV antigen expression could be demonstrated in one of these tumors only (6.7%). The present findings provide support to the concept on HPV as an etiological agent in laryngeal squamous cell carcinoma, most probably acting synergistically with chemical carcinogens. In addition to the 'high risk' HPV 16, a risk to develop a laryngeal malignancy may be associated with the 'low risk' types HPV 6 and 11 as well, previously demonstrated in benign laryngeal papillomas only.

Artifacts in ultrastructure of respiratory cilia caused by various fixation procedures and different types of handling.

The ciliary ultrastructure with different fixatives and buffer combinations and artifacts caused by handling the specimens was studied in samples from respiratory mucosa. After different standard fixatives the ciliary ultrastructure did not vary much. Glutaraldehyde in cacodylate gave the best result; the contrast was good and the cell membrane did not show undulation and so many blebs as with other fixatives. With old 4% formaldehyde + 1% glutaraldehyde inphosphate the cytoplasm was darker and the contrast was not as good as with a fresh fixative. Mechanical damage caused rupture of the cell membrane and sometimes changes in axonemal architecture. These findings are similar to those often seen in human samples. The axonemal architecture was always intact if the cell membrane was intact.

Congenital dermoid cysts of the tongue.

A case of large dermoid cyst in the tongue in a 3 1/2-month-old child is presented. Histologically it was an epidermoid cyst. Typically corresponding cysts are diagnosed during the first four months of life. When the cyst was punctured, some keratin escaped and caused a granulation tissue reaction with granulocytes between the muscles of the tongue. The cyst was treated by marsupialization. No abnormality in the shape or function of the tongue was seen after 24 months.

Long-term safety and efficacy of budesonide nasal aerosol in perennial rhinitis. A 12-month multicentre study.

A long-term safety study of intranasally administered budesonide, a topical glucocorticoid, has been performed. 104 patients with perennial rhinitis, allergic or non-allergic, participated in a multicentre study in seven ENT-clinics utilising an identical protocol. A budesonide dosage of 400 micrograms/day was used as starting dose, but the patients were at liberty to reduce the daily dose to 200 micrograms. The patients were observed at intervals up to 12 months. At the entry and follow-up visits the following parameters were recorded: rhinoscopic findings, nasal symptom scores, blood chemistry, hematology, urinalysis and determination of plasma cortisol levels before and after stimulation with ACTH (Synacthen). Nasal biopsies taken from 50 of the patients at the beginning and completion of the study were examined in a blinded way by an independent pathologist. The analysis revealed no histopathological changes of the nasal mucosa. At rhinoscopy no signs of atrophy or candida were reported. Lividity of the nasal mucosa was significantly reduced during the trial, which was also the case for nasal congestion and secretion. All nasal symptom parameters assessed by the patients were significantly reduced from baseline during the follow-up period. No clinically significant changes in the hematological and blood chemistry parameters were observed. Plasma cortisol analysis before and after challenge with ACTH revealed no influence on the hypothalamic pituitary adrenal axis. No tachyphylaxis was observed; on the contrary, there was a clear tendency for reduction of the daily dose of budesonide necessary to keep the patients symptom-free.(ABSTRACT TRUNCATED AT 250 WORDS)

Tumor differentiation and tumor-host interactions as prognostic determinants in squamous cell carcinoma of the lip.

A series of 70 patients with the squamous cell carcinoma of the lip and followed-up for at least 5 years, was assessed on light microscopy and using histochemical staining for ANAE (acid-naphthyl acetate esterase) to demonstrate the morphological manifestations of tumor-host reactivity. The factors analysed include cancer differentiation (intrinsic malignancy) and stromal reactions (intensity of the immunocompetent cell infiltrate including the mast cells and the subpopulations, i.e. B- or T lymphocytes or mononuclear phagocytes). Differentiation of the lip cancer was shown to be directly (although not statistically significantly) related to the 5-year survival, as was also the intensity of the stromal immunocompetent cell infiltration. Cancer metastases were evidently the most powerful prognostic determinants, their development being influenced both by the intensity of the stromal immunocompetent cell infiltrate and cancer differentiation. B lymphocytes far outnumbered the T and MPS cells in all the infiltrates studied, the percentages of the latter two cell types, however, being inversely related to the intensity of the infiltrate. The cell composition in the infiltrates was seemingly without effect on the frequency of metastases and the 5-year survival, as was the stromal mast cell reaction, too. It was concluded that analysis of tumor-host relationships using a variety of morphological and immunohistochemical techniques may be of benefit in predicting the clinical course of lip cancer.

Bilateral chronic otitis media.

We have compared the clinical presentations and results of operative treatment in 86 patients with bilateral chronic otitis media with findings in 641 patients with unilateral disease. Concomitant conditions such as cleft palate, rhinitis and chronic adenotonsillitis were found significantly more frequently in those patients with bilateral chronic otitis media than in the patients with unilateral disease. Additionally, cholesteatomas in the cases in which both ears were involved were larger than in those cases which only one ear was involved. The overall results of surgery were similar in the bilateral and unilateral cases. The timing of operation in cases of bilateral chronic otitis media and the special problems of operation on an only hearing ear are discussed.

The mycotic flora of adenoids and antibodies to Candida albicans in children.

We cultured the adenoid tissues of 72 children with recurrent respiratory infections for fungal organisms. We also took fungal cultures of nasopharyngeal secretions from 20 healthy children and 13 healthy adults as controls. Culture for fungi were positive in 15% of the patients, in 15% of the healthy adults and in 25% of the healthy children. Candida albicans, C. parapsilosis, C. tropicalis and Aspergillus sp. were the most common organisms found. In studying the children with recurrent respiratory infections, we were unable to find any significant correlation between the positive cultures and the age, type of day-care and previous antibiotic therapy given. We then studied the hemagglutination titers against C. albicans in 44 patients. This titer was 1:160 or lower in all but three patients, and was 1:320 in these latter three patients. However, fungal cultures were negative in all patients having hemagglutination titers of 1:80 or more.