A comparative morphologic and morphometric study about geniculate ganglion development in man and in rat.

CONCLUSIONS: Human-rat geniculate ganglion (GG) have multiple origins: (1) An initial proximity (20 µm) to the endocranial foramen of the IAM, suggests neural crest induction; and (2) The influence of epibranchial placodes: the tensor tympani muscle (TTM) and the otic apical coil. OBJECTIVES: This study was undertaken to determine the comparative development of human-rat GG. MATERIALS AND METHODS: A light microscopic study of the GG in human material obtained from spontaneous abortions at 9, 13, 14, 17, 18, and 30 weeks, and one neonate was done. This study examined Webster rat embryos and a post-natal series. Specimens were fixed in Bouin fluid, embedded in paraffin, cut, and stained with H&E. The histomorphometric data were obtained with image analysis software. RESULTS: The human fetus of 9 weeks presents two neuronal groups in the VII nerve: one near (20 µm) the IAM endocranial foramen, foraminal, and the other, tympanic. Neonate GG is located between the TTM and the cochlear apex (inwards). In the 16 day old rat embryo GG is placed within a canal containing the stapedial artery. In the adult rat the GG and the stapedial artery are placed within the IAM.

Principles of cranial base ossification in humans and rats.

CONCLUSIONS: 1. The principle of bilateral symmetry depends on the chordal cartilage that is the keystone in cranial base ossification in rats and humans, due to its anatomical situation and for the production of the chordin protein that regulates the bone morphogenetic protein BMP-7. 2. In humans and in rats, foramen lacerum closure follows a line of intramembranous ossification that depends on BMP-7, regulated by the first branchial pouch. 3. The cranial base ossification patterns and centres are similar in humans and in rats, except in the otic capsule, palate and the lateral pterygoid plate. 4. The neural crest may induce cranial ossification through the cranial nerves. OBJECTIVES: To study the patterns of cranial base ossification in humans and in rats, considering the chordal cartilage, and the otic, nasal and orbit capsules, as well as the participation of the branchial arches and pouches. METHODS: This was a light microscopy study of human fetal specimens obtained from spontaneous abortions with the following crown-rump-lengths (crl) 45, 74, 90, 134, 145 and 270 mm, and a 1-day-old neonate (360 mm crl), who had died of sudden death syndrome. We also examined Webster albino rat embryos of 16, 18 and 20 days of gestation and a postnatal series of rats 8 h and 1, 3, 4, 6, 7, 10 and 13 days old, as well as adult animals. RESULTS: In the 45 mm human fetus, the chordal cartilage with the nasal, otic and orbit capsules initiates cranial base ossification. Foramen lacerum closure begins in the 16-day-old rat embryo, following a line of membranous ossification between the external pterygoid process and the lateral alisphenoidal wing at ovalis foramen level. This is not a timing symmetrical process, which may persist until the 10th postnatal day in the rat. In the human fetus of 74 mm, the foramen lacerum space is closed by a membranous fusion ossification between the chordal cartilage and otic capsule, finishing at the 270 mm specimen. Endochondral ossification of the human otic capsule first appeared in the 145 mm (18 weeks) fetal specimen with four ossifying centres. The rat otic cartilaginous capsule showed rapid endochondral ossification, in the third and fourth postnatal day specimens.

Inflammatory myofibroblastic tumor of the temporal bone: a histologically nonmalignant lesion with fatal outcome.

INTRODUCTION: Inflammatory myofibroblastic tumor (IMFT) of the temporal bone is an unusual but distinct clinicopathologic entity. CASE REPORT: We report the case of a 75-year-old patient with an IMFT located in the temporal bone. Symptoms included VI, X, XI, and XII cranial nerves palsies. Computed tomography and magnetic resonance images are described. The lesion was locally aggressive and outcome was fatal. IMFT was identified by analysis of postmortem specimen with histopathologic and immunohistochemical confirmation. DISCUSSION: IMFT can be locally destructive lesions. Involvement of the skull base and cervical spine is indistinguishable from an aggressive infection or a malignant tumor and can be fatal as in our case report. The difficulties in establishing clinicopathologic diagnosis, radiological imaging characteristics, and treatment are discussed.

[Analysis of the anthropometric, epidemiological, and clinical parameters in patients with snoring and obstructive sleep apnoea]. / Análisis de los parámetros antropométricos, epidemiológicos y clínicos en los pacientes con roncopatía y síndrome obstructivo de apnea-hipopnea del sueño.

OBJECTIVES: The existence of snoring, apnoeas and diurnal somnolence constitutes obstructive sleep apnoea (OSA), a disease of high prevalence that can cause serious complications. We have made a descriptive study of the epidemiological and clinical characteristics of patients with suspected OSA, with the main target of knowing the value of some of these characteristics in the evaluation of these patients. PATIENTS AND METHOD: We have had access to a retrospective sample of 433 patients (361 men and 72 women) with an average age of 47 (11.1) years (range, 18-75), referred due to suspected OSA. The variables and examinations studied were: age, gender, electrocardiogram, spirometry, blood pressure, smoking, neck perimeter, body mass index (BMI), daytime drowsiness (Epworth Sleepiness Scale), nasal and pharyngeal examination, Müller's manoeuvre, and Respiratory Disturbance Index (RDI). RESULTS: Patients with OSA included in this study are older and more obese, and they have a greater neck perimeter. In addition, they present greater daytime sleepiness and a greater frequency of pharyngeal collapse in Müller's mano-euvre than mere snorers. Clinical and epidemiological parameters were seen to correlate better with the existence of OSA in clearly obese individuals (BMI >30) than in individuals with normal BMI scores (<24) or even overweight (25-29). As far as age was concerned, the clinical and epidemiological parameters showed more statistically significant differences between patients with OSA and simple snorers among the youngest individuals in our sample (<43 years of age). CONCLUSIONS: Physical examination and the clinical and epidemiological data are useful to complete the diagnostic assessment of these patients.

Análisis de los parámetros antropométricos, epidemiológicos y clínicos en los pacientes con roncopatía y síndrome obstructivo de apnea-hipopnea del sueño / Analysis of the anthropometric, epidemiological, and clinical parameters in patients with snoring and obstructive sleep apnoea

Objetivos: Los ronquidos, las apneas y la somnolencia diurna constituyen el síndrome de apnea-hipopnea obstructiva del sueño (SAHOS), enfermedad de elevada prevalencia que puede causar graves complicaciones. Hemos realizado un estudio descriptivo de las características epidemiológicas y clínicas de los pacientes con sospecha de SAHOS, con el objetivo principal de conocer el valor de algunas de esas características en la evaluación de los pacientes. Pacientes y método: Hemos dispuesto de una muestra retrospectiva de 433 pacientes, 361 varones y 72 mujeres, con una media ± desviación estándar de edad de 47 ± 11,1 (intervalo, 18-75) años, remitidos por sospecha de SAHOS. Las variables y exploraciones estudiadas fueron edad, sexo, electrocardiograma, espirometría, presión arterial, tabaquismo, perímetro del cuello, índice de masa corporal (IMC), test de somnolencia diurna (Epworth Sleepiness Scale), exploración nasal y faríngea, maniobra de Müller e índice de apnea-hipopnea (IAH). Resultados: Los pacientes con SAHOS incluidos en este estudio tienen más edad, son más obesos y tienen mayor perímetro cervical. Además, presentan más somnolencia diurna y mayor frecuencia de colapso faríngeo en la maniobra de Müller que los roncadores simples. Por otra parte, se observó que los parámetros clínicos y epidemiológicos se correlacionan mejor con el diagnóstico de SAHOS en los individuos con obesidad franca (IMC > 30) que en los individuos con IMC normal (< 24) e incluso con sobrepeso (IMC 25-29). En cuanto a la edad, los parámetros clínicos y epidemiológicos mostraron más diferencias estadísticamente significativas entre los pacientes con SAHOS y los roncadores simples en los individuos más jóvenes de nuestra muestra (menores de 43 años). Conclusiones: La exploración física y los datos epidemiológicos y clínicos son útiles para completar la evaluación diagnóstica de estos pacientes

Objectives: The existence of snoring, apnoeas and diurnal somnolence constitutes obstructive sleep apnoea (OSA), a disease of high prevalence that can cause serious complications. We have made a descriptive study of the epidemiological and clinical characteristics of patients with suspected OSA, with the main target of knowing the value of some of these characteristics in the evaluation of these patients. Patients and method: We have had access to a retrospective sample of 433 patients (361 men and 72 women) with an average age of 47 (11.1) years (range, 18-75), referred due to suspected OSA. The variables and examinations studied were: age, gender, electrocardiogram, spirometry, blood pressure, smoking, neck perimeter, body mass index (BMI), daytime drowsiness (Epworth Sleepiness Scale), nasal and pharyngeal examination, Müller’s manoeuvre, and Respiratory Disturbance Index (RDI). Results: Patients with OSA included in this study are older and more obese, and they have a greater neck perimeter. In addition, they present greater daytime sleepiness and a greater frequency of pharyngeal collapse in Müller’s mano-euvre than mere snorers. Clinical and epidemiological parameters were seen to correlate better with the existence of OSA in clearly obese individuals (BMI >30) than in individuals with normal BMI scores (<24) or even overweight (25-29). As far as age was concerned, the clinical and epidemiological parameters showed more statistically significant differences between patients with OSA and simple snorers among the youngest individuals in our sample (<43 years of age). Conclusions: Physical examination and the clinical and epidemiological data are useful to complete the diagnostic assessment of these patients

The predictive value of clinical and epidemiological parameters in the identification of patients with obstructive sleep apnoea (OSA): a clinical prediction algorithm in the evaluation of OSA.

We sought to analyze the predictive value of anthropometric, clinical and epidemiological parameters in the identification of patients with suspected OSA, and their relationship with apnoea/hypopnoea respiratory events during sleep. We studied retrospectively 433 patients with OSA, 361 men (83.37%) and 72 women (16.63%), with an average age of +/-47, standard deviation +/-11.10 years (range 18-75 years). The study variables for all of the patients were age, sex, spirometry, neck circumference, body mass index (BMI), Epworth sleepiness scale, nasal examination, pharyngeal examination, collapsibility of the pharynx (Müller Manoeuvre), and apnoea-hypopnoea index (AHI). Age, neck circumference, BMI, Epworth sleepiness scale, pharyngeal examination and pharyngeal collapse were the significant variables. Of the patients, 78% were correctly classified, with a sensitivity of 74.6% and a specificity of 66.3%. We found a direct relationship between the variables analysed and AHI. Based on these results, we obtained the following algorithm to calculate the prediction of AHI for a new patient: AHI = -12.04 + 0.36 neck circumference +2.2286 pharyngeal collapses (MM) + 0.1761 Epworth + 0.0017 BMI x age + 1.1949 pharyngeal examinations. The ratio variance in the number of respiratory events explained by the model was 33% (r2 = 0.33). The variables given in the algorithm are the best ones for predicting the number of respiratory events during sleep in patients studied for suspected OSA. The algorithm proposed may be a good screening method to the identification of patients with OSA.