[MALT and the Epithelium of the Middle Ear Mucosa. Morphological Studies]. / MALT und Epithel der Mittelohrschleimhaut. Morphologische Untersuchung.

INTRODUCTION: The mucosa of the middle ear and the Eustachian Tube changes in different ways when faced with recurrent episodes of inflammation. It thereby adapts to these new stimuli and insults from the environment. One of these changes is the development of MALT (mucosa associated lymphoid tissue). Another adaptation is an alteration of the epithelium. It was therefore the purpose of this study to look for a connection between the occurrence of these changes. MATERIAL AND METHODS: 90 sections of temporal bones were examined under the light microscope and the incidence of MALT and nature of the epithelium found were compared. RESULTS: Particularly in the middle ear, we demonstrated that in cases where MALT was found within the mucosa, columnar epithelium was frequently found in locations where it is typically rare. Squamous epithelium was in many cases replaced by cuboidal epithelium. DISCUSSION: We demonstrated that the mucosa of the middle ear changed its morphology towards the characteristics typically found in the upper respiratory tract in cases where MALT had developed as subepithelial lymphoid follicles. It can therefore be concluded that both changes represent the mucosa's reaction to recurrent or chronic inflammation.

Benign and malignant salivary gland diseases in children A retrospective study of 549 cases from the Salivary Gland Registry, Hamburg.

OBJECTIVE: Tumors of salivary glands in children are rare. Basically all types of salivary gland diseases during the period of childhood are described. The incidences of salivary gland tumors in children (0-14 years) differ completely from those in adults. Especially the malignant neoplasms are very rarely described in literature. Only some collective reviews and case reports try to summarize frequency, distribution concerning sex and age, morphology and localization. METHODS: In our study we were able to draw data from the Hamburg Salivary Gland Registry, concerning the last 25 years regarding histopathological diagnosis, age, gender and localisation of the pathologies. Findings were compared to other studies. Most of the specimens were presented by the Clinic for Otorhinolaryngology and Head and Neck Surgery, University Hamburg, Eppendorf. As a reference centre for salivary gland diseases some material was sent by other institutions. RESULTS: This study will give a detailed survey of salivary gland diseases and tumors in children up to the age of 14 which have undergone surgical therapy/biopsy. We present the general distribution of the different tumors/diseases, the distribution in certain age groups and the various locations. 549 cases could be examined. Comparing the distribution of malignant tumors with other studies, the epithelial-myoepithelial carcinomas followed by salivary duct carcinomas represent the largest group in childhood. CONCLUSIONS: The study shows that comparing to adulthood different tumors play an important role in adolescence. The distribution of tumors in childhood may help in diagnostic. Further many salivary gland diseases in childhood underwent surgery/biopsy although this is not supposed to be the proper treatment. The study shows that the right diagnosis most often can only be reached by surgery and histology.

[Histomorphological study of experimentally induced canalolithiasis]. / Histomorphologische Untersuchung bei experimentell induzierter Kanalolithiasis.

Free otoconia in the posterior semicircular canal (pSCC) are regarded as the main reason for benign paroxysmal positional vertigo. We investigated the distribution of otoconia in the membranous labyrinth of guinea pigs (n = 34) after a defined rotatory/angular kinetic acceleration. The angular kinetic energy of the rotatory experiment produced a dislocation of the otoconia and sometimes of the complete gelatinous otolithic membrane of the utricular and saccular macula. The otoconia could be observed in all three semicircular canals but predominated in the dark cell areas of the utricular side of the lateral SCC. A total obstruction of the semicircular canal could never be seen. Close to the lateral crista, perilymphatic hemorrhage could frequently be observed. The saccular otoconia were located in the amalgamation between endolymphatic membrane and saccule. The results of this histological study can form the basis for different theories about the genesis of canalolithiasis and cupulolithiasis and the vertigo which accompanies them.

[Extranasal glioma. On the differential diagnosis of frontonasal abnormalities]. / Das extranasale Gliom. Zur Differentialdiagnose und Therapie frontonasaler Fehlbildungen.

A case of extranasal glioma without other heterotopias of brain tissue is presented. The endonasal biopsy of this tumor presented histologic evidence of ectopic glial tissue surrounded by connective and mucosa tissue. Before any surgical procedure can be performed, radiographic (computed tomography and magnetic resonance imaging) examination is essential to rule out possible communication of the tumor with intracranial space. Surgical excision is necessary to prevent deformities of the nasal structure from occurring. Previously reported cases of nasal glioma are reviewed and problems in diagnosis and management are discussed.

[Clinical relevance of developmental changes of the endolymphatic sac]. / Klinische Relevanz entwicklungsbedingter Veränderungen des Saccus endolymphaticus.

BACKGROUND: Outcome of endolymphatic sac shunt surgery crucially depends on endolymphatic sac morphology. The intraoperative finding of a fibrotic sac, e.g., will lead to therapy-failure. Aim of the present study was to determine possible developmental changes in endolymphatic sac morphology which could imply, that a shunt operation should not be undertaken in older age. METHOD: 46 histological temporal bone serial sections were examined. All sections were taken from the "Wittmaack Temporal Bone Collection". All specimens were obtained from patients with morphologically healthy ears, especially without a history of Menière's disease or other kinds of vertigo. RESULTS: During the fetal period the endolymphatic sac is a wide cavity that is surrounded by immature embryonal connective tissue. In older age this cavity gradually shrinks, leading to stenosis in about 80% of the cases. The endolymphatic duct, however, remains open. CONCLUSION: The increasing fibrosis of the endolymphatic sac is part of the natural involution of the inner ear. It constitutes a natural limitation for the outcome of endolymphatic sac shunt surgery in the elderly.

[Primary carcinoma of the ear canal. Clinical aspects, intratemporal growth behavior and surgical strategy]. / Das primäre Gehörgangskarzinom. Klinik, intratemporales Wachstumsverhalten und operative Strategie.

BACKGROUND AND OBJECTIVE: The symptoms and microscopic findings in carcinoma of the external auditory meatus are often unspecific and misinterpreted as recurrent otitis externa. A definite diagnosis is therefore often delayed, frequently resulting in advanced tumor stages with unfavorable prognosis at the time of diagnosis. PATIENTS/METHODS: In a retrospective analysis of 11 of our own patients and four cases from the Wittmack collection, the clinical data and course of this disease were examined with particular focus on the intratemporal bone growth pattern and possible surgical strategies. RESULTS: Histopathologically, all cases consisted of squamous cell carcinoma of variable differentiation, with predomination of higher tumor stages (T2-T4: 93.3%) and little initial lymph node metastases (N+: 14.3%; M+: 0%). Osseous destruction was present (almost obligatory) in 93.3% (determined histopathologically and radiologically with CT). Follow-up (to a maximum of 6 years) after surgical resection and postoperative irradiation shows local recurrence at an average of 10 months in 40% of the cases, with a metastasis rate of 44.4%. Mean overall survival is 29.7 months, and 45.5% of the patients experience an average tumor-free period of 46.4 months. The most important prognostic factor in this context is the initial tumor stage. CONCLUSION: In regard to prognosis of external auditory meatus carcinoma, early diagnosis is of vital importance. Especially older patients (50-80 years) who previously have had no history of ear disease should undergo early computer tomographical examination and biopsy in cases of recurrent external otitis.

[The value of saccotomy in Menière disease. A long-term analysis of 42 cases]. / Zur Wertigkeit der Saccotomie beim Morbus Ménière. Eine Langzeitanalyse von 42 Fällen.

MATERIAL AND METHODS: Saccotomy is well known to be a specific alternative treatment for patients suffering from conservatively intractable Meniere's disease. In a long-term study, we investigated the results in hearing and vertigo after this operation and evaluated the subjective contentment of our patients. For the first time, we focused on the influence of an intraoperatively observed fibrotic narrowing (11 cases) of the endolymphatic sac ("sac fibrosis") on these results. RESULTS: We found complete restitution or significant improvement of the typical vertigo attacks after saccotomy in more than 80% of the cases with a normally shaped endolymphatic sac as determined microscopically during operation. In the cases with sac fibrosis, however, we saw a considerable reduction of this percentage to about 36%. Regardless of the presence of sac fibrosis, 50% of our patients showed progressive hearing loss in the operated ear after saccotomy. The postoperative hearing remained unchanged in about 25% of the cases. The contentment of the patients depended mostly on the postoperative vertigo and not on the hearing. CONCLUSION: We consider a microscopically normally shaped and wide saccus endolymphaticus to be a very important prognostic factor for the success of saccotomy. Consequently, preoperative selection of patients with sac fibrosis, for example, with high-resolution MRI, appears to be advisable.

[Anatomy of the valve system of the internal jugular vein]. / Zur Anatomie der Venenklappen der V. jugularis interna.

BACKGROUND: Central venous catheters (CVC) in the internal jugular vein have become an important adjunct to the overall management of intensive care patients, but their use is associated with frequent neck complications. In a review of the literature anatomical variation in size, form and function of the valve system of the internal vein was found. PURPOSE: This study macroscopically and microscopically investigates the anatomical variety of the vein valves of the inferior internal jugular vein. MATERIAL AND METHODS: 100 cadavers from legal autopsies were investigated. We selected 45 patients with an acute myocardial infarction death and a control group (55 patients) formed by different causes of death. The veins were prepared for light microscopic study, the specimens were serially sectioned (ca. 30 sections) and stained with hematoxylin and eosin. RESULTS: Anatomical variety was observed predominantly unilateral on the right side of the internal jugular vein. The valves were often bicuspid at the right side (92%) and tricuspid on the left side (64%) and mostly located ca. 2 cm above the subclavia-jugularis bifurcation. In the histological study, a variability of the net of collagen and elastin fibres in the tunica intima and media was observed. The structure of the adventitia was constant. 18 patients with a jugular valve vein incompetence (age over 60) appeared to have thickening of the tuberculum in the sinus of the valve. The cups of the valves were found rudimentary in these patients with advanced stages of tricuspid incompetence. CONCLUSION: The present study demonstrates the variety of the valves of the jugular vein. They play an important role to impede the retrograde flow during cardiopulmonary resuscitation as well as in jugular vein cannulation.

[Histopathological studies of intratemporal growth behavior of middle ear carcinoma]. / Histopathologische Untersuchungen zum intratemporalen Wachstumsverhalten des Mittelohrkarzinoms.

BACKGROUND: Otological hemorrhage otorrhea, and pain are amongst the first clinical signs of the middle ear carcinoma, which is usually diagnosed in advanced stages. Sudden deafness, facial nerve paralysis, and other symptoms of inner ear damage may be observed in the final stage. However, middle ear carcinoma is diagnosed extremely seldom in its early stages. The clinical management of this pathology is based on the knowledge of the tumor's pathways and its anatomic behavior. METHODS: Our study investigated 20 cases of middle ear carcinomas from the Wittmaack temporal bone bank (14 squamous cell carcinomas, 5 adenocarcinomas, and 1 adenoidcystic carcinoma) to analyze the behavior of the tumor growth and its influence on clinical symptoms. The aim was to determine criteria for early clinical diagnosis. RESULTS: The tumor arises in different regions of the temporal bone, and varying symptoms will subsequently reflect its pathway. When the tumor is confined to the middle ear area, its main location is the hypotympanum from which tumor spreads into the eustachian tube and, via infiltration of the adjacent bone structures (anterior wall of the middle ear), into the tensor tympani muscle and the sympathetic plexus of the internal carotid artery. Destruction of the ossicles was observed in the mid-tympanic cavity, and often only a thin layer of fibrous tissue from the Fallopian canal separated the tumor from the facial nerve (this nerve was rarely affected directly). The medial wall (labyrinthine wall) of the tympanic cavity remained intact in the majority of examined cases. The tympanic sinus, the round window niche, and the oval window niche did not show tumor infiltration. In the epitympanum, the tumor grew and infiltrated the adjacent mastoid. Larger tumors affected the internal auditory canal and infiltrated the acoustic nerve and the labyrinth. CONCLUSION: Improving the poor prognosis of middle ear carcinoma requires early diagnosis based on axial computed tomography (CT). Important factors in patient selection include age (50-70 years), sex (mostly women), and especially clinical symptoms (otorrhea, pain, hearing loss).

Lipid peroxidation in lung tissue after chest trauma and correlation with the duration of the post-trauma survival period.

Blunt chest trauma is a frequently encountered cause of death in forensic pathology and one of the organs most likely to be affected are the lungs. Assuming that the victim survives the initial trauma, reperfusion processes take place, free radicals are formed and lipid peroxidation occurs. The aim of this study was to ascertain whether the length of the survival time is correlated with the extent of lipid peroxidation in the lung tissue following such ischaemia-reperfusion processes. A study of 470 samples taken from all five pulmonary lobes from 94 cadavers was carried out. Cases were allocated to different groups according to whether there was chest trauma and/or a known survival period. Lipid peroxidation was investigated by determining malondialdehyde (MDA) levels. The lowest mean level of peroxidation was found in control cases showing no evidence of chest trauma at autopsy and no apparent survival period. Our results suggest that the level of lipid peroxidation in lung tissue can be a reliable indicator of survival processes.

[Burn fatalities in advanced age]. / Brandtodesfälle im fortgeschrittenen Alter.

At the Institute for Legal Medicine in Hamburg (investigation period 1983 to 1993) post mortem examinations were carried out in 45 elder people ( > 60 years) who died from major burns. This retrospective epidemiologic and descriptive study evaluates the factors associated with accidents and suicides in relation to the burn surface area, burn depth, location, the cause of death in the burn victims and carbon monoxide or cyanide gas poisoning. Severe burn injuries were the most common cause of death (41%), and in the majority of our cases the traumatic shock led to death during the first two hours. The accidents occurred at home, and were frequently connected with alcoholism and chronic diseases.