[Also consider sinusitis in facial pain: wisdown tooth, tumor, acute parotitis]. / Auch das müssen Sie beim V. a. Sinusitis abklären: Weisheitszahn, Tumor, akute Parotitis.

In numerous cases of head and facial pain, the underlying causes are found to be ENT problems. The most common cause of pain affecting the forehead and mid-facial region is acute sinusitis, in which the sphenoidal sinus is more commonly affected than previously assumed. Pain in the oral-facial region is largely due to disorders of the masticatory apparatus, but inflammatory diseases of the oral mucosa, abscesses or the so-called Eagle syndrome may also be involved. An accurate history and a clinical examination often points the physician in the right direction. To establish an accurate diagnosis, endoscopy of the upper airways and digestive system, together with ultrasonography, are usually required, followed, where necessary, by a radiological and NMR work-up, and puncture or biopsy. Provided that an accurate diagnosis has been established and multidisciplinary cooperation is available, the therapeutic options are usually effective.

[Acquired fibrotic atresia of the external auditory canal]. / Die erworbene fibrotische Gehörgangsatresie.

BACKGROUND: There are very few communications on this pathologic entity, which is also called "postinflammatory medial meatal fibrosis" (PIMMF), its etiology and the adequate therapy. Apparently the cause is a chronic inflammation (or chronic ekzema) of the medial part of the external meatus or also a long-lasting otorrhea in chronic otitis media. The stratified epithelium of the eardrum and of the adjacent bony meatus is destroyed and replaced by fibrotic tissue. The lateral part of the auditory canal remains open and has the form of the finger of a glove, it may contain granulations, but often it is lined with a smooth stratified epithelium. A severe conductive hearing loss is the result of this anomaly. PATIENTS: During the last 10 years we operated on 46 patients (52 ears) for this pathology: after retroauricular opening, which allows the best control of the anterior tympanomeatal angle, the fibrotic tissue was removed keeping the lamina propria intact. The bony canal was widened, if necessary. The eardrum and the bony canal were covered with split skin graft from the retroauricular region, then the canal filled with an antibiotic package for 3 weeks. RESULTS: Underneath the fibrotic tissue we detected 3 cholesteatomata of the annular region, so it is important to remember, that the atresia may also cover a dangerous pathology. 6 times a second operation was necessary, besides that, we observed 14 recurrencies. All other patients had a wide epithelialized ear canal, their conductive hearing loss disappeared, and the results were stable over several years. Bacteriological and histological examinations were not helpful to clear up the etiology of this disease. CONCLUSIONS: Surgery is the treatment of choice of the acquired atresia of the external meatus. We suppose that in these patients a individual disposition causes the formation of this excessive fibrosis, which has some similarity with keloid formation.

Poly(ADP-ribose) binds to specific domains in DNA damage checkpoint proteins.

Poly(ADP-ribose) is formed in possibly all multicellular organisms by a familiy of poly(ADP-ribose) polymerases (PARPs). PARP-1, the best understood and until recently the only known member of this family, is a DNA damage signal protein catalyzing its automodification with multiple, variably sized ADP-ribose polymers that may contain up to 200 residues and several branching points. Through these polymers, PARP-1 can interact noncovalently with other proteins and alter their functions. Here we report the discovery of a poly(ADP-ribose)-binding sequence motif in several important DNA damage checkpoint proteins. The 20-amino acid motif contains two conserved regions: (i) a cluster rich in basic amino acids and (ii) a pattern of hydrophobic amino acids interspersed with basic residues. Using a combination of alanine scanning, polymer blot analysis, and photoaffinity labeling, we have identified poly(ADP-ribose)-binding sites in the following proteins: p53, p21(CIP1/WAF1), xeroderma pigmentosum group A complementing protein, MSH6, DNA ligase III, XRCC1, DNA polymerase epsilon, DNA-PK(CS), Ku70, NF-kappaB, inducible nitric-oxide synthase, caspase-activated DNase, and telomerase. The poly(ADP-ribose)-binding motif was found to overlap with five important functional domains responsible for (i) protein-protein interactions, (ii) DNA binding, (iii) nuclear localization, (iv) nuclear export, and (v) protein degradation. Thus, PARPs may target specific signal network proteins via poly(ADP-ribose) and regulate their domain functions.

A pilot study: locus of control and spiritual beliefs in alcoholics anonymous and smart recovery members.

To investigate whether Alcoholics Anonymous' (AA's) "higher power" concept encourages externally dependent behavior, this pilot study tested whether AA and Self Management and Recovery Training (SR) members are equal on measures of external locus of control. The AA sample (N = 48) and SR sample (N = 33) were similar in age, gender, and education levels, and both required a minimum of 8 weeks group involvement. A modified spiritual beliefs questionnaire (SBQ) was first administered to each sample to compare them on spiritual beliefs, and the drinking-related locus of control scale (DRIE) was then conducted to compare each sample on locus of control. Significant differences were found between both samples on five out of seven spiritual measures, with the AA group scoring consistently higher on these factors (p < .01). In addition, the AA sample was significantly more external on the DRIE scale than the SR sample (p = .00003). These findings suggest that AA members are generally more spiritually oriented and exhibit greater external locus of control relative to SR members. Future controlled trials are necessary to confirm whether these results are caused by particular programs or primarily due to a self-selective process.

Treatment of a recurrent choanal atresia by balloon dilatation.

A 16-year-old female patient with recurrent stenosis after unilateral choanal atresia that had been treated by surgery and laser therapy presented with restenosis 3 weeks after laser resection. As an alternative to repeat surgery, she was treated by balloon dilatation. Four balloon dilatations were performed (three at 4-week intervals and the last after an 8-week interval) over a 4-month period on an outpatient basis. She tolerated the treatment well without any complications. Over a follow-up period of 2 years the choana has remained completely open. The balloon dilatation described in this context here for the first time may be a good alternative to repeated operations in the treatment of recurrent choanal atresia, with minimal stress to the patient.

Syntheses of photoactive analogues of adenosine diphosphate (hydroxymethyl)pyrrolidinediol and photoaffinity labeling of poly(ADP-ribose) glycohydrolase.

Two isomeric azidoadenosyl analogues of adenosine diphosphate (hydroxymethyl)pyrrolidinediol [ADP-HPD; Slama, J. T., et al. (1995) J. Med. Chem. 38, 389-393] were synthesized as photoaffinity labels for poly(ADP-ribose) glycohydrolase. 8-Azidoadenosine diphosphate (hydroxymethyl)pyrrolidinediol (8-N3-ADP-HPD) inhibited the enzyme activity by 50% at ca. 1 microM, a concentration 80-fold lower than that where the isomeric 2-azidoadenosine diphosphate (hydroxymethyl)pyrrolidinediol did. [alpha-32P]-8-N3-ADP-HPD was therefore synthesized and used to photoderivatize poly(ADP-ribose) glycohydrolase. Irradiation of recombinant poly(ADP-ribose) glycohydrolase and low concentrations of [alpha-32P]-8-N3-ADP-HPD with short-wave UV light resulted in the covalent incorporation of the photoprobe into the protein, as demonstrated by gel electrophoresis followed by autoradiography or acid precipitation of the protein followed by scintillation counting. No photoincorporation occurred in the absence of UV light. The photoincorporation saturated at low concentrations of the photoprobe and photoprotection was observed in the presence of low concentrations of ADP-HPD, an indication of the specificity of the photoinsertion reaction. These results demonstrate that [alpha-32P]-8-N3-ADP-HPD can be used to specifically covalently photoderivatize the enzyme to characterize the polypetides that constitute the ADP-HPD binding site of poly(ADP-ribose) glycohydrolase. The photoincorporation reaction was further used to determine the ability of ADP-ribose polymers of varying size to compete with [alpha-32P]-8-N3-ADP-HPD for binding to the enzyme. Photoincorporation of [alpha-32P]-8-N3-ADP-HPD was inhibited by 80% in the presence of low concentrations of short, unbranched ADP-ribose oligomers (5-15 ADP-ribose units in length). No similar photoprotection was afforded by the addition of a high-molecular weight highly branched polymer. These results indicate that the photolabel shares a binding site with the short, linear polymer, but not with the long, highly branched polymer.

Synthesis of Glutathione in Leaves of Transgenic Poplar Overexpressing [gamma]-Glutamylcysteine Synthetase.

Internode stem fragments of the poplar hybrid Populus tremula x Populus alba were transformed with a bacterial gene (gshl) for [gamma]-glutamylcysteine synthetase ([gamma]-ECS) targeted to the cytosol. Lines overexpressing [gamma]-ECS were identified by northern analysis, and the transformant with the highest enzyme activity was used to investigate the control of glutathione synthesis. Whereas foliar [gamma]-ECS activity was below the limit of detection in untransformed plants, activities of up to 8.7 nmol mg-1 protein min-1 were found in the transformant, in which the foliar contents of [gamma]-glutamylcysteine ([gamma]-EC) and glutathione were increased approximately 10- and 3-fold, respectively, without affecting either the reduction state of the glutathione pool or the foliar cysteine content. A supply of exogenous cysteine to leaf discs increased the glutathione content from both transformed and untransformed poplars, and caused the [gamma]-EC content of the transformant discs to increase still further. The following conclusions are drawn: (a) the native [gamma]-ECS of untransformed poplars exists in quantities that are limiting for foliar glutathione synthesis; (b) foliar glutathione synthesis in untransformed poplars is limited by cysteine availability; (c) in the transformant interactions between glutathione synthesis and cysteine synthesis operate to sustain the increased formation of [gamma]-EC and glutathione; and (d) the foliar glutathione content of the transformant is restricted by cysteine availability and by the activity of glutathione synthetase.

Nitinol esophageal stents: new designs and clinical indications.

PURPOSE: To evaluate the clinical use of covered and noncovered, knitted nitinol stents in patients presenting new stent indications. METHODS: Self-expandable, knitted nitinol stents were implanted in four patients for treatment of dysphagia. In two patients who had malignant strictures and had esophago-respiratory fistulae and in one patient with an esophagocutaneous fistula, polytetrafluoroethylene (PTFE)-covered stents were implanted. One patient received a noncovered stent, but a retrograde approach through a percutaneous endoscopic gastrostomy (PEG) fistula had to be chosen for recanalization of an esophageal occlusion. Two patients received stents for treatment of benign strictures. RESULTS: Recanalization of the stricture and stent implantation were performed under fluoroscopic control without any procedure-related morbidity or mortality. Dysphagia improved in all patients and the esophageal fistulae could be sealed off by covered stents. During a maximum follow-up of 18 months, there was no stent migration or esophageal perforation. Complications observed were stent stenosis due to food impaction (1/4) and benign stent stenosis (2/2). Most complications could be treated by the interventional radiologist. CONCLUSION: Self-expandable, covered Nitinol stents provide an option for the treatment of dysphagia combined with esophageal fistulae. In combination with interventional radiology techniques, even complex strictures are accessible. For benign strictures, the value of stent treatment has not yet been proven.

NAD glycohydrolases and the metabolism of cyclic ADP-ribose.

Cyclic ADP-ribose is a recently discovered metabolite of NAD that functions in cellular calcium signalling. The discovery that NAD glycohydrolases can catalyze the synthesis and hydrolysis of cyclic ADP-ribose has renewed interest in this class of ADP-ribose transferring enzymes that were discovered over 50 years ago.

[Bilateral massive macronodular adrenal gland hyperplasia. A rare cause of Cushing's syndrome]. / Bilaterale massive makronoduläre Nebennierenhyperplasie. Eine seltene Ursache des adrenalen Cushing-Syndroms.

A 46-year-old man with known arterial hypertension for 10 years had, over the last two years, developed increasing obesity, particularly of the trunk, with other symptoms typical of Cushing's syndrome. Hormone analysis demonstrated hypercortisolism and decreased plasma ACTH concentration. The dexamethasone inhibition test failed to show any significant suppression of serum cortisol. Plasma ACTH was not increased in the corticotrophin-releasing hormone and the metyrapone tests. In the short ACTH test there was an excessive cortisol increase. Abdominal computed tomography revealed both adrenals to be enlarged (6 x 4 cm) and coarsely nodular. Adrenolytic treatment with ketoconazole (400 mg daily) caused symptoms of adrenal insufficiency, but a reduced dosage of 200 mg daily lowered the cortisol level to between 5 and 11 micrograms/dl and normalized the blood pressure and clinical signs of Cushing's syndrome disappeared. Subsequent bilateral adrenalectomy confirmed the diagnosis of massive macronodular adrenal hyperplasia. Substitution treatment with twice daily 25 mg cortisone acetate and 0.05 mg fludrocortisone was started postoperatively.

[Stapes surgery in otosclerosis and small middle ear abnormality]. / Die Stapeschirurgie bei Otosklerose und kleiner Mittelohrmissbildung.

Stapes surgery in otosclerosis (first and revision operation) and in minor middle ear malformation follows the same principles, but the surgical problems are rather different. When analyzing three groups of patients, which had been operated on the same technique, we could show that the risks of the operation in malformation and revision surgery are not greater than they are in primary otosclerosis surgery. The audiologic results are more satisfying in the latter; malformation surgery and revision surgery have almost the same results which are lying somewhat below those of primary otosclerosis surgery. In the hands of an experienced surgeon, who is able to adopt his surgical technique at the individual situation, stapes surgery is nearly without risk in all these indications; an improvement of the air-conducting level of 18-23 dB can be expected and a social hearing above 35 dB can be provided in 83% of otosclerosis patients, in 79% of malformation patients and in 57% of revision patients.

[Distant metastases of epitheliomas of the upper respiratory and digestive tracts]. / Les métastases à distance des épithéliomas des V.A.D.S.

Distant metastases of ENT tumors are rare; when analysing 1.666 patients, we found them in 6.5%. They started especially from tumors of the hypopharynx (19.7%), oral cavity (7.6%), oropharynx (5.6%) and larynx (3.2%). 9 metastases were diagnosed, before therapy started, all the others appeared late, even later than 5 years after therapy in some cases of carcinoma of the larynx. The metastases were situated in the lung (71 cases), the skeleton (45 cases), the pleura (11 cases) and the liver (8 cases), but in rare instances in almost every organon. The main examinations for staging are therefore: the radiograph of the chest, the sonography of the abdomen and the scintigraphy of the skeleton. These examinations may be completed, if necessary, by the CT-scan. A patient with distant metastases never could be healed.

[Otogenic extradural pneumatocele, 36 years after a gunshot injury]. / Otogene extradurale Pneumatozele, 36 Jahre nach Schussverletzung.

In the reported case an extradural pneumatocele developed 36 years after the mastoid tip had been destroyed by a bullet. It had reached the occiput and led to destruction of the bone surrounding its distal end, so that air could be found directly under the galea. In the literature there are only few case reports referring the otogenic origin of a posttraumatic extradural pneumatocele. Furthermore, an overpressure in the middle ear cleft or mastoid could be excluded because of the presence of a tympanic membrane perforation. In spite of a chronically infected middle ear, there was no infection of the pneumatocele.