Estriol induced squamous metaplasia on the nasal mucosa in patients with hereditary hemorrhagic telangiectasia.

BACKGROUND: The aim of this study was to evaluate by light and electron microscopy the effect of topical estriol on the nasal mucosa in patients with hereditary hemorrhagic telangiectasia (HHT). METHODS: Twelve patients were instructed to apply twice daily 0.1% estriol as a nose ointment over a period of 12 months. Written consent was obtained from each patient, allowing biopsy specimens of the nasal mucosa to be taken prior to and 3, 6 and 12 months after estriol application. RESULTS: Metaplastic change of the nasal mucosa was observed 6 months after topical estriol application. The former ciliated columnar epithelium changed into a keratinizing squamous epithelium. The effect was reversible after discontinuation of estriol application. CONCLUSIONS: For the first time, we could outline the effect of topical estriol on the nasal mucosa. These histomorphological findings, and the fact that estriol is a low-potency metabolite of estradiol, make estriol a valuable agent in the treatment of HHT patients.

Argon plasma coagulation (APC) surgery in otorhinolaryngology.

The Argon Plasma Coagulation (APC) technique has been used with success in open surgery and endoscopy for hemostasis and thermal devitalisation of pathological tissue. We developed techniques and instruments for the use of this technique in Otorhinolaryngology, because of its excellent hemostatic effects and devitalising properties. APC surgery is based on a monopolar high-frequency (HF) electrical current transmitted through ionized argon gas from the tip of an applicator to the tissue surface in a contact-free mode. Indications for the use of this technique include hyperplasia of the inferior turbinate in nasal obstruction, recurrent epistaxis in hereditary hemorrhagic telangiectasia, leukoplakia of the mucosa, recurrent respiratory papillomatosis (RRP) of the lower airway, in combination with flexible systems. A combined technique of blunt dissection and plasma coagulation has been designed for bloodless removal of the tonsils. This new technique offers a wide variety of advantages. The limited penetration depth makes APC surgery a safe procedure; damage to neighbouring tissue can be avoided. The APC technique is a useful and comparable inexpensive method to achieve devitalisation of tissues and easy to handle hemostasis.

Benign mixed tumor of the lacrimal gland. Clinical diagnosis and surgical management.

The accurate clinical diagnosis of benign mixed tumors of the lacrimal gland is important for the proper therapeutic management. We present an adult case with a benign mixed tumor of the orbital lobe of the lacrimal gland, 8 years after periorbital blunt injury. The tumor lesion was diagnosed later in the persisting traumatic tumefaction region. Clinical examination, ultrasonography and MRI revealed a soft-tissue mass with high density and peripheral enhancement over the superior lateral portion of the right eye with expansion to and invasion of the orbital roof and lateral wall. Lateral orbitotomy was performed to resect the tumor. Histopathology disclosed a pleomorphic adenoma of the orbital lobe of the lacrimal gland. Pleomorphic adenomas of the lacrimal gland are seen rarely. The awareness of the clinical and diagnostic features of benign mixed tumors of the orbital lobe should help to avoid complications arising from an incisional biopsy or incomplete tumor resection.

Administration of autologous fetal membranes: Effects on the coagulation in pregnant mini-pigs.

OBJECTIVE: A hallmark of the so-called amniotic fluid embolism is the induction of coagulation defects. Entry of meconium-free autologous amniotic fluid into the circulation, however, is innocuous. Little is known about the true causative agent or agents. The purpose of this study was to assess the effects of homogenized autologous fetal membranes (FM) on the coagulation system in the mini-pig model. DESIGN: Laboratory study. SETTING: University institute animal laboratory. SUBJECTS: Six near-term pregnant, Göttingen-bred mini-pigs. INTERVENTIONS: After induction of general anesthesia, FM were col-lected from all animals by cesarean section. Animals received 2 g FM (shredded and suspended in lactated Ringer's solution) via an ear vein. MEASUREMENTS: Blood samples were taken from a central vein before administration (baseline), immediately after administration, every 10 mins until 90 mins after administration, and every 20 mins until 150 mins after administration. The following parameters were measured: platelets, partial thromboplastin time, prothrombin time index, fibrinogen, factors II, V, VII, VIII, IX, X, XI, antithrombin III, and protein C. The values relative to baseline in the FM group were compared with a historical control group by rank order test. A p <.05 was considered significant. MAIN RESULTS: In the FM group (compared with the control group), platelets were lower; partial thromboplastin time was prolonged; fibrinogen was lower; prothrombin time index was lower (ie, prothrombin time was prolonged); protein C and antithrombin III were lower; and activity levels of factors V and VII were lower. The levels of factors II, VIII, IX, X, and XI showed a trend toward lower activity in the FM group, but the differences were not statistically significant. CONCLUSIONS: FM can activate coagulation in mini-pigs. The laboratory parameter changes seen are typical for disseminated intravascular coagulation. However, the full clinical picture of amniotic fluid embolism and disseminated intravascular coagulation could not be elicited despite the high dose of FM used.