Biomedical subjects
Publications and source records attributed to C Buchwald.
We report a case of an expansive tumour extending from the lachrymal sac into the adjacent maxillary sinus. Histology showed a benign exophytic papilloma. By means of the in situ (DNA) hybridization technique, human papilloma virus (HPV) 6/11 were demonstrated, indicating a viral aetiology, similar to exophytic papillomas of the nose and larynx.
The association between human papillomavirus (HPV) and cervical carcinomas is well known. HPV has been found in oral carcinomas and paranasal papillomas, and the question of a causal role of HPV has yet to be answered. Reports on the frequency of HPV in oral and paranasal sinus tumours should be considered in relation to the frequency of HPV in normal oral and nasal mucosa. In the present study 61 normal individual had oral smears taken and 48 had nasal smears. These were examined for HPV by DNA amplification with HPV consensus primers. HPV was not found in the oral mucosa, while a single individual harboured HPV in the nasal mucosa. It is concluded that HPV is rarely present in normal oral and nasal mucosa.
To determine the role of human papillomavirus (HPV) in the etiology of sinonasal papillomas, 57 inverted papillomas including 5 cases associated with carcinomas, 16 exophytic papillomas, and 5 cases of columnar cell papillomas were examined for the presence of HPV DNA by in situ hybridization and polymerase chain reaction (PCR). The genetic studies were performed on the formalin-fixed, paraffin-embedded material. In only 6% of the 52 benign inverted papillomas was HPV DNA identified, whereas 69% of the exophytic papillomas were infected by HPV DNA. In none of the 5 cases with columnar cell papillomas could HPV be demonstrated. HPV 6/11 was identified in all of these HPV-positive cases. In the carcinoma area, HPV was detected in 2 (1 HPV 6/11 and 1 HPV 18) of the 5 inverted papillomas associated with carcinomas. The findings confirm the presence of HPV DNA in sinonasal papillomas. The results also indicate that HPV 6/11 may be involved in the pathogenesis of, solely, exophytic papillomas. We found that in situ hybridization and PCR seem equally sensitive in detecting HPV in sinonasal papillomas.
The present epidemiological and clinical study comprises 82 patients with sinonasal papillomas diagnosed from 1975 to 1993. Histology showed 58 cases of inverted papillomas including 5 cases of associated carcinoma, 19 cases of exophytic papilloma, and 5 cases of columnar cell papilloma. The incidence of sinonasal papillomas in Copenhagen County was 0.74 per 100,000 inhabitants per year. The inverted and columnar cell papillomas were typically located in the middle meatus with a varying degree of involvement of the adjacent sinuses. The exophytic papillomas were predominantly located multicentrically on the nasal septum. Good results of treatment, especially with regard to inverted papillomas, were not correlated to the aggressiveness of surgery. A lateral rhinotomy with medial maxillectomy was performed as primary surgery in 28 patients. In 50% of these patients there were recurrences. The preliminary results of endonasal endoscopic surgery revealed a high success rate, i.e., no recurrences in 5 cases so far. The septal papillomas were typically resected by a simple endonasal procedure. There were recurrences in 66% of these cases. The midfacial degloving procedure may be advocated instead of or as a supplement to the lateral rhinotomy if the tumor cannot be visualized sufficiently by endoscopy. Smoking may dispose to sinonasal papillomas.
Midfacial degloving is a well-known technique for entering the nasal and paranasal cavities, the rhinopharynx and the base of the skull. We report our experience with a modification of midfacial degloving, applied to two patients with extensive bilateral benign tumours in the nasal cavities and the paranasal sinuses. No rhinoplastic procedure is necessary in this modification, and the access to the upper part of the nasal cavity is improved.
A case of adult onset laryngeal papillomas with tracheal and bronchial involvement present at onset is presented. The presence of human papilloma virus (HPV) DNA type 6/11 is demonstrated by in situ hybridization.
To determine a possible etiological role of human papillomavirus (HPV) in sinonasal papillomas and squamous cell carcinomas, it is necessary to investigate normal nasal mucosa of healthy persons for the presence of HPV. The material in the present study consists of 21 biopsies taken from the inferior concha of 21 otherwise healthy persons who underwent surgery for nose fractures or nasoseptal deviations. In addition, five inferior conchae were obtained from persons who had died of non-neoplastic diseases. HPV was not detected in any of these specimens, either by polymerase chain reaction or by in situ hybridization. Histologic evaluation showed that squamous metaplasia was a common finding in the biopsies. The presence of HPV in sinonasal papillomas and carcinomas may indicate that HPV is an etiological factor in these lesions.
The frequency of human papillomavirus (HPV) in sinonasal papillomas seems to vary considerably. The highest frequencies have been reported by investigators using in situ DNA or RNA hybridization. Few studies have used polymerase chain reaction, and in these reports the frequency of HPV detection is rather low. We have investigated the presence of HPV in sinonasal papillomas using the polymerase chain reaction with a set of degenerated consensus primers, which amplify the vast majority of the known HPV types. Human papillomavirus was found in three of 14 papillomas. By in situ hybridization the same three papillomas were positive for HPV type 6/11.
This investigation was performed in order to evaluate the observer variations in facial nerve function after surgery for an acoustic neuroma. From 1976-90, 507 patients were operated on by the same surgical team (M.T. and J.T.) using a translabyrinthine approach. One hundred and forty-four patients living in Copenhagen City and County were invited for interview and objective examination. Only 128 patients attended the interview and examination which were carried out by the same ENT physician. Data concerning observation of the facial nerve function only is presented. Its function was clinically evaluated (using the House and Brackmann (1985) grading scale) by two different observers i.e. the ENT physician and one of the surgeons. The patients were asked face-to-face with the ENT physician to estimate the degree of facial nerve function according to a 0-100 per cent scale. Comparing normal and abolished facial nerve function the judgments of the ENT physician and the surgeon agreed with the patient's own evaluation.
A man aged 23 years sustained a blunt injury to the neck. An unusually large haematoma and an abscess developed. The clinical picture, pathogenesis and treatment are described.
This investigation was performed to describe some aspects of the quality of life in subjects after translabyrinthine removal of an acoustic neuroma, resulting in unilateral total deafness. Two hundred ninety-three subjects who had been operated on during 1976 through 1990 and who were living outside the Copenhagen (Denmark) City and County received a postal questionnaire, to which 93% (n = 273) responded: 118 men and 155 women with a median age of 58 years (range, 18 to 81 years). The median observation period from surgery to the questionnaire was 6 years (range, 6 months to 14 years), and the median age at operation was 52 years (range, 15 to 76 years). Among the subjects, 22% had received postoperative hearing rehabilitation with various types of hearing aids in the ear not operated on. In 62%, tinnitus was experienced in the ear with tumor before surgery, and at the time of the questionnaire, 49% experienced tinnitus in the ear operated on. Half a year after surgery, 56% still experienced dizziness. Sixty-four percent reported damage to the facial nerve in relationship to the operation. At the time of the questionnaire, 12% indicated a total loss of facial nerve function. No vocational consequences were found in 74% after surgery. Information concerning different symptoms related to surgery was insufficient in 29%, while the quality of information in relation to surgery was more satisfying. In conclusion, the study demonstrates that deafness, dysequilibrium, and reduced facial nerve function caused the most severe problems. Improved information to patients before surgery may reduce the frequency of negative experiences.
Keloid formation is a rare complication of normal scar tissue development, also to the surgeon who performs surgery on the external ear. We are presenting 4 cases of keloid formation which occurred after ear piercing in 2 cases and after otoplasty in another 2 cases. The treatment of keloid formation caused difficulties and is not unequivocal. Therefore we wish to present our experiences as we have seen no cases of keloid formation after otoplasty described in the literature.
The combination of parapharyngeal abscess and torticollis in an adult on account of spastic contraction of the sterno-cleido-mastoid muscle is an extremely rare condition. The present authors have recently observed a case of this type where the diagnosis was difficult to establish. CT of the neck revealed the diagnosis with no difficulty. The indication for CT at an early stage in cases of unexplained neck infections is stressed.
The object of the study was a reassessment of the old but still widely accepted apophthegm that recurrent nerve palsy prohibits surgery in patients with pulmonary cancer. Out of 1,279 patients admitted over a 10-year period with proven or suspected pulmonary cancer, 23 were found to have recurrent nerve paralysis. Eleven of these were found inoperable by the preoperative work-up while 12 underwent thoracotomy. In three cases it was possible to perform a left upper lobectomy, which was considered to be radical both macro- and microscopically in two cases. The conclusion is that paralysis of the recurrent nerve, as might be foreseen, gravely worsens the prognosis, inverting the usual ratio of 80:20 between resections and exploratory thoracotomies. This, however, leaves a small group which will benefit from surgery, particularly considering the lack of alternative therapy.
The initially removed tumors from 42 patients with inverted papillomas of the nasal cavity and paranasal sinuses were subjected to an extensive histopathological examination in order to define the characteristics associated with multiple recurrences and development of malignancy. Two of the patients subsequently developed squamous cell carcinoma and eight patients had more than one recurrence. No specific histological characteristic was determined to be a predictor of multiple recurrences or development of malignancy. However, three patterns of characteristics emerged from the data which were found to be related to the development of malignancy, multiple recurrences, and benign behaviour. Malignancy was found to be associated with bilateral inverted papilloma, a predominance of mature squamous epithelium, the presence of all three epithelial types (metaplastic squamous, mature squamous, and cylindrical), severe hyperkeratosis, a mitotic index greater than or equal to 2 per high-power field (HPF), absence of inflammatory polyps among the papillomas, an abundance of plasma cells, and an absence of neutrophils. Multiple recurrences (without malignancy) were associated with a mitotic index greater than or equal to 2 per HPF and an absence of inflammatory polyps. Benign behaviour was associated with predominantly mucinous tumors, a mitotic index less than 1 per HPF, a ratio of neoplastic epithelium/connective tissue stroma greater than or equal to 6, and the presence of inflammatory polyps among the papillomas.
An unusual case of CSF leak from the nontumor ear after removal of a 3-cm acoustic neuroma is presented. Prior to tumor removal a ventricular-peritoneal shunt was established because of increased intracranial pressure. After the shunt was clamped the patient twice developed rhinoliquorrhea and underwent in both instances unsuccessful closure of the leak on the tumor side. Finally the leak was established in the nontumor ear, most likely due to sequelae after a hunting accident 20 years before, where a projectile created a defect in the tegmen tympani. The CSF leak was probably provoked by the pressure changes following tumor removal and shunt treatment.
Inverted papilloma is an unusual tumour in the nose and nasal sinuses with a marked tendency to recurrence following surgical treatment and with a greatly increased risk for synchronous or metachronous development of carcinoma. A retrospective investigation comprising 42 patients with histological revision revealed an incidence of 0.6/100,000 per annum. Two patients had also carcinomata. No significant differences were observed between the recurrence rates following simple excision, excision via the maxillary sinus or via lateral rhinotomy. Follow-up control for ten years is recommended.
The combination of a parapharyngeal abscess and torticollis in an adult, due to a spastic contraction of the sterno-cleido-mastoid muscle is an extremely rare condition. We have recently been exposed to such case, in which it was very difficult to make the diagnosis and where CT of the neck gave us the answers without any difficulty. The indication for CT at an early stage in unexplained neck infections is stressed.