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Biomedical subjects

H Glanz

Publications and source records attributed to H Glanz.

At least 19 recordsLinked to original sources
PubMed2006

Spectrometric measurement in laryngeal cancer.

Only early diagnosis of laryngeal cancer can prevent major or mutilating treatment. Recently, autofluorescence endoscopy has been developed to enhance endoscopic information and succeeded in facilitating the detection and demarcation of precancerous lesions, carcinoma in situ and cancer of the larynx. The aim of the present study is to quantify autofluorescence imaging by spectroscopy in order to validate the above mentioned findings. In a prospective study, 42 patients with suspected one-sided precancerous or cancerous lesions of the vocal folds were investigated during microlaryngoscopy. Autofluorescence (AF) was induced by filtered blue light (375-440 nm) of a xenon short arc lamp and processed by a CCD camera system (D-light AF System, STORZ, Germany). Autofluorescence images were gathered in a contact mode. For spectrometric measurements an optical multi channel analyzer (AVS-USB 2000, Avantes, The Netherlands) was applied. The results were compared to pathohistological findings. Under blue light excitation normal mucosa presented a bright green fluorescence. Intensity increased from the ventricular folds to the subglottic area. Averaged spectra of the normal laryngeal mucosa demonstrated different fluorescence maxima at 475, 515, 550, 600 and 630 nm. Highest intensity was measured at 515 nm explaining the green appearance of the autofluorescence picture. In contrast, precancerous as well as cancerous lesions showed a significant decrease in autofluorescence intensity with a reddish-violet color. Highest loss of autofluorescence intensity was measured at 515 nm. At this wave length intensity dropped 70% on average in comparison to the regularly appearing contralateral vocal fold. In contrast to 515 nm, the loss of intensity at 630 nm amounted to 38%. Sensitivity amounted to 97% and specificity to 82%. Comparable to autofluorescence endoscopy a differentiation between precancerous and cancerous lesions could not be detected. The reason for the loss of autofluorescence may predominantly be caused by mucosal thickening but also by changes in metabolism and higher nuclei density.

Carcinoma in Situ↗
PubMed2004

[Laryngeal epithelial dysplasia vs. laryngeal intraepithelial neoplasia].

Laryngeal cancer is the most frequent malignancy of the upper respiratory tract. Only the very early treatment of tumors or even of their precursor lesions will be both curative and organ preserving. Microsurgical techniques facilitate early detection and complete removal of limited lesions can be achieved quite frequently, but follow-up data for such lesions are difficult to obtain. The resulting lack of endpoint observations (i.e., malignant transformation, spontaneous involution) hampers the development, testing, and application of grading systems focusing on epithelial alterations, especially changes with only mild nuclear atypia and minimal structural alteration. Such lesions may be entirely benign or may indicate premalignant stages of well-differentiated carcinoma. For diagnosis we recommend a modified Kleinsasser's system to classify premalignant epithelial changes. Only the complete removal of suspicious lesions as far as possible or regular clinical follow-up in cases where complete removal cannot be achieved can prevent the development of advanced stage cancer.

Diagnosis, Differential↗
PubMed2004

Direct and indirect autofluorescence laryngoscopy in the diagnosis of laryngeal cancer and its precursor lesions.

Autofluorescence endoscopy has proven to facilitate the detection and delineation of precancerous lesions, carcinoma in situ and microinvasive cancer during bronchoscopy. The aim of the present study is to evaluate the diagnostic potential and limitations of this imaging technique applied during direct and indirect laryngoscopy. In a prospective study, 109 patients with suspected precancerous or cancerous lesions were investigated preoperatively by indirect autofluorescence laryngoscopy as well as during microlaryngoscopy. Autofluorescence was induced by filtered blue light (375-440 nm) of a xenon short arc lamp and processed by a CCD camera system (D-light-AF System, Storz, Tuttlingen, Germany). Autofluorescence images were immediately assessed for diagnosis, compared to the direct autofluorescence picture obtained during microlaryngoscopy and compared with pathohistological findings. Comparable to direct autofluorescence images, normal laryngeal mucosa showed a typical green fluorescence signal. Moderate and high epithelial dysplasia, carcinoma in situ, and microinvasive cancer displayed a diminished green fluorescence. False negative results were related to extreme hyperkeratosis. False positive cases showed mild dysplasia with inflammatory reactions or scarring. In 98 cases (90%) we found concordant results. According to our results, the presented technique seems to be a promising diagnostic tool for the early detection of laryngeal cancer and its precursor lesions during direct and indirect laryngoscopy. Scarring, marked hyperkeratosis, and inflammation can limit the predictive value of the method.

Carcinoma, Squamous Cell↗
PubMed2003

Indirect autofluorescence laryngoscopy in the diagnosis of laryngeal cancer and its precursor lesions.

Direct autofluorescence endoscopy of the larynx has proven to facilitate the detection and delineation of precancerous lesions, carcinoma in situ and cancer. The aim of the present study was to evaluate the diagnostic potential and limitations of this imaging technique applied during indirect laryngoscopy. In a prospective study, 116 patients with suspected precancerous or cancerous lesions were investigated preoperatively by indirect autofluorescence laryngoscopy. Autofluorescence was induced by filtered blue light (375-440 nm) of a xenon short-arc lamp and processed by a CCD camera system (D-light-AF System, Storz, Tuttlingen, Germany). Autofluorescence images were immediately assessed for diagnosis, compared to the direct autofluorescence picture obtained during microlaryngoscopy and compared to pathohistological findings. Comparable to direct autofluorescence images, normal laryngeal mucosa showed a typical green fluorescence signal. Moderate and high epithelial dysplasia, carcinoma in situ and cancer displayed a diminished green fluorescence. False negative results were related to extreme hyperkeratosis. False positive cases showed mild dysplasia with inflammatory reactions or scarring. In 103 cases (89%), we found concordant results. According to our results, the presented technique seems to be a promising diagnostic tool for the early detection of laryngeal cancer and its precursor lesions during indirect laryngoscopy. Scarring, marked hyperkeratosis and inflammation can limit the predictive value of the method.

Carcinoma in Situ↗
PubMed2001

Investigating quality of life and coping resources after laryngectomy.

Surgical procedures and in particular laryngectomy can become a life-saving treatment for patients with laryngeal or hypopharyngeal cancer, but can result in permanent damage. Clinical observation suggests that patients vary considerably in their ways of dealing with this new situation and in their ability to cope. The aim of our interdisciplinary group was to investigate the quality of life of laryngectomy patients and learn about their perceptions, situation and coping mechanisms. The development of an appropriate study design and a measurement strategy is presented. We investigated 29 laryngectomized patients who had joined the local self-help group. The patients were free from tumour disease and were mostly married with children, retired from work and had not graduated from high school. Assessment of the quality of life was performed with the European Organization for Research on Treatment of Cancer questionnaires QLQ-C30 and H+N35 and additional open questions. Analysis of the acquired data showed that family support was judged most important for overcoming the problems of disease and treatment. Deficits in this area were highly correlated with a low overall quality of life. Financial problems resulted because of the high percentage of retirement before or after therapy. We suggest that perioperative support taking these facts into consideration can result in an improved coping process. Further prospective studies are needed to reveal the effect of such measures.

Adaptation, Physiological↗
PubMed2000

Nitric oxide has no beneficial effects on ion transport defects in cystic fibrosis human nasal epithelium.

Nitric oxide (NO) has been reported to activate Cl- secretion via the cystic fibrosis transmembrane conductance regulator (CFTR) and inhibit epithelial Na+ absorption mediated by amiloride-sensitive epithelial Na+ channels (ENaC). These ion transport systems are defective in cystic fibrosis (CF): Cl- secretion by CFTR is impaired and Na+ absorption by ENaC is dramatically increased. By activating CFTR and depressing ENaC, NO is a potentially beneficial therapeutic agent for ion transport defects in human CF respiratory epithelia. To assess the effects of NO on human respiratory epithelial cells, the NO donors sodium nitroprusside (SNP) and spermine NONOate were applied to primary cultured nasal cells, surgically obtained from non-CF and CF patients. Measurements of transepithelial short-circuit current (ISC) showed that NO has no inhibitory potency against amiloride-sensitive nasal ENaC (nENaC) or amiloride-insensitive Na+-absorbing mechanisms in non-CF and CF epithelia. Furthermore, NO had no stimulatory effect on Cl- secretion by CFTR or any other Cl- conductance pathway in either tissue. Although NO elevated the intracellular Ca2+ concentration, we did not detect any activation of Ca2+-dependent Cl- channels. These results demonstrate that NO has no beneficial effect on CF epithelial cells of the upper airways.

Absorption↗
PubMed2000

Inverted papilloma of the nasal cavity and paranasal sinuses: clinical data, surgical strategy and recurrence rates.

BACKGROUND: In the last decade inverted papillomas of the nasal cavity and paranasal sinuses have been observed in increasing numbers, and treatment modalities have ranged from extensive open radical procedures to microinvasive endonasal surgical excision. OBJECTIVE: To establish criteria for selecting patients for open osteoplastic or endonasal surgery according to clearly defined pathological and clinical data. MATERIAL AND METHOD: In a retrospective study, clinical data of 55 patients treated surgically in the University ENT Clinic Giessen from 1991 to 1998 were analysed. In 33 patients (60%) endonasal excision of the papillomas was carried out and in 22 (40%) osteoplastic lateral rhinotomy or maxillotomy were performed. All histological specimens were revised. Patients were followed up and endoscopically examined until 31 March 1999. RESULTS: In 22 patients, tumours involving the frontal sinus, maxillary sinus, parts of the frontal skull base and anterior ethmoid, and the orbit were operated on using open osteoplastic procedures, with 4 (18%) recurrences observed. Tumours excised endonasally showed the same recurrence rate: 6 out of 33 (18%). These tumours were smaller in size and localized in the nasal cavity, the middle and posterior parts of the ethmoid involving the sphenoid, and the medio-posterior wall of the maxillary sinus. The functional outcome was excellent for all patients; two patients developed a mucocele. Cancerization was observed in three cases. CONCLUSIONS: In select cases the endonasal microsurgical approach to inverted papillomas has the same good results concerning function and tumour control as osteoplastic open rhinotomy. This method should still be preferred in tumours localized in the frontal sinus, anterior ethmoid. anterior. caudal and lateral parts of the maxillary sinus and beyond the sinuses.

Craniotomy↗
PubMed2000

Nicotine-induced endocytosis of amiloride-sensitive sodium channels in human nasal epithelium.

In previous studies we developed and introduced a method to examine the transport mechanisms of ions in primary cell cultures of human nasal epithelium. In the current study, substances, especially nicotine, that influence these mechanisms are investigated. Specimens of nasal and paranasal epithelium of patients treated by endonasal surgery because of chronic sinusitis (n = 217) were used as primary cell cultures. Cell cultures of smokers (n = 83) and non-smokers (n = 134) were differentiated. Transepithelial Ussing chamber measurements were performed to examine sodium channel functions and to evaluate the influence of nicotine. These examinations were accompanied by simultaneous continuous capacitance measurements. Whereas transepithelial parameters, such as short-circuit current, (Isc), potential (Vt) and resistance (Rt), in tissues derived from smokers and non-smokers showed no difference, the transepithelial conductance was reduced immediately in cell cultures with apical application of nicotine (2 mM). This decrease was accompanied by a marked reduction of epithelial surface area. In the presence of nicotine, amiloride (100 microM) completely lost its inhibitory capacity. Amiloride-insensitive sodium channels were unaffected by nicotine, as proved by Na+ substitution. Furthermore, the Na+ channel blocker was accompanied by an increase in intracellular Ca2+. We conclude that the nicotine-induced increase in intracellular calcium (Ca2+) has stimulated Ca2+-dependent protein kinase (PKC). PKC promotes endocytosis removing amiloride-sensitive Na+ channels from the cell membrane into the cell by means of vesicular transport.

Amiloride↗
PubMed1999

[Ion transport in nasal and paranasal sinus mucosa in mucoviscidosis and chronic sinusitis].

Cystic fibrosis (CF) is the most commonly inherited disease in Caucasians and is caused by a mutation in the gene encoding a membrane transport protein. This cystic fibrosis transmembrane conductance regulator (CFTR) is thought to be an apical Cl- channel activated by intracellular cAMP. Most recent findings suggest that CFTR is more than a pure Cl- channel and might be involved in the regulation of other transport systems. In the present study we show that CFTR as a Cl- channel plays only a minor role in primary cultured human nasal epithelium derived from non-CF and CF patients. These findings are especially of interest for non-CF human nasal epithelia in which CFTR is correctly inserted. In both tissues Cl- secretion is negligible as compared with Na+ absorption. We confirm and expand our previous observations that Na+ absorption in human nasal epithelium is the dominant ion transport process and that Cl- secretion is detectable in both CF and non-CF tissue. Moreover, we show that cAMP and ATP were not able to stimulate any silent Cl- channels in CF or non-CF human nasal epithelial cells. We further give evidence that in human nasal CF and non-CF epithelium Na+ absorption is mediated by epithelial Na+ channels (ENaC) that are either different from those of other epithelia or which exhibit altered regulation. These differences between Na+ channels of human nasal epithelium and "classical" epithelial Na+ channels include lack of activation by the intracellular second messenger cAMP and the steroid hormone aldosterone. We show further that human nasal Na+ channels are inhibited by Cl- channel blockers and exhibit a different pharmacology towards common Na+ channel blockers.

Chloride Channels↗
PubMed1999

Allergic fungal sinusitis caused by Bipolaris (Drechslera) hawaiiensis.

Depending on the aggressiveness of the pathogen and a patient's immunocompetence, fungal polypoid pansinusitis or allergic fungal sinusitis (AFS) may be a life-threatening disease. Apart from the clinical findings, its diagnosis is based on the demonstration of mucinous material with abundant eosinophils in the paranasal sinuses (indicating an allergic process), cultivation of the causative pathogen and immunocompetence of the patient. In a 20-year-old immigrant Sudanese woman, AFS due to Bipolaris (Drechslera) hawaiiensis was diagnosed. Because of intracranial extension, the disease had led to erosion of the cranial base and orbit with amaurosis on the right side and focal epilepsy. In addition to endonasal microsurgical pansinus operations, local irrigation therapy with amphothericin B was accompanied by systemic treatment with itraconazole after in vitro cultivation of the pathogen and determination of its sensitivities. Interdisciplinary management included a combination of endonasal surgery with debridement of infected tissues and wide drainage of the sinuses without removal of skull bone or the dural lesion in addition to specific antimycotic treatment. Injury to adjacent anatomical structures must be avoided in any case to prevent systemic or possibly lethal dissemination of infection.

Adult↗
PubMed1999

Endoscopic high-frequency ultrasound of the larynx.

Over the last few years the development of new high-frequency ultrasound equipment has improved the application and resolution of endoluminal ultrasound. Following our in vitro study on the anatomical basis of endolaryngeal high-frequency ultrasound we present the preliminary results of our sonographic examinations during microlaryngoscopy in order to characterize clinical applications. For the present study 38 patients underwent endolaryngeal ultrasound examinations. Laryngeal pathology included vocal fold polyps, laryngeal cysts, chronic laryngitis, Reinke's edema, epithelial dysplasia and cancer. The ultrasound examination was performed during microlaryngoscopy in a standardized pattern. A newly developed ultrasound apparatus was utilized with 10 MHz and 20 MHz catheters. Site, size and depth of the laryngeal lesion were evaluated. In 23 examinations of laryngeal carcinomas tumor size and infiltration could be measured and involvement of the thyroid cartilage or anterior commissure could be visualized. The exact extension of laryngeal cysts could also be seen. Ultrasound added no additional information to the endoscopic impression of the other laryngeal lesions. Present findings suggest that endoluminal high-frequency ultrasound might supplement microlaryngoscopy in the assessment of certain laryngeal lesions, especially for the evaluation of the size and infiltration of laryngeal tumors and to perform a more accurate preoperative staging without using computed tomography or magnetic resonance imaging.

Adult↗
PubMed1999

[Pathomorphological aspects of transoral resection of hypopharyngeal carcinoma with preservation of the larynx. Patient selection, treatment results].

BACKGROUND: In primary surgery of hypopharyngeal cancer, transcervical resection was chosen in order to preserve the larynx. This treatment produces good oncological results but also a high degree of morbidity so that in recent years transoral resection has been recommended. For wider application of this method it is very important to apply clearly defined criteria for selection of patients. MATERIAL AND METHODS: To define the criteria for selection for transoral microsurgical resection, we analyzed step serial sections of 33 whole organ specimens of hypopharyngeal squamous cell cancer (SCC) after primary radical surgery, mostly carcinoma of the piriform sinus. Criteria concerning the primary and the involvement of the neck nodes were differentiated. Twenty of 84 patients with hypopharyngeal cancer of different stages were treated by transoral resection and delayed neck dissection between 1994 and 1996. Most of the patients were irradiated postoperatively because of neck metastases. The therapeutic results after a minimum period of 24 months follow-up is listed according to Kaplan-Meyer. RESULTS: Three types were defined according to their site, growth, and spread into the larynx: Type I comprises limited exophytic, highly differentiated SCC with a minor tendency for metastasis originating in the upper half of the sinus. These tumors are well suitable for transoral resection. Type II includes tumors spreading superficially without deeper invasion of the larynx, especially of the laryngeal framework. These can be totally resected and the larynx preserved in spite of extended metastasis. Type III, the most frequent type, grows with ulceration and deeply infiltrates into the larynx and the neck. These tumors cannot be resected transorally. Primary radical resection is indicated. Up to 25% of all hypopharyngeal SCC could be treated by transoral resection, mostly with delayed neck dissection and postoperative irradiation. Functional results were excellent in all cases. Eating, voice, and air passage were normal. Oncological results with 80% disease free five-year survival rate were very good. Three patients died because of recurrences in the neck, only one because of a recurrence in the larynx. The rate of patients with a second primary, however, was extremely high (50%). CONCLUSIONS: By strictly following the pathological and clinical criteria for selection, about 25% of the SCC of the hypopharynx can be treated by transoral resection combined with neck dissection and postoperative irradiation with good oncological and excellent functional results, preserving the larynx without endangering the life of the patients.

Carcinoma, Squamous Cell↗
PubMed1999

[Multiple carcinomas in the upper aerodigestive tract. 1. Oral cavity and oropharynx].

BACKGROUND: During the last years an absolute increase of tumour incidence of squamous cell carcinoma as well as an increase in the occurrence of synchronous and metachronous multiple primaries in the upper aerodigestive tract can be observed. This study analyses the so-called "multi-centric cancerization" in patients with primary carcinoma of the oral cavity and the oropharynx. METHODS: During 2 observation periods of 5 years each, from 1985 to 1994, we retrospectively analyzed 235 patients with squamous cell carcinoma of the oral cavity and 232 patients with tumour localisation in the oropharynx. Besides age, sex, tumour localization, TNM-stage and grading, the risk factors tobacco and alcohol were added as causes for the development of multiple primaries. RESULTS: In the primary localisation of the oral cavity synchronous and metachronous double tumours increased from 7% to 17% besides the absolute increase in tumour incidence. In the oropharynx a total increase of second carcinomas from 3% to 20% was found. At the same time a growing abuse of tobacco and alcohol could be observed. CONCLUSIONS: Panendoscopy during pre-therapeutical staging should be obligatory. Regular oncological controls are mandatory, especially for younger patients with smaller tumours and good prognosis, but a high risk of second primaries. In the long run, prevention has to play a decisive role in the fight against second primary tumors of the upper aerodigestive tract. Possible improvements of early diagnosis, genetical examinations, information campaigns as well as research of carcinogenic environmental pollutants are of foremost interest to the clinician.

Adolescent↗
PubMed1999

[Endoscopic imaging techniques in the diagnosis of laryngeal carcinoma and its precursor lesions].

BACKGROUND: In order to improve preoperative diagnostic work-up in treatment of patients with laryngeal cancer and its precursor lesions additional endoscopical imaging techniques have been developed: 1. Autofluorescence endoscopy; 2. Contact endoscopy; 3. Endoscopic high-frequency ultrasound. These imaging techniques are used during microlaryngoscopy to get further information about tumor extension and differentiation. This paper describes the diagnostic potential of these imaging techniques in the evaluation of cancerous lesions of the larynx. MATERIAL AND METHODS: Patients in different stages of laryngeal dysplasia, carcinoma in situ and laryngeal cancer were examined by means of the previous mentioned imaging techniques during microlaryngoscopy (Autofluorescence endoscopy [n = 38], contact endoscopy [n = 323], endoscopic high-frequency ultrasound [n = 60]) and the results were compared to pathohistological findings. In autofluorescence endoscopy cancerous mucosa was illuminated using blue filtered light (380-460 nm) to obtain autofluorescence for optical demarcation of the lesion. Contact endoscopy was performed after staining of the laryngeal mucosa with methylene blue (1%). Two different endoscopes with 60 x and 150 x magnification were used. In both techniques a video image was achieved by using a xenon light source and a special video camera to register autofluorescence. The endoscopical high-frequency ultrasound examination was performed after flooding the larynx with 0.9% saline. Newly developed ultrasound catheters with frequencies between 10 to 20 MHz were inserted in the laryngeal lumen and moved in a standardized pattern during the examination. RESULTS: During the autofluorescence examination of the endolaryngeal mucosa precancerous and cancerous lesions showed a red to violet fluorescence outlined against the light green autofluorescence of the normal mucosa. Hyperplastic hyperkeratotic epithelium revealed a higher intensity of light green or even whitish autofluorescence compared to normal mucosa autofluorescence. After staining the vocal cords with methylene blue, it was possible to observe the cells, nuclei and cytoplasm of the laryngeal mucosa and their different grades of abnormality using the specially developed contact endoscopes. Endoscopic high-frequency ultrasound (10 to 20 MHz) was able to measure the vertical extension of laryngeal carcinomas bigger than 3 mm in size. The involvement of the thyroid cartilage or the anterior commissure could be visualized. Preoperatively, the critical T2 stage could be evaluated more precisely. In precancerous lesions and microinvasive cancer ultrasound added no additional Information to the microlaryngoscopical picture. CONCLUSION: Autofluorescence, contact endoscopy as well as endoscopic high-frequency ultrasound are promising new imaging techniques supplementing microlaryngoscopy: autofluorescence as well as contact endoscopy are suitable to differentiate dysplasia, carcinoma in situ, microinvasive lesions as well as the evaluation of tumorous margins, while high-frequency ultrasound improves the assessment of tumorous infiltration into the depth of the larynx. These imaging techniques enable the laryngologist to perform a more accurate diagnostic work-up in the assessment of laryngeal cancer and its precursor lesions.

Carcinoma in Situ↗
PubMed1998

Endolaryngeal high-frequency ultrasound.

High-frequency ultrasound can provide high-resolution imaging for diagnosing diseases of the head and neck. Over the last few years, a virtual technical evolution has led to the development of small and flexible ultrasound transducers with even greater anatomic resolution. The aim of the present study was to evaluate the efficacy of this new technique for imaging normal and altered anatomical structures of the endolarynx. Specially developed high-resolution, real-time ultrasound transducers (10 and 20 MHz) placed on the tip of endoluminal catheters were inserted into 20 autopsied larynges and five laryngectomy specimens. In a standardized examination process the endolarynx was analyzed in a real-time mode. Using this technique, exact 360 degrees cross sections of the larynx were obtained, demonstrating that it was possible to image the structures of the endolarynx with ultrasonography. Depending on the frequency used, all anatomical structures could be visualized up to a depth of 2 cm. In laryngeal cancer the depth of tumor as well as its relationship to the laryngeal framework could be clearly recognized. These findings suggest that this new endoluminal sonographic procedure represents a potentially important diagnostic tool in the assessment of laryngeal carcinoma.

Anatomy, Cross-Sectional↗
PubMed1997

Histomorphologic studies of the glottic region to elucidate the pathogenesis and functional significance of fibrinoid vocal cord lesions in infants and young children.

Focal lesions of the vocal cord in form of fibrinoid necrosis and thickening of the basement membrane are morphological findings in infants and young children that receive only scant attention and are also controversially valued. We discuss two causes for the pathogenesis of these findings: (1) recurrent laryngospasms and (2) a laryngeal phonotrauma resulting from frequent spells of shrill, presumably high-frequency crying. The aim of our study therefore was to gain insight into the development and functional significance of these lesions by examining their histological patterns and to draw the pertinent conclusions. In 56 deaths (natural and unnatural causes, fetal life up to 4 years, no pathological or traumatic laryngeal lesions) histological investigations were carried out on putrefaction-free material. For the histomorphological studies, horizontal sections through the region of the vocal cord were obtained and stained according to conventional and immunohistochemical staining methods. In 42 cases the thickness of the basement membrane was determined morphometrically. In 12 of the 56 cases (21%) we observed staged variations of focal lesions, ranging from fibrinoid necrosis to degenerative lesions with pronounced macrophage involvement and deposits of PAS-positive plaques. Measurements at the basement membrane revealed a thickness of 7.9 microm. Separate measurements at the anterior and posterior portions of the vocal fold showed a ratio of 1.7:1. When the cases were subdivided into those with and without fibrinoid necrosis the ratios were 2.5:1 and 1.5:1. This different pattern makes it unlikely that laryngospasm is the sole or essential cause. Pathogenetically more important might be phonatory overstraining due to maximum vibrations in only the anterior portions of the vocal fold, which is not specific for later SIDS victims. This assumption is also supported by the often observed conspicuous phonetic behavior of some later SIDS victims and the absence of these stage-like vocal cord lesions in stillborns and adults. It is presumably an age-specific, temporary finding which is completely reversible.

Basement Membrane↗
PubMed1997

Clinical and morphological aspects of laryngeal cysts.

To our knowledge only a few defined studies have been carried out on laryngeal cysts. These cysts represent a mixed group of benign laryngeal lesions that can cause diagnostic and therapeutic difficulties. The aim of this study was to characterize their histological structure and localizations in the larynx as well as to discuss theories about their genesis. Between 1973 and 1996, 342 laryngeal cysts were treated at Phillips University of Marburg, while from 1990 to 1996, 74 were treated at Justus Liebig University of Giessen. In all, 416 laryngeal cysts were treated by endolaryngeal microsurgery. All clinical charts were reviewed retrospectively and surgical specimens examined histomorphologically. Findings showed that 58.2% of the laryngeal cysts were located in the glottic area and 18.3% in the ventricular folds. The remainder were located on the aryepiglottic fold (2.2%) and interarythenoid region (0.7%). Two congenital cysts were also treated. Approximately 56% of the laryngeal cysts were lined by squamous cell epithelium, 37% by respiratory epithelium and 7% by oncocytic epithelium. In general, the laryngeal cysts were found to be a collection of inhomogenous lesions from different histogenetic origins with diverse symptoms related to their site and size. On the basis of our investigations, a new classification was established concerning the genesis and development of laryngeal cysts by subdividing cysts into congenital cysts, retention cysts, and inclusion cysts.

Adolescent↗