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Biomedical subjects

H Sudhoff

Publications and source records attributed to H Sudhoff.

At least 37 records · Page 2Linked to original sources
PubMed2003

[Eosinophilic granuloma of the temporal bone. Case report and literature review].

BACKGROUND: Eosinophilic granuloma, Hand-Schüller-Christian disease an Letterer-Siwe disease are characterised by ideopathic proliferation of histiocytes producing focal or systemic manifestations. Definitive diagnosis of histiocytosis is made by histopathology including immunohistochemical detection of S-100 and CD1a antigens. In general these diseases are summarised under the term Langerhans-cell histiocytosis (LCH). The localised form of LCH, in which the disease is limited to bones, lymphatic nodes or the lung, is commonly referred to as eosinophilic granuloma. Surgical excision, radiotherapy and chemotherapy, either alone or in combination, are the main treatment options. CASE REPORT: We present the case of a nine-year old boy with an extended eosinophilic granuloma of left temporal bone. The patient was submitted to a chemotherapeutic protocol with glucocorticoids, vinblastine and etoposide. Until today a successful treatment and a complete remission for one year can be reported. CONCLUSIONS: Unifocal eosinophilic granuloma is usually treated by local excision and low-dose irradiation. However treatment with the chemotherapeutic protocol offered an excellent alternative avoiding extensive surgical destruction of the temporal bone in this case.

Biopsy↗
PubMed2003

Regeneration of inner ear cells from stem cell precursors--a future concept of hearing rehabilitation?

The use of stem cells offers new and powerful strategies for future tissue development and engineering. Common features of stem cells are both their capacity for self-renewal and the ability to differentiate into mature effector cells. Since the establishment of embryonic stem cells from early human embryos, research on and clinical application of human ES cells belong to the most controversial topics in our society. Great hopes are based upon the remarkable observation that human ES cells can be greatly expanded in vitro, and that they can differentiate into various clinically important cell types. Recent advances in the cloning of mammals by nuclear transplantation provide new concepts for autologous replacement of damaged and degenerated tissues. In contrast, somatic stem cells of the adult organism were considered to be more restricted in their developmental potential. However, recent investigations suggest that somatic stem cells may have a wider differentiation potential than previously thought. In otology, initial experiments have revealed neural stem cell survival in cochlear cell cultures and under neurotrophin influence, neural stem cells seemed to develop into a neuronal phenotype. Further studies have to be carried out to investigate the full potential of stem cells as well as the molecular mechanisms that are involved in regulating cellular identity and plasticity. Clinically, advances in stem cell biology may provide a permanent source of replacement cells for treating human diseases and could open the development of new concepts for cell and tissue regeneration for a causal treatment of chronic degenerative diseases.

Animals↗
PubMed2002

Herpes zoster-associated trigeminal trophic syndrome: a case report and review.

The case of a 75-year-old Caucasian woman with a trigeminal trophic syndrome (TTS) is presented and discussed. TTS of the ala nasi subsequent to a herpes zoster infection has not been described previously. We provide a review of the literature with insights into the pathogenesis and current therapeutic strategies.

Aged↗
PubMed2001

[Alterations of the basal membrane in middle ear cholesteatoma].

Cholesteatoma epithelium is characterized by a keratinocyte disregulation accompanied by destruction of the ossicles and other bony parts of the temporal bone. Immunohistochemical methods using antibodies to fibronectin, tenascin and metalloproteinases were used to assess the alterations of the instrinsic and extrinsic components of the basement membrane. Spatial orientation of the basement membrane was preserved in histological sections. Collagen type IV, tenascin, fibronectin, basic fibroblastic growth factor (bFGF), and matrix metalloproteinases (MMPs) are related to the matrix, perimatrix of normal or pathological tissues. They were studied immunohistologically in twenty cholesteatomas, eight samples of normal auditory canal skin, and six specimens of normal middle ear mucosa. Cholesteatomas displayed alterations of the basal membrane, with presence of MMPs and a linear immunoreactivity for collagen type IV and laminin, disrupted in areas with intense inflammation. The electronic microscope revealed protrusions, duplications, thickening and disruptions of the lamina densa of the basement membrane. Thus, we conclude, that MMPs and bFGF could play an important role maintaining the proliferative activity and the aggressive behaviour of cholesteatoma in the middle ear.

Basilar Membrane↗
PubMed2001

[Osteoma of the maxillary sinus].

BACKGROUND: Osteoma of the paranasal sinuses is a rare and benign entity that develops slowly. If they occur, locations within the frontal sinus and ethmoid cells are more frequent, whereas osteomas in the sphenoid or maxillary sinus are very rare. CASE: We report on a 25-year old female patient presenting with a bony mass in the right maxillary sinus. A standard external approach using a modified Caldwell-Luc procedure was successfully employed as endoscopic endonasal surgery was limited by the size of the bony lesion. CONCLUSIONS: Trauma or infection are often suggested as an etiologic factor in the pathogenesis of osteoma. In our case the development of maxillary osteoma was related to dental extraction and postoperative fistula. External standard procedures remain mandatory if endonasal endoscopic surgery fails in the removal of osteoma of the paranasal sinuses.

Adult↗
PubMed2001

Cholesteatoma behind an intact tympanic membrane: histopathologic evidence for a tympanic membrane origin.

BACKGROUND: Several theories have been proposed with respect to the origin and pathogenesis of cholesteatoma behind an intact tympanic membrane. CASE REPORT: The authors describe a case of cholesteatoma behind an intact tympanic membrane in a 71-year-old man with a history of tympanic membrane retraction fixed to the incus without evidence of a perforation. The membrane eventually became detached, and remnants of keratinizing squamous epithelium were found on the incus. DISCUSSION: Mechanisms such as metaplasia, ectopic epidermis rests, or ingrowth of meatal epidermis have been proposed to explain the pathogenesis of cholesteatoma behind an intact tympanic membrane. These findings, based on temporal bone histopathology, support the role of an acquired epidermal rest. CONCLUSIONS: This case report provides evidence that cholesteatoma behind an intact tympanic membrane can be established from a resolved retraction of the pars tensa of the tympanic membrane.

Aged↗
PubMed2000

The pathology of the temporal bones of a child with acquired cytomegalovirus infection: studies by light microscopy, immunohistochemistry and polymerase-chain reaction.

STUDY DESIGN: The first case of an acquired cytomegalovirus (CMV) infection of the inner ear is reported in a 3-year-old girl in remission from acute lymphocytic leukemia. METHODS: Horizontal sections of the temporal bones were studied by light microscopy and immunohistological staining by avidin-biotin-complex-technique was performed on selected archival sections. Three sections were processed for detection of the virus genome by the polymerase chain reaction (PCR). RESULTS: By light microscopy the epithelium of the endolymphatic sac, the utricle and the semicircular canals showed deeply stained acidophilic inclusions and the stria vascularis had a loose structure especially in the intermediate layer. The changes were limited to the non-sensory parts of the labyrinth and no CMV type cells were observed in the organ of Corti. There was a loss of inner and outer hair cells and loss of cochlear ganglion cells caused by either the virus or treatment with gentamicin. Standard immunohistochemistry failed to demonstrate staining with CMV antibodies, but PCR, demonstrated CMV-DNA in one section. CONCLUSION: Molecular techniques may be able to detect acquired CMV infections in archival pediatric bones temporal bones. The histologic findings in the labyrinth were milder, however showed some similarity to children with congenital CMV labyrinthitis.

Autopsy↗
PubMed2000

[Protection of autogenous cartilage transplants from resorption using membrane encapsulation].

In reconstruction of cartilage defects, autogenous transplantation is known as a reliable and experienced method. Although a clinical application has not been reported until now, tissue engineering permits in vitro production of autogenous cartilage transplants. Nevertheless, in both methods the cartilage is exposed to individually varying resorptive mechanisms. Among other methods for in vivo tissue protection, the encapsulation with a semipermeable polyelectrolytecomplex membrane could guarantee sufficient protection against resorptive influences. Human septal cartilage was encapsulated (group 1) with polyelectrolytecomplex membranes and subcutaneously implanted on the back of thymusaplastic nude mice. Cartilage implants without encapsulation (group 2) were used as control. Scanning electron microscopy and histochemical investigations were performed 1, 4, 8, 12 and 16 weeks after implantation. Group 1 showed no signs of resorption and chronic inflammation at all. In contrast, group 2 presented, correlating to the time of implanta-tion, increasing signs of cell death and fibrotic transformation, representing an increased activity of resorption. In conclusion, tissue encapsulation with a polyelectrolytecomplex membrane could ensure a sufficient protection of human cartilage transplants from resorptive influences. For the plastic-reconstructive surgeon the desired result becomes more calculable.

Animals↗
PubMed2000

Macroencapsulation of human cartilage implants: pilot study with polyelectrolyte complex membrane encapsulation.

Autogenous cartilage transplantation is a generally accepted method in reconstructive surgery. A promising alternative to this established method could be represented by in vitro engineering of cartilage tissue. In both methods of autogenous transplantation, host response induces reduction of transplant size and transplant instability to an unforeseeable extent. To investigate if polyelectrolyte complex (PEC) membranes were able to avoid host-induced effects on implanted tissues without neglecting the tissue metabolism, human septal cartilage was encapsulated with polyelectrolyte complex membranes and subcutaneously implanted on the back of nude mice. Septal cartilage implants, without encapsulation served as control group. Histochemical and electron microscopic investigations were performed 1, 4, 8 and 16 weeks after implantation. In the case of an intact PEC-membrane no interactions between the host and the implant could be observed. In some implants, the capsule was torn in several areas and signs of chronic inflammation with the cartilage having been affected mildly could be observed. Implanted cartilage protected with PEC-encapsulation showed no signs of degeneration and significantly lower level of after effects of chronic inflammation than implanted cartilage without PEC-encapsulation. Therefore, it could be expected, that PEC membrane encapsulation offers a novel approach to protect cartilage implants from host response after autogenous transplantation.

Animals↗
PubMed2000

[Functional and morphological defects of the mucociliary system in secretory otitis media].

BACKGROUND: One of the main functions of the ciliated cells of the middle ear mucosa is the continuous drainage of fluids from the middle ear cavity to the Eustachian tube. Impaired mucociliary clearance is related to disturbed clearance of middle ear secretions and results in otitis media with effusion. The aim of this study was to evaluate the ciliary beat frequency (CBF) and the ultrastructure of cilia in young patients suffering from otitis media with effusion (OME). METHODS: CBF and ciliary ultrastructure were studied in 36 patients with OME and 10 normal subjects without any history of middle ear effusion. RESULTS: The CBF was significantly decreased in the study group (6.59 Hz, +/- 1.83) compared to the controls (10.68 Hz, +/- 1.87) and the incidence of ultrastructural defects was higher than in controls. The most common defect were compound cilia, random orientation of the ciliary axes, and defects of the central microtubules. Defects of the dynein arms were not observed.

Adult↗
PubMed2000

Massive epistaxis after rupture of intracavernous carotid artery aneurysm. Case report.

We present a case of massive epistaxis caused by an internal carotid artery aneurysm. The initial treatment with endovascular balloon embolization failed as a result of balloon displacement. After rebleeding, the intracavernous aneurysm was treated with an endovascular detachable balloon embolization technique, which resulted in cessation of epistaxis. The different treatment options for interventional radiology and management of ruptured carotid artery aneurysms are discussed.

Aneurysm, Ruptured↗
PubMed2000

[Comparative analysis of the proliferative capacity of cholesteatomas].

Cholesteatomas of the middle ear are frequently aggressive and produce bone destruction. Stimulation of the surrounding inflammatory tissue and autocrine mechanisms could be responsible for the keratinocytic dysregulation of cholesteatomas, as well as for abnormal proliferation patterns. The proliferative capacity of human cholesteatoma of the middle ear was studied through the kinetics of the epithelial cells of cholesteatomas and external ear canal. The APAAP method was used to study the monoclonal antibody MIB-1, which recognizes an antigen of cells in the division phase. Biopsies taken from the outer ear canal (n = 7) revealed an MIB-1 level (the ratio of MIB-1 positive cells to all cells) of 7.6% +/- 2.2%. Cholesteatoma samples (n = 13) showed an MIB-1 level of 17.4% +/- 8.9%, and heterogeneity of the proliferative areas. Epithelial invaginations into the surrounding stroma were characterized by intense mitotic activity. The results confirmed a statistically significant increase in keratinocytes in the cholesteatomas, with an MIB-1 level 2.3 times higher than that of meatal keratinocytes. PCNA, a nuclear proliferation antigen which expresses the growth phase of cells in normal and tumoral tissue, was determined in 15 biopsies of meatal skin and 7 specimens of cholesteatoma in the phase of infection and 8 non-infection. Although the number of proliferative cells changed depending on the site of the cholesteatorna, the amount of PCNA-positive cells was significantly higher in the cholesteatoma (2.5-15, mean 9.3) than in normal skin (1-2.8, mean 1.5) (p < 0.001). Finally, AgNOR (argyrophyllic nucleolar organizer regions), which express proliferative activity, were determined in 12 specimens of meatal skin and in 19 acquired and 2 congenital cholesteatomas. A mean of 3.71 AgNOR dots were counted in the cholesteatomas and 1.54 dots in meatal skin specimens. The immunohistological study with three different markers expressing cellular proliferative capacity showed hyperproliferation associated with keratinocyte dysregulation in cholesteatoma samples, which could explain the clinically aggressive and destructive behavior of these lesions.

Antibodies, Monoclonal↗
PubMed2000

Pathogenesis of attic cholesteatoma: clinical and immunohistochemical support for combination of retraction theory and proliferation theory.

OBJECTIVE: The aim of the current study was to provide support for a combination of the retraction and proliferation theories of acquired cholesteatoma. BACKGROUND: There is clinical evidence for formation of a retraction, but there is a lack of explanation for the transition from a retraction pocket to an active and expanding attic cholesteatoma. METHODS: Epidemiologic studies on the incidence of attic retractions and follow-up studies on patients with attic retractions were performed. Additionally, expression of proliferation marker and analysis of basement membrane were studied in samples of attic cholesteatoma. RESULTS: The prevalence of attic retractions was between 14% and 25% of investigated ears. In children with manifest secretory otitis, there were some attic cholesteatomas and 5% to 6% severe retractions. Some of them became precholesteatomas, requiring treatment and controls. Immunohistochemistry of attic cholesteatomas showed that proliferating keratinocytes were very often seen within epithelial cones growing toward the underlying stroma. These growth cones exhibited focal discontinuities of the basement membrane, especially in areas of intense subepithelial inflammation. CONCLUSIONS: As a possible explanation based on clinical and immunohistochemical findings, the authors propose a four-step concept for the pathogenesis of cholesteatoma that combines the retraction and proliferation theories: (a) the retraction pocket stage; (b) the proliferation stage of the retraction pocket, subdivided into cone formation and cone fusion; (c) the expansion stage of attic cholesteatoma; and (d) bone resorption.

Adolescent↗
PubMed2000

Angiogenesis and angiogenic growth factors in middle ear cholesteatoma.

HYPOTHESIS: This study aimed to analyze the localization and distribution of vessels and of these angiogenic growth factors: basic fibroblast growth factor (FGF-2), transforming growth factor-alpha (TGF-alpha), transforming growth factor-beta1 (TGF-beta1), and vascular endothelial growth factor (VEGF) in middle ear cholesteatoma in comparison with normal middle ear mucosa and auditory meatal skin. BACKGROUND: Angiogenesis is particularly important in many normal and pathologic processes, including wound healing and inflammation. Because proliferating tissues require an enhanced blood supply, angiogenesis appears to be a prerequisite for the expansion of cholesteatoma. METHODS: The expression of FGF-2, TGF-alpha, TGF-beta1, and VEGF was studied by immunohistochemistry. The amount of vessels (collagen type IV staining) was determined by an automatic imaging analyzing system. RESULTS: The results showed an altered expression and distribution of VEGF, FGF-2, TGF-alpha, and TGF-beta1 in cholesteatoma in relation to middle ear mucosa and auditory meatal skin. The results were consistent with rapidly growing, activated keratinocytes and stromal cells. Vascularization within the perimatrix of cholesteatoma showed a 4.3-fold increase compared with middle ear mucosa and a twofold increase compared with ear canal skin. An increase of 3.2- to 4-fold in the number of vessels was observed. A close relationship was seen between the density of capillaries, degree of inflammation, and expression of the angiogenic factors investigated, and an increased number of microvessels in cholesteatoma tissue. CONCLUSIONS: Angiogenesis enables and supports the sustained migration of keratinocytes into the middle ear cavity. Therefore, it is a pivotal factor in the destructive behavior of middle ear cholesteatoma.

Angiogenesis Inducing Agents↗
PubMed1999

Cholesteatoma in children.

Cholesteatoma in children is generally considered to be more aggressive and destructive than in adults. Each otologic surgeon has experienced widely extended cholesteatomas in children with large pneumatized mastoid processes. In this paper, we want to present clinical and experimental observations which imply that the destructive potential in children is similar to that in adults. Factors and observations that have led to the assumption that cholesteatoma in children is more aggressive will be discussed. Based on our experience and the literature, we tried to distill the current and leading thoughts concerning this intriguing entity.

Adolescent↗
PubMed1999

Recurrent respiratory papillomatosis associated with gastroesophageal reflux disease in children.

The hallmark of gastroesophageal reflux disease (GERD) is an increased exposure of esophageal and laryngeal mucosa to gastric juice. This exposure can cause complications such as chronic laryngitis or chronic respiratory diseases. We report our experience in managing three pediatric patients with severe recurrent juvenile laryngeal papillomatosis (JLP) associated with GERD. All patients showed a high rate of recurrence requiring multiple laser surgeries. Systemic alpha interferon therapy over a period of more than 1 year and photodynamic therapy with dihematoporphyrin produced no improvement. However, after therapy for GERD, the rate of recurrence of JLP decreased significantly. Although the course of respiratory papillomatosis is known to fluctuate, our findings suggest that gastroesophageal reflux may have a role in aggravating papillomatosis.

Adolescent↗
PubMed1999

[Epidermoid formation in the pathogenesis of congenital cholesteatoma--a current review].

BACKGROUND: Many theories have been suggested regarding the origin, pathogenesis, diagnosis, and incidence of congenital cholesteatoma. REVIEW OF LITERATURE: An overview on the current literature on congenital cholesteatoma of the middle ear is presented. It comprises the possible etiology and pathogenesis of congenital cholesteatoma. Among other theories, germ scattering, metaplasia, ingrowth of meatal epidermis, and reflux of amniotic fluid have been proposed. Special emphasis is put on the epidermoid formation theory, which has been described by Michaels and others. CONCLUSIONS: It is widely accepted that congenital cholesteatomas may originate from the postpartum persistence of epidermoid formations. Nevertheless, a clear transition from epidermoid formation to congenital cholesteatoma has yet to be confirmed.

Cholesteatoma, Middle Ear↗