Biomedical subjects
Publications and source records attributed to K O Nielsen.
A case of perichondritis and necrosis of the cartilage of the outer ear after acupuncture of the ear is presented. Repeated cultures showed growth of Pseudomonas aeruginosa. Despite intensive antibiotic treatment and extensive surgical toilet, the patient developed a severely deformed outer ear.
From 10 macroscopically normal larynges from adult persons the mucosa was removed in toto, stained with PAS-alcian blue, and the morphology of the subepithelial glands were studied. The glands presented as simple, tubular, usually purely mucous, or as larger, branched, sero-mucous tubular-alveolar. Their orifices were in areas lined with squamous or columnar epithelium. Three different types of main excretory ducts were observed, the commonest of equal caliber throughout, the other two with ampullar or funnel-shaped distensions.
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A comparison between a body-worn hearing aid with a conventional earphone/earmould system, and a free-field dynamic headphone demonstrated the significance of the coupling between the hearing aid earphone and the subject's ear. Measurement of the insertion gain revealed destruction of the ear-canal resonance with a conventional earmould, whereas the ear-canal resonance was preserved by the use of a dynamic headphone. The use of a body-worn hearing aid connected to a dynamic headphone showed a greater amplification at low as well as at high frequencies. Furthermore, a significantly better discrimination score and an improved sound quality were demonstrated with the dynamic headphone.
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By a periodic acid-Schiff (PAS)-alcian blue, elective staining method, and a whole-mount technique, morphologic and quantitative studies of goblet cells and mucous glands were done of mucosal biopsies from the subglottis, the entrance to the sinus of Morgagni, and the false vocal cords in 60 smokers with cancer of the larynx. In 30 of the patients the mucosal biopsies were taken at the time of diagnosis, and in the other 30 after radiotherapy. In the nonirradiated group of smokers there was an increased goblet cell density in the sinus of Morgagni and in the subglottis compared with that in the same areas of the larynx from nonsmokers, but only of significance in the subglottis. There was a definite tendency to a lower goblet cell density in the irradiated group of smokers and an increased number of goblet cell-free areas because of epithelial metaplasia to stratified squamous epithelium. This finding was significant in the subglottis only. In the nonirradiated as well as in the irradiated smokers there was a common occurrence of subepithelial mucous glands with mild to appreciable degenerative changes. This morphologic difference between smokers and nonsmokers may represent the toxic action of tobacco on the laryngeal mucosa and may thus enter into the pathogenesis of laryngeal cancer.
In 20 children, 21 ears with incipient adhesive otitis media were treated by mobilizing the thin, adherent tympanic membrane, strengthening it with a fascial graft, inserting Silastic on the promontory, and establishing middle-ear drainage. The evaluation criteria were adhesive, atrophic and retractive changes in the tympanic membrane. The median follow-up period was 19 months. At follow-up, the material showed a statistically significant improvement in hearing, with a median hearing-loss of 17 db. post-operatively against 30 db. pre-operatively. There was a pronounced improvement in the adhesive and atrophic, as well as in the retractive, changes in the tympanic membrane. The present method of otosurgery is taken to be justified by the threat that incipient adhesive otitis media will develop into total middle-ear atelectasis with maximum hearing-loss and a risk of cholesteatoma. A further justification is afforded by the favourable therapeutic results.
From 70 patients with laryngeal cancer, pieces of mucosa were taken from the subglottis, the entrance to the sinus of Morgagni, and from the ventricular fold. There were 35 taken at the time of diagnosis and the other 35 were taken after radiotherapy. By means of an elective staining method and a whole mount technique, morphological and quantitative studies of the goblet cells were performed. The findings were compared with corresponding investigations of goblet cells in normal larynges. The significantly lower density in the subglottis than in the sinus of Morgagni and ventricular fold observed in normal larynges was not found in the two groups of cancer patients. Instead, there was a tendency to an equalization of the goblet cell density in all 3 laryngeal regions. In the irradiated group the goblet cell density was lower, in all 3 regions, than in the nonirradiated cancer group and in normal larynges. In the close vicinity of the cancer the goblet cell density was reduced, possibly because the cancer process had initiated metaplasia to an epithelium which was poor in goblet cells. Between the two cancer groups and normal larynges there were no morphological differences in the goblet cells.
From 12 clinically and macroscopically normal larynges from adult persons all the mucosa was prepared and stained with PAS-alcian blue to study the morphology, distribution, and density of the goblet cells. In each larynx goblet cells were counted in 600 fields of 0.01768 mm2 mucosal surface, distributed on 18, 18 and 24 localities in the subglottis, glottis with the sinus of Morgagni, and supraglottis respectively. The goblet cells form a continuous pattern, comprising the entire subglottis, the anterior commissure, the sinus of Morgagni, the false vocal cords, vestibule of the larynx, and reaching to the cranial part of the laryngeal surface of the epiglottis. Another continuous, but goblet cell-free area extended from a couple of mm posterior to the anterior commissure, posteriorad on the cranial surface of the vocal cords, ary regions, aryepiglottic fold, the edge of the epiglottis, and 4-5 mm of the laryngeal surface of the epiglottic top, epiglottic vallecula, piriform recess, and the postcricoid region. Between the pseudostratified, ciliated columnar epithelium with goblet cells and the goblet cell-free stratified squamous epithelium there is a transitional epithelium in which the goblet cells alter from the 40 micron tall goblet cells characteristic of the respiratory tract epithelium to being quite flattened in order to disappear completely in the stratified squamous epithelium. The goblet cell density is significantly lower in the subglottis, viz. 125 cells per field, than in the glottis with the sinus of Morgagni and supraglottis, where the median density is 166 and 161 cells respectively per field. A possible correlation between the influence of the respiratory air upon the density of goblet cells and the complex anatomy of the larynx is discussed.
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Pieces of mucosa were removed from the subglottis, the entrance into the sinus of Morgagni, and from the ventricular fold in 82 patients with benign diseases of the larynx. The goblet cells in these specimens were studied morphologically and quantitatively by an elective staining method and a whole mount technique. In 38 patients, the clinical and histological findings indicated an inflammatory disease in the form of chronic laryngitis or laryngeal edema. In 44 patients, the diagnosis was a nonmalignant tumorous lesion, such as papilloma, polyp, or cyst. These findings were compared with a similar study of goblet cells in normal larynges. In the inflammatory group as well as in the tumor group, the goblet cell density in the subglottis and ventricular fold proved to be lower than in normal larynges, but significantly lower only on the ventricular fold. This finding is assumed to be a result of the increased turbulence of the respiratory air, due to the disease process in the glottic fissure, which causes a greater contact surface between the mucosa and the respiratory air. In the close vicinity of the tumorous lesion there was a reduced, but not significantly reduced, goblet cell density, possibly caused by a tumor-initiated metaplasia to an epithelium poor in goblet cells. There were no morphological differences in goblet cells between the two disease groups and the normal larynges.
By means of elective staining with PAS-alcian blue and a whole-mount technique, the entire mucosa from 10 macroscopically normal human adult larynges was investigated with a view to describing the morphology, number, and distribution of the intra-epithelial glands. The glands varied in shape from round to oblong and in size between 30 and 200 micron. The typical round intra-epithelial gland was found to consist of 15-30 mucus-secreting cells, radially arranged around a narrow lumen debouching in a narrow stoma surrounded by cilia. The glands were of irregular distribution in all regions of the larynx. In each larynx there were between 174 and 652 (median 309) intra-epithelial glands. The most striking finding was a pronounced fall in their number from the supraglottis to the subglottis. Two larynges contained intra-epithelial cyst-like structures measuring from 15 to 40 micron. In the supraglottis there was a significantly negative correlation between the occurrence of intra-epithelial and subepithelial glands. On the other hand, it was not possible to demonstrate a definite relationship between the active intra-epithelial glands and the cystic intra-epithelial structures.
The entire intra- and extralaryngeal mucosa from 10 adult persons having macroscopically normal larynges was examined by the whole-mount method and selective staining of the mucous elements by PAS-alcian blue in order to assess the number, distribution, and density of the subepithelial glands. After microdissection of the mucosa the glandular orifices were quantitated under the stereomicroscope. Glands were demonstrated in the various regions of all larynges. The total intralaryngeal number, when excluding the saccule, ranged between 603 and 1579 (median 890) glands. In 6 larynges, glands could be quantitated in the saccule, where their number ranged between 32 and 324 (median 89). In the extralaryngeal region the count for the total series ranged between 1 and 53 (median 9) glands. The median intralaryngeal density, excluding the saccule, was 0.27 gland/mm2, ranging between 0.23 and 0.47. The density was significantly greater in the glottic than in the sub- and supraglottic regions. The highest concentration of glands was observed in the saccule in which the median density was 0.82 gland/mm2. A correlation between gland density and age or sex was not demonstrable. On the basis of the results, the subepithelial glands must be considered a normal component of the mucociliary system in the laryngeal mucosa.