Biomedical subjects
Publications and source records attributed to Y Roth.
Normal in-vitro ciliary beat frequency is reported in a patient with retinitis pigmentosa. The significance of electromicroscopic ciliary defects in this condition is appraised.
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In vitro nasal and tracheal ciliary beat frequencies (CBFs) were measured photometrically in brush samples of 15 patients undergoing bronchoscopy. Tracheal and nasal CBF values in these patients were found to be significantly correlated (r = .74, p less than .01), and the latter did not differ significantly from the nasal CBF of 80 subjects serving as controls. Premedication with morphine and atropine and local anesthesia with lidocaine hydrochloride significantly decreased the CBF. Among the control subjects, a significantly higher CBF (13.6 +/- 1.5 Hz) was found in the young age group (10 to 19 years) as compared to other groups (12.2 +/- 1.7 Hz). Gender and ethnic origin did not influence CBF in any age group. These data support the possible use of the in vitro study of nasal epithelium to reflect the CBF in the lower respiratory tract.
The course of middle ear injuries secondary to blast effect was evaluated in 147 soldier-patients (210 ears) during the years 1967-1986. All perforations were in the pars tensa of the tympanic membrane. Ossicular chain interruption (11 ears) was associated mainly with dislocation of the incudo-stapedial joint. Mixed-type hearing loss was most prevalent (37%). Spontaneous closure occurred in 155 ears (73.8%), most of them (65.5%) within a 3-month period. Seven ears (3.3%) developed simple chronic suppurative otitis media; in 10 (4.8%), an invasive cholesteatoma developed, and in 6 others (2.8%), epithelial pearls were encountered behind an intact eardrum. Thirty-two patients were treated by immediate patching of the perforated drum, with an 84% rate of spontaneous closure; no cholesteatoma developed among this group, emphasizing the need for immediate patching. Tympanoplasty is recommended 1 year following the injury, and a 4-year follow-up period for detection of late complications is also recommended.
Preliminary results in 8 patients with Meniere's disease who underwent decompression of the endolymphatic sac in the past 3 years were good. There was improvement in general disability, and tinnitus control in 87.5% and stabilization of hearing in 62%. The single complication was dead ear in 1 patient. These results are in the acceptable range and encourage continuation of this operation.
3 patients with tonsillar lymphoma are described (a man of 68 and women of 62 and 57 years, respectively). The first had intermediate grade lymphoma localized in the tonsil and was treated by tonsillectomy and combined systemic chemotherapy. The second had low-grade lymphoma of the tonsil and widespread involvement of lymphoid tissue in the liver, spleen, mediastinum and retroperitoneum for which chemotherapy was given. The last had intermediate grade lymphoma, but had been misdiagnosed 4 years before as an undifferentiated carcinoma of the tonsil and was irradiated. After the malignant process had extended to the stomach, the correct diagnosis of diffuse large-cell lymphoma was made. Subtotal gastrectomy was followed by combined systemic chemotherapy. All patients responded well to treatment.
Persistence of neutralizing antibodies after revaccination against smallpox was studied. Single serum samples from 140 revaccinated donors were tested for neutralizing antibodies using the plaque reduction assay. The donors, aged 21-49 years at sampling, had been vaccinated in infancy and revaccinated at 8 and 18 years; they formed seven groups of 20 men each, revaccinated about 3, 5, 10, 15, 20, 25, and 30 years before sampling. The differences in mean titer among groups were insignificant (P greater than .01). The titer significantly decreased during the first 3 years after the revaccination but remained stable for at least 30 years thereafter (geometric mean titer, 10.5; 95% confidence interval, 6.8-16.4). The results suggest that there is probably no need for routine revaccinations beyond the primary and two revaccinations; nevertheless, persons at high risk should be revaccinated regardless of their vaccination status.
Studies of mucociliary clearance were made on 17 patients with bronchiectasis and excessive sputum production. Tracheal mucus velocity was measured. Five patients with primary ciliary dysfunction and 12 who had no clinical evidence of this defect were studied. The mean (+/- SD) tracheal mucus velocity of the five patients with proved or presumptive primary ciliary dysfunction was 2.9 +/- 0.2 mm per minute and for the 12 patients without ciliary dysfunction, 7.9 +/- 1.4 mm per minute. (The previously determined rate for normals was 4.7 +/- 1.3 mm per minute.) In four of five patients with ciliary dysfunction, CBF was below 7.5 Hz while in the one patient of the 12 without ciliary dysfunction CBF was at the lower limit of normal values. Thus, mucociliary clearance responds to load, depends partly on CBF, and has a built-in control system and the means for compensating for ciliary dysfunction.
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147 soldiers, in whom 210 ears were blast-injured, were studied retrospectively during 1967-1986. The nature of eardrum perforations, hearing impairment, complications, changes over the course of time and different modes of treatment were reviewed. In 92.8 of the ears the perforation was up to half of the eardrum surface, most significantly of the lower part of the drum. In 75% the perforation closed spontaneously: in 40% within a month, in 59% within 2 months and in 73% within a year. Most had impaired hearing, of whom 74% had sensorineural or mixed hearing loss; 60% complained of tinnitus and/or vertigo. In 13% purulent discharge had accompanied the perforation and in 8% a cholesteatoma had developed 1-4 years after injury. The recommended treatment of blast injury is early patching of the perforation and surgical exploration a year later in cases with residual conductive hearing loss or cholesteatoma.
Foreign objects in the external auditory canal are frequent in ENT practice. Invasion by the recently defined dung beetle, Maladera matrida, is a new phenomenon which causes extreme distress, usually starting after invasion by the insect in the early morning hours. Extracting it is very difficult. This beetle is a relatively new, albeit already common problem in Israel. As yet it cannot be effectively controlled. It may well become a more severe problem which will necessitate screening of windows in urban as well as rural areas.
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To identify possible altered flow of cerebrospinal fluid due to defective ependymal ciliary motion, 8 subjects, including 6 with Kartagener's syndrome (KS), 1 with primary ciliary dyskinesia (PCD) and 1 with situs inversus were studied by computerized tomography (CT) examination of the brain and paranasal sinuses and had their nasal cilia studied by in vitro ciliary beat frequency (CBF) analysis. Five of the 6 patients with KS and the one with PCD had abnormal CBF (slowed or absent), while the CBF of 1 KS patient and the subject with situs inversus was normal. CT evaluation of the brains of all subjects was normal. Sinus examinations of the 7 patients with KS and PCD revealed mucosal thickening. We conclude that slowed or absent ciliary activity as measured in vitro is not associated with brain abnormalities as demonstrated by CT examination.
Ciliary beat frequency (CBF) in various parts of brain ventricular system, as well as in trachea of hamsters, was examined. Coronal sections of brain and tracheal rings were maintained in a thermostatically controlled perfusion chamber and CBF measured by a photoelectric system equipped with a fiber-optic probe. CBF (Hz) values of lateral ventricle, aqueduct and fourth ventricle were 27.9 +/- 4.6; 30.7 +/- 7.7 and 31.9 +/- 7.8 Hz, respectively. CBF in the third ventricle--19.8 +/- 7.1 Hz--was significantly lower than in other segments of ventricular system. CBF in choroid plexus cilia was very slow, 5-10 Hz, whereas in tracheal rings amounted to 13.7 +/- 3.1 Hz. Bovine cervical mucus and mucus stimulant reversibly inhibited CBF in brain but not in trachea. Brain cilia in contrast to those in trachea were not capable of transporting particles. In addition to demonstrating differences between tracheal and ependymal cilia, this work suggests that cilial motility plays a functional role in local mixing of cerebrospinal fluid, but does not relate to the bulk flow within the ventricular system.
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