Erkki Virolainen

Risk factors for recurrent otitis media.

Risk factors for recurrent otitis media were studied in 115 otitis-prone children. A group of 323 children was used as controls. The care of children in day care centers, parental smoking and a low socioeconomic status of the family were associated with recurrent otitis media. The duration of breast feeding, the childs age at introduction of cows milk-based feeding and allergy were not associated with recurrent otitis media.

Detection of human papillomavirus (HPV) structural antigens and DNA types in inverted papillomas and squamous cell carcinomas of the nasal cavities and paranasal sinuses.

To assess the suggested etiological role of human papillomavirus (HPV), biopsies from 14 patients operated on for an inverted papilloma (11 cases) and squamous cell carcinoma (3 cases) of the nasal cavity and paranasal sinuses were analysed for light microscopical evidence of HPV, by indirect immunoperoxidase (IP-PAP) to demonstrate HPV structural proteins, and using in situ DNA-hybridization to disclose the DNA of HPV types 6, 11 and 16. The majority of the inverted papillomas contained areas of metaplastic squamous cells, including koilocytes as well as dysplastic changes consistent with intra-epithelial neoplasia as described in uterine cervix. In 3 patients, frankly invasive squamous cell carcinomas were found, originating from dysplastic squamous epithelium. Of the 14 lesions, 7 (50%) expressed HPV antigens, usually confined to only a few cells close to the surface of the epithelium. None of the malignant lesions expressed HPV antigens. In situ DNA-hybridization disclosed HPV 11 DNA alone in 5 lesions, but none of the lesions contained HPV 6 DNA. HPV 16 DNA was found in 2 lesions as a single HPV type, and in 3 other lesions concomitant with HPV 11. All three carcinomas contained HPV 16 DNA. The HPV DNA distribution proved to be different from that found in the genital tract HPV lesions; HPV DNA was less abundant in the nasal papillomas, and it was also found in the basal and suprabasal cells.(ABSTRACT TRUNCATED AT 250 WORDS)

A modified protocol for early treatment of osteomyelitis and osteoradionecrosis of the mandible

The treatment of osteoradionecrosis (ORN) and early chronic osteomyelitis (COM) of the mandible and maxilla is controversial. Hyperbaric oxygen (HBO) at two to three times the atmospheric pressure at sea level can result in tissue oxygen tension of almost 400 mmHg. Herewith HBO increases oxygen supply in hypoxic tissue, thus inducing fibroblastic proliferation and capillary formation.

Steroid hormone receptors in laryngeal carcinoma.

The larynx has long been shown to be a target organ for androgenic steroids in both women and men, and specific androgen receptors have been determined in normal laryngeal mucosa and in laryngeal carcinoma tissue. In this study, samples from 21 primary laryngeal carcinomas, from 4 recurrent laryngeal carcinomas and from 1 cervical metastasis of laryngeal carcinoma were obtained at the time of surgery to assay specific androgen, estrogen, and progesterone receptors. Specific androgen receptors were found in 8 samples (31%). The level of receptors varied from 1.7 femtomoles (fmol) per milligram to 7.3 fmol/mg cytosol protein. Detectable levels of specific estrogen receptors were found in 18 samples (69%) and progesterone receptors in 8 of the 15 samples studied (53%). There was no apparent correspondence with donors’ sex, since samples from both females and males contained all kinds of receptors. We know that antiestrogen inhibits the growth of squamous carcinoma cells lines positive for estrogen receptors in vitro and that this effect is reversible with the appropriate hormone. Thus, the relatively high percentage of estrogen and progesterone receptors found in laryngeal carcinoma tissue may open new aspects in the treatment of laryngeal carcinoma with antihormones.

Myringotomy in the Treatment of Acute Otitis Media in Children

The treatment of acute otitis media was studied in 158 children. All children (mean age 4 years) received penicillin orally 80 000--100 000 IU per day for 10 days. Myringotomy was performed on 68 children at the time of the diagnosis. The other 90 children were treated with penicillin and ear drops. The bacteriological findings from the nasopharynx at the time of diagnosis were equivalent in both groups. After 2 weeks, 42% of the children without myringotomy and 71% of the children with myringotomy were cured. The children who were not cured were treated with amoxicillin for 10 days. Four weeks after diagnosis 71% and 90% of the children respectively were cured. The differences between the two groups are significant. The observations indicate that myringotomy clearly accelerates the recovery from acute otitis media.

Diphenylpyraline (Lergobine®) in the Treatment of Patients Suffering from Allergic and Vasomotor Rhinitis

In a double-blind study, diphenylpyraline (Lergobine®) was given to 63 patients whose main symptoms were stuffiness of the nose, increased secretion of mucus, snuffling, sneezing and redness of the eyes. Fifty-seven patients were given placebo for identical symptoms. Diphenylpyraline was found to have a better effect on all the symptoms than placebo. The difference was statistically significant in respect of the discharge of mucus and redness of the eyes, and when the total symptoms were considered as a whole. In atopic patients the better effect of diphenylpyraline was highly significant.

Microvascular Free Tissue Transfers after Preoperative Irradiation in Head and Neck Reconstructions

Surgical reconstruction of large head and neck tumors involves great problems. Preoperative irradiation increases the risk of postoperative complications. The use of microvascular free flaps has definitive advantages over conventional reconstruction techniques and permits immediate preoperative high-dose radiation therapy. Eighty-eight patients, 55 (62%) men and 33 (38%) women, with head and neck tumors underwent microvascular reconstruction at the Turku University Central Hospital in 1985-1995; 77 of them were irradiated before surgery. All irradiated patients underwent primary reconstruction. The preoperative radiation dose was 50-65 Gy. The free tissue transfer was successful in 77 (88%) of the 88 patients. The success rate was 87% in irradiated patients and 91% in nonirradiated patients. Free tissue transfers are suitable for one-stage reconstruction in selected patients such as those receiving high-dose preoperative irradiation. The transfer of microvascular free flaps to the head and neck has become the most common reconstruction method owing to its increasing success rates as well as its excellent esthetic and functional results.

Experimental Basis for Lidocaine Therapy in Cochlear Disorders

In order to further our basic understanding of the effects of lidocaine hydrochloride in the inner ear, cochlear potentials and blood flow (CBF) were assessed after intravenous (i.v.), anterior inferior cerebellar artery (AICA), and local round window (RW) lidocaine administrations in guinea pigs and rats. Lidocaine RW applications produced a dose dependent decrease in compound action potentials (CAP) and cochlear microphonics (CM). The sensitivity changes were more pronounced at high frequencies. These findings suggest that lidocaine has specific pharmacological action in the inner ear other than simple anesthesia of the auditory nerve. The basal turn endocochlear potentials (EP) were not altered by topical lidocaine, implicating altered organ of Corti function following local application of lidocaine. RW applications of lidocaine had no effect on CBF or systemic blood pressure (BP). I.v. infusions caused substantial reductions in BP. In the case of systemic infusions the percent changes in CBF were equal to and accountable by the BP changes. The microinfusions (50 mg/ml, 100 nl/min) through AICA produced a 30%, long lasting increase in CBF. However, neither systemic lidocaine nor AICA infusions had an effect on CAP or CM. These findings indicate that systemically given lidocaine may not cross the blood-cochlear barrier and that the cochlear electrophysiological effects due to lidocaine when given locally are partly mediated by direct influence on cochlear hair cell function; they also suggest that lidocaine-induced interference with active ion transport in the lateral wall or an influence on CBF are not contributing factors.

Factors Affecting the Growth of Head and Neck Squamous Carcinoma Cell Lines

Cell plating density influences the growth pattern of human squamous cell carcinoma (SCC) cell lines in culture. SCC lines were used to study factors responsible for these effects. Experiments in which the medium was changed daily or in which conditioned medium was used showed that the growth-supporting factors were not found in the media. However, when cells were plated in dishes in which the same cell line had been grown to confluence and removed by scraping, logarithmic growth began immediately. The effect was not seen on areas of the plate that had been covered with coverslips or in dishes where fibroblasts had been cultured. Antibodies to fibronectin, laminin, and a variety of epidermal cell antigens were used to determine the nature of the growth-stimulating substances remaining on the dish following cell removal. Results indicate that an extracellular matrix with similarities to basement membranes was present on the conditioned dishes.

Local IgA-class antibodies against respiratory viruses in middle ear and nasopharyngeal secretions of children with secretory otitis media.

The presence of antibodies against some important respiratory viruses in the middle ear and nasopharyngeal secretions of 52 children with secretory otitis media (SOM) was investigated in order to find out about the role of these viruses in the development of SOM.The method employed was a sensitive radioimmunoassay test.