G. Borkowski

Recurrent respiratory papillomatosis associated with gastroesophageal reflux disease in children

Abstract 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 αinterferon 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.

Basement Membrane in Middle Ear Cholesteatoma Immunohistochemical and Ultrastructural Observations

We investigated the distribution of basement membrane zone (BMZ) components collagen type IV, collagen type VII, and fibronectin in human middle ear cholesteatoma, auditory meatal skin, and middle ear mucosa using both immunohistochemical and ultrastructural methods. Collagen type IV inununoreactivity of skin and middle ear mucosa is continuous in the BMZ, whereas cholesteatoma frequently showed absent immunoreactivity or focal discontinuities. Collagen type VII inununoreactivity is detected similarly within the BMZ of cholesteatoma and skin. Fibronectin immunoreactivity is observed within the dermoepithelial junction of skin and middle ear mucosa. In cholesteatoma, however, fibronectin immunoreactivity is markedly increased within the extrinsic BMZ and the subepithelial connective tissue. The ultrastructural arrangement of the BMZ of cholesteatoma is like that of skin; however, it exhibits distinct alterations of the lamina fibroreticularis and lamina densa. Our results outline cholesteatoma as a disease with disturbed cell matrix interactions analogous to those of wound reepithelialization.

Immunhistochemische Untersuchungen von Mittelohrschleimhautresten im Cholesteatom

ZusammenfassungDas Cholesteatom ist durch das Einwachsen verhornenden Plattenepithels in das Mittelohr charakterisiert. Um das Verhalten beider Epithelien zu beschreiben, wurden 50 Cholesteatompräparate mit Mittelohrschleimhautanteilen immunhistochemisch auf die Expression und Lokalisation von Interleukin-1 (Il-1), „transforming growth factor-α” (TGF-α), „epidermal growth factor” (EGF), „epidermal growth factor-receptor” (EGF-R), des Proliferationsmarkers MIB 1, des Protoonkogenprodukts c-myc und des Aktivierungsmarkers 4F2 vergleichend untersucht. Die Keratinozyten des Cholesteatoms besaßen eine deutlich höhere Aktivierungs- und Proliferationsrate als die Mittelohrschleimhautzellen. Die Epithelzellen der Mittelohrmukosa zeigten immunhistochemisch keine Expression von TGF-α, EGF-R, Il-1 und c-myc, im Gegensatz zur deutlichen Immunreaktivität der Cholesteatommatrix. Die lokale Freisetzung von Zytokinen und Wachstumsfaktoren, wie TGF-α, EGF und Il-1 aus Zellen des entzündlichen Infiltrats der Perimatrix, scheinen für das hyperproliferative Wachstumsverhalten der Cholesteatommatrix von besonderer Bedeutung zu sein. Die Ergebnisse können als Erklärungsansatz für das Fortschreiten des Cholesteatomwachstums unter Verdrängung der Mittelohrschleimhaut dienen.SummaryThe development of a middle ear cholesteatoma is usually associated with chronic inflammation and displacement of the mucosa present by the invading squamous epithelium. To analyze the clinically different behaviors of both epithelia, we used immunohistochemical methods to study the distribution and expression of interleukin-1 (Il-1), transforming growth factor-alpha (TGF-α), epidermal growth factor (EGF), epidermal growth factor-receptor (EGF-R), the proliferation marker MIB 1, c-myc proto-oncogene product and activation marker 4F2. Results stromal that keratinocytes in a cholesteatoma exhibited a much higher activation and proliferation rate when compared to middle ear mucosa cells. Middle ear epithelial cells showed no immunoreactivity for TGF-alpha, EGF-R, Il-1 and c-myc in contrast to the markedly positive immunoreactivity found in cholesteatoma matrix. The local release of cytokines and growth factors, such as TGF-alpha, EGF and Il-1 by inflammatory cells seems to be an important factor for the hyperproliferative behavior of cholesteatoma epithelium. Our findings could contribute to the pathogenesis of middle ear cholesteatoma and give a possible explanation for the sustained progression of its growth leading to displacement of the middle ear mucosa.

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.

Inflammation of Embryonic Connective Tissue in the Middle Ear Spaces

Objective --Persistent embryonic connective tissue has been considered to be a cause of chronic otitis media with effusion in neonates and of cholesteatoma in later life. As part of a study of pneumatization and resorption of embryonic connective tissue from the middle ear of pre- and postnatal infants, inflammatory processes of variable extents have been observed within the embryonic connective tissue. The aim of the present study was to characterize this inflammation and to detect patterns in its presence and distribution. Material and Methods --Twenty fetal temporal bones obtained at 4-8 months of development and 31 temporal bones from children who died of sudden infant death syndrome aged < 1 year were studied to assess the inflammation within the middle ear cleft and specifically in the embryonic connective tissue. Results --Sixteen of 27 (59.3%) pre- and 10/31 (32.2%) postnatal specimens displayed a non-specific inflammatory lymphocytic infiltration without signs of bacterial infection or the presence of or reaction to amniotic contents. Eleven of 27 prenatal temporal bones (40.7%) and 16/31 (51.6%) postnatal specimens showed no evidence of histologic middle ear inflammation. The presence or absence of inflammation was independent of age. Conclusion --Our observations indicate resorption of the embryonic connective tissue with individual variations indicating that genetic factors are responsible for the development of the middle ear spaces during the phases of development studied.