James B. Snow

Pathophysiology of the Ototoxicity of Cis-Diamminedichloroplatinum

The electrophysiologic and histopathologic changes in the inner ear caused by the administration of cis-diamminedichloroplatinum (CP) were studied in guinea pigs. The endocochlear dc potential (EP) gradually decreased after the intravenous injection of CP and reached approximately 0 mV on the fourth day, but the EP did not become negative. The cochlear microphonics also diminished and could not be recorded on the fourth day. The negative potential of the organ of Corti remained in the normal range during the experiment. A large negative summating potential (SP) was observed one day after injection, but the amplitude of the negative SP became small on the second day. Light microscopic examination demonstrated that the outer hair cells are destroyed in the basal turn of the cochlea and are preserved in the upper turns, while the inner hair cells are almost completely preserved in all turns. The stria vascularis was found to be slightly atrophic. Severe collapse of Reissners membrane was observed in the basal turn.

Immunohistopathology of human olfactory epithelium, nerve and bulb.

The immunohistochemical characteristics of the human olfactory system were studied using antiserum to the olfactory marker protein (OMP). OMP was detected in the olfactory receptor neurons and processes extending from the olfactory neuroepithelium to the olfactory bulb. The olfactory receptor cells located close to the epithelial surface also contained OMP. In severely degenerate regions, only a few OMP‐containing cells were observed. Differences in OMP‐staining intensity were noted among the olfactory receptor cells in thick neuroepithelium. Proliferating olfactory neuroepithelium contained OMP reactive and nonreactive olfactory receptor cells. The presence of OMP reactive and nonreactive olfactory neurons indicates the coexistence of two functionally different phases of olfactory neurons. These findings suggest that continuous cell turnover is occurring in human olfactory neuroepithelium.

Randomized preoperative and postoperative radiation therapy for patients with carcinoma of the head and neck: preliminary report.

Two hundred and ninety‐eight patients with squamous cell carcinoma of the oral cavity, oropharynx, supraglottic larynx, hypopharynx or maxillary sinus have been randomized for preoperative radiation therapy and surgery vs. surgery and postoperative radiation therapy plus, in the case of patients with lesions of the oral cavity and oropharynx, radical radiation therapy. Data have been analyzed on 243 patients in this interim report. The differences between the three groups with respect to local control and survival are not statistically significant at this time. Additional accrual and continued follow‐up are necessary to make definite treatment comparisons.

Vomeronasal Organs and Nerves of Jacobson in the Human Fetus

The vomeronasal organs and nerves of Jacobson were found on both sides of the nasal septum in a 28-week human fetus. The vomeronasal organ in the human is a tubular structure with an opening into the nasal cavity anteriorly and closed posterior end. The vomeronasal nerve is distributed equally to the medial and lateral aspects of the organ, courses along the nasal septum and goes through the cartilaginous cribriform plate with the olfactory nerve. The cellular configuration of the vomeronasal organ is similar to the olfactory neuroepithelium. No areas of receptor-free epithelium were found in the vomeronasal organs. Intraepithelial blood vessels and mitotic figures were not observed in the epithelium of the vomeronasal organs at 28 weeks. The lack of intraepithelial blood vessels and mitoses may suggest that the vomeronasal organs are undergoing degeneration at 28 weeks of gestation.

Does preoperative irradiation increase the rate of surgical complications in carcinoma of the head and neck?: A radiation therapy oncology group report

This is a comparison of the rate of surgical complications in a group of patients with advanced but operable carcinoma of the head and neck who underwent surgery after preoperative radiotherapy (5000 rad in five weeks, 200 rad fractions, directed to the primary tumor area and neck) versus another group operated without prior irradiation. Both groups of patients formed part of a randomized prospective multiinstitutional trial of the Radiation Therapy Oncology Group (73–03). Of 229 patients who had planned operations, 88 (38%) developed some degree of surgical complications, and in 28 (12%) the complications were rated as severe. The most frequently reported complications were delayed healing and fistula formation each occurring in approximately one‐fourth of each of the two treatment groups. Carotid blow‐out occurred in 5% or less of the cases. No significant statistical difference between treatment groups was noted for the overall complication rate or specific type of surgical complications. A trend was noted towards more complications in the preoperative group for patients with lesions in the oropharynx and supraglottic larynx. However, an opposite trend towards more complications in the no prior irradiation group was observed among patients with lesions in the oral cavity and hypopharynx. Surgical mortality and postoperative hospital stay were not significantly different between treatment groups. We conclude that preoperative irradiation for carcinoma of the head and neck, with the stated dose, followed by surgery in 4–6 weeks, does not substantially increase the rate of overall or specific type of surgical complications, surgical mortality or hospital stay versus those patients operated without prior irradiation.

Evaluation of randomized preoperative and postoperative radiation therapy for supraglottic carcinoma. Preliminary report.

One hundred and ten patients with supraglottic squamous cell carcinoma have been randomized for preoperative radiation therapy and surgery versus surgery and postoperative radiation therapy. Data have been analyzed on 94 patients in this preliminary report. The differences between the two groups with respect to local control and survival are not statistically significant at this time. Additional accrual and continued follow-up are necessary in order to make a more definite treatment comparison.

Comparison of preoperative and postoperative radiation therapy for patients with carcinoma of the head and neck. Interim report.

Three hundred and fifty-four patients with squamous cell carcinoma of the oral cavity, oropharynx, supraglottic larynx, hypopharynx or maxillary sinus have been randomized for preoperative radiation therapy and surgery versus surgery and postoperative radiation therapy plus, in the case of patients with lesions of the oral cavity and oropharynx, radical radiation therapy. Data have been analyzed on 320 patients in this interim report. In the supraglottic larynx group local-regional control is significantly better for surgery and postoperative radiation therapy. The treatment differences in local-regional control in the oral cavity oropharynx and hypopharynx groups are not statistically significant. No statistically significant treatment differences exist for survival in all sites or in any site; continued follow-up is necessary to make definite treatment comparisons.

Histopathology of the olfactory pathway due to ischemia

Various agents, such as trauma, viral infections and neoplasms cause olfactory dysfunction. However, little is understood concerning the role of ischemia. An experimental model of brain ischemia was developed in the Mongolian gerbil, and the olfactory pathway was studied. This animal was chosen because of its incomplete circle of Willis, since poor patency of the circle of Willis is not an uncommon finding in the aging human. Ischemia was induced by unilateral ligation of one common carotid artery or temporary occlusion of both common carotid arteries. Under both circumstances, ischemic changes occurred in the lateral olfactory tract, the olfactory ventricle, and the olfactory tubercle. Damage is more severe with bilateral temporary occlusion than unilateral ligation. The olfactory bulbs and neuroepithelium, however, are resistant to ischemia.

Assessment of surgical procedures for ménière's disease†‡

There are numerous surgical procedures for the treatment of Menieres disease, and the current status of their efficacy is controversial. A review of the literature is presented as a basis for the evaluation of the relative merit of these procedures. Emphasis is placed on endolymphatic sac procedures, sacculotomy, vestibular neurectomy and labyrinthectomy.

Histopathologic correlates of otoneurologic manifestations following head trauma

The clinical course of patients dying of head trauma and the physiologic evaluation of audition in guinea pigs subjected to several forms of head trauma are correlated with the histopathologic findings in the brains and temporal bones. In the patients there was wide spread hemorrhage, edema, disorganization and disruption of neural tissue. Loss of Purkinje cells and other neural elements was prominent. The temporal bone findings in the patients included laceration of and hemorrhage into the VHIth nerve as well as bleeding into the scala tympani. The membranous labyrinths demonstrated no specific changes secondary to the trauma. The guinea pigs developed a central form of hearing loss with elevated thresholds for evoked responses from the inferior colliculus and normal AC cochlear potentials. In the animals hemorrhage in the substance of the brain, necrosis of neural tissue, edema, disorganization and disruption were prominent. Although there was extravasation of blood in the tympanic and vestibular scalae, the membranous structures of the inner ears were well preserved.