Michael F. Pratt

Fulminant drechslera sinusitis in an immunocompetent host

Mycotic infections of the paranasal sinuses are rare. Sinusitis caused by Drechslera spicifera, a common saprophytic dematiacious fungus, has previously been reported in only three immunocompetent patients. Aggressive growth characteristics were not described in any of these reports. The case of a young immunocompetent pregnant woman with fulminant sinusitis caused by Drechslera spicifera is presented. The tumor, which invaded both orbits and the anterior cranial fossa, was rapidly progressive during pregnancy. After delivery of the baby, a combined craniofacial approach was used to excise the sinus mass while adjacent normal tissues were preserved. The pathophysiology and mycology of this uncommon sinus pathogen are reviewed. This case emphasizes the need for prompt surgical intervention to avoid potentially life‐threatening complications from a fulminant mycotic process in the paranasal sinuses. Indications for postoperative chemotherapy with amphotericin B are discussed.

Oculopharyngeal muscular dystrophy: recent ultrastructural evidence for mitochondrial abnormalities.

Oculopharyngeal muscular dystrophy is a rare, autosomal dominant disorder which has been traced through 11 generations of a French Canadian family. The classic presenting complaints are palpebral ptosis and oropharyngeal dysphagia. The dysphagia is usually progressive and leads to repetitive regurgitation, increased alimentation time, and weight loss. Immunologic studies generally reveal elevated levels of IgA and IgG, while manometry demonstrates poor pharyngeal contraction. The dysphagia is frequently relieved by cricopharyngeal myotomy. We present two case reports and also a new ultrastructural finding of abnormal metallic mitochondrial inclusions. This finding has not been previously described in this disorder.

Microsurgical application of freeze‐dried arterial allografts

Arterial allografts of 1.0 mm diameter and 1.0 cm length were freeze‐dried and placed into the femoral arteries of 15 Sprague‐Dawley albino male rats in order to study patency and tissue reactions of the host. Patency in the first three postoperative days was determined by monitoring viability of the epigastric island flap. All grafts were patent during this early postoperative period. Fourteen of the subjects were surgically explored after 2 months of observation. At that time, 13 (93%) remained patent. Histopathological studies, and transmission and scanning electron microscopy were used to analyze the specimens. These data demonstrated that freeze‐dried arteries are remodeled by the host, but do not induce a cellular immune reaction. Dependable freeze‐dried microarterial allografts have potential future application in clinical microvascular surgery.

Correlation of neutrophil activation and skin flap survival in pharmacologically altered pigs

In inflamed tissue, neutrophils produce tissue necrosis factors such as free oxygen radicals. We investigated the role of neutrophils in random flap survival using the tissue neutrophil marker myeloperoxidase (MPO), and in whole blood using flow cytometry with the neutrophil activation marker 2′7′ dichlorofluorescein diacetate. Hypopigmented pigs were treated with the experimental 21-aminosteroid lipid antioxidant U-74389G (oxygen free radical scavenger) before dorsal random skin flaps were elevated. Extent of flap survival was measured by surface planimetry 7 days after surgery. Mean flap survival was 64.1% ± 3.4% in the 3-mg/kg—treated group, and 68.0% ± 3.4% in the 1-mg/kg—treated group — both significantly greater than the survival in vehicle-treated controls (48.6% ± 2.3%). We measured MPO in tissue extracts using an enzyme-linked immunoassay, which showed less MPO in treated animals than in controls. Flow cytometry results were nonspecific. These data suggest that U-74389G improves random skin flap viability by inhibiting neutrophil infiltration into the flap.

Oncogenes in Head and Neck Cancer

At the annual meeting of the American Academy of Otolaryngology—Head and Neck Surgery, San Diego, Calif, September 1990, Presley M. Mock et al, San Antonio, Tex, presented their experience with amplification of oncogenes in head and neck cancer. Oncogene amplification has been identified as a good prognosticator in cases of neuroblastoma as well as breast and lung carcinoma. The hypothesis tested by this study was that prognosis in patients with head and neck carcinoma can also be correlated with oncogene amplification. C- myc oncogene amplification was compared with current prognosticators, including conventional staging parameters, patient age, and tumor site in 21 patients. At the time of surgical resection, normal mucosa and tumor specimens were obtained. Seventy-five percent of the patients who were entered in the study were classified as stage III or IV. Standard DNA extraction onto nitrocellulose paper and densitometer quantitation were performed. Amplification of C- myc ranged from