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The size and severity of perfusion defects in acute cerebral ischaemia on single photon emission tomographic (SPET) images may provide useful information regarding long-term (>3 month) stroke outcome. A decreased predictive value has been reported with delayed SPET more than 24 h after stroke onset. We examined 20 patients with acute middle cerebral artery (MCA) infarctions using serial 99Tcm-ECD or 99Tcm-HMPAO SPET (SPET 1 one day and SPET 2 three days after stroke onset). Neurological (NIH, SSS) and functional (Barthel, Rankin) scores were calculated simultaneously and 3 months post-stroke. The two SPET scans correlated equally well with the severity of functional and neurological deficits evaluated 3 months after stroke onset. In comparison to clinical assessment, the prognostic value of SPET was relatively better on the first day than the third day. Crossed cerebellar diaschisis correlated with early SPET deficits, but did not predict functional outcome. Our results suggest that SPET, either with 99Tcm-ECD or 99Tcm-HMPAO, can be used to predict stroke outcome in acute MCA infarction up to 72 h post-stroke without significant interference from luxury perfusion.

Abstract: Clinical significance of short outer dynein arms was examined in a long-term follow-up study of 76 patients with various respiratory symptoms. Clinical evaluations, nasal mucociliary transport rate (NMTR) measurement and transmission electron microscopy were performed. Follow-up examinations took place 5–11 years later. In the initial examination four patients and on follow-up seven patients were found to have short outer dynein arms in their nasal mucosal biopsies. Short dynein arms were associated with a slow NMTR, poorly coordinated ciliary beat direction, and clinical symptoms of perennial rhinitis and recurrent sinusitis. Short dynein arms were found to be a significant histologic finding and probably represent a variant of primary ciliary dyskinesia. In some cases short outer dynein arms may be a reversible finding with improving clinical symptoms. It is obvious that at least part of dynein defects are acquired.

A series of 156 formalin-fixed, paraffin-embedded biopsies from 40 patients with surgically-treated oral squamous cell carcinomas was analysed for the presence of human papillomavirus (HPV) infection by histopathological evaluation, in situ DNA hybridization and polymerase chain reaction (PCR). Epithelial changes suggesting a HPV lesion within, or adjacent to, the carcinoma lesions were found in 16 out of 40 patients (40%). Morphological signs of a flat HPV lesion were found in four cases (10%), those of inverted type in three cases (7.5%), and those of papillary type in nine cases (22.5%). HPV DNA was demonstrated in one of the lesions by in situ hybridization with biotin-labelled DNA cocktail probe containing HPV types 6, 11, 16 and 18. With the PCR technique, samples from 11 (27.5%) of the 40 patients proved to contain HPV DNA. Of these, HPV 6 was demonstrated in one case, HPV 16 in ten cases and HPV 18 in one case. HPV DNA was exclusively detected in the biopsies showing carcinoma tissue or its adjacent precancer lesions. No viral DNA was found in the biopsies derived from the tumour-free resection margins. These results provide further evidence to support the concept of HPV involvement in the aetiology of oral squamous cell carcinomas, most probably acting synergistically with other carcinogens.

We have created a method for measuring the orientation of cilia in the respiratory epithelium. Ciliary orientation is the direction perpendicular to the plane defined by the central tubules of the cilia and is an estimate of ciliary beat direction. Ciliary orientation can be estimated by measuring the angle between the plane defined by the central tubules and a reference line. The standard deviation of these measurements describes the variation present in the beat directions of the cilia. The reference line must be so chosen that the majority of measurements falls at about the middle of the 0°–180° range. We tested measurements by using both a glass angle measure and a semiautomatic image analyzer (IBAS I). The latter approach was faster and more reproducible. We made our measurements of normal tissues on samples obtained from two healthy adult non-smokers. Measurements were made in four areas of each sample, with 59–110 cilia in each. The differences between the maximum and minimum angles of the ciliary orientation in the same area varied from 167.9° to 85.4° from the reference line. The standard deviation varied from 18.0° to 35.4° and we consider this to be a normal variation in ciliary orientation. Of the cilia, 57% were within a standard deviation of 20°.

Summary: Ciliary orientation was studied in 43 patients with the ldquoimmotile ciliardquo syndrome. Twenty-four of these patients had total situs inversus. One mucosal specimen was taken from uterine cervical epithelium, 2 were from bronchial mucosa and 40 from nasal mucosa. The orientation of the cilia was measured from micrographs using a semiautomatic image analyzer (IBAS I). The results from patients were compared with those of 10 control subjects. The mean standard deviation and its standard deviation of the angles of ciliary orientation was 39.7° ± 9.2° in 43 patients and 27.4° ± 4.3° in the control group. The difference between the groups is highly significant statistically (P le 0.001). However, there were no statistically significant differences in the standard deviations of ciliary orientation between the fields sectioned near the cell membrane or near the ciliary tip. We were also unable to find any significant differences in the standard deviations of the ciliary angles in the specimens taken from brush biopsies and excisional biopsies. There were also no statistically significant differences between the standard deviations of the ciliary angles for the groups with or without situs inversus. If 35° is considered to be the limit value for the mean standard deviation between normal and pathological specimens in our total material, this would give a specificity of 0.90 and a sensitivity of 0.72.

Eye movement tests (saccade tests: reaction time, peak velocities and accuracy, and the eye tracking test) were studied in 53 insulin-dependent diabetic (IDDM) patients and 42 randomly selected non-diabetic control subjects, aged between 20 and 40 years. All subjects had central visual acuity of at least 0.1 in one eye, and none had ophthalmoplegia. The reaction time was longer and the accuracy decreased in the saccade test in diabetic patients as compared to control subjects. Peak velocities tended to be slower in diabetic patients, but no significant differences between diabetic and non-diabetic subjects were observed. The maximum eye movement velocities were reduced at all target velocities in diabetic patients as compared to control subjects. These findings can be explained on the basis of many potential disturbances in the central nervous system. Only the duration of diabetes had a clear association with maximum smooth pursuit eye movement velocities in the eye tracking test. Microvascular complications (retinopathy, nephropathy), autonomic neuropathy or metabolic control (high fasting blood glucose and glycated hemoglobin A1c) had no clear association with the results of eye movement tests. In conclusion, insulin dependent diabetes mellitus deteriorates the visuomotor responses.

Disodium cromoglycate particles were labelled with a pure ζ-radiator 99mTc using a novel co-precipitation technique based on spray drying. Metered dose aerosols as well as a dry powder dosage form were prepared using these labelled drug particles. Fractional deposition of the drug particles was determined in vivo by means of gamma camera. Inhalation patterns of seven healthy volunteers were compared to deposition patterns evaluated in vitro using a modified cascade impactor. On average only 9 per cent of the aerosol dose deposited in a whole lung area and about 81 per cent in the upper airways of the volunteers. The in vitro results showed clearly greater deposition of the drug particles into the imitated bronchial and alveolar stages. The physiological factors of the human respiratory tract as well as the individual differences in the inhalation techniques seemed to have a significant influence to the deposition and aerodynamic behaviour of the inhaled drug particles. The in vitro results indicated, however, the similar differences between the two inhalation dosage forms as the in vivo evaluation did.

Transmission electron microscopy (TEM) from nasal mucosa and nasal mucociliary transport rate (MTR) with a radio-isotopic method were examined in 144 patients with various respiratory symptoms. Examinations were not performed during acute infections. In cases of increased amount of tubulus anomalies: nasal MTR was not significantly slower than in other patients, the disorientation of ciliary beat direction was significantly larger, there was no connection with increased amount of compound cilia and there was no correlation to any specific symptom or respiratory disease. In cases of increased amount of compound cilia: nasal MTR did not differ from other patients and the disorientation of ciliary beat direction did not differ from other patients. In a follow- up study of 76 patients 5-11 years (mean 9.3 years) later the amount of tubulus anomalies and compound cilia had changed in most patients. In patients with less symptoms at the follow-up than primarily, there was a non-significant tendency to have less tubulus anomalies, too, but no change in the amount of compound cilia. The amount of tubulus anomalies and compound cilia is not stable. Their number can either increase or decrease during a follow-up. Tubulus anomalies are non- specific and probably secondary changes of minor clinical importance and compound cilia would seem to be quite irrelevant findings in the ultrastructural evaluation of respiratory cilia.

A 48-year-old man was examined because of anosmia. He was otherwise healthy except for mild arterial hypertension. He had stopped smoking 20 years ago. Previously he had been exposed to sulfuric acid gases for 3 years in his work. Clinical examination revealed no findings to explain his anosmia. The patient was fertile, indicating normal sperm/cilia motility. Nasal mucociliary function was examined by radioactive tracer and found to be markedly and constantly impaired. Ciliary ultrastructure in cross-sections was normal. However, in longitudinal sections the length of the cilia varied from 0.6 µm to 3.9 gm. The mean length of the cilia from the cell membrane to the tip was 2.5 ± 0.9 gm, in contrast to normal ciliary length of 5–7 µm. These findings represent a new structural defect among the various known ciliary abnormalities.

Scanning electron microscopy (SEM) and transmission electron microscopy (TEM) were used to study the ultrastructure of human respiratory cilia in 34 patients with chronic or recurrent respiratory infections and 11 control patients. Specimens of pathological mucosa were taken from 12 maxillary sinuses and 22 middle turbinates. Control tissues were taken from middle turbinates or from sphenoid sinuses during transsphenoidal pituitary surgery. Findings in control tissues or specimens with minimal amounts of pathological findings showed that TEM and SEM findings correlated well. TEM revealed axoneme structure better, while much larger populations of cilia could be studied three-dimensionally with SEM. SEM also was the better study when cilia orientations or lengths were evaluated. Optimal examination of ciliary ultrastructure required both TEM and SEM studies.

The effect of azelastine and some selected compounds on ciliary beating frequency (CBF) was investigated in vitro using human mucosal samples and in vivo using anesthetized guinea pigs. Further influence of azelastine on mucus secretion was evaluated in mice and on mucociliary clearance in anesthetized rabbits. Azelastine influenced the ciliary beating frequency neither in vitro nor in vivo. Azelastine, similarly to salbutamol, ambroxol, and bromhexine, increased mucus secretion measured by the tracheal output of phenol red. Azelastine dose-dependently enhanced mucociliary clearance measured by elimination of 99mTc-labeled erythrocytes in rabbits. The activity of azelastine proved to be about 10 times stronger than that of bromhexine. Since the ciliary activity remained unchanged under the influence of azelastine, it is likely that azelastine increases the mucociliary clearance by enhancing bronchial secretion. It is possible that the observed increase in mucociliary clearance may contribute to the beneficial effect of azelastine in the treatment of respiratory diseases.

We cultured the adenoid tissues of 72 children with recurrent respiratory infections for fungal organisms. We also took fungal cultures of nasopharyngeal secretions from 20 healthy children and 13 healthy adults as controls. Culture for fungi were positive in 15% of the patients, in 15% of the healthy adults and in 25% of the healthy children. Candica albicans, C.parapsilosis, C. tropicalis and Aspergillus sp. were the most common organisms found. In studying the children with recurrent respiratrory infections, we were unable to find any significant correlation between the positive cultures and the age, type of day-care and previous antibiotic therapy given. We then studied the hemagglutination titers against C. albicans in 44 patients. This titer was 1—160 or lower in all but three patients, and was 1—320 in these latter three patients. However, fungal cultures were negative in all patients having hemagglutination titers of 1—80 or more.

Mucociliary clearance of the nasal meatus and the middle ear cavity was measured by a radioisotopic method using 99mTc-labelled human serum albumin as a tracer substance. In the patients with secretory otitis me dia the tracer did not move in either ear indicating a lack of mucociliary clearance. Lowered nasal mucociliary transport velocity was found in 31 of the 46 child patients with recurrent or chronic respiratory infections. 11 from 31 patients (35 %) suffered from recurrent otitis media and 19 (62%) from secretory otitis media. Only one patient of the 15 cases with normal transport velocity had secretory otitis media. It seems that primarily or secondarily im paired mucociliary function plays an important role in the pathophyaiology of secretory otitis media.

According to reports in the literature, the incidence of occult acoustic neuroma is about 1%. This figure is relatively high compared with clinically encountered neuromas. Our material consisted of 298 temporal bones from 168 cases (129 paired specimens). No occult neuromas were discovered in our material. On the basis of earlier studies, we expected to find one or two occult neuromas, but there was only one case of a large cerebellopontine acoustic neuroma, and the patient died after a neurosurgical operation.

A study of 277 ears with chronic otitis media undergoing one-stage tympanoplasty has been carried out. The mean follow-up period was 6.4 years. Ears with intact ossicular chains were excluded. Ossiculoplasty was performed using autologous ossicles or cortical bone. Mean hearing gain was 10.8 dB. Closure of the postoperative air-bone gap to within 20 dB was achieved in 51% of cases. The best results were obtained in ears with intact stapes, while cholesteatomatous ears showed poorer results than other chronic ears. The present findings show that autologous ossicle and cortical bone are still suitable for ossicular reconstruction in chronic ears, especially when one-stage surgery is preferred.

The effect of HR-6 solutions containing adenosine triphosphate (either 0.5 or 5 mg/ml) and placebo on the symptoms of chronic rhinitis was studied in 11 patients in randomized, crossover study. The nasal mucociliary activity present in these patients was measured by a radioisotopic method and was impaired in all patients, varying from 1.4 to 5.5 mm/min with a mean of 3.2 mm/min. The duration of each treatment was 10 days, with wash-out periods of 4 days. The relief of the nasal symptoms was recorded. The active drugs on average improved nasal mucociliary activity by 1.9–2.1 mm/min against placebo (1.4 mm/min). At the end of the trial six patients preferred the active drugs for relief of nasal symptoms, none placebo and five had no preferences. The results indicate the need for long-term studies of HR-6 in patients with impaired mucociliary function.