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Eighteen cases of vertebral and spinal cord tumors associated with spine deformity are included in this study. Thoracic spine was involved most frequently. Neurological deficits were found in 14 patients. Surgical management was carried out in 14 cases. In 4 patients with complete transversal spine lesion percutaneous needle biopsy was done to establish the diagnosis. Surgery was supplemented by radiotherapy or radiotherapy and chemotherapy in 10 cases. Neurological improvement was found in 15 cases.

A review of 127 pediatric patients admitted to the Department of Neurosurgery between 1965 and 1993 because of spinal cord and vertebral column injuries is presented. The aim of this paper is to relate clinical appearance and age of the patient. Patients were subdivided into two age groups on the grounds of skeletal development features. The first included 22 patients (3-14 years of age), the second one included 105 patients (15-18 years of age). Accident type, injury mechanism, level of the spinal injury and type of treatment differed in these groups as was found clinically and statistically. Younger group was mostly treated conservatively and the results of treatment were better.

Seventy-three patients were treated due to cranio-cerebral junction disorders between 1980 and 1993. All patients were categorized into three groups depending on the disorder type: congenital (38%), traumatic (47%), or neoplastic (15%). In every group character of the lesion, neurological symptoms and indications for surgical or conservative management were analyzed. The outcome was following: neurological status was improved in 24 cases, in 30 cases the condition was stabilized, progressed in 18 cases and 1 patient died.

A series of 126 patients with spinal metastases and spinal cord lesion treated between 1963 and 1992 at Neurosurgery Department in Poznań has been presented. Neurological condition of the patient, neuroradiological and histological examinations are presented; modalities of management and results are discussed. Treatment was depended on the patient's conditions. Surgery was undertaken if spinal metastasis was the first symptom of the disease. Sixty-one per cent of patients died within 6 months after being diagnosed. Survival was longer in patients treated surgically. Fifty-six percent of them became ambulatory and in majority free of radicular pain. The longest survival was in prosthetic metastases, the shortest in pulmonary ones.

Between 1962 and 1993 were treated at the Department of Neurosurgery, Medical Academy in Poznań 11 patients (10 women and 1 man) with giant-cell tumours of the spine. Their mean age was (26.27 +/- 17.56) years. In all patients pain was the presenting symptom and 10 had neurological deficits. The cervical, thoracic and lumbo-sacral spine was involved; 9 patients were treated surgically and 3 patients received adjuvant radiotherapy. The follow-up time was from 2 months to 30 years.

The incidence of various histological subtypes of intracranial meningiomas and recurrences was examined in 565 patients with surgically treated meningiomas in the Department of Neurosurgery in Poznań, between 1960-1992. Approximately 60% of the tumours were located on the convexity (39.5%) and parasagitally (23%). Histological diagnosis in 88% of the patients was endotheliomatous (61%), fibroblastic (17%) and angiomatous (10%) meningiomas. The incidence of recurrence after complete removal of the meningioma was 7% for all sites, but much higher after partial removal. Among the recurrences, there was a higher degree of malignant and angiomatous subtypes. Surgery is the accepted form of treatment for meningiomas but it may prove insufficient as the only method of therapy in certain situations. Implications for the potential role of postoperative radiation therapy are discussed.

A series of consecutive 782 children with severe head trauma and spinal cord injury who were managed surgically or conservatively in the Department of Neurosurgery, Medical Academy in Poznań during 31 years was analysed. The clinical history, severity of injury (scales AIS, ISS), outcome of head and spinal cord injuries are reviewed. Factors important in predicting a poor outcome included the presence of brainstem contusion, intracranial haematomas and complete and severe partial spinal cord lesions.

We performed a randomized, double-blind, placebo-controlled cross-over study with two different concentrations of ipratropium bromide (Atrovent) nasal spray to evaluate its onset and duration of inhibition. Twenty-four subjects with perennial rhinitis participated in the trial. Fifteen minutes to 12 hours after administration of ipratropium bromide (42 or 168 micrograms/nostril) or placebo nasal spray, methacholine challenges were performed and nasal secretion weights measured. After placebo administration the effect of methacholine remained unchanged over the 12-h-period. Both the 42 and 168 micrograms/nostril doses significantly inhibited the nasal hypersecretions induced by methacholine challenge within 15 min of treatment (P < 0.05). The 168 micrograms dose of ipratropium bromide continued to significantly reduce secretion weights through 6 hours, but the effectiveness of the 42 micrograms dose disappeared within 3 h. In addition to having a longer duration, the 168 micrograms/nostril dose produced approximately twice the inhibitory effect of the 42 micrograms dose.

The diagnosis of brain tumor in a pregnant women is a dramatic event. The nature and timing of therapy at intracranial neoplasm are affected by the existence of the pregnancy. The authors report a two cases of cerebral neoplasm in pregnancy. Clinical syndromes, diagnosis, neurosurgical and obstetrical management are discussed.

A retrospective review of percutaneous needle biopsy due to the vertebral metastatic neoplasms performed in 92 patients treated from 1975 to 1992 at Department of Neurosurgery, K. Marcinkowski University of Medical Sciences. Thoracic biopsies constituted 45 per cent, lumbar-32 per cent, cervical-18 per cent and sacral ones 5 per cent of all procedures. An accurate diagnosis was made in 70 per cent of all cases. The highest accuracy rate was noted in lesions compromising the entire vertebral body (84 per cent) and posterior elements of the vertebrae (89 per cent). Tomographic X-rays, CT and MRI were helpful in visualization of concomitant paravertebral mass. In these cases accuracy rate of the biopsy was 82 per cent. The technique of percutaneous biopsy and histological results were also discussed.

The frequency of occupational allergic rhinitis has grown with the development of new allergens and the prodromic characteristic of occupational asthma. The clinician must carefully assess the often unimpressive symptomatology with a characteristic work/non work cycle. The nasal mucosa is examined rhinoscopically to eliminate a possible tumoural origin. The diagnosis is based on the results of the allergy tests (skin tests, laboratory tests, nasal allergen tests) and on knowledge of the patient's work environment. The diagnosis of occupational rhinitis requires eliminating the allergen(s). A report of an occupational disease is required. In the future, informing atopic subjects early, improving working conditions and modifying industrial techniques should lead to a reduction in the prevalence of allergic rhinitis and occupational pulmonary disease.

A case of 40 years old female with C2 vertebrae destruction caused by multiple myeloma treated surgically has been presented. The tumor has been resected through transoral approach and posterior pharyngeal wall. Posterior fusion has been performed with the use of a bony iliac graft. Good early result has been achieved after 1 month follow-up.

Exposure to cold dry air induces rhinorrhea and other nasal symptoms in many persons. To evaluate whether this response involves a neurogenic component, we delivered a unilateral cold dry air (UniCDA) nasal challenge to volunteers with previously documented reactivity to cold dry air. We measured their nasal secretory responses bilaterally using small filter paper discs to absorb secretions from the nasal mucosa. UniCDA increased nasal secretion both ipsilateral (p < 0.001) and contralateral (p < 0.001) to the challenge when compared with control challenge. Topical atropine (0.225 mg), a muscarinic antagonist, inhibited ipsilateral secretion (p < 0.002) when given ipsilateral to UniCDA. When atropine was given contralateral to UniCDA, there was a trend toward reduction of contralateral secretion but no effect on ipsilateral secretion. Topical anesthesia with lidocaine given ipsilateral to UniCDA inhibited ipsilateral (p < 0.02) and contralateral (p < 0.05) secretion immediately after challenge. Topical anesthesia did not inhibit methacholine-induced nasal secretion. Thus, UniCDA stimulates reflex secretion both ipsilateral and contralateral to challenge which is inhibitable by interrupting either the efferent or the afferent arm of the reflex arc. This human in vivo model supports the importance of neural mechanisms in airway responsiveness to an environmental stimulus.

Cold, dry air (CDA) causes rhinorrhoea and nasal congestion in some individuals. This response can be mimicked in the laboratory by exposing susceptible individuals to cold, dry air nasal breathing. One of the characteristics of this response is that nasal secretions are produced by both nostrils after a unilateral challenge. This study evaluated the role of cholinergic innervation on the ipsi- and contralateral responses to unilateral CDA challenge. Twelve individuals participated in a randomized, double-blind, placebo-controlled, 3-way crossover study where local atropine and placebo were alternated ipsilateral and the contralateral to the CDA challenge. The reproducibility of the model, assessed by the response after pre-treating with placebo, was excellent; after placebo, the ipsilateral response was double the size of the contralateral. Regardless of the site of application, atropine significantly reduced the secretory response to CDA by 60-70%. However, significant secretions were still induced by CDA, even after atropine treatment. We conclude that cholinergically-mediated neuronal pathways play a major role in the nasal secretory response to CDA. Additional neuronal pathways may, however, be involved. This method is a tool to understand the different components of the mucosal response to a cold and dry environment.

Aneurysmal bone cysts considered as a benign lesion are extremely rare in the skull or in the vertebral column. In the last 29-years were admitted to Department of Neurosurgery in Poznań 11 patients with aneurysmal bone cysts involving the skull in 4 and the spine in 7 cases. All but one patients were female, aged between 4 and 37 years. Location of skull cysts were: parietal in 1, occipital in 1, and parietotemporal in two cases. In patients with spinal affection the position of vertebral cysts were: cervical -2, dorsal -4 and lumbar -1 case. All patients suffered severe pain radiating to the adjacent area and showed local deformity of bone structure. Paraparesis or paraplegia were observed in cases with spinal involvement. In all patients, total surgical removal of the aneurysmal bone cysts was possible. Skull defect was covered with plastic materials. In the repair of the vertebral defect, pelvic bone grafts were used and fixed with wire suture. In follow-up ranging from 1 to 25 years there was no tendency for recurrence.

Oesophageal cancer is a substantial cause of mortality in the Western world and recent data indicate that the incidence is increasing. Despite better understanding of the pathogenesis and in the surgical management of the disease, little improvement in the survival rates has been achieved anywhere in the world, especially because screening for detection of premalignant lesions cannot, at present, be adequately applied to populations at risk. The present review summarizes current knowledge of the use of conventional screening methods as well as possible applications of new techniques to targeted populations to permit earlier diagnosis of premalignant lesions of the oesophagus.

A series of 511 patients after vertebral column and spinal trauma admitted to Department of Neurosurgery of University of Medical Sciences, Poznań from 1979 to 1992 has been analyzed. Isolated vertebral and spinal injuries in 49 per cent. In 51 per cent they were associated with multiple injuries. Traffic accidents constituted the main cause (50 per cent of multiple injuries). The severity of the injury was assessed on the base of AIS, ISS rating systems and spinal symptoms. The concomitant multiple injuries were no cause of delay to surgical intervention within vertebral column. The short-term results of the treatment were better in isolated spinal injuries, with 5 per cent mortality rate in both groups.

The effect of premedication with terfenadine, an H1 antagonist, on nasal challenge with antigen, histamine and methacholine was evaluated. A single dose of terfenadine had no effect on the response to a localized challenge with methacholine but completely blocked the secretory response to histamine on both the ipsilateral and contralateral sides. These results suggest that terfenadine has no anticholinergic activity and that the direct and reflex secretory response to challenge with histamine is mediated by the H1 receptor. A single dose of terfenadine significantly reduced sneezing and nasal secretion after challenge with antigen but had no effect on nasal congestion. A double-blind placebo-controlled clinical trial was undertaken to compare the effects of pretreatment with terfenadine for 1 week on the response to sequential nasal challenge with antigen and histamine. Terfenadine significantly reduced the number of sneezes and the levels of kinins, albumin and TAME esterase activity following challenge with antigen. The levels of histamine were also significantly reduced, suggesting inhibition of the degranulation of mast cells. The number of sneezes and the levels of albumin were also significantly reduced by terfenadine following challenge with histamine.

The surgical treatment of nasal polyps (in asthmatic patients) is still controversial today because of the contradictory, inconsistent, and unforeseen results reported in the literature. The 50 patients included in this study (mean age 49 years, range 25-67 years) came for a check-up on an average of 18 months (lower limit 12 months, upper limit 40 months) after a radical endoscopic intranasal ethmoidectomy. Thirty patients suffered from polyps and bronchial hyperreactivity; 12 patients in this group also suffered from aspirin intolerance. Twenty patients suffered from nasal polyps alone, and served as a control series. The following parameters were methodically noted relative to the date of ethmoidectomy: 1) the frequency of attacks and possible intervals of respiratory difficulty, pre- and postoperatively; 2) the basic treatment for the asthma, and the difference in size of the therapeutic doses necessary and/or the elimination of one or more therapeutic classes; 3) bronchospasticity, evaluated pre- and postoperatively by auscultation for wheezing and peak flow measurements. A bronchial challenge with carbamyl choline and a four-doses aspirin challenge over two days (10 mg, 50 mg, 100 mg, 400 mg) were carried out pre-and postoperatively in the absence of contra-indications. Ninety-one per cent of the patients have improved and now live in less discomfort. The factors studied show a lower frequency of attacks, a distinct decrease of respiratory difficulty, less need for anti-asthmatic medication and especially less oral corticoids, and a marked improvement in functional respiratory test. The carbamyl choline test confirms these data and even shows the totally reversible nature of nonspecific bronchial hyperreactivity in 30% of these patients. This series is too limited for us to say that intolerance to aspirin is reversible; perhaps only the reactivity threshold changes. In the 20 subjects with nasal polyps alone, no case of asthma have been recorded since the operation. Improvement of the asthmatic condition may be partly dependent upon a global diagnosis and treatment of the patient by the pneumo-immunoallergologist and the ENT-specialist. However, the nature of the surgical act seems to be of prime importance, and we must insist on the need for a radical marsupialization of the paranasal sinuses.

Twenty patients were selected on the basis of perennial rhinitis, the absence of allergy and with an eosinophil count higher than 20% of total leucocytes in nasal secretions (NARES). Nasal endoscopy with biopsies from the middle turbinate and sinus CT were performed. Biopsies were processed for histological examination and for immunofluorescence. The clinical progress during treatment was scrutinized. An acute congestive aspect of the nasal mucosa was noted in 4 cases, and micropolyposis in 9 cases. Sinus CT showed opacity of the ethmoidal cells in 87% of cases (maxillary sinuses: 75%; frontal sinus: 46%; sphenoidal sinus: 31%). An eosinophilic infiltrate of the nasal mucosa was constituted in 9 cases: In 6 cases, the cells expressed the Fc epsilon RII receptor, recognized by the monoclonal antibody Bb10. Anti-H1 drugs usually failed to result in a clinical improvement and local eosinophilia was not changed. Local corticoids were more effective but not sufficient in some cases, so that oral corticotherapy was needed. Ethmoidectomy was performed in three cases. NARES seems to evolve in three stages: (1) migration of eosinophils from the vessels to the secretions; (2) retention of eosinophils in the mucosa which might be linked to activation of unknown origin; (3) nasal polyposis. Numerous interactions between irritation of the epithelium, release of substance P, and eosinophils, lead to the hypothesis of a neurogenic origin of NARES.

Diplomyelia and diastematomyelia. Case report. Three cases of diplomyelia [1] and diastematomyelia [2] were studied and treated between 1980 and 1990 years. All patients had symptomatic onset in adulthood. Pathological features were caused by localization on the lesion in cervical, thoracic and lumbar segment of the spinal cord. Plain X-rays showed a variety of osseous malformations associated with spinal dysraphism. The most usefull radiographic examination was computerized tomography (CT). Indications to surgical treatment are discussed.

We present the clinical details and HLA typing of 15 Celtic Caucasian patients (four male, 11 female) with Behçet's syndrome (International Study Group criteria). The males affected were younger than the affected females, and three of these males had severe uveal involvement. Two of the 15 patients had the A2 Bw6 Dr4 haplotype but this did not confer family penetrance. Eight had gastrointestinal involvement: two females required ileostomy, two females had chronic diarrhoea, one female had severe ileitis and oesophageal lesions, two males had peptic ulcers, and one female had a peptic ulcer and primary biliary cirrhosis. All of those who developed gastrointestinal symptoms had either the Dr4 or the Dr7 antigens. This study is the largest HLA survey of Celtic Caucasians with Behçet's syndrome. The clinical features and HLA haplotypes are markedly different from 'Arab' and 'Japanese' varieties of Behçet's syndrome. The expression of the Dr4 and Dr7 antigens in those with gastrointestinal involvement possibly implicates class II antigens (Dr) in the pathogenesis of the manifestations of Behçet's disease in the bowel.

Subarachnoid haemorrhage (SAH) from an intracranial aneurysm or arteriovenous malformation is a grave complication of pregnancy. Authors critically analyzed 12 cases of verified SAH during pregnancy from an 11 identified and 1 unidentified cerebral vascular malformation. Aneurysms were responsible for SAH in 7, and arteriovenous malformations in 4 patients. Subarachnoid haemorrhage occurred during I trimester in 2, II trimester in 3, III trimester in 6 patients and after cesarean delivery in 1 case. We conclude that the decision to operate after SAH during pregnancy should be based upon neurosurgical principles, whereas the cesarean delivery should be done in every pregnant patient with SAH.

Nasal secretory eosinophilia was evaluated in inflammatory chronic rhinitis by a cytometric method. Thirteen control subjects and 97 patients (nasal polyps = 44; chronic sinusitis = 26; chronic rhinitis = 27) took part in this study. Secretory eosinophilia was low in the control group (0.3 +/- 0.2 to 1.3 + 0.8%), compared to: 13.8 +/- 8.2 to 15 +/- 7.6% in idiopathic chronic rhinitis, 16.3 +/- 7.3 to 22.7 +/- 10.2% in perennial allergic rhinitis, 18.5 +/- 6 to 25.3 +/- 6.1% in nasal polyps, 23.1 +/- 1.1 to 25.9 +/- 8.6% in nasal polyps with asthma, 27.3 +/- 7.1 to 30.3 +/- 7.8% in aspirin triad. The NARES syndrome was clearly individualized with a secretory eosinophilia between 48 +/- 16.9 and 58.8 +/- 10.7%. Nasal cytometry is a new method that confirms the role of secretory eosinophilia as an interesting marker in the study of inflammatory chronic rhinitis. Nevertheless reference values would be established only after a better knowledge of cell kinetics in nasal secretion under normal and pathological conditions.

An operative treatment within the spine due to the traumatic, neoplastic, vascular or other indications frequently result in complications as disturbance of the shape, flexibility, strength, mobility of the spine and injury of neural structures of a various degree. These complications may be prevented by minimizing surgical injury to the bone, ligaments, nerves and vessels and by adequate intra- and postoperative stabilization of the spine. The management will be effective only if the level, range and type of injury as well as spine tolerance against mechanical loads is diagnosed accurately. The authors included case reports.

Biological adhesives are made of human plasma and bovine heterologous proteins. These entail a poorly documented risk of sensitization. We report about two allergic accidents caused by the injection of Tissucol in the pituitary mucosa of patients suffering from the Rendu-Osler-Weber disease. The clinical picture of the first case was that of a serum sickness, and leukocytoclastic vasculitis was demonstrated. The second case was a delayed hypersensitivity accident, which was confirmed by the subsequent allergological investigation. Although the responsibility of thrombin seems to be evidenced in these two cases, it nevertheless remains exceptional. However, the risk of sensitization following repeated injections of heterologous proteins in a mucosa with a particularly high immunological responsiveness must be well-known. The increasing use of these biological products will probably result in a growing number of accidents, and we must now contemplate the possibility of screening this sensitization before using biological adhesive. Finally, the possibility of latent sensitization by the ingestion of beef must also be considered.

The authors propose a method, simple and practical, for quantitative cytological analysis of nasal secretions. A representative sample of secretions was collected in each nasal cavity by the washing-blowing technic. Homogenization using mucolytics was the first step in the laboratory. After cytocentrifugation and May-Grundwald-Giemsa staining, the light microscope (x 100) was used for the differential leukocyte count. The two factors Friedman's test (sample and experimentation) showed no analytic variability of the measure (p less than 0.05) for the analysed parameters. 534 specimens were obtained on 254 patients and 13 control subjects. All the parameters could be analysed for the two nasal cavities on 127 patients (47.6%), for only one nasal cavity on 62 patients (23.2%), at all 189 positive results (70.8%). The mean volume collected after a 7 ml washing-blowing test was 5 ml. The total leukocyte count varied between 6,833 +/- 1,424 and 44,638 +/- 31,226 per ml in the control group, between 125,246 +/- 36,108 and 498,245 +/- 367,328 per ml in the patient group. The mean eosinophil count varied between 0.3 +/- 0.2% and 1.3 +/- 0.8% in the control group, between 15.1 +/- 2.4% and 18.2 +/- 2.6% in the patient group. The neutrophil count was over 90% in the control group, between 75 and 80% in the patient group. The mean lymphocyte count was about 5% in the two groups, the monocyte count about 1%. So the washing-blowing technic enables a quantitative analysis of nasal secretions. Nasal cytometry seems to be an interesting method for studying the inflammatory secretory cells compartment.(ABSTRACT TRUNCATED AT 250 WORDS)

Subarachnoid haemorrhage from an intracranial aneurysm or arteriovenous malformation is a grave complication of pregnancy. The authors analyzed 11 cases of verified subarachnoid haemorrhage during pregnancy from 10 identified and 1 unidentified cerebral vascular malformation. The aneurysms were responsible for subarachnoid haemorrhage in 6, and arteriovenous malformation in 4 patients. We conclude that the decision to operate after subarachnoid haemorrhage during pregnancy should be based upon neurosurgical principles, whereas cesarean delivery should be done in every pregnant patient with subarachnoid haemorrhage.

The authors report 100 ethmoidectomies performed on 50 patients between 01/87 and 09/89. 75% have been treated anteriorly by systemic corticosteroids. 65% have had prior sinus surgery. Follow-up time ranged from 12 to 34 months (mean: 18 months). A regular treatment with intranasal steroid sprays was taken post-operatively by 96% of patients until three months and 48% until 18 months. 72% of patients considered the symptoms relief as satisfactorily (score of satisfaction greater than 8/10). Severe nasal obstruction, noted in 88% cases pre-operatively, reappeared in 26% 18 months post-operatively. Anosmia, encountered in 72% pre-operatively, disappeared post-operatively in one half of the cases with a good conservation of olfaction 18 months later. Anterior and/or posterior rhinorrhea, sneezing were also satisfactorily controlled. Results on facial pain were not significant. Endoscopic evaluation was performed by a physician who was not the surgeon. A normoplastic mucosa covered the ethmoid cavities in 40%. Localized oedema was observed in 38%. An asymptomatic recurrence, discovered on endoscopic examination, was present in 11%. The symptomatic recurrence rate was 11%. A CTscan control, performed the day of the endoscopic examination and analysed few weeks later, reinforced the degree of objectivity. A complete marsupialization of the ethmoid labyrinth without any remaining cell was confirmed in only 30%. Frequence and aspects of the opacities in the great sinuses were the same pre- and post-operatively. So, this study shows that the insufficiencies of the ethmoidectomy are 1) the difficulty to perform a complete marsupialization of the ethmoid 2) persistent opacities in the great sinuses 3) persistence of the mucosa disease after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Non-allergic rhinitis with eosinophilic syndrome (NARES) accounts for 14% of rhinitis. It is defined by a syndrome of nasal hyper-reactivity over more than three months, the absence of any atopic factor, and an eosinophilia of nasal secretions 20% greater than the leukocytes. The main features are evidenced by the authors on the basis of 20 observations. The symptoms are significantly more marked than in other forms of rhinitis. Olfactive disorders occur very frequently. The symptoms often fail to respond to anti-histamines and even corticoids. The frequency of a micropolyposis starting in the meatus is confirmed by endoscopy and a CT-scan reveals the frequency of hyperplasia of the sinusal mucosa (affecting first and foremost the ethmoid cells). Hyperadrenergy is frequently evidenced by papavenire IDR and by the isoprenaline IV test. Two cases revealed the coexistence of an intolerance to aspirin and a bronchial hyper-reactivity, evidenced by the Carbachol test. The histological and immunofluorescent examination of the pituitary mucosa evidenced an eosinophilic infiltration in 40% of cases. This infiltrate is often labelled by the BB10 monoclonal antibody. The evolution of NARES appears to involve three stages: secretory eosinophilia with a healthy mucosa, eosinophilic mucosa infiltration, and in situ activation of the eosinophils. An evolution towards an eosinophilic PNS and then a triad was observed in two cases. Hopothèses are put forward by the authors to explain the local nasal influx of eosinophils.

Nose and sinus pathology is frequently related to a chronic inflammation, the mechanisms of which involve different cell types that form the MALT, or effector cells. B-lymphocytes are three times more numerous than the T-lymphocytes, where the CD4+ cells predominate over the CD8+ cells. IgA's are mainly secreted by the plasmocytes. In IgA deficiency, a relative increase in IgG or IgD plasmocytes has been recorded. Antigenic information is obtained from cells presenting the antigen. Langerhans-like cells have been described. Two different populations of mast cells have been identified, whilst on the contrary eosinophilic cells are normally absent. The particularities of capillary vascularization and the extent of the nerve fibre network contribute to the creation of a micro-environment interacting with the lymphocytes. The phenomena of cellular interaction are described through the dynamic evolution of the IgE-dependent response in allergic rhinitis.

Ketoprofen was assayed in tissues of surgical patients after mechanical grinding of the tissue in liquid nitrogen; the fine powder obtained allowed the drug to be determined by HPLC in the same way as for liquid samples. The method was applied to the study of ketoprofen diffusion into the tonsillar tissue of 15 patients after a single intramuscular injection of ketoprofen (100 mg). A correction was made for blood contamination after hemoglobin determination.

The pathophysiology of nasal polyposis is yet unclear, but chronic disturbances of the inflammatory pathways may be suspected. Immunological investigations were performed in 3 series of patients: 37 with nasal polyps, 22 with chronic sinusitis, and 15 controls with healthy nasal and sinusal mucosa. Patients with nasal polyps had up to ten times more eosinophil density than patients with sinusitis or healthy mucosa. The average of mast cells and IgE or IgA, M, G plasma cells were not different in the various group. Deposited immune complexes were always absent. These results gave us the opportunity to discuss recent pathogenic theories.

Inverted papillomas are a benign tumors arising from the external wall of the nasal cavity. Sinus extension is easy to evaluate pre-operatively by using the CT-scan. Lateral rhinotomy is therefore not the only way to removing these tumors. Vestibular and endonasal approaches can be considered. Surgical treatment must however remove the tumor tissue completely since recurrence results directly from insufficiency and must be completed by an histological analysis of the whole tissue after its removal in view of its frequent association with carcinoma.

To assess the spectrum of hepatic abnormalities in acquired immune deficiency syndrome (AIDS), we reviewed clinical, biochemical, and pathological material in 32 patients with AIDS. Eight-four percent of AIDS cases had a history of intravenous drug abuse. Ninety percent of AIDS patients has some liver biochemical abnormality at the first presentation of illness. During the course of AIDS, significant (p less than 0.05, paired Student's t test) rises in alkaline phosphatase and bilirubin occurred, without rises in aminotransferases. Mean abnormalities were mild, reflecting approximately 2-fold increases over baseline. Liver failure was not believed to contribute to the death of any AIDS patient. Pathological findings in AIDS included specific infectious diagnosis in 26%, granulomas in 16%, hemosiderosis in 26%, nonspecific abnormalities in 39%, cirrhosis in 23%, and chronic active hepatitis in 3%. AIDS cases were also compared to 10 selected age, sex, and epidemiologically similar non-AIDS patients. Although granulomas or infections were not seen in our comparison group, only the incidence of chronic active hepatitis was significantly different between the groups. If only those with intravenous drug abuse were studied, then none of 24 AIDS patients versus four of eight non-AIDS cases (p less than 0.005) had chronic active hepatitis. AIDS patients with specific hepatic infections tended to have a higher alkaline phosphatase and aspartate aminotransferase (p less than 0.05) than noninfected cases. However, substantial overlap existed, and no difference in hepatomegaly was noted. Ninety percent of AIDS patients were ingesting at least one potentially hepatotoxic drug. We conclude that AIDS patients have a high incidence of underlying hepatic abnormalities. However, clinical and biochemical abnormalities are similar in our selected liver biopsy patients with intravenous drug abuse with or without AIDS. As expected, AIDS patients have a higher incidence of hepatic granulomas and infections, but these patients were not clearly distinguishable from other AIDS cases. Histological examination showed a wide array of changes by light microscopy, but no specific lesion of AIDS was noted. The low incidence of chronic active hepatitis in this AIDS population may imply that the altered T lymphocyte function in AIDS could influence the course of liver disease in these patients.

Cysticercosis is a parasitic infestation that commonly affects the central nervous system. This is a report of computed tomography findings in a patient with a noncalcified cyst causing asymmetric lateral ventricular obstruction at the foramen of Monro. The lesion was isodense and uniformly enhancing, an unusual finding possibly related to presentation early in the course of the disease. This disease should be considered in the differential diagnosis of the lesions at the foramen of Monro in patients with appropriate residence or travel history.

Patients with acquired immunodeficiency syndrome (AIDS) frequently have diarrhea and weight loss. We prospectively examined the upper and lower gastrointestinal tracts in 22 AIDS patients, although severe medical problems often precluded full evaluation. Ninety-six percent (21 of 22) lost weight, and 55% (12 of 22) had diarrhea. The mean (+/- SD) weight loss was 34 +/- 19 lb. Steatorrhea was found in 4 of 14 patients, and D-xylose tests were abnormal in 8 of 14 patients. Mean serum albumin was 3.3 +/- 0.8 g/dl. A significantly diminished plasma selenium level, which can influence immune function, was noted in these AIDS patients. Gastrointestinal infections were identified in 45% of patients. Although diarrhea and malabsorption were more common in the infected group, weight loss and albumin were similar in those with and without demonstrated infections. Flexible sigmoidoscopy showed that of 15 patients, there were two with Kaposi's sarcoma, 10 normals, and three with nonspecific endoscopic changes of colitis. Infection was documented in all patients with colitis. Panendoscopy of the upper gastrointestinal tract was positive for AIDS-related pathology in five of 10 patients, including two with Kaposi's sarcoma, one with Candida esophagitis, one with herpetic esophagitis, and one with gastroduodenitis (biopsy positive for cryptosporidia); five patients had a normal-appearing tract. Small bowel or colonic biopsies frequently showed nonspecific inflammatory changes, although pathogens were identified in six patients (27% of all biopsies). We conclude that a wide variety of gastrointestinal pathology, which includes infectious agents, neoplasms, and inflammatory changes, may occur in AIDS patients. Therefore, AIDS patients, particularly those with diarrhea or weight loss, deserve an intensive evaluation for remediable lesions of their gastrointestinal tracts.

The NARES is a new entity in rhinology. The incidence is more than 15% among all types of rhinitis. The clinical picture is a somewhat variable nasal hyper-reactivity, with frequent hyposmia. Three cases are recorded, which fit for classical criteria of diagnosis: negative allergic tests, more than 20% of local eosinophilia. The authors point out the absence of variation of eosinophilia after nasal challenge with an extract of house dust mite D. Ptéronyssinus. Nasal endoscopy and the computerized tomography show a propensity towards micropolyposis in 2 cases. A bronchial hyper-reactivity to carbamylcholine is detected twice. A cutaneous intolerance to aspirin is proved in one case. A state of adrenergic hyper-reactivity is established in the three patients. The authors suggest that NARES is precursor of the aspirin triad. A dysfunction of the autonomic nervous system, characterized by an adrenergic hyper-reactivity, leads to a neurogenic inflammation of the nasal mucosa. Eosinophils are attracted, and infiltrate the mucosa. Then the eosinophil-derived chemical mediators maintain a chronic inflammatory state. The best therapeutical means are discussed.

After an anatomical review, the authors describe the method for obtaining the temporo-parietal facial flap and its particularities in the rehabilitation of the canal down technic. The main indications of this flap are: the rehabilitation of unstable cavities, a Palva's flap alternation, a solution to the filling up after petrectomy or enlarged canal down technic.

Hereditary angioneurotic edema, although a rare clinical entity, can be fatal if diagnosis and appropriate therapy are not instituted before the performance of routine dental and oral surgical procedures. The pathophysiology, physical findings, and therapeutic treatment modalities have been reviewed, and a case involving both restorative and surgical dental intervention has been presented.

Immunohistological investigations were performed on a series of samples from 37 patients with nasal polyps, 22 with chronic sinusitis, and 15 controls with healthy nasal and sinusal mucosa. Mean numbers of plasma- and mast cells were not different in the various groups. Immunoglobulin isotypes were always predominantly IgA and IgM; IgE were scarce. Deposited immune complexes were always absent. A statistically significant difference, however, was observed in the number of eosinophils within the mucosa. Patients with nasal polyps had up to ten times more eosinophils per surface unit than patients with sinusitis or healthy mucosa.

The effect of cytostatics (Methotrexate, Oncovin and Dactinomycin) on early human trophoblast in vitro was studied by the tissue (organ) culture technique according to Trowell and by brief incubation with thymidine 3H. The cytostatics were tested by the method of Tanneberger in clinical and tenfold higher doses. The criteria for cytostatic efficacy were based an activity of DNA, histologic and histochemical changes, and secretion of hormonal chorionic gonadotropin. In vitro cultures of trophoblast were found to be a good model for evaluation of cytostatics, and the tested chemotherapeutics were effective chemotherapeutically. Upon addition to in vitro cultures they changed the structure and function of trophoblastic cells, resulting in depression of DNA resynthesis, histologic changes, changes in enzyme activities assessed histochemically, and impaired HCG secretion. The most pronounced effects were obtained with Dactinomycin or with a combination of Dactinomycin and methotrexate. Methotrexate alone had the weakest effect on DNA resynthesis and structure of the trophoblastic cells. The effect achieved with methotrexate after 120 hours was equal to the effect of Dactinomycin after 48 hours. Comparison of the histologic and hormonal results with DNA activity showed concordance between the intensity of morphologic and hormonal changes and impairment of nucleic acid functions.

Following the introduction of massive triple drug therapy with high doses of Endoxan, Proresid and Methotrexat instead of the earlier long-term Endoxan treatment in addition of surgery, percutaneous irradiation and intraperitoneal radio-gold, 3 year survival of advanced stages IIb-IV of ovarian carcinoma rose from 19.6% to 42.6%. The 3 year survival of all malignant ovarian tumors (primary or secondary) rose from 38.3% to 51.0%. Further development led to targeted multiple drug therapy (ultrahigh Endoxan, Proresid/VM26, Methotrexat and Adriblastin) according to oncobiogram. The main side-effects, their control and experience with combined chemotherapy and irradiation are described.

Vitamin C deficiency is an exceptional findings but emphasis is placed on the need for detection of latent minimally symptomatic and intricate cases, as illustrated by a 3 1/2 year old child with a latent form of Barlow's disease. Although results of biologic tests were fairly typical, clinical signs were restricted to hypotrophy, gingivostomatitis and proctorrhagia. A literature review failed to determine whether or not specific oral manifestations could be associated with Barlow's disease.