Light and electron microscopic studies of localized laryngeal amyloidosis

Summary We performed light and electron microscopic studies in a case of localized supraglottic laryngeal amyloidosis involving a 55-year-old woman. Tissue specimens were stained with hematoxylin and eosin, and alkaline Congo red with or without permanganate (KMnO₄) treatment, and were also examined with peroxidase-antiperoxidase immunohistochemistry. Biopsy specimens from the epiglottis showed diffuse replacement of the subepithelial region by amyloid, which showed a typical green birefringence under polarized light. Tissue affinity for Congo red was persistent after the KMnO₄ treatment. However, the tissue sections showed a positive reaction only to the anti-P component antibody. Electron microscopic studies revealed some disorders of the plasma cells, suggesting that these cells play an important role in focal production of amyloid fibrils.     

局限性上鼓室胆脂瘤的手术治疗

局限性上鼓室胆脂瘤由于有正常或接近正常的听力，要求耳外科医师选择合适的手术方法，目的在于既要彻底清除病灶，又要保存或增进原有的听力。我科自1998—2003年对21例（21耳）局限性上鼓室胆脂瘤采用上鼓室外侧壁凿开入路，清除胆脂瘤组织，选择性去除锤骨头及砧骨，重建上鼓室外侧壁并同期用人工听小骨重建恢复传音功能，效果满意，报道如下。     

Keratinic amyloidosis of the external auditory canal

Objective

We present a rare case of keratinic amyloidosis of the external auditory canal. This is only the seventh case reported of localized cutaneous amyloidosis of the external auditory canal with no systemic symptoms.

Patient

A 62-year-old man, who had complained of an itchy external auditory canal and left-side hearing loss, was referred to our hospital because of a bilateral external auditory canal mass.

Intervention

Biopsy of the external auditory canal mass suggested a diagnosis of amyloidosis. However, total systemic examination failed to identify any disease due to systemic amyloidosis. This led us to diagnose him with localized cutaneous amyloidosis of the external auditory canal.

Main outcome measure

We follow up periodically with systemic examination and local observation.

Results

Thirty months after the initial diagnosis, he remains in follow-up and has not shown any significant aggravation of the disease.

Conclusion

In previous cases, the chief complaints were itching sensations and pain in the external auditory canal as well as a sense of discomfort when wearing a hearing aid. This suggests that chronic stimulation and inflammation of the skin lining the external auditory canal induced amyloidosis.     

原发性喉淀粉样变的临床分析

目的:探讨原发性喉淀粉样变的临床特点及诊治措施。方法:回顾性分析1996-2011年收治的5例原发性喉淀粉样变患者的临床资料并进行总结。患者均行手术切除病灶,其中4例行喉裂开喉肿物切除术,1例行支撑喉镜病灶切除,均未行放疗和糖皮质激素治疗。结果:5例患者均痊愈出院,其中2例出院后失访,可以随访到的3例患者目前均情况良好,未见复发。随访时间0.3～7.5年,平均3.3年。结论:原发性喉淀粉样变好发于中年人,发病部位最常见的是声带,其次为室带、会厌前间隙等。早期手术治疗是最重要的治疗方式,喉内镜及CT检查对该病的诊断有重要价值;病理组织活检特别是刚果红染色阳性是诊断该病最特异的依据。     

Surgical treatment of the laryngotracheal amyloidosis

Two cases of primary localized amyloid tumor in the larynx and trachea surgically treated were herein reported. As recurrence of the amyloid tumor might lead to repeated resection in the same region, first trial of eradicative laryngofissure or laryngotracheofissure proved to be the effective approaches. The denuded area of the respiratory tract after removing amyloid tumor was covered with a split thickness skin graft and/or neighbouring mucosa applying soft rubber stent, then extensive scarring and schrinkage of the airways after surgery could thus be eliminated.     

Surgical management of intratemporal lesions

In order to evaluate the decisional elements in the surgical strategy of deep‐seated and/or extensive intratemporal lesions, a retrospective review of cases followed up between 1985 and 1996 in our department was undertaken. Eighty‐one adult patients presenting temporal bone lesions located or extending beyond the middle ear limits excluding vestibular schwannomas and surgically treated were included. The population comprised 38 men and 43 women (mean age: 43 years, range: 17–81). Pre‐, intra‐ and postoperative data were collected from medical files. The principal factors influencing the choice of the surgical approach were the location of the lesion and its presumed aggressiveness, the tumour involvement of the internal carotid artery and the labyrinth on preoperative imaging, and the preoperative hearing loss. A coherent algorithm based on these factors can be proposed for the surgical management of intratemporal lesions. High quality preoperative imaging is mandatory for the surgical planning.     

Primary localized amyloidosis of the nose

Two rare cases of primary localized amyloidosis of the nose are described. A 14-year-old woman presented with anosmia, facial pain, and recurrent episodes of bilateral epistaxis persisting for 2 years. Endoscopic sinus surgery was performed and amyloidosis was diagnosed. Amyloid was also found in the trachea. A 27-year-old woman presented with decreased bilateral hearing and recurrent episodes of bilateral epistaxis. Tympanostomy tube placement was performed and observation continued. The optimum treatment of amyloidosis of the nose has not yet established. We consider that the treatment should depend on the extent of the amyloidosis.     

鼻咽部淀粉样变性病的诊治分析

目的探讨鼻咽部淀粉样变性病的发病机制、分类、诊断及治疗。方法通过MRI、腹壁脂肪活检及病理学检查确诊的1例鼻咽淀粉样变性病患者,全麻鼻内镜下切除病变并结合文献进行分析。结果结合影像学资料经鼻内镜下完整切除病变,术后病检示黏膜下见大量无定型样物质,刚果红染色（＋＋）,术后随访1年无复发。结论鼻咽部淀粉样变性病需病理切片确诊,MRI是诊断与鉴别诊断该病的最佳辅助检查,其首选治疗方式为鼻内镜下手术切除。     

侵犯眶内鼻窦囊肿的手术治疗

目的探讨改良眉弓径路联合鼻内镜技术在侵犯眶内的哑铃形筛窦囊肿手术中的应用及疗效分析。方法2002年8月N2012年4月我科收治的7例侵犯眼眶的哑铃形巨大筛窦囊肿患者,全麻下采用改良眉弓切口,鼻内镜辅助下沿眶壁分离并切除眶内囊肿,然后采用鼻内镜囊肿造袋术,切除囊肿。结果7例患者术中眶内及鼻窦囊肿均能充分暴露,并在直视下全部去除。术后无脑脊液鼻漏、眶筋膜损伤和眶内、颅内感染等并发症。术后随访6-18个月,均未见复发。结论采用改良眉弓径路联合鼻内镜行侵犯眶内的哑铃形筛窦囊肿手术,增加了手术的精确性和安全性,切口短,瘢痕小,切除彻底,降低复发率,减少对面部美观的影响,是治疗侵犯眶内的巨大哑铃形筛窦囊肿的有效术式之一。     

Surgical management of bilateral abductor paralysis by extralaryngeal approach

Paralysis of the abductors of both vocal cords causes the vocal cords to lie in the midline or paramedian position. This compromises the airways and causes respiratory distress which may often be acute necessitating tracheostomy. A lateralisation of the vocal cord is required to provide adequate airway without significantly affecting speech. Extralaryngeal approach is our preferred approach. This article reports a study of eight cases who underwent arytenoid abduction by an extralaryngeal approach for bilateral abductor paralysis of vocal cords.     

螺旋CT三维重建咽旁隙的研究

目的探索螺旋CT扫描成人呈张口位时咽旁隙成像并行多平面重建和三维重建等后处理,为经口入路切除咽旁隙肿瘤提供解剖依据及术前指导。方法选择咽旁隙无占位性病变患者28例,放置张口器后行多层螺旋CT血管成像,应用多平面重建测量茎突长度并统计茎突末端与第一颈椎横突的关系,于颅底层面测量茎突至颈内动脉、下颌骨升支后缘的距离并进行统计学分析。利用容积重现和剪切技术对图像进行三维重建等后处理,观察颈内动静脉走行及是否存在变异移位等。结果茎突长度、茎突根部至颈内动脉、茎突根部至下颌骨升支后缘的平均距离分别为(2.50±0.80)、(1.09±0.26)、(2.27±0.29)cm,侧别、性别方面均无显著性差异（P＞0.05）。78.6%（44/56）茎突末端位于第一颈椎横突或以下,64.3%（36/56）颈内动脉起始部位低于舌骨,12.5%（7/56）咽旁隙段颈内静脉先走行于颈内动脉前方然后再转向后外。结论咽旁隙以茎突至毗邻解剖结构的距离为参考,有助于神经血管的定位。三维重建的图像能清晰地显示颅底、下颌骨升支、茎突、颈内动静脉等咽旁隙周边及内部结构。咽旁隙段颈内动静脉均存在一定的变异率,为模拟手术入路和术中颈内动脉定位提供重要信息。     

颈段食管癌的外科治疗16例临床分析

目的：探讨颈段食管癌的外科治疗方法及保留喉功能手术治疗的意义及可行性。方法：回顾性分析手术治疗颈段食管癌患者16例的临床资料,手术方式中,喉及喉咽全部切除食管内翻拔脱管状胃代食管术12例;喉及喉咽全部切除＋颈段食管切除气管代食管术1例;部分下咽＋颈段食管切除喉气管瓣代食管术1例;保留喉的食管内翻拔脱管状胃代食管术2例。均同期行双侧颈廓清术。结果：无手术死亡,手术切除率100％。术后并发肺部感染2例,吻合口瘘2例,吻合口狭窄2例,心功能衰竭1例,失访3例。喉功能保留率12．5％。3年生存率30．7％,5年生存率23．1％。结论：颈段食管癌可行非开胸食管内翻拔脱术切除肿瘤,以管状胃、喉气管瓣修复食管缺损,根据肿瘤所在部位及侵及范围,尽可能保留喉功能。     

鼻、咽及喉部淀粉样变12例临床分析

目的:探讨鼻、咽及喉部淀粉样变性的临床特点。方法:12例淀粉样变性病患者中,1例与多发性骨髓瘤有关的淀粉样变性者累及鼻咽部、喉部及面部,确诊后转血液科化疗;1例鼻部右下鼻甲浆细胞瘤伴淀粉样变性者在局部麻醉鼻内镜下切除后转血液科化疗;5例喉部声带息肉伴淀粉样变性者,行支撑喉镜下息肉及淀粉样变性组织切除术;3例局灶性双侧声带累及声门下气管病变者在支撑喉镜下分别用电刀接支撑喉镜息肉手术刀(外套塑料输液器绝缘)加(或)CO2激光切除术;2例咽部淀粉样变性者分别行全身麻醉下扁桃体切除术和直达喉镜用电刀接支撑喉镜息肉手术刀(外套塑料输液器绝缘)会厌舌面根部病变切除术。结果:1例与多发性骨髓瘤有关的淀粉样变性者18个月后死于恶病质伴肺炎及多器官功能衰竭;1例鼻部右下鼻甲浆细胞瘤伴淀粉样变性者随访2年无复发;5例喉部声带息肉伴淀粉样变性者随访1～3年无淀粉样变复发;3例局灶性双侧声带累及声门下气管病变者中,1例随访3年无复发,2例分别在术后4个月和6个月前连合及声门下局部复发1次,再行支撑喉镜下分别用电刀接支撑喉镜息肉手术刀切除术,随访6个月无复发;2例咽部淀粉样变性者(右侧扁桃体和会厌舌面根部)随访2年无复发。结论:鼻、咽...     

颅眶沟通性脑膜瘤的显微外科切除和眶顶重建

目的　本研究旨在探讨颅眶沟通性脑膜瘤的诊断、手术及预后。方法　收集我科 1 996年 1月～2 0 0 3年 7月入院的 32例颅眶沟通瘤病人中经病理确诊为脑膜瘤的 1 4例病人资料 ,就其临床表现、影像学变化、手术操作、病理特点和预后等方面予以总结和分析。结果　采用额下或额颞侧方入路 ,单纯硬膜外切除 9例 ,联合硬膜外、硬膜下切除 5例。全切 1 1例 ,大部切除 3例。随访 8例 ,3例接受立体定向放射治疗 ,5例未行放射治疗 ;复发 3例 ,均未行术后放疗。结论　颅眶沟通性脑膜瘤可以侵犯颅眶结合部许多重要解剖结构 ,且有复发倾向 ;本病治疗应强调充分暴露、彻底切除、骨性重建和术后放射治疗。     

Surgical management of scleromatous laryngotracheal stenosis

Objective

Scleroma is a chronic specific granulomatous disease of the upper respiratory tract caused by Klebsiella Rhinoscleromatis. It usually affects the subglottic region and upper trachea resulting in various degrees of stenosis. Patients with laryngotracheal stenosis may present with stridor, shortness of breath or exercise intolerance and may be tracheostomy dependent. In this work, we presented the experience of our Institute in the management of patients with scleromatous laryngotracheal stenosis using the already designed procedures for traumatic laryngotracheal stenosis.

Patients and methods

The study was a non controlled prospective study. It was conducted in Oto-Rhino-Laryngology and Head and Neck Surgery Department of Zagazig University Hospitals, Egypt. It included 38 patients with scleromatous subglottic stenosis and/or upper tracheal stenosis. The patients were classified into four grades according to Myer–Cotton's scale. The surgical treatment modalities included endoscopic CO₂ laser surgery with dilatation, laryngotracheal reconstruction, and partial cricotracheal resection with thyrotracheal anastomosis.

Results

The average follow-up period was 32.1 months. Twenty four patients (63%) had an excellent outcome. Nine patients (24%) had a good outcome. Five patients (13%) were still tracheostomy dependent. Eleven patients (29%) developed postoperative granulation tissue. The overall success rate was 87%.

Conclusion

Scleromatous laryngotracheal stenosis is considered a challenging surgical problem. It requires a multidisciplinary approach by well-trained personnel. The surgical techniques designed for cases of laryngotracheal stenosis of a traumatic etiology can be applied for cases of scleroma with approximately the same success rates.