Chondroma of the external auditory canal

Chondroma, a benign tumour which is common at many sites in the body, has not been reported in the English literature in the bony external auditory canal. The first such case at this anatomical site is described and the pathogenesis is considered.     

Paraganglioma of the external auditory canal

A rare case of paraganglioma of the external auditory canal is presented. It was treated by excision and no recurrence has been noted after 18 months of follow up.     

Fiberscope-assisted evaluation of prereconstructed and postreconstructed external auditory canal

The malignant tumors of the external auditory canal often invade the middle ear area through the narrow canal, so it is difficult to determine the surgical excisional margin. A patient undergoing external auditory canal reconstruction following excision of a squamous cell carcinoma using a chondrocutaneous flap and fiberscope-assisted preoperative and postoperative diagnoses are described. We obtained good patency of the canal postoperatively. This technique is quite simple and easy to use. We believe fiberscope-assisted surgery is useful for extracting lesions in small areas. In the future, its application will extend to the area of plastic surgery.     

The human external auditory canal, secretory system--an ultrastructural study

Human external auditory canal skin, with a special emphasis on the secretory system, was studied by light, transmission electron and scanning electron microscopy. Two types of secretory glands were observed: modified apocrine (ceruminous) and sebaceous. The sebaceous secretory cellere homogeneous; on the other hand, modified apocrine secretory cells contained heterogeneous secretory granules. They were ither dark granules or light granules. Evidence to support both the apocrine as well as the eccrine mode of secretion was noted in the modified apocrine gland. This finding is partly in agreement with early reports based on light microscopy with suggested only an apocrine mode and data based on transmission electron microscopy which showed only the eccrine mode. Significance of the secretion by the external ear canal and its role in a local immune defense system is discussed.     

Cryptococcosis: an unusual cause of endobronchial obstruction

We report the case of a 43 year old male patient, with normal immune function, who presented with right middle and lower lobe collapse. At bronchoscopy, a white lobulated lesion was seen, completely obstructing the origin of bronchus intermedius. Bronchial washings and biopsy of the lesion demonstrated cryptococcal organisms. The patient responded clinically and radiologically to amphotericin B and flucytosine; however, repeat bronchoscopy revealed only partial resolution of the endobronchial lesion.     

Impression-material foreign bodies of the middle ear and external auditory canal

Twenty-nine evaluable patients with endometrial cancer were treated with amonafide 300 mg/m2 for 5 consecutive days every 3 weeks. Two partial responses (8%) were seen. Hematologic toxicity was severe or life-threatening in 13 patients occurring as follows: leukopenia in 13 patients (45%); thrombocytopenia in 10 patients (34%); granulocytopenia in 13 patients (45%); and anemia in four patients (14%). In view of the low response rate and high toxicity, this dose schedule of amonafide does not warrant further investigation in endometrial cancer.     

External ear canal schwannoma: an unusual case report

To the best of our knowledge, this is the first report of external ear canal schwannoma in the English literature. Several detailed clinical and pathological features were demonstrated. We suggest that if a tender, encapsulated mass is found in the external ear canal, the diagnosis of schwannoma should be taken into consideration.     

Pneumothorax: an unusual cause of ICD defibrillation failure

We describe two patients with defibrillation failure of implantable cardioverter defibrillators (ICDs) resulting from large left pneumothoraxes following subclavian vein puncture during the implantation. Following pneumothorax drainage, low defibrillation thresholds (DFTs) were attained without further manipulations. The absence of other signs and symptoms of pneumothorax and the presence of satisfactory pacing function during the procedure, resulted in a significant delay in diagnosis. Pneumothorax should be included in the differential diagnosis when unexpected high DFTs are found during ICD implantation or predischarge testing. This complication is avoidable by a different surgical approach, cephalic vein cutdown.     

Programmed cell death in the development of the mouse external auditory canal

Programmed cell death (PCD) is an essential event for development. The purpose of this work was to ascertain how PCD, in vivo designated apoptosis, is involved in the development of the external auditory canal. We performed a time sequence study of the distribution of apoptosis during the development of external auditory canal (EAC) of the mouse. ICR mice ranging in age from embryonic day 11.5 (E11.5) to 12 days after birth (DAB) were used in the present study. A part of each head including both ears was removed and was processed according to its purpose. Light and electron microscopy for morphological studies and TUNEL method (Gavrieli et al. [1992] J Cell Biol., 119:493-501) for histochemical studies were used. On E11.5, distinct TUNEL-positive staining occurred in the branchial arch. Between E15.5 and 1DAB, TUNEL-positive cells were observed throughout the EAC and the number of these cells decreased with age. On E15.5 and E16.5, numerous TUNEL-positive cells were observed in a cavity remained in the epithelial plate. Transmission electron microscopy revealed that these cells had the features of apoptosis. From 3-12 DAB, no apoptosis was observed in the EAC except for the terminal differentiation of the skin of the EAC. Apoptosis was not observed during recanalization of the EAC, but occurred during the formation of the epithelial plate. The investigation established that PCD is involved in the formation of the epithelial plate, whereas only cornification of the epithelium of the EAC is associated with recanalization.     

Restoration of external auditory canal by filling mastoid cavity with carbon pellet

Percutaneous suspension plasty, using Eickenberg's double-needle applicator, is a further development of the semi-open endoscopic method suggested by Stamey for precluding urinary incontinence in women. The operative technique is outlined, and the follow-up results in 53 patients are analyzes. This is a contribution to the broadening scope of endourologic and percutaneous operative technique.     

Merkel cell carcinoma of the external auditory canal invading the intracranial compartment

Heparin-induced thrombocytopenia (HIT) is a common drug induced autoimmune condition. The thrombocytopenia is caused in most cases by an antibody directed against the complex PF4/heparin. Recently, we have induced an experimental model of HIT by idiotypic manipulation. To confirm further the idiotypic involvement of HIT, we have treated successfully three patients with HIT with high-dose intravenous gamma-globulin (IVIG). Our three patients joint other two cases previously reported who were treated with IVIG and point to the efficacy of this type of therapy with minimal side effects. IVIG suppression of the anti-PF4/heparin autoantibody may support the idiotypic etiology of HIT.     

Twenty-one cases of malignant tumor of the external auditory canal or middle ear

We have assessed the effects of intraplantar local anaesthetics (bupivacaine and lignocaine) on carrageenan-induced oedema, mechanical allodynia and spinal c-fos protein expression. Mechanical allodynia was evaluated using the vocalization threshold to paw pressure (VTPP) every 30 min until 60, 180 or 240 min after administration of carrageenan. Peripheral oedema, mechanical allodynia and spinal c-fos protein expression were maximal 180 min after carrageenan. Lignocaine did not influence either oedema or VTPP, but reduced spinal c-fos expression at 60 min after carrageenan without later effects. Bupivacaine induced an increase in VTPP at 30 and 60 min, limitation of oedema at 60 min and a reduction in spinal c-fos expression at 60 and 180 min, but these effects were not present 240 min after carrageenan. Intraplantar infiltration with lignocaine and bupivacaine before carrageenan transiently limited signs of inflammatory pain but did not prevent them.     

Odontogenic keratocyst: an unusual cause of unilateral nasal swelling

The odontogenic keratocyst is the least common of all odontogenic cysts which usually presents to the maxillofacial surgeon. An unusual case is described which presented to the ENT department with a rapidly enlarging unilateral intranasal mass. The clinical and radiological features of this lesion are presented and attention is drawn to the need for aggressive surgical excision because of its high recurrence rate.     

Adenoid cystic carcinoma of the external auditory canal: correlation between histological features and MRI appearances

A rare case of adenoid cystic carcinoma of the external auditory canal with magnetic resonance imaging appearances is reported. Both T1 weighted and T2 weighted MR images showed the tumour as a hypointense mass, although there was marked contrast enhancement. Microscopic examination of the resected tumour showed a preponderance of solid tumour cell nests. According to previous reports, these pathological and radiological findings indicate a poor prognosis.     

Bronchogenic cyst: an unusual cause of lump in the neck

This article describes a patient in whom disseminated infection with coccidioidomycosis was associated with hypercalcemia. The patient had a low level of 1,25-dihydroxyvitamin D and a suppressed parathyroid hormone value, an indication that the hypercalcemia was not mediated by vitamin D or parathyroid hormone. The episode resolved readily with administration of pamidronate, an outcome suggesting that this is effective treatment of hypercalcemia of this origin. On follow-up of the patient while he was receiving antifungal therapy for Coccidioides immitis, calcium values remained normal.     

POEMS syndrome: an unusual cause of bilateral optic disk swelling

Four cases of acute ileal diverticulitis are presented wherein early diagnosis helped avoid emergent surgery. All patients did well initially with conservative medical management. Acute ileal diverticulitis, although uncommon, should be suspected when the clinical presentation indicates an inflammatory condition of the lower right abdomen. Surgery, when required for recurrent disease, can be reserved for the interval between acute episodes.     

Kernohan-Woltman notch phenomenon: an unusual cause of ipsilateral motor deficit

Posttraumatic ipsilateral motor deficits are rare and raise etiologic and prognostic concerns for the rehabilitation team. We present two cases with an unusual central neurologic cause of ipsilateral weakness. The first patient was assaulted, with a resultant severe traumatic brain injury. Initial computed tomography showed a large right subdural hematoma (SDH) with significant mass effect. Following a craniotomy for evacuation of the SDH, the patient was noted to have paradoxical right-sided (ipsilateral) motor deficits. Postoperative magnetic resonance imaging (MRI) showed compression of the contralateral (left) cerebral peduncle against the tentorium, thus resulting in ipsilateral (right-sided) motor weakness (the Kernohan-Woltman notch phenomenon). Prior limited reports carried a grave prognosis for these patients. On discharge from inpatient rehabilitation, the patient was functioning at a Rancho Los Amigos Scale VI. The second patient was involved in a motor vehicle accident and was found to have a large left frontotemporal subdural hematoma with shift. A dense left hemiplegia was noted after hematoma evacuation. MRI also showed a right cerebral peduncle hypointensity. At discharge, the patient was rated a Rancho Los Amigos Scale VI. Physiatrists need to be aware of the causes of ipsilateral motor weakness as well as the limitations of prognostic data.     

Idiopathic pulmonary hilar fibrosis: an unusual cause of pulmonary hypertension

A 37-year-old man with progressive exertional dyspnea had pulmonary hypertension associated with pulmonary arterial and venous obstruction. An autopsy revealed that the cause of death was idiopathic pulmonary hilar fibrosis, a variant of mediastinal fibrosis. Pulmonary hilar fibrosis can mimic thromboembolic pulmonary hypertension, pulmonary veno-occlusive disease, and pulmonary venous hypertension.     

Biliary colonic ileus: an unusual cause of colonic obstruction]

PD 108635 (1) was identified as a potent dopamine D4 ligand and we wanted to replace the benzylic alcohol with a metabolically more stable moiety. Investigations led to the discovery of a series of isoindolinones having D4 affinity.