This report gives a detailed description of the fine structure of the olfactory mucosa in man. Using a special biopsy instrument and technique, fresh biopsies of olfactory epithelium were taken under local anaesthesia from eight normal volunteers. Transmission electron microscopy reveals that human olfactory epithelium has four major cell types: ciliated olfactory receptors, supporting cells, basal cells and microvillar cells. The ciliated olfactory receptors, as in other mammals, are bipolar neurons; the dendrite tip, modified to form the olfactory vesicle, bears 10-30 cilia that lack dynein arms. The supporting cells, markedly different from the goblet cells of respiratory epithelium, are not specialized for mucus secretion. Instead they are equipped to contribute materials to, and remove materials from, the surface mucus. The basal cells are stem cells that serve to replace epithelial cells and receptors lost during normal turnover or injury. In addition to ciliated olfactory neurons, supporting cells and basal cells, the human olfactory mucosa contains a distinct fourth cell type, the microvillar cell, of unknown function. The apical pole of the cell sends a tuft of short microvilli into the nasal cavity; its basal pole gives rise to a slender cytoplasmic process that resembles an axon. If microvillar cells prove to be sensory cells, the current concept of the human olfactory epithelium will have to be revised to include two morphologically distinct classes of receptors.
It has been shown that olfactory epithelium can be safely biopsied from the living, intact human being. Observations of the ultrastructure of this epithelium shows changes that can then be correlated with the etiology and degree of olfactory loss, allowing a greater understanding of both normal transduction and of the pathology of dysfunction. Examples of the common forms of olfactory dysfunction are presented and discussed. Additionally, the technique will allow additional immuno-histochemical and molecular study of the tissue, will increase the understanding of both normal and pathological function and should translate to new therapeutic regimens.
The standard of care of laryngeal cancer surgery is wide field excision of the larynx combined with ipsilateral thyroid lobectomy. A retrospective review of 247 laryngectomies performed between 1979 and 1989 was undertaken to determine specific intraoperative indications for thyroid gland removal. The incidence of thyroid disease in our patients with laryngeal cancer was compared to the normal population. Eight percent of thyroid specimens removed during laryngeal cancer surgery demonstrated invasion by squamous cell carcinoma. All patients having thyroid invasion had T3 or T4 laryngeal lesions that were stage IV at the time of surgery. All these lesions were found to have transglottic growth and laryngeal cartilage invasion by the pathologist. All of these patients also had abnormal thyroid glands intraoperatively and laryngeal cartilage destruction that was evident intraoperatively. Total thyroidectomy with bilateral paratracheal and pretracheal lymph node dissection is indicated when squamous cell carcinoma of the larynx involves the thyroid gland. Prophylactic ipsilateral thyroid lobectomy and isthmusectomy is warranted for large laryngeal cancers (T3, T4) that involve the anterior commissure, the subglottic area, or extend transglottically. Routine thyroid gland removal is not indicated for the majority of laryngeal cancers that do not meet the aforementioned criteria. Finally, abnormal thyroid histopathology was diagnosed in 37% of the surgical thyroid gland specimens removed during laryngectomy.
This paper evaluates the use of a maximum-likelihood adaptive staircase psychophysical procedure (ML-PEST), originally developed in vision and audition, for measuring detection thresholds in gustation and olfaction. The basis for the psychophysical measurement of thresholds with the ML-PEST procedure is developed. Then, two experiments and four simulations are reported. In the first experiment, ML-PEST was compared with the Wetherill and Levitt up-down staircase method and with the Cain ascending method of limits in the measurement of butyl alcohol thresholds. The four Monte Carlo simulations compared the three psychophysical procedures. In the second experiment, the test-retest reliability of ML-PEST for measuring NaCl and butyl alcohol thresholds was assessed. The results indicate that the ML-PEST method gives reliable and precise threshold measurements. Its ability to detect malingerers shows considerable promise. It is recommended for use in clinical testing.
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