Microscopical surgical management of cerebrospinal fluid rhinorrhoea with free grafts

Iatrogenic cerebrospinal fluid (CSF) rhinorrhoea can occur after intranasal ethmoidectomy or removal of pituitary tumours using a transsphenoidal approach, and is categorized as intraoperative or post-operative according to the time of onset. From 1989 to 1992 at Severance Hospital, Seoul, Korea, we successfully repaired nine cases of CSF rhinorrhoea using fibrin-glue-coated fascia or inferior turbinate mucosa under a surgical microscope. Neither recurrent leaks nor post-operative complications were associated with the free graft. Our results indicate that repair of CSF rhinorrhoea using free grafts under a surgical microscope is as successful as using a local flap, and it is a simple and very effective method in managing CSF rhinorrhoea. The surgical technique is discussed in detail.

KR-25003, a potent analgesic capsaicinoid

The crystal structure of N-[3-(3,4-dimethylphenyl)propyl] (4-hydroxy-3-methoxyphenyl)acetamide, C20H25NO3, was determined to a final R value of 0.047. The vanilloid, amide and dimethylphenyl groups of the compound are nearly perpendicular with respect to one another. The overall conformation in the crystalline state is somewhat different from that of other capsaicinoids. The molecules are stabilized by intermolecular hydrogen bonds.

Structural modeling of differential diagnosis, treatment, and results for allergic rhinitis

This paper analyzed the relationship among the differential diagnosis, treatment, and results for allergic rhinitis using the covariance structural model. The data were collected from 274 patients with suspected allergic rhinitis who visited the Otorlaryngology Department of the Paik Hospital during 1991-1993. After each patient's characteristics was categorized and combined into several common factors, covariance structure analysis was performed to analyze the structural relationships among the differential diagnosis, treatment, and results of treatment using the significant factors obtained from discriminant analysis. The significant characteristics influenced the diagnosis were the results of skin test from mite/animal, and from mugworts, the results from laboratory tests, rhinorrhea and sneezing, and nasal polyps. The significant characteristics that influenced the method of treatment were: nasal polyps, headache/general symptom, family history/medication, and septal deviation. Headache/general symptom was the only significantly influencing factor for the treatment results.

The development of a decision support system for diagnosing nasal allergy

This paper deals with the problem of improving the capability of the medical decision support system (MDSS) for diagnosing nasal allergy by integrating the previously developed expert system with the neural network approach. Three knowledge acquisition methods were used to develop the expert system: statistical, rule-based, and the combined approach. Among the three, a combined approach showed the best prediction rate based on discriminant analysis. Using the results of a combined approach as input values, the neural network was developed using back-propagation method. Unlike the expert system, the neural network system provides the resulting allergy status in probabilistic terms. Managerial as well as legal issues were also discussed in this paper.

The crystal structure of licarin-B, (C20H20O4), a component of the seeds of Myristica fragrans

The crystal structure of licarin-B, a component of Myristicae Semen was determined by single crystal X-ray diffraction analysis. Crystal of the compound, which was recrystallized from the mixture of hexane and ether, is monoclinic with a = 12.740 (1), b = 7.219(1), c = 9.284(1) A, beta = 94.75(1) degrees, Dx = 1.26, Dm = 1.27 g/cm3, space group P2l, and Z = 2. The structure was solved by direct method and refined by least-squares procedure to the final R value of 0.040 for 1532 independent reflections ¿F > or = 3 sigma (F)¿. The compound is a dimeric phenylpropanoid, and belongs to the neolignan analogues. The molecules are arranged along with the screw axis. The intermolecular contacts appear to be the normal van der Waals' forces.

Variability of the surgical anatomy of the neurovascular complex of the cerebellopontine angle

The variability of the anatomic relationship of the anterior inferior cerebellar artery (AICA) to the facial (seventh) and vestibulocochlear (eighth) nerves was studied in 52 cerebellopontine angles (CPAs) from 26 adult cadavers. The AICA originated from the basilar artery (98.1%) or from the vertebral artery (1.9%) as a single (92.3% of CPAs) or duplicate (7.7%) artery. Each of the 52 CPAs had one or more arterial trunks that coursed in close proximity to the seventh and eighth cranial nerves and thus were said to be nerve-related. The nerve-related arterial trunks were divided into three segments based on their relationship to the nerves and meatus: the premeatal, meatal, and postmeatal segments. The nerve-related branches of the AICA gave rise to the internal auditory artery in 92.3% of the CPAs, the recurrent perforating artery in 78.8%, and the subarcuate artery in 30.8%. The importance of understanding the surgical anatomy of the neurovascular complex of the CPA when performing a vestibular neurectomy is reviewed.

Improved endonasal sinus surgery by use of an operating microscope and a self-retaining retractor speculum

An improved method for better and safer endonasal sinus surgery by use of an operating microscope and a newly designed self-retaining retractor speculum has been developed. The advantages of this method are summarized as follows; 1) the target site is clearly magnified and focused, 2) both of the operator's hands are available for the surgery itself, 3) complete removal of the entire diseased tissues is possible, 4) the risk for complications is reduced, and 5) better training opportunities for the trainees are possible. The results of the surgery appear to be superior enough to recommend.

Inner medullary hemodynamics in chronic salt-depleted dogs

The effects of chronic salt depletion on medullary hemodynamics remain unknown. In the present study, sodium excretion, renal hemodynamics including papillary plasma flow, measured by the albumin-accumulation technique, and papillary tissue solute content were determined during hydropenia in 13 anesthetized sodium-replete and 10 sodium-depleted dogs. Salt depletion induced a significant rise in plasma renin activity and aldosterone without potassium depletion. Mean arterial pressure, GFR, and renal blood flow were similar in sodium-depleted and sodium-replete dogs. Despite a similar distribution of cortical blood flow (measured by the microsphere method) in the two groups, papillary plasma flow was markedly reduced in sodium-depleted dogs (8.8 +/- 1.7 vs. 22.8 +/- 1.9 ml X min-1 X 100 g-1 in sodium-replete dogs), associated with a significant decrease in renal sodium excretion. Furthermore, papillary osmolality and sodium concentration were significantly greater in sodium-depleted dogs. Ultrastructure examination revealed smooth muscle cells surrounding the efferent arterioles and pericytes with contractile potential encircling descending vasa recta. These results suggest that included in the complex hemodynamic adjustment to chronic sodium depletion is a significant reduction in inner medullary blood flow that may be important in maintaining enhanced papillary solute concentration. In addition, the anatomy of the medullary vasculature is compatible with regional regulation of medullary blood flow.