Transsphenoidal surgery utilizing computer-assisted stereotactic guidance

Computer-assisted guidance technology represents the next step in the application of stereotactic techniques to skull base surgery. Use of this 3-D technique reduces operative time and complications as the technique allows a more direct approach with precise real-time anatomical guidance. We present seven cases of transsphenoidal parasellar surgery where this technique has been employed. The pathology included lesions of the sella turcica, parasellar region and the petrous apex.

[Study on the gene polymorphismand the levels of α₁-antitrypsin (α1-AT) in patients with lung cancer in Harbin]

BACKGROUND

To study the gene polymorphism and the dynamic changes of the level of α₁-antitrypsin(α₁-AT) in patients with lung cancer of Chinese Han race in Harbin and its clinical significance.

METHODS

The phenotypes of α₁-AT from 99 patients with lung cancer and 749 normal persons were determined by polyacrylamide gel isoelectricfocusing electrophoresis. The levels of α₁-AT in serum were determined by monophonic immunodiffusion.

RESULTS

The common subtypes, such as M₁M₁ , M₁M₂ , M₂M₃, etc, were positive and the deficiency subtype was negative in both of the two groups. There was no significant difference in phenotypes and gene frequencies between the two groups ( P > 0. 05) . The level of α₁-AT in patients with lung cancer were remarkably higher than that in normal group ( P < 0. 05) , and significantly increased after anti-inflammatory or/and chemical treatment ( P < 0. 05) .

CONCLUSIONS

There is no significant difference in gene polymorphism of α₁-AT between the patients with lung cancer and normal persons, but the dynamic changes of α₁-AT are valuable to differentiate inflammation from cancer, estimate the efficacy of chemotherapy, and formulate and adjust the treatment scheme.

[Effect of NaFeEDTA fortified soy sauce on iron deficiency anemia in students]

NaFeEDTA fortified soy sauce was given to 300 students with iron deficiency anemia (IDA) for 3 months. The subjects were divided into three groups: control group, low iron supplemented group (Fe 5 mg/d) and high iron supplemented group (Fe 20 mg/d). Hemoglobin (Hb), serum iron, serum ferrtin, erythrocyte protoporphyrin, total iron binding capacity and serum transferrin were evaluated before and after the study. The results showed that Hb, serum iron, ferrtin and transferrin of the intervention groups had improved and erythrocyte protoporphyrin, total iron binding capacity decreased. There were no differences between the two intervention groups after the trial. The parameters of both intervention groups were much better than those of the control group. The results suggested that NaFeEDTA fortified soy sauce had positive influence on IDA.

Reinforcement of an end-to-end tracheal resection anastomosis with fibrin glue: a case report

Tracheal resection and primary anastomosis is the treatment of choice for a short-segment stenosis. However, the procedure does carry the risk of two potentially fatal complications: anastomosis breakdown and leak. We describe the case of a 67-year-old man who was treated for a 3-cm tracheal stenosis secondary to a prolonged intubation and multiple tracheostomies. The patient underwent a tracheal resection and primary anastomosis. The anastomosis was reinforced with fibrin sealant, which created an airtight seal. The patient was extubated postoperatively, and he healed without complication. Fibrin sealant is a convenient, safe, and effective material for reinforcing anastomotic suture lines.

[Estrogenicity of black cohosh (Cimicifuga racemosa) and its effect on estrogen receptor level in human breast cancer MCF-7 cells]

The estrogenicity of Black Cohosh (Cimicifuga racemosa, CR) was tested in vivo and in vitro and its effect on estrogen receptor (ER) level of human breast cancer MCF-7 cells were investigated. Based on the body weight of animals, 75, 150 and 300 mg/kg of CR were administered by tube feeding to immature female mice for 14 days. Estrus was observed and the uterine and ovary weights of mice were measured. The optimal dose of CR for the growth of MCF-7 cells was screened by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazoliumbromide (MTT) assay. Subsequently, Growth curves of MCF-7 cells in blank control, 4.75 micrograms/L of CR and 0.3 nmol/L of 17 beta-estradiol groups were observed for 5 days. ER level in MCF-7 cells was analyzed by indirect immunofluorescence assay in flow cytometry. The results showed that uterine weight increased with the increasing dosage of CR and the days of estrus was significantly prolonged in the 300 mg/kg group (P < 0.05). The concentration of CR at 4.75 micrograms/L showed the strongest enhancement effects (64.7%). The doubling time (TD) of cell growth in CR group and 17 beta-estradiol group were 32.1 h and 31.7 h respectively, which were shorter than that of blank control (TD = 35.3 h). Additionally, 4.75 micrograms/L of CR significantly increased ER levels compared with the blank control (P < 0.01). Taking all the results together, CR has an estrogen-like action. The enhancing effect of CR on ER level is one of the potential mechanisms involved with its therapeutic role in climacteric syndrome.

[The clinic significance of serum hyaluronate and tumor necrosis factor alpha levels in liver diseases]

Serum levels of hyaluronic acid (HA) and tumor necrosis factor alpha (TNF alpha) in 94 patients with various liver diseases and 31 healthy controls were studied by RIA, Serum TNF alpha in hepatitis, liver cirrhosis (LC) and primary hepatic carcinoma (PHC) was higher than that of the control. Serum HA in chronic hepatitis, LC and PHC was higher than that in the control. The serum level of HA showed a positive correlation with the serum level of TNF alpha. It is considered that the increase of serum HA indicates an early fibrogenic tendency in patients with liver diseases. TNF alpha is involved in the formation of hepatic fibrosis.

Genetic and molecular mechanisms of age regulation (homeostasis) of blood coagulation

Blood coagulation plays a critical role not only in hemostasis but also in many physiological and pathological conditions. Epidemiological studies have shown that blood coagulation capacity in humans increases with age. Towards understanding the underlying mechanisms, the age regulation of factor IX, a key blood coagulation factor, was extensively studied. A series of human factor IX minigenes, consisting of various components of the human factor IX gene, were constructed and subjected to systematic analyses with HepG2 cells in culture and over the entire life span of transgenic mice. These studies identified critical gene structures that are essential for the unique age-dependent expression patterns of the human factor IX gene--one acting by stabilizing gene transcription and another increasing the amount of mRNA present, presumably by augmenting mRNA stability. These studies have set the stage for analyzing the overall age-based regulatory mechanisms of blood coagulation.

[Clinical application of magnetic resonance angiography in the body]

OBJECTIVE

To identify the accuracy and reliability of magnetic resonance angiography (MRA) in evaluating patients with vascular lesions in the body.

METHODS

171 patients with suspected vascular lesions in the body were examined by MRA and compared with the results of X-ray angiography (XRA) or operation.

RESULTS

MRA showed abnormal vein in 12 patients and normal in 6 corresponding to XRA or operation. MRA revealed aneurysm in 54 patients: aortic dissection (26), aortic aneurysm (15) and peripheral aneurysm (13). Two peripheral aneurysms could not only be found by MRA. The sensitivity of MRA was 97% for aneurysm lesions. The sensitivity of MRA in the diagnosis of suspicious peripheral artery stenosis in 84 patients was 95%, the specificity 89%, and the accuracy 92% in comparison with those of XRA and operation.

CONCLUSION

MRA is accurate and reliable in evaluating vascular lesion in the body and can replace XRA in many cases.

Solitary mastocytoma in an infant - case report with review of literature

Solitary mastocytoma in infants is an uncommon disease which is characterized by mast cell hyperplasia and release of mast cell mediators. The most common presentation is pruritus. The treatment of solitary mastocytoma is symptomatic. Cutaneous mastocytoma tend to resolve by adulthood.

Management of osteomas of the paranasal sinuses

Craniofacial osteomas are benign tumors of the skull base, often involving the paranasal sinuses. The frontal sinus is the most common site of involvement, followed by the ethmoid, maxillary, and sphenoid sinuses, respectively. The growth rate is very slow, and it may take many years for osteomas to become clinically apparent. The origin of these tumors has been ascribed to embryologic tissue maldevelopment, trauma, or infection. The tumors are hard and lobulated with an ivory-like appearance, often mixed with a coarse granular component. The bone is compact or cancellous, with vascular or connective tissue components. The complications of osteoma growth are obstruction of sinus ostia, extension into adjacent bones and the intracranial cavity, and displacement of anatomic structures. Management of uncomplicated sinus osteomas is controversial, since surgery involves serious potential risks. When surgery is performed, these tumors can be successfully managed via endoscopic, open, or combined techniques. This article reviews the clinical findings, diagnostic studies, and treatment of 16 patients with paranasal osteomas. The indications for surgical intervention are discussed.

Analysis of cellular and decellular allogeneic dermal grafts for the treatment of full-thickness wounds in a porcine model

BACKGROUND AND METHODS

The need for a reliable skin substitute to improve burn treatment has been long apparent. We have investigated the use of cryopreserved cellular and decellularized porcine allogeneic dermal grafts (CADGs or DADGs) in conjunction with an overlying thin split-thickness autograft (STSG) in a one-step technique. Control mirror-image wounds were treated with thin STSG alone. Autograft "take" rates and wound contraction were determined; biopsies were taken at weeks 2, 5, and 8, and blinded scar assessment was performed at week 10.

RESULTS

The percent take of autografts overlying CADGs or DADGs was comparable to that of control sites (83.0 +/- 8.3% vs. 81.1 +/- 11.5% for CADG vs. control; 93.2 +/- 7.6% vs. 90.2 +/- 11.1% for DADG vs. control). CADGs did not alter wound contraction or cosmetic outcome. By contrast, DADG treatment inhibited wound contraction (42.9 +/- 17.8% vs. 30.9 +/- 10.4% contraction for control vs. DADG at week 10; p < 0.017) and significantly improved cosmetic outcome in 10 of 12 paired wounds (p < 0.012).

CONCLUSION

CADGs and DADGs permitted simultaneous engraftment of an overlying thin STSG. Although CADGs had no effect on wound contraction and cosmetic outcome, DADGs significantly reduced wound contraction and improved cosmetic outcome of full-thickness wounds in a porcine model. The use of DADGs may represent a potential improvement in burn care.

[Effects of cytokines on somatostatin in nude mice bearing human renal cell carcinoma]

We studied the relationship between the production of SS and treatment with cytokines and a new method for the treatment of renal cell carcinoma. 4.4 x 10(6)RCC94616 cells were injected subcutaneously into the back of nude mice. Five groups with TNF, IL-2, rIFN, TNF + IL-2, TNF + rIFN and controls were randomly divided according to the mean diameter of experimental tumor. After the last injection of cytokines, 0.5-0.8 ml blood, 1g tumor tissue, para-tissue and normal tissue were havested respectively. Contents of SS were tested by radioimmunoassay. In the treatment groups with cytokines, the concentration of SS was changed, siginificantly increased in the TNF + IL-2 group (P < 0.01). The effect on distribution of SS by cytokines may also be mediated by the regulation of human immunity and antitumor activity. It may be suggested that the method of TNF + IL-2 + SS is best to treat renal cell carcinoma.

Combined surgery and radiation therapy for squamous cell carcinoma of the hypopharynx

Squamous cell carcinoma of the hypopharynx remains a highly lethal disease. This article documents our experience with 132 patients undergoing surgical management of squamous cell carcinoma of the hypopharynx, of whom 80% received postoperative radiation therapy. Local-regional control was obtained in 61% of the patients. Five-year overall and disease-free survival rates were 30% and 41%, respectively. Prognosis was better in patients with limited disease: local disease permitting larynx-sparing surgery, N0/N1 clinical neck, and stage I/II/III disease. Cancer of the hypopharynx remains an aggressive entity associated with poor prognosis. Novel strategies stressing improved local-regional control with prevention of distant metastasis are warranted.

Characterization of novel cell lines from pleomorphic adenomas of the parotid gland established in a collagen gel system

The pathobiology of salivary neoplasms can best be studied in a model system that reflects the native state of the tumor. The present study describes the use of a three-dimensional collagen gel (organoid) system in which pleomorphic adenomas of the parotid gland were propagated in vitro. Five pleomorphic adenoma cultures were established as organoid gels and compared with touch-preparations or cryopreserved specimens of native tumor. The organoid cultures demonstrated normal DNA content, the expression of myoepithelial cell proteins, and the production of sulfated acid mucins; these cellular and secretory features mimicked those found in the archival specimens. Further, organoid cultures of pleomorphic adenoma could be initiated after monolayer culture, demonstrating that culture on a plastic support does not alter the nature of the cells. Development of an in vitro culture system that maintains the native state of pleomorphic adenoma is an important tool for studying the pathobiology of these tumors.

[Study of nitric oxide synthases, nitric oxide and tumor necrosis factor in different types of ascites]

The purpose of this study was to elucidate the clinical significance of nitric oxide synthases (NOS), nitric oxide (NO) and tumor necrosis factor (TNF) in different types of ascites. NOS, NO and TNF in ascitic transudates of 21 patients with liver cirrhosis, ascitic exudate of 32 patients with liver cirrhosis and carcinogenesic ascites of 19 patients were measured by Griess, ELISA and colorimetric methods. Compares to the value in ascitic transudate of 21 patients with liver cirrhosis, NOS (7.32 +/- 3.13 nmol.min-1.g-1), NO (15.4 +/- 7.6 mumol/L) and TNF (331.7 +/- 121.2 mumol/L) in ascitic exudate of 32 patients with liver cirrhosis were significantly higher (P < 0.01). The NO (10.7 +/- 3.2 mumol/L) and TNF (185.6 +/- 84.1 mumol/L) in carcinogenesic ascites of 19 patients were between those in ascitic exudates and those in ascitic transudates of patients with liver cirrhosis (P < 0.05 or 0.01). The NOS activity was highest in carcinogenesic ascites. The decrease of 24h urine volume in patients with cirrhosis was relative to the increase of NO level in ascites. Those suggested that measurements of NOS, NO and TNF in ascites are helpful in differential diagnosis of ascites. The separation between NO level and NOS activity in ascites indicates that the ascites is carcinogenesis.

Secondary pharyngeal myotomy for tracheoesophageal speech

Pharyngeal myotomy in the post-laryngectomy patient has been described to reduce pharyngoesophageal spasm and facilitate vocal rehabilitation and tracheoesophageal speech. This report describes the complications and speech outcomes in 22 consecutive patients who underwent a secondary pharyngeal myotomy. The patients were all drawn from a hospital clinic dedicated to voice rehabilitation after laryngectomies. Their ages ranged from 54 to 81-years-old with a mean of 64. Two patients suffered surgical complications--both had pharyngocutaneous fistulas which resolved with conservative management. One patient had an incomplete myotomy and was treated with injection of boulinum toxin in the pharyngeal plexus. This treatment resulted in good vocalization. Seventeen of 22 patients in the study were long-term TEP users, and all of these were judged to have good speech quality. Our experience with myotomy for TEP speech demonstrates that many patients with pharyngoesophageal spasm can benefit from the procedure and successfully phonate. There were several complications related to the procedure, but these were successfully managed conservatively and without long-term sequela. Pharyngeal myotomy as an adjunct to TEP is useful and effective in selected patients.

Tracheoesophageal puncture in irradiated patients

Tracheoesophageal puncture (TEP) with use of a voice prosthesis is widely accepted as an excellent method of postlaryngectomy vocal rehabilitation. Many patients with advanced cancer require postoperative radiotherapy (RT), while other cancer patients have been treated with RT as a primary treatment and come to laryngectomy for salvage. The influence of RT on outcome of the TEP procedure with respect to successful speech and potential complications has not been widely discussed. We retrospectively reviewed 77 consecutive cases of TEP in patients who had received RT and laryngectomy for laryngeal cancer. All cases had a minimum of 6 months of follow-up. All 77 patients were successful in obtaining speech with the TEP, and 75 (97%) continued to be TEP users thereafter. Eight patients (10%) developed complications in the course of treatment. There was no mortality. In selected patients, TEP after RT is a relatively safe and effective method of vocal rehabilitation.

Surgical access to tumors of the cervicothoracic junction

BACKGROUND

Surgical resection of tumors of the cervicothoracic junction is often problematic due to the limitations imposed by the thoracic cage and adjacent neurovascular structures. The majority of surgical approaches to this region have been designed with the intent of providing adequate exposure for vertebrectomy with tumor resection and vertebral column stabilization. These approaches do not provide adequate exposure for a heterogeneous group of tumors which also involve the cervicothoracic junction. We used a combined cervicothoracic surgical approach to determine its efficacy in tumor resection.

METHOD

Seventeen patients with a heterogeneous group of malignancies arising in a variety of soft tissues underwent combined cervicothoracic resection. The approach consisted of anterior cervical access, median sternotomy, and anterior thoracotomy.

RESULTS

Complete gross tumor resection was accomplished in all 17 patients, 15 of whom had negative microscopic margins. Extensive reconstruction was employed in 6 patients. Three patients received intraoperative brachytherapy implants and 5 patients received external-beam postoperative radiotherapy. Local tumor control was obtained in 12 patients, and 10 patients are currently alive, free of disease (median: 12 months; range: 3-47 months). There was no inadvertent sacrifice of neurovascular structures. The sternoclavicular joint was maintained in all patients. There were 4 major complications, and no perioperative mortality associated with the surgical procedure.

CONCLUSION

The combined "trap door" technique provides sufficient exposure for resection of cervicothoracic tumors. Surgery is performed with limited morbidity with the sparing of uninvolved neurovascular structures. The sterno-clavicular joint was maintained in all patients. Preliminary results using this approach for resections of tumors of the cervicothoracic junction are encouraging.

[Spiral shaped bacteria in the human gastric biopsy]

Biopsy specimens from the gastric mucosa of 149 patients who underwent gastroduodenal endoscopy for upper gastrointestinal complaints were studied by light microscopy and culture. Spiral shaped bacteria were detected in four of the specimens by smears with Gram stain. The positive rate was 2.68%, but these bacteria and HP did not grow in culture. The characteristic helical morphology of the bacteria appears to be similar to that of the bacteria found in the stomach of cats and dogs. And what of significance in these cases is the presence of spiral shaped bacteria in association with chronic gastritis.