Endoscopic cartilage myringoplasty with the removal of a small rim of the external auditory canal to repair marginal perforations

Objective

To evaluate the graft success rate and postoperative hearing gain for marginal perforations using endoscopic cartilage myringoplasty with the removal of a small rim of the external auditory canal (EAC).

Study design

Prospective case series.

Materials and methods

We performed a prospective study in 41 patients with marginal perforations who underwent endoscopic cartilage myringoplasty with the removal of a small rim of EAC. Patients were followed up for 6 months.

Results

Of the 41 patients with unilateral marginal perforation included in this study, the graft success rate was 100% (41/41). The mean ABG improved from 11.31 ± 9.71 dB preoperatively to 7.31 ± 2.32 dB postoperatively for small-and medium-sized perforations (P = 0.13); the mean ABG improved from 21.46 ± 8.39 dB preoperatively to 9.84 ± 2.41 dB postoperatively for large perforations (P < 0.05); the mean ABG improved from 28.79 ± 6.74 dB preoperatively to 10.13 ± 3.56 dB postoperatively for subtotal and total perforations (P < 0.05). There were no cases of graft lateralization or significant blunting or atelectasis or graft adhesions. Three patients developed postoperative otorrhoea and five patients had mild myringitis.

Conclusions

Endoscopic cartilage myringoplasty with the removal of a small rim of the EAC is simple and feasible, showing a high graft success rate and minimal complications for repairing marginal perforations.

The styloid process and the formation of sigmoid sinus diverticulum: is there a link?

INTRODUCTION

Sigmoid sinus diverticulum has been considered the most common cause of pulsatile tinnitus; the mechanism underlying sigmoid sinus diverticulum formation is unclear. To the best of our knowledge, no previous studies have assessed whether the formation of sigmoid sinus diverticulum is related to compression of the internal jugular vein by the styloid process.

OBJECTIVE

To discuss the relationship between the styloid process and the formation of sigmoid sinus diverticulum.

METHODS

The medical records of nine patients diagnosed with venous pulsatile tinnitus caused by sigmoid sinus diverticulum were reviewed between April 2009 and May 2019. All patients underwent high-resolution computed tomography of the temporal bones, computed tomography venogram of the head and neck, magnetic resonance venography, and brain magnetic resonance imaging. The length and medial angulation of the styloid process were measured, and compression of the internal jugular vein was recorded.

RESULTS

The study population consisted of nine female right-sided pulsatile tinnitus patients with a mean age of 53.8±4.6 years. The mean lengths of the styloid process were 3.9±0.6cm on the right side and 4.1±0.7cm on the left side. The mean medial angulation of the styloid process was significantly smaller on the right side than the left side (65.3°±1.2° vs. 67.8°±1.7°, p<0.05). In addition, computed tomography venogram of the head and neck demonstrated the left internal jugular vein was compressed by the styloid process in eight of the nine patients.

CONCLUSION

The formation of sigmoid sinus diverticulum with venous pulsatile tinnitus may be related to compression of the contralateral internal jugular vein by the styloid process. However, accumulation of data in additional cases is required to verify this suggestion.

Hemostasis of idiopathic recurrent epistaxis in children with microwave ablation: a prospective pilot case series

OBJECTIVE

We evaluated microwave ablation (MWA) for treatment of idiopathic recurrent anterior epistaxis (RAE) in children, in terms of technical feasibility, efficacy, and safety.

STUDY DESIGN

A prospective pilot case series.

SETTING

Tertiary university hospital.

METHODS

Children with idiopathic RAE were treated with endoscopic MWA and reevaluated at 1 and 4 weeks and at 6 months thereafter. The primary outcome was successful hemostasis on the day of the procedure. Secondary outcomes were the rebleeding rates after 1 and 4 weeks, and 6 months, and any complications.

RESULTS

Of the 92 children with idiopathic RAE who met the inclusion criteria, the operation was interrupted in 7 children due to intraoperative noncooperation, and silver nitrate cautery was performed instead. All procedures were completed, and hemostasis was achieved within 10-20 s by MWA in 85 children. Two to four ablations were conducted. No recurrent epistaxis occurred and no severe MWA -related complications, such as septal perforation or synechiae formation, were observed at the 6-month follow-up.

CONCLUSIONS

Endoscopic MWA is a feasible and safe technique for the treatment of idiopathic pediatric RAE in the clinical setting, especially those cases that do not respond to in-office chemical cautery.

Randomized Comparative Study of Microwave Ablation and Electrocautery for Control of Recurrent Epistaxis

OBJECTIVE

To compare the outcomes of adult patients with recurrent epistaxis treated intraoperatively with either bipolar electrocautery or microwave ablation (MWA).

STUDY DESIGN

Prospective randomized control study.

MATERIALS AND METHODS

One hundred ten patients with idiopathic recurrent epistaxis who met the inclusion criteria were randomly assigned into MWA group and bipolar electrocautery group. Primary outcomes were the proportion of patients in each group whose bleeding had stopped within 24 hours after treatment and time to achieve successful hemostasis. Secondary outcomes were the rebleeding rate after 3 days, 1 and 12 weeks, and 6 months and complications.

RESULTS

Successful immediate arrest of epistaxis was achieved in all patients. The times to achieve successful hemostasis were 2.13 ± 1.04 minutes in the MWA group and 6.60 ± 2.68 minutes in the bipolar electrocautery group (P = .000). The rates of recurrent bleeding were similar in patients treated with the different approaches (P = .231). However, secondary crusting was observed endoscopically in 59 patients in the bipolar electrocautery group, while pseudomembrane of the ablation zone was seen in 19 (36.5%) patients in the MWA group. Nevertheless, there were no severe postoperative complications, including septal perforation and orbit and brain complications, in either group at the 6-month follow-up.

CONCLUSION

Bipolar electrocautery and MWA had similar outcomes for the treatment of adult patients with recurrent epistaxis. However, MWA resulted in rapid hemostasis with less local nasal pain and less crust. Thus, MWA could be a favorable treatment option for patients with idiopathic recurrent epistaxis.

Microwave Ablation for the Removal of Benign Lesion of Nasal Cavity: "How I Do It"

Background

Isolated benign lesions of the nasal cavity are commonly seen in the rhinology clinic; their treatment using various therapies has been explored in several studies.

Methods

In this retrospective study, isolated lesions of the nasal cavity were removed from 47 patients using microwave ablation (MWA) with a 2450-MHz cooled MWA antenna and sent for histological examination.

Results

The most commonly involved site was the nasal septum (n = 21, 44.7%), followed by the inferior turbinate (n = 12, 25.5%), bulla ethmoidalis (n = 9, 19.1%), and uncinate process (n = 5, 10.6%). The most common pathology was hemangioma (n = 36, 76.6%), followed by nasal polyp (n = 9, 19.1%) and squamous papilloma (n = 2, 4.3%). All lesions were removed endoscopically using MWA in patients administered local anesthesia. The total duration of ablation was 5 to 10 minutes, with an average duration of 7.3 ± 2.6 minutes. Follow-up at 6 months revealed no severe complications, including no cases of recurrent epistaxis, septal perforation, or synechiae of the nasal cavity.

Conclusions

The advantages of MWA are its short ablation time and minimal complications. This was demonstrated in our study in which a single session of MWA was sufficient to excise the isolated lesion while providing hemostasis. Most of the patients well tolerated the procedure, which could be performed using local anesthesia in the outpatient setting.

Microwave ablation: A new technique for the prophylactic management of idiopathic recurrent epistaxis

OBJECTIVE

The objective of this study was to compare the re-bleeding of idiopathic recurrent epistaxis with no definite bleeding site treated with either prophylactic microwave ablation (MWA) or continuous observation.

STUDY DESIGN

Case series with chart review.

SUBJECTS AND METHODS

61 patients with idiopathic recurrent epistaxis but no definite bleeding sites in the first operation were assigned to prophylactic MWA group (n = 39) and continuous observation group (n = 22). Patients in prophylactic MWA group were given prophylactic MWA at the common bleeding sites. Patients in continuous observation group were only observed in the ward. The bleeding sites, re-bleeding and complications were evaluated during 3 months follow-up period.

RESULTS

Rebleeding was experienced by 7 of the patients (17.9%) who were treated with prophylactic MWA whereas, 13 of the patients (59.1%) who used continuous observation had rebleeding. The rebleeding rate for patients undergoing prophylactic MWA group was lower than that for the observation-only group (p < 0.01). All the ablations were completed for the patients with known bleeding site within 1-2 min. These patients only had the complain of slight postoperative pain, no serious complications (including nasal adhesion, crust, septal perforation, etc.) were found in the follow-up period.

CONCLUSIONS

MWA is a simple, convenient, rapid, and definite hemorrhage control method with minimally invasive therapeutic technique. Prophylactic MWA at the common bleeding sites helps to significantly reduce the rate of rebleeding in patients in whom no definite bleeding sites have been identified.

Microwave ablation versus silver nitrate cautery for treating recurrent epistaxis in adolescents: A prospective, randomized case-control study

OBJECTIVE

To compare the outcomes of adolescent patients with recurrent anterior epistaxis (RAE) treated with either silver nitrate cauterization or microwave ablation (MWA).

STUDY DESIGN

and methods: In this prospective, randomized study, one hundred 13-18-year-old adolescents with RAE were assigned to two groups: the MWA group (n = 50) or the silver nitrate cauterization group (n = 50). Both groups were followed up for 12 months. The primary and secondary outcomes were evaluated.

RESULT

Ablation hemostasis was successfully achieved within 10-20 s in all patients in the MWA group. Eighteen (36.0%) patients in the silver nitrate group had recurrent epistaxis compared to three (6.0%) in the MWA group (P = 0.01) within 2-8 weeks after treatment. Two (2/48, 4.2%) patients in the MWA group had recurrent epistaxis compared to seventeen (17/43, 39.5%) in the silver nitrate group at 6 months; this difference was statistically significant (P = 0.01). However, 8 (8/37, 21.6%) patients in the MWA group had recurrent epistaxis compared to 15 (15/41,36.6%) in the silver nitrate group at 12 months; this difference was not statistically significant (P = 0.12). No treatment-related complications, including necrosis or septal perforation were seen in either group during follow up.

CONCLUSIONS

MWA may be a useful treatment for adolescents with RAE, as it had a lower incidence of recurrent epistaxis within 6 months of treatment compared to silver nitrate cauterization.

Comparison of the medical costs and effects of large traumatic eardrum perforations treatment

OBJECTIVE

We investigated the medical costs and effects of ofloxacin drops (OFLX), gelatin sponge patches, spontaneous healing, and endoscopic myringoplasty on healing in large tympanic membrane perforations (TMPs).

METHODS

In total, 100 patients with large traumatic TMPs involving >50% of the eardrum were randomly assigned to OFLX, gelatin sponge, spontaneous healing, or endoscopic myringoplasty treatment groups. Medical costs, closure times, and closure rates were compared among groups at 6 months.

RESULTS

The closure rates in the OFLX, gelatin sponge, spontaneous healing, and endoscopic myringoplasty groups were 95.7%, 82.6%, 58.3%, and 91.7%, respectively (P = 0.05). The mean closure time was 13.73 ± 6.14 days in the OFLX group, 15.89 ± 4.95 days in the gelatin sponge group, 48.36 ± 10.37 days in the spontaneous healing group, and 12 days in the endoscopic myringoplasty group (P < 0.001). The mean medical costs in US dollars were $15.53 ± 3.15, $103.64 ± 111.58, $11.17 ± 1.33, and $715.90 in the OFLX, gelatin sponge, spontaneous healing, and endoscopic myringoplasty groups, respectively (P < 0.001).

CONCLUSION

Although the gelatin sponge and myringoplasty treatments significantly shortened the closure time compared with spontaneous healing, the gelatin sponge patch did not significantly improve the closure rate, and the medical cost of myringoplasty was significantly higher than that of the other treatments. In contrast, OFLX significantly shortened closure time and had a higher closure rate than spontaneous healing, and the medical costs were lower than those of the gelatin sponge and myringoplasty procedures.

Pretreatment factors affecting traumatic tympanic membrane regeneration therapy using epidermal growth factor

OBJECTIVE

The use of epidermal growth factor (EGF) to achieve closure of human traumatic tympanic membrane perforations (TMPs) was recently reported. However, pretreatment factors affecting healing outcomes have seldom been discussed. This study was performed to evaluate pretreatment factors contributing to the success or failure of TMP healing using EGF.

DESIGN AND PARTICIPANTS

This was a retrospective cohort study of 95 TMPs who were observed for at least 6 months after EGF treatment. Eleven factors considered likely to affect healing outcome were evaluated by univariate and multivariate logistic regression analyses.

INTERVENTIONS

Each traumatic TMP was treated by daily topical application of EGF. The main outcome measures were complete closure versus failure to close and mean closure time.

RESULTS

A total of 95 patients were included in the analyses. The total closure rate was 92.6% at 6 months, and the mean closure time was 10.5 ± 4.8 days. The closure rate was not significantly different according to the duration of perforation ≤3 days and >3 days (P = 0.816). However, the mean closure time was significantly different according to the duration of perforation (P < 0.001). The perforation size did not affect the closure rate (P = 0.442). The mean closure time in the low-dose EGF group was significantly shorter than that in the high-dose EGF group (P = 0.001). Logistic regression analyses showed that perforations with preexisting myringosclerosis were more likely to fail to close compared to those without preexisting myringosclerosis (P = 0.001). Multivariate logistic regression analyses showed that the duration of perforation (P = 0.011), size of perforation (P < 0.001), and involvement of the malleus in perforation (P = 0.005) were factors independently correlated with closure time.

CONCLUSIONS

Daily application of EGF can be used to treat all traumatic TMPs. The size of the perforation and inverted edges did not affect the closure rate, and the most beneficial dosage was sufficient to keep the eardrum moist. Multivariate logistic regression analyses revealed a significant correlation between preexisting myringosclerosis and failure to heal. Nevertheless, the size of perforation, starting time of application, and malleus injury were independent prognostic factors for prolonged healing time.

Assessment and spontaneous healing outcomes of traumatic eardrum perforation with bleeding

OBJECTIVE

This study investigated the influence of the degree of bleeding from the remnant eardrum on the spontaneous healing of human traumatic tympanic membrane perforations (TMPs).

STUDY DESIGN

A case series with chart review.

SETTING

A tertiary university hospital.

MATERIALS AND METHODS

The clinical records of traumatic TMP patients who met the case selection criteria were retrieved and categorized into two groups based on the documented degree of bleeding from the remnant eardrum: with and without bleeding. The demographic data and spontaneous healing outcomes (i.e., healing rate and duration) of these two TMP types were analyzed using the chi-squared test or t-test.

RESULTS

One-hundred and eighty-eight cases met the inclusion criteria and were analyzed. Of these, 58.5% had perforations without bleeding and the remaining 41.5% had perforations with bleeding. The overall closure rate at the end of the 3-month follow-up period was 90.9% for perforations without bleeding and 96.2% for perforations with bleeding; the difference was not statistically significant (P>0.05). However, the average closure time differed significantly between the two groups (P<0.05): 29.4±3.7days for perforations without bleeding and 20.6±9.2days for perforations with bleeding. The closure rate was significantly different between the groups (62 vs. 15.6%, P<0.01) within 2weeks for medium-sized perforations. In total, 11 (39.3%) large-sized perforations achieved complete closure in the group with bleeding, while none of the large-sized perforations closed in the group without bleeding within 2weeks. The closure rate of medium-sized perforations was not significantly different (79.2 vs. 92%, P>0.05) between the groups without and with bleeding within 4weeks, while the closure rate of large-sized perforations was significantly different between the groups without and with bleeding (27.2 vs. 75%, P=0.0).

CONCLUSION

This study shows that traumatic TMPs with bleeding significantly shortened the closure time compared to TMPs without bleeding. This finding indicates a significant correlation between the prognosis of traumatic TMPs and the degree of eardrum bleeding: severe bleeding from and a hematoma in the remnant eardrum appear to be good signs.

Relation between eardrum flap area and healing outcome of traumatic eardrum perforation

OBJECTIVE

To retrospectively study the clinical effects of eardrum flap area on the healing outcome following traumatic perforation.

METHODS

Totally 291 traumatic eardrum perforations with in-/everted edges were included in this study. They were randomly divided into three groups and received conservative treatment, epidermal growth factor (EGF) via Gelfoam patching, or edge-approximation plus Gelfoam patching respectively. Patients in each group were further divided into two subgroups according to the eardrum flap area less than or equal to 1/2 or >1/2 of the perforation size. The healing rate and mean closure time after tympanic membrane perforation were evaluated at three months.

RESULTS

Of the total 291 participants, 281 were included in the final statistical analysis. The area of curled edge did not affect the healing outcome significantly in any groups (P>0.05). The healing rate varied slightly: 90.7% vs 92.3% in spontaneous healing group, 98.2% vs 97.4% in EGF via Gelfoam patching group, and 96.5% vs 100% in edge-approximation plus Gelfoam patching group. In addition, in all groups the area of curled edge did not affect the mean closure time significantly (P>0.05). The closure time was (32.3+/-2.4) d vs (30.6+/-3.1) d in sponaneous healing group, (13.4+/-2.5) d vs (13.1+/-1.9) d in EGF via Gelfoam patching group, and (11.9+/-3.1) d vs (12.2+/-2.1) d in edge-approximation plus Gelfoam patching group.

CONCLUSION

The eardrum flap area of traumatic eardrum perforation does not significantly affect the clinical outcomes.

Topical application of epidermal growth factor with no scaffold material on the healing of human traumatic tympanic membrane perforations

OBJECTIVE

We evaluated the effects of conservative treatment and topical application of epidermal growth factor (EGF) with no scaffold material on the healing of human traumatic tympanic membrane perforations (TMPs).

STUDY DESIGN

Prospective, randomised clinical trial.

METHODS

A prospective analysis was performed between January 2015 and March 2015 for the treatment of human traumatic TMPs. The closure rate, closure time, hearing gain and rate of purulent otorrhoea were compared between the topical application of EGF and conservative treatment.

RESULT

In total, 97 patients were analysed. The total closure rates did not significantly differ between the observation and EGF groups (83.0% versus 92.0%, P = 0.182). The total average closure time in the observation group was significantly longer than in the EGF group (25.1 ± 10.5 versus 11.7 ± 5.2 days, P = 0.001). When the closure rate was evaluated according to perforation size, no significant difference was seen for medium or large perforations (P = 0.18 and 0.21, respectively). When closure time was evaluated according to perforation size, a significant difference was seen for medium and large perforations (P = 0.001).

CONCLUSIONS

This study suggests that topical application of EGF with no scaffold material may significantly shorten the closure time of human traumatic TMPs. Such a shorter recovery time may lead to reduced healthcare costs. This alternative technique to a classic myringoplasty is particularly beneficial and suitable for the closure of large human traumatic TMPs.

Traumatic tympanic membrane perforations: a study of etiology and factors affecting outcome

OBJECTIVE

The purposes of this study were to determine the factors involved in the spontaneous healing and to profile the various etiologies of traumatic tympanic membrane (TM) perforation.

METHODS

A retrospective review was performed on 729 cases of traumatic TM perforation diagnosed in the emergency department and outpatient clinic from January 2007 to March 2011.

RESULTS

A total 641 patients with traumatic TM perforations were enrolled in the study. The group consisted of 320 male and 321 female patients with a mean age of 33.6 years (3-79 years). The types of trauma included compression injury (554 patients), blast injury (55 patients), and instrumental injury (32 patients). The causes of conflict by a slap or a fist were spouse or lover (52%), parents and sibling (3%), school teachers (4%), schoolmate (12%), state police and prisoner (7%), and blow against the ear during street fight (22%). Of the 641, 137 were lost during follow-up; of the remaining 504, perforations closed spontaneously in 451 (89%), within a mean of 27.4 days. Wet perforations with bloody or watery discharge significantly improved the healing rate (P < .01) and shortened the average perforation closure time (P < .01), as compared with dry perforations. Although the perforation that involved malleus or umbo damage did not significantly affect the healing rate (P > .05), a significantly prolonged closure time (41.6 vs 23.8 days) was observed as compared with no damage. However, the curled edges did not also affect the outcome of spontaneous healing; the healing rate was 91% and 88% (P > .05), and the average closure time was 28.1 and 26.7 days (P > .05), respectively, for with and without curler edges. By perforation size, the overall healing rate was 92% and 54% (P < .01), and the average closure time was 22.8 and 47.3 days (P < .01), respectively, for small and larger perforations. Moreover, 7 patients had neomembrane formation on follow-up, 2 developed cholesteatoma, 1 developed tympanosclerosis, and 1 developed facial paralysis.

CONCLUSION

In our experience, domestic violence and street fight were the most common causes of the traumatic TM perforation. Traumatic TM perforations have excellent prognosis. However, preexisting tympanosclerosis and the perforation that involved malleus or umbo damage could lengthen the healing time of perforation, Wet perforations with bloody or watery discharge accelerate the healing, but the curled edges did not affect the outcome of spontaneous healing.

Effect of treatment at different time intervals for traumatic tympanic membrane perforation on the closure

CONCLUSION

Treatment of traumatic tympanic membrane (TM) perforation with everted or involute edge flaps at different time intervals within 1 week after the injury did not affect the perforation closure rate and mean closure time.

OBJECTIVE

To retrospectively analyze the effect of treatment at different time intervals for traumatic tympanic membrane perforation with gelatin sponge patch and edge approximation plus gelfoam patching.

METHODS

Patients with traumatic TM perforation visited at different days since the injury for medical treatment (1, 2, 3, 4, and 5-7 days post trauma). These patients were treated with the following prominent methods of treatment: gelatin sponge patch treatment and edge approximation plus gelfoam patching. Measurement indicators were perforation closure rate and mean closure time at 3 months.

RESULTS

In the group treated with the gelatin sponge patch technique, the patients sought medical treatment at different time intervals since the injury. Accordingly, the outcome of the treatment varied in terms of the perforation closure rates achieved in different patients in this group. The respective perforation closure rates were 100%, 100%, 96%, 94%, and 89% in accordance with the time interval at which the patients were treated since the injury. The results were not significantly different when compared by statistical analysis (p > 0.05); the mean closure times in each of the different sets of cases in this group were calculated and the following values were reported: 7.1 ± 2.3, 8.2 ± 1.6, 8.7 ± 1.2, 9.2 ± 3.1, and 10.7 ± 3.9 days. On the other hand, in the edge approximation plus gelfoam patching group, the perforation closure rates were 100%, 97%, 96%, 97%, and 94%, respectively. This was in accordance with the time elapsed since the injury for the patients who visited the hospital on different days. Statistical analysis confirmed that the perforation closure rates for the different cases of this group did not have any significant difference (p > 0.05); the mean closure times were 7.6 ± 1.9, 7.9 ± 2.2, 9.2 ± 2.8, 8.5 ± 3.6, and 11.2 ± 4.1 days, respectively, indicating that differences were not significant even in terms of mean closure rates for the different cases of this group (p > 0.05).

A new biologically active acylated triterpene saponin from Silene fortunei

A new acylated triterpene-saponin (1), together with a mixture of the known jenisseensosides C and D, has been isolated from the roots of Silene fortunei. The structure of the new compound was established by chemical means and spectroscopic methods as 3-O-[beta-D-galactopyranosyl-(1-->2)-beta-D-glucuronopyranosyl]-28 -O- [[alpha-L-arabinopyranosyl-(1-->2)-alpha-L-arabinopyranosyl- (1-->3)-b eta-D-xylopyranosyl-(1-->4)-alpha-L-rhamnopyranosyl-(1-->2)]-[beta-D- glucopyranosyl-(1-->3)]-4-O-acetyl-beta-D-fucopyranosyl]quillaic acid. This saponin showed a significant enhancement of granulocyte phagocytosis in vitro.

Jennisseensosides C and D, biologically active acylated triterpene saponins from Silene jenisseensis

We previously reported the isolation and structure elucidation of a new trans-p-methoxycinnamoyl triterpene-saponin along with its cis-p-methoxycinnamoyl isomer as an inseparable mixture from the roots of Silene jenisseensis. In a continuing study on this plant, two additional new acylated triterpene-saponins were obtained as an inseparable mixture. Their structures have been established by chemical means and spectroscopic methods including 1D and 2D homonuclear and heteronuclear correlation NMR spectroscopy as 3-O-[beta-D-galactopyranosyl-(1-->2)-beta-D-glucuronopyranosyl]-28 -O-[{alpha-L-rhamnopyranosyl-(1-->2)}-{4-O-trans-p-methoxycinnamoyl++ +}-beta-D-fucopyranosyl] quillaic acid and its cis-isomer, respectively. They showed a significant enhancement of the granulocyte phagocytosis in vitro.

[Studies on liposoluble constituents from the aerial parts of Siegesbeckia orientalis L]

Eight compounds were isolated from the aerial parts of Siegesbeckia orientalis L. and their structures were elucidated by spectroscopic methods(IR, EI-MS, 13C-NMR, 1H-NMR, 1H-1H COSY, 1H-1H NOESY and 1H-13C COSY). Compounds I and II are new natural products and named siegesesteric acid(I) and siegesetheric acid(II), their structures were confirmed as ent-17-acetoxy-18-isobutyryloxy-16(alpha)-kauran-19-oic acid(I) and ent-17-ethoxy-16(alpha)-(-)-kauran-19-oic acid(II). The others were identified as known compounds: ent-16 beta, 17-dihydroxy-kauran-19-oic acid (III), kirenol(IV), beta-sitosteryl glucoside(V), heneicosanol(VI), methyl arachidate(VII) and beta-sitosterol(VIII). These compounds, except kirenol and beta-sitosterol, were isolated for the first time from the title plant.

[Analysis of phenylethanoid glycosides of Herba cistanchis by RP-HPLC]

The Chinese drug "Rou Cong-rong" (Herba Cistanchis) is one of the commonly used drugs in Chinese traditional medicine. It is used to reinforce the vital function of kidney, especially that of the sexual organs and induce laxation, for the treatment of impotence, premature ejaculation in men, infertility, morbid leukorrhea, profuse metrorrhagia in women, and chronic constipation in the aged. This paper deals with the qualitative and quantitative analysis of phenylethanoid glycosides of four species and one variety of Genus Cistanche and 23 lots of commercial crude drugs of Herba Cistanchis by RP-HPLC. The results were as follows: the chemical constituents of Cistanche deserticola Ma, C. salsa (C. A. Mey) G. Beck, C. salsa var. albiflora P. F. Tu et Z. C. Lou and C. tubulosa were similar while those of C. sinensis were different from the others; the contents of echinacoside and acteoside of C. salsa, which were 2.13% and 1.51%, were the highest of the genus Cistanche. An ODS column (Alltima C18, 5 microns, 250 x 4.6 mm) was employed. Linear gradient elution of acetonitrile--1.5% acetic acid was used as mobile phase, and concentration of acetontrile was from 8% to 20% (0-60 min) in the qualitative analysis, and from 11.5 to 20% (0-35 min) in the quantitative analysis. The flow rate was 1.2 ml.min-1. The detection wavelength was set at 335 nm.

Acylated triterpene saponins from Silene jenisseensis

From the roots of Silene jenisseensis a new trans-p-methoxycinnamoyl triterpene saponin has been isolated along with its cis-p-methoxycinnamoyl isomer as an inseparable mixture. Their structures were established by chemical means and spectroscopic methods including 1D- and 2D-homonuclear and heteronuclear correlation NMR spectroscopy as 3-O-[beta-D-galactopyranosyl-(1 --> 2)-beta-D-glucuronopyranosyl]-28-O-[beta-D-glucopyranosyl-(1 --> 2)-alpha-L-rhamnopyranosyl- (1 --> 2)-beta-D-4-O-trans-p-methoxycinnamoyl-fucopyranosyl] quillaic acid and its cis-isomer, respectively. They did not show any activity in the in vitro chemoluminescence granulocytes assay, but exhibited only a weak inhibitory effect in the cyclooxygenase inhibition assay.

[Chemical components of volatile oil from Echinops grijisii Hance]

The volatile oil obtained from Echinops grijisii roots was analysed by GC-MS method. Twenty four constituents have been identified from the oil, among which cis-beta-farnesene and 5-(3-buten-1-ynyl)bithiophene are the main ones.

[Herbalogical studies on rou congrong (herba Cistanchis)]

This paper deals with the investigation of the original plants of Rou Congrong and Cao Congrong recorded in the herbalogical works of the past dynasties. The results have shown that Rou Congrong is the dried fleshy stem of Cistanche deserticola and C. salsa, and Cao Congrong is the dried fleshy stem of Orobanche coerulescens. The substitutes and false drugs of Rou Congrong were also investigated.

[An investigation of medicinal Rhodiola in Sichuan Province]

Twenty-two species of Rhodiola produced in Sichuan Province are reported in this paper, including their distributions, habitats and localities. Among them, there is a new species named Rhodiola wolongensis. Its morphology has been described in Latin. I key for the identification of all these 22 species has been compiled and presented.

Glyyunnansapogenins G and H: Two New Pentacyclic Triterpenoids of the 18alphaH-Oleana-9(11),12-diene Type from Glycyrrhiza yunnanensis Roots

Two new pentacyclic triterpenoid sapogenins of the 18alpha H-oleana-9(11),12-diene type named glyyunnansapogenins G and H were isolated from the roots of GLYCYRRHIZA YUNNANENSIS Cheng f. et L. K. Tai. Their structures were elucidated as 18alpha H-oleana-9(11),12-diene-3beta,21alpha,29-triol and 18alpha H-3beta,21alpha-dihydroxyoleana-9(11),12-dien-29-oic acid, respectively, by spectroscopic methods. This is the first report of the occurrence of the 18alpha H series of oleana-9(11),12-diene compounds in nature.

[Herbalogic studies on the Chinese drug fangfeng]

Through a critical study of the descriptions of Fangfeng in the ancient Chinese herbals, it may be concluded that the chief botanical source of this drug was Saposhnikovia divaricata, besides, the roots of Peucedanum ledebourielloides and P. wawrii may also be used. The root of Glehnia littoralis may be used as an substitute and called Shifangfeng. The difference in geographical sources of Fangfeng in ancient and present times is also discussed.