Chronische Diarrh?en unter NSAR

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Nitrofuran drugs as common subversive substrates of Trypanosoma cruzi lipoamide dehydrogenase and trypanothione reductase

Lipoamide dehydrogenase (LipDH), trypanothione reductase (TR), and glutathione reductase (GR) catalyze the NAD(P)H-dependent reduction of disulfide substrates. TR occurs exclusively in trypanosomatids which lack a GR. Besides their physiological reactions, the flavoenzymes catalyze the single-electron reduction of nitrofurans with the concomitant generation of superoxide anions. Here, we report on the interaction of clinically used antimicrobial nitrofurans with LipDH and TR from Trypanosoma cruzi, the causative agent of Chagas' disease (South American trypanosomiasis), in comparison to mammalian LipDH and GR. The compounds were studied as inhibitors and as subversive substrates of the enzymes. None of the nitrofurans inhibited LipDH, although they did interfere with the disulfide reduction of TR and GR. When the compounds were studied as substrates, T. cruzi LipDH showed a high rate of nitrofuran reduction and was even more efficient than its mammalian counterpart. Several derivatives were also effective subversive substrates of TR, but the respective reaction with human GR was negligible. Nifuroxazide, nifuroxime, and nifurprazine proved to be the most promising derivatives since they were redox-cycled by both T. cruzi LipDH and TR and had pronounced antiparasitic effects in cultures of T. cruzi and Trypanosoma brucei. The results suggest that those nitrofuran derivatives which interact with both parasite flavoenzymes should be revisited as trypanocidal drugs.     

颈总动脉切除术10例回顾性分析

目的 探讨颈总动脉切除术的适应症和术前准备的一般规律。方法 对我院自1986年～2003年17年问的10例颈总动脉切除术病例进行回顾性分析。其中年龄22～59岁，急诊手术4例，选择性颈动脉切除6例。结果 急诊手术中2例出现中枢神经系统并发症，选择性手术组中1例出现中枢神经系统并发症。除1例因脑转移癌死亡外，随访均健在。结论 行不重建血管的颈总动脉及分歧部切除术，高龄患者须严格掌握适应症，须无脑血管疾病史，术前须进行Matas试验，要有侧支循环建立的客观依据；对年轻患者(30岁以下)可适当放宽手术指征。     

面神经功能评价标准(讨论稿)

为了制订一个有权威性、与国际接轨、且全国同行认可的面神经功能的评价标准（面神经分级），2004年6月份《中华耳鼻咽喉科杂志》编辑部组织部分专家进行了讨论，并结合我国的具体情况，邀请相关专家完成了标准的起草，并组织北京的耳科学专家进行充分的讨论和修改。经过北京专家修改后的《面神经功能评价标准（系统）》讨论稿送给全国耳科学专家征求意见，大部分专家在2005年4月底之前将该地区同行对于标准草案的意见反馈回了编辑部。同时，编辑部将该草案放到中华耳鼻咽喉头颈外科网上（http：／／www．odhns．org．cn／）进一步在全国范围内征求意见。综合上述意见，再次整理该草案，并在2005年5月的山东济南耳科学学术会议上对草案的必要性及具体实施办法进行了热烈的讨论，提出了很多建设性的意见和建议。在制定面神经麻痹评分系统方面，大家认为建立国内统一的面神经麻痹评分系统是必要的，利于学术交流和与国际接轨。从长远角度出发，应该有中国的评价系统，这需要我们有目的地研究，建议暂按House—Brackmann标准，在国内进行多中心、前瞻性研究。然后根据多中心研究结果，制订我国面神经麻痹评分标准。根据以上意见，我们将该草案在本栏目中刊出，进一步征求全国各地专家和读者的意见和建议。希望广大专家和读者踊跃发表意见，可将您的看法用信件（100710，北京东四西大街42号耳鼻喉科姬广茜收）或者邮件（Email：jiguangqian@cma．org．cn）的方式反馈给我们。[编者按]     

骨膦和153钐乙二胺四甲撑磷酸治疗头颈 肿瘤骨转移的随机对照临床观察

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3 cases of mucoepidermoid bronchial malignant tumors

Mucoepidermoid tumors of the lung are extremely uncommon. Like the considerably more common mucoepidermoid tumors of the salivary glands, their histology is characterized by two components: a glandular mucoid element and an epidermoid element. The degree of malignancy is still a subject of discussion, but as with mucoepidermoid tumors of the salivary glands, mucoepidermoid carcinomas of the bronchus may be of either high or low-grade malignancy. The three cases reported here were of high-grade malignancy and metastasized irrespective of the degree of cellular differenciation. We have concluded that mucoepidermoid lung tumors should be considered as malignant lesions and the treatment has to consist in radical resection.     

Amyloid Pseudotumor Treated by Tracheal Resection

Primary amyloidosis is a rare disease, and even more so when it appears as a tumorlike formation in the lung or tracheobronchial tree. On rare occasions it has been treated by pulmonary resection but never before by tracheal or bronchial sleeve resection. A case of tracheal sleeve resection for tumorlike amyloidosis is reported. If the lesion is well circumscribed to a relatively short tracheal or bronchial segment, sleeve resection appears to be a satisfactory and economical solution. However, the problem of a mucosa undermined by amyloid deposits above and below the tumorlike lesion entails the risk of anastomotic stenosis. For this reason in future cases, particularly those with extensive involvement, piecemeal endoscopic removal should be considered as the method offering the best prognosis and least risk.     

Evaluation eines Trainingssystems für die Felsenbeinchirurgie mit optoelektrischer Detektion

Problem

This work presents a new training concept for surgery of the temporal bone. It is based on a model of gypsum plastic with optoelectric detection of risk structures. A prototypical evaluation is given.

Material and methods

The training models are based on high-resolution computed tomographic data of a human skull. The resulting data set was printed by a three-dimensional (3D) printer. A 3D phantom is created from gypsum powder and a bonding agent. Risks structures are the facial nerve, semicircular canal, cochlea, ossicular chain, sigmoid sinus, dura, and internal carotid artery. An electrically conductive metal (Wood’s metal) and a fiber-optic cable were used as detection materials for the risk structures. For evaluating the training system, a study was done with eight inexperienced and eight experienced ear surgeons. They were asked to perform temporal bone surgery using two identical training models (group A). In group B, the same surgeons underwent surgical training with human cadavers. In the case of injuries, the number, point in time, degree (facial nerve), and injured structure were documented during the training on the model. In addition, the total time needed was noted.

Results

The training systems could be used in all cases. Evaluation of the anatomic accuracy of the models showed results that were between 49.5% and 90% agreement with the anatomic origin. Error detection was evaluated with values between 79% and 100% agreement with the perception of an experienced surgeon. The operating setting was estimated to be better than the previous“gold standard.” The possibility of completely replacing the previous training method, which uses cadavers, with the examined training model was affirmed.

Conclusions

This study shows that the examined system fulfills the conditions for a new training concept for temporal bone surgery. The system connects the preliminary work with printed and sintered models with the possibilities of microsystem engineering. In addition, the model’s digital database permits a complete virtual representation of the model with appropriate further applications (“look behind the wall,” virtual endoscopy).