Primary aspergillosis of the sphenoid sinus with pituitary invasion – a rare differential diagnosis of sellar lesions

Summary Aspergillosis belongs to the group of mycotic diseases of paranasal sinuses. The invasive forms, and particularly the fulminant forms, are potentially fatal. Isolated aspergillosis of the sphenoid sinus or the clivus is a difficult diagnosis, since the often misleading clinical manifestations of this rare disease develop late. These patients become apparent by neurological signs such as cavernous sinus syndrome, pseudotumor of the pituitary or the orbit. Diagnosis is often made intra-operatively or on histological examination. We report a case of invasive aspergillosis uniquely involving the sellar area revealed by clinical features suggesting a pseudotumor of the pituitary. Although such lesions are almost always seen in immune suppressed subjects, in our case, the patient was immune competent and had no past history of sinusitis. The question of whether, and when to perform limited or extensive surgery remains an issue for discussion, owing to the rarity of this disease honed by lack of experience. It depends on several factors: the kind of disease, the immunity, the subtype of invasive fungal sinusitis and the degree of tissue invasion.     

Effects of gender on prognosis of patients with known or suspected coronary artery disease undergoing contrast-enhanced dobutamine stress echocardiography.

BACKGROUND: Gender differences in the predictors of outcome among patients with known or suspected coronary artery disease (CAD) undergoing contrast-enhanced dobutamine stress echocardiography (CE-DSE) have not been completely determined. METHODS AND RESULTS: Follow-up (30+/-17 months) data for 581 men and 309 women with known or suspected CAD who underwent CE-DSE (mean age: 66 years) were obtained. Hard cardiac events included cardiac death and nonfatal myocardial infarction. Total cardiac events included hard cardiac events, unstable angina, congestive heart failure, and late revascularization (>3 months). Cardiac events occurred in 123 male and 50 female patients. Positive results for CE-DSE were associated with worse prognosis in both men and women (2-year total event free rate: 73.5% vs 88.2% in men, p<0.0001, 80.3% vs 91.3% in women, p<0.01). Addition of CE-DSE results, including abnormal left ventricular end-systolic volume response and left ventricular ejection fraction at peak stress <50%, to the clinical and rest echocardiography model provided incremental information for predicting total cardiac events (increase in chi-square value for the model from 60 to 72, p<0.001) in men and (increase in chi-square value for the model from 17 to 32, p<0.001) in women. CONCLUSIONS: CE-DSE provides incremental information for predicting future cardiac events in both men and women.     

Lenticulostriate arteries in aging process: an angiographic study

Histological studies describe in detail the changes of the small arteries wall with controversial results concerning lumen narrowing during the aging process. In this study, the anatomic and the angiographic parameters of the medial and lateral lenticulostriate arteries were analysed in 64 carotid angiograms. Only 20% of the total number of lenticulostriate arteries were shown on angiograms. Collateral branches were rarely visible, especially those of medial group. The course of the lenticulostriate arteries was mostly straight or moderately tortuous. No significant differences were noted in any of the measured parameters when compared with the age (p greater than 0.05). It appears that age-related changes spread over external layers of small arteries, with no lumen narrowing or filling defect.     

Adipose tissues differentiated by adipose-derived stem cells harvested from transgenic mice

Objective: To induce adipocyte differentiation in vitro by adipose-derived stromal cells (ASCs) harvested from transgenic mice with green fluorescent protein (GFP) and assess the possibility of constructing adipose tissues via attachment of ASCs to typeⅡcollagen scaffolds. Methods: Inguinal fat pads from GFP transgenic mice were digested by enzymes for isolation of ASCs (primary culture). After expansion to three passages of ASCs, the cells were incubated in an adipogenic medium for two weeks, and the adipocyte differentiation by ASCs in vitro was assessed by morphological observation and Oil Red O staining. Then they were attached to collagen scaffolds and co-cultured for 12 hours, followed by hypodermic implantation to the dorsal skin of nude mice for 2 months. The newly-formed tissues were detected by HE staining. Results: The cultured primary stem cells were fibroblast-like and showed active proliferation. After being incubated in an adipocyte differentiation medium, the lipid droplets in the cytoplasm accumulated gradually and finally developed into mature adipocytes, which showed positive in Oil Red O staining. A 0. 5-cm3 new tissue clot was found under the dorsal skin of the nude mice and it was confirmed as mature adipose tissues by fluorescent observation and HE staining. Conclusions: ASCs can successfully differentiate adipose tissues into mature adipocytes, which exhibit an adipocyte-like morphology and express as intracytoplasmic lipid droplets. It is an efficient model of adipose tissues engineered with ASCs and type I collagen scaffolds.     

抑郁症焦虑症状和焦虑症的抑郁症状

目的　探讨抑郁症和焦虑症的抑郁和焦虑症状的差异 ,为鉴别诊断提供依据。方法　使用HAMD和HAMA对5 5例抑郁症患者和 2 0例焦虑症患者进行评定。结果　 (1)抑郁症组绝大部分为中、重度抑郁 (92 .7% ) ,焦虑症组无一例为重度抑郁 ;(2 )抑郁症组的HAMD总分和除焦虑 /躯体化以外的因子分均显著高于焦虑症组 (P <0 .0 5或P <0 .0 1) ,(3)抑郁症患者和焦虑症患者的HAMD和HAMA评分均呈显著性正相关 (P <0 .0 0 1)。结论　HAMD总分有助于鉴别抑郁症和焦虑症。     

Aneurysms of the anterior communicating artery and subclavian artery in association with congenital absence of unilateral internal carotid artery]

We encountered a rare case of unilateral internal carotid arterial defect complicated with anterior communicating aneurysm and subclavian artery aneurysm. The patient was a 56-year-old man in whom cerebral angiography and 3D-CTA revealed defects in the right internal carotid artery and the right carotid canal, and an unruptured aneurysm in the anterior communicating artery. In addition, the patient was also found to have an unruptured aneurysm in the right subclavian artery. As both the aneurysms were considered to have a high risk of rupture and such subclavian aneurysms were likely to cause an embolism, radical surgery was performed for each aneurysm. The postoperative course was uneventful, and the patient was discharged without ambulatory limitations. Although the defect in the internal carotid artery is a relatively rare vascular deformity, the incidence of cerebral aneurysm is about 30% in such cases due to the marked hemodynamic stress involved. On the other hand, there have been only two previous case reports of internal carotid arterial defect complicated with a subclavian aneurysm. Moreover, there have been no previous reports of internal carotid arterial defect complicated with both an intracranial aneurysm and a subclavian aneurysm, as observed in the present case. Thus, this case was very rare and is reported here.     

经喉内镜手术治疗喉部疾病的并发症分析

目的：分析经喉内镜手术后并发症的发生原冈及其防治措施。方法：使用从德国STORZ公司引进的国内首套喉内镜手术系统，治疗包括声带小结、声带息肉、喉乳头状瘤、声带囊肿、会厌囊肿、喉部炎性假瘤、喉部血管瘤等58例患者，并随访2～36个月，观察主要并发症并作相应处理。结果：58例患者中发音正常者54例，发音功能明显好转者4例。主要并发症有：牙齿松动2例，牙齿脱落1例，声带粘连1例，舌体麻木1例，舌运动障碍1例，术后拔管时喉痉挛1例。结论：经喉内镜手术可住微创的前提下彻底清除病灶，并最大限度地保留发音功能，只要术前严格掌握适应证，术中精细操作，其并发症是可以避免的。