Management of sphenoid sinus cerebrospinal fluid rhinorrhea: making use of an extended approach to the sphenoid sinus.

OBJECTIVES: Specific information addressing the management of cerebrospinal fluid (CSF) fistulas that originate from within the sphenoid sinus remains scant. The objective of this study was to review the cause and management of CSF rhinorrhea arising from the sphenoid sinus. STUDY DESIGN AND SETTING: This is a retrospective chart review of 12 cases of CSF rhinorrhea arising from the sphenoid sinus that occurred in 11 patients. All patients were treated at a single institution between 1994 and 1999. RESULTS: All patients were managed surgically with sphenoid sinus fat obliteration using an endoscopic sublabial, transseptal approach. This approach was successful for all 12 cases, with median duration of follow-up of 18 months. CONCLUSIONS: Endoscopically assisted transseptal repair of CSF fistulas that originate within the sphenoid sinus offers an alternate approach to previously described methods of repair in this region. Advantages include wide access to the entire sphenoid sinus, improved access to laterally pneumatized regions within the sphenoid sinus, and rostral mucosal closure over the repair within the sinus.     

丁公藤碱Ⅱ类似物的合成及其生物活性

本文设计合成了丁公藤碱Ⅱ的C_2脱氧和C_8电子等排类似物。药理结果表明,丁公藤碱Ⅱ的C_2羟基是保持其缩瞳活性的关键部分之一;目的物2和4各自分别具有拟和抗胆碱活性;电子等排目的物16和17既无拟也无抗胆碱作用。     

Effect of cytochrome P-450 and flavin-containing monooxygenase modifying factors on the in vitro metabolism of amiodarone by rat and rabbit

Experiments were conducted to affirm hepatic cytochrome P-450 involvement in the biotransformation of the class III antiarrhythmic agent, amiodarone (Am; Cordarone X) to its major metabolite, desethylamiodarone (DEA). Male Sprague-Dawley rats and male New Zealand white rabbits were treated with phenobarbital (PB) or 3-methylcholanthrene (3-MC) (to induce cytochrome P-450 (PB-inducible cytochrome(s) P-450) or P-448 (MC-inducible cytochrome P-450). In vivo decreases in rat hepatic microsomal cytochrome P-450 were achieved either by a single ip dose of CCl4 or by a 2-day treatment with CoCl2. In vitro biotransformation of Am by hepatic microsomes from PB-induced and 3-MC-induced rats and PB-induced rabbits was significantly greater than that from noninduced animals. Conversely, in vitro DEA production was significantly decreased with hepatic microsomes from CCl4- and CoCl2-pretreated rats. The classic P-450 inhibitors, piperonyl butoxide, SKF 525A, n-octylamine, and CO provided a significant reduction in the in vitro formation of DEA by microsomes from induced animals. In vitro DEA formation by hepatic microsomes from PB- and 3-MC-induced rats was significantly decreased by 0.5 mM chloroquine (specific inhibitors of PB-inducible cytochrome(s) P-450) and 0.3 mM quinacrine (specific inhibitor of MC-inducible cytochrome(s) P-450), respectively. Further evidence for involvement of gut microsomal flavin-containing monooxygenase was provided by the inhibition of gut microsomal-mediated in vitro DEA formation in the presence of methimazole. Methimazole had no effect on hepatic microsomal DEA production in vitro.(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparative changes in hepatic DNA, RNA, protein, lipid, and glycogen induced by a subtoxic dose of CCl4 in chlordecone, mirex, and phenobarbital pretreated rats

Male Sprague-Dawley rats (200-250 g) were maintained on a normal powdered diet or on a similar diet containing 10 ppm chlordecone (CD), 10 ppm mirex (M) or 225 ppm phenobarbital (PB) for 15 days. On day 15, the animals received a single i.p. administration of CCl4 (100 microliters/kg). Hepatic DNA, RNA, protein, lipid and glycogen were determined 1, 4, 6, 12, 24 and 36 h after CCl4 administration. A significant decrease (18%) in hepatic protein was observed 24 h after CCl4 challenge in the CD-pretreated rats; significant changes were not observed in the other treatment groups. Hepatic RNA was decreased (37%) in CD-pretreated rats at 36 h; no changes were observed in the DNA content. Hepatic RNA and DNA were increased (20% and 16%, respectively) 6 h after exposure to CCl4 alone. Lipid content was increased at all time points starting at 4 h in response to CCl4 challenge in the CD-pretreated rats. In the M- and PB-pretreated rats increases in hepatic lipid (22 and 28%, respectively) were observed only at the 6-h time point. Only a transient increase occurred after CCl4 alone at 4 h. While depletion of hepatic glycogen was manifested in all groups at all time points following CCl4, that in the CD + CCl4 group was the greatest. A recovery of glycogen beginning at 12 h was observed in the rats receiving CCl4 alone and in the M and PB pretreated animals. No such recovery was evident in CD + CCl4 group. These studies indicate that biochemical changes compatible with cellular death are more pronounced in the CD-pretreated rats than in those receiving CCl4 alone, suggesting that the metabolic and supportive biochemical mechanisms for hepatocellular repair are suppressed in rats receiving CD + CCl4.     

Comorbidity,limitations in activities and pain in patients with osteoarthritis of the hip or knee

Background  

This study aims to contribute to the knowledge of the influence of comorbidity in OA. The objectives of the study were (i) to describe the prevalence of comorbidity and (ii) to describe the relationship between comorbidity (morbidity count, severity and the presence of specific diseases) and limitations in activities and pain in elderly patients with knee or hip OA using a comprehensive inventory of comorbidity.     

Effect of an oxytocin antagonist on plasma oxytocin levels during nocturnal uterine contractions in the pregnant baboon.

TT-235 is a potent oxytocin (OT) antagonist that blocks the action of OT at the receptor level. Previous studies have shown that pregnant baboons demonstrate nocturnal uterine contractions induced by OT as they near delivery. The purpose of this study was to evaluate the changes in plasma OT levels following uterine contraction blockage with TT-235. A tethered pregnant baboon model in its last trimester of pregnancy was used. Three blocks of arterial blood samples, immediately before, plus 1 h and plus 2 h following an OT antagonist injection, were collected once nocturnal uterine contractions were detected. Each block consisted of a continuous 10 min withdrawal with 10 samples per block (1 ml/min). A TT-235 dosage of 300 micrograms/kg and saline for control were utilized. Uterine activities were monitored as pressure changes in the amniotic fluid, and the frequency and mean amplitude of contractile activity per 10 min intervals were expressed as contractile force. Plasma OCT levels were determined by a radioimmunoassay following plasma extraction with petroleum ether. The contractile force was decreased by 77% (p < 0.05) within 2 h after TT-235 administration while it increased 23% following saline infusion. Plasma OT levels were unchanged following saline infusion while they increased 82% (p < 0.05) 2 h after the administration of TT-235. If a positive feedback existed between uterine contractions and OT release, one would expect plasma OT levels to be decreased with contractile activity following TT-235 infusion. Since this is not the case in the present study, the data suggest that there is either a negative feedback or an independent relationship between nocturnal uterine contractions and OT release.     

遗传性牙釉质发育不全家系分析

目的:分析一遗传性牙釉质发育不全家系的发病情况及病变特征,明确其遗传方式,为进一步基因定位和克隆奠定基础。方法:2003-05在中国山东某市发现一遗传性牙釉质发育不全家系,先证者为1名43岁男性牙釉质发育不全患者。该家系现存活3代,共有36名家庭成员。对先证者及其家族进行口腔检查和全身检查,制备牙齿磨片镜下观察,对该患者及其亲属成员进行家系调查,系谱分析,明确可能的遗传方式。结果:①口腔及全身临床表现:口腔检查可见大量牙石,釉质病变涉及全口牙齿,牙体呈黄褐色,磨耗重,釉质易碎裂剥脱。X射线显示牙釉质密度基本与牙本质相同,髓腔形态未见异常。临床表现符合Witkop1989年分类中的钙化不全型牙釉质发育。全身系统检查排除系统性疾病。无四环素用药史,家族中无近亲结婚者,附近居民无相似病变。②牙齿磨片观察结果:可见釉丛及釉板明显,且数目增多,表明釉质发育较差。③遗传方式:该家系36名成员,3代中均有患者,共检出遗传性牙釉质发育不全患者13人,其中男7例,女6例,传递方式符合常染色体显性遗传的特点。结论:该家系为常染色体显性遗传性钙化不全型牙釉质发育不全家系,为下一步定位该家系致病基因奠定基础。     

The Treatment of Septicemia in Pacemaker Patients

The authors analyzed the data of seven patients who had undergone open heart surgery because of pacemaker endocarditis in the past 4 years. Repeated surgical interventions on the pacemaker system were found to be the most common predisposing factors. Staphylococcus aureus and Staphylococcus epidermidis were the most common causative organisms. Two-dimensional echocardiography was important in the diagnosis of cases with atypical clinical picture and negative blood cultures. We concluded that: (1) any pacemaker patient with fever should be considered to have a pacemaker endocarditis; (2) all of these patients should be examined by two-dimenensional echocardiography; and (3) the total removal of the infected hardware seems to be the only way to achieve complete recovery.