Congenital lesions of the naso-frontal midline

Dermoids cysts, gliomas and encephaloceles are uncommon congenital lesions that result from an aberrant embryologic development. Six cases of these nasal lesions have been treated. These may present an intracranial extension as a consequence of an unusual closure of the anterior neural tube and it requires an early diagnosis to avoid local and intracranial infectious complications. Therefore, an early surgical correction is thus imperative. Neuroimaging studies may help to predict intracranial involvement.     

Intracranial complications of otitis

Since the advent of antibiotics, endocranial complications due to infectious ear disease are actually unfrequent. They occur predominantly in young adults with a long term chronic otitis media and cholesteatoma. The mortality for endocraneal complications still remains significant. We report six cases of endocraneal complications due to infectious ear disease, that have been seen in our service over the last eight years; remarking that half of the studied patients had an acute ear disease. A review of the literature helps to understand the actual standard of diagnosis and treatment.     

Analysis of 2,500 squamous cell carcinoma of the head and neck

The purpose of this paper is to define the prevalence of squamous cell carcinoma of the head and neck as seen at the ENT Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain in the last years, studying 2500 cases. Relative frequencies at the various sites, age distribution, male to female ratios, TNM stage are reported. From the results we point out that laryngeal squamous cell carcinomas (1297 cases) were more than 50% of all tumors, followed by oropharygeal carcinomas, oral cavity carcinomas and hypopharyngeal carcinomas. The mean age was 61 years, and patients with nasopharyngeal carcinomas were the youngest. 92% of the patients were males, and the highest rate of males was seen in the larynx and hypopharynx (97% males). Only 9% of the patients were non-smokers and 18% were not alcohol drinkers. Hypopharyngeal squamous cell carcinomas concentrated the highest rate of patients with severe toxic consumption. A significant proportion of earlier tumors was only seen in the larynx and oral cavity (54% and 41% Stages I-II, respectively). On the other hand, hypopharyngeal carcinoma, oropharyngeal carcinoma and nasopharyngeal carcinomas were mainly diagnosed in advanced stages.     

Loss of heterozygosity on chromosome 13q12-q14, BRCA-2 mutations and lack of BRCA-2 promoter hypermethylation in sporadic epithelial ovarian tumors

BACKGROUND: BRCA-1 and BRCA-2 are tumor suppressor genes in familial breast-ovarian carcinoma syndrome. BRCA-1 is also a tumor suppressor gene in sporadic ovarian carcinomas. However, the role of BRCA-2 in sporadic ovarian tumors remains unclear. METHODS: DNA from 52 patients with clinically apparent sporadic ovarian tumors was extracted from blood and from fresh-frozen tumor tissue and normal tissue (10 benign, 7 borderline, and 35 malignant). Loss of heterozygosity (LOH) was analyzed in six microsatellite loci on chromosome 13q. BRCA-2 mutations were detected by single-strand conformation polymorphism analysis and the protein truncation test. BRCA-2 promoter methylation was evaluated by methylation specific polymerase chain reaction analysis. RESULTS: LOH on chromosome 13q12-q14 was identified in 16 tumors (30.8%): Fifteen of these tumors were carcinomas (15 of 35 tumors; 42.8%) and one was a borderline tumor. LOH was frequent in carcinomas with serous differentiation (12 of 16 tumors; 75%). LOH on chromosome 13q12-q14 coexisted with LOH on chromosome 17q in 10 carcinomas. BRCA-2 methylation was not detected in any tumor. BRCA-2 mutations were found in three tumors (one somatic nonsense and two germline frameshift). BRCA-2 fulfilled the two hits for a tumor suppressor gene in these three tumors; in one of them, a BRCA-1 tumor suppressor role had been demonstrated previously. CONCLUSIONS: The results suggest that BRCA-1 and BRCA-2 may act synergically in sporadic ovarian carcinomas with serous differentiation. The demonstration of BRCA-2 germline mutations in patients with ovarian carcinoma with LOH on chromosome 13q12-q14 and lack of a remarkable family history of cancer suggest that the proportion of ovarian carcinomas that result from hereditary predisposition may be higher than previously estimated.     

Bilateral monitoring of cerebral oxygen saturation in aortic arch surgery

Cerebral ischemia with consecutive neurological damage is a typical complication in aortic arch surgery. Therefore, intraoperative neuromonitoring is of increasing interest. This paper describes the role of bilateral near-infrared-spectroscopy (NIRS) in detecting cerebral ischemia. In the case of a patient with acute aortic dissection (Daily, type A), an unexpected sudden reduction of perfusion of the right carotid artery could easily be detected with the help of two instruments INVOS 3100A. The decrease in the saturation values from 74% to 54% correlated well with the drop of blood pressure in the right radial artery. Clamping of the aorta with interruption of the blood flow into the innominate artery through the false lumen was the reason for the low cerebral perfusion. After repositioning the aortic clamp NIRS in combination with invasive blood pressure monitoring sufficiently allowed to control the further course of cerebral perfusion. The NIRS is a non-invasive, easy to handle, and easy to interpret method for intraoperative monitoring of the neurological status. Therefore in our opinion it has got some relevant advantages in contrast to other neuromonitoring methods in aortic arch surgery.     

Cardiovascular safety profile of almotriptan, a new indolic derivative for the treatment of migraine

Almotriptan is a new 5-HT(1B/1D) receptor agonist effective for treating acute migraine attacks with or without aura. As 3-5% of patients treated with sumatriptan experience chest symptoms thought to be of cardiac origin, we investigated the cardiovascular safety profile of almotriptan in comparison with that of sumatriptan in six animal models. Almotriptan did not modify blood pressure or heart rate in conscious telemetered normotensive Wistar rats (p.o.), in anaesthetised beagle dogs (i.v.), or in conscious beagle dogs (i.v.), and only produced transient increases when administered (s.c.) to telemetered cynomolgus monkeys. Almotriptan did not consistently affect the duration of the electrocardiogram (ECG) intervals in anaesthetised beagle dogs even when the drug was administered into the coronary artery, nor was ECG morphology altered in telemetered cynomolgus monkeys. In contrast, sumatriptan i.v. consistently increased mean blood pressure and heart rate in conscious beagle dogs. Finally, almotriptan did not modify coronary blood flow at a dose of up to 0.3 mg/kg i.v. in conscious beagle dogs. Thus, almotriptan has a favourable cardiovascular safety profile.     

Characterization of TNP-470-induced modifications to cell functions in HUVEC and cancer cells

The aim of the present work is to characterize (both in vitro and in vivo) the influence of TNP-470 on different cell functions involved in angiogenesis and, more particularly, on endothelial cell growth, cell migration and vessel formation. In addition, a possible direct anti-tumor activity was investigated. To this end, we made use in vitro of human umbilical cord endothelial vein (HUVEC) cells and two human cancer cell lines. The TNP-470 effects on the growth of cancer cell lines were compared to those of Taxol (an inhibitor of microtubule depolymerization), a cytotoxic reference which also displays strong antiogenic activity at low (non-toxic) doses. The in vitro effects were characterized on the mouse mammary MXT adenocarcinoma, on which we also characterized the influence of three clinically active anti-tumor compounds (as cytotoxic references). The purpose of this part of the study was to determine the actual TNP-470-related anti-tumor activity and to evaluate the possible toxic side-effects at the doses at which this compound induces tumor growth inhibition. These investigations were completed by analyzing the TNP-470 effects on HUVEC cell motility and in vitro and in vivo vessel formation. The results show that in vitro, TNP-470 inhibited the growth not only of HUVEC, but also of neoplastic cells. Furthermore, TNP-470 clearly inhibited in vitro endothelial cell motility (p<10(-5)). However, it had only a minor effect (p=0.02) on the formation of HUVEC cell networks on Matrigel(R). In vivo, TNP-470 was able to inhibit tumor growth (on the MXT model) at a dose (50 mg/kg) associated with toxic side-effects. Histological examination showed a significant inhibition of vessel formation (p<0.001) at high (toxic) and intermediary (non-toxic) doses (50 and 20 mg/kg). However, we also observed that TNP-470 stimulated lymphocyte proliferation. Thus, care must be taken with the TNP-470 compound in combination with other anti-tumoral agents in order to avoid certain unfortunate clinical complications.     

Value of sphenoidal electrodes in the EEG diagnosis of herpes encephalitis

EEG features in acute necrotizing encephalitis show periodic activity, localized in the temporal area with a slow background activity. Nevertheless, this periodic activity is transient and may lack. Sphenoidal electrodes study of the internal face of the temporal lobe could record such activity in herpes encephalitis. Sphenoidal electrodes were inserted in 4 patients known to have herpes encephalitis. In 2 cases, periodic discharges were observed both on the surface and sphenoidal electrodes, while in 2 cases, periodic discharge was observed under only sphenoidal electrodes. Faced with uncertain diagnosis of herpes encephalitis, it may be useful to insert sphenoidal electrodes to record deep periodic discharges, not seen on surface electrodes, in order to confirm the diagnosis.     

002 高血压及抗高血压药物与Ⅱ型糖尿病

本文采用前瞻性群体研究旨在确定降压药物的应用与继发Ⅱ型糖尿病的危险之间是否存在独立的相关性。 作者对12 550名(年龄45-64岁)无糖尿病的成年人进行全面健康评价(包括药物的使用及血压测定)。高血压判定标准为收缩压≥140mmH-g(1mmHg=0.1333 kPa)或舒张压≥90mmHg。确定高血压患者3 804例，根据使用降压药物的种类分为血管紧张素转化酶抑制剂(ACEI)162例，β阻滞剂543例，钙拮抗剂96例，噻嗪利尿剂458例，其它单一药物137例，多种药物(≥2种)934例，其余1 474例高血压患者未给予任何抗高血压药物治疗。随访3年及6年后，通过测定空腹血糖浓度[糖尿病判定标准为：空腹血糖≥126m/dl(≥7.0mmol/L)餐后血糖≥200m/dl(≥11.1mmol/L)]评价糖尿病新病例的发生率。