眼眶硬化性骨髓外造血细胞瘤

骨髓外造血细胞瘤可发生于包括骨髓纤维化、慢性骨髓性门血病和非常少见的红细胞增多症等骨髓增殖紊乱时。当纤维巨细胞增值伴有坚硬肿块形成时，该区域被称为硬化性骨髓外造血细胞瘤（SEMHTs），据我们所知．我们描述的是第一例发生于双侧眼眶SEMHTs的多发性骨髓纤维变中性。     

Supracricoid laryngectomy with Cricohyoidopexy--a clinico oncological & functional experience

Supracricoid laryngectomy with Cricohyoidopexy (CHP) is a procedure that is commonly practiced in France & Canada. Eight such procedures were carried out at Kidwai Memorial Institute of Oncology, Bangalore during the period from 1991 through 1996. Four Glottic, 3 transglottic & one supraglottic cancers were subjected to this procedure. The study comprised of 7 males & 1 female. The average age was 52 years. Two procedures were done as salvage procedures for radiotherapy (RT) failures. The patients have a follow-up ranging from one year to six years, except for one who died soon after discharge from hospital secondary to myocardial infarction. Median follow up was four years. The three year acturial disease free survival was 83%. Six out of 8 (75%) were decannulated, and physiologic deglutition without aspiration was established in all patients. Hospital stay ranged from 11 to 62 days averaging 29 days. The speech was analyzed together with other partial laryngectomies and was found to be qualitatively worse than speech after other partial laryngectomy procedures. In addition speech intensity levels after CHP were lower than in other partial laryngectomy procedures. The speech however allowed normal social interaction. This procedure certainly has distinct oncological advantage in encompassing circumferential horse-shoe lesions with minimal subglottic extension which in the past would have received total laryngectomy and needs to be included in the repertoire of speech restorative surgery in laryngeal cancers.     

Parotid tuberculosis simulating malignancy

An interesting case of parotid tumour simulating malignancy is reported. The rarity of this lesion and the associated clinical and diagnostic problems are emphasized together with the relevant literature.     

The androgenic polycystic ovary.

The polycystic ovary has the capacity to produce excessive androgens (delta4-androstenedione, dehydroepiandrosterone, and testosterone). Whether this disorder is caused by constant pituitary priming of the ovaries due to hypothalamic-pituitary derangement or an ovarian enzyme defect, the end result is the same, i.e., abnormal androgen production. In an effort to explain the syndrome, we offer the hypothesis of an inherently sensitized adrenal secreting excessive androgen which leads to an imbalance in the hypothalamic-pituitary axia. The result is a tonic stimulation of the ovaries eventuating in "the androgenic polycystic ovary."     

A comparison of fixed-bearing and mobile-bearing total knee arthroplasty at a minimum follow-up of 4.5 years

BACKGROUND: Durable long-term independent results with the Low Contact Stress rotating-platform (mobile-bearing) and the Insall Burstein-II (fixed-bearing) total knee prostheses have been reported, but no studies describing either the mid-term or long-term results and comparing the two prostheses are available, to our knowledge. METHODS: Thirty-two patients who had bilateral arthritis of the knee with similar deformity and preoperative range of motion on both sides and who agreed to have one knee replaced with a mobile-bearing total knee design and the other with a fixed-bearing design were prospectively evaluated. Comparative analysis of both designs was done at a mean follow-up period of six years, minimizing patient, surgeon, and observer-related bias. Clinical and radiographic outcome, survival, and complication rates were compared. RESULTS: Patients with osteoarthritis had better function scores and range of motion compared with patients with rheumatoid arthritis. However, with the numbers available, no benefit of mobile-bearing over fixed-bearing designs could be demonstrated with respect to Knee Society scores, range of flexion, subject preference, or patellofemoral complication rates. Radiographs showed no difference in prosthetic alignment. Two knees with a mobile-bearing prosthesis required a reoperation: one had an early revision because of bearing dislocation and another required conversion to an arthrodesis to treat a deep infection. CONCLUSIONS: We found no advantage of the mobile-bearing arthroplasty over the fixed-bearing arthroplasty with regard to the clinical results at mid-term follow-up. The risk of bearing subluxation and dislocation in knees with the mobile-bearing prosthesis is a cause for concern and may necessitate early revision. LEVEL OF EVIDENCE: Therapeutic Level II.     

Endoscopic resection of a juvenile angiofibroma: the role of the XPS microdebrider

Juvenile angiofibromas are vascular tumors found almost exclusively in the adolescent male. Although benign, their clinical course can be aggressive and can result in major morbidity and mortality. Endoscopic transnasal resection of juvenile angiofibromas, confined to the nose, paranasal sinuses, pterygopalatine fossa, and medial infratemporal fossa, has been a significant advance in their management, eliminating or reducing the need for extensive soft tissue and bony dissection of traditional surgical approaches. We discuss a case of a juvenile angiofibroma resected transnasally using the XPS microdebrider (Medtonic Xomed, Jacksonville, Florida) and outline the role of this instrument in this surgery.     

Ultrastructural and physiological studies of the stalk-sectioned rat pituitary gland.

A pituitary stalk-section rat model was prepared that would be suitable for the study of the direct effects of steroids on the pituitary gland. In this model, the hypophyseal stalk was severed surgically and metal foil was inserted to prevent regeneration of portal vessels. The major portion of the pituitary no longer had a direct communication with the hypothalamus, and the only blood supply was from short portal vessels that supply the dorsolateral part of the gland. The effectiveness of the lesion was demonstrated by very high levels of serum prolactin and very low FSH and LH. Light microscopic examination revealed a large infarct in the central region of the gland with stainable cells in the peripheral area. Fourteen days after stalk-section, the infarct had shrunken appreciably, and after 21 days it was replaced by a scar. Ultrastructural studies revealed the presence of functional mammotropes in the peripheral regions of the pituitary gland, while other cells were smaller, less active, and contained fewer secretory granules. After LHRH administration there was an increase in serum LH, thus indicating the presence of a substantial number of viable gonadotropes. This was confirmed by the ultrastructural findings which now showed the appearance of large, well-granulated gonadotropes. When LHRH was given to estradiol 17-beta primed ovariectomized stalk-sectioned rats, there was a great augmentation of LH release, and many castration cells were now apparent. Therefore, the administration of estrogen and LHRH was needed for the gonadotropes of the isolated pituitary to function optimally in the synthesis and secretion of FSH and LH. The stalk-sectioned animal model permits evaluation of pituitary function isolated from hypothalamic control while it leaves the surviving pituitary gland in its normal anatomical position.