Endodissection of the thoracic esophagus. Technique and clinical results in transhiatal esophagectomy.

OBJECTIVE: Transhiatal esophagectomy (THE), mostly performed in patients with adenocarcinoma of the esophagus, bears the risk of damage to mediastinal structures because the physician's vision is poor during esophageal dissection. The authors report a new endoscopic technique, which enables microsurgical dissection of the esophagus under visual control, that can be performed simultaneously to the abdominal approach. The clinical results in unselected patients with malignant esophageal disease were compared with those of patients undergoing conventional THE. METHODS: Thirty unselected patients (24 men and 6 women; median age, 60 years; age range, 35 to 80 years), mostly with adenocarcinoma of the esophagus, underwent endodissection between April 1991 and July 1992. Thirty patients, who underwent conventional THE between January 1986 and December 1990, were selected using a matched pair algorithm. RESULT: Three significant intraoperative complications were recorded during endodissection (one case of mediastinal bleeding; one case of postoperative bleeding; and one case of a lesion of the right main bronchus), and all were managed without further patient morbidity. The mortality rate (30 days) was 6.6% in the endodissection group (vs. 9.9% THE; not significant [NS]). The frequency of postoperative severe pulmonary complications was 13.3% in the endodissection group (vs. 30% in THE; p < 0.05). The rate of recurrent nerve palsy was only 6.6% in the endodissection group (vs. 13.3% in THE; NS). CONCLUSIONS: Endodissection is especially helpful during esophageal dissection at or above the trachea. It allows identification of mediastinal structures and controlled biopsy of mediastinal lymph nodes. This study showed that endodissection eliminates the "blind angle" during conventional THE, prevents recurrent nerve damage, and reduces pulmonary distress during transhiatal esophagectomy.     

Digital photography and video archives in ENT

Digital media have become standard documentation tools in modern ENT clinics. To date, multiple formats are generated by variable data sources. Old fashioned archiving techniques with numerous print-outs, hard copies or even slides would soon generate an unmanageable data flood and require costly manpower for proper and precise maintenance. It has become obvious that data archiving is the prime challenge for modern hospital information technology. Multiple computerized multimedia archives exist and offer promising solutions for collecting and managing these data. From a clinical point of view, not only data centralisation but also interactions with existing network components and hospital information technology systems have to be made available. Here, we describe variable data sources and formats, centralisation techniques, networking options and discuss available digital documentation solutions.     

Nodular basal cell carcinoma is associated with increased hyaluronan homeostasis

Background Basal cell carcinoma (BCC) is one of the most frequent forms of malignancy in humans. Although BCC is a tumour of low degree of malignancy, if left untreated, it can be locally aggressive, eat away at tissues and cause ulceration. Nodular is the most common subtype of BCC (>50%). Although apparently non‐invasive, micronodular, a certain subgroup of nodular, is likely to recur. Glycosaminoglycans (GAGs), such as hyaluronic acid (HA), are extracellular matrix molecules of high importance in malignant transformation, metastasis and other complex remodelling processes. Objectives To investigate the expression of GAGs and their metabolizing enzymes in nodular BCC, when compared with adjacent healthy human skin tissue specimens. Methods Total GAGs were isolated and purified from nodular BCC and normal adjacent human skin tissue specimens. GAGs were subsequently fractionated by electrophoresis on cellulose acetate membranes and characterized using specific GAG‐degrading enzymes. The content of HA in total GAGs was measured using ELISA and the expression of HA synthases (HAS), hyaluronidases (HYAL) and HA receptors (CD44 and receptor hyaluronic acid‐mediated motility (RHAMM) was assessed using RT‐PCR. Results Nodular BCC is associated with increased levels of HA concomitant with upregulation of gene expression of HAS3, HYAL3 and RHAMM, when compared with normal adjacent skin. Conclusion These results indicate that HA homeostasis in nodular BCC shows distinct features which may be helpful in understanding the complex behaviour of nodular subtype of BCC, thus eventually leading to new treatment strategies.     

A novel role for the metabotropic glutamate receptor-7: modulation of faecal water content and colonic electrolyte transport in the mouse

Background and purpose:

Increasing evidence implicates metabotropic glutamate receptor mGlu₇ in the pathophysiology of stress-related disorders such as depression and anxiety. Mood disorders are frequently associated with gastrointestinal (GI) dysfunction; however, the role of mGlu₇ receptors outside the CNS is unknown. This present study investigated the expression and possible functional role of mGlu₇ receptors in the mouse colon.

Experimental approach:

Expression of mGlu₇ receptor mRNA and protein was studied in mouse colon by in situ hybridization and Western blotting. Effects of the selective mGlu₇ receptor agonist AMN082 on defecation and faecal parameters were studied in an isolation-induced stress model. AMN082 effects on ion transport and neuronal intracellular signalling were examined via Ussing chambers and calcium imaging.

Key results:

mGlu₇ receptor mRNA and protein were highly expressed in colon mucosa. Stress-induced faecal output was unaffected by AMN082, although faecal water content was increased. In mucosa/submucosa preparations, 100 nM and 1 µM AMN082 increased bethanechol-induced changes in short-circuit current in the Ussing chamber. This was sensitive to tetrodotoxin. Also, 100 nM AMN082 significantly increased calcium signalling in a subset of submucosal neurons.

Conclusions and implications:

Activating mGlu₇ receptors increased colonic secretory function in vivo and ex vivo. In a group of submucosal neurons, AMN082 strongly induced calcium signalling and the presence of submucosal nerves was required for the AMN082-dependent increase in secretion. These data suggest that targeting mGlu₇ receptors may be useful in the treatment of central components of stress disorders and also stress-associated GI dysfunction such as diarrhoea or constipation.     

血小板激活因子对大鼠脑血管通透性的影响及药物的保护作用

颈内动脉注射血小板激活因子(PAF),再给伊文思蓝,可见脑实质染色程度加深,而颈内动脉只注射伊文思蓝,脑实质未见染色。而我们合成的新药SZ-1可剂量依赖性地抑制PAF诱导的脑实质伊文思蓝染色程度的加深。在体外培养的脑微血管平滑肌细胞上,PAF能显著刺激¹⁴C-花生四烯酸的释放,而SZ-1能剂量依赖性地抑制这种释放,提示PAF在脑内产生的损害除与其他因素相关外,还与其刺激花生四烯酸释放有密切关系,SZ-1对PAF引起的脑部损害有保护作用。     

Speichelchemische Untersuchungen der Submandibularisdrüse bei Fazialisparesen

Zusammenfassung Bei 41 Patienten mit peripheren Fazialisparesen und sieben gesunden Kontrollpersonen wurden nach Pilocarpinstimulation speichelchemische Analysen im Seitenvergleich durchgeführt. Dabei zeigten sich die Elektrolyte Natrium und Calcium sowie das Ferment Amylase im Speichel der paretischen Seite erhöht. Die Natriumkonzentrationserhöhungen werden nach entsprechenden Modellvorstellungen als Störung der physiologischen Natriumrückresorption (zelluläre Natriumpumpe) des Drüsengangepithels interpretiert. Die Natriumkonzentrationserhöhungen waren abhängig vom Schweregrad der Parese und bildeten sich während der Ausheilung zurück. Es liegen noch nicht genügend Befunde im Frühstadium einer Fazialisparese vor, um die Zuverlässigkeit dieses Parameters zur Fazialisdiagnostik beurteilen zu können.Für Kalium und Protein wurden im Submandibularisspeichel der paretischen und gesunden Seite keine Unterschiede festgestellt.Die Elektrolyttransportstörungen des Submandibularisgangsystems bei Fazialisparesen wurden als gut untersuchbares Modell einer Parasympathikusläsion aufgefaßt. Dies erscheint für die einer biochemischen Untersuchung schwer zugänglichen Labyrinthosen von Interesse, bei denen ursächlich Störungen des vegetativen Zusammenspiels diskutiert werden.Bei diesen könnte eine erhöhte Natriumkonzentration im Corti-Organ bedingt durch eine pathologische Natriumrückresorption einige Symptome ungeklärter Labyrinthosen verständlicher machen.Auszugsweise vorgetragen auf der 49. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie (Bumm et al. 1978)     

蝙蝠葛碱和粉防己碱对[3H]WEB 2086与体外牛脑前动脉平滑肌细胞结合的影响(英文)

用标记的血小板活化因子拮抗剂[³H]WEB 2086,在培养的牛脑前动脉平滑肌细胞上鉴定了血小板活化因子受体。结果表明在25℃时该细胞上存在两种与配基具有不同亲和力的受体结合位点,其中K_d-1=22.8±5.0 nmol·L^-1,K_d-2=186+20.5 nmol·L^-1;B_max-1=2.1±0.3 pmol/10⁴细胞,B_max-2=12.1±1-5 pmol/10⁶细胞。蝙蝠葛碱和粉防己碱均能抑制[³H]WEB2086与上述细胞的结合。