Autograft Ossiculoplasty in Cholesteatoma Surgery: Is It Feasible?

OBJECTIVE: To investigate whether autologous ossicles can be safely used in ossicular reconstruction in cholesteatoma surgery after attempting cholesteatoma removal under the operating microscope. STUDY DESIGN: A prospective fine-section histological study of formalin-stored ossicles, harvested from cholesteatomatous ears, to evaluate for existence of residual cholesteatoma after surface disease clearance under the operating microscope. METHODS: One hundred four ossicles were harvested from 76 patients with cholesteatoma for the study. These malleus heads and includes were categorized into three groups: group 1, ossicles with retained shape and useful bulk, treated by microscopic stripping alone; group 2, ossicles with retained shape and useful bulk, treated by microscopic stripping and drilling; and group 3, badly eroded ossicles, treated by microscopic stripping alone. These treated ossicles were then subjected to 4 microm histopathological study. RESULTS: Residual disease was identified in 6 of the 104 ossicles. Residual disease was found only in badly eroded ossicles that are not suitable for reconstruction. All the usable ossicles were free of disease. CONCLUSIONS: Autologous ossicles that have retained body and bulk are safe to use for reconstruction after surface stripping under the operating microscope. Additional burring probably adds a further margin of safety.     

Renal angiomyolipoma with lymph node involvement: a case report and literature review

Renal angiomyolipomas (AMLs) are relatively common tumors containing fatty tissue, blood vessels, and muscular cells in various proportions. Typical AMLs can be diagnosed without histological confirmation by a combination of ultrasound and computed tomography imaging in up to 95% of cases. In contrast, simultaneous involvement of the kidney, renal vein, or lymph nodes is uncommon and might be confused with a metastasizing malignant tumor. We present a pathologically proven case of the very uncommon simultaneous involvement of the kidney and the lymph nodes in AML.     

Safety and patient experience with transtympanic electrocochleography

OBJECTIVES/HYPOTHESIS: Transtympanic electrocochleography (t-ECOG) is a sensitive diagnostic instrument used for Meniere's disease. It is sensitive by virtue of the recording electrode's position on the promontory of the cochlea where the signals are generated. There is concern about the invasive nature of t-ECOG in comparison to extratympanic recording techniques. The purpose of this study was to examine the safety issues, complications, and patient experience with t-ECOG. STUDY DESIGN: Observational study utilizing retrospective chart review and patient survey. METHODS: The medical records of 205 patients who underwent t-ECOG were reviewed for complications. Complications included persistent tympanic membrane perforation, hearing loss, otitis media, otitis externa, ear canal injury, hemotympanum, and pain. An additional 36 patients undergoing t-ECOG were surveyed on subjective measures such as pain during topical anesthesia of the tympanic membrane, during transtympanic placement of the needle electrode, and during the test procedure and overall experience with t-ECOG. RESULTS: There was one case of a nonhealed, persistent perforation in the setting of acute otitis media directly as a result of t-ECOG. Two patients developed otitis media, and three patients had ear pain for up to 5 days. All 36 patients felt the procedure to be tolerable with minimal discomfort. CONCLUSIONS: Transtympanic electrocochleography may be performed with good patient acceptance and infrequent complications.     

Macular translocation: unifying concepts, terminology, and classification

PURPOSE: To describe some unifying concepts, terminology, and classification of macular translocation so as to facilitate communication within the scientific community. METHODS: A panel of ophthalmologists with expertise in macular translocation reviewed available data and developed some unifying concepts, terminology, and classification of macular translocation. RESULTS: Macular translocation may be defined as any surgery that has a primary goal of relocating the central neurosensory retina or fovea intraoperatively or postoperatively specifically for the management of macular disease. It may be classified according to the size of the retinotomy and, where applicable, the technique of chorioscleral shortening used. The direction of macular translocation is denoted by the movement of the neurosensory macula relative to the underlying tissues. Effective macular translocation may be defined as successful intraoperative or postoperative relocation of the fovea overlying a subfoveal lesion to an area outside the border of the lesion. The concepts of minimum desired translocation and median postoperative foveal displacement can give some useful idea of the likelihood of effective macular translocation before surgery. CONCLUSIONS: Use of a common standardized terminology for macular translocation will facilitate communication within the scientific community and enhance further research in this area. However, the definitions, terms, classification, and concepts concerning macular translocation are likely to continue to evolve as macular translocation undergoes further modifications and refinements.     

The dental implications of chronic use of acidic medicines in medically compromised children

Objective: Liquid oral medicines form a significant proportion (11%) of the medicines used by the population as a whole, either prescribed or over the counter. The active agent, as well as some of the other ingredients, can pose a threat to oral health. Method: Eight liquid oral medicines and two effervescent preparations routinely prescribed for longterm use by paediatric renal patients were assessed for titratable acidity and pH values. Results: All of the medicines tested were acidic and the majority were well below the critical pH of 5.5 at which enamel demineralisation takes place. The titratable acidity values, at a pH of 6.7, ranged between 0.01 and 1.54 for the liquid preparations but were 8.4 and 10.6 for the two effervescent tablets tested. Conclusion: Surplus acid in effervescent preparations while ensuring palatability of medicines and thus compliance, may produce unwanted dental side effects in children who are already medically compromised.     

Circumdatin G, a new alkaloid from the fungus Aspergillus ochraceus

The crude extract of the broth of Aspergillus ochraceus was found to inhibit the final stage of polyprotein processing during hepatitis C virus replication. Bioassay-guided fractionation led to the isolation of the known compound mellein as the active component of the extract. Also isolated were circumdatin F and a new alkaloid, circumdatin G. The structure of circumdatin G was determined by spectroscopic analysis.     

Nocturnal enuresis and obstructive sleep apnoea in two children

Nocturnal enuresis was a symptom of childhood obstructive sleep apnoea, OSAS. We reported two children with secondary nocturnal enuresis which disappeared after tonsillectomy and adenoidectomy for proven OSAS. Pathogenesis of secondary nocturnal enuresis in OSAS was discussed.     

抗原穴位注射增强机体免疫功能的神经免疫调节作用

目的 探讨神经免疫调节在抗原穴位注射增强机体免疫功能的作用。方法 采用免疫组化、免疫荧光标记和RT－PCR定量分析技术,观察了不同途径免疫的大鼠中枢神经的下丘脑外侧区（LH）和杏仁核区（AA0中IL－1β、IL－6的表达与脾脏单个核细胞的IL－1β、IL－2γ变化的关系。结果 抗原穴位注射组小鼠LH和AA脑区IL－10β、IL－6的表达明显高于皮下注射组。但阳性细胞表达的高峰时间相似。免疫荧光标记结果显示细胞因子阳性细胞为神经元。穴位免疫组脾脏单个核细胞IL－2和IFN－γ的表达明显高于皮下免疫组,IL－1β的表达无差异。结论 结果提示抗原经不同注射途径（皮下、穴位）免疫动物,动物中枢神经系统的神经免疫调节功能活动的作用时程是相似的,仅表现为神经免疫调节的作用强度不同;LH和AA脑区IL－1β、IL-6介导的神经免疫调节功能与机体的免疫功能状态呈正相关;神经元神经免疫调质／递质的来源。抗原经穴位注射增强机体免疫功能的作用机制可能为穴位免疫可更有效的动员中枢神经系统的免疫相关脑区的神经免疫调节功能,参与对免疫系统的功能调节。