Petrous Apex Cholesteatoma

Primary or secondary petrous apex cholesteatoma requires surgical management. We describe here five patients with cholesteatoma in the petrous apex on whom different surgical approaches to this region were used. Translabyrinthine-transcochlear (transotic) approach with VII-XII anastomosis was used in four patients. In one patient middle fossa approach with otic capsule and facial canal leaving intact was used. All patients are without recurrence of cholesteatoma with improving of the facial nerve function in one case. We discuss specific pathologies of the petrous apex, the surgical approach to this region indicated according to the size and type of pathology diagnosed, hearing loss and facial nerve function. Possible complications of this surgical procedure and their management are also discussed.     

GC-MS assay for acetaminophen in human hair segments

A detailed procedure for sensitive analysis of acetaminophen (APAP) in human hair segments by gas chromatography-mass spectrometry is reported. The limit of quantitation was as low as 0.1 ng/mg. The linear concentration range of the assay was 0.1–10 ng/mg. The interday and intraday coefficients of variation were below 10%. The method was successfully applied to hair analysis of APAP in an actual poisoning case.     

高寒区创伤足跟部软组织缺损及骨髓炎的修复

目的探讨多种皮瓣对修复高寒环境下创伤所致足跟部软组织缺损的疗效。方法对高寒环境创伤、冻伤足踝、跟部大面积组织缺损患者35例(其中11例伴有骨髓炎形成),伤肢经早期复温处理,并根据各种缺损创面,应用下肢的皮瓣转移。结果采用皮瓣修复术后伤口Ⅰ期愈合者31例,4例皮瓣远端皮缘部分坏死;创伤区愈合后皮瓣质地优良,外形与功能满意。结论高寒区创伤后伤肢早期及时复温,采用多种皮瓣修复足部软组织缺损,有利于控制感染创面及骨髓炎。     

耳蜗的扫描电镜观察

为研究柯替氏器的超微结构,用豚鼠、猫及4个月胎儿的耳蜗,在扫描电镜下观察。柯替氏器呈螺旋梯状,围绕在蜗轴周围。蜗尖部的柯替氏器较宽,蜗底部的较窄,其上方的前庭膜由单层扁平上皮组成,上皮表面有微绒毛。紧贴表面的盖膜由原纤维组成。大多数原纤维平行排列,表面与边缘的原纤维多交织成网。柯替氏器中有3排外毛细胞与1排内毛细胞,二者之间有柱细胞头板,外毛细胞上的听毛排列成W形,内毛细胞上的听毛排列成弧形。此外,所有细胞表面均有微绒毛。在轻度噪音刺激后,听毛减少并紊乱,微绒毛也减少或消失。 4月胎儿的柯替氏器有3～4排外毛细胞,其表面为绒球状听毛,后来发育为W形排列。内毛细胞为1排,表面为束状的原始听毛,后变为弧形排列。本文还观察到断裂的柯替氏器中,暴露出外毛细胞的柱状胞体及底部的杯状支持结构。外毛细胞由外指细胞所肩托。外指细胞的指突与外毛细胞均倾斜排列,交错成一定角度。当暴露出外柱细胞时,其胞体上细下粗,表面有传入神经纤维。当外毛细胞、外柱细胞等掀向上方后,可见隧道中纵行的神经纤维束及其分支,即螺旋隧道束与放线隧道纤维,它们系橄榄耳蜗束的传出纤维。     

Transplantation of fetal cortex to the brain of newborn rats: A retrograde fluorescent analysis of callosal and thalamic projections from transplant to host

Fetal cerebral cortical tissue was transplanted into the cerebral hemisphere of 0–1-day-old rats. In some cases, the transplants were placed into or adjacent to cortical lesion cavities made immediately prior to transplantation. Injections at maturity of fast blue and diamidino yellow into the host contralateral cortex and ipsilateral thalamus demonstrated the presence of callosal and thalamic projections from transplant to host. Numerous single-labeled neurons were often arranged in cell bands or clusters. This apparent topography and the absence of double-labeling resembled normal labeling patterns.     

Respiratory virus infections in transplant recipients after reduced-intensity conditioning with Campath-1H: high incidence but low mortality

Respiratory virus infections can cause serious morbidity and mortality after conventional allogeneic stem cell transplantation. However, the incidence and outcome of these infections after reduced intensity conditioning has not been reported. Between 1997 and 2001, 35 episodes of respiratory virus infections were noted in 25 of 83 transplant recipients conditioned with fludarabine, melphalan and Campath-1H, and 80% of them received early antiviral therapy. Parainfluenza virus (PIV) 3 was the commonest isolate (45.7%) followed by respiratory syncytial virus (37%). Patients with myeloma were more susceptible to these infections [odds ratio (OR) 4.1, P = 0.01] which were often recurrent in patients with severe acute or chronic graft-versus-host disease (GVHD) (OR 10.6, P = 0.03). Infection within the first 100 d (OR 5.0, P = 0.05) and PIV 3 (OR 9.2, P = 0.01) isolation were risk factors for developing lower respiratory infection. Although more than half of the episodes progressed to lower respiratory infection, the mortality was only 8%. This could have been due to early initiation of antiviral therapy, but the attenuation of pulmonary damage due to the reduced-intensity conditioning, low incidence of GVHD and, paradoxically, the low CD4+ T-cell subset in this setting might also have been contributory factors.