The petrous carotid artery: anatomic relationships in skull base surgery

Advanced transcranial lesions may be successfully resected through a variety of contemporary skull base approaches. The identification and isolation of the internal carotid artery throughout its petrous course is essential in most of these surgical techniques. Anatomic landmarks normally used to identify this vital structure, however, may be severely distorted by tumor involvement or previous operative dissection. In an effort to define surgical landmarks that may be used in the identification of the petrous carotid artery, histologic sections of 100 temporal bones from adults were examined and microscopic measurements were recorded from the anatomic dissection of 10 fresh cadaver halfheads. On the basis of these studies, structures we have found useful in identification of the vertical petrous carotid artery during lateral skull base approaches include the: base of the styloid process, bony vascular crest, basal turn of the cochlea, medial wall of the eustachian tube, and the cochleariform process. Identification of the horizontal segment can be achieved by the preliminary delineation of the middle meningeal artery, greater petrosal nerve, tensor tympani muscle, mandibular and maxillary divisions of the trigeminal nerve, and the eustachian tube. Specific anatomic relationships with associated measurements are detailed and correlated with selected, illustrative cases.     

A technique to obtain and process surgical specimens of the human vestibular aqueduct for histopathological studies of the endolymphatic duct and sac.

The endolymphatic sac (ES) may play a crucial role in the pathophysiology of Ménière's disease. This paper presents a technique to obtain and process fresh human specimens of the endolymphatic duct (ED) and the presumably more active intraosseous portion of the ES obtained at surgery. The specimens are preserved with an intact bony shell around the ED and the intraosseous ES. This allows ultrastructural histopathological evaluation of the intraluminal contents, the epithelium and the subepithelial tissue as well as the mutual relationships of these structures. Various factors influencing ES ultrastructure are discussed. The results obtained from this method may increase our understanding of the possible role of the ES in the etiology of different inner ear disorders.     

Tumor vascular signals in renal masses: detection with Doppler US

The vascularity of 49 renal masses (26 malignant and 23 benign lesions) was investigated with duplex Doppler ultrasound. Doppler signals obtained at the margins of renal masses were defined as "tumor signals" when the Doppler-shifted frequency of the lesion exceeded the frequency shift in the ipsilateral main renal artery. These exceeded 2.5 kHz with a 3-MHz insonating frequency. Among the 26 renal masses that subsequently proved to be malignant, tumor signals were obtained in 15 of 18 (83%) untreated renal cell carcinomas, in three of four Wilms tumors, and in two patients with metastases to the kidney, but not in the one patient with lymphoma. None of the 23 benign renal masses demonstrated tumor signals. Tumor vascularity in malignant lesions gives rise to abnormal, high-velocity, Doppler-shifted signals that can help in the differential diagnosis of renal masses.     

Incarceration and the acquired immunodeficiency syndrome: Autopsy results in Texas prison inmates

The Texas Department of Criminal Justice (TDCJ) houses many subjects with acquired immunodeficiency syndrome (AIDS) who receive medical care in a comprehensive AIDS treatment center. In this case-control autopsy survey, we compared pathological outcomes of TDCJ inmates treated at the center (n = 155) with nonincarcerated patients who died during the same period (n = 155). Using multiple regression analysis and a proportional hazards model, survival time in the prisoners was equivalent to that in the controls. With few exceptions, the prevalences of opportunistic viral, fungal, protozoal, and bacterial infections contributing to mortality were equivalent between groups. Mycobacterium tuberculosis was isolated more frequently in the inmates, and M avium intracellulare was isolated less frequently (P < .0001). The inmates had a higher prevalence of bacterial infection of the central nervous system (CNS) (9.1% v 1.4%; P < .006); half of all CNS bacterial infections were caused by M tuberculosis. Inmates had significantly lower prevalences of vacuolar myelopathy (P < .006) and severe wasting disease (P < .0009). We conclude that survival of prison inmates with AIDS treated in a comprehensive AIDS treatment center was equivalent to that of nonincarcerated subjects with AIDS. Prevalences of certain complications of AIDS differed in the inmates, showing that the prison environment influenced some of the underlying causes of AIDS morbidity and mortality.     

Development of acute autoimmune encephalomyelitis in mice: Factors regulating the effector phase of the disease

The development of acute experimental autoimmune encephalomyelitis (EAE) in mice is potentiated by the use of Bordetella pertussis vaccine as an adjuvant. Histamine sensitizing factor (HSF) extracted from B. pertussis is the active adjuvant agent and causes a mild increase in cerebrovascular permeability. During the development of EAE, there is an additional increase in vascular permeability of the brain and spinal cord. The adjuvant action of B. pertussis HSF does not appear to mimic a generalized beta-adrenergic blockade, since the course of EAE is not potentiated by adrenalectomy. The cerebrovascular permeability changes observed in EAE are probably mediated by vasoactive amines, since the expression of EAE can be blocked by vasoactive amine antagonists.     

Detection of reactive oxygen species (ROS) and apoptosis in human fragmented embryos

In human in-vitro fertilization (IVF)-embryo transfer, the in-vitro culture environment differs from in-vivo conditions in that the oxygen concentration is higher, and in such conditions the mouse embryos show a higher concentration of reactive oxygen species (ROS) in simple culture media. ROS are believed to cause damage to cell membranes and DNA fragmentation in somatic cells. This study was conducted to ascertain the level of H2O2 concentration within embryos and the morphological features of cell damage induced by H2O2. A total of 62 human oocytes and embryos (31 fragmented, 15 non-fragmented embryos, 16 unfertilized oocytes) was obtained from the IVF-embryo transfer programme. The relative intensity of H2O2 concentrations within embryos was measured using 2',7'-dichlorodihydrofluorescein diacetate by Quanti cell 500 fluorescence imaging and DNA fragmentation was observed with transmission electron microscopy and an in-situ apoptosis detection kit. The H2O2 concentrations were significantly higher in fragmented embryos (72.21 +/- 9.62, mean +/- SEM) compared to non-fragmented embryos (31.30 +/- 3.50, P < 0.05) and unfertilized oocytes (30.75 +/- 2.67, P < 0.05). Apoptosis was observed only in fragmented embryos, and was absent in non-fragmented embryos. Electron microscopic findings confirmed apoptotic bodies and cytoplasmic condensation in the fragmented blastomeres. We conclude that there is a direct relationship between increased H2O2 concentration and apoptosis, and that further studies should be undertaken to confirm these findings.      

Biology of Hyalomma impeltatum (Acari: Ixodidae) under laboratory conditions

Completion of the life cycle of Hyalomma impeltatum Schulze & Schlottke required an average of 108 d at 26 +/- 1 degree C, 92-96% RH, and 12:12 (L:D) photoperiod. Weights of unfed larvae, nymphs, and females were 0.02, 0.16, and 15.4 mg, respectively, and increased 23-, 164-, and 55-fold, respectively, as a result of feeding on guinea pigs. Larvae and adults exhibited host-seeking behavior less than 1 d after hatching and molt, respectively; nymphs exhibited host-seeking behavior 2.9 d after molt. The mean (+/- SE) feeding period as larvae was 5.9 (+/- 2.23) d, nymphs 6.7 (+/- 1.10) d, and females 8.0 (+/- 0.19) d. Larvae molted 12.4 (+/- 0.26) d and nymphs molted 28.9 (+/- 0.22) d after engorgement. A sex ratio of 1.26:1 female/male was determined from emerged adults. Females began oviposition 8.9 (+/- 0.22) d after engorgement and produced 10,680 (+/- 300) eggs per female. Egg hatch was 84% (+/- 2.68) after an incubation period of 32.8 (+/- 0.19) d. Females converted 55% of engorged weight into eggs and produced 12,475 (+/- 188) eggs/g of engorged body weight. A freshly laid egg on the first day of oviposition weighted 47.7 (+/- 0.65) micrograms. An inverse relationship between egg weight and rate of egg production was observed.