Embolization of dural arteriovenous fistulas draining into the transverse or sigmoid sinus

The results of embolisation of dural arteriovenous fistulas draining into the transverse or sigmoid sinus were evaluated in 20 patients. Tinnitus was the main symptom in all patients although one also suffered from vertigo and sudden deafness. Nine patients were treated with PVA (polyvinylalcohol) alone and 11 with combined PVA and bucrylate (isobutyl-2-cyanoacrylate) in 1–9 procedures. Recurrence of symptoms, requiring repeated procedures was common but at subsequent clinical follow up 10 patients had no tinnitus, 5 were improved and only 5 experienced no change. Complications occured in six patients: four had transient neurological symptoms and one of these also developed a necrotic wound which later healed. One patient suffered from a cranial nerve palsy and one had an intracranial haemorrhage after a transvenous embolisation. This last patient recovered completely. The best clinical results were achieved in small fistulas and fistulas treated with combined bucrylate and PVA.     

鼻窦灌注液中加用布地奈德在慢性鼻炎鼻窦炎内镜术后治疗效果观察

目的：研究鼻窦灌注液中加用布地奈德在慢性鼻炎鼻窦炎内镜术后的疗效。方法：选择鼻炎鼻窦炎患者110例,随机分为给予鼻窦灌注液冲洗的对照组和在鼻窦灌注液中加用布地奈德冲洗的观察组,每组55例。观察糖精清除时间、呼吸功能以及炎症因子水平。结果：观察组的糖精清除时间、步行后心率、呼吸频率、呼吸困难严重程度分级标准（MRC评分）以及检测炎症因子IL1、IL2、IL4、IL6、IL8水平均低于对照组;1 s呼吸频率、6 min步行距离均明显高于对照组。结论：鼻窦灌注液中加用布地奈德能够有效的改善治疗效果、缓解炎症状态,具有积极的临床价值。     

氢氧化钙碘仿糊剂根管消毒治疗有窦型慢性根尖周脓肿的临床观察

目的:观察氢氧化钙碘仿糊剂运用于有窦型慢性根尖周脓肿根管内封药消毒的临床效果。方法:选择在同一牙列上有二颗磨牙均患有窦型慢性根尖周脓肿的病例50例,共100颗患牙。将同一病例的二颗患牙分别设为实验组和对照组,同时进行根管治疗。实验组(50颗牙)采用氢氧化钙碘仿糊剂根管内封药消毒,对照组(50颗牙)采用氢氧化钙糊剂根管内封药消毒,对两组根管消毒效果进行临床观察和比较。结果:实验组74%(37/50)封药1次后即可行根管充填术,对照组52%(26/50)封药1次后可行根管充填术,两组间封药1次的根管充填率存在显著性差异(P<0.05)。实验组平均封药次数为1.30次,对照组平均封药次数为1.56次。结论:用氢氧化钙碘仿糊剂根管内封药消毒能够减少有窦型慢性根尖周脓肿根管封药消毒的次数,有利于窦道的尽快愈合。     

CT characterization of inflammatory paranasal sinus disease in cystic fibrosis

Purpose: In patients with cystic fibrosis (CF) the prevalence of paranasal sinus affection approaches 100%. We hypothesized that the hyperviscous mucus reducing mucociliary clearance in CF patients could give sinonasal inflammatory patterns different from those in non-CF patients. We wanted to compare the extent and distribution of paranasal sinus disease and the inflammatory patterns in these two groups of patients.Material and Methods: One-hundred-and-eight CF patients (3-54 years old) and 79 controls (7-51 years old) with paranasal sinus disease confirmed at coronal CT were compared. The extent of disease was noted for each sinus and summed for all sinuses. Inflammatory patterns were identified and classified into: 1) routine surgery group (sporadic, infundibular and ostiomeatal complex (OMC) patterns) and 2) complex surgery group (sinonasal polyposis and sphenoethmoid recess (SER) patterns).Results: CF patients had more widespread sinonasal inflammatory changes and more advanced disease for each sinus. Most CF patients displayed sinonasal polyposis and SER patterns while most controls displayed sporadic, infundibular or OMC patterns. As a result, 67% of CF patients were classified to the complex surgery group, compared to only 19% of controls.Conclusion: The impaired mucociliary clearance in CF causes widespread inflammatory paranasal sinus disease, with inflammatory patterns more often requiring extensive surgery, with a higher risk of cerebrospinal fluid leak or bleeding, or involving areas that are more difficult to reach with the endoscope.     

Sinonasal neuro endocrine carcinoma extending into orbit — a case report

Small Cell Neuroendocrine Carcinomas of the Sinonasal tract are extremely uncommon and distinct neoplasms with aggressive clinical behavior. They have similar morphological and immunohistochemical features to those of small cell carcinomas of the lung. They should be distinguished from Olfactory Neuroblastomas. We report a case of this rare entity. A 46-year-old woman presented with a history of injury to the right eye with facial pain and proptosis as the primary symptoms. Later she developed nasal stuffiness. C.T. Scan revealed a space occupying lesion in the right nostril extending into ethmoid sinus and orbit. Functional endoscopic sinus surgery was done with decompression of the orbit. The biopsy material was obtained from ethmoid sinus and orbit. Histopathological examination of the biopsy specimen along with Immunohistochemical stains confirmed a Small Cell Neuroendocrine Carcinoma. Patient was treated with Radiotherapy and chemotherapy and responded well.     

Rokitansky-Aschoff Sinuses of the Gallbladder are Associated with Black Pigment Gallstone Formation: A Scanning Electron Microscopy Study

Rokitansky-Aschoff sinuses are the result of hyperplasia and herniation of epithelial cells through the fibromuscular layer of the gallbladder wall and are usually referred to as adenomyomatosis. The role of this study is to demonstrate that Rokitansky-Aschoff sinuses of the gallbladder are a risk factor for the formation of black pigment gallstones. A total of 179 removed gallbladders, were hystologically examinated. Sixty-four of the 179 consecutive cholecystomized patients had typical adenomyomatosis. Thirty-eight of the 64 patients with adenomyomatosis had black pigment gallstones, alone ( n =22) or in association with single ( n =12) or multiple ( n =4) cholesterol gallstones in the same gallbladder. Twelve of these patients did not have the typical risk factors for black stones (hemolysis, cirrhoses, gastrectomy, etc). Gallstones were examined by infrared spectroscopy and X-ray diffractometry. In addition, in a subset of 14 patients, the gallstones and the gallbladder wall were examined by scanning electron microscopy. At least in the initial phases of formation, Rokitansky-Aschoff sinuses were found close to small intraparietal vessels and sometimes they contained black pigment microstones. After the fourth to fifth decades of life, black gallstones can be found in the Rokitansky-Aschoff sinuses and in the main gallbladder lumen. Black pigment gallstones can form in Rokitansky-Aschoff sinuses of the gallbladder in absence of the typical risk factors for bilirubin suprasaturation of bile.     

儿童功能性鼻内镜鼻窦手术围术期的护理

目的 探讨经鼻内镜手术治疗儿童慢性鼻窦炎的围手术期护理。方法 手术前后做好患儿的心理护理;术后注意并发症的观察及护理;注重疼痛不适的护理;重视术腔处理的重要性,防止术腔粘连。结果39例鼻内镜鼻窦手术患儿术后无护理并发症发生,进行术腔清理及随访6～18个月以上,均获得满意效果。结论 鼻内镜下行鼻窦手术,同时配合以积极而完善的围手术期护理,及出院后的延续护理,可有效提高手术效果,促使患儿早日康复,减少复发。     

经鼻内镜切除鼻窦良性肿瘤临床观察

目的观察经鼻内镜切除鼻窦良性肿瘤的效果。方法选择20例鼻腔鼻窦良性肿瘤患者,另选20例内翻性乳头状瘤患者,40例患者均采用经鼻内镜切除术治疗,观察2种疾病的治疗效果。结果 20例鼻窦良性肿瘤患者中1次手术完全切除18例,2次完全切除1例,2次大部分切除1例,随访均未复发。20例内翻性乳头状瘤患者中恶变3例;1次手术完全切除15例,术后发现残留2例,后经治疗随访均未复发。结论内镜手术具有视野清晰、面部无瘢痕、损伤小的优点,经鼻内镜切除术对良性肿瘤的临床疗效与标准外进路相近。     

Hedgehog signaling in the posterior region of the mouse gastrula suggests manifold roles in the fetal-umbilical connection and posterior morphogenesis

Although many fetal birth defects, particularly those of the body wall and gut, are associated with abnormalities of the umbilical cord, the developmental relationship between these structures is largely obscure. Recently, genetic analysis of mid‐gestation mouse embryos revealed that defects in Hedgehog signaling led to omphalocoele, or failure of the body wall to close at the umbilical ring (Matsumaru et al. [ 2011 ] PLos One 6:e16260). However, systematic spatiotemporal localization of Hedgehog signaling in the allantois, or umbilical precursor tissue, and the surrounding regions has not been documented. Here, a combination of reagents, including the Ptc1:lacZ and Runx1:lacZ reporter mice, immunohistochemistry for Smoothened (Smo), Sonic Hedgehog (Shh), and Indian hedgehog (Ihh), and detailed PECAM‐1/Flk‐1/Runx‐1 analysis, revealed robust Hedgehog signaling in previously undocumented posterior sites over an extended period of time (～7.0–9.75 dpc). These included the recently described proximal walls of the allantois (Ventral and Dorsal Cuboidal Mesothelia; VCM and DCM, respectively); the ventral embryonic surface continuous with them; hemogenic arterial endothelia; hematopoietic cells; the hindgut; ventral ectodermal ridge (VER); chorionic ectoderm; and the intraplacental yolk sac (IPY), which appeared to be a site of placental hematopoiesis. This map of Hedgehog signaling in the posterior region of the mouse conceptus will provide a valuable foundation upon which to elucidate the origin of many posterior midline abnormalities, especially those of the umbilical cord and associated fetal defects. Developmental Dynamics 240:2175–2193, 2011. © 2011 Wiley‐Liss, Inc.