Endoscopic resection of intranasal meningo-encephalocele accompanying meningioma.

This paper aims to present the case of a 43-year-old woman diagnosed with a rare condition of meningoencephalocele that arose from a meningioma, and treated with endoscope-assisted transnasal tumor extirpation and repair of the skull base defect with tensor fascia lata flap. Endoscope-assisted operation is a viable and minimally invasive alternative to traditional craniotomy. With improved endoscopic equipment and operative technique, we can perform more reliable surgery and provide better quality of life for these patients.

Patient satisfaction and treatment outcome of fungus ball rhinosinusitis treated by functional endoscopic sinus surgery.

Fungal rhinosinusitis is an important clinical problem with diverse manifestations. Although many literatures had found low recurrence rate after surgical treatment of fungus ball rhinosinusitis, patient satisfaction and treatment outcomes (symptom-free and symptom improvement rate, etc.) for fungus ball sinusitis are not yet well established. The purpose of this study is to estimate the patient satisfaction and treatment outcome in patients with fungus ball rhinosinusitis undergoing functional endoscopic sinus surgery (FESS). Medical records of consecutive patients with diagnosed fungus ball rhinosinusitis treated by FESS between 1995 and 2005 were reviewed retrospectively. The post-operative improvement in individual symptom was assessed by chart review and telephone visiting. Ninety consecutive patients (21 men and 69 women) were eligible for the study. Six patients (7%) presented bilateral fungus ball rhinosinusitis. Multiple paranasal sinus fungus ball involvements were found in 48 patients (53%). Complete resolution of complaints with respect to nasal discharge, postnasal drip, cough with sputum, nasal bleeding, fetid odor of nose, olfactory dysfunction, nasal obstruction, headache, and facial pain or pressure were described in 74 patients (82%). The overall patient satisfaction rate was 96%. The estimated recurrence rate of fungus ball rhinosinusitis treated with FESS was 3%, with a mean follow-up of 81 months. Treatment protocol of fungus ball rhinosinusitis with FESS and without postoperative antifungal drugs is efficient because of very low recurrence rate, high patient satisfaction, and very high symptom-free rate. Furthermore, the obvious difference of symptom-free rate between fungus ball rhinosinusitis and chronic rhinosinusitis highlights the need of further studies to discover the pathophysiology of fungal sinusitis.

Symptoms treatment for allergic rhinitis using diode laser: results after 6-year follow-up.

Allergic rhinitis is a very common chronic disease. The purpose of this study was to measure the outcome of treating allergic rhinitis with diode laser, over a long-term follow-up of 6 years. Forty-two consecutive patients with newly diagnosed allergic rhinitis that was refractive to conservative medical therapies were enrolled in the study. Treatment was with a diode laser (wavelength 805 nm, laser parameter 12 W, in 'contact' mode) under local anesthesia between September 1999 and May 2000. A quality of life questionnaire was used after a follow-up period of 6 years to assess the outcome of diode laser surgery. All 42 patients suffered from either perennial or persistent-type allergic rhinitis. Twenty-five out of 42 patients (60%) replied to the questionnaire 6 years after laser surgery. The mean operation time was 1 min 28 s for each patient. No complications were observed (e.g., major bleeding), and no nasal packing was necessary. Statistical analysis revealed significant improvements in symptom score, medication score and total score 6 years after laser surgery. A total of 60% of the patients described improvements in symptom scores, and 68% of the patients described improvements in total score 6 years after laser treatment. It was evident that the effectiveness of laser surgery persisted through the 6 years of follow-up. Long-term follow-up after 6 years confirmed that diode laser surgery for allergic rhinitis is a useful procedure that has a long-lasting effect and can be performed in an outpatient surgery under local anesthesia. Minimal discomfort, long-term effectiveness and short operation time are other reasons why this treatment should be selected for patients with allergic rhinitis that is refractive to conservative management.

Pilot on-site tests to evaluate the permeability of infiltration gutters.

This study assessed the performance and developed a simple approach for estimating infiltration capacity of two infiltration gutters by using on-site tests. Permeable-brick and redbrick infiltration gutters were constructed on-site. Water infiltrated from the surfaces of two vertical sides (NFS-2S), bottom (NFS-B), and three faces (NFS-3S) of two gutters were measured under nonflowing and steady-state conditions. Tests results from NFS-2S and NFS-3S indicate that the permeability and water depth for both gutters are linearly dependent on each other. Experimental results also indicate that, when the bottom of the gutter is clogged, the permeable-brick gutter still retains approximately 93 and 79% for redbrick gutter of their infiltration capacity for NFS-3S. On the whole, permeable-brick gutter has an advantage over redbrick gutter in stormwater infiltration. Based on these results, the permeability for different water depths and widths of these two gutters can be obtained.

Strictly endoscopic and harmonic scalpel-assisted surgery of nasopharyngeal angiofibromas: eligible for advanced stage tumors.

CONCLUSIONS: With the assistance of the harmonic scalpel, endoscopic surgery is eligible for advanced nasopharyngeal angiofibromas with skull base or infratemoporal fossa invasion. OBJECTIVES: To evaluate the safety and efficacy of strictly endoscopic removal of early and advanced stage nasopharyngeal angiofibromas. Patients and methods. Eight operations for seven consecutive patients presenting with a nasopharyngeal angiofibroma were performed via minimally invasive endoscopic resection by a single surgeon (M.K.C.). All patients were operated with curative intent. RESULTS: Using Radkowski staging, one, two, one, one, and three tumors were stage Ia, IIa, IIb, IIc, and IIIa lesions, respectively. All the tumors were removed successfully by strictly endoscopic surgery. No complications associated with the operation occurred. The average follow-up was 54 months. One recurrence (14.3%) occurred in this series and the salvage surgery was performed by second curative endoscopic procedure.

Minimally invasive endoscopic resection of the submandibular gland: a new approach.

BACKGROUND: This study evaluates the benefits of a new approach, endoscopic resection of the submandibular gland through the hyoid midline level skin incision by use of an ultrasonically activated scalpel. METHODS: Twelve operations for patients presenting with submandibular gland disease were performed via minimally invasive endoscopic resection by a single surgeon (M-KC). RESULTS: All 12 submandibular gland resections were successfully performed endoscopically, and no conversions to conventional open resection were necessary. Of the 12 patients who underwent excision, 3, 6, and 3 had mixed tumor, sialoadenitis with sialolithiasis, and chronic sialoadenitis, respectively. The procedures lasted 50 to 125 minutes (median duration, 70 minutes). No complications associated with the operation occurred, and the scar was almost invisible because of its concealed location with the neck in the natural position. CONCLUSIONS: Endoscopic resection of the submandibular gland is a feasible method for treatment of benign lesions. The main advantages of this procedure are that the small operative scar is concealed in the submental skin crease, resulting in improved cosmetic results and minimization of the possibility of facial nerve injury.

Outcome survey of therapy with diode laser in patients with allergic rhinitis.

OBJECTIVE: To measure the outcome of treatment of allergic rhinitis with a diode laser in the contact mode. DESIGN: Prospective study. SETTING: Tertiary care centre. METHOD: Forty-two newly diagnosed patients participated in the study. MAIN OUTCOME MEASURES: After a follow-up of 1 year, we measured the result of treatment by an allergy outcome survey questionnaire in the 3 months, 6 months, and 1 year following the operation. RESULTS: Twenty-seven of 42 patients (64.3%) who replied filled out the questionnaire completely. The mean operation time took 1 minute, 28 seconds per patient, no nasal packing was necessary, and no complications were observed. Statistical analysis revealed significant improvement in the symptom score 1 year after laser surgery. The outcome of laser surgery declines with time. CONCLUSION: Short-term results revealed that diode laser treatment of allergic rhinitis is a useful procedure that can be performed as outpatient surgery under local anesthesia. The short operation time and less discomfort provide other reasons for choosing this treatment for allergic rhinitis.

The alkaloids and other constituents from the root and stem of Aristolochia elegans.

Two new aristolactams, aristolactam E (1) and aristolactam-AIIIa-6-O-beta-D-glucoside (2), three novel benzoyl benzyltetrahydroisoquinoline ether N-oxide alkaloids, aristoquinoline A (3), aristoquinoline B (4), and aristoquinoline C (5), and a new biphenyl ether, aristogin F (6), together with 62 known compounds have been isolated from the root and stem of Aristolochia elegans Mast. The structures of the new natural products were established on the basis of spectral evidence. Some of the isolated compounds were examined for their antioxidative and antityrosinase activities. Occurrence of the isoquinolones, biphenyl ethers, and benzoyl benzyltetrahydroisoquinoline ether alkaloids in the same plant indicated the definite possibility of these metabolites as biotransformation intermediates of bisbenzyltetrahydroisoquinoline alkaloids. This can be useful to solve the catabolic process of bisbenzyltetrahydroisoquinoline alkaloids.

Constituents from the root and stem of Aristolochia elegans.

Four new tetralones, aristelegone-A (1), aristelegone-B (2), aristelegone-C (3), and aristelegone-D (4); one new isoquinoline, pericampylinone-A (5); four new biphenyl ethers, aristogin-A (6), aristogin-B (7), aristogin-D (8), and aristogin-E (9); three new lignans, aristelegin-A (10), aristelegin-B (11), and aristelegin-C (12); and a new dimer, aristolin (13), have been isolated from the root and stem of Aristolochia elegans. The structures were established on the basis of 1D and 2D NMR and mass spectral data. This is the first report of isoquinolones and biphenyl ethers from this plant which may be representative units for the formation of bisbenzylisoquinoline alkaloids that are common metabolites of Aristolochia species. Aristolin (13) is also the first report of a diterpene linked with an aristolochic acid.