Cholesterol granulomas of the petrous apex; endonasal endoscopic approach.

OBJECTIVE: Cholesterol granulomas are benign lesions that sometimes occur on the petrous apex (PA). We report our experience using an endoscopic endonasal approach to remove PA cholesterol granulomas. MATERIAL AND METHODS: A retrospective patient chart analysis was conducted at a tertiary care university hospital. RESULTS: Four patients (3 females, 1 male) were included in this study. Patients' ages ranged from 27 to 78 years. Computed tomography (CT) and magnetic resonance imaging (MRI) for diagnosis and computer-assisted navigation were performed. The most common symptom was abducens nerve palsy. The largest granuloma measured 5 x 2 cm and was located on the left side. An endoscopic endonasal approach was chosen and navigation was applied (3/4 patients) to identify the optimal area for opening the granuloma. No complications occurred, and patients were free from recurrence during the follow-up period. CONCLUSION: The endoscopic endonasal approach to PA cholesterol granulomas is feasible and safe. Intra-operative navigation is recommended to identify the position of the internal carotid artery and determine the safest area for opening the granuloma without damaging the artery. Another advantage of this approach is an easier follow-up through diagnostic nasal endoscopy.

Effect of biphosphonates on abnormal mandibular growth of rats intoxicated with uranium.

Intoxication with uranium induces severe alterations in kidneys and in acute intoxications inhibits bone formation and bone growth. Administered at high doses, uranium leads to death, an event that can be prevented by the administration of ethane-1-hydroxy-1,1 biphosphonate (EHBP), which would presumably exert its effect via its chelating properties. Based on this information, the aim of the present study was to determine the best therapeutic method for treatment using biphosphonates to prevent mandibular growth alterations in animals that survive uranyl nitrate poisoning. Seven groups of Wistar rats weighing 14 g were used as follows: I, untreated control; II, one intraperitoneal injection (IPI) of 2 mg Kg(-1) of body weight of uranyl nitrate (238U). In groups III to VII animals were intoxicated as in Group II and in addition were given a single injection of 10 mg Kg(-1) of ethane-1-hydroxy-1, 1-biphosphonate (EHBP), or 3-amine-1, 1-hydroxypropylene-1, 1 biphosphonate (APD) as follows; Group III, IPI of EHBP given immediately after poisoning (0 h); IV, IPI of EHBP given at 24 h; V, subcutaneous injection (SCI) of EHBP at 0 h; VI, SCI of EHBP at 48 h; VII SCI of APD at 0 h. Survivors were killed on the sixtieth day. Body weight increase, survival rate, and biometric parameters of mandibular growth (Eratalay's method) were studied. Student's "t" test was used for statistical analysis. On day 60 there was only one survivor in Group II and none in Group IV. All animals in the other groups survived. Mandibular growth parameters showed the worst results in Group VII and the best in Group V for which no difference with the controls was observed. These results show that a single subcutaneous injection of EHBP given immediately after uranium poisoning, apart from preventing death, is capable of preventing undesirable alterations in mandibular growth.

[The use of neoadjuvant selective intra-arterial polychemotherapy and its modifier verapamil in the combined treatment of colorectal cancer]. / Primenenie neoad'iuvantnoi selektivnoi vnutriarterial'noi polikhimioterapii i ee modifikatora verapamila v kombinirovannom lechenii kolorektal'nogo raka.

After combined treatment of 74 patients for colorectal cancer using preoperative neoadjuvant intraarterial selective polychemotherapy (IAPCT) three-year survival index have constituted (77.0 +/- 5.2)%, the cancer recurrence have occurred in (10.8 +/- 2.8)%, distant metastases were revealed in (17.5 +/- 4.2)%. Using verapamil as a IAPCT modifier in 54 patient three-year survival have increased by 11.8%, the frequency of distant metastases occurrence have reduced by 10.1%.

Neoadjuvant intra-arterial polychemotherapy of locally advanced rectal cancer.

In order to evaluate the usefulness of pre-operative intra-arterial selective polychemotherapy (PIASP), we carried out a retrospective study of 107 patients (65 males, 42 females) with locally advanced rectal cancer (LARC) (pT3-4 N0-1 M0), who were treated between 1988 and 1991. Fifty-two patients (MG) underwent PIASP (Adriablastin 60-90 mg, fluorouracil 3-4 g) with subsequent radical surgery. Fifty-five patients (R0) received surgery alone. Angiographic findings after PIASP showed approximately 50-70% reduction in the vascular network in the tumour and surrounding tissues. A post-operative morphological study confirmed the considerable tumour dystrophy, necrobiosis and necrosis. Comparative statistical analysis in two patient groups showed that overall 5-year survival was significantly better in MG (64.76 +/- 1.85%) than in R0 (38.23 +/- 1.74%; chi 2 = 9.1; P < 0.05). A similar situation was observed in all research subgroups: T3 N0 M0 (MG, 85.71 +/- 3.29% and R0, 65.63 +/- 2.85%; chi 2 = 2.61; P < 0.05); T3 N1 M0 (MG, 47.06 +/- 4.68% and R0, 0.0, chi 2 = 14.37; P < 0.05); T4 N0-1 M0 (MG, 8.57 +/- 4.29% and R0, 0.0, chi 2 = 2.09; P < 0.05). Significantly better 5-year survival rates were seen in MG than in R0 with the medial cellular differentiation in carcinoma (77.42 +/- 2.98% and 36.23 +/- 2.41%, chi 2 = 9.81; P < 0.05, respectively), the most frequent histological tumour structures. There is a trend for improved 5-year survival in low differentiation carcinoma (MG, 47.62 + 5.29% and R0, 35.29 +/- 4.37%, chi 2 = 0.28, P > 0.05). The MG group showed eight local relapses of disease (15.38%), while the R0 group showed 21 (38.1%), the MG group demonstrated 12 distant metastasis (23.07%) while R0 demonstrated 19 (34.54%), the median relapse-free survival was 101.6 weeks in MG and 74.45 weeks in R0. The use of the combined PIASP with subsequent surgery treatment of patients with LARC allows a better prognosis than does surgery alone.

Lethality due to uranium poisoning is prevented by ethane-1-hydroxy-1,1-biphosphonate (EHBP).

The processes of uranium extraction, purification, and manufacture involve the risk of chemical intoxication. Acute uranium poisoning elicits renal failure which in turn may lead to death. Great efforts have been put into the search for a protective agent for acute uranium poisoning. Several chelating agents such as EDTA, Tiron, DTPA, or aminosalicylic acid have been experimentally assayed. However, even when these agents are able to reduce the mortality none of them achieve 100% survival. We herein present the use of EHBP to prevent mortality due to uranium poisoning. Rats weighing 14 g were employed in two different experiments: A) The surviving animals were killed on the 60th day; and B) The animals were killed on the 9th day. In both experiments 4 groups were considered: 1. untreated control; 2. one intraperitoneal (IP) injection of uranyl nitrate (2 mg kg-1 of body weight); 3. 1 IP injection of EHBP (10 mg kg-1 of body weight); and 4. treatments 2 and 3 combined. In both experiments 50% of the animals in group 2 died on the eighth day. All the animals of the other groups were alive at the end of the experiment. Histological analysis of the kidneys of the animals of experiment B revealed renal damage in the exposed animals, whereas no structural alterations were detected in the kidneys of the other three groups, including those given uranyl nitrate and treated with EHBP. These results show the efficiency of only one injection of EHBP to avoid renal damage and to counteract the mortality due to uranium poisoning with a success rate of 100%.

[The immediate results of the combined treatment of rectal cancer using intra-arterial selective polychemotherapy]. / Neposredstvennye rezul'taty kombinirovannogo lecheniia raka priamoi kishki s ispol'zovaniem vnutriarterial'noi selektivnoi polikhimioterapii.

The treatment experience of 127 patients with the locally spread rectal cancer was summarized. The combined with preoperative intraarterial chemotherapy course application causes significant injurious effect on the tumor (more than 3 times decrease of the viable tumor tissue part by volume in rectal adenocarcinoma, the appearance of subcapsular necrosis regions in metastatically injured regional lymphatic nodes in 32.2% of observations) and is characterized by low common toxicity.

[Multiple primary malignant neoplasms of the large intestine]. / Pervichno-mnozhestvennye zlokachestvennye novoobrazovaniia tolstoi kishki.

Of the 3182 patients with malignant tumors of the large intestine, in 140 (4.4%), the primary multiple malignant neoplasms were revealed: in 59 (42.1%) of them--the synchronous, in 81 (57.9%)--the metachronous ones. Surgical treatment was performed in 137 (97.9%) patients, including the radical treatment--115 (83.9%). The postoperative lethality was 7.3%. 75.3% of the patients are alive for five years, 21.3%--for ten years.