The superior turbinectomy approach to isolated sphenoid sinus disease and to the sella turcica.

Sphenoidotomy or sphenoidectomy are most commonly performed as part of a more extensive pansinus procedure. However, rhinologists may find themselves occasionally in a need to surgically treat an isolated sphenoid sinus disease. With the introduction of endoscopic sinus techniques and instrumentation, intranasal sphenoidotomy has become increasingly popular. The most common approach used is the intranasal, transethmoid sphenoidectomy. Alternatively, many surgeons perform middle turbinectomy to approach the sphenoid sinus transnasally. We describe our direct transnasal, nontransethmoid, nontransseptal approach to the sphenoid sinus. Superior tubinectomy is performed to enhance the exposure of the anterior sphenoid wall. Seventy patients underwent sphenoid sinus exploration for isolation sphenoid sinus disease or for pituitary lesions. Surgical goals were achieved in all patients and there were no complications related to the technique. The superior turbinectomy approach to isolated sphenoid sinus disease provides excellent exposure and avoids the sequelae of total ethmoidectomy or middle turbinectomy.

Induction of B cell hyperplasia in simian immunodeficiency virus-infected rhesus macaques with the simian homologue of Kaposi's sarcoma-associated herpesvirus.

A simian homologue of Kaposi's sarcoma-associated herpesvirus (KSHV), the eighth human herpesvirus (HHV8), was isolated from a simian immunodeficiency virus (SIV)-infected rhesus macaque (Macaca mulatta) that developed a multicentric lymphoproliferative disorder (LPD). This simian rhadinovirus is genetically similar to a recently described rhesus rhadinovirus (RRV) (Desrosiers, R.C., V.G. Sasseville, S.C. Czajak, X. Zhang, K.G. Mansfield, A. Kaur, R.P. Johnson, A.A. Lackner, and J.U. Jung. 1997. J. Virol. 71:9764-9769) and is designated RRV 17577. RRV 17577 was experimentally inoculated into rhesus macaques with and without SIV(mac239) infection to determine if RRV played a role in development of the LPD observed in the index case. In contrast to control animals inoculated with SIV(mac239) or RRV alone, two animals coinfected with SIV(mac239) and RRV 17577 developed hyperplastic LPD resembling the multicentric plasma cell variant of Castleman's disease, characterized by persistent angiofollicular lymphadenopathy, hepatomegaly, splenomegaly, and hypergammaglobulinemia. Hypergammaglobulinemia was associated with severe immune-mediated hemolytic anemia in one RRV/SIV-infected macaque. Both RRV/SIV-infected macaques exhibited persistent RRV viremia with little or no RRV-specific antibody response. The macaques inoculated with RRV alone displayed transient viremia followed by a vigorous anti-RRV antibody response and lacked evidence of LPD in peripheral blood and lymph nodes. Infectious RRV and RRV DNA were present in hyperplastic lymphoid tissues of the RRV/SIV-infected macaques, suggesting that lymphoid hyperplasia is associated with the high levels of replication. Thus, experimental RRV 17577 infection of SIV-infected rhesus macaques induces some of the hyperplastic B cell LPDs manifested in AIDS patients coinfected with KSHV.

Expression of the gibbon ape leukemia virus receptor-1 in rhesus macaque tissues.

A cDNA fragment specific for the rhesus macaque gibbon ape leukemia virus (GaLV) receptor (Glvr-1) was isolated by polymerase chain reaction (PCR) amplification and oligonucleotide primers specific for human Glvr-1 and a cDNA library derived from rhesus macaque brain. Sequence analysis of the fragment revealed the polypeptide domain necessary for infection by GaLV. This fragment was utilized to elucidate expression levels of Glvr-1 RNA in rhesus macaque tissues. By Northern blot analysis, Glvr-1 RNA is most abundantly expressed in the thymus and bone marrow, with detectable levels also in the brain and testes of juvenile male macaques. In the developing 70-days gestation fetus, Glvr-1 expression was observed predominately in the liver and spleen. Although additional studies are required, these studies support the notion that cell types involved in hematopoiesis express Glvr-1.

Unusual presentation of a pituitary abscess.

We present a case of a pituitary abscess without an identifiable source. The patient presented with progressive visual field defects, unilateral visual loss, and proptosis. However, no symptoms or signs of local or systemic infectious process were present. Computerized tomography and magnetic resonance imaging studies suggested but did not confirm the diagnosis. Emergent transsphenoidal drainage resulted in a complete recovery.

Hospital offers cardiac crisis program to industry.

A university medical center has initated a cardiac crisis plan that reaches out to industry to promote preventive health care among employees. The program described here served as a marketing tool for the medical center to establish its credibility among business leaders.