The sagittal grooves of the middle nasal turbinate determine paradoxical curvatures and bifidities.

BACKGROUND: Paradoxical curvature of the middle nasal turbinate (MT) is a common anatomic variant, usually found and reported on coronal CT slices. However, less attention has been paid to the sagittal groove (SG) which is determining it. AIM: The study aimed to determine paradoxical curvatures and bifidities in the sagittal groves of middle nasal turbinate. MATERIAL AND METHOD: A retrospective CBCT study on the archived files of 52 adult patients was performed. RESULTS: Different patterns of MT bifidity were found: (1) unilateral bifid MTs; (2) bifid and trifid MTs and "wandering" single SGs; (3) bilateral bifid middle turbinates and double SGs, (4) bilateral false bifid appearance due to middle and superior turbinates fusion and (5) bifid concha bullosa media. Digital "dissections" of patients' files allowed us to conclude that paradoxical curvature as well as bifidity of MTs relate to the placement and number of the SGs on the MTs. Such SGs were previously documented in prenatal MTs since the 14th week, as well as in pædiatric patients. CONCLUSIONS: It seems reasonable to speculate that paradoxical curvature, as well as bifidity of MT, this later being previously undocumented, are just adult vestiges of the primitive MT morphology. Nevertheless, documentation of the MT morphology should not rely exclusively on coronal CTs, as combined morphologies of that turbinate could occur.

Bilateral giant and unilateral duplicated sphenoidal tubercle.

The sphenoidal tubercle (SphT), also known as pyramidal tubercle or infratemporal spine projects from the anterior end of the infratemporal crest of the greater sphenoidal wing. As it masquerades the lateral entrance in the pterygopalatine fossa it could obstruct surgical corridors or the access for anaesthetic punctures. The SphT is, however, an overlooked structure in the anatomical literature. During a routine cone beam computed tomography study in an adult male patient we found bilateral giant SphTs transforming the infratemporal surfaces of the greater wing into veritable pterygoid foveae. Moreover, on one side the SphT appeared bifid, with a main giant partition, of 9.17 mm vertical length, and a secondary laminar one. The opposite SphT had 14.80 mm. In our knowledge, such giant and bifid SphTs were not reported previously and are major obstacles if surgical access towards the pterygopalatine fossa and the skull base is intended.

The temporomandibular joint: pneumatic temporal cells open into the articular and extradural spaces.

The pneumatisation of the articular tubercle (PAT) of the temporal squama isa rare condition that modifies the barrier between the temporomandibular joint(TMJ) space and the middle cranial fossa. During a routine examination of thecone-beam computed tomography (CBCT) files of patients who were scannedfor dental medical purposes, we identified a case with multiple rare anatomicvariations. First, the petrous apex was bilaterally pneumatised. Moreover, bilateraland multilocular PAT were observed, while on one side it was further found thatthe pneumatic cells were equally dehiscent towards the extradural space and thesuperior joint space. To the best of our knowledge, such dehiscence has not previouslybeen reported. The two temporomastoid pneumatisations were extendedwith occipital pneumatisations of the lateral masses and occipital condyles, thelatter being an extremely rare evidence. The internal dehiscence of the mandibularcanal in the right ramus of the mandible was also noted. Additionally, doublemental foramen and impacted third molars were found on the left side. Suchmultilocular PAT represents a low-resistance pathway for the bidirectional spreadof fluids through the roof of the TMJ. Further, it could add to a morphologicalpicture of hyperpneumatisation of the posterior cranial fossa floor, which couldsignify the involvement of the last four cranial nerves in the clinical picture of TMJpain.

Rare anatomic variation: Giant unilateral concha bullosa superior.

The lateral nasal wall attaches the nasal turbinates, which could be, either pneumatized, or paradoxically curved. The turbinate pneumatization-concha bullosausually indicates the pneumatization of the middle turbinate. However, concha bullosasuperior (CBS) is also, although rare, anatomic possibility of variation. We report here a case of unilateral giant septated CBS, which was not, to our knowledge, previously reported. The case was documented in Cone Beam Computed Tomography (CBCT). Subtle pneumatizations of inferior turbinates were found bilateral, as also were the middle conchae bullosae. The left concha bullosasuperior was very large (17.43/5.34mm), dropping down between the left middle turbinate and the contralaterally deviated nasal septum, and contacting the paradoxical curvature of the middle turbinate on that side. An incomplete oblique septum divided it incompletely into anterior and posterior chambers, it was communicating with a posterior ethmoid air cell, and was draining in the superior meatus. Care should be taken not to misdiagnose a giant CBS as a middle turbinate pneumatization, in order not to misjudge surgical corridors. Therefore, a careful anatomic CT or CBCT diagnosis would be of use for the plan of treatment.

Rare anatomic variation: true bifid inferior turbinate.

Nasal anatomic variations are relevant during nasal surgical and endoscopic procedures. The extent of imaging methods, such as the cone beam computed tomography (CBCT), allows a better characterization of such peculiar anatomic traits. The bifid inferior turbinate (BIT) is a rare finding, being previously reported less than ten times. It was found and described on CT scans of patients, being usually associated with the absence of the uncinate process (UP). We hereby report for the first time a bilateral true BIT which differs from the previously reported BITs by the fact that the UPs were present and the bifidity was oriented laterally. In the light of this new find, we consider that the variant resulted from UP displacement should be regarded as a false bifid, or double, inferior turbinate. Bifidity of the inferior turbinate was not previously evaluated in CBCT, as well as in three-dimensional volume renderizations. So, CBCT proves as an efficient tool to investigate prevalence of rare anatomical variants. Noteworthy, CT studies of patients on a case-by-case basis allows a better performance of surgical and endoscopic procedures.

Anti-inflammatory sesquiterpenes from Curcuma zedoaria.

From the methanolic extract of the rhizome of Curcuma zedoaria, we isolated anti-inflammatory sesquiterpene furanodiene (1) and furanodienone (2) along with new sesquiterpene compound 3 and known eight sesquiterpenes, zederone (4), curzerenone (5), curzeone (6), germacrone (7), 13-hydroxygermacrone (8), dehydrocurdione (9), curcumenone (10), and zedoaronediol (11). Their structures were elucidated on the basis of spectroscopic data. The anti-inflammatory effect of isolated components on 12-O-tetradecanoylphorbol-13-acetate (TPA)-induced inflammation of mouse ears were examined. Compounds 1 and 2 suppressed the TPA-induced inflammation of mouse ears by 75% and 53%, respectively, at a dose of 1.0 micromol. Their activities are comparable to that of indomethacin, the normally used anti-inflammatory agent.

The maxillary sinus and its endodontic implications: clinical study and review.

OBJECTIVES: Endodontic infections of posterior maxillary teeth sometimes spread to the maxillary sinus, generating severe complications. The aim of this study is to present the various problems encountered during endodontic treatment of these teeth. METHODS: The files of 125 cases of odontogenic chronic maxillary sinusitis were reviewed retrospectively. RESULTS: Chronic apical periodontitis was the cause in 99 cases and traumatising endodontic treatment in 26 cases. Foreign intra-sinusal bodies were occasionally seen as a consequence of different endodontic treatments of posterior maxillary teeth. CONCLUSIONS: A knowledge of dento-antral relationships is particularly important in the prevention of sinusal accidents and complications during various therapeutic manoeuvres, which should be performed according to and depending on the regional morphology.

Prognostic significance of the diameter of perineural invasion in radical prostatectomy specimens.

We assessed whether the quantification of cancer invasion into the perineural space influences the prognosis of patients treated with radical prostatectomy. We conducted a retrospective study of clinical and pathologic features in 640 consecutive patients with clinical stage Tla-T3bNXM0 prostate cancer who were treated with radical retropubic prostatectomy by the same surgeon between 1989 and 1995. None had received preoperative hormonal therapy or radiotherapy. Detailed pathologic analysis, including the presence and maximum diameter of perineural invasion (PNI), was performed by 2 pathologists. Treatment failure was defined as either a serum prostate-specific antigen (PSA) level > 0.4 ng/mL and rising or initiation of adjuvant therapy. The median follow-up time was 48 months (range, 1 to 111 months). Overall, PNI was detected in 477 patients (75%). The progression-free 5-year probability rate after prostatectomy for patients with PNI was 70% +/- 3% compared with 94% +/- 2% for patients without PNI (P <.001). The mere presence of PNI was not an independent predictor of progression in a Cox proportional hazards analysis when the other established prognostic factors (serum PSA level, pathologic stage, surgical margin, and tumor volume) were considered. However, the increasing diameter of the largest focus of PNI was strongly associated with other established prognostic factors and the probability of progression after radical prostatectomy. Although little adverse effect in patients with PNI < 0.25 mm was seen 5 years after surgery, those with a PNI diameter of 0.25 to 0.5 mm were significantly (P <.001) less likely to remain free of progression; only 36% of those with PNI of 0.5 to 0.75 mm (P <.001) and 14% of those with PNI > or =0.75 mm (P =.002) were free of progression. In a Cox proportional hazard analysis, the PNI diameter was an independent predictor of prognosis. These results support that the measurement of the PNI diameter, easily recorded from prostatectomy specimens, could add important information to the prognosis of prostate cancer patients. Controversy regarding the significance of PNI may result from the lack of quantitative assessment of PNI in previous studies.

[Clinical experience with the artificial urinary sphincter AMS 800 for male incontinence].

BACKGROUND: The aim of this study is to evaluate the therapeutic efficacy of artificial urinary sphincter AMS 800 implants for male patients with urinary incontinence. METHODS: Eleven male patients with urinary incontinence were treated by implantation of the artificial urinary sphincter AMS 800 between 1988 and 1992. Patient age at the surgery ranged from 14 to 79 years, with a mean age of 58 years. At presentation, 9 patients (82%) had true incontinence and 2 had overflow incontinence, and medical treatments and/or surgical procedures (Teflon injections in 2 and Sling procedure in 1) had been attempted previously elsewhere in all patients. The etiologies of incontinence were post-prostatectomy (transurethral resection in 4 and radical retropubic prostatectomy in 4) in 8 patients (73%) and myelomeningocele, spinal cord injury, pelvic trauma in one each. There were 5 patients with abnormal cystometrogram, and 2 of them were performing intermittent self catheterization. Vesicoureteral reflux was determined in 2 patients preoperatively, which were surgically corrected one year before AMS800 implant in a patient and simultaneously in another patient. The cuff was placed around the bulbous urethra (9), pendulous urethra (1) or bladder neck (1). The device was activated 6 weeks post implantation, and the assessment of therapeutic effects was started 2 weeks after activation. RESULTS: Follow up ranged from 3 weeks to 75 months, with a mean of 56 months, if 3 cases done explantation due to periprosthetic infections were excluded. After AMS 800 implantation 5 patients (45%) were completely continent, 4(36%) required the use of not more than 1 pad per day, while a patient was not satisfied with the results and another patient was not definitive because of early explantation before device activation. Hence complete or near complete continence was achieved in 9 patients (81%). A patient is performing intermittent self catheterization in conjunction with the AMS 800 without any complications up until now. There were 3 periprosthetic infections (27%) associated with 2 cuff erosions, that consequently required explantation. Besides periprosthetic infection, neither complications nor mechanical device failures was experienced. CONCLUSION: In conclusion, the AMS 800 artificial urinary sphincter was safe with reasonable mechanical reliability and offered acceptable and satisfactory urinary control to the selected patients with incontinence.

[Anti-bacterial zeolite balloon catheter and its potential for urinary tract infection control].

We present here a production of anti-bacterial zeolite balloon catheter and investigated its potential for controlling urinary tract infection. This anti-bacterial balloon catheter showed a bactericidal effect against Pseudomonas aeruginosa, Staphylococcus aureus and Escherichia coli in vitro studies. The antibacterial effects were correlated with the concentration of anti-bacterial zeolite and size of catheter. We tried this catheter for 11 various urological patients who needed a long-term indwelling of a balloon catheter for lower urinary tract obstruction and neurogenic bladder. All patients were already indwelled silicon balloon catheter for 3 to 6 months and suffered with complicated urinary tract infection. Nine patients who had this anti-bacterial zeolite balloon catheter indwelled for 3 to 7 months and exchanged every 2 to 4 weeks, and no patient was taking antibiotics during this trial. Two patients (22.2%) showed good results by the urinary tract infection (UTI) criteria and 5 patients (55.4%) showed good effects by doctor's judgment. This anti-bacterial zeolite balloon catheter might be useful for patients who need long-term balloon catheter indwelling.