诱导型一氧化氮合酶在翼状胬肉中的表达及其意义

目的探讨诱导型一氧化氮合酶(iNOS)在翼状胬肉中的表达及发病过程中的作用。方法采用免疫组化Elivision法检测20例翼状胬肉、10例正常结膜中iNOS的表达。结果20例翼状胬肉中iNOS的阳性表达率为80%(16/20),正常结膜中iNOS的阳性表达率为0(0/10)。iNOS阳性表达两组间差异有显著意义,P<001。结论iNOS在翼状胬肉中的高表达,提示iNOS可促进血管形成,可能与翼状胬肉的发生、发展有关。因此,抑制iNOS可望成为治疗翼状胬肉,减少术后复发的新思路。     

中耳乳突炎HRCT表现及其与IL-1相关性研究

目的 :探讨慢性中耳乳突炎的HRCT特征及IL 1在慢性中耳乳突炎中引起骨破坏的作用 ,旨在提高对各型慢性中耳乳突炎的诊断水平。方法 :对 4 8例慢性中耳乳突炎患者 ,行HRCT扫描 ,并与手术病理结果对照分析 ,采用放射免疫分析法检测IL 1在 4 8例慢性中耳乳突炎组织中及患者血清中含量 ,并与 6例正常皮肤组织及 30例正常血清中含量比较。结果 :①高分辨率CT显示胆脂瘤病变大多呈团块状病变 ,常伴有明显的听骨破坏和盾板骨质破坏 ;单纯型、肉芽肿型多数呈片状、条索状或网状病变 ,听骨破坏相对轻 ,少有盾板骨质破坏。②IL 1在中耳乳突炎中表达率为 10 0 % ,与正常皮肤组织、肉芽肿组织相比 ,胆脂瘤组织中IL 1过度表达 ,差异有显著性意义 (P <0 .0 1)。胆脂瘤组织中IL 1与胆脂瘤的骨质破坏程度高度相关 (r =0 .917,P <0 .0 1)。结论 :根据中耳腔软组织影的形态及骨质破坏而非病变的密度改变 ,大多数中耳乳突炎患者可籍HRCT扫描准确诊断 ;组织中IL 1与胆脂瘤型中耳乳突炎CT上骨质破坏程度高度相关 ,IL 1在胆脂瘤中的过度表达是中耳乳突炎导致骨破坏最重要因素之一。     

iNOS、CD34在翼状胬肉中的表达与血管形成的关系

目的探讨诱导型一氧化氮合酶(iNOS)和CD34在翼状胬肉中的表达及其发病过程中的作用。方法采用免疫组化Elivision法检测20例翼状胬肉、10例正常结膜中iNOS和CD34的表达,并检测MVD。结果20例翼状胬肉中iNOS的阳性表达率为80%(16/20),正常结膜中iNOS的阳性表达率为10%(1/10)。CD34在翼状胬肉和正常结膜的阳性表达率分别为85%(17/20)和30%(3/10)。iNOS、CD34阳性表达两组间差异有显著统计学意义(P<0.005)。翼状胬肉和正常结膜中微血管密度(MVD)分别为45.85±11.06和23.64±6.87,两组间差异有显著统计学意义(P<0.001)。结论iNOS、CD34在翼状胬肉中的高表达,提示iNOS、CD34可促进血管形成,可能与翼状胬肉的发生、发展有关。因此,选择性抑制iNOS和CD34可望成为治疗翼状胬肉,减少术后复发的新思路。     

iNOS,FⅧ-RAg在喉鳞状细胞癌的表达与血管形成的关系

目的探讨诱导型一氧化氮合酶(iNOS)和FⅧ-RAg在喉癌组织中的表达及其侵袭转移过程中的作用。方法采用免疫组化Elivi-sion法检测30例喉鳞状细胞癌、10例声带息肉中iNOS和FⅧ-RAg的表达,并检测微血管密度(MVD)。结果30例喉癌组织中iNOS的阳性表达率为80%(24/30),声带息肉中iNOS的阳性表达率为10%(1/10)。FⅧ-RAg在喉癌组织和声带息肉的阳性表达率分别为70%(21/30),0%(0/10)。FⅧ-RAg,iNOS阳性表达两组间差异有统计学意义,P<0.025。喉癌组织和声带息肉中MVD分别为65.85±13.06,5.64±3.57,两组间差异有统计学意义(P<0.001)。结论iNOS,FⅧ-RAg在喉癌组织中的高表达,提示iNOS,FⅧ-RAg可促进血管形成,可能与喉癌的发生、发展和侵袭转移有关。因此,选择性抑制iNOS和FⅧ-RAg可减少肿瘤的发展和侵袭转移。     

Ki-67、p53、mdm2在中耳胆脂瘤上皮中的表达及其意义

少量表达.mdrrd蛋白在中耳胆脂瘤上皮细胞的LI为36.1±7.0,显著高于外耳道皮肤上皮细胞(1.7±0.5,t=3.325,P=0.003).Pearson相关分析发现中耳胆脂瘤上皮细胞p53、mdm2蛋白表达存在正相关(r=0.499,P=0.031).结论 与正常外耳道皮肤上皮细胞比较,中耳胆脂瘤上皮细胞具有过度增殖的趋势.p53、mdm2异常表达与中耳胆脂瘤发生密切相关,二者在上皮细胞层的分布特性与其病理状态相关.     

iNOS、CD34在喉鳞状细胞癌组织中的表达与血管形成的关系

目的探讨诱导型一氧化氮合酶(iNOS)和CD34在喉鳞状细胞癌中的表达及其发病过程中的作用。方法采用免疫组化Elivision法检测30例喉鳞状细胞癌、10例声带非典型增生中iNOS和CD34的表达,并检测MVD。结果30例喉鳞状细胞癌中iNOS的阳性表达率为80.33%(25/30),声带非典型增生中iNOS的阳性表达率为10%(1/10)。CD34在喉鳞状细胞癌和声带非典型增生的阳性表达率分别为80%(24/30),30%(3/10)。iNOS、CD34阳性表达两组间差异有统计学意义(P<0.025)。喉鳞状细胞癌和声带非典型增生中微血管密度(MVD)分别为43.45±10.06、21.34±6.31,两组间差异有显著统计学意义(P<0.001)。结论iNOS、CD34在喉鳞状细胞癌中的高表达,提示iNOS、CD34可促进血管形成,可能与喉鳞状细胞癌的发生、发展及侵袭转移有关。因此,选择性抑制iNOS和CD34可望成为基因治疗喉鳞状细胞癌的新思路。     

大肠腺癌组织中Ezrin蛋白的表达及意义

目的 研究探讨大肠腺癌组织Ezrin的表达,并分析其与临床病理特征之间的关系.方法 运用免疫组化检测大肠腺癌70例、大肠腺瘤20例和正常大肠黏膜10例中Ezrin 的表达情况.结果 在大肠腺癌中的阳性表达率为77.1%( 54 /70)、大肠腺瘤中的阳性表达率为25.0%(5 /20),正常大肠粘膜中阳性表达率为00.0%(0/10);Ezrin的表达在大肠腺癌与大肠腺瘤、正常大肠粘膜中差异有统计学意义(P<0.05,P<0.01).大肠腺癌中Ezrin的阳性表达率随肿瘤分化程度的降低而升高,高分化腺癌为70.0%(14/20),中分化腺癌为78.0%(32/41),低分化腺癌为88.9%(8/9).(P<0.05),与患者性别、年龄、肿瘤大小、浸润深度、淋巴结是否转移及TNM分期均无相关性(P>0.05).结论 Ezrin在大肠腺癌、大肠腺瘤及大肠正常粘膜中的阳性表达率依次递减,提示Ezrin可能参与了大肠腺癌的发生与发展.Ezrin的阳性表达与肿瘤分化程度存在相关性,可作为判定其预后的生物学指标.     

Caspase-3在翼状胬肉中的表达及临床意义

目的探讨Caspase-3在翼状胬肉中的表达及发病过程中的作用。方法采用免疫组化Elivision法检测20例翼状胬肉、10例正常结膜中Caspase-3的表达。结果20例翼状胬肉中Caspase-3的阳性表达率为45%(9/20),正常结膜中Caspase-3的阳性表达率为90%(9/10)。Caspase-3阳性表达两组间差异有显著意义,P<0.05。结论Caspase-3在翼状胬肉中的低表达,提示细胞凋亡和增殖异常,可能与翼状胬肉的发生、发展有关。     

听骨链CT仿真内窥镜成像技术的临床应用价值

目的　探讨听骨链CT仿真内窥镜 (CTVE)成像技术的初步临床应用价值。方法　使用HiSpeedCT/i扫描机 ,层厚 1 0mm、螺距 1 0、骨算法、视野 9 6cm× 9.6cm、间隔 0 1mm重建 ,对 10例正常中耳和 2 1例临床怀疑中耳病变 (14例手术 )的患者进行CTVE成像。正常及异常中耳的观察阈值分别为 - 6 0 0～ - 2 0 0HU和 5 0～ 30 0HU。结果　CTVE能清楚显示正常听骨链的形态、大小及相互关系 ,锤骨、砧骨及锤砧关节的显示率为 10 0 % (38/38) ,镫骨底板的显示率为 32 % (12 /38) ,只有 2 1%(8/38)可以分辨镫骨的前、后脚 ;18例中耳炎患者中 12例胆脂瘤形成 ,CTVE上有不同程度的听小骨破坏。 1例中耳畸形显示听骨链发育异常。结论　CTVE是一种新的、非侵袭性的方法 ,能显示听骨链的立体影像 ,有利于听骨链病变的显示和诊断     

PCNA,Bcl-2和Bax在翼状胬肉中的表达及其意义

目的检测翼状胬肉中PCNA,Bcl-2和Bax的表达水平,探讨PCNA,Bcl-2和Bax在翼状胬肉发病中的作用。方法采用免疫组化Elivision法检测20例翼状胬肉、10例正常结膜中的PCNA,Bcl-2和Bax表达水平。结果20例翼状胬肉中PCNA,Bcl-2和Bax的阳性表达率分别为95%(19/20),95%(19/20)和80%(16/20),正常结膜中PCNA,Bcl-2和Bax的阳性表达率分别为60%(6/10),20%(2/10)和60%(6/10)。PCNA和Bcl-2阳性表达两组间差异有显著意义(P<0.05),而Bax阳性表达两组间差异无显著意义(P>0.05)。结论翼状胬肉的发生发展可能与PCNA的高表达和Bcl-2与Bax表达失衡有关,可能是细胞异常增殖和凋亡失衡的共同结果。     

The value of single-shot turbo spin-echo diffusion-weighted MR imaging in the detection of middle ear cholesteatoma

Introduction Single-shot (SS) turbo spin-echo (TSE) diffusion-weighted (DW) magnetic resonance imaging (MRI) is a non echo-planar imaging (EPI) technique recently reported for the evaluation of middle ear cholesteatoma. We prospectively evaluated a SS TSE DW sequence in detecting congenital or acquired middle ear cholesteatoma and evaluated the size of middle ear cholesteatoma detectable with this sequence. The aim of this study was not to differentiate between inflammatory tissue and cholesteatoma using SS TSE DW imaging. Methods A group of 21 patients strongly suspected clinically and/or otoscopically of having a middle ear cholesteatoma without any history of prior surgery were evaluated with late post-gadolinium MRI including this SS TSE DW sequence. Results A total of 21 middle ear cholesteatomas (5 congenital and 16 acquired) were found at surgery with a size varying between 2 and 19 mm. Hyperintense signal on SS TSE DW imaging compatible with cholesteatoma was found in 19 patients. One patient showed no hyperintensity due to autoevacuation of the cholesteatoma sac into the external auditory canal. Another patient showed no hyperintensity because of motion artifacts. Conclusion This study shows the high sensitivity of this SS TSE DW sequence in detecting small middle ear cholesteatomas, with a size limit as small as 2 mm.     

中耳胆脂瘤开放式乳突切开鼓室成形术并发症分析

 目的 分析中耳胆脂瘤开放式乳突切开鼓室成形术并发症发生情况,探讨发生原因。方法 回顾分析2007-02至2017-02随访的438例行开放式乳突切开鼓室成形术的中耳胆脂瘤患者术后并发症发生情况。结果 438例中耳胆脂瘤手术患者,常见的10种手术并发症为术后听力下降(15.8%)、外耳道狭窄(9.6%)、患侧味觉下降(7.8%)、术后眩晕(3.7%)、感染(2.5%)、人工听骨脱出(2.1%)、术后复发(2%)、术后耳鸣(1.8%)、脑脊液耳漏(1.1%)、术后面瘫(0.5%)。其中术后听力下降、外耳道狭窄、患侧味觉下降发生最多,排在前三位。结论 中耳结构复杂,手术医师需不断熟悉解剖,提高手术技巧,开展新技术,有效避免并发症。     

CT Findings in the External Auditory Canal after Transcanal Surgery

BACKGROUND AND PURPOSE:Middle ear surgery is often performed through the external auditory canal, and the CT appearance of the external auditory canal after transcanal middle ear surgery can mimic erosive pathology such as carcinoma, external auditory canal cholesteatoma, or necrotizing external otitis. We reviewed the CT findings in a group of patients following transcanal surgery to highlight this potential pitfall in interpretation.MATERIALS AND METHODS:Twenty-seven temporal bones in 25 patients with a history of a transcanal approach to the middle ear and available postoperative CT imaging were identified. Images were assessed for changes along or involving the walls of the external auditory canal, including widening, irregularity, bony defects, and soft tissue opacification.RESULTS:Osseous changes along the floor of the external auditory canal were demonstrated in 25 of 27 (92.6%) temporal bone CT scans. Similar changes were present in the superior and anterior walls of the external auditory canal in 21 and 18 temporal bones, respectively. The anterior wall was the most common site for complete bony defects (10 of 27 temporal bones). The posterior wall was the least often involved, with osseous changes in 15 of 27 temporal bones and bony defects in 3 cases. Soft tissue thickening was seen most commonly along the floor. No patient was found to have a superimposed pathologic process of the external auditory canal.CONCLUSIONS:CT findings in the external auditory canal after transcanal surgery include thinning, irregularity and/or flattening of the bone, soft tissue thickening, and bony wall defects. Although these changes may be subtle, they may mimic pathology and should be included in the differential diagnosis of osseous abnormality of the external auditory canal.

Middle ear surgery performed through the external auditory canal (EAC) often involves drilling a portion of the bony canal wall to provide access and necessary exposure.^1–3 In the absence of associated transmastoid surgery (such as a canal wall down mastoidectomy), the postoperative status may not be immediately obvious to the interpreting radiologist, and relevant history may not be provided. On CT, such postoperative changes in the external canal can mimic bony and soft tissue changes typically associated with neoplasms, external canal cholesteatoma, or aggressive infections of the EAC. Prior literature has predominantly focused on the appearance of the middle ear after surgery.^4–11 We describe the CT appearance of the EAC after transcanal surgery so that postoperative change can be included in the differential diagnosis, even in the absence of available history, and erroneous diagnoses may be avoided.     

External auditory canal cholesteatoma: clinical and imaging spectrum

BACKGROUND AND PURPOSE: Cholesteatoma is an inflammatory lesion of the temporal bone that uncommonly involves the external auditory canal (EAC). In this large case series, we aimed to define its imaging features and to determine the characteristics most important to its clinical management. METHODS: Thirteen cases of EAC cholesteatoma (EACC) were retrospectively reviewed. Clinical data were reviewed for the history, presentation, and physical examination findings. High-resolution temporal bone CT scans were examined for a soft-tissue mass in the EAC, erosion of adjacent bone, and bone fragments in the mass. The middle ear cavity, mastoid, facial nerve canal, and tegmen tympani were evaluated for involvement. RESULTS: Patients presented with otorrhea, otalgia, or hearing loss. Eight cases were spontaneous, and five were postsurgical or post-traumatic. CT imaging in all 13 cases showed a soft-tissue mass with adjacent bone erosion. Intramural bone fragments were identified in seven cases. This mass most often arose inferiorly (n = 8) or posteriorly (n = 8), but it was circumferential in two cases. We noted middle ear extension (n = 5), mastoid involvement (n = 4), facial canal erosion (n = 2), and tegmen tympani dehiscence (n = 1). CONCLUSION: Temporal bone CT shows EACC as a soft-tissue mass within the EAC, with adjacent bone erosion. Bone fragments may be present within the mass. The cholesteatoma may extend into the mastoid or middle ear, or it may involve the facial nerve canal or tegmen tympani. Recognition of this entity and its possible extension is important because it may influence clinical management.     

Congenital malformations of the external and middle ear: high-resolution CT findings of surgical import

The external auditory canal, middle ear, and bulk of the ossicular chain develop from the first branchial groove, first and second branchial arches, and first pharyngeal pouch. Embryologic development of these structures is complex and only rarely are two anomalies identical. Development of the inner ear structures occurs independently of external ear structures, and concomitant involvement is unusual. This study includes 11 cases of unilateral external auditory canal atresia and two cases of bilateral atresia. Eight cases (four bilateral) of isolated congenital ossicular anomalies are also included. Emphasis is placed on findings of surgical import. All patients were studied with computed tomography only, because it was believed that the bony and soft-tissue detail achieved is superior to that with conventional multidirectional tomography.     

Tuberculous otomastoiditis on high-resolution temporal bone CT: comparison with nontuberculous otomastoiditis with and without cholesteatoma

BACKGROUND AND PURPOSE: Our purpose was to evaluate the differential findings of tuberculous otomastoiditis (TOM) and nontuberculous chronic otomastoiditis with or without middle ear cholesteatoma on high-resolution CT of the temporal bone. MATERIALS AND METHODS: We reviewed 19 cases of TOM, 30 cases of chronic otomastoiditis (COM), and 30 cases of COM with cholesteatoma (CHOM), all of which had been confirmed by pathologic examination after surgery or middle ear mucosal biopsy. Two neuroradiologists analyzed the findings of temporal bone CT. RESULTS: The soft tissue attenuation in the entire middle ear cavity, preservation of the mastoid air cells without sclerotic change, and soft tissue extension to the external auditory canal (EAC) or mucosal thickening of the bony EAC, had statistical significance (chi(2) test, P < .05) between the TOM group and the COM group and between the TOM group and the CHOM group. Erosion of the ossicles and scutum was statistically significant (chi(2) test, P < .05) between the TOM group and the CHOM group. CONCLUSION: Findings of soft tissue in the entire middle ear cavity, preservation of mastoid air cells without sclerotic change, soft tissue extension, or mucosal thickening of the EAC with intact scutum seemed to be helpful in differentiating TOM from COM and CHOM.     

外中耳先天畸形的HRCT研究

目的 研究外中耳先天畸形的高分辨CT（HRCT）表现，为临床诊断和治疗提供准确信息。资料与方法 对临床诊断的外、中耳先天畸形35例行HRCT扫描，单纯横断位扫描5例，横断位加冠状位扫描30例。结果 （1）外耳畸形32例共42耳，其中外耳道骨性闭锁30耳，显示闭锁板为完全性26耳，不完全性4耳。膜性闭锁5耳。双侧分别为不同类型闭锁1例。外耳道狭窄7耳，其中狭窄合并对侧闭锁1例。合并畸形中，面神经管垂直段明显前移22耳，下颌髁状突明显后上移25耳，乙状窦前移4耳，均见于骨性外耳道闭锁。伴发的中耳畸形主要为小鼓室及不同程度的听骨发育不全或缺如。合并内耳发育不全1例。（2）单纯性中耳畸形3例共6耳，均表现为听小骨异常。合并小鼓室1例，耳咽管和鼓室窦畸形扩大1例。结论 HRCT能准确显示外中耳先天畸形的类型、程度以及合并畸形，为临床治疗方案的正确制定提供重要的参考依据。     

High-resolution CT of the temporal bone in dysplasia of the auricle and external auditory canal.

PURPOSETo determine CT findings in the external, middle, and inner ear of patients with microtia and external auditory canal dysplasia.METHODSWe used high-resolution CT, with multiplanar or axial 1-mm continuous sections, coronal or sagittal reformations, or low-dose spiral acquisitions, to examine 184 temporal bones of children with microtia.RESULTSIn cases of minor microtia, auditory canal stenosis was the most common associated abnormality; in those with major microtia, atresia was predominant. Middle ear malformations depended on the severity of the auricular anomalies. Inner ear changes could also be noted. Ossicle dysplasias occurred in 98% of patients (stapes, 72%), absence of the oval window in 36%, labyrinthine malformations in 13%, closed round window in 6%, facial canal displacement in up to 75%, and aberrations of the vascular canal in 38% of patients with third-grade auricular deformity.CONCLUSIONA variety of external, middle, and, less frequently, inner ear changes were detected in connection with microtia.