阻塞性睡眠呼吸暂停综合征患者上气道MRI观察

目的　通过比较清醒状态下阻塞性睡眠呼吸暂停综合征 (obstructivesleepapneasyndrome,OSAS)患者与健康人上气道及其周围软组织的差异 ,探讨OSAS的发生机制。方法　应用磁共振成像 (magneticresonanceimagiug ,MRI)对 1 8例经多导睡眠监测 (PSG)确诊的OSAS患者的上气道扫描 ,对上气道的软腭后区 (retropalatalregion ,RP)、舌后区 (retroglossalregion ,RG)和会厌区 (epiglottalregion ,EPG)截面积、各区咽壁厚度、RP区咽侧脂肪垫 (lateralparapharyngealfatpad ,LPFP)的截面积等进行测量。选择 1 9例无打鼾的同年龄组健康人做对照组。结果　①患者组RP、RG区气道截面积小于对照组 (P <0 0 5 ) ;患者组EPG区气道截面积与对照组无统计学差异 (P =0 2 0 4) ;②患者组RP、RG、EPG区气道前后径与左右径 (AP/L)比值均大于对照组 (P <0 0 5 ) ;③患者组RP区LPFP截面积大于对照组 ,(P <0 0 1 ) ;④患者组RP、RG、EPG区咽后壁厚度大于对照组 (P <0 0 5 ) ,患者组RP区咽侧壁厚度与对照组无统计学差异 ,而患者组RG和EPG区咽侧壁厚度均大于对照组 (P <0 0 5 ) ;⑤正中矢状位测量患者软腭截面积、厚度和长度均大于对照组 (P <0 0 1 )。结论　上气道截面积及其AP/L比值、咽侧壁厚度、咽后壁厚度 ,RP区L     

电影磁共振及纤维喉镜对阻塞性睡眠呼吸暂停低通气综合征患者上气道阻塞部位检查对比研究

目的 探讨电影磁共振(cine magnetic resonance,CMR)检查及纤维喉镜下Müller试验对阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome , OSAHS)患者进行上气道阻塞部位定位的应用价值.方法 选取2015年9月~2016年4月到郑州大学第一附属医院咽喉头颈外科就诊并经多导睡眠监测(PSG)及专科检查确诊的阻塞性睡眠呼吸暂停低通气综合征患者22例,于术前行纤维喉镜下Müller试验检查并分别在睡眠及清醒状态下行电影磁共振检查,观察软腭区、舌后区及会厌区狭窄或阻塞发生情况.结果 电影磁共振与纤维喉镜下Müller试验对于软腭区阻塞的定位(22例对22例)具有完全的一致性(Kappa=1),而对于舌后区(13例对6例)(Kappa=0.412)、会厌区(4例对2例)(Kappa=0.621)及多部位同时阻塞的定位(13例对6例)(Kappa=0.412),二者一致性一般.结论 对多部位阻塞的中重度OSAHS患者,术前应用电影磁共振及纤维喉镜检查能够更好地明确阻塞部位.     

阻塞性睡眠呼吸暂停征患者睡眠状态下阻塞定位研究

目的 应用磁共振成像（ｍａｇｎｅｔｉｃ ｒｅｓｏｎａｎｃｅ ｉｍａｇｅｉｎｇ，ＭＲＩ）和纤维鼻咽喉镜对阻塞性睡眠呼吸暂停综合征（ｏｂｓｔｒｕｃｔｉｖｅ ｓｌｅｅｐ ａｐｎｅａ ｓｙｎｄｒｏｍｅ，ＯＳＡＳ）患者睡眠状态下上气道的阻塞部位进行定位，并探讨上述两种方法对阻塞定位的应用价值。地对经多导睡眠监（ｐｏｌｙｓｏｍｎｎｏｇｒａｐｈｙ，ＰＳＧ）确诊的１５例ＯＡＳＡ患者应用超快速ＭＲＩ在睡眠状态下对其     

便携睡眠监测阻塞定位仪与多道睡眠仪及纤维喉镜检查的比较

目的研究整合了便携式多道睡眠仪（polysomnography，PSG）和上气道测压功能的便携睡眠监测阻塞定位仪（ApneaGraph）的临床应用价值。方法经PSG确诊为阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome，OSAHS）的32例患者，均行传统的上气道纤维喉镜检查判定阻塞部位。ApneaGraph进行整夜睡眠呼吸监测和同步上气道压力测定。上气道阻塞部位分为上下两部分：上部阻塞主要为腭后区，下部阻塞主要为舌后区。①分析ApneaGraph与传统PSG的呼吸暂停低通气指数（apnea hypopneaindex，AHI）之间相关性；②通过上气道压力测定，分析各平面阻塞特点，判定阻塞平面及计算各平面阻塞次数占气道阻塞总次数的比率，并与传统喉镜阻塞定位进行比较。结果呼吸事件分析：PSG和ApneaGraph测定的AHI（x^-±s）分别为（52．2±18．1）次／h和（50．2±16．0）次／h，两者高度相关（r=0．876，P〈0．001）。阻塞定位分析：①上气道测压：可见单纯上部阻塞和上下部联合阻塞两种模式，28例（87．5％）上部气道阻塞次数占气道阻塞总次数的比率〉50％，4例（12．5％）下部气道阻塞次数占气道阻塞总次数的比率〉50％；②纤维喉镜检查：可见单纯腭后区阻塞和腭后区、舌后区联合阻塞两种阻塞模式，其中18例单纯腭后区狭窄，13例腭后区和舌后区联合狭窄，1例腭后区和舌后区均未见明显狭窄；③上气道测压与传统纤维喉镜检查比较：上部（腭后区）阻塞时，两种检查方法的符合率为84．4％（27／32）；下部阻塞（舌后区）的符合率为53．1％（17／32）。结论ApneaGraph可作为便携PSG，对睡眠呼吸疾病作出初步定性诊断，并通过上气道压力测定，与纤维喉镜检查相结合，较好地判断睡眠时患者气道阻塞部位。     

CT测量在阻塞性睡眠呼吸暂停综合征上呼吸道狭窄定位诊断中的意义

目的　确定上呼吸道CT扫描测量对阻塞性睡眠呼吸暂停综合征 (obstructivesleepapneasyndrome,OSAS)患者上呼吸道狭窄或阻塞部位的定位诊断意义。方法　采用螺旋CT自鼻咽顶部到声门之间的区域进行连续扫描 ,应用图像工作站测量软腭后区、悬雍垂区、舌后区和会厌后区的气道横截面积和各径线长度以及咽壁厚度等指标 ,通过 2 2 5例健康人测量确立正常值范围。同样检测 5 4例经多导睡眠监测系统确诊的OSAS患者 ,其中 14例测量睡眠呼吸暂停发作时上呼吸道CT扫描的结果 ,与相应解剖区的正常值比较。结果　 5 4例OSAS患者中 ,12例无明显的上呼吸道狭窄 ,4 2例中有6 7个平面存在狭窄。仅有 1个平面狭窄者 2 4例 ,表现为软腭后区狭窄者 14例 ,悬雍垂区狭窄者 2例 ,舌后区狭窄者 3例 ,会厌后区狭窄者 5例。 14例表现为相邻的两个解剖区域的共同狭窄 ,其中为软腭后区 +悬雍垂区者 4例 ,悬雍垂区 +舌后区者 5例 ,舌后区 +会厌后区者 5例。 1例表现为软腭后区、悬雍垂区和舌后区的狭窄 ,有 3例表现为整个上呼吸道 4个解剖区域的狭窄。 14例OSAS睡眠呼吸暂停发作时上呼吸道CT扫描的结果与常规CT扫描测量所提示的上呼吸道狭窄部位基本一致。结论　大部分OSAS患者存在上呼吸道的解剖性狭窄 ,上呼吸道的CT扫描测量可以较好     

药物诱导睡眠下纤维鼻咽喉镜和多导睡眠仪的同步检查

目的　改进既往Muller动作的纤维鼻咽喉镜检查和常规的多导睡眠描记( polysomnography ,PSG)监测 ,观察药物诱导睡眠下纤维鼻咽喉镜和PSG监测的所见 ,探讨同步检查的可行性。方法　前瞻性自身对比研究。药物诱导睡眠下的纤维鼻咽喉镜检查和PSG监测 ,之前或之后予常规的纤维鼻咽喉镜检查和PSG监测 ,观察两者检测结果的差别。结果　 32例阻塞性睡眠呼吸暂停低通气综合征 (obstructivesleepapneahypopneasyndrom ,OSAHS)患者中 ,鼻咽狭窄 17例 ,均伴有口咽狭窄 ;鼻咽、口咽伴有喉咽狭窄 8例 ;2例为口咽狭窄 ,伴扁桃体肥大 ,5例为喉咽狭窄。其中悬雍垂腭咽成形术后 3例中 ,2例为喉咽狭窄 ,1例为鼻咽狭窄。药物诱导睡眠下的PSG监测与常规PSG监测结果明显相关。但异常程度高于常规的检查。药物睡眠呼吸暂停指数的下降同步于咽部的阻塞 ,但恢复迟于咽部的阻塞。三部位均狭窄的睡眠呼吸暂停低通气指数 (apnea hypopneaindex ,AHI)改变最为严重 ,鼻咽并口咽次之 ,再次为单独的喉咽或口咽狭窄。结论　药物诱导睡眠下的纤维喉镜和PSG监测可以清楚的显示鼻咽、软腭、舌根在鼾声和OSAHS中的动态变化 ,在观察鼻咽、口咽阻塞的同时 ,同步记录到OSAHS的存在及程度 ,为从形态学和机能学的角度深入分析鼾声和OSAHS提供了可     

药物诱导睡眠下纤维鼻咽喉镜和多导睡眠仪的同步检查

目的 改进既往Muller动作的纤维鼻咽喉镜检查和常规的多导睡眠描记(polysomnography，PSG)监测，观察药物诱导睡眠下纤维鼻咽喉镜和PSG监测的所见，探讨同步检查的可行性。方法 前瞻性自身对比研究。药物诱导睡眠下的纤维鼻咽喉镜检查和PSG监测，之前或之后予常规的纤维鼻咽喉镜检查和PSG监测，观察两者检测结果的差别。结果 32例阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrom，OSAHS)患者中，鼻咽狭窄17例，均伴有口咽狭窄；鼻咽、口咽伴有喉咽狭窄8例；2例为口咽狭窄，伴扁桃体肥大，5例为喉咽狭窄。其中悬雍垂腭咽成形术后3例中，2例为喉咽狭窄，1例为鼻咽狭窄。药物诱导睡眠下的PSG监测与常规PSG监测结果明显相关。但异常程度高于常规的检查。药物睡眠呼吸暂停指数的下降同步于咽部的阻塞，但恢复迟于咽部的阻塞。三部位均狭窄的睡眠呼吸暂停低通气指数(apnea-hypopnea index，AHI)改变最为严重，鼻咽并口咽次之，再次为单独的喉咽或口咽狭窄。结论 药物诱导睡眠下的纤维喉镜和PSG监测可以清楚的显示鼻咽、软腭、舌根在鼾声和OSAHS中的动态变化，在观察鼻咽、口咽阻塞的同时，同步记录到OSAHS的存在及程度，为从形态学和机能学的角度深入分析鼾声和OSAHS提供了可能。     

上气道压力测定对阻塞性睡眠呼吸暂停综合征阻塞部位定位诊断研究

目的研究上气道持续测压系统各项观测指标的临床意义,探讨阻塞性睡眠呼吸暂停综合征(obstructivesleepapneasyndrome,OSAS)的上气道阻塞特点.方法应用含5个传感器的测压管,全夜观察30例OSAS患者上气道各平面(鼻腔、软腭上、软腭下、舌根下)及食管内的压力变化;分析每次阻塞性或混合性呼吸暂停及低通气时的压力波形,判定阻塞平面及多平面阻塞患者各平面阻塞出现的频率.结果当口鼻气流停止时,可观察到与气流曲线一致的压力变化波形,即阻塞平面上方的传感器不显示压力波动,而其下方的传感器压力波动幅度增加,呼吸气流恢复时全部传感器均显示与呼吸波一致的压力波动.共观察到3种阻塞模式①单纯软腭平面阻塞型;②软腭平面与舌根平面联合阻塞型,此型患者多数为在睡眠初期表现为腭咽平面阻塞,随着睡眠程度加深,则出现舌根平面阻塞;③鼻咽、软腭及舌根平面联合阻塞型.结论上气道持续测压系统可准确判定OSAS的阻塞平面,并可观察患者整夜睡眠中阻塞平面的动态变化,对OSAS的诊断及治疗有重要的指导意义.     

清醒及诱导睡眠状态下电子喉镜对阻塞性睡眠呼吸暂停低通气综合征定位诊断的比较

目的：比较在清醒及诱导睡眠两种不同状态下，电子喉镜对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）定位诊断结果的差异。方法：经多导睡眠监测确诊的98例OSAHS患者，分别在清醒状态及用咪唑安定诱导睡眠后用电子喉镜对其上呼吸道进行动态观察，以确定阻塞部位，并对两组结果进行比较。结果：98例患者在清醒状态下经电子喉镜定位诊断，存在多部位阻塞者占58．2％（57／98）；而在诱导睡眠后存在多部位阻塞者占77．5％（76／98），两组差异有统计学意义（P〈0．01）。结论：大部分的OSAHS患者上呼吸道存在多部位阻塞；在诱导睡眠状态下，阻塞部位要比清醒状态时多。     

CT测量在阻塞性睡眠呼吸暂停综合征上呼吸道狭窄定位诊断中的意义

目的 确定上呼吸道CT扫描测量对阻塞性呼吸暂停综合征（obstructive sleep apnea syndrome,OSAS）患者上呼吸道狭窄或阻塞部位的定位诊断意义。方法 采用螺旋CT自鼻咽顶部到声门之间的区域进行连续扫描，应用图像工作站测量软腭后区、悬雍垂区、舌后区和会厌后区的气道横截面积和各径线长度以及咽壁厚度等指标，通过225例健康人测量确立正常值范围。同样检测54例经多导睡眠监测系统确诊的OSAS患者，其中14例测量暂停发作时上呼吸道CT扫描的结果，与相应解剖区的正常值比较。结果 54例OSAS患者中，12例无明显的上呼吸道狭窄，42例中有67个平面存在狭窄。仅有1个平面狭窄者24例，表面为软腭后区狭窄者14例，悬雍垂区狭窄者2例，舌后区狭窄者3例，会厌后区狭窄者5例。14例表现为相邻的两个解剖区域的共同狭窄，其中为软腭后＋悬雍垂区者4例，悬雍垂区＋舌后区者5例，舌后区＋会厌后区者5例。1例表现为软腭后区、悬雍垂区和舌后区的狭窄，有3例表现为整个上呼吸道4个解剖区域的狭窄。14例OSAAS睡眠呼吸暂停发时上呼吸道CT扫描的结果与常规CT扫描测量提示的上呼吸道狭窄部位基本一致。结论 大部分OSAS患者存在上呼吸道的解剖性狭窄，上呼吸道的CT扫描测量可以较好的确定具体狭窄部位，常规CT扫描测量提示的上呼吸道狭窄部位与睡眠呼吸暂停发作时上呼吸道的阻塞部位基本一致。     

One‐stop neck lump clinic: phase 2 of audit. How are we doing?

One‐stop neck lump clinic: phase 2 of audit. How are we doing? Regular monitoring and audit of a service are integral to ensuring maintenance of efficiency and standards. This is particularly important where the quality of the service is operator dependent, as is the case in the clinical diagnosis of neck lumps and fine needle aspiration cytology. The one‐stop neck lump clinic has now been running in the department for more than 20 months. A previous article described the results of the first phase audit carried out at 6 months and had identified a waiting time to be seen that was longer than that recommended by the British Association of Otorhinolaryngologists, Head and Neck Surgeons. Measures were implemented to reduce this waiting time and a second audit was carried out after another 10 months with the aims of assessing if modification of the means of referral reduces waiting time and if the outcomes of clinical performance in phase 1 could be maintained or improved. We discuss the results of phase 2 in the audit spiral.     

A Decrease in Maxillary Sinus Pressure,as Seen in Upper Airway Allergy or Infection,Results in an Increase in Upper Airway Nitric Oxide Levels

The paranasal sinuses are connected to the nasal cavity via small osties. Ostial occlusion, caused by mucosal swelling, will result in a slowly increasing negative pressure inside the sinus cavity. In parallel, the oxygen content in the sinus will decrease, resulting in the development of relative hypoxia. Hypoxia is a powerful inducer of nitric oxide (NO) synthase, and inducible NO synthase has been shown to be present in considerable amounts in the upper airways, including the sinuses. The present study was designed to investigate whether a reduction in sinus pressure would affect upper airway NO production. Thirteen healthy volunteers were investigated. A pressure chamber was used to lower the ambient pressure to-4.9 kPa. NO was sampled from one nostril or via a drainage tube inserted into the maxillary sinus before, during and after the hypobaric exposure. When the pressure was decreased, NO levels increased from 256 &#45 15 to 316 &#45 19 ppb ( n =13, p <0.001). The NO levels remained elevated (282 &#45 21 ppb; p <0.05) when measurements were repeated 20 min after leaving the chamber. The nasal airway resistance (V2 tot ) also increased as a result of the chamber session (from 16 &#45 2° before to 21 &#45 3° after; p <0.05). An increase in NO levels was also found when the experiments were repeated with NO sampled directly from the maxillary sinus (225 &#45 6 before and 265 &#45 9 ppb after; n =6, p <0.001). For control purposes the nasal analyses were repeated again, this time under hyperbaric conditions (+4.9 kPa). This resulted in a slight decrease in the NO levels (from 273 &#45 22 to 241 &#45 17 ppb; n =10, p <0.001), but there was no change in the nasal airway resistance. We conclude that a reduction in sinus pressure, as seen in upper airway allergy or infection, may result in an increase in upper airway NO production.     

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance Angiogenesis is essential for tumour growth and invasion. Vascular endothelial growth factor (VEGF) is a prime mediator of tumour angiogenesis. VEGF‐C is a closely related protein that effects lymphatic endothelial cells and may be important in the process of lymphatic metastasis. The purpose of this study was to evaluate the expression of these cytokines in patients with T1 and T2a glottic, squamous cell carcinoma, in comparison with normal epithelial control tissue, to ascertain any association with radioresistance. Twenty‐two tumours treated by radiotherapy (13 radiosensitive, nine radioresistant) and seven normal control tissues were studied. The minimum follow‐up was 2 years after radiotherapy. Expression of VEGF and VEGF‐C was evaluated by immunohistochemistry of formalin‐fixed, paraffin‐embedded biopsy specimens. Analysis was carried out using a quantitative computer image analyser. Both VEGF and VEGF‐C were detectable in tumour and normal control specimens. There was increased expression in tumour specimens of both VEGF (P = 0.03) and VEGF‐C (P < 0.001). In addition, the expression of VEGF‐C was associated with tumours of higher histological grade (P = 0.021). There was, however, no difference in VEGF and VEGF‐C expression between radioresistant and radiosensitive tumours. The expression of VEGF and VEGF‐C is increased in early laryngeal squamous cell carcinoma (SCC). However, measuring the expression of these proteins cannot predict radioresistance in this tumour group.     

Treatment of Maxillary Sinus Carcinoma: Clinical Results Using the Kitasato Modality

The conventional therapeutic regimen for maxillary sinus carcinoma consists of dissection of the maxilla, full-dose irradiation and extensive chemotherapy. However, the results obtained with this treatment are often poor. Even when patients recover, their quality of life is significantly reduced as a result of deformity of facial structures and swallowing and articulation dysfunctions. A retrospective analysis of 68 patients with maxillary sinus carcinoma treated with the Kitasato modality between 1975 and 1999 was conducted. All patients underwent pergingival maxillary sinus surgery combined with pre- and postoperative irradiation therapy with standardized total doses of 16 Gy; the postoperative irradiation was given in combination with regional intra-arterial infusion chemotherapy administered via the superficial temporal artery. All visible tumor lesions were removed where possible in order to preserve or facilitate cellular immunity after surgery. The cumulative 5-year survival rates were 85.7% for Stage II patients, 88.1% for Stage III, 76.6% for Stage IVA and 75.0% for Stage IVB.     

Cervical Reflex Induced by Click Stimuli in Cats

We studied click-evoked potentials in the anterior horn of the spinal cord in 17 cats. A concentric needle electrode was inserted into the anterior horn of the spinal cord at levels C3-C6. Potentials evoked with 105 dB SPL clicks were recorded with a peak latency of 4.89-5.10 ms only at the C3 level. These responses were observed 45-60 dB SPL above the auditory brainstem response (ABR) threshold, and no potentials were evoked by stimulation of the contralateral ear. Average was performed 100 times with changes in stimulation frequency of 1-20 Hz. The amplitude of the potentials decreased with increasing stimulus frequency, but there were no changes in ABRs. The responses disappeared after destruction of the medial vestibulospinal tract at the obex level, but ABRs were still recorded. The spinal nucleus of the accessory nerves was located in the anterior horn of the spinal cord at levels C1-C6, and the sternocleidomastoid muscle motoneurons were found at levels C1-C3. The click-evoked potentials recorded in this study reflect responses of the spinal nucleus of accessory nerves through the vestibulospinal tract to click stimulation. The responses have the same characteristics as vestibular-evoked myogenic potentials that can be recorded using surface electrodes over the sternocleidomastoid muscles of humans.     

Tongue Base Reduction with Temperature-controlled Radiofrequency Volumetric Tissue Reduction for Treatment of Obstructive Sleep Apnea Syndrome

In recent years a considerable effort has been made to establish the use of different surgical techniques for the treatment of obstructive sleep apnea syndrome (OSAS). Nevertheless, treatment of hypopharyngeal obstruction due to tongue base hypertrophy remains in many ways an unsolved problem. The aim of this study was to evaluate the safety and efficacy of tongue base reduction with temperature-controlled radiofrequency volumetric tissue reduction in the treatment of OSAS. Twenty patients with OSAS and tongue base hypertrophy were treated with radiofrequency tissue ablation. An intensified treatment protocol was used, delivering 2,800 J per treatment session under local anesthesia. Two nights of polysomnography testing were performed before and after treatment. Daytime sleepiness, snoring and postoperative morbidity were assessed using questionnaires. Mean respiratory disturbance index (RDI) was reduced from 32.1 to 24.9/h after a mean of 3.4 treatment sessions. Six patients (33%) were cured after the procedure (reduction in RDI of &#83 50% and a postoperative RDI of <15/h) and ten (55%) showed an improvement of >20% in their RDI. Daytime sleepiness and snoring improved significantly. Peri- and postoperative morbidity was low; one severe complication occurred (tongue base abscess). We were able to achieve similar cure and responder rates to those reported in a recently published pilot study but with a reduced number of treatment sessions. We believe that this technique may improve patient acceptance and have beneficial cost implications.     

A simple objective evaluation and grading for facial paralysis outcomes

Matrix metalloproteinase (MMP)-2 and -9 degrade type IV collagen, which is one of the major components of the basement membrane in normal tissue and expressed in the surroundings of the cancer nest in squamous cell carinoma. The degeneration of type IV collagen is an essential step in the metastasis to lymph nodes and distant organs. In this study, we examined MMP-2 and -9 levels of cancer tissue and serum obtained from patients with head and neck squamous cell carcinoma (HNSCC) in order to evaluate the relationship between the clinicopathologic features and MMPs. We examined the production of MMP-2 and -9 in cancer tissue homogenates of 73 patients who had HNSCC and the serum MMP levels of 16 patients with HNSCC and 8 healthy volunteers. We also studied the localization of MMP-2 in the carcinoma using an immunohistochemical approach. The concentrations of MMP-2 and -9 in the tissue homogenates and serum were measured by means of a sandwich enzyme immunoassay using a monoclonal antibody. Immunohistochemical analyses were performed with monoclonal antibody to MMP-2. The concentration of MMP-2 in the tumor tissue homogenates was unrelated to tumor size, but that in patients with lymph node metastases was significantly higher than in those without lymph node metastases. The concentration of MMP-9 was unrelated to lymph node metastasis and tumor size. The levels of both MMP-2 and -9 in serum were unrelated to lymph node metastasis. Immunohistochemistry indicated that MMP-2 was mainly expressed in cancer cells. Because MMP-2 degrades type IV collagen, the level of MMP-2 in carcinomas may be a useful indicator of the degree of invasion and metastasis.     

A case of cortical deafness and anarthria

The nasal epithelium protects the underlying tissue from damage. Epithelial cell growth is controlled by epidermal growth factor (EGF) and is possibly affected by toxic proteins, e.g. eosinophil cationic protein (ECP). The aims of this study were to examine nasal fluid epithelial cell counts and their relations to EGF, eosinophils and ECP in 23 patients with seasonal allergic rhinitis and 20 healthy controls. Nasal fluid epithelial cell counts were lower in patients than in controls. EGF levels did not differ between patients and controls, and correlated with epithelial cell counts in controls but not in patients. Eosinophils and ECP were higher in patients than in controls, but did not correlate with epithelial cell counts. The role of growth factors, such as EGF, in regulating epithelial cells merits further study.     

Lack of significant estrogen and progesterone receptor expression in nasal telangiectasias in hereditary hemorrhagic telangiectasia: an immunohistochemical analysis

Obstructive sleep apnea syndrome (OSAS) is characterized by snoring and apnea during sleep leading to decreased oxygen saturation and disturbed sleep, excessive daytime sleepiness and neuropsychological disturbances. This study investigates cognitive neuropsychological abilities in a group of 53 OSAS patients before and after treatment with uvulopalatopharyngoplasty. General intellectual ability, verbal learning and memory as well as executive functioning were measured at baseline and 6 months postoperatively. After surgery there were significant improvements in verbal learning and memory (mean change - 39, SD 57.3, p <0.001), recall (mean change - 24.3, SD 39.3, p <0.001) and executive functioning (as assessed by percentage of errors on the Wisconsin Card Sorting Test; mean change-9.1, SD 15.7, p <0.001). These improvements were in accordance with improvements in the degree of sleep apnea, the oxygen desaturation index (mean change -9.7, SD 15.9, p <0.001) and arterial minimum oxygen saturation (mean change 4.5%, SD 10.2%, p <0.01). Surgical treatment seems to improve verbal learning, memory and recall and executive functions in parallel with better oxygenation in OSAS.