Nd∶YAG激光治疗伴有腺样体肥大分泌性中耳炎的方法和疗效

目的探讨激光治疗伴有腺体样肥大分泌性中耳炎的方法和疗效。方法32例(49耳)伴有腺体样肥大分泌性中耳炎的患儿,手术切除部分腺样体后,全部在内镜下用Nd∶YAG激光对残存腺样体进行照射;对9例17耳进行激光鼓膜切开术,其他23例32行耳鼓膜穿刺冲洗。随访3个月。结果术后1个月腺样体无明显残留;分泌性中耳炎49耳的治愈率、好转率及无效率分别为57.2%(28耳)、28.6%(14耳)和14.2%(7耳),无严重并发症发生。结论Nd∶YAG激光治疗伴有腺体样肥大的分泌性中耳炎安全有效。     

儿童腺样体肥大与变态反应关系的研究调查

目的探讨腺样体肥大与变态反应之间的相关性。方法2006年9月-2007年9月我科收治的腺样体肥大、无唇裂病史入院手术患儿共53例，并比较腺样体肥大患儿和正常同龄儿童的中耳功能的差异。结果①未合并分泌性中耳炎的单纯腺样体肥大与末梢血中嗜酸性粒细胞水平无明显相关性（r=-0．19，P〉O．05），合并分泌性中耳炎的腺样体肥大与末梢血中嗜酸性粒细胞水平呈负相关（r=-0．34，P〈O．05）；②腺样体大小与中耳压力有明显的负相关性（r=-0．41，P〈0．05）。结论腺样体肥大与变态反应之间无直接关系，而当变态反应引起中耳病变时肥大的腺样体致咽鼓管功能障碍加重中耳的渗出是中耳疾病的发病基础。     

内镜辅助切除腺样体治疗儿童慢性鼻窦炎和分泌性中耳炎27例

儿童睡眠呼吸疾病最重要的原因在于腺样体肥大，同时腺样体肥大也是慢性鼻窦炎和分泌性中耳炎的重要基础因素。我们对27例并发慢性鼻窦炎和（或）分泌物中耳炎的患儿采用内镜辅助经口腔腺样体切除术，观察慢性鼻窦炎和分泌性中耳炎的治疗效果。疗效满意，报告如下。     

儿童腺样体肥大的CT表现

目的 探讨儿童腺样体肥大的CT表现。资料与方法 回顾分析32例经手术病理证实的儿童腺样体肥大的CT表现。结果 儿童腺样体肥大的CT征象为：鼻咽顶后壁软组织增厚堵塞后鼻孔14例，合并副鼻窦炎12例，合并分泌性中耳炎6例，增强扫描病灶不均匀强化。结论 CT检查可以明确病灶范围及其合并症。     

Nd-YAG激光治疗分泌性中耳炎

近年来由于激光的发展,Nd-YAG激光开始进入了耳鼻喉科。我院应用Nd-YAG激光对26例分泌性中耳炎进行了治疗,随访效果满意。 1 临床资料 本组26例(30耳),男性21例、女性5例。年龄8～19岁6例,20～49岁15例、50～73岁9例。病程1d～3个月。病因为上感10例、腺样体肥大3例、鼻     

腺样体切除联合鼓膜置管术治疗儿童复发性分泌性中耳炎

腺样体肥大、慢性腺样体炎一直被认为是引起分泌性中耳炎（Secretory otitis media,SOM）的重要原因,既往对无明显腺样体肥大的儿童复发性分泌性中耳炎患者仅行鼓膜置管术,术后具有复发率高的弊端,我们采用腺样体切除术（Adenoidectomy,AT）联合鼓膜置管术治疗儿童复发性分泌性中耳炎取得了良好效果,报告如下。     

多种激光联合早期干预婴幼儿鲜红斑痣

目的评价优化脉冲技术（Optimal Pulse Technology,OPT）、脉冲染料激光（Pulsed dye laser,PDL）和连续Nd：YAG激光联合治疗婴幼儿鲜红斑痣的疗效与安全性。方法鲜红斑痣患儿32例,年龄3个月至7岁,先经OPT治疗2次,再用PDL治疗3次,共经过5次治疗,治疗间隔2—3个月。其中5例伴有疣状增生患儿,联合应用连续Nd：YAG激光治疗。观察临床疗效与不良反应的发生情况。结果32例鲜红斑痣患儿,痊愈9例,痊愈率28．1％;显效18例,显效率56．3％,总有效率84．4％;5例伴疣状增生者均1次治愈,治愈率100．0％。比单纯应用PDL治疗,疗效有所提高。32例患者中,出现轻度色素减退3例（占9．4％）,出现色素沉着2例（6．3％）,无瘢痕形成。结论OPT、PDL治疗婴幼儿鲜红斑痣疗效可靠、并发症少,连续Nd：YAG激光可辅助治疗有疣状增生的病变。     

528例分泌性中耳炎患儿腺样体的CT表现

目的:分析分泌性中耳炎患儿鼻咽腺样体肥大的16层MDCT表现.方法:对528例被确诊为分泌性中耳炎的小学生进行鼓膜检查、听力检查、声阻抗检查和鼻咽部横断面CT平扫检查并比较.结果:528例被确诊为分泌性中耳炎的小学生均有不同程度的鼻咽腺样体肥大和听力损失,并且鼻咽腺样体肥大的程度与听力损失的程度和比率呈正相关.结论:16-MDCT扫描可清楚显示鼻咽腺样体肥大及其程度,对分泌性中耳炎患儿鼻咽腺样体肥大的临床治疗有重要的指导价值.     

先天性心脏病患儿分泌性中耳炎的螺旋CT诊断价值

目的评价螺旋CT对先天性心脏病患儿分泌性中耳炎的诊断价值。资料与方法回顾性分析我院2008-02～2010-10收治的先天性心脏病反复上呼吸道感染的残疾儿童46例78耳分泌性中耳炎的螺旋CT表现。结果 28例37耳有不同程度的乳突密度增高,气房减少,听小骨完整,周围骨质无破坏;21例41耳仅表现为乳突气房模糊。2例支气管扩张;6例唇腭裂;8例腺样体肥大;1例鼻中隔偏曲;38例伴不同程度的筛窦、上颌窦积液。结论螺旋CT可清晰显示中耳、乳突、鼻旁窦结构及腺样体肥大程度,对先天性心脏病患儿分泌性中耳炎的临床诊断有重要的指导价值。     

腺样体刮除术及鼓室置管术治疗儿童分泌性中耳炎疗效观察

目的：探究分析腺样体刮除术联合鼓室置管术治疗儿童分泌性中耳炎的临床疗效。方法采用分析的方法对收治的108例（120只患耳）分泌性中耳炎的患儿的临床资料,根据治疗方法的不同,将108例患儿随机分成实验组和对照组,每组各54例,对照组采用单纯鼓室置管术,实验组采用腺样体刮除术联合鼓室置管术。分析对比两组患者的临床治疗有效率及并发症情况。结果实验组的治疗有效率明显高于对照组（ P＜0．05）,实验组治疗后的听阈较对照组的降低幅度更大（ P＜0．05）,实验组发生鼓膜穿孔、化脓性中耳炎、听力下降等并发症的情况均明显低于对照组（ P＜0．05）。结论腺体刮除术联合鼓室置管术治疗儿童分泌性中耳炎的临床疗效好,并发症少,安全可靠,较利于儿童听力的发育。     

Dealing with cancer--conversations with radiotherapy patients

Thirty in-patients treated by radiotherapy were questioned in qualitative interviews about the information they had received from the physicians and their way to deal with the disease and the physicians. Furthermore 18 persons out of this group were accompanied continuously. The confidential relationships between the patients and the author of the study brought about spontaneous conversations showing some new aspects of the way to experience disease and therapy. Despite a poor prognosis and an initially insufficient information, the patients formulated their questions openly. Generally they desired a clearer communication. They criticized above all the lack of information and attention from the physicians. A need for confidence, frankness, and the conveyance of a justified hope was expressed. The physician's stress and resulting lack of time was complained of. During the time of accompanying which lasted several weeks, it became evident that information means a way to deal with the disease to which the patient can make his individual contribution. The majority of questions as well as emotional reactions as fear or depression came from those patients who seemed to be quiet persons.     

湿润烧伤膏与手术联合治疗褥疮的护理

目的 :减少溃疡期褥疮的术前准备时间 ,缩短褥疮的总病程。方法 :将 1996年 5月至 2 0 0 2年 5月收住院的 4 2例溃疡期褥疮病人按随机原则分为 2组 ,2 1例术前用湿润烧伤膏纱换药处理 ,为A组 (试验组 ) ;2 1例用庆大霉素紫草油纱布换药处理 ,为B组 (对照组 )。 2组病例的年龄、性别、发病原因、病灶部位、病灶范围等经统计学处理 ,无显著性差别 ,有可比性。两组病人均换药至创面新鲜行皮瓣转移手术 ;比较两组平均术前换药时间 ,及换药 +手术的总住院日。术前术后两组患者均运用护理程序施行整体护理。结果 :A组术前平均换药时间为 8 4 9± 2 2 3天 ,B组为 15 6 0± 6 70天 ;A组平均治愈时间为 2 0 5 0± 4 81天 ,B组为 35 31± 7 70天。结论 :湿润烧伤膏换药与庆大霉素紫草油纱布换药比较 ,前者可明显缩短褥疮手术的术前准备时间及病人的总住院天数。     

Radiochemotherapy with temozolomide for patients with glioblastoma

Background

The objective of this retrospective analysis was to assess long-term outcome and prognostic factors of unselected patients treated for glioblastoma (GB) at a single center with surgery, standard radiotherapy (RT), and concomitant temozolomide (TMZ). From 1999?C2005, the institutional protocol included surgery and RT with TMZ. From 2005 on, adjuvant TMZ was routinely added.

Patients and Methods

Between April 1999 and September 2009, 181 patients with GB were treated with RT (60 Gy in 30 fractions) and concomitant TMZ (75 mg/m²/day throughout RT). Biopsy only had been performed in 53 patients (29.3%), 128 patients (70.7%) had undergone resection, which was complete based on postoperative MRI in 51 patients (28.2%). Adjuvant TMZ was applied in 67 of 181 patients (37%).

Results

Median overall survival (OS) and progression-free survival (PFS) were 15.0 (95% CI, 13.1?C16.8) and 7.2 months (95% CI, 5.9?C8.5), respectively. After complete resection, partial/subtotal resection and biopsy, median OS was 23.20, 14.75, and 7.89 months (p < 0.001), respectively. In multivariate Cox proportional hazards regression models, extent of resection (p < 0.0001), Karnofsky??s performance score (p < 0.0001) and adjuvant TMZ (p = 0.001) were significant independent prognostic factors for OS. RT with concomitant TMZ was well tolerated in the majority of patients and could be completed as scheduled in 146 patients (80.7%), while 11 patients (6.1%) discontinued RT. Another 35 patients (19.3%) interrupted concomitant chemotherapy.

Conclusion

RT with concomitant TMZ is a feasible regimen with acceptable toxicity in routine practice. Our data are compatible with a beneficial effect of adjuvant TMZ on OS and PFS.     

MEBO药纱门诊治疗烧(烫)伤71例的体会

作者报道用MEBO药纱敷盖门诊治疗烧（烫）伤71例，均获治愈。经随访1年，深Ⅱ度创面疤痕发生率为15％（3／20），浅Ⅲ度创面疤痕发生率为38．9％（7／18）。     

Bronchogenic carcinoma: staging with MR compared with staging with CT and surgery

Thirty-three patients suspected of having bronchogenic carcinoma were studied prospectively using magnetic resonance (MR). In this group, 30 underwent examination with computed tomography (CT), 15 underwent thoracotomy, six had mediastinal biopsy procedures performed, and eight underwent bronchoscopy. MR studies, which included transaxial spin-echo imaging (TR, 0.5 and 2.0 sec; TE, 28 and 56 msec) of all patients and sagittal or coronal imaging of 18, were performed without knowledge of CT findings, using only plain radiographs as a guide. CT and MR studies were interpreted separately. CT and MR provided comparable information regarding the presence and size of mediastinal lymph nodes. MR better discriminated mediastinal nodes from vascular structures. However, in two of 11 patients who had multiple mediastinal lymph nodes that were normal in size at CT examination and surgery, MR suggested a confluent abnormal mass, probably because of its poorer spatial resolution. MR was superior to CT in showing enlarged hilar lymph nodes, but CT was better for demonstrating bronchial abnormalities. In three of four patients who had a proved hilar mass with distal obstructive pneumonia, MR (TR, 2.0 sec) helped distinguish between the mass and collapsed lung.     

臭氧治疗船员下肢损伤89例

2006年10月至2007年4月,我科采用引进的德国赫尔曼Medozon型臭氧发生装置系统产生的臭氧治疗船员下肢损伤89例,疗效满意.现报告如下.     

Tumor Burden Assessment with Positron Emission Tomography with

Objective: In patients with advanced cancer, total tumor burden affects the likelihood of tumor response and has important implications for prognosis. The aim of this study was to select the optimum 2-[F-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG PET) tumor uptake parameter to accurately measure tumor burden in advanced metastatic renal cell cancer, in comparison with volumes measured with computed tomography (CT), as a reference test.Materials and Methods: Six patients with metastatic renal cell carcinoma measurable on CT were studied. CT and FDG PET scans were carried out on all patients within 4 weeks prior to their entry into a phase I-II radioimmunotherapy trial. CT-based evaluation of disease extent (tumor volume) and 4 PET-based measurements (standardized uptake value[SUVmax], SUVav, volume, and total lesion glycolysis [TLG]) were performed independently by a radiologist (VN) and a nuclear medicine physician (TA). The degree of correlation between conventional (CT) extent of disease and parameters describing tumor concentration of FDG was then determined.Results: Fifty-seven CT-measurable metastatic lesions in lung, abdomen, and scalp were evaluated in 6 patients. There was a high correlation between CT and FDG PET volume estimates for lesions greater than 5 cm(3) in size. However, a PET-derived parameter that embodies both FDG uptake and lesion size, the TLG, correlated better with CT-derived tumor volume than did FDG PET volume alone.Conclusion: Using CT volume as a gold standard, the optimal PET-based estimate of total tumor burden in patients with metastatic renal cancer is the sum over all lesions of the total lesion glycolysis.     

烧伤合并多器官功能衰竭117例临床分析

目的　探讨烧伤合并多器官功能衰竭 (MOF)的临床特点。方法　对 1993年 1月— 2 0 0 2年 12月治疗的 117例烧伤合并MOF作出分析。结果　吸入性损伤、休克、全身性感染是烧伤后导致MOF的常见诱因 ,烧伤合并MOF后果严重、死亡率极高。结论　抓住休克、感染的预防 ,是减少MOF发生率、降低烧伤死亡率的关键。