中国阻塞性睡眠呼吸暂停低通气综合征治疗回顾

目的评价我国阻塞性睡眠呼吸暂停低通气综合征(obstructivesleepapneahypopneasyndrome,OSAHS)的治疗工作。方法对1995年1月到2004年12月共10年间国内发表的有关OSAHS治疗研究的论著进行回顾性分析。结果10年间国内发表有关OSAHS治疗方面的论著201篇,文献数量逐年增加,其中回顾性病例分析文章占绝大多数,疗效评价标准不统一导致报告的治疗有效率差别明显;相同疗效评价标准下,远期疗效低于近期疗效;多部位手术疗效明显好于单纯悬雍垂腭咽成形术(uvulopalatopharyngo-plasty,UPPP)疗效。结论今后应在中华医学会制定的OSAHS诊断治疗指南的指导下,统一疗效评价标准,开展多中心、大样本的随机对照试验(randomizedcontrolledtrials,RCT),研究并推广上呼吸道解剖性狭窄和上呼吸道咽壁易塌陷性增强的客观评估方法,对不同的情况采用不同的治疗措施,使我国OSAHS治疗工作达到一个新的水平。     

鼻敏片治疗常年性变应性鼻炎的疗效观察

目的观察鼻敏片对常年性变应性鼻炎的临床疗效。方法43例常年性变应性鼻炎随机分为两组，鼻敏片组23例，安慰剂组20例，观察治疗前后患者的临床症状、体征、变应原皮肤滴定试验的变化。结果鼻敏片组临床疗效明显优于对照组（P〈0．01），变应原皮肤滴定试验风团改善明显（P〈0．05）。结论鼻敏片对变应性鼻炎具有良好的临床疗效。     

射频消融治疗悬雍垂腭咽成形术后无效的阻塞性睡眠呼吸暂停低通气综合征

目的探讨等离子低温射频消融(radiofrequency ablation,RFA)治疗悬雍垂腭咽成形术(uvulopal-atopharyngoplasty,UPPP)术后无效的阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syn-drome,OSAHS)的疗效。方法选择39例UPPP术后无效的OSAHS患者接受RFA治疗。比较治疗前后呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSaO2)、鼾声评级和Epworth嗜睡程度评分,评价治疗效果。结果治疗总有效率53.8%,患者治疗8周后鼾声评级的降低较治疗前无显著差异(P>0.05),Epworth嗜睡程度评分较治疗前明显降低(P<0.01)。治疗后6个月AHI较治疗前明显减低(P<0.05),LSaO2较治疗前明显升高(P<0.05)。结论对UPPP术后无效的OSAHS,RFA是一种有效的补救性治疗方法。     

慢性鼻窦炎鼻息肉鼻内镜手术后应用中药治疗的临床观察

目的 探讨鼻窦炎口服液在鼻窦手术后的辅助治疗作用。方法 86例病例随机分为治疗组和对照组各43例,对照组术后常规给予抗生素、激素等治疗,治疗组除常规治疗外,术后同时加用中药鼻窦炎口服液治疗。结果 治疗组治愈率93.0％,对照组对治愈率76.7％,经卡方检验X~2=4.44.P<0.05),两组疗效差异有显著性意义。治疗组鼻腔分泌物稀薄,粘膜水肿反应轻,消退快,术腔上皮化过程明显缩短,复发率为2.3％,明显低于对照组7.0％。结论 鼻窦炎口服液不但可以提高和巩固手术疗效,减少复发,而且术后可以减少抗生素、激素用量,可长期服用,无药物毒副作用。     

Zur Diagnose und Therapie solitärer extramedullärer Plasmozytome

Summary The rare solitary extramedullary Plasmacytoma is discussed and compared to the more common disseminated form. Based upon the pertinent literature, some diagnostic problems, clinical and pathological features as well as prognostic and therapeutic aspects of the solitary lesion in the ENT field are reviewed. In connection to one personal case, the authors analyze Trotter's Median Labiomandibular Glossotomy.

     

Internal maxillary artery ligation for idiopathic intractable epistaxis

Epistaxis though common, is rarely life threatening. Routinely nose pinching, anterior find posterior nasal packing and endoscopic cauterization of bleeding points is sufficient to control epistaxis in 99% of the cases. It is mandatory to rule out local and systemic causes before labeling a case as idiopathic by using a battery of investigative modalities. Here are two interesting cases of epistaxis which did not respond to conventional therapeutic modalities in which transantral internal maxillary artery ligation was attempted leading to complete cure.     

Molecular pathways and genetic factors in the pathogenesis of laryngopharyngeal reflux

The prevalence of laryngopharyngeal reflux (LPR) has been constantly rising in the western world and affects today an alarmingly high percentage of the general population. Even though LPR and gastroesophageal reflux disease (GERD) are both the product of gastroesophageal reflux and seem to be sibling disorders, they constitute largely different pathological entities. While GERD has been for a long time identified as a source of esophageal disease, LPR has only recently been associated with head and neck disorders. Despite the high incidence of LPR and its great impact on patients’ quality of life, little is known regarding its pathogenesis. On the other hand, studying the molecular and genetic basis of a disease is of fundamental importance in medicine as it offers better insight into the pathogenesis and opens new, disease-specific therapeutic trends. The aim of this study is to enlighten any known or suspected molecular mechanisms that contribute to the pathogenesis of LPR, and to suggest new trends for future research.     

Effect of Internal Maxillary Arterial Occlusion on Nasal Blood Flow in Swine

Objectives: The precise effects of therapeutic occlusion of the internal maxillary artery (IMA) on distal nasal mucosal perfusion are unknown. A better understanding of these effects has important implications regarding the rationale and expected efficacy of certain therapeutic interventions for epistaxis management. The authors developed an animal model to assess these issues. Study Design: The effects of “proximal” and progressively more “distal” occlusions of the IMA on nasal mucosal blood flow (NBF) were assessed in anesthetized swine using continuous laser Doppler flowmetry. The levels of arterial occlusion were selected to simulate clinical therapeutic occlusions used for the management of epistaxis. Methods: Nineteen swine were entered into one of four experimental groupings: proximal IMA occlusion using platinum micro-coils (n = 6), mid-grade distal IMA occlusion with polyvinyl alcohol particulate (PVA) suspensions (300 to 500 microns, n = 5), high-grade distal IMA occlusion with polyvinyl alcohol particulate suspensions (50 to 150 microns, n = 5), and sham control (n = 2). Results: All embolizations resulted in acute decreases in average NBF from 120 mL/min per 100 g to 40 mL/min per 100 g (P <.05 for all groups). NBF returned to baseline in all three treated groups within 2 to 8 days after therapeutic embolization, depending on the level of occlusion (coils, 2 d; mid-grade PVA, 2–3 d; high-grade PVA, 8 d). Follow-up angiography showed recanalization and collateralization as possible methods of reestablishing NBF. Conclusions: This study supports the rationale for performing distal IMA occlusion with transarterial particulate embolization, in order to provide a longer period of time of diminished NBF. This theoretically should promote hemostasis within an injured portion of the nasal mucosa by decreasing perfusion pressure within the capillary bed. However, the benefits of distal IMA embolization must be balanced against potential ischemic complications, as may be more commonly seen with high-grade particulate embolization.     

耳石复位法治疗良性阵发性位置性眩晕32例

目的 探讨耳石复位法治疗良性阵发性位置性眩晕（BPPV）的的效果。方法 应用Epley管石复位法、Semont管石解脱法及Barbecue翻滚法对良性阵发性位置性眩晕32例予以治疗。结果 32例中经耳石复位法治愈27例(84.4%)，有效 3例(9.4%)，复位失败2例(6.3%)，后经前庭功能训练治愈。结论 耳石复位法是BPPV的首选治疗方法，对于复位失败的患者前庭功能训练可获得较好的疗效。     

Burning Mouth Syndrome

Most clinicians dread seeing the patient presenting with a primary complaint of a burning pain on one or more oral mucosal surfaces.Unlike most other clinical conditions presenting in a dental office,burning mouth syndrome is poorly understood with few evidence based remedies.More recently,advances have been made towards clarifying the possible etiology of the disorder and testing the possible therapeutic modalities available.This article attempts to summarize the "state of the art" today.     

头颈鳞状细胞癌乏氧微环境与放疗抵抗相关性的研究进展

头颈鳞状细胞癌(HNSCC)的治疗方式有手术和放化疗.治疗后HSNCC的高复发率及其显著的转移能力是影响HNSCC患者预后的主要因素,且放化疗存在各种并发症,包括放射性口腔黏膜炎、局部软组织损伤等,严重影响患者生活质量.而肿瘤局部组织内乏氧造成的乏氧微环境与肿瘤治疗抵抗和复发的关系密切相关,如果能采取措施改善肿瘤微环境...     

Atypical lipomatous tumour of the head and neck region with dyspnea and dysphagia: a case report

Liposarcoma is one of the most common soft tissue sarcomas in adults. Atypical lipomatous tumour (ALT) rarely occurs in the head and neck region. Histopathologic grade of these tumours affect prognosis of this disease. The mainstay of treatment for ALT is surgical excision. In this article, a case of a huge ALT arising from the head and neck region and invading nearly entire left hemi-facial region is presented. Clinical and histopathologic features and therapeutic approaches related to this tumour are discussed reviewing the literature.     

Endoscopic optic nerve decompression for traumatic optic neuropathy in children

Objectives

To discuss the necessity of nasal endoscopic surgery for pediatric traumatic optic neuropathy and its therapeutic effect.

Methods

We retrospectively reviewed the cases of 41 children (involving 43 eyes) with traumatic optic neuropathies who were treated in our department by endoscopic optic nerve decompression and postoperative corticosteroid in large doses from Feb. 2000 to Apr. 2010. A 6-month follow-up study was performed for each patient in order to observe the postoperative eyesight recovery and analyze the therapeutic effect.

Results

The eyesight of 11 patients out of 41 patients reached 0.2-0.3 postoperatively, the eyesight of 16 patients recovered from counting fingers to 0.1 after the surgery, the eyesight of 6 patients ranged from light sensation to seeing the hand movement, the eyesight of 7 children did not recover from the operation. The prognosis in the children who underwent the decompression 7 days post-traumatically was much worse than other children.

Conclusions

The age of the patients was not the main element influencing the decision-making process for the operation. The main elements affecting the prognosis were the degree of injury and the time interval between the trauma and the time when patients underwent the surgery. The operation opportunity and plan are very important to a successful operation.     

脑活素拮抗豚鼠庆大霉素耳毒性机理的研究

目的探讨脑活素拮抗豚鼠庆大霉素耳毒性作用机理。方法取听力正常豚鼠60只,随机分为4组,每组15只A组(脑活素组),肌肉注射脑活素360mg·kg-1·d-1;B组(庆大霉素组),肌肉注射庆大霉素120mg·kg-1·d-1;C组(庆大霉素 脑活素组),肌肉注射庆大霉素 脑活素,剂量同上;D组(生理盐水组),肌肉注射等量生理盐水。各组均连续用药10d再饲养一周,第17d处死,取左侧听泡,进行琥珀酸脱氢酶化学组织染色观察其活性;取右侧听泡行石蜡包埋切片,在光镜下进行螺旋神经节细胞计数,免疫组织化学SP法检测脑源性神经生长因子(brain-derivedneurotrophicfactor,BDNF)在耳蜗中的表达。结果庆大霉素 脑活素组螺旋神经节细胞退行性病变数目明显低于庆大霉素组,神经纤维变性明显较少,琥珀酸脱氢酶活性明显增高,BDNF在耳蜗中呈阳性表达。结论脑活素对庆大霉素所致耳毒性有明显保护作用,其机理在于脑活素能拮抗庆大霉素对毛细胞有氧代谢的抑制,与BDNF对螺旋神经元的营养修复作用有关。     

经验性治疗与Dx-pH监测诊断咽喉反流的一致性比较

目的探讨经验性治疗及24小时Dx-pH检测诊断以声嘶为主诉者咽喉反流性疾病(laryngopharyngeal reflux disease,LPRD)的一致性。方法对以声嘶为主诉或主诉之一、非首选手术治疗、可疑存在咽喉反流的成年患者50例给予反流症状指数量表(reflux symptom index,RSI)、反流体征评分量表(reflux finding score,RFS)评估并行24小时Dx-pH监测后,建议改善生活方式并给予经验性抗反流药物(质子泵抑制剂+促胃肠动力药物)治疗8周。患者8周后复测RSI,评估治疗效果及经验性药物治疗与Dx-pH监测诊断LPRD的一致性。结果8周经验性药物治疗后,RSI评分提示显效16例,有效13例,无效21例,即所有患者中诊断LPRD 29例,阳性率58.00%。29例患者RSI每项评分治疗后均较治疗前降低(P<0.05)。治疗前Dx-pH监测Ryan指数阳性14例,阳性率28.00%;以治疗效果为标准,Ryan指数诊断LPRD敏感性34.48%,特异性80.95%,阳性预测值71.43%,阴性预测值47.22%,两种诊断方法一致性差(Kappa=0.141,P=0.230)。Ryan阴性,但治疗显效、有效的19例患者中,pH6.0阈值下≥3次反流事件者18例。结论以声嘶为主诉患者中有较高的咽喉反流发生率,Ryan指数诊断LPRD虽然特异性高,但敏感性不足,容易造成漏诊。     

卡介苗素治疗分泌性中耳炎的临床疗效观察

目的观察免疫调节剂卡介苗素(EBCG)对分泌性中耳炎(secretory otitis media,SOM)患者的临床疗效,并讨论其免疫学机制。方法将60例(66耳)SOM患者随机分为EBCG组和对照组,每组30例,两组患者同时给予西替利嗪10mg和贝莱30mg口服及鼓膜穿刺抽液,其中EBCG组同时给予EBCG注射液0.5mg肌肉注射,隔日1次,两组均治疗4周为一疗程,对比观察两组的治疗效果并作统计学分析。结果治疗4周后,EBCG组痊愈16例,有效9例,总有效率为83.3%,未出现毒副作用;对照组痊愈5例,有效12例,总有效率为56.7%,两组有效率比较差异有统计学意义(P<0.01)。结论BECG治疗SOM安全有效,且无毒副作用。     

头孢克洛缓释片治疗成人急性鼻窦炎临床研究

目的 评价头孢克洛缓释片治疗成人急性鼻窦炎的疗效及安全性。方法 62例18-65岁诊断为急性鼻窦炎受试病例,连续服用头孢克洛缓释片(750 mg／次,每日两次,口服)14天,进行多中心的开放式研究。分别在治疗前后对病例进行症状和体征的评估,记录治疗期间发生的不良事件。结果 临床治愈15.5％,好转72.4％,总有效率87.9％(P<0.05)。12.9％的受试病例发生了以胃肠道事件为主的非严重性不良事件。结论 头孢克洛缓释片治疗急性鼻窦炎有良好临床疗效,并具有良好的安全性,可作为口服抗生素的一种有效选择。     

用耳鸣匹配法评价耳鸣治疗中的疗效

目的：为耳鸣疗效提供评价依据。方法：治疗前后分别以耳鸣匹配试验进行测试，分析测试结果与疗效相关性。结果：不同等级疗效的患者，其耳鸣匹配试验结果存在明显差异。结论：耳鸣匹配是评价耳鸣疗效的重要指标之一。     

A case of squamous cell carcinoma of the head and neck producing granulocyte-colony stimulating factor with marked leukocytosis

In squamous cell carcinoma of the head and neck (SCCHN), tumor cells have been shown to secrete detectable amounts of various cytokines, such as interleukin (IL)-6, IL-10, and transforming growth factor (TGF)-beta. These tumor-derived factors might be responsible for promoting malignancy. Here, we describe a SCCHN patient with tumor produced G-CSF and characterized by marked leukocytosis. In this 45-year-old man, severe leukocytosis developed in parallel with aggressive tumor growth. G-CSF production by the tumor was confirmed by immunohistochemistry (IHC). Serum G-CSF levels were elevated. The leukocyte counts and the blood G-CSF level decreased following a course of radiotherapy. Tumor cells were also positive for G-CSF receptor, suggesting autocrine growth regulation by G-CSF. Moreover, the tumor cells were also investigated by IHC with anti-p53, anti-P-glycoprotein (P-gp), anti-thymidylate synthase (TS), and anti-dihydropyrimidine dehydrogenase (DPD), which molecules are thought to contribute the acquisition of therapeutic resistance. The tumor cells were positively stained for TS and DPD, but neither p53 nor P-gp. These results suggest that a variety of molecules may be responsible for acquisition of high malignancy.     

平阳霉素囊内注射治疗复发性喉囊肿的疗效观察

目的观察平阳霉素囊肿内注射治疗复发性喉黏液囊肿的远期疗效。方法39例复发性喉黏液囊肿患者,经间接喉镜或直达喉镜暴露喉囊肿,以0.2%平阳霉素利多卡因稀释液注入喉囊肿内,每月1次,连续注射2次为一疗程。结果39例患者中,27例患者注射一疗程,3例注射二疗程,1例注射三疗程;35例患者在间接喉镜下完成治疗,4例在直达喉镜下进行。经1年以上随访,发现36例治愈,3例显效。治疗过程中及治疗后无明显不良反应。结论表麻下平阳霉素囊肿内注射暴露清楚,手术简单,治疗后不易复发,是治疗复发性喉囊肿的有效方法。