鼻内镜治疗巨大蝶、筛窦囊肿侵犯颅底7例临床分析

甘的探讨鼻内镜治疗巨大蝶、筛窦囊肿侵犯颅底的方法．方法自从2000年1月至2009年6月,收治的7例巨大蝶、筛窦囊肿,均有侵犯颅底、联合耳鼻喉科在内窥镜下切除囊肿。并用鼻自体材料进行颅底重建修补．结果7例头痛,鼻塞症状均改善,术后1周眼球均恢复正常位置。眼球突出度恢复正常。视力不同程度恢复,复视消失,所有患者术后无颅内感染、脑膜脑膨出、脑疝等并发症。随访6个月。6a,其中2a以上者5例．1例自发性脑脊液鼻漏患者于术后2a再次出现脑脊液鼻漏。经保守治疗后治愈;1例经鼻内镜再次修补手术治愈;其余患者均一次性手术成功,未出现脑脊液鼻漏．结论鼻内窥镜手术治疗蝶、筛窦囊肿仍不失为一种安全有效的方法．     

外伤性额眶及前颅底凹陷粉碎骨折并脑脊液鼻漏一期手术治疗12例报告

目的探讨一期手术治疗额眶及前颅底凹陷粉碎性骨折并脑脊液鼻漏的治疗。方法分析12例施行一期手术,预留前额部带蒂筋骨膜瓣、人工硬脑膜等修补硬膜缺损,防止脑脊液鼻漏患者资料。采用耳脑胶或小颅骨连接钛片重塑眉弓,凹陷骨折一期拼接复位。结果 4例患者术后仍有少量漏脑脊液,其中3例卧床2周内停止,1例卧床近2.5个月停止;2例颅内感染,抗生素治疗后治愈;1例原裂伤处伤口拆线裂开,每日换药后治愈;1例术前眼前手动的,术后眼前数指。全部患者脑脊液漏均治愈,无死亡病例。结论额眶及前颅底凹陷粉碎骨折并脑脊液鼻漏,及时手术处置并进行颅骨重建和硬脑膜修复,能有效防止脑脊液鼻漏及并发症发生,同时恢复患者容貌,提高生存质量,避免多次手术。     

内镜下结肠息肉电切术出血的防范与治疗

目的 探讨内镜下结肠息肉电切术出血的防范与治疗.方法 采用PENTAX3831、PENTAX3840电子结肠镜下圈套器高频电凝电切术联合钛夹、黏膜下注射肾上腺素对72例104个结肠息肉进行切除.结果 息肉有效切除率100%,术中出血8例,予钛夹钳夹或根基部注射1:10,000去甲肾上腺素止血,术后6小时内少量血便2例,予静脉注射血凝酶后出血停止,无穿孔等严重并发症发生.结论:肠镜下高频电凝电切术切除息肉操作方便,疗效确切,联合术前、术后钛夹钳夹、粘膜下注射肾上腺素能有效防范及治疗出血.     

多静脉途径介入栓塞海绵窦区硬脑膜动静脉瘘

目的探讨多静脉途径介入栓塞海绵窦区硬脑膜动静脉瘘的方法、策略和疗效。方法27例海绵窦区硬脑膜动静脉瘘患者,分别经岩下窦、面静脉和眼上静脉等静脉途径介入栓塞治疗。结果23例临床治愈,4例症状明显缓解。术后即刻造影提示22例瘘口完全消失,5例虽将海绵窦致密填塞,但其中2例仍有少量翼丛引流,1例通过海绵间窦向对侧引流,2例存在少量岩上窦后引流,压颈1个月后消失。栓塞术后并发症主要表现为头痛和呕吐,3例出现轻度复视,后自行恢复;无1例出现永久性介入相关并发症。临床随访5个月～6年,患者无临床症状复发。结论多静脉途径介入栓塞是治疗海绵窦区硬脑膜动静脉瘘安全、有效的方法。     

鼻内镜手术治疗非鼻窦炎息肉状病变

目的：探讨鼻内镜手术在非鼻窦炎息肉状病变方面的应用。方法：利用鼻内镜手术治疗脑脊液鼻漏、脑膜脑膨出、蝶筛窦囊肿、异物、霉菌病、垂体瘤、后鼻孔闭锁、内翻性乳头状瘤共70例。结果：69例均一次手术成功,1例脑脊液鼻漏再次手术成功,在6个月-6年的随访中,仅后鼻孔闭锁及蝶窦霉菌各2例在术后曾曾出现肉芽,经微波治疗后痊愈。结论：鼻内镜能广泛应用于非鼻窦炎息肉状病变的治疗,脑脊液鼻漏、脑膜脑膨出最佳适应证;对其它手术也能体现出其进路简便、创作小、直视下操作、视野清晰、不留颅面部畸形等优点。     

经动脉途径栓塞海绵窦区硬脑膜动静脉瘘

目的 探讨经动脉途径介入栓塞海绵窦区硬脑膜动静瘘的疗效和策略.方法 回顾性分析经动脉途径介入栓塞治疗的19例海绵窦区硬脑膜动静脉瘘.结果 15例临床治愈,3例明显好转,1例治疗失败.其中术后即刻造影提示12例瘘口完全消失;6例经主要供血动脉栓寒后,经瘘口血流量明显减少,压颈1个月后5例临床治愈,1例症状明显缓解.经动脉治疗失败病例改经岩下窦入路双侧海绵窦微弹簧圈栓塞后治愈.无一例出现永久性介入相关并发症.临床随访7个月到4年,病人尤临床症状复发.结论 经动脉途径介入栓塞对于部分海绵窦区硬脑膜动静瘘的病人是安全、有效且经济的治疗方法 .     

荧光素钠鼻腔局部使用在内镜经鼻脑脊液鼻漏修补术中的应用

目的 探讨荧光素钠鼻腔局部使用在脑脊液鼻漏术前定性诊断及内镜经鼻修补术中漏口定位诊断中的作用.方法 15例内镜经鼻手术治疗的脑脊液鼻漏病人,术前及术中将5%荧光素钠棉片放置在中鼻道、筛顶、蝶筛隐窝及术中可疑漏口部位,以棉片颜色由黄褐色变为绿色为脑脊液漏判断标准,与糖定量检查、术中所见及术后随访结果 判断诊断的准确率.结果 15例脑脊液鼻漏病人,其中10例为自发性脑脊液鼻漏、5例为外伤性脑脊液鼻漏.术前定性诊断率及术中定位准确率为100%.随访2～24个月,脑脊液鼻漏无复发,无并发症发生.结论 荧光素钠在鼻腔局部使用是脑脊液鼻漏术前定性诊断及内镜经鼻修补术中漏口定位诊断的一种无创、简便、可靠的方法 ,可以作为鞘内荧光素钠一种替代的诊断及定位脑脊液鼻漏的方法 .     

腰椎术后脑脊液漏的早期诊断及治疗

目的 探讨腰椎术后脑脊液漏的预防措施及治疗方法.方法 回顾性分析笔者所在医院11例术后发生脑脊液漏的临床资料.结果 本组10例切口Ⅰ/甲愈合,脑脊液漏停止;感染1例切口Ⅰ/丙愈合,脑脊液漏停止;经过随访脑脊液漏无复发.结论 术中及术后加强预防可以有效的减少脑脊液漏的发生率,在治疗上最好的办法是通过熟练的手术技巧采用手术缝合方法对硬膜损坏处进行修复.     

经岩下窦介入栓塞海绵窦区硬脑膜动静脉瘘3例临床分析

目的 探讨经静脉人路栓塞治疗海绵窦区硬脑膜动静脉瘘的效果.方法 经股静脉-岩下窦入路到达病变侧海绵窦,用游离弹簧圈等多种栓塞材料填塞海绵窦,同时闭塞瘘口.结果 3例中全部愈或好转,1例在栓塞治疗后眼部症状消失.栓塞术后最常见症状为头痛伴呕吐.随访3个月到5年未见复发.结论 静脉入路栓塞治疗硬脑膜动静脉瘘是一种安全、有效的方法,应作为首选治疗方法.     

经颅垂体瘤手术中的鞍隔切口及缺损的一期修复重建

目的 探讨在经颅垂体瘤手术中使用钛夹、人工脑膜等材料进行的修复切口及缺损鞍隔重建价值及意义.方法 对我院38例经颅垂体瘤手术中进行鞍隔缺损程度分级并进行鞍隔修复重建,切除肿瘤后使用钛夹、人工脑膜、医用耳脑胶对鞍隔进行一期修复、重建,对照组为未进行鞍隔重建的74例患者,比较两组患者的围手术期及远期并发症和预后情况.结果 随访14～46个月,鞍隔重建组中,1例患者术后3 h CT显示鞍区未压迫视神经的小血肿,均未发生脑脊液漏、颅内感染、空蝶鞍综合征及其他并发症.鞍隔未重建组中,1例术后1 h因鞍区出血出现进行性视力下降及意识障碍并再次开颅手术,空蝶鞍发生率及需二期经蝶手术患者的脑脊液漏、颅内感染的发生率高于鞍隔重建组(P<0.05),但两组的尿崩症发生率及垂体功能、视力恢复情况差异无统计学意义(P>0.05).结论 经颅垂体瘤手术中依据鞍区的解剖生理状态进行鞍隔修复重建非常必要,钛央、人工脑膜、耳脑胶在其中具有新的应用价值,可显著减少术后因鞍区出血需再次手术、空蝶鞍、二期经蝶手术脑脊液漏和颅内感染的发生率,此技术具有推广价值.     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

A preliminary screening study on the associated proteins in human psoriasis vulgaris by serum proteomics technologies

Objective：To investigate the optimum screening conditions of associated proteins in human psoriasis vulgaris by serum proteomics technique, and to screen the different expression proteins related with psoriasis vulgaris. Methods：Serum samples of peripheral blood were collected from newly diagnosed psoriasis vulgaris patients in the clinic, and 20 matched healthy persons. Serum albumin IgG was removed by filtering with ProteoExtract Albumin/IgG. After comparative proteomics analysis the different protein spots were identified using 2-DE and MS. Results ：Electrophoresis figures with high resolution and reproducibility were obtained. Three different expression proteins were found only in the serum from psoriasis vulgaris patients, while nine other different proteins expressing from healthy volunteers. Conclusion：The protein expression was different in the serum between the psoriasis vulgaris patients and healthy volunteers. It was hoped that we could find the biomarkers related to psoriasis vulgaris by using proteomics.     

A CASE OF HUGE GASTRIC DISOPYROBEZOAR

PYTOBEZOARS are common bezoars in gastrontestinal tract, commonly seen in stomach and mall intestine,1but huge disopyrobezoars are     

Acupuncture Treatment of Chest Bi Syndrome

CASE HISTORY A male,a retired officer of 61 years old,paid his first visit on May 12,2006.The patient stated that 2 weeks before he suddenly got paroxysmal precordial choking pain,with irregular attacks.Each attack would last several seconds to several minutes.The attack was accompanied with heavy oppressed sensation in the precordial region,palpitation,lassitude,and in severe cases,sweating,which was once diagnosed by a hospital as'coronary heart disease'.Recalling the case history,the patient said that several days before he got angry with others because of some affairs in work,and he was not so used to the life pattern since he had just retired from his busy working post.At usual times,he was quick tempered and peevish.In recent days,he had poor appetite,and loose stool.     

Instructions to Contributors

The English edition of Chinese Journal of Integrative Medicine is edited and published by the Chinese Journal of Integrated Traditional and Western Medicine Press.Original scientific papers of advanced clinical and experimental medicine in the field of complementary/alternative medicine or integrative medicine are expected.     

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