飞行人员变应性鼻炎的临床诊治和医学鉴定（摘要）

目的总结飞行人员变应性鼻炎的临床诊治和健康鉴定经验。方法分析飞行人员因变应性鼻炎而住院诊治的病历资料53份，对其进行分类、分型和分度，并总结与继发性气压伤之间的关系。结果飞行人员变应性鼻炎分为Ⅰ类（飞行中无继发性气压伤表现）30例，Ⅱ类（飞行中出现继发性气压伤表现，包括Ⅱa继发性鼻窦气压伤4例；Ⅱb继发性耳气压伤16例，Ⅱc继发性鼻窦气压伤＋耳气压伤3例）共23例。     

飞行人员鼻窦气压伤的临床诊治和医学鉴定

目的 总结飞行人员鼻窦气压伤的临床诊治和医学鉴定经验. 方法 整理、分析73例飞行人员鼻窦气压伤临床资料. 结果 ①Ⅱ_a类56例(仅有鼻窦气压伤),Ⅱ_c类17例(鼻窦气压伤+耳气压伤).②发生于额窦54例,上颌窦10例,筛窦3例,蝶窦2例,额窦+上颌窦和额窦+筛窦各2例.③原发性气压伤24例(由窦口本身病变所致),继发性气压伤49例(由窦口周围病变所致).④继发性鼻窦气压伤Ⅰ型(鼻腔结构异常型)15例、Ⅱ型(炎症型)25例、Ⅲ型(变态反应型)8例和Ⅳ型(肿瘤型)10例;其中7例两型并存,1例3型并存;窦内型7例、窦外型42例.⑤轻度34例(46.6%),重度39例(53.4%).⑥62例飞行合格,2例飞行暂时不合格,9例飞行不合格. 结论 额窦气压伤发生比例最高.对鼻窦气压伤进行分类、分型和分度具有重要的临床航空医学意义.继发性病变所占比例较高,炎症型是窦口周围病变的重要原因,重度鼻窦气压伤需要手术治疗,Ⅱ_c类气压伤是最易导致医学停飞的疾病.     

飞行人(学)员鼻科疾病诊治和医学鉴定规范

目的 规范飞行人(学)员鼻科疾病诊断、治疗和医学鉴定行为,提高航卫保障质量.方法 分析我院40年飞行人(学)员鼻科疾病住院资料,借鉴国内外该领域的研究成果,总结笔者的临床航空医学经验,提出统一的操作规范.结果 ①飞行人员人(学)员鼻科疾病的诊断分为急性和慢性[包括慢性鼻-鼻窦炎(不伴鼻息肉)和慢性鼻-鼻窦炎(伴鼻息肉)],Ⅰ类(地面生活有症状或体征,包括Ia地面生活有症状和体征,Ib仅有体征)和Ⅱ类(地面生活无症状,飞行中出现气压伤表现,包括Ⅱa鼻窦气压伤、Ⅱb耳气压伤和Ⅱc鼻窦气压伤合并耳气压伤);鼻窦气压伤分为原发性(窦口本身病变所致)和继发性(窦口周围病变所致,包括I型-鼻腔结构异常型、Ⅱ型-炎症型、Ⅲ型-变态反应型、Ⅳ型-肿瘤型,窦外型和窦内型),及轻度和重度.②飞行人(学)员鼻科疾病应根据急慢性、分类分型和分度特点及有无并发症采用无创或微创治疗.③飞行人(学)员鼻科疾病应根据疗效、功能检查(包括鼻窦气压功能)进行医学鉴定.结论 按规范进行飞行人(学)员鼻科疾病诊断、治疗和医学鉴定,可以降低停飞率,提高复飞率.     

改装体检飞行员鼻科资料分析

目的 总结飞行员改装体检经验,提出飞行员鼻科体检的操作规范. 方法 分析改装体检和随访飞行员的×××份鼻科资料. 结果 鼻镜检查鼻中隔偏曲122例、下鼻甲肥大25例、中鼻甲肥大15例、均排除Ⅰ类疾病(地面有症状)和Ⅱ类疾病(地面无症状,飞行中有继发性气压伤表现),判断为生理性变异.诊断鼻窦囊肿9例、慢性肥厚性鼻炎2例、变应性鼻炎3例、慢性鼻窦炎鼻息肉21例(34例为Ⅰ类疾病,1例为Ⅱ类疾病).11例改装体检不合格,其余鼻科体检合格.新机飞行员中2例因鼻科疾病停飞,4例治疗后恢复飞行. 结论 飞行员患鼻科疾病可直接或因继发性气压伤而危及飞行安全.根据随访资料看,改装体检时所做的结论是恰当的,按操作规范进行鼻科体检,是保证体检和健康鉴定质量的重要措施之一.     

鼻内接触性头痛的发病机制及诊治

目的 探讨鼻内接触性头痛的发病机制及其有效的诊治手段.方法 回顾性分析73例鼻腔接触性头痛患者的临床资料,经鼻窦CT及内镜检查评估鼻腔解剖异常情况及接触类型,同时测定骨间隙CT值,并通过内镜手术纠正鼻腔解剖结构异常.结果 73例中,67例局部麻醉后头痛消失,5例上颌窦穿刺后头痛消失;内镜检查发现,73例中筛泡肥大31侧,钩突肥大、内移、气化59侧,中鼻甲异常91侧,鼻中隔高位偏曲51例,其中57例存在同侧2处及以上相邻解剖结构黏膜接触.73例中,术后1周内头痛消失64例(87.67%),头痛减轻9例(12.33%).随访12个月,痊愈59例(80.82%),有效12例(16.44%),无效2例(2.74%).结论 接触性头痛患者鼻腔解剖异常以鼻中隔高位偏曲、中鼻甲变异及其邻近结构的病变最明显.解剖结构黏膜挤压及鼻窦自然口阻塞是接触性头痛的主要原因,内镜及鼻窦CT结合局麻试验可有效诊断鼻内接触性头痛.     

飞行人员鼻科疾病谱研究（摘要）

目的总结飞行人员鼻科疾病谱的变化规律。方法对1966～2007年闾住院的320名373例次飞行人员的鼻科疾病谱进行对比分析。结果排鼻科疾病谱前位的为慢性鼻窦炎、鼻息肉、鼻窦气压伤、鼻中隔偏曲、变应性鼻炎、慢性鼻炎、鼻窦囊肿、急性鼻窦炎、鼻腔鼻窦肿瘤、鼻外伤等。飞行合格283人，暂时飞行不合格12人，永久停飞25人。     

鼻中隔偏曲与单侧上颌窦炎性病变的临床观察与CT图像处理

目的通过临床和CT图像观察了解鼻中隔偏曲与单侧上颌窦炎性病变的关系，探讨鼻中隔偏曲在慢性鼻窦炎发病中的作用。方法前瞻性、连续收集经鼻窦冠状位CT扫描证实的鼻中隔偏曲伴单侧上颌窦炎性病变（包括慢性上颌窦炎、上颌窦浆液性囊肿、上颌窦后鼻孔息肉和霉菌性上颌窦炎）患者56例，观察单侧上颌窦炎性病变与鼻中隔偏曲的关系。随机抽取10例患者的鼻窦冠状位CT图像，按Uygur法计算钩突所在平面两侧下鼻甲、钩突和中鼻甲的横断面积（以坐标纸格数表示）在各自鼻腔所占的百分数，并与10例正常对照（鼻中隔正直、无鼻窦病变）进行比较。结果56例患者中，单侧慢性上颌窦炎25例，上颌窦后鼻孔息肉9例，上颌窦浆液性囊肿5例，霉菌性上颌窦炎17例；病变位于鼻中隔偏曲鼻腔宽大侧35例（62．5％），狭窄侧21例（37．5％）。10例鼻中隔偏曲伴单侧上颌窦炎性病变患者下鼻甲、钩突和中鼻甲的横断面积在各自鼻腔所占的百分数在鼻腔宽侧为48．8％，窄侧为44．1％，两侧无显著性差异（P〉0．05）。10例正常对照下鼻甲、钩突和中鼻甲的横断面积在各自鼻腔所占的百分数为右侧40．1％，左侧39．8％，两侧无显著性差异（P〉0．05）。结论鼻中隔偏曲使鼻腔宽大侧发生单侧上颌窦炎性病变的机会大于鼻腔狭窄侧；临床处理上颌窦炎性病变的同时应矫正偏曲的鼻中隔，恢复鼻腔鼻窦正常的结构和功能，阻断鼻中隔偏曲造成的代偿失调。     

空勤人员鼻科疾病谱研究

目的 通过分析空勤人员鼻科疾病谱提出飞行人员鼻科疾病的防治建议.方法 对1966-2007年间住院的320名空勤人员的373例次鼻科疾病谱进行对比分析.结果 排在鼻科疾病谱前位的为慢性鼻窦炎鼻息肉、鼻窦气压伤、鼻中隔偏曲、变应性鼻炎、慢性鼻炎、鼻窦囊肿、急性鼻窦炎、鼻腔鼻窦肿瘤和鼻外伤等.飞行合格283人,暂时飞行不合格12人,飞行不合格25人.结论 飞行人员鼻科疾病较常见,且与气压伤的关系密切,应积极治疗Ⅰ类鼻腔鼻窦疾病(地面生活有症状),阻止其向地面生活无症状、飞行中出现鼻窦气压伤和(或)耳气压伤症状的Ⅱ类疾病转化.有效治疗Ⅱ类疾病是降低停飞率的重要措施. Abstract： Objective To suggest the protection of aircrews on the base of analyzing disease spectrum of nasal cavity and sinus. Methods The disease spectrum of nasal cavity and sinus was made by analyzing 373 cases of 320 aircrews who were hospitalized from 1966 to 2007. The medical evaluation was reviewed. Results The top diseases in spectrum were chronic sinusitis and nasal polyp, sinus barosinusitis, deviation of nasal septum, allergic rhinitis, chronic rhinitis, cyst in nasal sinus, acute sinusitis, tumor in nasal cavity and sinus, and nasal injuries. In medical evaluation, 283 aircrews were qualified for flying compared to 12 were temporarily grounded and 25 were permanently grounded. Conclusions The nasal cavity and sinus diseases are common in aircrews and usually character barosinusitis and (or) aural barotrauma. The type Ⅰ nasal cavity and sinus diseases (with symptoms on ground) should be treated in time to prevent their transition to type Ⅱ (no obvious symptoms on ground but with symptoms of sinus barosinusitis and (or) aural barotrauma in flight).Duly treating type Ⅱ nasal cavity and sinus diseases would be the effective measure for reducing aircrew's grounding rate.     

170例气压伤飞行人员的低压舱检查资料分析（摘要）

目的总结飞行人员低压舱耳气压机能和鼻窦气压机能的检查经验。方法收集耳气压伤和鼻窦气压伤住院的飞行人员低压舱检查资料170份，对其进行分类统计。结果（1）治疗前耳气压机能检查118例，合格22．9％（27／118），机能不良77．1％（91／118）；鼻窦气压机能检查20例，合格30％（6／20），机能不良70％（14／20）。     

鼻中隔偏曲与鼻窦炎的相关性研究

鼻窦炎致病因素中，鼻腔解剖结构异常在临床中较为常见，其中鼻中隔偏曲占有重要地位。鼻中隔偏曲本身就可以是其他结构异常的原因，如偏曲对侧的中鼻甲、筛泡、钩突的气化或肥大、对侧下鼻甲的代偿性增生等，这在不同程度上增加了鼻窦炎的发病率。本文着重从二者的相互影响关系出发，对二者相关的解剖、发病机制和治疗进行相关性分析。     

Glutamine supplementation in vitro and in vivo,in exercise and in immunodepression

In situations of stress, such as clinical trauma, starvation or prolonged, strenuous exercise, the concentration of glutamine in the blood is decreased, often substantially. In endurance athletes this decrease occurs concomitantly with relatively transient immunodepression. Glutamine is used as a fuel by some cells of the immune system. Provision of glutamine or a glutamine precursor, such as branched chain amino acids, has been seen to have a beneficial effect on gut function, on morbidity and mortality, and on some aspects of immune cell function in clinical studies. It has also been seen to decrease the self-reported incidence of illness in endurance athletes. So far, there is no firm evidence as to precisely which aspect of the immune system is affected by glutamine feeding during the transient immunodepression that occurs after prolonged, strenuous exercise. However, there is increasing evidence that neutrophils may be implicated. Other aspects of glutamine and glutamine supplementation are also addressed.     

Temporal changes in the oxidation state in in vitro blood

The rates at which the paramagnetic compounds deoxyhemoglobin (Hb) and methemoglobin (MHb) form in vivo within an area of hemorrhage are unknown. The present experiment establishes the baseline concentrations and rates of change in paramagnetic hemoglobin concentrations, as well as the pH in normal heparinized and clotted human blood maintained in vitro at 37 degrees C under anaerobic conditions over 30 hours. There was a moderate increase in Hb concentration in normal heparinized blood (average increase was 15.5%, rate = 0.50%/hour) and a slight increase in MHb concentration in the heparinized blood and clots (average increase was 1.4%, rate = 0.044%/hour). A second experiment was done to verify the activity of the RBC systems responsible for maintaining the hemoglobin molecule in the reduced state. Conversion of MHb to Hb in these samples proceeded at a rate of 5.6%/hour. In a third experiment, blood from 11 normal subjects maintained at 4 degrees C 25 degrees C was analyzed for MHb concentration over the course of 28 days. The level of MHb formation remained in the range of normal for at least 11 days in all subjects. The authors conclude that at basal conditions created in vitro, the blood levels of both Hb and MHb remain at relatively low levels. Therefore, if the accumulation of Hb and/or MHb occurs in acute in vivo hematomas it must be driven by intrinsic tissue factors.     

Carcinoma in situ in cryptorchid testes in post-pubertal patients]

The pathohistologic analysis of testis sections of 37 postpuberty patients with different types of cryptorchism is performed. The tissue samples were taken during orchiopehy, fixed in Bouin's solution and treated by the standard histologic techniques. The morphologic criteria are presented for identification of the presence of the so called carcinoma in situ cells found in two cases. Besides, in 13 patients rare, mainly single, atypical germinative cells were found in a smaller number of the seminiferous tubules. It has been concluded that the presence of carcinoma in situ cells in undescended testes of some patients and considering the simple way of sampling, lack of complications and high reliability of the diagnostic procedure, it is absolutely justified to take routine biopsy of testes during orchiopexy in each postpuberty and perhaps prepuberty patient.     

我国医用辐射防护研究概况

医学放射学技术的迅速发展及介入放射学在临床广泛应用，使更多的人受到电离辐射的照射，同时也促进了医疗照射防护工作的发展。文中重点综述了我国医用辐射防护工作者近年来在Ｘ射线ＣＴ的医疗照射防护、对介入放射学工作者的剂量监测以及应用医疗照射防护体系，降低医疗照射剂量等方面所作出的成绩和研究进展     

颈动脉斑块患者血液流变学指标变化探讨

颈动脉斑块形成是动脉硬化的明显特征，可作为观察全身动脉硬化病变的窗口。近年来，颈动脉斑块发病率越来越高，有关这方面的文献报道也较多。颈动脉位置表浅、运动较少，又是动脉粥样硬化的好发部位，故此处的粥样斑块比较容易检测。本研究随机抽取了2005年12月～2007年10月我院住院患者249例，分析其颈动脉病变的超声检查结果与血液流变学指标，探讨颈动脉硬化、斑块形成与血液黏度的相关性。