Nasal glioma: An immunohistochemical and ultrastructural study

A case of a 14 month old Japanese female infant presenting with nasal glioma Is reported. The tumor had been noticed at the nasal radix since birth and had slowly and progressively enlarged. There was no communication between the tumor and the cranial cavity on radiological examination. The tumor was macroscopically anchored to the nasal septum by a fibrous stalk, and histologically consisted of nests or trabeculae of either polygonal or spindle cells with plump eosinophilic cytoplasm and oval nuclei, separated by vascular-rich connective tissue intermingled with multinu-cleated giant cells. These tumor cells were immunohisto-chemically positive for glial fibrillary acidic protein as well as for S-100 protein and vimentin. An electron microscopic examination revealed collagen fibers and basal lamina between the tumor cells and the fibroblasts. Tumor cells possessed abundant intermediate filaments, which showed occasional Rosenthal fiber-like structures, in their cytoplasm and processes. A few oligodendrocytes and cilia of 9 micro-tubule doublets either with or without 2 central microtubules were also noted. These clinicopathological findings suggested that this tumor was once an encephalo(meningo)cele, which probably degenerated as a result of the loss of intracranial communication and then appeared to be isolated from the intracranial tissue.     

继发性唇裂鼻畸形硅胶植入整复术

本文介绍一种使继发性唇裂鼻畸形获得较好外形的新手术方法。术式包括切除偏曲的鼻中隔软骨,并将一片硅胶植入于中央作为鼻小柱支柱,从而矫正歪斜的鼻小柱和抬高鼻尖,使两侧鼻孔形态对称一致,用本法为11例单侧唇裂畸形较重者进行了整复,随访4个月至4年半。绝大多数(10/11)取得满意效果,未见有严重感染和变形等并发症。     

改良内侧上颌骨切除术治疗21例鼻息肉病

目的:探讨鼻息肉病的可行性手术方法,以提高治疗效果。方法:21例鼻息肉病患者一侧行唇龈沟径路,保留下鼻甲的改良内侧上颌骨切除术(modifiedmedialmaxillectomy,MMM);另侧行单纯鼻息肉摘除和鼻内筛窦切除术,并作为对照组。结果:术后随访12～34个月,平均20个月;改良内侧上颌骨切除术侧未见复发,另侧复发6例,两组复发率差异有显著性(P<0.05)。结论:改良内侧上颌骨切除术使鼻息肉病患者术后复发率显著降低,治疗效果显著,是一种可供选择的有效的治疗手段。     

Gastroesophageal reflux disease (GERD), extraesophageal reflux (EER) and recurrent chronic rhinosinusitis

Chronic polypoid rhinosinusitis (CRS) is a common disease, affecting approximately 16% of the adult population in the US every year. In addition to many well known predisposing factors, an association with reflux disease is hypothesized. Such an association might explain the recurrence of polyposis in the face of improved surgical techniques and postsurgical treatment of CRS. At present it is unclear whether extraesophageal reflux directly injures the sinus mucosa, whether gastroesophageal reflux leads to vagus-mediated neuroinflammatory changes, or whether both mechanisms occur separately or simultaneously. In patients suffering from recurrent CRS (n=20) and healthy volunteers (n=20), ambulatory 24 h two channel pH testing was performed. The number of reflux events, the fraction of the total time during which pH was below 4, and the reflux area index (RAI) were determined in the esophagus as well as in the hypopharynx. Patients with recurrent CRS had significantly more reflux events in the esophagus and the fraction of pH<4 and the RAI were increased up to 10-fold compared to healthy volunteers. In contrast to the esophagus, these differences were not observed in the hypopharynx. Recurrent CRS is often associated with GERD but not with EER. Recurrent disease or prolonged recovery after surgery should raise the suspicion of reflux disease as a possible triggering factor. Because GERD itself cannot be diagnosed by laryngoscopy, and because of the subjectivity of symptoms such as heartburn, the otolaryngologist should consider double-probe pH testing as the diagnostic procedure of choice.     

兔实验性上颌窦炎模型的制备和扩大上颌窦自然开口的疗效

目的 探讨实验性上颌窦炎动物模型的制备方法，并在此基础上讨论扩大兔上颌窦自然开口对慢性上颌窦炎的治疗效果。方法 40只新西兰大白兔分为6组；空白对照组(5侧)，假手术对照组(10侧)、窦口阻塞组(13侧)，仅注入细菌组(10侧)窦口阻塞加注入金黄色葡萄球菌组(20侧)，窦口阻塞加注入肺炎链球菌组(22侧)；将鼻窦炎模型再分为窦口开放和窦口扩大两组，观察术后不同时间的窦腔脓性分泌物和细菌培养情况。结果 对照组(空白对照组 假手术对照组)细菌培养阳性率为13．3％(2／15侧)，窦口阻塞组为84．6％(1l／13侧)，仅注入细菌组为10．0％(1／10侧)，窦口阻塞加注入金黄色葡萄球菌和肺炎链球菌组均为100．0％(20／20侧，22／22侧)。扩大上颌窦自然开口对实验性上颌窦炎的有效率达80.8％(21／26侧)，开放上颌窦窦口对实验性上颌窦炎的有效率达50．0％(8／16侧)。结论 窦口阻塞加注入细菌的方法可成功制造实验性上颌窦炎模型，窦口扩大术对实验性上颌窦炎的疗效较窦口开放术好。     

伴有齿槽嵴裂的单侧唇裂术后继发鼻畸形的修复

目的探讨伴有齿槽嵴裂的单侧唇裂术后继发鼻畸形的修复方法。方法对34例伴有齿槽嵴裂的单侧唇裂术后继发畸形的患者,在行齿槽嵴植骨的同时,行彻底的鼻整形手术。结果术后随访1~3年,植骨区成活良好,鼻畸形较整形前明显改善,接近正常外形,效果满意。结论在行齿槽嵴植骨的同时,行彻底的鼻整形手术,能够取得满意的效果,并且节省了医疗费用,缩短了治疗时间。     

ATP下鼻甲注射治疗药物性鼻炎的价值

目的 探讨ATP下鼻甲注射治疗药物性鼻炎的价值,并对ATP治疗药物性鼻炎的机理进行分析。方法 对80例采用ATP下鼻甲注射治疗(ATP组)与40例采用激光治疗(激光组)作疗效比较。结果 ATP组有效率(95％),与激光组(100％),疗效相当,无显著性差异(P>0.05)。结论ATP下鼻甲注射治疗药物性鼻炎疗效佳,起效快,痛苦小,简便易行,费用低廉,且无毒、副作用,值得推广。     

鼻息肉上皮细胞凋亡与bcl-2的表达及意义

目的　了解细胞的凋亡和癌基因bcl 2在鼻息肉的发病机制中的作用。方法　应用免疫组织化学的方法检测 45例鼻息肉细胞凋亡早期蛋白 (M3 0 )和bcl 2的表达 ,用下鼻甲粘膜作自身对照。结果　鼻息肉上皮和下鼻甲粘膜上皮的M3 0指数分别为 0 482± 0 3 2 ;1 0 62± 0 5 47,其差别有统计学意义 (P <0 0 1)。bcl 2阳性细胞在鼻息肉表层上皮和腺上皮均有表达 ,在下鼻甲中未见表达 ,其指数为 14 5 1± 4 46。结论　鼻息肉的发病机制及其生长过程与上皮细胞的增殖和凋亡的失平衡有关。bcl 2的表达可能是鼻息肉上皮凋亡抑制的原因 ,在鼻息肉上皮细胞增殖和凋亡失平衡的过程中起重要作用     

Effects of topical anti-inflammatory drugs on eosinophil survival primed by epithelial cells. Additive effect of glucocorticoids and nedocromil sodium

Background Eosinophil infiltration is a hallmark of the inflammatory response in rhinitis and in nasal polypcsis. Objective We studied the effect of steroids and nedocromil sodium on eosinophil survival primed by epithelial cells from healthy (nasal mucosa) and inflamed (nasal polyp) respiratory tissue. Methods Blood eosinophils were incubated with increasing concentrations (10^-11 10^-5 M) of topical steroids (fiuticasone propionate, budesonide, triamcinolone acetonide and beclomethasone dipropionate) and/or nedocromil sodium prior to the addition of human epithelial cell conditioned media (HECM), eosinophil viability was measured and IC₅₀ for each drug was calculated. Results All four steroids and nedocromil sodium caused a dose-related inhibition of HECM-induced eosinophil survival. The IC₅₀ of steroids were lower in eosinophils primed by mucosa HECM than on those primed by polyp HECM (fluticasone, 4nM vs 114nM: budesonide, 21 nM vs 280 nM; triamcinolone, 7 nM vs 853 nM; and beclomethasone, 171 nM vs 181 nM). The combined inhibitory effect of 10^-7M budesonide plus 10^-5M nedocromil (43.8 ± 10.8%, P < 0.03) was significantly higher than budesonide (28.5 ± 9.2%) or nedocromil (16.7 ± 5.4%) alone and close to 10^-5M budesonide (52.3 ± 11%). No differences were found in cytokine (IL-8, IL-6, GM-CSF, TNFα, IL-lβ and RANTES) concentrations between HECM from mucosa and polyps. Conclusion These results suggest that topical anti-inflammatory drugs may diminish airway eosinophilic infiltration by decreasing eosinophil viability, that nasal polyp epithelial cell secretions may induce steroid resistance in eosinophils, and that nedocromil sodium has additive effects with steroids.