外耳道胆脂瘤的临床诊疗进展

目的外耳道胆脂瘤（EACC）是耳鼻咽喉科的一种少见疾病，早期病变特征不典型，常被漏诊、误诊，虽为良性肿瘤，但其生物学上具有侵蚀性，早期诊断、早期治疗非常重要。由于其发病率比较低，关于分型、分期国际上尚无统一标准，治疗方式主要包括保守治疗和手术清理胆脂瘤病变，因此需要进一步收集更多的数据进行全面的研究。本文系统地回顾国内外相关文献，并总结分析EACC的病因、发病机制及临床特点，详细描述EACC的诊断与治疗情况，以期引起耳科医师的重视，给临床提供一些帮助。     

Severe Obesity Increases Risk of Infection After Revision Total Hip Arthroplasty

BackgroundThe increasing prevalence of obesity has resulted in an increased number of revision total hip arthroplasties (rTHAs) performed in patients with a high body mass index (BMI). The aim of this study is to evaluate whether obesity negatively affects (1) complication rate, (2) reoperation and revision rate, and (3) patient-reported outcome in rTHA.MethodsIn this registry-based study, we prospectively followed 444 rTHAs (cup: n = 265, stem: n = 57, both: n = 122) performed in a specialized high-volume orthopedic center between 2013 and 2015. The number of complications, and reoperation and revision surgery was registered until 5 years postoperatively. Oxford Hip Score (OHS) was evaluated preoperatively, and at 1 and 2 years postoperatively. Patients were categorized based on BMI to nonobese (<30 kg/m², n = 328), obese (30-35 kg/m², n = 82), and severe obese (≥35 kg/m², n = 34).ResultsSevere obese patients, but not obese patients, had higher risks of complications and re-revision than nonobese patients. In particular, the risk of infection following rTHA was higher in severe obese patients (24%) compared to nonobese patients (3%; relative risk, 7.7). Severe obese patients had overall poorer OHS than nonobese patients, but improvement in OHS did not differ between severe obese and nonobese patients. No differences between obese and nonobese groups on OHS were observed.ConclusionIn our study, severe obesity was associated with an increased risk of infection following rTHA. Patients with high BMI should be counseled appropriately before surgery.