南京地区社区成年健康人群鼻咽部机会致病菌携带情况调查

目的了解南京地区社区成年健康人群鼻咽部机会致病菌携带情况。方法对南京地区社区1019例成年健康者进行非感染状态下鼻咽拭子菌种鉴定。结果鼻咽部检出率较高的机会致病菌依次为凝固酶阴性葡萄球菌、金黄色葡萄球菌、嗜血杆菌属、肺炎链球菌和肺炎克雷伯杆菌;单一菌群携带率为30.7%,复合致病菌携带率为3.4%,总携带率为34.2%;随年龄增长,金黄色葡萄球菌、嗜血杆菌属的检出率显著降低(P<0.05)。结论南京地区社区健康成年人群鼻咽部普遍存在大量凝固酶阴性葡萄球菌,同时金黄色葡萄球菌、嗜血杆菌属、肺炎链球菌和肺炎克雷伯菌等亦有较高检出率。     

直视下小切口胃肠胆囊切除术护理配合的研究

目的探讨直视下小切口胃肠胆囊切除术护理配合。方法分析直视下小切口胃肠胆囊切除术护理配合全过程。结果患者经治疗及护理后平均6d痊愈出院,术后无严重并发症发生。结论直视下小切口胃肠胆囊切除术全过程护理配合,疗效确切,治愈率高,手术时间短,创伤小,患者痛苦轻,恢复快,住院时间短。是一种比较受欢迎的手术方式。     

Rapid identification of noncapsulated Streptococcus pneumoniae in nasopharyngeal samples allowing detection of co-colonization and reevaluation of prevalence

Noncapsulated pneumococci are atypical Streptococcus pneumoniae that lack a capsule and therefore do not react with any available antisera. These isolates, which are often referred as nontypeable pneumococci (NTPn), are difficult to identify as their differentiation from closely related species such as Streptococcus pseudopneumoniae and other streptococcus of the mitis group is not always straightforward. We developed a low-cost and easy assay to detect and quantify NTPn in primary samples (which may contain multiple species) obtained from nasopharyngeal swabs. The strategy is based on a multiplex polymerase chain reaction targeting lytA, cpsA, aliB-like ORF2, and 16S rDNA genes, plus a restriction fragment length polymorphism assay to differentiate typical from atypical lytA. The application of the proposed methodology to over 500 nasopharyngeal samples found that the prevalence of NTPn in colonization was 3-fold higher than that estimated by routine methods (from 2.9% to 8.6% in the study collection). The international clone Norway^NTST344 was the major clone identified.     

Outcome of Acute Otitis Media and its Relation to Clinical Features and Nasopharyngeal Colonization at the Time of Diagnosis

Children ( n = 115; age range 1-9 years) with a diagnosis of acute otitis media (AOM) were eligible for this study and were enrolled within 24 h of the onset of symptoms signs. A nasopharyngeal culture was obtained at the initial visit. Children were treated with a single oral antibiotic for 7 days. Changes in symptoms signs and tympanic membrane features assessed by a scoring system were monitored for 1 month and related to the nasopharyngeal pathogen recovered on Day 1. More than 80% of children had no symptoms signs by Day 3, and 60% of cases had normal tympanic membranes by Day 29. Children without any symptoms signs on Day 3 had significantly lower symptom sign scores on Day 1 ( p = 0.005). Seventy-nine percent of cases carried middle ear pathogens in the nasopharynx at diagnosis: Streptococcus pneumoniae (48%); Haemophilus influenzae (24%); and Moraxella catarrhalis (16%). Children with S. pneumoniae showed significantly higher tympanic membrane scores than children with no pathogen at Days 8, 15 and 29 ( p < 0.01 for each comparison). Multivariate regression analysis revealed that lower tympanic membrane score on Day 1, the absence of S. pneumoniae in the nasopharynx and treatment with amoxillin were independent factors for rapid normalization of the tympanic membrane. These data suggest that the clinical course of AOM may be predicted, in part, at the time of diagnosis by means of careful evaluation of symptoms signs and the tympanic membrane as well as knowledge of pathogens harbored in the nasopharynx.     

The nasopharynx in infants with cleft lip and palate

Objective

The purpose of this study was to use three-dimensional computed tomography data and computer imaging technology to assess the skeletal components of the naso-pharyngeal area in patients with cleft lip and palate and to quantify anatomical variations.

Methods

CT scans were obtained from 29 patients of Malay origin with cleft lip and palate aged between 0 and 12 months and 12 noncleft patients in the same age group, using a GE Lightspeed Plus Scanner housed in Hospital Universiti Sains Malaysia. Measurements were obtained using the ‘Persona’ three-dimensional software package, developed at Australian Craniofacial Unit, Adelaide.

Results

The results of the present study show that there is an increased nasopharyngeal space in cleft lip and palate that may lead to compression of the nasopharyngeal structures, including the Eustachian tube. Alterations of the medial pterygoid plate and the hamulus may lead to an alteration in the origin and orientation of the tensor veli palatini muscle leading to alteration in its function.

Conclusions

These anatomical variations may compromise the dilatory mechanism of the Eustachian tube, thus leading to recurrent middle ear infections in cleft children and subsequent loss of hearing.     

Aspects anatomocliniques des métastases cérébrales des carcinomes nasopharyngés

Metastasis to the central nervous system, either through a hematogenous route or through the cerebrospinal fluid, is extremely rare in nasopharynx cancer. We aim to expose clinical aspects, therapeutic features and prognosis of nasopharyngeal carcinoma with brain metastases. We retrospectively reviewed the medical history of about 420 patients with nasopharyngeal carcinoma treated during 17 years at the university hospital of Sfax (Tunisia). Among them, three patients had brain metastasis. We excluded patients with direct extension to the brain. Tumours of the nasopharynx were locally advanced. The first patient had brain metastases at the initial diagnosis. The two other patients had brain metastases at 10 and 16 months during the follow-up. Ocular signs were the symptoms. Lesions were unique in two patients. Synchronous bone metastases were recorded in the three cases. All patients had whole brain radiation therapy and palliative chemotherapy. All patients had a progression of the disease and died. Brain metastases in nasopharynx cancer represent a rare event. Prognosis is poor, depending on age, surgical excision and synchronous metastases. Survival does not exceed 6 months.     

Olfactory bulb volume and olfactory function after radiotherapy in patients with nasopharyngeal cancer

Objective

Radiotherapy is the primary method of treatment for nasopharyngeal cancer (NPC) and many side effects were reported in patients receiving radiation to this area. This study was conducted to evaluate the long-term effects of radiotherapy following NPC on olfactory bulb (OB) volume and olfactory function.

Methods

Twenty-four patients with NPC who received radiotherapy at least 12 months ago were recruited. Fourteen healthy subjects with similar demographical characteristics were recruited as the healthy control group. All volunteers were subjected to a nasoendoscopical examination, and abnormalities that could potentially cause olfactory dysfunction were the exclusion criteria from the study. An experienced radiologist segmented the MRI coronal, axial and sagittal slices manually for three-dimensional OB volume measurement in a blinded manner. Olfactory function was assessed using the Connecticut Chemosensory Clinical Research Center (CCCRC) test, and average score (0: worst, 7: best) was calculated as the total CCCRC olfactory score.

Results

The mean CCCRC score was 5.5 ± 1.1 for the nasopharyngeal cancer patients, whereas the mean score of healthy control group was 6.4 ± 0.4. There was a significant difference in the olfactory scores (p = 0.003). The mean OB volume in the NPC group was 46.7 ± 12.1 mm³. Among the patients with NPC, the cisplatin receiving group had a mean OB volume of 47.2 mm³, whereas the cisplatin + docetaxel receiving group had a mean OB volume of 46.5 mm³, and they were similar. The MRI measurement of the healthy control group was 58.6 ± 13.8 mm³. The OB volumes of the healthy control group were significantly higher (p < 0.05).

Conclusion

Radiotherapy following nasopharyngeal cancer results in a diminished OB volume and deteriorated olfactory function. Chemosensory olfactory dysfunction might be a contributing factor to lack of appetite, cancer cachexia and consequent lowered quality of life in NPC patients.     

啮蚀艾肯菌致鼻咽颅底感染1例报道

目的 总结1例啮蚀艾肯菌引起鼻咽颅底感染的诊疗经验,提高对该菌感染病的认识。方法 回顾性分析1例啮蚀艾肯菌致鼻咽颅底感染患者的病例资料,并结合文献进行讨论。结果 本例患者完善内镜检查、影像学检查以及实验室检查,鼻咽颅底组织2次病理报告均为慢性肉芽肿性炎,经实验室确诊为啮蚀艾肯菌感染,予清创引流、口服抗生素2个月后,患者痊愈,术后随访3个月未复发。结论 鼻咽颅底感染临床少见,临床症状、影像学检查与鼻咽癌相似。啮蚀艾肯菌为罕见致病菌,发病率低。诊治上,需结合病理学、病原学检查明确诊断,及早清创引流、选取合适的抗感染药物。     

放大喉镜在鼻咽部检查中的应用

目的 评价放大喉镜在鼻咽部检查中的应用价值.方法 对耳鼻咽喉科就诊的6774例患者施行放大喉镜下鼻咽部检查,连接影像工作系统记录图像文字资料,可疑病变在放大喉镜或鼻内镜直视下取活检.结果 患者对放火喉镜的耐受率98.9%(6700/6774)明显优于间接鼻咽镜30.9%(2095/6774),差异有统计学意义(X~2=6872.75,P＜0.005).放大喉镜可清晰呈现鼻咽部多种病变,能及早发现可疑病变.615例曾分别用纤维鼻咽镜(192例)及鼻内镜(423例)检查显示鼻咽部隆起,放大喉镜检查发现其中418例双侧对称,表面光滑,未见异常,经病理检查证实为正常组织;其他197例于放大喉镜下也显示为鼻咽部隆起,经病理检查证实为各种良恶性病变.结论 放大喉镜检查光亮度强,分辨率高,能早期发现鼻咽部病变,诊断准确率和活检阳性率较高,对鼻咽部疾病诊断具有重要价值.     

Fibrosing inflammatory pseudotumor of the nasopharynx: MR features and histopathologic correlation

Pupose

To describe the magnetic resonance (MR) imaging features of six cases of pathologically proven fibrosing inflammatory pseudotumor involving the nasopharynx, and to compare the MR signal intensities of the lesions with histopathologic findings.

Methods

We reviewed the MR finding of six patients with pathologically proved fibrosing inflammatory pseudotumor at the nasopharyngeal wall with respect to the following points: extent, margins, signal intensity and enhancement degree of the lesion; cervical lymphadenopathy and response to steroid therapy. MR findings were correlated with histopathologic findings.

Results

All lesions showed ill-defined margins and looked less-likely contour bulging features. The signal intensity of the lesions was hypointense or slightly heterogeneous relative to brain cortex on both T1- and T2-weighted images, and enhancement was weakly homogeneous in all cases. There was no demonstrable cervical lymphadenopathy in all cases. After steroid therapy, the lesions showed decreased extent and weaker enhancement in three patients. Histopathologic findings showed high degree of polymorphous inflammatory cellular infiltration with underlying significant reactive fibrosis.

Conclusion

Fibrotic inflammatory pseudotumors involving nasopharynx are very rare, and can mimic malignancy. MR imaging showed ill-defined margins, hypointensity or slightly heterogenous signal intensity on T2-weighted image and weak enhancement. There was no significant cervical lymphadenopathy.