小儿化脓性中耳炎的病原学调查

目的　调查小儿化脓性中耳炎的主要病原菌及其对抗生素的耐药情况。方法　对 5 2例化脓性中耳炎患儿的中耳分泌物进行细菌培养 ,每份标本分别用 5 %～ 7%羊血平板和自制改良巧克力平板分离 ,置烛缸培养。对获得的病原菌用K -B纸片琼脂扩散法行药物敏感试验。结果　分离出 46株致病菌 ,嗜血杆菌 (15株 )和金黄色葡萄球菌为主 ,嗜血杆菌对青霉素和复方新诺明的耐药率分别为 83.3%和 40 % ,以金黄色葡萄球菌为主的临床常见菌对氨苄青霉素和氧哌嗪青霉素的耐药率分别为 95 .5 %和 5 4.2 %。结论　嗜血杆菌和金黄色葡萄球菌是本地区小儿化脓性中耳炎的主要致病菌 ,两者对青霉素类抗生素的耐药率皆较高。     

自制黄连滴耳液的临床疗效观察

目的　探讨自制黄连滴耳液治疗中耳炎的疗效。方法　应用自行研制的黄连滴耳液滴耳 ,早中晚各一次 ,每次 3～ 5滴 ,治疗急、慢性化脓性中耳炎 4 5例 ,并与常规治疗组用 3%氧氟沙星滴耳液滴耳 4 5例作对照。结果　治疗组总有效率为 93.3% ,对照组总有效率为 82 .2 2 % ,用 χ2 检验 ,两者有显著性差异 (P <0 .0 1)。结论　复方黄连滴耳液对急慢性化脓性中耳炎具有较好的有效性、安全性、实用性。 3%氧氟沙星滴耳液只有抗菌作用 ,而无黄连滴耳液直接促进中耳粘膜干燥、消肿止痛和收敛渗湿之功效。     

Effect of platelet-activating factor on secretion of mucous glycoprotein from chinchilla middle ear epithelial cells in vitro

Platelet-activating factor (PAF) is a naturally occurring phospholipid that acts as a pleiotropic mediator and mediates cell-cell reactions under physiological and pathological conditions. Recently, it has been shown that PAF is a strong secretagogue of mucous glycoprotein in the airways, suggesting its role in mucous glycoprotein secretion and the pathogenesis of otitis media with effusion. In the current study, we examined the effect of PAF on mucous glycoprotein secretion in cultured chinchilla middle ear epithelial cells. PAF at 1 M significantly stimulated mucous glycoprotein secretion from cultured chinchilla middle ear epithelial cells. This action was concentration-dependent, with secretions reaching near maximum when the cells were incubated with PAF at 100 M. In a time-dependent study, PAF demonstrated an initial rapid stimulation of mucous glycoprotein secretion, followed by a gradual increase thereafter. A six-fold increase was seen in the first 2 h compared with controls. Cycloheximide, a protein synthesis inhibitor, demonstrated an inhibitory effect on PAF-stimulated mucous glycoprotein secretion in this study. These findings suggest that PAF plays an important role in the pathogenesis of otitis media with effusion by stimulating mucous glycoprotein secretion in vitro.Supported by NIH grant P0I-D000133 from the National Institute on Deafness and Other Communication Disorders.     

Epidemiology of chronic suppurative otitis media and deafness in a rural area and developing an intervention strategy

Of 613 children evaluated in a village in Haryana 94 (15.3%) were observed to have chronic suppurative otitis media (CSOM). Fifty eight (61.7%) children had hearing impairment. CSOM contributed to 71.6% of the hearing impaired (58/81). On analysis of association of CSOM with literacy and socio-economic status of mothers, and age, sex, and upper respiratory tract infections (URI) in children positive correlation was observed only with URIs (P<0.001). Literacy and socio-economic status of the mothers did not correlate significantly with knowledge about treatment seeking, and ear cleaning practices, probably due to the narrow range of incomes and literacy levels. An intervention program consisting of play, demonstrations, health charts and slogans, and aural cleaning and antibiotic drops was introduced.     

分泌性中耳炎对内耳听觉功能的影响

为了解分泌性中耳炎（ Ｏ Ｍ Ｅ）对内耳听觉功能的影响,对 Ｏ Ｍ Ｅ２２０ 例、３０４ 耳分别进行纯音测听及声阻抗测定。结果表明,部分 Ｏ Ｍ Ｅ 患者骨导听阈升高,除造成传音性耳聋外,合并感音性耳聋（ Ｓ Ｎ Ｈ Ｌ）为３１８％ ,并随着病程延长, Ｓ Ｎ Ｈ Ｌ 发病率增高。提示应积极有效地治疗本病,应用扩血管及营养神经药物可防治 Ｓ Ｎ Ｈ Ｌ的发生。     

Cardiac effects of contrast media in MR angiography: evaluation in an experimental model of myocardial ischemia

RATIONALE AND OBJECTIVES: The authors evaluated the cardiac tolerability of paramagnetic contrast agents for magnetic resonance (MR) angiography in an in vitro model of ischemic rat heart. MATERIALS AND METHODS: The left anterior descending coronary artery was temporarily occluded in a perfused rat heart model to induce cardiac ischemia and reperfusion. A dose of 0.4 mL of gadobenate dimeglumine, of gadopentetate dimeglumine, or of D-mannitol was injected directly into the aorta both during the ischemia and during the reperfusion period. The left ventricular pressure and heart rate were recorded. RESULTS: Myocardial ischemia resulted in decreased cardiac activity, with a reduction in left ventricular pressure and heart rate. A further decrease in cardiac activity was temporarily induced by injection of contrast medium during both the ischemic and early reperfusion phases. Less marked responses were induced by a hyperosmolal solution of mannitol. CONCLUSION: These results suggest that the transient cardiac effects induced by bolus injection of paramagnetic contrast medium may be regarded as the combined effects of the osmotoxicity of the contrast medium solution and the chemotoxicity of the contrast medium molecule.     

Time-resolved MR angiography of the upper abdomen: initial clinical experience

In this study, thirty-eight patients with a variety of upper abdominal diseases were examined with three-dimensional time-resolved MR angiography (7 sec/data set). Visualisation of arterial and venous anatomy was excellent in the majority of patients. Moreover, subtraction images could be calculated and organ perfusion could be assessed. It is concluded that this technique opens new perspectives for a comprehensive evaluation of vascular and parenchymal disease. Received: 14 April 1998; Revision received: 23 October 1998; Accepted: 9 November 1998     

Benign and malignant hepatocellular tumors: evaluation of tumoral enhancement after mangafodipir trisodium injection on MR imaging

The aim of this work was to study the ability of mangafodipir trisodium (Mn-DPDP)-enhanced MR imaging in differentiating malignant from benign hepatocellular tumors. Eleven patients with pathologically proved hepatocellular carcinomas, six with focal nodular hyperplasias, and one with a single hepatocellular adenoma were examined by spin-echo and gradient-echo T1-weighted sequences before, 1 h after, and 24 h after intravenous injection of Mn-DPDP (5 μmol/kg). Quantitative analysis including enhancement and lesion-to-liver contrast-to-noise ratio, and qualitative analysis including the presence of a central area and a capsule were done on pre- and post-Mn-DPDP-enhanced images. Enhancement was observed in all the tumors with significant improvement (p < 0.05) in contrast-to-noise ratio 1 h after, and 24 h after intravenous injection of Mn-DPDP. There were no significant differences in the mean enhancement and the mean contrast-to-noise ratio (CNR) between benign and malignant tumors. No enhancement was seen within internal areas observed in 7 hepatocellular carcinomas, and in 5 focal nodular hyperplasias, and within capsules which were observed in 9 hepatocellular carcinomas. In our study, Mn-DPDP increased CNR of both benign and malignant tumors but did not enable differentiation between benign and malignant tumors of hepatocellular nature. Received: 7 October 1997; Revision received: 25 February 1998; Accepted: 10 July 1998