喉癌的磁共振成像表现：附24例分析

分析２４例喉癌术前磁共振成像（ＭＲＩ）所见，并与手术、病理对照。ＭＲＩ清楚地显示了喉癌的三维形态，使能正确判断会厌前间隙（ＰＥＳ）、喉旁间隙（ＰＧＳ）侵犯及喉软骨破坏，这对估计肿瘤能否切除及手术方式的选择具有重要参考意义。     

喉癌MRI分期评价

目的评价ＭＲＩ在喉癌术前Ｔ分期中的价值。方法对５９例喉癌的ＭＲＩ资料进行回顾性分期，并与纤维喉镜及手术病理对照。结果ＭＲＩ对各期喉癌分期的准确性分别是：Ｔ１：９５％（２０／２１），Ｔ２：８８％（１５／１７），Ｔ３：８５％（１１／１３）Ｔ４：１００％（８／８）。纤维喉镜分期的准确性是：Ｔ１：９１％（１９／２１），Ｔ２：８８％（１５／１７），Ｔ３：４７％（８／１３），Ｔ４：１３％（１／８）。结论ＭＲＩ能准确判断会厌前间隙（ＰＥＳ）、喉旁间隙（ＰＧＳ）浸润及软骨破坏，因而可显著提高喉癌术前分期的准确性，对临床治疗方案选择具有重要意义。     

热休克蛋白在喉癌中的表达

目的探讨热休克蛋白（ｈｅａｔｓｈｏｃｋｐｒｏｔｅｉｎｓ，ＨＳＰｓ）在喉癌组织及其正常喉粘膜中的表达。方法采用狭缝杂交（Ｓｌｏｔｂｌｏｔａｎａｌｙｓｉｓ）技术对２１例喉癌组织及其正常喉粘膜的ＨＳＰ９０、ＨＳＰ７０和ＨＳＰ２７ｍＲＮＡ表达水平进行检测。结果①ＨＳＰ９０α和ＨＳＰ７０在喉癌组织中呈过度表达，表达量是自身正常喉粘膜的５倍以上。②ＨＳＰ２７和ＨＳＰ９０β在喉癌组织及正常喉粘膜中呈低水平表达，其表达量在两种组织中差异无显著性。结论ＨＳＰ７０和ＨＳＰ９０α在喉癌的致病过程中起着重要的作用。弄清它们的作用机理，将为ＨＳＰｓ用于喉癌的生物治疗提供理论依据。     

喉癌术前MRI与术后全喉切片诊断作用的前瞻性研究

本文就９例喉癌术前以纤维喉镜为主的临床检查、ＭＲＩ检查与全喉切除后连续全器官病理切片检查的结果进行了前瞻性对比研究。主要从声门下区、声带、室带、声门上区等四个平面比较，发现术前进行ＭＲＩ可清晰而较准确地显示肿瘤向会厌前间隙、声带旁间隙、喉软骨支架等部位的侵犯范围，其与术后全器官病理切片在判断病变范围方面的符合率（８８．９％）远高于纤维喉镜检查与病理的符合率（４４％）。     

热休克蛋白在喉癌中的表达

目的 探讨热休克蛋白（ＨＳＰｓ）在喉癌组织及其正常喉粘膜中的表达。方法 采用狭缝杂交技术对２１例喉癌组织及其正常喉粘膜的ＨＳＰ９０、ＨＳＰ７０和ＨＳＰ２７ｍＲＮＡ表达水平进行检测。结果 ①ＨＳＰ９０α和ＨＳＰ７０在喉癌组织中呈过度表达，表达量是自身正常喉粘膜的５倍以上。②ＨＳＰ７０和ＨＳＰ９０β在喉癌组织及正常喉粘膜中呈低水平表达，其表达量在两种组织中差异无显著性。结论 ＨＳＰ７０和ＨＳＰ９０α在     

纤维喉镜与核磁共振（MRI）在喉癌诊断中的应用

将２５例喉癌的术前纤维喉镜检查和喉部ＭＲＩ与手术、病理进行比较，结果提示：纤维喉镜是喉癌诊断的最基本和最重要手段，能对Ｔ１、Ｔ２声门癌作出准确分期；ＭＲＩ对显示粘膜面肿瘤虽然并不重要，但能准确判断肿瘤对会厌前隙、声门旁隙、喉软骨及喉外的侵犯；两者作用互补，对喉癌的诊断、术前分期及手术方法的选择具有重要意义。     

同时性喉重复癌（附3例报告）

本文回顾性复习近年来从７０例喉癌中发现的３例同时性喉重复癌（ＬＳＭＰＣ），均为男性，平均年龄４２岁，发病率４２８％；ＬＳＭＰＣ的临床特征，尤其是喉癌发病部位及Ｔ分期与第二原发癌的诸多关系，与以异时性喉重复癌（ＬＭＭＰＣ）资料为主的喉重复癌资料进行比较，有许多差异。因此，ＬＳＭＰＣ并非少见，应对ＬＳＭＰＣ的临床特点、诊断与治疗给予足够的重视。     

喉鳞癌组织两种P糖蛋白单克隆抗体的检测

为了解喉鳞癌的多药耐药性，以期提高综合治疗中化疗的效果，采用免疫组化技术对未经任何治疗的喉鳞癌患者在手术中取出的新鲜肿瘤组织进行了Ｐ糖蛋白（Ｐ－ｇｌｙｃｏｐｒｏｔｅｉｎ，ＰＧＰ）单克隆抗体ＪＳＢ１及单克隆抗体Ｃ２１９的检测。对比了肿瘤组织分化程度、肿瘤大小及有无淋巴结转移与ＰＧＰ表达阳性之间的关系。结果发现，单抗ＰＧＰＪＳＢ１的阳性率为６５．２％（ｎ＝２３），而单抗Ｃ２１９检测的６例ＰＧＰ均为阴性，与分化无关，与肿瘤大小、转移亦无相关性。多药耐药因子的表达及其对于化疗的指导作用尚需进一步加以研究。建议当喉癌患者接受化学疗法时，可同时采用三苯氧胺（ＴＡＭ）为耐药调节剂以便提高治疗效果。     

喉癌术前放射治疗及单纯手术疗效比较

目的 探讨喉癌术前放射治疗加手术的治疗方式能否比单纯手术提高治愈率。方法 应用前瞻性的随机分组的方法进行临床试验。初治的喉癌病例（不包括声门型Ｔ１病变），年龄在７５岁以下，不伴有喉梗阻，经过临床检查确定解剖分型、ＴＮＭ分期（１９７８ＵＩＣＣ）及手术类型后，通过抽签的方法将患者分入单纯手术组（ＳＡ组）或综合治疗组（ＲＳ组）进行治疗。结果 共完成治疗３７０例，ＳＡ组２１５例，ＲＳ组１５５例，ＳＡ组３年     

喉癌患者血清唾液酸测定的临床意义

采用比色法对６１例喉鳞状细胞癌、２５例喉及颈部良性病变患者和４０例正常人的血清唾液酸（ＳＡ）含量进行测定。结果表明，喉癌患者血清ＳＡ含量高于良性病变患者和正常人，差异有极显著性意义（Ｐ＜０．０１）。以大于正常人血清ＳＡ含量的ｘ＋２ｓ为阳性，喉癌患者血清ＳＡ阳性率为６７．５％，良性疾病患者阳性率为１６．０％，差异有极显著性意义（Ｐ＜０．０１）。此外，血清ＳＡ含量与喉癌患者的临床分期及预后密切相关。提     

Speech-evoked brainstem response in normal adolescent and children speakers of Brazilian Portuguese

This study aimed to analyze the coding responses of speech sounds (syllable/da/) in children and adolescent speakers of Brazilian Portuguese with typical development and normal hearing, aged between 8 and 16 years, in order to establish normative data of speech ABR response. This normative data can be used as a reference for speech ABR responses and also to enable the diagnosis in individuals with different pathologies. The analyze for absolute latency of speech sounds, more specifically the syllable/da/, for speech-ABR in children and adolescent speakers of Brazilian Portuguese with typical development were: right ear - wave V (6,43–6,57), wave A (7,35–7,57), wave C (18,19–18,46), wave D (21,99–22,42), wave E (30,73–31,05), wave F (39,19–39,55) and wave O (47,75–48,24) and left ear - wave V (6,44–6,57), wave A (7,36–7,59), wave C (18,26–18,55), wave D (22,22 -22,50), wave E (30,58–30,97), wave F (39,05–39,35) and wave O (47,78–48,13). For the amplitude values (μv), the responses were within the following ranges: right ear - wave V (0,10–0,14), wave A (0,19–0,25), wave C (0,08–0,13), wave D (0,11–0,17), wave E (0,17–0,42), wave F (0,14–0,33) and wave O (0,11–0,31) and left ear - wave V (0,09–0,13), wave A (0,08–0,23), wave C (0,08–0,14), wave D (0,10–0,15), wave E (0,20–0,26), wave F (0,16–0,22) and wave O (0,12–0,20). For the values of complex VA (slope: μv/ms and area μv x ms) the follow values obtained were: right ear – slope (0,32–0,42) and area (0,29–0,38) and left ear – slope (0,30–0,39) and area (0,27–0,35).     

Streptococcus pneumoniae resistant to penicillin: Incidence and potential therapeutic options

Streptococcus pneumoniae was recovered from 12 (50%) samples of middle ear fluid of 24 consecutive patients with AOME and in mixed culture of middle ear pathogens from one (4%) additional specimen. Two (15.3%) isolates had intermediate resistance to penicillin (minimal inhibitory concentration (MIC) 0.125 and 1.0 μg/mL). The antimicrobial susceptibility to various antimicrobials of 30 S pneumoniae strains recovered from patients seen in the last 12 months was also determined. One of the patients with AOME developed bacteremia that resolved uneventfully, whereas the other developed meningitis. MIC₉₀ was determined from penicillin (2 μg/mL), erythromycin (>32 μg/mL), cefaclor (32 μg/mL), loracarbef (≥64 μg/mL), cefixime (16 μg/mL), ceftibuten (>64 μg/mL), chloramphenicol (16 μg/mL), cefpodoxime (4 μg/mL), ciprofloxacin (2 μg/mL), cephalexin (≥64 μg/mL), augmentin (2 μg/mL), cefprozil (8 μg/mL), clindamycin (64 μg/mL), TMP-SXT (>64 μg/mL), clarithromycin (32 μg/mL), rifampin (0.06 μg/mL), cefuroxime (2 μg/mL), cefotaxime (0.25 μg/mL), vancomycin (0.25 μg/mL), and imipenem (0.5 μg/mL). Cefprozil, vancomycin, and rifampin inhibited all strains, whereas cefpodoxime, cefuroxime, clindamycin, and clarithromycin exhibited very good activity.     

Ultrastructural abnormalities of the cilia in human nasal epithelia

Nasal mucosal cilia were observed with electron microscope in 14 patients with immotile cilia syndrome (ICS), 9 with nasal papilloma (NP), 23 with sinobronchial syndrome (SB), 2 with sinusitis combined with dextrocardia (SC), 1 with Kartagener's syndrome (KS), and 5 normal controls (C). Abnormalities such as complex cilia, cilia with abnormal axonemes and cilia with randomly oriented central microtubules were frequently found in the groups of ICS (8.1%) and NP (10.4%) while less in other groups: SB (4.9%), SC (5.3%), KS (4.7%) and C (3.9%). The percentage of cilia with defective dynein arms (DA) was the highest in the ICS group (94.0%), followed by the groups of SC (53.7%), SB (47.5%), NP (41.2%), C (35.8%) and KS (33.3%). The ICS group was found to be the largest in the number of defective DA per a cilium (4.1), followed by the groups of NP (1.0), SB (0.6), SC (0.7), KS (0.4) and C (0.4). Increased rates of defective DA were also recognized in cilia of tracheal mucosa and flagella of sperm in 7 patients with ICS examined. In conclusion, neither abnormal cilia nor defective DA of cilia are specific findings for ICS. However, when we observe these findings in high percentage in nasal mucosa as well as in other organs, we may define this condition as ICS.     

Neurologic findings in children with ear malformations

Cephalic neural crest cells contribute to the formation of the external and middle ears, the supporting cells of the statoacoustic ganglion, other cranial nerve components, and the face. The anlage of otic sensory structures receive inductive stimuli from adjacent rhombencephalic tissue. The complex series of interactions that guide organogenesis of the outer, middle, and inner ear structures may explain why neurologic dysfunction is likely to be associated with malformations of the ear. We reviewed the records of 100 patients with complex ear anomalies with or without hearing loss. Mean age was 4.2 years (range 1 day-27 years). Malformations, either bilateral (70) or unilateral (30), involved the external ear (94), middle ear (16), and/or inner ear (12). Eighty-five patients had neurologic dysfunction. Cranial nerve dysfunction was found in 56 patients and involved nerves VIII (39 auditory and/or vestibular), VII (22), II (11), VI (8), V (4), III (3), X (3), XII (1), and IX (1). Sixty-four patients had evidence of central nervous system dysfunction such as mental deficiency/developmental delay (44), non-paretic gait disorders (17), hypotonia (16), microcephaly (13), seizures (8), motor deficits (8), autistic features (7), and radiographically confirmed intracranial abnormalities (5). Eleven of 19 children with hypoactive vestibules had delayed motor development or poor balance. Seventy-four patients had anomalies in other organ systems: 56 craniofacial, 28 osseous, 19 cardiac, 16 genito-urinary, 14 ocular, 11 gastrointestinal, and 7 cutaneous. Sixty-one patients had syndromic conditions, 32 of them branchial arch syndromes. The level of cognitive competence was not related to severity of craniofacial, ear, or cranial nerve abnormality. Children with ear malformations deserve neurologic and pediatric evaluations in addition to an otologic work-up.     

A clinical treatise upon the nasal septal perforation]

Thirty nine cases of septal perforation of various origins were presented using clinical such as backgrounds age, gender, possible causes, and size of septal perforation evaluated by diameter. The cases included 26 males and 13 females with a mean age of 35 years range: 8 to 85 years. Possible causative factors were as follows: septal surgeries (9), other nasal and paranasal surgeries (17), nasal cautery or tamponade (2), occupational (2), collagen disease (2), inflammatory (1) and idiopathic (5). Signs and symptoms related to perforations were minor, such as stuffy nose (3), running nose (3), nosebleed (5), dry sensation (4), nasal pain (1), and asymptomatic (23). Sizes of perforations by largest diameter were small (less than 10 mm) in 7, moderate (11-20 mm) in 13, and large (more than 21 mm) in 6. The size of perforations tended to be variable, but two cases with collagen disease showed large perforations 35 mm. Although iatrogenic and idiopathic cases comprised the majority of cases (80%), such a few cases of grave significases as collagen and hematological diseases showed unusually large perforations.     

CO2激光与掺钕钇铝石榴石激光治疗声门型喉癌手术并发症的比较研究

目的 比较CO2和掺钕钇铝石榴石(Nd:YAG)两种激光治疗声门型喉癌的手术并发症的发生率,并探讨减少并发症的有效方法.方法 采用回顾性分析1999年1月1日至2008年12月31日在北京大学第一医院耳鼻咽喉头颈外科接受支撑喉镜下CO2和Nd:YAG激光治疗的83例患者的临床资料,比较两组并发症的发生率.CO2激光治疗组32例,其中原位癌2例,T1N0M021例,T2N0M0 8例,T3N0M0 1例,采用非接触式脉冲激光;Nd:YAG激光治疗组51例,原位癌3例,T1N0M0 36例,T1N2M0 3例,T2N0M0 9例,采用光纤接触式激光.结果 CO2激光并发症共4例(12.5%),其中喉软骨膜炎1例(3.1%),舌体麻木1例(3.1%),门齿松动1例(3.1%),皮下气肿1例(3.1%);Nd:YAG激光并发症27例(52.9%),其中术后出血2例(3.9%),呼吸困难5例(9.8%),喉软骨膜炎7例(13.7%),肺部感染4例(7.8%),舌体麻木2例(3.9%),咽颈瘘1例(2.0%),声带固定4例(7.8%),喉狭窄2例(3.9%).结论 Nd:YAG激光较CO2激光更易发生手术并发症,少数并发症需要紧急处理,通过适当预防措施可以减轻并发症,避免严重后果.     

10种移植物修复头颈缺损的体会

１９８３年１２月－１９９４年１２月应用１０种组织瓣修复头颈肿瘤切除术后缺损１０３例，其中吻合血管的髂骨游离移植１１例，带血管蒂的上斜方肌肌皮瓣７例，后置舌瓣２例，胸大肌肌皮瓣３０例，舌骨下肌皮瓣２２例，前额皮瓣２０例，外侧斜方肌肌皮瓣４例，胸锁乳突肌肌皮瓣２例，。胸锁乳突肌锁骨瓣２例，颈阔肌肌皮瓣３例。作者对不同移植物的利弊，适应证和临床应用体会进行了讨论。     

儿童吸气性喉喘鸣的病因分析

目的 探讨儿童吸气性喉喘鸣的发生原因,提高儿童吸气性喉喘鸣的诊治率.方法 回顾性分析2005年1月至2007年1月深圳市儿童医院住院的吸气性喉喘鸣患儿共378例,男245例,女133例;年龄12 h～30个月,中位年龄4个月.全部病例均行胸部X线摄片检查,218例进行了胸部CT扫描、电子喉镜、直接喉镜、纤维支气管镜等检查.结果 急性喉炎140例,喉软化117例,急性喉气管支气管炎54例,声带麻痹18例,先天性气管软化9例,先天性喉蹼8例,先天性喉裂6例,喉囊肿6例,喉乳头状瘤6例,急性会厌炎4例,先天性声门下狭窄3例,气管支气管异物3例,甲状舌管囊肿1例.除先天性气管软化9例,先天性喉裂6例,先天性声门下狭窄3例,声带麻痹18例,仅给予对症治疗外,复发性喉乳头状瘤尚在治疗中,其他病例均获痊愈.结论 儿童吸气性喉喘鸣病因复杂,以急性喉炎和喉软化最为多见.由炎症引起的喉喘鸣经保守治疗可获痊愈,电子喉镜检查是喉喘鸣患儿必要的检查手段,有时需配合胸部CT和纤维支气管镜检查.     

儿童腺样体肥大与耳鼻咽喉科常见疾病关系的研究进展

腺样体肥大(AH)是小儿耳鼻咽喉科的常见病、多发病。国内外学者关于AH的病因、临床症状及治疗方式均有深入研究并达成共识,但其与耳鼻咽喉科相关疾病的关系仍未得到广泛关注和重视。研究发现,AH与小儿耳鼻咽喉科的过敏性鼻炎(AR)、急慢性鼻-鼻窦炎(ARS/CRS)、急性中耳炎、分泌性中耳炎、中耳胆脂瘤、急慢性扁桃体炎、扁桃体肥大、儿童阻塞性睡眠呼吸暂停综合征(OSAS)及其他咽喉部疾病等均有密切联系。     

声带息肉手术前后嗓音声学分析及心理听觉评价

为建立嗓音主、客观综合检测方法，对３０例声带息肉患者手术前后测试嗓音频率微扰商、振幅微扰商、标准化噪声能量级；喉平均呼气流率；频闪喉镜下观察声带振动的规则性、对称性、闭合状态、粘膜波动、等质性。心理听觉评价分为音哑总分度、粗糙型、气息型、无力型、紧张型。经统计学相关分析检验证明：嗓音微扰值增大与声带振动的不规则有显著性相关；心理听觉评价中的粗糙型、气息型与声带振动的规则性、声门关闭状况及喉平均呼气流率有显著性相关。实验证明多参数嗓音综合检测分析方法对嗓音疾病的疗效评价是一种简单、实用、有效的方法。