口服免疫疗法:前景如何?

自1911年首先为花粉症患者应用脱敏疗法以提高对“花粉毒”的免疫性以来,一直认为花粉提取液应通过注射途径给药。由于逐渐了解到注射变应原可能发生的危险,1920年以后就试图通过别的途径给药,如鼻局部应用或口服。继续谋求其他给药途径的目的在于避免或减少发生过敏反应的危险性和增进临床效果。有关口服免疫疗法虽曾有过一些乐观的报道,但直到最近才有令人信服的对照试验结果。Taudorf等报道了桦花粉肠溶胶囊口服治疗花     

Sinonasal malignancy: what's new?

Tumors of the nasal cavity are located at a complex anatomic site and show a huge histological diversity. Although dealing with a rare malignancy, the last decade has brought--besides new histological and clinical classifications--a variety of new insights into etiological agents, tumor biology and therapeutic concepts as well as valuable overviews of rare histological subtypes. This review tries to disentangle the different medical and scientific aspects of the most frequently encountered histological types of tumors in the nasal cavity and the paranasal sinuses. We concentrate on epidemiology, classification, etiology, cytogenetics and molecular genetics, outcome and prognosis as well as treatment modalities, as far as the past few years have brought considerable new insights. Our principal aim is to provide the clinician with important data from publications of the last decade.     

Adenoidectomy: does it work?

Adenoidectomy is a common, routine paediatric operation for which the evidence base for effectiveness is lacking. While there is a broad evidence base of variable quality for other common children's ENT operations, most published data including adenoidectomy is combined with the effect of combined tonsillectomy or grommet surgery. For the common indications for adenoidectomy, does it work?     

Nasal septal packing: which one?

The aim of this study was to investigate the effects of four different types of nasal packs on pain, nasal fullness and postoperative bleeding following septoplasty. Prospective randomised double blind study was conducted. The study group included 119 patients who underwent endonasal septoplasty under general anaesthesia. Four types of nasal packing materials were utilized: (1) Merocel standard 8-cm nasal dressing without airway, (2) Doyle Combo splint (DCS), (3) Merocel in a glove finger and (4) Vaseline gauze. All packs were removed at the 48th hour (±3?h) after the surgery. Three different variables were investigated following the surgical procedure: (1) pain, (2) nasal fullness and (3) bleeding after removal of the nasal packing material. DCS produced the greatest pain at the first and sixth postoperative hours. At the first postoperative day, the greatest pain score was reported for Merocel in the glove finger and the least for Merocel. The pain scores during the removal of the nasal packings were highest for Merocel and lowest for Merocel in the glove finger. DCS had the lowest nasal fullness score. Bleeding ratio was highest for Merocel, followed by Vaseline gauze, DCS and Merocel in the glove finger. Many different commercially available packing materials are presently used, each with inherent advantages and disadvantages. We evaluated the pain, nasal fullness and bleeding potential of four nasal packing materials and determined that Merocel had the highest pain potential during removal and the highest rate of bleeding following removal.     

Tympanometry by general practitioners: reliable?

BACKGROUND: The diagnosis of otitis media with effusion (OME) is difficult using only medical history and otoscopy. Tympanometry may, therefore, be helpful in the diagnosis and follow-up of OME in general practice. Studies regarding the reliability of tympanogram production and validation of tympanogram outcome have been performed. OBJECTIVE: To gain insight into the usability of microtympanometry and the degree of agreement and accuracy of tympanogram classification in general practice. METHODS: Data were collected in the offices of 49 general practitioners (GP's). The usability of the microtymp was monitored against a checklist. GP's (39) classified 47 tympanograms according to Jerger's modified classification, designating them as 'OME', 'no OME' or 'interpretion impossible'. The gold standard was the consensus over the 47 tympanograms reached by three doctors very experienced in tympanometry. RESULTS: Of the general practitioners, 61% handled the microtymp faultlessly. The overall inter-observer agreement was moderate to substantial; with respect to the gold standard 74% of the general practitioners had a satisfactory to almost perfect agreement. These results were achieved after instruction and training; longer practice produced no significant improvement in the agreement. CONCLUSION: After training and instruction microtympanometry is a reliable diagnostic instrument in general practice. The classification of tympanograms is satisfactory. Classification problems arise when the curve is not a good one. Additional criteria for the assessment of the curves are proposed.     

Electronystagmography: how helpful is it?

Two hundred and sixty patients tested with electronystagmography (ENG) for evaluation of complaints of disequilibrium were the representative sample for this study. As all new dizzy patients currently receive an ENG, the goal of this project was to determine how much an ENG adds to the diagnostic acumen, and which patients really needed an ENG in order to maximize efficiency and minimize patient cost. Results indicate the suspected diagnosis prior to ENG is assisted by its use only when the cause is thought to be central or is uncertain. The percentage of unknown causes of disequilibrium decreased from 34.2 to 13.8 per cent and the percentage of central causes increased from 13.1 to 23.1 per cent. Electronystagmography does not significantly aid in the diagnosis of peripheral lesions except as confirmation. Specific findings and recommendations are discussed.     

Percutaneous tracheostomy: ready or not?

A novel approach to tracheostomy has recently been introduced, based on the Seldinger guide-wire technique. A well-packaged percutaneous tracheostomy kit promises a rapid and safe alternative to the traditional surgical tracheostomy. At the National Defence Medical Centre, this percutaneous approach was tried on four patients. Deficiencies in the kit instruments were discovered which, with the expected "learning curve," led to unexpected difficulties. Thus, the promise of percutaneous tracheostomy remains as yet unfulfilled.