鼻内镜下多种入路手术治疗上颌窦病变

目的：探讨鼻内镜下不同入路处理上颌窦病变的方法及其适应证。方法245例上颌窦病变患者,采用鼻内镜下中鼻道上颌窦开窗术、下鼻道上颌窦开窗术、犬齿窝入路上颌窦开窗术、鼻腔外侧壁切开术、鼻腔外侧壁切除术不同入路进行手术治疗。结果245例患者手术顺利,无手术并发症发生。185例慢性鼻窦炎合并上颌窦炎患者治愈144例,好转39例,无效2例;上颌窦囊肿、真菌性鼻窦炎、上颌窦内翻性乳头状瘤及乳头状瘤癌变患者均无复发。结论单纯行中鼻道上颌窦开窗术可处理绝大部分的上颌窦囊肿、上颌窦出血性坏死性息肉、累及上颌窦的真菌性上颌窦炎及慢性鼻窦炎,而对于累及上颌窦前内的病变,可适当将上颌窦开窗口向前扩大。当上颌窦发育较大,齿槽隐窝较明显时,采用中鼻道、下鼻道上颌窦开窗术联合犬齿窝入路。泪前隐窝区域病变采用鼻内镜下鼻腔外侧壁切开术。广泛侵及上颌窦及鼻腔外侧壁（如下鼻甲）的恶性肿瘤,则需要采用鼻腔外侧壁切除术。     

鼻内镜下鼻道双钻孔上颌窦囊肿吸切术36例报告

上颌窦囊肿是耳鼻喉科常见病、多发病,随着鼻内镜的问世,经鼻下鼻道开窗、经上颌窦自然开口、泪前隐窝入路等术式相继开展。2004年8月～2009年3月,我们实施鼻内镜下鼻道双钻孔上颌窦囊肿吸切术36例,取得良好效果。现报告如下。     

真菌性鼻窦炎47例临床分析

目的 探讨对真菌性鼻·鼻窦炎的诊治方法.方法对47例真菌性鼻·鼻窦炎患者的临床资料进行回顾性分析.结果 47例均有不同程度鼻塞症状;流脓涕并具有臭味,有时鼻腔内排出黑褐色团块;患侧头痛,放射至眼周,部分患者伴有流泪、眼周胀痛等症状.行CT检查,病变以上颌窦为主,部分累及筛窦及蝶窦;窦腔内有不同程度的密度增高,病变窦内致密模糊,有散在钙化斑,窦壁受压呈膨胀性改变;17例中心可见点状钙化斑,4例上颌窦内侧壁骨质吸收,5例上颌窦内侧壁移向鼻腔,鼻道内可见软组织影.均行鼻内镜下鼻窦根治术,术后均行病理检查确诊.本组均治愈,随访6个月～3年无复发.结论 真菌性鼻窦炎经组织病理学检查确诊;鼻窦CT检查有辅助诊断价值,鼻内镜下鼻窦根治术是本病的主要治疗手段.     

经鼻内镜治疗真菌性鼻窦炎20例体会

随着广谱抗生素和激素的广泛应用，真菌性鼻窦炎的发病有上升趋势。1999～2004年，我们于鼻内镜下治疗真菌性鼻窦炎20例，效果较好。现将体会报告如下。资料与方法：20例真菌性鼻窦炎患者，男7例，女13例；年龄22～68岁，平均34岁。病程6个月～15a。其中病变局限于单纯上颌窦12例，同时侵及筛窦6例．仅累及蝶窦2例。均单侧发病。表现为涕中带血6例，鼻塞、脓涕等10例，头痛4例。鼻内镜检查示鼻中隔偏曲2例，中鼻甲息肉变6例，钩突肥大4例，中鼻道灰褐色干酪样物8例。     

鼻内镜手术治疗非侵袭性真菌性上颌窦炎的疗效

真菌性上颌窦炎根据菌群致病类型不同,分为非侵袭性真菌性上颌窦炎和侵袭性真菌性上颌窦炎两大类。非侵袭性真菌性上颌窦炎只局限于上颌窦腔内,不侵犯黏膜和骨壁,造成毗邻组织损伤〔1〕。临床多表现为鼻塞、流脓涕,涕有恶臭味等。鼻内窥镜及监视系统是一项近年来广泛应用于鼻科疾病治疗的技术,因其可以伸入狭窄的鼻腔和鼻道内,对鼻腔鼻窦进行精细治疗,故创伤小,预后良好〔2〕。本文就非侵袭性真菌性上颌窦炎患者进行分组对比治疗,分析鼻内镜手术疗效。     

可调节探钩在高血压患者真菌性上颌窦炎手术中的应用

目的 探讨鼻内镜下应用可调节探钩治疗高血压患者真菌性上颌窦炎的疗效.方法 随机将63例非侵袭性真菌性上颌窦炎高血压患者分为两组：A组32例,采用鼻内镜下中鼻道径路结合术中应用可调节探钩径路治疗;B组31例,采用鼻内镜下经中、下鼻道联合径路治疗.术后随访半年,比较两组疗效,同时观察患者术后舒适程度及血压波动情况.结果 A组治愈31例,治愈率96.9％;B组治愈29例,治愈率93.5％.A组术后反应轻,不适程度小,血压波动小;B组术后反应重,疼痛显著,血压波动大,两组比较差异有统计学意义（P＜0.05）.结论 相比较经鼻内镜下中、下鼻道联合径路,鼻内镜下中鼻道径路结合术中应用可调节探钩治疗高血压患者真菌性上颌窦炎具有血压波动小、疼痛轻、出血少、创伤小、恢复快的优点,符合微创理念,值得临床推广.     

70°鼻内镜下上颌窦真菌球手术治疗的效果分析

目的 探讨70°鼻内镜下上颌窦真菌球的手术治疗效果.方法 对40例经0°鼻内镜手术(A组)和40例经70°鼻内镜手术(B组)的患者于术后1年时应用电子鼻咽喉镜分别检查两种手术后上颌窦真菌球存在情况,对比两组间的疗效差异.结果 所有80例术后1年上颌窦开放口均开放良好.A、B二组病例中,上颌窦内有真菌团块存在者分别为9例和1例,B组疗效优于A组(χ2=7.31,P＜0.01).结论 70°鼻内镜下经中鼻道入路进行上颌窦真菌球手术治疗是一种安全、可靠和有效的治疗方法,比0°手术治疗为优.     

真菌性鼻窦炎 CT 影像学的非特征性表现

目的：回顾性分析真菌性鼻窦炎（ FRS） CT影像学的非特征性表现,旨在提高其术前诊断的准确性。方法收集109例FRS患者,分析其CT影像学的非特征性表现,并与临床表现、术中所见及病理结果进行横向比较。结果109例FRS患者中,病变侵及单侧上颌窦67例,单侧蝶窦9例,单侧筛窦4例,双侧上颌窦7例,双侧蝶窦2例,双侧筛窦2例;同时累及上颌窦、筛窦7例,蝶窦、筛窦8例;全组鼻窦3例。骨质不同程度增生硬化34例,骨质局限性破坏吸收17例。87例窦腔内有钙化影,22例可见密度均匀或不均匀增高的软组织影。结论 FRS的CT影像学表现,除特征性的病窦内钙化影外,亦可表现为病窦内密度均匀或不均匀增高的软组织影,多伴骨壁压迫性破坏吸收或骨质增生硬化。     

嗅神经母细胞瘤误诊为出血性息肉1例报告

患者女，49岁，因右侧鼻塞6个月，鼻出血4个月于2005年9月10日收入院。6个月前患者出现右侧鼻腔阻塞，持续加重，4个月前右鼻腔开始出血，间断发作，量少。半个月前CT发现右侧鼻腔肿物。查体见右侧鼻腔血凝团块，清除后见中鼻道内暗红色新生物及少量坏死组织。初步诊断为“鼻腔肿物（右）”。鼻CT扫描示右侧中下鼻甲外形增大，右上颌窦自然口受压闭塞，右上颌窦、右蝶窦及右筛窦炎症。     

下鼻道钻孔鼻内窥镜下治疗上颌窦良性占位171例疗效分析

鼻内窥镜下手术治疗慢性鼻窦炎和鼻息肉的有效性已被临床所证实,也有取代柯-陆氏手术之势,但在处理上颌窦较重病变(乳头状瘤、真菌性鼻窦炎等)时常受视野、进路等限制。2001-2004年,我院采用鼻内窥镜下下鼻道钻孔术治疗上颌窦良性占位性病变171例,疗效满意。现报告如下。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.