腭扁桃体乳头状肥大

本病罕见。Roberts(1896)第一次描述为扁桃体乳头状瘤,Ogino和Matsui(1924)首次作了报告。日本共报告35例(包括作者们的5例)。世界文献在近十年内仅发现1例。本文报告一例5岁半女孩。主诉咽部异物感,检查双侧腭扁桃体中度肥大,表面呈多发性,不同大小而质软的乳头状增生,但无溃疡、粘连或脓液。咽扁桃体肥大但不呈乳头状。在全麻下作了扁桃体和增殖体切除术。扁桃体标本测量,右3.2×3.1×2.Ocm,左2.9×1.6×1.2cm,重量:右6克,左4.2克。病理检查:扁桃体表面呈乳头状,隐窝深,淋巴组绸生发中心增大且数量增多,复层鳞状上皮有局灶性损害,并有大量多核白细胞浸润。     

0～6岁听力损失儿童的发现年龄及发现途径

目的探讨0~6岁听力损失患儿的发现年龄、发现途径及其听力特点。方法自制调查问卷表,随机对在北京同仁医院就诊的265例双侧听力损失患儿的一般情况、发现年龄、发现途径和听力损失程度等进行问卷调查,并对其听力进行确认,相关数据作了统计学分析。结果265例听力损失患儿的平均(x-±s,下同)发现年龄(23·21±10·02)个月,平均首诊年龄(28·01±13·41)个月;从性别和地区分析,女孩的平均发现年龄(27·11±13·13)个月,较男孩的(21·03±12·32)个月晚约6·1个月(t=2·421,P<0·05),农村地区听力损失患儿的平均发现年龄为(28·27±11·09)个月,较城市听力损失患儿的(19·52±13·05)个月晚8·65个月(t=-3·675,P>0·05)。从发现途径分析,通过言语发育异常被发现的听力损失患儿较其他途径的发现年龄晚(P>0·05);从听力损失程度分析,听力损失程度轻度和中度比极重度者发现年龄晚(P<0·05)。结论普通耳科门诊就诊听力损失患儿的平均发现年龄和首诊年龄都比较晚,特别是农村地区及听力损失程度轻者尤为突出。因此,推行新生儿及婴幼儿听力损失的早期筛查和干预,加强耳聋知识的宣传,提高家长的防聋治聋意识,是非常有必要的。     

镫骨足板与前庭器的三维形态研究及其临床意义

目的通过对镫骨、球囊和椭圆囊三者之间的空间关系进行三维测量,为小窗人工镫骨植入术中足板开窗位置提供优化设计的依据。方法取新鲜颞骨标本4块,不脱钙聚合物包埋,骨切片机连续薄切片,经图像处理重建前庭腔、椭圆囊、球囊、镫骨等结构,以镫骨足板为假设水平面,对在此平面下椭圆囊和球囊做等高线图,同时进行镫骨足板与椭圆囊、球囊的垂直距离的三维测量。结果椭圆囊与球囊之间存在一“V”形裂隙,其夹角17·0°~68·0°,平均(x-±s,下同)为(50·31±19·90)°,变异较大。“V”形端点接近于镫骨足板中心点的内侧,并指向前上方向;“V”形裂隙的开口指向后下方向。三维测量结果显示,足板中点与前庭器结构的垂直距离为(2·20±0·55)mm,最大3·0mm,最小1·6mm。结论镫骨足板的后下象限可能为足板开窗的最佳位置。     

扁桃体软剥离术100例效果观察

我们采用弯止血钳夹持湿棉球替代金属剥离子 ,实现了止血与剥离同步的手术方法 ,效果满意。一、临床资料1993～ 1998年对 2 0 0例住院患者实施扁桃体切除术。手术适应证选择参照教科书标准。随机分为两组 :治疗组 (软剥离术 ) 10 0例 ,男女之比为 5 2∶48,年龄8～ 6 0岁 ,平均 (2 4 5± 10 7)岁 ( ｘ±ｓ,下同 ) ;对照组 (传统剥离术 ) 10 0例 ,男女之比 5 5∶45 ,年龄 7～ 5 9岁 ,平均 (2 4 8± 11 2 )岁。二组资料显示 ,性别和年龄相当 ,扁桃体局部改变和病理检查结果差异无显著性。二、方法患者取坐位 ,麻醉用 2 %利多卡因10ｍｌ以生理…     

不同年龄患者腭扁桃体的电镜和电镜放射自显影研究

为了深入研究不同年龄组腭扁桃体功能状态,作者对4组共54例因慢性扁桃体炎而摘除的扁桃体采用电镜和电镜放射自显影的方法进行了研究。作放射自显影时,从病变最轻的部位取1.0×0.5mm 组织块,放入盛5ml199培养基与10%小牛血清之小瓶内(38℃),然后分别加入胸腺嘧啶-~3H、脲嘧啶-~3H 及脯氨酸-~3H、甘氨酸-~3H 和组氨酸-~3H 的混合氨基酸,于38℃孵育90分钟,用法进行放射自显影。采用胸-~3H 是为可显示能进行分裂的细胞,脲-~3H 是用来判断各种 RNA 生命的情     

低温等离子扁桃体切除术后出血临床分析CSCD

目的分析低温等离子扁桃体切除患者术后出血临床特征,探讨可能的危险因素。方法回顾性分析联勤保障部队第九〇八医院耳鼻咽喉科诊治的574例行低温等离子扁桃体切除术患者术后出血临床特点及可能危险因素,探讨不同出血部位与出血程度的关系,分析不同年龄组术后出血特征区别。结果术后总出血率为5.40%(31/574),以继发性出血为主,单因素分析结果显示>14岁组和≤14岁组患者术后出血率分别为8.30%(22/265)和2.91%(9/309),差异比较有统计学意义(P<0.01);扁桃体切除术+UPPP患者术后出血率为10.77%(7/65),比单纯扁桃体切除术患者(6.45%,16/248)及扁桃体切除术+腺样体切除术患者(3.07%,8/261)明显增高,差异比较有统计学意义(P<0.05);多因素二元Logistic回归分析结果显示年龄与术后出血呈显著相关(r=1.522,P<0.01);7例扁桃体下极出血中严重出血4例,明显高于扁桃体中段出血(0例)和扁桃体上极出血(1例),差异比较有统计学意义(P<0.01);不同年龄组在出血类型、出血程度及出血部位方面差异比较均无统计学意义(P均>0.05)。结论年龄是低温等离子扁桃体切除术后出血的独立危险因素,扁桃体下极出血与术后严重出血显著相关。     

慢性扁桃体炎病人腭扁桃体内T和B淋巴细胞的生物化学和免疫特性

从38例慢性扁桃体炎病人的腭扁桃体分离出淋巴细胞混悬液,研究其生化和免疫特性。结果:E-玫瑰花值42.52±1.17%,E-早玫瑰花值30.62±1.41%,红细胞抗体补体(EAC)11.96±2%,红细胞抗体(EA)10.34±1.25%。作者认为各家研究结果不一的原因,是由于测定的方法不一致。年龄与腭扁桃体淋巴细胞玫瑰花形成能力有关。扁桃体淋巴细胞E-玫瑰花值较恒定;E-早     

腺相关病毒介导的内皮抑素对鼻咽癌移植瘤生长和转移的抑制作用

目的研究重组腺相关病毒介导的人内皮抑素对裸鼠鼻咽癌肝脏异位移植瘤生长和转移的抑制作用。方法检测携带人内皮抑素的重组腺相关病毒(RECOMBINANT ADENO-ASSOCIATED VIRUSCARRYING HUMAN ENDOSTATIN GENE,RAAV-HENDO)体外感染效率、蛋白表达及生物活性。建立裸鼠鼻咽癌肝脏异位移植瘤动物模型,经尾静脉分别注射携带人内皮抑素基因的RAAV-HENDO(HENDO组)、携带增强型绿色荧光蛋白基因的RAAV-EGFP(RAAV-CARRYING ENHANCED GREEN FLUORESCENT PROTEIN GENE,RAAV-EGFP,EGFP组)和磷酸缓冲液(PBS组),观察动物肝脏成瘤、肺转移及生存期等情况,免疫组化检测肿瘤微血管密度,原位末端标记(TERMINAL DEOXYNUCLEOTIDYL TRANSFERASE-MEDIATED DUTP NICK-END-LABELING,TUNEL)法检测肿瘤细胞凋亡指数。结果体外实验表明:RAAV体外感染效率达98%;免疫荧光染色显示内皮抑素蛋白主要表达于细胞质;RAAV-HENDO感染细胞培养上清对ECV304细胞72H增殖抑制率为67·3%。动物实验表明:相对PBS组,HENDO组抑瘤率为70·7%;HENDO组、EGFP组、PBS组肺转移率分别为0·0%、50·0%、66·7%;微血管平均(X-±S,以下同)密度分别为(3·67±1·63)、(19·67±2·16)、(22·50±3·02),组间比较差异有统计学意义(P<0·01);凋亡平均指数分别为(28·83±5·27)%、(6·17±2·79)%、(4·50±2·17)%,组间比较差异有统计学意义(P<0·01);3组动物平均生存期分别为(36·50±8·46)D、(24·00±5·66)D、(21·17±3·92)D,组间比较差异有统计学意义(P<0·01)。结论重组腺相关病毒介导的内皮抑素能有效抑制裸鼠鼻咽癌肝脏异位移植瘤的生长和转移,其可能机制为抑制肿瘤新生血管形成,诱导肿瘤细胞凋亡。     

鼻科学

20050573嗅相关神经的临床解剖学观测/朱杭军…//临床耳鼻咽喉科杂志·2005,19(2)·76~78目的:了解嗅神经的正常走行及其与视神经、鼻窦之间的关系,为临床开展相关手术提供解剖学资料,并为预防鼻窦手术中嗅神经损伤提供解剖学依据。方法:在16例32侧成人尸头上对嗅神经、嗅束、嗅球进行解剖测量,并观察其与视神经、鼻窦之间的关系。结果:嗅束的长度为(29·33±2·11)mm,中点处宽度为(3·36±0·83)mm,嗅束中点内侧距前颅底中线垂直距离为(5·48±1·02)mm,嗅束与矢状线之间夹角为(21·32±3·28)°,嗅球长度为(10·43±2·35)mm,宽度为(5·12…     

~(133)氙清除法测定正常与病变扁桃体的血流

扁桃体病变时可以产生血流动力学变化,但文献中尚无定量测定腭扁桃体的血流的报导。作者采用~(133)氙清除法测定正常人扁桃体和慢性扁桃体炎以及肥大型扁桃体的血流。扁桃体/血液分离系数由~(133)氙水/气、红细胞/气、血浆/气和扁桃体匀浆/气分离系数的数值计算,并与血球比积功能做出曲线图。受检对象为:正常人10例,平均年龄27.2岁;慢性扁桃体炎11例,平均25.1岁;肥大型扁桃体11例,平均25.5岁。总计32例,平均25.9岁。慢性扁桃体炎的诊断标准是:反复咽喉痛史,口臭,前柱充血,扁桃体有脓栓或挤压出脓栓,颈淋巴结肿大。肥大型扁桃体的诊断标准是:无常发扁桃体炎史,扁桃体肥大,妨碍发音和吞咽,局部检查无任何感染体征。在检查前,受检者禁烟,一小时内要在保持恒温为20.8±1.2℃和相对湿度为51.57±1.85%的实验室内进行。检查时平静呼吸,不要咳嗽、     

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance Angiogenesis is essential for tumour growth and invasion. Vascular endothelial growth factor (VEGF) is a prime mediator of tumour angiogenesis. VEGF‐C is a closely related protein that effects lymphatic endothelial cells and may be important in the process of lymphatic metastasis. The purpose of this study was to evaluate the expression of these cytokines in patients with T1 and T2a glottic, squamous cell carcinoma, in comparison with normal epithelial control tissue, to ascertain any association with radioresistance. Twenty‐two tumours treated by radiotherapy (13 radiosensitive, nine radioresistant) and seven normal control tissues were studied. The minimum follow‐up was 2 years after radiotherapy. Expression of VEGF and VEGF‐C was evaluated by immunohistochemistry of formalin‐fixed, paraffin‐embedded biopsy specimens. Analysis was carried out using a quantitative computer image analyser. Both VEGF and VEGF‐C were detectable in tumour and normal control specimens. There was increased expression in tumour specimens of both VEGF (P = 0.03) and VEGF‐C (P < 0.001). In addition, the expression of VEGF‐C was associated with tumours of higher histological grade (P = 0.021). There was, however, no difference in VEGF and VEGF‐C expression between radioresistant and radiosensitive tumours. The expression of VEGF and VEGF‐C is increased in early laryngeal squamous cell carcinoma (SCC). However, measuring the expression of these proteins cannot predict radioresistance in this tumour group.     

Treatment of Maxillary Sinus Carcinoma: Clinical Results Using the Kitasato Modality

The conventional therapeutic regimen for maxillary sinus carcinoma consists of dissection of the maxilla, full-dose irradiation and extensive chemotherapy. However, the results obtained with this treatment are often poor. Even when patients recover, their quality of life is significantly reduced as a result of deformity of facial structures and swallowing and articulation dysfunctions. A retrospective analysis of 68 patients with maxillary sinus carcinoma treated with the Kitasato modality between 1975 and 1999 was conducted. All patients underwent pergingival maxillary sinus surgery combined with pre- and postoperative irradiation therapy with standardized total doses of 16 Gy; the postoperative irradiation was given in combination with regional intra-arterial infusion chemotherapy administered via the superficial temporal artery. All visible tumor lesions were removed where possible in order to preserve or facilitate cellular immunity after surgery. The cumulative 5-year survival rates were 85.7% for Stage II patients, 88.1% for Stage III, 76.6% for Stage IVA and 75.0% for Stage IVB.     

Tongue Base Reduction with Temperature-controlled Radiofrequency Volumetric Tissue Reduction for Treatment of Obstructive Sleep Apnea Syndrome

In recent years a considerable effort has been made to establish the use of different surgical techniques for the treatment of obstructive sleep apnea syndrome (OSAS). Nevertheless, treatment of hypopharyngeal obstruction due to tongue base hypertrophy remains in many ways an unsolved problem. The aim of this study was to evaluate the safety and efficacy of tongue base reduction with temperature-controlled radiofrequency volumetric tissue reduction in the treatment of OSAS. Twenty patients with OSAS and tongue base hypertrophy were treated with radiofrequency tissue ablation. An intensified treatment protocol was used, delivering 2,800 J per treatment session under local anesthesia. Two nights of polysomnography testing were performed before and after treatment. Daytime sleepiness, snoring and postoperative morbidity were assessed using questionnaires. Mean respiratory disturbance index (RDI) was reduced from 32.1 to 24.9/h after a mean of 3.4 treatment sessions. Six patients (33%) were cured after the procedure (reduction in RDI of &#83 50% and a postoperative RDI of <15/h) and ten (55%) showed an improvement of >20% in their RDI. Daytime sleepiness and snoring improved significantly. Peri- and postoperative morbidity was low; one severe complication occurred (tongue base abscess). We were able to achieve similar cure and responder rates to those reported in a recently published pilot study but with a reduced number of treatment sessions. We believe that this technique may improve patient acceptance and have beneficial cost implications.     

Cervical Reflex Induced by Click Stimuli in Cats

We studied click-evoked potentials in the anterior horn of the spinal cord in 17 cats. A concentric needle electrode was inserted into the anterior horn of the spinal cord at levels C3-C6. Potentials evoked with 105 dB SPL clicks were recorded with a peak latency of 4.89-5.10 ms only at the C3 level. These responses were observed 45-60 dB SPL above the auditory brainstem response (ABR) threshold, and no potentials were evoked by stimulation of the contralateral ear. Average was performed 100 times with changes in stimulation frequency of 1-20 Hz. The amplitude of the potentials decreased with increasing stimulus frequency, but there were no changes in ABRs. The responses disappeared after destruction of the medial vestibulospinal tract at the obex level, but ABRs were still recorded. The spinal nucleus of the accessory nerves was located in the anterior horn of the spinal cord at levels C1-C6, and the sternocleidomastoid muscle motoneurons were found at levels C1-C3. The click-evoked potentials recorded in this study reflect responses of the spinal nucleus of accessory nerves through the vestibulospinal tract to click stimulation. The responses have the same characteristics as vestibular-evoked myogenic potentials that can be recorded using surface electrodes over the sternocleidomastoid muscles of humans.     

Lack of significant estrogen and progesterone receptor expression in nasal telangiectasias in hereditary hemorrhagic telangiectasia: an immunohistochemical analysis

Obstructive sleep apnea syndrome (OSAS) is characterized by snoring and apnea during sleep leading to decreased oxygen saturation and disturbed sleep, excessive daytime sleepiness and neuropsychological disturbances. This study investigates cognitive neuropsychological abilities in a group of 53 OSAS patients before and after treatment with uvulopalatopharyngoplasty. General intellectual ability, verbal learning and memory as well as executive functioning were measured at baseline and 6 months postoperatively. After surgery there were significant improvements in verbal learning and memory (mean change - 39, SD 57.3, p <0.001), recall (mean change - 24.3, SD 39.3, p <0.001) and executive functioning (as assessed by percentage of errors on the Wisconsin Card Sorting Test; mean change-9.1, SD 15.7, p <0.001). These improvements were in accordance with improvements in the degree of sleep apnea, the oxygen desaturation index (mean change -9.7, SD 15.9, p <0.001) and arterial minimum oxygen saturation (mean change 4.5%, SD 10.2%, p <0.01). Surgical treatment seems to improve verbal learning, memory and recall and executive functions in parallel with better oxygenation in OSAS.     

Measurement of chemosensory function

Although hundreds of thousands of patients seek medical help annually for disorders of taste and smell, relatively few medical practitioners quantitatively test their patients' chemosensory function, taking their complaints at face value. This is clearly not the approach paid to patients complaining of visual, hearing, or balance problems. Accurate chemosensory testing is essential to establish the nature, degree, and veracity of a patient's complaint, as well as to aid in counseling and in monitoring the effectiveness of treatment strategies and decisions. In many cases, patients perseverate on chemosensory loss that objective assessment demonstrates has resolved. In other cases, patients are malingering. Olfactory testing is critical for not only establishing the validity and degree of the chemosensory dysfunction, but for helping patients place their dysfunction into perspective relative to the function of their peer group. It is well established, for example, that olfactory dysfunction is the rule, rather than the exception, in members of the older population. Moreover, it is now apparent that such dysfunction can be an early sign of neurodegenerative diseases such as Alzheimer's and Parkinson's. Importantly, older anosmics are three times more likely to die over the course of an ensuring five-year period than their normosmic peers, a situation that may be averted in some cases by appropriate nutritional and safety counseling. This review provides the clinician, as well as the academic and industrial researcher, with an overview of the available means for accurately assessing smell and taste function, including up-to-date information and normative data for advances in this field.