高分辨率CT对慢性化脓性中耳炎术前病变评估及术式选择的临床价值

【目的】 探讨颞骨高分辨率CT( HRCT) 对慢性化脓性中耳炎术前病变评估及术式选择的临床价值。【方法】 收集慢性化脓性中耳炎患者77例术前HRCT检查, 按HRCT检查提示有无中耳骨质破坏分为A、B组,将术中所见(包括上鼓室、鼓窦病变组织性质,听骨链缺损及咽鼓管鼓室口病变,解剖异常) 与术前颞骨HRCT诊断比较。【结果】 A组32例HRCT显示上鼓室、鼓窦、乳突有软组织影充填,无骨质吸收或破坏, 均行鼓窦凿开探查, 5例行封闭式鼓室成形术,21例行开放式鼓室成形术,6例行鼓窦探查术+鼓膜成形术,术中上鼓室鼓窦病变组织性质(肉芽、胆脂瘤)、听骨链病变、咽鼓管鼓室口病变与HRCT诊断符合率分别为68.8%、0、66.7%、60%;B组45例HRCT显示上鼓室、鼓窦、乳突有软组织影充填,骨质有吸收或破坏,3例行封闭式鼓室成形术,40例行开放式鼓室成形术,2例行乳突根治术,术中上鼓室鼓窦病变组织性质(肉芽、胆脂瘤)、听骨链病变、咽鼓管鼓室口病变与术前CT显示的病变符合率分别75%、89.7%、90%、64.3%。HRCT较好显示中耳乳突解剖异常(乙状窦前位、天盖低位、颈静脉高位)及乙状窦壁、天盖、骨性半规管骨质破坏情况,与术中发现符合率100%。【结论】 颞骨HRCT检查对慢性化脓性中耳炎术式选择、手术入路和病灶清除及手术的安全性有重要参考价值,对上鼓室鼓窦病变性质、听骨链破坏评估的准确性存在一定局限性,随着中耳病变加重并出现骨质破坏,准确性相应增加。     

56例乳突根治手术失败原因分析

我科自 1988年至 1998年共收治中耳乳突手术后再次行乳突根治术患者 56例 ,现对乳突根治术失败原因分析如下。1　临床资料56例中 ,男 35例 ,女 2 1例 ,年龄最小为 11岁 ,最大为 68岁 ,第一次手术至本次手术时间 ,最长的 2 3年 ,最短的 32ｄ ,其中已行二次根治术者 8例。再一次手术均在局麻及手术显微镜下操作 ,无发生面瘫者 ,术中所见病变主要有①病灶清除不彻底 :乳突气房未全部敞开 ,其中发现中下鼓室胆脂瘤或肉芽 9例 ,上鼓室 ,鼓室胆脂瘤 35例 ,乳突腔胆脂瘤 32例。②引流不畅 :其中外道口狭窄 2 9例 ,鼓窦入口狭窄包括肉芽填塞 19例 ,…     

75例开放式鼓室成形术治疗体会

目的　探讨开放式鼓室成形术对中耳手术的疗效。方法　采用乳突轮角化清除鼓窦、乳突病变后 ,开放鼓室 ,清除鼓室病变 ,并进行听力重建 75例分析。结果　 75例术后均获得干耳。结论　开放式鼓室成形术能较好、较彻底地清除鼓室各部病变 ,术后效果优于传统手术方法。     

自体乳突皮质骨粉在中耳乳突手术中的应用

目的总结自体乳突皮质骨粉在中耳乳突手术中的应用价值及经验体会。方法对慢性化脓性中耳炎、胆脂瘤中耳炎患者46例术中应用了自体乳突皮质骨粉修复填充,其中乳突根治术19例,乳突病变切除+鼓室成型术27例。开放乳突前以大号切割钻磨削乳突皮质骨,收集骨粉备用,术中以骨粉填充上鼓室或封闭鼓窦入口,并填充缩小乳突腔,骨粉表面覆盖筋膜。结果所有病例术后术腔明显缩小,平均干耳时间为6周,3个月内干耳率为95.7%(44/46),行鼓室成型术者鼓膜形态正常,无回缩袋形成。结论自体乳突皮质骨粉取材方便、易于塑形、无排斥反应,是中耳乳突手术中理想的修复填充材料。     

耳内窥镜乳突手术的临床应用

目的讨探耳内窥镜在中耳乳突手术中的应用。方法利用2.7mm、4.0mm直径和30°、70°,不同角度的硬质耳内窥镜对中耳各病变部位,尤其是对耳常规、耳显微镜不易窥清的病变隐蔽部位,和为减少病变复发进行手术以及常规乳突中耳炎症术后复查。结果耳内窥镜下行单纯乳突凿开术11耳,乳突根治术8耳,乳突根治 鼓室成形术16耳,一般术后1月术腔可达上皮化。用于复查耳常规、耳显微镜乳突术后14耳,发现胆脂瘤复发4耳,分泌性中耳炎置管引流术后10耳,发现所置管被堵塞2耳,均经采取相应措施得以康复。结论耳内窥镜手术是耳科手术的重要组成部分,并为耳常规、耳显微镜手术提供了可靠的保证。     

中耳胆脂瘤手术ICD-9-CM-3编码分析

手术治疗特别是中耳病变切除联合鼓室成形术是目前根治中耳胆脂瘤最主要的方法,依据2012年版的中耳炎手术分型指南内容,按照手术对外耳道后壁和鼓窦上鼓室侧壁处理方式不同,中耳病变切除具体类型和对应ICD-9-CM-3编码为:完壁式乳突根治术20.4900x009、开放式乳突根治术20.4900x008、完桥式乳突根治术20.49和上鼓室鼓窦切开术20.4900x007等,为避免上述手术编码的混淆,编码员应掌握每种术式的具体内涵。同时对于重要的其它手术操作如鼓室成形术19.4～19.5、耳甲腔成形术18.79、外耳道后壁重建术18.6和乳突缩窄术20.92等也不能漏编和多编。编码员应加强中耳结构和手术知识的学习,当不能确定手术具体类型时,应与耳鼻喉医师沟通,确定正确手术类型和内容时方可编码。     

乳突根治术后再行修正手术的适用范围与疗效观察

目的探讨乳突根治术后再行修正手术的适用范围并观察疗效。方法回顾分析乳突根治术后再行修正手术患者26例（胆脂瘤24例,慢性中耳炎2例）,乳突根治术后术耳均持续或间歇性流脓伴听力下降;其中22例行病变切除后听骨链重建,4例未行听骨链重建,予咽鼓管封闭;所有患者行耳甲腔成型、自体骨粉或耳后肌骨膜瓣乳突缩腔、自体软骨重建上鼓室及外耳道后壁,术中取中耳乳突分泌物与病变组织送培养及药敏试验。结果26例患者修正术后干耳时间（6.1±2.2）周,术后气导平均听阈（500、1000、2000、4000Hz）低于术前[（56.2±38.2）dBvs（62.2±28.4）dB],术后气骨导差（ABG）亦低于术前[（28.4±25.6）dBvs（38.4±14.6d）dB],手术前后比较差异均有统计学意义（均P＜0.05）。4例行咽鼓管封闭患者术后6个月听力气骨导与术前比较无明显变化,余22例患者术后6个月复查,术后ABG低于术前[（15.8±8.2）dBvs（35.5±13.6）dB,P＜0.05]。1例分泌物培养为铜绿假单胞菌的患者术后并发化脓性软骨膜炎,经多次清创及换药后治愈,遗留轻度耳廓畸形。所有患者随访26个月以上,疗效稳定。结论乳突根治术后不干耳的主要原因是中耳乳突病变组织残留、面神经嵴过高及耳道口狭小。再行修正手术时完全切除病变组织及乳突气房,使用耳后肌骨膜瓣与骨粉缩窄乳突腔,行耳甲腔成型术扩大外耳道口有助于引流,从而缩短干耳时间;可利用软骨重建上鼓室及外耳道后壁;人工听骨听力重建和鼓室成型术可提高患者听力;无条件行听力重建的患者,行咽鼓管鼓口阻塞封闭也可达到术后早期干耳的目标。     

乳突根治术后再手术的原因分析

乳突根治术是治疗慢性中耳炎常见手术 ,由于中耳乳突的显微解剖复杂 ,术者技术不够熟练 ,解剖不清 ,术中病变清除不彻底 ,术腔未开放 ,致引流不畅 ,外耳道口处理不当致术腔通气量与术腔表面积之间的正常比例关系失调等致术后长期流脓 ,需再次手术 ,1981～ 1999年笔者共收治乳突根治术后再手术 31例 (37耳 ) ,现根据术中所见 ,对再手术的原因及处理分析如下。1　临床资料1.1　一般资料 :本组患者 31例 (37耳 ) ,男 2 1例 ,女 10例 ,年龄 6～ 5 8岁 ,乳突根治术后的乳突再手术时间 1个月至 30年。乳突再次手术在全麻及显微镜下进行 ,2 8例随访…     

乳突再根治术58例分析

目的 :分析乳突根治失败的原因 ,探讨乳突再根治术的方法。方法 :对 5 8例乳突再根治术之术中所见及处理进行回顾性分析。结果 :乳突根治失败的原因主要是中耳乳突解剖结构复杂、手术难度大、病变组织清除不彻底、解剖变异术腔未完全开放、乳突气房残留、引流不畅、术后换药不当等。结论 :乳突根治术中应彻底清除气房及病变组织 ,通畅引流 ,最好能使用电钻并在显微镜下操作     

42例慢性化脓性中耳炎手术治疗失败的原因分析

目的:探讨慢性化脓性中耳炎乳突根治、鼓室成形术后症状复发或不干耳的原因,以提高手术技巧及中耳炎治愈率。方法:回顾性分析42例(44耳)乳突改良根治术后再次住院的临床资料。结果:39例患者经乳突再次根治手术后经门诊随访1~2年,均获得干耳,2例患者经术后患耳仍有间断流液,经局部滴用抗感染药及坚持换药18个月后1例获得干耳,1例患者仍在换药中,术后2年干耳率为97.6%。结论:对中耳解剖结构的不熟悉,手术经验不足、技巧欠佳,残留病变气房及病灶清除不彻底,面神经嵴过高、外耳道狭窄等导致引流不畅,术后未按时换药清理等是乳突根治术失败的主要原因,显微镜下彻底清除病灶并确保术腔的引流通畅,尽早使术腔上皮化是防止手术失败的关键。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.