影像技术在鼻咽部血管纤维瘤诊治中的应用

目的 探讨影像学技术在鼻咽部血管纤维瘤诊治中的作用。方法 对３例鼻咽部血管纤维瘤患者进行ＣＴ、ＭＲ、数字减影血管造影（DSA）检测,并对肿瘤供血动脉进行手术前栓塞。结果 CT、MR均能良好地显示鼻咽部血管纤维瘤的侵犯范围,CT对骨质侵犯显示清晰,MR同晨反映软组织侵犯范围方面优于CT。DSA可明确肿瘤血供,手术前栓塞可明显减少术中出血。结论 影像学技术在鼻咽部血管纤维瘤诊治中的合理应用,可提高本病的治疗效果。     

控制性降压在鼻咽血管纤维瘤手术中的应用

目的:探讨控制性降压在减少鼻咽血管纤维瘤术中出血的应用价值。方法:将32例鼻咽血管纤维瘤患者随机分为控制性降压组和对照组,每组各16例。控制性降压组在全麻下用硝普钠(sodium nitropruddide,SNP)进行降压,并对血流动力学和血气分析变化进行观察。结果:控制性降压组出血量为(465．5±146．7)ml,对照组出血量为(1454．5±289．3)ml;降压组手术时间为(90．92±28．3)min,对照组为(160．5±97．8)min,两组术中出血量和手术时间比较均有显著差异(P＜0．01)。结论:控制性降压是减少鼻咽血管纤维瘤术中出血的一种有效方法。     

鼻咽纤维血管瘤术前栓塞的价值

目的：探讨鼻咽纤维血管瘤术前栓塞的应用价值。方法：17例鼻咽纤维血管瘤患者,单纯手术摘除10例,术前3天进行数字减影血管造影（DSA）检查及血管内栓塞术7例。结果：7例术前栓塞组术中出血200～700mL,平均430mL;输血0-550mL;10例单纯手术组出血550～1430mL,平均1200mL,输血350～1200mL。术前栓塞组出血量和输血量较单纯手术组显著减少。结论：术前瘤体栓塞治疗鼻咽纤维血管瘤是安全有效、理想的术前辅助治疗手段。     

Le Fort I osteotomy for extensive juvenile nasopharyngeal angiofibroma: a retrospective study

INTRODUCTION: Juvenile nasopharyngeal angiofibroma (JNA) is a rare, nonencapsulated, benign neoplasm typically diagnosed in adolescent boys. Surgery is the usual treatment modality for JNA. The optimal surgical procedure should allow maximal exposure of the tumor for complete excision with minimum morbidity. One possible surgical approach is Le Fort I maxillary osteotomy. The aim of this study was to review our experience with the Le Fort I osteotomy and to investigate the feasibility of this approach for extensive JNA invaded into pterygopalatine and infratemporal fossae. METHODS: We retrospectively studied patients who had undergone JNA resection via the Le Fort I osteotomy approach from July 2000 to September 2007, considering tumor location and size, complications, and tumor recurrence associated with the surgical approach. RESULTS: Six patients of JNA (all boys; mean age, 15.5 years) were identified through the chart review. All the angiofibromas had extended into the pterygomaxillary space and infratemporal fossa. The mean follow-up for this cohort was 50.1 months. No intraoperative and postoperative complications were noted, except for slight diplopia in one patient due to injury of the left medial rectus muscle. There were no cases of tumor recurrence that could be attributed to the procedure. CONCLUSION: Our experience suggests that the Le Fort I osteotomy approach is a useful technique for the removal of extensive JNA invaded into pterygopalatine and infratemporal fossae. It has distinct advantages over traditional anterior or lateral approaches, providing a more direct vision, improved exposure, and cosmesis.     

鼻内镜下带吸引高频电刀切除鼻咽血管纤维瘤的治疗效果

目的探讨鼻内镜下带吸引高频电刀切除鼻咽血管纤维瘤的手术方法和治疗效果。方法回顾性分析2009年1月-2015年12月10例鼻咽血管纤维瘤的临床资料,全部患者均在鼻内镜下行带吸引高频电刀切除术,观察术中平均出血量、术后恢复时间、有无残留和复发。结果全部病例的肿瘤均一次性切除,平均出血量465 ml,无术后并发症,无残留,随访6~18个月无复发。结论尽管术前未行血管栓塞术,但在术中控制性低血压基础上,鼻内镜下带吸引高频电刀切除AndrewsⅡ期及以下(肿瘤局限鼻腔、鼻咽部及侵犯鼻窦)的鼻咽血管纤维瘤是可行的。     

术前血管栓塞治疗鼻咽纤维血管瘤1例报告

鼻咽纤维血管瘤常发生于青春期男性 ,发病原因不明。因其源于颅底 ,肿瘤生长扩张能力强 ,而且血供丰富易致凶猛的大出血 ,故临床上虽属良性 ,但发展甚恶。其治疗主要靠手术彻底切除 ,但由于瘤体血供丰富 ,术中出血量大 ,影响手术视野 ,给根治造成困难。我科采用术前动脉栓塞术 ,治疗 1例 ,取得满意疗效 ,现报告如下。图 1　鼻窦矢状位ＭＲＩ(Ｔ1 Ｗ )示肿瘤位于鼻咽部 ,涉及鼻腔后部。1　临床资料患者 ,男 ,19岁 ,因左侧进行性鼻塞伴反复出血 1年余 ,于 2 0 0 1年 2月 15日入院。患者鼻出血反复发作 ,轻重不一 ,曾于入院前 5个月和 1个月各…     

硬腭颊部联合径路切除侵犯翼腭窝鼻咽纤维血管瘤

目的探讨采用硬腭颊部联合径路切除侵犯翼腭窝鼻咽纤维血管瘤.方法总结1990年～2001年收治并经手术和病理证实的6例翼腭窝侵犯的鼻咽纤维血管瘤的手术方法.结果6例翼腭窝侵犯的鼻咽纤维血管瘤均一次完整切除.结论硬腭颊部联合径路是治疗侵犯翼腭窝鼻咽纤维血管瘤的有效手术方法.     

An Unusual Case of Wilson's Disease

A man of 61 with a 26-year history of progressive cerebellarataxia was admitted to hospital. He was found to have chronicliver disease and died 22 days after admission. A diagnosisof hepatolenticular degeneration (Wilson's disease) was supportedby clinical investigations and confirmed at autopsy, when tissuecopper studies were performed. Several unusual features werepresent, including a unilateral Kayser—Fleischer ring,a hepatocellular carcinoma, peripheral neuropathy, pontine demyelinationand calcification of neurones in the medulla. The significanceof these findings is discussed with a review of the relevantliterature.     

鼻咽未分化癌的疗效分析

目的：分析鼻咽未分化癌的治疗方法治疗效果。方法：鼻咽未分化癌46例，其中Ⅰ期1例，Ⅱ期5例，Ⅲ期25例，Ⅳ期15例。37例根治性放疗中，19例行放疗＋化疗（9例联合用药，10例单药化疗），18例行单纯放疗；9例因已出现远处转移或治疗中自行放弃行姑息性放疗。采用Kaplan-Meier方法进行生存率分析，显著性差异采用Log-rank检验。结果：①全组1、3、5、10年生存率分别为80．9％、47．6％、35．7％、28．6％，中位生存期为32个月。按分期的生存率曲线差异有显著性（P=0．0005）。②根治性放疗组中，局部控制率为75．7％（28／37例），局部病灶控制与否对生存曲线的影响有显著性差异（P=0．0417）。根治性放疗＋联合化疗与单纯根治性放疗的1、3、5、10年生存率分别为100％、75％、75％、62．5％和75％、50％、31．3％、25％，鼻咽未分化癌根治性放疗＋联合化疗疗效好于单纯根治性放疗（P=0．0811）。③姑息治疗的生存情况是1年生存率为55．5％（5／9例），无2年以上生存者。结论：①鼻咽未分化癌进展快，发生远处转移早，生存率差。②放射治疗敏感，是主要的有效方法；未发生远处转移的鼻咽未分化癌根治性放疗＋联合化疗可提高生存率。     

缝隙连接蛋白在鼻咽癌中的表达

【目的】探讨缝隙连接蛋白基因Connexin2 6、Connexin32 (Cx2 6、Cx32 )在鼻咽癌组织中的表达 ,研究分析Cx2 6、Cx32的表达与鼻咽癌之间的相关性。【方法】采用免疫组化检测 4 2例鼻咽慢性炎性黏膜活检组织和 4 9例鼻咽低分化鳞癌活检组织中Cx2 6、Cx32的表达。【结果】鼻咽低分化鳞癌组织中 ,Cx2 6、Cx32的表达分别为 6 1.2 %和 12 .2 % ,鼻咽慢性炎性黏膜组织中 ,Cx2 6、Cx32的表达分别为 95 .2 %和 85 .7%。两者比较 ,Cx2 6、Cx32在两种组织中的表达有显著性意义 (P <0 .0 1)。38例含有鳞状或柱状上皮的癌组织中 ,癌组织中Cx2 6表达为 5 2 .6 % ,明显低于鳞状或柱状上皮中的表达 97.4 % (P <0 .0 1) ;癌组织中Cx32表达为10 .5 % ,明显低于鳞状或柱状上皮中的表达 84 .2 % (P <0 .0 1)。【结论】Cx2 6、Cx32的表达异常与鼻咽组织癌变密切相关。     

Case Report: 6-Year-Old Male with Autism and Systemic Onset Juvenile Rheumatoid Arthritis

Autism is a developmental disorder characterized by pervasive social and communication impairments and restricted range of interests and activities. Although the specific cause is unknown, proposed etiologies for autism have included autoimmune dysregulation of cellular or humoral components and maternal–fetal immunoregulation problems. Juvenile rheumatoid arthritis (JRA) constitutes several heterogeneous arthritides with onset in childhood. JRA is believed to be an autoimmune disorder whose pathogenesis is currently being elucidated. We present a case report of a 6-year-old male diagnosed with both autism and systemic onset JRA (SO-JRA). This co-occurrence has not previously been reported in the medical literature and raises the issue of a possible association between these 2 entities. Additional research to determine the frequency with which these 2 disorders coexist and to delineate potential immune mechanisms in autism could provide insights as to the etiology of both autism and SO-JRA and/or suggest a pathway to address treatment.     

鼻咽放线菌病的诊断与治疗

【目的】分析鼻咽放线菌病的临床特点,总结该病诊断和治疗的新观点。【方法】回顾性分析本院近10年来门诊和住院治疗的9例鼻咽放线菌病患者的临床资料。【结果】男7例,女2例,平均年龄31.4±6.5岁。临床易误诊为鼻咽癌,采用鼻内窥镜手术和青霉素治疗全部治愈。【结论】微生物学和病理检查可确诊鼻咽放线菌病,青霉素结合鼻内窥镜手术治疗效果好。     

同期放化疗治疗中晚期鼻咽癌的疗效分析

[目的]观察同期放化疗治疗中晚期鼻咽癌(Ⅲ或Ⅳa期)的疗效.[方法]128例确诊为Ⅲ、Ⅳa期的中晚期鼻咽癌患者随机分为同期放化疗组(A组)和单纯放疗组(B组),每组64例.两组放疗方法相同,为常规分割剂量.A组在放射治疗的第1、5周给予2个周期顺铂 氟尿嘧啶方案化疗;B组只给单纯放射治疗.[结果]所有病人均顺利完成治疗方案.A组与B组治疗结束时鼻咽原发灶消退率分别是93.75%(60/64)、73.44%(47/64);颈淋巴结消退率分别是100%(64/64)、89.06%(57/64);A组1、3、5年生存率分剐为96.88%(62)、76.56%(49)、54.69%(35);B组1、3、5年生存率分别为90.63%(58)、45.31%(29),32.81%(21),差异有显著性(P＜0.05).毒副作用:A组胃肠道反应、骨髓毒性高于B组(P＜0.05);两组口腔黏膜及皮肤反应程度相当.[结论]同期放化疗可以提高中晚期(Ⅲ或Ⅳa期)鼻咽癌患者的肿瘤消退率,降低远处转移和提高5年生存率,其毒性反应可以耐受,不影响放疗的顺利完成,值得在临床中推广.     

Juvenile Sex Offenders: A Case Against the Legal and Clinical Status Quo

The past two decades have seen a movement toward harsher legal sanctions and lengthy, restrictive treatment programs for sex offenders. This has not only been the case for adults, but also for juveniles who commit sex offenses. The increased length and severity of legal and clinical interventions for juvenile sex offenders appear to have resulted from three false assumptions: (1) there is an epidemic of juvenile offending, including juvenile sex offending; (2) juvenile sex offenders have more in common with adult sex offenders than with other juvenile delinquents; and (3) in the absence of sex offender-specific treatment, juvenile sex offenders are at exceptionally high risk of reoffending. The available data do not support any of the above assumptions; however, these assumptions continue to influence the treatment and legal interventions applied to juvenile sex offenders and contributed to the application of adult interventions to juvenile sex offending. In so doing, these legal and clinical interventions fail to consider the unique developmental factors that characterize adolescence, and thus may be ineffective or worse. Fortunately, a paradigm shift that acknowledges these developmental factors appears to be emerging in clinical areas of intervention, although this trend does not appear as prevalent in legal sanctions.     

鼻咽癌患者放射治疗期间的护理

目的探讨鼻咽癌患者放射治疗期间的鼻腔护理方法及效果。方法回顾性分析并总结2012年1月至2016年12月在第二军医大学长海医院进行放射治疗的258例鼻咽癌患者的临床资料。结果患者在放射治疗过程中和放射治疗结束后无明显不适(包括鼻塞、干燥、鼻出血、鼻咽异物感等),所有患者在放射治疗结束后1个月通过电子鼻咽镜检查电子鼻咽镜下评分均在8分以上。结论以鼻腔冲洗为主的综合护理措施有利于鼻咽癌患者的康复,值得在临床推广应用。