消痔灵治疗小儿克氏区出血的疗效观察

目的：探讨治疗小儿克氏区出血的有效方法。方法：黏膜下注射消痔灵治疗126例克氏区出血。结果：126例中94例经一次注射治愈;28例再次出血,但出血量明显减少,经2～3次注射治愈;4例因治疗无效,改用全麻后行Nd：YAG激光手术治愈。结论：黏膜下注射消痔灵治疗小儿克氏区出血安全、有效,患儿易于接受     

成人原发性鼻出血的诊疗方式

鼻出血作为耳鼻咽喉科急诊最常见的症状之一,目前很大一部分患者是由年资较浅的住院医师或规培生在处理,迫切需要了解这一急诊病症的常规处理方式。这样才能在临床实际处理患者的过程中有的放矢,为患者选择合适的处理方式。通过总结近十年国内外对鼻出血的临床及实验研究进展,本文综述了常见鼻出血处理方式及其优缺点,可作为临床处理鼻出血的一个参考。     

Vitamin D levels and effects of vitamin D replacement in children with periodic fever,aphthous stomatitis,pharyngitis, and cervical adenitis (PFAPA) syndrome

Background

The periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome is an autoinflammatory disease characterized by regularly recurrent fever episodes due to seemingly unprovoked inflammation.

Objective

To assess serum 25-hydroxyvitamin D [25(OH)D] concentrations in children with PFAPA syndrome and evaluate longitudinally the effect of wintertime vitamin D supplementation on the disease course.

Study design

We have evaluated 25 Italian patients (19 males, 6 females, aged 2.4–5.3 years), fulfilling the Euro-Fever PFAPA criteria. For each patient, we recorded demographic and anthropometric data, clinical manifestations, serum calcium, phosphate, and 25(OH)D. After 400 IU vitamin D supplementation during wintertime, clinical and auxological characteristics, calcium, phosphate, and 25(OH)D levels were re-evaluated. Data were compared with a sex- and age-matched control group.

Results

PFAPA patients showed reduced 25(OH)D levels than controls (p < 0.0001). Regarding the effect of seasons on vitamin D, winter 25(OH)D levels were significantly reduced than summer ones (p < 0.005). Moreover, these levels were significantly lower than in healthy controls (p < 0.005), and correlated with both fever episodes (p < 0.005) and C-reactive protein values (p < 0.005).After vitamin D supplementation, PFAPA patients showed a significantly decreased number of febrile episodes and modification of their characteristics (mean duration of fever episodes, p < 0.05; number of febrile episodes per year p < 0.005).

Conclusions

Deficient and insufficient vitamin D serum levels were found in most children with PFAPA syndrome, and hypovitaminosis D might be a significant risk factor for PFAPA flares. However, vitamin D supplementation seems to significantly reduce the typical PFAPA episodes and their duration, supporting the role of vitamin D as an immune-regulatory factor in this syndrome.     

Vitamin D levels in children with recurrent tonsillitis

Aim

Although recurrent tonsillitis can be the consequence of defects in immune system, the exact etiology of recurrent tonsillitis is not clear. In this study, our aim was to determine the serum vitamin D levels and vitamin D receptor polymorphism among children undergone tonsillectomy due to the recurrent tonsillitis.

Methods

A 106 children undergone tonsillectomy due to recurrent tonsillitis and a 127 healthy children aging between 2 and 12 years were enrolled in this study, to determine serum 25-hydroxyvitamin D level and vitamin D receptor gene polymorphisms (Apa1, Taq 1, fok1). Serum vitamin D level was measured with ELISA (nmol/L) and receptor gene polymorphism was determined by PCR. Vitamin D serum level below 80 nmol/L was accepted as insufficient.

Results

The average serum vitamin D level was 176 ± 79 nmol/L in recurrent tonsillitis group and 193 ± 56 nmol/L in control group. There was no significant difference between the groups (p = 0.13). In recurrent tonsillitis group, 18% (n = 15) of children had their serum vitamin D levels below 80 nmol/L. The vitamin D receptor gene polymorphism (APA1, TAQ 1, FOK 1) in each group was compared (AA, Aa, aa, TT, Tt, tt, FF, Ff, ff). There was no significant difference between the two groups. The vitamin D serum levels and receptor sub-genotypes are also compared, and there was no significant difference between the groups.

Conclusion

There is no difference between the serum vitamin D level and receptor gene polymorphism among children with recurrent tonsillitis and healthy children. But vitamin D insufficiency is more prevalent in children with recurrent tonsillitis group (18%).     

Evaluation of bone mineral density and 25-(OH) vitamin D levels in middle-aged and elderly women with recurrent benign paroxysmal positional vertigo

Abstract

Background: Middle-aged and elderly perimenopausal women are prone to developing BPPV without definite cause. Objectives: This study aimed to investigate the correlation between bone mineral density (BMD), 25-(OH) vitamin D, and serum calcium levels in patients with benign paroxysmal positional vertigo (BPPV) in middle-aged and elderly women.

Material and methods: A total of 103 women with two or more recurrent BPPV episodes (group A) and 80 age-matched healthy controls (group B) were recruited. All subjects had BMD and serum 25-(OH) D levels measurements taken, and the results were compared.

Results: BMD was reduced in group A, and the proportion of osteoporosis was higher than in group B (p?=?.039). The BMD T-score and 25-(OH) vitamin D level were lower in group A than in group B (p?=?.004 and p?<?.0001, respectively). In group A, the BMD T-score was lower (p?=?.017) and serum 25-(OH) vitamin D level was higher (p?<?.0001) in premenopausal women than in menopausal women.

Conclusions and Significance: Our study found that middle-aged and elderly women with recurrent BPPV, especially postmenopausal women, may present decreased BMD and serum vitamin D levels.     

难治性原发性鼻出血101例

目的 探讨难治性原发性鼻出血的治疗方法。方法 对101例难治性鼻出血患者行鼻内镜检查,并双极电凝出血点或搔刮出血点行鼻腔微创填塞或改良的后鼻孔填塞等治疗。结果 一次性治愈78例,二次行内镜检查23例,临床均治愈。结论 对有明确出血点的患者首选双极电凝止血,对于出血点不明确者可用鼻腔微创填塞及改良后鼻孔填塞法治疗。     

Depression and anxiety levels in mothers of children with epistaxis: A controlled study

IntroductionPediatric epistaxis is very common. A child's illness can lead to depression and anxiety in the parents. The association between pediatric epistaxis and mothers’ anxiety has not been well documented.ObjectiveThe present study is aimed at measuring depression and anxiety levels in mothers of children with mild, recurrent epistaxis.MethodsThis prospective, clinical, questionnaire-based study examined 43 mothers of children with recurrent epistaxis and 42 mothers of healthy children. The depression and anxiety levels of the mothers in both the groups were assessed with the Beck Depression Inventory (BDI), the state-trait anxiety inventory–state (STAI-S), and the state-trait anxiety inventory–trait (STAI-T).ResultsNo statistically-significant differences were found between the two groups of mothers in terms of educational level, employment, age, or economic status. The mean STAI-S scores were higher in the mothers of children with epistaxis (p = .010). However, no statistically-significant differences were found between the two groups for the BDI and STAI-T scores.ConclusionsThe results of this comparative study suggest that mild, recurrent epistaxis in children can significantly increase their mothers’ state anxiety levels, but epistaxis has no significant effect on either depression or trait anxiety.     

Low 25-hydroxyvitamin D levels in postmenopausal female patients with benign paroxysmal positional vertigo

Objective: Several studies have reported the association of benign paroxysmal positional vertigo (BPPV) with vitamin D deficiency. This study aimed to evaluate serum 25-hydroxy vitamin D (25 (OH) D) levels in native Chinese postmenopausal women with de novo idiopathic BPPV and to investigate the possible relationship between the occurrence of BPPV and low 25 (OH) D levels.

Methods: This retrospective study comprised of 85 postmenopausal women with de novo idiopathic BPPV and 80 age-matched healthy controls. All subjects had bone mineral density (BMD) and serum 25 (OH) D levels measurements recorded, and the results were compared.

Results: The prevalence of reduced BMD (T score?p?=?.004). The mean serum 25 (OH) D levels were also significantly lower in female patients with BPPV than in healthy controls (19.1?±?5.2 vs. 22.5?±?5.8, p?p?=?.031).

Conclusion: Our study suggests that low 25 (OH) D may be a risk factor for BPPV in postmenopausal women.     

Serum 25-hydroxyvitamin D3 levels in children with allergic or nonallergic rhinitis

ObjectivesThe relationship between vitamin D and allergic diseases such as asthma and atopic dermatitis is shown in several studies. But there is a lack of knowledge about vitamin D status in children with allergic rhinitis (AR). We aimed to investigate serum vitamin D levels of children with AR or nonallergic rhinitis (NAR), to compare with normal subjects and to evaluate the relationship between vitamin D and the severity of AR.MethodsThe study included a total of 141 children (76 patients with rhinitis and 65 control subjects), who applied to the Pediatric allergy immunology outpatient. Skin prick tests were performed using the same antigens for all patients. Serum 25-hydroxyvitamin D3 (25OHD3) levels were measured. AR was classified according to the ARIA guidelines.ResultsMean 25OHD3 levels were 18.07 ± 6.1 ng/mL in the AR group, 14.81 ± 4.86 in the NAR, and 24.03 ± 9.43 ng/mL in the control group. These differences among groups were statistically significant (p = 0.001). Vitamin D status was determined as deficient in 32 (66.7%) patients, insufficient in 14 (29.2%) and normal in 2 (4.2%) of the AR group. These frequencies for NAR and control groups are 25 (89.3%), 3 (10.7%), 0, and 25 (38.5%), 32 (49.2%), 8 (12.3%), respectively. Vitamin D status was found to be different among groups (p = 0.001). There were not any association between 25OHD3 levels and allergen sensitivity (p > 0.05). The comparison of the mean 25OHD3 levels according to the severity and duration of AR did not detect statistically significant difference among groups (respectively, p = 0.384, p = 0.23 Denburg J, Fokkens WJ, Togias A5).ConclusionsThe mean serum 25OHD3 levels of the children both with AR and NAR were lower than control group. No association between 25OHD3 levels and allergen sensitivities was found in our study. We did not find any relationship between 25OHD3 levels and the severity and duration of allergic rhinitis     

The pathology of visible blood vessels on the nasal septum in children with epistaxis

Objective

Epistaxis is common in children, but its cause remains unknown. About half the children who present with epistaxis have prominent vessels on the nasal septum. The aim of this study was to determine the pathological nature of the prominent septal vessels in children with recurrent epistaxis.

Methods

4 mm punch biopsies of the nasal septal mucosa were taken from 5 children undergoing nasal cautery under general anaesthesia.

Results

Histology showed that the prominent vessels were thin-walled arterioles and capillaries with a surrounding inflammatory infiltrate. There was no evidence of venous varicosities or arterial microaneurysms.

Conclusion

We postulate a mechanism for septal neovascularisation due to chronic low-grade inflammation as a cause for recurrent epistaxis in children.     

高血压鼻出血临床路径应用的初步探讨

目的探讨临床路径(CP)用于高血压鼻出血患者的效果.方法以2004年高血压鼻出血43例作为研究对象,上半年20例实施传统的治疗与护理,下半年23例实施CP,对比两组治疗效果.结果入院后血压控制至正常时间对照组为106h,实验组为72h(P＜0.05);鼻出血停止的时间对照组为36h,实验组为24h(P＜0.05);住院费用对照组为(1 723±213)元,实验组为(1 469±128)元(t=2.52,P＜0.05);住院天数实验组缩短到6d(χ2=4.773,P＜0.05);两组并发症与预后比较差异无显著性.结论CP应用于高血压鼻出血的患者,提高了服务质量,规范了医疗护理行为,减少了患者住院费用,缩短了住院时间,值得临床推广应用.     

Role of routine coagulation studies in idiopathic epistaxis

Epistaxis, being the commonest ENT emergency requiring hospital admission, is clearly an important condition — not only to the specialist but also to any general practitioner. The role of routine coagulation studies in the management of patients suffering from epistaxis is unclear. In an attempt to address this issue, the prospective case study was carried out in the department of ENT in Government medical college and hospital Nagpur over span of 2 years from October 2001 to November 2003 in which 100 cases were studied. Coagulation studies were carried out in 100 patients but only 7 patients had abnormal coagulation profile. No other coagulation abnormalities were identified. This study supports the view that there does not appear to br role for routine coagulation studies in patients of epistaxis. The investigation for potential haemostatic disorder should be performed when clinically indicated and if necessary, in consultation with the hematology service.     

Serum vitamin D levels in children with recurrent otitis media

The aims of this study were to evaluate serum vitamin D levels in cases of recurrent otitis media and investigate the effect of vitamin D therapy on the risk of re-occurrence of the disease. This prospective study was performed by comparing serum vitamin D levels in children with recurrent otitis media and healthy children. Eighty-four children between 1 and 5 years of age and diagnosed with recurrent otitis media were enrolled as the study group. One hundred-and-eight healthy children with similar demographic characteristics were enrolled as the control group. Patients were divided into groups according to their serum 25(OH) vitamin D levels. In patients with low initial serum vitamin D levels, vitamin D therapy was administered in addition to conventional treatment for otitis media. Mean serum 25(OH) vitamin D level in the study group was 11.4 ± 9.8 ng/mL Serum 25(OH) vitamin D levels were below 20 ng/mL in 69 % (n = 58) of cases in this group. In the control group, mean serum 25(OH) vitamin D level was 29.2 ± 13.9 ng/mL and was below 20 ng/mL in 30 % (n = 32) of cases. Comparison of serum 25(OH) vitamin D levels and PTH in the study and control groups revealed a statistically significant difference (p < 0.05). Treatment was initiated in cases diagnosed with vitamin D deficiency, and patients were followed up in due course. The only episodes detected over the course of 1-year follow-up were one attack in five patients and two attacks in two. We believe that co-administration of supplementary vitamin D together with conventional treatments is appropriate in the management of upper respiratory infections such as otitis media.     

难治性自发性鼻出血临床分析

目的：探讨难治性自发性鼻出血的临床特征和防治策略。方法：回顾性分析289例难治性自发性鼻出血患者的临床资料。结果：难治性自发性鼻出血有明显的季节、年龄、性别和伴随疾病特征,出血部位以鼻中隔居多,反复出血主要与出血部位不明有关。结论：控制好血压是预防难治性自发性鼻出血的关键;一旦鼻出血发生,治疗重点应放在首次治疗上;多种形式的综合治疗是治疗难治性自发性鼻出血的必要手段。     

鼻窦内窥镜下探明鼻出血部位及其临床应用价值(附226例报告)

目的 :探讨鼻窦内窥镜下诊治鼻出血的应用价值及其适应证。方法 :回顾分析 2 2 6例非外伤鼻出血患者经鼻窦内窥镜检查的临床资料。结果 :出血部位 :中鼻道 5 2例 ,中鼻甲 6例 ,鼻中隔后段 4 4例 ,下鼻甲后端 5 7例 ,鼻底部 6例 ,鼻中隔前上端 2 8例 ,部位不明确 3 3例。鼻窦内窥镜下鼻腔填塞 12 6例 ,微波、激光、烧灼 78例 ,手术 4 2例。患者均获得满意的止血效果。结论 :鼻窦内窥镜检查鼻出血 ,诊断准确 ,治疗方便 ,效果好。     

Atrial natriuretic peptide levels in children with habitual epistaxis

OBJECTIVE: By virtue of no identifiable causes in the majority of children with habitual epistaxis, it continues to be problematic in pediatric clinical practice. The purpose of this study is to explore the possible change of atrial natriuretic peptide (ANP) levels in the children with epistaxis. METHODS: Both the plasma and nasal mucus ANP levels have been determined in 30 sick children by a sensitive radioimmunoassay (RIA) technique. RESULTS: Our results revealed that the plasma and nasal mucus ANP levels were considerably decreased in 24 children with habitual epistaxis when compared with control group (P<0.05), making up 80%, and amongst the interest of these are the nasal mucus ANP levels changing inversely as the times bled from the nose. CONCLUSION: Although the plasma and nasal mucus ANP levels will not establish the diagnosis of its etiology, it is helpful for us to know the cardiovascular status compensating for chronic blood loss in the children with habitual epistaxis.     

Vitamin D levels in children undergoing adenotonsillectomies

Objective

Because of the recent data supporting an immunoregulatory role for vitamin D, we evaluated levels of vitamin D in children undergoing adenotonsillectomies (T&A) and controls.

Methods

We prospectively collected data from 47 children undergoing T&As and 15 undergoing unrelated elective procedures at a tertiary care children's hospital. Demographic and disease specific data was obtained in addition to a blood sample for the measurement of 25-hydroxy (OH)-vitamin D.

Results

There were no differences in vitamin D levels between the groups and levels did not correlate to any disease parameters in the children undergoing T&A. The only significant differences were related to race in that African American children had significantly lower vitamin D levels compared to Caucasians.

Conclusion

This pilot study did not show an association between serum vitamin D and the need to have adenotonsillectomy.     

Efficacy of conservative treatment modalities used in epistaxis

Objective  To assess the efficacy of conservative modalities in the management of epistaxis. Study design  Prospective case studies. Setting  Rural medical college hospital. Patients  Indoor and outdoor patients with epistaxis. lntervention  Conservative(non surgical) management techniques in epistaxis. Results  Chemical cauterization was successful in 72.07% cases, anterior nasal packing in 84.5% and posterior nasal packing in 95.6% cases. Conclusion  Out of 300 cases of epistaxis included in the study (except for one case that required internal maxillary artery ligation). all cases were treated successfully with conservative treatment alongwith treating the underlying pathology causing epistaxis.