半规管开窗放置链霉素对正常的膜迷路积水耳的内耳功能…

为探索临床应用氨基甙类药物治疗Ｍｅｎｉｅｒｅ病的途径和可行性，对豚鼠正常耳和人工造成膜迷路积水耳行外半规管开窗放置硫酸链霉素后的内耳功能和形态进行观察。结果表明开窗放药后正常耳耳蜗电图（ＥＣｏｃｈＧ）动作电位（ＡＰ）阈值无变化，积水耳ＡＰ阈值升高，正常耳和积水耳冰水试验眼震消失。光镜下正常耳给药后三个半规管壶腹嵴和椭圆囊斑前庭上皮严重受损，耳蜗毛细胞正常；积水耳用药后前庭上皮受损更重，部分变性、萎     

豚鼠膜迷路积水模型耳蜗Ca2+-ATP酶的变化

目的了解Ｃａ２＋ＡＴＰ酶在耳蜗活动位点及膜迷路积水后耳蜗Ｃａ２＋ＡＴＰ酶的变化。方法选成年健康、Ｐｒｅｙｅｒ反射正常豚鼠１４只,左耳装圆窗电极后阻塞内淋巴,经声反应阈（ＣＡＰ阈值）证明膜迷路积水形成;右侧为对照耳。用枸橼酸铅细胞组化法测定Ｃａ２＋ＡＴＰ酶,在透射电镜下Ｃａ２＋ＡＴＰ酶以磷酸铅黑色颗粒显示。结果对照耳Ｃａ２＋ＡＴＰ酶活动部位在蜗管前庭膜内淋巴侧、内外毛细胞皮板及静纤毛、血管纹中间细胞指突膜等处;实验性膜迷路积水后,声反应阈提高,前庭膜、内外毛细胞等处之Ｃａ２＋ＡＴＰ酶颗粒明显减少。结论膜迷路积水后声反应阈提高,前庭膜、内外毛细胞等处Ｃａ２＋ＡＴＰ酶活性明显下降,两者呈负相关。     

豚鼠膜迷路积水模型耳蜗Ca^2＋ATP酶的变化

目的 了解Ｃａ＾２＋－ＡＴＰ酶在耳蜗活动位点及膜迷路积水后耳蜗Ｃａ＾２＋－ＡＴＰ酶的变化。方法 选成年健康、Ｐｒｅｙｅｒ反射正常豚鼠１４只，左耳装圆窗电极一阻塞肉淋巴，经声反应阈（ＣＡＰ阀值）证明膜迷路积水形成；右侧为对照耳。用枸橼酸铅细胞组化法测定Ｃａ＾２＋－ＡＴＰ酶，在透射电镜下Ｃａ＾２＋－ＡＴＰ酶以磷酸铅黑色颗粒显示。结果 对照耳Ｃａ＾２＋－ＡＴＰ酶活动部位在蜗管前庭膜内淋巴侧、内外毛细胞皮     

后半规管阻塞术对内耳功能与形态影响的实验观察

本实验对１５只豚鼠行后半规管阻塞术，术前、术后测定ＣＡＰ阈值和ＥＮＧ，并作常规火棉胶连续切片及透射电镜观察内耳形态变化。结果显示：ＣＡＰ阈值手术前、后无显著性差异（Ｐ＞０．０５）；眼震持续时间，术后１周明显缩短（Ｐ＜０．０１），术后８周接近术前（Ｐ＞０．０５）。术后１周，光镜下见耳蜗底圈前庭膜向蜗管内膨隆，其余结构无明显异常；电镜观察见椭圆囊、壶腹峙毛细胞个别线粒体肿胀，耳蜗毛细胞正常。术后８周组内耳各结构正常。初步表明该手术对内耳功能与结构无永性损害。     

关于耳科、颅底外科的迷路手术操作

近年来在中耳手术中,对胆脂瘤引起的迷路瘘孔进行了积极的治疗。该文对迷路部分切除术后尚能保存听力的问题进行了探讨。该作者发现在中耳手术中膜迷路部分切除或者充填半规管的病例术后骨导听力仍能保存,有的甚至还有提高。因此作者研究了切断豚鼠外半规管对听力的影响,观察了听神经瘤手术中外半规管切断后耳蜗电位的变化。结果豚鼠外半规管切断后２小时和听神经瘤手术中病人外半规管切断后１小时的ＥＰ、ＣＡＰ、ＣＭ均稳定无变化。但是如果进一步开放前庭,耳蜗电位便急剧下降。实验提示外半规管切断后不能引起听力下降,同样上半规管…     

迟发性膜迷路积水的诊断与治疗

目的探讨迟发性膜迷路积水的诊断和治疗。方法回顾性分析37例（40耳）迟发性膜迷路积水患者的临床资料,包括纯音测听、前庭诱发的肌源性电位（vestibular evoked myogenic potentials,VEMP）、高刺激ABR、前庭双温试验等结果。主要予以利尿剂、血管扩张剂等药物治疗。结果37例患者均为中、重度以上感音神经性聋。膜迷路积水与听力下降同侧25例,对侧9例,双侧3例。水平半规管和球囊均有积水10例,水平半规管积水9例,球囊积水15例,VEMP和双温试验均正常3例。VEMP正常12例,异常者25例,其中6例患侧p13-n23振幅消失,5例p13潜伏期延长,14例患侧p13-n23低振幅。37例患者中一周内完全控制眩晕发作18例;眩晕明显减轻、二周后完全控制17例;2例行化学迷路切除后眩晕未再发作。结论迟发性膜迷路积水的诊断应依据纯音测听、耳蜗电图、前庭双温试验和前庭诱发肌源性电位等检查结果综合判定;治疗以药物治疗为主,利尿剂和血管扩张剂是主要治疗药物。     

临床庆大霉素耳毒性的组织病理所见

庆大霉素对耳蜗及前庭神经上皮损害的研究,早已为动物实验及临床所证实。但庆大霉素中毒后人的颞骨组织病理学的检查,英文文献未有报导。作者报告一例48岁女性肾移植后患者,在用庆大霉素后发现听力及前庭反应丧失。患者死后,进行了颞骨组织病理学研究。患者生前有中耳炎史。颞骨组织病理学可见到中耳有相应的病变。耳蜗血管纹、螺旋韧带、骨螺旋板、蜗小管及前庭膜均正常。盖膜示由于人为因素轻度抬起,但感觉神经上皮组织完整。在耳蜗中底转螺旋器支持细胞有轻微挤压,无内淋巴积水。耳蜗顶转和中转的毛细胞均正常。在基底转下段的毛细胞全部消失,上段外毛细胞的最内排消失,此处(11.5mm)还有小区域的外毛细胞全部消失。基底转下段螺旋神经节细胞部分消失。前庭感觉神经上皮有明显病理改变。三个半规管壶腹嵴毛细胞有空泡形成,基底部更严     

速尿对实验性膜迷路积水前庭碳酸酐酶活性的影响

为进一步探讨速尿对膜迷路脱水的机理，采用组织，细胞化学染色法，观察速尿对壶腹嵴毛细胞，前庭移行细胞，暗细胞及椭圆囊毛细胞碳酸酐酶的影响。结果显示，碳酸酐酶主要分布于半月面移行细胞侧膜和前庭暗细胞指状突胞膜；实验性膜迷路积水耳碳酸酐酶分布与正常耳无显著变化；速尿对前庭暗细胞，移行细胞的碳酸酐酶有明显抑制作用。     

经迷路前庭神经切断术

经迷路彻底切除第八颅神经是治疗前庭性眩晕的最佳方法。对伴有严重听力障碍有眩晕患者,可建议对其患耳施行该术。术中,术者可在直视下切除全部神经上皮,并能切除前庭神经的节前纤维,消除患耳前庭功能,失败率低。多数耳蜗神经可予以分离,适应症系晚期梅尼埃病。全麻下行乳突切除术,暴露鼓窦,确定外半规管。将脑膜板、乙状窦轮廓化。于窦膜角内,沿着岩上窦清除迷路上气房。用切割钻头,由上而下切除迷路。首先打开外半规管,确定上、后半规管的总脚,继之切除上半规管,但保留其壶腹部,作为确定上前庭神     

小儿Mondini‘s聋106例报告

报告１０６例（１９９耳）Ｍｏｎｄｉｎｉ＇ｓ聋的临床资料。患儿多自幼出现重度耳聋。高分辨颞骨ＣＴ扫描示单纯耳蜗畸形４耳，耳蜗、前庭或半规管畸形９０耳，耳蜗形态正常仅前庭或半规管畸形１０５耳（称前庭型或不典型Ｍｏｎｄｉｎｉ＇ｓ聋）；１９９耳中伴前庭导水管扩大８１耳。并对该病病因、临床表现及防治进行讨论。     

颞下窝咽侧区肿瘤的诊断与手术治疗

目的 寻求颞下窝咽侧区肿瘤的早期诊断及有效的手术途径。方法1978～2002年我院手术治疗颞下窝咽侧区肿瘤75例。手术采用4种进路：①颌下进路。②截断下颌骨颌下联合进路。③耳前颌下进路。④经上颌窦前外进路。绝大多数采用第1种手术入路。恶性肿瘤术后行放疗或化疗；继发性肿瘤在切除原发性肿瘤的同时予以切除。结果手术效果良好，无并发症。良性肿瘤38例术后6个月～18年(其中26例超过5年以上)，1例复发。恶性肿瘤37例中，12例死亡，5例失访，余20例观察3～5年无复发及转移。结论①颞下窝咽侧区肿瘤CT扫描及针吸细胞病理检查是有效的诊断手段。②颌下进路是该区肿瘤较好的手术途径。③术中彻底止血、尽可能消灭死腔及负压引流对预防切口感染和预防呼吸道阻塞都相当重要。     

Cation transport in the ampulla of the semicircular canal and in the endolymphatic sac

Summary We examined the effects of anoxia and ethacrynic acid on the endolymphatic potential and cation activity in the superior ampulla of the guinea pig, using double-barrelled ion-exchanger microelectrodes. In normal guinea pigs the ampullar endolymphatic potential was +3.9±1.2 mV (n=32), the Cl^– activity 130±4.6 mM (n=9), and the Na⁺ activity 18.4±4.4 mM (n=20). After anoxia, the ampullar DC potential decreased rapidly and reversed its polarity within 5 min. It then decreased gradually for 60 min and increased afterwards to approximately zero. K⁺ activity decreased gradually after a latency of 10 min, whereas Na⁺ activity increased. During the gradual decrease of a negative ampullar endolymphatic potential, an increase in Na⁺ activity was observed. Thirty minutes after the intravenous injection of ethacrynic acid (100 mg/kg), the potential began to decrease, changed to a negative polarity, and approached a maximum negative level 100 min after the injection. The decrease in K⁺ activity corresponded to the reduction of potential whereas Na⁺ activity remained unchanged. The DC potential of the endolymphatic sac in normal guinea pigs was + 14.7±5.1 mV (n=17). The Na⁺ concentration was 103.3±14.7 mM (n=14) and the K⁺ concentration was 11.6 ±0.8 mM (n=4). After anoxia, the DC potential decreased rapidly and approached 0 mV within 8 min. No negative potential could be observed. The Na⁺ concentration began to increase 2 min after anoxia and reached the extracellular Na⁺ concentration about 30 min later. No significant effect of intravenous administration of ethacrynic acid (100 mg/kg) on DC potential and Na + concentration could be observed. The results suggest the presence of a different ion transport system in the endolymphatic sac from that of the cochlea and the ampullae of the semicircular canals.     

The role of the condyle in the growth of the mandible and in facial balance

The condyle is not responsible for the growth of the body of the mandible, as the latter does not extend in length caudally at the expense of the ascending rami (through the classical relocation phenomenon), but does so deep to these, at the level of the lower insertions of the sphenomandibular ligaments (i.e., from the inlet inner border of the inferior dental canals). Philogenetically and ontogenetically, its appearance reflects the adaptation of the mandible of mammals to the morphologic and functional changes that took place in their cephalic skeleton (more erect posture, more vigorous mastication). Its chief role in man is to stabilize the mandibular body and to allow it to be properly mobilized, although contributing also to its forward and downward movements (namely in its posterior aspect). As such, it plays an active role in mandibular growth, and this role varies according to the primary "potential" of the condylar cartilage. Such primary-type potential for condylar growth may be adequately assessed by studying the shape of the mandible, as well as through an analysis of craniofacial architecture. Most of the conventional diagrams depicting mandibular growth are defective. Another figurative system has to be innovated, that will differentiate each skeletal unit--body, condyle, coronoid process, angle, alveolodental arch--, the sum of which confers the shape, the size, and the multiple variations to the mandible as a whole.     

Use of autograft and homograft TORP and PORP in the reconstruction of the conductive system in the middle ear

The restoration of a functional transmission system of the middle ear is extremely difficult after a radical operation which leaves a large surgical cavity or in the absence of the tympanic membrane and ossicles, when the window and the tympanic ostium of the tube are covered with thick granulation and fibrous tissue. This article describes my experience in restoring the transmission system of the middle ear combining autograft and homograft with TORPs and PORPs.     

Cation transport in the ampulla of the semicircular canal and in the endolymphatic sac

We examined the effects of anoxia and ethacrynic acid on the endolymphatic potential and cation activity in the superior ampulla of the guinea pig, using double-barrelled ion-exchanger microelectrodes. In normal guinea pigs the ampullar endolymphatic potential was + 3.9 +/- 1.2 mV (n = 32), the Cl- activity 130 +/- 4.6 mM (n = 9), and the Na+ activity 18.4 +/- 4.4 mM (n = 20). After anoxia, the ampullar DC potential decreased rapidly and reversed its polarity within 5 min. It then decreased gradually for 60 min and increased afterwards to approximately zero. K+ activity decreased gradually after a latency of 10 min, whereas Na+ activity increased. During the gradual decrease of a negative ampullar endolymphatic potential, an increase in Na+ activity was observed. Thirty minutes after the intravenous injection of ethacrynic acid (100 mg/kg), the potential began to decrease, changed to a negative polarity, and approached a maximum negative level 100 min after the injection. The decrease in K+ activity corresponded to the reduction of potential whereas Na+ activity remained unchanged. The DC potential of the endolymphatic sac in normal guinea pigs was + 14.7 +/- 5.1 mV (n = 17). The Na+ concentration was 103.3 +/- 14.7 mM (n = 14) and the K+ concentration was 11.6 +/- 0.8 mM (n = 4). After anoxia, the DC potential decreased rapidly and approached 0 mV within 8 min. No negative potential could be observed. The Na+ concentration began to increase 2 min after anoxia and reached the extracellular Na+ concentration about 30 min later.(ABSTRACT TRUNCATED AT 250 WORDS)     

The effects of alcohol and smoking upon the age, anatomic sites and stage in the development of cancer of the oral cavity and oropharynx in females in the south west Netherlands

A retrospective review of 303 women, aged 40 or over, with squamous cell carcinomas of the oral cavity or oropharynx was conducted in the south-west Netherlands to study the effects of smoking and alcohol upon the age of onset, site and stage of disease. It was noted that patients presenting with oropharyngeal cancers were younger and had a higher incidence of smoking and history of heavy drinking. Age at presentation was also affected by the amount of alcohol and tobacco consumed with non-users presenting with tumors approximately 15 years later. A specific finding was that heavy drinkers and smokers tended to present with late-stage-disease.