新型双腔鼓室和咽鼓管冲洗管联合药物治疗分泌性中耳炎的疗效观察

目的 探讨鼻内镜下使用新型双腔鼓室和咽鼓管冲洗管,辅以曲安奈德冲洗鼓室、咽鼓管治疗分泌性中耳炎的疗效.方法 2009年8月至2011年7月来我科就诊的45例分泌性中耳炎患者,经知情同意后采用数字表法随机分为对照组和治疗组.治疗组25例36耳,鼻内镜下将新型双腔鼓室、咽鼓管冲洗管置入咽鼓管,辅以曲安奈德冲洗鼓室和咽鼓管;对照组20例30耳,行鼓膜穿刺,鼓室内注射地塞米松、α-糜蛋白酶予以治疗.结果 治疗组治愈25耳(69.4％),好转5耳(13.9％),总有效率83.3％.对照组治愈22耳(73.3％),好转2耳(6.7％),总有效率80.0％.2组比较差异无统计学意义(P＞0.05).治疗组首次治疗有效26耳(72.2％),对照组首次治疗有效21耳(70.0％),2组比较差异无统计学意义(P＞0.05).治疗组耳痛、眩晕、鼓膜瘢痕、中耳炎感染等不良反应发生率与对照组比较差异均有统计学意义(P＜0.05).术后1个月内治疗组复发5耳(13.9％),对照组复发11耳(36.7％),2组比较差异有统计学意义(P＜0.05).结论 新型双腔鼓室和咽鼓管冲洗管可以取样、抽吸、冲洗,将其置入咽鼓管,辅以曲安奈德冲洗鼓室和咽鼓管,可以起到清除鼓室及咽鼓管积液、消除肿胀、改善黏膜功能的作用,其治疗分泌性中耳炎的疗效与传统鼓膜穿刺给药法疗效相仿,但术后耳痛少,复发率低,不良反应少.     

飞行人员中耳通气新方法

及时中耳通气对预防航空性中耳炎很重要。调查了1500名飞行人员,发现1202名用捏鼻鼓气法,195名用运动下颌法,3名用福氏法,82名用运动软腭法。用纤维喉镜观察运动软腭时发现软腭紧张,用肌电图检查发现腭帆张肌在开放咽鼓管中起主要作用,鼓室压图检查发现82名中的多数咽鼓管功能是正常的。设计了训练方法。结论认为腭帆张肌负责咽鼓管开放,因此运动软腭法又名为腭帆张肌咽鼓管开放法。     

花粉症继发航空性中耳炎的快速免疫治疗效果的观察

目的 观察快速免疫疗法对继发航空性中耳炎的疗效。方法 对68例花粉症继发航空性中耳炎飞行员实施快速免疫疗法,通过咽鼓管咽口检查、细胞学检查、鼓室压图检测和各种临床症状发生率统计,进行疗效比较。结果 治疗后变应原反应强度明显减弱,咽鼓管咽口分泌物中肥大细胞和嗜酸性粒细胞反应强度明显降低,咽鼓管咽口形态多转为正常,耳鼓室压图异常程度明显下降,咽鼓管功能明显改善。结论 快速免疫疗法治疗花粉症并继发航空性中耳炎有明显疗效,能有效地减少航空性中耳炎的发生。     

鼻内窥镜下咽鼓管注药治疗分泌性中耳炎

目的:探讨咽鼓管注药治疗分泌性中耳炎的疗效。方法:以1%麻黄素和1%地卡因喷鼻腔及鼻咽部3次,充分麻醉和收敛鼻咽粘膜后,以30°鼻内窥镜观察咽鼓管口,吸除管口分泌物,将导管置入咽鼓管口,先向管内注入空气数次后注入地塞米松5mg,以空针推入少量空气后,再将全部药液注入鼓室。结果:275耳中治愈253耳,好转16例,无效6耳;治愈率92%,无并发症发生。结论:鼻内窥镜下咽鼓管注药治疗分泌性中耳炎取得较好疗效,经验值得借鉴。     

飞行员中耳疾病42例分析

1984年2月至1994年4月，空军总医院收治患中耳疾病的飞行员42例，现分析如下：一、临床资料患者均为男性飞行员，年龄23－50岁，身体无其他疾病。中耳疾病种类如附表。二、治疗与飞行结论对卡他性中耳炎（共11例）和急性化脓性中耳炎者，采取常规药物治疗。首先去除病因，全身应用足够量的抗生素，鼻内滴快麻液。其中对慢性卡他性中耳炎者，依据中耳病变程度分别施以鼓膜按摩术与咽鼓管吹张术或局部理疗，均治愈。渗出性的中耳炎，咽鼓管通畅者，可用保守疗法治疗；咽鼓管狭窄者，应行鼓膜造孔术。照此原则治疗的3例，前者治愈；后2例，1例…     

中耳气压伤的82例临床分析

目的总结飞行员咽鼓管咽口周围疾病与航空性中耳炎的关系。方法收集1979年9月至2006年4月间某医院收治的飞行员航空性中耳炎资料82例,其中原发性航空性中耳炎27例,继发性航空性中耳炎55例。结果（1）继发性航空性中耳炎治愈率高于原发性航空性中耳炎,有统计学差异;（2）继发性航空性中耳炎停飞率低于原发性航空性中耳炎,有统计学差异。结论（1）原发性航率性中耳炎由隐性咽鼓管功能障碍所致,保守治疗效果欠佳,鼓膜置管又不易被患者接受,最终停飞率高。（2）继发性航卒性中耳炎由咽鼓管咽口周围病变引起,通过治疗相关疾病,多数疗效确切,可以恢复飞行。     

高压氧治疗合并中耳气压伤20例临床分析及护理

中耳气压伤是高压氧治疗中的常见并发症。1994年1月～12月在我科做高压氧治疗者557人,发生中耳气压伤者36人,占6.46％。36例中资料较完整的20例,现报告如下。1 临床资料 本组男16例、女4例,年龄18～60岁。气压伤双耳14例,单耳6例。原因:感冒、慢性鼻咽炎11例、咽鼓管调压不当6例、陈旧性中耳炎2例、外伤性鼓膜穿孔（已愈合）1例。20例均有耳痛、耳呜。经耳科检查鼓膜腔积液8例、鼓膜充血鼓膜内陷7例、鼓室内少量出血2例、鼓膜破裂3例。2 发生中耳气压伤的原因 加压时中耳腔内处于负压状态,当中耳内外压力差超过12.0kPa,肌肉将无力使咽鼓管开放。如咽鼓管调压不当可出现耳痛、耳鸣、耳聋、眩晕、恶心,甚至鼓膜破裂。咽鼓管调压不当的原因是:①不能正确做咽鼓管调压动作,如吞咽、咀嚼、闭嘴捏鼻鼓气等使咽鼓管肌肉收缩的方法;②意识不清或昏迷;③咽鼓管通气障碍,如上呼吸道感染、鼻窦炎、鼻甲肥大、息肉、肿瘤、咽鼓管肌张力不良、咽鼓管炎症、水肿等。     

腭裂修复术同期中耳置管治疗渗出性中耳炎

目的　探索腭裂修复同期鼓膜切开中耳置管 ,对腭裂渗出性中耳炎及听力损失的影响。方法　选择在腭裂修复前作声阻抗检查鼓室图为B型 ,声镫骨肌反射阴性 ,脑干听觉诱发电位检查V波反应阈≥ 30dB患儿 76例 ,分观察组和对照组两组 ,观察组为腭裂修复同期中耳置管 45例 ,对照组为单纯行腭裂修复 31例。术后 2周进行鼓室图 ,脑干听觉诱发电位检查 ,并进行统计学处理。结果　观察组术后V波反应阈平均值 ,听力损失及鼓室图均有改善 ,与术前比有显著差别 (P <0 .0 0 1) ,对照组术前术后V波反应阈平均值 ,听力损失及鼓室图均无明显差别 (P >0 .0 5 ) ,术前两组V波反应阈平均值 ,听力损失及鼓室图差异无显著性 (P >0 .0 5 ) ,术后观察组V波反应阈平均值 ,听力损失及鼓室图优于对照组 ,两组比较差异显著 (P <0 .0 0 1)。结论　中耳置管可作为腭裂渗出性中耳炎及听力损失的常规治疗手段 ,提高患者听力 ,避免粘连性中耳炎发生。     

双侧先天性听骨链畸形一例报告

曹××,女,19岁,工人,住院号186537。患者因双耳聋15年于1987—10—20入院,15年前无任何诱因,双耳听力下降,并逐渐加重,无耳流脓及药物中毒史,曾按神经性耳聋,行针刺治疗无效。诊断为双耳硬化症收入院。检查,鼻、咽、喉无异常,双耳廓发育正常,双外耳道狭窄明显,未能窥视鼓膜,用耳镜置入扩张后,见鼓膜完整,内陷明显,捏鼻鼓气双咽鼓管通气良好,乳突区正常,音叉试验。双骨导正常,吕内氏双阴性,盖来氏试验双(±),纯音测听,语言频率双耳骨导平均损失13dB,双耳气导平均损失41～48dB,双耳骨气导差为30～35dB,阻抗测听,鼓室图双耳呈“A”型曲线,镫骨肌反射双耳110dB无反射,乳突X线片,左侧呈板障型,右侧呈硬化型,初     

CO_2激光鼓膜造孔术治疗鼓室积液

本文报告一种针对鼓室积液进行外科治疗的新技术——CO_2激光鼓膜造孔术(LAM)。26例(39耳)患者中包括分泌性中耳炎34耳,鼻咽肿瘤放疗后鼓室积液4耳,咽鼓管异常开放症1耳.接受手术的39耳中同期置入鼓室通气管23耳,术后主观听力及纯音气导听阈较术前改善.作者认为LAM较传统鼓膜切开术有以下优点:(1)鼓膜切口精确度高,造孔直径可控性较好;(2)手术时间缩短,一般3~5min即可完成;(3)造口孔开放时间可达4~6周;如置入通气管则开放期可维持更长;(4)非接触式操作,使手术安全性提高,避免了鼓室和可能的听骨链损伤.文中就激光工作参数的选择以及手术并发症预防等问题进行了讨论.     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.