鼻及鼻窦的霉菌性疾病

鼻窦的霉菌性感染由于不同的病理、生理过程可以表现出不同的类型 ,其诊断、预后尤其是治疗也各不相同。霉菌性鼻窦炎完整的诊断除术前常规的病史、体检及影像学检查外 ,还应包括术中对患病局部组织形态学了解 ,组织病理学检查 ,微生物学检查 ,血清学检查等。不同类型的霉菌性鼻窦炎治疗原则也有很大的区别 ,霉菌球性者完全靠手术治疗 ,而变态反应性和慢性侵袭性霉菌性鼻窦炎除手术治疗外 ,则应分别配合全身及局部的皮质激素治疗及抗霉菌药物治疗 ,急性爆发性霉菌性鼻窦炎的治疗则首先在治疗全身原发疾病的基础上应用抗霉菌药物 ,局部组织的清创或扩大范围的手术亦是非常重要的。     

大环内酯类药物用于治疗慢性鼻窦炎及鼻息肉的抗炎机制

近年来关于应用长期低剂量大环内酯药物治疗慢性鼻窦炎及鼻息肉的文献报道较多,其作用机制目前普遍认为与其抗炎作用有关,本文着重介绍其用于治疗慢性鼻窦炎及鼻息肉的相关机制.     

颈部多间隙感染12例临床分析CSCD

目的总结颈部多间隙感染患者的临床特点和治疗经验。方法回顾性分析吉林市人民医院耳鼻咽喉头颈外科收治的12例颈部多间隙感染患者的详细临床资料,对其感染来源、实验室结果、影像学检查、治疗方式、疗效等进行总结和分析。结果男10例,女2例,2例牙源性感染,白细胞及C反应蛋白均不同程度升高,颈部增强CT可见局部软组织肿胀、密度不均,部分患者可见气体影或边缘及分隔样强化。6例保守治疗,6例手术治疗,所有患者均治愈出院,无死亡病例。结论颈部多间隙感染患者根据病情轻重选择保守或手术治疗,手术治疗的关键在于彻底清创引流,合理应用抗生素和规律控制血糖,必要时多科联合治疗以提高治愈率。     

脑卒中患者吞咽障碍功能检查与诊断评估

吞咽障碍是脑卒中后常见并发症,多数伴有构音障碍和摄食困难,严重影响预后,及时准确的评估是成功治疗的关键.本文通过回顾文献了解目前脑卒中吞咽障碍的发病机制及诊断评估的方法,以此指导制定合理有效的治疗方案,尽早干预以降低致残率和死亡率.本文就目前脑卒中患者吞咽障碍的发病机制、功能检查及诊断评估进行综述,旨在科学的指导康复治疗,改善预后.     

儿童慢性鼻窦炎药物治疗和手术治疗时机的选择

儿童慢性鼻窦炎是常见病、多发病,由于儿童鼻窦炎与成人有所区别,因此临床诊断和治疗程序有其特殊性,不能照搬成人鼻窦炎的治疗方式.目前较为提倡"3阶段阶梯性治疗方案"使医师们所面临的最大挑战是选择合适的药物治疗和手术治疗时机.本文就儿童慢性鼻窦炎的药物治疗及手术时机的选择做一综述.     

慢性鼻及鼻窦炎术后病情迁延不愈因素分析

本文复习了近些年来国内外关于鼻内镜手术的疗效及其相关文献,对慢性鼻及鼻窦炎(chronic rhinosinusitis,CRS)术后病情迁延不愈的影响因素进行分析,患者的鼻纤毛功能、免疫状态、感染及围手术期治疗等是影响CRS治疗效果的主要因素.     

喉真菌病

喉真菌病临床少见,过去认为其常发生于免疫功能低下宿主,但是近来的报道发现喉真菌病发生于免疫功能正常宿主者越来越多见.喉真菌病临床表现及喉内镜检查均没有特异性,病理检查发现真菌结构是诊断喉真菌病的"金标准".喉真菌病临床及病理表现与喉癌类似,容易造成误诊,治疗包括手术治疗及非手术治疗.本文对近年来相关文献做一综述,以提高我们对该病的认识及重视.     

慢性鼻及鼻窦炎术后病情迁延不愈因素分析

本文复习了近些年来国内外关于鼻内镜手术的疗效及其相关文献,对慢性鼻及鼻窦炎(chronic rhinosinusitis,CRS)术后病情迁延不愈的影响因素进行分析,患者的鼻纤毛功能、免疫状态、感染及围手术期治疗等是影响CRS治疗效果的主要因素.     

视神经管骨折治疗效果回顾

报告65例(眼)视神经管骨折病人的治疗结果。单纯药物(地塞米松)治疗19例,5例视力有一定程度恢复;5例只有光感;9例无视力。手术视神经管减压+地塞米松治疗46例,25例视力有一定程度改善;21例无改善。认为药物治疗与手术治疗效果相似。本文就视神经管骨折的临床表现及治疗原则进行讨论。     

慢性鼻及鼻窦炎术后病情迁延不愈因素分析

本文复习了近些年来国内外关于鼻内镜手术的疗效及其相关文献,对慢性鼻及鼻窦炎(chronic rhinosinusitis,CRS)术后病情迁延不愈的影响因素进行分析,患者的鼻纤毛功能、免疫状态、感染及围手术期治疗等是影响CRS治疗效果的主要因素.     

The efficacy of group communication treatment in adults with chronic aphasia.

We examined the effects of group communication treatment on linguistic and communicative performance in adults with chronic aphasia. Participants were randomly assigned to two treatment and two deferred treatment groups. Groups were balanced for age, education level, and initial aphasia severity. Twenty-four participants completed the 4-month treatment trial. While in the treatment condition, all participants received 5 hours of group communication treatment weekly, provided by a speech-language pathologist. The focus of treatment included increasing initiation of conversation and exchanging information using whatever communicative means possible. While awaiting group communication treatment, participants in the deferred treatment groups engaged in such activities as support, performance, or movement groups in order to control for the effects of social contact. Linguistic and communicative measures were administered to all participants at entry, after 2 and 4 months of treatment, and following 4 to 6 weeks of no treatment. In addition, participants in the deferred treatment groups received an additional administration of all measures just before their treatment trial. Results revealed that participants receiving group communication treatment had significantly higher scores on communicative and linguistic measures than participants not receiving treatment. In addition, significant increases were revealed after 2 months of treatment and after 4 months of treatment. No significant decline in performance occurred at time of follow-up.     

高压氧治疗突发性聋的再评价

目的 观察突发性聋高压氧（ｈｙｐｅｒｂａｒｉｃ ｏｘｙｇｅｎａｔｉｏｎ,ＨＢＯ）治疗前后血清脂质过氧化物代谢产物丙二醛（ｍａｉｏｎｄｉａｌｄｅｈｙｄｅ,ＭＤＡ）和超氧化物歧化酶（ｓｕｐｅｒｏｘｉｄｅ ｄｉｓｍｎｔａｓｅ,ＳＯＤ）的浓度变化及对高压氧治疗效果的影响。方法 ６０例７９耳突发性聋的患者,随机分为综合组３０例４３耳和单纯组（单纯高压氧组）３０例３６耳,另有３０名健康志愿者做正常组。治疗前后     

New modification of hot-water irrigation in the treatment of posterior epistaxis.

BACKGROUND: Tamponade treatment for epistaxis is painful and traumatic to the nasal mucosa, and may necessitate hospitalization for several days. Hot-water irrigation (HWI) was introduced as a treatment of epistaxis more than 100 years ago. In a previous study the treatment proved to be effective, less painful, and less traumatic, and required a shorter hospital stay than tamponade treatment. However, HWI has the risk of aspiration during treatment. To minimize this risk, a special catheter has been designed. OBJECTIVES: To evaluate the modified HWI and to compare the results with tamponade treatment, with respect to patient compliance, effectiveness, recurrence of bleeding, pain, complications, and length of hospital stay. PATIENTS: A total of 122 patients, hospitalized for posterior epistaxis, were randomized to receive either HWI or tamponade treatment. RESULTS: In the HWI group, 31 (55%) of the patients could be discharged from the hospital after the initial treatment only, compared with 29 (44%) of the patients treated with tamponade. Using a 10-cm visual analog scale, the mean pain score during treatment was 4.7 in the HWI group compared with 7.5 in the tamponade group. The mean hospital stay was 2.9 days for the HWI group vs. 4.0 days for the tamponade group. After discharge from the hospital, necrosis or synechia was found on rhinoscopy in 12 patients (40%) in the tamponade group compared with none in the HWI group. CONCLUSIONS: Compared with tamponade treatment, HWI is as effective, requires a significantly shorter hospital stay, is less traumatic to the nose, and is significantly less painful.     

腺样体扁桃体切除术治愈儿童阻塞性睡眠呼吸暂停综合征的偏误研究

阻塞性睡眠呼吸暂停综合征（OSAS）在我国儿童中的发病率分别为男童5.8%和女童3.8%,会影响儿童正常的生长发育,导致儿童生长迟滞、神经认知缺陷、智力发育及行为异常等问题,因此早期识别与诊断并进行适当的早期治疗至关重要。儿童OSAS的治疗方法多种多样,从内科的药物治疗到外科的手术治疗,从耳鼻咽喉的专科治疗到多学科联合治疗,治疗效果参差不齐,公认的一线治疗仍然是手术,而手术又以腺样体扁桃体联合切除术（AT）为主流。AT术后疗效及并发症众说纷纭,有学者认为AT治疗儿童OSAS疗效显著,症状可完全缓解;另有一部分学者则认为AT治疗儿童OSAS的疗效有待商榷,术后并发症及残余疾病很难避免,AT还不足以治愈OSAS患儿。对儿童OSAS的AT治疗进行阐述,以期为临床治疗儿童OSAS提供参考。     

Writing treatment for severe aphasia: who benefits?

Writing treatment that involved repeated copying and recall of target words was implemented with 8 individuals with severe aphasia in order to discern the best candidates for the treatment. Four of the 8 participants had strong positive responses to the copy and recall treatment (CART), relearning spellings for 15 targeted words during 10 to 12 weeks of treatment and up to 5 additional words during a month-long homework-based program. Of the 4 other participants, 3 learned the spellings of some target words but failed to reach criterion, and 1 had a poor treatment outcome. Insights regarding possible factors that limited success were gained by examination of individual responses to treatment as well as performance on the pretreatment assessments of semantic, phonological, and orthographic processes. Among the factors associated with success were (a) consistent, accurate completion of daily homework, (b) a relatively preserved semantic system, (c) the ability to discern words from nonwords, and (d) adequately preserved nonverbal visual problem-solving skills. Aphasia severity and minimal pretreatment spelling abilities did not necessarily limit the response to treatment. Participants with positive treatment outcomes demonstrated improved spelling of target words following repeated copying within a single treatment session, and accurately completed daily writing homework. Thus, pretreatment assessment and stimulability within initial treatment sessions provided indications of likely outcome.     

Acute maxillary sinusitis--a comparison between 27 different treatment modes

When comparing the outcome of different treatment modes for acute maxillary sinusitis, the roentgenological examination can be recommended for the objective evaluation as a complement to the clinical examination. Using the occipito-mental projection and an additional occipito-mental side view, the diagnosis can be established in a cheap and simple way, and the treatment effect can be followed during the course of treatment in the form of radiological sinus changes. The treatment outcome of 27 different treatment modes in 1320 cases of acute maxillary sinusitis (2039 maxillary sinuses) was compared. There was little difference between the treatment groups as to therapeutic effect, whether using antral drainage alone, antibiotics alone or the combination of both. Factors other than treatment outcome must be important for the consideration of treatment choice, e.g. pharmacokinetics, administration, dosage, treatment cost, number and type of side effects, etc.     

Safety and usefulness of the long-term intranasal topical treatment with steroids for olfactory dysfunction

Intranasal topical steroids are commonly used for the treatment of olfactory dysfunction. Although the side effects are considered to be minimal, these have not been studied in detail. We examined the side effects of intranasal topical treatment with steroids in patients with olfactory dysfunction. We treated 62 patients with intranasal topical application of 0.1% betamethasone sodium phosphate (Rinderone) administered to the olfactory clefts. After treatment for 1 or 2 months, serum ACTH or cortisol was reduced in 42 (68% of total) patients, however, no clinical symptoms associated with steroid side effects were observed. The treatment was discontinued in 8 of these patients, who elected to withdraw from the treatment. In these patients, the serum ACTH or cortisol returned to normal a month after stopping the treatment. In the remaining 34 patients, the topical treatment was continued and in only 4 of these patients, minor steroid-associated side effects such as the sensation of facial swelling and facial hair thickening, appeared 2-5 months after beginning the treatment. These side effects disappeared within a month after stopping the treatment. Regarding the therapeutic efficacy, in 18 (78%) of the 23 patients who continued treatment for an average period of 5 months, steroid treatment significantly improved their olfactory dysfunction. In conclusion, although it is important to consider the potential side effects of long-term intranasal topical treatment with steroids for olfactory dysfunction, this treatment is a highly effective method against olfactory dysfunction with minimal side effects.     

Wh interrogative production in agrammatic aphasia: an experimental analysis of auditory-visual stimulation and direct-production treatment

The effects of auditory-visual stimulation treatment derived from principles associated with a stimulation approach for aphasia treatment and direct-production treatment derived from a behavioral or learning approach were examined in 4 neurologically stable agrammatic aphasic subjects. Subjects were trained to produce selected exemplars of wh interrogative morphemes in complete sentence contexts, while the acquisition, response generalization (both within and across interrogative forms), stimulus generalization (to language samples), and maintenance effects of the two treatments were assessed. An alternating treatments design (ATD) in combination with a multiple-baseline design across behaviors and a multiple-baseline design across subjects was employed. Interrogative constructions were counterbalanced across subjects and treatments, and probes were administered daily to assess treatment effects. Results indicated that direct-production treatment was consistently more effective than auditory-visual stimulation treatment in facilitating acquisition of target responses for all subjects. Response generalization within interrogative forms paralleled acquisition regardless of treatment approach. Stimulus generalization to the elicited language-sample condition was not evident, however, trained responses were maintained subsequent to treatment. These data provided support for using direct-production treatment for interrogative intervention with agrammatic aphasic patients and indicated that training a selected number of exemplars of target interrogatives results in generalization of that question form to novel language responses. However, the lack of generalization across interrogatives indicated that wh interrogatives do not constitute a response class and, thus, pointed out a need for programming generalization to untrained members of that linguistic class and to spontaneous language.