内镜鼻窦手术后视网膜中央动脉栓塞致双眼失明一例

患者男,64岁,因在外院行内镜下双侧上颌窦开放鼻息肉切除术后发现双眼视力无光感7 h于2009年8月入我院.患者因鼻塞、流涕1年余在外院就诊,以慢性鼻-鼻窦炎伴鼻息肉收入院,并于2009年8月局麻下行双侧上颌窦开放鼻息肉切除术.术中患者自感鼻骨及上颌骨额突处剧烈疼痛.手术中医生曾多次询问患者视物情况均无异常发现.术毕发现双眼无光感,眶周无瘀血、结膜无充血,立即予双侧球后注射山莨菪碱5 mg,20%甘露醇250 ml静脉点滴,无效.术后5 h急诊来我院于眼科门诊给予球后注射山莨菪碱10 mg,硝酸甘油10 mg舌下含化,无效.     

鼻息肉伴中鼻甲气化积脓1例

患者男 ,6 5岁。鼻塞、流脓涕伴间断头痛 6年 ,于 1998年 4月 9日入院。既往 2 0年间曾行左上颌窦根治术及左下甲部分切除术 1次 ,鼻息肉切除术 10次。查体 :双侧鼻腔可见灰白色赘生物堵满前鼻孔 ,触之柔软 ,可活动 ,其余结构不能窥见。CT示 :双侧上颌窦窦壁完整 ,其内充满软组织密度 ,密度均匀 ,边缘清晰 ,双侧鼻腔内均可见软组织密度填塞。诊断为 :双侧鼻息肉。手术方法 :于局麻下行鼻内窥镜下双侧鼻息肉切除术 ,双侧筛窦切除术、上颌窦中鼻道造口术及双中鼻甲全切除术。术中见双侧鼻息肉 ,均来自筛窦及上颌窦 ,用息肉咬钳摘除之 ,并扩大…     

鼻息肉患者上颌窦内病变的观察与上颌窦口扩大术

回顾分析 1 995～ 2 0 0 1年慢性鼻窦炎鼻息肉患者住院手术1 33例 (1 92侧 )在上颌窦口扩大术中记载的上颌窦内病变情况 ,以探讨鼻息肉患者上颌窦口扩大术的指征 ,报告如下。一、临床资料1 33例患者中 ,男 98例 ,女 35例 ,年龄 6～ 67岁 ,平均35 5岁。经鼻内镜检查和CT扫描诊断为慢性鼻窦炎鼻息肉 ,按 1 997年海口标准进行分型分期。所有患者均在鼻内镜下行鼻息肉切除术、部分或全筛切除术、上颌窦口扩大术 ,其中 87例 (1 61侧 )行额窦口开放和 1 1例 (1 3侧 )行蝶窦口扩大术。术中以 2 5°和 75°鼻内镜经扩大的上颌窦口观察上颌窦内病变…     

鼻平滑肌肉瘤2例报告

鼻平滑肌肉瘤是一种少见的疾病。我们经治 2例 ,报告如下。1　病例报告例 1　女 ,37岁。因右鼻塞伴流脓性涕 1年入院。近 1年曾在院外 2次行“右鼻息肉摘除术”。专科检查 :右侧鼻腔息肉样肿物 ,肿物突出右侧前后鼻孔。X线检查 :右侧鼻腔右上颌窦密度增高 ,右上颌窦内侧壁较为模糊。 1 986年 3月 2 6日行“右鼻息肉”摘除术。术中见肿物与息肉不同 ,色泽稍红 ,质软脆 ,基底广。病理检查为“鼻脂肪肉瘤”。遂于 4月 1 0日全麻下行右鼻侧切开、鼻腔鼻窦肿物切除术。术中见眶内侧壁、上颌窦内侧壁和鼻窦前壁均受肿瘤破坏。术后病理检查和 Mass…     

软腭背侧T/NK细胞淋巴瘤1例

患者,男,54岁。因双侧持续性鼻塞伴时有头痛2个月于2010年4月2日到我院就诊。患者曾到多家医院就诊,均诊断为慢性鼻窦炎、左上颌窦囊肿,建议手术治疗。我院鼻窦冠状位CT示:双侧筛窦软组织密度影,左上颌窦内见囊肿及右上颌     

筛窦巨大骨瘤1例报告

病人,女,53岁,以鼻塞、流脓涕伴头痛20年于2005年3月10日入院。专科检查:双鼻道见少许黏脓涕,双中鼻道见灰白半透明息肉,双侧筛窦、上颌窦区压痛。鼻窦冠状位CT扫描见双侧额窦、上颌窦、筛窦及左侧蝶窦内软组织影,提示有慢性炎症,左侧筛窦内高密度影(图1)。术前诊断:慢性鼻窦炎(Ⅱ型2期)、左筛窦骨瘤。3月12日全麻鼻内镜下行双侧鼻息肉摘除、上颌窦自然口扩大、左筛窦骨瘤摘除及左蝶窦口开放术。术中出血量少,骨瘤长于左侧筛窦内壁,约1.5 cm×1.0 cm×1.0 cm大小,与眶纸样板无粘连,眶纸样板受压变薄,无骨壁缺损,筛窦及上颌窦腔内少量息肉样…     

鼻内镜术并发眶内巨大气肿1例

患者 ,男 ,47岁。因进行性双侧鼻阻塞伴流黏稠涕 5年于 2 0 0 2年 1 1月 2日入院。入院诊断“慢性鼻窦炎 ;鼻息肉 ,Ⅱ型Ⅲ期”。鼻内镜检查 :双侧鼻腔黏膜呈慢性充血状 ,鼻中隔居中 ,双侧下鼻甲形态正常 ,中鼻道内可见荔枝肉样新生物生长 ,总鼻道内可见脓性分泌物。鼻窦CT冠状位示 :双侧前中组筛窦、上颌窦黏膜增厚 ,窦腔缩小 ,双侧鼻腔可见软组织密度增高影。入院后行各项常规辅助检查未见异常。于局麻下行鼻内镜下双侧筛窦、上颌窦开放 ,息肉摘除术。手术采取Messerklinger术式 ,切除双侧钩突 ,开放双侧前中组筛窦 ,见双前中组筛窦内黏…     

鼻腔鼻窦转移性肾透明细胞癌一例报道并文献综述

目的 探讨鼻腔鼻窦转移性肾透明细胞癌的临床特点及诊疗方法.方法 回顾性分析1例肾透明细胞癌转移至鼻腔鼻窦患者病历资料,并检索1993～2020年间国内外发表的相关文献,包括本例共有64篇文献76例患者纳入研究,总结其临床表现、诊断、治疗方法及预后.结果 76例中男61例,女15例.症状出现较多者为鼻出血58例、鼻塞25...     

上颌窦非霍奇金恶性淋巴瘤1例

患者男,14岁,因右侧反复鼻塞4月余,右面颊肿痛7d,于2002年6月20日收入院.患者4个月前感冒后右侧鼻塞,7d前无明显诱因的右面颊肿痛,除右侧鼻塞外无其他不适.他院诊为右侧上颌窦炎,用抗炎药物静脉滴注,无明显疗效,来我院就诊.体检示心肺无异常,全身浅表淋巴结无肿大.右侧鼻唇沟变浅,右鼻旁肿胀,轻压疼,质软,无波动感,固定.鼻外形正常,双下鼻甲肿大,右侧下鼻道内侧偏移,与鼻中隔接触,对麻黄素不敏感,右侧下鼻道黏膜完整.鼻中隔略向右侧偏曲,余无异常.血常规、肝功、血沉等常规检查均无阳性结果,副鼻窦CT检查示右侧上颌窦内软组织影,密度均匀,侵及右侧上颌窦内壁,CT诊断为右侧上颌窦内占位病变.遂在全麻下行右侧上颌窦探查术(唇龈切口).术中见上颌窦前壁软组织呈鱼肉状,质脆,易出血,上颌窦前壁骨组织变软,上颌窦内充满灰白色肿物,质脆,易出血.切除部分上颌窦前壁软组织和上颌窦内灰白色肿物,快速冰冻病理检查为小细胞恶性肿瘤,恶性淋巴瘤可能性大.考虑到可能是恶性淋巴瘤且化疗效果较好,不宜行破坏性手术,故尽可能切除上颌窦内肿物及上颌窦前壁可疑组织,送病检.鼻内窥镜下检查右侧中鼻道,见有灰白色肿物,表面尚光滑,下鼻道内移,切除中鼻道肿物,扩大上颌窦自然开口,填塞鼻腔.术后病理为B细胞恶性淋巴瘤,免疫组化染色CD20阳性,CD45RO阴性.于术后14d用CHOP方案行第1次化疗,后每隔3周用CHOP方案化疗1次,共4次,每次化疗3d.化疗时辅以护肝治疗、升白细胞药物及抗感染治疗,每次化疗后检查血常规和肝功均无明显异常.随访1年鼻腔通畅,未见异常,面部无肿胀,CT检查示双侧上颌窦内无异常组织影.     

鼻内镜术后并发前额部脓肿1例

患者 ,女 ,5 7岁。因双侧渐进性鼻塞 2年于2 0 0 2年 3月 1 8日入院。体检 :一般情况良好。专科检查见中下鼻甲肿大 ,双侧中鼻道充满灰白色、半透明、表面光滑、不易出血之肿物 ,鼻窦区无肿胀、压痛。鼻窦冠状位CT扫描示 :双侧中鼻道内软组织密度增高影 ,双侧上颌窦、筛窦、额窦密度增高 ,未见骨质破坏。入院诊断 :鼻息肉 (双 ) ,慢性鼻窦炎 (双 )。全麻鼻内镜下行双侧鼻息肉摘除加鼻窦开放术。术后鼻腔通气明显改善 ,1周后痊愈出院。 3个月后患者出现前额部脓肿再次入院。体检 :左侧鼻腔中鼻甲前端与鼻腔外侧壁粘连 ,前额部穿刺为脓液。鼻…     

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance Angiogenesis is essential for tumour growth and invasion. Vascular endothelial growth factor (VEGF) is a prime mediator of tumour angiogenesis. VEGF‐C is a closely related protein that effects lymphatic endothelial cells and may be important in the process of lymphatic metastasis. The purpose of this study was to evaluate the expression of these cytokines in patients with T1 and T2a glottic, squamous cell carcinoma, in comparison with normal epithelial control tissue, to ascertain any association with radioresistance. Twenty‐two tumours treated by radiotherapy (13 radiosensitive, nine radioresistant) and seven normal control tissues were studied. The minimum follow‐up was 2 years after radiotherapy. Expression of VEGF and VEGF‐C was evaluated by immunohistochemistry of formalin‐fixed, paraffin‐embedded biopsy specimens. Analysis was carried out using a quantitative computer image analyser. Both VEGF and VEGF‐C were detectable in tumour and normal control specimens. There was increased expression in tumour specimens of both VEGF (P = 0.03) and VEGF‐C (P < 0.001). In addition, the expression of VEGF‐C was associated with tumours of higher histological grade (P = 0.021). There was, however, no difference in VEGF and VEGF‐C expression between radioresistant and radiosensitive tumours. The expression of VEGF and VEGF‐C is increased in early laryngeal squamous cell carcinoma (SCC). However, measuring the expression of these proteins cannot predict radioresistance in this tumour group.     

Treatment of Maxillary Sinus Carcinoma: Clinical Results Using the Kitasato Modality

The conventional therapeutic regimen for maxillary sinus carcinoma consists of dissection of the maxilla, full-dose irradiation and extensive chemotherapy. However, the results obtained with this treatment are often poor. Even when patients recover, their quality of life is significantly reduced as a result of deformity of facial structures and swallowing and articulation dysfunctions. A retrospective analysis of 68 patients with maxillary sinus carcinoma treated with the Kitasato modality between 1975 and 1999 was conducted. All patients underwent pergingival maxillary sinus surgery combined with pre- and postoperative irradiation therapy with standardized total doses of 16 Gy; the postoperative irradiation was given in combination with regional intra-arterial infusion chemotherapy administered via the superficial temporal artery. All visible tumor lesions were removed where possible in order to preserve or facilitate cellular immunity after surgery. The cumulative 5-year survival rates were 85.7% for Stage II patients, 88.1% for Stage III, 76.6% for Stage IVA and 75.0% for Stage IVB.     

Tongue Base Reduction with Temperature-controlled Radiofrequency Volumetric Tissue Reduction for Treatment of Obstructive Sleep Apnea Syndrome

In recent years a considerable effort has been made to establish the use of different surgical techniques for the treatment of obstructive sleep apnea syndrome (OSAS). Nevertheless, treatment of hypopharyngeal obstruction due to tongue base hypertrophy remains in many ways an unsolved problem. The aim of this study was to evaluate the safety and efficacy of tongue base reduction with temperature-controlled radiofrequency volumetric tissue reduction in the treatment of OSAS. Twenty patients with OSAS and tongue base hypertrophy were treated with radiofrequency tissue ablation. An intensified treatment protocol was used, delivering 2,800 J per treatment session under local anesthesia. Two nights of polysomnography testing were performed before and after treatment. Daytime sleepiness, snoring and postoperative morbidity were assessed using questionnaires. Mean respiratory disturbance index (RDI) was reduced from 32.1 to 24.9/h after a mean of 3.4 treatment sessions. Six patients (33%) were cured after the procedure (reduction in RDI of &#83 50% and a postoperative RDI of <15/h) and ten (55%) showed an improvement of >20% in their RDI. Daytime sleepiness and snoring improved significantly. Peri- and postoperative morbidity was low; one severe complication occurred (tongue base abscess). We were able to achieve similar cure and responder rates to those reported in a recently published pilot study but with a reduced number of treatment sessions. We believe that this technique may improve patient acceptance and have beneficial cost implications.     

Cervical Reflex Induced by Click Stimuli in Cats

We studied click-evoked potentials in the anterior horn of the spinal cord in 17 cats. A concentric needle electrode was inserted into the anterior horn of the spinal cord at levels C3-C6. Potentials evoked with 105 dB SPL clicks were recorded with a peak latency of 4.89-5.10 ms only at the C3 level. These responses were observed 45-60 dB SPL above the auditory brainstem response (ABR) threshold, and no potentials were evoked by stimulation of the contralateral ear. Average was performed 100 times with changes in stimulation frequency of 1-20 Hz. The amplitude of the potentials decreased with increasing stimulus frequency, but there were no changes in ABRs. The responses disappeared after destruction of the medial vestibulospinal tract at the obex level, but ABRs were still recorded. The spinal nucleus of the accessory nerves was located in the anterior horn of the spinal cord at levels C1-C6, and the sternocleidomastoid muscle motoneurons were found at levels C1-C3. The click-evoked potentials recorded in this study reflect responses of the spinal nucleus of accessory nerves through the vestibulospinal tract to click stimulation. The responses have the same characteristics as vestibular-evoked myogenic potentials that can be recorded using surface electrodes over the sternocleidomastoid muscles of humans.     

Lack of significant estrogen and progesterone receptor expression in nasal telangiectasias in hereditary hemorrhagic telangiectasia: an immunohistochemical analysis

Obstructive sleep apnea syndrome (OSAS) is characterized by snoring and apnea during sleep leading to decreased oxygen saturation and disturbed sleep, excessive daytime sleepiness and neuropsychological disturbances. This study investigates cognitive neuropsychological abilities in a group of 53 OSAS patients before and after treatment with uvulopalatopharyngoplasty. General intellectual ability, verbal learning and memory as well as executive functioning were measured at baseline and 6 months postoperatively. After surgery there were significant improvements in verbal learning and memory (mean change - 39, SD 57.3, p <0.001), recall (mean change - 24.3, SD 39.3, p <0.001) and executive functioning (as assessed by percentage of errors on the Wisconsin Card Sorting Test; mean change-9.1, SD 15.7, p <0.001). These improvements were in accordance with improvements in the degree of sleep apnea, the oxygen desaturation index (mean change -9.7, SD 15.9, p <0.001) and arterial minimum oxygen saturation (mean change 4.5%, SD 10.2%, p <0.01). Surgical treatment seems to improve verbal learning, memory and recall and executive functions in parallel with better oxygenation in OSAS.     

Measurement of chemosensory function

Although hundreds of thousands of patients seek medical help annually for disorders of taste and smell, relatively few medical practitioners quantitatively test their patients' chemosensory function, taking their complaints at face value. This is clearly not the approach paid to patients complaining of visual, hearing, or balance problems. Accurate chemosensory testing is essential to establish the nature, degree, and veracity of a patient's complaint, as well as to aid in counseling and in monitoring the effectiveness of treatment strategies and decisions. In many cases, patients perseverate on chemosensory loss that objective assessment demonstrates has resolved. In other cases, patients are malingering. Olfactory testing is critical for not only establishing the validity and degree of the chemosensory dysfunction, but for helping patients place their dysfunction into perspective relative to the function of their peer group. It is well established, for example, that olfactory dysfunction is the rule, rather than the exception, in members of the older population. Moreover, it is now apparent that such dysfunction can be an early sign of neurodegenerative diseases such as Alzheimer's and Parkinson's. Importantly, older anosmics are three times more likely to die over the course of an ensuring five-year period than their normosmic peers, a situation that may be averted in some cases by appropriate nutritional and safety counseling. This review provides the clinician, as well as the academic and industrial researcher, with an overview of the available means for accurately assessing smell and taste function, including up-to-date information and normative data for advances in this field.