鼻及鼻窦化脓性炎症患儿的血过氧化脂质指标

近年来强调类脂质代谢过程紊乱和自由基过氧化脂质（ＬＰＯ）在各种疾病发生上的作用。ＬＰＯ代谢过程的过度活化可导致细胞膜损伤，抑制细胞分裂，生物活性聚合物的积聚。对儿童患鼻及鼻窦炎症时的ＬＰＯ改变很少研究。鼻及鼻窦炎发病率占总人口中５％，占耳鼻喉科病的１２％～２９％。该作者对８４例１～１４岁各类鼻及鼻窦化脓性炎症（男５３例，女３１例，复发性鼻疖１２例，急性化脓性筛窦炎１７例，急性化脓性上颌窦炎２８例，慢性化脓性上颌窦炎２７例）和５０名健康儿童对照组。于入院时，治疗过程中，出院时，甚至５月～１．５年后…     

单发性鼻窦炎细菌学检测及药敏试验结果分析

目的：了解单发性鼻窦炎细菌分布及对常用抗生素敏感情况。方法：对９４例上颌窦炎和４１例筛窦炎,蝶窦炎患者行功能性鼻窦内窥镜手术,将取出的窦腔分泌舶和粘膜进行细菌培养分离和常用抗生素的药敏试验。结果：１３５份标本中,有菌生长１１９份（８８．１５％）,共分离细菌１９２株,混合细菌生长６２份,厌氧菌７５株,分离菌株对青霉素的总敏感度为５３．１２％。头孢唑啉钠总敏感度为８７．５０％〉厌氧菌对甲硝唑的总敏感度     

慢性鼻窦炎患者上颌窦粘膜白细胞介素-1βmRNA及细胞粘附分子的定位研究

白细胞介素-1β（IL－1β）是慢性鼻窦炎窦口潴留液中的主要细胞因子，其炎症以鼻及鼻窦粘膜的多形核中性粒细胞（PMNS）浸润为特征。报告对慢性鼻窦炎患者上颌窦粘膜中IL－1βmRNA的定位研究以及对培养的人粘膜微血管内皮细胞和慢性鼻窦炎患者上颌窦粘膜的细胞粘附分子、细胞间粘附分子-1（ICAM－1）及内皮-淋巴粘附分子-1（ELAM-1）表达和分布的研究。标本来源于5例诊断明确的慢性上颌窦炎的成年患者，用地高辛标记的寡核着酸探针作原位杂交法检测IL－-βmRNA，以相应细胞粘附分子的单克隆抗体按免疫组化方法检测ICAM-1及和EL…     

成人慢性鼻窦炎的细菌学研究

随着医学影像学和鼻窦内窥镜手术的开展，对慢性耳窦炎有了进一步的认识。70至SO年代的文献报告慢性鼻窦炎主要有厌氧菌感染引起，近来研究发现厌氧菌在慢性鼻窦炎中的作用不大，尤其在1［童患者。为此，需要对厌氧菌在成人慢性易窦炎中的作用进行研究。该作者前瞻性研究了76倒成人保守治疗无效而计划行易窦内窥镜手术的慢性鼻窦炎患者，术中取筛窦组织送细菌培养，发现58例（7．3％）有细菌生长，其中40例为单一细菌生长，18例有两种或以上细菌生长，46例有凝血酶阴性的葡萄球菌，12例有金黄色葡萄球菌；18例（23．7％）无细菌生长。IO例…     

鼻内窥镜下经上颌窦自然开口冲洗注药治疗小儿鼻窦炎

对120例（212侧）慢性化脓性上颌窦炎患儿，在鼻内窥镜下置入中号肾分泌造影管，经上颌窦自然开口反复冲洗窦腔，排除上颌窦内脓液，同时注入抗生素。经观察，90％的患儿经治疗后，鼻塞及流脓涕症状消失，10％的患儿症状减轻。表明该法是治疗小儿鼻窦炎的较好方法。     

中药冲洗联合窦内充氧治疗慢性上颌窦炎

作者用中药（大黄、黄连、黄柏煎剂）窦内冲洗并联合充氧治疗慢性上颌窦炎。结果：治疗组59例，近期总有效率为98．3％。对照组用生理盐水冲洗后注入庆大霉素8万~u，55例近期总有效率为74．5％，统计学处理两组有显著性差异（P＜0．01）。治疗组远期治愈41例占70．7％，近期治愈44例占74．6％，无显著差异（P＞0．05），而对照组近期治愈26例占47．3％，远期治愈18例占32．7％，有显著差异（P＜0．05）。表明中药窦内冲洗联合充氧治疗慢性上颌窦炎确实有效。     

单侧上颌窦占位性病变的CT诊断

目的探讨CT扫描对常见的单侧上颌窦占位性病变的诊断意义。方法回顾性总结2006年1月～2008年1月我科治疗的108例单侧上颌窦占位性病变患者的临床及影像学资料,并以组织病理学结果作为对照,对比分析CT扫描在单侧上颌窦占位性病变中的诊断意义。结果108例单侧上颌窦占位性病变中慢性上颌窦炎36例（33．3％）,上颌窦肿瘤32例（29．6％）,真菌性上颌窦炎19例（17．6％）,上颌窦囊肿14例（13．0％）,上颌窦后鼻孔息肉5例（4．6％）,上颌窦出血坏死性息肉及上颌窦嗜酸性肉芽肿各1例（0．9％）。大多数上颌窦占位性病变都具有其特有的临床及影像学表现,鼻窦CT扫描在单侧上颌窦占位性病变的术前诊断总体准确率为79．1％;其中上颌窦囊肿的术前诊断准确率为92．9％,慢性上颌窦炎为90．0％,上颌窦癌为80．0％,真菌性上颌窦炎为86．4％,鼻内翻性乳头瘤为50．0％。结论CT扫描对单侧上颌窦占位性病变的术前诊断有着十分重要的作用,大多数病变通过鼻窦CT检查可以作出初步的定位或定性诊断,并制定出合理的手术方案,最终确诊仍有赖于组织病理学检查。     

内窥镜引导下上颌窦口细菌培养

25例成人急性和慢性急性发作的上颌窦炎病人经内窥镜检查发现中鼻道上颌窦开口有溢脓，并经X光片除外筛窦及额窦疾患者作为细菌取材对象。以上病人在7天内均未用过抗生素。取材方法在2畅盘托卡因和1吸麻黄素鼻腔喷雾后，以广，外径4mm的硬性鼻内窥镜寻见上颌窦开口。然后用铝杆、海藻酸钙为刷头的取样器取材。结果，25例中流感嗜血杆菌8例，金黄色葡萄球菌（凝固酶阳性）5例，肺炎链球菌4例，卡他球菌2例，产气杆菌和脑膜炎双球菌各1例。25例中有17例是多种菌复合感染。周为上颌窦的分泌物多流向鼻咽部，因此由鼻前庭取材不能反映上颌窦的…     

功能性鼻窦内窥镜手术治疗慢性上颌窦炎的疗效观察

对48例慢性上颌窦炎患者行功能性鼻窦内窥镜手术（FESS），单纯钩突切除术6例，约突切除术＋前、中筛房开放术13例，钩突切除术＋全筛切除术18例，钩突切除术＋全筛切除及中鼻甲成形术11例。经观察，术后2个月上颌窦功能恢复正常16例（33．3％），3．5个月恢复正常20例（41．7％），5个月恢复正常9例（18．8％）；累积治愈率为93．8％。表明FESS后，上颌窦粘膜生存条件改善后，具有自我恢复功能的能力。此外，术中尽量避免不必要的创伤，对于上颌窦功能的恢复有促进作用。     

内窥镜鼻窦手术治疗儿童慢性鼻窦炎

儿童鼻窦的解剖特点决定了在儿童的慢性鼻窦炎中，上颌窦炎最常见，自１９９０年以来，我院对５１例（９７侧）经药物和上颌窦穿刺冲洗失败患儿行内窥镜下鼻窦手术。其中大部分（５０例）有慢性上颌窦炎，１０冽有中鼻甲水肿和息肉样变，６例有筛窦炎。行上颌窦中鼻道开窗术１００侧次，筛窦开放术１２侧次，中鼻甲部分或全部切除术３２侧次，手术后２０例头痛消失，４３例鼻呼吸通畅，３７例黄脓涕消失，疗效满意，故内窥镜鼻窦手术是目前治疗儿童慢性上颌窦炎较为理想的方法。     

学龄儿童慢性鼻窦炎36例细菌学分析

目的：探讨学龄儿童慢性窦炎的细胞学特征,为临床治疗提供依据。方法：采用鼻道脓液进行细菌培养及药敏试验。结果：细菌培养阳性率为８３．３％,复合感染率为３６．１％;需氧菌株占７６．７％,厌氧菌株占５５．６％。抗生素药敏试验较分散。结论：学龄儿童慢性鼻窦炎厌氧菌感染甚高,应尽可能在细菌培养和药敏试验下指导治疗。     

Bacteriological findings and antimicrobial susceptibility in chronic sinusitis with nasal polyp

CONCLUSIONS: We recommend amoxacillin/clavulanate, cephalosporins and macrolides rather than penicillin as the first-line drug in chronic sinusitis with nasal polyps. In cases where there is no improvement of symptoms, cultures should be taken from the middle meatus, followed by appropriate selection of second-line antibiotics according to the sensitivity test results. OBJECTIVE: To investigate the causative bacteria and the antimicrobial susceptibility in patients with chronic sinusitis and nasal polyps in Korea. MATERIALS AND METHODS: The bacteriology and antimicrobial susceptibility of maxillary sinus aspirates from 81 patients were evaluated. RESULTS: Aerobes were isolated from 58.0% of the cultures from the middle meatus and from 48.1% of those from the maxillary sinus. Staphylococcus aureus, Haemophilus influenzae, and Streptococcus pneumoniae were the most prevalent aerobic pathogens. Anaerobes were isolated from 8.6% of the cultures from the middle meatus and from 18.5% of the cultures from the maxillary sinus. The predominant anaerobic organisms were Prevotella and Peptostreptococcus in adults but none of them were cultured in children. A high rate of concordance of the middle meatus and maxillary sinus was noted. Monomicrobial infection was most commonly observed. Ampicillin-resistant H. influenzae isolates were cultured in 46% of the cases. Penicillin resistance rates were 93% for Staph. aureus; 25% of Strep. pneumoniae were intermediate and 25% were resistant.     

慢性鼻窦炎的需氧菌分析

目的分析慢性鼻窦炎的需氧菌分布及对常用抗生素敏感情况,为临床药物治疗慢性鼻窦炎提供依据。方法在鼻内镜手术中以无菌方式取215个慢性鼻窦炎的鼻窦内容物(实验组),进行需氧菌培养和常用抗生素的药敏试验,并与正常人群60例中鼻道分泌物(对照组)的细菌培养结果对比。结果实验组中检出单一细菌者占92%,2种细菌混合感染者占8%;对照组均检为单一细菌。实验组单菌感染的G 菌占54.7%,G-菌占45.3%;对照组G 菌占73.3%,G-菌占26.7%。蝶窦、筛窦以G 菌感染为主;额窦、上颌窦以G-菌感染为主。实验组需氧菌耐药情况严重。结论慢性鼻窦炎需氧菌感染以单一细菌为主,G 菌占大多数,但G-菌的肠道菌群感染比例较高。不同的鼻窦中需氧菌种类不同。慢性鼻窦炎需氧菌耐药性严重。临床围手术期应用抗生素治疗宜先进行细菌培养与药物敏感试验。     

Bacteriological findings and antimicrobial susceptibility in chronic sinusitis with nasal polyp

Conclusions. We recommend amoxacillin/clavulanate, cephalosporins and macrolides rather than penicillin as the first-line drug in chronic sinusitis with nasal polyps. In cases where there is no improvement of symptoms, cultures should be taken from the middle meatus, followed by appropriate selection of second-line antibiotics according to the sensitivity test results. Objective. To investigate the causative bacteria and the antimicrobial susceptibility in patients with chronic sinusitis and nasal polyps in Korea. Materials and methods. The bacteriology and antimicrobial susceptibility of maxillary sinus aspirates from 81 patients were evaluated. Results. Aerobes were isolated from 58.0% of the cultures from the middle meatus and from 48.1% of those from the maxillary sinus. Staphylococcus aureus, Haemophilus influenzae, and Streptococcus pneumoniae were the most prevalent aerobic pathogens. Anaerobes were isolated from 8.6% of the cultures from the middle meatus and from 18.5% of the cultures from the maxillary sinus. The predominant anaerobic organisms were Prevotella and Peptostreptococcus in adults but none of them were cultured in children. A high rate of concordance of the middle meatus and maxillary sinus was noted. Monomicrobial infection was most commonly observed. Ampicillin-resistant H. influenzae isolates were cultured in 46% of the cases. Penicillin resistance rates were 93% for Staph. aureus; 25% of Strep. pneumoniae were intermediate and 25% were resistant.     

Microbiology and antimicrobial management of sinusitis

The growing resistance to antimicrobial agents of all respiratory tract bacterial pathogens has made the management of sinusitis more difficult. The upper respiratory tract including the nasopharynx serves as the reservoir for pathogenic bacteria that can cause respiratory infections including sinusitis. During a viral respiratory infection, potential pathogens can relocate from the nasopharynx into the sinus cavity, causing sinusitis. Establishment of the correct microbiology of all forms of sinusitis is of primary importance, because it can serve as a guide for choosing the adequate antimicrobial therapy. This article summarizes the current information regarding the microbiology of all forms of sinusitis and approaches to antimicrobial therapy.     

Clinical value of bacteriological examinations of nasal and paranasal mucosa in patients with chronic sinusitis

Although many investigations on the bacteriology of chronic sinusitis have been reported, there is still much discussion about the physiological flora of the nose and paranasal sinuses, the role of the various aerobic and anaerobic “pathogenic” bacteria, and the influence of the anatomical location from which samples for bacteriology are taken. We conducted a qualitative and semi-quantitative bacteriological examination of patients with chronic sinusitis undergoing a transnasal sinus operation (patient group), and of patients without chronic sinusitis undergoing a septoplasty (control group). In both groups brush smears of the inferior nasal turbinate and biopsies of the middle nasal turbinate were taken, with additional biopsies of the maxillary sinus and ethmoidal bulla in the chronic sinusitis group . In both groups coagulase-negative staphylococci were identified in almost all samples. Staphylococcus aureus was found in 22% (middle turbinate) to 33% (inferior turbinate) of the samples from the control group and in 33% (maxillary sinus, middle turbinate) to 50% (inferior turbinate) of the samples from the patient group. Other (pathogenic) aerobic bacteria were found much more rarely and only slight distinctions between control and patient group were observed. The concentrations of the different bacterial species (colony-forming units) were comparable in both groups. Strictly anaerobic bacteria and fungi were not identified. Only small discrepancies between the various methods and/or locations of sampling were found. Based on our bacteriological findings a differentiation between patients with and without chronic sinusitis was not possible. These results shed doubt on the clinical value of bacteriological examinations of nasal and paranasal mucosa in patients with chronic sinusitis. Received: 19 September 2000 / Accepted: 10 April 2001     

Efficacy of two third-generation cephalosporins in prophylaxis for head and neck surgery

Optimal antimicrobial prophylaxis during head and neck surgery is as yet unclear. The semisynthetic third-generation cephalosporin antibiotics would appear to have potential usefulness because of their broad antibacterial spectrum, favorable pharmacokinetic properties, and record of safety. Eighty patients were prospectively randomized into this placebo-controlled, double-blind study to receive either placebo, cefoperazone sodium, or cefotaxime sodium preoperatively and for 24 hours postoperatively. Infection rates were 78% for the placebo group and 10% for the group receiving the cephalosporin antibiotics. Infections were polymicrobial. Anaerobic bacteria constituted 42% of the pathogens isolated. Wound and serum antibiotic concentrations exceeded the minimal inhibitory concentration of the bacterial flora. This study establishes the necessity of antimicrobial prophylaxis for contaminated oncologic procedures of the head and neck. Our experience indicates that cefoperazone and cefotaxime are particularly useful.     

Bacterial spectra and antibiotics in odontogenic infections. Renaissance of the penicillins?]

BACKGROUND: The role played by odontogenic infection in dental, oral, and maxillofacial surgery is not to be underestimated even at the present time. An extensive, standardized, prospective study was performed with the intention of verifying the bacterial spectrum of odontogenic infections to evaluate antibiotic sensitivity. MATERIAL AND METHODS: Bacterial spectra and resistograms of 65 patients with an odontogenic infection were analyzed in a prospective study under standardized conditions for specimen collection and transport. RESULTS: A total of 226 bacterial strains were analyzed. The ratio between anaerobes and aerobes was approximately 2:1. The most frequent aerobes were members of the genera Streptococcus (46 isolates), Staphylococcus (10 isolates), and Neisseria (9 isolates), respectively. The anaerobic gram-positive spectrum was dominated by members of the genera Eubacterium (19 isolates), Peptostreptococcus (16 isolates), and Actinomyces (12 isolates). The most frequently isolated gram-negative anaerobes were Prevotella (46 isolates), and Fusobacterium (21 isolates).The overall resistance to antibiotics was very low: only 7.3% of all bacteria were resistant to penicillin G/V, and 8.8% showed resistance to ampicillin. The resistance rates to other beta-lactam antibiotics were 4.4% to piperacillin and 0.6% to imipenem, respectively.Penicillin G presented the highest antimicrobial activity among aerobes: only 4.5% of anaerobic strains were resistant of penicillin G. The other resistance rates of anaerobic bacteria to antibiotics were as follows: ampicillin 24%, doxycycline 34%, erythromycin 18%, and clindamycin 9.3%. Penicillin G was also highly antimicrobially active to anaerobes. The resistance rates were: penicillin G 8.1%, ampicillin 2.6%, doxycycline 9.2%, erythromycin 10.2%, and clindamycin 1.4%, respectively.     

Differential diagnosis of purulent and non-purulent acute maxillary sinusitis in young adults

In acute maxillary sinusitis, purulence could best be assessed from sinus washings, but evaluation based on aspirates was also reliable, provided that the amount of secretion was adequate. Injection-aspirates were of negligible diagnostic value in this respect. Sinus washings and aspirates which were clinically defined as purulent were almost invariably indicative of bacterial infection. The bacterial etiology was most accurately obtained by sinus aspiration. Only 14.5% of cultured specimens were negative for pathogenic bacteria. In maxillary sinusitis, judged to be non-purulent, 52.5% of cultures grew a pathogen. The most common pathogen was Haemophilus influenzae, which accounted for 90% of these isolations. There was a clear correlation between occurrence of many PMNs and pathogen positive culture in non-purulent cases. Thus, antimicrobial therapy which is effective against Haemophilus influenzae seems indicated in most cases of non-purulent maxillary sinusitis.