耳廓开放性外伤的治疗方法探析

目的 探讨耳廓开放性外伤的治疗方法。方法 23耳耳廓开放性外伤经彻底清创，肝素生理盐水冲洗伤口后，对位缝合。术后用抗生素抗感染、丹参扩张血管、罂粟碱改善微循环。结果 23耳中2耳失访，18耳完全成活，1耳部分成活，2耳完全坏死。结论 耳廓撕裂伤、断伤、带有皮蒂的耳廓离断伤，由于断端双侧血管丰富，经对位缝合后容易成活。但耳廓完全离断伤由于缺乏血供，经对位缝合后不易成活，可采用去皮血管植入包埋法，带肌蒂皮瓣移植法或尝试显微外科技术施行血管吻合，以提高耳廓完全离断伤的成活率。     

诊治7例鼻腔嗅神经母细胞瘤的体会

目的：提高临床对鼻腔嗅神经母细胞瘤的认识及治疗效果。方法：７例患者按Ｋａｄｉｓｈ分期，Ｂ期２例，Ｃ期５例，单纯放疗３例，术前放疗４例，放射剂量为５０００￣７０００ｃＧｙ。均随访至１９９７年１２月，结果：存活５例，存活时间分别为２０，２２，２３，２９及７６个月；结论：放疗对该肿瘤有效；放疗与化疗结合的方法值得探讨，该瘤病理上可能存在不同的亚型。     

急性化脓性耳廓软骨膜炎手术疗效分析

目的 探讨能够缩短化脓性耳廓软骨膜炎疗程,降低耳廓畸形发生率且具个体化的局部治疗方法.方法 回顾分析1 989年4月～2010年2月我科诊治的25例化脓性耳廓软骨膜炎的临床资料.除进行抗生素治疗外,局部治疗方法包括清创术后重新行耳甲腔成行术;脓腔穿刺置静脉留置针进行持续负压引流;清创后创腔置管引流.结果 自定义疗效评定...     

Effects of time of contact and concentration of caustic agent on generation of injuries

OBJECTIVES: Solid caustic soda (CS) ingestion levels continue high in Brazil. The aggressiveness of a caustic agent depends, among other factors, on its concentration and time of contact with mucosa. However, the interdependence of these factors in the production of caustic lesion in the esophageal mucosa is not known, especially regarding CS as the strongest corrosive agent. We analyze the effects of concentration and time of contact on the aggressiveness of CS to the esophagus of live animals. STUDY DESIGN/METHODS: One milliliter of CS at concentrations between 1.83% and 73.33% was applied to rats. The solution was kept in contact with the mucosa for 10 to 120 minutes. Internal and external organ aspects were analyzed and the epithelium, submucosa, muscle layer, and adventitia were analyzed microscopically RESULTS: Epithelial necrosis was observed at all concentrations. Among the necrotic layers, the submucosa was observed starting at the 7.33% concentration, and the muscular layer and adventitia were observed at 14.66% concentration. Damage to the pulmonary parenchyma and trachea occurred at 33.66% after 10 minutes, and perforation of the esophagus was observed only after 120 minutes. After 10 minutes, important corrosive lesions installed in the esophageal layers, expanding in depth and superficial extension. The use of heparin had no effect on the production of lesions. CONCLUSIONS: Ten minutes were sufficient to provoke necrosis, and longer contact increased the area of necrosis. Solution concentration levels were more important in damage production: 1.83% was sufficient for epithelial necrosis, 7.33% caused submucosal necrosis, and 14.66% muscle and adventitia necrosis; 33.66% solutions caused lung and trachea damage after 10 minutes and esophageal perforation after 120 minutes.     

Scales of degree of facial paralysis: analysis of agreement

IntroductionIt has become common to use scales to measure the degree of involvement of facial paralysis in phonoaudiological clinics.ObjectiveTo analyze the inter- and intra-rater agreement of the scales of degree of facial paralysis and to elicit point of view of the appraisers regarding their use.MethodsCross-sectional observational clinical study of the Chevalier and House & Brackmann scales performed by five speech therapists with clinical experience, who analyzed the facial expression of 30 adult subjects with impaired facial movements two times, with a one week interval between evaluations. The kappa analysis was employed.ResultsThere was excellent inter-rater agreement for both scales (kappa > 0.80), and on the Chevalier scale a substantial intra-rater agreement in the first assessment (kappa = 0.792) and an excellent agreement in the second assessment (kappa = 0.928). The House & Brackmann scale showed excellent agreement at both assessments (kappa = 0.850 and 0.857). As for the appraisers’ point of view, one appraiser thought prior training is necessary for the Chevalier scale and, four appraisers felt that training is important for the House & Brackmann scale.ConclusionBoth scales have good inter- and intra-rater agreement and most of the appraisers agree on the ease and relevance of the application of these scales.     

术前使用布地奈德对声带息肉手术疗效的影响

目的 研究术前使用布地奈德雾化吸入治疗对手术疗效的影响。方法 按病程将3个月以内和1年以上患者随机分为两组,一组术前给予布地奈德雾化治疗,一组没有,术后两周复诊。分别于初诊、手术前和复诊时使用嗓音测试仪对病人进行测试并记录参数。结果 病程3个月以内患者术前给予雾化治疗后,其术后声学参数明显改善。结论 病程3个月以内患者术前给予雾化治疗能缩短术后恢复时间。     

A national audit of sinus surgery. Results of the Royal College of Surgeons of England comparative audit of ENT surgery

The results of a national audit of sinus surgery are presented. Forty-six consultant ENT surgeons reported on over 2500 sinus procedures. There has been an exponential rise in the number of surgeons in England and Wales performing functional endoscopic sinus surgery (FESS) in recent years. Sixty-five per cent of surgeons in our study used the FESS technique and 81% had formal or other training. Outpatient sinus endoscopy and CT scans have become more routine pre-operative investigations, whilst the use of plain films has waned. There was a wide variation in the numbers of FESS procedures performed by individual surgeons in the 6-month period (between 5 and 85). The overall complication rate was 0.75% for conventional surgery and 1.41% for functional surgery but no major complications were recorded. The primary symptom of blockage was most successfully treated by both conventional and functional surgery (70% and 84% asymptomatic or improved at 6 months). Pain was relieved in 75% of functional procedures and 47% of conventional procedures and discharge relieved in 76% of FESS procedures and 47% of conventional procedures.     

CT对鼻腔鼻窦内翻性乳头状瘤起源的探讨

目的 探讨鼻腔鼻窦内翻性乳头状瘤起源的CT影像学特点。 方法 回顾性分析47例经鼻内镜手术及术后病理组织学确诊的鼻腔鼻窦内翻性乳头状瘤患者的CT影像学资料。对肿瘤病变在CT上的骨质变化进行分析,并与术中发现的肿瘤起源根蒂部位进行对比,分析CT影像中骨质改变与肿瘤起源之间的关系。 结果 47例患者中,39例有骨质增生影像表现,其中37例骨质增生部位与肿瘤起源的根蒂部位一致,一致性达78.7%,提示可根据骨质增生部位推测肿瘤起源位置。 结论 CT影像中的骨质增生与鼻腔鼻窦内翻性乳头状瘤的根蒂起源部位有较高的一致性,有助于术前评估肿瘤起源和指导术前制定合理的手术方案。     

磷霉素在减轻卡那霉素耳中毒过程中的作用

本文采用磷霉素笔卡那霉素联合应用，经扫描电镜、透射电镜、耳蜗铺片和组织化学反应观察，了解磷霉素减轻卡那霉素耳毒性的机制以及卡那霉素所致耳毒性的发展过程。通过实验可以看到磷霉素有保护溶酶体膜的作用，所以能减轻卡那霉素的耳毒性，但由于它不能直接对抗AmAn耳毒性作用机制，因而不能完全预防其耳毒性。     

慢性鼻窦炎病原学变迁的研究

目的:了解慢性鼻窦炎病原学分布的变迁。方法:术中收集2010年全年111例(实验组)上颌窦或筛窦脓性分泌物,分别进行需氧菌和真菌培养,同时以30例健康受试者作为对照组,其培养结果与2005年的各种数据比较,分析病原微生物的分布变化。结果:实验组共培养出15种病原微生物,主要为肺炎克雷伯菌、甲型链球菌、鲍曼不动杆菌、表皮葡萄球菌、铜绿假单胞菌、白色念珠菌等;需氧菌和真菌培养阳性率为81.8%,其中革兰阳性菌37.8%,革兰阴性菌54.4%,各种真菌7.8%;对照组检测出表皮葡萄球菌、流感嗜血杆菌、甲型链球菌、卡他布兰汉菌和金黄色葡萄球菌5种细菌,与实验组比较差异有统计学意义(χ2=0.009,P<0.01);与2005年数据(革兰阳性菌56.3%,革兰阴性菌43.7%,真菌阳性率1.4%)比较,其分布特征有明显差异。结论:细菌感染是慢性鼻窦炎的重要原因之一;细菌分布结构从原来的革兰阳性菌变成现在的以革兰阴性菌为主,真菌感染也不容忽视。应用抗生素治疗宜先进行细菌培养与药敏试验。     

扁桃体术后出血的原因分析

目的：探讨扁桃体术后出血的常见原因,并提出相应的预防措施。方法：选取扁桃体切除术患者1192例,根据其是否发生术后出血分为两组,对两组患者的基本资料和治疗情况进行统计学分析。结果：扁桃体术后出血者中成年、男性患者,合并高血压、肝脏疾病,术前长期服用阿司匹林,术前长期使用肾上腺皮质激素,局部麻醉,术中采取纱球压迫止血,术后剧烈咳嗽,不合理进食,以及围手术期存在焦虑情绪的患者所占比例明显高于未发生出血者,两组比较差异有统计学意义（P〈0．05）。而患者是否合并糖尿病对其术后出血影响不大（P〉0．05）。经Logistic回归分析,焦虑,合并高血压、肝脏疾病,使用纱球压迫止血,术后剧烈咳嗽以及不合理饮食都是患者发生扁桃体出血的原因（P〈0．05）。结论：扁桃体术后出血与多方面的因素密切相关,在临床工作中应给予针对性的预防。     

鼻窦骨瘤手术进路的选择

目的:探讨鼻窦骨瘤手术进路的选择,分析各种手术的方法和特点。方法:31例患者中鼻 侧切开术14例,其中经典鼻侧切开术3例,扩大鼻侧切开术6例,单纯眉弓切口手术5例;鼻内镜下手术8例;冠 状切口颅骨切开术8例;Caldwell Luc进路手术1例。肿瘤彻底切除26例,部分切除2例。结果:术中出现脑脊 液鼻漏2例,均修补成功;术后出现球后出血,导致右眼失明1例。31例患者中随访28例,失访3例,平均随访时 间3.7年。彻底切除肿瘤的26例均无复发;部分切除肿瘤的2例带瘤生存。结论:鼻窦骨瘤手术进路的选择主要 依据骨瘤的位置、大小及鼻窦局部解剖特点以及有无重要神经、血管的侵犯等,也要考虑器官结构的功能、美容及 术者的经验和技术。     

Spontaneous expulsion of schwannoma of epiglottis

A rare case of spontaneous expulsion of schwannoma of epiglottis is being reported. These are neurogenic tumours arising from the schwan sheath of peripheral, cranial and sympathetic nerves. The great majority of these neurogenic tumours originate from aryepiglottic fold or false vocal cords. However the neurofibroma of the epiglottis are quite uncommon.     

鼻出血预后多因素分析

目的：探讨影响鼻出血预后的因素。方法：对126例鼻出血患者的临床资料进行统计学分析。结果：对鼻出血预后显著影响的因素有年龄、病程、合并高血压、心理健康状况,以及治疗中是否联合应用裸花紫珠片。结论：发病后3天内治疗,用药中联合裸花紫珠片,加之心理疏导,能显著改善鼻出血的预后。     

中耳癌20例报告

目的：提高临床对中耳癌的认识，做到及时诊断与治疗。方法：20例均先行手术治疗，其中14例采用扩大的乳突根治术，3例行侧颞骨切除术，3例行颞骨次全切除术；有颈淋巴结转移的3例同时行根治性颈淋巴结廓清术。术后均辅以放疗。结果：随访5～13年，3、5年生存率分别为55．0％(11／20)，45．0％(9／20)。结论：中耳癌手术治疗应根据其侵及中耳乳突的范围，以及有助于放射治疗发挥作用而选择不同的术式。     

Effects of Intratympanic Injection of Isosorbide on the Vestibular Function of Animal Models of Endolymphatic Hydrops

ObjectivesThe aims of this study were to investigate the effects of intratympanic injections of isosorbide on vestibular function in animal models of endolymphatic hydrops and to find a new treatment option for the acute onset of vertigo in Ménière disease (MD).MethodsSeventy male guinea pigs received intratympanic injection of isosorbide (IT-ISB). The animals were divided into three study groups: control, a chronic hydrops model, and an acute hydrops model. Intracochlear drug concentrations were measured using high-performance liquid chromatography. Vestibular function was analyzed using an animal rotator test with bidirectional sinusoidal harmonic acceleration before and after IT-ISB administration. Histological changes were also investigated.ResultsISB successfully permeated the perilymph through the round window membrane (RWM) at all three concentrations (25%, 50%, and 100%). In the chronic hydrops model, while IT-ISB histologically induced a reduction of endolymphatic hydrops, vestibular function was unchanged. In the acute hydrops model, no endolymphatic hydrops was histologically observed, and vestibular symmetry was also preserved after IT-ISB.ConclusionISB passed through the RWM into the perilymphatic space even at lower concentrations. IT-ISB histologically reduced hydrops in the chronic model and preserved symmetrical vestibular function in the acute model. IT-ISB could be a treatment candidate for acute attacks of vertigo in MD.     

10例耳部原发性横纹肌肉瘤的临床病理分析

目的分析耳部原发性横纹肌肉瘤的临床病理特征及其免疫组织化学特点，为该肿瘤的诊断提供依据。方法对10例耳部原发性横纹肌肉瘤采用光学显微镜和免疫组织化学染色方法观察。所用抗体有：波形蛋白（Vimentin），结蛋白（Desmin），平滑肌肌动蛋白（SMA），肌红蛋白（Myoglobin）。结果10例中男性8例，女性2例，平均年龄8．6岁，其中胚胎性横纹肌肉瘤9例，葡萄型横纹肌肉瘤1例；免疫组织化学：Vimentin及Myoglobin染色10例均呈阳性，Desmin染色7例阳性。SMA染色8例阳性。结论耳部原发性横纹肌肉瘤缺乏特异性临床表现。故诊断困难，对可疑病例及时做活检进行HE染色和免疫组织化学检查方可对该病作出诊断。     

Experimental Analysis of Behavior of Homing Pigeons as a Result of Functional Disorders of their Lagena

Behavioral experiments concerning the homing abilities of pigeons were done by sectioning their lagenal nerves or interfering with the function of the lagena using a magnet. Twenty-one birds were treated in this way and 30 birds from the same loft of racing pigeons were used as controls. The results of homing tests clearly revealed a magnetic influence on the function of the lagena in terms of the navigation ability of pigeons: the treated birds were either lost or significantly delayed while the controls returned within 30 min of release. The lagena of birds is a unique organ and it is concluded that it is a key element in the magnetic sensory system of birds.     

Development of a script of phonemically balanced monosyllable lists of Mandarin-Chinese

Objectives To develop a set of monosyllable audiometry test material that can be used in speech recognition testing in Mandarin Chinese. Materials and Methods In an effort to improve reliability and efficiency in clinical practice, a set of 30 test lists of 25 monosyllable test items each was designed with consideration of the following: length of the list, phonemical balance (PB), word utility frequency, coverage of common words, and equivalency among lists. The 30 lists contained 750 monosyllabic words and were constructed on the basis of Chinese phoneme distribution probability summarized in the Manual of Acoustic. The occurrence incidence of the 22 consonants, 36 vowels, and 4 tones of the Chinese Mandarin characters in the 30 test lists were calculated. To achieve PB, 489 monosyllables were selected from the 2500 most commonly used Chinese characters and the 4000 most commonly used Chinese phrases to compile the 30 monosyllable test lists using a computer algorithm with manual adjustment. Results Thirty phonemical balanced word lists of common Mandarin Chinese monosyllabic words were compiled. Each list consisted of 25 monosyllables. A total of 489 phonemes (consonants, vowels and tones) were included in the set. Conclusions This set of lists can potentially be used as the basic lists for future development of Mandarin PB monosyllable speech test materials.     

Ramsay Hunt综合征首诊误诊分析

目的探讨Ramsay Hunt综合征误诊的原因。方法对64例Ramsay Hunt确诊患者首诊进行回顾性分析。比较耳部疱疹和神经痛阳性率,筛选更敏感的诊断指标;统计误诊疾病种类和比例,提出鉴别诊断的重点;按首诊医师不同分为社区医师组和专科医师组;以首诊症状是否典型分为症状不典型组和症状典型组,并分层分析。结果耳部神经痛阳性率高于疱疹阳性率（P〈0.05）。误诊28例,误诊率为43.8%,最易误诊为炎症（67.9%）。社区医师误诊率高于相关专科医师（P〈0.05）。症状不典型时社区医师误诊率高于症状典型时（P〈0.05）;而专科医师误诊率无差别（P〉0.05）。结论减少误诊率,可将耳部神经痛作为诊断Ramsay Hunt综合征的主要指标;注意神经痛与炎症疼痛鉴别及同时出现的耳部和面部体征。