不伴Ⅱb型多发性内分泌肿瘤综合征的咽喉部多发性黏膜神经瘤一例

不伴Ⅱb型多发性内分泌肿瘤综合征(multiple endocrine neoplazia Ⅱb，MENⅡb)的多发性黏膜神经瘤(multiple mucosal neuroma，MMN)甚为罕见，现有文献仅见5例报道，病变分别位于结膜、支气管、舌、直肠乙状结肠和喉部。我们收治1例不伴MENⅡb的咽喉部MMN，报道如下。     

声带黏膜上皮病变的临床特征与治疗

目的 探讨声带黏膜鳞状上皮病变的临床特征与治疗效果.方法 分析343例声带黏膜鳞状上皮病变患者的病史、电子鼻咽喉镜或频闪喉镜及手术显微镜下的形态学特征及病理学结果,探讨声带黏膜鳞状上皮病变的治疗方式、治疗效果与临床特征的相关性.结果 根据343例声带黏膜鳞状上皮病变的镜下特征分为4型.Ⅰ型为炎性渗出型,19例,经保守治疗声带形态及声音质量恢复正常.Ⅱ、Ⅲ、Ⅳ型病变均行显微支撑喉镜下CO2激光手术.Ⅱ型为息肉摩擦型,72例,采用声带黏膜上皮下切除术;Ⅲ型为伴声带沟型,64例,采用黏膜切开挖槽术;Ⅳ型为单纯角化型,188例,采用声韧带下切除术或声带肌切除术.手术一次治愈率为90.7％( 294/324),复发率为9.3％(30/324),癌变率6.5％ (21/324).癌变者均为Ⅳ型患者(11.2％),第一次手术诊断8例,二次手术诊断13例,其中2例患者第三次手术采用喉垂直部分切除术.结论 根据声带黏膜鳞状上皮病变的形态学特征,采用保守或CO2激光手术,可以最大限度地保留喉功能,减少并发症.     

CD34在鼻息肉组织中的表达及意义

目的 检测CD34在鼻息肉组织中的表达,探讨CD34+细胞在鼻息肉上皮修复和炎症反应中的作用.方法 采用免疫组织化学方法检测10例鼻息肉组织和10例对照中鼻甲黏膜组织中的表达.结果 4例鼻息肉上皮基底细胞可见CD34表达,在中鼻甲黏膜上皮中未见CD34表达.在鼻息肉和对照中鼻甲黏膜上皮下固有层中可见到CD34+炎症细胞...     

CD44和nm23-H1基因蛋白在喉癌中的表达

目的:探讨CD44和nm23-H1基因蛋白在喉癌中的表达及临床相关性问题.方法:应用免疫组织化学方法对组织中CD44和nm23-H1基因蛋白的表达进行观察,其中喉癌40例、喉癌旁组织20例、喉正常黏膜12例.同时与临床相关资料进行对比研究.结果:喉癌组织中CD44和nm23-H1基因蛋白的表达明显高于喉正常黏膜.喉癌有淋巴结转移者CD44基因蛋白表达高于无淋巴结转移者,有淋巴结转移者nm23-H1基因蛋白表达低于无淋巴结转移者.CD44基因蛋白表达与喉癌淋巴结转移、临床分期和病理学分级呈正相关,与肿瘤T分级无关;nm23-H1基因蛋白表达与喉癌淋巴结转移及临床分期呈负相关,与T分级无关.结论:CD44和nm23-H1基因蛋白在喉癌的发生、发展及转移过程中起着协同、调控作用,有可能成为临床判断和评价预后的重要分子生物学指标.     

CD137L在喉癌中的表达及其临床病理学意义

目的:检测CD137L在喉癌中的表达,探讨其在喉癌发生和发展中的作用。方法:应用免疫组织化学染色法检测50例喉癌肿瘤组织和9例癌旁正常喉黏膜CD137L的表达。结果:CD137L在50例喉癌中阳性表达率为100%,而在9例癌旁正常喉黏膜组织中CD137L蛋白表达为阴性,与癌旁正常喉黏膜组织比较,喉癌CD137L阳性表达率明显增高,差异有统计学意义(P<0.01)。CD137L表达与患者年龄、性别和肿瘤生长部位无相关性,而与病理学分级、肿瘤T分期和有无淋巴结转移相关。结论:CD137L在喉癌组织的表达在喉癌发展过程中发挥重要作用。     

喉神经内分泌癌

目的:探讨喉神经内分泌癌的诊断和治疗.方法:对10例喉神经内分泌癌的临床、病理、诊断、治疗和预后进行回顾性分析.结果: 8例非典型类癌主要行外科手术:1例单纯行水平半喉切除术者于术后22个月死亡;1例失访;其余6例均随访超过2年以上,未见复发.2例小细胞喉神经内分泌癌采用手术切除+放化疗的联合性治疗方案,1例经联合治疗仍于术后14个月死亡;1例术后正行放化疗中.结论:喉神经内分泌癌是一种较为罕见的恶性肿瘤,正确诊断有赖于临床特点、组织病理学、免疫组织化学检查.不同类型的喉神经内分泌癌应行不同的治疗方法,预后差异较大.     

慢性鼻窦炎鼻息肉筛窦黏膜病理形态学研究

目的　探讨慢性鼻窦炎鼻息肉 (chronicsinusitisandnasalpolyps,CSNP)各型的病理变化特点和病变规律。方法　采用HE、VanGieson′s染色、阿尔辛蓝 过碘酸 雪夫等染色法观察并测量CSNP病变黏膜主要结构的改变。用透射电镜和扫描电镜重点观察黏膜上皮纤毛的改变。结果　光镜下黏膜上皮、纤维组织均有不同程度的增生 ,基底膜增厚 ,黏液腺体增多。其中Ⅰ型病变最轻 ,Ⅲ型病变最显著 ,而黏液腺体增多在Ⅱ型最明显。电镜观察 ,透视电镜下CSNP各型表现为纤毛结构异常 ,纤毛细胞减少 ,杯状细胞增多 ;扫描电镜下可见纤毛从排列稍乱 ,到紊乱、倒伏、大片脱落 ,被微绒毛所代替等病变逐渐加重的过程。结论　 3型CSNP筛窦黏膜病变和组织结构有明显的量和质的差别 ,海口标准 (1997)CSNP临床分型分期具有病理学基础 ,能代表CSNP发生发展及转归规律。     

重视遗传性肿瘤规范处理——多发性内分泌腺瘤2A型

多发性内分泌腺瘤2型(multiple endocrine neoplasia type 2,MEN2)又称为Sipple综合征,其病理学特征为甲状腺髓样癌(medullary thyroid carcinoma,MTC)或甲状腺C细胞增生,是一种有明显家族倾向的常染色体显性遗传疾病,表现为在同一患者身上同时或先后出现2个或2个以上的内分泌腺腺瘤或增生而产生的一种以受累腺体功能亢进为表现的临床综合征。根据不同的临床表现可分为MEN2A、MEN2B、     

鼻内镜治疗慢性鼻窦炎嗅觉障碍的临床病理学研究

目的探讨鼻内镜治疗慢性鼻窦炎嗅觉障碍的临床疗效与嗅黏膜病理学变化的关系。方法对52例(104侧)嗅觉障碍病人行功能性鼻内镜手术(FESS),同时辅助药物治疗,并对治疗前后嗅黏膜进行了组织学观察及统计学分析。结果104侧嗅黏膜术前均发现有病理组织学的改变,以嗅细胞的减少占首位,为73%(73/100);其次是嗅上皮萎缩,为49%(49/100);4侧呼吸上皮化生。Ⅰ型与Ⅱ型相比术前嗅细胞减少、嗅上皮萎缩,差异有统计学意义(P<0.05)。术后随访6个月,嗅觉恢复66.3%,嗅觉改善23.1%,为嗅上皮正常或轻中度病变者;嗅觉无变化10.6%,为嗅上皮中重度病变和呼吸上皮化生者。各临床分型于术前、术后在嗅细胞减少、嗅上皮萎缩,差异有统计学意义(P<0.01)。结论慢性鼻窦炎分型与嗅上皮病理学变化明显相关,嗅细胞减少、嗅上皮萎缩是嗅觉障碍的病理学基础,鼻内镜技术是治疗嗅觉障碍的有效方法,药物治疗明显提高疗效。     

慢性鼻-鼻窦炎增厚基底膜样物质的形态学研究

目的对慢性鼻-鼻窦炎损伤上皮下增厚的基底膜样物质进行观察并确定其组成成分。方法收集40例慢性鼻一鼻窦炎患者鼻内镜手术后筛窦病变黏膜组织，同时将10例接受鼻中隔矫正术患者术中切除的筛窦黏膜组织作为对照。对上述标本行过碘酸-希夫（periodic acid-schiff，PAS）染色，测量基底膜样物质的厚度；采用免疫组化方法、苦味酸-天狼星红偏振光法确定基底膜样物质的主要成分；透射电镜进一步观察。结果与正常对照组相比，慢性鼻．鼻窦炎Ⅰ型、Ⅱ型患者鼻黏膜基底膜样物质增厚，差异有统计学意义（t值分别为5．426、8．375，P值均〈0．01）；Ⅱ型与Ⅰ型相比，差异也有统计学意义（t=3．908，P〈0．01）。变应组与非变应组间基底膜增厚无统计学意义（t=0．803，P〉0．05）。增厚的基底膜样物质主要由Ⅰ型、Ⅲ型、Ⅳ型胶原纤维组成，未见纤维连接蛋白、层黏连蛋白及IgA、IgG、IgM等免疫复合物沉积。透射电镜观察到增厚的基底膜样物质是胶原原纤维编织成厚的网状结构且无细胞成分。结论长期慢性炎症会引起损伤的鼻窦黏膜上皮下Ⅰ型、Ⅲ型、Ⅳ型胶原纤维沉积，产生逐渐增厚的基底膜下层。     

Laryngeal solitary multiple mucosal neuromas without multiple endocrine neoplasia (MEN) type 2B

The first case of laryngeal solitary multiple mucosal neuromas (MMN) was reported. A 73-year-old man who had complained of hoarseness and abnormal prickly sensation in the throat for 3 months visited our hospital. Many small whitish-yellow nodules were observed in the laryngeal mucosa from the right arytenoid to the interarytenoid region. Using laryngomicroscopy biopsy was performed twice. The pathological study showed neurogenic nodular lesions consisting of regularly arranged nerve bundles with many axons and Schwann cell proliferation, and so MMN was finally diagnosed. As MMN is regarded as a constant component of multiple endocrine neoplasia (MEN) type 2B, screening of MEN type 2B was performed, however, they were all within normal limits. This case was, therefore, diagnosed as a laryngeal solitary MMN without MEN type 2B.     

Statistical detection and analysis of mismatch negativity derived by a multi-deviant design from normal hearing children

To shorten the time of measurement of mismatch negativity (MMN) and to objectify the analysis of MMN characteristics, auditory evoked potentials (AEP) were recorded and MMNs were statistically examined. AEPs from 16 healthy children between the ages of 5 and 7 were elicited using a multi-deviant design including: frequency, duration, intensity, and gap. For detection of MMN an automatic method was applied based on statistical analysis (t-tests) of AEP sweeps. The incidences found were compared to the incidences of MMNs detected by visual inspection of difference waveforms. MMN features such as peak amplitude, peak latency, onset latency, duration of MMN, and area under the curve were evaluated for MMN intervals identified by statistical analysis. MMN incidences identified by statistical analysis (44) reflected a consistency of 84% to visually identified (52) incidences of MMN. Scalp distribution of MMN was mainly fronto-central. Peak latencies of the duration MMN differed significantly from those of the other deviant MMNs. The multi-deviant paradigm was successfully applied for measuring children’s AEPs. The statistical approach proved applicable for analysing the data objectively.     

A paradigm to measure mismatch negativity responses to phonetic and acoustic changes in parallel

The mismatch negativity (MMN) of the event-related potential has been purported to be an objective index of central auditory processing. The present study tested a new paradigm to measure the MMN responses to phonological changes in parallel with those to simple acoustic changes. Stimulus sequences consisted of repetitive consonant-vowel syllables interspersed with infrequent phonetic changes (in place of articulation or voicing) and repetitive sinusoidal tones with occasional acoustic changes (in frequency or duration). The speech and tone stimuli were delivered to the opposite ears (right and left, respectively) at a stimulus onset asynchrony (SOA) of 300 ms. The MMNs elicited in this new paradigm were compared with those measured in a conventional paradigm, in which the speech and tone stimuli were presented in separate sequences at an identical speech-speech or tone-tone SOA (600 ms) of the new paradigm. The MMNs elicited in the two paradigms had a similar morphology and topography, although the MMNs measured with the new paradigm were slightly smaller for 3 out of 4 types of deviants. The results suggest that the new paradigm enables the measurement of reliable MMNs to phonetic changes in parallel with those to acoustic changes.     

Processing of English words with fine acoustic contrasts and simple tones: a mismatch negativity study

The purpose of this study was to compare the robustness of the event-related potential (ERP) response, called the mismatch negativity (MMN), when elicited by simple tone stimuli (differing in frequency, duration, or intensity) and speech stimuli (CV nonword contrast /de:/ vs. /ge:/ and CV word contrast /del/ vs. /gel/). The study was conducted using 30 young adult subjects (Groups A and B; n = 15 each). The speech stimuli were presented to Group A at a stimulus onset asynchrony (SOA) of 610 msec and to Group B at an SOA of 900 msec. The tone stimuli were presented to both groups at an SOA of 610 msec. MMN responses were elicited by the simple tone stimuli (66.7%-96.7% of subjects with MMN "present," or significantly different from zero, p < 0.05) but not the speech stimuli (10% subjects with MMN present for nonwords, 10% for words). The length of the SOA (610 msec or 900 msec) had no effect on the ability to obtain consistent MMN responses to the speech stimuli. The results indicated a lack of robust MMN elicited by speech stimuli with fine acoustic contrasts under carefully controlled methodological conditions. The implications of these results are discussed in relation to conflicting reports in the literature of speech-elicited MMNs, and the importance of appropriate methodological design in MMN studies investigating speech processing in normal and pathological populations.     

Mismatch negativity and adaptation measures of the late auditory evoked potential in cochlear implant users

A better understanding of the neural correlates of large variability in cochlear implant (CI) patients' speech performance may allow us to find solutions to further improve CI benefits. The present study examined the mismatch negativity (MMN) and the adaptation of the late auditory evoked potential (LAEP) in 10 CI users. The speech syllable /da/ and 1-kHz tone burst were used to examine the LAEP adaptation. The amount of LAEP adaptation was calculated according to the averaged N1-P2 amplitude for the LAEPs evoked by the last 3 stimuli and the amplitude evoked by the first stimulus. For the MMN recordings, the standard stimulus (1-kHz tone) and the deviant stimulus (2-kHz tone) were presented in an oddball condition. Additionally, the deviants alone were presented in a control condition. The MMN was derived by subtracting the response to the deviants in the control condition from the oddball condition. Results showed that good CI performers displayed a more prominent LAEP adaptation than moderate-to-poor performers. Speech performance was significantly correlated to the amount of LAEP adaptation for the 1-kHz tone bursts. Good performers displayed large MMNs and moderate-to-poor performers had small or absent MMNs. The abnormal electrophysiological findings in moderate-to-poor performers suggest that long-term deafness may cause damage not only at the auditory cortical level, but also at the cognitive level.     

Identification of the mismatch negativity in the responses of individual listeners

The mismatch negativity (MMN) was recorded from normal adults in three stimulus conditions: two contrast conditions and a control condition in which standard and deviant stimuli were identical. Averaged waveforms were analyzed by examiners blind to the evoking stimulus condition. Hit rates, a false alarm rate, and d' values were determined based on the number of MMNs identified in each condition. Hit rates were low and the false alarm rate was relatively high, resulting in unacceptably small d' values. The relationship between MMN findings and corresponding behavioral discrimination data for individual listeners was not systematic. Factors that may contribute to ambiguity and error in MMN data analysis are discussed.     

Use of the median method to enhance detection of the mismatch negativity in the responses of individual listeners

The median method was evaluated as an alternative way of expressing the mismatch negativity (MMN). Traditionally, signal averaging has been used to extract these event-related potentials from unwanted background noise. However, mean values are biased by unrejected artifact that skews the relatively small distribution of values on which the MMN is based. Because the median is a more valid measure of central tendency in asymmetric distributions, it may describe MMN data more accurately. Better representation of the signal in the median waveform might enhance detection of the MMN in the responses of individual listeners. Mean and median waveforms were computed from previously recorded MMN data. Visually identified MMNs were validated using area and onset latency criteria. Detectability of the MMN was not improved using median waveforms. Despite this result, a theoretical argument for use of the median is presented.     

以颈部淋巴结肿大为首发症状的局灶型Castleman病诊治体会

目的 总结颈部Castleman病的临床特征与诊治体会.方法 回顾性分析2000年5月至2008年10月期间8例以颈部淋巴结肿大为首发症状的Castleman病患者临床资料.肿物位于颈部Ⅰ区1例,Ⅱ区3例,Ⅲ区3例,Ⅳ区1例.8例病例均行常规CT检查表现为类圆形软组织肿块影,其中4例增强扫描后周围可见环性增强区.8例血常规检查大致正常,其中6例患者轻度贫血.结果 本组病例均为局灶型Castleman病,手术完整切除肿大淋巴结,肿大淋巴结呈椭圆形,大小约(2 cm×2 cm×3 cm)～(4 cm×3 cm×2 cm),界限清楚,与周围组织无明显粘连.病理类型为透明血管型.术后随访7～30个月未见复发.结论 局灶型Castleman病表现为单一部位的淋巴结肿大,CT等影像榆查可以提示诊断,手术切除疗效好.     

以溃疡为主要表现的咽喉部病变临床诊治分析

目的 回顾分析10例以咽喉溃疡病变为主要表现患者的病历资料,为临床医师诊疗该类疾病提供参考。方法 对纳入的病例从临床表现、病变部位、溃疡特点、诊疗经过、病理诊断、预后情况进行分析,结合典型病例及文献复习阐述该类疾病的临床特点。结果 最后确诊喉结核6例(声门上区1例,声门区4例,声门下区1例),溃疡性咽喉炎2例、淋巴瘤1例、下咽癌1例。所有患者根据最后诊断接受相应治疗。结论 对咽喉部溃疡性病变,首先需明确诊断,除单纯溃疡外,应考虑到特异性感染、恶性肿瘤等疾病可能,明确诊断后才能精准施治,得到确切疗效。     

Effect of inverting electrode on mismatch negativity presence for perceptible/imperceptible tonal frequency contrasts

The effect of inverting electrode location and stimulus perceptibility on the presence of the mismatch negativity (MMN) evoked response was investigated in 20 normal-hearing adult females. Perceptible and imperceptible frequency contrasts were employed in an oddball paradigm. The perceptible contrast consisted of an 1122Hz standard and a 1000Hz target, while the imperceptible contrast consisted of an 1122Hz standard and an 1120Hz target. Data were referenced separately to the tip of the nose, the ipsilateral mastoid, and the mathematical average of the two mastoids. Presence of a response was determined according to strict criteria established a priori. The correspondence between MMN findings and parallel behavioral discrimination data was not systematic. Inverting electrode had an effect of MMN presence. MMNs were more likely to be present for mastoid-referenced data than nose-referenced data. Thus, when using the current paradigm, a mastoid reference is suggested to optimize the detection of the MMN response.