副流感嗜血杆菌感染致后鼻孔右侧气管支气管出血1例

患者 ,男 ,5 7岁。因咳嗽、咯血、鼻出血 2d于2 0 0 2年 6月 17日收治入院。行纤维内镜检查发现 ,右侧后鼻孔区毛细血管曲张、破裂 ,有活动性出血 ,气管右侧壁、右侧支气管、右侧二级支气管内均有同与后鼻孔所见病损。胸部X线检查及CT扫描 :右中下肺炎。痰和咽拭培养 :均为副流感嗜血杆菌生长。行鼻腔填塞、抗感染治疗 1周后 ,复查胸透 :右中下肺部炎症吸收。纤维内镜示 :右侧后鼻孔区毛细血管曲张减轻 ,右侧气管支气管毛细血管曲张消失 ,出血停止。治疗 2周后复查纤维内镜 :右侧后鼻孔区毛细血管曲张明显好转 ,右侧气管支气管正常 ,出血…     

鼻出血致心肌缺血二例

例 1　 男 ,64岁。因反复右鼻出血5ｄ入院。每日出血 1、2次 ,每次量约4 0～ 60ｍｌ,多次在门诊鼻腔填塞无效 ,急诊入院。患者平时身体健康 ,常规体检心电图正常。查体 :脉搏 84次 /ｍｉｎ、血压 10 5 /60ｍｍＨｇ(1ｍｍＨｇ =0 13 3ｋＰａ) ,一般情况差 ,贫血貌 ,心、肺、腹正常 ,右侧鼻腔Ｌｉｔｔｌｅ区粘膜糜烂 ,无活动性出血。血常规 :血红蛋白 66ｇ/Ｌ、红细胞数2 4 1× 10 12 /Ｌ。给予止血、抗炎、对症治疗。 2日后右鼻腔再次出血 ,量多 ,立即给予后、前鼻孔填塞 ,填塞后仍有少量渗血。 3日后突感胸闷、胸痛、全身冷汗 ,阵发性意识…     

高原鼻出血致心肌缺血二例

例 1　男 ,汉族 ,18岁。 1999年 12月5日由内地入伍进藏 ,2 5日身体复查 (含心电图 )未见异常。因无明显原因反复左侧鼻出血 1ｄ于 2 0 0 0年 1月 3日急诊入院。全身检查未见异常。专科检查见鼻中隔左侧前下方粘膜弥漫性渗血 ,用1%麻黄素棉片收缩止血效果不佳 ,用凡士林纱条作前鼻孔填塞后止血。患者自行将鼻腔填塞物取出 ,入睡后护士发现患者不断做吞咽动作 ,立即叫醒检查 ,见左侧鼻腔仍在不断渗血 ,再次做前鼻孔凡士林纱条填塞 ,出血停止。血常规及出凝血时间、血小板计数、胸部透视 ,心电图均正常。次日上午患者感胸闷、心前区隐痛、全身…     

"Z"形皮瓣鼻孔成形术治疗单侧鼻前孔缩窄1例

患者 ,男 ,5 6岁。因右鼻孔缩窄半年入院。体检 :一般情况好 ,血压 1 5 0 / 1 0 0ｍｍＨｇ( 1ｍｍＨｇ =0 .1 33ｋＰａ)。心肺肝脾未见异常。鼻翼外观无明显改变 ,右侧鼻前孔正常 ,鼻中隔无偏曲 ;左侧鼻前孔明显缩小 ,直径约 1ｍｍ ,沿狭窄的鼻前孔处可见环状瘢痕 ,左鼻前孔不能扩张 ,大小固定 ,鼻腔内部结构无法窥清 ,后鼻孔检查未见异常。既往史 :半年前因高血压病并发鼻出血住院治疗 ,其间曾作后鼻孔栓塞 ,否认心肺肝肾疾患史。术前查三大常规、心电图、胸透均无异常。控制血压使之稳定于正常范围内。术前向患者说明手术的必要性与可行性…     

鼻中隔矫正术后迟发大量鼻出血3例

例 1　男 ,46岁。因鼻中隔偏曲致鼻腔反复出血十余年 ,而于 1 997年 1 0月 1 2日行鼻中隔矫正术 ,术后 3d取出鼻腔内全部填塞纱条 ,鼻腔无活动性出血、渗血 ;术后第 7天清理双侧鼻腔内痂皮 ,无活动性出血、渗血 ;1 2 h后 ,左侧鼻腔突发大出血 ,检查为左侧鼻中隔近鼻顶部筛前动脉处搏动性出血。行前鼻孔填塞无效 ,改用前后鼻孔填塞后仍有渗血。测血压 1 2 5/90 mm Hg(1 mm Hg=0 .1 33k Pa) ,除用抗炎、止血药物静脉滴注外 ,给予复方降压片半片 3次 /d口服 ,使血压维持 1 0 0 /70 mm Hg,鼻出血、渗血渐止。 5d后取出鼻腔前、后鼻孔全部填塞…     

合并脑梗死2例鼻出血的治疗体会

例1男,87岁.因脑梗死,右侧肢体运动障碍2d,于1997年6月20日在我院急症科治疗.患者有高血压、心脏病史,治疗期间突然鼻出血,左侧明显,考虑到患者年龄大,有心脑疾患,行鼻后孔填塞危险性大,故快速行左侧前后鼻孔油纱填塞,术后血止,48h后取出填塞物,观察1周未再出血.例2男,84岁.因左侧肢体活动不灵,语言不清1d,于1998年3月17日急症入院.脑CT示右侧脑梗死.在神经内科治疗第4天突然右侧鼻出血,口中吐血,有鲜血顺右侧咽后壁流下,初步诊断为右侧鼻后孔出血,快速行右后鼻孔油纱填塞术成功.     

以鼻出血为首发症状的慢性肾衰1例报道

患者,男,45岁,因左鼻反复出血2h入院.入院后给予左侧前鼻孔填塞后左鼻出血停止.查体:患者脸色土黄,贫血貌,精神状态尚可,血压200/120 mmHg,左侧鼻腔填塞完好,无渗血,右侧鼻腔通畅,无出血.追问病史,患者自诉既往体健,否认高血压及其他慢性病史,仅于10余年前行阑尾切除术.入院后给予测血压2次/d,舌下含服卡托普利25 mg及口服依那普利10 mg降压,降压效果欠佳.     

层袋状填塞法治疗Woodruff′s区出血

Woodruff′s区位于下鼻道后端外侧壁上 ,是后鼻孔出血的最常见部位。常用的袋状前鼻孔填塞法因下鼻甲阻隔 ,常不能控制该区出血 ,不得不改行后鼻孔填塞。我们对袋状填塞法稍做改进 ,以层袋状填塞法从前鼻孔处理该区出血 ,效果满意 ,患者痛苦小。1　资料与方法1 .1 　 临床资料Woodruff′s区活动性出血未控制者 2 8例 (31侧 ) ,男 1 7例 ,女 1 1例 ;年龄 40～ 85岁 ,平均约 55岁。其中已行前鼻孔填塞者 1 4例 ,已行前后鼻孔填塞者 1 0例。1 .2 　 处理方法嘱患者轻轻擤净鼻腔血块 ,头稍低 ,使出血从前鼻孔流出 ,而不向后流入鼻咽部。保持此…     

原发性脑脊液鼻漏

原发性自然性脑脊液鼻漏罕见,作者报告2例。例1,女,50岁,自述入院前两周,当头部前倾时便有清亮液体从右鼻孔流出,并感口内有咸味。无头部外伤史及感染、手术、新生物史。流出液体化验检查,葡萄糖为65mg/dl,头颅CT检查未见骨质破坏或肿物,右侧蝶窦内有液平面,碘剂脑池造影CT扫描,见鞍前部有较多造影剂存留,提示为部分性空蝶鞍伴有活动性脑脊液漏入右侧蝶窦。采用唇下经鼻中隔进路进入蝶窦,发现右侧蝶窦侧壁较薄,有多个小孔,脑脊液即从小孔流入蝶窦,由大     

鼻腔深部出血不同治疗方式的对比观察

目的 探讨更为完善的鼻腔深部出血的首选治疗方式。方法 A组：首选前鼻孔填塞，其次是后鼻孔填塞和相关动脉结扎术。B组：首选前鼻孔填塞，部分行后鼻孔填塞，其次行鼻内镜检查及明胶海绵微型填塞。C组：首选鼻内镜检查及明胶海绵微型填塞。结果 A组(52例)：前鼻孔填塞2～5次；无效后30例行后鼻孔填塞1～3次；仍出血者行动脉结扎术18例。治愈45例，转院7例，痊愈率86．5％(45／52)；输血者17例，平均住院14．4d，均未见确切出血点。B组(58例)：均前鼻孔填塞1～3次，9例1次后鼻孔填塞后行鼻内镜检查；明确出血点55例，明胶海绵填塞治愈：首次37例，二次18例；自愈3例，痊愈率100％(58／58)，输血者5例，平均住院10．7d。C组(67例)镜下明确出血点63例，明胶海绵填塞治愈：首次58例，二次5例；自愈4例，痊愈率：100％(67／67)。无输血者，平均住院5．7d。结论 鼻内镜下明胶海绵微型填塞，应该逐步成为鼻腔深部出血的首选治疗方式，而且尤其适用于鼻腔狭窄、隐蔽部位出血状态。     

Xylitol enhances bacterial killing in the rabbit maxillary sinus

OBJECTIVES: Factors that alter airway surface liquid (ASL) ionic concentrations may influence the course of sinusitis. Xylitol has been shown to effect ASL ionic composition in vitro and to reduce nasal bacterial carriage, otitis media, and dental caries in vivo. We examined the effect of xylitol on experimental sinusitis in the rabbit model. STUDY DESIGN: Prospective randomized controlled study of xylitol, saline, and Pseudomonas aeruginosa administration to the rabbit maxillary sinus. METHODS: P. aeruginosa was administered to the sinuses of 26 New Zealand white rabbits. Saline was placed in the left maxillary sinus and xylitol in the right. The rabbits were randomly assigned to one of three groups: one, simultaneous administration of bacteria and solutions with bacterial analysis at 20 minutes, 11 rabbits; two, preadministration of solutions 1 hour before bacterial infection with analysis at 20 minutes, 11 rabbits; three, established sinusitis, 4 rabbits had daily injections of solutions for 5 days starting 7 days after P. aeruginosa administration. RESULTS: In group 1, 6.96% of injected bacteria were retrieved on the left (saline), whereas 0.095% were retrieved on the right (xylitol) (P = .034). In group 2, 5.64% of inoculum was recovered from the left and 2.89% from the right (P = .188). Group 3 demonstrated evidence of sinusitis with recovery of noninoculate bacteria. with no difference between right and left. CONCLUSIONS: Xylitol reduces experimental sinusitis when administered simultaneously with bacteria. Its effect in established sinusitis is less clear. A role may exist for xylitol in nasal irrigation fluid in human disease.     

Infected inferior turbinate pneumatization

With the widespread utilization of endoscopic nasal surgery, the interest in nasal structures has increased. Inferior turbinate pneumatization is among the most rare causes of nasal obstruction. In the current literature, there are only ten reported cases of inferior turbinate pneumatization. A 52-year-old male patient presented with nasal obstruction, purulent nasal discharge, facial pain and headache. Anterior rhinoscopic examination showed bilateral middle and inferior turbinate hypertrophy and edema of the nasal mucosa. Computed tomography (CT) revealed bilateral frontal, anterior and posterior ethmoidal and maxillary sinusitis with bilateral concha media bullosa and right infected inferior turbinate pneumatization. In this report, infection of this rare anatomical abnormality is presented for the first time and documented with acoustic rhinometry, CT and peroperative photography.     

鼻腔孤立性纤维瘤1例

孤立性纤维肿瘤(solitary fibrous tumor,SFT)是一种罕见肿瘤,因其组织学的复杂性、多样性,容易误诊。笔者就我科1例SFT患者结合文献对其临床症状、组织学、免疫组织化学和内镜下诊断及鉴别诊断等进行讨论。1临床资料患者,女,56岁。1d前无诱因出现双侧鼻腔出血,以右侧为著,量较多,能自止;平时时有鼻痒,     

Report of two rare cases of fungal sinusitis]

Two cases of aspergillosis of the paranasal sinuses are reported. The first case was a 30-year-old man who had a 5-month history of bilateral proptosis. Physical examination revealed nasal polyps in both middle meatus. A skin test for Aspergillus was positive. Laboratory study showed levels of serum IgE and IgE specific for Aspergillus level to be elevated significantly. Computed tomography (CT) and magnetic resonance imaging (MRI) showed pansinusitis with some bone erosion. The patient underwent bilateral Caldwell-Luc procedures and external sinus surgery (frontal, ethmoid and sphenoid sinuses). Histopathological examination showed thin septate hyphae in allergic mucin. The patient is now being treated with sinus irrigation and oral administration of fluconazole and suplatast tosilate. The second case was a 78-year-old man who had a 2-month history of nasal obstruction and a 3-week history of headaches. He also had a history of diabetes mellitus. Physical examination showed swelling of the nasal septum due to abscess. CT showed an abscess in the nasal septum and opacification of the left sphenoid sinus. There was no bone destruction. The patient underwent left sphenoid sinus surgery, and histopathological examination revealed aspergillosis of the sphenoid sinus. He presented with left visual disturbance and blepharoptosis 2 months after surgery. Ocoulusion of the internal carotid artery was revealed by MR angiography and it was thought to be caused by intracranial invasion of aspergillus. Loss of consciousness and right hemiplegia ensued despite antifungal chemotherapy. The patient died about 1 year after the onset of symptoms. Case 1 was thought to involve allergic aspergillus sinusitis, and Case 2 invasive aspergillus sinusitis. We emphasize the significance of headache, diabetes mellitus and lesion in the sphenoid sinus as a sigh of intracranial aspergillus invasion, based on our experience as well as findings reported by other clinicians in the Japanese literature.     

Bilateral subdural empyemas with meningitis secondary to acute barosinusitis

IntroductionIntracranial complications of acute rhinosinusitis are rare, but may turn life-threatening.Case summaryWe report a healthy 30-year-old male who complained of frontal headache, which developed while on a plane. A brain CT showed a low-density lesion on the left frontal convexity with right maxillary and ethmoid sinusitis. Despite receiving intravenous antibiotics, a follow-up brain CT showed two lesions with adjacent dural and leptomeningeal enhancement. A paranasal sinus CT revealed aggravated left frontal sinusitis and right maxillary sinusitis. The patient underwent craniotomy and brain abscess removal along with endoscopic sinus surgery. Seventeen days after the surgery, the patient was discharged with no neurological sequelae.ConclusionTo the best of our knowledge, this case is the first report regarding the association between barotrauma and intracranial complications of acute rhinosinusitis. A high index of suspicion and well-timed surgical evacuation may ensure a full recovery.     

The correlation between bacteriological findings in the nose and maxillary sinus in acute maxillary sinusitis

Nasal and sinus bacteriology have been investigated in healthy controls and in patients with acute maxillary sinusitis. Comparatively few healthy noses were sterile, and in controls the nasal bacterial flora commonly consisted mainly of staphylococci and diphtheroid rods. Nasal specimens from patients with sinusitis showed most common findings to be “no growth,” pneumococci, Haemophilus influenzae and staphylococci in that order. In aspirated sinus secretions there was a predominance of pneumococci, “no growth” and Haemophilus influenzae. Other bacteria were uncommon. Staphylococci were shown conclusively to be nasal contaminants. The same organisms were found in the nasal and sinus secretions of patients with sinusitis in only 64 percent, thus indicating that nasal samples are of low predictive value in reflecting sinus flora. It can be argued that in the individual patient with sinusitis it is more reliable to base therapy on the results of previous bacteriological investigations than on the individual bacteral findings in the nose.     

Sinusitis during nasotracheal intubation

Sinusitis is mentioned as one complication of nasotracheal intubation. 30 patients admitted to the I.C.U. and prolonged intubated (+5 days) underwent clinical examination and C.T. scan: 23 C.T. scan revealed anomalies and 5 sinusitis. One patient had blood cultures positive for the organism present on nasal cultures. Patients nasally intubated are at risk for sinusitis which can have adverse effects.     

Massive Concha Bullosa with Secondary Maxillary Sinusitis

Concha bullosa is a common anatomic variation of the middle turbinate; however, sinusitis secondary to the concha bullosa is rare. A 52-yr-old woman presented with nasal obstruction and posterior nasal drip. Computed tomography and examination of the nasal cavity revealed septal deviation on the left side, and a massive concha bullosa and maxillary sinusitis on the right side. The lateral lamella of the affected turbinate was removed and the inspissated material was drained. Histopathologic examination of the excised lesion in the concha bullosa revealed bacterial colonies in the mucus plug. We report here on a massive concha bullosa with secondary maxillary sinusitis.     

The role of topical corticosteroids after functional endoscopic sinus surgery for chronic sinusitis and/or nasal polyps

Introduction. The objective was determination of the influence of Fluticasone propionate nasal spray on the recurrence rate of chronic sinusitis and/or nasal polyps after functional endoscopic sinus surgery (FESS) using a randomized double‐blind placebo‐controlled trial. Methods. From 1994 to 1997, 162 patients were included in this trial after FESS for chronic sinusitis and/or nasal polyps. Postoperatively they were treated for 1 year with study medication (double‐blind). Study medication contained Fluticasone propionate nasal spray 400 μg bid, or Fluticasone propionate nasal spray 800 μg bid, or placebo bid. Symptoms (using visual analogue scales) and nasendoscopy findings were scored preoperatively and postoperatively for 1 year. Results. No reduction of the recurrence rate of chronic sinusitis or nasal polyps was found in the patient‐groups using Fluticasone propionate nasal spray. No reduction was found when separate groups were analysed (such as nasal polyps, chronic sinusitis, allergy, no history of FESS or use of topical corticosteroids, or high score at FESS). Conclusion. In this trial no positive influence of Fluticasone propionate nasal spray could be found on the recurrence rate of chronic sinusitis and/or nasal polyps.     

单侧鼻腔鼻窦占位性病变的临床误诊分析

目的:通过对213例单侧鼻腔鼻窦占位性病变的回顾性分析,研究该类病变的临床诊断及其误诊情况,为临床医生对此类患者的诊断和治疗提供参考。方法:结合近年来相关文献,通过对213例单侧鼻腔鼻窦占位性病变患者的诊断及误诊资料作临床分析,对被误诊患者的临床表现、影像学检查、病理作回顾性研究。结果:213例患者中,鼻息肉65例,鼻窦囊肿66例,真菌性鼻窦炎20例,良性肿瘤31例,恶性肿瘤28例,鼻腔异物3例;左侧鼻腔鼻窦116例,右侧鼻腔鼻窦97例。误诊情况:213例中,将恶性肿瘤误诊为鼻息肉12例,误诊率5.63%;鼻腔异物误诊为鼻窦炎2例,误诊率0.94%;内翻性乳头状瘤误诊为鼻息肉6例,误诊率8.45%;真菌性鼻窦炎误诊为化脓性鼻窦炎5例,误诊率2.35%;鼻窦囊肿误诊为鼻窦炎8例,误诊率3.75%。结论:详询病史,仔细专科检查,包括鼻内镜、鼻窦三维CT、鼻窦三维MRI及活组织病理检查等对判断该类病变的部位和性质至关重要,有助于早期诊治,并减少误诊误治。