CO2激光治疗声带白斑疗效分析

目的探讨显微喉镜下CO₂激光治疗声带白斑的临床疗效。方法回顾分析2013年1月²014年12月在本院行显微喉镜下CO₂激光治疗的144例声带白斑病例的疗效。术后随访12³6个月。结果108例经1次手术,34例经2次及多次手术后效果显著,未发生癌变;2例经多次手术后发生癌变。结论显微喉镜下CO₂激光是治疗声带白斑有效的手术方式。     

喉显微手术治疗早期声带癌的临床体会

目的总结喉显微手术在早期声带癌切除术中的临床体会。方法本组患者18例，均为声门型喉癌。均在全麻下支撑喉镜显微镜下，配合激光、微波切除。结果18例均未做气管切开，术后无呼吸困难、出血等并发症，术后当天即可自由活动，生活自理，平均住院时间6～8天。术后随访1．5～5年，仅1例复发，再次支撑喉镜手术切除肿瘤术后恢复良好，随访2年未再复发。结论支撑喉镜时早期声门癌切除，手术时间短，出血少，喉功能保留好，术后恢复快，住院周期短，是治疗早期声门癌的良好方法。     

支撑喉镜下喉显微手术1080例临床体会

我科于1992年3月到2000年3月在全麻支撑喉镜下用喉显微手术治疗声带小结、声带息肉等1 080例,取得良好的效果,现报告如下.     

支撑喉镜下喉显微手术的并发症及防治

喉显微手术临床已广泛应用,我科采用支撑喉镜与显微镜相结合行声带手术126例,现就并发症发生的原因及防治介绍如下.     

喉神经纤维瘤误诊为声带息肉1例

患者女,25岁.声嘶2个月,在外院诊断为左声带息肉,黏膜表面麻醉下行左声带息肉摘除术.术后声嘶不见好转,且出现呼吸困难,逐渐加重.于术后10 d来我院诊治.检查:一般状态欠佳,吸气性呼吸困难Ⅱ度以上.间接喉镜检查见左侧喉室有一肿物,色红,声门裂狭窄.入院后当日行气管切开术,次日行纤维喉镜检查:见左侧喉室有一2cm×2 cm大小红色肿物,表面光滑、基底较广,侵入左声带,并突入声门下.在全身麻醉下行喉裂开、喉肿物切除术.切除的肿瘤大小为2 cm×2.6cm×2.5cm.转移胸骨舌骨肌带蒂肌瓣修补术腔,肿瘤组织送病理检查,报告为喉间叶瘤,富于细胞.     

支撑喉镜下喉内镜与显微镜手术治疗声带良性病变的疗效比较

我科自2004年1月～2004年6月无选择地随机采用支撑喉镜下喉内镜及显微镜下治疗声带良性病变168例,其中支撑喉镜下喉内镜手术(喉内镜组)73例,显微镜手术(显微镜组)95例.对其疗效进行比较,探讨治疗本病的适用方法,报告如下.     

吸割器结合激光治疗喉乳头状瘤

目的提高喉乳头状瘤治愈率,减少手术并发症.方法在喉乳头状瘤手术中应用吸引切割器和CO2激光.结果喉乳头状瘤患者手术后发音得到明显改善,复发率降低.结论喉乳头状瘤手术中,应用吸割器和CO2激光,可使手术更精确、对声带的创伤小、术后发音效果好,复发率降低.     

电视监视喉内镜联合支撑喉镜的应用

我科采用全身麻醉喉内镜联合支撑喉镜电视监视下治疗声带良性病变109例,报告如下。     

喉神经鞘瘤1例

资料患者男性,52岁。因声嘶3个月入院。3个月前患者无明显诱因出现持续性声嘶,伴有发声费力,从事重体力活动时呼吸困难,无咽痛、发热、咳嗽、饮水呛咳及吞咽困难,曾自行口服"消炎药"治疗无效。体格检查:一般情况好,心、肺功能正常。纤维喉镜下可见:喉黏膜无明显充血;左室带水平杓会厌皱襞内侧新生物直径约1.0 cm,表面黏膜光滑,向内遮盖左声带;     

电视支撑喉内镜下声带良性病变切除术的疗效观察

目的分析在全麻下应用电视支撑喉内镜对声带良性病变的治疗方法和临床疗效。方法回顾分析北京武警总队医院2003年5月～2005年7月在全麻下应用电视支撑喉内镜对声带良性病变104例进行治疗的临床资料。结果随访1～14个月均无复发。结论对104例声带良性病变采用电视支撑喉内镜手术治疗，无一例发生意外及严重并发症且疗效可靠。     

Segmentation and accuracy in copying and drawing: Experts and beginners

As part of an ongoing investigation into real-world copying and drawing, I recorded the eye-hand drawing strategies of 16 subjects with drawing experiences ranging from expert to novice while they copied a line drawing of a standing nude. The experts produced accurate copies whereas all the beginners produced marked inaccuracies of overall scaling, proportion and shape. Analysis of eye and hand movements showed that the experts alone segmented the original drawing into simple line sections that were copied one at a time using a direct eye-hand strategy not requiring intermediary encoding to visual memory. The results suggest that segmentation into simple lines defines the task-specific process of accurate copying, and that this process is restricted to experts, i.e. acquired through training and practice. Additional preliminary tests also suggest that a similar process may apply to drawing a model from life.     

Proximal and accommodative convergence and age

The authors have estimated the phoria for distant and near fixation in two groups of subjects (mean age 27.5 ± 4.4 and 59.2 ± 8.2 years). Different accommodative stimuli were induced by adding minus lenses for distant fixation and plus lenses for near fixation. Statistical analysis of the experimental data indicates that, for distant fixation, the value of phoria per unit of accommodative stimulus is significantly lower in presbyopic than in nonpresbyopic subjects. Also, during near fixation, the accommodative convergence (AC/A ratio) is more reliable in the presbyopic subjects when the accommodative stimulus is progressively reduced. This varying behavior indicates in presbyopic subjects that proximal convergence is of greater relative importance in the determination of the fusion-free position. In nonpresbyopic subjects, accommodative convergence is the more important component.     

Anesthesia and preoperative and postoperative medications

Although certain methods such as retrobulbar blocks are used extensively, improvements in procedure can always be implemented. The use of ultrasound, low concentrations of anesthesia, careful monitoring, and, in the case of risk patients, anesthesia standby are all important considerations to ensure uneventful treatments. Topical anesthesia eliminates needle risk as well as risk of ptosis and bruising. Because it has been demonstrated that bacteria routinely enter the anterior chamber during uncomplicated cataract surgery, certain irrigation solutions are helpful, but still debatable. Postoperatively, diclofenac, flurbiprofen, and timolol have all been proven to be effective in reducing ocular inflammation, reducing incidence of CME, and controlling pressure increase, respectively.     

Anesthesia and preoperative and postoperative medications

Retrobulbar blocks, although widely used, still have potentially serious complications. Topical anesthesia presents less risk of injury to the globe and less pain but requires careful usage and an experienced surgeon. New techniques, however, allow for an increase in the percentage of patients able to have topical anesthesia. Preoperatively, 2.5% phenylephrine is found to be just as effective as 10% phenylephrine, and, when compared with wound closure and surgeon's experience, the effect of prophylactic medications was found to be negated. Postoperatively, diclofenac is found to be as effective an anti-inflammatory agent as prednisolone. Also, the addition of 10% phenylephrine to 4% pilocarpine drops enhances the effectiveness of pharmacologic treatment of postoperative iridocorneal adhesions. In addition, ophthalmologists should be aware of emerging antibiotic resistance.     

Paraneoplastic and non-paraneoplastic retinopathy and optic neuropathy: Evaluation and management

Paraneoplastic syndromes involving the visual system are a heterogeneous group of disorders occurring in the setting of systemic malignancy. Timely recognition of one of these entities can facilitate early detection and treatment of an unsuspected, underlying malignancy, sometimes months before it would have otherwise presented, and gives the patient an increased chance at survival. We outline the clinical features, pathogenesis, and treatment strategies for the retinal- and optic nerve–based paraneoplastic syndromes: cancer-associated retinopathy; melanoma-associated retinopathy; paraneoplastic vitelliform maculopathy; bilateral diffuse uveal melanocytic proliferation; paraneoplastic optic neuropathy; and polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes syndrome. Distinguishing these disorders from their non-paraneoplastic counterparts (e.g., autoimmune-related retinopathy and optic neuropathy, and acute zonal occult outer retinopathy) and determining appropriate systemic evaluation for the responsible tumor can be challenging. In addition, we discuss the utility and interpretation of autoantibody testing.     

Nodes and nodal points and lines in eyes and other optical systems

The typical stigmatic optical system has two nodal points: an incident nodal point and an emergent nodal point. A ray through the incident nodal point emerges from the system through the emergent nodal point with its direction unchanged. In the presence of astigmatism nodal points are not possible in most cases. Instead there are structures, called nodes in this paper, of which nodal points are special cases. Because of astigmatism most eyes do not have nodal points a fact with obvious implications for concepts, such as the visual axis, which are based on nodal points. In order to gain insight into the issues this paper develops a general theory of nodes which holds for optical systems in general, including eyes, and makes particular allowance for astigmatism and relative decentration of refracting elements in the system. Key concepts are the incident and emergent nodal characteristics of the optical system. They are represented by 2 × 2 matrices whose eigenstructures define the nature and longitudinal position of the nodes. If a system's nodal characteristic is a scalar matrix then the node is a nodal point. Otherwise there are several possibilities: Firstly, a node may take the form of a single nodal line. Second, a node may consist of two separated nodal lines reminiscent of the familiar interval of Sturm although the nodal lines are not necessarily orthogonal. Third, a node may have no obvious nodal line or point. In the second and third of these classes one can define mid-nodal ellipses. Astigmatic systems exist with nodal points and stigmatic systems exist with no nodal points. The nodal centre may serve as an approximation for a nodal point if the node is not a point. Examples in the Appendix , including a model eye, illustrate the several possibilities.     

Sensitivity to first- and second-order motion and form in children and adults

We compared the sensitivity of adults and children aged 3-10 years to first- and second-order motion and form. For first-order stimuli, at all ages sensitivity was better for motion than form, and motion thresholds were better at 6 Hz than at 1.5 Hz. For second-order stimuli, at all ages sensitivity was better for form than motion, and motion thresholds were better at 0.25 cyc/deg than at 1 cyc/deg. Thresholds became adult-like later for motion than for form and later for first-order than second-order stimuli. For first-order stimuli, the changes with age were larger and more protracted.     

Estrogen and progesterone receptors and human conjunctiva

Freshly frozen conjunctival tissue from premenopausal and postmenopausal women and male subjects were processed for estrogen and progesterone receptors by using monoclonal antibodies and a peroxidase-antiperoxidase technique. No immunocytochemical staining was localized in the nuclei of the cells treated with the monoclonal antibodies to human estrogen receptor or human progesterone receptor in any of the conjunctival specimens, in contrast to the strongly positive staining in breast adenocarcinoma controls. Immunocytochemical staining disclosed no evidence for estrogen or progesterone receptors on cells of the ocular surface.