人工耳蜗植入电极插入技巧对蜗内电极位置的影响

目的　观察不同手术技巧对多导人工耳蜗植入术后蜗内电极位置的影响。方法　采用澳大利亚Nu cleus 2 4M (直电极 )、Nucleus 2 4Contour(弯电极 )以及不同的手术技巧 ,术后以改良斯氏位X线拍片 ,测量、比较蜗内电极插入的深度。结果　 59例人工耳蜗植入病例中 ,3 2例Nucleus 2 4M型人工耳蜗常规手术的电极X片显示电极在平面图上的深度为 2 68°～ 3 53° ,平均 2 78.6° ;15例Nucleus 2 4M型人工耳蜗采用改进的电极插入方法 ,术后耳蜗电极X片在平面上显示弯成 3 60°～ 445° ,平均深度 3 91.7° ;12例Nucleus 2 4Contour型人工耳蜗植入采用标准术式 ,术后蜗内电极X片在平面上显示电极弯成 3 80～ 455° ,平均 42 3°。结论　澳大利亚Nucleus 2 4M型人工耳蜗通过改良的手术技巧可使电极插入的深度更大 ,部分病例可与弯电极相似 ,Nucleus 2 4Contour型人工耳蜗的电极则更靠近蜗轴     

多导人工耳蜗植入后电极阻抗的初步研究

目的研究多导人工耳蜗植入后电极阻抗变化的特点,对比直电极和弯电极的阻抗差异,为人工耳蜗植入术后的调试提供参考。方法在Nucleus多导人工耳蜗编程调试界面上,应用R126V1.3和NRTV3.0软件,测试11例语前聋儿童在不同时期的阻抗值,并进行分析比较。结果CI24M和CI24Rcontour两种植入体阻抗随时间变化的基本规律是:术中较低,开机时最高,以后随时间推移逐渐降低。CI24Rcontour阻抗高于CI24M。结论人工耳蜗植入体阻抗开机后随时间推移而逐渐降低,新型CI24Rcontour植入体与CI24M相比,其阻抗值在术中至开机后3周内明显要高。     

Nucleus人工耳蜗弯电极和直电极植入后的心理物理指标比较

目的对比Nucleus CI 24导Contour弯电极与Nucleus CI 24导直电极植入后的电阻阻抗、刺激阈值和舒适阈。方法植入澳大利亚NucleuS人工耳蜗的患者分为2组,1组（19例）植入Nucleus CI 24导Contour电极阵列（弯电极）,另1组（11例）植入CI 24M电极阵列（直电极）。所有患者耳蜗植入术后15天开机调试,并于开机时及开机后1周、1月、3月分别记录各电极的电阻、刺激闽值和最大舒适阈。结果开机后由于Nucleus 24直电极的刺激阈值呈上升趋势,3月和6月时弯电极的阈值明显低于直电极阈值,且差异有统计学意义（P〈0．05）。开机1周、1月和6月2组的舒适阈接近。开机后弯电极和直电极的电阻值接近。结论Nucleus CI 24导Contour弯电极的刺激阈值稳定,刺激阈和舒适阈之间动态范围较宽。     

直电极与弯电极人工耳蜗植入患者神经兴奋分布空间的比较

目的 比较Nucleus 24M型直电极与Nucleus 24Contour型弯电极人工耳蜗植入患者的神经兴奋分布空间的宽度,评估电极类型和电极位置对于电极问刺激干扰程度的影响.方法 18名人工耳蜗植入患儿分为两组,其中24M和24Contour植入患者各9名,年龄1.3～7.9岁.按照病因、病程、植入年龄、电极植入角度4个因素将两组患者进行配对.使用NRT3.1测试软件分别对每名患者的5、10、15三个电极进行听神经电诱发复合动作电位(electrically evoked compound action potential,ECAP)测试.测试时,探测脉冲固定加在测试电极,掩蔽脉冲按顺序分别加到1至22号电极,得出一系列的ECAP波形,将ECAP波形幅度从最高降到70.7%所覆盖的电极范围定义为神经兴奋分布空间的宽度.分析电极类型、电极位置这两个因素对神经兴奋分布空间宽度的影响.结果 电极类型、电极位置对神经兴奋分布空间宽度有显著影响.弯电极的兴奋空间分布宽度在5、10、15号三个电极位置均显著窄于直电极组.5、10号电极的兴奋空间窄于15号电极,但5号和10号电极之间无统计学差异.结论 在耳蜗的底部和中部,Nucleus24 Contour弯电极的电极间刺激干扰小于直电极,有助于提高患者中、高频的电极分辨能力.     

锥形束CT评估人工耳蜗植入术后电极位置与植入损伤的研究北大核心CSCD

目的 通过锥形束CT评估感音神经性耳聋患者人工耳蜗植入术(cochlear implantation,CI)后电极位置与植入损伤,为CBCT的应用提供参考。方法 选取在我科行人工耳蜗植入术的35名成人重度或极重度感音神经性耳聋患者为研究对象,年龄13-73岁,在术后3-4天均行植入侧颞骨CBCT扫描。使用NNT Viewer软件对扫描所得的DICOM数据进行后处理。观察电极位置以及植入后内耳损伤程度。结果 两款直电极植入耳蜗后均贴于耳蜗管外侧壁,81%(17/21)诺尔康CS-10A标准电极完全植入,75%(12/16)MED-EL SONATATI100标准电极完全植入。诺尔康CS-10A标准电极的平均植入深度角为366.46°±46.24°,平均植入长度为19.85mm±1.56mm,MED-EL SONATATI100标准电极的平均植入深度角为575.72°±100.33°,平均植入长度为26.66mm±4.02mm。诺尔康CS-10A标准电极植入后有1例发生骨螺旋板升高,1例发生电极从鼓阶进入前庭阶,MED-EL SONATATI100标准电极植入后有2例发生电极从鼓阶进入前庭阶。结论 CBCT具有高空间分辨率、低金属伪影、低辐射量以及成像时间短的优势,可用来评估人工耳蜗术后电极植入深度角、植入长度、电极位置、显示电极与周围结构的关系及植入后内耳损伤程度,具有较大的临床应用价值。     

CT三维重建对人工耳蜗植入术后电极位置的观察

目的：探讨建立CT扫描及三维重建技术观察人工耳蜗植入（CI）电极的方法,并比较不同CT扫描三维重建方法的耳蜗内植入电极的影像学特征及其临床应用价值。方法：6例CI患者全部作术后CT扫描并分别应用多层面重建的容积再现（VR）、平均密度投影（AIP）、表面遮盖显示技术（SSD）3种方法进行三维重建,观察人工耳蜗植入术后耳蜗内电极。结果：3种方法的三维重建图均可直观地显示电极形态、走行及其在耳蜗内植入的深度和植入电极与内耳的空间关系,并可清晰识别耳蜗内的电极数目。结论：CT扫描三维重建方法可直接观察植入电极的形态及位置,可准确判断电极在耳蜗内电极数目,有其独特的临床应用价值。     

Nucleus 24 Contour人工耳蜗植入术初步体会

目的 报道16例Nucleus24Contour人工耳蜗的手术方法和初步效果。方法 介绍Nucleus24Contour人工耳蜗手术方法、注意事项和结果,与Nucleus24M人工耳蜗植入后的编程调试结果(T-Level,C-Level)进行比较。结果 16例病人术后4～5次编程调试后,声场测听达到20～35dB(HL),平均24.4±5.8dB,C-level。T-Level和C-Level均比Nucleuse24M要小,动态范围比Nucleus24M大。结论 初步结果显示,Nucleus24Contour人工耳蜗性能比Nucleus24M型人工耳蜗有某些提高,但手术时应注意操作特点。     

人工耳蜗植入术中蜗内电极X线拍片的临床意义

目的:探讨耳蜗X线拍片在人工耳蜗植入术中的临床意义。方法:对54例人工耳蜗植入患者术中常规使用可移动C-臂数字X线拍片机拍片,观察耳蜗电极的形态和植入深度,常规行NRT检查。结果:52例蜗内电极均呈自然螺旋状,无扭曲或打折,拍片显示刺激电极全部植入耳蜗内。2例插入蜗内的电极串呈"C"形,提示电极未能全部插入,其中1例与术中所见一致,为电极植入不全;1例为术中未能发现的蜗内电极扭曲打折。结论:人工耳蜗植入术中常规在电极植入后进行耳蜗X线拍片,对了解电极植入部位和植入深度非常有益,特别是对于电极植入有难度的患者,更应及时拍片,可避免术后再次手术。     

人工耳蜗植入术后锥体束CT影像评估

目的利用锥体束CT及多种后处理重建技术显示植入耳蜗电极位置、深度、计数植入电极数及测量离蜗轴距离,并对植入电极清晰度进行评价,探讨锥体束CT对人工耳蜗植入术(cochlear implantation, CI)后植入电极影像评估的应用价值。方法收集行CI手术患者35例,所有患者在术后行植入侧锥体束CT扫描,仪器为（VATECH）PaX Uni3D高分辨锥体束CT,管电压为：89 KV,管电流为：4.0 mA;并分别做垂直及平行于蜗轴轴位的冠状及斜矢状位的MPR图像和三维图像;计数植入电极数、测量电极深度、离蜗轴距离、评估电极位置,并进行电极清晰度的评价。结果锥体束CT可清晰显示耳蜗内电极矩阵走行,可测量电极植入深度和计数电极个数;测得植入电极共766颗,平均（21.88±2.17）颗;测定电极植入深度的平均值（19.37±1.96）mm,对比术中实际测定深度平均值（19.31±2.03）mm,两组数据差异无统计学意义（P＞0.05）。两位医生对电极清晰度的评价一致性良好（t=-0.502,P=0.619）。结论锥体束CT能显示植入电极位置、深度、计数植入电极数及测量离蜗轴的距离,可应用于临床CI术后对耳蜗内植入电极的评估。     

神经反应遥测技术在人工耳蜗植入术中的应用

目的 探讨人工耳蜗植入术中神经反应遥测(neural response telemetry，NRT)技术的应用情况。方法 对10例Nucleus CI24M及4例Nucleus CI24R(CS)人工耳蜗植入术的患儿在术中及术后一个月进行NRT检测，比较两者术中和术后的电诱发复合动作电位(electrically-evoked compound action potential，ECAP)阈值差异，并利用术中ECAP阈值指导首个言语处理器映射图。结果 14例患儿术中各电极的ECAP平均阈值均高于术后一个月开机时相应电极的ECAP平均阈值，CI24M植入体各电极的术中ECAP阈值比术后相应电极的ECAP阈值平均高11CL；术中10个电极相应的ECAP波形采集只需5分钟；术后开机整个过程约1小时。结论 术中应用NRT技术可快捷地了解植入体安置的情况，指导术后首个映射图的调试，明显节省了术后开机调试的时间，操作简单、方便，值得推广。     

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance Angiogenesis is essential for tumour growth and invasion. Vascular endothelial growth factor (VEGF) is a prime mediator of tumour angiogenesis. VEGF‐C is a closely related protein that effects lymphatic endothelial cells and may be important in the process of lymphatic metastasis. The purpose of this study was to evaluate the expression of these cytokines in patients with T1 and T2a glottic, squamous cell carcinoma, in comparison with normal epithelial control tissue, to ascertain any association with radioresistance. Twenty‐two tumours treated by radiotherapy (13 radiosensitive, nine radioresistant) and seven normal control tissues were studied. The minimum follow‐up was 2 years after radiotherapy. Expression of VEGF and VEGF‐C was evaluated by immunohistochemistry of formalin‐fixed, paraffin‐embedded biopsy specimens. Analysis was carried out using a quantitative computer image analyser. Both VEGF and VEGF‐C were detectable in tumour and normal control specimens. There was increased expression in tumour specimens of both VEGF (P = 0.03) and VEGF‐C (P < 0.001). In addition, the expression of VEGF‐C was associated with tumours of higher histological grade (P = 0.021). There was, however, no difference in VEGF and VEGF‐C expression between radioresistant and radiosensitive tumours. The expression of VEGF and VEGF‐C is increased in early laryngeal squamous cell carcinoma (SCC). However, measuring the expression of these proteins cannot predict radioresistance in this tumour group.     

Treatment of Maxillary Sinus Carcinoma: Clinical Results Using the Kitasato Modality

The conventional therapeutic regimen for maxillary sinus carcinoma consists of dissection of the maxilla, full-dose irradiation and extensive chemotherapy. However, the results obtained with this treatment are often poor. Even when patients recover, their quality of life is significantly reduced as a result of deformity of facial structures and swallowing and articulation dysfunctions. A retrospective analysis of 68 patients with maxillary sinus carcinoma treated with the Kitasato modality between 1975 and 1999 was conducted. All patients underwent pergingival maxillary sinus surgery combined with pre- and postoperative irradiation therapy with standardized total doses of 16 Gy; the postoperative irradiation was given in combination with regional intra-arterial infusion chemotherapy administered via the superficial temporal artery. All visible tumor lesions were removed where possible in order to preserve or facilitate cellular immunity after surgery. The cumulative 5-year survival rates were 85.7% for Stage II patients, 88.1% for Stage III, 76.6% for Stage IVA and 75.0% for Stage IVB.     

Tongue Base Reduction with Temperature-controlled Radiofrequency Volumetric Tissue Reduction for Treatment of Obstructive Sleep Apnea Syndrome

In recent years a considerable effort has been made to establish the use of different surgical techniques for the treatment of obstructive sleep apnea syndrome (OSAS). Nevertheless, treatment of hypopharyngeal obstruction due to tongue base hypertrophy remains in many ways an unsolved problem. The aim of this study was to evaluate the safety and efficacy of tongue base reduction with temperature-controlled radiofrequency volumetric tissue reduction in the treatment of OSAS. Twenty patients with OSAS and tongue base hypertrophy were treated with radiofrequency tissue ablation. An intensified treatment protocol was used, delivering 2,800 J per treatment session under local anesthesia. Two nights of polysomnography testing were performed before and after treatment. Daytime sleepiness, snoring and postoperative morbidity were assessed using questionnaires. Mean respiratory disturbance index (RDI) was reduced from 32.1 to 24.9/h after a mean of 3.4 treatment sessions. Six patients (33%) were cured after the procedure (reduction in RDI of &#83 50% and a postoperative RDI of <15/h) and ten (55%) showed an improvement of >20% in their RDI. Daytime sleepiness and snoring improved significantly. Peri- and postoperative morbidity was low; one severe complication occurred (tongue base abscess). We were able to achieve similar cure and responder rates to those reported in a recently published pilot study but with a reduced number of treatment sessions. We believe that this technique may improve patient acceptance and have beneficial cost implications.     

Cervical Reflex Induced by Click Stimuli in Cats

We studied click-evoked potentials in the anterior horn of the spinal cord in 17 cats. A concentric needle electrode was inserted into the anterior horn of the spinal cord at levels C3-C6. Potentials evoked with 105 dB SPL clicks were recorded with a peak latency of 4.89-5.10 ms only at the C3 level. These responses were observed 45-60 dB SPL above the auditory brainstem response (ABR) threshold, and no potentials were evoked by stimulation of the contralateral ear. Average was performed 100 times with changes in stimulation frequency of 1-20 Hz. The amplitude of the potentials decreased with increasing stimulus frequency, but there were no changes in ABRs. The responses disappeared after destruction of the medial vestibulospinal tract at the obex level, but ABRs were still recorded. The spinal nucleus of the accessory nerves was located in the anterior horn of the spinal cord at levels C1-C6, and the sternocleidomastoid muscle motoneurons were found at levels C1-C3. The click-evoked potentials recorded in this study reflect responses of the spinal nucleus of accessory nerves through the vestibulospinal tract to click stimulation. The responses have the same characteristics as vestibular-evoked myogenic potentials that can be recorded using surface electrodes over the sternocleidomastoid muscles of humans.     

Congenital nasal masses: diagnosis and management

One hundred and nine congenital nasal masses which presented to two children's hospitals over a 20 year period are reviewed. The diagnosis of the nasal mass is discussed with respect to age, mode of presentation, and site of the lesion, and a management protocol is advocated.     

Lack of significant estrogen and progesterone receptor expression in nasal telangiectasias in hereditary hemorrhagic telangiectasia: an immunohistochemical analysis

Obstructive sleep apnea syndrome (OSAS) is characterized by snoring and apnea during sleep leading to decreased oxygen saturation and disturbed sleep, excessive daytime sleepiness and neuropsychological disturbances. This study investigates cognitive neuropsychological abilities in a group of 53 OSAS patients before and after treatment with uvulopalatopharyngoplasty. General intellectual ability, verbal learning and memory as well as executive functioning were measured at baseline and 6 months postoperatively. After surgery there were significant improvements in verbal learning and memory (mean change - 39, SD 57.3, p <0.001), recall (mean change - 24.3, SD 39.3, p <0.001) and executive functioning (as assessed by percentage of errors on the Wisconsin Card Sorting Test; mean change-9.1, SD 15.7, p <0.001). These improvements were in accordance with improvements in the degree of sleep apnea, the oxygen desaturation index (mean change -9.7, SD 15.9, p <0.001) and arterial minimum oxygen saturation (mean change 4.5%, SD 10.2%, p <0.01). Surgical treatment seems to improve verbal learning, memory and recall and executive functions in parallel with better oxygenation in OSAS.