人类免疫缺陷病毒感染及艾滋病在耳鼻咽喉头颈外科的临床表现

目的 提高对人类免疫缺陷病毒感染者及艾滋病患者在耳鼻咽喉头颈外科临床表现的认识,以便能及时诊治并做好必要的防护.方法 分析55例坦桑尼亚首诊于耳鼻咽喉头颈外科的HIV感染者及艾滋病患者的临床表现及其预后.55例患者中男23例,女32例;年龄3～67岁,中位年龄31岁.结果 55例患者中腮腺肿胀17例次(30.9%);鼻腔、口腔、咽部卡波西肉瘤19例次(34.5%);慢性化脓性中耳炎12例次(21.8%);颈部肿块11例次(20.0%);咽部肿物7例次(12.7%);口腔及咽部黏膜糜烂溃疡6例次(10.9%);口腔白色念珠菌感染2例次(3.6%).HIV感染者或艾滋病患者经治疗后耳鼻咽喉科感染状况可缓解,但易反复发作,且逐渐加重.结论 HIV感染者及艾滋病患者可首诊于耳鼻咽喉头颈外科.对耳鼻咽喉科感染等治疗缓解后反复发作者,应除外是否合并HIV感染或是否为艾滋病患者.

Abstract：

Objective To improve the recognition of clinical manifestation of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) in otorhinolaryngology head and neck surgery, and to emphasize the early diagnosis, correct treatment and effective protection. Methods Fifty-five patients with HIV infection and AIDS encountered in the department of otorhinolaryngology head and neck surgery in Tanzania were included in this study. There were 23 males and 32 femals with age ranged from 3 -67 years, medium 31 year. The clinical manifestation and prognosis of the patients were analyzed and summed up. Results Parotid glands swelling was the most commonly seen clinical manifestation in the 55 cases. Among the cases reported here, 17 (30.9%) showed parotid glands swelling, 19(34. 5% ) had Kaposi's sarcoma in nasal cavity or oral cavity or pharynx,12(21.8% ) were accompanied with chronic suppurative otitis media, 11 (20.0%) had masses in the neck,7 ( 12.7% ) had masses in the pharynx, 6 ( 10.9% ) were seen to have ulcer in oral and pharyngeal mucosa,2(3.6% ) showed infection due to candidaalbicans. The infection in most cases could be controlled and symptoms relieved, but recurrence could occur over time and got worse gradually. Conclusions Many patients with HIV infection and AIDS first see a doctor in otorhinolaryngology head and neck surgery.Patients who had the above clinical manifestations in repeated poor results should be observed carefully,early diagnosis and treatment are important to prevent transmission, prolong life and maximize the quality of life of the patients.     

Severity of clinical manifestations and laryngeal exposure difficulty predicted by glossoptosis endoscopic grades in Robin sequence patients

ObjectiveTo evaluate the performance of two glossoptosis airway obstruction classifications in predicting symptom severity and laryngeal exposure difficulty in Robin Sequence (RS) patients.Setting: Public tertiary hospital otolaryngology section (Hospital de Clínicas de Porto Alegre - HCPA).PatientsAll RS patients diagnosed at HCPA from October 2012 to February 2015 were enrolled, a total of 58 individuals. They were classified in isolated RS, RS-Plus and syndromic RS.InterventionPatients were submitted to sleep endoscopy and a score was attributed according to Yellon and de Sousa by a blinded researcher. Symptom severity evaluation was performed as defined by Cole classification.Main outcome measureAssociation between endoscopic findings and clinical symptoms severity and laryngeal exposure difficulty.ResultsTwenty four patients were identified as isolated RS (41.4%), 19 patients presented as RS-Plus (32.7%) and 15 patients had well defined diagnosed syndromes (25.9%). Concomitant airway anomalies were found in 18 patients (31%). Specifically 17.4% in isolated RS, 55.6% in RS- Plus and 28.6% in the syndromic group had such anomalies (P = 0,03). Probability of presenting severe clinical symptoms as graded by Cole was higher in grade 3 Yellon classification (68.4%, P = 0.012) and in moderate and severe de Sousa classification (61.5% and 62.5%, respectively, P = 0.015) than in milder grades of obstruction. This findings were considered significant even after controlling for patient age. Laryngeal exposure difficulty was correlated with de Sousa and Yellon (Rho = 0,41 and Rho = 0,43, respectively; P < 0,05).ConclusionPatients with higher degrees of obstruction in sleep endoscopy had a higher probability of presenting a more severe clinical manifestation and a more difficult laryngeal exposure. Since the number of patients included in this study was small for subgroup analyses, it is not clear if this association is restricted to a specific group of RS.     

七叶皂甙钠治疗咽喉-头颈部炎性疾病临床应用

目的观察七叶皂甙钠治疗咽喉-头颈部炎性病变疗效,探讨其临床使用价值。方法选择58例2009年1月后住院咽喉一头颈部炎性病变患者设为A组,将2000年1-2008年12月住院咽喉-头颈部炎性病变54例患者设为B组,回顾复习B组患者治疗方法,在B组患者治疗方案基础上,调整糖皮质激素用法和用量,加用七叶皂甙钠静脉滴注,对A组患者进行治疗。结果两组中扁桃体病变或颈深部感染患者治疗时间比较,P〉0．05,无统计学差异;两组中急性会厌炎患者治疗时间比较,P〈0．05,差异具有统计学意义。结论七叶皂甙钠具有抗炎、抗渗出、抗氧化等多方面药理作用,能缩短疗程,增加疗效,减少糖皮质激素使用量,减轻副作用,对咽喉-头颈部炎性病变的治疗有独到的优势。     

Otological manifestations in head injury and their management - a case report

32 year old male presented with right facial palsy following head injury. Clinical evaluation showed hemotympanum on right with moderately severe conductive hearing loss, grade III LMN facial palsy and BPPV. HRCT of temporal bone demonstrated fracture base of skull involving the roof of mastoid with no evidence of bony injury to fallopian canal. Conservative management of head trauma resulted in satisfactory outcome except for conductive hearing loss and faciel palsy. Facial palsy was managed conservatively [physiotherapy and oral steroids] with full recovery of function after 4 weeks. Conductive hearing loss was managed by combined approach tympanaplasty. Preoperutively incudostapedial joint dislocation and fracture anterior crus of stapes were noted. Type II tympanoplasty with horizontal incus repositioning was carried out. PTA after 6 weeks showed 15-20 dB air-bone gap compared to 50-55dB air-bone gap preoperatively. BPPV recovered spontaneously. This case is reported to highlight:

Prognostic factors in oral squamous carcinoma and their relation to clinical staging

One hundred and three patients with an oral squamous carcinoma were studied in an attempt to determine the clinical factors which affect survival. The 5 yr actuarial survival of the whole group of patients was 55%. Although survival depended on clinical staging, in those patients with no palpable nodes on presentation the tumour size did not affect survival. The most significant factor determining survival was the presence of palpable lymph nodes on presentation. Palpable nodes were more likely in patients with large tumours than those with small tumours. On the basis of these findings a modification of the TNM classification is suggested giving more weight to the presence of cervical nodes than in the present staging system.     

Efficacy and safety of cefdinir in the treatment of maxillary sinusitis

Cefdinir is a new, extended-spectrum, orally active, third-generation cephalosporin that is resistant to bacterial β-lactamase production. To evaluate efficacy and safety of the antibiotic in maxillary sinusitis, its use was compared with amoxicillin/clavulanate (amox/clav), which is a well-accepted β-lactamase-resistant antibiotic. In this investigator-blinded multicenter phase III clinical study, 569 patients were randomly assigned to one of three treatment regimens: one daily dose of cefdinir ¶600 mg (OD), cefdinir 300 mg every 12 h (BD), and amox/clav 500/125 mg every 8 h. All antibiotics were administered orally for 10 days. Maxillary sinusitis was documented by typical clinical signs and symptoms and was confirmed by X-ray imaging. Before treatment, the genus and species of any pathogens were determined from sinus aspirates. Cultures were tested for β-lactmase production and in vitro resistance to cefdinir and amox/clav. The ¶effectiveness of antibiotic treatment was evaluated 7–¶14 days after therapy and whether or not recurrent clinical symptoms or persistent infection was determined 21–¶35 days post-therapy. The appearance of any adverse events was classified as associated or not associated with the medication of the study. Present findings showed that the in vitro susceptibility of pathogens to cefdinir and amox/clav was similar. Cefdinir OD or BD was therapeutically as effective as or better than amox/clav, although cefdinir BD was not as useful as amox/clav clinically. Cefdinir OD and BD and amox/clav were well tolerated. The statistical incidence of adverse events was the same among the three treatment groups, although cefdinir OD treatment had significantly fewer treatment discontinuations due to adverse events than BD and amox/clav.     

Clinical effectiveness of palifermin in prevention and treatment of oral mucositis in children with acute lymphoblastic leukaemia: a case–control study

The aim of this study was to evaluate the efficacy of palifermin, an N-terminal truncated version of endogenous keratinocyte growth factor, in the control of oral mucositis during antiblastic therapy. Twenty patients undergoing allogeneic stem-cell transplantation for acute lymphoblastic leukaemia were treated with palifermin, and compared to a control group with the same number of subjects and similar inclusion criteria. Statistical analysis were performed to compare the outcomes in the treatment vs. control groups. In the treatment group, we found a statistically significant reduction in the duration of parenteral nutrition （P=0.002）, duration of mucositis （P= 0.003） and the average grade of mucositis （P= 0.03）. The statistical analysis showed that the drug was able to decrease the severity of mucositis. These data, although preliminary, suggest that palifermin could be a valid therapeutic adjuvant to improve the quality of life of patients suffering： from leukaemia.     

舌骨悬吊联合悬雍垂腭咽成型术治疗重症阻塞性睡眠呼吸暂停低通气综合征

目的：探讨舌骨悬吊联合腭咽成型手术治疗重症睡眠呼吸暂停低通气综合征的手术方法和效果。方法：对22例符合重症阻塞性睡眠呼吸暂停低通气综合征标准的患者进行了改良的舌骨悬吊联合腭咽成型手术,并对所有的患者进行了随访,对17例患者进行了手术前后的舌咽平面间隙的测量和睡眠呼吸监测。结果：随访结果显示,17例术后6、12个月两项睡眠监测指标均较术前有明显改变（P＜0.01）,舌-咽距离由术前5.00～9.00?mm（平均为7.06?mm）,增加到术后的9.00～13.00?mm（平均为11.00?mm）。打鼾症状明显减轻或消失,呼吸暂停次数明显减少,白天嗜睡消失或基本消失,精力充沛。根据杭州疗效评定标准,术后6个月及1年的有效率均为100%,但治愈率和显效率有所变化。结论：改良的舌骨悬吊联合腭咽成型手术简单,时间短,花费少,效果好,值得临床推广。     

儿童中耳炎临床特征及治疗进展

儿童中耳炎在小儿耳鼻咽喉科是最常见的疾病之一,1岁前有50％的婴儿罹患中耳炎,3岁前罹患中耳炎则高达80％。儿童中耳炎的病程迁延,可引起注意力、认知感及听力下降,从而影响患儿的生活质量,严重者可以并发颅内外并发症而危及生命。笔者阅读相关的文献,现综述如下。     

Discrepancy between clinical and pathological neck staging in oral cavity carcinomas

Introduction

The presence of cervical lymph node metastases in patients with oral cavity squamous cell carcinoma reduces survival by up to 50%.

Retropharyngeal and parapharyngeal abscess in children—Epidemiology, clinical features and treatment

Objective

To describe the clinical presentation, diagnosis, management and complications of children with retropharyngeal abscesses (RPAs) and parapharyngeal abscesses (PPAs).

Methods

A retrospective chart review was conducted at two tertiary care, pediatric hospitals in Israel. The medical records of all children <18 years who had been admitted with a diagnosis of RPA or PPA during an 11-year period (January 1997 to February 2008) were reviewed. Data on demographics, presenting symptoms, physical examination findings, imaging studies and interpretation, laboratory results, hospital course, medical treatment and surgical interventions were retrieved.

Results

A total of 39 children were diagnosed as having RPA (n = 26, 67%) or PPA (n = 13, 33%). There was a predominance of boys (61.5%). The mean age of all the children at diagnosis was 4 years. The annual incidence increased over the 11-year period. The most common symptoms at presentation included fever (n = 27, 70%) and neck pain (n = 24, 62%). The physical examination revealed cervical lymphadenopathy in 30 children (77%), limitation of neck movements in 25 (64%), torticollis in 21 (54%), drooling in three (8%), and stridor in two (5%). Computerized tomographic (CT) scanning with contrast was performed in 37 patients (95%), of whom 17 underwent surgical drainage. Thirteen children were positively diagnosed as having an abscess by the finding of pus at surgery, of whom 12 had been found to have an abscess on their CT scan. All the patients received intravenous antibiotics. There was no significant difference in the duration of hospital stay between those who underwent surgery and those who were treated with antibiotics alone. There were no treatment failures and no complications in either of the two groups.

Conclusion

Children with RPA most commonly present with restricted neck movements, fever and cervical lymphadenopathy, and rarely with respiratory distress or stridor. Many patients with RPA and PPA can be treated successfully without surgery. CT scans are helpful in diagnosing and assessing the extent of the infection, but they are not always accurate.     

成人阻塞性睡眠呼吸暂停综合征患者认知功能障碍的诊断及治疗研究进展

阻塞性睡眠呼吸暂停综合征(OSAS)是一种发病率较高的睡眠及呼吸障碍性疾病,可对全身多系统及器官产生损害。近年研究发现,OSAS可导致认知功能障碍,但其具体发病机制尚不明确,可能与慢性间歇低氧、睡眠结构紊乱等有关。认知功能障碍对OSAS患者的生活及工作产生了诸多不利影响。对OSAS伴发的认知功能障碍进行早期诊断及治疗对认知功能障碍的改善具有积极意义。     

电针疗法联合手法灸治疗Meige综合征1例并文献复习

目的 观察电针疗法联合手法灸治疗Meige综合征的疗效及优势。方法 整理1例Meige综合征患者资料,辨证取穴,针刺得气后连接电针仪。留针30 min后出针施以手法灸10～15 min。1次/d, 7 d为1疗程,5个疗程结束后观察患者症状改善情况。结果 5个疗程结束后患者症状基本消失,无复发。结论 电针联合手法灸治疗Meige综合征疗效及优势显著。     

OSAHS患者CPAP治疗前后MMP-9和FFA水平变化

目的探讨OSAHS治疗前后MMP-9、FFA的变化及呼吸紊乱指数、最低血氧饱和度及血脂的相关性,为研究OSAHS病情程度及与心血管疾病、内分泌疾病的关联提供相关依据。方法对50例符合纳入条件的重度OSAHS患者在进行CPAP治疗前及治疗后6个月PSG监测并抽取清晨空腹血清测定MMP-9、FFA及临床常规血脂四项(TG、TCH、HDL、LDL),并做相关比较。结果①OSAHS患者治疗后呼吸紊乱指数(AHI)下降,与术前比较有统计学意义(P<0.01),最低血氧饱和度(SO2)上升,与术前比较有统计学意义(P<0.05)。②OSAHS患者治疗后MMP-9水平较治疗前有统计学意义(P<0.01)。FFA水平较治疗前有统计学意义(P<0.01)。③OSAHS患者治疗后TG、TCH、LDL值下降,HDL值上升,较术前均有统计学意义(P<0.01)。结论应用持续正压通气(continuous positive airway pressure,CPAP)治疗OSAHS可以降低MMP-9与FFA的水平,有效降低OSAHS所致炎症反应及心血管疾病的发生。     

喉保留策略在喉癌治疗中的应用—美国临床肿瘤学会临床实践指南更新(2017)介绍

美国临床肿瘤学会2017年对喉保留策略在喉癌治疗中的应用——美国临床肿瘤学会临床实践指南进行更新。对适当的患者采用保喉方法治疗并不影响生存率。对T₁、T₂期患者应采用内镜手术切除病灶或放疗。对于T₃、T₄期患者应行喉保留手术、联合放化疗或单纯放疗。对广泛受累的T₃或T_4a期或治疗前已有严重喉功能不全的患者应行全喉切除术以提高生存率及生活质量。治疗前患者应接受喉语音及吞咽功能的基础评估。指南推荐了评价喉发声及吞咽功能的最佳方案。     

下鼻道后穹窿鼻出血的临床特点及综合治疗

目的：总结下鼻道后穹窿鼻出血的临床特点并分析其综合治疗措施。方法：212例鼻出血住院患者中23例（10．8％）确诊为下鼻道后穹窿鼻出血,1例在全身麻醉下行鼻内镜鼻腔探查＋电凝止血术,其余22例在局部麻醉下行鼻腔探查＋电凝止血术。所有患者在术中排除了嗅裂、蝶筛隐窝及中鼻道出血,术中行下鼻甲骨折内移位后见下鼻道后穹窿活动性出血,立即给予双极电凝止血。术后电凝区域及鼻黏膜糜烂处填塞少量纳吸棉组织。结果：所有患者术中均发现明确的出血点并成功止血;术后1周内未再出血。随访6～12个月患侧鼻腔无再发鼻出血,无鼻腔粘连。结论：难治性鼻出血如排除嗅裂、蝶筛隐窝及中鼻道出血,则应考虑下鼻道后穹窿出血的可能。术中将下鼻甲往内侧骨折移位彻底暴露下鼻道后穹窿并仔细探查是发现和治疗下鼻道后穹窿鼻出血的关键。