鼻中隔偏曲患者窦口鼻道复合体CT观察

为观察鼻中隔偏曲对窦口鼻道复合体的影响，自１９９４年４月－１９９５年２月对３２例鼻中隔偏曲患者做了高分辨率连续冠状ＣＴ扫描，结果发现：（１）３２例患者中１５例有同侧或双侧ＯＭＣ炎性病变，鼻中隔偏曲角度越大，ＯＭＣ病变发生率越高；（２）对有ＯＭＣ病变的患者测量钩突角度和筛漏斗宽度无实际应用价值；（３）鼻中隔偏曲与ＯＭＣ解剖变异的关系因便数过少尚难作出定论。     

鼻中隔偏曲患者窦口鼻道复合体CT观察

2007-02-2009-02我们随机抽取50例鼻中隔偏曲患者行鼻窦连续冠状CT扫描,以观察鼻中隔偏曲对窦口鼻道复合体(ostiomeatal complex,)的影响,以及鼻中隔偏曲与病变的关     

鼻中隔偏曲及鼻中隔结节与鼻窦炎的关系

目的 探讨鼻中隔偏曲、鼻中隔结节与慢性鼻窦炎的关系。方法 通过前鼻镜、鼻窦冠状位CT、鼻内镜检查，观察2001年2月-2002年11月住院的30例鼻中隔偏曲患者鼻腔、鼻窦情况及79例慢性鼻窦炎患者鼻中隔的情况，并作统计分析。结果 30例鼻中隔偏曲患者中有11例鼻窦炎，均为I型、前组鼻窦炎，其中高位偏曲23例，伴鼻窦炎9例，6例为双侧；低位偏曲7例，伴鼻窦炎2例。79例鼻窦炎思者中有30例鼻中隔偏曲，其中，岗位偏曲22例，18例为前组鼻窦炎；低位偏曲8例，6例为前组鼻窦炎；鼻中隔结节4例，均为病程较长的Ⅱ、Ⅲ型鼻窦炎患者。结论鼻中隔岗位偏曲与鼻窦炎的发病密切相关，鼻中隔偏曲多引起前组鼻窦炎，往往双侧发病。鼻中隔结节可作为慢性鼻窦炎的一个并发症。     

冠状CT扫描及三维重建在鼻科的应用

为了寻求对鼻、鼻窦病变，窦口鼻道复合体解剖结构有较好的显示方法，获得较为真实的影像，使鼻肉镜手术更安全，可靠、彻底，对１６８例鼻窦炎及１０７例鼻窦炎伴鼻息肉患者行鼻窦冠状ＣＴ扫描，并对ＯＭＣ进行三维重建，同时与内镜检查及正常组相对照。     

窦口鼻道复合体纤毛上皮CT及电镜观察

为探讨窦口鼻道复合体（ＯＭＣ）在鼻窦炎发生中的重要作用。对２２例（３０侧鼻腔）因慢性鼻窦炎而接受功能性鼻窦内窥镜手术的患者，术前应用冠状ＣＴ影像进行定量分析，同时对术中取出的ＯＭＣ区粘膜（中鼻甲、钩突、筛泡）行扫描电镜检查，用图像分析仪定量测定纤毛覆盖面积。结果发现ＣＴ影像病变程度与纤毛上皮损伤成正相关。提示：作为各鼻窦引流口集中部位的ＯＭＣ区的病变引起纤毛上皮的损害，进而使粘液纤毛清除均能降低，     

鼻中隔偏曲合并变应性鼻炎患者手术治疗初步分析

目的观察合并鼻中隔偏曲的变应性鼻炎（AR）患者手术矫正中隔治疗AR的疗效。方法对确诊为常年性AR且愿意行手术治疗的113例患者常规行鼻内镜检查及鼻窦冠状位CT扫描，了解鼻腔变异情况后分成2组，分别行鼻中隔黏膜下矫正术、鼻中隔黏膜下矫正术＋前筛开放术和（或）息肉摘除术，术后3个月、6个月、1年时随访，根据常年性AR的诊断标准及疗效评定标准判定疗效，并进行临床分析。结果合并鼻中隔偏曲的113例AR患者手术后短期（3个月）有效率为94．7％（107／113例），长期（1年）有效率为90．3％（102／113例）。结论对经过常规药物治疗效果不理想、合并鼻中隔偏曲的常年性AR患者，手术矫正中隔，可取得较好效果。     

鼻中隔偏曲合并变应性鼻炎患者手术治疗初步分析

目的 观察合并鼻中隔偏曲的变应性鼻炎(AR)患者手术矫正中隔治疗AR的疗效.方法 对确诊为常年性AR且愿意行手术治疗的113例患者常规行鼻内镜检查及鼻窦冠状位CT扫描,了解鼻腔变异情况后分成2组,分别行鼻中隔黏膜下矫正术、鼻中隔黏膜下矫正术+前筛开放术和(或)息肉摘除术,术后3个月、6个月、1年时随访,根据常年性.AR的诊断标准及疗效评定标准判定疗效,并进行临床分析.结果 合并鼻中隔偏曲的113例AR患者手术后短期(3个月)有效率为94.7%(107/113例),长期(1年)有效率为90.3%(102/113例).结论 对经过常规药物治疗效果不理想、合并鼻中隔偏曲的常年性AR患者,手术矫正中隔,可取得较好效果.     

鼻内镜下复杂鼻中隔偏曲矫正术52例报告

目的:探讨鼻内镜下复杂鼻中隔偏曲矫正术的疗效及手术体会。方法:对52例高位后段、巨大嵴突和棘突、多种弯曲形态并存、鼻中隔骨折脱位及需二次矫正偏曲,经鼻内镜检查及鼻窦CT扫描(冠状位)确诊的患者采用经鼻内镜下偏曲矫正术,随访6个月以上。结果:52例患者鼻中隔矫正效果满意,鼻腔通气良好,无鼻中隔穿孔、鼻腔粘连及鼻梁塌陷等症状。结论:在鼻内镜下行复杂鼻中隔偏曲矫正术,照明度好,视野清晰宽广,精细准确,保持了鼻中隔稳定性,安全、微创,符合鼻生理功能的需要及微创手术的要求。     

青少年鼻中隔成形术

传统观点对青少年鼻中隔偏曲不主张行鼻中隔手术。国外学者通过长期临床观察发现面中部外伤和鼻中隔手术对鼻和上颌骨的发育并无明显影响[1,2 ] ,我科自 1994年 6月～ 1997年 10月对 10例青少年鼻中隔偏曲患者在内窥镜下施行了鼻中隔成形术 ,报道如下。10例患者中男 7例 ,女 3例。 12、15岁各 2例 ,13、14岁各 3例。所有患者均行鼻内窥镜和鼻窦ＣＴ扫描检查 ,其中软骨部“Ｃ”型弯曲 2例 ,“Ｓ”型弯曲 2例 ,嵴状突起 2例 ,棘状突起 1例 ,鼻中隔高位偏曲伴低位嵴状突起 3例。 10例中有 5例伴有上颌窦炎和筛窦炎 ,主要临床表现为鼻塞 (10例 )…     

鼻中隔偏曲伴下鼻甲肥大患者的鼻窦CT分析

目的　通过对鼻中隔偏曲患者鼻窦CT的测量分析,初步评价鼻中隔偏曲程度与下鼻甲肥大的相关性。方法　分析98例鼻中隔偏曲患者鼻窦冠状位CT,将与鼻中隔偏曲方向一致的鼻腔设为对照组,与鼻中隔偏曲方向相反的鼻腔设为实验组。测量并记录鼻中隔偏曲角度,双侧下鼻甲骨、内侧黏膜、外侧黏膜厚度。结果　实验组和对照组下鼻甲内侧黏膜、骨、外侧黏膜厚度差异有统计学意义（P <0.05）。实验组下鼻甲内侧黏膜、骨、外侧黏膜厚度差异有统计学意义（P <0.05）。实验组下鼻甲内侧黏膜、骨、外侧黏膜厚度与鼻中隔偏曲角度的相关性无统计学意义,但相关系数r 提示三者与鼻中隔偏曲角度的相关性：骨＞内侧黏膜＞外侧黏膜。结论　鼻中隔偏曲伴代偿性下鼻甲肥大,不仅由下鼻甲黏膜增厚引起,也可由下鼻甲骨本身增生引起,鼻中隔矫正术术前行鼻窦CT检查,对鼻中隔偏曲伴下鼻甲肥大患者手术方式的选择有一定帮助。     

QoR-15在加速康复外科改善慢性鼻-鼻窦炎伴鼻息肉围手术期生活质量评估中的应用

目的 探讨15项恢复质量量表(QoR-15)在加速康复外科(ERAS)改善慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)围手术期生活质量评估中的应用效果。 方法 将74例CRSwNP患者随机分为ERAS组36例和对照组38例。ERAS组围手术期实施优化的治疗方案,对照组围手术期按照传统方案进行。采用QoR-15对两组患者术前,术后24、48 h生活质量进行评估。 结果 ERAS组、对照组术前Lund-Mackay鼻窦CT评分分别为(9.13±1.88)、(9.60±1.86)分,Lund-Kennedy内镜评分分别为(2.69±0.78)、(2.57±0.72)分,两组比较,P均>0.05。ERAS组、对照组的手术时间分别为(1.69±0.60)、(1.77±0.65)h, 术中出血量分别为(191.67±60.35)、(202.63±60.34)mL,两组比较,P均>0.05。ERAS组、对照组手术后出现恶心呕吐率分别为11.11%(4/36)、7.89%(3/38),两组比较,P均>0.05。手术前ERAS组和对照组QoR-15总计分分别为(139.19±4.21)、(140.07±5.96)分,两组比较,P>0.05;术后24 h ERAS组和对照组总计分分别为(102.75±10.83)、(83.14±5.43)分,两组比较,P<0.05;术后48 h ERAS组和对照组总计分分别为(115.31±10.14)、(109.65±9.52)分,P>0.05。 结论 QoR-15可作为患者结局报告量表对ERAS在CRSwNP围手术期生活质量的效果进行评估。     

1～3期帕金森病患者的嗓音特征研究

目的探讨1~3期帕金森病(Parkinson’s disease,PD)患者的嗓音特征。方法对30例(男女各15例)年龄在60~69岁的1~3期帕金森病患者(PD组)的嗓音进行嗓音障碍指数(voice handicap index,VHI)主观评估,采用嗓音声学分析和电声门图对其嗓音进行客观分析,并以28例(男女各14例)同龄健康人作为对照组,比较两组结果。结果 PD组和对照组VHI评分的差异有显著统计学意义,PD组高于对照组(P<0.001)。PD组和对照组嗓音声学分析结果中的基频震颤、振幅震颤和基频标准差的差异有统计学意义,PD组高于对照组(P<0.05)。电声门图测量结果两组间差异无统计学意义(P>0.05)。结论 1~3期帕金森病患者的嗓音声学特征为嗓音的基频震颤、振幅震颤和基频标准差显著增高。     

环杓后肌失神经及神经再支配后兴奋性的研究

为研究环杓后肌失神经及其神经再支配后的兴奋性,将15只狗分成3组即神经植入组、神经肌蒂组及对照组,每组5只.术后6个月发现植入神经、带肌蒂的神经均与正常喉返神经兴奋性无显著性差异(P>0.05),且神经兴奋性高于肌肉兴奋性.两个恢复神经再支配组的环杓后肌与正常环杓后肌兴奋性亦无显著性差异(P>0.05),而失神经的环杓后肌与两个神经修复组及正常环杓后肌的兴奋性则有高度显著性差异(P<0.01),且其兴奋性最低.结果表明,当功能性电刺激治疗双侧喉返神经麻痹时,刺激电极安放在修复的神经上比安放在环杓后肌处效果要好.     

Characterization of a new allele of Ames waltzer generated by ENU mutagenesis

Mutation in the protocadherin 15 (Pcdh15) gene causes hair cell dysfunction and is associated with abnormal stereocilia development. We have characterized the first allele (Pcdh15(av-nmf19)) of Ames waltzer (av) obtained by N-ethyl-N-nitrosourea (ENU) mutagenesis. Pcdh15(av-nmf19) was generated in the Neuroscience Mutagenesis Facility (NMF) at The Jackson Lab (Bar Habor, USA). Pcdh15(av-nmf19) mutants display circling and abnormal swimming behavior along with lack of auditory-evoked brainstem response at the highest intensities tested. Mutation analysis shows base substitution (A--> G) in the consensus splice donor sequence linked to exon 14 resulting in the skipping of exon 14 and the splicing of exon 13-15. This results in the introduction of a stop codon in the coding sequence of exon 15 due to shift in the reading frame. The effect of nmf19 mutation is expected to be severe since the expressed Pcdh15 protein is predicted to truncate in the 5th cadherin domain. Abnormalities of cochlear hair cell stereocilia are apparent in Pcdh15(av-nmf19) mutants near the time of birth and by about P15 (15 days after birth) there is evidence of sensory cell degeneration. Disorganization of outer hair cell stereocilia is observed as early as P2. Inner hair cell stereocilia are also affected, but less severely than those of the outer hair cells. These results are consistent with characteristics of the mutation in the Pcdh15(av-nmf19) allele and they support our previous finding that Protocadherin 15 plays an important role in hair-bundle morphogenesis.     

Foley catheter action in the nasopharynx: a cadaveric study

OBJECTIVES: To determine the action of the Foley catheter in the posterior nasal cavity in relation to balloon volume, and to deduce its implications in the treatment of posterior epistaxis. DESIGN: Human cadaveric study. MATERIALS: Twenty nasal fossae of 10 adult cadavers. INTERVENTIONS: A Foley catheter (size 14) was inserted into the nasopharynx via each nostril. The catheter balloon was inflated to its recommended maximum volume with 15 mL of water. Firm traction was applied to the catheter. Colored liquid was instilled into the ipsilateral aspect of the nasal cavity, and liquid leakage into the contralateral side was monitored using a nasoendoscope. The balloon was reduced in volume by 1-mL steps, and the same fluid infusion and documentation procedures were performed for each reduced volume until the balloon slipped out of the nose. The procedure was repeated in the opposite nostril. MAIN OUTCOME MEASURES: Successful choanal sealing and anterior balloon shift into the nasal fossa in relation to the balloon size. RESULTS: The Foley catheter balloon sealed the choana without any leakage of infused liquid into the contralateral side at appropriate inflation volumes in 17 (85%) of 20 nasal fossae. Complete sealing between volumes of 12 and 15 mL was achieved in 13 fossae (65%), between 11 and 15 mL in 10 nasal fossae (50%), and between 5 and 15 mL in 3 nasal fossae (15%). Failure to seal at any volume occurred in 3 nasal fossae (15%). Bimodal seal (ie, complete seal at high [15 mL] and low volumes [4-7 mL], but leakage in intermediate volumes) occurred in 3 nasal fossae (15%). The balloon remained in the nasopharynx under traction and did not slip past the choanal rim to encroach on the middle and inferior turbinates until the balloon volume was reduced to between 4 and 7 mL. The balloon slid out of the nose at a volume of 5 mL or less. The inflation volumes ranging from 8 to 12 mL were statistically more effective in sealing the choana than lower volumes (4-7 mL) (P<.002, chi(2) test). CONCLUSIONS: At different inflation volumes, the Foley catheter balloon acts primarily (1) as a platform for an anterior gauze pack (at 4-15 mL); (2) as an effective seal of the choana (at 8-15 mL usually and at 4-7 mL occasionally); and (3) as a compressor of the region behind the middle and inferior turbinates (at 4-7 mL), provided that the balloon under traction does not slip out of the nose.     

Assessing outcomes after partial and total tonsillectomy for sleep-disordered breathing in children using Clinical Assessment Score-15

IntroductionThe Clinical Assessment Score-15 (CAS-15) is an office-based tool for assessing the risk of sleep disordered breathing (SDB), a relatively common condition in the pediatric population. Change in CAS-15 following total tonsillectomy (TT) has been shown to have a large effect size, but it is unclear how it varies following partial intracapsular tonsillectomy (PIT). Thus, the objective of the present study is to evaluate the utility of the CAS-15 score in assessing the effectiveness of PIT and how this compares to change after TT.Material methodsChildren ages 2–18 undergoing PIT (N = 16) or TT (N = 8) with or without adenoidectomy for SDB completed the CAS-15 before surgery and at their post-operative follow-up visit. Changes in CAS-15 score were assessed by paired t-test. The mean difference in CAS-15 change between PIT and TT was evaluated by unpaired t-test for unequal variances. Differences in participant characteristics were determined via unpaired t-test for unequal variances.ResultsParticipants undergoing PIT did not differ significantly than those undergoing TT with regard to age, sex, BMI percentile, pre-op CAS-15 score or tonsil size, or admission rates following surgery (p > 0.05). The median follow-up after surgery was 5.2 (PIT) and 4.4 (TT) weeks. CAS-15 score improved significantly following PIT (42.8 ± 12.3 vs. 9.4 ± 5.6, p < 0.0001) and TT (45.5 ± 13.3 vs. 7.9 ± 5.8, p < 0.0002). The decrease in CAS-15 for PIT did not differ from TT (33.3 ± 11.8 vs. 37.6 ± 15.0, p > 0.49).DiscussionCAS-15 decreases drastically following PIT and TT, indicating significant improvement of SDB symptoms. Because the change in CAS-15 after PIT was similar to TT, PIT may be preferred due to the decreased morbidity of the procedure. Given the cost, time required, inconvenience, and other limitations of overnight polysomnography (PSG), which is the gold standard method of diagnosing SDB, CAS-15 may be a suitable replacement or adjunct for the assessment of SDB following PIT in addition to TT.     

The role of history, Epworth Sleepiness Scale Score and body mass index in identifying non-apnoeic snorers

Seventy-one adults referred with snoring over a 9-month period were assessed and their apnoeic-status determined by clinical assessment using symptoms suggestive of the obstructive sleep apnoea-hypopnoea syndrome, the Epworth Sleepiness Scale score (ESS) and body mass index (BMI). The results of clinical assessment were compared to that of overnight six-channel polysomnography where snoring noise level, pulse rate, capillary oxygen saturation, breathing effort, oronasal airflow and body position were monitored. Polysomnography detected an apnoea-hypopnoea index (AHI) of < 15 episodes/h in 61(86%) patients and an AHI of > or = 15 episodes/h in 10 (14%) patients. Clinical assessment alone identified 57 patients with AHI of < 15 episodes/h as 'non-apnoeic snorers' and six patients with AHI of > or = 15 episodes/h as 'apnoeic snorers'. The sensitivity of this method of clinical assessment in identifying the 'non-apnoeic snorers' from amongst patients referred with snoring was 93.4% and its specificity was 60% (P < 0.001).     

加速康复外科在鼻中隔偏曲矫正术围手术期的应用效果

目的 探讨在鼻内镜下鼻中隔偏曲矫正术围手术期实施加速康复外科(ERAS)理念的效果.方法 前瞻性选取中山市人民医院行鼻内镜下鼻中隔偏曲矫正术的40例患者纳入研究.随机分为常规组和ERAS组,每组20例.常规组给予常规围手术期处理措施,ERAS组给予ERAS方案.比较两组术后鼻部疼痛视觉模拟评分(VAS)、术后住院时间、...     

Interstitial thermoradiotherapy for recurrent head and neck cancer

From 1985 to 1987, 22 head and neck sites in 20 patients with recurrent tumors were treated with interstitial thermoradiotherapy (ITRT). The sites treated were 15 neck (68%), four tongue (18%), two parotid (9%), and one buccal mucosa (4%). Squamous cell carcinoma was diagnosed in 21 sites and adenocarcinoma in the other. All patients had prior radiotherapy (RT), including 15 who underwent a combination of RT and surgery. Interstitial RT with iridium 192 (mean dose, 40 Gy) was combined with interstitial microwave hyperthermia (mean thermal dose, 90 units). Complete response (CR) was obtained in 15 (68%) sites and partial response (PR) in seven (32%) sites. There were no local recurrences in the 15 CR patients during a period of observation of up to 30 months. Of the seven PR patients, one had radical neck dissection and is free of tumor after 28 months. Tumor volume was an important factor influencing CR (P less than .001), whereas RT and thermal dose were not (P = .3). Of the 20 patients treated, 19 experienced major subjective benefit. Serious complications occurred in two patients: one had localized soft tissue necrosis, the other had aspiration pneumonia. ITRT was well-tolerated by patients despite prior aggressive therapy. High objective response rate and low toxicity demonstrate the value of this treatment combination in the management of patients with postradiation recurrence of head and neck tumors.     

Role of class D L-type Ca2+ channels for cochlear morphology

Voltage-gated Ca(2+) channels formed by subunits (class D Ca(2+) channels) tightly regulate neurotransmitter release from cochlear inner hair cells (IHCs) by controlling the majority of depolarisation-induced Ca(2+) entry. We have recently shown that the absence of these channels can cause deafness and degeneration of outer hair cells (OHCs) and IHCs in alpha1D-deficient mice (alpha1D(-/-)) (Platzer et al., 2000. Cell 102, 89-97). We investigated the time-dependent patterns of degeneration during postnatal development in the alpha1D(-/-) mouse cochlea using light and electron microscopy. At postnatal day 3 (P3), electron microscopy revealed no morphological aberrations in sensory cells, in afferent as well as in efferent nerve endings. But at P7 we observed a beginning degeneration of afferent nerve fibres by electron microscopy. By P15, we found a loss of OHCs in apical turns but electron microscopy revealed no ultrastructural changes in IHCs and efferent axons as compared to C57 black control animals (C57BL). We demonstrated by serial ultrathin sectioning of 15 days old alpha1D(-/-) mice that intact efferent nerve fibres formed direct contacts with IHCs as the degeneration of afferent nerve fibres progressed. We also saw a notable degeneration of spiral ganglion cells at P15. By 8 months, nearly all spiral ganglion and sensory cells of the organ of Corti were absent. Random ultrathin sectioning gave the impression that synaptic bodies abundant in wild-type animals were absent in nearly all alpha1D(-/-) mice investigated. We conclude that besides presumably reduced synaptic bodies the absence of class D L-type Ca(2+) channels does not prevent morphological development of the cochlea until P3 but may cause cochlear degeneration thereafter. The observed pattern of degeneration involves afferent nerve fibres (P7) followed by cell bodies in the spiral ganglion (P15), OHCs (P15) and IHCs (after P15).