等离子射频舌根部分切除术治疗阻塞性睡眠呼吸暂停低通气综合征

目的探讨提高阻塞性睡眠呼吸暂停低通气综合征(obstructivesleepapneahypopneasyndrome,OSAHS)的有效治疗方法。方法采用等离子低温射频舌根部分切除术治疗72例OSAHS,术前及术后12周进行多导睡眠仪监测和Epworth嗜睡程度评分确定治疗效果。结果术后舌根体积明显缩小,自觉症状明显改善,Epworth嗜睡程度评分较治疗前明显降低和AHI明显降低。结论等离子低温射频舌根部分切除术在阻塞性睡眠呼吸暂停综合征的治疗中显示出一定的可行性、有效性和安全性。为临床医师提供了一种新的、理想的治疗手段。在上气道阻塞性疾病的治疗中将有更加广阔的应用前景。     

持续正压通气、等离子消融和改良腭咽成形术综合治疗重症阻塞性睡眠呼吸暂停综合征

目的探讨重症阻塞性睡眠呼吸暂停低通气综合征的治疗方法,提高临床疗效和减少并发症。方法对15例经多导睡眠监测仪监测确认为重症阻塞性睡眠呼吸暂停低通气综合征患者术前进行为期1W的持续正压通气,再进行改良腭咽成形和等离子软腭、悬雍垂、舌根及下鼻甲消融,扩大咽气道。结果术后随访3~6m,无明显并发症,所有患者均取得了满意效果。患者射频治疗前和治疗12W后多导睡眠参数比较显示治疗后Ⅰ+Ⅱ期睡眠时间明显缩短,Ⅲ+Ⅳ期睡眠时间明显延长,睡眠效率及最低脉氧饱和度(LspO2)均显著提高(P<0.01);呼吸暂停低通气指数减低及打鼾时间缩短均较治疗前相比差异非常显著(P<0.01)。患者射频治疗12W后软腭长主及悬雍垂度的缩短及鼾声评级的降低均较治疗前相差非常显著(P<0.01)。Epworth嗜睡程度评分亦较治疗前明显降低(P<0.01)。结论持续正压通气、腭咽成形术和等离子消融综合治疗阻塞性睡眠呼吸暂停低通气综合征具有较好的近期疗效,且方便、安全、微创、恢复快,无不良反应,有较好的发展前景,值得推广应用。     

软腭等离子射频打孔消融治疗阻塞性睡眠呼吸暂停综合征

目的探讨等离子低温射频软腭打孔消融对阻塞性睡眠呼吸暂停低通气综合征的临床疗效.方法对65例经多导睡眠图监测确诊为阻塞性睡眠呼吸暂停低通气综合征的患者行软腭等离子低温射频打孔消融术,缩短软腭及悬雍垂.结果术后随访3～6个月,患者均取得了满意效果.患者射频治疗前和治疗12周后多导睡眠参数比较显示治疗后Ⅰ+Ⅱ期睡眠时间明显缩短,Ⅲ+Ⅳ期睡眠时间明显延长,睡眠效率及最低脉氧饱和度(LSpO2)均显著提高(P＜0.05);呼吸暂停低通气指数减低及打鼾时间缩短与治疗前相比差异非常显著(P＜0.01).患者射频治疗12周后软腭长度及悬雍垂长度的缩短及鼾声评级的降低均较治疗前有显著差异(P＜0.01).Epworth嗜睡程度评分亦较治疗前明显降低(P＜0.01).结论等离子低温射频软腭打孔消融对于轻度OSAHS患者具有较好的近期疗效,且方便、安全、微创、康复快,无不良反应,有较好的发展前景,值得推广应用.     

扩大鼻侧切开联合额骨开窗治疗颅鼻沟通瘤

目的探讨颅鼻沟通瘤的手术入路和术后颅底组织缺损的修复方法。方法对5例鼻腔鼻窦肿瘤累及前颅底的手术入路、手术方法、修复材料、并发症、手术效果及生存率进行回顾性分析。结果全部病人随访3~5年,无脑脊液鼻漏、颅内感染等明显并发症。3年生存率为100%,5年生存率为80%。结论扩大鼻侧切开联合房垛样额骨开窗切除颅鼻沟通瘤,修复颅底缺损、重建功能是一种简便、安全、有效的方法。     

InterMiG: international differences in the therapeutic approach to migraine patients in specialized headache centers

BackgroundThere is currently a wide therapeutic arsenal for migraine patients, without a single first-line preventive drug and we choose the different available alternatives taking into account comorbidities, national guidelines, previous treatments and personal experiences.Our objective was to evaluate the differences in the use of migraine treatments between neurologists from different countries.MethodsThis is a multi-centre observational study carried out by neurologists from specialized headache units in seven countries, retrospective with consecutive inclusion of all patients presenting with a migraine diagnosis, over a period of three months.ResultsA total of 734 patients were recruited but only 600 were considered in the analysis in order to homogenize the patient cohorts from countries: 200 Spain (ES), 100 Italy (IT), 85 Russia (RUS), 80 Germany (DE), 60 Portugal (PT), 45 Poland (PL) and 30 Australia (AU). 85.4 % of patients were women with a mean age of 42.6 ± 11.8 years. Considering previous and current preventive treatment, the order of use was: antidepressants (69.3 %), antiepileptic drugs (54.7 %), beta-blockers and antihypertensive drugs (49.7 %), OnabotulinumtoxinA (44.0 %) and others (36.2 %).Statistically significant differences were found between all pharmacological classes: antidepressants were commonly used in all countries, with the exception of Poland (AU: 76.7 %, IT: 71.0 %, DE: 60.0 %, PL: 31.1 %, PT: 71.7 %, RUS: 70.6 %, ES: 78.5 %; p < 0.0001); antiepileptic drugs were more frequently prescribed in Portugal, Australia and Spain (AU: 73.3 %, IT: 40.0 %, DE: 37.5 %, PL: 48.9 %, PT: 85.0 %, RUS: 29.4 % and ES: 69.0 %; p < 0.0001); beta-blockers and antihypertensive drugs were frequently used in all countries except Italy (AU: 60.0 %, IT: 14.0 %, DE: 53.8 %, PL: 48.9 %, PT: 68.3 %, RUS: 49.4 % and ES: 59.0 %; p < 0.0001); BTX-A were predominately used in Spain, Italy and Australia (AU:56.7 %, IT:58.0 %, DE:20.0 %, PL: 42.2 %, PT: 26.7 %, RUS: 24.7 % and ES: 58.5 %; p < 0.0001) and others were most frequently used in Poland (AU: 0.0 %, IT: 19.0 %, DE: 42.5 %, PL: 95.6 %, PT: 31.7 %, RUS: 3.5 % and ES: 49.5 %; p < 0.0001). If only patients without comorbidities are considered (200/600), statistically differences between countries persist in all preventive treatments.ConclusionsThere is heterogeneity in the choice of preventive treatment between different countries. Prospective comparative studies of the different oral and subcutaneous alternatives would help to create a global therapeutic algorithm that would guarantee the best option for our patients.     

Unusual deletions within the immunoglobulin heavy-chain locus in acute leukemias

We have investigated the structure of the Ig heavy (IGH) chain locus in 309 cases of acute leukemia. Seventy-one cases of B-cell precursor (BCP) acute lymphoblastic leukemia (ALL) were analyzed: in six cases deletion of joining (JH) segments in the presence of cytogenetically normal chromosome 14 was observed. Similar deletions were seen in 1 out of 8 cases of biphenotypic acute leukemia analyzed: this case exhibited t(9:22)(q34;q11) and coexpressed both myeloid and B cell differentiation antigens. Five of the 7 cases analyzed had deleted the JH segments from both chromosomes. Because these deletions may have contributed to the pathogenesis of the disease we have attempted to define their boundaries. Using probes that map both 5' and 3' of JH, the 3' (centromeric) boundary of the deletions was mapped to an approximately 30-kb central region of the 60 kb between C delta and C gamma 3 in 10 of the 12 deleted chromosomes. In the remaining two chromosomes, the 3' boundary mapped to S mu. The 5' (telomeric) boundary could not be defined. However, three cases with biallelic deletion of JH showed biallelic deletion of the most proximal variable (VH) (VH6 and VH5-B2) genes, indicating that the deletions spanned over 500 kb. VH5-B1 and VH5-B3 were retained in germline configuration and no gross deletions were observed using a VH3 subgroup-specific probe, indicating that the 5' boundary mapped within the VH locus. Unusual deletions of the portion of the IgH locus including JH segments and the C mu and C delta genes may occur in acute leukemias with immunophenotypic evidence of commitment to the B cell differentiation pathway. The possible consequences of the deletions remain to be determined. However, the clustering of the centromeric boundary of the deletions to S mu and to a region between the C delta-C gamma 3 genes, a known "hot spot" for recombination, may indicate the operation of a distinct pathogenic mechanism.     

Early developmental outcome after the Norwood procedure for hypoplastic left heart syndrome

OBJECTIVE: To assess intellect and adaptive behavior in children with hypoplastic left heart syndrome (HLHS) who had undergone at least two surgical stages of the Norwood procedure. METHODS: Fourteen children with HLHS >3 years of age participated in the study. The patients underwent intelligence quotient (IQ) testing, and their parents were interviewed regarding their children's adaptive behavior. Results were compared with those of 10 family controls. Outcomes were studied for possible correlation with perioperative variables. RESULTS: Among the HLHS patients, the median scores for full scale IQ and adaptive behavior were 88 and 91, respectively (normal = 100 +/- 15). One child met criteria for mental retardation. Family controls scored generally higher than did HLHS patients, but only differences in adaptive behavior were statistically significant. A negative correlation was found between stage I circulatory arrest time and full scale IQ. CONCLUSIONS: Children with HLHS most often function in the low-normal range of intelligence and adaptive behavior. A prolonged circulatory arrest time may result in decreased intellectual function.     

A national study of the availability and use of electrophysical agents by Australian physiotherapists

Electrophysical agents (EPAs) are a core part of physiotherapy practice and entry level education. With the increase in the number of EPAs over time, their availability and use in contemporary physiotherapy practice is an important consideration when determining entry level curricula. Thus, the aim of the study was to ascertain the current availability and usage of EPAs in Australian physiotherapy practice. A purpose-designed questionnaire was mailed to all registered physiotherapists in Australia. A response rate of 27% was obtained (n=3,538). Nonresponder analyses indicated that the results were representative of the total population of Australian physiotherapists. Over 70% of respondents had access to ultrasound, cold packs/ice, heat packs, electrical stimulation for sensory stimulation, and interferential therapy. Two main groups of EPAs were used relatively frequently. The first group was used daily or monthly by 60% of respondents (ultrasound, hot packs, and cold packs/ice), and a second group (electromyographic and pressure biofeedback, interferential therapy, and electrical stimulation for sensory stimulation) was used on a daily or monthly basis by between 30% and 45% of the sample. A group of EPAs, including ultraviolet light, microwave, and shortwave diathermy, was not used by over 90% of the sample. The study has provided contemporary national data on EPA availability and use in Australia.     

黏膜下双极射频等离子消融下鼻甲治疗鼻甲肥厚的临床疗效

目的 :评价低温射频消融下鼻甲治疗慢性肥厚性鼻炎的临床效果。方法 :用射频消融术缩小 95例下鼻甲肥大致鼻塞患者的下鼻甲 ,术前及术后 3个月应用视觉模拟评分表 (VAS)评价鼻塞的主观感觉。结果 :患者术前鼻塞VAS评分左侧为 (6 9.5± 8.6 ) % ,右侧为 (71.3± 11.5 ) % ;术后 3个月左侧为 (2 6 .1±8.9) % ,右侧为 (31.3± 10 .5 ) % ,左右侧分别与术前比较 ,差异有高度显著性 (P <0 .0 1)。结论 :等离子低温射频下鼻甲消融术是安全、有效、微创的治疗鼻甲肥厚的方法。