鼻内镜下鼻中隔成形术临床应用观察

目的探讨鼻内镜下鼻中隔成形术的优点.方法鼻内镜下行鼻中隔成形术50例,其中高位和后段偏曲6例.结果50例均一次完成手术,偏曲的鼻中隔均获得彻底矫正.手术时间30～72 min,平均48 min,偏进的鼻中隔获得彻底矫正,随访6～9个月,平均7.1月,治愈45例(90%),好转5例(10%).无鼻中隔血肿、脓肿、穿孔、鼻腔粘连、鼻梁塌陷等并发症发生.结论鼻内镜下鼻中隔成形术,手术时间短,术中出血少,疼痛轻,术后并发症少,可同期行鼻窦手术,完全可以取代传统的鼻中隔黏膜下切除术.     

鼻尖的类型和手术设计

目的探讨适合国人的鼻尖分类体系,并设计相应的手术方案。方法根据鼻的形态差异,将鼻尖分为5型,即前伸型、后缩型、低垂型、肥大型和混合型,综合应用切除、缝合和填充移植物的手术方法行鼻尖修整术,并对手术效果进行评价。结果本组1028例患者,术后鼻孔不对称10例,7例经再次手术后满意;线结反应3例;移植物从切口突出1例。随访973例患者3周至7年,效果满意。结论鼻尖分类体系能够指导手术设计和操作,并获得稳定、满意的手术效果。     

鼻内镜下上颌窦（扩大）内壁切除术在鼻内翻性乳头状瘤手术中的应用

目的探讨鼻内镜下上颌窦（扩大）内壁切除术在鼻内翻性乳头状瘤手术中的应用价值。方法回顾分析2002年1月～2006年12月采用鼻内镜下上颌窦（扩大）内壁切除术治疗鼻内翻性乳头状瘤10例的临床资料。结果10例均在鼻内镜下完全切除。10例随访12～72个月,平均30个月;术后仅1例术后1年后复发;10例均无溢泪发生。结论鼻内镜下上颌窦（扩大）内壁切除术在鼻内翻性乳头状瘤手术中的应用是可行的,基本接近鼻侧切开的手术范围;最大优点是可避免面部瘢痕、创伤小、手术视野清晰、能够准确完整地切除肿瘤、术后复发率低。     

辐射对豚鼠鼻黏膜组织结构及微血管的影响

目的：探讨辐射对豚鼠鼻黏膜结构及微血管的损伤。方法：选择健康豚鼠84只，随机分为对照组（12只）及照射组（72只）。均在同样条件下喂养。将照射组豚鼠置于直线加速器射线内照射，每周1次，每次照射5Gy，计3周，总剂量15Gy，建立辐射损伤动物模型。分别于照射后0．5、1.0、2．0、3．0、5．0、6．0个月处死动物12只，随机取6只做鼻腔黏膜微血管铸型，另6只做病理检查。对照组在假照射后6个月处死动物，随机各选6只分别做鼻黏膜微血管铸型检查和病理检查。结果：照射组豚鼠的鼻黏膜辐射后早期表现为急性炎症反应，黏膜大量坏死、脱落，电镜下见仅少部分黏膜表面还被覆着正常的纤毛结构。以后黏膜开始修复，至6个月时基本结束，但大部分黏膜失去了正常的纤毛柱状上皮结构特点，部分区域甚至代为组织转化的鳞状上皮；微血管铸型可见，早期改变为毛细血管扩张充血及血管内皮细胞肿胀，以后逐渐出现毛细血管的扭曲变形、闭塞及中断，毛细血管数量大量减少，致血液回流障碍，微静脉萎瘪。后期部分区域出现新生的毛细血管，但结构紊乱，不具备微循环的功能。结论：鼻黏膜的损伤、晚期的鳞状上皮组织转化以及鼻黏膜微循环的破坏是放疗后鼻腔功能障碍的病理学基础。     

Effects of ethmoidal nerve stimulation on respiration-related neurones in the dorsal medulla of the cat

Stimulation of the nasal mucosa produces a number of respiratory reflexes the afferent limb of which is provided by the ethmoidal nerve, a branch of the trigeminal nerve. In the cat this nerve terminates within the trigeminal nucleus. It has no direct projection to brainstem respiratory centres. This study examines the response of respiratory-related neurones in the nucleus of the solitary tract (NTS) to ethmoidal stimulation. It demonstrates that these neurones show both excitatory and inhibitory responses to ethmoidal stimulation. Thus, the NTS appears to be involved in respiratory reflexes initiated by stimulation of the nasal mucosa.     

1910名初中新生慢性鼻-鼻窦炎与鼻中隔偏曲的相关性分析

目的　了解初中新生慢性鼻-鼻窦炎发病与鼻中隔偏曲的相关性。 方法　分层随机抽取郑州市1910名12~15岁初中新生，采取问卷调查及专科体检的形式，根据量表、体检结果，了解鼻中隔偏曲和慢性鼻-鼻窦炎患病情况，分析两者相关性。 结果　抽样初中新生慢性鼻-鼻窦炎的患病率为6.2%（119/1910）；慢性鼻-鼻窦炎患病群体与非患病群体中，轻、中度鼻中隔偏曲的发生率分别为27.7%（33/119）和31.2%（559/1791），两者差异无统计学意义（χ2=0.632，P>0.05）；重度鼻中隔偏曲的发生率分别为13.4%（16/119）和8.0%（144/1791），两者差异有统计学意义（χ2=4.248，P<0.05）。 结论　初中新生慢性鼻-鼻窦炎发病与重度鼻中隔偏曲具有相关性。     

Viral titers in nasal lining fluid compared to viral titers in nasal washes during experimental rhinovirus infection

BACKGROUND: The concentration of rhinovirus in nasal wash specimens from infected volunteers peaks at 48-72 h after inoculation. The volume of expelled nasal fluid peaks at the same time, raising the question of whether the viral concentration in nasal wash reflects viral replication in nasal cells or merely the production of an increased volume of nasal fluid during a cold. OBJECTIVES: To determine the amount of rhinovirus in nasal lining fluid during colds before the nasal fluid has been diluted in a nasal wash. STUDY DESIGN: Rhinovirus titers were determined in nasal wash specimens collected daily for five days from 14 subjects with type16 rhinovirus infection. The urea concentration in nasal lining fluid equals that in blood. By determining the urea concentration in a nasal wash and comparing it to the urea concentration in blood from the same subject, it was possible to determine the amount of dilution of the nasal lining fluid. The dilution factor (reciprocal of the dilution) was then used to calculate the viral concentration in undiluted nasal lining fluid. RESULTS: The dilution factor in 70 nasal washes varied from 5 to 64. The viral GMTs (+S.E.) in nasal washes were 1.79 (+0.3) TCID(50)/ml at 24 h, 3.11 (+0.15) at 48 h, and 2.61 (+0.3) at 72 h. The viral GMTs in nasal lining fluid, based on urea adjusted values, paralleled those in nasal washes but were approximately one log higher. Virus concentrations returned to near baseline values by day 5. CONCLUSIONS: The temporal pattern of rhinovirus shedding observed in nasal wash specimens, with a peak in virus concentration at 48-72 h after infection, is a true indication of virus production in nasal cells and not an artifact of the increased amount of nasal fluid produced during the early phase of a cold.     

Differential expression of lactoseries carbohydrate epitopes HNK-1, CD15, and NALA by olfactory receptor neurons in the developing chick

 The formation of the nasal lining with its sensory and its nonsensitive respiratory epithelium requires a spatially ordered pattern of cellular differentiation. Aiming at identifying cell recognition molecules that may be involved in cellular differentiation steps, we applied a panel of antibodies to terminal carbohydrate sequences of the lactoseries on the developing chick olfactory epithelium. This approach is based on the idea that these terminal sugar residues may be involved in certain steps of maturation. Restricted expression of three epitopes NALA, HNK-1, and CD15 was observed in olfactory receptor neurons. The first immature olfactory receptor neurons were observed by day 3 of incubation, expressing the HNK-1 epitope, whereas a total epithelial staining was observed for NALA. By day 9 of incubation high numbers of HNK-1 positive immature olfactory receptor neurons were observed. At the same time mature olfactory receptor neurons showed immunoreactivity for CD15, whereas NALA was still expressed throughout the whole epithelial cell population. However, there was a pronounced staining in the population of mature olfactory receptor neurons. Around hatching only CD15 was detectable in (mature) olfactory receptor neurons, whereas HNK-1 and NALA immunoreactivity have switched to glandular and sustentacular cells respectively. The differentiation-dependent expression patterns of these three cell surface molecules suggest them as suitable markers to explore mechanisms that determine embryonic olfactory receptor neurogenesis. Accepted: 15 October 1997     

Allergic conversion of protective mucosal immunity against nasal bacteria in patients with chronic rhinosinusitis with nasal polyposis

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