二亚硝基哌嗪对转基因小鼠TNF受体相关因子2和p16的表达

目的研究二亚硝基哌嗪(N,N′-dinitrosopi- perazine,DNP)对TgN(p53mt-LMP1)/HT小鼠鼻腔和鼻咽黏膜上皮细胞增殖与TNF受体相关因子2(TNF receptor-associated Factor 2,TRAF2)、p16基因表达的影响及两者关系。方法HE染色法观察转基因小鼠组(TC)、转基因小鼠DNP诱导组(T1)和野生小鼠组(CC)、野生小鼠DNP诱导组(CI)鼻腔和鼻咽黏膜上皮细胞增殖特征;免疫组织化学染色法检测小鼠鼻腔和鼻咽黏膜上皮组织中TRAF2、p16基因的表达水平。结果TI、TC、CI和CC组小鼠鼻腔或鼻咽黏膜上皮癌前病变率分别为90%、10%、0和0。与TC、CI和CC组相比,TI组TRAF2基因表达水平显著增高(P<0.01),而p16基因表达水平显著降低(P<0.01);TRAF2和p16基因表达水平在TC和CC组之间的差异亦有统计学意义(P<0.01)。结论TgN(p53mt-LMP1)/HT小鼠鼻腔和鼻咽黏膜上皮细胞增殖活性增加,DNP可提高其增殖活性,而细胞增殖活性增加与TRAF2基因表达水平上调和p16基因表达水平下调密切相关。     

变应性真菌性鼻窦炎CT影像特征

目的回顾性总结变应性真菌性鼻窦炎CT影像表现,并与手术中所见比较,探讨其CT影像特征及其在诊断中的参考作用。方法收集21例确诊为变应性真菌性鼻窦炎患者的CT影像资料。男17例,女4例;年龄15岁～50岁。鼻窦CT扫描采用骨窗和软组织窗扫描。术前行鼻内镜检查、皮肤点刺变态反应皮试、总IgE及鼻分泌物嗜酸粒细胞涂片检查。手术中记录鼻窦和鼻腔病变且与CT影像对照。术后行组织病理学检查和真菌涂片＋培养。结果鼻内镜检查见所有病例鼻腔单发或多发半透明粉白色息肉,周围稀薄黄色或黏白色分泌物。9例11侧鼻腔可见果酱样黄褐色黏着分泌物。鼻窦CT扫描提示单侧鼻窦发病10例（10侧）,双侧病变为11例（22侧）;单侧或双侧病变全组鼻窦均受累;鼻窦腔散在均匀高密度影,呈毛玻璃样特征,周边为软组织影,3例4侧颅底骨质吸收,1例颅内侵犯。20例行鼻内镜手术,1例行双冠经路＋鼻内镜手术。术中见17例窦腔有果酱样黄褐色黏着分泌物（黏蛋白）,4例窦腔为褐绿色泥样分泌物。随访6个月至7年,治愈14例,好转7例,其中3例术后2年再手术。结论鼻窦CT扫描显示鼻窦腔内片状毛玻璃样高密度影,可伴骨质吸收或侵袭性生长,为变应性真菌性鼻窦炎具有诊断意义的影像检查特征。     

慢性鼻窦炎鼻息肉患者术前术后生存质量的评估及影响因素分析

目的:对慢性鼻窦炎、鼻息肉患者行功能性鼻窦内镜手术术前术后生存质量进行评估,并分析相关的影响因素,以评价该手术的优越性和指导临床治疗。方法:引用并修改SNOT-20量表,制成慢性鼻窦炎、鼻息肉术前术后生存质量评估量表,均让患者自行填写,随访3个月,随访数据采用统计学方法加以分析。结果:术前术后整体生存质量得分及各维度得分均有明显提高,改善率为88.24%;术前患者感觉对生活影响最大的是:第一维度中鼻塞52.94%,第二维度中记忆力减退18.82%,第三维度中经常担心自己病情8.24%;第四维度中影响社交活动14.12%。术后改善最明显的是:第一维度中鼻塞58.82%,第二维度中记忆力减退10.59%,第三维度中烦躁易怒9.41%,第四维度中影响社交活动的10.59%;术前相关的影响因素是年龄、性别、并发症,术后为年龄、性别、并发症、前期手术史及围术期的处理,分型与生存质量无相关性。结论:功能性鼻窦内镜手术作为治疗慢性鼻窦炎、鼻息肉最有效的临床方法之一,能够明显地改善患者的生存质量。影响生存质量的主要相关因素为:年龄、性别、并发症、前期手术史和围术期处理。     

Retrograde axonal transport of true blue dye by the peripheral autonomic nerves in canine nasal mucosa

Summary In this study we employed retrograde axonal transport of (E)-2,2-vinylendi-benzofuran-5-carboxamidin-diaceturate or true blue (TB) to study the peripheral autonomic innervation of the canine nasal mucosa. After injection of TB into the nasal mucosa, labeled neurons were found in the ipsilateral sphenopalatine ganglion (SPG) and the superior cervical ganglion (SCG). There were no labeled neurons in the middle cervical or stellate ganglia. This indicated that the origin of the postganglionic sympathetic fibers of the nasal mucosa was only from the ipsilateral SCG. When TB was injected into the nasal mucosa of dogs following a caudal or ethmoidal neurectomy, labeled neurons could still be found in the SPG and SCG. When TB was injected into the nasal mucosa of dogs following ethmoidal and vidian neurectomies or with maxillary neurectomy added, some labeled neurons could still be found in both the ipsilateral SPG and SCG. These results support the concept that another pathway — perhaps perivascular — exists for postganglionic sympathetic fibers other than the vidian and ethmoidal nerves. Labeled neurons were still observed in SPG when TB was applied to the canine nasal mucosa following neurectomy of either the ethmoidal or the caudal nasal nerve. However, retrograde labeled neurons could not be found in SPG following simultaneous neurectomies of the ethmoidal and caudal nasal nerves. These results show that the postganglionic parasympathetic fibers originating in the SPG travel along the ethmoidal and caudal nasal nerves.Presented at Tenth Midwinter Meeting of the Association for Research in Otolaryngology, Clearwater Beach, Florida, 3 February 1987     

鼻腔扩容术的临床疗效观察

目的评价鼻腔扩容术治疗OSAHS患者主客观症状的改善情况。方法观察30例行鼻腔扩容术的成年OSAHS患者,所有患者于术前进行多道睡眠图（PSG）描记,鼻声反射和鼻阻力测试等鼻功能检查,填写白天嗜睡主观评分Epworth嗜睡量表（Epworth sleepiness score,ESS）、鼻塞主观视觉模拟量表（visual analogue scale,VAS）评分、鼾声评分量表,以上主客观检查于鼻腔手术后3个月重复记录。所有患者接受鼻腔扩容术（鼻中隔三线减张成形术、双侧下鼻甲外移、双侧中鼻甲内移和双侧中鼻道鼻窦对称性开放）。结果鼻腔扩容术后患者鼻腔总阻力显著降低[（0.89±0.23）kPa·s/L vs（0.29±0.12）kPa·s/L,P〈0.01],鼻塞VAS评分显著降低[8.2±1.1 vs 2.1±0.73,P〈0.01],白天嗜睡ESS评分显著降低（12.7±1.2 vs 8.6±2.9,P〈0.01）,打鼾程度减轻（62.2±25.6 vs 45.6±18.6,P〈0.01）。轻度OSAHS患者呼吸暂停低通气指数（apnea and hypopnea index,AHI）较术前显著下降（P〈0.05）,觉醒指数较术前显著下降（P〈0.01）,最低动脉血氧饱和度（lowest SaO2,LSaO2）较术前显著升高（P〈0.01）。中度和重度OSAHS患者的AHI指数、觉醒指数、LSaO2均较术前无显著改变（P〉0.05）。LSaO2、睡眠结构各阶段的比例、快动眼睡眠阶段的长度在所有OSAHS患者均没有显著变化（P〉0.05）。30例OSAHS患者鼻腔扩容术的总体有效率为26.7%。结论鼻腔扩容手术可以改善OSAHS患者鼻塞及白天嗜睡、睡眠打鼾等相关睡眠主观症状,并在一定程度上改善OSAHS患者的阻塞性睡眠呼吸暂停的严重程度,应适当选择其手术适应证。     

Nasal septal abscess caused by anaerobic bacteria of oral flora

Although nasal septal abscess (NSA) was formerly common, it has become rare since the development of antibiotics. NSA, if left untreated, can lead to intracranial complications such as meningitis and eventually result in saddle-nose deformity. NSA often occurs after injury, and indigenous skin bacteria such as Staphylococcus aureus are frequently detected. We treated a patient who had injured the upper alveolus in a fall on the stairs and developed NSA two weeks later. Anaerobic bacteria, including Veillonella parvula and Peptostreptococcus sp., were detected. Symptoms were relieved by needle and incisional drainage. Our patient represents a very rare case of NSA in terms of the cause of onset and the detected bacteria. Early drainage can result in good outcomes.     

地塞米松和组胺对人鼻息肉组织黏蛋白MUC5AC mRNA和蛋白表达的影响

目的:研究地塞米松和组胺对培养的人鼻息肉组织黏蛋白MUC5AC mRNA和蛋白表达的影响。方法:实验分为对照组、组胺刺激组和地塞米松干预组,采用RT-PCR和免疫组织化学技术分别检测鼻息肉组织中MUC5AC mRNA和蛋白的表达。结果:组胺刺激组鼻息肉组织MUC5AC mRNA和蛋白表达分别为0.6389±0.0526和0.1934±0.0137,均较对照组(分别为0.3495±0.0357和0.1172±0.0173)明显增加(均P<0.01),地塞米松抑制后两者均明显降低(分别为0.4988±0.0603和0.1444±0.0075)(均P<0.05)。结论:炎性递质组胺可上调黏蛋白表达;地塞米松可下调黏蛋白表达,这可能是它抑制鼻息肉黏液过度分泌的途径之一。     

鼻腔鼻窦异位脑膜瘤的诊治(附9例报道)

目的 探讨提高鼻腔鼻窦异位脑膜瘤临床诊治水平的方法。方法 回顾性分析9例鼻腔鼻窦异位脑膜瘤的临床资料，总结诊疗经验。结果 9例患者全部为沙粒体型脑膜瘤，临床症状无特异性，因病史长短不同而表现各异。所有病例均行手术治疗，其中2例复发，再次手术而愈。结论 鼻腔鼻窦异位脑膜瘤的治疗以手术为主，而鼻内镜手术可作为治疗该类肿瘤的重要方式。     

鼻腔鼻窦术后鼻内窥镜检查的意义

目的 探讨鼻腔鼻窦术后鼻内窥镜检查的意义。方法 对120例各种鼻腔鼻窦术后病人，在术后1－6个月内行鼻内窦镜检查术。结果 鼻腔鼻窦术后30％病人存在鼻道粘连、鼻息肉及其他新生物残留或复发，上颌窦自然开口堵塞，新的造孔狭窄及鼻窦仍有脓性分泌物。结论 鼻腔鼻窦术后人窥镜检查有助于了解手术效果及疾病转归，尽早发现各种并发症，彻底清除病变组织。     

眼科首诊的鼻腔鼻窦疾病临床分析

目的 提高鼻眼相关疾病的诊断水平.方法 对35例眼科首诊的鼻科疾病患者的临床资料进行回顾性分析.结果 35例患者经眼眶、鼻窦CT及鼻内镜检查确诊均为鼻科疾病.结论 鼻窦与眼眶关系密切是鼻眼相关疾病的解剖基础,CT扫描有助于对此区域病变的早期诊断,眼科医师在排除患者眼科疾病的情况下,及时认识到这一点,从而避免了漏诊和误诊.