Endoscopic transnasal drainage for orbital implantation cyst after orbital wall reconstruction

An implantation cyst after orbital wall reconstruction may present as a late complication, which can cause local pain, proptosis, diplopia, and vision impairment. Previous surgical strategies prefer transconjunctival or subtarsal approach for cyst drainage, a similar approach to orbital wall reconstruction. These strategies may have risk of secondary infection. Herein, we propose an endoscopic transnasal surgical approach, through which the removal of implant and cyst drainage can be performed conveniently. The residual, medial single-layer cyst wall is generally strong enough to support the orbital soft tissues without the need for a new implant. We believe this surgical approach can simplify the procedure, reduce the complications, and prevent cyst recurrence.     

新型超细鼻胃镜联合色素染色门诊机会性筛查早期胃癌及癌前病变的临床应用价值

目的 探讨新型超细鼻胃镜联合色素染色门诊机会性筛查早期胃癌及癌前病变的临床应用价值.方法 2016年1月至2018年5月在我院内镜室应用日本Fujifilm最新型EG-530 NW超细电子胃镜经鼻腔插入对7421例门诊患者进行上消化道检查.统计患者的活检病理结果,分析癌前病变、早期胃癌、进展期胃癌患者的临床及病理特征、...     

Self-training in unsedated transnasal EGD by endoscopists competent in standard peroral EGD: prospective assessment of the learning curve

BACKGROUND: Training programs in unsedated transnasal (UT) EGD are scarce. OBJECTIVE: To prospectively assess the learning curve for unsupervised UT-EGD. SETTING: Endoscopy service, without experience in UT-EGD. SUBJECTS: Consecutive patients referred for diagnostic EGD. INTERVENTION: UT-EGD was attempted in 140 study patients by 2 endoscopists who trained by themselves in UT-EGD (skilled endoscopist [n = 70]; a trainee having recently achieved competency in conventional EGD [n = 70]) and in 10 controls (endoscopist skilled in UT-EGD) by using a 4.9-mm-diameter videoendoscope. MAIN OUTCOME MEASUREMENTS: Technical success, sedation administered, patient tolerance acceptance, procedure duration for each decade of 10 consecutive patients investigated by the same endoscopist; intention-to-treat analysis. RESULTS: Both self-trained endoscopists fulfilled predefined criteria of competency in UT-EGD since the first attempts. They completed examinations of adequate quality with exclusive transnasal scope insertion (n = 139 [99.3%]), no sedation (n = 138 [98.6%]), and patient accepting repeat procedure (n = 135 [96.4%]) in proportions not significantly different from controls for all decades. Compared with a median procedure duration of 5.5 minutes (interquartile range [IQR] 5.0-8.5 minutes) in controls, procedures were significantly longer for all trainee's decades (eg, first decade 20.0 minutes [IQR 15.0-29.0 minutes], P < .001) but none for the skilled endoscopist. Overall discomfort, pain, gagging, and belching were not significantly different for study patients versus controls. Fifty-six of 69 study patients (81%) with a previous history of conventional EGD preferred UT-EGD. LIMITATIONS: Generalizability to other small-caliber endoscopes. CONCLUSIONS: Endoscopists competent in conventional EGD may obtain excellent results with UT-EGD (except for procedure duration) beginning with their first attempts, even without supervision or structured training.     

Real-time evaluation of dyspeptic symptoms and gastric motility induced by duodenal acidification using noninvasive transnasal endoscopy

Background  Although different pathophysiological mechanisms have been suggested to be involved in functional dyspepsia, a practical method to clarify them has not been established. The aim of this study was to evaluate dyspeptic symptoms and gastric motility induced by duodenal acidification using transnasal endoscopy. Methods  Fourteen healthy volunteers (mean age, 32 years) were enrolled. Transnasal endoscopy was performed on all fasting volunteers. Dyspeptic symptoms and antral contractions were evaluated before and after duodenal infusions of pure water (20 ml/min for 5 min) and acid (0.1 N HCl, 20 ml/min for 5 min). The severity of various symptoms was assessed by each subject using a 10-cm visual analog scale every 2 min. The maximum severity scale was calculated as the mean of the individual maximum values. The motility number was defined as the mean number of antral contractions in 1 min. Results  The maximum severity score for a heavy feeling in the stomach and other symptoms significantly increased after the acid infusion compared with after the pure water infusion. During pure water infusion, there were no changes in the motility number. On the other hand, the motility number significantly decreased after duodenal acidification (before vs. after, 2.93 ± 0.12 times vs. 1.11 ± 0.23 times, P < 0.0001). Conclusions  Duodenal acid exposure induces dyspeptic symptoms and inhibits antral motility. Transnasal endoscopy enabled us to evaluate both dyspeptic symptoms and gastric motility simultaneously.     

Transesophageal echocardiography through nasal way as a guide to percutaneous closure of patent foramen ovale

Percutaneous device closure of patent foramen ovale (PFO) has become an effective and safe alternative to medical or surgery treatment. Transesophageal echocardiography (TEE), as commonly used to guide this procedure, has the limitation to require general anesthesia. Recently, intracardiac echocardiography (ICE) with AcuNav probe was used to guide percutaneous PFO closure. We report a 42 year-old man with two previous cryptogenetic strokes in whom both diagnosis and guidance of PFO closure were performed by means of TEE using the AcuNav catheter introduced through nasal way (TEENW). This technique, that does not require general anesthesia, provided adequate and complete view of the Amplatzer procedure. TEENW might offer a feasible and equivalent echocardiographic alternative either to standard TEE or ICE as a guide to percutaneous PFO closure.     

普罗帕酮鼻黏膜给药研究体外法与在体法的相关性

目的以盐酸普罗帕酮为模型药物,采用离体羊鼻黏膜渗透实验与在体大鼠鼻腔灌流实验,探讨鼻黏膜吸收的影响因素,并进行体外法与在体法的相关性的考查。方法通过改变介质pH值、药物浓度、制成β-环糊精包合物等方法改变药物的理化性质,测定不同条件下药物透过离体羊鼻黏膜的渗透系数Pm、平均渗透速度或透过分数,测定相应条件下在体大鼠鼻腔黏膜吸收速度常数k、平均吸收速度或吸收分数,并应用体外法实验与在体法实验中提取的参数进行相关性检验。结果药物的浓度、介质的pH值以及环糊精包合物的形成等理化因素,对其体外法和在体法透膜均有很大影响。在本研究的各种条件下,体外法与在体法实验均有很好的相关性。结论本研究对于正确评价鼻腔吸收体外与在体实验方法,完善和发展鼻腔吸收的系统研究方法提供了确切的实验依据。     

Usefulness of bone window CT images parallel to the transnasal surgical route for pituitary disorders

Summary.  Objective: Before operating on 130 patients with pituitary disorders, we evaluated their bone window CT images sliced parallel to the transnasal surgical route to assess the surgical anatomy of the nasal cavity for transnasal surgery.  Methods: High resolution bone window CT was performed in 3- to 5-mm slices parallel to the imaginary line connecting the inferior margin of the piriform aperture and the top of the sellar floor, parallel to the transnasal surgical route.  Results: This CT angle was useful in evaluating the width and depth of the operative field, the bony components of the nasal conchas, deviation of the nasal septum, the bony structure and mucosa in the sphenoid sinus, and the condition of the sellar floor. In patients requiring repeat surgery, the location of thin or thick nasal mucosa, residual bony septum, and inadequate sellar floor opening were easily detected.  Conclusion: Bone window CT images sliced parallel to the transnasal surgical route provide direct visualization of the nasal anatomy for the transnasal approach. This method is helpful in determining how far to remove the sellar floor laterally, especially in cases requiring repeat surgery. Published online February 10, 2003  Correspondence: Takumi Abe, M.D., Department of Neurosurgery, Showa University School of Medicine, 5-8 Hatanodai 1, Shinagawa-ku, Tokyo 142-8666, Japan.     

咽鼓管上三角在扩大经鼻蝶入路神经内镜手术切除岩尖下区肿瘤中的意义

目的 探讨咽鼓管上三角(SET)在扩大经鼻蝶入路神经内镜手术切除岩尖下区肿瘤中的意义。方法 回顾性分析2017年1月至2021年8月扩大经鼻蝶入路神经内镜手术切除的13例岩尖下区肿瘤的临床资料。连接骨性咽鼓管内侧与咽鼓管圆枕顶部的水平线定义为SET,颈内动脉岩骨段水平部和咽鼓管与水平线的倾斜角度分别定义为角α和角β。根据术前MRI增强影像评估肿瘤向两侧扩展程度,分为重度、中度、轻度扩展。结果 术后病理检查显示脊索瘤8例,软骨肉瘤3例,脑膜瘤2例。肿瘤全切除6例(46.2%),次全切除3例,部分切除4例。术后发生脑脊液漏2例、外展神经麻痹2例,未发颈内动脉损伤。术后随访6～36个月,2例复发,再次手术,无死亡病例。定量测量13例26侧SET的面积在28.0～95.2 mm²,平均(65.6±22.2)mm²。8侧重度扩展SET面积[(76.5±27.6)mm²]较10侧中度扩展侧SET面积[(42.2±15.7)mm²]和8侧轻度扩展SET面积[(40.5±10.7)mm²]明显...     

超细胃镜的临床应用进展

本文介绍了超细胃镜的进镜特点及临床应用现状,并指出其具有较高的安全性,在临床应用中具有重要意义,但仍需要进行相应改进。