Survivin及Caspase-3在鼻腔鼻窦内翻性乳头状瘤及鼻腔鳞状细胞癌中的表达及其意义

目的探讨细胞凋亡抑制蛋白Survivin及半胱氨酸天冬氨酸蛋白酶3(Caspase-3)在鼻腔鼻窦内翻性乳头状瘤(sinonasal inverted papillomas,SNIP)及鼻腔鳞状细胞癌(nasal squamous cell carcinoma,NSCC)中的表达及其意义。方法采用免疫组化Envision二步法检测37例SNIP、19例NSCC及20例下鼻甲黏膜组织标本中的Survivin及Caspase-3的表达。结果 SNIP组和NSCC组中Survivin的表达率分别为67.6%(25/37)、89.5%(17/19),均显著高于下鼻甲黏膜组的表达率0(0/20,P<0.01)。NSCC组中Caspase-3的表达率为26.3%(5/19),显著低于下鼻甲黏膜组的表达率100.0%(20/20,P<0.01),SNIP组中Caspase-3的表达率为43.2%(16/37),低于下鼻甲黏膜组,但两者之间的差异无显著性(P>0.05)。Survivin和Caspase-3在SNIP和NSCC中的表达呈负相关(P<0.01)。结论 Survivin可能在SNIP和NSCC发生和发展过程中起着重要的促进作用,且与Caspase-3呈负相关,Survivin可能成为SNIP和NSCC基因治疗的新靶点。     

长期低剂量红霉素治疗慢性鼻窦炎

目的观察长期低剂量红霉素治疗慢性鼻窦炎的疗效。方法自2002年5月-2002年10月,对68例慢性鼻窦炎患者应用低剂量红霉素治疗,3个月、6个月后分别观察其症状、鼻内镜检查、鼻窦CT检查及鼻窦黏膜病理的改善情况,同时检测治疗前后的糖精传输时间(saccharinetime,ST)。结果3个月、6个月后各项症状及检查好转率分别为:63.2%、69.1%鼻腔通气改善;58.8%、64.7%鼻涕量减少;70.3%、75.7%头痛减轻;23.8%、23.8%嗅觉改善;52.8%、62.3%鼻内镜检查好转;50.8%、55.9%CT扫描较用药前改善:46.7%、53.3%病理检查示鼻窦黏膜炎症减轻。平均ST治疗前为35.6±6.5分钟,用药3个月后为28.3±6.4分钟,6个月后为18.9±7.6分钟。结论长期低剂量应用红霉素对治疗慢性鼻窦炎有较好的疗效。     

A long standing foreign body in the ethmoid-a case report

Headache is the most common complaint in present Jay ENT practice, it happens to be the most frequent and misunderstood wmptom. Foreign bodies in the paranasal sinuses invariably pose challenges to the surgeon due to the complex anatomy. Here, we present a case report of an unusual long standing foreign body of 40 years, in the ethmoid, presenting headache as a feature, after 37 years.     

出血性脑静脉窦血栓的血管内治疗

目的探讨合并颅内出血的脑静脉和静脉窦血栓治疗方法。方法对17例患弥漫性脑静脉和静脉窦血栓合并蛛网膜下腔和脑实质内出血者，采用经颈动脉和椎动脉内间断溶栓和静脉窦内留置微导管连续溶栓5-10d；同时辅以全身抗凝治疗2年。结果治疗后经脑CT复查证实，15例颅内出血在1周内得以控制，1个月内蛛网膜下腔出血和脑内血肿均完全吸收。颅内压在治疗2周后，基本稳定在280mm H2O以下。2例颅内出血严重，于治疗3d后死亡。结论同时应用血管内溶栓和全身抗凝是治疗合并蛛网膜下腔和脑内出血的脑静脉和静脉窦血栓的较为可靠和安全的方法之一。     

鼻科导航系统：我们都应该使用吗？

由于鼻窦邻近重要的解剖结构,内镜鼻奥手术可能会导致严重的手术并发症。近年来,随着导航系统的发展,越来越多的医疗机构开始接受和使用导航系统。在本文中,我们总结了导航辅助鼻窦手术的发展历史和原理,回顾了关于该主题的医学文献,并试图评估导航系统在现代鼻科临床实践中所应该扮演的角色。     

鼻腔及鼻窦内翻性乳头状瘤临床分期中CT的作用

目的探讨鼻腔及鼻窦内翻性乳头状瘤临床分期中CT的应用价值。方法回顾性分析33例鼻腔及鼻窦内翻性乳头状瘤的CT影像资料及手术资料。结果按照Krouse分期标准,将本组病例分为四期(四组)。在每组中将CT分期与手术所见分期比较,结果如下(相符/不相符):T1期1/0,T2期22/2,T3期3/3,T4期2/0,总共28/5。结论鼻腔及鼻窦内翻性乳头状瘤虽无特异CT表现,但CT影像与手术所见对比显示,它能较准确判断肿瘤的侵及范围,是鼻腔及鼻窦内翻性乳头状瘤分期中不可缺少的资料之一。     

揭盖法治疗鼻窦囊肿（附61例报告）

目的：探讨鼻窦内窥镜下“揭盖法”手术治疗鼻窦囊肿的方式和优点。方法：分析61例鼻窦囊肿患者的发病部位,囊肿性状,并对本组所有病倒采用了鼻窦内窥镜手术治疗,其方法为“揭盖法”,即手术打开与鼻腔相接的囊壁,而不去掉与周围结构相邻的囊壁,是为囊肿“揭盖”或“开窗”。结果：所有病例在局麻或全麻下均顺利完成手术,无并发症发生,术后症状均明显改善,随访3--6月,未发现引流口封闭。结论：鼻窦囊肿行鼻窦内窥镜手术,只要去除与鼻腔相接的囊壁（揭盖法),而无需去掉与周围结构相邻的囊壁。这种手术方式,既保证了囊腔的引流,也避免了并发症的发生,囊肿开口再封闭的可能性较小。     

Respiratory Epithelial Adenomatoid Hamartoma in the Nasal Cavity

We report a 65-year-old male with a hamartoma in the left nasal cavity. A mass was found in the left nasal cavity and was diagnosed as a benign tumor on the basis of preoperative findings. Left lateral rhinotomy was performed to completely remove it and the lesion was found to have arisen from the inferior turbinate. The pathological diagnosis was respiratory epithelial adenomatoid hamartoma. We discuss the pathological features of this disease.     

Concha bullosa. A radiological study and a new classification

ObjectiveA pneumatised middle turbinate is called concha bullosa. It has been classified according to its extension in the coronal plane. We propose the first classification according to the axial extension of pneumatisation of the middle turbinate.Material and methodsBulbous concha bullosa was classified in six categories according to the degree of pneumatisation of the body of the middle turbinate in the axial plane.Results196 CT sinonasal scans were included. 28.06% of patients had concha bullosa, unilateral in 13.26% and bilateral in 14.79%. The most common concha bullosa found was type I, followed by type III, II, IV and V. There were no statistically significant differences by side, between the patients with or without chronic rhinosinusitis without polyps.ConclusionOur results support the hypothesis that concha bullosa is not related to chronic rhinosinusitis. Furthermore, type IV and V cells mean posterior aeration of the middle turbinate. Those variations are rare and posterior, so they can easily pass unnoticed during endoscopic sinus surgery. Our classification is also important as a surgical reference, and it can be easily studied on the preoperative CT scan.