应用自体耳甲软骨瓣重建眶底

目的研究自体耳甲软骨瓣应用于眶底重建,对眶底骨折引起的复视和眼球内陷的疗效。方法自2003年7月～2007年6月应用耳甲软骨瓣重建眶底共21例。本组患者术前均经轴位和冠状位眶部CT证实存在眶底骨折下陷,且部分眶内容物疝入上颌窦,患侧眼球突出度与健侧相差3mm以上。自患侧耳廓切取耳甲软骨瓣（保留两侧软骨膜）,经下眼睑下缘切口入路,用耳甲软骨瓣修补眶底骨质缺损。术后均随访3个月以上,观察复视和眼球内陷的治疗效果,以及供区耳廓有无畸形。结果本组21例患者术后复视消失者19例（90.5%）、明显改善者2例（9.5%）;双侧眼球突出度相差≤2mm共17例（81.0%）,2.1mm～3.0mm共3例（14.3%）,〉3mm共1例（4.7%）;无一例出现耳廓畸形和耳甲软骨瓣感染。结论对于眶底骨折伴有眶底下陷,眶内容物疝入上颌窦以及双侧眼球突度相差明显的患者,应用耳甲软骨瓣重建眶底,可显著改善复视和眼球内陷等眼功能障碍,且不会引起供区耳廓畸形。     

Commentary on: “Evaluation of variations in sinonasal region with computed tomography”

This letter is a commentary on the article titled “Evaluation of variations in sinonasal region with computed tomography”, published in the January 2016 issue of World Journal of Radiology. The authors definition of the secondary middle turbinate is incorrect. The authors stated that the secondary middle turbinate is an accessory turbinate that is seen between the superior and middle turbinates. It should originate from the middle meatus posterosuperior to the ethmoid infundibulum.     

Evaluation of ceruloplasmin levels in patients undergoing surgical interventions with nasal polyps

Objective

Oxidative stress is believed to have a role in the development of nasal polyps (NPs). It is also known that ceruloplasmin (CP), an acute phase protein, limits oxidative stress. The purpose of this study was to evaluate the ceruloplasmin levels in patients with NPs.

Methods

One hundred and twenty patients with NPs, septal deviations and concha hypertrophies were recruited to the study. Patients were divided in two groups; group 1 (n = 60) consisted of patients with NPs, and group 2 (n = 60) consisted of septal deviations and concha hypertrophies. Polyp specimens were taken from all patients who underwent endoscopic surgery due to NPs, as well as control specimens were acquired who underwent an operation due to septoplasty or concha hypertrophy. Blood and tissue samples were obtained to assess CP levels.

Results

There were no statistical differences in gender, age and biochemical values between two groups (p > 0.05 for all). Compared to group 2, group 1 had significantly higher CP levels both in serum and the tissue samples (both p < 0.001).

Conclusion

As a result of our study; CP levels both in serum and the tissue in patients with NPs were higher, may be consequence of the inflammation, than in patients without NPs.     

Learning Curve of Septoplasty with Radiofrequency Volume Reduction of the Inferior Turbinate

Objectives

Since few studies on surgical training and learning curves have been performed, majority of inexperienced surgeons are anxious about performing operations. We aimed to access the results and learning curve of septoplasty with radiofrequency volume reduction (RFVR) of the inferior turbinate.

Methods

We included 270 patients who underwent septoplasty with RFVR of the inferior turbinate by 6 inexperienced surgeons between January 2009 and July 2011. We analyzed success score, cases of revision, cases of complication, operation time, and acoustic rhinometry.

Results

Success score was relatively high and every surgeon had few cases of revision and complication. No significant difference was found in success score, revision, complication case, or acoustic rhinometry values between early cases and later cases. Operation time decreased according to increase in experience. However, there was no significant difference in the operation time after more than 30 cases.

Conclusion

We can conclude that 30 cases are needed to develop mature surgical skills for septoplasty with RFVR of the inferior turbinate and that training surgeons do not need to be anxious about performing this operation in the unskilled state.     

张斌霞调治慢性失眠经验

张斌霞教授治疗慢性失眠遵循平调阴阳,补虚泻实的总治法,认为慢性失眠发病多与心、肝、脾、肾四脏密切相关,以心肾为根本,肝胆为枢机,脾胃为通路,在治疗过程中根据辨证,侧重有所不同。张教授治疗失眠强调以阴阳为纲,认为不论采用何种治疗都应遵循"平调阴阳,引阳入阴"的治疗大法,不可忽视阴阳变化,而一味安神。张教授治疗慢性失眠,以疏利肝胆为法,方用柴胡加龙骨牡蛎汤加减,尤爱甘松一药,因其性甘温,除醒脾健胃外,还可理气开郁,有肝脾同调之功。张教授治疗慢性失眠避用破气消积药物,取厚朴花而非厚朴,因厚朴花理气化湿无厚朴燥湿下气之力,花类药物质轻升散,可更好助脾胃升发清阳。张教授认为,慢性失眠病程较长,具有久病多虚、久病及肾、久病入络、久病致郁、久郁生痰特点,补虚多从肾入手,根据病邪性质,选择性配伍化瘀通络、疏肝解郁、理气化痰之品,常有良效。     

石决明炮制工艺研究

目的:研究石决明的炮制工艺。方法:采用正交设计、多指标综合评分优选石决明的煅制醋淬工艺,并对其煅制盐淬工艺进行研究。结果:高温煅制醋淬的最佳工艺为:石决明于900℃煅制1.5h,以1.2倍量醋淬制。石决明煅制醋淬品的质量显著优于生品、煅制盐淬品及煅制品。结论:石决明的煅制醋淬工艺科学、可行;应采用多指标综合制定石决明的炮制标准。     

柴胡加龙骨牡蛎汤治疗顽固性荨麻疹40例

目的:观察柴胡加龙骨牡蛎汤治疗顽固性荨麻疹的临床疗效。方法:选取2012年3月—2015年3月本院收治的顽固性荨麻疹患者共80例,随机分为治疗组和对照组,每组各40例。对照组患者口服依巴斯汀片,每日1次,剂量根据医嘱随时调整;治疗组口服柴胡加龙骨牡蛎汤加减。观察两组患者的临床疗效及治疗前后症状积分变化情况。结果:两组患者治疗后各个症状积分优于治疗前,且治疗组优于对照组,差异均有统计学意义(P0.05)。对照组有效率为60.0%,治疗组有效率80.0%,两组有效率比较,差异具有统计学意义(P0.05)。结论:柴胡加龙骨牡蛎汤治疗顽固性荨麻疹临床疗效显著。     

不同频率和持续时间经皮电刺激耳甲区对大鼠癫痫发作抑制作用的比较

目的:比较不同频率经皮电刺激耳甲区对大鼠癫痫发作的影响,以明确不同刺激频率及刺激持续时间所产生的抑制效应的差别。方法:健康成年SD大鼠44只,随机按刺激持续的时间长度分为4组:30s组、5min组、10min组和30min组,每组9～12只。以腹腔注射戊四氮造成大鼠急性癫痫模型,记录动物癫痫发作前后大脑皮层场电位信号,以刺激后癫痫发作被抑制的后效应持续时间和刺激结束后以30s为单位时间统计10个单位时间段内大鼠癫痫发作率为指标,观察不同频率(2Hz、20Hz和100Hz)的耳甲区经皮电刺激对大鼠癫痫发作抑制作用的差别。结果:(1)20Hz的耳甲区经皮电刺激在所有刺激持续时间中平均后效应持续时间为(169.50±45.96)s,和2Hz、100Hz刺激频率后效应持续时间(50.12±21.38)s和(67.44±23.92)s相比,刺激后抑制癫痫发作的持续时间较长(P<0.05);(2)在2Hz刺激条件下,30s组抑制癫痫发作的后效应持续时间较长(P<0.01),癫痫发作率下降,与其它刺激持续时间组相比差异具有统计学意义(P<0.05);(3)在100Hz刺激条件下,30min组抑制癫痫发作的后效应持续时间较长(P<0.01),癫痫发作率下降,与其它刺激持续时间组相比差异具有统计学意义(P<0.05)。结论:耳甲区经皮电刺激能明显抑制大鼠癫痫发作,20Hz的刺激频率对大鼠癫痫模型的治疗作用较好,2Hz的刺激频率在短期刺激后表现出较好的治疗作用,100Hz的刺激频率在长期刺激后才能表现出较好的治疗作用。     

Comparison of conchal cartilage graft with nasal septal cartilage graft for reconstruction of orbital floor blowout fractures

Our aim was to compare autogenous nasal septal cartilage and conchal cartilage as grafts for reconstruction of orbital blowout fractures. Twenty-two patients with blowout fractures were randomly assigned to two groups for treatment with a graft of nasal septal cartilage or conchal cartilage. Patients were evaluated for the presence of enophthalmos, diplopia, dysfunction of the infraorbital nerve, and restriction of the ocular muscles. Patients with enophthalmos of more than 2 mm were included in the study, and were followed up postoperatively at 10 days, 1 month, and 3–6 months. The patients treated with a nasal septal cartilage graft had significantly better correction of enophthalmos than those treated with conchal cartilage (p = 0.02) after 10 days (p = 0.02), 1 month (p = 0.004), and 3–6 months (p = 0.001). There was significantly less residual enophthalmos in the nasal septal graft group after 1 month (0.91 compared with 1.72 mm, p = 0.02), and after 3–6 months (1.0 compared with 2.54 mm, p = 0.008). Correction of enophthalmos was considerably better in patients who were operated on within 4 weeks of injury. We think that nasal septal cartilage is a better graft than conchal cartilage for reconstruction of blowout fractures. The time to intervention (the earlier the better) is a critical point in the correction of enophthalmos.