隐匿性中耳炎的早期手术干预

目的：探讨隐匿性中耳炎的早期手术干预措施。方法:回顾分析19例隐匿性中耳炎患者的病例资料。结果:19例患者均无耳漏病史,发病时间只有几周甚至几天,而中耳腔内却形成不可逆性病变,甚至已伴有组织结构破坏。手术清除病变,解除引流通道的阻塞。随访6个月至3年,病变无复发。结论：隐匿性中耳炎应作为慢性中耳炎的特殊分型,不应忽视。若按早期中耳炎治疗病情不能稳定甚至加重,并经CT证实中耳乳突腔有填塞表现者,无论是否有鼓膜穿孔,均应行早期外科手术干预。     

急性会厌炎误诊气管异物的救治体会

０　引言　急性会厌炎发病急，病情变化快，常可突发窒息而致死，与气管异物同属于耳鼻咽喉科常见急症，但两者的病史与检查各有特点，故将其相互误诊者实不多见，笔者曾经历一例，教训深刻，报告如下．１　病例报告　患者男性，３３岁，服用阿莫仙胶囊呛咳后呼吸困难１ｈ急诊．患者就诊前曾因咽痛不适在外院检查诊断为“急性咽炎，急性扁桃体炎”，给予阿莫仙胶囊等口服药物治疗；返家途中服用阿莫仙胶囊２粒后剧烈呛咳，随之憋气不适、吸气性呼吸困难，转来我院．查体：急性痛苦病容，吸气性呼吸困难Ⅱ～Ⅲ度，可闻及轻度喉鸣音；咽部粘膜…     

早期原发扁桃体非霍奇金淋巴瘤临床治疗体会

目的分析早期原发扁桃体非霍奇金淋巴瘤的临床疗效及不良反应。方法回顾性分析2004年3月至2010年3月西安医学院附属宝鸡医院收治的34例原发扁桃体非霍奇金淋巴瘤患者的临床资料,其中弥漫大B细胞型淋巴瘤31例、T细胞淋巴瘤3例,均为Ⅰ~Ⅱ期。18例给予放疗联合化疗的综合治疗,即先采用环磷酰胺、长春新碱、多柔吡星、泼尼松等药组成(CHOP)方案化疗3~4个周期,序贯受累野放疗,放疗后再给予2~3个周期CHOP方案化疗,16例采用单纯放疗。近期疗效根据恶性淋巴瘤Cheson疗效判定标准评价。结果 34例患者确诊前被误诊18例,误诊率为52.9%。34例患者均可评价疗效,近期总有效率均为100.0%。综合治疗组3年生存率为88.9%(16/18),单纯放疗组为75.0%(12/16),但单纯放疗组37.5%(6/18)的患者发生远处转移,给予CHOP方案化疗的66.7%(12/18)获近期缓解。综合治疗组口腔干燥症、牙齿脱落、面部肌肉萎缩、口腔溃疡发生率均低于单纯放疗组[16.7%(3/18)比93.8%(15/16),11.1%(2/18)比50.0%(8/16),0.9%(1/18)比37.5%(6/16),0.9%(1/18)比37.5%],差异有统计学意义(P<0.05)。结论早期原发扁桃体非霍奇金淋巴瘤容易被误诊、误治,综合治疗较单纯放疗后期放射性不良反应轻微。     

羟基丁酸-羟基辛酸共聚体/胶原骨软骨一体化支架修复膝关节软骨损伤

BACKGROUND: Due to the complex physiological characteristics of the osteochondral tissue, the clinical repair of knee cartilage injury often has dissatisfied outcomes. Tissue engineering methods and tools provide a new idea for osteochondral repair. OBJECTIVE: To observe the effect of poly(hydroxybutyrate-co-hydroxyoctanoate/collagen) osteochondral tissue-engineered scaffold on the repair of articular cartilage injury in a rabbit. METHODS: The poly(hydroxybutyrate-co-hydroxyoctanoate/collagen) osteochondral tissue-engineered scaffold was prepared by solvent casting/particle leaching method. Then, seed cells were isolated and cultured on the scaffold. Twenty-four healthy New Zealand white rabbits, 4 weeks of age, were used for the study. Under balanced anesthesia, an articular cartilage defect (4.5 mm in diameter, 5 mm in depth) was created on the rabbit’s femoral condyle using a bone drill. After modeling, rabbits were randomized into three groups and given direct suture in blank group, pure scaffold implantation in control group and implantation of the scaffold-cell complex in experimental group. Femoral condyle of each rabbit was taken out for gross and histological observations at 8, 20 weeks after surgery. RESULTS AND CONCLUSION: At 8 weeks after surgery, transparent film-covered defects and small/irregular cells were found in the experimental group; the defects were filled with fibrous tissues in the control group; while there was no repair in the blank group. Until the 20th week, the defects were covered with hyaline cartilage-like tissues, accompanied by regular cell arrangement in the experimental group; in the control group, the defects were covered with white membranous tissues, and many chondrocytes were found at the basement and edge; in the blank group, some newborn tissues were visible at the defect region. These findings suggest that the poly (hydroxybutyrate-co- hydroxyoctanoate/collagen) osteochondral tissue-engineered scaffold carrying seed cells contributes to articular cartilage repair.