不同手术方式治疗慢性鼻-鼻窦炎对上颌窦黏膜纤毛传输功能的影响

目的:比较不同手术方式治疗慢性鼻-鼻窦炎的疗效及其对上颌窦黏膜纤毛传输功能的影响,为临床制定治疗慢性鼻-鼻窦炎的优选术式提供参考依据。方法:选取2013年9月-2014年12月于本院耳鼻咽喉科就诊的160例确诊为慢性鼻-鼻窦炎的患者作为研究对象,将其随机分为4组,分别为治疗组1~4,每组各60例。治疗组1接受上颌窦自然开口扩大术,治疗组2接受上颌窦开窗术,治疗组3接受经泪前隐窝上颌窦开放术,治疗组4接受上颌窦口球囊扩张术。观察和比较4组患者的术后鼻腔黏膜的覆盖、水肿、囊泡形成、骨质暴露、瘢痕形成等情况,上颌窦窦腔内分泌物性状、蓄积情况以及术后3个月和6个月时行上颌窦腔糖精实验及窦口周黏膜活检情况。结果:四组手术后均取得较好临床疗效,而组4的临床总有效率显著高于其他三组(均P0.05)。术后3、6个月,组4Lund-Kennedy评分和MMT时间均明显低于其他三组(均P0.05);在上颌窦黏膜活检方面:术后炎性细胞数量及状细胞和黏膜下腺体细胞形态及黏膜下结构水肿改善程度亦在中组四最为显著(P0.05)。结论:上颌窦窦球囊扩张术治疗慢性鼻-鼻窦炎疗效较高,可有效改善状细胞和黏膜下腺体细胞形态及鼻窦黏膜水肿、窦口通畅引流等作用,且安全性高。     

清栓酶治疗视网膜中央动脉阻塞并发脑血栓一例

我单位用清栓酶治疗“脑血栓”时间较长,但用于视网膜中央动脉阻塞并发脑血栓还是首例,现报告如下: 病历摘要:郑守荣,男性,70岁,吉林籍,因右眼视力下降半年,于1990年12月4日入院。头晕、头痛后突然右眼视力障碍,视物模糊不清,无眼球胀痛及虹视,经白求恩医大一院眼科检查诊断“右视网膜中央动脉阻塞”,同时给予血管扩张药对症治疗,效果不明显,近一月视力下降明显,故入院治疗。查体,体温36℃,脉搏88次/min,呼吸20次/min,血压17.3/10.67kpa。一般情况尚可,神志清楚,自动体位,全身皮肤粘膜未见出血点及黄染,浅表淋巴结不大,头颅无畸型,耳鼻无     

多育赛多孢菌性鼻窦炎1例——致病菌的鉴定和体外抗真菌药物敏感性研究

目的报告国内首例多育赛多孢菌致鼻窦炎,并探讨致病菌的鉴定及其对抗真菌药物体外敏感性。方法取患者左侧上颌窦分泌物进行真菌培养和形态学鉴定,分离菌株β-球蛋白、rDNAITS序列分析确切鉴定,对分离菌进行7种抗真菌药体外药敏试验。结果根据菌株的形态学特点和基因序列结果鉴定为多育赛多孢菌。体外药敏试验显示该菌对7种抗真菌药物耐药。结论多育赛多孢菌所致的真菌病较少见,其确切鉴定靠形态学特征和基因分析。该菌株对多种抗真菌药物耐药。     

鼻-眶-脑真菌病及其诊疗对策

鼻-眶-脑真菌病（Rhino—orbital—cerebral mycosis,ROCM）是一组累及面部、鼻、眼眶及脑的真菌感染。该病发展迅速,病死率高达80％,并常致失明、眼球坏死、面瘫等后遗症,给患者身心造成极大伤害。早期认识及正确处理该病,是预防并发症、降低病死率的关键。ROCM多由接合菌感染所致,早期可表现为头痛、单侧视力减退、眼睑下垂、外展受限等症状,疾病的后期,常出现单侧视力丧失、疼痛性眼肌麻痹及面瘫;影像学表现为鼻窦炎、海绵窦、颈内动脉等血管的阻塞;组织病理以炎细胞浸润、肉芽肿、血管炎及真菌性血栓形成、动脉栓塞为主要特征。     

5-氨基酮戊酸光动力联合伊曲康唑治疗着色芽生菌病1例

患者男,68岁。右前臂和手背丘疹、红斑块、鳞屑伴瘙痒6 a,疼痛、部分指功能障碍1 a。真菌直接镜检发现菌丝及厚壁孢子,皮肤病理组织检查真皮内见棕黄色厚壁孢子。诊断为着色芽生菌病。经2次5-氨基酮戊酸光动力联合伊曲康唑治疗,随访半年,疗效满意。     

糖尿病患者感染轮枝镰刀菌致角膜炎1例

报道糖尿病患者感染轮枝镰刀菌致真菌性角膜炎1例。患者男性,48岁,因右眼红,痛,视力下降20天就诊。患者有2型糖尿病史近10年,注射胰岛素血糖一直控制不佳。刮取角膜分泌物标本进行真菌荧光染色镜检和培养。对培养的菌株进行形态学(乳酸酚棉兰染色)和分子生物学鉴定。真菌荧光染色镜检阳性,镜下可见分支分隔的菌丝及鹿角状菌丝。真菌培养阳性,乳酸酚棉兰染色镜下可见多数棒状的小分生孢子。ITS和Beta-tubulin基因序列分析鉴定为轮枝镰刀菌。依据临床和实验室检查确定诊断右眼角膜炎(真菌性),2型糖尿病。给予患者那他霉素等滴眼液点右眼局部抗炎抗真菌对症处理,用药治疗后再次行眼科检查,患者右眼症状较治疗前明显好转。出院后继续抗真菌抗炎治疗2周,门诊随访。     

达克宁霜治疗真菌性外耳道炎

真菌性外耳道炎为耳鼻喉科门诊常见疾患之一。我院自 1 992年以来用达克宁霜治疗真菌性外耳道炎 ,取得满意效果。1 .1　一般资料　本组 31例患者共 36耳患真菌性外耳道炎 ,其中男 2 5例 ,女 6例 ,年龄 1 8～ 71岁。均有耳内发痒及闷胀感 ,检查外耳道深部有白色、灰色、黄色或烟黑色霉苔 ,呈薄膜式或粉丝状 ;外耳道皮肤充血肿胀 ,表面有轻度糜烂 ,或少量脓性分泌物 ;将 31例患者 ( 36耳 )外耳道内分泌物作涂片镜检 ,均发现有菌丝体或芽胞状物。1 .2　治疗方法　先清除外耳道内苔膜或筒块状物 ,用生理盐水清洁外耳道 ,拭干创面。然后用小棉棒…     

蝮蛇抗栓酶治愈麻痹性斜视2例报告

本院内科1990年收治二例麻痹性斜视患者,经用中国蛇协蛇毒研究所沈阳青峰制药厂生产的蝮蛇抗栓酶治疗痊愈,现予报告于下。例一,刘××,男性,59岁,90年2月6日入院,住院号90-78.患者89年9月27日突然右眼内侧疼痛,头晕,右服睑肿胀下垂,眼球外凸并觉燥热、刺痒、干胀,视力下降,复视,无恶心、呕吐、头痛及肢体麻木瘫痪.曾到某医院眼科住院作鼻咽活检、脑血管造影、脑 CT 等检查,排除了鼻咽癌、脑血管意外及占位性病变.微循环检查为高粘滞综合征。经中西药治疗未见好转而于90年2月6日入本院内科.既往患十二指肠溃疡,无高血压史。查体:体温、脉搏、呼吸、血     

黑水国遗址汉代人群的上颌窦炎症

上颌窦是位于鼻腔周围最大的骨质腔,由于其所处位置及结构的特殊性,相比额窦、筛窦、蝶窦,上颌窦更容易受到感染产生炎症反应,因此上颌窦炎是现代社会最常见的炎症性疾病之一。通过对黑水国遗址汉代人群上颌窦的观察,发现该墓地中有40.5%的个体上颌窦内出现骨形态的改变,以穗状骨片为主。女性上颌窦炎出现率远高于男性,但无统计学上的显著差异,男性上颌窦炎左侧出现率高于右侧,女性右侧高于左侧。按照不同的年龄段划分,从未成年期到中年期上颌窦炎的出现率随着年龄的增长而增长,但是通过二元逻辑回归检验,发现上颌窦炎与年龄之间并无统计学上的显著意义。在患有上颌窦炎的个体中,有66.7%的个体都出现了牙周病,一半以上的个体出现了龋齿。这似乎预示着上颌窦炎与牙齿疾病之间有着一定的联系。张掖黑水国遗址汉代人群上颌窦炎的高出现率可能是多因素导致的结果,包括寒冷干燥的气候环境、空气污染、牙齿疾病以及病原微生物等。     

113例儿童外阴阴道念珠菌病临床特征分析

目的分析113例儿童外阴阴道念珠菌病的临床特征。方法收集近5年至我院就诊的113例儿童外阴阴道念珠菌病的患儿临床资料,统计分析临床特点、真菌学检查结果及菌株对两性霉素B、氟胞嘧啶、氟康唑、伊曲康唑、伏立康唑5种药物的体外敏感性。结果 113例患儿年龄范围3个月～16岁,平均年龄10.96岁,其中76.1%的患儿为10～12岁。临床症状主要为外阴瘙痒(47.8%)及外阴分泌物增多(36.3%)。共培养出念珠菌108株,以白念珠菌为主(91.7%),其次为光滑念珠菌(5.6%),近平滑念珠菌、克柔念珠菌和热带念珠菌均为1%。所有的白念珠菌对两性霉素B均敏感,对伊曲康唑、氟康唑、伏立康唑耐药率分别为11.1%、10.1%、8.1%,对氟胞嘧啶耐药率为1%。治疗上以外用抗真菌药物为主。结论 113例儿童外阴阴道念珠菌病以白念珠菌所致多见,不同念珠菌的耐药情况具有差异,规范的治疗有待进一步探讨。     

Relationship between the lingual fossa depth, mesiodistal and bucolingual diameter of dental crown in permanent maxillary incisors with the living Slovenians.

On 311 dental stone casts of living children aged from 8 to 12 years, were measured the lingual fossa depth, MD diameter, and the BL diameter of the permanent maxillary incisors. The correlations and the differences of measured variables between left and right incisors, centrals and laterals, male and female incisors as well as the correlations between measured variables themselves were analysed. High left-right symmetry was established, except for directional asymmetry in female centrals. A significant positive correlation in terms of positive allometry between the lingual fossa depth and MD diameter was found. In the light of these results, the significance of the lingual fossa depth as a factor of strength is discussed.     

犬齿窝与人类中面部骨骼的演化

犬齿窝是包括现代人类在内的许多人族成员面部骨骼的重要性状,但在分类学上的意义仍存在争议。有学者认为该性状是一个发生于基础面形的近祖性状,除了一些例外,在灭绝和现生的大猿及人属中都存在。另有学者认为,犬齿窝是仅存在于智人及其直系祖先的衍生性状,在发育上与颧齿槽突嵴有关。这种关系并非总是成立,在智人中存在着明显的差异：弧型颧齿槽突嵴和直斜型颧齿槽突嵴与犬齿窝有时共存,有时不共存。我们由此推测,犬齿窝的发生和形态与上颌窦的前部发育有关,颧齿槽突嵴的形态与鼻窦的侧面发育有关。在人类演化的过程中,犬齿窝经历了不同的变形,比如上颌沟(如南方古猿非洲种、傍人粗壮种)、上颌小窝(如傍人粗壮种)、上颌沟(如匠人)或犬齿窝缺如(如傍人埃塞俄比亚种、傍人鲍氏种、肯尼亚扁脸人、人属鲁道夫种)。犬齿窝消失的原因各类群并不相同,如中新世和早更新世人属以及中更新世人属(如人属海德堡种/人属罗得西亚种、人属尼安德特种)。人属罗得西亚种具有弱化的犬齿窝,不具备演化为智人的可能,因此被排除在智人的演化支之外。     

The maxillary sinus of Paradolichopithecus sushkini (late Pliocene, southern Tajikistan) and its phyletic implications

Paradolichopithecus sushkini is a large fossil cercopithecine from the late Pliocene discovered at Kuruk-Say, southern Tajikistan. Despite its rather long face and large size, many authorities regard Paradolichopithecus not as a baboon, but as a large macaque, mainly based on the cranial morphology of European specimens. Among Old World monkeys, macaques are the only species that possess a maxillary sinus. Thus, we evaluated the presence/absence and morphology of this feature in P. sushkini using computed tomography (CT) scans of two Kuruk-Say cranial specimens in order to assess this species' taxonomic affinities. One of the specimens shows a thin bony wall separating a small area from the nasal cavity. Posterior to this structure is a pair of bony ridges: one protrudes from the alveolar process and the other descends from the superior portion of the nasal wall. A similar configuration was detected in the other specimen. These features strongly suggest the presence of a maxillary sinus in this species. This interpretation is supported by the fact that the superior portion of the alveolar process is excavated in the adult specimen. Thus, both specimens exhibit a maxillary sinus expanding laterally to share the external thin wall of the muzzle, and such a configuration may depend on the reduction of the maxillary bone, i.e., the presence of a maxillary fossa. The Kuruk-Say specimens probably retained a small maxillary sinus, despite the reduced size of the maxillary body. Thus, based on this evidence, P. sushkini probably belongs to the macaque lineage rather than that of baboons, although structural influences of the maxillary fossa leading to formation of the maxillary sinus have yet to be evaluated in extant macaques and baboons.     

Oronasal squamous cell carcinoma in an African hedgehog (Erinaceidae albiventris).

Oronasal squamous cell carcinoma was diagnosed in an adult African hedgehog (Erinaceidae albiventris). Clinically, the carcinoma presented as a firm right maxillary swelling with deviation of the nose to the left. The carcinoma was attached to the hard palate and protruded into the oral cavity. At necropsy, the carcinoma appeared centered in the right maxillary sinus, and had replaced the maxilla and extended into the nasal cavity. Metastatic foci were not found.     

Ancestral loss of the maxillary sinus in Old World monkeys and independent acquisition in Macaca

Cercopithecoid monkeys are unique among primates in that all species (except macaques) lack a maxillary sinus, an unusual condition among eutherian mammals. Although this uncommon distribution of cranial pneumatization was noted previously, the phylogenetic ramifications have not been investigated fully. Recently, character state optimization analysis of computed tomography (CT) data from extant Old World monkeys suggested that the loss of the sinus may have occurred at the origin of the group, unlike previous hypotheses positing only a reduction in size of the structure. To critically evaluate the "early loss" hypothesis, a recently recovered complete cranium of Victoriapithecus macinnesi from Maboko Island, Kenya, was examined by CT to determine the extent of its cranial pneumatization. This taxon is crucial for evaluating character state evolution in Old World monkeys, due to its phylogenetic position, preceding the cercopithecine/colobine split. CT analysis reveals only cancellous bone lateral of the nasal cavity, indicating that Victoriapithecus does not possess a maxillary sinus. Phylogenetic evaluation of the fossil with extant catarrhine taxa strongly supports the early loss of the sinus in cercopithecoids. The results suggest that the maxillary sinus found in the genus Macaca is not homologous with that of other eutherians, which may provide insights into the origin and function (if any) of the paranasal pneumatizations.     

Paranasal pneumatization in extant and fossil Cercopithecoidea

Unlike most primates, extant cercopithecoids lack maxillary sinuses, which are pneumatic spaces in the facial skeleton lateral of the nasal cavity proper. Character state analysis of living cercopithecoids across well-supported topologies suggests that the sinus was lost at the origin of the superfamily, only to have evolved again convergently in extant macaques. Recent work has shown that a) the 'early loss' hypothesis is supported by the lack of any pneumatization in Victoriapithecus, a stem cercopithecoid, b) like extant macaques, the fossil cercopithecine Paradolichopithecus shows evidence of presence of the maxillary sinus (MS), and c) unlike extant colobines, the fossil colobine Libypithecus also possesses a maxillary sinus. To more fully assess the pattern of cercopithecoid sinus evolution, fossil taxa from both subfamilies (Colobinae, Cercopithecinae) were examined both visually and by computed tomography (CT). The observations were evaluated according to standard anatomical criteria for defining sinus spaces, and compared with data from all extant Old World monkey genera. Most taxa examined conformed to the pattern already discerned from extant cercopithecoids. Maxillary sinus absence in Theropithecus oswaldi, Mesopithecus, and Rhinocolobus is typical for all extant cercopithecids except Macaca. The fossil macaque Macaca majori possesses a well-developed maxillary sinus, as do all living species of the genus. Cercopithecoides, on the other hand, differs from all extant colobines in possessing a maxillary sinus. Thus, paranasal pneumatization has reemerged a minimum of two and possibly three times in cercopithecoids. The results suggest that maxillary sinus absence in cercopithecoids is due to suppression, rather than complete loss.     

Canal systems in the temporal bone and their right-left differences

The first part of the facial canal is the pars labyrinthica. Its means lateral length is in our material 2.63 mm on the right and 3.03 mm on the left side. The mean width of the pore on the fundus area was 1.3 mm on the right side and 1.07 mm on the left. The geniculate fossa had a mean length of 2.54 mm on the right and of 3.14 mm on the left side. The widths of different areas of the pars labyrinthica and fossa geniculata were also measured. The angle between the first and second parts of the Fallopian canal was estimated with different methods. The mean width of the tympanic part of the facial canal was found to be 1.79 mm on the right side and 1.67 mm on the left, the mean width of the mastoideal part was 1.8 mm on the right side and 1.7 mm on the left. Distances of the mastoideal part of the Fallopian canal to mastoideal cells, ear drum, sigmoid sinus and external surface of the temporal bone were also measured. Measurements of the sigmoid sinus, the bulb of internal jugular vein and the cavum musculi stapedii are included, too. The ranges found in our material are also given.     

The depth of the lingual fossa in permanent incisors of Norwegians. II. Differences between central and lateral incisors correlations, side asymmetry and variability

The depth of the lingual fossa in permanent incisors of Norwegians (plaster casts and extracted teeth) was studied. In the plaster casts the depth of the lingual fossa in the right side incisors was (in mm): I,sup=0.51,I(2)sup= 0.30, I(1)inf =0.07 and I (2)inf =0.08. For 1(1)sup significant bilateral asymmetry was found (p<0.00l). All incisors were positively correlated in the depth of the lingual fossa, mandibular higher than maxillary. In both jaws centrals were better correlated across the midline than laterals, and centrals to laterals were less correlated than centrals to centrals and laterals to laterals. Interjaw correlations of 1(1)sup were higher than interjaw correlations with I(2)sup. Dental field theory is confirmed: The upper lateral and lower central were the most variable incisors in each jaw for lingual fossa depth. The values for this trait in Norwegians are within the Caucasoid range.     

The depth of the lingual fossa in permanent incisors of Norwegians. I. Method of measurement, statistical distribution and sex dimorphism

The depth of the incisor lingual fossa in permanent extracted incisors and plaster casts of Norwegians was examined. It was shown that plaster casts are well suited for measurements of lingual fossa depth, and that the measurements can be performed with great accuracy. Skewness values showed the symmetry of the distribution to decrease with decreasing mean lingual fossa depth. Kurtosis was found small in maxillary incisors, in mandibular outside the limits for normal theory. The distribution of the depth of the lingual fossa cannot generally be described as normal. No sex differences were found. The inheritance of this trait in Norwegians is probably not sex linked.