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。     

Immunity features in patients with upper respiratory tract disease caused by Chlamydia

Comparative analysis of results of clinical and laboratory evaluation of patients with chronic nasal or nasal sinuses' diseases (chronic rhinitis or maxillary sinusitis) associated or not associated with Chlamydia infection was performed. It was shown that in patients infected with Chlamydia, along with unidirectional changes typical for all patients irrespective from presence or absence of Chlamydia, the features of immune response against these infectious agents take place.     

Comparative characterization of the microflora of the upper respiratory tract mucous membranes in bronchial asthma and allergic persistent rhinitis

A total of 250 patients with diagnosed bronchial asthma (BA) were examined by microbiological methods. Among them--188 children and 62 adults. In 87 patients the microflora of nasal mucosa was studied, in 40--of pharynx only and in 123 patients--both the nasal and the pharynx. For comparative analysis earlier data obtained in 69 patients with persistent allergic rhinitis (PAR) were used. The cultures isolated from the nasal mucosa of BA patients were shown to number 18 genera and 42 species, while among those isolated from pharynx mucosa 20 genera and 40 species. Monocultures were isolated from the nasal mucosa only in 23% of the examined patients and from the pharynx mucosa--only in 1.42%. Associations with different numbers of components were isolated from nasal and pharynx mucosa (2 to 6, 2 to 8 respectively). Staphylococcus aureus was regarded as the main species of nasal biocenosis in BA and PAR, as well as pharynx biocenosis in BA. Besides, in BA other Staphylococcus species (schleiferi, caprae, capitis, hominis, etc.), reversely related to the main species, could be isolated from both mucous membranes. Similarities and differences in microflora of biocenoses in both nosological forms, confirming links between PAR and BA, are considered.     

Microbial biocenosis of the nasal mucosa in healthy persons and in Staphylococcus carriers

The normal microflora of the nasal mucosa in man is differentiated into main, complementary and casual microflora, taking into account its isolation rate and characteristics of microbial contamination. The main microflora of adults, in contrast to children, is represented, in addition to coagulaso-negative (CN) staphylococci, by bacteria of the genus Corynebacterium. In staphylococcal carrier state a decrease in the isolation rate and the amount of bacteria belonging to the main and complementary microflora (CN staphylococci, Micrococcus, Streptococcus, Bacillus) was observed. Moreover, in carriers the weakening of the degree of association between CN staphylococci, Micrococcus, Corynebacterium, Streptococcus in symbiotic pairs was noted. In the absence of S. aureus carrier state the main and complementary microflora was characterized by the combination of the factors of antagonism and persistence, while in carrier state the complex of colonization factors was defective in the main microflora and well pronounced in coagulase-positive staphylococcal strains and enterobacteria.     

真菌球型上颌窦炎鼻内镜下两种手术路径的临床研究

目的:比较鼻内镜下中鼻道联合下鼻道小视窗双路径术和单独下中鼻道开窗术治疗真菌球型上颌窦炎的临床疗效。方法:采用前瞻性随机对照试验,将2013年8月~2015年5月在我院择期行手术治疗的50例真菌球型上颌窦炎患者分为观察组与对照组,每组25例,对照组行鼻内镜单独下中鼻道开窗术,观察组在对照组的基础上联合下鼻道小视窗术。术前及术后6个月采用鼻腔鼻窦结局测试20条量表(SNOT-20)对两组患者进行评分,术后6个月对鼻黏膜纤毛清除功能及疗效进行评估,比较两组手术时间及术中出血量。结果:术后6个月两组SNOT-20量表评分显著低于术前,且观察组显著低于对照组(P0.05)。术后6个月观察组粘膜纤毛传输时间(MTT)显著低于对照组(P0.05)。两组总有效率、手术时间及术中出血量比较,差异均无统计学意义(P0.05)。结论:鼻内镜下以上两种手术路径治疗真菌球型上颌窦炎的疗效相近,但鼻内镜下中鼻道联合下鼻道小视窗双路径术更有利于减轻患者症状及促进鼻黏膜纤毛清除功能恢复。     

THE TREATMENT OF SINUSITIS IN CHILDREN

The sulfonamides and antibiotics have been of great value in reducing the duration and severity of acute sinusitis in children.Chemotherapy, in the acute case, will probably prevent much chronic sinusitis of the infectious type.The most common variety of chronic sinus disease is due to a primary allergic condition plus secondary infection. It is impossible to treat these cases successfully without treating the allergy as well as the infection.The home use of any nose drop preparation is of very little value in the treatment of chronic sinusitis of any type or localization.The local nasal use of sulfonamides or antibiotics is not based upon rational principles. Their clinical value is negligible. They may, moreover, be decidedly irritating to the nasal mucosa.One should not hesitate to resort to rational surgical procedures to improve nasal ventilation in a child with sinusitis.While the advent of chemotherapeutic, antibiotic and antihistaminic drugs has been of inestimable value in the treatment of chronic sinusitis, we must not neglect to surgically correct anatomical defects and irreversible pathological mucosal changes which interfere with proper nasal physiological processes.     

趋化因子CCL-18 在慢性鼻- 鼻窦炎中的表达及意义

目的:分析趋化因子CCL-18在不同组织病理特征慢性鼻-鼻窦炎和正常鼻黏膜的表达差异,探讨CCL-18在慢性鼻-鼻窦炎中的表达及意义。方法:采用苏木精-伊红染色(HE),Masson染色及过碘酸-雪夫(PAS)染色对慢性鼻-鼻窦炎组织进行病理分析。采用Western blot检测CCL-18蛋白水平在不同组织病理特征慢性鼻-鼻窦炎和正常鼻黏膜组织中的表达差异。结果:CCL-18蛋白水平在伴鼻息肉和不伴有鼻息肉慢性鼻窦炎均较正常鼻黏膜组织中显著上调(P<0.05)。CCL-18蛋白水平在嗜酸性粒细胞慢性鼻窦炎的表达水平明显高于非嗜酸性粒细胞慢性鼻窦炎(P<0.05)。腺体型,纤维炎症型及水肿型慢性鼻-鼻窦炎中CCL-18表达水平均高于正常鼻黏膜,以水肿型表达最为显著(P<0.05)。结论:CCL-18在嗜酸性粒细胞和水肿型慢性鼻窦炎中高度表达,提示CCL-18可能参与慢性鼻-鼻窦炎中嗜酸性粒细胞的浸润这一基本病理过程。     

Mucociliary clearance in chronic sinusitis: related human nasal clearance and in vitro bullfrog palate clearance

Nasal mucociliary clearance was measured in both healthy subjects and patients with chronic sinusitis using saccharin granule technique. Nasal mucociliary transit time (ST) was significantly slower in the patients with chronic sinusitis compared with that in controls (p less than 0.005). Nasal mucus collected from each nasal cavity was used for in vitro bullfrog palate clearance studies and compared to the in vivo nasal ST. Mucociliary clearance rate (MTR) on frog palate was 12.5 +/- 2.5 mm/min in the mucus from control subjects, 6.1 +/- 1.5 mm/min in the mucus from the patients. The difference was statistically significant (p less than 0.005). The MTR on frog palate in the patients whose nasal ST was within normal range was significantly slower than that in controls (p less than 0.005), but not significantly different from that in the patients whose nasal ST was over the normal range. These results suggest that the nasal mucous properties which decreased the mucociliary clearance on frog palate did not contribute to the mucociliary clearance of the patients who had a normal one. No significant correlation existed between MTR on frog palate and nasal ST in both control and chronic sinusitis. In chronic sinusitis patients, decelerated nasal ST was recovered significantly by normal saline nebulization compared with the value before the nebulization (p less than 0.01). None of the significant change of ST was observed in control before and after the nebulization.     

Characteristics of staphylococci isolated from newborn infants

The microflora of the skin and the nasal mucosa was studied in 14 healthy newborns, 3 newborns with purulent infections and a nurse working in a neonatal ward. To make this study, washings were obtained with the use of 0.1% Triton X-100 solution. The determination of the number of microorganisms, the percentage of staphylococci, the percentage of lecithinase-positive staphylococci and the number of colonies with antagonistic properties revealed that these characteristics differed according to the state of health of the newborns and the time elapsed after their birth, and that changes in the number of antagonistically active bacteria occurred in parallel with changes in the total number of bacteria. Among S. aureus strains isolated from the subjects covered by the survey strains belonging to phagovar 80, as well as untyped strains, and among S. epidermidis strains those belonging to biovars I and II occurred most frequently. Strains belonging to the same biovar or phagovar differed in their plasmid markers.     

Drug resistance stability in staphylococci under different conditions. The mechanism of the recovery of streptomycin sensitivity of a staphylococcal population in patients 7 months after hospital discharge

A method for analysis of antibiotic sensitivity restoration in staphylococcal populations in humans is described. The mechanism of streptomycin sensitivity restoration in staphylococcal populations on the nasal mucosa of 59 patients 7 months after discharging from surgical stationary was studied. Quantitative estimates for loss of superinfecting streptomycin-resistant staphylococci, initial streptomycin-resistant staphylococci and resistance determinants by the initial streptomycin-resistant staphylococci are presented.     

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。     

Microflora of the mucous membrane of human tonsils in the normal state and in pathology

A total of 50 healthy persons and 50 chronic tonsillitis patients were examined with the use of the bacteriological method. The microflora of tonsillar mucous membrane was represented by 8 genera of facultative anaerobic microorganisms. In the biocenosis of the tonsillar mucosa of the healthy subjects the occurrence of Streptococcus was 1.5-fold greater than in that of the patients; microorganisms of the genus Staphylococcus prevailed on the tonsillar mucosa of chronic tonsillitis patients 1.3-fold prevailed more often and Klebsiella and Neisseria prevailed 4-fold more often. Among the microorganisms isolated from the patients, cultures simultaneously having two or more pathogenicity markers occurred twice as often as among the representatives of the microbiocenosis obtained from the healthy subjects. The microflora of the tonsillar mucosa of the chronic tonsillitis patients was characterized by resistance to penicillins, macrolides and aminoglygosides, but was simultaneously sensitive to lincosamides and glycopeptides.     

Antibiotic sensitivity of the microflora isolated in ENT diseases]

Sensitivity of beta-hemolytic streptococci of group A, Streptococcus viridans, Staphylococcus aureus, epidermal staphylococci, pneumococci, Proteus and Ps. aeruginosa isolated in 1975-1978 from patients with tonsillitis, otitis, sinusitis and other otorhinolaryngological diseases was studied with respect to 19 antibiotics. Data on comparison of the antibiotic sensitivity of the microflora isolated from the patients with otorhinolaryngological diseases in 1964-1974 and 1975-1978 are presented. It was shown that beta-hemolytic streptococci were highly sensitive to all the antibiotics tested except tetracycline. Among Streptococcus viridans the strains resistant to many antibiotics were more frequent than among beta-hemolytic streptococci. Most of the Staphylococcus aureus strains were sensitive to gentamycin, cephaloridin, oxacillin and resistant to the other antibiotics. The epidermal staphylococci were characterized by approximately the same antibiotic sensitivity as Staphylococcus aureus. Resistance of the predominating majority of the Pneumococcus strains to tetracycline was noted. Proteus and Ps. aeruginosa were resistant to all the antibiotics except aminoglycosides. The microflora isolated from the cases with otorhinolaryngological diseases in 1975-1978 were mainly characterized by lower antibiotic sensitivity than that isolated from the cases with the same diseases in 1964-1974. It is possible to suppose that the microorganisms isolated from the patients with otorhinolaringological diseases had no significant differences with respect to their antibiotic sensitivity from those isolated from the patients with other pathological processes.     

鼻内镜手术合并大环内酯类抗生素治疗鼻窦炎43例

目的：评价鼻内镜手术治疗合并术后利用大环内酯类抗生素治疗鼻窦炎的疗效,探讨鼻窦炎患者治疗前后血清中IL-17及其受体的表达及血清中总IgE的变化。方法：鼻窦内窥镜行病侧上颌寞自然口扩大及下鼻道开窗双进路,彻底清除鼻腔、鼻窦病变组织,术后采用大环内酯类抗生素治疗;采用酶联免疫法检测30例患者治疗前后血清中IL-17,IL-17R及IgE的含量。结果：治疗30例,其中术后病理证实鼻寞真菌球20例,治愈20例;曲霉菌感染23例,治愈10例,6个月随访无复发;与只治疗前相比,手术治疗后鼻窦炎患者血清IL-17,IL-17R及IgE的含量均明显降低。结论：鼻内镜手术是治疗真菌性鼻一鼻窦炎的主要方法,IL-17和IL-17R均参与鼻窦炎的发病过程,可作为诊断鼻窦炎的新指标,鼻内镜术后使用大环内酯类抗生素进一步巩固治疗,可降低复发率。     

Nasal septal deviation in a mediaeval population

In modern populations, there is evidence that nasal septal deviation (NSD) may be associated with maxillary sinusitis, and that those with NSD may differ in craniofacial morphology from those without or with less severe NSD. Whether these associations hold true for earlier populations has yet to be investigated. The current work is a step toward remedying this. The study group comes from a mediaeval English archaeological site. NSD was quantified using image analysis. Maxillary sinusitis was identified from new bone formation in the antrum. Cranial morphology was assessed using standard craniometric measurements. The results provided no evidence for a relationship between NSD and maxillary sinus disease. NSD was associated with reduced measures of upper facial height, suggesting decoupling of growth in vertical height of the nasal septum and the bony structures surrounding it.     

The role of anaerobic bacteria in sinusitis

The normal oropharyngeal flora contained aerobic and anaerobic bacteria that can cause respiratory infections including sinusitis. Some of these bacteria can interfere with the growth of potential pathogens and may play a role in preventing infections. Anaerobic bacteria emerge as pathogens as the infection becomes chronic. This may be the result of the selective pressure of antimicrobial agents that enable resistant anaerobic organisms to survive, and from the development over time of conditions appropriate for anaerobic growth, which include the reduction in oxygen tension and an increase in acidity within the sinus cavity. Anaerobes were isolated in acute maxillary sinusitis of odontogenic origin and in over half of the patients with chronic sinusitis whenever proper techniques for their cultivation were employed. These organisms were also recovered in acute sinusitis that was associated with dental infections. The predominant isolates were pigmented Prevotella and Porphyromonas, Fusobacterium and Peptostreptococcus spp.     

Diagnosis of odontogenic maxillary sinusitis by spiral computed tomography using a dental program

Genyantrum mucosal changes and the upper jaw ridge were analyzed in different forms of periodontitis and in cases of endodontic treatment failure with the dental filling material being in maxillary sinus cavity. Spiral computed tomography using the Denta Scan software could confirm the odontogenic nature of the changes found in 57 (85.0%) patients with suspected maxillary sinusitis.     

Crosstalk between platelet-derived growth factor-induced Nox4 activation and MUC8 gene overexpression in human airway epithelial cells

Reactive oxygen species (ROS) contribute to chronic airway inflammation, and NADPH oxidase (Nox) is an important source of ROS. However, little is known of the role that ROS play in chronic upper respiratory tract inflammation. We investigated the mechanism of ROS generation and its association with mucin gene overexpression in the nasal epithelium. The level of platelet-derived growth factor (PDGF) expression was increased in sinusitis mucosa, and high-level PDGF expression induced intracellular ROS, followed by MUC8 gene overexpression in normal human nasal epithelial cells. Knockdown of Nox4 expression with Nox4 siRNA decreased PDGF-induced intracellular ROS and MUC8 expression. Infection with an adenovirus containing Nox4 cDNA resulted in Nox4 overexpression and increased intracellular levels of ROS and MUC8 expression. PDGF and Nox4 overexpression are essential components of intracellular ROS generation and may contribute to chronic inflammation in the nasal epithelium through induction of MUC8 overexpression.     

Microflora of gastrointestinal tract in patients with chronic cholecystitis

AIM: Assessment of quantitative and qualitative characteristics of gastrointestinal microflora in patients with chronic cholecystitis. MATERIALS AND METHODS: Bacteriological analysis of biopsy samples of esophageal and gastric mucosae as well as stool samples was performed in 10 healthy volunteers and 28 patients with chronic cholecystitis. RESULTS: Opportunistic microorganisms are acquiring greater significance in formation of gastrointestinal microbiocenosis. Significant increase of both isolation rate and density of gastrointestinal tract colonization by staphylococci, enterobacteriae and anaerobic microorganisms was revealed. CONCLUSION: Obtained results showed abnormalities of microbiocenosis of esophageal and gastric mucosae and presence of intestinal disbacteriosis of different degrees of intensity.     

Method of determining the microbial flora of the small intestinal cavity and mucosa in different gastrointestinal tract diseases]

Intestinal microflora in patients with chronic enterocolitis and duodenal ulcer was studied. Both the cavity of the small intestine and the structures of its mucosa were investigated. The method of aspiration biopsy was used, the samples of multiple washings of the intestinal mucosa and its homogenate were used for seeding. The results thus obtained in indicated that the structures of the mucosa contained microorganisms similar to those isolated from the intestinal cavity, but in lesser amounts and with different characteristics. The proposed method of detecting the microflora in the intestinal cavity and mucosa is simple and can be used in clinical practice.