Clinical research of 24-hour double-probe pH-metry in the laryngopharyngeal reflux diseases / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To determine the clinical value of 24 h double-probe pH-metry for the diagnosis and treatment of laryngopharyngeal reflux (LPR).</p><p><b>METHODS</b>According to the pH-metry results (whether the reflux events record in the upper esophagus is more than 6.9), patients of refractory pharyngolaryngitis were divided into LPR and control groups (each of 17 cases). All patients treated with anti-acid therapy and conventional pharyngo-laryngitis therapy. Correlation between pH-metry and the reflux symptom index (RSI), the reflux symptom index (RFI) were analyzed. Changes of the RSI and RFI in different group were calculated in post-treatment.</p><p><b>RESULTS</b>In the LPR group, the median reflux events of the upright time were higher than the supine time (Z = -3.62, P < 0.01), but the difference was not discovered in the control group (Z = -0.60, P > 0.05). There was no statistical difference between RSI, RSI and RFS with pH-metry, and with moderate concordance (k were 0.47, 0.53, P < 0.01, respectively). Compared to pre-treatment, the RSI and RFI were decreased both in LPR group and control group, Amplitude decreased in LPR group significantly higher than the control groups, with statistical difference (t were 3.74, 3.01, P < 0.01, respectively).</p><p><b>CONCLUSION</b>The 24 h double-probe pH-metry is significant for the anti-acid therapy of LPR.</p>

Establishment and pathophysiological observation of an experimental animal model of traumatic optic neuropathy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To establish an animal model of traumatic optic neuropathy (TON) that resemble to clinical state and study the mechanical principle and change of pathophysiology of its nerve injury for clinical diagnosis and treatment.</p><p><b>METHODS</b>New Zealand white rabbits were used as the research objects. The method introduced by Wang Yi was repeated and improved. Mild and severe animal models of TON were established by reformed Wang Yi operation separately. After the spring gun struck, all animals were observed on pupils and direct light reflex and received the examinations of pattern reversal visual evoked potentials (PR-VEP). The pathophysiology of normal and injury optic nerve was observed.</p><p><b>RESULTS</b>After recovery from anesthesia, the mydriasis and disappearance or dullness of direct light reflex happened in all injured eyes. No brain contusion, infection, orbital fracture and death were found. One optic nerve was broken with complete tunica vaginalis. The latency and amplitude of injured eyes deteriorated gradually. In group B, the waves became flat rapidly. After injury, the optic nerve underwent 3 stages: edema, hyperplasia and atrophy. The pathomorphological changes of injured eyes in group B were more serious than that in group A in any time.</p><p><b>CONCLUSIONS</b>The reformed operation can establish constant nerve injury with high success rate. In mildly injured eyes, the injury deteriorated gradually. However, part visual function remained. In severely injured eyes, the pathomorphological changes were irreversible sooner after struck, and the visual function lost completely. There is a good correlation between PR-VEP and pathomorphology. PR-VEP can guide the clinical diagnosis and treatment.</p>

Clinical research on delayed traumatic epistaxis and pseudoaneurysm / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the diagnosis and treatment of delayed traumatic epistaxis and put forward a concept of arteriola pseudoaneurysmal epistaxis originated from maxillofacial medium-sized artery.</p><p><b>METHODS</b>The clinical data of 53 patients who had the typical symptoms of delayed traumatic epistaxis and received digital subtraction angiography examination and treated in recent 10 years were retrospectively analyzed.</p><p><b>RESULTS</b>Among the 53 patients, 8 patients suffered from interval carotid artery pseudoaneurysm. For these 8 patients, 1 died of massive epistaxis before embolization, 7 received transcatheter arterial embolization( 6 cured and 1 died). Twenty patients suffered from traumatic carotid cavernous fistula, all were cured with endovascular occlusion by detachable balloon. Twenty-five patients suffered from maxillofacial artery hemorrhage. For these 25 patients, 21 were treated by transcatheter arterial embolization with gelatin sponge and coils, 4 by anterior ethmoidal artery ligation. The followed-up ranged from 6-72 months (median 5 years). All patients were successfully treated without serious complications and recurrent hemorrhage, except one patient who had recurred hemorrhage three weeks after transcatheter arterial embolization. This patient was again successfully treated by artery ligation.</p><p><b>CONCLUSIONS</b>Interval carotid artery pseudoaneurysm, carotid cavernous fistula and maxillofacial medium-sized artery and arteriola pseudoaneurysm are the main causes of delayed traumatogenic epistaxis. Early diagnosis by digital subtraction angiography examination and transcatheter arterial embolization or artery ligation are the useful methods to treat delayed traumatic epistaxis and pseudoaneurysm.</p>