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Objective@#To analyze the clinical characteristics and appropriate surgical procedures, and discuss the classification of congenital middle ear malformation.@*Methods@#All cases were from the Center of Otorhinolaryngology, the Sixth Medical Center of Department of PLA General Hospital. All of these cases, including 26 male patients (ears) , 10 female patients (11 ears) , aged from 7 to 57 years old, had normal external auditory canal, tympanic membrane, conductive hearing loss, type A tympanogram and negative Gelle′s test. Tympanoplasty was performed in all cases. The deformity was classified to three types,i.e., Type I (stapes foot plate mobility): Ⅰa, ossicular chain deformity with normal stapes suprastructure; Ⅰb, ossicular chain deformity with abnormal stapes suprastructure; Type Ⅱ (stapes foot plate fixation): Ⅱ a,normal ossicular chain, Ⅱ b, ossicular chain malformation; and Type Ⅲ: vestibular window osseous atresia or undeveloped, or with round window atresia. The malformation of type Ⅱ and Ⅲ may be accompanied with abnormal facial nerve. In addition, the papers on middle ear malformation published from 1982 to 2017 were analyzed retrospectively. The clinical data of 451 ears malformation were summarized.@*Results@#According to the revisional classification criteria in 37 ear samples from our hospital, 20 ears were type I. 6 type Ⅰa cases were used PORP (partial ossicular replacement prosthesis) to reconstruct the ossicular chain; 14 type Ⅰb cases were used TORP (total ossicular replacement prosthesis) to reconstruct the ossicular chain. For the 5 ears of type Ⅱ, 2 of which were type Ⅱ a and 3 were type Ⅱ b. 4 ear samples of type Ⅱ were implanted with Piston ossicular prosthesis, 1 was implanted with TORP in which the ossificated foot plate was removed with periosteum preserved. 12 ear samples were type Ⅲ, with vestibular window osseous atresia, facial nerve malformation, and stapes suprastructure malformation. The pistons ossicular prosthesis were implanted in vestibular window in 3 ears with facial nerve covering vestibular window partially. The surgery had to be given up in 5 ears, and TORP was implanted in 4 ears at the opening with preserved periosteum at the beginning of the tympanic scala because of facial nerve covering vestibular window totally. 30 ears with complete follow-up data had no sensorineural hearing loss and the average air-bone conduction decreased 23.3±10.7 dB (P<0.05).There were 234 ears of type Ⅰ in 451 ears of congenital middle ear malformation reported in the literature. 113 of which were type Ⅰa, the basic surgery was ossicular chain shaking and artificial or autogenous PORP implantation. Type Ⅰb was 121 ears, with autogenous or artificial TORP and PORP. Type Ⅱ was125 ears, including type Ⅱa 22 ears, Ⅱb 60 ears, and no subclassification for 43 ears. The surgery of type Ⅱ was the same as otosclerosis. The vestibular window atresia of type Ⅲ was 92 ears, the surgery of 17 ears had to be abandoned, the other ears underwent vestibular window, promontory or semicircular canal opening to reconstruct hearing with Piston, autogenous or artificial TORP.@*Conclusion@#Referring to the classification of congenital middle ear malformation combining with appropriate surgical materials and methods, otologists can better understand and choose appropriate surgical method to the middle ear malformation.
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Objective To report the curative effect of the epitympanoplasty with cartilage obliteration in the treatment of middle ear cholesteatoma .Methods This study retrospectively analysed 123 cases ,with middle ear cholesteatoma treated in our department from November 2009 to July 2012 .The operation included mastoidectomy with posterior canal wall preserved ,lateral wall of attic resected ,facial recess opened to the epitympanum ,epitym-panum obliterated with cartilage and mastoid cavity blocked with bone dust .All cases were followed up on complica-tions and hearing improvement .Results All cases were followed up 6~38 months .In 123 cases ,there were 2 ca-ses had cholesteatoma recurrence in the middle ear cavity ,6 cases had infection of post auricular incision after opera-tion ,3 cases had residual marginal tympanic membrane perforation ,2 cases had ossicular replacement prosthesis ex-clusion ,and 6 cases had canal wall skin swelling or defect .The rest cases acquired full -recovery after 2 or 3 wound dressing changes .Out of 123 cases ,83 cases had the whole hearing document ,the average AB gap at 0 .5 ,1 ,2 kHz reduced from 32 .2 ± 11 .2 dB pre-operation to 20 .7 ± 12 .4 dB post -operation .The AB gap of pre - and post -operation had significant difference (P<0 .001) .Conclusion The mastoidectomy with posterior canal wall preserved greatly shortened the healing time .The resection of lateral wall of epitympanum can exposed operating field more completely and remove lesions thoroughly .The cartilage obliteration in the attic can prevent the retraction pocket formation effectively .This technique provides alternative in treating middle ear cholesteatoma .
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OBJECTIVE@#To improve the diagnostic and therapeutic efficiency for secondary laryngeal tuberculosis through an analysis on the clinical features of patients with this disease.@*METHOD@#A retrospective study was made among 49 cases with laryngeal tuberculosis treated in Tibetan General Hospital of Chinese PLA, and the clinical data were carefully analyzed to summarize the clinical experience of this disease.@*RESULT@#Of 49 patients, 24 cases had 1 year history, 11 cases had 1 to 3 years, 9 cases had 3 to 5 years, 5 cases had 5 years or more. Thirty-eight patients had the history of tuberculosis and 11 had none. Thirty-four patients had taken anti-tuberculosis drugs but none had standard therapy as demanded. All cases had mild general symptoms (mild fever, night sweats, weight loss, et al) and atypical local symptoms (hoarseness, sore throat). Therefore, 42 cases were misdiagnosed as non-specific chronic laryngitis, of which 15 cases got worse after oral administration or inhaling of steroid hormones. Seven persons were misdiagnosed as laryngeal cancer. All patients were confirmed pulmonary tuberculosis by X ray exam or CT scanning. Twelve cases had strong positive PPD tests and 2 cases were detected positive by sputum smear. All patients was treated by standard systematic and local chemical therapy against tuberculosis (inhaling of antituberculosis drugs for 1 to 2 months). All were cured but one died in a road accident, and none had recurrence after 1- to 9- year follow-up.@*CONCLUSION@#All of those the patients with long period hoarseness and sore throat should take chest CT scan or X-ray exam for the highest incidence of pulmonary tuberculosis at high altitudes. CT scanning is the prefer for its high resolution. Pathological biopsy and diagnostic therapy should be taken to make accurate diagnosis. Usually steroid hormones should not be recommended.
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Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Altitude , Retrospective Studies , Tibet , Tuberculosis, Laryngeal , Diagnosis , Drug TherapyABSTRACT
Objective To analyze and evaluate the use of small incision in the treatment of senile intertrochanteric fracture in artificial femur head replacement.Method 79～98 years old senile patients suffered from intertrochanteric fracture use small incision and artificial femur head replacement,a total of 18 cases including male 6 cases and female 12 cases,averaged eighty six years old,type of fracture according to Evans classification,type Ⅲ six cases,type Ⅳ eight cases,type Ⅴ four cases.Result 18 cases were followed up for 3～19 months,no case died,joint function in good situation,6～21 days post operation walk with help of tools,the average time was 7 days,use activity rate of hip joint,degree of pain and living self-service situation as criteria,success rate reached 91%,no relaxation or descendent of prosthesis.Conclusion Trauma is relatively small in use small incision and artificial femur head replacement in the treatment of senile intertrochanteric fracture,the result is satisfactory.
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BACKGROUND: Diabetic glycometabolism disorder and lipoid metabolism disorder are often reciprocal causation, which cause the reduction of hepatic glycogen and the changes of many plasma factors. Hence, the occurrence of vascular complications in heart, kidney and brain is common. It becomes a hot topic in latest researches to find an effective medicine for the secondary prevention of diabetes.OBJECTIVE: To study the interventional effects of leizhusun' s juice on hepatic glycogen, plasma glucose and blood fat.DESIGN: A randomized and controlled observatory study by employing experimental animals as subjects.SETTING: Laboratory of Pharmacy College of Xianning College.MATERIALS: Totally 40 male Wistar rats with a bodymass of (230 ± 20) g were obtained from the Experimental Animal Center of Wuhan General Hospital of Guangzhou Military Area.METHODS: The diabetic rat model was established by the injection of Alloxan(200 mg/kg) into abdominal cavity in the laboratory of Pharmacy College of Xianning University between September 2002 and June 2003. Leizhusun' s juice(LZS) of different doses(205.70 mg/kg and 436. 40 mg/kg) was respectively perfused into the stomach for 28 days, and healthy rats were used as normal control. Levels of hepatic glycogen(HG) in liver and the factors in plasma were detected.MAIN OUTCOME MEASURES: HG, glucose(Glu), triacylglycerol (TG), non-esterified fatty acid(NEFA), total cholesterol(TC), low-density lipoprotein cholesterol(LDL-c), high-density lipoprotein cholesterol (HDL-c), and malondialdehyde(MDA) contents, and superoxide dismutase (SOD) activitiesRESULTS: The level of Glu in LZS-Ⅱ group(436.40 mg/kg) was (9.65± 1.14) mmol/L, TG was(1. 31 ±0. 18) mmol/L, NEFA was(0. 51 ±0. 04)mmol/L, LDL-c was(0.79 ±0. 19) mmol/L, and MDA was(6.31 ±0. 83)nmol/L, which were significantly lower than Glu of (16. 14 ± 1.59) mmol/L,TG of(1.94 ±0. 31) mmol/L, NEFA of(0.59 ±0. 05) mmol/L, LDL-c of (1.34 ±0.28) mmol/L and MDA of(10.95 ±2.90) nmol/L in experimental control(Model) group( t= 3. 478 - 9. 379, P ＜ 0.01), while the HDL-c was (1.09±0.13) mmol/L, SOD was(39.76±6.23) NU/mL and HG was (6.70 ±0.62) mg/g in LZS-Ⅱ group, which were significantly higher than HDL-c of(0.55 ± 0. 11) mmol/L, SOD of (23.24 ± 3.35) NU/mL and HG of (4.06±1.24) mg/gin Model group( t = 5. 388 - 9. 000, P ＜0.01). Furthermore, the decreasing effect on LDL-c and increasing effect on SOD in both LZS groups had dose-dependence relationship( P ＜ 0.05 -0.01 ).CONCLUSION: LZS significantly decreases plasma Glu, TG, NEFA, LDL-c and MDA levels, but increases HDL-c, SOD and HG levels, which displays obvious antidibetic effects.