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Objective·To evaluate the quality of clinical practice guidelines of obstructive sleep apnea(OSA)published worldwide.Methods·The guidelines of OSA were retrieved in PubMed,Embase,China National Knowledge Infrastructure(CNKI),Wanfang Data,SinoMed,MedSci,The Cochrane Library,and the websites such as Medlive,U.S.Preventive Services Task Force(USPSTF),National Institute for Health and Care Excellence(NICE),New Zealand Guidelines Group(NZGG),Scottish Intercollegiate Guidelines Network(SIGN),and Guidelines International Network(GIN)from establishment to December 2022.Two reviewers screened the literature and extracted the main information independently,using the Appraisal of Guidelines for Research and Evaluation Ⅱ(AGREE Ⅱ)and Reporting Items for Practice Guidelines in Healthcare(RIGHT)to evaluate the quality of the included OSA guidelines.Subgroup analysis was performed according to the publication regions of guidelines.The inter-evaluator consistency test was also performed and the results were expressed as the intra-class correlation coefficient(ICC).All the included guidelines were read entirely and the clinical questions they raised were summarized.Results·A total of 35 OSA guidelines were included.The ICC value of 0.975 showed a good inter-evaluator agreement.The results of AGREE Ⅱ showed that the average score of all guidelines was(63.60±16.45)%,with a minimum of 23.40%and a maximum of 91.67%.In the six domains,the scores of"Rigor of development"[(56.07±25.89)%]and"Applicability"[(53.57±15.52)%]were relative low.The average reporting rate of RIGHT of all the included guidelines was(67.84±20.03)%,with a minimum of 14.29%and a maximum of 94.29%,and the three domains with the lowest reporting rates were"Review and quality assurance"[(31.40±45.51)%],"Funding and conflict of interest declaration and management"[(56.43±33.95)%]and"Other aspects"[(56.19±36.85)%].Subgroup analysis showed that guidelines in Asian had a lower score in"Rigor of development"and a lower overall score of AGREE Ⅱ than the guidelines in America and Europe(both P<0.05),and the reporting rates in the domains of"Evidence"and"Other information"of RIGHT of the Asian guidelines were also lower than those in the guidelines in America and Europe(P<0.05).These guidelines focused on 42 clinical questions which were classified to 3 aspects,i.e.screening and diagnosis,treatment and long-term management of OSA.Conclusion·The quality of current global OSA guidelines varies a lot,and they need to be strengthened in terms of rigor of development,applicability,review and quality assurance,funding and conflict of interest declaration and management,especially those in Asia.
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OBJECTIVE Aimed to analyze the demographic,anthropometric,severity,and common comorbidities of individuals with suspected obstructive sleep apnea(OSA)referred to the OSA diagnosis and treatment center of the Sixth People's Hospital affiliated with Shanghai Jiao Tong University School of Medicine from 2012 to 2021.METHODS Data of subjects with suspected OSA who underwent polysomnography(PSG)from January 2012 to December 2021 were collected.Subjects were categorized into five groups based on the PSG study date with a two-year interval.Clinical characteristics trends were compared across groups,focusing on the comparison between 2020-2021 and 2018-2019 to explore changes after COVID-19 epidemic.RESULTS 1.A total of 5870 subjects were included from 2012 to 2019[age(43.2±12.7)years,21.7％females].OSA prevalence was 84.8％.Over the two-year intervals,age,female proportion,OSA severity,and other indicators showed no significant changes.Body mass index(median 26.8kg/m2 to 26.0kg/m2)and overweight rates(78.1％to 73.4％)decreased yearly,as did the proportions of subjects who smoked(38.1％to 27.8％)and consumed alcohol(13.5％to 6.4％).The prevalence of hypertension increased yearly(40.3％to 51.8％),while awareness rates gradually decreased(70.3％to 59.4％).Diabetes prevalence remained relatively stable(9.4％to 9.7％),with increased awareness(49.5％to 66.2％).Dyslipidemia prevalence remained high(76.7％to 78.3％),with low awareness rates(20.8％to 28.7％).2.A total of 805 subjects were included from 2020 to 2021.Compared with 2018-2019,the proportion of females decreased(14.9％vs.22.0％),and OSA severity increased(apnea-hypopnea index 40.4 times/h vs.29.2 times/h).Prevalence rates of hypertension,diabetes,dyslipidemia(47.1％,6.9％,62.1％)and awareness rates(52.4％,57.7％,17.8％)were lower than those from 2018-2019.3.Compared with subjects with known their comorbidities,unknown subjects had significantly higher levels of systolic blood pressure(141 mmHg vs.134 mmHg),diastolic blood pressure(93 mmHg vs.85 mmHg),fasting blood glucose(7.87 mmol/L vs.6.07 mmol/L),and low-density lipoprotein(3.08 mmol/L vs.2.91 mmol/L)(P＜0.05).CONCLUSION From 2012 to 2021,individuals with suspected OSA referred for PSG test showed a tendency toward younger age,lower proportion of females,fewer comorbidities,but increased OSA severity.The awareness rate of comorbidities needs improvement,emphasizing the importance of a multidisciplinary approach to the diagnosis and treatment of OSA.
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Objective To investigate the effects of different doses of diphtheria toxin on cochlear structure and auditory function of adult wildtype mice.Methods The auditory-mature wild type C57BL/6J mice 4 weeks old were randomly devided into 50 ng/g group, 100 ng/g group and control group.C57BL/6J mice in the 50 ng/g or 100 ng/g group were injected 50 ng/g or 100 ng/g diphtheria toxin intraperitoneally for one time, respectively, and the control mice were injected equal volume of normal saline for one time.Then we investigated the ABR threshold change and morphological change of inner and outer hair cell and spiral ganglion neuron 7 days after the injection.Results At 7 day post diphtheria toxin injection compared with those of in control group, in the 50 ng/g group, there was no threshold elevation across frequencies(8 kHz ABR threshold was 20.0±3.78 and 20.83±2.04 dB SPL for 50 ng/g and control respectively), and no loss of inner and outer hair cells (for both groups, the HC loss rates were 0.3%~1%) or SGN (the SGN density was 39.45±3.65, 41.03±3.73/105 μm2, in 50 ng/g and control, respectively).However, the 100 ng/g group, compared with those of in control group, the ABR threshold (8 kHz ABR threshold was 63.0±4.47 dB SPL, respectively)was significantly elevated across each frequency(t=19.62,P<0.001), and there was significant loss of outer hair cell (the loss rate of IHC and OHC was 0.5%±0.1%, 10.7%±0.3%, respectively), which was 10% loss in the apical, middle and basal turn(t=42.219,P<0.001).And the loss of spiral ganglion neuron (the SGN density was 25.55±3.66/105 μm2) was 38%, which was significantly different from the control(t=10.985,P<0.001).Conclusion High dose injection of diphtheria toxin can cause loss of outer hair cell and spiral ganglion neuron in wild type auditory-mature C57BL/6J mice.
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Objective To establish an auditory evoked potential (AEP) detection system in zerbafish.Methods The AEP detection tank was designed and made, and then verified for its quality and reliability via four experiments: anesthesia experiment, swim bladder deflation, noise exposure and goldfish AEP test.Finally, zebrafish (total length form 10 mm to 46 mm) were determined using this system for AEP.Zebrafish randomly were divided into five groups according to total length (TL=12~15 mm, n=6;TL=17~20 mm,n=4;TL=22~26 mm, n=4;TL=32~37 mm, n=9;and TL=42~46 mm,n=12).Goldfish, as control group, were purchased for local petshop (TL=38~54 mm,n=8).Results The results of these four verifying experiments confirmed the biological, rather than artefactual, nature of the responses represented by the recorded waveforms.The AEPs were detected up to a much higher frequency limit (12 kHz) than previously reported.In this study, all fish demonstrated a range of hearing frequency from 100 Hz to 12 kHz without frequency expansion during development.The best hearing was observed at 600 Hz~1 kHz.The mean values of the frequency-averaged thresholds (mean SEM) were 141.7±1.32, 124.8±1.31, 121.8±1.49, 117.8 ±1.09 and 124.4±1.87 dB w, respectively, for the 5 TL groups.The AEP thresholds demonstrated both developmental improvement and age-related loss of hearing sensitivity.Conclusion An auditory evoked potential detection system of zerbafish has been established with stable performance and can be used for AEP detection of zebrafish.
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Objective To investigate the effects of the intellegent CO2 laser assisted Fisch stapedotomy with artificial stape prostheses in the treatment of otosclerosis.Methods A total of 28 patients with otosclerosis who had undergone the intellegent CO2 laser assisted Fisch stapedotomy with artificial stape prostheses were retrospectively e-valuated.The intellegent CO2 lasersare was used to vaporize stapedius tendon,posterior crus of stapes,and most importantly perforate stapes footplate.Bone and air conduction thresholds were determined at 0 .5 ,1 ,2 ,and 4 kHz preoperatively and 6 months postoperatively in all patients.Results No sustained vertigo or sensorineural hearing loss occurred postoperatively.There were no statistically significant differences between preoperative and postopera-tive average bone conduction thresholds.Preoperative and postoperative air bone gap were 30.38(23.13,39.38)dB HL,9.75(8.25,10)dB respectively and the postoperative results were significantly different from the preopera-tive.Conclusion The intellegent CO2 laser can be used safely in stapes footplate surgery and is well suited for trea-ting otosclerosis.
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OBJECTIVE@#To examine the value of self-treatment for Posterior canal benign paroxysmal positional vertigo (PC-BPPV). The treatment effect was compared between patients treated with modified Epley in outpatient clinic combined with self treatment at home and patients treated by modified Epley alone.@*METHOD@#A randomized controlled trial were carried out in the Department of Otolaryngology Head and Neck Surgery, the Affiliated Sixth People's Hospital of Shanghai Jiao Tong University from December 2012 to May 2013. 147 out of 150 patients with unilateral idiopathic BPPV-PSC were enrolled in follow-up. Among which, 73 patients were allocated in modified Epley-alone group and 74 were allocated in slef-treatment group.@*RESULT@#The success rate was 53.4% in modified Epley-alone group vs 83.8% in self-treatment group (P 0.05), the risk rate was 0.752, 95% CI (0.486 - 1.163). In the self-treatment group, the success rate of hand repositioning group and chair-assisted repositioning group was 87.5% vs 81.0% (P > 0.05), the risk rate was 1.081, 95% CI (0.888-1.316). Incidence rate of serious complications was 0% in the modified Epley-alone group and 1.3% in the self-treatment group (P > 0.05).@*CONCLUSION@#Complementary self-treatment with modified Epley maneuver treated PC-BPPV sooner and more effectively, Compared with modified Epley maneuver alone. And its incidence rate of serious complications didn't increase. Chair-assisted repositioning showed better result than hand repositioning alone, and self-treatment at home can reduce the effect of the gap. We found that complementary self-treatment with modified Epley maneuver had more benefits for patients with PC-BPPV.
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Aged , Female , Humans , Male , Middle Aged , Benign Paroxysmal Positional Vertigo , Therapeutics , Follow-Up Studies , Patient Positioning , Methods , Self Care , Treatment OutcomeABSTRACT
OBJECTIVE@#To study the experience of clinical features and treatment of deep cervical necrotizing fasciitis.@*METHOD@#All 29 cases of cervical necrotizing fasciitis patients were diagnosed by CT, 12 cases underwent tracheostomies, lateral neck incisions and drainage operations, the other 17 patients underwent lateral neck incisions and drainage operations. Sequently washing, dressing changes and anti infection treatments were taken.@*RESULT@#Twenty-eight cases were cured, 1 cases died. During a follow-up of half a year,no relapse.@*CONCLUSION@#When patient was sufferd the cervical necrotizing fasciitis, surgical operation for exploration should be taken as soon as possible,and incision and drainage in the treatment of cervical abscess would obtain a satisfactory curative effect, which would prevent serious complications.
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Adult , Aged , Female , Humans , Male , Middle Aged , Fasciitis, Necrotizing , Diagnosis , General Surgery , NeckABSTRACT
OBJECTIVE@#The harvesting procedures on cadaver heads and a radioanatomic study of measuring dimensions of skull base by endoscopic endonasal approach were performed. The measurements could do help to design the nasoseptal mucoperiosteum and improve the rate of repair success.@*METHOD@#The surgical procedures were demonstrated on cadaver heads specimens. Then 20 adult CT scans of sinus and skull base were calculated by workstations. The dimensions of three different skull base (the defect of anterior skull base/cribriform plate approach, sellar region/planum sphenoidale region and clivus region) of maximum areas, length and width, were measured. And with these data the nasoseptal flap were designed for providing enough area to cover the defect. The distance from the projection of sphenopalatine foramen to related area of skull base were plused for obtaining desired the length of nasoseptal flap.@*RESULT@#The mean length from the projection of sphenopalatine to the anterior skull base, planum/sella area and clivus were 49.56 mm, 57.47 and 67.19 mm, respectively. The means of areas of anterior dural defect, transsellar defect and panclivectomy were 16.13 cm2, 14.03 cm2 and 13.12 cm2, respectively. The average length of the nasoseptal flap ranged between 64.71-65.93 mm, the width ranged between 28.57-30.95 mm with an average area of 22.95 cm2.@*CONCLUSION@#One side of nasal septal flap can provide enough area to reconstruct the anterior skull base and planum/sella area. In some cases, the flap can not completely cover the area of clivus region because of the limitation of its length.
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Adult , Humans , Endoscopy , Methods , Nasal Septum , Diagnostic Imaging , Transplantation , Skull Base , Diagnostic Imaging , General Surgery , Surgical Flaps , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE@#The role of different local flaps in small external nasal skin defect reconstruction was discussed.@*METHOD@#Forty-two cases of the small size nasal defects (diameter < 2 cm) were repaired with local external nose flap (includes the dorsal nasal flap, nasolabial flap and bilobed flap). The clinical and follow-up data were analyzed of patients with small external nasal skin defects, who accepted different local flaps reconstruction. Dorsal nasal flap, nasolabial flaps (includes island flap, slid flap and axial flap) and bilobed flap were tailored to reconstruct different external nasal defect. Twenty-seven patients were male and fifteen patients were female, the patients' age ranged from 28 to 74 years, the median age was 61 years. Thirty-eight cases resulted from resection of skin malignant tumor and four cases were benign lesions. The diameter of defects was 1-2 cm. The defects were reconstructed by single-stage dorsal nasal flap in 7 cases. There were 30 cases of caudolateral nasal defects were reconstructed by nasolabial flap, single-stage island nasolabial flap in 7 cases, axial flap in 18 cases and slid flap in 5 cases. Superior lateral defects were reconstructed by single-stage bilobed flap in 5 cases.@*RESULT@#All defects were repaired successfully. All tissue flaps survived and had not necrosis. There was no tumor recurrence during 3 months to 2 years follow-up.@*CONCLUSION@#The dorsal nasal flap, nasolabial flap and bilobed flap can be used safely and effectively to repair the small external nasal defect and have satisfactory curative effect.
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Adult , Aged , Female , Humans , Male , Middle Aged , Dermatologic Surgical Procedures , Methods , Face , Pathology , General Surgery , Nose , Pathology , General Surgery , Plastic Surgery Procedures , Methods , Skin , Pathology , Surgical FlapsABSTRACT
This paper demonstrates a 3D rotatory chair and the development of control rotatory system based on PLC, corresponding software and user interface. The PLC-based three-dimensional rotatory chair has the advantage of maneuverability and stability according to the result of the experiment.
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Equipment Design , Labyrinth Diseases , Rehabilitation , Rehabilitation , Software , User-Computer InterfaceABSTRACT
OBJECTIVE@#To explore the significance of MR and endoscopy in the postoperative management of skull base reconstruction with a vascular pedicle nasoseptal mucoperiosteal flap.@*METHOD@#The immediate, and delayed postoperative MR imaging scans and endoscopic data of 8 patients who underwent endonasal endoscopic reconstruction of skull base dural defects with a vascular pedicle nasoseptal mucoperiosteal flap were retrospectively studied. Among the 8 patients, 7 cases have integrated immediate, delayed postoperative MR and synchronous endoscopic data which were harvest at the first week and at a 3- to 7-month interval respectively. One case was followed up by CT and endoscopy. The intracranial parenchymal changes, local situation of skull base defect site, the septal flap, healing of flap donor site and the transition of naso sinus mucosa were fully evaluated to explore the healing process and to improve the success rate of the reconstruction.@*RESULT@#We can obtain the key postoperative information of intracranial and the skull base reconstruction site with MR and endoscopy. The MR can exclude the intracranial complications such as postoperative intracranial hematoma, cerebral edema, or pneumocephalus, and clearly show the location and extent of skull base defects, the position of the flap, the overlapping manner between the dural defect margin and the flap and the postoperative cerebrospinal fistula. In immediate and postoperative follow-up with MR, the septal flap had homogeneous enhanced image with a roughly "C" figure under the skull base, indicating stable blood supplement. The synchronous endoscopic examination also proved the survival of the septal flaps in 7 cases , the cerebrospinal fluid leakage in 1 case. One case flap necrosis. The septal flaps presented edema and congested in the immediate postoperative endoscopy, and returned to normal in the delayed examination. The non-vascular materials such as gelatin sponge and fat tissue had the different characteristics signal. Nasal mucosal edema and sinus ventilation continually recovered during the follow up and the exposed septal cartilage on the donor site resurfaced by mucosa in 2 months.@*CONCLUSION@#MR and endoscopy could provide the critical postoperative information about the vascular pedicle septal flap reconstruction. MR combined with endoscopy not only could rule out the complications, but also could gain the information such as the position, blood supply and healing of the flap, at the same time detected the cerebrospinal fluid leakage to provide accurate information for the secondary stage reconstruction. The information got from MR and endoscopy were important for the surgeon and the radiologist to recognize the flap and to evaluate for variations that may suggest potential flap failure.
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Adult , Humans , Male , Middle Aged , Cerebrospinal Fluid Rhinorrhea , Endoscopy , Magnetic Resonance Spectroscopy , Nasal Mucosa , Transplantation , Nasal Septum , Periosteum , Transplantation , Postoperative Period , Plastic Surgery Procedures , Methods , Retrospective Studies , Skull Base , General Surgery , Surgical FlapsABSTRACT
Nasopharyngeal cancer is a low differentiated squamous cell carcinoma, and the radiation therapy is the primary choice. It's 5 year survival rate may reach 64.4%, while 10.0% cases may suffer from the local recurrence. The salvage radiation or surgery is still the main choice for recurrent cases now. However the recurrent tumor become radiation insensitive and meanwhile, morbidity and mortality become higher. The experience of open salvage surgery on the recurrent radiation insensitive tumor had been proved safely, and the related morbidity and mortality are acceptable. Recently, the endoscopic salvage surgery has been developed, some preliminary experience has been obtained and the result looks promising. In this article, the pathobiological characteristics of the postradiation local recurrent nasopharyngeal cancer, the anatomy of nasopharyngus and related skull base area, especially the petroclival region and current situation of endonasal endoscopic salvage surgery were reviewed here. Basic principle of oncological surgery that endoscopic surgery should followed and possible endoscopic surgical approaches were proposed.
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Humans , Carcinoma , Carcinoma, Squamous Cell , Radiotherapy , General Surgery , Endoscopy , Nasopharyngeal Carcinoma , Nasopharyngeal Neoplasms , Radiotherapy , General Surgery , Neoplasm Recurrence, Local , Radiotherapy , General Surgery , Radiation Tolerance , Salvage Therapy , Methods , Skull Base , Survival RateABSTRACT
OBJECTIVE@#To discuss the role of forehead flap in large external nasal defect reconstruction.@*METHOD@#We retrospectively reviewed the clinical and follow-up data of 11 patients with large or full-thickness external nasal defects, which were reconstructed with single-or two-stage interpolated or island forehead flaps from January 2007 to June 2011. All patients were male,defects of 9 cases were resulted from resection of skin malignant tumor and traumatic defect in 2 cases. The average diameter of defects was 3.3 cm (2.5-5.0 cm). Four cases had alar full thickness defect. The supratrochlear and angular artery of the elders (>70 yrs) and patients with suspicious peripheral blood vessel lesions were scanned before the surgery by Doppler ultrasonic. The defects were reconstructed by two-stage interpolated flap in 7 cases; five cases were reconstructed by single-stage island flap technique. A nasolabial flap based on piriform aperture was turned into the nasal cavity to reconstruct the lining.@*RESULT@#All defects were repaired successfully. All tissue flap survived and the scar was not conspicuous. One patient had nostril stenosis with mild nasal congestion complain at the 6th postoperative month.@*CONCLUSION@#The forehead flap, interpolated or island, can be used safely and effectively to repair the large external nasal defect in experienced hands.
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Adult , Aged , Aged, 80 and over , Humans , Male , Middle Aged , Young Adult , Forehead , General Surgery , Nose , Pathology , General Surgery , Plastic Surgery Procedures , Methods , Retrospective Studies , Skin Transplantation , Surgical FlapsABSTRACT
OBJECTIVE@#To explore the use of transnasal endoscopy and open surgical approaches for management of sinonasal and adjacent skull base benign fibro-osseous lesions, the surgical methods, precautions, clinical efficacies were also described.@*METHOD@#Fifteen patients were reviewed, including osteoma in 6 cases, Ossifying fibroma in 2 cases and fibrous dysplasia in 7 cases. Analyzed the pathological features and CT images, and to select surgical approach according to the location and extent of lesions. Eleven patients were operated through transnasal endoscopic procedure, including 7 cases with ipsilateral nasal approach and 4 cases with extended binasal approach; 4 cases with open surgical approach, including trans-eyebrow approach in 1 case and bicoronal approach in 3 cases.@*RESULT@#All patients were followed up for 2 months to 4 years, gross resection of lesions in 10 cases but partial resection in 5 cases with fibrous dysplasia. The clinical symptoms and facial deformity in all cases were eliminated or significantly relieved postoperatively. Cerebrospinal fluid leakage occurred in 1 case, was successfully repaired during the endoscopic operation. Preoperative diplopia in 3 cases, 2 cases disappeared after six months, one case was improved significantly. There were no postoperative orbital or intracranial complications.@*CONCLUSION@#Surgery is an effective means to resect lesions which had obviously clinical symptoms. The location and extent of lesions were the decisive factor to choose an open or endoscopic approach. Endoscopic sinus surgery can manage the midline skull base lesions which extend from the posterior wall of the frontal sinus to the clivus, well the open surgical approach is suitable for lesions locating the area beyond the medial orbital wall. No matter choosing which approach, osteoma, ossifying fibroma can be completely removed. For the fibrous dysplasia, as an extensive but self-limiting lesion, the surgery is performed only for relieving symptoms and facial deformity. So the partial resection is preferred and reasonable other than radical total resection. Even the severe fibrous dysplasia lesions caused the optic canal stenosis but present normal vision, it is unnecessary to perform prophylactic decompression of the optic nerve.
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Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Endoscopy , Fibroma, Ossifying , Pathology , General Surgery , Osteoma , General Surgery , Paranasal Sinuses , Pathology , Skull Base , PathologyABSTRACT
OBJECTIVE@#To investigate lesion size caused by channel radiofrequency volumetric reduction of porcine tongue base in vitro using the technique of three-dimensional reconstruction. And to evaluate safety about channel radiofrequency volumetric reduction of tongue base.@*METHOD@#Eighteen fresh porcine tongues were randomly separated into six groups,and each group had three ones. The tongue bases were designed six points according to description of Powell. Tongues base were acted on 10 s and 6 level by Coblation radiofrequency system and were cut into serial freezing histological sections. These segments were sectioned at 20 microm on the injury lesion and stained with H & E. Collected 2D digital imagine of order histological sections, drawn and cut apart part of the lesion of these sections. Images were processed IPS and were taken three-dimensional reconstruction and statistics analyzes with SPSS10.0.@*RESULT@#The mean value of tongue base lesion volumes among points was (359.5 +/- 5.6) mm3, (364.3 +/- 7.0) mm, (363.7 +/- 7.2) mm3, (354.1 +/- 11.8) mm3, (349.4 +/- 17.2) mm3, (353.5 +/- 7.9) mm3 separately. Statistic analysis by one-way ANOVA showed that there was a insignificant difference between the groups (P>0.05).@*CONCLUSION@#These results demonstrated no significant effect lesion size in channel radiofrequency volumetric reduction in the different points of the tongue base. These data also indicated that coblation radiofrequency system is a safe method for obstructive sleep apnea hypopnea syndrome.
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Animals , Catheter Ablation , Methods , In Vitro Techniques , Sleep Apnea, Obstructive , General Surgery , Surgery, Computer-Assisted , Swine , Tongue , Wounds and Injuries , General Surgery , Treatment OutcomeABSTRACT
OBJECTIVE@#To investigate the methodology and efficacy of endoscopic sphenopalatine artery diathermy in management of refractory epistaxis.@*METHOD@#Twenty patients with severe intractable posterior epistaxis, who had underwent various procedures like nasal packing, electro- or chemical cautery or others and still exacerbated, were subjected to this study. Under general anesthesia, according to the endoscopic anatomy of the sphenopalatine foramen, the sphenopalatine artery was identified under the posterior tip of the middle turbinate. After the pedicle of the artery was delineated, a bipolar cauterized the artery and transected it.@*RESULT@#Twenty patients have been followed up for 5 to 20 months with an average of 10 months. No patients suffered recurrent epistaxis during the period. Only 1 patients in this series reported minor nasal adhesion.@*CONCLUSION@#Diathermy of sphenopalatine artery, as a purely endonasal procedure, is an effective and microinvasive means of achieving long-term control of refractory epistaxis. It has few complications associated with other forms of arterial ligation.
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Adult , Aged , Female , Humans , Male , Middle Aged , Diathermy , Methods , Endoscopy , Epistaxis , General Surgery , Maxillary Artery , General Surgery , Treatment OutcomeABSTRACT
OBJECTIVE@#To compare the levels of the fasting blood glucose (FBG) and blood fat of the patients with obstructive sleep apnea hypopnea syndrome (OSAHS) before and after surgery, meanwhile to analyze the influence on blood glucose and blood fat after the changes of body mass index (BMI), apnea-hypopnea index (AHI) and lowest oxygen saturation (LSpO2).@*METHOD@#Thirty-one patients with severe OSAHS were performed Z-palatoplasty (ZPP) or ZPP combined with genioglossus advancement with hyoid suspension (GAHM). Cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL) and FBG were detected before and after surgery.@*RESULT@#Preoperative HDL was negatively related to BMI and AHI, but not LSpO2. After surgery the BMI, AHI, LSpO2, HDL and FBG were all improved. The change of HDL had correlation with the changes of BMI and AHI, and there was linear correlation with HDL and BMI (r= -0.36).@*CONCLUSION@#The surgery of ZPP and ZPP combined with GAHM can improve the AHI, LSpO2, BMI, the FBG and blood fat of the patients with OSAHS. Lose weight and rectifying sleep disordered breathing were important to improve glycolipid metabolism disorder of the patients with OSAHS.
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Adult , Female , Humans , Male , Middle Aged , Blood Glucose , Metabolism , Body Mass Index , Lipids , Blood , Obesity , Blood , General Surgery , Sleep Apnea, Obstructive , Blood , General SurgeryABSTRACT
Objective:To investigate lesion size caused by channel radiofrequency volumetric reduction of por-cine tongue base in vitro using the technique of three-dimensional reconstruction. And to evaluate safety about channel radiofrequency volumetric reduction of tongue base. Method: Eighteen fresh porcine tongues were randomly separated into six groups,and each group had three ones. The tongue bases were designed six points according to description of Powell. Tongues base were acted on 10 s and 6 level by Coblation radiofrequency system and were cut into serial freezing histological sections. These segments were sectioned at 20 μm on the injury lesion and stained with H & E. Collected 2D digital imagine of order histological sections, drawn and cut apart part of the le-sion of these sections. Images were procesed IPS and were taken three-dimensional reconstruction and statistics an-alyzes with SPSS10. 0. Result: The mean value of tongue base lesion volumes among points was (359. 5± 5. 6)mm~3 ,(364. 3±7. 0)mm~3 ,(363. 7±7. 2)mm~3, (354. 1±11. 8)mm~3, (349. 4±17. 2)mm~3 ,(353. 5±7. 9)mm~3 separately. Statistic analysis by one-way ANOVA showed that there was a insignificant difference between the groups(P>0. 05). Conclusion:These results demonstrated no significant effect lesion size in channel radiofrequency volumetric reduction in the different points of the tongue base. These data also indicated that coblation radiofre-quency system is a safe method for obstructive sleep apnea hypopnea syndrome.
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OBJECTIVE@#To explore the significance of the lacrimal bone at the lateral nasal wall in endoscopic dacryocystorhinostomy.@*METHOD@#The position, dimension and thickness of the exposed lacrimal bone at the lateral nasal wall in 10 cadaveric heads(male 5, female 5) were examined and the anatomy of uncinate process, the maxillary line and M point were studied, too.@*RESULT@#The lacrimal bone at the lateral nasal wall is always situated immediately anterior to the uncinate process. The average length and width of the lacrimal bone was 9.23 mm and 3.63 mm, respectively. The lacrimal bone was very thin with an average thickness of 0.06 mm.@*CONCLUSION@#The study indicates that the lacrimal bone is so thin that a bony rongeur is usually sufficient to nibble it away. The medial wall of the sac is then removed without the use of drill or chisel with less operative trauma. The uncinate process, the maxillary line and M point are reliable landmarks in endoscopic dacryocystorhinostomy.
Subject(s)
Adult , Female , Humans , Male , Dacryocystorhinostomy , Nasal Bone , General Surgery , Orbit , General SurgeryABSTRACT
Objective:To evaluate the difference of vestibular compensation between triple semicircular canal occlusion(TCO) and labyrinthectomy(LE)in guinea pigs.Material and Methods:TCO was performed on 8 guinea pigs,while LE was did on 7 guinea pigs.Behavior and ENG were recorded in detail preoperatively and repeatedly up to one month postoperatively according to the experiment design.Results:There was spontaneous nystagmus towards the nonoperated side on the first postoperative day and nystagmus absence during sinusoidal angular acceleration stimuli on the operated side was observed in all the animals.All the animals displayed head tilt towards the operated side (right)and an unsteady gait towards the right along the vertical axis after surgery,while the animals performed LE rolled towards the operated side.On the 3rd postoperative day,faint nystagmus appeared on the operated side,but the left and right nystagmus was significantly asymmetrical.The left and right nystagmus still remained asymmetrical on the 5th and 10th day postoperatively.From the 15th postoperative day,left and right nystagmus returned symmetrical in the animals performed TCO,while left and right nystagmus returned symmetrical only at the pendular amplitude of 120°,150°,180°,in the animals performed LE up to 30th postoperative day.There was a significant reduction of nystagmus to the operated side at the Pendular amplitude of 60°and 90° one month after the LE and there was 3 animals still displayed head tilt towards the operated side.Conclusion: the animals compensated faster and more completely after TCO than LE.