Complications analysis of adenoidectomy assisted with ablation under nasal endoscope / 中国医师进修杂志

Objective To analyze the complications of adenoidectomy assisted with ablation under nasal endoscope. Method Two hundred and seventy-two cases of adenoidectomy assisted with ablation under nasal endoscope from April 2014 to April 2018 were retrospectively studied. The type, number, causes and processing methods of postoperative complications were analyzed. Results There were 67 cases (24.63％) with atlantoaxial rotatory deformity, 27 cases (9.93％) with fever, 11 cases (4.04％) with headache, 4 cases (1.47％) with postoperative recurrence, and 1 case (0.37％) with secondary postoperative haemorrhage. Conclusions The technology of adenoidectomy assisted with ablation under nasal endoscope is an efficient and minimally invasive method with less complications in the treatment of children adenoidectomy diseases. Atlantoaxial rotatory deformity is a common postoperative complication which is easy to be ignored by clinical doctors. The prognosis is good, after given a positive symptomatic treatment.

The tolerance of contemporaneous multiplane operations in obstructive sleep apnea-hypopnea ;syndrome / 中国医师进修杂志

Objective To observe the tolerance of contemporaneous multiplane operations in obstructive sleep apnea-hypopnea syndrome(OSAHS). Methods Twenty-three patients were enrolled. According to the different obstructive level, the different operations were chosen to complete upper airway reconstruction in contemporaneous operation group (group A, 13 patients). In the simple palatopharynx level obstructive group (group B, 10 patients), bilateral tonsillectomy and H-UPPP was chosen. Results The operation time in group A was significantly longer than that in group B:(121.0 ± 35.4) min vs.(80.7 ± 25.3) min, P0.05). Conclusions Individual therapeutic schedule for OSAHS patients should be formulated. Operating the different obstructive levels simutaneously, which would solve upper airway occlusion and complete the upper airway reconstruction at the same time. No more adverse events happen, compared with the simple palatopharynx level obstructive group, though the operation time may be longer.

Congenital preauricular fistula infection: a histopathology observation / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the pathology characteristics of congenital preauricular fistula with infection, in order to reduce the recurrence rate after surgery and improve operative technique.@*METHOD@#Twenty-five patients diagnosed as congenital preauricular fistula with infection were analyzed. There were 14 patients in infection history group, 9 in infective stage group, and 2 in recurrence group respectively. The whole piece of fistula and scar tissue was completely excised during operation. The specimens were observed by naked eye and serial tissue sections were analyzed.@*RESULT@#(1) Macroscopically, in infection history group, initial morphology can be maintained near the fistula orifice, but the distal tissue was dark red scar tissue. In infective stage group, the distal tissue of the specimens was granulation tissue and cicatricial tissue. The granulation tissue was crisp and bright red. In recurrence group, multicystic lesions with severe edema was observed, with a classical dumb-bell appearence. (2) Microscopically, in infection history group and recurrence group, we can see that the distal fistula tissue was discontinuous and was separated by scar tissue. In infective stage group, we can find neo-angiogenesis and infiltration of plasma cells, lymphocytes, neutrophil between interrupted fistula tissues. (3) All patients were followed up for 6-12 month, without recurrence.@*CONCLUSION@#The fistula tissue of congenital preauricular fistula with infection was divided by the scar tissue, and they did not communicate with each other. Complete delineation of fistula is hardly achieved by methylene blue staining. Radical excision of the fistula and scar tissue may help to avoid leaving viable squamous epithelial remnants and reduce the recurrence rate.

The influence of nasal continuous positive airway pressure therapy on tumor necrosis factor-α and interleukin-6 in patients with chronic heart failure and severe obstructive sleep apnea syndrome / 中国医师进修杂志

Objective To investigate the influence of nasal continuous positive airway pressure (nCPAP) therapy on tumor necrosis factor-ot (TNF-α) and interleukin-6 (IL-6) in patients with chronic heart failure (CHF) and severe obstructive sleep apnea syndrome (OSAS).Methods Seventy-two cases with CHF and severe OSAS were divided into treatment group (36 cases) and control group (36 cases) by random digits table.Treatment group was treated by nCPAP and routine drug while control group only by routine drug treatment for 12 weeks.The changes of TNF-α and IL-6 before and after therapy were observed.Results The serum TNF-αt and IL-6 before treatment between two groups was no significant difference (P＞ 0.05).The serum TNF-αt and IL-6 after 12 weeks treatment in both two groups was significantly lower than that before treatment [treatment group:(29.94 ± 8.27) ng/L vs.(13.17 ± 3.61) ng/L,(92.08 ± 11.88) ng/L vs.(46.17 ± 20.01) ng/L;control group:(28.01 ± 7.21) ng/L vs.(22.13 ± 5.43) ng/L,(96.01 ± 12.19) ng/L vs.(68.66 ± 11.10) ng/L] (P ＜ 0.05),the treatment group decreased more significantly (P ＜ 0.05).Conclusion nCPAP therapy could effectively decrease the levels of TNF-α and IL-6 and reduce inflammation response in patients with CHF and severe OSAS.

Effect of nasal continuous positive airway pressure on patients with chronic heart failure due to hypertensive heart disease complicated with severe obstructive sleep apnea hypopnea syndrome / 中国医师进修杂志

Objective To investigate the clinical efficiency of nasal continuous positive airway pressure (nCPAP) on patients with chronic heart failure(CHF) due to hypertensive heart disease complicated with severe obstructive sleep apnea hypopnea syndrome (OSAHS).Methods Fifty cases with CHF due to hypertensive heart disease complicated with severe OSAHS were divided into treatment group and control group with 25 cases each by the method of random digits table.nCPAP and routine drug treatment were administered in treatment group,while only routine drug treatment was given in control group.Cardiac functional grading,blood pressure,left ventricular end diastolic dimension (LVDd),left ventricular ejection fraction (LVEF),B-type natriuretic peptide (BNP),high-sensitivity C-reactive protein (hs-CRP) were compared before and after 3-month therapy.Results The effective rate in treatment group was significantly higher than that in control group [76.00％(19/25) vs.40.00％(10/25)],and there was significant difference (P ＜0.05).There was significantly decreased in blood pressure in two groups at the end of the therapy [treatment group:(127.52 ± 10.38)/(72.44 ±4.92) mmHg(1 mmHg =0.133 kPa) vs.(176.80 ± 12.90)/ (100.44 ±5.55) mmHg;control group:(150.12 ± 18.96)/ (81.64 ±9.42) mmHg vs.(176.00 ± 11.69)/ (96.08 ± 18.59) mmHg] (P ＜ 0.01),but the blood pressure was significantly lower in treatment group than that in control group (P ＜0.05).LVDd,BNP and hs-CRP in treatment group was declined significantly [(49.12 ± 3.18) mm vs.(57.44 ± 3.62) mm,525.52 ng/L vs.785.25 ng/L,(7.76 ± 1.69) mg/L vs.(18.04 ± 2.58) mg/L](P＜ 0.01);LVEF was significantly increased [(46.12 ± 2.52)％ vs.(38.68 ± 4.65)％](P＜ 0.01).There was no significant difference in LVDd and LVEF in control group before and after therapy (P ＞ 0.05).BNP and hs-CRP also were declined significantly [668.66 ng/L vs.850.96 ng/L,(12.88 ± 2.02) mg/L vs.(19.40 ± 2.30) mg/L] (P ＜ 0.05 or ＜ 0.01),but the above two were significantly lower in treatment group than those in control group(P ＜ 0.05).Conclusion nCPAP therapy can effectively improve the symptoms of heart failure,decrease blood pressure,improve cardiac function,reduce the inflammation response to patients with CHF due to hypertensive heart disease complicated with severe OSAHS.

The investigation of prognostic factors of 137 patients with sudden hearing loss / 中国医师进修杂志

Objective To investigate the prognosis correlation factors of sudden hearing loss.Methods A retrospective analysis was performed in 137 cases (149 ears) of sudden hearing loss.The relationships between the age,prehospital delay time,type of hearing loss,degree of hearing loss,and whether with dizziness,tinnitus,diabetes mellitus,high blood pressure and therapeutic effect were observed.Results The total effective rates in ＜ 45 years,45-59 years and ＞ 59 years patients were 86.36％(38/44),77.78％ (56/72) and 57.58％ (19/33) respectively.There were statistical differences in the total effective rate between ＜ 45 years,45-59 years patients and ＞ 59 years patients (x2 =8.128,P =0.004; x2 =4.525,P =0.033).The total effective rates in patients who were treated ≤7 d,8-14 d and ≥ 15 d were 83.52％ (76/91),76.67％(23/30) and 50.00％(14/28) respectively.There were statistical differences in the total effective rate between patients who treated ≤7 d,8-14 d and patients who were treated ≥ 15 d (x2 =13.050,P =0.000; x2 =4.459,P =0.035).The total effective rates in low-mid frequency type,all frequency type,total deafness type and mid-high frequency type were 89.66％ (52/58),84.44％ (38/45),7/12,47.06％ (16/34) respectively.There were statistical differences in the total effective rate between low-mid frequency,all frequency type and total deafness type,mid-high frequency type (P ＜ 0.05).The total effective rates in hearing loss mild degree,middle degree,severe degree,extremely severe degree and total deafness were 87.23％ (41/47),86.11％ (31/36),61.90％ (13/21),7/15 respectively.There were statistical differences in the total effective rate between mild degree,middle degree and severe degree,extremely severe degree and total deafness (P ＜ 0.05).The hearing loss prognosis with the dizziness,diabetes mellitus,high blood pressure was worse.Conclusions It is considered that the age,prehospital delay time,type of hearing loss,degree of hearing loss,and whether with dizziness,high blood pressure,diabetes mellitus are related to the total effective rate.The prognosis of hearing loss can be estimated according to these correlation factors.