The eosinophilic otitis media(EOM) is an intractable disease characterized by the presence of a highly viscous yellow effusion with extensive accumulation of eosinophils in the middle ear; granulation tissue can been discovered in the middle ear cavity; most of patients have association with bronchial asthma; resist to conventional treatment for otitis media; EOM patients show gradual deterioration of hearing and sometimes become deaf suddenly; effective treatment involves use of topical and oral steroids. This article summarizes the progress of the EOM's diagnosis and treatment.
Asthma ; complications ; Ear, Middle ; physiopathology ; Eosinophilia ; pathology ; Eosinophils ; Hearing Loss ; complications ; Humans ; Otitis Media ; pathology

Objective To study the effects of treating limbs pain of patients with depression after cerebral apoplexy with self-designed hemiparalysis-washing formula.Methods 80 patients with limbs pain after cerebral apoplexy in our hospital from May 2013 to November 2013 were recruited into a control group and a treatment group randomly,40 patients in each group.The control group was treated with 30mg edamvone and 100ml 0.9％ sodium chloride or 0.5％ glucose injection,Ⅳ in 30min,and twice daily.Meanwhile,regular functional rehabilitation training was adopted for the patients.The treatment group was additional treated with self-designed hemiparalysis-washing formula on the basis of the control group.VAS,HAMD-24,MESSS,STREAM and therapeutic effects were evaluated in both groups after one month treatment.Results ① clinical therapeutic effects comparison:the total effective rate was 90％ and 70％ in the treatment group and the control group respectively,with statistical difference between the two groups (t=3.58,P＜ 0.01).② VAS,HAMD-24,MESSS,STREAM comparison:VAS,HAMD-24,MESSS,STREAM score was (2.28 ± 0.54)、(11.34 ± 3.02)、(13.49±4.27)、(44.76±20.71)in the treatment group respectively,and(2.90 ± 0.75) 、(14.24 ± 3.35)、(17.55 ±4.91) 、(34.56 ±15.56) in the control group respectively.Both groups showed obviously improvement than the before treatment,and the effects were better in the treatment group than the control group (all P＜0.05).Conclusion Self-designed hemiparalysis-washing formula improve limbs pain in patients with cerebral apoplexy and relieve their depression.

The vertebral artery dissection may be associated with the structural abnormalities of vascular wall or enviromental factors.The symptoms are usually caused by the luminal stenosis or the formation of blood clot,including the pain in posterior neck or mastoid region with local neurological deficits.The diagnostic methods for vertebral artery dissection include digital subtraction angiogaphy,magnetic resonance imaging,CT angiograpby and color Doppler ultrasonography.Anticoagulation is the main treatment option for most patients with vertebral artery dissection.

Objective　To study the effect of acute serious smoke inhalation injury to unilateral lung on contralateral lung and the therapeutic efficacy of massive bronchoscopic lavage with saline to the primary injured bronchoalveolus at early stage after smoke inhalation on mitigating the secondary damage of the other lung and so as to confirm the therapeutic validity of lung lavage to smoke inhalation injury. Methods　Fifteen mongrel dogs were insufflated with sawdust smoke into left lung and then randomized into 2 groups. The dogs in group A were maintained intravenous glucose saline transfusion and breathed air freely for 24 h after injury. Those in group B received a massive bronchoscopic lavage with 250 ml of saline to injured lung at 1 hour after injury and then were administrated similarly to those in group A. Gas exchange function of bilateral lungs in the process were observed and pathologic and phyiopathologic changes of the lung specimen were examined after the process. Results　While the total lavaging volume was kept to 250 ml, the liquid volume remained in left lung after each operating was from 90 ml to 140 ml. All animals had a significant decline in pulmonary function after smoke inhalation injury. PaO2 in group B decreased significantly soon after the lavage and then increased gradually to exceeding that in group A. The left lung showed serious edema similarly in two groups but in right lung the water content was less, dynamic and static compliance was more in group B than in group A. Conclusion　Bronchoalveolar massive lavage at early post-injury stage to injured lung after unilateral lung smoke inhalation injury can mitigate secondary damage of the non-injured lung. Lung lavage can decrease the intensity of secondary systemic inflammatory reaction and show a therapeutic validity to smoke inhalation injury.

Objective　To review the experience in the management of burned patients inflicted by inhalation injury in our institute in the past 42 years. Methods　Patients with inhalation injury were analyzed chronically in three different periods as 1958 to 1980, 1981 to 1990, and 1991 to 2000. Results　The mortality rates in general and in terms of different degrees decreased obviously with the elapse of time. In other words, the rates were 48.93%, 26.60% and 8.53 for the above three periods. Conclusion　The mortality of inhalation injury was decreased dramatically during the last decade in our institute. Five main measures consisting of inhalation of high concentration or pure oxygen, preventive tracheotomy, frequent tracheal lavage with small amount of lavage fluid at early stage of postburn, mechanical ventilation with PEEP and humidification as early as possible, and application of exogenous pulmonary surfactant contribute greatly to the decrement of death rate in the patients with inhalation injury.

ObjectiveTo investigate the clinical significance of transforming growth factor β1 (TGF-β1)and vascular endothelial growth factor (VEGF) expression in tissues of nasal inverted papilloma (NIP).MethodsThe clinical data of patients with NIP underwent surgical resection were retrospectively analyzed.The TGF-β1 and VEGF expression in NIP tissues and nasal polyps tissues were detected by immunohistochemistry method.100 patients with NIP were divided into benign lesions,atypical hyperplasia and malignant group according to result of pathological diagnosis,the nasal polyps was used as the control group.ResultsThe positive expression rate of TGF-β1 and VEGF in the NIP group were 46.0％ and 32.0％,compared with the control group the differences were significant(all P ＜ 0.05 ).In different pathological groups,the results of TGF-β1 and VEGF expression were malignant group ＞ atypical hyperplasia ＞ benign lesions.The positive expression rate of TGF-β1 and VEGF in the NIP group had significantly positive correlation(P ＜ 0.05).ConclusionThe TGF-β1 and VEGF expression were closely related to the the occurrence,development and malignant of NIP.TGF-β1 was highly expressed in the NIP tissues,and could increase the expression of VEGF and promote the formation of neovascularization of NIP.

Objective To investigate the pharmacodynamics of remifentanil required to prevent laryngeal mask airway (LMA) insertion response in patients anesthetized with propofol by TCI. Methods Thirty-six ASA Ⅰor Ⅱ patients aged 18-59 yr with body mass index ＜ 30 kg/m2 undergoing elective breast operation were enrolled in the study. Propofol was administered by TCI at an effect-site concentration of 4.0 μg/ml. When the patients lost conciousness, TCI of remifentanil was started. The initial target plasma concentration of remifentanil was set at 2.9 ng/ml, and the ratio of two consecutive effect-site concentrations was 1.2. LMA was inserted at 3 min after the target effect-site concentration and the plasma concentration achieved the balance. Criteria of successful insertion were defined as Muzi score≤2 and the increase in MAP and HR≤ 15% of the baseline values within 3 min after insertion. EC50 was determined by modified Dixon's up-and-down sequential trial and the 95 % confidence interval was calculated. Results The EC50 of remifentanil was 2.75 ng/ml. The 95% confidence interval was 2.51-3.01 ng/ml. Conclusion The EC50 of remifentanil for suppression of cardiovascular response to LMA insertion is 2.75 ng/ml in patients anesthetized with propofol by TCI.

Objective To approach the therapeutic effects and complication of combined induction chemo-therapy and hyperfraetionated radiotherapy for nasopharyngeal carcinoma.Methods Form January 2000 to November 2002,101 patients with nasopharyngeal carcinoma were treated by combined induction chemotherapy and hyperfrac-tionated radiotherapy.For hyperfraetionated radiotherapy,y-ray from 60 Co were performed and two daily fractions of 1.2Gy were given,with an interval of≥6 hours,5 days per week to a median dose of 7255cGy for nasopharynx and 7201cGy for neck.For induction chemotherapy,carboplatin and 5-fluorouraeil were transfused.Results The inci-denee rate of greater than or equal to the third grade acute mucositis was 24.8%.The complete remission rate after treatment was 83.2%.The 1,2 and 5 year survival rate was 90.1%,82.2%-and 57.4%.Conclusion With this treatment schedule,patient's tolerance and therapeutic effect is good.It provids a treatment means for nasopharyngeal carcinoma.But it must be validated by the large-scale clinical trials.

To investigate the CT findings of thoracic sarcoidosis and improve the understanding and diagnostic level of the disease. Retrospective analysis of the pathology or clinical treatment were observed in 20 patients with thoracic sarcoidosis accorded with the diagnostic standard of CT performance. There were 15 cases confirmed by pathology and 5 cases verified after clinical treatment. There were hilar or mediastinal lymph nodes in 90% cas-es, pulmonary mainly nodules in 60% case, pulmonary fibrosis in 20% cases, bronchovascular bundle thickening in 15%cases, pleural effusion in 10% cases, interlobular septal thickening in 15% cases, ground-glass opacity in 10% cases and pulmonary consolidation in 5% cases. CT findings of thoracic sarcoidosis may help improve the rate of its diagnosis.

Objective To observe the effects of Shenqi Fuzheng injection on peripheral blood T lymphocyte subsets, T-cell apoptosis and cytokine in patients with sepsis and approach their significance.Methods Forty patients with sepsis admitted into Department of General Surgery of the General Hospital of Tianjin Medical University were randomly divided into two groups: routine group (20 cases, received routine western medicine treatment) and Shenqi Fuzheng treatment group (20 cases, received routine western medicine treatment and intravenous drip of Shenqi Fuzheng injection 250 mL per day), 7 days as a course of treatment in both groups. On the 1st, 3rd and 7th day after treatment, evaluation of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores was carried out in the two groups. The percentages of peripheral blood T-lymphocyte subsets CD4+, CD8+, CD4+/CD8+ and apoptosis were measured by flow cytometry. Meanwhile, tumor necrosis factor-α (TNF-α), interleukins (IL-6 and IL-10) levels were detected by enzyme linked immunosorbent assay (ELISA).Results APACHE Ⅱ scores of two groups on the 3rd day were apparently decreased in comparison with those on the 1st day after treatment, and this situation persisted until the 7th day after treatment; meanwhile, the decrease in APACHE Ⅱ score in Shenqi Fuzheng treated group was more notable than that in routine group (10.05±3.71 vs. 13.15±4.65,P < 0.05). Along with the prolongation of time, in both groups, the peripheral blood TNF-α and IL-6 levels were gradually decreased; the IL-10 level was gradually increased, until the 7th day it began to decrease. On the 7th day, the TNF-α and IL-6 levels in Shenqi Fuzheng treated group were decreased more significantly than those in routine group [TNF-α (ng/L): 204.6±18.1 vs. 218.9±21.3, IL-6 (ng/L): 3.68±0.30 vs. 3.95±0.49, bothP < 0.05]. There was no significant difference between Shenqi Fuzheng treated group and routine group in the IL-10 level on the 7th day (ng/L: 173.8±23.3 vs. 174.8±18.9,P > 0.05). On the 1st, 3rd and 7th day after treatment, the percentage of CD4+ T cells and CD4+/CD8+ ratio were firstly fallen and then elevated up, the percentage of CD8+ T cells was gradually decreased, and the percentages of CD4+ and CD8+ apoptosis showed a trend of rise up first and then fall in the two groups. On the 7th day after treatment, there were significant differences between Shenqi Fuzheng treated group and routine group in terms of the percentage of CD4+, CD4+/CD8+ ratio and the rate of CD4+ apoptosis [CD4+ T cells: (38.3±4.7)% vs. (35.5±5.5)%, CD4+/CD8+: 1.55±0.29 vs. 1.36±0.27, CD4+ T apoptosis: (11.2±3.8)% vs. (14.1±5.5)%, allP < 0.05]. There were no statistically significant differences between routine group and Shenqi Fuzheng treated group in the percentages of CD8+ T cells and CD8+ apoptosis at each time point (allP > 0.05).Conclusion Shenqi Fuzheng injection can effectively reduce the percentage of CD4+ T cell apoptosis, increase the percentage of CD4+ T cells and CD4+/CD8+ ratio, lower the inflammatory factors, improve the immune function and disease severity in patients with sepsis.