Tonsillectomy and adenoidectomy (T& A) is a frequent surgical procedure in children with obstructive sleep apnea (OSA). Many symptomatic children who do not fulfill the currently recommended criteria for T& A ...Tonsillectomy and adenoidectomy (T& A) is a frequent surgical procedure in children with obstructive sleep apnea (OSA). Many symptomatic children who do not fulfill the currently recommended criteria for T& A may benefit from topical intranasal steroid therapy. However, the expression of glucocorticoid receptor (GCR) expression in adenoid and tonsillar tissue is currently unknown. The objective of this study was to assess and compare expression patterns of the human GCR in children who undergo T& A for either recurrent throat infections (RI) or OSA. Adenotonsillar tissues from 36 children with OSA or RI were subjected to quantitative PCR using specific primers for GCR-α and GCR-β and to immunohistochemistry and Western blotting for protein expression of GCR isoforms. mRNA encoding for expression of both GCR-α and GCR-β was detected in the tonsils and adenoids of all children, with markedly higher relative abundance of the GCR-α . Furthermore,GCR-α mRNA expression was increased in OSA-derived adenoid and tonsil tissues compared with RI, whereas no differences emerged for GCR-β . Immunoblots confirmed these findings for the protein transcripts of these genes, and immunohistochemistry showed a specific topographic pattern of distribution for both receptors in tonsillar tissue. GCR-α and GCR-β are expressed in pediatric adenotonsillar tissue, are more abundant in OSA patients, and demonstrate a specific topographic pattern of expression. These findings along with the high GCR-α :GCR-β ratio suggest a favorable profile for topical steroid therapy in snoring children with adenotonsillar hypertrophy.展开更多
目的 探讨儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopneasyndrome,OSAHS)患儿的治疗方法和疗效观察。方法 经多道睡眠监测(polysomnography,PSG)确诊的4-12岁OSAHS患儿59例:扁桃体切除和(或)经口内镜(内窥镜,下...目的 探讨儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopneasyndrome,OSAHS)患儿的治疗方法和疗效观察。方法 经多道睡眠监测(polysomnography,PSG)确诊的4-12岁OSAHS患儿59例:扁桃体切除和(或)经口内镜(内窥镜,下同)引导下腺样体刮除54例;选择长期正压通气治疗(continue positive airway pressure,CPAP)2例;保守治疗3例。采用儿童OSAHS生活质量调查表(quality of life for children with obstructive sleep apnea 18 items,OSA-18)对患儿进行治疗前后的随访。结果 围手术期无术后出血、急性呼吸道梗阻发生。随访12-18个月,手术患儿无鼻咽闭锁、咽鼓管功能障碍、腺样体残留等并发症;OSA-18调查评分显示:治疗后76.3％(45例)的患儿生活质量总体指标,88.1％(52例)的患儿睡眠呼吸障碍,67.8％(40例)的患儿身体症状得到显著改善。长期CPAP治疗的有效治疗压力在5.6-7.8 em H2O左右。3例保守治疗者略有改善。结论 手术切除引起上气道阻塞的肥大的扁桃体和(或)腺样体是儿童OSAHS有效的治疗手段之一,纤维鼻咽镜检查、头颅侧位X线摄片有助于手术适应证的确定。经口内镜引导下腺样体刮除术具有直视下操作,视野清晰,切除彻底,可避免损伤周围重要结构的特点。展开更多
0122775 电动辅助增殖腺切除术与增殖腺刮匙增殖腺切除术的比较/Stanislaw P Jr//Arch Otolaryngol Head Neck Surg.-2000,126(7).-845～849 西交图0122776 扁桃体切除术和增殖腺切除术对儿童行为的影响/Goldstein N A//ArchOtolaryngol...0122775 电动辅助增殖腺切除术与增殖腺刮匙增殖腺切除术的比较/Stanislaw P Jr//Arch Otolaryngol Head Neck Surg.-2000,126(7).-845～849 西交图0122776 扁桃体切除术和增殖腺切除术对儿童行为的影响/Goldstein N A//ArchOtolaryngol Head Surg.-2000,126(4).-494～498展开更多
9930707 扁桃体周下端脓肿/Licameli GR//Otolaryngol Head Neck Surg.-1998,118(1).-95～98 一军大9930708 工作室激光辅助悬雍垂腭成形术的短期效果分析/Astor F C//Otolaryn-gol Head Neck Surg.-1998,118(4).-478～480
Normal children have a smaller upper airway than adults, but, nevertheless, sn ore less and have less apnea. We have previously shown that normal children have an upper airway that is resistant to collapse during slee...Normal children have a smaller upper airway than adults, but, nevertheless, sn ore less and have less apnea. We have previously shown that normal children have an upper airway that is resistant to collapse during sleep. We hypothesized tha t this resistance to collapse is due to preservation of upper airway neuromotor responses during sleep. Furthermore, we hypothesized that upper airway responses would be diminished in children with the obstructive sleep apnea syndrome (OSAS ). We therefore compared the upper airway pressure-flow relationship during sle ep between children with OSAS and controls. Measurements were made by correlatin g maximal inspiratory airflow with the level of nasal pressure applied via a mas k. Neuromotor upper airway activationwas assessed by evaluating the upper airway response to 1) hypercapnia and 2) intermittent, acute negative pressure. We fou nd that children with OSAS had no significant response to either hypercapnia or negative pressure during sleep, compared with the normal children. After treatme nt of OSAS by tonsillectomy and adenoidectomy, there was a trend for normalizati on of upper airway responses. We conclude that upper airway dynamic responses ar e decreased in children with OSAS but recover after treatment. We speculate that the pharyngeal airway neuromotor responses present in normal children are a com pensatory response for a relatively narrow upper airway. Further, we speculate t hat this compensatory response is lacking in children with OSAS, most likely due to either habituation to chronic respiratory abnormalities during sleep or to m echanical damage to the upper airway.展开更多
文摘Tonsillectomy and adenoidectomy (T& A) is a frequent surgical procedure in children with obstructive sleep apnea (OSA). Many symptomatic children who do not fulfill the currently recommended criteria for T& A may benefit from topical intranasal steroid therapy. However, the expression of glucocorticoid receptor (GCR) expression in adenoid and tonsillar tissue is currently unknown. The objective of this study was to assess and compare expression patterns of the human GCR in children who undergo T& A for either recurrent throat infections (RI) or OSA. Adenotonsillar tissues from 36 children with OSA or RI were subjected to quantitative PCR using specific primers for GCR-α and GCR-β and to immunohistochemistry and Western blotting for protein expression of GCR isoforms. mRNA encoding for expression of both GCR-α and GCR-β was detected in the tonsils and adenoids of all children, with markedly higher relative abundance of the GCR-α . Furthermore,GCR-α mRNA expression was increased in OSA-derived adenoid and tonsil tissues compared with RI, whereas no differences emerged for GCR-β . Immunoblots confirmed these findings for the protein transcripts of these genes, and immunohistochemistry showed a specific topographic pattern of distribution for both receptors in tonsillar tissue. GCR-α and GCR-β are expressed in pediatric adenotonsillar tissue, are more abundant in OSA patients, and demonstrate a specific topographic pattern of expression. These findings along with the high GCR-α :GCR-β ratio suggest a favorable profile for topical steroid therapy in snoring children with adenotonsillar hypertrophy.
文摘目的 探讨儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopneasyndrome,OSAHS)患儿的治疗方法和疗效观察。方法 经多道睡眠监测(polysomnography,PSG)确诊的4-12岁OSAHS患儿59例:扁桃体切除和(或)经口内镜(内窥镜,下同)引导下腺样体刮除54例;选择长期正压通气治疗(continue positive airway pressure,CPAP)2例;保守治疗3例。采用儿童OSAHS生活质量调查表(quality of life for children with obstructive sleep apnea 18 items,OSA-18)对患儿进行治疗前后的随访。结果 围手术期无术后出血、急性呼吸道梗阻发生。随访12-18个月,手术患儿无鼻咽闭锁、咽鼓管功能障碍、腺样体残留等并发症;OSA-18调查评分显示:治疗后76.3％(45例)的患儿生活质量总体指标,88.1％(52例)的患儿睡眠呼吸障碍,67.8％(40例)的患儿身体症状得到显著改善。长期CPAP治疗的有效治疗压力在5.6-7.8 em H2O左右。3例保守治疗者略有改善。结论 手术切除引起上气道阻塞的肥大的扁桃体和(或)腺样体是儿童OSAHS有效的治疗手段之一,纤维鼻咽镜检查、头颅侧位X线摄片有助于手术适应证的确定。经口内镜引导下腺样体刮除术具有直视下操作,视野清晰,切除彻底,可避免损伤周围重要结构的特点。
文摘0122775 电动辅助增殖腺切除术与增殖腺刮匙增殖腺切除术的比较/Stanislaw P Jr//Arch Otolaryngol Head Neck Surg.-2000,126(7).-845～849 西交图0122776 扁桃体切除术和增殖腺切除术对儿童行为的影响/Goldstein N A//ArchOtolaryngol Head Surg.-2000,126(4).-494～498
文摘9930707 扁桃体周下端脓肿/Licameli GR//Otolaryngol Head Neck Surg.-1998,118(1).-95～98 一军大9930708 工作室激光辅助悬雍垂腭成形术的短期效果分析/Astor F C//Otolaryn-gol Head Neck Surg.-1998,118(4).-478～480
文摘Normal children have a smaller upper airway than adults, but, nevertheless, sn ore less and have less apnea. We have previously shown that normal children have an upper airway that is resistant to collapse during sleep. We hypothesized tha t this resistance to collapse is due to preservation of upper airway neuromotor responses during sleep. Furthermore, we hypothesized that upper airway responses would be diminished in children with the obstructive sleep apnea syndrome (OSAS ). We therefore compared the upper airway pressure-flow relationship during sle ep between children with OSAS and controls. Measurements were made by correlatin g maximal inspiratory airflow with the level of nasal pressure applied via a mas k. Neuromotor upper airway activationwas assessed by evaluating the upper airway response to 1) hypercapnia and 2) intermittent, acute negative pressure. We fou nd that children with OSAS had no significant response to either hypercapnia or negative pressure during sleep, compared with the normal children. After treatme nt of OSAS by tonsillectomy and adenoidectomy, there was a trend for normalizati on of upper airway responses. We conclude that upper airway dynamic responses ar e decreased in children with OSAS but recover after treatment. We speculate that the pharyngeal airway neuromotor responses present in normal children are a com pensatory response for a relatively narrow upper airway. Further, we speculate t hat this compensatory response is lacking in children with OSAS, most likely due to either habituation to chronic respiratory abnormalities during sleep or to m echanical damage to the upper airway.
