不典型乳腺癌X线表现分析（附24例报告）

目的 充分认识乳腺钼靶X线检查在乳腺癌病灶显示及定性诊断中的价值.方法 回顾性分析24例X线征象不典型乳腺癌的临床资料、乳腺类型、X线表现及超声结果.结果 本组X线表现不典型乳腺癌均有较典型临床表现,以扪及乳内及腋窝肿物最常见（100%）.X线表现共分为5种类型：阴性型（6例） 增生型（7例） 良性占位型（5例） 炎症型（5例） 淋巴结型（1例）.发生于致密腺体型乳腺9例 多量腺体型4例 少量腺体型11例.同时行超声检查者17例,其中15例检出实质性肿块或结节.结论 对于无钙化的乳腺癌,钼靶X线检查在病灶显示及定性诊断中有一定的局限性,应充分结合超声检查与临床资料.     

钙剂治疗血清钙正常不典型疼痛6例报告

全身不典型疼痛是临床常见的症状,临床表现多样,临床检查提示除外内脏病变引起的牵涉痛,临床倾向于是骨、关节和肌肉痛,可能为不典型骨质增生引起.笔者于2004～2005年在新疆泽普县人民医院援疆期间用钙剂治疗一些不典型疼痛患者,收到良好效果,现报告如下.     

进行性假性类风湿发育不良症2例临床分析

摘要：目的 提高对进行性假性类风湿性发育不良症的认识。方法 报道2例进行性假性类风湿性发育不良症的病例,并通过文献复习对本病的临床表现及影像学改变进行分析总结。结果PPD的临床特点：发病于幼年,可累及的关节包括指间、腕、肘、肩、髋、膝、踝等关节,其中以指间、髋、膝关节受累明显。随年龄增大,骨关节的损害加重。影像学检查,双手关节关节间隙变窄,以掌指关节局部梭形膨大为其典型特征,髋关节表现为关节间隙变窄,关节髋臼面局部增生硬化。双膝关节关节间隙变窄,关节面不整,可出现滑膜骨软骨瘤。与文献不同之处,此2例患者血沉增快,累及骶髂关节,脊柱受累不明显。     

不典型乳腺癌的乳腺钼靶摄影分析

目的 探讨不典型乳腺癌的X线表现及诊断,以进一步提高不典型乳腺癌的诊断准确率.方法 19例不典型乳腺癌均为手术病理证实.结果 19例X线表现,7例显示局部片状致密影,边界不清,3例显示为局部结构紊乱.2例显示局部腺体纠集,呈星芒征,4例显示钙化灶,形态不规则、分布较分散的钙化灶,1例致密型乳腺摄片未见具体肿块及明显钙化,2 例伴腋下淋巴结肿大.结论 乳腺癌的X线表现不典型,易引起误诊、漏珍.影像科医生阅片时,应结合临床,仔细阅片、全面分析,以尽量提高诊断与病理符合率.高品质的乳腺片是诊断不典型乳腺癌的有效保证.     

髌骨软化症的X线、CT、MRI表现分析及价值

目的通过对76例患者临床X线、CT及MRI表现的研究,探讨X线、CT及MRI对髌骨软化症的诊断意义。方法对76例怀疑髌骨软化症患者行膝关节正侧位检查及膝关节CT、X线、MRI检查,对比分析X线、CT及MRI检查结果。结果关节镜分级诊断和X线、MRI成像效果进行比较。其中有一级15例表现为关节软骨软化,CT检查呈阴性,MRI信号强度变化9例;其中二级13例患者表现为疱样肿胀,通过CT检查,其中2例关节间隙扩大,11例患者MRI信号异常;三级21例表现为软骨表面不规则局部变薄,其中4例在CT检查中关节间隙的宽度不一致、3例患者髌骨外移,MRI显示20例局部软骨变薄,关节腔积液,关节间隙变化;四级17例表现软骨溃疡及骨外露,软骨下骨囊性变的CT检查15例,MRI显示17例病变的骨外露,兼并和关节腔积液。结论髌骨软化症晚期多数利用X射线和CT发现,但对病状早期发现并不明显,而MRI比X线或CT对髌骨软化症的早期发现和临床提供更准确的信息,对有修复能力的髌骨有效的非手术治疗更有临床意义。     

43例不典型腕管综合征的临床症状及神经肌电图分析

目的 总结分析不典型腕管综合征的临床表现、神经肌电图改变及治疗方法,为临床诊治积累经验.方法 对2009年6月至2014年2月于本院诊治的43例不典型腕管综合征患者的临床资料进行回顾性分析.结果 43例不典型腕管综合征患者中,最常见的症状为一侧上肢麻木,还可出现上肢胀痛、乏力,大鱼际肌萎缩;易误诊为颈椎病、末梢神经炎等;以优势手发病多见,常可累及双侧;神经肌电图检查显示正中神经感觉纤维最常受累,随着病情进展,可出现运动纤维损害.结论 不典型腕管综合征仅依靠临床症状和体征,往往造成误诊、漏诊,神经肌电图检查是诊断腕管综合征的最常用辅助检查,该病早期治疗效果较好,首选保守治疗,效果不理想可考虑手术治疗.     

水晶丹外敷治疗腹腔化疗渗漏1例疗效观察

化疗是治疗肿瘤的重要手段之一.化疗分为全身化疗和局部化疗.而腹腔化疗是局部化疗的一种,临床上化疗药物外渗是化疗过程中较常见的局部并发症.外渗药物可导致局部皮肤及软组织非特异性炎症,表现为局部皮肤组织红肿、疼痛及周围组织坏死.严重者甚至经久不愈,溃疡可深及肌腱及关节,以静脉化疗者多见,然而腹腔化疗渗漏却非常少见,其处理的方法有待探讨.现将我科1例腹腔化疗渗漏患者使用水晶丹外敷取得良好效果的病例报道如下.     

86例不完全川崎病临床分析

目的 探讨小儿不完全川崎病的临床特点及并发症和治疗情况,提高对不完全川崎病的认识和诊疗水平.方法 对2010年8月至2012年6月确诊的不完全川崎病86例患者的临床资料进行回顾性分析.结果 350例川崎病中86例为不完全川崎病,发生率为24.6％.不完全川崎病在性别上与典型川崎病无显著性差异(P＞0.05).在小于1岁年龄段两组发生率差异有统计学意义(x2=-7.016,P＜0.01).不完全川崎病最常见的临床表现为发热,其次是指趾改变(65.1％),最少见的是皮疹(20.9％).除发热外,其余各项表现与典型川崎病比较差异均有显著性(P＜0.01);不完全川崎病有白细胞、血小板、C反应蛋白及血沉明显升高,轻度贫血、肝酶升高较为常见,同典型川崎病实验室检查相符,两组比较无显著性差异(P＞0.05).冠状动脉扩张20例(23.3％)与典型川崎病的冠脉扩张(23.1％)发生率差异无显著性(P＞0.05);冠脉瘤8例(9.3％),与典型川崎病的冠脉瘤(6.1％)发生率差异无显著性(P＞0.05).结论 不完全KD并非其临床特征表现不典型,同样会对冠状动脉造成损害.     

胸椎小关节紊乱误诊内脏疾病

胸椎小关节紊乱是临床上常见的损伤性疾病，可表现为多种不同程度的急慢性肋间神经痛、胸腹腔脏器功能紊乱等相关症状，临床上极易误诊为心血管系统、呼吸系统、消化系统疾病。作者在临床工作中发现被误诊为“肺及肝脏肿瘤、胆囊炎、肠炎及便秘”的胸椎小关节紊乱患者12例，现将3例典型病例报告如下。     

伴急腹症的川崎病儿童临床分析4例

川崎病(Kawasaki disease,KD)是临床儿科中较为常见的发热性疾病,典型症状为发热、杨梅舌、结膜充血等.在发达国家,KD是儿童获得性心脏病最常见的病因[1].然而一些KD病例由于早期症状不典型或被其他表现掩盖,导致误诊漏诊,延误患儿诊治.本文探讨以发热、腹痛为突出症状的KD患儿4例病例,旨在为临床诊治KD提供参考.     

Serum and synovial fluid osteocalcin in rheumatic diseases.

The mechanisms involved in juxta-articular bone destruction are poorly understood. Osteocalcin or gamma-carboxyglutamic acid (GLA) protein is a small non-collagenous bone protein. It is a sensitive marker of osteoblastic bone formation. Its seric variations in the serum in such rheumatisms as rheumatoid arthritis remain unclear. Further information on local osteoblastic activity may be obtained by assaying the level of osteocalcin in the synovium. Its serum level can be evaluated by radioimmunoassay. The same method can be used in the synovial fluid. Paired serum and synovial fluid samples have been assayed from 63 patients, 33 patients with inflammatory arthritis (rheumatoid arthritis, psoriasis, chondrocalcinosis, pyogenic arthritis) and 30 patients with mechanical joint effusion (osteoarthritis, meniscal lesions). Serum levels of osteocalcin were the same in the inflammatory group (m: 8.69 +/- 0.68 ng/ml) and in the mechanical group (m: 10.2 +/- 0.67 ng/ml). In the synovial fluid, the levels of osteocalcin were significantly lower in the inflammatory group (m: 3.27 +/- 0.40 ng/ml) than in the mechanical group (m: 6.91 +/- 0.47 ng/ml). The same results were obtained with the ratio of synovial fluid osteocalcin on serum osteocalcin. There was a significant correlation between serum and synovial fluid osteocalcin and an inverse correlation between synovial fluid osteocalcin and the number of synovial fluid cells. The present study suggests that periarticular osteoblastic depression, among patients with inflammatory arthritis, is likely.     

检测早期类风湿关节炎(RA)患者血清中IL-33水平的临床意义

目的观察探对检测早期类风湿关节炎(RA)患者血清中的IL-33水平的结果,总结其检测的临床意义。方法选取我院2009年7月至2011年7月收治的早期类风湿关节炎(RA)患者48例作为观察组,以同期在我院进行健康体检者50例作为对照组,观察比较两组受检者血清中IL-33水平,同时也检测观察组患者滑液及血清中的IL-33水平。结果观察组患者的血清中IL-33水平明显高于健康者(P<0.05),具有统计学意义;观察组患者的滑液和血清中均有IL-33表达,但浓度比较无显著差异(P>0.05),无统计学意义。结论对早期类风湿关节炎(RA)患者进行血清IL-33水平的检测,能够较好地反应出滑膜内的病变严重程度,对早期诊断并评估类风湿关节炎(RA)患者的疾病发展有重要的临床指导意义。     

Failure of intraarticular ceftazidime in a patient with Pseudomonas aeruginosa septic arthritis

This report describes a patient with Pseudomonas aeruginosa septic arthritis who received ceftazidime by the intravenous and intraarticular routes. Concentrations of ceftazidime in the synovial fluid following both routes of administration were measured and found to be above the minimum inhibitory concentration. Despite this the organism was not eradicated. We were unable to find other literature describing the disposition of ceftazidime in synovial fluid and therefore this single-patient study provides novel information. We were unable to account for the apparent failure of therapy.     

Clinical diagnosis of rheumatoid arthritis

Rheumatoid arthritis is a common disease that is now known to progress to irreversible erosive changes in the joints much more quickly than previously recognized. Physicians thus need to identify the early symptoms and signs to make a prompt clinical diagnosis and then start earlier aggressive treatment. Critical features are morning stiffness and symmetrical inflammation involving usually small joints of the hands and feet. Soft tissue swelling is the most important sign of inflammation and begins most often at the metacarpal phalangeal or proximal interphalangeal joints. Joints are tender and warm but often not hot and red. Elevation of erythrocyte sedimentation rate can help confirm the presence of inflammation but the most important laboratory test is synovial fluid analysis which further confirms inflammation but can also help exclude many of the other potentially confusing causes of arthritis. Rheumatoid factor is present in 75% of patients but can also be seen with some other diseases.     

Plasma and synovial fluid concentrations of piroxicam during prolonged treatment with piroxicam pivalic ester

Piroxicam pivalic ester (CHF 10/21) is a prodrug of piroxicam and is characterized by a reduced gastric irritant activity. Plasma and synovial fluid samples were simultaneously taken from 7 patients with mono- or poly-articular arthritis causing knee effusion, during 4 weeks of treatment with CHF 10/21 at the dose of 30 mg/day. The time courses of plasma levels of both the prodrug and the active principle were studied and a correlation of the latter with synovial fluid levels was made. After 14 days of treatment the steady-state was reached in the systemic (plasma) and peripheral (synovial fluid) compartments with therapeutically active drug levels. Clinical results were good and a complete disappearance of local pain occurred in 2 cases. Good gastric tolerance was also achieved.     

Pharmacokinetics of lumiracoxib in plasma and synovial fluid

BACKGROUND: Lumiracoxib is a new cyclo-oxygenase-2 (COX-2) selective inhibitor in development for the treatment of rheumatoid arthritis, osteoarthritis and acute pain. OBJECTIVE: To investigate the pharmacokinetics of lumiracoxib in plasma and knee joint synovial fluid from patients with rheumatoid arthritis. DESIGN: Open-label multiple-dose study evaluating the steady-state pharmacokinetics of lumiracoxib in plasma and synovial fluid after 7 days of treatment with lumiracoxib 400 mg once daily. PATIENT POPULATION: Males and females aged 18-75 years with rheumatoid arthritis, having moderate to significant synovial fluid effusion of the knee. OUTCOME MEASURES: Following a 7-day washout period for previous nonsteroidal anti-inflammatory drugs, 22 patients (17 female, 5 male) received lumiracoxib 400 mg once daily for seven consecutive days. On day 7, following an overnight fast, a final dose of lumiracoxib was administered and serial blood and synovial fluid samples were collected for up to 28 hours. Lumiracoxib and its metabolites (4'-hydroxy-lumiracoxib and 5-carboxy-4'-hydroxy-lumiracoxib) were measured by validated high performance liquid chromatography-mass spectrometry methods. The steady-state pharmacokinetics of lumiracoxib were evaluated in plasma and synovial fluid by both a population pharmacokinetic model and noncompartmental analysis.RESULTS: Lumiracoxib was rapidly absorbed (peak plasma concentration at 2 hours) and the terminal elimination half-life in plasma was short (6 hours). Lumiracoxib concentrations were initially higher in plasma than in synovial fluid; however, from 5 hours after administration until the end of the 28-hour assessment period, concentrations of lumiracoxib were higher in synovial fluid than in plasma. Peak drug concentration in synovial fluid occurred 3-4 hours later than the peak plasma concentration. The mean steady-state trough concentration of lumiracoxib in synovial fluid (454 microg/L) was approximately three times higher than the mean value in plasma (155 microg/L), and the area under the concentration-time curve from 12 to 24 hours after administration was 2.6-fold higher for synovial fluid than for plasma. Median lumiracoxib protein binding was similar in plasma and synovial fluid (range 97.9-98.3%). Concentrations of 4'-hydroxy-lumiracoxib, the active COX-2 selective metabolite, remained low in comparison with parent drug in both plasma and synovial fluid. The concentration of lumiracoxib in synovial fluid at 24 hours after administration would be expected to result in substantial inhibition of prostaglandin E(2) formation. CONCLUSION: The kinetics of distribution of lumiracoxib in synovial fluid are likely to extend the therapeutic action of the drug beyond that expected from plasma pharmacokinetics. These data support the use of lumiracoxib in a once-daily regimen for the treatment of rheumatoid arthritis.     

微创针刀镜在膝关节痛风性关节炎中的应用价值及安全性

目的 对膝关节痛风性关节炎患者使用微创针刀镜手术诊治价值进行探究,并对其安全性进行分析.方法 回顾性分析41例膝关节痛风性关节炎患者的临床资料,全部患者均应用微创针刀镜手术进行治疗,评估其诊治过程,对比手术前后患者膝关节功能评分、VAS评分变化情况.结果 41例患者中,镜下均可见尿酸盐结晶.18例患者行滑膜病理检查,17例符合痛风典型病理表现.41例患者中痊愈20例,显效11例,有效7例,3例患者治疗无效,临床有效率为92.68%;41例膝关节痛风性关节炎患者治疗后Lysholm评分为(96.21 ±1.32)分,明显高于治疗前的(54.51 ±1.26)分,差异有统计学意义(P<0. 05);41例膝关节痛风性关节炎患者治疗后VAS评分为(3.51 ±0.96)分,明显低于治疗前的(8.05 ±1.02)分,差异有统计学意义(P<0.05).41例患者中无严重并发症发生,且术后的恢复较好.结论 应用微创针刀镜诊治膝关节痛风性关节炎患者,不仅可作为诊断膝关节痛风性关节炎的重要辅助手段,同时疗效显著,并发症少,且可明显改善患者膝关节功能评分与VAS评分,值得临床给予应用与推广.     

肌骨超声在类风湿关节炎评估中的应用研究

目的:对肌骨超声在类风湿关节炎评估中的应用情况进行探讨。方法:选取50例2016年9月~2018年4月某院接收的类风湿关节炎患者,将其作为观察组,同时随机选取50例体检健康者作为对照组,对两组患者同时进行肌骨超声检查,对比两组患者的检查结果。结果:对照组患者没有检查出滑膜增生、膝关节积液和血流信号,观察组患者的滑膜增生率为66.0%,膝关节积液发生率为62.0%,血流信号出现率为60.0%,两组患者的检查结果差异显著,具有统计学意义(P<0.05);对照组的关节滑膜厚度和积液厚度明显低于观察组,组间差异显著,有统计学意义(P<0.05);对照组患者软骨厚度高于观察组,组间差异有统计学意义(P<0.05)。结论:肌骨超声在类风湿关节炎诊断中应用,能够尽快对患者关节病变的情况进行诊断,使临床治疗有科学的参考,让患者及时接受治疗,因此值得在临床中应用推广。     

A comparison of plasma and synovial fluid profiles of standard and controlled-release formulations of ketoprofen in patients with rheumatoid arthritis

The plasma and synovial fluid profiles of standard and controlled-release formulations of ketoprofen were compared in 8 patients with rheumatoid arthritis. During chronic dosing with both forms of ketoprofen, peak drug concentrations were lower and occurred later in the synovial fluid than in the plasma. These findings were more pronounced in the case of the controlled-release formulation. The apparent elimination half-life of standard ketoprofen in synovial fluid was prolonged compared to its half-life in plasma, a finding which has not been previously documented. This may explain the clinical observation that, despite a very short plasma elimination half-life, standard ketoprofen exerts a satisfactory therapeutic effect when given twice daily. There was no accumulation of ketoprofen from either formulation in synovial fluid after steady state had been achieved. It is suggested that future pharmacological studies with anti-inflammatory agents should include both synovial fluid and plasma concentration data.     

Tryptophan metabolism in the joint diseases.

Tryptophan metabolites through kynurenine pathway and 5-hydroxytryptophan pathway in the synovial fluid, blood and urine of patients with rheumatoid arthritis and those with osteoarthritis were investigated in order to know the specificity of the tryptophan metabolism, especially the role of serotonin in the joint diseases. A metabolic map of tryptophan in the synovial fluid was also made. It was found that tryptophan in rheumatoid arthritis was metabolized mainly to anthranilic acid through kynurenine in the kynurenine pathway, whereas in osteoarthritis the pathway of kynurenic acid and nicotinic acid was characteristic. Otherwise in 5-hydroxytryptophan pathway there were no significant differences in the levels of 5-hydroxytryptamine and 5-hydroxyindole acetic acid in the synovial fluid between rheumatoid arthritis and osteoarthritis but the activity of monoamine oxidase in the synovial fluid was higher in osteoarthritis than in rheumatoid arthritis.