胆固醇酯转运蛋白基因多态性在多囊卵巢综合征中的初步研究

目的:探讨胆固醇酯转运蛋白(CETP)在PCOS患者中的基因多态性和血脂、性激素的关系,以进一步认识PCOS脂代谢的特点。方法:应用PCR酶切方法检测108例PCOS患者及60例对照组的CETPTaqIB位点基因多态性。结果:CETPTaqIB基因频率及基因型分布在两组间分布差异无显著性。结论:CETPTaqIB基因多态性影响PCOS患者的HDLC水平,该基因在PCOS患者分布与正常人群分布无差异性。     

Routinely collected general practice data aids identification of people with hyperglycaemia and metabolic syndrome.

AIMS: To assess the performance of a risk score comprising data routinely available in general practice records (age, gender, body mass index, family history of diabetes, smoking habits and prescribed anti-hypertensive drugs or steroids) in detecting diabetes, impaired glucose tolerance and metabolic syndrome. METHODS: In a population-based, cross-sectional study in a semi-rural general practice in Jutland, Denmark, Cambridge Risk Scores were calculated for 1355 patients without known diabetes (69% response rate) who completed questionnaires and underwent anthropometric measurement and an oral glucose tolerance test. RESULTS: Prevalences of diabetes, impaired glucose tolerance and metabolic syndrome were 2.29% (95% CI: 1.56-3.23), 6.64% (95% CI: 5.38-8.10) and 13.4% (95% CI: 11.5-15.2), respectively. Area under the ROC curve for the risk score and diabetes was 83.8% (75.9-91.7) and for metabolic syndrome [European Group for the Study of Insulin Resistance (EGIR)] was 78.1% (74.6-81.6). Twenty per cent of the population had a risk score above 0.246; at this threshold the sensitivity to detect diabetes was 71.0% (53.4-83.9), the specificity 81.2% (79.0-83.2), positive predictive value 8.1% (6.6-10.0) and likelihood ratio 3.77 (2.94-4.85). For metabolic syndrome (EGIR) corresponding values for sensitivity were 50.3% (43.1-57.5), specificity 84.7% (82.5-85.6), positive predictive value 33.6% (28.2-39.4), and likelihood ratio 3.28 (2.69-4.00). CONCLUSIONS: Undiagnosed hyperglycaemia and metabolic syndrome are common. The Cambridge Risk Score is a practical first step in a screening procedure to identify individuals with these disorders who might benefit from diagnostic testing or to direct preventive interventions.     

老年牙周组织疾病216例证候分析

目的 探讨老年牙周组织疾病的证候特点。方法 对 1998 年 1 月-2003 年 12 月门诊接诊的 216 例老年牙周组织疾病进行回顾性分析。结果 阴虚火旺型 124 例(57.4%),气血不足型 51 例(23.6%),胃火炽盛型 16 例(7.5%),气滞血瘀型 14 例(6.4%),痰湿阻络型 11 例(5.1%)。结论 老年牙周组织疾病证候表现以虚为主、虚中夹实,阴虚火旺型和气血不足型是其主要证候类型。     

Klippel-Trenaunay综合征的MRI诊断

目的分析Klippel—Trenaunay综合征（KTS）的MRI影像表现，评价其在KTS诊断中的作用。方法对经临床和影像检查符合KTS诊断标准的31例KTS患者患肢进行MR常规扫描、MR血管成像（MRA）、静脉血管成像（MRV）和X线顺行静脉造影（XRV）检查，并观察肢体及静脉病变情况。结果12例MRI发现肢体软组织内血管瘤。软组织肥大27例。浅静脉曲张21例。静脉畸形27例。20例同时行MRV与下肢XRV的患者显示浅静脉曲张和特征性坐骨神经均分别为17和11例。下肢XRV检查显示静脉属支增多10例；MRV显示静脉属支增多15例和静脉行径异常4例。MRV显示深静脉异常8例，下肢XRV显示深静脉异常7例。结论MRI是诊断KTS有效和可靠的影像检查方法。     

Post-polio syndrome patients treated with intravenous immunoglobulin: a double-blinded randomized controlled pilot study

Post-polio syndrome (PPS) is characterized by new muscle weakness, atrophy, fatigue and pain developing several years after the acute polio. Some studies suggest an ongoing inflammation in the spinal cord in these patients. From this perspective, intravenous immunoglobulin (IvIg) could be a therapeutic option. We performed a double-blinded randomized controlled pilot study with 20 patients to investigate the possible clinical effects of IvIg in PPS. Twenty patients were randomized to either IvIg 2 g/kg body weight or placebo. Primary endpoints were changes in pain, fatigue and muscle strength 3 months after treatment. Surrogate endpoints were changes in cerebrospinal fluid (CSF) cytokine levels. Secondary endpoints were pain, fatigue and isometric muscle strength after 6 months. Patients receiving IvIg reported a significant improvement in pain during the first 3 months, but no change was noted for subjective fatigue and muscle strength. CSF levels of tumour necrosis factor- α (TNF- α ) were increased compared with patients with non-inflammatory neurological disorders. In conclusion, in this small pilot study no effect was seen with IvIg treatment on muscle strength and fatigue, however IvIg treated PPS patients reported significantly less pain 3 months after treatment. TNF- α was increased in the CSF from PPS patients. The results are promising, but not conclusive because of the low number of patients studied.     

MRI in greater trochanter pain syndrome

The greater trochanter pain syndrome refers to pain on the lateral aspect of the hip joint. This is frequently attributed to trochanteric bursitis and distension of the subgluteal bursae. Associated tears of the tendons of gluteus medius and minimus have been described and may result from repetitive frictional trauma to these tendons and their associated bursae secondary to impingement beneath the tensor fascia lata. Occasionally tendinous damage may result from acute local direct trauma or a hyperadductive strain injury. We describe MRI in two patients with chronic lateral hip pain.     

颈动脉分叉血液动力状态的计算流体力学初步研究

目的应用计算流体力学（CFD）方法结合血管影像显示在体颈动脉分叉的血流动力状态.方法选取1例志愿者,采用Siemens多层螺旋CT机行左侧颈动脉CT血管成像检查（CTA）,扫描所得原始图像经计算机后处理后,用CFD方法计算并显示血液动力学各项指标.结果（1）该血管血液流率均值范围为0.04～0.36 m/s,颈外和颈内动脉的内侧壁（均以分叉顶点为参照）可见一高血流速区,球部可见较大片低血流速区;颈动脉分叉及颈内、外动脉近端均可见血液涡流与回流.（2）血液绝对压、静态压和动态压的均值范围分别为100 266.70～101 615.90 Pa、-10 58.34～290.88 Pa、6.12～553.25 Pa;（3）管壁切应力均值范围为0.59～5.35 Pa,在颈动脉球部及颈内动脉后壁显示大范围的低切应力区,最低约为0.25 Pa,颈外动脉前外侧壁存在一小范围低切应力区.结论CFD方法结合血管影像能计算并显示在体颈动脉分叉的个体化血液动力学指标.     

主观症状及实验检查诊断早期干眼症

目的 分析主观症状及实验检查对早期干眼症患者诊断的意义。方法 对55例（109眼）已确诊的早期干眼症患者（无或仅伴有轻微体征）的临床症状及实验检查进行回顾性分析及比较。结果 患者中主观症状所占比率：干涩感94％，视疲劳感82％，异物感74％，明显高于其他症状（P〈0．05）。实验检查的阳性率：基础泪液分泌试验（Schirmer I test，SIt）35％，泪膜破裂时间检查（break-up time，BUT）85％，角结膜荧光素（fluorescent，FL）染色60％，其中BUT阳性率明显高于SIt和FL（P〈0．05）。结论 主观症状及实验检查可为早期干眼症诊断提供有利依据。     

Haemodynamic studies in early stroke

Summary We investigated prospectively a consecutive series of 81 patients suffering from acute middle cerebral artery (MCA) ischaemia by transcranial Doppler ultrasonography (TCD) within 24 h of the onset of symptoms. To monitor the haemodynamic changes follow-up recordings were carried out at short intervals during the next 2–3 weeks until stable haemodynamic status was achieved. In order to estimate the value of early TCD examinations in predicting the extent of brain damage seen later on, initial MCA flow reduction was correlated with infarction size and pattern on computed tomography. Fifty-three cases showed sufficient ultrasound penetration through the temporal bone. MCA flow asymmetries were recorded in 45 patients (85%); occlusion was observed in 17. Recanalization occurred in 11 patients followed by transient hyperaemia in 3, leaving residual stenosis in 2. Initial increase of flow velocities normalized within days or weeks in 7 out of 9 patients, while 2 developed residual MCA stenosis. Nineteen patients showed a considerable flow reduction on admission, which returned to normal in 9; transient hyperaemia was detected in 5 of these. Eight patients did not show any MCA flow asymmetry. Our study revealed very variable haemodynamic changes in acute stroke, which influenced further diagnostic and therapeutic management. The high rate of spontaneous recanalizations of MCA occlusions followed by transient hyperaemia in many cases has an important bearing on thrombolytic or theological therapy. Flow velocity differences could be related to infarction pattern rather than to infarction volume. Early MCA flow asymmetry recorded by TCD within the first 24 h could not reliably predict the extent of persistent brain damage or clinical outcome.     

Balloon occlusion of the internal carotid artery in 40 cases of giant intracavernous aneurysm: technical aspects,cerebral monitoring,and results

Summary We have studied the results of carotid occlusion in the treatment of giant intracavernous carotid artery (ICA) aneurysms in 40 patients. Clinical, angiographic, Doppler and cerebral blood flow (CBF) criteria for tolerance of occlusion are discussed. The patients had headaches (47.5%), cranial nerve compression (87.5%), decreased visual acuity (20%), ruptured aneurysm (15%) and 5% were asymptomatic. Balloon occlusion tests were performed under light sedation anaesthesia: a successful test required perfect clinical tolerance and adequate angiographic collateral circulation in arterial, parenchymatous, and venous phases. Additional criteria include xenon 133 CBF measurements, and transcranial Doppler sonography of the middle cerebral artery. According to these criteria, 5 patients did not tolerate test occlusion and required an extra-intracranial (EC-IC) bypass. Mean follow-up was 4.7 years. All patients were radiologically cured of their ancurysm, and in 35 the symptoms resolved, although 3 had persistent ocular motor nerve palsies, and in 4 visual defects were unchanged. Complications were 1 permanent and 3 transient neurological deficits. Balloon occlusion of the ICA is an effective, reliable form of treatment for intracavernous giant aneurysm and should replace surgical ligation of the cervical carotid artery. With CBF or Doppler monitoring, the risk of neurological deficit is diminished. EC-IC bypass prior to ICA occlusion is indicated if test occlusion is not tolerated.