颞侧透明角膜隧道切口的二期人工晶体植入术

探讨经颞侧透明角膜隧道切口的二期人工晶体植入术的方法及优点。方法 :用钻石刀在颞侧角膜周边血管弓中央的透明角膜上 ,做一深 0 3mm ,长 3 2mm ,宽 1 75mm的角膜隧道切口 ,对 5 0例5 3只眼的无晶体眼行二期人工晶体植入术 ,植入可折叠人工晶体。随访 6～ 12个月 ,平均 8 4个月 ,观察术后视力、角膜曲率、人工晶体位置及术中、术后并发症。结果 :手术时间为 15～ 40分钟 ,平均 2 6分钟。术后第一天矫正视力≥ 0 5者 2 0只眼 (占 37 73 % ) ;术后 1周和 3个月矫正视力≥ 1 0者分别为 2 6眼 (占 49 0 5 % )和 35眼 (占 6 6 0 3 % )。术后一天和三个月平均散光为 0 6 1± 0 42D和 0 5 1± 0 37D与术前比较无统计学差异。手术并发症主要为术中后囊破裂 ( 5眼 ) ,术后晶体偏心 ( 2眼 )和黄斑囊样水肿 ( 3眼 )。结论 :经颞侧透明角膜隧道切口的二期折叠式人工晶体植入术具有手术时间短、并发症少、操作简单、视力恢复快等优点 ,适应于绝大部分的无晶体眼患者。     

3种结膜囊冲洗液在内眼术前应用的效果分析

目的 探讨既具有清洁结膜囊作用、且刺激性小,也利于环境保护的内眼手术前结膜囊冲洗液在临床应用的方法.方法 排除局部及全身炎性反应,需行内眼手术的患者210例210只眼.随机抽签法分组,A组为实验组用生理盐水200 ml,B组为对照组用0.02%升汞+生理盐水各100 ml.C组为对照组用0.4%庆大霉素液及生理盐水各100 ml冲洗作为结膜囊冲洗液,每组70例70只眼.冲洗前、后用眼拭子采集结膜囊标本并在1 h内送检做细菌培养.分别对3组患者在冲洗后15,30 min结膜充血情况进行比较观察.结果 3组患者在冲洗前细菌阳性率分别为:A组62.86%.B组54.29%.C组50.00%;3组患者冲洗前结膜囊细菌培养阳性率组间比较差异无统计学意义(P>0.05);3组患者冲洗后细菌阳性率分别为:A组31.43%,B组27.14%,C组20.00%;3组患者冲洗后结膜囊细菌培养阳性率组间比较,差异无统计学意义(P>0.05).3组患者结膜囊细菌培养:冲洗前后差异有统计学意义(P<0.05).3组患者冲洗后15 min及30 min结膜充血情况比较:B组的刺激性较大,C组居中.A组刺激性较小. 结论单纯使用生理盐水代替传统的内眼术前结膜囊冲洗液,可减少化学药物对患者眼部的刺激性、毒性等不良反应,减少抗生素的使用,同时可为手术医生提供清晰的手术视野,表明单纯使用生理盐水可以代替传统的内眼结膜囊冲洗液.     

Survivin基因蛋白、微血管密度在卵巢癌中的表达与CPA血流的关系

目的探讨Survivin基因蛋白、微血管密度(MVD)在卵巢癌中的表达与彩色血管能量成像(CPA)血流的关系。方法术前应用CPA检测50例卵巢癌患者及20例卵巢良性肿瘤的血流信号及其阻力指数RI,术后采用免疫组化法检测该组织中Survivin基因蛋白及MVD的表达。结果Survivin基因蛋白在卵巢癌中的阳性表达率(60%)显著高于良性组(30%,P<0.05)。Survivin基因蛋白在低分化卵巢癌中的阳性表达率(84%),中分化卵巢癌中的阳性表达率(58%),高分化卵巢癌中的阳性表达率(15%),各组间比较有显著性差异(P<0.05)。Survivin基因蛋白在临床Ⅲ、Ⅳ期的阳性表达率(80%)显著高于临床Ⅰ、Ⅱ期(30%,P<0.05)。卵巢癌中的Survivin基因蛋白表达强度与CPA血流分级呈正相关(r=0.677,P<0.05)。卵巢癌中的MVD(50.16±5.06)显著高于良性组(20.90±2.71,P<0.05),Survivin基因蛋白阳性表达组的MVD(52.71±6.79)显著高于阴性表达组(37.21±4.92,P<0.05)。卵巢癌中的MVD与CPA的血流分级呈正相关(r=0.675,P<0.05)。卵巢癌的RI值(0.39±0.04)显著低于良性组(0.68±0.07,P<0.05),卵巢癌的RI值与Survivin基因蛋白表达强度及MVD均呈负相关(r1=-0.537,r2=-0.421,P<0.05)。结论巢卵癌中Survivin基因蛋白及MVD的表达为临床应用CPA提供了可靠的病理学基础,而CPA则为临床诊断卵巢癌提供了敏感的血流信息。     

术前X线眼球异物角膜缝环定位及测量

目的：探讨眼球异物定位及测量。材料与方法：110例患者均行眼球异物摘除术前角膜缝环定位及拍摄标准眼球侧位，轴位及正位片。结果：术前测出眼球异物的准确位置，利于眼科手术医生摘除异物。结论：术前眼球异物的准确定位对及时摘除异物有重要的指导价值。     

Hyalinizing trabecular tumor of the thyroid gland: characteristic features on ultrasonography

We report a case of hyalinizing trabecular tumor of the thyroid gland and describe the characteristic ultrasonographic features of this tumor. This was a rare tumor of follicular cell origin with a trabecular pattern of growth and marked intratrabecular hyalinization. The tumor had an irregular shape, a delicately jagged border, and hypoechoic and heterogeneous internal echoes on B-mode ultrasonography. Very rich intratumoral blood flow, the so-called “tumor inferno” was evident on power Doppler ultrasonography. In the clinical management of thyroid nodules, clinicians should be aware of this peculiar type of thyroid tumor and its characteristic ultrasonographic findings.     

Clinical efficacy of prostate cancer detection using power doppler imaging in American and Japanese men

PURPOSE: The aim of this study was to compare the detection rates of tumor vascular flow as measured by power Doppler imaging (PDI) in 2 populations and to determine whether PDI can reduce the number of unnecessary prostate biopsies in men with serum prostate-specific antigen (PSA) concentrations less than 10.1 ng/ml. METHODS: The patient populations were Japanese (group 1) and American (group 2) men with either serum PSA concentrations of 4.1-10.0 ng/ml or abnormal findings on digital rectal examination (DRE) plus PSA concentrations less than 4.1 ng/ml. We compared the overall diagnostic accuracy of DRE, gray-scale transrectal sonography (TRUS), and PDI between the 2 groups. RESULTS: In total, 275 men were studied, 154 in group 1 and 121 in group 2. Cancer was identified in 27% of men in group 1 and in 60% of group 2. Men with cancer in both groups differed significantly in age, peripheral zone volume, and mean number of positive biopsy cores. The sensitivity and specificity of PDI in group 2 were significantly inferior to those in group 1. The negative predictive value (NPV) of PDI was significantly higher for group 1 than for group 2. The NPV of PDI in group 1 was equivalent to that for the combination of DRE and TRUS, whereas the NPV for PDI in group 2 was significantly inferior to that of DRE and TRUS.CONCLUSIONS: Tumor vascularity could be detected by PDI more effectively in Japanese men with cancer than in American men with cancer. We hypothesize that this difference was a result of larger cancer volumes and smaller prostates in the Japanese men. PDI did not provide any performance advantage over DRE and TRUS in avoiding unnecessary biopsies.     

Role of transvaginal sonography in the diagnosis of peritoneal inclusion cysts.

OBJECTIVE: The aim of this prospective study was to investigate the accuracy of B-mode transvaginal sonography alone and combined with color Doppler imaging and cancer antigen 125 (CA 125) plasma concentrations in differentiating peritoneal cysts from other adnexal masses. METHODS: Between September 1999 and September 2003, 213 adnexal masses underwent transvaginal sonography combined with power Doppler evaluation. Plasma concentrations of CA 125 were measured before surgery. The sonographic suspicion of peritoneal cysts (the presence of a bizarre lump-shaped cyst with a thin wall and fine internal septations with or without an ovary suspended among adhesions) was then compared with the surgical diagnosis. The overall agreement between the sonographic test results and the surgical findings was calculated by the kappa index. The diagnostic value of each test was also evaluated with likelihood ratios (LRs). RESULTS: Thirteen of 213 patients were found to have peritoneal cysts. Specificity and sensitivity of B-mode sonography for differentiating peritoneal cysts from other adnexal masses were 96% (95% confidence interval, 94%-97%) and 62% (95% confidence interval, 35%-83%), respectively. The value of the negative LR (0.40) indicated a good clinical test, whereas the positive LR (15) indicated an excellent test. Power Doppler imaging did not seem to increase the accuracy of B-mode transvaginal sonography (kappa = 0.51 and 0.52, respectively), nor did the association of CA 125 plasma concentration (kappa = 0.34). CONCLUSIONS: Transvaginal sonography alone is a useful method for detection of peritoneal cysts.     

Evaluation of D-dimer and factor VIII in cirrhotic patients with asymptomatic portal venous thrombosis

D-dimer and factor VIII levels raise in advanced cirrhosis. We investigated the behavior and the diagnostic usefulness of D-dimer and factor VIII in cirrhotic patients with asymptomatic portal venous thrombosis. Factor VIII coagulant and D-dimer values were measured in 136 consecutive outpatients with stable cirrhosis divided according to Child-Pugh (CP) classification, who underwent color/power ultrasonography to detect portal thrombosis. Portal thrombosis was found in 33 patients (24.2%). In patients without thrombosis, factor VIII was significantly higher in CP class C compared with class A and B. Conversely, class C patients with portal thrombosis had lower factor VIII levels than those without thrombosis. In both groups, D-dimer was significantly increased in class C compared with class A and B. In class C, thrombotic patients showed higher D-dimer values than did patients without thrombosis. In class C, a D-dimer value > or = 0.55 microg/mL provided a sensitivity and a negative predictive value for portal thrombosis of 100%, and a factor VIII coagulant level < or = 80% showed a specificity and a negative predictive value of 76% and 84%, respectively. In class B, a D-dimer value > or = 0.225 microg/mL had a sensitivity of 89% and a negative predictive value of 82%. In conclusion, our study shows that factor VIII values increase in severe cirrhosis but significantly decrease in the presence of concomitant portal thrombosis, likely because of consumption during thrombosis; D-dimer is enhanced by both liver failure and portal thrombosis; in severe cirrhosis, normal D-dimer and factor VIII values may safely exclude the presence of asymptomatic portal thrombosis.     

双眼白内障人工晶体植入术的临床分析

目的:探讨双眼人工晶体植入手术时间间隔.方法:对52例双眼人工晶体植入的病例进行分析.结果:双眼手术时间间隔为3 d.术后双眼矫正视力0.3以上者45例,占86.5%.双眼术后矫正视力差异无显著性.结论:提示3d内双眼分别行人工晶体植入不影响视力预后.