Tc-99m-MIBI双时相显像评价甲状旁腺机能亢进症的临床研究

目的:在甲状旁腺机能亢进症患者中,评价双时相Tc-99m-MIBI甲状旁腺显像对异常甲状旁腺组织的诊断和定位。方法:35例临床检查和生化指标提示甲状旁腺机能亢进的患者,手术前1周内行双时相Tc-99m-MIBI甲状旁腺平面显像。注射740MBq的Tc-99m-MIBI,15分钟和2小时后,分别进行颈胸前位平面显像,部分病人在延迟相还进行SPECT断层显像。结果:Tc-99m-MIBI甲状旁腺显像结果与手术结果对比,双时相Tc-99m-MIBI甲状旁腺平面显像对甲状旁腺腺瘤诊断灵敏度是75%(27?36),而SPECT断层显像的灵敏度是86%(31?36);甲状旁腺增生诊断灵敏度是50%(2?4)。结论:本研究认为双时相Tc-99m-MIBI甲状旁腺显像对甲状旁腺腺瘤的诊断和定位有较高的临床价值,尤其是SPECT断层显像,而对甲状旁腺增生的诊断,有必要进行进一步研究。     

超声检查维持性血液透析患者继发性甲状旁腺功能亢进的临床价值

目的了解维持性血透患者继发性甲状旁腺功能亢进的超声表现，探讨彩色多普勒超声在继发性甲状旁腺功能亢进诊治中的临床价值。方法对39例维持性血液透析且在1个月内检查过血清PTH患者进行甲状旁腺的超声检查，发现病灶后记录其部位、大小、数目及声像图特点，血流供应情况。结果39例维持性血透患者中，增大甲状旁腺检出率19例SHP组为47．37％，20例非SHP组有3例（15％）。增大甲状旁腺超声表现为边界清晰类圆形均质低回声结节。SHP患者17个病灶有丰富血供。结论超声检查对继发性甲状旁腺功能亢进手术治疗有定位诊断的价值，可为选择超声引导下介入治疗提供影像依据。     

Calcium and phosphorus metabolism parathyroid hormone, calcitonin and bone histology in pseudohypoparathyroidism

Abstract. High blood levels of immunreactive parathyroid hormone and normal levels of calcitonin were detected in a 14-yearoIdgirl suffering from pseudohypoparathyroidism. Antibodies to parathyroid hormone have not been detected. Normalization of the serum calcium concentration suppressed parathyroid hormone and stimulated calcitonin secretion to a reproducible extent. Prolonged administration of parathyroid extract induced an increase ofphosphaturia and subsequently normalized the serum calcium level, while intestinal absorption of calcium did not improve. High values for the exchangeable calcium pool and the bone accretion rate of calcium were found. Histologically the iliac crest bone showed a deficient degree of mineralization and a high osteoclastic activity. Treatment with die hydrotachysterol for over a year did not normalize the respons-of urinary excretion of phosphate and cyclic AMP to administration of parathyroid extract. The data presented are compatible with a relative resistance of the renal tubules, the bone tissue and probably the gut to parathyroid hormone and with the co-existence of a moderate degree of osteomalacia and secondary hyperparathyroidism.     

持续非卧床式腹膜透析患者合并继发性腹膜炎

目的 了解持续非卧床式腹膜透析（continuous ambulatory peritoneal dialysis,CAPD）合并继发性腹膜炎的临床表现特点,以提高对此症的诊治水平。方法对在2003年1月～2003年4月期间澳门仁伯爵综合医院肾科收治的3例CAPD患者合并继发性腹膜炎的临床资料进行回顾性分析,并以同期收治的8例CAPD相关性腹膜炎为对照组,对两组患者的年龄、CAPD时间和化验结果进行统计分析。结果3例继发性腹膜炎患者均为女性,年龄（75.3±5.5）岁,既往无腹膜炎史。在入院时,所有患者均被误诊为CAPD相关性腹膜炎。对两例患者进行腹部X线平片检查分别可见膈下游离气体和小肠梗阻征象。治疗延误3～28天,最后诊断分别为回肠穿孔、乙状结肠缺血性坏死和绞窄性切口疝。两组患者的年龄、血红蛋白、血白细胞（WBC）、血清白蛋白、C反应蛋白（CRP）和入院时腹膜透析液WBC计数（D1）无显著性差异（P〉0.05）;继发性腹膜炎和CAPD相关性腹膜炎的不同点表现在：①CAPD时间明显长[（24.6±7.5）月vs（10.5±8.2）月,P=0.035];②多数患者在发病早期可见粉红色腹膜透出液;③对抗炎治疗效果差（P〈0.05）;④病死率高（67%vs 0）。结论CAPD患者合并继发性腹膜炎的临床表现和CAPD相关性腹膜炎有所不同,其临床误诊率和病死率高,应引起临床医生重视。     

Neurological complications of acute multifocal placoid pigment epitheliopathy

Acute multifocal placoid pigment epitheliopathy (AMPPE) is an autoimmune chorioretinal disease that can be complicated by neurological involvement. There is limited information on this potentially treatable condition in the neurological literature. The objective of this patient series is to describe the neurological complications of AMPPE. We retrospectively identified patients with neurological complications of AMPPE seen at Auckland Hospital between 2008 and 2013 and summarised cases in the literature between 1976 and 2013. We identified five patients with neurological complications of AMPPE at Auckland Hospital and 47 reported patients. These patients demonstrated a spectrum of neurological involvement including isolated headache, stroke or transient ischaemic attack, seizures, venous sinus thrombosis, optic neuritis, sensorineural hearing loss and peripheral vestibular disorder. We propose criteria to define AMPPE with neurological complications. A cerebrospinal fluid (CSF) lymphocytosis in a patient with isolated headache may predict the development of cerebrovascular complications of AMPPE. Patients with cerebrovascular complications of AMPPE have a poor prognosis with high rates of death and neurological disability among survivors. Predictors of poor outcome in those who develop neurological complications of AMPPE are a relapsing course, generalised seizures and multifocal infarction on MRI. All patients with neurological complications of AMPPE, including headache alone, should be investigated with an MRI brain and CSF examination. Patients with focal neurological symptoms should receive intravenous (IV) methylprednisolone followed by a tapering course of oral steroids for at least 3 months. Patients with AMPPE and an isolated headache with a CSF pleocytosis should be treated with oral steroids.     

甲状旁腺CT三维重组对难治性继发性甲状旁腺功能亢进症的术前诊断意义和生化相关性研究

目的：探讨甲状旁腺CT三维重组在难治性继发性甲状旁腺功能亢进症( SHPT)术前诊断与评价中的应用价值,并分析增生甲状旁腺的体积与主要生化指标的相关性。方法48例确诊SHPT患者术前行甲状旁腺CT三维重组,将检查结果与术后病理对照研究,分析两者的一致性和CT检查的检出率,并研究增生甲状旁腺的体积与血磷及甲状旁腺激素( PTH)的相关关系。结果 CT三维重组对增生甲状旁腺的检出阳性率为92．9%(172/185),甲状腺双侧叶后方检出率差异无统计学意义;CT测得的增生甲状旁腺体积与术前血磷及PTH值均呈明显正相关性。结论 CT三维重组对难治性继发性甲状旁腺功能亢进症患者的增生甲状旁腺有很高的检出率,能清晰显示病灶的解剖位置以及与相邻结构的关系,结合相关生化检查能较好的反映患者病情的严重程度,对临床术前诊断和评价增生甲状旁腺具有很高的指导意义。     

Eye Tumors Misdiagnosed as Glaucoma

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关节镜治疗踝关节继发性骨关节炎中短期疗效分析

目的：探讨应用踝关节镜治疗踝关节继发性骨关节炎的疗效。方法：9例踝关节骨关节炎患者行踝关节镜检查和关节镜手术治疗。结果：所有患者均获得随访,术后平均随访18个月。根据美国足踝骨科协会(AOFAS)的评分标准,优4例、良4例、可1例,优良率为88.89%,所有患者均未出现术后感染及神经血管损伤等并发症。结论：踝关节镜手术可明显改善踝关节继发性骨关节炎的疼痛症状,对踝关节炎的诊治有重要意义,值得临床推广。     

继发性甲状旁腺功能亢进患者甲状旁腺切除术后重度低钙血症相关因素分析

目的：探讨继发性甲状旁腺功能亢进（SHPT）患者甲状旁腺切除术后重度低钙血症（SHC）相关因素,进而建立SHC防治策略。方法回顾性分析2012年3月—2014年5月在我院行甲状旁腺切除治疗的S H P T病例资料。行单因素及多因素分析明确S HC的独立影响因素,确定定量因素界值。结果共收集88例病例资料,术后发生S HC46例（52.3％）。单因素分析显示年龄、ALP、iPTH、切除的甲状旁腺数（RTPN）具有统计学显著差异,多因素分析显示年龄、iPTH、RTPN≥4为SHC的独立影响因素,确定的界值为年龄48岁（PPV68.8％,NPV67.5％）和iPT H 1750 pg／ml（PPV85.4％,NPV87.5％）。结论年龄、甲状旁腺激素水平、甲状旁腺切除数量为SHPT患者甲状旁腺切除术后SHC的独立影响因素。选择性地对高危患者实施静脉补钙,选择合理的手术方式,可作为防治S HC的初步策略。     

急性深静脉血栓患者早期下床活动与卧床休息的系统评价

目的：评价与卧床休息相比,早期下床活动对急性深静脉血栓患者继发肺栓塞率的有效性。方法运用计算机检索Cochrane、JBI、Medline、EMbase、CINAHL、Web of Knowledge、CBM、万方和CNKI数据库,查找关于对比早期下床活动和卧床休息处理急性深静脉血栓患者继发肺栓塞问题的相关研究文献。检索时间均从建库至2015年1月1日。由2位评价员按纳入与排除标准独立筛选文献、提取资料并评价质量后,采用RevMan 5．3软件进行M eta分析。结果共纳入9项研究,共847例患者。M eta分析结果显示：与卧床休息相比,早期下床活动对急性深静脉血栓患者继发肺栓塞率[RR＝0．42,95％ CI（0．16,1．09）,P＝0．08]差异无统计学意义。结论现有证据表明：早期下床活动不会增加深静脉血栓患者继发肺栓塞率。鉴于纳入研究数量有限,上述结论尚需开展更多研究予以验证。