颞骨肿块的HRCT诊断与鉴别诊断

目的研究颞骨肿块的HRCT表现和临床意义。方法回顾性分析16例经手术病理或临床证实的颞骨肿块的HRCT表现。结果骨纤维异常增殖症4例,颈静脉球瘤3例,骨软骨瘤、嗜酸性肉芽肿、外耳道癌和骨瘤各2例,粘液瘤1例,HRCT表现各具特征。结论HRCT扫描能清晰显示颞骨肿块的形态、密度和范围,结合临床和其他检查有助于定性诊断,为临床治疗提供依据。     

婴幼儿感染金黄色葡萄球菌耐药性与耐药基因研究

目的 调查婴幼儿感染标本分离的金黄色葡萄球菌耐药性与耐药基因携带状况。方法 收集南京市儿童医院2013年10-12月婴幼儿感染标本分离出的金黄色葡萄球菌20株,首先采用K-B法和E-test法做抗菌药物敏感性试验,再用聚合酶链反应(PCR)的方法分析β-内酰胺类药物耐药基因(blaZ、mecA)及大环内酯类药物耐药基因(ermA、ermB、ermC、mphC、msrA)。结果 20株金黄色葡萄球菌对头孢西丁、青霉素、红霉素、克林霉素的耐药率,分别为50.0%、100.0%、40.0%、40.0%;耐药基因共检出mecA基因11株占55.0%、ermB基因1株占5.0%、ermC基因7株占35.0%;该组菌中17号株对头孢西丁敏感,检出mecA基因,其他菌株头孢西丁药敏结果耐药株均能检出mecA基因,头孢西丁敏感株均未检出mecA基因。结论 mecA、ermB、ermC基因是该组菌对β-内酰胺类和大环内酯类药物耐药的重要原因,对婴幼儿感染标本分离的金黄色葡萄球菌进行β-内酰胺类药物耐药基因(blaZ、mecA)及大环内酯类药物耐药基因(ermA、ermB、ermC、mphC、msrA)检测研究尚为国内首次。     

功能性单心室的超声心动图诊断

目的 探讨经胸超声心动图对单心室的诊断价值.方法 43例患者术前均进行经胸超声心动图检查,术后对检查结果进行回顾性分析,并与CT及手术结果对比.结果 本组43例功能性单心室中左优势型31例(72％),右优势型5例(12％),不定型7例(16％),所有病例与手术及螺旋CT对照,主要诊断符合率100％.结论 超声心动图对功能性单心室的诊断准确率高,对临床有重要的指导作用.     

Repair of sheep metatarsus defects by using tissue-engineering technique

Tissue-engineering bone with porous β-tricalcium phosphate (β-TCP) ceramic and autologous bone marrow mesenchymal stem cells (MSC) was constructed and the effect of this composite on healing of segmental bone defects was investigated. 10-15 ml bone marrow aspirates were harvested from the iliac crest of sheep, and enriched for MSC by density gradient centrifugation over a Percoll cushion (1.073g/ml). After cultured and proliferated, tissue-engineering bones were constructed with these cells seeded onto porous β-TCP, and then the constructs were implanted in 8 sheep left metatarsus defect (25 mm in length) as experimental group. Porous β-TCP only were implanted to bridge same size and position defects in 8 sheep as control group, and 25 mm segmental bone defects of left metatarsus were left empty in 4 sheep as blank group. Sheep were sacrificed on the 6th, 12th, and 24th week postoperatively and the implants samples were examined by radiograph, histology, and biomechanical test. The 4 sheep in blank group were sacrificed on the 24th week postoperatively. The results showed that new bone tissues were observed either radiographic or histologically at the defects of experimental group as early as 6th week postoperatively, but not in control group, and osteoid tissue, woven bone and lamellar bone occurred earlier than in control group in which the bone defects were repaired in “creep substitution” way, because of the new bone formed in direct manner without progression through a cartilaginous intermediate. At the 24th week, radiographs and biomechanical test revealed an almost complete repair of the defect of experimental group, only partly in control group. The bone defects in blank group were non-healing at the 24th week. It was concluded that engineering bones constructed with porous β-TCP and autologous MSC were capable of repairing segmental bone defects in sheep metatarsus beyond “creep substitution” way and making it healed earlier. Porous β-TCP being constituted with autologous MSC may be a good option in healing critical segmental bone defects in clinical practice and provide insight for future clinical repair of segmental defect.     

咽异感症与消化道疾患的关系初探

目的 探讨咽异感症与上消化道疾患的关系。方法 采用纤维胃镜对随机诊为咽异感症患者进行检查。结果 ９１例咽异感症患者中发现有上消化道疾患５１例，占５６．４％。结论 上消化道疾患可能是咽异感症重要发病因素之一。     

尿微量白蛋白免疫球蛋白G和α1微球蛋白在儿童过敏性紫癜早期肾损伤中的诊断价值

目的探讨尿微量白蛋白（MA）、免疫球蛋白G（IgG）和α1微球蛋白（α1-MG）检测在儿童过敏性紫癜（HSP）早期肾损伤中的诊断价值。方法采用散色比浊法检测45例HSP和49例过敏性紫癜性肾炎（HSPN）儿童尿MAI、gG和α1-MG的水平,通过与50例正常对照组儿童比较,评价其在HSP早期肾损伤中的诊断价值。结果 HSP和HSPN儿童中尿MAI、gG和α1-MG水平均显著高于正常对照组（P〈0.05）,尿MA在HSPN组中的水平显著高于HSP组（P〈0.05）,而尿IgG和α1-MG水平在HSP和HSPN组中并无显著差异（P〉0.05）。结论尿MAI、gG和α1-MG均可诊断儿童HSP早期肾损伤情况,且指标尿MA还可反映HSP肾损伤严重程度,对临床早期治疗有一定价值。     

髓外浆细胞瘤误诊2例

1 病例简介 例1 女67岁,左眼视力下降2个月,左眼球外突1月.专科检查:左眼上睑外侧可触及1.5cm×1.0cm×0.5cm的椭圆形隆起,表面光滑,无波动感,左眼向下、内、前方移位外突,左眼球向颞侧活动受限.全身检查:浅表淋巴结无肿大,全身各部无压痛,肝脾未扪及.实验室检查:血清免疫球蛋白及尿Bence-Jones蛋白阴性,血沉159mm/h,骨髓相检查未见异常.X线平片:头颅及脊柱骨质未见异常.CT扫描:左泪腺区见一卵圆形肿块,密度均匀,边界较清,大小约为2.6cm×2.3cm×2.0cm,CT值约53.0Hu;眼球受压向下、内、前方移位,外直肌受压;眶外侧壁骨质破坏;视神经无异常(图1).CT诊断:左侧泪腺恶性肿瘤,以恶性混合瘤的可能性大.     

后溪配悬钟穴治疗急性腰椎间盘突出症的随机对照研究

目的观察针刺后溪、悬钟穴治疗急性腰椎间盘突出症的临床疗效。方法将符合纳入标准的83例患者随机分为治疗组41例和对照组42例,对照组给予地塞米松联合甘露醇静脉滴注,治疗组在对照组治疗的基础上配合针刺后溪、悬钟穴,1次/d,共7 d。治疗结束后统计2组的临床疗效及治疗前后VAS和ODI评分。结果治疗组总有效率为90.2%,对照组总有效率为73.8%,2组总有效率经统计学分析,差异有统计意义（P〈0.05）。2组VAS和ODI评分治疗前后比较,显著下降,差异有高度统计意义（P〈0.01）;治疗后2组比较,治疗组VAS和ODI评分较对照组下降显著,差异有统计意义（P〈0.05或P〈0.01）。结论针刺后溪、悬钟穴对急性腰椎间盘突出症疗效肯定。