绝对期青光眼视网膜神经纤维层活体影像学观察

尽管青光眼是多因素疾病，但最终均为视网膜神经节细胞的凋亡、变性和视神经的损害。Quigiey等的研究表明，青光眼患者的视网膜神经节细胞(RGC)丢失40％左右将出现临床可检测的视野损害。然而，临床绝对期青光眼视功能完全丧失时RGC是否完全丧失?本研究应用光学相干断层扫描仪(optic coherence tomograph，OCT)对绝对期青光眼的视网膜神经纤维层(retinal nerve fiber layer，RNFL)进行了定量观察，以间接了解RGC在绝对期青光眼患者的丢失情况。     

中心性浆液性脉络膜视网膜病变频域光相干断层扫描与时域光相干断层扫描图像比较

Objective To compare difference of the cross-sectional pathological imaging and quantitative measurement of central serous chorioretinopathy (CSC) between time-and fourier-domain optical coherence tomography (OCT). Methods Consecutive 26 patients (26 eyes) with unilaterial CSC were subsumed. Bilateral eyes of all the patients underwent time-and fourier-domain OCT. Horizontal and vertical line scanning and radial six-line scanning protocols were used for time-domain OCT examination; horizontal and vertical high resolution five-line scanning and macular cube scanning protocols were used for fourier-domain OCT examination. The characteristics of OCT images, retinal segmentation and the quantitative measurement were compared between these two methods. Results Fourier-domain OCT could yield the three-dimensional images of surface of inner limiting membrane (ILM) and RPE. The band of external limiting membrane (ELM) of normal subjects and CSC patients, and the inner segment and outer segment (IS/OS) of normal subjects could be clearly shown by fourier-domain OCT. However, the band of IS/OS disappeared in 65.4 % of the CSC patients. The outer boundary of retina was defined in front of the retinal pigmental epithelia (RPE) by fourier-domain OCT. The foveal thickness of normal subjects and CSC patients was (180. 50 ±12.69) and (158. 41 ± 34.20) μm, respevtively. The height of detachment of neuralepithelial layer was (245.84± 154.61) μm measured by fourier-domain OCT. The band of IS/OS of normalsubjects could be clearly shown by time-domain OCT. However, the band of IS/OS disappeared in 73.4%of the CSC patients, which showed no difference with fourier-domain OCT (Z=-0. 108, P=0. 914). Theouter boundary of retina was defined in front of the IS/OS band by OCT. The foveal thickness of normal subjects was (141.16±12.75) μm, which was thinner than that measured by fourier-domain OCT (t= 20. 671,P= 0. 000). The foveal thickness and the height of detachment of neural epithelial layer was (146.40± 36.28) μm and (240. 32±156. 82) μm measured by time-domain OCT, respectively, which showed no significant difference with which measured by fourier-domain OCT (t value was from 0. 026 to 1. 517, P value was from 0. 144 to 0. 980). Conclusions Fourier-domain OCT yields better visualization of intraretinal layers and more accurate definition of outer boundary of retina than time-domain OCT. Thus the measurements by fourier-domain OCT were more accurate. Moreover, three-dimensional images of CSC shown by fourier-domain OCT enable the comprehensive observation of pathological morphology and location.     

洞头县2012—2013年居民恶性肿瘤死亡原因分析

目的了解海岛地区居民恶性肿瘤死亡水平及流行特征。方法采用国际疾病分类法ICD-10进行编码,对洞头县2012—2013年居民恶性肿瘤死亡率进行标化,分析死亡原因及潜在减寿年数(PYLL)、平均减寿年数(AYLL)。结果洞头县居民恶性肿瘤平均死亡率为246.20/10万,标化死亡率为162.69/10万,居全死因第1位;男性死亡率为338.90/10万,女性死亡率为147.10/10万,差异有统计学意义(P0.01)。恶性肿瘤前5位死因依次为肝癌、食管癌、胃癌、肺癌和结直肠癌。不同年龄组恶性肿瘤死因不同,死亡率随着年龄增长而升高。潜在减寿年数依次为肝癌、食管癌、肺癌、胃癌和白血病;平均减寿年数依次为白血病、宫颈癌、乳腺癌、肝癌和鼻咽癌。结论恶性肿瘤是洞头县居民主要死因,严重危害洞头县居民的生命和健康。     

27例一侧肺致密影的病因分析

一侧肺叶病变如 :感染性疾病 ,风湿免疫系统疾病 ,以及部分肿瘤性疾病等 ,在诊断尚未明确之前一定要慎用糖皮质激素 ,以免干扰和掩盖了疾病的自然发展过程 ,甚至感染的播散 ,延误诊治。对一侧肺叶病变原因分析 ,可有助于疾病的诊断及监测诊断并指导治疗。本文对 2 0 0 3年 1月～ 12月门诊或住院2 7例一侧肺叶病变患者进行病因分析总结。本组 2 7例均为我院门诊或住院病人。男 18例 ,女 9例。年龄 7～ 83岁 ,平均 4 5岁。2 7例患者依据临床症状、体征、胸片或胸部 CT影像学检查 ,同时化验血常规 ,血 K+、Na+、Cl-血气分析。　　病因分析 :…     

被动凝集法和ELISA法检测成人肺炎支原体抗体的临床价值比较

目的比较被动凝集(PPA)法与酶联免疫吸附试验(ELISA)检测成人肺炎支原体(MP)感染的临床价值。方法分别采用PPA、ELISA法检测90例成人CAP患者的MP抗体及MP-IgA、MP-IgM、MP-IgG抗体并进行分析。结果 PPA法检测MP抗体阳性率为72.2%(65/90),ELISA法检测总抗体阳性率为50.00%(45/90),差异有统计学意义(P<0.05)。ELISA法检测MP-IgA阳性率为26.7%(24/90),MP-IgM的阳性率为22.2%(20/90),差异无统计学意义(P>0.05),且存在一致性(Kappa=0.520);MP-IgG阳性率为37.8%(34/90),与MP-IgM、MP-IgA阳性率比较差异有统计学意义(P<0.05)。PPA滴度越高,ELISA法MP-IgA、MP-IgM阳性检出率越高。结论 ELISA检测MPIgA、IgM、IgG联合PPA检测MP抗体效价可以提高CAP诊断的准确性,对早期诊断成人MP感染有重要临床意义。     

主动腹膜内外气压平衡技术在完全腹膜外腔镜腹股沟嵌顿疝修补术中的应用

目的：探讨主动腹膜内外气压平衡技术在完全腹膜外腔镜腹股沟嵌顿疝修补术（ TEP）中的可行性及适用性。方法选择58例腹股沟嵌顿疝患者,由同一副主任医师应用主动腹膜内外气压平衡技术行TEP。结果本组手术时间（63.4±5.7）min,术中出血量（24±5.0）mL,住院时间（5.5±1.0）d,术后肠功能恢复时间（25.6±5.1）h,随访（22±5.0）个月,无疝复发,无肠粘连、肠梗阻、气体栓塞等并发症。结论主动腹膜内外气压平衡技术应用于TEP治疗腹股沟嵌顿疝的安全、可行。     

噻托溴铵联合沙美特罗/氟替卡松对老年支气管哮喘患者肺通气功能的改善

目的：探讨联合吸入噻托溴铵和沙美特罗/氟替卡松对老年支气管哮喘患者肺通气功能的影响。方法：将本院呼吸内科100例确诊为支气管哮喘的患者随机分为吸入噻托溴铵和沙美特罗/氟替卡松治疗组43例,沙美特罗/氟替卡松组29例,噻托溴铵组28例。治疗6个月后,观察治疗疗效、治疗前后肺功能变化及治疗后肺功能改善率。结果：联合吸入噻托溴铵和沙美特罗/氟替卡松组的总有效率为88.4%,明显高于噻托溴铵组的67.9%和沙美特罗/氟替卡松组的72.4%,差异具有统计学意义,P〈0.05。同时联合吸入噻托溴铵和沙美特罗/氟替卡松组的肺功能改善率高于其他两组,改善更显著,差异具有统计学意义。结论：噻托溴铵联合沙美特罗/氟替卡松能明显改善支气管哮喘患者肺通气功能,疗效显著。     

闭合性眼外伤致黄斑裂孔的光相干断层扫描图像分析

Objective To observe the features of the images of optical coherence tomograpy (OCT) in patients with traumatic macular hole (TMH), and detect the clinical significance of OCT. Methods Consecutive 74 patients (74 eyes) diagnosed with TMH by examinations of visual acuity, slit lamp, and direct or indirect ophthalmoscopy underwent optical coherence tomography (OCT), The analysis software of OCT was used to make the quantitative measurements of TMH. And the TMH were classified according to the morphological characteristics of the images of OCT. 50°color fundus photography was performed on the patients after OCT. The relationship of TMH with the average visual acuity, disease duration, average neuroepithelial thickness on the margin of hole, and the base diameter and the apex diameter of macular hole were retrospectively analyzed. Results The characterisctics of the images of 74 cases (74 eyes) of TMH were classified into 5 types: macular holes with symmetric edema of the neurosensory retina at the margin in 27 eyes (36.5%), macular holes with asymmetric edema of the neurosensory retina at the margin in 12 eyes (16.2%), macular hole with full-thickness defect of neurosensory retina without edema or detachment at the margin in 14 eyes (18.9 %), macular hole with localized detachment of the neurosensory retina at the margin without edema in 17 eyes (23.0 %), and macular hole with thinning neurosensory retina in 4 eyes (5. 4 %).There was no significant difference of visual acuity among different types of TMH (F=1. 574, P=0. 191).The visual acuity was positively related with the marginal retinal thickness (r=0. 342, P=0. 003), but not related to age, diameter of macular hole or the disease duration(r value was from-0. 022 to-0. 134, P value was from 0. 863 to 0. 261). The disease duration of Type IV TMH was shorter than that of other TMH types. In the patients with the disease duration over 90 days, Type I TMH was predominant. The average retinal thicknesses at the margin of the hole showed significant differences among different TMH types (F= 13.921, P= 0.000). Conclusions TMH could be divided into 5 types according to the characteristics of images of OCT; the clinical characteristics of different types of TMH varies.     

3种方法治疗宫颈糜烂的临床比较

目的:寻找一种治疗各类宫颈糜烂最佳疗效的方法。方法:用奥平栓、爱宝疗、BPM红外光疗仪3种方法治疗宫颈糜烂进行疗效比较。结果:①Ⅰ°糜烂:3种方法有差异(P<0.05)。②Ⅱ°糜烂:奥平栓与爱宝疗无差异(P>0.05),而与红外光疗仪有差异(P<0.05),③Ⅲ°糜烂:3种方法均有显著差异(P<0.001)。④单纯型:3种方法有差异(P<0.05)。⑤颗粒型:奥平栓与爱宝疗有差异(P<0.05)。乳头型:3种方法均有显著差异(P<0.001)。结论:根据不同的患者及宫颈糜烂的程度和类型,选择不同的治疗方法,对提高治愈率和预防宫颈癌具有重要意义。     

影响重度闭合性肾损伤治疗决策的临床因素分析

目的:探讨影响重度闭合性肾损伤治疗决策的因素,最大限度保存肾功能并降低死亡风险。方法:回顾性分析76例重度闭合性肾损伤患者的临床资料,采用χ2检验、t检验及多因素Logistic回归分析方法分析各临床因素对治疗决策的影响。结果:76例重度闭合性肾损伤患者中,Ⅳ级53例,Ⅴ级23例。与非手术组比较,手术组收缩压(P=0.001)、舒张压(P=0.003)、血红蛋白水平(P=0.039)更低,心率更快(P=0.016),输血率更高(P0.001),Ⅴ级肾损伤所占比例更高(P0.001),肾周出血弥漫更明显(P=0.019)。在多因素Logistic回归分析中,肾损伤分级(OR=20.289,P=0.009)和心率(OR=1.08,P=0.027)是手术治疗的独立危险因素。非手术组中,微创治疗组患者血红蛋白更低(P0.001),输血率更高(P=0.001),肾周血肿(PRD)更大(P=0.026)。受试者工作特征曲线(ROC)显示需要微创治疗的肾周血肿的最佳临界距离为3.1cm。在多因素回归分析中,PRD≥3.1cm(OR=73.547,P=0.002)是微创干预的唯一预测因素。结论:非手术治疗可用于重度闭合性肾损伤患者,其中PRD是介入干预治疗的重要指标,而肾损伤分级和心率的变化是手术探查的独立危险因素。