微创玻璃体切割联合曲安奈德眼内注射术治疗糖尿病性视网膜病变的护理配合

[目的]总结微创玻璃体切割联合曲安奈德眼内注射术治疗糖尿病性视网膜病变的护理配合。[方法]对28例糖尿病性视网膜病变病人行微创玻璃体切割联合曲安奈德眼内注射手术治疗,同时加强护理配合。[结果]28例病人手术均顺利完成。[结论]加强糖尿病性视网膜病变病人行微创玻璃体切割联合曲安奈德眼内注射手术治疗的护理配合是手术成功的保证。     

康柏西普联合微创玻璃体切除术对增生性糖尿病视网膜病变的影响

目的探讨康柏西普联合微创玻璃体切除术治疗增生性糖尿病视网膜病变的疗效及安全性。方法回顾性分析2015年3月至2017年2月增生性糖尿病视网膜病变患者168例(168患眼,均为单眼),根据患者治疗方法的不同分为A组(57例)、B组(55例)、C组(56例),A组:25G玻璃体微创手术+玻璃体腔注射康柏西普(术前、术后);B组:玻璃体腔注射康柏西普(术前)+25G玻璃体微创手术;C组:25G玻璃体微创手术。观察对比各组25G玻璃体微创手术所用时间,术中、术后(3个月、6个月)最佳矫正视力(BCVA)、黄斑中心凹视网膜厚度(CMT)。术后6个月判定各组视力改善情况。结果 A组和B组平均手术时间均较短,C组手术用时最长(P0.05),术中C组明显出血、医源性视网膜裂孔发生率以及电凝止血频率最高,A组和B组平均手术时间及术中情况比较,差异无统计学意义(P0.05);术后3个月、6个月BCVA、CMT均较术前明显改善,A组与B组比较差异无显著性(P0.05),A组和B组均优于C组(P0.05);术后6个月,A组视力改善率为84.21%,高于B组(74.55%)与C组(553.57%)(P0.05);A组在术后1个月内玻璃体出血发生率、再次手术率以及术后激光补充次数均低于其他两组,而晚期出血、牵拉性视网膜脱离(TRD)、高眼压发生率C组最高,A组与B组差异无显著性(P0.05)。结论微创玻璃体切除术术前、术后均行玻璃体腔内注射康柏西普可有效治疗增生性糖尿病视网膜病变,安全性佳,且相对单纯微创玻璃体切除术或仅术后球内注射康柏西普更具优势。     

微创玻璃体切除术后早期高眼压发生的相关因素分析

目的探讨微创玻璃体切除术后引起早期高眼压的相关因素。方法 2016年4月至2017年10月我院开展的微创玻璃体切除术治疗玻璃体视网膜疾病的患者217例。观察术后高眼压发生率,并对影响眼压高低的相关因素进行分析。结果微创玻璃体切除术后26眼(11.98%)发生高眼压。高眼压组术前最佳矫正视力(Log MAR)、手术时间、术后眼压高于无高眼压组;两组间前房闪辉及房水细胞分级差异有统计学意义(P0.05)。有晶体眼、人工晶体眼及无晶体眼术后高眼压发生率比较,差异无统计学意义(P=0.065)。25 g玻切术组高眼压发生率高于27 g玻切术组(P=0.026)。硅油组高眼压发生率为22.3%,灌注液组为4.7%,空气组无高眼压发生,三组间差异有统计学意义(P0.001)。糖尿病视网膜病变、眼内填充物(硅油)、术后前房闪辉及术后眼压波动是引起微创玻璃体切除术后早期高眼压的独立危险因素。结论微创玻璃体切除术后早期高眼压的发生受多种因素影响,对于手术时间长、糖尿病视网膜病变患者、眼内填充物为硅油及术后前房炎症反应重的患者尤其要重视术后早期高眼的防治。     

23G微创玻璃体切割术治疗儿童晚期视网膜母细胞瘤的护理

目的探讨23G微创玻璃体切割术治疗眼内晚期视网膜母细胞瘤的护理要点。方法采用23G微创玻璃体切割术治疗11例(12眼)眼内晚期(D期或E期)视网膜母细胞瘤患儿,配合做好心理护理、术后并发症护理及延续性护理工作。结果 12眼均完成视网膜肿物切除;随访半年,病情稳定8眼,肿瘤复发4眼。结论玻璃体手术能够有效切除眼内晚期视网膜母细胞瘤,积极有效的围术期护理对预防并发症,促进病情恢复具有重要意义。     

玻璃体切除术治疗自发性玻璃体积血105例临床分析

目的:探讨自发性玻璃体积血的病因及玻璃体切除术的治疗效果。方法:对2010年1月²012月12月在我院接受玻璃体切除术,随诊超过6个月的自发性玻璃体积血患者105例(116眼)的病因及手术效果进行回顾性分析。结果:术中清除玻璃体积血,明确病因。其中糖尿病性视网膜病变63眼(占54.3%),老年黄斑变性8眼(占6.9%),视网膜裂孔11眼(占9.5%),孔源性视网膜脱离13眼(占11.2%),视网膜静脉阻塞12眼(占10.3%),视网膜静脉周围炎3眼(占2.6%),Terson综合征3眼(占2.6%),放射性视神经视网膜病变3眼(占2.6%)。术后99眼(占85.3%)视力提高,13眼(占11.2%)视力无明显变化,4眼(占3.4%)视力下降。术中和术后并发症发生率低。结论:自发性玻璃体积血的病因多样,以糖尿病性视网膜病变、视网膜裂孔、孔源性视网膜脱离、视网膜静脉阻塞、老年性黄斑变性居多。玻璃体切除术能尽早明确病因,提高视力。     

玻璃体切除治疗无晶体眼及人工晶体眼视网膜脱离的疗效观察及护理

目的探讨玻璃体切除术治疗无晶体眼及人工晶体眼视网膜脱离的临床效果.方法以无晶体眼及人工晶体眼原发性视网膜脱离76例为对象,采取玻璃体切除联合巩膜环扎或巩膜外垫压术及单纯巩膜环扎或巩膜外垫压术,对其进行临床对照观察.结果随访3个月～2年,49例玻璃体切除联合巩膜环扎或巩膜外垫压术组视网膜复位39侧,复位率86.7%;27例单纯巩膜环扎或巩膜外垫压术组视网膜复位11例,复位率64.8%.结论玻璃体切除联合巩膜环扎或巩膜外垫压术是治疗无晶体眼及人工晶体眼原发性视网膜脱离有效的方法[1],良好的心理护理、正确的体位护理等是视网膜复位、减少或防止术后并发症的保证.     

玻璃体切除术治疗外伤性视网膜脱离的护理

外伤性视网膜脱离是眼外伤的严重并发症,手术是主要的治疗方法,尤其是眼球穿孔伤、眼内异物伤性视网膜脱离,因有屈光间质混浊,玻璃体积血,增生性玻璃体病变,手术难度大,复位困难,用传统的方法治疗成功率低,甚至无法治疗.1997年1月至2000年5月我院采用玻璃体切除术治疗外伤性视网膜脱离29例,效果良好,现将护理体会报告如下.……     

23G微创玻璃体切除治疗黄斑裂孔性视网膜脱离的围手术期护理

黄斑裂孔性视网膜脱离是一种特殊类型的孔源性视网膜脱离,是黄斑全层裂孔形成后,液化的玻璃体经此孔到达视网膜神经上皮层下而造成的,是眼科临床常见疾病[1],其发生率占孔源性视网膜脱离的10％～20％[2],较早即产生严重的视力损害,常造成视力下降、视物变形及视野缺损等.黄斑裂孔性视网膜脱离治疗较为棘手,实施手术治疗对术后视功能恢复有重要意义.自20世纪70年代开创现代玻璃体手术以来,玻璃体视网膜手术领域取得了极大的发展,微创玻璃体切割术也日益引起人们的关注[3].23 G高速玻璃体切割术是近年来发展迅速的新型微创玻璃体切割术,与传统20 G玻璃体切割术相比,具有切口小、免缝合、损伤小、手术时间短、恢复快等优点[4].我院2011年3月至2012年12月对接受23G玻璃体切割术联合内界膜剥除术治疗的20例(20只眼)特发性黄斑裂孔性视网膜脱离患者进行手术治疗,效果满意,现报道如下.     

部分视网膜切除在复杂性视网膜脱离术中的应用

对于严重增殖性玻璃体视网膜病变引起的视网膜皱褶、视网膜僵硬、卷曲、网膜下膜增殖,经玻璃体切割,充分网膜前膜剥离和重水使用仍不能展平视网膜者,利用视网膜切开松解视网膜,对僵硬部分视网膜行切除术或同时行网膜下膜剥离使视网膜获得复位,提高了手术的成功率。作者自2002年应用该技术治疗该类患者9例,获得一定疗效,现总结如下。     

玻璃体切除治疗无晶体眼及人工晶体眼视网膜脱离的疗效观察及护理

目的 探讨玻璃体切除术治疗无晶体眼及人工晶体眼视网膜脱离的，临床效果。方法以无晶体眼及人工晶体眼原发性视网膜脱离76例为对象，采取玻璃体切除联合巩膜环扎或巩膜外垫压术及单纯巩膜环扎或巩膜外垫压术，对其进行临床对照观察。结果 随访3个月～2年，49例玻璃体切除联合巩膜环扎或巩膜外垫压术组视网膜复位39例，复位率86．7％；27例单纯巩膜环扎或巩膜外垫压术组视网膜复位11例，复位率64．8形。结论 玻璃体切除联合巩膜环扎或巩膜外垫压术是治疗无晶体眼及人工晶体眼原发性视网膜脱离有效的方法，良好的心理护理、正确的体位护理等是视网膜复位、减少或防止术后并发症的保证。     

Diagnostic cytology in veterinary medicine: a comparative and evidence-based approach

Diagnostic cytology is a core veterinary pathology service involving specimens from domestic animals, laboratory animals, and exotic species. Evidence-based application of cytopathology involves management of preanalytical factors, and thorough evaluation of the diagnostic accuracy of the technique in each species and for all specimen types. Unique to veterinary medicine is the reliance on cytology as the basis for crucial medical decisions such as humane euthanasia, especially when the patient is critically ill or when financial considerations limit diagnostic and therapeutic options. This article reviews the cytologic criteria for the diagnosis of selected neoplastic and infectious diseases.     

Evaluation of informative value of laboratory tests and test complexes for the occupational diseases

The authors discuss the criteria for rational selection of laboratory parameters most informative for the diagnosis of occupational diseases. Such criteria as diagnostic significance, diagnostic specificity, diagnostic informative value according to Kulback (Igx), and diagnostic selectiveness ensure the optimal selection of laboratory parameters for the diagnosis of occupational diseases. Diagnostic sensitivity is not a stable value, as it depends on the disease severity and degree of exposure to harmful factors. Basic requirements, which should be taken account of when selecting the complex of laboratory methods for the diagnosis of occupational diseases, are defined.     

《现代临床检验诊断系统》的开发研究

目的开发《现代临床检验诊断系统》，应用于临床和患者的检验诊断信息的查询。方法基于我科出版的《现代临床检验诊断手册》，参考近年出版的临床检验诊断文献，编写《现代临床检验诊断系统》，做成个人计算机（PC）和局域网络（WEB）版本。结果系统中编写了1000多种检验项目，采用模糊查询的方法，在个人计算机或网络终端输入检验项目的关键词或代码，即可查询到该项目的标本采集、标本量、使用容器、检测的方法、概要、参考范围、临床意义、标本采集方法和注意事项以及部分检验项目的医学决定水平。结论软件融知识性、实用性、普及性于一体，内容丰富详细，界面清楚、美观明析，查阅快速方便，便于临床和患者的推广应用。     

Multicenter evaluation of two commercial amplification kits (Amplicor, Roche and LCx, Abbott) for direct detection of Mycobacterium tuberculosis in pulmonary and extrapulmonary specimens

Direct detection of Mycobacterium tuberculosis was performed in parallel with the Amplicor M. tuberculosis test (Roche Diagnostic System, USA) and the LCx M. tuberculosis (Abbott Diagnostic Division, USA) on 697 samples, collected from 481 patients, in three different Italian laboratories. Though both systems are licensed only for pulmonary specimens, 113 extrapulmonary specimens (represented mainly by pleural fluids, cerebrospinal fluids and urines) were included in the study. Amplification results were compared with acid-fast microscopy, culture, and identification of isolates. Final clinical diagnosis was used to resolve discrepant results. M. tuberculosis was detected in 105 specimens by both assays, whereas 561 were agreeing negatives; 21 and 6 of the remaining true-positive samples scored positive with LCx only and with Amplicor only, respectively. There were three false-positives with LCx and one false-positive with Amplicor. The diagnostic sensitivity of both methods was significantly better when only respiratory specimens were considered (78% versus 59% in nonrespiratory samples with Amplicor, and 88% versus 65% with LCx). Our data reveal a significantly better sensitivity of the LCx (p = 0.026) and a slight better specificity of the Amplicor assay. It is noteworthy that 16 of the 21 Amplicor-negative specimens in which LCx detected M. tuberculosis were culture negative, thus suggesting that the higher diagnostic sensitivity of the latter assay is attributable to its better analytical sensitivity. However, the majority of such samples originated from patients under antimicrobial treatment, which makes uncertain the clinical significance of such increased sensitivity. Considering true-positive for LCx and true-negative for Amplicor, the 16 culture-negative/LCx-positive/Amplicor-negative specimens resulted true-positives after the resolution of discrepancies, the final overall sensitivity and specificity values of the LCx assay were not significantly different from the ones of the Amplicor assay.     

Diagnostic pathology and laboratory medicine in the age of "omics": a paper from the 2006 William Beaumont Hospital Symposium on Molecular Pathology

Functional genomics and proteomics involve the simultaneous analysis of hundreds or thousands of expressed genes or proteins and have spawned the modern discipline of computational biology. Novel informatic applications, including sophisticated dimensionality reduction strategies and cancer outlier profile analysis, can distill clinically exploitable biomarkers from enormous experimental datasets. Diagnostic pathologists are now charged with translating the knowledge generated by the "omics" revolution into clinical practice. Food and Drug Administration-approved proprietary testing platforms based on microarray technologies already exist and will expand greatly in the coming years. However, for diagnostic pathology, the greatest promise of the "omics" age resides in the explosion in information technology (IT). IT applications allow for the digitization of histological slides, transforming them into minable data and enabling content-based searching and archiving of histological materials. IT will also allow for the optimization of existing (and often underused) clinical laboratory technologies such as flow cytometry and high-throughput core laboratory functions. The state of pathology practice does not always keep up with the pace of technological advancement. However, to use fully the potential of these emerging technologies for the benefit of patients, pathologists and clinical scientists must embrace the changes and transformational advances that will characterize this new era.     

Diagnostic ratings of hypnotizability

A clinically derived system for the diagnostic rating of hyp-notizability is described. 5 major categories of hypnotizability are differentiated. Diagnostic ratings are contrasted with standardized verbatim tests of hypnotic susceptibility. Potential usefulness in both laboratory and clinical settings is stressed.     

3种梅毒血清学诊断试验的临床应用评价

目的通过比较3种梅毒血清学检测方法的敏感性、特异性,选择简单、快速、敏感性高和特异性强的检测方法。提高对梅毒（特别是妊娠期隐性梅毒）的早期诊治,控制梅毒传播。方法采用甲苯胺红不加热血清反应素试验（TRUST）,梅毒螺旋体特异性抗体明胶凝集试验（TPPA）,梅毒螺旋体抗体诊断试剂盒（胶体金法）3种方法检测218例血清标本,TPPA法和胶体金法检测40例质控标本。结果TRUST、TPPA、胶体金法对95例梅毒血清标本和123例非梅毒血清标本对照组的敏感性分别为78．9％、97．9％、88．4％,特异性分别为84．6％、98．4％、96．7％。TPPA法的敏感性明显高于TRusT法和胶体金法,差异有统计学意义（P〈0．05）;胶体金法对2NCU梅毒确认抗体室内质控和低浓度室间质评标本均不能检出,其敏感性明显低于TPPA法,差异有统计学意义（P〈0．05）;TPPA法的特异性明显高于TRUST法,差异有统计学意义（P〈O．05）,TPPA法特异性高于胶体金法,差异有统计学意义（P〈0．05）。结论TPPA法有极高的敏感性和特异性,可作为梅毒血清抗体检测的确证方法;胶体金法简便快速,较适用于临床急诊标本检测;TRUST法适用于梅毒疗程观察和疗效判断,有助于判断梅毒复发及再感染,采用TPPA和TRUST联合检测,既可提高梅毒检出的阳性率,减少漏诊和误诊;又可作为病程观察和疗效判断的指标,以便梅毒患者能得出及时有效的诊治,对有效控制妊娠期梅毒和胎传梅毒的发生及梅毒传播都具有较大的临床价值。     

Diagnostic error in a national incident reporting system in the UK

Rationale, aims and objectives Diagnostic errors and delays carry potentially grave consequences for patients and feature prominently in studies of adverse events in health care. Diagnostic errors present a particular challenge for error/incident reporting systems because they involve clinical reasoning and are difficult to define precisely. The aim of the present study was to investigate what insights can be gained about diagnostic error from an incident reporting system. Methods Diagnostic errors reported to the UK's National Reporting and Learning System (NRLS) between November 2003 and October 2005 were investigated. We analysed reported level of harm to the patient and incident location and we compared diagnostic with non‐diagnostic incidents. We also assessed the quality of reporting in a subset of reports associated with a patient's death. Results Of 316 589 incidents reported in the period under investigation, 1674 were diagnostic (0.5%). Diagnostic incidents were more likely than other incidents to be associated with moderate or severe harm, or a patient's death and were more likely to occur in a hospital emergency department than other incidents. Diagnostic incidents in emergency departments were more likely to be associated with greater harm than similar incidents in wards. Observed reporting quality (detail; clarity) was very variable. Conclusion These findings replicate findings from studies in emergency departments and suggest that reporting systems have a role to play in understanding diagnostic errors alongside other sources of error analysis. Accurate and complete reporting of adequate volume enhances the potential contribution of an incident reporting system to understanding diagnostic error.