真菌性鼻窦炎临床诊断和实验室诊断的对照研究

目的 比较真菌性鼻窦炎的临床诊断和真菌实验室诊断的差异.方法 回顾100例真菌性鼻窦炎患者,根据临床表现、影像学检查及手术中所见作为临床诊断的标准,同时在术中取鼻窦黏膜送病理检查,鼻窦分泌物送真菌涂片镜检和培养.结果 100例患者中,真菌球性鼻窦炎、变应性真菌性鼻窦炎、急性暴发性侵袭性真菌性鼻窦炎以及慢性侵袭性真菌性鼻窦炎分别是82例、10例、6例和2例.临床诊断、病理诊断、真菌涂片和培养的阳性率分别是95%、61%、78%和74%.上述检测方法 的阳性率之间差异有统计学意义(P<0.01).结论 临床诊断可以作为初步判断真菌性鼻窦炎的主要手段,特别是真菌球性鼻窦炎、变应性真菌性鼻窦炎以及急性暴发性侵袭性真菌性鼻窦炎.真菌性鼻窦炎的诊断需要结合临床诊断、病理检查、真菌涂片和培养,真菌培养是确定致病真菌的主要手段.     

辅助检查对明确诊断变应性真菌性鼻窦炎的价值

目的回顾性总结变应性真菌性鼻窦炎CT影像表现及病理学特征并与临床相结合,探讨辅助检查对准确诊断变应性真菌性鼻窦炎的价值。方法收集30例确诊为变应性真菌性鼻窦炎的CT影像资料和组织病理学检查结果,男13例,女17例,鼻窦炎CT扫描采用骨窗和软组织窗扫描并结合组织病理学检查及临床检查结果。结果单侧鼻窦发病26例,双侧鼻窦发病4例,单侧或双侧病变均为多鼻窦受累。CT扫描影像特点为鼻窦腔散在均匀高密度影,呈毛玻璃特征,周边为软组织影,与周边水肿软组织影对比明显;伴不同程度骨质吸收或结构不清,有9例鼻窦扩张增大和鼻窦骨壁骨质压迫性吸收。鼻腔或鼻窦内黏蛋白分布与CT显示毛玻璃样高密度影一致。病理学特征:光镜下(HE染色):无定形淡嗜酸性或淡嗜碱性变应性黏蛋白,大量嗜酸性粒细胞及夏-莱结晶,鼻窦黏膜仅表现为水肿或增生,无真菌侵犯。结论变应性真菌性鼻窦炎的影像检查、病理学特征与其他鼻窦炎不同,可辅助准确诊断变应性真菌性鼻窦炎。     

70例鼻腔鼻窦真菌感染的病理诊断分析

目的探讨真菌性鼻窦炎的分类、致病机制、致病真菌类型及临床病理学表现,以提高对真菌性鼻窦炎的病理诊断水平。方法回顾性分析2010年3月至2011年5月我院收治的70例真菌性鼻窦炎患者的临床资料。结果 70例真菌性鼻窦炎患者中非侵袭型46例,真菌球29例,变应性真菌性鼻窦炎17例;侵袭性24例,急性侵袭性真菌性鼻窦炎13例,慢性侵袭性真菌性鼻窦炎11例。结论真菌性鼻窦炎有侵袭型和非侵袭型2种,其病理过程和临床表现不同,临床可通过真球菌、变应性黏液及病变组织内真菌进行病理诊断。     

变应性真菌性鼻窦炎的临床诊断和治疗

目的总结变应性真菌性鼻窦炎的临床特点,探讨临床诊断和治疗经验。方法回顾性分析18例确诊为变应性真菌性鼻窦炎患者的病例资料。患者男12例,女6例;年龄17～58岁。均根据CT扫描的病变范围实施鼻内镜手术,有条件者术后配合免疫治疗。结果鼻内镜检查均见鼻腔单发或多发半透明粉白色息肉。包括真菌在内的2种以上变应原阳性(2 ～4 )。CT扫描提示鼻窦腔内片状高密度阴影,呈毛玻璃样特征,周边为软组织影。内镜下见鼻窦腔内果酱样黄褐色或褐绿色泥沙样分泌物。术后组织病理学检查组织内较多嗜酸粒细胞浸润,但未见真菌。经综合治疗后随访6个月至3年,治愈13例,好转5例。其中10例术后配合免疫治疗者治愈9例。结论根据实验室及专科检查,结合鼻内镜手术所见及术后组织病理学检查,可以对变应性真菌性鼻窦炎作出正确诊断。给予以鼻内镜手术为基础的综合治疗,尤其是术后配合免疫治疗,可以取得比较满意的治疗效果。     

变应性真菌性鼻窦炎的诊断与治疗

变应性真菌性鼻窦炎(allergjc fungal sinusitis,AFS)是真菌性鼻窦炎的一种类型有其独特的免疫、病理及临床特点,本文从其发病机制、临床表现、病理学及影像学检查诊断及治疗几个方面进行综述。     

48例非侵袭性真菌性鼻窦炎术后局部冲洗疗效分析

真菌性鼻窦炎分为侵袭性和非侵袭性两大类,临床常见的真菌球和变应性真菌性鼻窦炎属非侵袭性真菌性鼻窦炎[1-2].本科室从2003年4月至2009年12月跟踪随访90例非侵袭性真菌性鼻窦炎(noninvasive fungal sinusitis)患者,随访时间6个月至3年.所有患者术前均进行鼻内镜、鼻窦CT检查和术后组织病理切片检查,使用过碘酸-雪夫法(Periodicacid-Schiff,PAS)病检证实均诊断为真菌性鼻窦炎[3].     

真菌性鼻-鼻窦炎的诊断与治疗

目的:提高真菌性鼻-鼻窦炎的诊治水平。方法:6例行上颌窦根治术,24例行鼻内窥镜手术。鼻内窥镜手术中摘出息肉,切除钩突,清理窦内分泌物和息肉样变黏膜,分别送病理检查、分泌物涂片检查和真菌培养,术中彻底冲洗。5例慢性侵袭型患者全身应用制霉菌素6周。变应性者雷诺考特或辅舒良喷鼻半年,口服强的松4周递减,其中1例行变应性脱敏治疗18个月。结果:30例中27例随访6个月至5年全部治愈,治愈率90%。鼻腔内窥镜检查见术腔干净,黏膜无水肿,无分泌物,窦口或下鼻道开窗口通畅。结论:手术彻底清除病灶加根据致病细菌类型采取不同治疗方法是提高治疗效果的关键。     

鼻内镜手术治疗真菌球型鼻窦炎52例

随着鼻科学研究的发展,真菌性鼻窦炎的诊断和治疗成功率不断提高.根据真菌组织的侵袭性和宿主的免疫状态,将真菌性鼻窦炎分为侵袭性和非侵袭性.前者包括急性爆发型、慢性侵袭型;后者包括真菌球型和变应性真菌性,其中真菌球型鼻窦炎在临床中最为常见.1998年1月～2006年6月笔者应用鼻内镜手术治疗52例真菌球型鼻窦炎患者,疗效满意,报告如下.     

真菌性鼻窦炎患者的诊断进展

目前临床上对于真菌性鼻窦炎的诊断,运用较多的是鼻内镜检查结合典型的CT表现。鼻内镜和CT检查是真菌性鼻窦炎术前诊断的重要辅助检查,但对于区别真菌性鼻窦炎的类型以及真菌的种类有着一定的局限性,甚至对于一些不典型的真菌性鼻窦炎在早期的诊断上有着一定的盲区。随着分子检测技术及血清学技术的成熟,将对于真菌性鼻窦炎的诊断及分型提供依据。但是目前分子检测技术对于取材及设备要求较高,在临床上的应用较少,而对于血浆1,3-β-D葡聚糖检测(G试验)、半乳甘露聚糖抗原检测(GM试验),虽然取材很方便,但对于怎样提高其敏感度及特异性,减少假阳性及假阴性的发生,并且应该怎样更好的应用到真菌性鼻窦炎的诊断治疗上,还需要进一步的研究。     

真菌性鼻-鼻窦炎

目的探讨真菌性鼻-鼻窦炎的发病、分类及诊治,提高临床医师的认识和诊治水平.方法回顾性分析真菌性鼻-鼻窦炎26例的诊治过程,结合文献复习进行讨论.结果随访6个月到5年,治愈率96.15%;分泌物涂片真菌阳性率为92.31%;真菌培养阳性率为69.23%,曲霉菌属占83.33%;全部病例均经病理检查确诊.结论真菌性鼻-鼻窦炎的类型不同,其诊断标准、治疗原则各不相同,明确诊断依赖于思想重视、典型的分泌物、临床表现和CT检查及真菌学检查;彻底清理病变、术后定期复查是主要治疗手段.临床医师特别是中小医院临床医师(包括放射科医师)要进一步提高对本病的认识水平和诊治水平,尽量减少漏诊、误诊和误治.     

2230例变应性疾病患者血清特异性抗体测定分析

目的检测变应性疾病血清特异性抗体筛选相关过敏原,为临床诊断和治疗提供依据。方法采用过敏原检测系统,对2 230例变应性疾病患者的血清特异性免疫球蛋白E(immunoglobulin,IgE)及总IgE水平进行了检测。结果 2230例变应性疾病患者中过敏原以屋尘螨(28.3%)、粉尘螨(26.6%)为最高,其后依次为蒿(14.9%)、猫毛皮屑(9%)、牛羊肉(9%)、蟑螂(8.3%)、鱼虾蟹(8.1%)、霉菌(6.6%)、牛奶(6.1%)、矮豚草(5.6%)、腰果花生(4.6%)、榆、梧桐、柳、三角叶杨(3.8%)、鸡蛋白(3.8%)、黄豆(3.1%);总IgE阳性率为46.9%。结论血清特异性IgE及总IgE的检测分析可以帮助临床寻找相应过敏原,为变应性疾病的预防、诊断和治疗提供依据。     

Allergic diseases, immunoglobulin E, and autoimmune pancreatitis: a retrospective study of 22 patients

Background Autoimmune pancreatitis （ALP） is a chronic inflammatory disease of pancreas.We evaluated the clinical manifestations,imaging,and histological presentations of AlP in Chinese patients,and investigated the roles of immunoglobulin E （IgE） and allergic diseases in the diagnosis and pathogenesis of AIP.Methods The clinical records of 22 patients diagnosed with AlP were reviewed and analyzed.All patients with AlP fulfilled the 2006 revised diagnostic criteria proposed by Japan Pancreas Society or the Korean Criteria for AIP.Results Half （11/22） of AlP patients had allergic diseases.Twenty-one patients had elevated serum IgE levels,and 14 patients had IgE levels more than 3 times that of normal.There were no significant differences between the patients with higher or lower IgE,with or without allergic disease,in clinical features,laboratory tests,diffuse or focal lesions,or the choice of treatment methods; however,more complaints of body weight loss were observed in patients with higher IgE levels.Patients with higher IgE levels and with allergic diseases were more likely to have onset in March,April,May,August,September,or October.IgE levels decreased after therapy,but increased again during recurrence.Increased number of mast cells was found in the pancreatic tissue in AIP.Conclusions IgE maybe a useful marker for monitoring therapeutic response and recurrence of AlP.Allergic processes may play an important role in the pathogenesis of AIP.     

51例变态反应霉菌性鼻窦炎诊疗分析

目的 提高对变态反应霉菌性鼻窦炎的认识,有利于诊断和治疗.方法 分析51例变态反应霉菌性鼻窦炎的发病趋势,临床表现、影像学特点及疗效.结果 发病率呈增高趋势,与多种因素有关.手术是主要的治疗方法.结论 CT和彩色超声的联合运用,可明显提高对变态反应霉菌性鼻窦炎的诊断水平,有助于与鼻腔恶性肿瘤、鼻窦囊肿等鉴别.鼻内镜联合...     

Diagnostic imaging, preautopsy imaging and autopsy findings of

Background Aquired immune deficiency syndrome （AIDS） presents a challenge to medical researchers because of its unique pathological and clinical picture. The clinical data, particularly autopsy evidence, from China have failed to provide enough pathological and etiological evidence for AIDS diagnosis, which impairs the reliability of the diagnosis and our full understanding of the occurrence and development of AIDS complications. The purpose of this study was to investigate the imaging and pathologic characteristics of AIDS. Methods Autopsy, imaging and pathological data from 8 cases of AIDS were retrospectively analyzed. Routine CT scanning of different body parts was performed during their periods of hospitalization. Transverse CT scanning was conducted from the skull to the pelvis immediately after the occurrence of death. After routine formalin fixing, 7 cardevers were cross sectioned for autopsy in freezing state and 1 for gross autopsy. Tissues were obtained from each section and organs for pathological examinations. Results The autopsy data indicated the presence of parasitic infections, bacterial infections, fungal infections, and virus infections in AIDS patients. Pneumocystis pneumonia, pulmonary tuberculosis, coccobacteria pneumonia, Aspergillus pneumonia, cytomegaJovirus pneumonia, toxoplasma encephalitis, lymphoma and cerebrovascular diseases were found in these patients. Conclusions During the course of AIDS progression, the concurrent multiple infections as well as tumor development may resuJt in multiple organ pathological changes and clinically complex symptoms that further complicate the imaging and pathological manifestations, thus resulting in difficult differential diagnosis. A combination of imaging data and autopsy data can help to clarify the diagnosis.     

真菌性鼻-鼻窦炎32例的临床回顾

目的:探讨真菌性鼻-鼻窦炎的诊断、分型与鼻内镜的治疗效果。方法:回顾性分析在我院2002年1月～2006年2月经鼻内镜鼻窦手术治疗的32例(34侧)真菌性鼻-鼻窦炎的临床资料、诊断与治疗。结果:术后随访6～54个月,全组病例获得治愈。结论:真菌性鼻-鼻窦炎临床易误诊;术前CT、MRI检查可助早期诊断;临床分型对指导治疗有着重要的意义;鼻内镜鼻窦手术是治疗真菌性鼻-鼻窦炎的有效手段并具有微创的优点。     

CT诊断和鼻内窥镜手术对真菌性鼻-鼻窦炎的诊治探讨

目的探讨真菌性鼻-鼻窦炎恰当的诊断及治疗方法。方法回顾性对2005年4月～2009年4月我科收治的35例真菌性鼻-鼻窦炎的临床症状、CT表现及鼻内窥镜治疗效果分析。结果 35例真菌性鼻-鼻窦炎经鼻内窥镜下鼻窦开放手术后冲洗鼻窦治疗后随访6个月～2年3,3例1次治愈2,例复发经再手术解除鼻窦口堵塞后用刮霉菌素冲洗鼻窦治疗后治愈,随访6个月无复发。结论 CT检查是诊断真菌性鼻-鼻窦炎的有效检查手段,鼻内窥镜下鼻窦开放后联合制霉菌素冲洗鼻窦是治疗真菌性鼻-鼻窦炎的有效方法。     

磁共振脊髓造影对腰椎退行性病变的诊断价值

目的评价磁共振脊髓造影(MRM)对腰椎退行性病变的临床诊断价值。方法以L3-4、L4-5和L5-S1间隙和其下位的左右神经根作为研究单位,前瞻性观察了36例临床诊断为腰椎退行性病变患者的108个研究单位的临床资料及其常规CT、MRI、MRM影像资料。以临床诊断为金标准,用配对χ2检验比较常规CT、MRI、MRM在病变类型诊断、硬膜囊病变定位和神经根病变定位3个方面的敏感度和特异度,评价MRM的准确性。结果腰段MRM图像质量优良率为94.4%,无创伤和不良反应,平均检查时间为18 min,费用为1 080元/次。结论MRM具有特异性高、敏感度高、操作简便、图像质量优良、安全性好、成本低的特点,在腰椎退行性病变的诊断和手术计划中具有重要参考价值。     

Differentiation of neuromyelitis optica from multiple sclerosis in a cohort from the mainland of China

Background Although there were criteria for diagnosis of neuromyelitis optica （NMO） and multiple sclerosis （MS）,it is still difficult to differentiate NMO from MS,due to the overlapping clinical manifestations.Therefore it is necessary to characterize clinical features of NMO and MS patients in the mainland of China,to simplify the process of disease diagnosis,and to identify criteria for the differential diagnosis of NMO and MS.Methods A total of 138 Chinese Han patients from the mainland of China including 73 NMO,60 MS and 5 MS-like patients with positive NMO-IgG were included in the study.Clinical records were reviewed retrospectively and the results of clinical examination,laboratory experiments,magnetic resonance imaging （MRI） and evoked potentials （EPs） were compared between NMO and MS patients.In addition,the relationship between the NMO-IgG serologic status and clinical characteristics were analyzed.Results Compared with MS patients （1.3∶ 1.0）,more female prevalence was observed in NMO patients （4.2∶ 1.0; P=0.003）.There were also statistically significant differences in visual EPs,oligoclonal bands,brainstem lesions in MRI and longitudinally extensive spinal cord lesions （LESCLs） between NMO and MS patients.Brainstem lesions observed in brain MRI were found in 17.9% of MS patients,over 3.7 times higher than in NMO patients （4.8%,P=0.024）.When stratified NMO patients by NMO-IgG,LESCLs were found in 42.1% of NMO-IgG-negative NMO patients,over 3.5 times higher than in NMO-IgG-positive patients （11.9%,P=0.008）.Statistical difference was also observed in CD4＋/CD8＋ ratios between NMO-IgG-positive and-negative NMO patients.Conclusions Comprehensive analysis of MRI,laboratory and EPs data can facilitate differential diagnosis of MS and NMO.In addition,the combination of LESCLs and brain MRI findings failing to satisfy MRI criteria for MS is highly sensitive and specific for NMO.     

Clinical value of optimized magnetic resonance imaging for evaluation of patients with painful hip arthroplasty

Background The imaging evaluation of pain in patients who have had a hip arthroplasty （HA） is challenging,and traditional imaging techniques,including magnetic resonance imaging （MRI） and computerized tomography （CT）,are limited by metallic artifact.The purpose of the present study was to investigate the use of modified MRI techniques to visualize periprosthetic soft tissues and the bone-implant interface,and to evaluate the value of MRI for the assessment of patients with painful hip arthroplasty.Methods Fifty-six painful hips in fifty-six patients following primary HA were assessed using optimized MRI,CT and standardized radiographs.The diagnosis of MRI was correlated with intraoperative findings as well as with microbiological and histological examinations （when available）.The sensitivity and the specificity of MRI diagnosis were determined according to final diagnosis.The chi-square test was performed to detect a difference between MRI and final diagnosis.Results Forty-eight patients have received revision surgery and final diagnosis were established.MRI was demonstrated high sensitivity and specificity in detecting aseptic loosening （93％ and 95％）,periprosthetic infection （94％ and 97％）,adverse local tissue reaction （100％ and 100％） and periprosthetic fracture （100％ and 100％）.MRI was determined to be the most sensitive technique in detecting implant loosening for any reason,with a sensitivity of 93.8％ for acetabular shell and 97.1％ for femoral stem,compared to 81.3％ and 80.0％ on CT,75.0％ and 77.1％ on radiographs.Conclusions Optimized MRI was effective for the assessment of the periprosthetic soft tissues and bone.The use of modified magnetic resonance imaging parameters provided a useful adjunct to conventional examinations for the evaluation of patients with painful hip arthroplasty.