光学相干断层成像(Optical Coherence Tomograpyhy,OCT)原理及应用

光学相干断层成像术(OpticalCoherenceTomography,OCT)是一种新的光学诊断技术,可进行活体眼组织显微镜结构的非接触式、非侵入性断层成像.OCT是超声的光学模似品,但其轴向分辨力取决于光源的相干特性,可达10um,且穿透深度几乎不受眼透明屈光介质的限制,可观察眼前节,又能显示眼后节的形态结构,在眼内疾病尤其是视网膜疾病的诊断,随访观察及治疗效果评价等方面具有良好的应用前景.     

Postero-medio-anterior approach of the ankle for the pilon fracture

A good view of the operative field is important for better reduction and fixation in surgical treatment of fractures. The exposure of the ankle joint for the pilon fracture is commonly through the anterior approach, or combined with the medical approach. But sometimes it is still difficult to have complete viewing of the articular surface and to apply internal fixation by that approach. In recent years, we developed a "postero-medio-anterior" approach of the ankle joint by one incision. This approach provides an excellent exposure of the anterior, medial and posterior aspects of the ankle joint with a clear view of the articular surface. In our 45 cases of pilon fracture during 1991 to 1995, there was no incisional injury to the neurovascular bundle. Superficial wound edge necrosis was noted in two cases which healed later without further procedure. Therefore, we recommend this approach as a simple and reliable incision for open reduction of pilon fractures.     

免疫组织化学法在鼻窦真菌球诊断中的价值

目的　研究鼻窦真菌球的主要致病菌种 ,探索组织切片中快速鉴定主要条件致病真菌的组织病理学方法。方法　 2 5例鼻窦真菌球患者接受鼻窦病变清除术 ,对其组织病理标本分别进行了碘酸雪夫染色 (paraaminosalicylic ,PAS)和免疫组织化学染色 ,并比较两种方法的敏感性。 结果鼻窦真菌球以上颌窦发病率最高 ,其次是蝶窦。致病真菌检测 :曲霉菌感染 2 3例 (92 % ) ,白色念珠菌感染2例 (8% )。鼠抗曲霉单克隆抗体、兔抗白色念珠菌多克隆抗体可以分别鉴定组织中的曲霉菌和白色念珠菌。免疫组化和PAS染色的敏感性差异无显著性 (χ2 =0 2 72 ,P >0 0 5 )。结论鼻窦真菌球感染以曲霉菌属多见 ,免疫组化技术具有抗原特异性强、诊断快速的特点 ,为确定鼻窦组织的真菌感染以及鉴定真菌菌属提供了新的可靠方法     

Blunt hepatic injury: minimal intervention is the policy of treatment

BACKGROUND: Many publications recommend nonoperative treatment for stable blunt hepatic injury patients. Unstable hemodynamic status is the only indication for surgery. When operation is indicated, controversies exist regarding which operative procedure will be more beneficial to the patients. The purposes of this study are to compare the results of operative and nonoperative management of patients with blunt hepatic injuries and to identify the optimal surgical approach when surgery is indicated. METHODS: Different prospective protocols of treating adult blunt hepatic injuries were conducted. From 1992 to 1993 (group I), urgent surgery would be performed in the presence of hemoperitoneum. The policy shifted to aggressive nonoperative approach between 1996 and 1997 (group II). The patients from each period were divided into three subgroups. Group A included the patients who received nonoperative treatment in either period. Group B consisted of the patients who received surgery in the first period and nonoperative management in the second period. Group C included the patients who were operated on in either group. Comparisons were made between matched groups. RESULTS: Groups IA and IIA patients had minor injuries and could be successfully treated nonoperatively. The results of groups IB and IIB were similar concerning hospital stay, morbidity, and mortality. Transfusion requirements of group IIB patients were significantly higher (2.2 vs. 1.1 units,p = 0.01) than those of group IB. However, 25 (58%) celiotomies of group IB patients were nontherapeutic. When surgery was indicated, group IC patients had significantly higher liver-related mortality (14 of 49 vs. 3 of 55, p = 0.002). Anatomic resection was performed more frequently in that period. CONCLUSION: Nonoperative treatment significantly decreased the rate of nontherapeutic laparotomy but carried the risks of higher transfusion requirements and delaying operation. When surgery was indicated, the policy of minimal intervention positively affected the patients' outcomes. The goal of surgery should be hemorrhage control rather than resection of the injured liver tissues.     

自体角膜缘干细胞联合羊膜移植治疗复发性翼状胬肉

目的　探讨自体角膜缘干细胞联合羊膜移植治疗复发性翼状胬肉的临床效果。方法　将 84例 (84只眼 )复发性翼状胬肉患者随机分为治疗组 (4 6例 )和对照组 (38例 )。治疗组采用自体角膜缘干细胞联合羊膜移植治疗 ,对照组行单纯羊膜移植 ,术后随访 3个月至 2年。结果　角膜上皮均于 1周内完全愈合。治疗组 4 6例中 3例复发 ,复发率为 6 .5 % ;对照组 38例中 9例复发 ,复发率为 2 3.7%。两组相比具有显著性差异 (χ2 =5 .0 0 6 ,P <0 .0 5 )。结论　自体角膜缘干细胞联合羊膜移植抑制了结膜下纤维组织增生 ,重建角膜缘部屏障功能 ,能有效治疗复发性翼状胬肉。     

转内皮抑制素基因治疗大鼠角膜新生血管

目的:探讨转染内皮抑制素(Endostatin)基因对酸烧伤引起的大鼠角膜新生血管的基因治疗。方法:通过限制性内切酶酶切反应、聚合酶链式反应、DNA测序及用NCBIBLAST软件与基因库序列比较的方法进行鉴定,鉴定后在大肠杆菌中扩增,用质粒纯化试剂盒抽提纯化;用750g/L硝酸银和250g/L硝酸钾混合烧灼液制作大鼠角膜新生血管模型,用结膜下注射脂质体包裹的质粒pBlast- hEndostatin来进行体内基因治疗。结果:实验证实质粒pBlast-hEndostatin含有人endostatin基因。结膜下注射脂质体包裹的质粒Tel押029-82245172Email押IJO.2000@163.compBlast-hEndostatin对酸烧伤引起的炎症性角膜新生血管有明显抑制作用,术后6,10,15d对角膜新生血管面积的抑制率分别为37%,40%,43%;对角膜新生血管密度也有明显的抑制作用,抑制率达40%。对角膜新生血管长度和角膜炎症细胞没有明显抑制作用。角膜新生血管面积与角膜水肿、角膜混浊呈正相关。结论:用结膜下注射脂质体包裹的内皮抑制素基因可以部分抑制酸烧伤引起的大鼠角膜新生血管。其作用机制是转基因产生的内皮抑制素蛋白直接抑制角膜新生血管的形成,而不是通过抑制炎症反应来抑制角膜新生血管的形成。     

小梁切除术联合自体巩膜植入术治疗青光眼的临床研究

目的观察小梁切除术联合自体巩膜植入术治疗青光眼的临床疗效。方法对12例(12眼)青光眼患者施行小梁切除术联合自体巩膜植入术。术后观察眼压、视力、滤过泡形态、并发症等,并做超声生物显微镜(UBM)观察。结果经3～18mo的随访,术后视力11眼(92%)维持不变或提高。眼压由术前平均(36.15±11.39)mmHg降至术后1a平均(13.21±4.98)mmHg,有非常显著性差异(P<0.01),末次随访眼压≤21mmHg者11眼(92%),其中9眼形成弥散性滤过泡,术后前房轻度变浅4眼,术后3～7dUBM检查睫状体脱离2眼,无其它并发症发生。结论小梁切除术联合自体巩膜植入术,能有效降低眼压,经济安全术后视力稳定,值得临床应用推广。     

早期原发性开角型青光眼的视网膜光阈值改变

目的:观察早期原发性开角型青光眼视网膜光敏度分布情况及改变特点。方法:采用日本TopconSBP2020自动视野SDT340程序检测早期原发性开角型青光眼与正常眼的中心3°视网膜光敏感度。结果:早期原发性开角型青光眼各方向的视网膜光敏度与正常眼比较有非常显著差异(P<0.01);早期原发性开角型青光眼上方视网膜光敏度与其他各方比较有显著差异(P<0.05);早期青光眼的MD,ST与正常眼比较差异非常显著(P<0.01)。结论:视网膜光敏度的定量检测能做为早期原发性开角型青光眼的较早期视功能检测。     

液氮冷冻治疗鳞屑性睑缘炎的疗效观察

目的:观察液氮冷冻治疗鳞屑性睑缘炎的临床疗效。方法:选取近几年在我院就诊的鳞屑性睑缘炎患者126例234眼,随机分为液氮冷冻治疗观察组65例120眼,每周2-3次治疗,6～10次为一疗程,同时滴用抗生素眼液及眼膏;药物治疗对照组61例114眼,采用滴抗生素眼液及眼膏和2％黄降汞眼膏,20—25 d为一疗程,经治疗二疗程后进行疗效比较。结果:观察组治愈64眼,有效30眼,无效26眼。有效、无效者继续治疗一疗程后治愈32眼,总治愈率80％,对照组治愈48眼,有效30眼,无效36眼,总治愈率42.11％,经统计学处理(X2=-35.47,P<0.01),差异有显著性。结论:液氮冷冻治疗鳞屑性睑缘炎有明显的疗效。