重庆地区成年女性甲状腺结节检出情况及影响因素分析

目的 了解重庆地区健康体检人群中成年女性的甲状腺结节(thyroid nodules,TNs)检出情况及影响因素,为甲状腺疾病的防治提供参考。方法 分析重庆某大型三甲医院健康体检中心38 069例健康女性体检者甲状腺超声检查情况及代谢相关指标,计算甲状腺结节的检出率并分析其影响因素。结果 38 069例健康女性体检者中,16 042例检出甲状腺结节,检出率为42.1%,多发性甲状腺结节8 908例,占比为55.5%,甲状腺结节的检出率随年龄增长而增加(P<0.01)。多因素logistic 回归分析提示,年龄增加(>30岁)、中心性肥胖(OR=1.16,95%CI:1.08～1.25)、高血压(OR=1.16,95%CI: 1.07～1.25)是甲状腺结节的独立危险因素(P<0.01); 低BMI是甲状腺结节的保护因素(OR=0.89,95%CI: 0.81～0.98, P<0.01)。结论 重庆地区女性甲状腺结节检出率较高,对于高龄、中心型肥胖及高血压女性人群应该重点进行甲状腺结节的超声筛查,以便早期发现和诊断。     

动态喉镜下咬检性切除早期声带癌

目的：利用动态喉镜观察声带振动及黏膜波动,以早期诊断声带癌,并在图象放大屏幕下活检性切除病变组织;术后动态观察手术侧声带振动及黏膜波的恢复情况,以冀早期发现声带癌复发。方法：对12例早期声带癌,利用动态喉镜活检性切除病变组织。经病理检查其中2例为原位癌,10例为表浅浸润癌。结果：术后11例恢复声带振动及黏膜波动;1例未恢复,予以预防性放疗。术后随访2年以上无肿瘤复发。结论：利用动态喉镜活检性切除早期声带癌并术后动态观察,于表麻下施术,患者痛苦小,治疗时间短,术后发声良好。     

Thyroid carcinoma mimicking a toxic adenoma

A young woman with a thyroid papillary carcinoma behaving as an autonomously hyperfunctioning nodule is described. Only 17 similar patients have been seen in the past 25 years. It is emphasized that hyperthyroidism does not exclude malignant disease in hot nodules. This possibility suggests that all thyroid nodules, either cold or hot, require careful management. Therefore, in at risk cases, surgery could be the most useful treatment.     

甲状腺切除病例喉返神经损伤的分析

目的：研究甲状腺切除术的主要并发症－－喉返神经（ＲＬＮ）麻痹的相关因素。方法：回顾性研究１５６３例甲状腺手术患者的临床资料,重点分析ＲＬＮ损伤与术式、ＲＬＮ在术中是否被分离保护以及与甲状腺疾病的病理关系。结果：ＲＬＮ损伤率是７．８％,与组织病理恶性程度明显相关（Ｐ〈０．０１）,但术中如明确找到ＲＬＮ并加以保护,术后则无ＲＬＮ永外性损害,暂时麻痹仅１．６％。结论：术中对ＲＬＮ的保护应该强调避免医源性     

京剧嗓音的声学分析及音域特征

目的　从声学角度客观地检测京剧的嗓音特征 ,为京剧演唱者嗓音的训练和保护提供参考。方法　对 73名 1 6～ 5 7岁不同行当的专业京剧演员或学员 ,利用Dr Speech计算机频谱分析系统对元音 /a/、/i/歌唱舒适音和唱段进行声学参数的检测和分析。结果　各行当元音 /a/、/i/歌唱舒适音的基频 (fundamentalfrequency,F0 )分别是 :丑角 (2 72 6± 42 0 )Hz( x±s ,下同 )、(30 4 2± 2 2 1 )Hz;小生 (499 3± 34 0 )Hz,(485 4± 1 8 7)Hz;老生 (335 6± 6 0 0 )Hz,(31 7 9± 45 1 )Hz ;花脸 (31 9 0±6 1 3)Hz,(34 0 1± 6 8 8)Hz;老旦 (42 7 6± 47 2 )Hz,(437 7± 45 8)Hz ;花旦 (5 35 8± 48 8)Hz,(5 6 1 6± 2 9 2 )Hz ;青衣 (5 48 0± 6 9 5 )Hz,(5 43 5± 79 3)Hz;其它声学参数 :频率微扰 (pitchperiodperturbation,或Jitter)、振幅微扰 (amplitudeperturbation ,或Shimmer)和声门噪声能量 (也称标准化噪声能量级 ,normalizednoiseenergy ,NNE)均在软件提供的正常值范围内 ;京剧演员歌唱音域的跨度为 1 7～ 2 8个八度 ,最低音和多数最高音均比西洋唱法的高音声部相应的值高。结论　京剧嗓音有着独特的声学特征 ;结果对其嗓音的训练和保护有一定的临床参考     

Neurological prognosis correlated with variations over time in the number of subependymal nodules in tuberous sclerosis

In tuberous sclerosis (TS), brain CT reveals subependymal nodules, cortical tubers and white matter lesions. This study is a retrospective analysis of the relationship between the variations over time in the number of subependymal nodules and the clinical course in cases of tuberous sclerosis. Twenty-four children with tuberous sclerosis, who attended the National Children's Hospital as outpatients, were followed by means of brain CT examinations for 7 years and 1 month on average. Cranial MRI was also performed in 22 cases. Brain CT disclosed subependymal nodules already in early infancy. In almost all cases, the number of subependymal nodules gradually increased with age, especially around the frontal horn of the lateral ventricle. The increase stopped at around age 10. The cases with five or more subependymal nodules at the initial or subsequent CT examination (17 patients; Group A) exhibited a significantly greater number of cortical tubers than those with less than five (five patients; Group B) and had white matter lesions unlike Group B. In addition, the number of cases with either infantile spasms or mental retardation was significantly higher in Group A than Group B (P<0.005). In conclusion, the number of ventricular subependymal nodules may allow prediction of the severity of the cerebral dysfunction in TS. Our results suggest that its variation may reflect the degree of the embryologic disorder when neuronal cells grow in the early gestational period.     

颈部粗短或颈椎病患者的喉动态内镜直视法声带息肉摘除术

目的：探讨喉动态内镜直视下声带息肉摘除术对体胖颈部粗短或颈椎病患者的疗效。方法：对42例体胖颈部粗短或颈椎病患者在喉动态内镜直视下，以弯形声带息肉钳经口咽部行声带息肉摘除术，术中并以喉动态镜观察其声带的对称性、规律性、黏膜波动度及声带闭合度，若发现残留息肉，即时可再次修整摘除。结果：手术均一次成功，无一例发生并发症。术后随访未见复发，音声恢复良好。结论：该术式对体胖颈部粗短或颈椎病患者的声带息肉摘除具有临床应用价值。     

正常与病态下嗓音的客观指标的评价

对158例正常人和136例各种喉疾病患者连续元音[i]发声时的平均气流率、声强、频率、频率微扰商和发声效率同步进行了测定.并对各测定指标间的相互关系进行了探讨.频率微扰商是表示连续元音发声时声带振动相邻周期间的微细变动量;发声效率反映平均气流率与声能的有效转换率.在低、中和高强度发声时.随发声强度的提高,平均气流率.频率和发声效率随之提高而频率微扰商则变小.中等声强发声时.平均气流率与声强,声强与频率均呈正相关;而平均气流率与发声效率.声强(男性)和频率(女性)与频率微扰商均呈负相关.多数喉疾病患者显示出较正常人高的平均气流率和频率微扰商,发声效率则降低.当声强和频率作为参考指标时,平均气流率,频率微扰商和发声效率可作为评价喉发声功能的客观、定量指标.