人工耳蜗植入术中圆窗耳蜗电图评价耳蜗残余听功能

目的应用术中圆窗耳蜗电图评估极重度感音神经性聋患者耳蜗残余听功能。方法20例患者全麻下人工耳蜗植入手术过程中,行术中圆窗耳蜗电图测试,测出的复合动作电位（CAP）阈值与术前纯音测听或其他听力测试之阈值进行比较。结果20例患者术中圆窗耳蜗电图测试测出的复合动作电位（CAP）阈值与术前1、2、4kHz听力测试阈值分别有较好的相关系数（0．20429,0．04076,0．38163）。结论术中圆窗耳蜗电图可以较准确客观地评估极重度感音神经性聋患者耳蜗残余听功能,且是人工耳蜗植入术前听力学评估方法的有意义的补充。     

Round pneumonia in children

We evaluated four children with rounded densities on their chest radiographs in whom the final diagnosis was presumed to be lower respiratory tract infection. The differential diagnose between round pneumonia and a neoplastic process is difficult to make. In this report, all of cases of round pneumonia have resolved clinically and radiographically with antibiotic therapy.     

明胶海绵和透明质酸在地塞米松圆窗灌注中对豚鼠圆窗膜形态及功能的影响

目的圆窗分别放置明胶海绵与透明质酸,观察地塞米松圆窗灌注对豚鼠圆窗膜形态及功能影响。方法①36只豚鼠随机分为3组,Ⅰ组圆窗龛放置明胶海绵并在圆窗置管;Ⅱ组圆窗龛放置含2%透明质酸明胶海绵置管,Ⅲ组圆窗龛放置明胶海绵置管,Ⅱ组和Ⅲ组经圆窗置管向圆窗灌注地塞米松7d后。用光学显微镜和扫描电镜观察圆窗膜变化。36只豚鼠中随机取6只左耳作为正常对照（Ⅳ组）。②另取18只豚鼠,按给药时间分为1、4、7d3组,每组各取3只分为实验组和对照组,实验组圆窗放置透明质酸明胶海绵,对照组圆窗放置明胶海绵。各组经圆窗置管圆窗灌注地塞米松后,用LC-6A高效液相色谱仪测定外淋巴液中地塞米松浓度。结果光镜和扫描电镜检查发现Ⅰ、Ⅱ和Ⅲ组圆窗膜厚度和形态与正常对照Ⅳ组比较无明显差异（P〉0.05）;圆窗放置透明质酸明胶海绵后豚鼠外淋巴液中地塞米松含量明显高于明胶海绵组（P〈0.01）。结论①圆窗放置明胶海绵和透明质酸对豚鼠圆窗膜形态无明显影响。②透明质酸明胶海绵能提高地塞米松的圆窗膜通透性。     

圆韧带在股骨头缺血坏死过程中的病理变化及意义

对股骨头缺血坏死和股骨颈骨折两组病人的圆韧带进行组织学观察及动脉口径的测量。观察到两组圆韧带的差别主要表现为炎症反应的程度。两组病人的圆韧带动脉口径差异不大,在统计学方面无显著性意义。股骨头发生渐变坏死过程中,圆韧带动脉不能代偿血循环,它对股骨头的血供无明显的临床意义。     

Round opacity as a presentation of pneumocystis jirovecii pneumonia in an HIV-infected patient

We present the case of a human immunodeficiency virus (HIV)-infected patient who arrived at our emergency department with fever, headache and exertional dyspnea. Throughout their stay, a chest x-ray was taken and a rounded opacity in his left lung was observed. CT images showed same abnormality and also ground glass opacities were seen. Symptoms and images strongly suggested a pulmonary infection due to pneumocystis jirovecii, however a presence of a round lesion should always lead to neoplasia being suspected. We empirically started treatment based on trimethoprim and sulfamethoxazole. Once available, flexible bronchoscopy and bronchoalveolar lavage was performed and stained preparations from his respiratory specimens confirmed the diagnosis of pulmonary pneumocystis infection. Finally, after 4?days of antibiotic therapy, an important clinical improvement was documented; a new chest x-ray was performed and the previous rounded opacity was absent. This finding strongly suggested a case of round pneumonia.     

恶性梗阻性黄疸病人经圆韧带途径肝内胆管空肠吻合术

目的　评价经圆韧带途径行Ⅲ段胆管空肠吻合术姑息性治疗不能切除的恶性梗阻性黄疸病人的临床效果。方法　对 1999年 1月至 2 0 0 2年 12月间 5例不能切除的肝门部恶性梗阻性黄疸病人实施经圆韧带途径显露Ⅲ段肝内胆管 ,并与空肠行Roux en Y式吻合术。对术后血清胆红素和碱性磷酸酶进行动态检测 ,并就病人住院时间、术后生活质量、生存时间进行观察。结果　 5例病人实施肝内胆管空肠吻合术后血清胆红素逐渐降低至正常范围 ,2例病人临终前可维持无黄疸状态。术后 1例并发胆漏 ,1例住院期间因胃肠道恶性梗阻恶病质死亡 ,其他病人均存活超过 13个月 ,最长达 2 3个月。本组 5例术后均无胆管炎和复发性胆道梗阻。结论　经圆韧带途径肝内胆管空肠吻合术是恶性梗阻性黄疸病人姑息治疗的有效术式 ,损伤小 ,方法简便 ,减黄效果确切 ,病人生存质量提高     

经圆窗膜应用甲强龙治疗常规治疗失败的突发性耳聋的临床研究

目的探讨经圆窗膜应用甲强龙（甲泼尼龙琥珀酸钠）治疗常规治疗失败的突发性耳聋的疗效。方法经常规治疗后2周以上无效的突发性聋患者23例耳，分为圆窗膜给药组和对照组；圆窗膜给药组12例耳，其中伴有顽固性耳鸣7例耳；对照组11例耳，其中伴有顽固性耳鸣6例耳。经圆窗膜应用甲强龙的治疗方法即鼓膜局麻后从鼓膜后下方穿刺注入甲强龙，3d注射1次，4次为1个疗程。对照组给予口服都可喜（阿米三嗪＋萝巴新）和弥可保2周。所有患者在治疗前和治疗结束后1周查电测听。结果圆窗膜给药组听力恢复显效2例耳（16．7％）、有效3例耳（25．0％），对照组听力恢复显效0例耳、有效2例耳（18．2％）。经治疗后圆窗膜给药组7例耳顽固性耳鸣中耳鸣消失1例耳（14．3％）、改善3例耳（42．9％），对照组6例耳顽固性耳鸣中无耳鸣消失、改善2例耳（33．3％）。两组比较疗效差异有统计学意义（P〈0．01）。结论经圆窗膜应用甲强龙治疗常规治疗失败的突发性耳聋仍可取得一定的疗效。     

Validation of quantitative NMR

NMR is by definition a quantitative spectroscopic tool because the intensity of a resonance line is directly proportional to the number of resonant nuclei (spins). This fact enables, in principle, a precise determination of the amount of molecular structures and, hence, of substances in solids as well as liquids. With the increase of sensitivity due to stronger and stronger static magnetic fields including improved electronics the detection limits have been pushed down significantly. However, the lack of a precise protocol that considers and controls the aspects of both the measurement procedure as well as the spectra processing and evaluation is responsible for the fact that quantitative investigations of identical samples in various laboratories may differ severely (deviations up to 90% relative to gravimetric reference values).

Here, a validated protocol for quantitative high resolution ¹H-NMR using single pulse excitation is described that has been confirmed by national and international round robin tests. It considers all issues regarding linearity, robustness, specificity, selectivity and accuracy as well as influences of instrument specific parameters and the data processing and evaluation routines. This procedure was tested by the investigation of three different 5-model-compound mixtures. As a result of the round robin tests using the proposed protocol it was found that the maximum combined measurement uncertainty is 1.5% for a confidence interval of 95%. This applies both for the determination of molar ratios and of the amount fractions of the various components. Further, the validation was extended to purity determinations of substances as shown for 1,8-epoxy-p-menthane (cineole).     

Primitive round cell liposarcoma of the omentum: diagnostic value of ultrastructural study

A 25-year-old woman presented with abdominal distension first observed 1 month earlier. She had a rapidly growing omental tumor that was eventually diagnosed as round cell liposarcoma by ultrastructural examination. This case illustrates the importance of ultrastructural study and the limitations of immunohistochemistry in the diagnosis of such tumors, particularly when they grow in unusual locations.     

Juvenile Granulosa Cell Tumor of the Testis: A Case Presenting as a Small Round Cell Tumor of Childhood

We describe the case of a testicular juvenile granulosa cell tumor (JGCT) in a 4-year-old boy. The highly undifferentiated appearance and robust mitotic activity of the neoplasm led to an initial impression of an aggressive, small round cell tumor of childhood. Immunocytochemical and ultrastructural studies excluded the usual members of that group, and led to the correct diagnosis. To our knowledge, this is the oldest reported patient to present with this tumor in the testis, and the first with clinical evidence of hormonal activity. The benign behavior of testicular JGCT mandates that it be distinguished from other, much more aggressive, neoplasms which it may resemble.