个性化综合性治疗泪道阻塞的临床观察

目的探讨泪道阻塞个性化综合治疗的临床疗效。方法临床收集165例(185只眼)泪道阻塞患者。根据病史、泪道冲洗、结合泪囊造影明确阻塞部位和程度。采用以泪囊鼻腔吻合术、KTP术、KTP 微孔支架植入术、泪道扩张术为主,辅以抗炎抗粘药物冲洗治疗。随访3~12个月。结果用本方法治疗的185只眼中,148只眼(80%)治愈;28只眼(15%)有效;9只眼(5%)无效。总治愈率95%。结论泪道阻塞应根据病情选择适当的个性化综合性治疗方法,不仅提高了泪道阻塞的治愈率,而且提高了难治性泪道阻塞的疗效。     

Malignancy Rate and Malignancy Risk Assessment in Different Lesions of Uncertain Malignant Potential in the Breast (B3 Lesions): An Analysis of 192 Cases from a Single Institution

BackgroundThe question of how to deal with B3 lesions is of emerging interest.MethodsIn the breast diagnostics of 192 patients between 2009 and 2016, a minimally invasive biopsy revealed a B3 lesion with subsequent resection. This study investigates the malignancy rate of different B3 subgroups and the risk factors that play a role in obtaining a malignant finding.ResultsThe distribution of B3 lesions after minimally invasive biopsy was as follows: atypical ductal hyperplasia (ADH), 7.3%; flat epithelial atypia (FEA), 7.8%; lobular neoplasia (LN), 7.8%; papilloma (Pa), 49.5%; phylloidal tumour (PT), 8.9%; radial sclerosing scar (RS), 3.1%; mixed findings, 10.4%; and other B3 lesions, 5.2%. Most B3 lesions were detected by stereotactic vacuum-assisted biopsy (44.3%), 36.5% by ultrasound-assisted biopsy, and 19.3% by magnetic resonance imaging-assisted biopsy. Most B3 lesions (55.2%) were verified by surgical resection, whereas 30.7% were downgraded to a benign lesion. About 14.1% of the cases were upgraded to malignant lesions, 9.4% to ductal carcinoma in situ and 4.7% to invasive carcinoma. In relation to individual B3 lesions, the following malignancy rates were found: 28.6% (ADH), 13.3% (FEA), 33.3% (LN), 12.6% (Pa), 5.9% (PT), and 0% (RS). The most important risk factor was increasing age. Postmenopausal status was considered an increased risk for an upgrade (p = 0.015). A known malignancy in the ipsilateral breast was a significant risk factor for a malignant upgrade (p = 0.003).ConclusionIncreasing knowledge about B3 lesions allows us to develop a “lesion-specific” therapy approach in the heterogeneous group of B3 lesions, with follow-up imaging for some lesions with less malignant potential and concordance with imaging or further surgical resection in cases of disconcordance with imaging or higher malignant potential.     

Cronkhite-Canada综合征三例报道并文献复习

Cronkhite-Canada综合征(CCS)目前被认为是一种非遗传性疾病,临床较为罕见,内镜下多表现为胃肠道多发息肉,临床上以消化道症状、皮肤色素沉着、脱发、脱甲等为主要表现。本文分析了2012年8月至2021年9月于山东大学齐鲁医院确诊为CCS的3例患者的临床特点及诊疗过程并作文献复习。CCS的诊断基于病史、体格检查、胃肠息肉的内镜检查和组织病理学结果,消化内镜是其最直接的检查手段。3例CCS患者内镜下均表现为胃肠道弥漫性多发息肉,均存在脱发、脱甲表现;病例1和病例3白蛋白水平均降低,病例2和病例3抗核抗体(ANA)阴性,病例1未查ANA,3例均无幽门螺杆菌(HP)感染。糖皮质激素及质子泵抑制剂(PPI)为CCS的主要治疗药物,病例1未使用糖皮质激素治疗,仅给予PPI及支持治疗,后期出现血便、肠坏死,起病6年后因胃癌行全胃切除术;病例2和病例3确诊CCS后给予泼尼松、PPI等治疗后好转。早期诊断、以糖皮质激素为中心的药物治疗、定期内镜检查和新的治疗方案可能为未来更好的预后提供更多实践经验,可提高临床医师对该病的认识和理解、减少漏诊和误诊。     

大柴胡汤加减治疗内科杂证

大柴胡汤加减治疗胆囊炎、胆石症、急性胰腺炎、便秘、肺炎、偏头痛等内科杂证。     

醒脑开窍针法对脑外伤患者认知功能和日常生活能力的影响

目的：观察醒脑开窍针法对脑外伤（TB）I患者认知功能和日常生活能力影响。方法：将60例TBI认知功能障碍患者随机分为观察组（规范化醒脑开窍针法）、对照组（非规范化的醒脑开窍针法）。治疗前后分别采用神经行为认知状态检查表（NCSE）和改良的Barthel指数评定法（MB）I来评定2组患者的认知功能和日常生活能力。结果：观察组治疗前后比较,在定向能力、专注能力、复述能力、记忆能力、命名能力、计算能力方面上,差异有非常显著性或显著性意义（P〈0.01,P〈0.05）;对照组治疗前后比较,在定向能力、复述能力方面上,差异均有显著性意义（P〈0.05）;治疗后2组间比较,在专注能力、定向能力、复述能力、记忆能力方面上,差异有非常显著性或显著性意义（P〈0.01,P〈0.05）。2组MBI治疗前后比较,差异均有非常显著性意义（P〈0.01）;治疗后2组间MBI比较,差异有显著性意义（P〈0.05）。结论：规范化的醒脑开窍针法能更有效地改善脑外伤后认知功能和日常生活能力。     

针药结合治疗排卵功能障碍性不孕症38例疗效观察

目的:观察电针配合桂枝茯苓胶囊治疗排卵功能障碍性不孕症的临床疗效。方法:将76例患者随机分成2组各38例,治疗组行电针配合桂枝茯苓胶囊治疗,对照组肌肉注射人绒毛膜促性腺激素(HCG),观察2组排卵率和妊娠率。结果:2组的排卵率比较,差异无显著性意义(P=0.05),但治疗组的妊娠率高于对照组,差异有显著性意义(P<0.05)。结论:电针配合桂枝茯苓胶囊治疗排卵功能障碍性不孕症有较好疗效,值得临床推广应用。     

Ideas on several issues of acupuncture-moxibustion science

The Shanghai Journal of Acupuncture and Moxibustion and Journal of Acupuneture and Tuina Science witnessed a development of numerous authors. On the occasion of the 6th anniversary of Journal of Acupuncture and Tuina Science, I＇d like to share my ideas about several issues on acupuncturemoxibustion science.     

子宫体中肾管腺癌一例并文献复习

中肾管腺癌是一种罕见的恶性肿瘤,来源于正常的中肾管残留组织或残留组织的过度增生,发病率低,多发生于宫颈,少见于子宫体。子宫体中肾管腺癌（UCMA）临床表现无特异性,主要为阴道出血,术前易被误诊为生殖道炎症、子宫肌瘤、宫颈癌和子宫内膜癌等。其确诊常依赖于细胞学、活检病理、免疫组织化学染色及和分子学特征,其中GATA3是中肾管腺癌特异性标志物。另外,UCMA预后较差,治疗方案常包括手术及辅助性放化疗。报告1例术前被误诊为子宫肌瘤的UCMA病例,并对相关文献进行复习,总结该病的临床特征,以期减少误诊,提高对本病的认识。     

强直性脊柱炎的中医康复指导

整理中医药对强直性脊柱炎的辨证施治,以及涉及饮食调养、药膳、中成药、验方、外治法、功能锻炼、日常保健等防治措施。中医药防治强直性脊柱炎,有规范的诊断标准和防治措施,在该病的治疗康复中发挥着重要的作用。