与Graves眼病有关的眼肌自身抗原抗体的分子免疫学研究

为探讨Ｇｒａｖｅｓ眼病（ＧＯ）的发病机理，我们对新近发现的眼肌自身抗原及存在于ＧＯ患者血清的眼肌抗体进行了研究。血清取自１８例正常人、１８例活动性ＧＯ、１０例无限征的Ｇｒａｖｅｓ甲亢（ＧＨ）和３例桥本甲状腺炎（ＨＴ）患者。人眼肌膜蛋白经ＧＯ患者混合ＩｇＧ亲和层析后进行ＳＤＳ－聚丙烯酰胺凝胶电泳，显示分子量为４５、２８、５５和６４ｋＤ等蛋白条带。经正常人混合ＩｇＧ亲和层析未能显示上述结果。Ｗｅｓｔｅｒｎ印迹杂交虽然未能证实仅与患者血清作用的独特的眼肌抗原的存在，但６４ｋＤ印迹存在于６１％的ＧＯ、３０％的ＧＨ、０％的ＨＴ患者，正常人仅２２％阳性。抗６４ｋＤ阳性率ＧＯ组明显高于对照组（Ｐ＜０．０５）。眼肌抗体（ＥＭＡｂ）特别是抗６４ｋＤ抗体对于ＧＯ发病机理的作用值得进一步研究。     

中西医结合治疗颈性眩晕的临床观察

目的：观察中西医结合治疗颈性眩晕的疗效。方法：将80例颈性眩晕患者随机分为两组,对照组口服氟桂利嗪胶囊,治疗组在对照组基础上,另服自拟益气补髓汤加减。两组均连用2周后判断疗效。结果：治疗组总有效率为93％,对照组为78％,两组比较,差异有统计学意义（P〈0．05）。结论：中西医结合治疗颈性眩晕疗效显著。     

Clinical exophthalmometry: a comparative study of the Luedde and Hertel exophthalmometers

Exophthalmometry, the quantitative assessment of the position of the globe in the orbit, is a clinically useful measurement. The purpose of this study was to examine the performance of a simple exophthal-mometer that would lend itself to accurate and convenient use in clinical practice. In this study, two observers independently performed exophthalmometry on 100 eyes using the Hertel and Luedde instruments. The results were compared between instruments and between observers. There was no statistically or clinically significant difference between measurements taken with the Luedde as compared with the Hertel instrument. The Luedde exophthal-mometer has a number of advantages over the Hertel exophthalmometer, and represents a simple, inexpensive and equally reliable means of evaluating clinically the anteroposterior position of the eye in the orbit.     

甲状腺相关眼病患者的眼球病理改变

甲状腺相关眼病(TAO)是一种眼眶常见的自身免疫性疾病,其发病机制尚未完全阐明.目前已有大量研究报道了TAO可累及眼球不同部位,但尚无一个系统的归纳总结.本研究将结合目前国内外研究报道,对TAO眼球各部位受累的证据进行归纳梳理,以探讨TAO患者眼球不同结构的病理改变.     

Cervico-cephalalgiaphobia: a subtype of phobia in patients with cervicogenic headache and neck pain? A pilot study

Objectives: The term ‘cephalalgiaphobia’ was introduced in the mid-1980s and defined as fear of migraine (attacks). We hypothesized that a specific subtype of cephalalgiaphobia affects patients with cervicogenic headache (CEH). This study aimed to: (1) define the term ‘cervico-cephalalgiaphobia’; (2) develop a set of indicators for phobia relevant to patients with CEH; and (3) apply this set to a practice test in order to estimate the frequency of cervico-cephalalgiaphobia in the Dutch primary care practice of manual physical therapy.

Methods: A systematic approach was used to develop a definition and potential indicators for cervico-cephalalgiaphobia. An expert group appraised the definition and the set of indicators (score per indicator: never; sometimes; often/always). An invitation to participate in the practice test was sent to Dutch manual physical therapy practices (n?=?56) representing 134 manual physical therapists (MPTs). The cut-off point for percentages of scores for coverage of the indicators was set at ≥?60%.

Results: The expert group agreed with the proposed definition of cervico-cephalalgiaphobia. A set of eight indicators for cervico-cephalalgiaphobia was selected from 10 initial indicators. Thirty-six MPTs provided data from 46 patients diagnosed with CEH. The coverage of ‘often/always’ was substantial for the indicators, ‘Short-term positive results in previous manual physical therapeutic treatment’, ‘Shorter interval between treatment sessions’, ‘Fear of “locked facet joints” of the neck’, ‘More frequent manipulation’, and ‘Fear of increase in headaches’. Coverage was also substantial for ‘never’ regarding ‘Long-term positive results in previous manual physical therapeutic treatment’. ‘Confirmation of “locked facet joints” of the cervical spine by MPT as a cause for increase of CEH’ scored ‘often/always’ in all patients. Coverage for ‘Increased use of medication with insufficient effect’ was substantial, scoring as ‘sometimes’ in 39 (84.8%) patients.

Discussion: Cervico-cephalalgiaphobia was defined and a set of eight indicators formulated based on the literature and clinical expertise. The practice test provides valuable information on the frequency of indicators for cervico-cephalalgiaphobia in the Dutch manual physical therapy practice, suggesting that cervico-cephalalgiaphobia is common in patients with CEH.     

Cervicogenic headache: evaluation of the original diagnostic criteria

A variety of headaches are frequently associated with the occurrence of neck pain. The purpose of this paper was to describe the adherence to diagnostic criteria of a series of patients enrolled on the basis of two clinical criteria: (1) unilateral headache without side-shift, and (2) pain starting in the neck and spreading to the fronto-ocular area. One hundred and thirty-two patients (36 male and 96 female) entered the study. Sixty-two patients were assigned to Group A (patients fulfilling criteria 1 and 2), 40 to Group B (criterion 2 only) and 12 to Group C (criterion 1, only). Eighteen subjects were excluded because X-rays of the neck were not available. Patients were evaluated regardless of whether or not they fell into one or more of the following diagnostic categories: cervicogenic headache (CEH), migraine without aura (M) and headache associated with disorders of the neck (HN) (IHS definitions). Fulfillment of the diagnostic criteria for CEH was found to be particularly frequent in Group A. A higher frequency of CEH diagnosis was found when two criteria were used (Group A) than in Group B (P = 0.001); in the former group a higher mean number of diagnostic criteria for CEH were also present (P = 0.001). Group A patients more frequently presented pain episodes of varying duration or fluctuating, continuous pain and moderate, non-excruciating, non-throbbing pain than Group B patients (P = 0.04 and P = 0.08, respectively). In Group C patients, the frequency of these two criteria was relatively low (17%) especially of the first mentioned variable. The presence of at least five of the seven 'pooled' CEH criteria (present in > or = 50% of the patients) might be deemed a reliable cut-off point, allowing the headache to be diagnosed as 'probable' CEH. If patients fulfilling M or HN criteria in addition to the CEH criteria are added to the 'pure' CEH group a total of 74% of Group A patients may have a CEH picture. The temporal pattern of pain and the quality of pain in Group A showed good sensitivity and specificity (> or = 75) when compared with Group B; therefore, the chances of diagnosing a definite CEH are significantly more frequent in patients presenting with unilateral pain that also begins as a neck pain. Head/neck trauma and radiological abnormalities in the cervical spine were not significantly associated with CEH, M or HN diagnoses. An improvement of the current diagnostic IHS criteria might make it possible to avoid the existing, partial overlap of CEH with HN and M. Extensive use should be made of the GON, and other, blockades in the routine work-up of CEH, both in the differential diagnosis and in the mixed forms (CEH + M, and CEH + HN), in order to improve the efficiency of the current diagnostic system.     

甲亢平消丸加减治疗甲状腺功能亢进症的临床研究

目的：探讨甲亢平消丸加减治疗甲状腺功能亢进症（甲亢）的临床疗效。方法：将确诊为甲亢的120例患者按随机数字表法分为治疗组和对照组,每组各60例。对照组采用他巴唑、丙硫氧嘧啶治疗,治疗组给予甲亢平消丸加减治疗。两组均治疗10周后评价疗效。结果：两组有效率比较,差异有显著性意义（P〈0．05）。结论：甲亢平消丸加减治疗甲亢,在改善临床症状和控制甲状腺激素水平方面疗效显著。     

大椎穴合谷刺为主治疗颈源性头痛160例临床观察

目的：观察大椎穴合谷刺为主对颈源性头痛的治疗效果。方法：160例病人随机进行针刺治疗,穴位取大椎,凤池等穴。结果：针刺能够很好的缓解颈源性头痛,该方法治疗简单,方便。     

眼球突出的CT诊断

观察分析眼球突出的ＣＴ表现,探讨眼球突出的病因诊断,材料与方法,对１０５例经手术病理或临床证实的眼球突出的ＣＴ表现进行回顾性分析。结果：眼球突出不仅是眶内病变的常见表现,亦可继发生眶及眶周病变。可由内分泌,肿瘤,炎症及外伤等多种疾病引起。