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膝、腕关节滑膜超声在类风湿关节炎中的临床价值比较

摘要:目的:探讨类风湿性关节炎(RA)病人膝、腕关节滑膜关节滑膜的超声检查指标与RA临床指标的相关性。方法:通过高频超声及彩色多普勒超声对RA病人(50 例)的膝、腕关节的滑膜情况(包括滑膜厚度、关节积液程度、滑膜彩色血流分级)进行观察,并获取RA患者疾病活动度(DAS28)分值、炎症指标C反应蛋白(CRP)、红细胞沉降率(ESR)、标记性抗体抗瓜氨酸抗体(CCP)和类风湿因子(RF)滴度水平并对上述指标做相关分析。结果:①RA病人膝关节滑膜厚度、关节积液程度、滑膜血流信号分级等级与患者DAS28(r=0.35、r=0.38、rs =0.54,Plt;0.05)、CRP(r=0.41、r=0.45、rs =0.57,Plt;0.05)、ESR(r=0.38、r=0.42、rs=0.51,Plt;0.05)均呈正相关;腕关节滑膜厚度、滑膜血流等级信号与患者DAS28(r=0.55、rs=0.69,Plt;0.05)、CRP(r=0.53、rs =0.67,Plt;0.05)、ESR(r=0.48、rs=061,Plt;0.05)均呈正相关,且相关系数高于膝关节组;②膝关节组滑膜厚度与关节积液程度、滑膜血流分级等级均呈正相关(Plt;0.05),关节积液程度与滑膜血流分级呈正相关(Plt;0.05);腕关节组滑膜厚度与滑膜血流分级等级均呈正相关(Plt;0.05);③膝、腕关节之间仅滑膜血流信号等级成等级正相关(Plt;0.05)。结论:膝、腕关节滑膜超声能较好地观察类风湿性关节炎病人滑膜的病变,其指标能作为一种客观有效的评价疗效、判断疾病活跃性及评估预后的指标,尤其应该以腕关节作为RA病人的优选关节。

免散瞳眼底照相法在筛查糖尿病患者视网膜病变中的优势分析

目的　对比分析免散瞳眼底数码照相法和散瞳后直接用眼底镜检查法在筛查糖尿病视网膜病变（DR）的优劣势，为DR早期防治提供可靠而简便易行的筛检方法。 方法　对2010年12月－2011年6月就诊的352例确诊糖尿病患者进行免散瞳眼底照相和普通眼底镜检查法检查眼底后对比两者在DR检出率差异。免散瞳眼底照相使用日本Topcon TRC-NW300彩色数码眼底照相机，所使用的眼底镜型号为M374451。视网膜病变分级以2002年国际DR严重程度分级标准进行分期。 结果　两种方法测得352例患者眼底视网膜病变阳性结果为：数码照相测得阳性总数61例（占17.33%），其中轻至中度非增殖性DR38例（占10.80%），重度至增殖性DR23例（占6.53%）。眼底镜测得阳性总数60例（占17.05%），其中轻至中度非增殖性DR38例（占10.80%），重度至增殖性DR22例（占6.25%）。两种方法的测得结果高度一致（P＞0.5）。 结论　免散瞳眼底数码照相法和传统散瞳后眼底镜检查法相比在筛查DR效果等同，但有着简便易行、省时省力和检查结果可保存的优点，对患者进行定期监测对比和指导治疗都有着重要意义。

视网膜母细胞瘤的彩色多普勒超声诊断分析

超声生物显微镜在睫状体及其相关疾病检查中的应用

睫状体位于虹膜后，是常规眼科方法检查的ldquo;盲区rdquo;，由于它的隐蔽位置，使睫状体及其相关 疾病的临床检查和诊断十分困难。超声生物显微镜检查(ultrasound biomicroscopy,UBM)采用高频超声波作为检测能源，可穿过透明组织和非透明组织。因此，UBM不但能观察到虹膜表面的形态，还能观察到后房及虹膜后组织的情况，其令人满意的分辨力和清晰度，为临床检查睫状体的形态、位置以及病变提供了良好的工具。现对UBM在睫状体及其相关疾病检查中的应用及其临床意义作一综述。（中华眼底病杂志，2002，18：79-81）

Effect of acoustic earplugs combined with sedative drugs on improving the success rate of MRI examinations in children with epilepsy

ObjectiveTo investigate the effect of acoustic earplugs combined with sedative drugs on improving the success rate of MRI examinations in children with epilepsy, and to provide an effective clinical evidence for MRI examination in children with epilepsy for the future.MethodsSeventy-four children with epilepsy who came to the Second Affiliated Hospital of Guangzhou Medical University, between July 2016 and February 2018 were included in this research. To test the effectiveness of acoustic earplugs on children with epilepsy in improving MRI success rates, participants were divided into two groups randomly. The control group only took the drug and withont using the acoustic earplugs. The observation group used both the drug and acoustic earplugs. The comparing the success rate of MRI examination between the two groups.ResultsThe observed group (with the acoustic earplugs) showed a success rate of 97.29% (36/37), the control group (without the acoustic earplugs) showed a success rate of 18.91% (7/37). The success rate of the observed group was higher than the control group (P<0.05) significantly.ConclusionsThe use of acoustic earplugs combined with sedative drugs is effective in improving the success rate of MRI examination in children with epilepsy and can be widely used in clinical practice.

Clinical Preliminary Observations on Laparoscopic Staging of Gastric Cancer

目的：探讨腹腔镜检查对胃癌分期的价值。方法: 2007 年1月至2007 年11 月收治的胃癌患者14 例胃癌患者在全麻下行腹腔镜检查。结果: 腹腔镜T分期与术后病理检查结果符合率为92.9％，术前临床T分期与术后病理检查结果符合率为64.3%。腹腔镜分期显著优于临床分期Plt;0.05。在14例术前临床分期均未发现腹膜转移的病例中，腹腔镜探查发现有腹膜转移（P1-P3）者4例，腹腔镜对腹膜转移的评估显著优于临床分期P lt;0.05。结论: 腹腔镜可作为常规检查手段的一种补充，能对进展期胃癌进行准确的诊断和分期，有助于手术决策制定及估计治疗结果与预后，避免不必要的剖腹探查。

The clinical features of primary uveal lymphoma of four cases

ObjectiveTo investigate the clinical, ophthalmological and pathological features of primary uveal lymphoma.MethodsRetrospective clinical study. From 2012 to 2018 in Beijing Tongren Eye Cener, 4 cases and 4 eyes of patients with primary uveal lymphoma were included in the study. Among them, 3 cases were male and 1 case was female. The average age was (54 ± 13.58) years old. The average time from initial diagnosis to pathological diagnosis was (18.50 ± 9.29) months. 3 cases were enucleated and 1 case was biopsied. Extranodal marginal zone lymphoma (EMZL) of the mucosa associated lymphoid tissue (MALT) was confirmed by pathological examination. BCVA, fundus color photography, color Doppler ultrasound and orbital MRI were performed in all eyes. UBM, OCT, FFA and ICGA were performed in 2 eyes, 3 eyes, 3 eyes and 2 eyes respectively. The clinical, imaging and pathological changes were observed. Following up time was ≥ 6 months.ResultsAt the initial diagnosis, BCVA was 0.6, 0.02 and 0.01 in 1, 2 and 1 eye respectively. Choroid, ciliary body and iris were involved in 3 eyes, choroid in 1 eye. The fundus of the eyes showed infiltration of choroid in yellow and white color, and the lesions were beyond the vascular arch to the equator and peripheral areas. Color Doppler ultrasonography showed that choroidal diffuse thickening and extrascleral extension (ESE) which was the corresponding hypoechoic areas behind the sclera. Among them, ESE showed crescent thickening in 1 eye and nodular thickening in 3 eyes. UBM showed that the echo of ciliary body was thicken and the internal echo was decreased with the iris involved. OCT showed that RPE was wavy and local retinal neuroepithelial layer detached. FFA showed that the early lesions were mottled with strong and weak fluorescence, and the late fluorescence leakage. The posterior wall of the eyeball was thickened and enhanced in MRI.ConclusionThe clinical manifestations of uveal lymphoma are various, color Doppler ultrasound has characteristic manifestations and ESE of crescent or nodular thickening is valuable in diagnosis.

彩色多普勒能量图在眼部疾病的诊断应用

乳腺包裹性乳头状癌 3 例报道并文献复习

目的总结乳腺包裹性乳头状癌（encapsulated papillary carcinoma，EPC）的临床病理学特征、诊断、鉴别诊断以及治疗方法，从而加深对 EPC 疾病的认识以及规范诊治。方法回顾性分析遵义医科大学附属医院 2012 年 1 月至 2018 年 11 月期间收治且经术后石蜡标本病理学检查明确诊断为 EPC 患者的临床资料，并结合相关文献总结其临床病理学特征以及治疗方法。结果共收集到 3 例患者，均为女性，年龄分别为 36 岁、50 岁、70 岁。其中 2 例以“发现乳腺肿块”就诊，肿块均为单发，边界清楚；另 1 例以“乳房胀痛伴乳头溢血溢液 2+ 年”入院。2 例患者的免疫表型为 Luminal 型，1 例免疫表型为三阴性型。 2 例 Luminal 型患者以手术治疗为主，而三阴性型以手术治疗及术后化疗为主。3 例患者目前在随访中、无复发及转移。结论乳腺 EPC 是厚的纤维囊壁包裹且囊壁肌上皮缺乏特殊亚型的浸润性癌，预后较好。其中 Luminal 型 EPC 的治疗原则同导管原位癌（ductal carcinoma in situ，DCIS），而三阴性型 EPC 的治疗参照传统型浸润性乳腺癌。

Characteristics of results of color Doppler flow imaging in retinopathy of prematurity

ObjectiveTo observe the morphologic characteristics of color Doppler flow imaging (CDFI) and blood stream in patients with retinopathy of prematurity, and provide the new clinical diagnostic gist.MethodsCDFI was performed on 78 patients (156 eyes) with ROP at Ⅳ and Ⅴ stage, who had the diseases history such as prematurity and low birthweight which had been diagnosed by indirect ophthalmoscope, underwent the examination of CDFI. Morphologic characteristics of the results of CDFI and features of blood flow of the pathological changes were observed. ResultsIn the patients with ROP at the Ⅳ stage, a weak zonal echo originated from one side of peripheral wall of eye ball in the vitreous body, and extended to the echo of post pole and wall of eye ball and joined the echo of optic disc. In the patients with ROP at the V stage, lumplike echo connected closely with echo of lens and the circumambience was surrounded; the focus looked like lotus when combined with retinal detachment: the swelled “corona” wrapped and tightly connected with the lens, and the thin “caulis” showed weak zonal echo which attached to the optic disc. The features of blood flow showed the signal of blood stream connected with central retinal artery at the “caulis”, which was analyzed by Doppler spectrum as the bloodflow spectrum of artery and vein in the same direction which was the same as the central retinal artery and vein.ConclusionsIn patients with ROP at the IV and V stage, the results of CDFI mainly shows zonal or lumplike echo, in which the bloodflow signal extended with central retinal artery could be seen. The morphological changes of CDFI and the features of blood flow are useful in diagnosis of ROP. (Chin J Ocul Fundus Dis, 2005,21:282-284)