诱导痰(Is)是以高渗盐水或其他诱导物雾化吸入诱导无痰或少痰受检者产生足量痰液，以对气道分泌物的细胞及其他液相成分进行分析研究的一种检测方法，具有经济、无创、准确、重复性较好等优点，能客观地反映气道状态，而且与气道活检的病理改变基本一致，能早期敏感地发现病情变化，并可借此深入研究呼吸系统疾病发病机制及治疗干预。目前，这种检测技术已较成熟，并被广泛应用。 1958年Bickerman等首次建立了诱导痰检测方法，对不能自然咳痰的患者进行高渗盐水雾化获得痰液，利用二硫苏糖醇(DTr)等黏液裂解剂对痰进行处理，消除黏液的影响，提高了肺部肿瘤患者癌细胞的检出率。随后又应用于结核和条件致病菌引发的肺部炎症的诊断。1992年，Pin等首次将诱导痰技术应用于哮喘气道炎症的研究，随后该技术在 COPD、慢性咳嗽、肺间质纤维化等临床研究中得到进一步应用，分析项目也从单一的细胞和病原体等有型成分的检测发展为对痰液液相成分的检测。近年来，越来越多的研究利用诱导痰技术对多种呼吸道疾病的发病机制、诊断与治疗进行研究，逐渐扩大了该技术的应用范围。本文主要阐述诱导痰细胞学检查技术的方法学及临床应用。
ObjectiveTo compare the short-term effectiveness of one-stage posterior debridement with non-structural bone graft and structural bone graft in the treatment of single segment thoracic tuberculosis.MethodsThe data of 61 patients with single segment thoracic tuberculosis, who were treated by one-stage posterior debridement, bone graft fusion, and internal fixation between June 2011 and August 2015, was retrospectively analyzed. All of them, 26 cases were treated with structural bone graft (group A) and 35 cases with non-structural bone graft (group B). No significant difference was found between the two groups in gender, age, disease duration, comorbidity, involved segments, paravertebral abscess, and preoperative American Spinal Injury Association (ASIA) grade, C reactive protein (CRP), visual analogue scale (VAS) score, and Cobb angle of involved segments (P>0.05). But the preoperative erythrocyte sedimentation rate (ESR) in group B was significantly lower than that in group A (t=3.128, P=0.003). The operation time, intraoperative blood loss, hospitalization stay, VAS score, ESR, CRP, ASIA grade, postoperative complications, Cobb angle of involved segments and its correction rate and loss rate, and bone fusion time were recorded and compared between the two groups.ResultsCompared with group A, group B had shorter operation time, less intraoperative blood loss, and longer hospitalization stay, showing significant differences (P<0.05). The follow-up time of group A was (36.3±10.0) months, which was significantly longer than that of group B [(18.4±4.2) months] (t=10.722, P=0.000). At last follow-up, the VAS score, ESR, and CRP in the two groups all significantly improved when compared with those before operation (P<0.05); the CRP of group B was significantly higher than that of group A (t=–2.947, P=0.005); but there was no significant difference in ESR and VAS score between the two groups (P>0.05). At last follow-up, the ASIA grade of the two groups significantly improved when compared with those before operation, and there was no significant difference between the two groups (Z=–1.104, P=0.270). There were 9 cases and 10 cases of complications in groups A and B, respectively, and there was no significant difference (χ2=0.254, P=0.614). The Cobb angle in group B was significantly higher than that in group A at 3 days after operation (t=–2.861, P=0.006), but there was no significant difference in Cobb angle between the two groups at last follow-up (t=–1.212, P=0.230). The postoperative correction rate and loss rate of Cobb angle in group A were higher than those in group B, and there was a significant difference in the loss rate between the two groups (t=2.261, P=0.031). All patients got bone graft fusion and the bone fusion time of group B was significantly shorter than that of group A (t=4.824, P=0.000).ConclusionNon-structural and structural bone graft can both achieve good effectiveness in the treatment of single segment thoracic tuberculosis, but the former has the advantages of less surgical trauma and shorter fusion time.
【摘要】 目的 总结复杂胫骨平台骨折手术治疗的临床经验。 方法 2007年1月-2009年12月，采用切开复位内固定治疗复杂胫骨平台骨折56例。男37例，女19例；年龄19～76岁，平均45.6岁。骨折按Schatzker分型:Ⅳ型12例，Ⅴ型26例，Ⅵ型18例。合并半月板损伤20例，膝内侧副韧带损伤9例，外侧副韧带损伤8例，交叉韧带损伤4例。受伤至手术时间7～14 d，平均9 d。 结果 术后53例切口Ⅰ期愈合；2例术后3 d切口出现浅表感染，1例术后7 d外侧切口出现皮肤坏死、钢板外露，均对症处理后愈合。56例均获随访，随访时间14～49个月，平均19个月。骨折均于术后4～8周愈合，平均6周。并发膝关节僵硬1例、创伤性关节炎2例、异位骨化1例，相应处理后治愈。术后12个月按美国特种外科医院评分标准评价疗效，获优43例，良5例，可4例，差4例，优良率85.7%。 结论 手术治疗复杂胫骨平台骨折需重视软组织条件，掌握好手术时机、选择合适内固定、提高手术技巧、术后有效的功能锻炼是保证疗效的关键。【Abstract】 Objective To summarize the clinical experiences of surgical treatment for complex tibial plateau fractures. Methods From January 2007 to December 2009, 56 patients with complex tibial plateau fractures underwent open reduction and internal fixation. The patients included 37 males and 19 females with the age of 19-76 years old (average 45.6 years old). The Schatzker type of the fractures were type Ⅳ in 12 patients, type Ⅴ in 26, and type Ⅵ in 18. The injuries included meniscus injury in 20 patients, injury of lateral collateral ligament of knee in 9, injury of lateral collateral ligament in 8, and cruciate ligaments injury in 4. The time duration between the injury and the surgery was 7-14 days (average 9 days). Results After the surgery, the incision healed at I stage in 53 patients. The incision was superficially infected 3 days after surgery in 2 patients, and the Necrosis of skin around the incision and revealed steel plate were found 7 days after surgery in 1 patient; the injuries was healed after corresponding treatment. All of the patients were followed up with the average follow-up period of 14-49 months (average 19 months). The fractures healed 4-8 weeks (average 6 weeks) after the surgery. Knee joint ankylosis was found in one, traumatic arthritis was found in two, and heterotopic ossification was found in one; the injuries was healed after corresponding treatment. Twelve months after the surgery, the therapeutic effect according to HSS criteria indicated that the score was excellent in 43, good in 5, generally in 4 and poor in 4; with a fine rate of 85.7%. Conclusion Appropriate conditions of the soft tissue, good surgical opportunity, a appropriate fixation, improved surgical technique and effective postoperative functional training are the key points of surgical treatment for complex tibial plateau fractures.
Objective Chronic cough is often present as increasing cough reaction to various physical and chemical stimulating factors. This study is aimed to investigate the difference of cough sensitivity and its mechanisms which are not clear among different causes of chronic cough. Methods Patients with chronic cough were recruited from cough clinic of Guangzhou Institute of Respiratory Diseases between 2005 to 2010. Using a modified diagnostic algorithm of chronic cough, common causes were identified. Capsaicin cough provocation test was also performed in these patients to assess the cough threshold. The relations between cough reflex sensitivity and duration of cough, cough severity, pulmonary function, induced sputum cell counts were then investigated. Results Through the diagnostic algorithm of chronic cough, the current study evaluated 133 adult patients, including 24 cases with upper airway cough syndrome (UACS) , 26 patients with cough variant asthma (CVA) , 31 cases with eosinophilic bronchitis (EB) , 30 patients with atopic cough (AC) , 22 cases with gastroesophageal reflux induced cough (GERC) . There were 30 healthy volunteers recruited as normal control. The cough threshold of LgC5 in AC, CVA, EB, GERC and UACS was 1.70 ±0.70, 2.12 ±0.67, 2.13 ±0.69, 1.69 ±0.73, 2.16 ±0.66, respectively. The LgC5 of the normal group ( 2.63 ±0.39) was higher than those in chronic cough groups( All P lt; 0.05) . The LgC5 of AC and GERC were lower than CVA, EB and UACS ( all Plt;0.05) . Duration and daytime score of cough showed positive correlations with LgC5( r =-0. 280, -0. 168, all P lt;0.05) . Pulmonary function and differential cell count of induced sputumwere not associated with LgC5 ( all Pgt;0.05) . Conclusions Different cause of chronic cough exhbit high cough reflex sensitivity to different extent. The difference of cough sensitivity may reflect the different pathogenesis among different causes, and may be related to the type of nerve fiber dominating the cough reflex.
ObjectiveTo explore the spectrum and frequency of respiratory symptoms in outpatients clinics.MethodsPatients were enrolled from outpatient clinic of Guangzhou Institute of Respiratory Disease. Information about respiratory symptoms especially cough was obtained from the survey questionnaire from July 2013 to August 2013 .ResultsA total of 900 were eligible out of 939 questionnaires. The mean age of the patients was (48.9±18.3) years, 453 (50.3%) were males, 447 (49.7%) were females. The cases of cough, wheeze, polypnea, chest distress, pharyngalgia, catarrh, chest pain, throat itching, fever, hemoptysis and other symptom was 687 (76.3%), 310 (34.4%), 307 (34.1%), 173 (19.2%), 107 (11.9%), 101 (11.2%), 82 (9.1%), 59 (6.6%), 36 (4.0%), 10 (1.1%) and 129 (14.3%) out of the patients, respectively. In patients with cough, 69.5% of them considered cough as their predominant symptom, and 22.1% of them reported that cough was the only symptom. 56.3% of cases were chronic cough, while acute and subacute cough accounted for 29.7% and 14.0%, separately. The proportion of female in acute cough was significantly higher than that of males (60.3%vs. 39.7%, P<0.01).ConclusionsCough, especially the chronic cough is the most common reason for patients who seeking health care in outpatient clinic of respirologist. There are more females suffered from acute cough than males.
Objective To explore the effectiveness and related issues in the treatment of multiple segments of thoracolumbar tuberculosis through posterior unilateral debridement with bone graft and internal fixation. Methods The clinical data of 29 patients with multiple segments of thoracolumbar tuberculosis who met the selection criteria were retrospective analyzed between January 2012 and July 2015. There were 17 males and 12 females, with age of 21-62 years (mean, 37.4 years). Lesions contained 3-8 vertebral segments, including 3 segments in 6 cases, 4-6 segments in 17 cases, and 7-8 segments in 6 cases. The center lesions located at thoracic spine in 8 cases, lumbar spine in 10 cases, and thoracolumbar segment in 6 cases, and thoracic lumbar skip lesions in 5 cases. The complications included vertebral abscess in 7 cases, psoas major abscess in 6 cases, sacral spine muscle abscess in 7 cases, iliac fossa and the buttocks abscess in 1 case, spinal canal abscess in 2 cases. Preoperative neurological function was assessed according to the American Spinal Injury Association (ASIA) classification: 1 case of grade B, 3 cases of grade C, 8 cases of grade D, and 17 cases of grade E. The disease duration was 6-48 months (mean, 19.3 months). All the patients were treated with posterior unilateral transpedicular or transarticular debridement with bone graft fusion and internal fixation under general anesthesia. Pre- and post-operative visual analogue scale (VAS) score, Oswestry disability index (ODI), and sagittal Cobb angle were recorded and compared. Bridwell classification standard was used to evaluate bone graft fusion. According to the number and the center of the lesion, the necessity to placement of titanium mesh cage was analyzed. Results All the patients were followed up 18-30 months (mean, 24 months). Cerebrospinal fluid leakage occurred in 3 cases, intercostal neuralgia in 2 cases, wound unhealed and fistula formation in 1 case, and ofiliac fossa abscess recurred in 1 case, and all recovered after symptomatic treatment. During follow-up, no fracture or loosing of internal fixation was found and all the lesions were cured at last follow-up. According to Bridwell classification standard, bone graft achieved bony fusion during 4-9 months after operation. The VAS score, ODI, and Cobb angle at immediate after operation and at last follow-up were significantly improved when compared with preoperative ones (P<0.05). At last follow-up, the neural function of all patients improved significantly when compared with preoperative one (Z= –3.101, P=0.002). The ratio of no placement of titanium mesh cage was significantly higher in patients with more than 6 lesion segments (6/6, 100%) than in patients with less than 6 lesion segments (4/23, 17.4%) (χ2=14.374, P=0.000). And the ratio of placement of titanium mesh cage was not significantly different between the patients with the different locations of center focus (χ2=0.294, P=0.863). Conclusion For treating multiple segments of thoracolumbar tuberculosis, the method of posterior unilateral debridement with bone graft and internal fixation can decrease the damage of posterior spinal structures and surgical trauma.
ObjectiveTo explore the feasibility of posterior debridement, decompression, bone grafting, and fixation in treatment of thoracic spinal tuberculosis with myelopathy, and investigate the effects of surgical timing on postoperative outcomes.MethodsThe clinical data of 26 patients with thoracic spinal tuberculosis with myelopathy between August 2012 and October 2015 was retrospectively analyzed. All patients underwent posterior unilateral transpedicular debridement, decompression, bone grafting, and fixation and were divided into two groups according to surgical timing. Group A included 11 patients with neurological dysfunction lasting less than 3 months; group B included 15 patients with neurological dysfunction lasting more than 3 months. No significant difference was found between the two groups in gender, age, involved segments, preoperative erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Cobb angle of involved segment, and preoperative American Spinal Injury Association (ASIA) classification (P>0.05). The operation time, intraoperative blood loss, hospitalization stay, perioperative complications, and bone fusion time were recorded and compared between the two groups. The change of pre- and post-operative Cobb angle of involved segments was calculated. Neurological function was assessed according to ASIA classification.ResultsAll patients were followed up 25-60 months (mean, 41.6 months). No cerebrospinal fluid leakage occurred intra- and post-operation. The hospitalization stay and perioperative complications in group A were significantly less than those of group B (P<0.05). There was no significant difference in operation time, intraoperative blood loss, and bone fusion time between the two groups (P>0.05). At last follow-up, there was no significant difference in ESR and CRP between groups A and B (P>0.05), but they were all significantly lower than those before operation (P<0.05). In group A, 1 patient with T6, 7 tuberculosis developed sinus that healed after dressing; the implants were removed at 20 months with bony union and no recurrence was found after 36 months of follow-up. One patient with T4, 5 tuberculosis in group B underwent revision because of recurrence and distal junctional kyphosis of the thoracic spine at 26 months after operation. There was no internal fixation-related complications or tuberculosis recurrence occurred in the remaining patients. At last follow-up, the Cobb angles in the two groups significantly improved compared with those before operation (P<0.05), but there was no significant difference in the Cobb angle and correction degree between the two groups (P>0.05). At last follow-up, the ASIA classification of spinal cord function was grade C in 1 case and grade E in 10 cases in group A, and grade D in 2 cases and grade E in 13 cases in group B; the ASIA classification results in the two groups significantly improved compared with preoperative ones (P<0.05), but no significant difference was found between the two groups (Z=–0.234, P=1.000).ConclusionPosterior unilateral transpedicular debridement, decompression, bone grafting, and fixation is effective in treatment of thoracic spinal tuberculosis with myelopathy. Early surgery can reduce the hospitalization stays and incidence of perioperative complications.
Objective To investigate the etiological diagnosis of chronic cough with pharyngitis-like manifestations. Methods Patients with chronic cough and pharyngitis-like manifestations were recruited from Outpatient Department of Guangzhou Institute of Respiratory Diseases between December 2002 to March 2010. The causes of chronic cough were investigated using a well-established diagnostic protocol, including history taking and physical examination, pulmonary function tests, induced sputum cytology, 24-h esophageal pH monitoring, etc. The final diagnosis depended on clinical manifestations, examination findings, and a successful response to therapy. Results 326 patients with chronic cough and pharyngitislike manifestations were included in the study with amedian duration of 24 ( 2 ～480) months, amean age of 41 ±13 years. The causes of chronic cough were identified as follows: post nasal drip syndrome or upper airway cough syndrome in 73 cases ( 23. 31% ) , cough variant asthma in 61 cases( 18. 71% ) , eosinophilic bronchitis in 70 cases( 22. 47% ) , gastroesophageal reflux-induced cough in 54 cases ( 16. 56% ) , atopiccough in 48 cases ( 14. 72% ) , and others in 40 cases ( 12. 27% ) . There is no significant difference in percentage of common causes of chronic cough ( P gt; 0. 05) . Conclusion The proportions of upper airway syndrome and other common causes are similar in chronic cough with pharyngitis-like manifestatioins, whichsuggest pharyngitis-like manifestations are not specific for diagnosis of upper airway cough syndrome.
Objective To measure the included angle between tibia anatomical axis and anterior cortex, and to define the relative position of them in order to give direction in placement of tibia extra-medullary alignment bar during total knee arthroplasty. Methods A total of 100 healthy volunteers were included (49 left knees and 51 right knees). There were 52 males and 48 females, aged 20-86 years with an average age of 45.2 years (20-35 years in 29 cases, 35-50 years in 32 cases, and over 50 years in 39 cases). The tibiofibular lateral X-ray films were taken to measure the included angle between tibia anatomical axis and anterior cortex with AutoCAD2004 system. The samples were grouped according to gender, age, and side. Results The included angles between tibia anatomical axis and anterior cortex ranged from 3.007 to 3.021° with an average of 3.001°; the angles were (2.965 ± 0.361)° in male and (3.041 ± 0.311)° in female; the angles were (2.996 ± 0.332)° in the left knee and (3.006 ± 0.347)° in the right knee; and the angles were (2.918 ± 0.346)° in 20-35 years age group, (3.060 ± 0.330)° in 35-50 years age group, and (3.014 ± 0.336)° in over 50 years age group. No significant difference was found in the included angle between tibia anatomical axis and anterior cortex between male and female, among different ages, and between left and right knees (P gt; 0.05). Conclusion The included angle between tibia anatomical axis and anterior cortex is about 3°, so tibia extra-medullary alignment bar should be placed at the angle of 3° with anterior cortex during total knee arthroplasty.
ObjectiveTo compare the effectiveness of posterior and anterior psoas abscess debridement and local chemotherapy in abscess cavity combined with focus debridement, bone grafting, and fixation via posterior approach in treatment of thoracolumbar spinal tuberculosis, and explore the feasibility of psoas abscess debridement via posterior approach.MethodsBetween June 2012 and December 2015, the clinical data of 37 patients with thoracolumbar spine tuberculosis and psoas abscess were retrospectively analyzed. All the patients underwent posterior focus debridement, bone grafting, and internal fixation, and were divided into two groups according to different approaches to psoas abscess debridement. Twenty-one patients in group A underwent abscess debridement and local chemotherapy in abscess cavity via posterior approach; 16 patients in group B underwent abscess debridement and local chemotherapy in abscess cavity via anterior approach. No significant difference was found between two groups in gender, age, disease duration, involved segments, preoperative erythrocyte sedimentation rate (ESR), preoperative C-reactive protein (CRP), side of psoas abscess, maximum transverse diameter and sagittal diameter of psoas abscess, accompanying abscess, abscess cavity separation, preoperative Cobb angle of involved segments, preoperative American Spinal Injury Association (ASIA) classification (P>0.05). The operation time, intraoperative blood loss, hospitalization time, time of abscess absorption and bone fusion were recorded and compared between 2 groups. The change of pre- and post-operative involved segments Cobb angle was observed. Neurological function was assessed according to ASIA classification.ResultsExcept that the operation time of group B was significantly longer than that of group A (t=–2.985, P=0.005), there was no significant difference in intraoperative blood loss, hospitalization time, time of abscess absorption and bone fusion between 2 groups (P>0.05). All patients were followed up 18-47 months (mean, 31.1 months). No cerebrospinal fluid leakage occurred intra- and post-operation. Four patients in group A underwent second-stage operation of abscess debridement and local chemotherapy in abscess cavity via anterior approach. All patients got abscess absorption, meanwhile ESR and CRP level normalized at last follow-up. The involved segments Cobb angle improved significantly when compared with preoperative values in both 2 groups (P<0.05); and there was no significant difference between 2 groups at last follow-up (P>0.05). Nine patients with spinal cord injury had significant neurological recovery at last follow-up (Z=–2.716, P=0.007).ConclusionPosterior focus debridement, bone grafting, and internal fixation combined with abscess debridement and local chemotherapy in abscess cavity is effective in treatment of thoracolumbar spinal tuberculosis, but in some cases anterior abscess debridement is still required.