青光眼视神经纤维损害的临床检查方法

目前青光眼仍然是世界上主要的致盲原因之一,过去的几年里,它的定义、诊断及监测都有了新的发展。新技术的进步使检查青光眼所引起的结构和功能的破坏有了不同以往的新方法。迄今为止,倍频视野检查、短波自动视野检查法、共焦激光扫描眼底镜、激光扫描旋光分析法、光学相干断层成像术已经成为青光眼常规检查的一部分,并且是诊断青光眼的重要工具。本文通过介绍这些检查设备的原理、应用前景,分析它们各自的优势及不足。

睑板腺功能障碍临床诊断新进展

睑板腺功能障碍(meibomian gland dysfunction,MGD)是眼科门诊常见的疾病之一,临床上MGD的诊断需根据症状、体征和相应的辅助检查进行综合评估。传统的检查方法如裂隙灯检查、泪膜破裂时间、泪液分泌试验等在MGD的诊断中有着明确的价值,而在2017年我国睑板腺功能障碍诊断与治疗专家共识中,一些新兴的临床检查方法如睑板腺缺失率、泪膜脂质层厚度等也作为MGD的辅助诊断标准。传统的方法和新兴的检测技术结合起来用于MGD的诊断,将会得到更全面、准确的结论。

不同程度肩峰下撞击综合征的临床检查准确性

背景：已经有多种检查方法用于诊断肩袖疾病，但尚缺乏它们用于诊断单纯滑囊炎、肩袖部分撕裂及全层撕裂方面的研究。本研究假设肩袖损伤的严重程度可影响常用临床检查方法的诊断价值。方法：三种不同程度的肩袖损伤，即滑囊炎、肩袖部分撕裂和肩袖全层撕裂，通过八项物理检查方法（Neer撞击征、Hawkins-Kennedy撞击征、疼痛弧征、冈上肌肌力试验、Speed试验、交叉内收试验、坠臂试验和冈下肌肌力试验）来评价它们的诊断价值，以似然比和验后概率作为评价指标。并用前向逐步logistic回归分析法确定诊断不同程度撞击征的最佳组合检查。结果：八项检查方法的灵敏度、特异度、阳性预测值、阴性预测值和总体准确性差异非常大。Hawkins-Kennedy撞击征、疼痛弧征和冈下肌肌力试验的组合对各种程度撞击征的验后概率最高（95％），疼痛弧征、坠臂征和冈下肌肌力试验组合对肩袖全层撕裂的验后概率最高（91％）。结论：撞击征的严重程度影响这些常用临床检查方法的诊断价值。评估肩袖损伤患者的病情时，应考虑这些检查方法准确性的差异。

Nutritional modulation of the inflammatory response in inflammatory bowel disease-From the molecular to the integrative to the clinical

Nutrient deficiencies are common in patients with inflammatory bowel disease （IBD）. Both total parenteral and enteral nutrition provide important supportive therapy for IBD patients, but in adults these are not useful for primary therapy. Dietary intervention with omega-3 polyunsaturated fatty acids contained in fish oil may be useful for the care of IBD patients, and recent studies have slyessed the role of PPAR on NFKB activity on the potential beneficial effect of dietary lipids on intestinal function.

Balthazar computed tomography severity index is superior to Ranson criteria and APACHE Ⅱ scoring system in predicting acute pancreatitis outcome

AIM： Acute pancreatitis （AP） is a process with variable involvement of regional tissues or organ systems. Multifactorial scales included the Ranson, Acute Physiology and Chronic Health Evaluation （APACHE Ⅱ） systems and Balthazar computed tomography severity index （CTSI）. The purpose of this review study was to assess the accuracy of CTSI, Ranson score, and APACHE II score in course and outcome prediction of AP. METHODS： We reviewed 121 patients who underwent helical CT within 48 h after onset of symptoms of a first episode of AP between 1999 and 2003. Fourteen inappropriate subjects were excluded; we reviewed the 107 contrastenhanced CT images to calculate the CTSI. We also reviewed their Ranson and APACHE Ⅱ score. In addition, complications, duration of hospitalization, mortality rate, and other pathology history also were our comparison parameters. RESULTS： We classified 85 patients （79%） as having mild AP （CTSI 〈5） and 22 patients （21%） as having severe AP （CTSI ≥5）. In mild group, the mean APACHE II score and Ranson score was 8.6±1.9 and 2.4±1.2, and those of severe group was 10.2±2.1 and 3.1±0.8, respectively. The most common complication was pseudocyst and abscess and it presented in 21 （20%） patients and their CTSI was 5.9±1.4. A CTSI ≥5 significantly correlated with death, complication present, and prolonged length of stay. Patients with a CTSI ≥5 were 15 times to die than those CTSI 〈5, and the prolonged length of stay and complications present were 17 times and 8 times than that in CTSI 〈5, respectively. CONCLUSION： CTSI is a useful tool in assessing the severity and outcome of AP and the CTSI ≥5 is an index in our study. Although Ranson score and APACHE II score also are choices to be the predictors for complications, mortality and the length of stay of AP, the sensitivity of them are lower than CTSI.

Risk factors of acute cholecystitis after endoscopic common bile duct stone removal

AIM： To evaluate the risk factors of acute cholecystitis after endoscopic common bile duct （CBD） stone removal. METHODS： A total 100 of patients who underwent endoscopic CBD stone removal with gallbladder （GB） in situ without subsequent cholecystectomy from January 2000 to July 2004 were evaluated retrospectively. The following factors were considered while evaluating risk factors for the development of acute cholecystitis： age, gender, serum bUirubin level, GB wall thickening, cystic duct patency, presence of a GB stone, CBD diameter, residual stone, lithotripsy, juxtapapillary diverticulum, presence of liver cirrhosis or diabetes mellitus, a presenting illness of cholangitis or pancreatitis, and procedure-related complications. RESULTS： During a mean 18-mo follow-up, 28 （28%） patients developed biliary symptoms; 17 （17%） acute cholecystitis and 13 （13%） CBD stone recurrence. Of patients with acute cholecystitis, 15 （88.2%） received laparoscopic cholecystectomy and 2 （11.8%） open cholecystectomy. All recurrent CBD stones were successfully removed endoscopically. The mean time elapse to acute cholecystitis was 10.2 mo （1-37 mo） and that to recurrent CBD stone was 18.4 mo. Of the 17 patients who received cholecystectomy, 2 （11.8%） developed recurrent CBD stones after cholecystectomy. By multivariate analysis, a serum total bUirubin level of 〈1.3 mg/dL and a CBD diameter of 〈11 mm at the time of stone removal were found to predict the development of acute cholecystitis. CONCLUSION： After CBD stone removal, there is no need for routine prophylactic cholecystectomy. However, patients without a dilated bile duct （〈11 mm） and jaundice （〈1.3 mg/dL） at the time of CBD stone removal have a higher risk of acute cholecystitis and are possible candidates for prophylactic cholecystectomy.

Clinical outcomes of enteroscopy using the double-balloon method for strictures of the small intestine

AIM:To evaluate the clinical outcome of enteroscopy, using the double-balloon method, focusing on the involvement of neoplasms in strictures of the small intestine. METHODS: Enteroscopy, using the double-balloon method, was performed between December 1999 and December 2002 at Jichi Medical School Hospital, 3apan and strictures of the small intestine were found in 17 out of 62 patients. These 17 consecutive patients were subjected to analysis. RESULTS: The double-balloon enteroscopy contributed to the diagnosis of small intestinal neoplasms found in 3 out of 17 patients by direct observation of the strictures as well as biopsy sampling. Surgical procedures were chosen for these three patients, while balloon dilation was chosen for the strictures in four patients diagnosed with inflammation without involvement of neoplasm. CONCLUSION: Double-balloon enteroscopy is a useful method for the diagnosis and treatment of strictures in the small bowel.

Laparoscopic hemicolectomy in a patient with situs inversustotalis

As among persons with normal anatomy, occasional patients with situs inversus develop malignant tumors. Recently, several laparoscopic operations have been reported in patients with situs inversus. We describe laparoscopic hemicolectomy with radical lymphadenectomy in such a patient. Careful consideration of the mirror-image anatomy permitted safe operation using techniques not otherwise differing from those in ordinary cases. Thus, curative laparoscopic surgery for colon cancer in the presence of situs inversus is feasible and safe.

Role of colonoscopy in patients with persistent acute diverticulitis

AIM： To identify patients with persistent acute diverticulitis who might benefit from an early colonoscopy during their first hospitalization. METHODS： All patients hospitalized between July 2000 and December 2006 for acute diverticulitis who underwent colonoscopy were included in the study. Patients were followed during hospitalization and after discharge. Patients were considered to have a persistent course of acute diverticulitis if symptoms continued after 1 wk of conventional treatment with 1V antibiotics, or if symptoms recurred within 2 mo after discharge. Patients were considered to benefit from an early colonoscopy if the colonoscopy was therapeutic or if it changed a patient＇s outcome. RESULTS： Three hundred and six patients were hospitalized between July 2000 and December 2006 with the diagnosis of acute diverticulitis. Two hundred and twenty four of these were included in the study group. Twenty three patients （10.3%） fulfilled the criteria for a persistent course of acute diverticulitis. Of them, four patients （17.4%） clearly benefited from an early colonoscopy; these patients＇ clinical course is described. None of the patients with a regular non-persistent course demonstrated any benefit from colonoscopy. CONCLUSION： Early colonoscopy detected other significant pathology, which accounted for the clinical presentation in 17% of patients with persistent acute diverticulitis. Therefore, we believe an early colonoscopy should be considered in all patients with a persistent clinical course.

A case of bowel schitosomiasis not adhering to endoscopic findings

Schistosomiasis is a chronic worm infection caused by a species of trematodes, the Schistosomes. We may distinguish a urinary form from Schistosomes haematobium and an intestinal-hepatosplenic form mainly from Schistosomes mansonicharacterized by nausea, meteorism, abdominal pain, bloody diarrhea,rectal tenesmus, and hepatosplenomegaly. These infections represent a major health issue in Africa,Asia, and South America, but recently S mansoni has increased its prevalence in other countries, such as Europe countries and USA, due to international travelers and immigrants, with several diagnostic and prevention problems. We report a case of a 24-yearold patient without HIV infection, originated from Ghana, admitted for an afebrile dysenteric syndrome.All microbiologic studies were negative and colonoscopy revealed macroscopic lesions suggestive of a bowel inflammatory chronic disease. Since symptoms became worse, a therapy with mesalazine (2 g/d) was started,depending on the results of a bowel biopsy, but without any resolution. The therapy was stopped after 2 wk when the following result was available: a diagnosis of"intestinal schistosomiasis" was done (two Schistosoma eggs were detected in the colonic mucosa) and this was confirmed by the detection of Schistosoma eggs in the feces. Therapy was therefore changed to praziquantel(40 mg/kg, single dose), a specific anti-parasitic agent,with complete recovery. Schistosomiasis shows some peculiar difficulties in terms of differential diagnosis from the bowel inflammatory chronic disease, as the two disorders may show similar colonoscopic patterns.Since this infection has recently increased its prevalence worldwide, it was considered in the differential diagnosis of our patient with gastrointestinal symptoms.

孔源性视网膜脱离外路手术的研究进展

孔源性视网膜脱离RRD是目前常见的急性致盲性眼病,其发病主要与视网膜裂孔、玻璃体液化及有一足够拉力将视网膜与色素上皮分开有关。当发生视网膜脱离,感光细胞层营养受到损伤,若不及时复位可能导致视网膜萎缩及变行造成不可恢复的视力障碍。目前临床对RRD多通过手术方式进行治疗并获得一定效果,近年来随着医学技术不断创新及对疾病研究的进一步深入,各种手术也在原有基础上进行不同程度的改良以期达到更好的治疗效果。本文现就RRD的临床表现、检查方法及手术治疗进行详细分析与综述,以期为日后临床更好的帮助患者恢复视功能,改善生活质量提供参考依据。

A Case Report of One-Point Gastric Cancer

Carcinoma of the stomach is the most common malignant tumor in China. Due to advanced endoscopic techniques and equipment, the detection of early gastric carcinoma （EGC） has increased worldwide. Yet gastric one-point cancer is rarely detected.

痰细菌学检查阴性的肺结核病例病灶活动性的判定

目的探讨痰细菌学检查阴性的肺结核病例的病灶是否具有活动性的判定。方法对一组接触源肺结核病人进行检查,进行综合性分析。结果接触源病例痰细菌学检查大部分为阴性结果,而经肺部 X 线征象进行分析判断,结合病史、临床表现及其它辅助检查,显示病灶有活动性的特征,说明痰细菌学检查阴性的肺结核病人是潜在的不能忽视的一个传染源。结论痰细菌学检查阴性的肺结核病人。判断病灶是否具有活动性,必须运用非细菌学检查方法,包括 X 线诊断学,临床诊断学的理论、方法和经验,对肺部x线征象进行分析、病灶分类,结合病史和体格检查,必要的实验室检查和辅助检查等综合方法进行判定。