非接触式角膜内皮镜SP-3000P测量中央和周边角膜厚度的重复性研究

中央角膜厚度（central corneal thickness，CCT）可以显示角膜内皮泵的功能，反映包括角膜内皮失代偿、角膜扩张、角膜水肿、青光眼、球形角膜和干眼等一些眼前节疾病。然而，周边角膜厚度的报道较少，主要原因是周边角膜厚度测量时难以准确定位。非接触式角膜内皮镜已成为测量角膜厚度的一种常用方法，其检查具有非侵入性，可以在角膜中央和周边聚焦测量相应部位的厚度，同时可以测量角膜内皮细胞的密度和形态。

电子皮镜对掌跖部痣细胞痣的观察

目的 了解电子皮镜在确诊无毛部痣细胞痣中的意义。方法 利用电子皮镜观察了 2 6例掌跖部痣细胞痣 3 1个病灶 ,并参考国外相关资料 ,总结了其电子皮镜所见特点。结果 15个病灶为毛刷型 ,8个平行型 ,6个格子型 ,2个复合型。其病理组织学上均确诊为痣细胞痣。结论 电子皮镜可以为掌跖部 (无毛部 )痣细胞痣的诊断及鉴别诊断提供重要依据 ,具有重要意义。

丘疹结节型色素性基底细胞癌的电子皮镜所见

目的 探讨丘疹结节型色素性基底细胞癌的电子皮镜所见及其在临床诊断中的意义。方法 利用电子皮镜观察丘疹结节型色素性基底细胞癌 6例 8个病灶 ,术后做组织病理确认。结果 丘疹结节型色素性基底细胞癌在电子皮镜下所见具有特征性 ,术后病理均诊断为基底细胞癌。结论 电子皮镜检查可以为丘疹结节型色素性基底细胞癌的诊断及鉴别诊断提供依据 ,具有重要意义。

皮镜的临床应用

皮镜是一种新近发展起来的、主要针对色素性皮肤病损的诊断工具 ,尤其在脂溢性角化病、痣细胞痣、色素性基底细胞癌等与恶性黑色素瘤的鉴别诊断中具有重要意义。皮镜具有无创伤 ,诊断准确性高等优点 ,本文就其基本知识作一综述。

Cogan-Reese综合征角膜内皮镜与虹膜组织学检查一例

患者男性，30岁。主冈左眼视物云雾状遮挡及夜间视物出现光圈半年于2011年11月29日来我院就诊。1个月前外院就诊时，左眼压32～44mmHg，怀疑原发性开角型青光眼，

微创经皮肾镜治疗马蹄肾结石的疗效分析

目的 探讨应用微创经皮镜取石术（MPCNL）治疗马蹄肾结石方法的疗效及安全性.方法 选取从2008年11月～2011年11月在本院进行治疗的30例马蹄肾结石患者,男性20例,女性10例,平均年龄为（39.8±5.2）岁（20～70岁）,记录患者结石的大小及位置.为患者签订知情同意书后进行手术治疗.结果 所有30例患者均一次建立通道成功.术中平均出血量为（35.6±7.7）ml（10～110 ml）,平均手术时间为：（49.3±6.5）min（30～150 min）,术后结石清除率（SFR）为89.3%.所有患者随访12～24个月未见并发症及结石复发.结论 应用微创经皮镜取石术（MPCNL）治疗马蹄肾结石是一种安全且有效的手术方法,值得在临床上推广.

微创经皮肾镜治疗重复肾肾结石的疗效分析

目的:探讨应用微创经皮镜取石术(MPCNL)治疗重复肾肾结石方法的疗效及安全性。方法:我们选取从2009年11月～2012年11月在我院进行治疗的28例重复肾肾结石患者,男性15例,女性13例,平均年龄为36.5±1.2(20～70岁),记录患者结石的大小及位置。为患者签订知情同意书后进行手术治疗。结果:术中平均出血量为25.6±8.9(10～50)ml,平均手术时间为:56.3±6.5(30～100)分钟,结石清除率(SFR)为89.3%,另外3例存在少量碎石残留的患者改形ESWL术后结石全部排除。所有患者随访过程中未见并发症及结石复发。结论:应用微创经皮镜取石术(MPCNL)治疗重复肾肾结石是一种安全且有效的手术方法,值得在临床上推广。

F14微通道在经皮肾镜取石手术中的临床应用

目的:探讨应用F14微通道行微创经皮镜取石术(MPCNL)治疗上尿路结石的疗效及安全性。方法:选取从2009年11月至2011年11月在我院进行治疗的72例结石小于2.5cm以下的上尿路结石患者,建立F14经皮肾通道进行以钬激光或气压弹道碎石取石。结果:72例患者均一次建立通道成功。术中平均出血量为20.7±5.2(5-40)mL,平均取石时间为35.3±10.8(25-60)min,一期结石清除率为95.83%,平均住院时间为9.5±2.8d。所有患者随访6-12个月未见结石复发。结论:应用F14微通道行微创经皮镜取石术(MPCNL)治疗上尿路结石创伤更小,出血更少,恢复更快等优点,是一种安全有效的手术方法,值得在临床上推广。

临床病史和数字图像分析结果对不同皮肤镜使用者的价值比较

Background. The clinical history of a given pigmented lesion could in fluence the therapeutic decision. Teledermatology and automated image analysis also hold great potential for revolutionizing dermatology services. Aim. The aim of this retrospective study was to evaluate the diagnostic accuracy of users with differ ent experiences in dermoscopy with and without information about patients and th eir history compared with classification by an automated analysing system. Setti ng. One hundred and fifty-seven dermoscopic images of pigmented lesions, taken and proved by histopathology at the Pigmented Lesions Clinic of theDepartment o f Dermatology of the University Tuebingen,Germany, were included. Methods. All i mages were viewed by three investigators with different experience: excellent (A ), average (B) and beginner (C). In the first dermoscopic classification, no inf ormation was available. After 3 months the same images were once more classified by the three investigators, now with the information about the patients and the ir history. The melanocytic lesions were tested by the Tuebinger Mole Analyser. Results. For user A the sensitivity, specificity and diagnostic accuracy reveale d no improvement on including the history (81.3% to 84.4% , 94.6% to 92.3% and 92.0% to 90.7% ), whereas user B clearly improved his results (75.0% to 87.5% , 76.9% to 88.5% and 76.5% to 88.3% ). No change in the sensiti vity was seen by user C (84.4% ), but there was a clear improvement in the spec ificity (69.2% to 87.7% )-and diagnostic accuracy (72.2% to 87.0% ). Usi ng the computer algorithm, a sensitivity of 100% , a specificity of 76.9% and a diagnostic accuracy of 81.9% were achieved. Conclusions. The study revealed results relevant to the use of dermoscopy: (1) continuing dermoscopic education influences the diagnostic accuracy; (2) the history is helpful for averaged use rs and beginners in dermoscopy; (3) digital image analysis has the highest sensi tivity, but a lower specificity compared to the clinicians; and (4) digital derm oscopy could be used for store-and-forward systems in teledermoscopy.

Effect of percutaneous endoscopic gastrostomy on gastroesophageal reflux in mechanically-ventilated patients

AIM： To investigate the effect of percutaneous endoscopic gastrostomy （PEG） on gastroesophageal reflux （GER） in mechanically-ventilated patients. METHODS ： In a prospective, randomized, controlled study 36 patients with recurrent or persistent ventilatorassociated pneumonia （VAP） and GER 〉 6% were divided into PEG group （n=16） or non-PEG group （n = 20）. Another 11 ventilated patients without reflux （GER 〈 3%） served as control group. Esophageal pH-metry was performed by the ＂pull through＂ method at baseline, 2 and 7 d after PEG. Patients were strictly followed up for semi-recumbent position and control of gastric nutrient residue. RESULTS： A significant decrease of median （range） reflux was observed in PEG group from 7.8 （6.2-15.6） at baseline to 2.7 （0-10.4） on d 7 post-gastrostomy （P 〈 0.01）, while the reflux increased from 9 （6.2-22） to 10.8 （6.3-36.6） （P〈 0.01） in non-PEG group. A significant correlation between GER （%） and the stay of nasogastric tube was detected （r= 0.56, P〈 0.01）. CONCLUSION： Gastrostomy when combined with semi- recumbent position and absence of nutrient gastric residue reduces the gastroesophageal reflux in ventilated patients.

Severe delayed complication after percutaneous endoscopic colostomy for chronic intestinal pseudo-obstruction: A case report and review of the literature

Percutaneous endoscopic colostomy （PEC） is increasingly proposed as an alternative to surgery to treat various disorders, including acute colonic pseudo-obstruction, chronic intestinal pseudo-obstruction and relapsing sigmoid volvulus. We report on a severe complication that occurred two months after PEC placement. A 74-year-old man with a history of chronic intestinal pseudo-obstruction evolving since 8 years was readmitted to our hospital and received PEC to provide long-standing relief. The procedure was uneventful and greatly improved the patient＇s quality of life. Two months later, the patient developed acute stercoral peritonitis. At laparotomy, the colostomy flange was embedded in the abdominal wall but no pressure necrosis was found at the level of the colonic wall. This complication was likely related to inadvertent traction of the colostomy tube. Subtotal colectomy with terminal ileostomy was performed. We review the major features of 60 cases of PEC reported to date, including indications and complications.

Natural orifice translumenal endoscopic surgery: Progress in humans since white paper

Since the first description of the concept of natural orifice translumenal endoscopic surgery (NOTES), a substantial number of clinical NOTES reports have appeared in the literature. This editorial reviews the available human data addressing research questions originally proposed by the white paper, including determining the optimal method of access for NOTES, developing safe methods of lumenal closure, suturing and anastomotic devices, advanced multitasking platforms, addressing the risk of infection, managing complications, addressing challenges with visualization, and training for NOTES procedures. An analysis of the literature reveals that so far transvaginal access and closure appear to be the most feasible techniques for NOTES, with a limited, but growing transgastric, transrectal, and transesophageal NOTES experience in humans. The theoretically increased risk of infection as a result of NOTES procedures has not been substantiated in transvaginal and transgastric procedures so far. Development of suturing and anastomotic devices and advanced platforms for NOTES has progressed slowly, with limited clinical data on their use so far. Data onthe optimal management and incidence of intraoperative complications remain sparse, although possible factors contributing to complications are discussed. Finally, this editorial discusses the likely direction of future NOTES development and its possible role in clinical practice.

Acute pancreatitis and cholangitis: A complication caused by a migrated gastrostomy tube

Percutaneous endoscopic gastrostomy (PEG) is generally considered safe with a low rate of serious complications. However, dislocation of the PEG-tube into the duodenum can lead to serious complications. An 86-year old Japanese woman with PEG-tube feeding sometimes vomited after her family doctor replaced the PEG-tube without radiologic confirmation. At her hospitalization, she complained of severe tenderness at the epigastric region and the PEG-tube was drawn into the stomach. Imaging studies showed that the tip of PEG-tube with the infl ated balloon was migrated into the second portion of the duodenum, suggesting that it might have obstructed the bile and pancreatic ducts, inducing cholangitis and pancreatitis. After the PEG- tube was replaced at the appropriate position, vomiting and abdominal tenderness improved dramatically and laboratory studies became normal immediately. Our case suggests that it is important to secure PEG-tube at the level of skin, especially after replacement.

Investigation and prediction of enteral nutrition problems after percutaneous endoscopic gastrostomy

AIM： To investigate and predict enteral nutrition problems after percutaneous endoscopic gastrostomy （PEG）. METHODS： We retrospectively analyzed data for 252 out of 285 patients who underwent PEG at our hospital from 1999 to 2008 after PEG were defined as： Enteral nutrition problems （1） patients who required ≥ 1 mo after surgery to switch to complete enteral nutrition, or who required additional parenteral alimentation continuously; or （2） patients who abandoned switching to enteral nutrition using the gastrostoma and employed other nutritional methods. We attempted to identify the predictors of problem cases by using a logistic regression analysis that examined the patients＇ backgrounds and the specific causes that led to their problems. RESULTS： Mean age of the patients was 75 years, and in general, their body weight was low and their overall condition was markedly poor. Blood testing revealed that patients tended to be anemic and malnourished. A total of 44 patients （17.5%） were diagnosed as having enteral nutrition problems after PEG. Major causes of the problems included pneumonia, acute enterocolitis （often Clostridium difficile-related）, paralytic ileus and biliary tract infection. A multivariate analysis identified the following independent predictors for problem cases： （1） enteral nutrition before gastrectomy （a risk reduction factor）; （2） presence of esophageal hiatal hernia; （3） past history of paralytic ileus; and （4） presence of chronic renal dysfunction. CONCLUSION： Enteral nutrition problems after PEG occurred at a comparatively high rate. Patient background analysis elucidated four predictive factors for the problem cases.

Retrograde jejunoduodenogastric intussusception due to a replacement percutaneous gastrostomy tube presenting as upper gastrointestinal bleeding

Percutaneous endoscopic gastrostomy (PEG) tube complications can be serious or life threatening. Retrograde intussusception is a very rare complication of PEG tubes with only 9 cases reported in the literature. We describe a case of retrograde intussusception, associated with the use of a Foley catheter as a replacement gastrostomy tube, presenting with upper gastrointestinal bleeding. To our knowledge, this is the first reported case of PEG-related retrograde intussusception successfully managed in a non-surgical manner. Retrograde intussusception likely occurred due to migration of the replacement tube with resultant securing and invagination of the proximal jejunum when the gastrostomy tube was anchored to the abdominal wall.

Laparoscopic cystogastrostomy for the treatment of pancreatic pseudocysts: A case report

Pancreatic pseudocysts （PPs） are collections of pancreatic secretions that are lined by fibrous tissues and may contain necrotic debris or blood. The interventions including percutaneous, endoscopic or surgical approaches are based on the size, location, symptoms and complications of a pseudocyst. With the availability of advanced imaging systems and cameras, better hemostatic equipments and excellent laparoscopic techniques, most pseudocysts can be found and managed by laparoscopy. We describe a case of a 30-year-old male patient with a pancreatic pseudocyst amenable to laparoscopic cystogastrostomy. An incision was made through the anterior gastric wall to expose the posterior gastric wall in close contact with the pseudocyst using an ultrasonically activated scalpel. Then, another incision was made for cystogastrostomy to obtain complete and unobstructed drainage. The patient recovered well after operation and was symptom-free during a 6-mo follow-up, suggesting that laparoscopic cystogastrostomy is a safe and effective alternative to open cystogastrostomy for minimally invasive management of PPs.

Plasmapheresis and corticosteroid treatment for persistent jaundice after successful drainage of common bile duct stones by endoscopic retrograde cholangiography

Prolonged cholestasis is a very rare complication of endoscopic retrograde cholangiography (ERC). Only few cases with this complication are reported in the English literature. We report persisting cholestatic jaundice in a 73-year old man after successful therapeutic ERC for choledocholithiasis. Serologic tests for viral and autoimmune hepatitis were all negative. A second-look ERC was normal also. He denied any medication except for prophylaxis given intravenous 1 g ceftriaxon prior to the ERC procedure. After an unsuccessful trial with ursodeoxycholic acid and cholestyramine for 2 wk, this case was efficiently treated with corticosteroids and plasmapheresis. His cholestatic enzymes became normal and intense pruritis quickly resolved after this treatment which lasted during his follow- up period. We discussed the possible mechanisms and treatment alternatives of intrahepatic cholestasis associated with the ERC procedure.

Endoscopic findings in a patient with Henoch-Schonlein purpura

Henoch-Schonlein purpura (HSP) is a systemic vasculitis of the small vessels of the skin, joints, GI tract, and kidney. It preferentially affects children but may also occur in adults. We report a 60-year-old man with HSP who presented with colicky abdominal pain, bloody diarrhea, arthralgia, and skin rash. The gastrointestinal tract was viewed by upper endoscopy and colonoscopy. We found characteristic endoscopic findings in the stomach, cecum and sigmoid colon, the combination of which has rarely been demonstrated in one patient. Histologic examination of skin biopsy specimens revealed leukocytoclastic vasculitis with positive staining for IgA in the capillaries. Endoscopy appears to have substantial diagnostic utility in patients suspected of having HSP, especially when abdominal symptoms precede the cutaneous lesions.

Effects of endoscopic sphincterotomy on biliary epithelium:A case-control study

AIM: To study the long-term effects of endoscopic sphincterotomy on biliary epithelium. METHODS: This is a prospective case-control study. A total of 25 patients with a median age of 71 years (range 49-89 years) and prior endoscopic sphincterotomy (ES) for benign disease formed the fi rst group. The median time from ES was 42 mo (range 8-144 mo). Another 25 patients with a median age of 76 years (range 44-94 mo) and similar characteristics who underwent current endoscopic retrograde cholangio-pancreatography (ERCP) and ES for benign disease formed the second group (control group). Brush cytology of the biliary tree with p53 immunocytology was performed in all patients of both groups. ERCPs and recruitment were conducted at the Endoscopic Unit of Aretaieion University Hospital and Tzaneio Hospital, Athens, from October 2006 to June 2010. RESULTS: No cases were positive or suspicious for malignancy. Epithelial atypia was higher in the first group (32% vs 8% in the second group, P = 0.034). Acute cholangitis and previous biliary operation rates were also higher in the fi rst group (acute cholangitis, 60% vs 24% in the second group, P = 0.01; previous biliary operation, 76% vs 24% in the second group, P = 0.001). Subgroup analysis showed that previous ES was the main causal factor for atypia, which was not related to the time interval from the ES (P = 0.407). Two patients (8%) with atypia in the fi rst group were p53-positive. CONCLUSION: ES causes biliary epithelial atypia that represents mostly reactive/proliferative rather than premalignant changes. The role of p53 immunoreactivity in biliary atypia needs to be further studied.