滤泡性淋巴瘤合并脾梗死一例

滤泡性淋巴瘤(follicular lymphoma,FL)是来源于滤泡生发中心B细胞的惰性非霍奇金淋巴瘤(non-Hodgkin′s lymphoma,NHL),发病率仅次于弥漫性大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL),大约占新诊断NHL的22%,FL多以无痛性浅表淋巴结肿大为主要临床表现,但合并脾梗死,国内及国外文献报道很少。本文报道1例FL合并脾梗死,并结合文献进行总结和分析,以提高临床诊治水平。     

应用锥形束CT评价前牙唇舌侧牙槽骨高度及厚度的研究

目的评价锥形束CT(CBCT)在体内外定量测量前牙唇舌侧牙槽骨高度及厚度的准确性。方法体外实验利用CBCT测量10个干下颌骨下前牙牙槽窝的高度和厚度,并与直接测量结果进行比较;体内实验选取待拔除的22颗前牙,拔除前使用CBCT测量牙槽骨的高度和厚度,并与拔除后即刻直接测量的结果进行比较。结果体外实验CBCT与直接测量结果之间的差异无统计学意义(P>0.05);体内实验CBCT对唇侧牙槽骨厚度测量结果大于CBCT测量结果(P<0.05),而其他3个参数二者之间的差异无统计学意义,造成差异的原因可能与拔牙的损伤和CBCT拍摄过程中患者的移动有关。结论 CBCT可以较好地反映前牙唇舌侧牙槽骨高度和厚度的实际情况。     

毛细支气管炎雾化吸入的治疗及护理体会

目的探讨雾化吸入治疗毛细支气管炎的临床疗效和护理效果。方法将患者随机分为对照组和治疗组两组,分别采取不同的方法进行治疗,观察疗效,以便进行科学的护理。结果治疗组治愈66例,治愈率94.2%,对照组治愈43例,治愈率64.2%,两组有显著性差异。结论雾化吸入治疗能够显著改善毛细支气管炎患儿临床症状,在雾化吸入治疗时,有效的护理对提高临床治疗效果至关重要。     

关节镜手术的护理

随着电子、光学和机械科学的发展,医用器械设备不断更新,关节镜设备日益精良,关节镜技术在临床诊断、治疗等方面日益取得进展.关节镜是内镜的一种,但它是一种特殊的内镜.由于关节本身结构复杂,而且种类繁多.在关节镜外科,发展最快的是膝关节镜.     

南昌市无烟卫生系统创建调查分析

目的 比较两轮控烟暗访结果,了解南昌市无烟卫生机构的创建进程,总结推广控烟先进经验,并查找工作中存在的薄弱环节,提出改进建议.方法 2016年及2018年采取实地走访、隐蔽拍摄、调查问卷等形式对南昌市近百家卫生行政部门、公共卫生机构及医疗机构进行暗访.结果 2018年全市卫生机构暗访综合评分为(94.8±5.9)分,明显高于2016年的(79.4±16.3)分.2018年各类卫生机构入口处禁烟提示设置、禁烟标识设置、控烟宣传材料、室外吸烟区设置、烟草制品禁售、室内吸烟状况得分均较2016年明显增加.结论 南昌市无烟卫生系统创建日见成效,但距建成100%无烟环境尚有差距,还需进一步加大控烟宣传力度,完善相关监管处罚机制,加强政策的执行和监督.     

疑难唾液腺结石病的治疗研究

Sialolithiasis occurs in approximately 0.45% to 1.20% of the general population. The typical clinical symptom manifests as a painful swelling of the affected glands after a meal or upon salivary stimulation, which extremely affects the life quality of the patients. With the development of sialendoscopy and lithotripsy, most sialoliths can be successfully removed with preservation of the gland. However, sialoliths in the deep hilar-parenchymal submandibular ducts and impacted parotid stones located in the proximal ducts continue to pose great challenges. Our research center for salivary gland diseases (in Peking University School and Hospital of Stomatology) has used sialendoscopy for 17 years and treated >2 000 patients with salivary gland calculi. The success rate was approximately 92% for submandibular gland calculi and 95% for parotid calculi. A variety of minimally invasive surgical techniques have been applied and developed, which add substantial improvements in the treatment of refractory sialolithiasis. Further, the radiographic positioning criteria and treatment strategy are proposed for these intractable stones. Most of the hilar-parenchymal submandibular stones are successfully removed by a transoral approach, including transoral duct slitting and intraductal basket grasping, while a small portion of superficial stones can be removed by a mini-incision in submandibular area. Impacted stones located in the distal third of parotid gland ducts are removed via "peri-ostium incision", which is applied to avoid a cicatricial stenosis from a direct ostium incision. Impacted parotid stones located in the middle and proximal third of the Stensen's duct are removed via a direct mini-incision or a peri-auricular flap. A direct transcutaneous mini-incision is commonly performed under local anesthesia with an imperceptible scar, and is indicated for most of impacted stones located in the middle third, hilum and intraglandular ducts. By contrast, a peri-auricular flap is performed under general anesthesia with relatively larger operational injury of the gland parenchyma, and should be best reserved for deeper intraglandular stones. Laser lithotripsy has been applied in the treatment of sialolithiasis in the past decade, and holmium ∶YAG laser is reported to have the best therapeutic effects. During the past 3 years, our research group has performed laser lithotripsy for a few cases with intractable salivary stones. From our experiences, withdrawal of the endoscopic tip 0.5-1.0 cm away from the extremity of the laser fiber, consistent saline irrigation, and careful monitoring of gland swelling are of vital importance for avoidance of injuries of the ductal wall and the vulnerable endoscope lens during lithotripsy. Larger calculi require multiple treatment procedures. The risk of ductal stenosis can be alleviated by endoscopic dilation. In summary, appropriate use of various endoscopy-assisted lithotomy helps preserve the gland function in most of the patients with refractory sialolithiasis. Further studies are needed in the following aspects: Transcervical removal of intraglandular submandibular stones, intraductal laser lithotripsy of impacted parotid stones and deep submandibular stones, evaluation of long-term postoperative function of the affected gland, et al.     

IgG4相关唾液腺炎的临床病理特点及诊断

SUMMARY Immunoglobulin G4-related sialadenitis (IgG4-RS) is a newly recognized immune-mediated disease and one of immunoglobulin G4-related diseases (IgG4-RD). Our multidisciplinary research group investigated the clinicopathological characteristics and diagnosis of IgG4-RS during the past 10 years. Clinically, it showed multiple bilateral enlargement of major salivary glands (including sublingual and accessory parotid glands) and lacrimal glands. The comorbid diseases of head and neck region including rhinosinusitis, allergic rhinitis, and lymphadenopathy were commonly seen, which could occur more early than enlargement of major salivary glands. Internal organ involvements, such as autoimmune pancreatitis, sclerosing cholangitis, and interstitial pneumonia could also be seen. Thirty-five (38.5%)patients had the symptom of xerostomia. Saliva flow at rest was lower than normal. Secretory function was reduced more severely in the submandibular glands than in the parotid glands. Serum levels of IgG4 were elevated in almost all the cases and the majority of the patients had increased IgE levels. CT, ultrasonography, and sialography showed their imaging characteristics. Histologically it showed marked lymphoplasmacytic inflammation, large irregular lymphoid follicles with expanded germinal centers, prominent cellular interlobular fibrosis, eosinophil infiltration, and obliterative phlebitis. Their immunohistological examination showed marked IgG-positive and IgG4-positive plasma cell infiltration and high IgG4/IgG ratio. The disease could be divided into three stages according to severity of glandular fibrosis. The serum IgG4 level was higher and the saliva secretion lower as glandular fibrosis increased. IgG4-RS should be differentiated from other diseases with enlargement of major salivary gland and lacrimal gland, such as primary Sjögren syndrome, chronic obstructive submandibular sialadenitis, and eosinophilic hyperplastic lymphogranuloma.     

105例口腔颅颌面部纤维性结构不良的临床病理分析

目的: 比较不同类型口腔颅颌面部纤维性结构不良(fibrous dysplasia,FD)的临床病理特点,为临床诊治及预后判断提供依据。方法: 收集2013年1月至2020年12月于北京大学口腔医院确诊为FD或McCune-Albright综合征(McCune-Albright syndrome, MAS)的患者105例,分析其临床资料、影像学和病理学特点,分别归类为单骨型、多骨型、MAS型及口腔颅颌面部特有的口腔颅面型纤维性结构不良(craniofacial fibrous dysplasia,CFD)四型,对各型的临床病理特征、治疗及随访资料等进行分析。结果: 105例患者的男女比为1 ∶1.3,发病年龄0~56岁(中位数为12岁)。本组病例中,单骨型43例(40.95%), 其中上颌骨29例,下颌骨12例,颧骨2例;多骨型32例(30.48%);MAS型7例(6.67%);发生在颅上颌部位的FD,经影像学分析确诊CFD型23例(21.90%)。CFD在患者性别、术前血清碱性磷酸酶水平等方面有别于其他类型的FD。病理学上,各型FD的形态特点类似,但多骨型及MAS型患者可能出现以纤维成分增生为主的特征。结论: 口腔颅颌面部FD的临床和病理特点有别于身体其他部位发生的FD病变,CFD的临床和病理特点与发生于颅颌面部的单骨型或多骨型FD也有显著差异,应注意区分,以进一步明确CFD在临床处置及预后等方面的特殊性。     

血站实验室采用不同模式检测HBsAg的性能评价

目的对6家血站实验室单独使用1种和联合使用2种酶联免疫(ELISA)试剂检测乙型肝炎表面抗原(HBsAg)进行性能评价,为各实验室制定合理的HBsAg筛查策略提供参考依据。方法将来自16家实验室的898份HBsAg初筛反应性标本分别寄送至6家血站实验室,使用2种ELISA试剂检测HBsAg。采用化学发光法和中和试验作为确认方法。分别在各实验室选择1种性能相对优异的试剂作为比较试剂,利用统计学方法分析各实验室单独使用1种试剂和联合使用2种试剂的灵敏度、特异性和符合率。结果 898份HBsAg初筛反应性标本中,剔除16份数据不完整的标本,在余下的882份标本中,确认阳性571份,确认阴性311份。各实验室使用的2种试剂其灵敏度差异较大(P0.05),其中在实验室B、D、E和F中,灵敏度相对优异的试剂其符合率亦更高(P0.05)。性能相对优异的试剂单独检测和2种试剂联合检测进行性能比较,各实验室2种检测模式的灵敏度差异无统计学意义(P0.05);实验室C、D和F单一试剂检测的特异性优于2种试剂联合检测(P0.05),其余实验室2种检测模式的特异性差异无统计学意义(P0.05);实验室D和F单一试剂检测的符合率优于2种试剂联合检测(P0.05),其余实验室2种检测模式的符合率差异无统计学意义(P0.05)。结论在血站实验室使用ELISA试剂盒进行HBsAg检测,存在单独使用1种试剂的检测性能等同于或优于联合使用2种试剂的情况,是否采用单一试剂代替2种试剂联合检测作为HBsAg的筛查策略,需进行科学的评估和确认。