【摘要】 目的 了解原发性良性阵发性位置性眩晕（benign paroxysmal positional vertigo，BPPV）的双温试验及纯音测听结果临床特点。 方法 2009年6月—2010年6月诊断为原发性BPPV患者54例，于手法复位前行双温试验及纯音听阈测试，分析原发性BPPV患者的双温试验、纯音测听结果的临床特点。 结果 40例患耳无半规管轻瘫，其病程为（4.25±2.75）周，14例患耳半规管轻瘫，其病程为（9.21±5.85）周，两组间平均病程差异具有统计学意义（t=4.235，Plt;0.05）；39例后半规管BPPV中11例患耳半规管轻瘫，15例水平半规管BPPV中3例患耳半规管轻瘫，两组患耳半规管轻瘫发生率无统计学意义（χ2=2.679，Pgt;0.05）；39例后半规管BPPV中16例患耳听力下降，15例水平半规管BPPV中7例患耳听力下降，两组患耳纯音测听异常率无明显统计学差异（χ2=0.141，Pgt;0.05）。 结论 原发性后半规管BPPV与水平半规管BPPV半规管轻瘫及纯音听阈异常发生率相近，病程长者更易出现半规管轻瘫。【Abstract】 Objective To investigate the clinical features of results of bithermal test and pure tone test for patients with idiopathic benign paroxysmal positional vertigo (BPPV), and discuss strategies for prevention. Methods A total of 54 patients diagnosed to have BPPV during June 2009 to June 2010 underwent bithermal caloric test and pure tone test before particle repositioning maneuver. Then, we analyzed the clinical features of the test results. Results The course of 40 patients with canal paresis (CP) was (4.25±2.75) weeks, which had a significant difference from the course of 14 patients with CP in the abnormal side, which was (9.21±5.85) weeks (t=4.235, Plt;0.05). Among the 39 patients with posterior semicircular canal benign paroxysmal positional vertigo (PSC-BPPV), 11 cases of canal paresis were found in the abnormal ear, and of the 15 patients with horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV), 3 cases of canal paresis were found. There was no statistical difference in the rate of canal paresis between the two groups of patients mentioned above (χ2=2.679,Pgt;0.05). Sixteen out of the 39 PSC-BPPV patients and seven out of the 15 HSC-BPPV patients had hearing loss (HL) in the abnormal ear with no statistical difference between the two groups of patients in the incidence of hearing loss (χ2=0.141,Pgt;0.05). Conclusion The incidence of CP and HL in the abnormal ear of patients with HSC-BPPV and PSC-BPPV is similar, and patients with long course of disease are more likely to have CP.
Objective To investigate inter-observer reproducibility in the pathologic diagnosis of breast intraductal proliferative lesions (BDPL). Methods Forty three BDPL patients were diagnosed by criterion of Page. Every specimen from each case was sorted randomly. All slides were classified as mild usual hyperplasia, moderate-severe usual hyperplasia, mild atypical hyperplasia, moderate-severe atypical hyperplasia, ductal carcinoma in situ, or ductal carcinoma in situ with invasion. Inter-observer agreement of the two groups was statistically analyzed using Kappa test. Then we compared all the diagnoses of individual pathologist with the consensus opinion confirmed by two breast pathologists to analyze the diagnostic accuracy and undue diagnosis. Results Inter-observer reproducibility of the trial group was higher than that of the control group (The total K value of 6, 3, and 2 diagnoses in the two groups were 0.289 3, 0.337 1, 0.492 8, 0.100 3, 0.150 3 and 0.340 3, respectively). When the categories were simplified, inter-observer reproducibility increased. There were still undue diagnoses of different degrees among pathologists of the trial group. Conclusion Using the same criteria is an important method to increase the diagnostic reproducibility and accuracy. More practice is needed to familiarize with these criteria.