超声在脊柱结核合并寒性脓肿诊断中的探讨

目的:针对超声对脊柱结核合并寒性脓肿的临床诊断及治疗中的应用,谈一谈经验和认识。方法:结合X线摄片、CT、MR1的影像表现,利用超声诊断及超声引导下穿刺技术,研究每个病例声像图特征并进行分类总结。结果:超声对脊柱结核合并寒性脓肿的诊断病理符合率达95%左右。结论:超声对椎体旁及远处流注脓肿的范围、位置、脓液量、鉴别诊断、超声引导下穿刺抽液、药物灌注及预后评估均提供了可靠的参考信息。     

猫抓病的病理诊断及与结核的鉴别

目的 猫抓病(cat scratch disease,CSD,COS)目前认为是一种革兰氏阴性杆菌(汉塞巴尔通体)引起的急性传染病,W-S银染色阳性.研究猫抓病的临床表现、临床及病理的诊断标准及与结核的鉴别,提高诊断水平.方法 通过病例分析做出猫抓病和结核病的鉴别要点.结论 猫抓病是一种传染病,其与结核的病理鉴别要点为微脓肿或星形脓肿的形成.     

胸部空洞性病变84例X线分析

目的；探讨不同病因空洞的Ｘ线表现，正确诊断与鉴别诊断。方法：据临床资料和Ｘ线表现。结合手术病理及其它辅助检查分析。结果：结核空洞２７例，包括矽肺结核支气管胸膜瘘胸壁形成窦腔和支气管胸膜瘘的空腔。癌性空洞１３例及涉及１２个病种的其它空洞性病变４４例，结论：多种病因所形成的空洞病变，在空洞形成的过程中，其发生部位，形态大小都有类似表现或表现特殊，演变过程不定者，难从影像学或单一的检查方法作诊断或鉴别诊     

腰大肌寒性脓肿术后B超检查的临床价值

腰大肌寒性脓肿常向周围组织间隙流注,形成流注脓肿或形成较隐匿的窦道、瘘管,手术清除不彻底易复发,或脓肿清除后局部死腔残留引起积液。术后常规B超检查可及时发现液性暗区并间断动态观察,引导穿刺治疗、鉴别术后积液或脓肿复发。     

超声诊断阻塞性黄疸100例分析

阻塞性黄疸是由于肝内或肝外胆管阻塞而引起的,确定梗阻的部位及性质对治疗及预后都有重要意义.B超能明确显示胆囊的大小、形态、胆管的内径及走向、结石或肿瘤的大小及所在部位等,可对阻塞性黄疸的鉴别诊断提供重要依据.我们对100例阻塞性黄疸患者的超声诊断情况进行了分析,现报道如下:     

螺旋CT对脊柱结核诊断的价值

目的探讨螺旋CT在脊柱结核诊断中的价值。方法对33例经临床或病理证实的脊柱结核的CT表现进行回顾性分析。结果33例患者中,病变部位在颈椎2例、胸椎10例、腰椎15例、胸腰段6例。单个椎体受累8例,多个椎体受累25例。在脊柱结核影像表现中,死骨9例,椎间隙变窄5例,冷性脓肿13例,椎管狭窄8例,后凸畸形2例。结论在脊柱结核的诊断中,螺旋CT具有重要价值。     

肺部空洞性病变CT7例误诊分析

肺空洞是肺部疾病常见的影像学表现,很多疾病在发展过程中均可形成空洞,不同病变空洞的形态各有特点.一般主要在肺癌空洞、结核空洞和炎性空洞三者之间进行鉴别.本文回顾性总结7例被误诊的肺部空洞性病变,对其影像学表现进行分析,以进一步提高对空洞性病变的诊断和鉴别诊断能力,减少误诊.     

脊柱结核的CT与MRI影像表现(附28例分析)

目的探讨脊柱结核的CT与MRI的影像特点,比较两者在脊柱结核中的诊断价值。方法回顾性分析了2010年2月-2012年2月我院经病理证实和经抗结核药物治疗后临床痊愈的28例脊柱结核患者的临床资料。结果脊柱结核的CT表现为溶骨性、虫蚀状、碎骨片状骨质破坏伴有硬化,椎旁软组织中见砂粒样钙化,冷脓肿形成,椎间隙变窄,椎管受累等;MRI表现为椎骨质破坏,破坏区周围见不同程度的水肿区,椎间盘破坏,椎旁脓肿形成,椎管受累,韧带下型等。结论脊柱结核病变具有多样性,MRI对脊柱结核的早期诊断、病变范围的确定方面要明显优于CT,而CT在显示死骨和钙化等方面具有优势,两者结合有助于脊柱结核的诊断、鉴别诊断以及治疗效果的观察。     

上胸椎结核并截瘫患者的康复护理

截瘫是胸椎结核的直接并发症,产生截瘫的主要原因是由于结核性肉芽组织、脓肿、死骨压迫脊髓,若不及时治疗,可导致终生残疾。笔者所在医院骨外科于2001年1月至2003年1月共收治20例上胸椎结核并截瘫患者,实施前路开胸病灶清除一期植骨内固定术。术前术后患者康复护理得当与否对上胸椎结核并截瘫患者恢复起着极其重要的作用。通过对20例上胸椎结核并截瘫患者术前术后实施了康复指导,收到良好的效果,为患者康复奠定了基础。现将护理体会总结如下。     

皮下型与其他少见部位肺吸虫病临床病理特征的比较研究

目的 比较皮下型与少见部位肺吸虫病的临床病理特征,探讨少见部位肺吸虫病的诊断与鉴别诊断.方法 收集2002年1月至2009年1月收治的心包、左大脑颞顶叶、左Ⅲ段肝叶、右侧阴囊、左胸膜、右髂骨、肠系膜淋巴结、右锁骨上淋巴结、左颌下淋巴结、右腋旁淋巴结肺吸虫病各1例共10例,结合流行病学及免疫学检查对其临床资料和病理标本与13例皮下型肺吸虫病例进行回顾性对比分析.结果 23例中13例皮下型肺吸虫病术前诊断肺吸虫病10例(诊断符合率77%),10例少见部位肺吸虫病术前诊断分别为结核性心包炎、颅内占位、肝脓肿、右侧阴囊炎、左胸膜占位、右髂骨脓肿、阑尾炎及左锁骨上、左颌下、右腋旁淋巴结结核,术前误诊率100%,显著高于皮下型肺吸虫病(x2=13.6,P＜0.05).23例患者流行病学调查结果显示,均有生食田螺、淡水溪蟹史.皮内试验及免疫学检查,病理学特点基本一致.结论 少见部位肺吸虫病临床特点不典型,易误诊,病理检查结合流行病学资料及免疫学检查能明确诊断并与Langerhans细胞组织细胞增生症、结核、肿瘤等疾病鉴别.     

Vertebral tuberculosis revealed by thoracic manifestations. A study of five cases

BACKGROUND: Spine is the most frequent location of bone tuberculosis, which can seldom be revealed by thoracic manifestations. METHODS: In a seven-years retrospective study, we reported radioclinical manifestations revealing Pott's disease, methods of diagnosis and the treatment outcome. RESULTS: Five non immunocompromised female patients were hospitalized between 1997 and 2003 in Clinical Department of Pulmonary Diseases in Abderrahmane Mami Hospital Ariana Tunisia, for thoracic manifestations that led to the diagnosis of Pott's disease, which represents 4.2% of extrapulmonary tuberculosis and 1.3% of all cases of tuberculosis cared for in the same period. The median age was 48.6 years. The disease was revealed by a paramediastinal radiographic shadow infiltrating the contiguous left lung in one case, abscesses of chest wall in two cases. Another patient was hospitalized for a tuberculous empyema. The last case had a diffuse miliary shadow in both lungs. All patients complained from thoracic or respiratory problems and constitutional symptoms, that evolved for an average of 5.6 months. Computed tomography (CT) and magnetic resonance imaging (MRI) of the spine identified monolevel spondylitis in two cases and multilevel disease in three cases. Diagnosis of tuberculous infection was confirmed in only one case by CT-guided biopsy of a perivertebral abscess, it was retained in three cases by bacteriological and or histopathological exams obtained from extra-vertebral lesions, and presumed in the fifth on a favorable treatment outcome. All patients had at least one extra-vertebral location of tuberculosis. Four patients were treated successfully with antituberculosis chemotherapy, prescribed for 18 to 22 months. Relapse occurred only in one patient, who received 12 months of treatment. CONCLUSION: Pott's disease can be observed in non immunocompromised patients. In the Lung Diseases Department, it is often revealed by thoracic manifestations and associated to pulmonary lesions, which makes the formal diagnosis easy. Here, vertebral tuberculosis does not have anatomical specificities; nevertheless, the multilevel forms are relatively frequent. It constitutes an index of bacillus dissemination, requiring the search for other extra-vertebral locations.     

Case report on the development of a brucellosis-related epidural abscess

Brucellosis is an endemic disease in developing countries. The most commonly observed complications include bone-joint involvement, particularly sacroiliitis and spondylitis. Epidural abscesses caused by brucellosis are a rare complication. We describe the case of a 33-year-old man presenting with high fever, back pain, and weakness. At physical examination, the patient was found to be paraparetic. At thoracic MRI, spondylodiscitis and epidural abscess with significant cord compression were observed. In laboratory examinations, Rose Bengal and tube agglutination tests were positive in patient's serum for brucellosis, and specific antibiotherapy was initiated. Total laminectomy was performed and the abscess was aspirated. The biopsy sample was consistent with chronic non-specific inflammation in acute abscess. No growth was detected in the abscess or blood cultures. Following surgery, medical treatment was initiated and, at six weeks' follow-up, clinical and MRI findings indicated that he had recovered. The diagnosis of spinal epidural abscess due to brucellosis should be considered among differential diagnoses in endemic regions. Early diagnosis and specific treatment are important to prevent later complications.     

老年脊柱结核的CT与MRI表现对比分析

目的 观察并分析老年脊柱结核的CT与MRI表现.方法 CT设备采用美国GE公司生产的Lightspeed64排螺旋CT机,扫描线平行于椎间隙,横断面扫描,层厚3 mm,层距3 mm,连续扫描脊柱可疑区,拍摄骨窗、软组织窗观察,必要时作增强扫描;MR检查设备选择Siemens公司生产的1.5T symphony超导磁共振扫描仪,扫描采用矢状面T1WI、T2WI序列和横轴面T2WI序列,部分病例行增强扫描,造影剂用马根维显(Gd-DTPA)注射液,0.1 mmol/kg静脉推注.结果 35例老年脊柱结核患者同时累及2个椎体19例占54.3％,累及＞2个椎体14例,占40.0％,仅有2例为累及1个椎体;共累及椎体86个,累及部位:颈椎15个、胸椎19个、下胸椎11个、腰椎38个、骶椎3个;所有患者CT发现椎体伴椎间盘破坏、椎旁肿块或脓肿、硬膜外或椎孔侵犯、韧带下扩散、脊膜强化和钙化例数分别为35、30、5、1、1、25例,与CT相比MRI分别为35、30、15、20、16、2例.结论 老年脊椎结核的CT以及MRI表现各有特点,临床综合分析CT以及MRI老年脊柱结核表现,对于其诊断及鉴别诊断、治疗有重要意义.     

A Moroccan woman with genital tuberculosis

A 28-year-old nulliparous Moroccan woman presented at an outpatient gynaecology clinic because she had been unable to conceive for the last 2 years. She had an enlarged right adnexus. Histopathological examination of the resected right adnexus was suspicious for tuberculosis. After isolating Mycobacterium bovis from a psoas abscess 3 months later, a 6-month regimen with anti-tuberculosis drugs was started, and the clinical response was good. Female genital tuberculosis is rare in developed countries. Symptoms are few and non-specific. The disease can be suspected incidentally during the subfertility work-up. The fallopian tubes are the most commonly affected site. A definitive diagnosis is difficult to make, even when tuberculosis is strongly suspected. Histopathological findings can support a diagnosis of tuberculosis, and molecular PCR techniques that detect DNA are promising. Treatment of genital tuberculosis is similar to that of pulmonary tuberculosis, although it is difficult to monitor treatment response. The chance of spontaneous conception after treatment is very small, and IVF is often the only treatment option.     

不同术式治疗胸腰椎结核合并巨大脓肿71例疗效分析

目的探讨不同手术方式治疗胸腰椎结核合并巨大脓肿的临床效果。方法采用不同手术方式,包括经胸入路或胸膜外肋横突入路、肾切口入路、倒“八”字腹膜外入路或后路入路,治疗胸腰椎结核并巨大脓肿71例,其中男37例,女34例,年龄17～78岁,平均42．0岁。病程：2月一3年。多椎体脊柱结核≥2个椎体,包括跨越性病灶,病灶分布为T7～8,2例,T8-9,1例,T9-10,3例,T10～11,11例,T11～12,4例,T12-L1,3例,T12、L1—2,4例,L1-2,12例,L2～3,10例,L3—4,5例,L4～5,5例,L5～S1,3例,L1～3,2例,L2—4,3例,T12、L2～3,1例,L2～5,2例。神经功能按美国脊髓损伤学会（ASIA）的分级：B级4例,C级6例,D级9例,E级52例。术前后凸Cobb角5°-61°,平均（31．2°±9．2°）。CT和MR显示均有明显的死骨,椎旁巨大脓肿术中吸尽乳白色脓液820—3100ml,平均1370ml,3例伴脊髓受压严重者于12—48h抗痨治疗后急诊手术,其余68例术前抗痨支持治疗2—4周,术后继续抗痨12—18月。结果随访1～4年,平均16月,手术时间平均180min,术中出血量平均900ml,3例术中发生脑脊液漏行修补,术后未发生脑脊液漏。术后6例伤口不愈合,形成窦道,经抗痨局部换药治疗后治愈。4例术后再次形成椎旁脓肿,量约100—150ml,再次病灶清除后治愈。死亡2例。1例术后发生内固定物松动,未处理。术后复发4例,再次手术后末次随访均临床治愈,结核无复发。伴神经损伤者4例术前ASIAB级恢复至D级,余均恢复至E级。结论根据病灶部位、病变程度,采用不同手术方式治疗胸腰椎结核并巨大椎旁脓肿均能达到清除病灶、脊髓减压及矫正脊柱后凸畸形的良好治疗效果。     

扩散加权成像在颅脑部分病变中的应用

介绍了扩散加权成像（diffusion-weighted imaging,DWI）的物理基础及成像原理,重点阐述了其在颅脑疾病中的诊断及评价,包括在脑梗死、颅脑肿瘤、脑脓肿与坏死性囊变肿瘤鉴别诊断中的应用等．分析了其在应用中存在的问题,对其发展前景进行了展望。     

Intracerebral tuberculomas in a pregnant Somalian woman

A pregnant Somalian woman aged 28 years, in the Netherlands for the last five years, suffered from a progressive hemiparesis, epilepsia, behavioural problems and low fever. Brain MRI showed multiple lesions with contrast enhancement. Extensive serologic and parasitologic tests on serum and cerebrospinal fluid did not disclose any cause. A brain biopsy revealed only necrosis, but bacterial culture and polymerase chain reaction (PCR) supplied the diagnosis of 'tuberculosis'. PCR on the cerebrospinal fluid remained negative. In the meantime the chest X-ray showed miliary tuberculosis and a spine MRI thoracic spondylodiscitis and a large paravertebral abscess. Subsequently the patient was treated successfully with tuberculostatic agents. Her healthy child which was born by caesarean section was treated with the tuberculostatic agents as well.     

Tuberculosis of the breast: a case report

Primary tuberculosis of the breast is a rare disease. It usually occurs in female of reproductive age. Any form of tuberculosis mastitis may present with feature of malignancy. Diagnosis is mainly based on identification of tubercle bacilli. We report a 42-year-old woman with primary tuberculosis abscess of the breast, who underwent surgical resection. Fine needle biopsy failed to achieve specific diagnosis before surgical operation. She responded to anti-TB therapy postoperatively. In endemic area, tuberculosis should be considered in the differential diagnosis of breast tumors.     

32例腰椎结核伴寒性脓肿的围手术期护理体会

目的:探讨腰椎结核伴寒性脓肿疾病的护理方法。方法:回顾性分析32例腰椎结核伴寒性脓肿患者围手术期的护理。结果:患者均经手术治疗,术前加强营养,术后予抗结核治疗,效果满意。结论:腰椎结核伴寒性脓肿应采取全身抗结核治疗配合手术及综合护理等手段,加快患者的康复。     

新疆维吾尔族脊柱结核的特点及影像学诊断对比分析

目的 探讨维吾尔族脊柱结核的特点及影像学诊断评价.方法 回顾性分析194例经手术病例证实的脊柱结核患者的X线平片、CT、MRI扫描及增强扫描检查等临床资料.结果 脊柱正侧位X线平片、CT、MRI对脊柱结核的诊断准确率分别为912%、943%、964%.对椎体、骨质破坏包括附件的破坏,死骨形成,敏感性分别为924%、985%、974%.对椎间隙的狭窄椎旁软组织肿块、腰大肌肿块、椎管及脊髓的受累显示率分别为872%、904%、995%.结论 脊柱正侧位X线平片是诊断脊柱结核的基础方法.如需进一步了解死骨椎旁软组织肿胀、椎间盘破坏、椎管及脊髓的受累,MRI准确率高,评价细致、全面,并且能早期诊断.