脊柱创伤的CT诊断

目的：评价ＣＴ检查对脊柱创伤的诊断价值，提出脊柱创伤后作ＣＴ检查的适应证。材料和方法：５３例脊柱创伤的病人均作了平片及ＣＴ检查，并对各种类型脊柱创伤的平片和ＣＴ征象进行了回顾性分析。结果：ＣＴ能清楚显示三柱解剖结构、骨性椎管情况及脊髓受压程度，提高了诊断正确性，并提出了对下颈椎及椎管横径变窄的诊断价值。结论：笔者认为每个脊柱创伤的病人应先作平片检查，当具有下列五种平片征象时应作ＣＴ检查：１．椎体前缘严重楔形变；２．椎弓根间距增宽；３．椎体后缘高度减低；４．脊柱后突畸形；５．椎体前后错位。此外，当临床上有截瘫和神经症状时，即使平片表现轻微，也是作ＣＴ检查的适应证。     

椎管内硬膜外神经鞘瘤的诊断和治疗

为了探讨椎管内硬膜外神经鞘瘤的诊断与治疗方法 ,作者分析了 4 2例椎管内硬膜外神经鞘瘤的X线片、MRI和CT的诊断特点 ,观察了患者的围手术期情况、手术治疗的方法和手术前后患者脊髓或神经功能改善的情况、手术时间以及术中出血、输血等。结果显示 ,术后患者神经功能均有明显的恢复 ,MRI结合X线和CT检查显示对病变性质和部位诊断有重要意义。所有患者均行肿瘤切除 ,其中 12例患者在切除肿瘤的同时 ,进行了脊柱植骨内固定 ,防止继发性脊柱不稳定 ,随访示脊柱神经鞘瘤治愈率高。研究表明 ,影像学对神经鞘瘤有较高的诊断率 ,最后确诊依靠病理诊断 ;椎管内神经鞘瘤治愈率高 ,可以根据不同部位和脊柱稳定性情况选择适当内固定的方法     

隐性神经管闭合不全的MRI分析

目的:探讨隐性神经管闭合不全的临床表现及MRI征象,提高对该病的诊断水平。方法:搜集了39例手术和病理证实的隐性神经管闭合不全的资料,对其临床表现、手术结果和MRI征象进行回顾性分析。结果:脑脊膜膨出4例,背侧皮窦7例,脊柱脂肪瘤19例,原发性脊髓栓系综合征5例,脊髓纵裂2例,骶尾部畸胎瘤2例。MRI术前诊断与手术结果符合37例,约94.9%;2例误诊,约占5.1%。结论:MRI能明确显示隐性神经管闭合不全的部位、范围、信号改变及其与邻近组织的关系,是目前诊断该病的最有效检查方法。     

前路Z-PLATE钢板内固定在胸腰段爆裂骨折中的应用

目的：评价Z-PLATE钢板在胸腰椎骨折中的应用效果。方法：对26例胸腰椎骨折行前路椎体次全切及椎管减压、髌骨植骨、Z-PLATE钛钢板内固定系统前路内固定病例的临床资料进行回顾性分析。结果：经平均15个月随访，术后脊柱序列及胸腰段脊柱曲度恢复正常，椎管腔扩大，椎管无占位，植骨融合良好，无继发性后凸畸形发生，无钢板、螺钉断裂及松动等并发症。结论：前路手术可一期实现椎管侧前方减压，且直接、彻底，使神经获得最大限度的功能恢复。Z-PLATE重建钢板直接作用于骨折部位，可以对椎体间支撑植骨块加压，促进植骨融合，增加了脊柱的承载能力，符合脊柱的生物力学特征，适合于胸腰椎骨折的脊柱稳定性重建和早期功能恢复。     

脊髓型颈椎病MRI运动扫描揭示脊髓动态致压因素

脊髓型颈椎病 (cervicalspondyloticmyelopathy ,CSM) ,是颈椎病分类中最严重的一型 ,目前国内外脊柱外科学者一致主张早期诊断早期治疗[1,2 ] 。MRI扫描是检查颈椎最有效的方法 ,但目前颈椎病的检查 (包括CT和X线检查 )多是常规静态检查 ,这对于活动度较大的颈段脊柱而言显然是忽略了椎管内退变结构的动态性致压改变尤其是与脊髓之间的相互动力学关系。颈椎病患者MRI的多角度动态运动扫描则能够显示椎管内诸退变结构对脊髓所形成的动态性损害 ,并希望通过揭示动态状态下脊髓潜在性的压迫因素而达到对CSM较静态检查更早期的诊断目的。…     

MSCT与MR检查脊柱结核的临床应用分析

目的探讨脊柱结核诊断中MSCT与MR应用价值。方法分析我院确诊脊柱结核82例患者MSCT与MR影像学检查资料,比较两种影像学方式脊柱结核阳性征象检出率,病灶检出时间及检查所需总时间等。结果两种影像学方式对脊柱结核骨质破坏、椎旁脓肿及椎管狭窄等炎性征象检出率比较差异无统计学意义(P<0.05);MRI对脊柱结核脊髓侵犯检出率显著高于MSCT,差异有统计学意义(P<0.05);MRI对脊柱结核骨质坏死、钙化检出率显著低于MSCT,差异有统计学意义(P<0.05);MRI对脊柱结核病灶检出时间和检查所需总时间均显著长于MSCT,差异有统计学意义(P<0.05)。结论 MSCT与MR检查各具优势,联合应用以提高诊断准确度。     

脊柱压缩性骨折的CT检查

脊柱压缩性骨折是指X线检查,发现椎体受压而产生各种不同的变形,如楔形,扁平形甚至套式畸形等。虽然,这种检查方法对脊柱外伤是重要的,但是用“压缩”、“变形’不足以说明骨折损伤的实际程度和范围,特别是对外伤后椎管变化及其对脊髓和神经的影响显示不清。本文报告15例脊柱压缩性骨折的CT所见,以期提高脊柱外防的诊断水平,并强调CT检查的必要性。 资料和方法     

脊椎损伤的X线诊断

目的：提高X线诊断脊柱损伤价值的认识。方法：分析158例脊柱骨折的X线表现与CT表现。结果：158例207个椎体骨折中,单纯椎体骨折106例,多个椎体骨折32例,单纯屈曲压缩型133例,爆裂型21例,骨折脱位型4例。结论：X线平片是检查脊柱损伤的基本方法,X线平片表现较难区分单纯屈曲压缩型和爆裂型骨折,侧位片上椎体后缘线不连续（成角、后移）是诊断爆裂型椎体骨折较可靠的征象。CT检查是脊柱损伤必要的补充手段,能明显区分单纯屈曲压缩型和爆裂型骨折,对骨折的分型、判断脊柱失稳、骨性椎管受损,脊髓压迫程度及对制定治疗方案均有重要价值。     

曲面重建在旋转型脊柱侧弯中的应用

脊柱畸形较为常见 ,不伴有旋转的脊柱畸形 ,一般可通过ＭＲＩ冠状位和矢状位成像得到较好的显示 ,而伴有旋转的较为复杂的脊柱畸形 ,例如脊柱侧弯病例 ,除了三维表面重建显示大体形态外 ,以往尚无更好的方法来连续显示椎管结构及椎体骨质改变 ,因此也大大增加了此类手术术前评估及手术实施的难度[1～ 4 ] 。随着螺旋ＣＴ应用的日益广泛 ,尤其在骨科的应用探索 ,我们采用螺旋ＣＴ曲面重建 (ｃｕｒｖｅｄｍｕｌｔｉｐｌｅｐｌａｎｅｒｅｃｏｎ ｓｔｒｕｃｔ,ＣＭＰＲ)技术对伴有旋转的脊柱畸形进行重建显示 ,取得了良好的成像效果 ,为临床手术…     

椎管内神经鞘瘤的低场MRI诊断

目的:探讨椎管内神经鞘瘤的低场MRI表现及诊断价值。方法:搜集12例经手术病理证实的椎管内神经鞘瘤,重点分析其MRI特点及发病部位。结果:本组病例肿瘤均为单发,T1WI肿瘤呈低或等信号,T2WI呈高信号,增强后显著强化,12例肿瘤病理均无钙化。MRI对椎管内神经鞘瘤定位诊断符合率100%,定性诊断符合率83.3%。结论:低场MRI可作为诊断椎管内神经鞘瘤的敏感检查方法,正确认识其MRI征象能帮助术前诊断,并指导手术。     

A Little to a Lot or a Lot to a Little?

PURPOSE: To determine whether a little dose to a large normal lung volume or a high dose to a small lung volume is more critical for induction of clinical pneumonitis. The second question is if dose-volume histogram (DVH) parameters are more reliable, if the lungs are analyzed as separate organs or as a whole organ. PATIENTS AND METHODS: We analyzed the clinical and DVH data from 49 patients treated for a thoracic malignancy using 3-D conformal treatment plans. 18 patients had developed a clinical pneumonitis (CTC II or III). The majority of patients (n = 48) received radiochemotherapy for non-small-cell lung cancer (NSCLC) with a combination of paclitaxel and carboplatin. Patients were generally treated 5 fx/week, single dose 2 Gy, using a two-series approach (shrinking field) up to a total dose of 60-70 Gy. For every individual patient, the overall dose distribution was recalculated in the Helax-TMS by means of adding dose plans according to the total dose applied in each series. The lungs were defined both as separate organs and as a whole organ. Low-dose volume (< or = 10 Gy, Vlow), moderate-dose volume (> 10-40 Gy, Vmod) and high-dose volume (> 40 Gy, Vhigh), as well as V10-V40 and mean lung dose (MLD) were defined from the cumulative DVH. Dose-effect relationships were fitted with a logistic regression model. RESULTS: Manifestation of clinical pneumonitis was within 3 months from termination of irradiation in all cases. For the ipsilateral lung, the incidence of pneumonitis was closely correlated to Vhigh. The pneumonitis rate increased from 13% up to 60%. By contrast, with increasing Vlow the pneumonitis rate dropped to < 10%. A similar but less pronounced effect was seen for the total lung. The lung volumes Vlow, Vmod and Vhigh of the ipsilateral, contralateral and whole lung were significantly correlated to the corresponding MLD. The incidence of pneumonitis increased with increasing MLD for the ipsilateral lung with a D50 of 32 Gy and a gamma 50 of 0.98. For the whole lung, the observed increase was less steep. MLD showed a close correlation to NTCP calculated by the Kutcher model. However, NTCP calculation overestimated the pneumonitis risk for the ipsilateral lung and underestimated the risk for the whole lung due to the steeper gradient. The logistic regression curve for the DVH parameters V10-V40 showed an increase of steepness toward higher doses. From the logistic regression curves, a DVH template indicating critical borders of V10-V40 was generated for the ipsilateral as well as for the total lung. CONCLUSION: Our data indicate that it is reasonable to disperse the dose outside the target volume over large areas in order to reduce the volumes of lung receiving > 40 Gy. Reducing the high-dose volume reduces the pneumonitis rate more than a corresponding reduction in the low-dose regions of the DVH. Landmarks for DVH optimization as defined in this analysis may serve as a basis for DVH contrains in IMRT planning. Separate organ analysis produced more reliable results and should be preferred to whole-organ analysis, if techniques mainly involving one side of the lung are applied. Further validation of these constraints is necessary prior to general recommendation.     

Suicide by a rifle with a muzzle brake: a particular entrance wound

The authors describe a case in which a 21-year-old male committed suicide using a rifle equipped with a muzzle brake, placed in contact with his head. A muzzle brake for firearms is a device positioned at the mouth of a weapon, which dissipates the gases, that are generated subsequent to the gun being discharged. Generally, when a gun is pressed against an anatomical region, where the skin lies on the bone surface without interposition of other soft parts, the entrance wound consists of many lacerated branches, originating from a central lack of tissue. In this case report, the use of a rifle with a muzzle brake generated an unexpected wound, circular in shape, with a diameter of 0.8 cm. This lesion was surrounded by a bruised area, circular in shape, and an abrasion collar of the height of 0.5 cm. In addition, a muzzle imprint mark consisting of intradermal bruises, composed of a narrow red line concentrically encircling the entrance hole, was found. In order to analyze in detail if this particular entrance wound could be associated with a weapon equipped with the muzzle brake, ballistic tests – with weapons compatible with that used by the victim – were performed.     

Death of a seven-month-old child in a washing machine: a case report

The authors present a case which brings out a unique modality of child homicide by placing the baby in a washing machine and turning it on. The murder was perpetrated by the baby’s mother, who suffered from a serious depressive disorder. A postmortem RX and then a forensic autopsy were performed, followed by histologic examinations and toxicology. On the basis of the results of the autopsy, as well as the histology and the negative toxicological data, the cause of death was identified as acute asphyxia. This diagnosis was rendered in light of the absence of other causes of death, as well as the presence of typical signs of asphyxia, such as epicardial and pleural petechiae and, above all, the microscopic examinations, which pointed out a massive acute pulmonary emphysema. Regarding the cause of the asphyxia, at least two mechanisms can be identified: drowning and smothering. In addition, the histology of the brain revealed some findings that can be regarded as a consequence of the barotrauma due to the centrifugal force applied by the rotating drum of the washing machine. Another remarkable aspect is that we are dealing with a mentally-ill assailant. In fact, the baby’s mother, after a psychiatric examination, was confirmed to be suffering from a mental illness—a severe depressive disorder—and so she was adjudicated not-guilty-by-reason-of-insanity. This case warrants attention because of its uniqueness and complexity and, above all, its usefulness in the understanding of the pathophysiology of this particular manner of death.

     

Hemodynamic during a postexertional asystolia in a healthy athlete: a case study

Hemodynamic events leading to spontaneous postexertional vasovagal syncope are not completely understood because of the lack of beat-to-beat data. We report a case study of a young athlete who undergoes a syncopal episode during the recovery period following a maximal cycle-ergometer test. The episode was monitored by an impedance cardiograph which can gather noninvasively beat-to-beat the flow of heart rate (HR), stroke volume (SV), cardiac output (CO), diastolic filling rate (SV/DT), and myocardial contractility index (PEP/LVET). The most important findings of this report are the dramatic reduction of SV/DT preceding the syncope, the increment of SV together with the reduction of HR preceding and following the syncope, the prompt recovery of CO values after the syncopal episode despite the bradycardia, and the reduction of PEP/LVET after the syncope. This report confirms the importance of active recovery immediately after strenuous exercise and supports the hypothesis that the reduction of SV/DT in the presence of an inotropic stimulation can trigger the vasovagal reaction.     

Identification of a cannabimimetic indole as a designer drug in a herbal product

A cannabimimetic indole has been identified as a new adulterant in a herbal product being sold illegally in Japan for its expected narcotic effect. Liquid chromatography-mass spectrometry and gas chromatography-mass spectrometry analyses indicated that the product contained two major compounds. One was identified as a cannabinoid analog (1RS,3SR)-3-[4-(1,1-dimethyloctyl)-2-hydroxyphenyl]cyclohexan-1-ol (1) by direct comparison with the authentic compound, which we reported previously. The other compound (2) showed a molecular weight of 341 daltons, and accurate mass spectral measurements showed its elemental composition to be C₂₄H₂₃NO. Both mass and nuclear magnetic resonance spectrometric data revealed that 2 was 1-pentyl-3-(1-naphthoyl)indole [or naphthalen-1-yl-(1-pentylindol-3-yl)methanone] being identical to JWH-018, which was synthesized by Wiley and coworkers in 1998. This compound was reported as a potent cannabinoid receptor agonist possessing a pharmacological cannabimimetic activity.     

Going out on a limb for a difficult diagnosis: a case report

Sacral tumors with fetiform features are rare and pose a diagnostic challenge to the ultrasonologist. Sacrococcygeal teratomas (SCT) and parasitic twins can have very similar sonographic features but have different implications to an affected pregnancy. While postnatal histopathology is ultimately necessary to distinguish between a SCT and a heteropagus twin, certain characteristics, such as the presence of a vertebral column and the pattern and rate of tumor growth, may be useful to guide counseling and management decisions.