CT平扫混合征和黑洞征及其联合征象对脑出血患者早期血肿扩大的预测价值

目的探讨CT平扫混合征和(或)黑洞征预测原发性脑出血患者早期血肿扩大的价值。方法前瞻性连续纳入2011年7月至2016年7月重庆医科大学附属第一医院原发性脑出血患者244例,发病至首次CT时间均≤6 h,根据是否存在早期血肿扩大分为血肿扩大组(82例)和未扩大组(162例)。收集患者一般资料进行组间比较,包括既往史、临床特点、入院格拉斯哥昏迷评分(GCS)、影像学特征[黑洞征、混合征及黑洞征和(或)混合征]等;对早期血肿扩大的影响征象进行多因素Logistic回归分析;采用受试者工作特征曲线计算约登指数,并对早期血肿扩大的影像学征象的预测值进行分析。结果 (1)早期血肿扩大者中,黑洞征27例(32.9%)、混合征33例(40.2%)、混合征和(或)黑洞征50例(61.0%)。(2)将血肿体积按1 ml、发病至入院首次CT时间按1 h、入院GCS按1分递增进行赋值,并将黑洞征、混合征分别纳入进行多因素Logistic回归分析,结果显示,混合征(OR=14.04,95%CI:5.16~38.18)、黑洞征(OR=5.69,95%CI:2.12~15.30)均为早期血肿扩大的独立危险因素(均P0.01);经过进一步调整显示,混合征和(或)黑洞征也为早期血肿扩大的独立危险因素(OR=14.08,95%CI:5.99~33.08,P0.01)。(3)经受试者工作特征曲线分析,混合征和(或)黑洞征预测早期血肿扩大的敏感度、特异度、阳性预测值、阴性预测值和约登指数分别为:61.0%、90.1%、76.0%、82.0%和0.511,其约登指数比黑洞征(约登指数:0.280)和混合征(约登指数:0.346)更接近1。结论与单一征象相比较,混合征联合黑洞征对脑出血早期血肿扩大的预测能力更好。     

CT混合征与CT血管成像斑点征对急性脑出血血肿扩大的预测价值

目的分析CT混合征与CT血管成像(CTA)斑点征对急性脑出血患者血肿扩大的预测价值。方法回顾性连续纳入2016年3月至2018年12月昆明医科大学第二附属医院脑血管病科收治的急性脑出血患者,发病6 h内进行基线CT及CTA扫描,明确血肿体积、部位、形态及密度(混合征及斑点征),并于发病24 h后复查CT判定是否出现血肿扩大,根据判定结果将符合纳入标准的186例急性脑出血患者分为血肿扩大组(56例)和非血肿扩大组(130例)。收集患者一般临床资料并进行组间比较,对血肿扩大的各影响因素进行Logistic回归分析,计算受试者工作特征(ROC)曲线下面积并比较混合征与斑点征对血肿扩大的预测价值。结果血肿扩大组出现混合征[35.7%(20/56)]、斑点征[44.6%(25/56)]的比例明显高于非血肿扩大组[混合征12.3%(16/130)、斑点征15.4%(20/130)],差异均有统计学意义(χ2值分别为13.738、18.269,均P<0.01);患者入院时存在CT混合征(OR=3.273,95%CI:1.955~5.413)、CTA斑点征(OR=3.207,95%CI:1.275~8.069)及低GCS评分(OR=1.382,95%CI:1.215~1.573)、高血糖(OR=1.281,95%CI:1.088~1.509)、基线血肿体积大(OR=1.118,95%CI:1.023~1.222)、血肿形态不规则(OR=4.530,95%CI:1.297~15.828)均是血肿扩大的独立危险因素。混合征联合斑点征预测血肿扩大的敏感度、特异度、阳性预测值、阴性预测值分别为51.8%、78.5%、50.9%、79.1%,其ROC曲线下面积为0.666(P<0.01),略高于单一斑点征(曲线下面积0.642,P=0.002)及单一混合征(曲线下面积0.617,P=0.011)。结论除血糖、GCS评分、基线血肿体积、血肿形态以外,混合征、斑点征也与血肿扩大相关。混合征联合斑点征预测急性脑出血血肿扩大的能力优于单一征象。     

混合征联合点征对脑出血患者血肿扩大预测价值

目的探讨单一混合征和点征及两者联合征象对脑出血患者血肿扩大的预测价值。方法纳入脑出血患者171例,根据患者是否发生血肿扩大分为血肿扩大组36例和血肿未扩大组135例。患者入院行CT和CT血管成像检查,记录混合征、点征和两者联合征等影像学征象,入院24 h内复查CT。用二元logistic回归分析血肿扩大的影响因素,采用ROC曲线分析各影像学征象的预测价值。结果血肿扩大组两者联合征象比例较血肿未扩大组明显升高(52.8%vs 17.8%,P=0.000)。二元logistic回归分析显示,两者联合征象为血肿扩大的独立危险因素(OR=5.169,95%CI:2.348～11.381,P0.05)。ROC曲线分析显示,两者联合征象预测血肿扩大的约登指数较混合征象及点征象更高(35.0%vs 6.8%和7.4%);两者联合征象的敏感性、特异性、阳性预测值、阴性预测值分别为52.8%、82.2%、44.2%、86.7%,曲线下面积为0.675(95%CI:0.599～0.745,P=0.000),有预测血肿扩大的价值。结论两者联合征象可能可以预测脑出血的血肿扩大。     

CT灌注成像原始像点征预测急性自发性脑出血血肿扩大的初步研究

目的探讨CT灌注成像原始像"点征"与有临床意义的血肿体积扩大的相关性。方法选择发病6h内的急性自发性脑出血患者44例,根据是否有"点征",分为"点征"阳性组(14例)和"点征"阴性组(30例)。所有患者均接受基线CT平扫、CT灌注成像和24h后CT平扫。应用计算机辅助容积测量软件测定血肿体积并判断血肿体积有无扩大,盲法评估CT灌注成像判定"点征"及其评分。结果 31.8%的患者被判定为"点征"阳性。"点征"阳性组患者脑实质内血肿体积的变化绝对值和百分比明显大于"点征"阴性组,差异有统计学意义。CT灌注成像原始像显示的"点征"在有临床意义的脑实质内血肿扩大阳性患者与阴性患者比较,差异有统计学意义。CT灌注成像原始像的敏感性为75.0%,特异性为92.9%,阳性预测值为85.7%(OR=39.00,95% CI:6.256～243.126)。结论 CT灌注原始像"点征"可以用于预测自发性脑出血的急性期血肿扩大。     

脑CT平扫低密度影联合CTA斑点征对自发性脑出血早期血肿增大的预测价值

目的：分析头颅CT平扫低密度影(HD)联合头颅CT血管造影（CTA）斑点征（SS)对于自发性脑出血早期血肿增大的预测意义。方法：回顾性分析285例自发性脑出血患者入院时头颅CT、CTA及发病24h复查头颅CT情况,根据头颅CT及CTA将患者分为4组：SS(-)HD(-)、SS(+)HD(-)、SS(-)HD(+)、SS(+)HD(+),血肿增大定义为血肿体积增加＞33％或＞6mL。结果：24h后复查头颅CT有64例患者出现血肿增大。4组间年龄、性别、高血压及糖尿病病史、入院时血压、格拉斯哥昏迷评分（GCS）及脑出血部位比较,差异无统计学意义（均P＞0.05）,但入院时4组患者脑出血量与出现血肿增大的例数比较,差异有统计学意义（均P<0.05）。其中SS(+)HD(+)组患者入院时出血量较大,24h内出现血肿增大的病例数更多（61.5%）。CTA斑点征、CT平扫低密度影及二者联合出现均为脑出血早期血肿增大的独立危险因素。CT平扫低密度影敏感性较高,但二者联合表现出较高的特异性。结论：在脑出血早期, CTA斑点征联合CT平扫低密度影能协助急诊医师快速及较准确地进行脑出血血肿扩张危险分层。     

CTA斑点征对急性高血压脑出血患者血肿扩大的预测价值分析

目的分析CTA斑点征对急性高血压脑出血患者血肿扩大的预测价值。方法选取2013—2015年在普宁市人民医院神经内科急诊就诊的急性高血压脑出血患者72例,均在发病6 h内进行颅脑CT及CTA检查,发病24h后复查CT。比较CTA斑点征阳性患者和CTA斑点征阴性患者一般资料,记录血肿扩大情况,并分析CTA斑点征对急性高血压脑出血患者血肿扩大的预测价值。结果颅脑CTA原始图像斑点征阳性20例(27.8%),斑点征阴性52例(72.2%)。CTA斑点征阳性患者和CTA斑点征阴性患者性别、血肿部位、血肿形态、出血是否破入脑室、年龄及首次CT检查时血肿体积比较,差异均无统计学意义(P0.05)。72例患者血肿扩大率为29.1%,其中14例血肿扩大发生在6 h内、7例血肿扩大发生在6～24 h;21例血肿扩大患者中18例出现病情加重,其中2例在24 h内死亡。CTA斑点征预测血肿扩大的灵敏度为80.9%,特异度为94.1%,诊断准确率为90.3%。结论急性高血压脑出血患者血肿扩大发生率较高、预后较差,而CTA斑点征可有效预测急性高血压脑出血患者血肿扩大。     

“九分法”在预测原发性脑出血患者血肿扩大及不良临床预后中的价值

目的探讨"九分法"在预测原发性脑出血患者血肿扩大及不良临床预后中的价值。方法选择79例自发性脑出血患者按照"九分法"评分后,分为0~3分组55例和4~9分组24例。采用CT血管造影(CTA)原始图像中寻找"点征"以及基线CT平扫血肿体积计算,比较2组基线资料、美国国立卫生研究院卒中量表(NIHSS)、血肿扩大、外科手术干预及死亡人数,同时比较"九分法"与单纯使用"点征"预测血肿扩大的优劣。结果与0~3分组比较,4~9分组点征阳性、复查血肿扩大、30dNIHSS评分、外科手术干预、90d病死率明显升高,差异有统计学意义(P<0.05,P<0.01)。"九分法"预测血肿扩大阳性预测值为50.0%,阴性预测值为96.4%,敏感性85.7%,特异性81.5%。与单纯使用"点征"预测比较,"九分法"预测血肿扩大阳性预测值下降,阴性预测值升高。结论 "九分法"能够有效预测血肿扩大及不良临床预后,在临床运用中应结合"九分法"对脑出血患者进行分层治疗。     

CT双期增强扫描在自发性脑出血患者点征检出中的优势及临床价值

目的探讨多层螺旋CT双期增强扫描在自发性脑出血患者点征检出中的优势及临床价值。方法对89例自发性脑出血患者进行头颅CT平扫、动脉期及静脉期增强扫描,记录动脉期及静脉期点征出现部位、多少及大小变化,观察血肿变化,对比分析动脉期与双期扫描点征检出区别,重建观察CTA图像。结果 89例动脉期检出点征27例,检出率30. 33%,共34处,血肿内29处,血肿周围5处;静脉期新增8例,共12处,血肿内9处,血肿周围3处,静脉期8处点征增大。双期共检出35例,检出率39. 33%,共46处; CTA成像检出动脉瘤3例,左侧大脑前A1段缺如4例,右侧大脑后动脉期P1段缺如1例,血管畸形1例。31例患者血肿扩大,其中有29例出现点征,静脉期检出点征及点征增大病例血肿均扩大。动脉期与双期扫描点征检出差异有统计学意义(P 0. 05),脑内血肿扩大阳性率与双期扫描点征检出率,差异有统计学意义(P 0. 05)。结论多层螺旋CT双期增强扫描对点征检出率较高,可以有效地预测血肿早期扩大。     

肠梗阻手术指征的多排螺旋CT征象

目的探讨CT征象在肠梗阻患者手术适应证选择中的价值。 方法回顾性分析2013年6月至2017年5月宝鸡市中医医院269例临床诊断肠梗阻病例的图像资料。其中13例放弃治疗,185例保守治疗好转,71例手术解除梗阻。肠梗阻原因：阑尾炎7例,疝7例,肿瘤22例,黏连19例,扭转9例,粪石7例,共71例。对完全性梗阻、移行带、黏连带前位、腹腔脂肪密度增高、肠粪征、漩涡征、鸟嘴征、缆绳征、腹腔积液的CT征象进行统计,采用多因素Logistic回归模型分析及析因分析小肠梗阻各CT征象及各征象联合与手术治疗的相关性。 结果多因素Logistic回归模型分析显示,完全性梗阻、移行带、黏连带前位、肠粪征、腹腔积液5个征象在手术组与非手术组之间具有统计学意义(完全性肠梗阻P＝0.036;移行带P＝0;黏连带前位P＝0.024;肠粪征P＝0.006;腹腔积液P＝0),其特异度、敏感度、阴性预测值、阳性预测值,OR值均>1。 结论完全性梗阻、移行带、黏连带前位、肠粪征、腹腔积液5个征象对肠梗阻患者手术时机的选择具有良好的参考价值。     

CT混合征对自发性脑出血患者预后及术后再出血预测价值的研究进展

自发性脑出血是一种严重的脑血管病,具有较高的致残率及病死率。手术治疗在降低自发性脑出血患者的病死率和改善功能预后方面有一定作用,但术后再出血是严重的并发症之一,可导致患者预后不良。头部CT混合征对预测血肿扩大及不良预后具有一定的价值,关于混合征预测自发性脑出血患者不良预后和术后再出血的研究逐渐增多。作者对相关研究进展进行文献复习,对混合征在自发性脑出血患者不良预后及术后再出血的预测价值进行分析,以期为临床诊治提供参考。     

Aquarium sign in sepsis

A 91-year-old man appeared in our lab with fever for a transthoracicechocardiography assessment. Highly unusual echo images werefound, with a size and movement resembling ‘bubbles inan aquarium’ in every cardiac chamber, both left and right.The patient died 8 days later, due to a methicillin-resistantStaphylococcus aureus sepsis. These are highly unusual imagesthat should not be confused with microbubbles from contrastagents or radiofrequency ablation, and were previously reportedonce in association with atrioesophageal fistula.     

Sharma's parachute sign a new laparoscopic sign in abdomino pelvic tuberculosis

AimsTo demonstrate a new laparoscopic sign “Sharma's Parachute sign” in abdominopelvic tuberculosis in women with infertility.MethodsA total of 104 women who were diagnosed to have abdominopelvic tuberculosis, on endometrial sampling or on laparoscopy were enrolled in this ongoing study on tuberculosis in infertility. A new laparoscopic “Sharma's parachute sign” was looked for in these cases on laparoscopy.ResultsThe mean age, pairty and duration of infertility was 27.6 years, 0.58 and 4.1 years respectively. Menstrual dysfuction were common especially hypomenorrhoea (34.61%), oligomenorrhoea (36.53%) along with constitutional symptoms and abdomino pelvic pain or lump. Diagnosis of abdominopelvic tuberculosis was made by identification of acid fast bacilli (AFB) on microscopy or culture of endometrial aspirate or peritoneal biopsy or positive gene Xpert or positive polymerase chain reaction (PCR) or histopathological demonstration of epithelioid granuloma on endometrial or peritoneal biopsy, various laparoscopic findings on pelvic and abdominal organs were tubercles and shaggy areas (white deposits, caseous nodules encysted ascites, abdominal and pelvic adhesions, tubal findings (hydrosalpinx, pyosalpinx, beaded or calcified tubes). A new “Sharma's parachute sign”in which ascending colon was totally adherent to anterior abdominal wall with its mesocolon looking like an open parachute with small caseous nodule was seen in 11 (10.5%) cases.ConclusionDiagnostic laparoscopy is an important investigation for abdominopelvic tuberculosis showing various adhesions including new parachute sign.     

大脑中动脉高密度征与磁敏感血管征对大脑中动脉闭塞评估的一致性

目的探讨CT平扫大脑中动脉高密度征(HMCAS)与磁敏感加权成像大脑中动脉(MCA)磁敏感血管征(SVS)的一致性。方法回顾性连续纳入150例发病6 h内前循环脑梗死急性期患者,均接受头部CT、MRI一站式检查,并记录患者基线情况。对CT及MRI进行分析,记录HMCAS、SVS存在情况,共有75例与DSA结果进行对照;HMCAS与SVS的一致性采用Kappa检验并行假设u检验。结果以DSA为参照标准,HMCAS和SVS对急性MCA主干闭塞的敏感度、特异度分别为42.4%(14/33)、36.4%(12/33)和92.9%(39/42)、90.5%(38/42);HMCAS与SVS的一致性检验值κ=0.804,u值为9.570(P0.05)。结论 MCA的HMCAS与SVS呈高度一致性,可为急性缺血性卒中的早期诊断、治疗方式的选择及溶栓后血管再通预测提供参考依据。     

The hyperkalemic Brugada sign

Background

A few case reports have indicated that hyperkalemia can induce a Brugada pattern in the electrocardiogram. The specific clinical and electrocardiographic features of the hyperkalemic Brugada sign, however, have not been previously described.

Methods

A case series was collected from hospitalized hyperkalemic patients with a type I Brugada pattern in the electrocardiogram, and a literature review was performed. Electrocardiograms were examined for rhythm and morphology, and clinical characteristics were analyzed.

Results

Nine new cases with the hyperkalemic Brugada sign were identified with an additional 15 cases found in the literature. Of the 9 cases, 8 were male patients, and all were critically ill; 5 of the 9 died within 48 hours. The mean (±SD) serum potassium level was 7.8 ± 0.5 mEq/L. The mean QRS width was 144 ± 31 milliseconds, and all had abnormal QRS axis. In 6 cases, there was a wide complex rhythm without visible P waves. The clinical and electrocardiographic characteristics of 15 cases found in the literature were remarkably similar to those in our series.

Conclusions

The hyperkalemic Brugada pattern differs in substantial ways from the electrocardiogram of patients with the genetic Brugada syndrome. Many patients have wide complex rhythms without visible P waves, marked QRS widening, and an abnormal QRS axis. Most patients are male, and many are critically ill. Prompt recognition of this clinical and electrocardiographic entity may expedite the initiation of appropriate treatment for hyperkalemia.     

A new diagnostic sign for rheumatoid arthritis: Avicenna sign

Aim: The status of a new sign for diagnosing rheumatoid arthritis is discussed for the first time in this study. It is defined as marked tenderness on the anterior surface of leg (shin) on pressure of about 4 kg by thumb. The sign has been denoted as ‘Avicenna sign’. Methods: All cases were selected by convenient sampling from patients who were referred to two rheumatology clinics in Tabriz, Iran. Sample size was calculated as 618 using Cochran's sampling equation. Diagnosis of rheumatoid arthritis was made according to American Rheumatism Association criteria. Two physicians were asked to examine the sign on all of the selected patients separately. One of them (a general physician) was not informed about methodology and objectives of the study, whereas a rheumatologist was well informed and he collected data using a written questionnaire. Test–retest method and discriminant analysis were used to test reliability and validity of the sign for diagnosing rheumatoid arthritis. The effects of intervening variables including osteoporosis and consumption of some medications were controlled employing Chi‐square test. Results: When the general physician examined patients with Avicenna sign to diagnose rheumatoid arthritis, sensitivity and specificity of the sign were reported as 77.1% and 98.4%, respectively. The corresponding values were 81.3% and 98.4%, respectively, when the rheumatologist examined the patients. Conclusions: This study suggested considerable diagnostic value of the sign for rheumatoid arthritis. Consumption of acetaminophen or NSAIDs had no effect on the status of Avicenna sign while taking gluccocorticoids made it unreliable for diagnostic purposes.     

Feasibility of carotid artery stenting in patients with angiographic string sign

Background : Treatment of angiographic string sign (SS) of the carotid artery with carotid endarterectomy or carotid artery stenting (CAS) has been associated with a high incidence of periprocedural neurological events. We describe our experience with CAS in a case series of symptomatic patients with severe carotid stenosis and angiographic SS. Methods : We performed a retrospective review from 1999 to 2009 using our cardiac cath laboratory database and identified nine patients with the angiographic SS who underwent CAS. All patients were referred for carotid angiography by a neurologist due to symptoms (stroke or transient ischemic attack (TIA)). All lesions were predilated and treated with self‐expanding stents. Distal protection devices were utilized (six patients) once they became available. Periprocedural outcomes and long‐term follow‐up was reviewed when available. Results : The average time from onset of symptoms to CAS was 45 days. All CAS procedures were technically and clinically successful without acute complications. One year follow‐up was available in eight patients. One patient had a possible TIA, and the remaining seven patients did not report any events (death, stroke, TIA or myocardial infarction). Carotid ultrasound evaluation at 12 months was available in six patients and showed no evidence of restenosis. Conclusions : In our experience, CAS in patients with severe symptomatic carotid stenosis and angiographic SS is feasible, with an acceptably low periprocedural complication rate. © 2010 Wiley‐Liss, Inc.     

超声间接征象在诊断肝外胆管癌中的价值分析

目的探讨超声间接征象在诊断肝外胆管癌中的临床意义。方法选自2001年12月至2007年12月间,经CT、MR及手术证实的72例肝外胆管癌病例。空腹常规超声检查肝胆胰脾。重点观察梗阻段胆管及近段胆管扩张情况和相关器官继发改变的超声间接征象,详细记录并留存图像信息,随访临床结果作对照分析。结果72例肝外胆管癌病例中,全部具有近段胆管扩张,显著扩张64例,中度扩张7例,轻度扩张1例。本组胆管扩张的显示率为100%。依据梗阻段胆管狭窄的程度与形态、近段胆管扩张的程度与范围、扩张段与狭窄段胆管的移行状态等超声间接表现,判断梗阻部位的准确率为97.22%（70/72）,病因提示其诊断相符率为94.44%（68/72）。结论注重超声间接征象表现,无疑对梗阻部位的判定及病因的提示性诊断皆有重要临床价值。