结核性脑膜炎的早期诊断策略

目的 探讨结核性脑膜炎（简称结脑）的早期诊断方法。方法 回顾性分析1996年1月2004年12月在我院诊治的结脑患者80例临床资料。结果 本组80例患者均做过腰椎穿刺检查，第一次脑脊液有52例符合结脑诊断，28例可疑；第二次复查有19例符合，9例可疑；第三次复查剩余9例才符合。80例患者均行头颅CT平扫和增强。异常47例，其中脑积水32例，脑梗死31例，两者均有15例。增强者有72例表现为鞍上池，四叠体池粒状强化，其中31例低密度影，有17例轻度强化。结论 反复多次腰椎穿刺做脑脊液检查和头颅CT平扫及增强是早期诊断结脑的有效方法。     

双源CT在肢体动脉损伤中的应用价值

目的:探讨双源CT血管成像在肢体动脉损伤中的应用价值及技术优势。方法:对7例疑有肢体动脉损伤的患者行双源CT血管成像检查,其中上肢动脉双源CT血管成像3例,下肢动脉双源CT血管成像4例,并对术后患者行双源CT血管成像复查。使用德国西门子Somatom Definition双源CT扫描机,对比剂浓度350或370mg/ml,总量80~100ml,注射速率为4.0ml/s。对薄层横断面图像分别采用多平面重建,容积重建,最大密度显影等后处理技术进行血管重建。结果:所有的血管成像均显示血管丰富、清晰,血管边缘光滑自然、与周围组织形成良好的对比,无阶梯样或截断伪影,图像质量优良完全满足临床诊断要求,术前诊断与术后诊断的符合率达100%。结论:对于疑有动脉损伤的肢体外伤患者,双源CT血管成像可以作为一种首选的血管成像方法,通过多种重建技术进行三维血管重建,为临床诊断和治疗方案的制定提供了有力的证据。     

结核性脑膜炎的早期诊断策略

目的探讨结核性脑膜炎(简称结脑)的早期诊断方法.方法回顾性分析1996年1月～2004年12月在我院诊治的结脑患者80例临床资料.结果本组80例患者均做过腰椎穿刺检查,第一次脑脊液有52例符合结脑诊断,28例可疑;第二次复查有19例符合,9例可疑;第三次复查剩余9例才符合.80例患者均行头颅CT平扫和增强.异常47例,其中脑积水32例,脑梗死31例,两者均有15例.增强者有72例表现为鞍上池,四叠体池粒状强化,其中31例低密度影,有17例轻度强化.结论反复多次腰椎穿刺做脑脊液检查和头颅CT平扫及增强是早期诊断结脑的有效方法.     

幕上脑室外室管膜瘤的影像学诊断

目的 探讨发生于幕上脑室外室管膜瘤的CT和MRI表现及其诊断价值,以提高脑实质内不典型室管膜瘤的诊断准确率.方法 回顾性分析18例经病理证实发生于幕上脑实质的室管膜瘤患者的临床、病理及影像学资料.18例患者均接受CT和MRI平扫检查,15例接受MRI增强扫描,1例接受CT增强扫描.结果 18例肿瘤均发生于幕上脑实质,好发于侧脑室旁及颞顶枕叶交界区,其中侧脑室旁8例.18例肿瘤中6例为实性,10例为囊实性,2例为囊性.瘤内出血6例,钙化2例,瘤周Ⅱ～Ⅲ度水肿12例,Ⅰ度水肿4例,2例无明显水肿表现.CT和MRI增强扫描均表现为肿瘤实性部分及囊壁明显不均匀强化,囊变坏死区不强化,其中MRI增强扫描常可见条索状血管影.结论 幕上脑实质内室管膜瘤的MRI表现较具特征性,影像学表现与病理有一定相关性.大囊小结节、大囊大结节、多囊变及瘤内出血、钙化是瘤体的常见征象,肿瘤实质内出现条索状血管影,也是幕上脑实质内室管膜瘤的特征性表现,有助于MRI的诊断和鉴别诊断.     

肝脓肿的CT诊断

目的 探讨CT在肝脓肿诊断和鉴别诊断中的作用,为提高肝脓肿的CT表现与病理基础关系的认识.方法 回顾性分析13例经肝穿和临床证实的肝脓肿患者CT资料,13例均行CT平扫及增强扫描.结果 典型肝脓肿8例,病灶平扫呈圆形、椭圆形囊样低密度肿块5例、病灶内有分隔2例、病灶内有小气泡影1例,增强扫描8例边缘强化呈环征;不典型肝脓肿5例,CT平扫表现为边缘模糊低密度肿块,增强扫描CT可见（1）肿块缩小征;（2）周围充血征;（3）簇状征.结论 CT扫描特别是动态增强扫描在肝脓肿诊断和鉴别诊断中具有重要作用.     

腹盆腔局灶型Castlman病的CT与MR表现分析

目的：探讨腹部局灶型Castlman病的CT与MR影像特征与病理基础,提高对这种罕见疾病的认识和了解,减少误诊。方法：回顾性分析本院经手术病理证实的10例腹盆腔局灶型Castlman病患者的CT和MR表现及相应临床资料。结果：术后病理2例为浆细胞型,8例为透明血管型。4例位于腹膜后（其中1例位于肾周脂肪裳）,4例位于小肠系膜,1例位于大网膜,1例位于右肾下极髓质。4例病灶中央可见树枝状、结节状钙化（包含MR双低信号无强化钙化影）,4例较大肿块（直径>5cm）中央出现裂隙及放射状CT低密度区及MR T1WI低信号区,9例病灶周围可见渗出。8例周围可见增粗迂曲血管影。5例周边可见卫星结节子灶。动态增强扫描所有病灶均可见明显强化,其中3例呈渐进性持续强化,7例呈动脉期明显强化,强化程度接近于邻近动脉,延长期强化缓慢消退,4例可见包膜样边缘延迟强化。结论：腹部局灶型Castlman病少见,其影像表现与病理类型密切相关,以透明管型为主。且具有一定影像学特征。腹盆腔孤立性肿块,周边可见卫星结节灶,增粗迂曲管影及不同程度渗出,增强扫描病灶高强化、缓慢消退是腹盆腔局灶型透明血管Castlman的...     

CT血管成像在骨盆骨折中的临床应用价值

[目的]探讨多排螺旋CT及双源CT血管成像在骨盆骨折动脉损伤中的临床应用价值.[方法]从2008年5月～2009年12月,对31例骨盆骨折患者行多排螺旋CT或双源CT血管成像检查,其中男19例,女12例,平均年龄32岁(17～54岁).对轴位扫描图像进行三维容积重建(VR),最大密度投影(MIP),多平面图像重建(MPR)以显示血管与骨的解剖结构.[结果]CTA准确的显示了血管损伤的位置和性质,且三维容积重建图像能清楚显示血管与周围骨的解剖位置关系,指导术前准备.31例骨盆骨折患者21例血管正常,10例异常.10例血管损伤包括2例动脉挫伤闭塞,5例假性动脉瘤影,3例明显造影剂外渗.[结论]CTA是骨盆骨折动脉损伤的一种可靠检查方法,并对术前准备有重要指导意义.可基本取代传统的动脉导管造影.     

支气管肺隔离症的螺旋CT诊断

目的分析支气管肺隔离症的螺旋CT征象,探讨螺旋CT增强扫描和血管重建的诊断价值。方法对21例经手术和病理证实、且影像资料完整的病例进行了回顾性分析。21例患者均做了CT平扫与增强,13例做了血管重建。结果1)21例肺隔离症中有16例为肺叶内型,5例为肺叶外型。14例位于左肺下叶,7例位于右肺下叶。2)CT示软组织密度肿块或结节12例,囊肿样病变9例,病灶周围肺气肿。3)增强CT显示了15例供血动脉,显示率71.4%(15/21);而血管重建的显示率为92.3%(12/13)。隔离肺无强化(15例)或边缘轻微强化(6例)。结论螺旋CT增强扫描和血管重建能很好地显示肺隔离症的病变特征和异常供血动脉,有利于确诊此病和制订手术治疗方案。     

门静脉海绵样变性的MRI诊断

目的 探讨MRI在诊断门静脉海绵样变性(CTPV)中的价值.方法 回顾性分析30例经临床证实的CTPV患者的MRI平扫、动态增强扫描和(或)动态对比增强磁共振血管成像(DCE-MRA)资料.结果 30例CTPV患者MRI表现:平扫时可见门静脉主干和(或)分支闭塞,闭塞的门静脉周围可见由侧支循环静脉形成的团块状软组织信号影.动态增强扫描动脉期可见肝实质灌注异常,门静脉期可见广泛开放的侧支循环静脉强化.DCE-MRA显示上述改变更直观.结论 MRI以及DCE-MRA能清晰地显示CTPV及其迂曲扩张的侧支循环.正确认识、直观地评价CTPV侧支循环的影像解剖学特征,为临床采取正确的治疗措施提供更多的依据.     

CT血管造影在诊断颈动脉海绵窦瘘中的应用

目的 探讨CT血管造影(CTA)在诊断颈动脉海绵窦瘘中的应用.方法 8例颈动脉海绵窦瘘患者,应用GE light speed 64 CT扫描机,先常规行颅脑平扫,再行CTA检查.结果 CT平扫显示8例患者均有不同程度的眼球突出、眼肌肿胀,海绵窦扩大,眼眶内后上方见粗细不均的条状软组织密度影4例.CTA显示8例患者海绵窦明显扩张、强化,且海绵窦、眼上静脉与颈动脉同步强化,CTA可见迂曲扩张的眼上静脉呈蚯蚓状与海绵窦相通,8例可见与海绵窦相通的大脑中静脉在动脉期提前显影,其中1例患者合并左侧大脑中动脉分叉处动脉瘤.结论 CTA对诊断颈动脉海绵窦瘘有重要的应用价值.     

长春新碱过量引起严重毒副反应1例的护理体会

报道1例霍奇金淋巴瘤患者因误用长春新碱（VCR）10mg一次性静脉推注后治疗护理情况。其出现间断性神志恍惚、眼睑闭合不全、言语不清、口腔黏膜糜烂、全身疼痛、麻痹性肠梗阻、尿潴留、手足麻木等症状,经积极解救,禁食,持续胃肠减压、胃管内注入麻油、开塞露、生理盐水灌肠,合理应用肠外营养,注重疼痛、心理护理,做好口腔、肛周护理,预防感染加重,患者病情得到控制好转出院。     

Correlates of stages of change of smoking among inhabitants of deprived neighbourhoods

BACKGROUND: This study examines the prevalence and correlates of stages of change of smoking, in terms of psychosocial, structural and sociodemographic factors, among inhabitants of deprived neighbourhoods. METHODS: Cross-sectional data were obtained from a survey on health related behaviour. Subjects were 2009 current and former smokers, aged 20-46, living in deprived neighbourhoods in Rotterdam, the second largest city in the Netherlands. Three groups of smokers were formed according to the stages of change-definitions of the Transtheoretical Model: smokers not planning to quit (precontemplators), smokers planning to quit (contemplators/preparators) and former smokers (actors/maintainers). Smokers planning to quit and smokers not planning to quit were compared regarding psychosocial factors (attitude, social norm, self-efficacy), structural factors (neighbourhood problems, material deprivation, financial problems, employment status) and sociodemographic factors (age, gender, marital status, cultural background, educational level). Former smokers were compared with smokers planning to quit regarding structural and sociodemographic factors. Logistic regression was used to assess correlates of stages of change. RESULTS: Smokers planning to quit (prevalence = 19%) reported a more positive attitude, stronger social norms and higher self-efficacy expectations in quitting smoking than smokers not planning to quit (prevalence = 57%). Smokers planning to quit less often were Dutch-born, more often had attended higher vocational schooling or university and more often reported experiencing two or more neighbourhood problems compared to smokers not planning to quit. Former smokers (prevalence = 24%) were older, more often Dutch-born, married, employed and higher educated, compared to smokers planning to quit. Furthermore, former smokers less often reported material deprivation and financial problems than smokers planning to quit. CONCLUSION: Among people living in deprived neighbourhoods, different factors correlate with different stages of change of smoking. Implications for health promotion are discussed.     

Choice of measures of vaccination and estimates of risk of pediatric pertussis

BackgroundVaccination uptake at the individual level can be assessed in a variety of ways, including traditional measures of being up-to-date (UTD), measures of UTD that consider dose timing, like age-appropriate vaccination, and risk reduction from individual doses. This analysis compared methods of operationalizing vaccination uptake and corresponding risk of pertussis infection.MethodsCity-wide case-control study of children in Philadelphia aged 3 months through 6 years, between 2001 and 2013. Multiple logistic regression was used to isolate the independent effects of each measure of vaccination uptake and the corresponding relative odds of pertussis.ResultsBeing UTD on vaccinations was associated with a 52% reduction in risk of pertussis (OR 0.48, 95% CI: 0.34, 0.69). Evaluation of delayed receipt of vaccine versus on-time UTD yielded similar results. There was a decrease in risk of pertussis for each additional dose received with the greatest reduction in pertussis infection observed from the first (OR 0.48, 95% CI: 0.28, 0.83) and second dose (OR 0.17, 95% CI: 0.08, 0.34). Additional doses conferred minimal additional protection in this age group.ConclusionExamining vaccination status by individual doses may offer improved predictive capacity for identifying children at risk for pertussis infection compared to the traditional UTD measure.     

两种不同肌瘤剔除术治疗子宫肌瘤的临床疗效比较

目的:比较腹腔镜子宫肌瘤剔除术与腹式子宫肌瘤剔除术的临床疗效。方法:回顾分析63例腹腔镜子宫肌瘤剔除术与61例腹式子宫肌瘤剔除术的临床资料,比较2种手术方式的手术时间、术中出血量、肛门排气时间、使用抗生素时间、术后感染率、体温恢复正常时间、住院时间等情况。结果:两组患者接受子宫肌瘤剔除术顺利完成,腹腔镜组手术时间长于开腹组(P0.05),腹腔镜组术中出血量及剔除肌瘤个数均少于开腹组(P0.05),术后腹腔镜组体温恢复正常时间、肛门排气时间、抗生素使用及住院时间均短于开腹组,两组患者最多随访6个月,腹腔镜组平均康复时间较开腹组短(P0.05),两组随访B超均未发现明显肌瘤结节。结论:腹腔镜子宫肌瘤剔除术损伤小,恢复快,住院时间短,是值得推广的微创手术。     

上海市某医院骨科平均住院日影响因素分析

对上海市某医院2003年-2007年骨科出院病人的住院日描述性分析．2003年-2007年骨科的床位利用指数与平均住院日相关性分析．2003年-2007年骨科床位与医护比例分析．2007年骨科前10大病种平均住院目影响因素分别进行单因素相关性分析和多因素逐步回归分析（STATA软件）。通过对骨科10大病种住院日影响因素分析,术前等待天数、手术类型、是否输血分别对10个、9个和8个病种的住院目有影响。输血因素和手术类型是医院不可控、由病人的病情决定的,术前等待天数是管理因素,是最值得医院重视的影响因素。     

性发育异常发病机制的研究进展

正常的性腺分化可分为3个过程：原始性腺形成、性别决定和卵巢/睾丸发育。在任一环节中,基因表达或调控发生异常均有可能导致性发育异常疾病的发生。性发育异常是指染色体、性腺和解剖性别不典型。随着分子生物学技术的发展,不断地发现新的基因或信号通路参与性腺分化和发育,如SRY、SF1、WT1、Sox9等基因与睾丸发育密切相关,Wnt/Rspo1/B连环蛋白通路、Dax1、Foxl2等基因在卵巢分化中发挥着重要作用,一些非编码RNA和转化生长因子也有重要的调节功能,且睾丸和卵巢发育均为主动过程,即使在出生后因某些基因的改变两者间也可出现横向分化。这些为揭示性分化异常的发病机制提供了可能。     

尘肺病患者145例死因调查

目的分析汉中市尘肺病的发生、发展和死亡原因，以提高尘肺病患者的生存质量。方法对145例尘肺病患者的死因进行回顾性分析，计算其平均发病年龄、死亡年龄及患尘肺病后的存活年限。结果矽肺的平均发病年龄和死亡年龄均早于煤工尘肺和石棉肺，尘肺病的主要死因为患肺部疾患，患尘肺病后的平均存活年限为12a。结论加强职业健康体检工作，对尘肺病人做到早发现早治疗和预防并发症的发生。     

One-year stability of the Measure of Processes of Care

BACKGROUND: The Measure of Processes of Care (MPOC) is a 56-item self-administered measure designed to examine what parents of a child with a chronic health problem think of the services they and their child receive, and to measure the extent to which these services are family-centred. Reliability and validity of the MPOC were established in prior studies. The aim of the present study was to assess the 1-year stability of the MPOC to justify its use as an evaluative tool. METHODS: Nine paediatric rehabilitation centres in the Netherlands participated in this short longitudinal survey study. Subjects were 205 parents (response rate 74.8%) of children aged 1-18 years who received care in one of the participating paediatric rehabilitation centres. All subjects filled out two MPOCs with a 1-year interval. RESULTS: All correlations between the scale scores of the MPOC at the first and second administration were relatively high and significant (range: 0.443-0.609, all P < 0.001), demonstrating high inter-individual stability. However, all mean scale scores, except for Providing General Information, significantly reduced after 1 year. CONCLUSIONS: The MPOC has a moderate 1-year stability. However, because of its tendency to score lower when repeated after 1 year, its use as an evaluative follow-up instrument to assess the effectiveness of a programme intervention is restricted.     

儿童皮质发育畸形的MRI诊断

目的探讨儿童皮质发育畸形(MCD)的MRI表现特点,为MCD的早期诊断提供依据。 方法选择2010年1月至2012年12月在四川省医学科学院·四川省人民医院放射科经MRI检查确诊为MCD的44例患儿为研究对象。回顾性分析及总结其MRI影像学特征。本研究遵循的程序符合四川省医学科学院·四川省人民医院人体试验委员会制定的伦理学标准,得到该委员会批准,征得受试对象及其监护人知情同意,并与监护人签署临床研究知情同意书。 结果本组44例经MRI确诊为MCD患儿中,巨脑回-无脑回为17例,多小脑回为14例,灰质异位为9例,脑裂畸形为4例。MCD的MRI特点中,巨脑回表现为脑回增宽、皮质增厚及白质变薄;无脑回表现为正常脑沟、脑回消失,皮质增厚及白质变薄;多小脑回表现为脑回增多、细小;灰质异位表现为皮质下及侧脑室周围深部白质区结节状、团块状或带状病灶,信号与灰质信号相同;脑裂畸形表现为从侧脑室到脑表面贯穿大脑半球的裂隙,表面覆盖灰质。 结论MRI是诊断儿童MCD的可靠影像学方法。     

244株真菌鉴定结果分析

目的 了解某院2000～2001年各类真菌的检出率。方法 用酵母样真菌同化试验编码鉴定板TH-15进行编码鉴定。结果 真菌分离率为8．85％；244株真菌分为10种，其中以白色念珠菌和热带念珠菌较高，分别占真菌总数的75．41％和11．47％；检出真菌的主要标本是痰和阴道分泌物。结论 及时进行真菌培养，有利于合理使用抗菌药物和控制真菌感染。