多层螺旋CT在肝静脉阻塞型布加综合征诊断和治疗中的应用

目的探讨肝静脉阻塞型Budd-Chiari综合征(BCS)多层螺旋CT动态增强规律及CT血管成像的诊断价值,评价多层螺旋CT检查对BCS治疗的指导意义。方法经血管造影证实的21例肝静脉阻塞型BCS患者,在DSA检查前2周内行肝脏多层螺旋CT动态增强扫描,并对其相关血管进行重建。病程短于3个月的有4例,3个月以上的17例。结果病程短于3个月的4例,CT平扫显示肝脏体积弥漫性增大,肝脏密度普遍降低;增强后表现为以肝门区和尾状叶为中心的斑片状强化,并随扫描时间延长强化范围扩大。病程3个月以上的17例,CT平扫显示肝脏形态异常,肝萎缩区或肝外周为低密度;增强后肝萎缩区及肝外周强化程度低,密度不均匀,其静脉引流血管闭塞,而静脉引流良好的区域强化均匀,其静脉引流至少有1支开通的肝静脉或扩张的副肝静脉。肝实质CT强化规律与肝静脉阻塞部位及肝内外侧支静脉形成密切相关。21例患者,共计42条肝静脉闭塞,其中肝左静脉9条,肝中静脉12条,肝右静脉16条,副肝静脉6条。横断面和CT血管成像显示肝静脉阻塞的正确率分别为61．9％和100％。结论多层螺旋CT动态增强扫描能够较准确地反映肝静脉阻塞型BCS肝内血流动力学变化,结合CTA可准确显示肝静脉阻塞部位、性质及肝内外侧支静脉,对指导BCS的治疗具有重要价值。     

彩色多普勒超声在布加氏综合征诊断中的应用

目的 探讨彩色多普勒血流显像(CDFI)对布加氏综合征(BCS)的诊断价值.方法 应用彩色多普勒超声对35例BCS的超声表现及诊断结果进行分析,将BCS分为3型:单纯肝静脉阻塞型、下腔静脉阻塞型和混合型.结果 单纯肝静脉阻塞型4例,下腔静脉阻塞型18例,混合型10例,误诊为肝硬化3例,诊断准确率为91.4%.结论 彩色多普勒超声能够显示布加氏综合征的血管阻塞部位、程度、范围及侧支循环,可作为布加氏综合征的首选诊断方法.     

CT静脉成像在布加综合征诊疗中的应用

目的：探讨CT静脉成像（CTV）技术在布加综合征（BCS）诊疗过程中的应用价值。方法对2012年1月至2014年1月该院收治的58例BCS患者进行CTV检查,对下腔静脉、肝静脉、门静脉及侧支血管进行重建分析。结果所有患者均完成CTV检查,被明确诊断为BCS。其中下腔静脉隔膜型19例,短段病变型15例,长段病变型8例,肝静脉型9例,合并血栓形成的7例。所有患者均见到侧支血管不同程度的代偿扩张,肝脏硬化及脾脏肿大等表现。结论 CTV技术的应用对于BCS的诊疗具有图像清晰、直观、全面,能够显示病变血管部位、性质及长度的优点,还能观察侧支血管扩张及肝硬化程度。     

磁共振成像在布加综合征诊断中的应用价值

目的:探讨磁共振(MRI)及磁共振静脉血管成像在诊断布加综合征(BCS)患者中的应用价值。方法:回顾性收集45例BCS患者的临床资料,分析患者常规MRI及磁共振静脉血管成像的影像学表现;根据病程将患者分为急性组和慢性组,对照分析两者的MRI特征;测量MRI轴位肝尾状叶横径,并与同期行上腹部MRI检查的21例肝脏正常者比较,利用ROC曲线分析其具有的诊断价值。分析组内相关系数(ICC)评价两名医师间各测量参数值的可靠性。结果:45例BCS患者中,包括肝静脉(HV)阻塞型BCS 8例、下腔静脉(IVC)阻塞型BCS 12例、混合型BCS 25例。45支IVC中,有37支发生梗阻,其中膜性梗阻17例、节段性梗阻20例;135支HV中,有74支发生梗阻,其中肝右静脉29支、肝中静脉25支、肝左静脉20支。BCS的MRI直接征象为HV或IVC梗阻,间接征象为梗阻处远端HV或IVC扩张、肝内外侧支血管粗大、肝尾状叶增大、副肝静脉扩张显影、HV或IVC血栓形成、脾大、腹水、肝硬化等。急性组患者大量腹水和肝脏体积增大的发生率均高于慢性组(P<0.05),而慢性组患者肝尾状叶增大、肝内结节、肝内外侧支循环、副肝静脉的发生率均高于急性组(P<0.05)。与正常组相比,BCS患者肝尾状叶横径显著增大(P<0.05),且ROC曲线下面积为0.879,当尾状叶横径取值45.2 mm时,敏感度和特异度分别为75.6%和90.5%。两名操作医师差异无统计学意义(P=0.427)。结论:MRI成像能清晰显示BCS的病变特征,有助于BCS的诊断及其病程分期、病变类型的判断。     

Budd-Chiari综合征肝静脉病变的CT诊断

目的分析Budd-Chiari综合征（BCS）肝脏病变在CT中的表现,探讨CT血管成像（CTA）在肝静脉病变中的诊断意义。方法收集9例BCS患者的CT检查资料,分析其对肝实质、肝静脉、副肝静脉和肝内交通支的显示能力。结果 9例患者中,显示肝叶比例失调9例,体积增大3例。尾状叶代偿性增大9例。增强扫描见肝脏花斑样强化6例,肝内出现再生结节3例。肝静脉发生病变的血管共计19条,其中肝右静脉5条,肝左、肝中静脉各7条。副肝静脉代偿性增粗或者显示多支者8例。肝内交通支形成9例。结论 CT检查能够准确显示BCS患者肝脏的改变,结合CTA和重建技术能够直观、清晰地显示肝静脉病变。     

三维动态增强MRA与SCTA在Budd-Chiari综合征诊断中的价值

目的　评价三维动态增强磁共振血管成像 (3DDCEMRA)和螺旋CT血管成像(SCTA)对Budd -Chiari综合征 (BCS)的诊断价值。方法　回顾分析 7例BCS的 3DDCEMRA和SCTA影像资料 ,以手术病理或下腔静脉造影结果为标准 ,评价 2种血管成像技术对BCS下腔静脉、肝静脉、门静脉的病变部位、程度以及肝内外侧枝循环的显示情况。结果　 4例 3DDCEMRA检查中显示 :下腔静脉狭窄 3例 ,闭塞 1例 ;肝静脉狭窄 3例 ,闭塞 1例 ;副肝静脉增粗 1例 ,肝内外侧枝循环形成 2例。 3例SCTA检查中显示 :下腔静脉狭窄 1例 ,闭塞 1例 ;肝静脉闭塞 1例 ,副肝静脉增粗 2例。结论　 3DDCEMRA和SCTA对Budd -Chiari综合征有很高的诊断价值 ,是术前全面评价BCS的 2种有效的无创性血管成像技术     

彩色多普勒超声在Budd—Chiari综合征的诊断价值

目的:探讨Budd-chiari综合征(B-CS)的特征性异常血管形态及其血流的变化。方法:对85例B-CS患者的肝静脉、下腔静脉。进行彩色多普勒超声分析。结果:85例B-CS其下腔静脉狭窄52例,闭塞9例;肝静脉狭窄102支,闭塞61支,其肝静脉间均见多条侧支血管;肝静脉血流经侧支血管流入未闭的肝静脉或经肝尾叶静脉及其他扩张的静脉分流入下腔静脉;下腔静脉闭塞时血流亦可逆向分流入肝静脉。结论:肝静脉、下腔静脉狭窄和闭塞及肝静脉间侧支血管形成是B—CS特征性异常血管形态;彩色多普勒超声可依据其特征性异常血管的病变类型、阻塞部位、梗阻程度和范围、侧支循环径路及血流动力学特点准确诊断B-CS。并作为首选检查方法。     

肝静脉型布-加综合征与肝窦阻塞综合征的CE-MRA鉴别诊断

目的提高肝静脉型布-加综合征和肝窦阻塞综合征的影像诊断水平。方法回顾性分析经DSA证实的30例肝静脉型布-加综合征及经病理证实的8例肝窦阻塞综合征的CE-MRA特点,归纳两者影像表现的差异。结果本组肝静脉型布-加综合征和肝窦阻塞综合征门静脉内径分别为1.53±0.33cm、1.47±0.39cm,差异无统计学意义（P=0.104）。（1）肝静脉型布-加综合征主要表现为：肝大、肝叶比例失调、尾状叶体积增大、脾大、腹水;30例肝静脉型布-加综合征患者,35支肝静脉显示不清、28支肝静脉闭塞（38.89%）、19支合并血栓（21.11%）、8支通畅（8.89%）;30例患者均显示的肝内侧支;静脉期肝脏强化分布表现为反＂爪＂型强化（40%）、内高外低强化（36.67%）、内低外高强化（10%）、均匀强化（10%）及不规则强化（3.33%）。（2）肝窦阻塞综合征主要表现为肝脾大、腹水;8例肝窦阻塞综合征患者,有18支（6例）肝静脉显示清楚、管腔通畅,余6支（2例）显示不清;8例肝窦阻塞综合征患者均未示肝内侧支血管;静脉期肝脏强化呈＂爪＂型分布（87.5%）,余1例强化不规则。结论 CE-MRA在鉴别肝静脉型布-加综合征和肝窦阻塞综合征中可提供可靠的信息,通过仔细观察影像表现,对两者诊断准确性会有进一步提高。     

Budd-Chiari综合征的超声诊断

目的 探讨Budd Chiari综合征(B-CS)的特征性异常血管形态及其血流的变化.方法 对85例B-CS患者的肝静脉、下腔静脉,进行彩色多普勒超声分析.结果 85例B-CS其下腔静脉狭窄52例,闭塞9例,肝静脉狭窄102支,闭塞61支,其肝静脉间均见多条侧支血管;肝静脉血流经侧支血管流入未闭的肝静脉或经肝尾叶静脉及其他扩张的静脉分流入下腔静脉;下腔静脉闭塞时血流亦可逆向分流入肝静脉.结论 肝静脉、下腔静脉狭窄和闭塞及肝静脉间侧支血管形成是B-CS特征性异常血管形态;彩色多普勒超声可依据其特征性异常血管的病变类型、阻塞部位、梗阻程度和范围、侧支循环径路及血流动力学特点准确诊断B-CS,并作为首选检查方法.     

布—加综合征CT诊断价值

目的探讨CT对布—加综合征(Budd-Chiari syndrome,BCS)的诊断价值。方法将31例经血管造影诊断为BCS的病例分为三型,分析各型CT表现。结果Ⅰ型:共20例,均可见下腔静脉增宽及奇静脉、半奇静脉扩张,5例可见副肝静脉增粗,3例可见下腔静脉肝上段钙化。Ⅱ型:共9例,7例见肝脏弥漫性增大,肝脏密度普遍性降低,增强扫描见以肝门区和尾状叶为中心的斑片状强化,8例可见腹水。Ⅲ型:共2例,1例见下腔静脉长段闭塞,1例见下腔静脉血栓。结论CT能准确反映各型BCS的下腔静脉及肝内血流动力学变化,对BCS的诊断及治疗具有重要价值。     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

A preliminary screening study on the associated proteins in human psoriasis vulgaris by serum proteomics technologies

Objective：To investigate the optimum screening conditions of associated proteins in human psoriasis vulgaris by serum proteomics technique, and to screen the different expression proteins related with psoriasis vulgaris. Methods：Serum samples of peripheral blood were collected from newly diagnosed psoriasis vulgaris patients in the clinic, and 20 matched healthy persons. Serum albumin IgG was removed by filtering with ProteoExtract Albumin/IgG. After comparative proteomics analysis the different protein spots were identified using 2-DE and MS. Results ：Electrophoresis figures with high resolution and reproducibility were obtained. Three different expression proteins were found only in the serum from psoriasis vulgaris patients, while nine other different proteins expressing from healthy volunteers. Conclusion：The protein expression was different in the serum between the psoriasis vulgaris patients and healthy volunteers. It was hoped that we could find the biomarkers related to psoriasis vulgaris by using proteomics.     

A CASE OF HUGE GASTRIC DISOPYROBEZOAR

PYTOBEZOARS are common bezoars in gastrontestinal tract, commonly seen in stomach and mall intestine,1but huge disopyrobezoars are     

Acupuncture Treatment of Chest Bi Syndrome

CASE HISTORY A male,a retired officer of 61 years old,paid his first visit on May 12,2006.The patient stated that 2 weeks before he suddenly got paroxysmal precordial choking pain,with irregular attacks.Each attack would last several seconds to several minutes.The attack was accompanied with heavy oppressed sensation in the precordial region,palpitation,lassitude,and in severe cases,sweating,which was once diagnosed by a hospital as'coronary heart disease'.Recalling the case history,the patient said that several days before he got angry with others because of some affairs in work,and he was not so used to the life pattern since he had just retired from his busy working post.At usual times,he was quick tempered and peevish.In recent days,he had poor appetite,and loose stool.     

Instructions to Contributors

The English edition of Chinese Journal of Integrative Medicine is edited and published by the Chinese Journal of Integrated Traditional and Western Medicine Press.Original scientific papers of advanced clinical and experimental medicine in the field of complementary/alternative medicine or integrative medicine are expected.     

Development Is A High Level Inheritance for China Time-honored Brand Products

<正>As culture is the soul of a nation,the three books,"History of Chinese Philosophy,""History of Chinese Culture"and"History of Chinese Science and Technology"have demonstrated the superiority of our great Chinese culture,and its significant impact in the field of international culture.Both core value and practical value of the Chinese culture are very clear,reflected in the views of universe,nature,life,health,disease,and therapy and related considerations,concepts,and technical methods.