血凝障碍与迟发性外伤性脑内血肿

血凝障碍与迟发性外伤性脑内血肿彭彪许铁民魏正怀肖国才我科自１９９３年１月～１９９６年１２月间共收治迟发性外伤脑内血肿（ＤＴＩＣＨ）３８例，占同期颅脑损伤６８０例的５．６％．发现ＤＴＩＣＨ与血凝障碍有关，报告如下．临床资料和方法３８例ＤＴＩＣＨ中男３３...     

迟发性外伤性脑内血肿

我们自１９８６年８月～１９９３年１２月共收治经ＣＴ复查证实的迟发性外伤性脑内血肿（ＤＴＩＣＨ）２４例，占同期收治颅脑外伤患者１１３４例的２．１％。报告如下。临床资料男１８例，女６例；年龄３～７４岁，平均４０．７岁。５０岁以上１２例，占５０％。车祸致伤...     

航海医学研究的心理学特色及方向

航海医学研究的心理学特色及方向周梦生关键词航海医学；心理学ＰＳＹＣＨＯＬＯＧＩＣＡＬＦＥＡＴＵＲＥＯＦＲＥＳＥＡＲＣＨＩＮＮＡＵＴＩＣＡＬＭＥＤＩＣＩＮＥＡＮＤＩＴＳＰＲＯＳＰＥＣＴ￥ＺｈｏｕＸｉｅｓｈｅｎｇ．（ＮａｎｔｏｎｇＭｅｄｉｃａｌＣｏｌｌｅ...     

外伤性硬膜外血肿的诊断与治疗

外伤性硬膜外血肿的诊断与治疗付一新杨华李玉明吴若秋外伤性硬膜外血肿（ＴＥＤＨ）是颅脑外伤常见的继发性损伤之一．我院１９８５年６月～１９９３年６月共收治１３０例（含合并硬膜下血肿、脑挫裂伤、脑内血肿等非主要损伤１２例），均经ＣＴ或手术证实．现报告如下．...     

脑弥漫性轴索损伤的CT诊断（附40例分析）

在急性脑外伤患者的ＣＴ片研究弥漫性轴索损伤的ＣＴ征象，目的是为ＤＡＩ的诊断提供影像学依据。回顾性分析经临床确诊的４０例ＤＡＩ患者的早期ＣＴ表现，结合文献提出ＤＡＩ的ＣＴ诊断标准：脑白质内单发或多发无占位效应的小出血灶，中线结构无移位；蛛网膜下腔出血或脑池内出血；脑室内出血；弥漫性脑肿胀。     

脑弥漫性轴索损伤的CT诊断

目的：分析脑弥漫性轴索损伤（ＤＡＩ）的急性期ＣＴ表现，为临床诊断ＤＡＩ提供影像学依据，材料和方法：分析６０例临床拟诊为ＤＡＩ的早期ＣＴ表现。结果：ＣＴ可见（１）弥漫性脑肿胀；（２）皮层下及脑深部小出血灶；（３）蛛网膜下腔出血及脑室内出血，硬膜下／外出血。结论：对有上述ＣＴ征象，结合临床表现，可考虑诊断为ＤＡＩ。     

颅内静脉窦血栓的影像学诊断

颅内静脉窦血栓 (ＣＶＴ)因其临床表现多变 ,且缺乏特异性 ,脑电图、脑脊液压力和成分分析及血液方面检查对确诊意义不大 ,经常误诊为胶质瘤、良性颅高压等疾病 ,近年来 ,随着ＣＴ ,ＭＲＩ ,ＤＳＡ(数字减影血管造影 )及ＴＣＤ等技术的广泛应用 ,诊断率已明显提高 ,对该病的影像学改变也有了较为深刻的认识。1　脑ＣＴ检查脑ＣＴ检查往往是最优先的检查方法 ,ＣＶＴ的ＣＴ表现分两类 :(1)直接征象 ,其一有空三角征 ,又称δ征 ,即在ＣＴ增强扫描时上矢状窦可见环形增强 ,三角形中央为等密度或低密度血栓影 ,此征阳性率达 70 % ,多数病例在数…     

THE EFFECT OF STANDARD TOTAL PARENTERAL NUTRITION ON THE GUT BARRIER FUNCTION AND ENTEROGENIC INFECTION

ＴＨＥＥＦＦＥＣＴＯＦＳＴＡＮＤＡＲＤＴＯＴＡＬＰＡＲＥＮＴＥＲＡＬＮＵＴＲＩＴＩＯＮＯＮＴＨＥＧＵＴＢＡＲＲＩＥＲＦＵＮＣＴＩＯＮＡＮＤＥＮＴＥＲＯＧＥＮＩＣＩＮＦＥＣＴＩＯＮＡＦＴＥＲＨＥＭＯＲＲＨＡＧＩＣＳＨＯＣＫＺＨＡＯＪｕｎ（赵军），ＬＩＺ...     

弥漫性细支气管肺泡癌的发展规律及影像学诊断

本文分析了１３例经病理证实的弥漫性细支气管肺泡癌（简称ＤＢＡＣ）的胸部平片和ＣＴ扫描资料。提出了几个有特征性的征象：（１）磨砂玻璃征；（２）腺泡样结节；（３）病理性支气管气像。同时探讨了各种征象的病理基础，并对鉴别诊断和早期确诊方法进行了探讨。     

24 小时内缺血性脑梗塞的CT 研究

通过回顾性分析病程在２４小时因性脑塞患者的ＣＴ片,对其早期ＣＴ征象进行评价,以提高对该病的早期诊断水平。方法回顾性分析经临床确诊的２５０例２４小时内脑梗塞及１００例正常人的ＣＴ表现,评价致密动脉征,豆状核征,脑岛带征,占位征,低密度灶,皮质征等ＣＴ表现。     

纵裂池出血的CT诊断

目的　提高即时纵裂池出血的CT诊断能力。方法　搜集经 2次以上颅脑CT检查能确诊的纵裂池出血 6 3例。另按顺序取自我科颅脑CT检查正常者 15 0例做对比资料。按Zimmerman等提法 ,将大脑镰及纵裂池以胼胝体为界分为上、前、后三部分作分析。结果　纵裂池出血表现为 :纵裂池线影增宽、密度增高 ;前纵裂池线影增长 ;侧脑室上方 10mm层面纵裂池内高密度线影前后连贯 ;纵裂池内高密度“之”字征 ;天幕切迹增宽。结论　上述结果是诊断纵裂池出血的重要CT征象。     

小儿外伤性迟发性脑内血肿

目的 探讨小儿外伤性迟发性脑内血肿的临床特点，诊断和治疗。方法 回顾性分析我院1987年1月-1998年12月收治的27例小儿外伤性迟发性脑内血肿。结果 27例小儿外伤性迟发性脑内血肿中，行血肿清除术13例，颅骨钻孔血肿内置管 增强尿激酶外引流术6例，非手术治疗8例，26例治愈，1例死亡，死亡率3.70%。结论 进行性意识障碍，头痛，呕吐，贫血加重和生命体征不稳定是小儿迟发性脑内血肿的基本临床特征，高度警惕本病的发生，及时再次CF扫描有利于早期诊断，掌握好手术和非手术治疗的指征，是治愈本病的关键。     

混合性中风的CT诊断

目的提高对混合性中风CT诊断的认识。方法对16例混合性中风的CT表现进行回顾性分析。结果根据CT表现,本组混合性中风分为3型:a)脑出血与脑梗死同时并存(7例,43.75%);b)脑出血继发脑梗死(3例,18.75%);c)脑梗死继发脑出血(6例,37.5%)。结论CT扫描是诊断混合性中风可靠的、最有用的检查方法。     

脑静脉系统血栓形成的CT、MRI表现(附2例报告并文献复习)

目的:探讨颅内静脉及静脉窦血栓形成的早期CT、MRI表现。方法:通过分析2例确诊脑静脉系统血栓形成的临床资料与影像学表现,结合有关文献归纳总结脑静脉系统血栓形成的影像学诊断要点。结果:脑静脉系统血栓形成的直接征象:CT平扫呈条索征及高密度三角征;CT增强呈空三角征。MR平扫脑静脉系统血栓处流空信号消失,呈等、稍高或高信号;MRV示病变血管充盈缺损或不显影。间接征象:所属静脉引流区脑水肿、脑梗死或梗死与出血并存;替代引流静脉扩张。结论:脑静脉系统血栓形成临床症状和体征无特征性,常规脑CT、MRI和脑MRV技术的结合是早期诊断本病理想的检查方法。     

Paranasal sinus hemorrhage: evaluation with MR imaging

Computed tomography (CT) and magnetic resonance (MR) imaging were performed in ten patients with paranasal sinus hemorrhage after trauma. Acute or subacute hemorrhage was detected on MR images by using T1- and T2-weighted imaging to identify the chemical state of the blood and to differentiate blood from mucosal thickening and sinus effusion. Surgical proof of intrasinus hemorrhage was obtained in only two cases. Displaced fractures, associated cerebral contusions, and traumatic encephalocele were well shown on MR imaging. Nondisplaced and minimally displaced fractures were better evaluated with CT.     

脑出血早期血肿扩大危险因素分析

目的：探讨脑出血后早期血肿扩大的各种危险因素的相关性。方法前瞻性登记四川省人民医院就诊的所有神经内科、神经外科的脑出血患者。纳入发病24h以内入院接受治疗的自发性脑出血患者,详细收集所有与早期血肿扩大相关的指标,根据血肿是否扩大,将患者分为血肿扩大组（HE）及非血肿扩大组（non-HE,NHE）。结果多因素回归分析结果显示,血肿形态是自发性脑出血患者血肿扩大的独立危险因素,而发病6h内CT检查结果则是判断血肿扩大危险因素的重要依据。结论自发性脑出血患者发病6h内CT检查提示血肿形态越不规则,发生血肿扩大的几率越高。     

蛛网膜下腔出血的CT诊断及其漏误诊原因分析

目的探讨蛛网膜下腔出血的CT诊断并分析其误诊、漏诊的常见原因。方法对100例经CT复查证实的蛛网膜下腔出血CT资料进行回顾性分析。结果100例中因出血部位及出血量不同,CT表现为分布于脑沟、裂、池内的线状、带状、片状或铸型高密度影。纵裂池及小脑幕出血灶边缘一般较模糊。出血部位以侧裂池和脚间窝最多,分别为46例及56例,2例纵裂池出血首次误诊为硬膜下血肿;1例四叠体池出血因出血量少首次CT检查为阴性,通过适时CT复查得以确诊。结论CT对蛛网膜下腔出血的诊断价值较高,可避免漏诊及误诊,并对其临床治疗具有重要把寻意义。     

MR imaging of brain contusions: a comparative study with CT

Ninety-eight brain contusions in 17 patients served as a data base for a comparative study of MR and CT for defining brain contusions. MR was the more sensitive technique, detecting 98% of the brain contusions compared with only 56% by CT. CT was slightly better for showing hemorrhagic components, documenting 77% of hemorrhages compared with 71% for MR. The appearance of the contusions on MR was variable, depending on the T1- and T2-weighting of the images and the constituents of the contusions, such as edema, hemorrhage, and encephalomalacia. On MR, hemorrhagic components appeared as high signal on T1-weighted images and as either low or high signal on T2-weighted images, depending on the age of the hemorrhage. The approximate ages of hemorrhagic contusions were often suggested by their appearance on T1- and T2-weighted images. CT is very effective for evaluating acute head trauma, but MR is recommended for documenting brain contusions during the subacute and chronic stages of head injuries.     

Initial CT manifestations of invasive pulmonary aspergillosis in 45 non-HIV immunocompromised patients: association with patient outcome?

PURPOSE: To assess early high-resolution computer tomographic (CT) signs of invasive pulmonary aspergillosis (IPA) in non-HIV immunosuppressed patients and their potential association with patient's outcome, including frequency and severity of pulmonary hemorrhage, taking also in consideration the impact of other known risk factors contributory to IPA. MATERIAL AND METHODS: A retrospective review of serial CT scans was performed in 45 immunocompromised patients with a total of 46 episodes of invasive pulmonary aspergillosis. All patients underwent CT beginning with the day they showed clinical or laboratory signs of infection. Serial follow-up CT included more than two, up to 12 CT examinations. Patient's outcome was judged by clinical and radiological follow-up and classified as survival, death by IPA, or death unrelated to IPA. The influence of patient's age, underlying disease, hematopoietic stem cell transplantation, neutropenia, graft versus host disease, and antifungal therapy onset was also statistically considered. RESULTS: Three main CT findings were identified: small nodules (<1cm) 43% (20/46), large nodules 21% (10/46) and consolidations, either in patchy+/-segmental 26% (12/46), or peribronchial distribution+/-tree in bud 9% (4/46). In 11 patients (24%) we found a combination of two or more of these signs: 9 (19%) patients presented concurrent small nodules accompanied by reticulation, tree in bud or peribronchial infiltrates, while 2 (4%) patients showed large pulmonary nodules accompanied by large consolidations. An accompanying "halo" sign was observed in 38 patients (82%). Crescent sign followed by cavitation was encountered in 29 patients (63%). Two patients succumbed to massive pulmonary bleeding caused by IPA. Twenty-one patients (15/46) deceased in this series, 12 of them succumbed to IPA, 1 died from cerebral invasive aspergillosis, while in 9 patients the cause of death was not primarily IPA. Manifest pulmonary hemorrhage occurred in 19% (9/46) of IPA episodes. CONCLUSION: Initial CT findings of invasive pulmonary aspergillosis consist mainly of small nodules or patchy consolidations, showing in 82% of cases an early halo sign. Serious pulmonary hemorrhage was an infrequent clinical complication in our series, with an attributable mortality of 4.3%. IPA-related lethality was 26%, in our cohort. None of the early HRCT signs seemed to predict outcome.     

Noncontrast CT assessment of early cerebral ischaemia

PURPOSE: To assess the diagnostic value of early signs of ischaemic cerebral infarction detected by unenhanced CT in the first 6-10 hours. MATERIAL AND METHODS: We reviewed the CT examinations of 42 patients (mean age: 61 years, range: 35-79) with suspected ischaemic stroke. We assessed CT findings at 6-10 hours of the onset of stroke for hemilateral evidence of main cerebral artery hyperdensity, sulcal effacement, liquoral space asymmetry, hypodensity of grey matter. The CT scans were performed without contrast medium. RESULTS: The topographic pattern of cerebral infarctions was: middle cerebral artery territory in 25 patients, anterior cerebral in 9, striatal lacunar infarction in 2, posterior junctional infarction in 5, anterior junctional infarction in 1. Early signs of infarction were present in 24 patients (57%). CT scans showed early signs in 20 cases (80%) of middle cerebral infarctions; 8 (32%) had middle cerebral artery hyperdensity; 3 (12%) had middle cerebral artery hyperdensity and sulcal effacement; 4 (16%) had sulcal effacement; 2 (8%) had liquoral space asymmetry; 3 (12%) had hypodensity of grey matter and liquoral space asymmetry. CT scans showed early signs in 4/9 (44%) of anterior cerebral infarctions. Sensitivity and specificity of early CT to cerebral infarction was 57% and 100%. The three cases with both hyperdense middle cerebral artery and sulcal effacement died of transtentorial herniation within the 10th day. The seven other deaths occurred in patients without early signs or particular patterns appearing in subsequent CT. DISCUSSION: In the management of ischaemic stroke the aim of neuroradiologic methods is to provide exact direction to immediate therapy by early diagnosis. In such cases the use of CT scanning aims at detecting signs of two main alterations of infarction: vascular occlusion and brain oedema. Middle cerebral artery hyperdensity, showing steady correspondence to infarction site and frequent disappearance on the follow-up CT, is indicative of embolic occlusion. Signs of "mass effect" are evident from the early stages in relation to the substantial concomitance of various types of brain oedema. The semeiology discussed in this study is more clearly detectable in middle cerebral artery infarction because this territory is the main site of embolic occlusion, and its larger size increases the "mass effect" due to oedema. The sensitivity obtained in this study is among the lowest values reported, which likely relates to our choice to use short scan times.