CT对肾结核的诊断意义探讨

目的探讨肾结核的CT表现，分析CT检查在肾结核诊断中的意义。方法对42例肾结核患者进行CT检查及增强扫描并结合其他临床资料作综合分析。结果CT检查肾内有低密度病灶，空洞形成，多发空洞有特征性改变。结论肾结核的CT表现有一定的特征性，CT检查优于其他方法，在肾结核的诊断中有重要意义。     

胆囊结石伴胆囊癌的诊治分析

目的探讨胆囊癌与胆囊结石的关系及胆囊结石伴胆囊癌的诊断和治疗特点。方法对1993年1月至2004年12月间收治的27例胆囊癌合并胆囊结石患者进行回顾性临床分析。结果27例胆囊癌合并胆囊结石患者,男10例,女17例,男女之比为1:1.7。平均年龄68.5岁,其中60岁以上22例。临床症状最常见为腹痛(85.2%)。既往有明确胆结石病史患者15例,入院后发现胆结石的有12例。行B超检查的23例,诊断胆囊癌的有12例(52.2%)。CT结合增强扫描检查12例,诊断胆囊癌的有8例(66.7%)。行肿瘤根治切除者8例,根治率29.6%。随访13例,随访期为3个月~7年,获随访者的平均存活时间为12个月。结论胆囊结石是胆囊癌的发病因素之一,胆囊癌早期诊断困难,晚期治疗效果差,伴胆囊结石的胆囊癌关键是要引起重视,不能满足胆囊结石的诊断而遗漏胆囊癌。对胆囊结石患者要密切随访,高危患者要尽早手术。     

Sensitivity and specificity of a self-administered questionnaire for familial screening of adult-onset dystonia.

We developed a self-administered questionnaire for screening the most common adult-onset dystonias. It was tested in 90 first-degree relatives of 22 adult-onset dystonia patients, yielding 79% sensitivity and 94% specificity. Simulation of a case-finding procedure based on serial application of the questionnaire and clinical examination of both subjects screening positive and subjects screening negative who had < 8 years of schooling increased sensitivity to 95% and specificity to 100%. This questionnaire may be an important screening resource for familial aggregation studies to be used in the context of a complex case-finding procedure.     

垂体脓肿的诊断与治疗(附10例报告)

目的探讨垂体脓肿的临床特点、诊断和治疗。方法回顾性分析10例垂体脓肿的病史、临床表现、影像学表现、手术记录和随访结果。结果8例早期出现尿崩症,影像学表现为MRI检查T1像等信号或低信号,T2像等信号或高信号,环行强化,5例垂体柄增粗50%,随访6个月至4年,均未见复发。结论早期尿崩症、垂体柄增粗和环形强化的囊性病灶应首先怀疑垂体脓肿,早期诊断、及时手术和合理的抗生素治疗是提高垂体脓肿预后的关键。     

The multiform and variable patterns of onset of orofacial granulomatosis

BACKGROUND: The recurrent chronic orofacial swelling caused by orofacial granulomatosis (OFG) can cause significant cosmetic and functional problems but can be prevented if the disease is diagnosed early and promptly treated. Although the enlargement of the lips is described to be the most common presenting complaint, the clinical onset of OFG may be characterized by minor associated mucosal and neurological manifestations, making early diagnosis very difficult or, sometimes, merely presumable. PATIENTS AND METHODS: We retrospectively analyzed the clinical manifestations of 19 patients with OFG, who were examined at our institution between 1998 and 2002, in order to determine their initial manifestations and presenting symptoms. RESULTS: A total of 10 patients showed classical recurrent enlargement of the lips (six lower; four upper) as presenting symptom. In the other nine patients, OFG onset was characterized by transient unilateral facial nerve palsy (two cases), intraoral manifestations (two cases), recurrent swelling of the periorbital area (two cases), of the chin (one case), of the zygomatic area (one case), and of the cheeks (one case). CONCLUSION: Our data underlined that OFG onset could be frequently characterized by widely variable, multiform, and temporary clinical findings. Involvement of atypical sites of the orofacial region and presence of single minor manifestations may occur as presenting symptoms, often preceding the development of traditional clinical findings.     

创伤性迟发性颅内血肿的诊断和治疗

目的 探讨创伤性、迟发性颅内血肿的早期诊断和治疗的临床效果。方法 对22例病人的发病年龄、性别、伤因、早期诊断和治疗效果进行了回顾性分析。经过2—6个月，按GOS评定治疗效果。结果 良好者12例，中残者5例，重残者1例，植物生存者1例，死亡者3例，死亡率为14％。结论 早期诊断和治疗本病对于提高治愈率和降低死亡率至关重要，早期手术治疗本病，乃是多数病人首选的治疗方法。     

Primary malignant melanoma of the bladder

Primary malignant melanomma of bladder is extremely rare: 18 cases are reported to date. An 82 year-old man underwent trans-urethral resection of bladder for a bleeding tumor of the posterior wall. Histological diagnosis was melanoma of the bladder. There was no history of previous or regressed cutaneous malignant melanoma. Margins of the bladder lesion contained atypical melanocytes similar to those commonly seen in the periphery of primary mucous membrane lesions. Clinical studies and radiological examinations were negative for other primary site of melanoma. The patient had a bladder recurrence that was consistent with primary tumor and died of widespread disease 9 months after diagnosis.     

输尿管囊肿的X线征象分析

目的总结输尿管囊肿的X线表现,以提高对该病的认识。方法搜集1995年1月至2005年12月间经手术、病理证实的输尿管囊肿18例,回顾性分析其X线表现。结果18例输尿管囊肿中,发生在单侧者16例,双侧2例。15例出现膀胱内边界清晰的充盈缺损,16例显示“光晕征”,12例显示“蛇头征”。结论输尿管囊肿有典型的影像学表现,静脉尿路造影可明确诊断,为手术提供可靠的影像资料。     

Comparison of diagnostic usefulness of predictive models in preliminary differentiation of adnexal masses

The purpose of this study was to compare prognostic models evaluating the probability of an ovarian cancer occurrence based on a number of clinical and ultrasonographic data in women with adnexal masses. A total of 686 women with adnexal masses underwent the examinations between 1994 and 2002. The recorded parameters included: age, menopausal status, body mass index, the grayscale and Doppler ultrasonographic examination, and selected markers concentration levels. In order to find the best combination of features, which significantly influences the probability of malignancy, stepwise logistic regression analysis, as well as artificial neural network, was used. The diagnostic efficiency of received models was estimated and compared using receiver-operating characteristics (ROC) curve. The results indicate that 431 and 255 patients had a benign and malignant ovarian tumor, respectively. Application of stepwise logistic regression analysis revealed statistically significant importance of eight features. The sensitivity and specificity for the received model were 65.71% and 77.59%, respectively. Three-layer perceptron network shows 13 features as significant predictors of malignancy. The network gave a sensitivity of 85.7% and specificity of 93.1%. Comparison of area under ROC curve for received models was 0.9679 vs 0.9716. Prognostic values of the analyzed neural model are not optimal but seem to surpass logistic regression model in terms of the predictive possibilities.     

Female pelvic floor. Descriptive anatomy and clinical exploration by transvaginal ultrasound

In order to assess the state and pathology of the woman's pelvis minor, a number of methods are commonly used among practitioners, encompassing clinical exploration, radiology, MRN, urodynamics, endoscopy and echography.

Echography has been poorly used in clinical pelvic exploration and its reliability is actually a matter of controversy 1. However, echographic surveys can provide us with valuable gynecological data on the state and pathologies of the soft pelvis, within the genital regions or even going beyond them, i.e. the rectal channel, bladder, urethra, anus, vascular plexuses, and all of their supporting tissues.

At our research unit, we have been employing Transvaginal Ultrasound echography (TVU) for a long time in conjunction with other pelvis-focused methods in order to study different kinds of pelvic alterations. TVU has proven to be friendly to use, fast, harmless and inexpensive, allowing serial explorations and producing high-quality dynamic images (loop-cinema, video-tape). Furthermore, this method is fairly aseptic in that the occurrence of faeces in the rectal ampolla is not a nuisance but a bonus in tracking the contours of the rectum walls and other topographical features which would be otherwise difficult to survey.

A complete pelvic floor TVU may add no longer than 5-8 minutes to a routine gynecological examination, can be implemented by the general gynecologist and generates data that can be further studied by the appropriate specialist for a more insightful evaluation 2.