经胸彩色多普勒超声心动图在小儿房间隔缺损封堵术中的应用价值

目的探讨经胸彩色多普勒超声心动图(TTE)在小儿继发孔房间隔缺损(ASD)封堵术中的应用价值。方法68例小儿ASD患者,封堵术前应用TTE筛选适应证,应用二维超声心动图(2DE)观察ASD位置、测量ASD大小和残余边缘长度。应用彩色多普勒血流显像(CDFI)显示过ASD分流束和各瓣膜反流情况。应用连续波多普勒(CW)估测肺动脉压力。封堵术中应用2DE监视封堵器位置是否正常,应用CDFI观察是否有残余分流。封堵术后应用2DE测量心腔内径的变化,观察封堵器是否有移位、脱落。应用CDFI观察是否有残余分流,应用CW估测肺动脉压力变化。结果本组68例小儿ASD患者经TEE术前筛选适应证、术中监测和术后疗效判断,实施ASD封堵术全部获得成功,包括合并畸形全部实施介入治疗,治疗效果满意。结论因小儿ASD患者行经食管超声心动图检查受限制,只能依靠TTE检查。因此TTE在小儿ASD封堵术中具有重要临床价值。     

彩色多普勒超声心动图在老年动脉导管未闭封堵术中的价值

目的探讨彩色多普勒超声心动图(CDE)在老年动脉导管未闭(PDA)封堵术中的价值。方法封堵术前应用CDE筛选25例老年PDA适应证,彩色多普勒血流显像(CDFI)分流束血流信号估测PDA肺动脉端直径,与心血管造影对照,经统计学相关处理判断其正确性;连续波多普勒(CW)测量三尖瓣最大反流速度峰值,根据简化伯努利方程ΔP=4V2估算跨三尖瓣压力阶差,再加上右心房固有压力估测肺动脉压力,与心导管对照,经统计学相关处理判断其正确性;所有患者均行封堵术介入治疗,封堵术后再应用CDE判断封堵术疗效。结果根据CDE特征筛选25例老年PDA实施封堵术全部获得成功,封堵术后CDE判断疗效满意。CDFI测量分流束血流信号估测PDA肺动脉端直径与心血管造影对照,呈正相关(r=0.71,P<0.001);CW估测肺动脉压力与心导管对照,呈正相关(r=0.63,P<0.001)。结论CDE在老年PDA封堵术中具有重要价值,封堵术前筛选适应证应用CDFI估测PDA肺动脉端直径和应用CW估测肺动脉压力是关键,封堵术后判断疗效应用CDFI观察有无过PDA残余分流很重要。     

Amplazer封堵器治疗巨大房间隔缺损

目的　分析和评价Amplatzer房间隔缺损封堵器介入性治疗巨大房间隔缺损的安全性与有效性。方法　诊断均经临床用彩色多普勒超声心动图(TTE)证实为继发孔型ASD ,以TTE多切面测量所得的房间隔伸展径、最大ASD缺损径、缺损周边残余组织的厚薄、硬度来选择合适型号的闭合器,随访有无残余分流及是否影响腔静脉及瓣膜功能,记录临床事件(心律失常、心功能不全等)。结果　19例患者封堵器置入成功,其中包括6枚型号4 0mm的封堵器,1枚型号4 2mm的封堵器。5例采用AGAAmplatzer封堵器,14例采用国产心健TM封堵器。术中1例,封堵失败,1例封堵器脱落,转胸外科手术。术后即刻17例无残余分流,2例微量分流;术后随访无血栓形成及封堵器移位、脱落等其他并发症发生。结论　Amplatzer伞堵闭巨大ASD安全、有效,值得推广,但应注意防止封堵器脱落     

彩色多普勒血流显像经胸超声心动图对室间隔缺损介入封堵治疗的价值

 目的探讨彩色多普勒血流显像(Color doppler flow imaging,CDFI)经胸超声心动图(Transthoraic echocardiogram,TTE)在室间隔缺损(Ventricular septal defect,VSD)介入封堵术前、术中及术后的应用价值.方法首先使用CDFI经胸超声心动图扫查选择适合做封堵术的VSD患者,然后监测导管引导Amplatzer封堵器治疗VSD的全过程,在监测过程中认真观察导管及封堵器的位置,配合封堵器的释放,观察封堵器是否已封堵好室间隔缺损处,周边有无残余分流.结果 CDFI经胸超声心动图扫查选择VSD 11例,均为膜部缺损.除1例因VSD上缘距主动脉瓣右冠瓣1.9～2.0mm,缺损口6.0 mm,并有胸骨畸形,封堵术改为经胸手术外,其余10例封堵成功,CDFI未见残余分流.结论 CDFI经胸超声心动图扫查对VSD封堵适应证的选择,封堵术中监测及封堵术后判断及追访均有着重要价值.     

国产封堵器经导管介入治疗巨大房间隔缺损的疗效

 目的 探讨使用国产封堵器介入治疗巨大房间隔继发孔缺损(atrial septal defect ,ASD) 的可行性和安全性.方法 经胸/经食管彩色多普勒超声心动图证实巨大ASD患者62例,在经胸超声心动图及X线透视监护下,根据ASD边缘不足情况分别制定封堵策略,选用国产封堵器行介入封堵治疗,记录围术期并发症,随访复查7 d、6个月、18个月经胸多普勒超声心动图、心电图和胸片和临床事件(心包填塞、心脏破裂、血栓、感染性心内膜炎和死亡).结果 56例巨大继发孔ASD经导管封堵成功,成功率90.3%.6例患者试封堵失败,根据分型分别为后缘并下腔静脉缘不足型3例,主动脉缘并下腔静脉缘不足型3例.围术期并发症包括封堵器脱落2例、房间隔残缘断裂1例,3例患者均行外科手术、取出封堵器/房间隔补片修补术.一过性ST段抬高和一过性黑矇各1例.术中及随访期间无临床事件发生.结论 巨大ASD 可以行介入封堵治疗,国产封堵器介入封堵巨大房间隔缺损患者安全、有效、并发症少、费用低,可作为有封堵适应证患者的首选方案.     

成人法洛三联症彩色多普勒超声心动图特征和规律性研究

目的：探讨成人法洛三联症（TOF）彩色多普勒超声心动图（CDE）特征和规律性,分析房间隔缺损（ASD）血流动力学与肺动脉瓣狭窄（PS）程度的关系,提高诊断准确率。方法：应用CDE检查62例成人TOF（14～57岁,平均24.8岁）,二维超声心动图（2DE）测量ASD大小,连续多普勒（CW）估测跨肺动脉瓣压力阶差,与心导管和手术对照。其中52例行心导管检查,14例行介入治疗,48例外科手术治疗。结果：根据CDE特征表现对56例做出正确诊断,诊断准确率90.3%,误诊继发孔ASD和PS各3例。2DE测量ASD直径5～33（18±12）mm与手术测量ASD直径7～35（21±13）mm呈正相关（r=0.52,P〈0.001）;CW估测跨肺动脉瓣压力阶差36～154（93±52）mmHg与心导管测量跨肺动脉瓣压力阶差30～140（86±50）mmHg呈正相关（r=0.67,P〈0.001）。彩色多普勒血流显像（CDFI）显示过房间隔分流束血流信号,其中左向右（61.3%）、双向（22.6%）、右向左（11.3%）和无分流（4.8%）。根据CDE筛选14例适应证实施介入治疗全部获得成功。结论：成人TOF的CDE特征明显,CDFI显示过ASD分流束血流信号呈多样化,与PS程度密切相关,CDE对成人TOF有特异性诊断价值,介入治疗前应用CDE判断ASD大小、位置和PS程度非常重要。     

经胸超声心动图在继发孔型房间隔缺损封堵术中的应用

目的 探讨经胸超声心动图（TTE）在继发孔型房间隔缺损（ASD）封堵术中的应用价值.方法 应用TTE筛选27例继发孔型ASD患者,经TTE引导进行封堵术.结果 27例患者成功进行了Amplatzer封堵术,24例无残余分流,3例残余分流（〈2mm）,术后1个月复查分流消失.结论 TTE在ASD介入治疗中起重要作用.     

新型单铆双盘状封堵器治疗房间隔缺损的安全性和疗效观察

目的 评价新型单铆双盘状封堵器治疗房间隔缺损(ASD)的安全性及疗效.方法 选取继发孔ASD患者49例,按选用封堵器的类型不同分为试验组34例,植入新型单铆双盘状封堵器(Sunflower封堵器),对照组15例,植入双盘状封堵器(SHSMA封堵器).记录两组患者的ASD直径、肺动脉收缩压(PASP)、右室收缩压(RVSP)、封堵器腰部直径、手术时间、透视时间及并发症发生率,术后随访心电图及1、3和6个月的经胸超声心动图.结果 49例手术全部成功,手术成功率为100％.试验组34例植入封堵器腰部直径为6 ～ 32 mm,对照组为14～34 mm.两组患者术中均无严重并发症,术后即刻超声心动图检查示,对照组1例可见残余分流,术后6个月残余分流消失,其他患者均未见心房水平分流,封堵器未影响右房室瓣返流.术前、术后心电图变化两组间差异无统计学意义(P＞0.05).结论 Sunflower封堵器与SHSMA封堵器治疗ASD同样安全和有效.     

超声心动图在房室间隔缺损经导管封堵术中监测的体会

目的探讨超声心动图在房间隔缺损经导管封堵术中监测的方法和价值。方法9例房间隔缺损(ASD)、14-例室间隔缺损(YSD)患者经胸超声心动图监测下行经心导管封堵术。结果超声监测下8例ASD封堵成功，1例因缺损口太大，封堵器无法固定而失败。14例VSD封堵成功，其中1例VSD术后有轻微残余分流。结论超声心动图在房室间隔缺损封堵术中的监测有着不可替代的重要价值。     

多孔型房间隔缺损封堵器封堵小儿多孔型房间隔缺损

目的 评估新型多孔型房间隔缺损封堵器治疗小儿多发性房间隔缺损的疗效.方法 2011年10月至2012年2月收治多发性房间隔缺损患儿3例,女1例,男2例.术前完善常规检查,根据超声和心导管检查结果先选择合适球囊和封堵器进行球囊扩张和缺损封堵,术后3d出院,出院后予阿司匹林(每天3 ～5 mg/kg)口服.结果 第1例心脏超声示房间隔缺损(Ⅱ),存在3个分流口,前两者相距5.4 mm,后两者相距3.6 mm,中间孔距主动脉瓣13.2 mm,距左房室瓣10.3 mm,房间隔长约28 mm,选择25 mmCribriform封堵.第2例心脏超声示有2个分流口,两者相距3 mm,房间隔长度为35 mm,术中选取25 mm Cribriform封堵器.第3例心脏超声示房间隔缺损(多发),术中选取30 mm Cribriform封堵.所有封堵器释放后位置好,心脏超声显示无残余分流和瓣膜反流.结论 Cribriform可应用于多发性房间隔缺损的封堵,疗效可靠,并发症少,但需注意术后抗凝治疗.     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.