单发肺结核空洞动态演变的影像学研究

目的 研究单发性肺结核空洞在化疗过程中与治疗后动态演变规律及其影像学表现.资料与方法 回顾性分析87例单发肺结核空洞患者治疗前后X线资料,其中27例进行了CT检查与复查,重点分析单发肺结核空洞X线与CT特征、动态演变规律及其影像学表现.结果 单发肺结核空洞影像学上多数表现为厚壁空洞,占79.3%,其中82.6%洞壁厚薄不均, 27.5%伴壁内结节,与肺癌空洞相类似.单发肺结核空洞在化疗过程中与治疗后动态演变规律及其影像学表现为:(1)空洞逐渐缩小最后吸收者66例,占75.9%;(2)薄壁或厚壁空洞转化为净化空洞11例;(3)形成纤维硬壁空洞1例;(4)形成结核瘤6例;(5)进一步恶化,空洞壁增厚,出现液平面或形成支气管播散灶3例.疗程结束后空洞仍发生影像学变化.结论 (1)肺结核空洞的转归有一定规律,影像学动态随访观察对鉴别诊断与疗效评价有重要价值;(2)疗程结束后空洞仍发生影像学变化,表明病理组织的吸收与肺组织修复滞后于肺结核的生物学治愈.     

聚合酶链反应DNA扩增对肺结核疗效监测

目的:探讨聚合酶链反应(PCR)痰结核杆菌DNA扩增对肺结核疗效监测的临床实用价值。方法:对31例初治涂阳肺结核患者进行2年的随访研究,定期行痰涂片抗酸染色和PCR检查。结果:31例中有27例痰PCR在治疗结束前转阴,另4例痰PCR持续阳性时间长达12月左右。31例中有3例初治有效后复发,2例为PCR持续阳性患者,1例为痰涂片和PCR复阳患者,PCR复阳时间比涂片早2月。485份痰标本痰PCR和涂片检查总符和率为88.9%(431/485)。结论:提示痰PCR是检测肺结核疗效敏感的方法,痰PCR和涂片检查总符合率较高,复发多见于痰PCR持续阳性患者。     

发病时间对初治肺结核空洞类型及痰涂片结果的影响

目的探讨发病时间对初治肺结核空洞类型及痰涂片结果的影响。方法收集2016年1月~2017年4月初治肺结核住院且行胸部CT检查患者共计461例,其中合并空洞174例(37.7%),根据主诉将发病时间(从出现症状至临床确诊的时间间隔)分为三组,即小于1个月为组I(180例)、1~3个月为组II(135例),大于等于3个月为组III(146例),根据痰涂片结果分为阳性组(125例)及阴性组(336例),对于分类资料的统计分析采用X^2检验。结果组I~组III空洞合并率依次为24.7%、31.6%及43.7%;其中厚壁空洞类型率依次降低,即44.8%、34.5%、20.7%,而虫蚀样空洞及虫蚀样+厚壁混合性空洞类型率依次升高,分别为30.2%、32.1%、37.7%及20.6%、26.5%、52.9%。组I~组III痰涂片阳性率依次为24.0%、32.8%、43.2%;厚壁空洞、虫蚀样空洞及厚壁+虫蚀样混合性空洞类型痰涂片阳性率分别为40.2%、35.8%、58.8%。是否合并空洞及痰涂片结果在组I vs组II、组I vs组III中具有统计学差异(P<0.05),而空洞类型在组I vs组III、组II vs组III中具有统计学差异(P<0.05)。结论随着发病时间延长,初治肺结核空洞合并率、含虫蚀样空洞类型率及痰涂片阳性率均逐渐升高,且是否合并空洞及不同空洞类型与痰涂片结果相关。     

周围型肺癌空洞位置的多层螺旋CT多平面重建诊断价值

目的 探讨离心性空洞(exodic cavity)与向心性空洞(esodic cavity)的多层螺旋CT(MSCT)表现及其对周围型肺癌空洞的诊断与鉴别诊断价值.方法 搜集经病理证实的周围型肺癌空洞110例和经病理、痰检以及临床治疗后随访证实的肺结核单发空洞(空洞壁厚度＞3 mm)106例的MSCT资料,其中56例周围型肺癌空洞和46例肺结核空洞行MPR,对比分析MPR与横断面薄层扫描对离心性空洞与向心性空洞的检出率.离心性空洞是指空洞位于肿块的背离肺门侧,向心性空洞是指空洞位于肿块的肺门侧.结果 离心性空洞在周围型肺癌空洞中的出现率明显高于肺结核空洞(χ2值为76.541,P值＜0.01),敏感性为63.6%(70/110),特异性为90.9%(70/77).向心性空洞在肺结核空洞中的出现率明显高于周围型肺癌空洞(χ2值为79.531,P值＜0.01),敏感性为64.2%(68/106),特异性为90.1%(68/75).行MPR后,离心性空洞在周围型肺癌空洞中的检出率为85.7%,向心性空洞在肺结核单发空洞中的检出率为84.8%,均高于横断面薄层扫描法的检出率(χ2值分别为10.083、8.100,P值均＜0.01).结论 离心性空洞与向心性空洞对周围型肺癌空洞和肺结核单发空洞的鉴别诊断有重要价值,MPR可提高离心性空洞与向心性空洞的检出率.     

现代肺结核空洞性病变的发病及影像学研究

目的观察肺结核空洞性病变的发生及其临床、影像学表现,探讨其发病和病理演变机制的变化与特征。资料与方法搜集本院161例空洞性肺结核患者的临床和CT检查资料。分析各类空洞病变的发生率、形态特征及其与发病年龄、发病时间、伴随征象和细菌学检查结果等临床因素的关系。结果161例中厚壁空洞133例(82.6%)、薄壁空洞13例(8.1%)、无壁空洞15例(9.3%)。120例为新发病例。患者从出现症状到CT检查的时间间隔为4h～317天,将120例新发病例分为急性、亚急性和慢性发病组。无壁空洞全部分布于急性和亚急性组,薄壁空洞仅见于急性组,厚壁空洞在各组均有分布。三种类型空洞在各组间的分布差异有统计学意义(P<0.05)。127例空洞伴有树芽征(78.9%),三种空洞伴发树芽征的比率差异有统计学意义(P<0.05)。结论肺结核空洞性病变发病率增高且越来越多地产生于肺实变基础上的迅速坏死,其发生方式和影像学变化反映了现代肺结核的发病及其病理演变的新特征。     

单发肺结核空洞的CT表现特征及鉴别诊断

目的　回顾性分析肺结核空洞的CT影像学特征 ,以提高其诊断与鉴别诊断水平。方法　 2 9例经病理或治疗证实的肺结核空洞。全部病例均进行了胸部X线正侧位平片和CT平扫 ,其中 19例同时有CT强化扫描。结果　 2 9例均为单发结节空洞 ,95 % (2 7 2 9)位于两肺上叶 ;空洞平均直径为 2 3 .5mm ;以类圆形为主 ,占 73 % (2 1 2 9) ;空洞外形以浅分叶或无分叶为主 ,占 82 % (2 4 2 9) ;76%(2 2 2 9)是厚壁空洞 ;5 1% (15 2 9)空洞内外壁均不光整。空洞壁CT增强不明显。全部病例胸部X片均见有周围卫星灶。结论　结核空洞多表现为厚薄不均的空洞。空洞周围有无卫星灶、空洞外缘分叶的深浅及空洞壁CT强化的幅度是与其它空洞鉴别的要点     

活动性肺结核的高分辨率CT征象分析

目的 探讨活动性肺结核的HRCT表现及特征.方法 回顾性分析79例活动性肺结核的临床及HRCT扫描资料,活动性肺结核的诊断依据:痰抗酸杆菌阳性(43例),及治疗期间获得的一系列胸部影像改变(36例).结果 小叶中心结节,65例(82.3%),树芽征65例(82.3%),支气管壁增厚58例(73.5%),肺实变61例(77.3%),空洞56例(73.2%),液体支气管征53例(72.8%),磨玻璃征45例(56.8%),线状影55例(73.1%),胸膜改变21例(26.6%),肺门及纵隔淋巴结肿大12例(15.1%),2种及2种以上肺部病变并存79例,小叶中心结节、树芽征、支气管壁增厚、肺实变及液体支气管征、空洞、磨玻璃影治疗后吸收好转例数25例(25/31),26例(26/31),8例(8/31),19例(19/26),11例(11/21),21例(21/36).结论 活动性肺结核的HRCT表现具有一定特征性,结合其他临床资料,可进一步提高对活动性肺结核的诊断水平.     

周围型肺癌与肺结核空洞的CT鉴别诊断

目的:研究周围型肺癌空洞与肺结核空洞的CT表现,提高其鉴别诊断水平.材料和方法:回顾性分析周围型肺癌空洞46例和肺结核空洞32例的CT表现.结果:癌性空洞一般为厚壁,内缘凹凸不平,有壁结节,分叶及胸膜凹陷征多见;而肺结核空洞以薄壁相对多见,周围常有卫星灶.厚壁空洞出现壁结节伴有胸膜凹陷征高度提示肺癌,而薄壁空洞,洞壁厚薄较均匀,周围伴有卫星灶者以肺结核最常见.结论:CT可清楚地显示空洞壁的状况及病灶本身的特点,是肺部空洞鉴别诊断的最佳影像学检查方法.     

肺内单发空洞X线和CT的诊断及其鉴别

目的探讨肺内单发性空洞的X线、CT诊断及其鉴别。方法随机收集不同疾病的肺单发空洞42例,全部病例均摄X线片,其中,18例又经CT扫描。本组病例经痰涂片或培养、纤支镜活检和手术病理证实。结果本组42例中肺癌空洞10例,肺结核25例,肺脓肿3例,肺真菌病2例,郎格罕氏细胞增生症(LCH)1例和韦格内氏肉芽肿病(WG)1例。结论阐述肺单发空洞的影像表现,掌握影像鉴别要点,以求正确诊断。     

夹层杯集菌离心涂片法初筛肺结核患者的临床应用价值

目的探讨夹层杯集菌离心涂片法检测抗酸杆菌提高门诊肺结核患者诊断准确率的临床应用价值。方法对1 762例门诊疑似肺结核患者的痰标本同时进行直接涂片法、浓缩集菌涂片法和夹层杯集菌离心涂片法检测抗酸杆菌,比较3种方法对即时痰的阳性检出率;对145例确诊肺结核住院患者的痰标本同时进行浓缩集菌涂片法和夹层杯集菌离心涂片法检测抗酸杆菌,比较2种方法对清晨痰的阳性检出率。结果夹层杯集菌离心涂片法检测门诊即时痰标本抗酸杆菌阳性检出率为15.6%,明显高于浓缩集菌涂片法(9.2%)和直接涂片法(5.9%)(P<0.05);同时夹层杯集菌离心涂片法在检测确诊肺结核住院患者的清晨痰标本阳性检出率显著高于浓缩集菌涂片法(P<0.05)。结论夹层杯集菌离心涂片法检测抗酸杆菌能够有效地提高门诊患者的确诊率,减少肺结核病的漏诊率,为临床医生的诊断治疗提供了重要参考依据。     

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.