读片窗

患者男,55岁.因右髋部酸痛不适1年余入院.体检:右髋部轻压痛,右髋活动稍受限,局部无红肿,右下肢无纵向叩击痛. X线平片示:右股骨粗隆间髓腔一类圆形透亮区,大小约2.5 cm×2.0 cm×3.0 cm,周围见硬化环,其内见条弧状高密度影分隔(图1).CT示:右股骨粗隆间髓腔见一不规则骨质破坏区,境界清楚,硬化带明显,内部可见斑点状、小斑片状高密度影,骨皮质完整(图2).MRI示:右股骨粗隆间髓腔异常信号,抑脂T2WI呈高低混杂信号,T1WI呈等低信号,DWI呈高信号,增强扫描后病灶呈明显不均匀强化,内部可见斑点状无强化低信号(图3-5).     

髌骨骨巨细胞瘤合并动脉瘤样骨囊肿1例

患者女,46岁.入院5月前因不慎高处跌落致右膝关节肿胀,伴疼痛,现经治疗后右膝关节仍肿胀入院.查体:右膝关节肿胀,髌骨处压痛,无活动受限,无红肿、发热.X线片示:右髌骨轻度膨胀性改变,内见囊状骨质破坏区(图1).CT示:右髌骨内见稍低密度的膨胀性骨质破坏区,位于中央(图2),大小约3.4cm×2.0 cm×4.0 cm,骨壳菲薄,边界尚清,部分皮质中断、增厚及轻度硬化(图3).MRI示:右髌骨增大变形,内见不均匀长T1长T2信号影,并可见少许液-液平面(图4,5),T2 WI抑脂序列呈多房状高信号影,内见低信号骨性或纤维性分隔,(图6).持续硬脊膜外麻醉下行右髌骨肿瘤刮除十骨水泥填充术,术中所见:右髌骨内可见淡黄色肿瘤组织,皮质破损,关节面处未见明显破坏.术后病理诊断:(右髌骨)骨巨细胞瘤合并动脉瘤样骨囊肿.     

骨样骨瘤恶性变1例报告

患者　男,49岁。右髋关节疼痛不适10余年,近1个月来加重,未曾治疗。体检:右股骨上段压痛,局部无明显红肿,皮温较对侧无明显增高。体温及血压正常。X线平片及CT扫描示(图1,2 ) :右股骨粗隆间皮质下见一约1cm大小“鸟蛋”样高密度“瘤巢”及环形低密度、边缘清楚透亮带,周围骨质呈片状明显硬化;CT扫描还可见右股骨粗隆间前方皮质局部破坏、不连续,病灶前髂腰肌后方见少许软组织密度影,右侧髂腰肌较左侧轻度肿胀。X线平片及CT扫描初步印象:右股骨粗隆间骨样骨瘤。临床上在C形臂X线机定位下行局部病灶清除术。术中所见:骨质苍白稀薄,病灶内…     

胫骨骨化性脂肪瘤一例

患者男,51岁。20天前扭伤后右小腿疼痛,不能站立、活动,继而出现右小腿肌肉肿胀。专科检查:右小腿中上段肿胀,无明显皮肤充血,局部皮温无明显升高,压痛、叩击痛明显,无明显骨擦音、骨擦感。数字X线摄影(DR)片:示右胫骨上段髓腔内类圆形透亮区,沿胫骨长轴生长,内见片状骨化影,周围见硬化缘,无骨膨胀,无骨膜反应(图1、2)。CT扫描:示右胫骨中上段病图1DR正位片:胫骨上段髓腔见类圆形透亮区,内见片样骨化影图2DR侧位片:病灶内片样骨化影,边界不规则图3CT横断位:病灶边缘光整,内见脂肪密度影及小片样骨化影图4MRI横断T2WI:病灶内脂肪信号…     

股骨骨化性纤维瘤一例

患者男,20岁。右膝关节疼痛半年余,近期加重。体检:右膝关节活动正常,股骨下端局部未触及包块,皮温不高,表面无曲张的血管,稍压痛。X线片示:右股骨下端内侧、偏前方可见偏心性、多发肥皂泡样低密度区,最大者约2.0cm×1.0cm,病变内缘骨质硬化增厚,外缘骨皮质变薄,轻度膨胀,未见中断(图1)。CT检查:右股骨下端骨皮质下见一约3.0cm×1.8cm大小的骨质缺损区,内见分隔及点状高密度影,边缘硬化,髓腔侧明显,未见骨膜反应及软组织肿块(图2)。考虑右股骨下端骨化性纤维瘤。行股骨肿瘤刮除 髂骨取骨植骨术。术后病理诊断:(右股骨)骨化性纤维瘤(图3)。…     

骨骺侵袭性骨母细胞瘤并动脉瘤样骨囊肿1例报告

患者男,13岁,右膝关节疼痛并活动障碍4月。查体:右膝关节屈伸受限(屈曲120°,伸直170°),右股骨下段内侧略肿胀,未触及包块,无压痛,叩击痛( )。外院曾按“右膝关节炎”治疗效果不明显。X线片:右股骨下端骨骺可见一大小约1.3 cm×1.5 cm类圆形骨质破坏区,密度不均匀,周围可见环状骨质硬化,其内可见点状钙化(图1),行体层摄影见病变内有不规则分格状骨棘及点状钙化,硬化边内缘毛糙,周围未见软组织肿块,骨皮质连续(图2)。X线诊断:右股骨骨骺端良性病变,骨骺结核不除外。MR扫描:右股骨远端髁间见类圆形骨质破坏区,呈等T1、长T2信号影,病变边界…     

蜡油样骨病1例报告

患者女,38岁。右手及前臂肿痛20余年,劳累后加剧,近来手指疼痛加重。查体:右手、前臂桡侧肿胀、隆起,皮肤色泽正常。触之表面高低不平,坚硬如石,边界清楚,轻度压痛。诸关节活动受限。X线检查:右肩胛骨上缘示“团块状”、“象牙质”样高密度骨化影,关节盂见斑点状致密影。右肱骨外侧骨皮质内缘骨质增厚、硬化,呈“蜡油样”流注,髓腔变窄,关节内亦见斑点状致密影,骨干外形轮廓无明显改变(图1)。右手第1、2指,掌骨骨皮质增厚、硬化,呈“象牙质”样改变,髓腔趋于消失。右手第3近节、中节指骨皮质内缘骨质增厚、硬化,髓腔变窄,骨干外形无改变。…     

骨恶性纤维组织细胞瘤一例

患者　女 ,2 7岁。 1年前无明显诱因出现右膝内侧疼痛 ,行走时加重 ,抗炎治疗稍有好转。体检 :右膝内侧压痛明显 ,无明显红肿 ,膝关节活动尚可 ,浮髌征 (- )。CT平扫 :右股骨内侧髁骨质斑片状破坏 ,骨皮质中断 ,邻近软组织轻度肿胀。右膝关节间隙未见异常 (图 1)。MRI:右股骨下端见长T1等T2 信号影 ,其周围软组织及右膝关节间隙未见明显异常。右胫骨上端亦可见小点状长T1等T2 信号影。MRA示病变上下方见较粗大供血动脉 ,病变血供丰富 ,股动脉稍受压移位 (图 2、3)。手术所见 :骨膜下骨质破坏 ,呈黄色肉芽泥沙状改变 ,边缘不清 ,向内侧…     

足肢骨纹状增生症二例

例1 女,7岁.右足隐痛不适3个月就诊,体检无明显异常.右足X线平片(图1)示:右足第4、5趾骨、跖骨及骰骨见斑点状、条片状致密骨性高密度影,似蜡泪样,跖骨骨皮质呈波浪样,部分骨骺亦见斑片状高密度影,诸骨关节面光整,诊断右足肢骨纹状增生症.     

右肩关节炎症致骨质破坏1例

患者女,54岁。无明显诱因出现右肩关节肿痛、活动受限6个月,加重近1个月入院,不伴右上肢麻木,无发热病史。查体:右肩关节肿胀,无破溃,局部压痛,肩关节活动受限,伸屈展活动范围约10°,右手活动好,右上肢皮肤光滑无异常,桡动脉搏动好。X线片示:右肱骨上段骨质破坏,周围见软组织肿块,其内见多发钙化影。诊断:右肱骨上段骨肿瘤,软骨肉瘤可能性大。CT示右肱骨上段骨质破坏、消失,肩胛骨及关节盂部分骨质受侵,边缘毛糙,右肩关节周围软组织明显肿胀,肌间隙模糊,其内见大量水样密度影,并可见多发斑片状钙化、碎骨片影及多个小气泡影(穿刺术后改变)…     

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.