手法治疗抽动秽语综合征

抽动秽语综合征一直被认为是病因不明的锥体外系疾病 ,是一种儿童期起病 ,以头面、肢体或躯干部的多发性肌肉抽动与不自主发声、猥亵言语及强迫症状为特征的疾病。笔者对 30例患者进行了详细系统的研究。发现手法可明显减轻患儿的症状 ,推测上颈段损伤可能与本病的发生密切相关 ,从而为脊柱源性疾病的研究开辟了新的领域。一般资料　 30例中 ,男 18例 ,女12例。年龄在 9～ 15岁 ,就诊时口服氟哌啶醇的 9例 ,最长用药时间有 10个月 ,间断用药 8例 ,停药的 5例 ,未曾用药 8例。用药期间抽动控制较理想 ,部分患儿反应迟钝。病因 :病因包括坠落…     

抽动—秽语综合征的心理分析与认知指导

抽动-秽语综合征，发病原因虽不确切，但专家认为与精神心理因素内在联系有关[1，2]。由于独生子女的增多，家长对孩子的娇惯，致使孩子任性，加之住宅楼群的环境改变等因系．使该病发病率日渐增高。我科1992年6月至1996年6月共收治26例该征患儿，现将心理分析与认知指导报告如下。1临床资料26例中男18例，女8例，年龄4-12岁，平均7．1岁。病程1～6．5年，平均1．8年。临床表现为突发性多部位不自主的肌肉抽动，伴暴发性不自主发声及刻板地发出咒骂及淫狠词句，其中秽语17例，皱眉、挤眼11例，磨牙3例，点头、摇头4例，斜颈2例，仰头1例，举…     

抽动-秽语综合征患儿父母焦虑状况调查

目的了解抽动秽语综合征患儿父母的焦虑状况,为对其进行心理干预提供依据。方法采用Zung焦虑自评量表(SAS),对60名抽动秽语综合征患儿父母进行问卷调查。结果抽动秽语综合征患儿父母焦虑评分(55.92±7.11)分,显著高于国内常模(P<0.01);出现频率较高的焦虑相关症状依次为焦虑、惊恐、乏力、睡眠障碍、不幸预感、静坐不能、躯体疼痛等。学龄前与学龄患儿父母的焦虑评分比较,差异无显著性意义(P>0.05)。结论抽动秽语综合征患儿对父母的身心健康均有影响。建议在重视患儿全面康复的同时注意其父母的心理健康,并及时给予有效干预。     

18F-FDG PET显像在大肠癌诊治中的应用

目的 介绍18F-氟代脱氧葡萄糖正电子发射型断层显像(18F-FDG PET)在大肠癌诊治中使用的最新进展。方法 对近几年来国外关于18F-FDG PET显像对大肠癌诊治研究进展进行分析和总结。结果 18F-FDGPET显像对早期诊断大肠癌复发、转移及大肠癌的分期均优于CT及MRI检查。结论 18F—FDG PET显像可以作为诊断大肠癌的一种重要检查手段，并有助于治疗方案的选择。     

抽动秽语综合征儿童智力与社会适应能力及行为问题的研究

目的探讨抽动秽语综合征儿童智力、社会适应能力及行为,为护理干预提供依据.方法对100名抽动秽语综合征儿童(观察组)及100名正常儿童(对照组)采用韦氏儿童智力量表、儿童适应行为评定量表、Achenbach儿童行为量表进行测评.结果观察组儿童智力不受影响.社会适应能力低于对照组儿童.观察组儿童交往不良发生率高于对照组(P＜0.05);但违纪及多动发生率低于对照组(P＜0.05);观察组男孩攻击行为发生率高于对照组.结论对抽动秽语综合征儿童,在药物治疗同时,应积极配合心理治疗及护理.预防社会适应能力的下降及行为问题的发生.     

安氟醚麻醉下健康志愿者脑葡萄糖代谢的显像研究

目的应用正电子发射断层扫描技术(positronemissiontomography,PET),研究健康志愿者吸入不同浓度安氟醚麻醉时脑葡萄糖代谢(CMGlu)的改变。方法选择5名志愿者,每位志愿者分别做3次PET扫描,采用PHILIPSCPETPlus扫描仪及18氟标记的脱氧葡萄糖(18FDG)标记技术测定CMGlu,第1次在清醒状态下扫描作为对照,第2、3次分别吸入0.5MAC和1.0MAC安氟醚。结果与清醒时比较,吸入0.5MAC和1.0MAC安氟醚后全脑CMGlu显著降低(P<0.05,P<0.01)。吸入0.5MAC安氟醚麻醉后脑内各区CMGlu计数均显著降低(P<0.05),但以丘脑、扣带回、额叶、楔叶、楔前叶和桥脑更为显著(P<0.01);与0.5MAC时比较,1.0MAC时全脑及脑内各区CMGlu计数均进一步降低(P<0.05),但程度基本一致。结论全脑及脑内各区CMGlu在吸入安氟醚麻醉时均可显著降低,且程度与吸入安氟醚的浓度似乎相关。丘脑、扣带回、额叶、楔叶、楔前叶和桥脑等脑区对安氟醚更为敏感。     

单发脑转移瘤的18F-FDG PET/CT显像特点

目的探讨单发脑转移瘤的18F-FDG PET/CT显像特点,以提高其诊断准确率。方法回顾性分析62例单发脑转移瘤患者的头部18F-FDG PET/CT显像资料,根据最大径将病灶分为1.0cm和≥1.0cm 2组,采用χ2检验比较2组病灶的瘤周水肿及18F-FDG摄取情况。依据CT表现将病灶分为高密度结节、等密度结节及囊性密度结节3种形式,采用χ2检验分析不同CT表现形式病灶的18 F-FDG摄取情况。结果本组62例单发脑转移瘤,发生于幕上52例(52/62,83.87%),幕下10例(10/62,16.13%)。1.0cm和≥1.0cm两组病灶的瘤周水肿差异有统计学意义(χ2=7.414,P=0.006),而18F-FDG摄取差异无统计学意义(χ2=2.647,P=0.104)。不同CT表现形式18 F-FDG摄取情况差异有统计学意义(χ2=14.480,P=0.001);大部分(11/12,91.67%)高密度结节型的病例18 F-FDG摄取不超过2级;而等密度结节型18F-FDG摄取均不低于1级,并以3级居多(17/34,50.00%);56.25%(9/16)的囊性密度结节型表现为18 F-FDG无摄取。结论单发脑转移瘤的18 F-FDG PET/CT表现形式多种多样,掌握其18 F-FDG PET/CT显像特点,有助于提高诊断准确率。     

PET/CT检查注射~(18)F-FDG方法研究

目的比较PET/CT检查经留置针和头皮针注射~(18)F-2-氟-2-脱氧-D-葡萄糖(~(18)F-FDG)的差异,探讨预置留置针用于PET/CT检查的可行性。方法将120例行PET/CT检查患者按检查时间段分为对照组、模型1组和模型2组,对照组按常规方法采用头皮针注射18F-FDG,模型1组和模型2组采用留置针注射~(18)F-FDG,注射前生理盐水冲洗量均为3 mL,注射后分别为5 mL、5mL、10mL,比较三组残留放射性活度;同期选择45例已预置留置针的患者为实验组,采用留置针注射并不拔除留置针,注射前后生理盐水冲冼量分别为5mL、10mL,与对照组比较放射性浓聚、药物污染、受辐射时间的差异。结果对照组与实验组放射性浓聚及药物污染发生率、受辐射时间比较,差异无统计学意义(均P0.05);模型1组残留放射性活度显著高于对照组(P0.05)。结论 PET/CT检查可经预置留置针注射18F-FDG,使用时须增加冲洗管道的生理盐水量。     

11C-acetate and 18F-fluorodeoxyglucose positron emission tomography of pulmonary adenocarcinoma

Positron emission tomography (PET) with 11C-acetate has been recently reported in detection of slow-growing tumors, such as well-differentiated adenocarcinomas of the lung, which are often negative with 18F-fluorodeoxyglucose (FDG) PET. Here we present findings of acetate-PET and FDG-PET in a case of adenocarcinoma that was comprised of peripheral ground glass opacity and solid central components, and was histologically comprised of both a well-differentiated and a moderately-differentiated adenocarcinoma, respectively. Acetate-PET was positive in both components, whereas FDG-PET was only positive in the solid central component. The present case demonstrates the figurative findings of acetate-PET and FDG-PET in lung adenocarcinoma.     

18-fluorodeoxyglucose positron emission tomography in cystic carcinoma of the breast

Cystic infiltrating ductal carcinoma of the breast is uncommon and frequently misdiagnosed because of the predominant cystic presentation clinically. Three premenopausal patients presented with huge cystic breast lesions measuring 10, 19, and 20 cm for 12-, 6-, 10-months duration, respectively. In the first patient, mammography showed a high-density, well-circumscribed huge breast mass, whereas in the other two patients mammography was not possible because of the huge breast size. In all three patients, breast ultrasound showed large cystic lesions suggestive of tumor with central necrosis or bleeding from which a variable amount (270, 1300, 600 ml) of bloody fluid was aspirated, respectively. In the first two patients, cytologic examination of the aspirate showed evidence of malignant cells, whereas the third patient was diagnosed by histologic examination of the cyst wall biopsy. In all three patients, a whole-body positron emission tomography (PET) scan showed intense focal 18-fluorodeoxyglucose (FDG) breast uptake corresponding to the solid component and a ringlike uptake corresponding to the cystic component most likely representing tumor necrosis, hemorrhage, or both. Furthermore, whole-body PET scan was valuable in predicting the response to chemotherapy, characterizing the pelviabdominal mass and detecting the presence of hepatic and spinal metastases in the three patients, respectively. 18-FDG PET scan can help characterize a cystic breast mass by identifying the extent of the cystic and the solid component. It is also useful in staging cystic infiltrating ductal carcinoma by detecting lymph node involvement as well as distant metastases.     

Muscle activity during a dash shown by 18F-fluorodeoxyglucose positron emission tomography

Background ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has been used to examine muscle activity during running. The dash is a basic activity in various kinds of sports but differs from running in terms of intensity and severity. The purpose of this study was to evaluate muscle activity during running at full speed using FDG PET. Methods Six healthy men were investigated during a dash for 10 min after intravenous injection of FDG (37 MBq). Another six healthy men were studied as controls. PET images were obtained 45 min after the FDG injection. Regions of interest were drawn on the anterior and posterior thighs and the anterior and posterior legs. The standardized uptake value (SUV) was calculated to examine the FDG uptake of muscle tissue per unit volume according to an equation. Results In the control group, the mean SUVs of the anterior thigh, posterior thigh, anterior leg, and posterior leg were 0.49 ± 0.04, 0.44 ± 0.02, 0.46 ± 0.05, and 0.44 ± 0.07, respectively. In the dash group, the mean SUVs of the anterior thigh, posterior thigh, anterior leg, and posterior leg were 0.74 ± 0.20, 0.79 ± 0.08, 0.61 ± 0.07, and 0.60 ± 0.08, respectively. FDG accumulation of every one of the four compartments in the dash group was significantly higher than that in the control. FDG accumulation of the posterior thigh was significantly higher than that of the anterior and the posterior leg in the dash group (P < 0.02). Conclusion Based on the results of our investigation, posterior thigh muscles were especially active during a dash.     

18F-fluorodeoxyglucose positron emission tomography influences management decisions in patients with biliary cancer

BACKGROUND: Although (18)F-fluorodeoxyglucose positron emission tomography (PET) has widespread clinical use, its role in cancers of the biliary tract is ill-defined. The aim of this study was to determine if preoperative PET provided additional staging information in patients with biliary tract cancer, beyond that obtained through conventional anatomic imaging. The role of PET in detecting disease recurrence after resection was also examined. STUDY DESIGN: Between March 2001 and October 2003, 126 patients with biopsy-proved or presumed biliary tract cancer (intrahepatic or extrahepatic cholangiocarcinoma and gallbladder carcinoma) underwent PET in addition to standard imaging evaluation. Histologic confirmation of the diagnosis was used as the reference standard with which PET results were compared. Patient followup information and serial imaging were reviewed for progression of lesions detected by PET. RESULTS: Of the 126 study patients, 93 (74%) underwent preoperative staging PET scans, the results of which changed the stage and treatment in 22 patients (24%): 15 of 62 (24%) with cholangiocarcinoma and 7 of 31 (23%) with gallbladder carcinoma. When used to assess for cancer recurrence (n=33), PET identified disease in 86% of patients but altered treatment in only 9%. So, of the entire study group, the findings of PET influenced management in 20% of patients (24% preoperative staging and 9% cancer recurrence). The sensitivity of PET for identifying the primary tumor was 80% overall: 78% for cholangiocarcinoma, 86% for gallbladder carcinoma. CONCLUSIONS: Most biliary tract cancers are (18)F-fluorodeoxyglucose avid tumors. In patients with potentially resectable tumors based on conventional imaging, PET identified occult metastatic disease and changed management in nearly one-fourth of all patients. PET also helped confirm recurrent cancer after resection.     

The influence of 18F-fluorodeoxyglucose positron emission tomography/computed tomography on the N- and M-staging and subsequent clinical management of intrahepatic cholangiocarcinoma

BackgroundIntrahepatic cholangiocarcinoma (ICC) is a highly metastatic cancer. ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) enables sensitive tumor and metastasis detection. Our aim is to evaluate the influence of pre-treatment PET/CT on the N- and M-staging and subsequent clinical management in ICC patients.MethodsBetween August 2010 and August 2018, 660 consecutive ICC patients, without prior anti-tumor treatments nor other malignancies, were enrolled. The diagnostic performance of PET/CT on the N- and M-staging was compared with conventional imaging, and the preoperative staging accuracy and treatment re-allocation by PET/CT were retrospectively calculated. Survival difference was compared between patients receiving PET/CT or not after propensity score matching.ResultsPatients were divided into group A (n=291) and group B (n=369) according to whether PET/CT was performed. Among 291 patients with both PET/CT and conventional imaging for staging in group A, PET/CT showed significantly higher sensitivity (83.0% vs. 70.5%, P=0.001), specificity (88.3% vs. 74.9%, P<0.001) and accuracy (86.3% vs. 73.2%, P<0.001) than conventional imaging in diagnosing regional lymph node metastasis, as well as higher sensitivity (87.8% vs. 67.6%, P<0.001) and accuracy (93.5% vs. 89.3%, P=0.023) in diagnosing distant metastasis. Overall, PET/CT improved the accuracy of preoperative staging from 60.1% to 71.8% (P<0.001), and modified clinical treatment strategy in 5.8% (17/291) of ICC patients, with unique roles in different tumor-node-metastasis (TNM) stages. High tumor-to-non-tumor ratio (TNR) predicted poor overall survival [hazard ratio (HR) = 2.17; 95% confidence interval (CI): 1.49–3.15; P<0.001]. Furthermore, patients performing PET/CT had longer overall survival compared with those without PET/CT (HR =0.74; 95% CI: 0.58–0.93; P=0.011) after propensity score matching.ConclusionsPET/CT was valuable for diagnosing regional lymph node metastasis and distant metastasis in ICC patients, and facilitated accurate tumor staging and optimal treatment allocation.     

Contribution of 18F-fluorodeoxyglucose positron emission tomography to the diagnosis of early pancreatic carcinoma

Background/Purpose  Pancreatic carcinoma has a poor prognosis, and early detection is essential to allow potentially curative resection. Despite the wide array of diagnostic tools available, the detection of small pancreatic tumors remains difficult. The aim of this study was to investigate the contribution of ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) to the diagnosis of early pancreatic cancer. Methods  FDG-PET was performed in 56 patients with pancreatic cancer who underwent curative surgery. The standardized uptake value (SUV) for FDG was calculated in each patient and the relationships between the SUV and various clinicopathological factors were analyzed. Results  The tumors ranged from 0.8 to 6.5 cm in diameter. When the cutoff value for the SUV was set at 2.5, 51 of the 56 patients (91%) had a positive FDG-PET study. The SUV did not show a significant difference in relation to tumor differentiation or pTS and pT factors. There was also no correlation between the SUV and the maximum tumor diameter (r = 0.22; P = 0.1). Five tumors had an SUV below the cutoff value, and all of these lesions had intermediate or scirrhous stroma rather than medullary stroma. Conclusions  These results indicate that FDG-PET is useful for the detection of small early pancreatic cancers.     

Is there a role for positron emission tomography with 18F-fluorodeoxyglucose in the initial staging of nodal negative oral and oropharyngeal squamous cell carcinoma

BACKGROUND: The aim of our study was to assess the value of positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) for the staging of clinically nodal negative necks in oral and oropharyngeal squamous cell carcinoma (SCC) using sentinel lymph node (SLN) biopsy and elective neck dissection (END) as "gold standard" for comparison. METHODS: Twelve patients (10 men, 2 women) with oral or oropharyngeal squamous cell carcinoma and no evidence of lymph node metastasis in the physical and radiologic examinations were eligible. At least 24 hours before surgery PET with FDG were performed. The SLN was localized by preoperative lymphoscintigraphy with 99m-Tc-Nanocoll and intraoperative use of a hand-held gamma-probe and selectively excised. All patients then underwent END. RESULTS: SLN and END revealed occult metastasis in 5 of 12 cases. SLN biopsy was accurately feasible in all 12 patients and diagnosed all 5 cases of occult metastasis (sensitivity and specificity of 100%). PET suggested two patients having occult metastasis, of which one turned out to be false positive (sensitivity 25%, specificity 88%). The mean size of the micrometastasis was 1.4 mm (range, 1.2-1.5 mm). CONCLUSIONS: PET with FDG turned out to have a poor sensitivity and specificity in revealing occult metastasis and has no role for the evaluation of otherwise clinically N0 necks. The failure to detect micrometastasis by PET is due to the technical limitations of resolution (4-5 mm). SLN biopsy, with END in cases of positive SLN, provides a highly accurate staging of N0 necks in oral and oropharyngeal carcinoma. Patients with negative SLN could be spared the risks and the morbidity of END.     

Surgical strategy for aortic prosthetic graft infection with 18F-fluorodeoxyglucose positron emission tomography/computed tomography

A 30-year-old man with Marfan syndrome who underwent Crawford type II extension aneurysm repair about 9 years ago was referred to our hospital with persistent fever. Computed tomography (CT) showed air around the mid-descending aortic prosthetic graft. Because the air did not disappear in spite of intravenous antibiotics, ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) was performed. FDG-PET/CT revealed four high-uptake lesions. After dissecting the aortic graft particularly focusing on the high-uptake lesions, this patient underwent in situ graft re-replacement of descending aortic graft with a rifampicin-bonded gelatin-impregnated Dacron graft and omentopexy. The patient remains well without recurrent infection at 3 months after surgery.