胃肠道穿孔患者采用腹部平片与多层螺旋CT诊断的临床效果对照研究

目的 比较多层螺旋CT与腹部平片诊断胃肠道穿孔患者的临床效果.方法 研究对象来源于收治的胃肠道穿孔患者45例,均采用多层螺旋CT与腹部平片诊断,比较两种方式的诊断效果.结果 45例患者接受腹部平片检查后提示胃肠壁均为阴性,游离气体检出率为60.0%,CT检出率为93.3%,对比有显著性差异(P<0.05);CT诊断胃肠道穿孔部位与原因的准确率为86.7%,显示征象为腹腔积液征与脂肪间隙密度提升.结论 多层螺旋CT诊断胃肠道穿孔患者相较于腹部平片临床准确度更高,值得推广.     

食管穿孔:28例X线检查

食管穿孔的早期正确诊断,对治疗与减低死亡率是十分重要的。作者报告28例成人食管穿孔(1972—1976)不包括吻合口瘘,其中21例是由医疗器械插入所致,3例为自发性,4例由食管旁手术所致。穿孔部位;颈段7例,胸段18例,腹段3例。最常见的症状为疼痛(86%),尤在吞咽时,疼痛部位并不一定与穿孔部位相一致,75%病例伴有发热。X 线检查应包括颈、胸、腹部。平片表现为颈、纵隔气肿,纵隔影增宽,气胸、胸腔积液,膈下游离气体等。有一个或一个以上X 线征者25例(89%),仅3例平片检查对诊断无帮助。26例作食管吞钡检查,除5例未发现漏孔外,21例均确诊穿孔的部位与扩散的范围。未发现漏孔的原因之一为局部炎症反应致漏孔封闭。不同部位的穿孔,其X 线征象也各有特点;颈段穿孔平片常见气肿局     

非创伤性下消化道穿孔的急诊影像学研究

目的:回顾性分析经手术证实的下消化道穿孔患者的影像资料,探讨急诊非创伤性下消化道穿孔的影像学诊断方法。方法:收集2005年～2007年我院经手术证实的57位下消化道穿孔患者的影像资料,包括立位腹平片、MSCT平扫或增强扫描及超声成像,所有影像学检查均在手术前24h内完成。以手术及术后病理所见为参考标准,评价立位腹平片、MSCT及超声影像诊断下消化道穿孔的准确性。结果:该组病例中有29例患者在手术前行立位腹平片检查,仅7例(24.1%)出现膈下游离气体。37例患者在手术前腹部超声检查,仅8例(21.6%)发现腹腔内游离气体,这8例患者中有4例(50%)经超声明确诊断了穿孔部位。10例患者在手术前行MSCT腹部平扫或增强扫描,9例患者(90%)的CT影像发现了腹腔内游离气体,其中有8例患者(88.9%)明确了穿孔部位。MSCT平扫或增强扫描发现下消化道穿孔所致腹腔内游离气体准确性明显优于X线立位腹平片(P=0.001)及腹部超声(P<0.001)。MSCT发现下消化道穿孔位置的能力较腹部超声(P=0.08)优越性不明显。结论:急诊腹部MSCT扫描能够准确发现下消化道穿孔所致腹腔内游离气体。     

螺旋CT对急性胃肠后壁穿孔的诊断价值

腹部平片(腹部立位片、腹部侧卧位片)是诊断急性胃肠穿孔的首选检查方法,但对网膜囊包裹的气体显示不佳,确定诊断较难,甚至无任何阳性发现。笔者搜集我院2003~2005年12例急性胃肠后壁穿孔患者,且全部经手术证实,对其螺旋CT资料进行回顾性分析,以探讨螺旋CT在诊断急性胃肠后壁穿     

X线与CT在诊断胃肠道穿孔中的对比分析

胃肠道穿孔是常见的外科急腹症,早期明确诊断至关重要[1]。腹部X线平片是胃肠道穿孔的传统诊断方法,简便、经济而直观,以观察膈下、腹壁下有无游离气体为主要诊断依据,但其准确性有限,并不能准确判断胃肠道穿孔的部位[2]。我院将CT应用于胃肠道穿孔的诊断中,取得良好效果．现报告如下。     

螺旋CT对胃肠道穿孔的诊断价值

胃肠道穿孔是严重的急腹症,早期、准确地诊断对临床治疗及预后非常重要。常规X线平片能显示膈下游离气体,但当腹腔内游离气体较少以及肠气较多时难以发现。螺旋CT扫描速度快,密度分辨力高,在穿孔部位、病因等。可为临床提供更详细的资料口引。笔者回顾分析我院经手术病理证实的19例胃肠道穿孔患者的螺旋CT表现,探讨螺旋CT扫描对胃肠道穿孔的诊断价值。     

肠气囊肿症1例

<正>女,81岁,无明显诱因出现腹胀,伴恶心、呕吐数次,为胃内容物,间断有上腹部不适,无明显腹痛,急诊入院,行腹部立位平片(图1a)及CT检查(图1b),提示:上消化道穿孔可能性大;腹腔多发小肠肠管扩张积气。实验室检查相关指标均正常,且无消化道穿孔的症状及体征支持,临床以腹胀待查,间位结肠急诊留观。开塞露通便后临床症状缓解,自行离院。4 d后患者腹胀加重,间断恶心,无呕吐,复查腹部立位平片(图1c),考虑消化道穿孔、肠麻痹,与4 d前对比加重,为进一步观察     

CT在急性胃肠穿孔中的诊断价值

胃肠道穿孔在急腹症中较常见，根据其典型的临床症状、体症和腹部立位X线平片即可诊断，但在不典型患者则需要CT予以协助检查诊断。     

食管病变在胸部平片上的表现

如不认识食管病变在胸片上的表现,可造成解释错误,作者列举7种食管疾病。(一)食管损伤:75%为器械伤,还有吃入异物引起食管梗阻或穿孔;化学性烧伤尤其碱性烧伤导致食管溃疡穿孔或狭窄;当病人发生喷射性呕吐同时有腔内压突然升高可造成远侧段食管破裂,出现Boerhaave 综合征。提示食管穿孔、纵隔炎与纵隔脓肿的平片征象有纵隔气肿、颈深部气肿与皮下气肿;纵隔软组织面消失;纵隔增宽;界限不清的纵隔肿块及液平     

螺旋CT在胃肠道穿孔中的诊断价值

目的:评价胃肠道穿孔的螺旋CT诊断价值。方法:33例经手术证实的胃肠道穿孔患者中,术前行腹部平片检查者28例,腹部CT扫描者33例。回顾性分析其CT表现,比较两种检查方法的诊断结果。结果:本组中X线平片和CT显示腹内游离气体的阳性率分别为71.4%(20/28例)和90.9%(30/33例),差异有显著性意义(P<0.05)。CT显示腹内游离气体呈新月状或小气泡影(n=30),胃肠穿孔处周围局限性积液或蜂窝组织炎(n=21),阑尾周围脓肿(n=4),肠梗阻(n=8),胃肠壁增厚(n=16),胃肠壁肿块(n=2),少量腹水(n=5)。术前CT对胃肠道穿孔病因诊断的符合率为87.9%(29/33)。结论:螺旋CT对诊断胃肠道穿孔及其病因和并发症有明显优势。     

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.