急性颞顶叶局灶性脑梗死后胼胝体DTI变化的初步研究

目的探讨一侧颞顶叶急性脑梗死梗死灶面积与胼胝体不同区域各向异性之间可能存在的变化。资料与方法连续采集病灶位于一侧颞叶、顶叶或一侧颞叶、顶叶均有病灶的急性脑梗死患者资料66例,男38例,女28例。年龄40～85岁,其中40～49岁10例,50～59岁18例,60～69岁20例,70岁以上18例。病灶面积≤200mm2者44例,>200 mm2者22例(剔除)。选取同期连续采集获得的与病变组44例匹配的正常成人作为对照分析组。病变组及正常组均行正中矢状位25梯度方向扩散张量成像(DTI)扫描,在正中矢状位部分各向异性(FA)图上分别测量胼胝体膝部、体部前1/3处、体部中部、体部后1/3处及压部的FA值,测量值进行统计分析。结果在胼胝体体部前1/3处、体部中部及体部后1/3处的FA值均为正常组大于病变组,其中体部前1/3处及体部后1/3处正常组与病变组之间差异存在统计学意义(t=2.838,P<0.05;t=8.223,P<0.05)。病变组胼胝体膝部及压部FA值均大于正常组,两组之间差异均有统计学意义(t=-3.428,P<0.05;t=-2.392,P<0.05)。结论颞顶部发生面积≤200 mm2的急性梗死时...     

MR anisotropy of corpus callosum in patients with focal acute cerebral infarct in the area supplied by unilateral middle cerebral artery

目的:利用MR DWI技术探讨单侧大脑中动脉供血区急性脑梗死时胼胝体各部分各向异性可能存在的变化.方法:连续选取病灶位于单侧大脑中动脉供血区的急性脑梗死患者66例(分为4组)及同期行MRI检查且年龄、性别与病变组匹配的66例40岁以上健康成人作为对照组.应用SSEPI序列行正中矢状面DTI扫描,在FA图上分别测量胼胝体膝部、体部前1/3处、体部中部、体部后1/3处及压部的FA值并进行统计学分析.结果:胼胝体体部前1/3处、体部中部及体部后1/3处的FA值均为正常组大于梗死组,胼胝体体部前1/3处及体部后1/3处的FA值正常组(分别为0.698±0.054和0.769±0.049)与梗死组(分别为0.665±0.049和0.653±0.078)之间差异存在统计学意义(t值为2.697和7.381,P＜0.05).胼胝体膝部及压部FA值均为梗死组(分别为0.780±0.082和0.772±0.049)大于正常组(分别为0.723±0.061和0.748±0.049),且两组之间差异有统计学意义(t值为-3.28和-2.08,P＜0.05).结论:单侧大脑中动脉供血区发生急性梗死时,连接双侧脑半球相应部位的胼胝体体部各向异性值减低,非承担这些脑叶间相互连接功能的膝部及压部各向异性值增高.     

急性单侧大脑中动脉供血区局灶性梗死患者胼胝体各向异性的MRI初步研究

目的:利用MR DWI技术探讨单侧大脑中动脉供血区急性脑梗死时胼胝体各部分各向异性可能存在的变化。方法:连续选取病灶位于单侧大脑中动脉供血区的急性脑梗死患者66例(分为4组)及同期行MRI检查且年龄、性别与病变组匹配的66例40岁以上健康成人作为对照组。应用SSEPI序列行正中矢状面DTI扫描,在FA图上分别测量胼胝体膝部、体部前1/3处、体部中部、体部后1/3处及压部的FA值并进行统计学分析。结果:胼胝体体部前1/3处、体部中部及体部后1/3处的FA值均为正常组大于梗死组,胼胝体体部前1/3处及体部后1/3处的FA值正常组(分别为0.698±0.054和0.769±0.049)与梗死组(分别为0.665±0.049和0.653±0.078)之间差异存在统计学意义(t值为2.697和7.381,P<0.05)。胼胝体膝部及压部FA值均为梗死组(分别为0.780±0.082和0.772±0.049)大于正常组(分别为0.723±0.061和0.748±0.049),且两组之间差异有统计学意义(t值为-3.28和-2.08,P<0.05)。结论:单侧大脑中动脉供血区发生急性梗死时,连接双侧脑半球相应部位的胼胝体体部各向异性值减低,非承担这些脑叶间相互连接功能的膝部及压部各向异性值增高。     

发育迟缓儿童胼胝体的MRI特征

目的探讨磁共振测量胼胝体径线对儿童发育迟缓的评估价值。方法收集120例1~5岁发育迟缓儿童与120例年龄匹配的正常发育儿童的头颅MRI资料,按照生长规律分为6个年龄组,在T_1WI正中矢状面测量胼胝体膝部、体部、压部厚度及胼胝体长度,比较各年龄组发育迟缓儿童与正常儿童胼胝体参数的差异,并通过受试者工作特征(ROC)曲线分析各参数的诊断临界值。结果第1~4年龄组(1~3岁)发育迟缓儿童胼胝体膝部及体部较正常发育儿童变薄(P0.05),胼胝体长度及胼胝体压部厚度在两组之间无明显差异;第5、6年龄组(3~5岁)胼胝体各项参数在病例组与对照组间无明显差异。通过ROC曲线分析第1~4年龄组胼胝体膝部厚度临界值分别为8.1mm、7.5mm、8.9mm、9.2mm,敏感度分别为85.0%、60.0%、75.0%、60.0%,特异度分别为55.0%、95.0%、75.0%、85.0%;胼胝体体部厚度临界值为4.3mm、4.3mm、4.5mm、4.7mm,敏感度分别为65.0%、75.0%、75.0%、50%,特异度分别为80.0%、65.0%、95.0%、90.0%。结论胼胝体膝部及体部的厚度可反映1~3岁发育迟缓儿童脑白质体积变化,胼胝体径线测量有助于该年龄段儿童的发育评估。     

急性脑梗死后胼胝体压部可逆性病变MRI表现(附4例报道)

目的探讨急性脑梗死后胼胝体压部可逆行性病变的发生机制。方法收集4例急性脑梗死后胼胝体压部可逆行性病变患者行MRI检查,结合文献进行分析。结果急性脑梗死后1～2周内胼胝体压部出现DWI呈高信号,ADC低信号的新发病变,临床未见与新发病变相关症状,1～2个月后胼胝体压部DWI高信号病变消失。结论急性脑梗死后可逆性胼胝体病变是华勒氏变性早期改变,其应与脑梗死、可逆性胼胝体压部病变综合征及原发性胼胝体变性等疾病鉴别。     

儿童伴有胼胝体压部可逆性病变的轻微脑炎/脑病的MRI特点

【摘要】目的：探讨儿童伴有胼胝体压部可逆性病变的轻微脑炎/脑病的MRI特点。方法：回顾性分析24例经临床证实的伴有胼胝体压部可逆性病变的轻微脑炎/脑病的MRI表现,分析其影像学特点。结果：24例患儿中Ⅰ型伴有胼胝体压部可逆性病变的轻微脑炎/脑病20例,Ⅱ型4例。Ⅰ型患儿均表现为胼胝体压部椭圆形或圆形病灶,病变边界清楚,无占位效应。Ⅱ型患儿除胼胝体压部受累外,还出现其它部位受累,其中胼胝体膝部受累3例、侧脑室周围脑白质受累2例、半卵圆中心受累1例以及左侧顶叶脑白质受累1例,病灶均表现为T1WI等或低信号,T2WI、T2-FLAIR为稍高信号,DWI为明显高信号,ADC图呈低信号。所有患儿复查时（间隔8～30天）原有病灶完全消失。结论：儿童伴有胼胝体压部可逆性病变的轻微脑炎/脑病头颅MRI表现特异,短期内可完全恢复,以Ⅰ型为常见。MRI能为儿童伴有胼胝体压部可逆性病变的轻微脑炎/脑病的临床诊断及鉴别诊断提供重要依据,避免过度医疗。     

遗传性痉挛性截瘫并薄型胼胝体的MRI表现

目的探讨遗传性痉挛性截瘫(hereditary spastic paraplegia,HSP)伴薄型胼胝体的颅脑和脊髓MRI特征,以期提高对该病的认识。方法回顾性分析5个家系8例临床和遗传学确诊为HSP伴薄型胼胝体患者的颅脑和脊髓MRI资料。分析每例患者的MRI特点,并分别测量胼胝体膝部、体部和压部的厚度,分别在C3和T2水平测量相应平面脊髓的前后径及横径,另选取20例在本院行颅脑平扫MRI及颈椎MRI的正常病例为对照组进行相应测量方法进行比较。结果 8例颅脑MRI均表现为胼胝体变薄,以膝部和体部明显,分别为(2.2±1.6)mm、(2.0±0.9)mm,与正常对照组比较差异有统计学意义(P<0.05);胼胝体压部未见明显变薄(P>0.05);C3、T2脊髓的前后径、横径明显小于对照组(P<0.05)。8例均出现双侧脑室周围白质内及额顶叶深部脑白质对称性异常信号灶,液体衰减反转恢复序列(FLAIR)呈高信号。7例有脑萎缩,7例有颈胸段脊髓萎缩且其中1例胸髓末段显示异常信号灶。结论 HSP伴薄型胼胝体的颅脑和脊髓具有典型的MRI特点,主要表现为胼胝体膝部及体部变薄、脑萎缩、侧脑室周围脑白质内及额顶叶深部脑白质对称性异常信号灶及脊髓萎缩。MRI对临床诊断和鉴别诊断有重要意义,但确诊还需结合临床表现和基因检查。     

正常成人胼胝体膝部及压部磁共振弥散张量成像定量研究

目的 探讨正常成人胼胝体膝部和压部的部分各向异性(FA)值不同年龄及性别间可能存在的差异.方法 连续采集277例健康成人志愿者,其中男119例,女158例,年龄20～81岁,分为20～29岁组(男19例、女19例)、30～39岁组(男26例、女40例)、40～49岁组(男33例、女50例)、50～59岁组(男30例、女35例)及≥60岁组(男10例、女15例)共5组.进行常规磁共振扫描及弥散张量成像,分别测量胼胝体膝部和压部FA值,比较其弥散特征,分析不同年龄和性别间FA值可能的差异.结果 正常成人胼胝体膝部和压部的FA值分别为0.788±0.047、0.796±0.052,膝部显著低于压部(t=-2.148,P=0.033).膝部与压部FA值均为男大于女,膝部FA值男女之间差异无统计学意义(t＝0.346,P＞0.05).压部FA值男女之间差异有统计学意义(t=2.737,P＜0.05).膝部及压部FA值均随年龄的增大逐渐减小,不同年龄组膝部及压部FA值之间差异均无统计学意义(F=0.617,P=0.651;F=1.140,P=0.338).结论 正常成人胼胝体膝部FA值显著低于压部,膝部与压部FA值均随年龄的增大逐渐减小,均为男大于女.     

正常儿童脑白质发育的DTI研究

目的 :用DTI研究正常儿童脑白质发育特点。方法 :收集50例1~12岁健康儿童脑DTI图像,分析第1组(1~3岁)、第2组(4~6岁)、第3组(7~9岁)及第4组(10~12岁)4个年龄组与脑白质内囊前肢、内囊后肢、胼胝体膝部、胼胝体压部及尾状核头部5个部位的各向异性指数(FA)值、ADC值的相关性及差异性。结果:内囊前肢、内囊后肢、胼胝体膝部及胼胝体压部的FA值与年龄呈正相关,尾状核头部的FA值与年龄呈负相关;内囊前肢、内囊后肢、胼胝体膝部、胼胝体压部及尾状核头部的ADC值均与年龄呈负相关。第1、2组间及第2、3组间内囊前肢、内囊后肢、胼胝体膝部及胼胝体压部的FA值、ADC值差异均有统计学意义(均P0.05);第3、4组组间胼胝体膝部及胼胝体压部的FA值、ADC值差异均有统计学意义(均P0.05)。结论:DTI的FA值和ADC值能反映脑白质发育差异。     

多发性硬化的正常表现脑白质的DTI定量

目的：应用磁共振弥散张量成像（DTI）技术，定量研究多发性硬化（MS）患者在常规磁共振上表现正常的脑白质（NAWM），以及探讨其相关的微观病理改变。材料和方法：采用3．0T磁共振仪，对34例Ms患者和25例性别年龄相匹配的正常志愿者均进行DTI检查。分别测量MS组和对照组的9个不同部位脑白质的平均弥散率（MD）和部分各向异性指数（FA值），这9个部位包括胼胝体膝部、体部、压部、内囊后肢、侧脑室旁白质、额叶白质、顶叶白质、枕叶白质以及小脑中脚。比较两组NAWM之间的MD和FA值是否存在差异。结果：MS组的NAWM的MD值均高于对照组（P〈0．05），以胼胝体体部、内囊、侧脑室旁及额叶白质、顶叶白质、枕叶白质更为显著（P〈0．01）；MS组的FA值与对照组比较，胼胝体体部、顶叶白质、额叶白质、枕叶白质及内囊、侧脑室旁发现明显降低（P〈0．05），以后4个部位更为显著（P〈0．01），而胼胝体膝部、压部和小脑结合臂有降低趋势，但无统计学意义。结论：应用DTI定量研究可以探测到多发性硬化的NAWM所出现的微观病理改变，表现为水分子的平均弥散幅度明显升高，以幕上明显，并且胼胝体体部、内囊后肢等白质纤维明显失去正常的方向性。DTI在对白质损伤程度的量化评估中具有重要的价值。     

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.