膝关节色素沉着绒毛结节性滑膜炎并周围组织受累1例

1病例报告患者男,36岁。因右膝关节酸痛及肿胀1年入院。查体:右膝关节肿胀,皮温略高,右膝外下见约3cm×2cm包块,质地较硬,移动性差,关节活动度0~100°,浮髌试验阳性。X线摄片检查:右膝关节周围肿胀软组织影,腓骨小头见一囊状透明区,周围有硬化缘,界限清。CT检查:右膝关节滑膜增厚呈结节状,关节面骨质可见多发弧形吸收区,腓骨头骨质不规则破坏,边缘有硬化带。MRI检查:右膝关节滑膜广泛不规则增厚呈结节状,腓骨小头及临近胫骨平台下缘受累,局部骨质缺损。实验室检查:白细胞8.3×109/L,中性粒细胞0.55;凝血功能正常。关节液穿刺检查:关节液…     

右腓骨下端巨大外生性骨软骨瘤1例

患者,男,46岁,20a前,无明显诱因发现右外踝有一约0.5cm×0.5cm肿物,质硬,无压痛,近2a肿物增长加快,即来我院就诊。查体:右外踝可见一约3cm×3cm×3cm的肿物,质硬,无活动度,无压痛,局部皮肤无红肿,局温不高,右踝关节活动良好。X线摄片检查:右腓骨小头后外可见一约3cm×3cm×3cm的骨样密度影(见图1),其压迫临近之胫骨,底部呈蒂状与骨干相连(见图2)。实验室检查无特殊。讨论骨软骨瘤是较常见的良性骨肿瘤,又称外生骨疣。多发生于10岁～20岁,男女发病率相等,病变多见于四肢长骨的干骺端。单发性者以股骨下端和胫骨上端最为常见。本例发生在腓骨…     

飞行员腓骨下端骨折漏诊1例

1 临床资料 患者,男性,32岁,歼-6飞行员,飞行时间900h。主诉右踝关节疼痛,活动时加重10个月。检查右踝关节表面无红肿、无畸形,外侧有压痛,关节外翻及内翻时疼痛加重。X线检查示:右腓骨下端见一长条形游离骨块,0.8cm×0.3cm大小。诊断:右腓骨下端陈旧性骨折。追问病史于1年前在打篮球时不慎摔倒,当时觉右踝关节疼痛,轻度肿胀,即找航医就诊,按右踝关节软组织损伤对症处理,未予局部X线检查。治疗     

平片诊断尤文氏瘤一例

患者　女 ,16岁。以右大腿及右膝关节间歇性肿痛 1月余 ,逐渐加重变为持续性就诊 ,疼痛夜间加重 ,伴发热 ,最高达39℃ ,曾诊断为“急性骨髓炎”并行切开引流术及抗感染治疗 ,症状无好转。体检 :重度贫血貌 ,右大腿下段皮肤菲薄 ,色泽暗 ,局部肿胀 ,压痛明显 ,局部皮温稍高 ,右大腿下段外侧见一术后愈合瘢痕。实验室检查 :白细胞 11.8× 10 9/Ｌ ,中性粒细胞 0 .6 8,淋巴细胞 0 .15。Ｘ线检查 :右股骨中下段广泛性骨质破坏呈节段性分布 ,骨干中央部及皮质见大范围筛孔状骨质破坏区 ,外缘见葱皮状骨膜增生。右股骨下段干骺端见大范围虫蚀状骨…     

肋骨嗜酸性肉芽肿1例报告

男 ,33岁。深呼吸和右上肢活动时感右上背部疼痛不适 1月余。体检 :一般情况好 ,右肩胛深部轻压痛 ,局部无红肿。实验室检查 :白细胞 9.8× 10 9/Ｌ ,中性粒细胞 0 .61、淋巴细胞 0 .32、嗜酸性细胞 0 .0 7;血沉 2 8ｍｍ /ｈ。胸部后前位Ｘ线片见右第 6后肋骨长约 4ｃｍ溶骨性破坏 ,骨皮质消失 ,无明显骨膜反应 ,其中隐约见分房膨胀性改变及其残留骨影 ,病灶与正常骨组织分界欠清晰 ,病变周围组织密度显示增高 (图 1)。Ｘ线诊断 :右第 6后肋骨溶骨性破坏 ( 1)骨结核 ?( 2 )恶性骨肿瘤 ?胸部ＣＴ平扫见右第 6后肋骨溶骨性破坏 ,呈膨胀性 ,边…     

异位阑尾1例

患者男性,2 4岁。转移性右下腹疼痛2 4小时入院。入院前1天感上腹部持续性胀痛,6小时后疼痛转移至右下腹,伴轻微畏寒、发热,无呕吐、腹胀及腹泻。入院查体:T :38℃,P :82 /min ,BP16 0 / 9.3kPa。腹平坦,未见肠型及蠕动波。麦氏点上方局限性压痛,无反跳痛及肌紧张。肠鸣音正常,实验室检查:血常规:WBC 12 .0×10 9/L ,N 85 %、L 15 % ,大、小便常规正常。诊断:急性阑尾炎。术中探查见盲肠后下端结肠带在盲肠壁的汇聚之点始终未能寻找到阑尾。遂向上延长切口暴露升结肠,在结肠带汇聚点上方约8cm处升结肠带上发现阑尾,长约10cm ,直径0 5…     

酷似肾盂结石的肾盂癌一例

患者　男 ,81岁。因反复血尿 11个月加重 14天入院。 11个月前无诱因出现血尿 ,运动后加重伴血块。自发病以来无畏冷发热 ,无尿频、尿急、尿痛 ,亦无腰痛症状。查体 :一般情况可 ,无特殊发现。实验室检查 :尿ＲＢＣ 15～ 2 0个 /ＨＰ ,ＷＢＣ 0～1个 /ＨＰ。腹部平片及ＩＶＰ见右肾盂内有一直径约 3 .0ｃｍ大小致密影 ,考虑为肾盂结石。ＣＴ平扫 :右肾盂内见一约 3 .0ｃｍ×2 .0ｃｍ× 2 .0ｃｍ边缘光滑的高密度结节影充满右肾盂 ,ＣＴ值10 8ＨＵ ,诊断为肾盂结石 (附图 )。手术所见 :右肾无增大 ,但肾盂扩张 ,其内充满肿物 ,遂切除右肾。术…     

膝部小豆骨骨折1例

患者男,43岁,左膝部被车撞伤1 h入院.体检:左膝关节活动受限,软组织肿胀,皮肤擦伤、渗血,压痛明显,未闻及骨擦音.X线检查:左胫骨平台、腓骨小头见线性骨折,小豆骨分裂成两半,断面锐利,相交呈"<"形(图1).诊断:左胫骨平台、腓骨小头及小豆骨骨折.     

髂窝自发性血肿误诊一例

患者 ,男 ,5 7岁。 40天前患脑梗塞 ,发热、咽痛、咳嗽半天再次入院。体格检查 :精神差 ,发热面容 ,体温 38.5℃ ,血压 2 0 /13 .2ｋＰａ ,心率 72次 /ｍｉｎ ,律齐 ,无杂音 ,咽红 ,扁桃体Ⅰ°肿大 ,双肺呼吸音粗 ,右上肢肌力Ⅰ级 ,右下肢肌力Ⅲ级 ,无病理性反射。实验室检查 :ＷＢＣ 2 6 .6× 10 9/ｌ,ＢＰＣ 110× 10 9/ｌ ,尿粪 ( -)。入院第 12天患者诉右腰及右髋部疼痛。图 1　右髂窝软组织密度肿块 ,中央部密度稍高 ,边界较清 ,右髂肌边界不清 ,右腰大肌受推压前移。Ｘ线平片 :右髂部密度稍增高 ,右髂骨正常。Ｂ超探查 :右髂窝处探及…     

阴沟肠杆菌肺炎1例报告

男 ,5 1岁。以发热 5ｄ ,晕厥半小时主诉入院。患病以来无咳嗽、心悸、气短 ,患Ⅱ型糖尿病 3年 ,尚未治愈。入院时胸片示左肺门见斑点状钙化影 ,余无异常。血常规ＷＢＣ :4.8× 10 9/Ｌ ,Ｎ 0 .94,Ｌ 0 .0 6。 38ｈ后 ,出现咳嗽、咯出棕红色痰 ,伴右胸疼痛 ,畏寒发热 ,下午重。体温在 38℃ 41℃之间。体检 :胸廓呈桶状 ,叩诊过清音 ,双肺未闻及罗音。心脏、腹部正常。纤支镜检查未见异常。胸片示右肺上中野密度不均片状模糊阴影 ,其间见大小不一多数薄壁空洞 ,无液平。左上肺野见密度不均斑、片状模糊阴影 (附图 )。血培养为阴沟肠杆菌生长…     

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.