椎-基底动脉开窗畸形的多层螺旋CT血管成像应用价值

目的探讨多层螺旋CT血管成像(CTA)对椎-基底动脉开窗畸形的诊断价值。方法选取我院1899例行头颈部CTA检查的患者,所有患者均采用本院的256层螺旋CT进行血管成像检查,回顾性分析椎-基底动脉开窗畸形的检出率、发生部位、形态及并发其他血管异常情况。结果1899例头颈部CT血管成像中,检出56例椎-基底动脉开窗畸形(检出率2.9%),其中基底动脉32例(近段15例、中段9例、远段8例)、椎动脉24例(左侧椎动脉15例、右侧椎动脉9例;颅内型5例、颅外型13例、颅内-外型6例);椎-基底动脉开窗畸形按形态可分为裂隙型(14处)、凸透镜型(31处)及重复型(11处);另外,56例椎-基底动脉开窗畸形中,11例伴有动脉瘤。结论多层螺旋CT的血管成像能够准确显示椎-基底动脉开窗畸形的发生部位、形态、毗邻关系,进一步的了解椎-基底动脉的开窗畸形。     

头颈联合CTA在椎基底动脉变异中的应用

目的:分析椎基底动脉变异的CTA表现,提高对椎基底动脉血管变异的认识和临床意义。方法:回顾性分析85例经16排CTA诊断为椎基底动脉变异患者的影像资料,观察椎基底动脉变异的起源、行径、管径异常、重复或开窗畸形、永存胚胎性血管的变异特征,以及是否合并颅内血管畸形或动脉瘤改变。结果:1 268例行头颈联合16排CTA检查的患者中发现椎基底动脉变异85例,其中椎动脉开口起源变异18例,行径变异25例,管径异常19例,重复或开窗畸形20例(合并颅内动脉瘤3例),永存胚胎性血管3例。结论:16排CTA能快速、立体、准确显示椎基底动脉变异及颅内畸形血管合并症。熟悉椎基底动脉变异的CTA特征能为临床治疗提供可靠的影像资料。     

256层CTA诊断头颈部动脉开窗畸形

目的探讨头颈部动脉开窗畸形的影像学特点及其临床意义。方法回顾性分析2011年1月～2011年12月360例头颈部CTA影像资料和临床表现,主要观察动脉开窗畸形的存在及表现。结果 360例中发现动脉开窗畸形18例,其中9例位于椎动脉,5例位于基底动脉,2例位于大脑中动脉;2例位于前交通动脉。根据血管窗大小及形态分型:10例为裂隙型,9例为凸透镜型。所有病例均表现为变异动脉的局限性重复,18例中1例伴有颅内动脉瘤。结论 MSCTA可以准确显示动脉开窗畸形的位置、形态和毗邻关系,有助于指导头颈部血管病变的诊断与治疗,应作为首选检查方法。     

3.0T MRA对头颈部动脉开窗畸形的诊断价值

目的 探讨3.0 T MRI三维时间飞跃法(3D TOF)或增强磁共振血管造影(CE MRA)对头颈部动脉开窗畸形的诊断价值.资料与方法 搜集2007年1月至2008年2月行颅颈部3.0 T MRI 3D TOF或CE MRA检查的患者资料371例,发现18例头颈部开窗畸形动脉,原始和减影图像经工作站后处理,得到容积重组(VR)、最大密度投影(MIP)、薄层最大密度投影多平面或曲面重组(thin slice MIP,TS MIP),比较各组图像对血管异常的显示情况.结果 371例中,头颈部动脉开窗畸形18例(检出率4.9%,18/371),位于基底动脉11例(检出率3.0%,11/371),其中10例位于基底动脉起始处,1例位于基底动脉干;位于椎动脉入颅底段3例(检出率0.8%,3/371);位于右侧大脑前动脉Al段1例;位于前交通动脉1例;位于大脑中动脉2例.18例中,3例(16.7%,3/18)椎基底动脉开窗畸形合并动脉瘤.结论 CE MRA或3D TOF MRA能清楚显示和诊断头颈部动脉开窗畸形这一少见血管异常.     

CTA对颅内动脉开窗畸形的诊断价值

目的 了解颅内动脉开窗畸形的CT血管成像(CTA)表现、检出率以及好发部位,探讨开窗畸形与动脉瘤之间的关系.资料与方法 搜集行颅颈CTA检查的412例患者资料,将原始图像经工作站处理,得到容积重组(VR)和最大密度投影(MIP)图像,综合分析各组图像对于血管异常的显示情况.结果 412例中,颅内动脉开窗畸形41例,共计44处,位于前交通动脉区23处(5.6%),基底动脉区18处(4.4%),椎动脉颅内段2处(0.5%),大脑中动脉1处(0.2%).48例动脉瘤患者的开窗畸形发生率与364例无动脉瘤者的开窗畸形发病率之间差异无统计学意义.结论 CTA可清楚显示颅内动脉开窗畸形,检出率为10.7%(44/412),好发部位为前交通动脉区、基底动脉,开窗畸形与动脉瘤之间并不存在明确的关系.     

椎-基底动脉开窗畸形的MRA诊断

目的 通过对椎-基底动脉开窗畸形磁共振血管造影术(magnetic resonance angiograhy,MRA)图像特点分析诊断该病.方法 回顾性分析1 200例颅脑检查患者的MRA图像,男女各半,年龄36～79岁,平均年龄(54.6±6.1)岁,其原始图像经工作站处理后,对其MRA图像进行观察.结果 共发现8例椎-基底动脉开窗畸形,检出率为0.67％(8/1 200);8例均为单发开窗畸形,无多发;凸透镜形开窗畸形2例,裂隙样开窗畸形2例,梭形开窗畸形4例;男女各半;性别间无明显性差异.结论 MRA可清晰地显示和诊断椎-基底动脉开窗畸形.     

大脑中动脉开窗的CT血管成像诊断

目的:探讨CT血管成像(CTA)在大脑中动脉开窗变异中的诊断价值,提高对该血管变异的认识。方法:搜集2008年1月-2012年2月的3778例患者的CTA资料,将所有原始图像经容积重建(VR)和最大密度投影(MIP)进行三维重建,分析大脑中动脉开窗影像学特点。结果:3778例中发现大脑中动脉开窗6例(男5例,女1例),检出率为0.16%。所有开窗均位于M1段,其中M1段近段5例(4例呈裂隙型,1例呈凸透镜型),中段1例呈凸透镜型。左、右大脑中动脉开窗各3例,且有1例同时合并基底动脉开窗。1例由1支桥血管与大脑中动脉和大脑前动脉近端围成,1例伴有早期颞极动脉的分支起源于开窗的下支血管。6例中1例同时合并左侧大脑中动脉瘤、前交通动脉瘤及基底动脉梭形动脉瘤;1例伴有动静脉畸形(AVM);1例伴有静脉畸形。结论:CTA能快速、直观地显示大脑中动脉开窗变异及其合并的血管性病变,可作为其诊断的首选方法。     

64排头颈CTA对颅内动脉开窗的诊断价值(附50例分析)

目的分析探讨64排螺旋CT血管成像(CTA)对动脉开窗的诊断价值。方法回顾性分析我院收治的50例动脉开窗患者的64排CTA临床资料,分析患者CTA特征及颅内开窗的临床意义。结果 50例颅内动脉开窗患者(单发48例,双发2例)共发现了52处开窗,位于基底动脉20处,前交通动脉18处,椎动脉颅内段7处,大脑前动脉2处(A1段1处、A2段1处),大脑前动脉与前交通动脉复合体2处,大脑中动脉1处,颈动脉1处,大脑后动脉P1段1处。形态呈裂隙状35处(开窗血管长度≤5mm),凸透镜状17处(5mm开窗血管长度≤12mm)。伴有6例动脉瘤患者的开窗发生率与44例无动脉瘤患者的开窗发生率相比差异无统计学意义。52处开窗CTA均能从多角度清晰显示它们的位置、形状及其与邻近结构的关系。结论 64排CTA可无创诊断动脉开窗,可提高经血管颅内动脉介入治疗或头颈联合区手术的成功率。     

椎基底动脉夹层瘤的影像学特征和介入治疗策略

目的　总结椎基底动脉夹层瘤的影像诊断和介入治疗经验。方法　收治临床表现为蛛网膜下腔出血 ,小脑梗死或基底动脉供血不足的椎基底动脉夹层患者 4 8例 ,全部病人进行DSA ,部分作CTA或MRA。 4例患者行单纯口服抗凝治疗 ,6例行血管内孤立治疗 ,4例行单纯血管内支架植入治疗(其中 2例行双支架植入 ) ,34例行支架植入加弹簧圈栓塞治疗。结果　无患者出现严重并发症或再次出血 ,椎基底动脉供血不足者临床症状明显改善 ,无手术死亡病例。结论　椎基底动脉夹层瘤好发于椎动脉PICA上段 ,内膜剥脱造成的血管内充盈缺损、血管狭窄和膨大相混杂呈串珠状或血管线样狭窄、偏心性动脉瘤为椎基底动脉的主要影像学特征。治疗策略应根据临床症状、夹层瘤的部位、形态及其与周围分支的关系而确定。对影像表现为血管轻度狭窄的缺血性颅内外夹层瘤可行药物抗凝治疗 ;对狭窄较重 ,尤其是累及基底动脉者可行支架植入。对出血的颅内夹层瘤均应手术治疗 :非供血主干侧PICA上段或PICA下段夹层瘤可行血管内隔绝 ;与PICA或前脊髓动脉毗邻者行支架植入加弹簧圈栓塞 ;累及PICA或前脊髓动脉者行近端闭塞 ,支架植入或外科手术治疗。优势供血侧或侧支循环不足的椎基底动脉夹层瘤应作支架植入加弹簧圈栓塞治疗。随着支架性能的不断改进     

头颈CTA对椎基底动脉变异的诊断价值

目的 :探讨头颈CTA对椎基底动脉变异的诊断价值及临床意义。方法 :回顾性分析43例在我院经DSA检查证实为椎基底动脉变异的临床资料,所有患者均行CTA检查,并以DSA为诊断标准,评价头颅CTA对椎基底动脉变异诊断的准确性。结果:43例中,CTA示9例椎动脉起始于主动脉弓,椎动脉行径变异13例,椎动脉管径变异9例,单侧椎动脉开窗畸形5例,双侧椎动脉开窗畸形1例,永存胚胎性血管6例,与DSA检查结果完全一致。结论:头颈CTA在椎基底动脉变异的诊断方面与DSA结果无异,且CTA更具安全性,能为临床治疗干预提供可靠的影像资料。     

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.