多层螺旋CT尿路造影在重复肾盂输尿管畸形诊断中的应用

泌尿系统先天发育异常中重复肾盂输尿管畸形发病率较高,传统的B超及静脉尿路造影(IVP)在该类疾病的诊断方面积累了许多经验.     

64层容积CT尿路造影对泌尿系统先天畸形的诊断价值

目的 探讨64层容积CT尿路造影(VCTU)对泌尿系统先天畸形的诊断价值.资料与方法 66例经手术、输尿管镜或临床证实的泌尿系统先天畸形患者行VCTU检查,并行容积再现(VR)、最大密度投影(MIP)、多平面重组(MPR)及曲面重组(CPR)后处理,获得尿路重建图像.结果 66例患者中(2例为多发畸形),肾盂输尿管重复畸形32例,马蹄肾7例,肾旋转不良6例,肾盏憩室5例,先天性肾盂输尿管连接处狭窄5例,先天性巨输尿管1例,输尿管开口异位1例,腔静脉后输尿管1例,输尿管囊肿3例,膀胱憩室7例.VCTU图像清晰、立体感强,可多角度观察尿路,诊断正确率达100％.结论 VCTU通过VR、MIP、MPR、CPR图像能准确显示泌尿系统先天畸形及其伴发病变,提高了病变检出率和诊断正确率,可作为诊断泌尿系统先天畸形的首选方法.     

CT尿路造影时患者的辐射剂量与风险评估

CT尿路造影(computed tomography urography,CTU)较泌尿系统其他影像检查方法具有更高的组织结构分辨能力和更清晰的三维影像效果,而且检查过程还具有无痛、快捷的特点,因此,被广泛用于临床泌尿系统及相关腹部疾病的影像学诊断,成为泌尿系统疾病首选的"一站式"影像学检查方法和评估诊断的金标准[1].CT尿路造影是采用大范围、重复多次并涉及照射人体辐射敏感部位(生殖腺)的高剂量薄层扫描方式,患者接受的辐射剂量居泌尿系统X线检查方法的首位,因此,在考虑到优越的影像诊断收益的同时,患者在检查中所接受的辐射剂量及所产生的伤害亦不容忽视.为此,笔者针对CTU检查时患者接受的辐射剂量与危险进行了测量与评估.     

附加肾的多层螺旋CT诊断二例

附加肾是泌尿系统中最罕见的畸形之一,文献报道不超过100例.以往影像诊断手段主要依靠B超及静脉肾盂造影(IVP),临床检出率极低,术前诊断非常困难.笔者搜集2004年4月至2006年2月间经多层螺旋CT尿路造影(MSCTU)诊断,手术及病理证实的附加肾2例,探讨MSCTU在诊断附加肾方面的价值.     

MSCT尿路成像在小儿先天性上尿路畸形的诊断价值

在泌尿系统疾病的影像学诊断中,CT一直占有非常重要的地位,传统的诊断方法如B型超声、X线、排泄性静脉尿路造影(IVU)及逆行尿路造影(RGU)等对小儿复杂泌尿系畸形的解剖形态、泌尿系功能及病因学诊断上存在很大局限性,往往需要CT检查以获得确定性诊断,为手术方案的制订提供帮助.本文着重探讨多层螺旋CT尿路成像(multi-slice spiral CT urography, MSCTU)在诊断小儿先天性泌尿系畸形方面的临床应用价值.     

多排螺旋CT泌尿系统造影诊断上尿路疾病的临床价值

多排螺旋CT泌尿系统造影(multi-detector CT urography, MDCTU)是注射造影剂几分钟待集合系统充盈后行薄层扫描,通过三维重建得到与静脉尿路造影(intravenous urography, IVU)类似的影像的方法,结合了IVU和CT的优点,弥补了相互的不足.目前关于MDCTU对上尿路病变的临床价值多是描述性,本研究将采用半定量的方法,通过探讨延迟期扫描及三维重建的作用,评价MDCTU诊断上尿路疾病的临床价值.     

磁共振尿路造影在肾积水中的诊断价值

常规静脉尿路造影(intravenous urography,IVU)一直是泌尿系统检查的主要方法[1]。近年来,其它影像学检查方法如超声、CT及MR等已越来越多地应用于泌尿系统检查,并能弥补IVU检查方法中的一些不足,但这些方法也均有一定的局限性。MR应用于尿路造影只有十几年时间,但已显示出较大的优势。磁共振尿路成像有2种成像方法:一是基于重T2权重像的非增强MR尿路造影(MR urography,MRU);一是增强后的MR静脉尿路造影(MR intravenous urography)[2]。本文主要评价非增强MR尿路造影(MRU)在尿路梗阻中的诊断价值,同时与超声、IVU及CT等成像方…     

螺旋CT尿路造影和静脉尿路造影诊断泌尿系梗阻性的临床分析

目的探讨螺旋CT尿路造影(MSCTU)和静脉尿路造影(IVP)技术在泌尿系梗阻性疾病诊断中的效果。方法对40例泌尿系梗阻性疾病患者,均接受螺旋CT尿路造影和静脉尿路造影技术检查。结果 40例患者顺利完成检查,与病理结果比较,螺旋CT尿路造影检出25例泌尿系结石、5例肿瘤、6例尿路狭窄、4例输尿管畸形,诊断符合率为100.00%,静脉尿路造影检出19例泌尿系结石,1例肿瘤,1例尿路狭窄,4例输尿管畸形,诊断符合率为62.50%;螺旋CT尿路造影对梗阻性积水显示准确率100.00%,较对照组的80.00%显著提高,差异存在统计学意义(P0.05)。结论螺旋CT尿路造影诊断效果优于静脉尿路造影技术,从定位、定性不同角度观察病变部位及周边情况。     

动态静脉尿路造影及MSCT尿路成像联合应用对泌尿系先天性畸形的诊断价值

目的:探讨动态静脉尿路造影(DIVU)及MSCT尿路成像(MSCTU)对泌尿系先天性畸形的诊断价值。方法:46例患者行DIVU检查,对尿路显影不良或需进一步明确诊断的12例再行MSCTU。结果:DIVU及DIVU后MSCTU联合诊断泌尿系先天性畸形46例,其中肾盂输尿管交界处狭窄12例,肾盂与输尿管重复畸形15例,输尿管囊肿7例,腔静脉后输尿管3例,肾融合畸形3例,肾发育不全2例,单侧肾缺如1例,异位肾1例,巨输尿管1例,膀胱憩室1例。结论:DIVU及MSCTU联合应用可明显提高先天性泌尿系畸形的显示率、诊断率。     

肾盂输尿管重复畸形的影像学评价

目的:分析肾盂输尿管重复畸形的影像学表现,评价各种影像学检查方法的诊断价值。方法:回顾分析13例经手术病理证实肾盂输尿管重复畸形的影像学资料(其中1例为双侧),13例均行静脉肾盂造影(IVU)和MRI平扫及磁共振水成像(MRU),其中4例行逆行造影,5例行CT扫描。结果:13例共14只肾盂输尿管重复MRI均能诊断,仅其中2例输尿管无积水扩张者未显示重复输尿管之汇合处,诊断准确率84.6%(11/13);13例IVU明确显示4例重复畸形,2例延迟显影才能诊断,6例肾盂输尿管重复未显影未能明确诊断,1例双侧重复畸形仅显示其中1侧,诊断符合率46.2%(6/13);4例逆行造影显示2例,1例输尿管下端肿瘤梗阻,另1例完全重复输尿管异位开口均插管失败,成功率50%(2/4);5例CT明确诊断4例,1例上段肾盂囊状扩张无肾盏误诊为囊肿,诊断符合率80%(4/5)。结论:肾盂输尿管重复畸形类型多样,依有无并发症而病理和影像不一,各种影像学检查方法各有其利弊,肾功能不良或伴输尿管异位开口者以CT和MRI结合MRU较适合。     

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.