婴儿肠旋转不良合并中肠扭转X线诊断

目的：评价腹部平片对婴儿肠旋转不良合并中肠扭转的诊断价值。材料与方法：经手术证实的婴儿肠旋转不良合并中肠扭转共１６例,结合手术＝病理回顾性分析其腹部平片表现。结果：（１）十二指肠完全性梗阻１６例,呈双球征１３例,三球征３例。（２）管状充 、狭细短跨度伴肠壁增厚肠段１５例。局限于右中上腹９例,中上腹５例,左上腹１例。（３）广泛充气扩张管形壁厚肠段,腔内有浅液面,类似小肠低位梗阻１例,结论：腹部平片简     

先天性肠旋转不良：附56例报告

本文分析了手术证实的先天性肠旋转不良56例。临床主要症状是在新生儿期呕吐胆汁,腹部平片以十二指肠部分性梗阻为重要表现,胃肠钡餐和钡剂灌肠检查显示下例X 线征象之一即可确诊本病:(1)十二指肠空肠连接处位置异常;(2)部分病例显示十二指肠空肠沿中腹部呈螺旋形下降(伴中肠扭转X 线征象);(3)空肠位于右上腹或全部小肠在右腹部;(4)肓肠异位。本文还讨论了本病胚胎学、病理和合并畸形等问题。     

婴儿肠旋转不良影像学检查的探讨

目的:探讨婴儿肠旋转不良影像学检查的价值.方法:回顾性分析41例经手术证实的婴儿肠旋转不良患者的病例资料.所有病例均摄腹部平片,16例行钡剂灌肠,18例行钡餐检查.结果:腹部平片显示十二指肠部分性梗阻32例,双泡征13例,小肠低位梗阻并腹腔积液3例,未见明显异常3例.钡剂灌肠显示阑尾位于右上腹10例,右中腹1例,左上腹4例,1例位置正常;与手术中记录的阑尾位置比较,诊断符合率较低(28.6%,4/14).钡餐检查显示十二指肠水平段及其近端扩张、梗阻,扩张远端呈鼠尾状改变6例,其中2例显示为完全性梗阻;十二指肠空肠曲位置异常11例;十二指肠螺旋型下降13例;空肠位于右侧腹9例,位置正常1例.结论:在肠旋转不良影像学检查中,腹部平片能提供肠道气体的异常信息,可作为本病的首诊检查方法;钡剂灌肠虽然可显示阑尾位置异常,但诊断准确性低,胃肠钡餐检查可显示十二指肠的位置和形态,是确诊本病的较好影像学方法.     

成人肠旋转不良及Ladd带致中肠扭转与十二指肠梗阻:病例报告与文献复习

目的探讨成人肠旋转不良及Ladd带致中肠扭转与十二指肠梗阻的临床表现、影像特征及鉴别诊断。方法分析1例成人肠旋转不良及Ladd带致中肠扭转与十二指肠梗阻病人的临床及影像资料,并复习相关文献。结果 CT平扫示胃及十二指肠上段、降段扩张,水平段管腔局部狭窄。CT血管成像示局部肠系膜及肠管围绕肠系膜上动脉顺时针旋转,呈"漩涡征"。手术证实为成人肠旋转不良及Ladd带致中肠扭转与十二指肠梗阻。结论成人肠旋转不良及Ladd带致中肠扭转与十二指肠梗阻为一种罕见疾病,其临床表现缺乏特异性,术前误诊率较高,影像检查具有一定提示作用,大多需手术证实。     

超声在诊断小儿肠旋转不良并中肠扭转中的应用

目的:探讨肠旋转不良并中肠扭转的超声表现。方法:回顾性分析我院2012年8月至2013年12月经手术证实的30例肠旋转不良并中肠扭转患儿的超声声像图。结果:超声疑诊肠旋转不良并中肠扭转30例,手术证实均为肠旋转不良伴肠扭转,其中肠管坏死穿孔1例,合并肠重复畸形1例,合并十二指肠隔膜1例。结论:"漩涡征"可作为超声提示肠扭转的依据,CDFI示漩涡征中心为动脉样频谱,周围见由内向外顺时针旋转的血流信号。腹部彩超是诊断肠旋转不良合并中肠扭转的首选检查方法。     

非新生儿小儿肠旋转不良的影像诊断价值

目的探讨非新生儿小儿肠旋转不良(malrotation of intestine)的影像表现,提高对本病的认识及诊断水平。方法回顾分析18例经手术证实的非新生儿小儿肠旋转不良的X线及CT表现,18例均行CT检查,其中10例行上消化道造影,11例行钡剂灌肠,另有8例行增强CT扫描。结果上消化道造影示十二指肠不完全梗阻6例;钡灌肠示回盲部位于右上腹2例,中上腹4例,左上腹3例;CT显示肠系膜根部类团块影,5例增强扫描可见典型"漩涡征",提示伴有中肠扭转,毗邻肠袢扩张,肠系膜静脉不同程度淤积扩张,18例患儿术前及术后均诊断为肠旋转不良,诊断准确率为100%。结论上消化道造影、CT平扫及增强扫描对非新生儿小儿肠旋转不良的诊断具有重要价值,对于不明原因的反复呕吐及腹痛的患儿应及时对其进行上述影像学检查。     

成人中肠旋转异常二例

中肠旋转异常婴幼儿多见 ,而成人罕见。笔者遇见 2例报告如下。例 1　男 ,5 3岁。恶心、呕吐 1月余。近来呕吐呈喷射状 ,伴上腹部疼痛 ,吐出草绿色水样物。胃镜见胃底、胃体糜烂性胃炎 ,病理诊断为胃多发性小溃疡。立位腹部平片见上腹部双泡征 ,中下腹少量肠腔积气。钡餐检查见胃、十二指肠明显扩张 ,十二指肠水平段远端梗阻 ,粘膜纹呈锥状 ,肠管径越来越细 ,考虑胃、十二指肠扩张 ,肠梗阻、先天畸形可能 (图 1、2 )。手术见胃、十二指肠水平段屈氏韧带处 (Ｔｒｅｉｔｚ)小肠系膜根部 180°扭转 ,回盲部阑尾位于右上腹 ,行肠系膜粘连剥离 ,…     

超声对先天性肠旋转不良并中肠扭转的诊断价值

目的:探讨超声对先天性肠旋转不良并中肠扭转的诊断价值。方法:收集42例先天性肠旋转不良患儿的临床资料,并将超声诊断结果与手术结果进行对比分析。结果:42例中,36例合并中肠扭转(85.7%)。超声诊断肠旋转不良34例(均合并中肠扭转),敏感度94.4%(34/36);漏诊8例;6例未合并中肠扭转的患儿超声未检出。结论:彩色多普勒超声可通过显示肠系膜上动脉与肠系膜上静脉的位置关系,以及中上腹部螺旋状的软组织团块影对该病作出明确诊断,可作为术前诊断的首选检查方法。但对不合并中肠扭转的肠旋转不良患儿,超声诊断能力有限,需结合X线造影等其他检查协助诊断。     

孪生儿肠旋转不良

例 1　男 ,5天 ,孪生儿之年长者 ,早产。出生后间歇性呕吐 ,量少 ,含胃内容物。第 4天腹胀明显 ,排出少量胎便。腹部仰卧位平片见胃充气扩张 ,小肠肠管内未见气体。胃肠造影见胃体增大 ,3 0 %泛影葡胺 10ｍｉｎ后未进入十二指肠水平部。即行剖腹探查 ,见胃扩张 ,十二指肠降段被索带压迫 ,小肠系膜发育差。术后复查腹部平片 ,小肠肠管内均匀充气 (图 1～ 3 )。例 2　男 ,5天 ,孪生儿之年幼者 ,早产。症状、腹部平片及胃肠造影结果与例 1相似。剖腹探查见十二指肠降段被粘连的索带压迫成角 ,肠系膜根部较狭窄。讨论　新生儿先天性肠旋转不良是…     

坏死性小肠结肠炎(NEC)中肠袢固定征的一种新原因探讨

NEC是一种新生儿时期重症疾病。肠袢固定征是指某一肠管在24～36小时以上其外形和位置相对无变化。越来越多的人认为此征象的出现提示肠管坏死有进展并将穿孔,是立即手术的指征。作者报导一例NEC所呈现的肠袢固定征是继发于粘连梗阻所致扩张的肠管。女婴,足月顺产,生后24小时患儿开始呕吐,粘稠血便3次,腹部X线片示肠管过度充气,随访腹部X线片显示肠管过度充气明显好转;第3天患儿肠管充气分布正常,但仍有血便;腹平片示近端空肠以下没有气体,中腹部可见     

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.