狭颅症的影象诊断方式和手术与病理的相互关系

作者分析了36例疑为狭颅症而行颅骨切开术病儿的影象学诊断资料,年龄1周至24个月,均摄了头颅平片,7例作了核素闪烁摄影,15例作了CT。     

狭颅症的影像学诊断

目的:探讨狭颅症的X线、CT和MRI表现以及不同影像学检查方法对本病的诊断价值。方法:回顾性分析5例狭颅症患者的临床及影像学资料,包括X线、CT和MRI。结果:5例狭颅症,1例表现为舟状头畸形,2例表现为尖头畸形,2例表现为短头畸形,5例均可见脑回压迹加深,4例可见蝶骨体前移及眼眶变浅,1例尖头畸形CT扫描可见幕上脑室扩大,1例短头畸形CT扫描示颅骨内板呈波浪状凹陷,视神经孔变窄,双侧眼球明显突出,MRI扫描示双侧脑室轻度扩大,后颅窝显示狭窄,中脑导水管及四脑室轻度受压,后移。垂体变薄。结论:狭颅症影像学表现极具特征性,X线片具有较高诊断价值,CT和MRI对判断颅内继发改变和鉴别诊断具有一定价值。     

双侧额顶大骨瓣切除治疗狭颅症30例

采用双侧额顶大骨瓣切除术治疗狭颅症肢体中枢性瘫痪３０例,并与颅缝再造效果３０例对比,现报告如下。１临床资料选两所医院１９８７～１９９５年狭颅症６０例,大骨瓣切除组与颅缝再造组各３０例,男性各１９例,女性各１１例,年龄均为２～４岁。２手术方法以双侧运动...     

125I粒子植入治疗胃癌有效性与安全性评价

目的 探讨125I粒子组织间植人治疗胃癌的有效性及该方法能否提高患者生存率.方法 选取同时期Ⅱ、Ⅲ期胃癌患者76例,按单纯随机分为根治性手术组(34例,仅行根治性手术,D2、D3术式)和根治性手术+125I粒子组(42例,行根治性手术+125I粒子治疗).治疗效果分CR(治疗后肿瘤完全消失达1个月以上)、PR(肿瘤较治疗前缩小50％以上至少1个月)、NC和PD,CR+PR为治疗有效,据此计算有效率.随访并计算患者生存率及并发症发生情况.率的比较采用x2检验.结果 根治性手术组总有效率50.00％ (17/34),根治性手术+125I粒子组总有效率为73.81％(31/42),2组差异有统计学意义(x2=4.578,P＜0.05).根治性手术+1251粒子组3年和5年生存率分别为61.90％(26/42)和42.86％ (18/42),均高于根治性手术组[11.76(4/34)和0(0/34)；x2=19.771和19.094,均P＜0.001].2组毒性和不良反应均较少.结论 根治性手术+125I粒子植入治疗Ⅱ、Ⅲ期胃癌较单纯根治性手术更有效,能进一步提高远期生存率,不良反应少.     

脑室-腹腔分流手术用于正常颅压性脑积水患者治疗临床观察

目的观察分析脑室-腹腔分流手术用于正常颅压性脑积水患者治疗的临床疗效。方法选取从2011年2月-2013年2月间收治的正常颅压性脑积水患者共62例,采用脑室-腹腔分流手术,对临床资料进行分析。结果入选患者的总体治疗有效率84．7％,临床效果较为满意,其中患者的分流手术时期选择对于患者的治疗有效率有显著性影响,发病到采取分流手术治疗少于3个月的患者,其治疗有效率为90．3％,明显要高于超过3个月患者的79．1％,两组患者具有显著性差异（P〈0．01）。结论脑室-腹腔分流手术用于正常颅压性脑积水患者能够取得满意临床效果,并且患者在发病后的3个月内进行手术治疗能够取得更好的手术效果。     

狭颅症的影像学表现

目的探讨狭颅症的X线、MRI表现及其诊断价值。方法回顾性分析15例狭颅症患者的影像学表现,全部行X线检查,11例行MRI检查。结果 X线表现:头颅前后径和横径变短,垂直径过长;脑回压迹明显增多、加深,颅壁薄而密度低,呈鱼鳞状;颅底下陷,后颅凹深而短。MRI表现:11例后颅窝深而短,5例示侧脑室轻度扩大,胼胝体发育不良、变薄5例,2例伴脑穿通畸形。结论狭颅症影像学表现极具特征性,X线平片具有较高诊断价值,MRI对判断颅内继发改变和鉴别诊断具有一定价值。     

胼胝体前部切开治疗顽固性癫痫50例临床分析

本文采用胼胝体前部切开术治疗顽固性癫痫50例;其中癫痫性慢性精神病者19例,加作扣带回部分毁坏术。手术无死亡及严重并发症,手术总有效率为88％。讨论了手术治疗顽固性癫痫的机理,手术适应证及如何施行手术等。     

颅骨血管瘤(附11例报告)

颅骨血管痛约占骨肿瘤的0.2％,但它在引起颅骨破坏性病变中占有较大比例,约10％左右。虽称血管瘤,但无真正原肿瘤细胞,胡非真性肿瘤。它的临床过程兼有良恶性肿瘤特点,且可引起颅神经症状,颅压增高症状等,所以对本病及时诊断和术前辩证,对手术方式的决定及治疗效果至关重要。就西安医大一院9例、阜宁县第二人民医院1例、佳县医院1例,共11例均经手术病理证实者进行分析;以期进一步提高颅骨X线平片对本病的诊断水平和临床疗效。     

儿童组织细胞增生症X颅骨病变的影象学诊断

分析儿童组织细胞增生症X颅骨病变的影像学表现和特点，并结合病理阐述其在临床诊断中的价值。材料和方法：回顾性分析经病理证实的儿童组织细胞增生症X伴颅骨破坏者21例，其中男性16例，女性5例。年龄从8个月～9岁，平均3．8岁。除X线平片外，13例还进行了CT扫描，其中单纯平扫5例，平扫＋增强8例。结果：21例颅骨破坏中，颅顶部破坏20例，占95％；颅底部9例，占42．9％；眼眶7例，占33．3％；面颅骨3例，占143％。结论：本症颅骨病变在X线影像学上有较特殊的表现，是临床诊断和鉴别诊断的重要手段，有时甚至可起到决定性的作用，并能有助于观察疗效，了解有无复发等。     

ICU重症病人应用经皮气管切开术的临床分析

目的 探讨应用经皮气管切开术对ICU重症患者建立人工气道的临床价值.方法 将ICU病房收治的危重症患者128例作为研究对象,随机分为研究组和对照组各64例,研究组患者给予经皮气管切开术建立人工气道,对照组患者使用传统气管切开术的方法建立人工气道,观察两组患者的临床疗效以及术后并发症发生情况等指标.结果 研究组患者手术时间、术中出血量、切口大小和切口愈合时间等指标均显著小于对照组,研究组患者不良并反应发生率为2.13％ (2/64),对照组不良反应发生率为21.88％ (14/64),组间比较差异具有统计学意义(P＜0.05).结论 ICU危重症患者使用经皮气管切开术具有手术时间短,术中出血量少,切口愈合快、并发症发生率低等特点,提高了患者的抢救成功率,效果显著,可适用于具有气管切开同样适应症的患者,可进一步推广使用.     

Results of irradiation of tumors in the region of the pineal body.

The clinical findings and results of radiation treatment in 14 patients with tumors in the region of the pineal body are presented. The neurologic signs and symptoms improved significantly in 11 patients (79 per cent). The survival rate for five years or more was 50 per cent. Radiation therapy as the primary method of treatment is discussed.     

不同口径的自体静脉移植修复小动脉缺损的实验研究

实验以38只家兔的股动脉作为受区血管,造成缺损后植入不同口径的自体静脉,术后2周内进行血流量、通畅率、血栓形成率和扫描电镜检查。结果表明,静脉口径比受区动脉口径小约20％时移植效果较好。     

Intra-arterial cis-platinum infusion with sodium thiosulfate protection and angiotensin II induced hypertension for treatment of hepatocellular carcinoma

Cis-diamminedichloroplatinum II (CDDP; 52-169 mg/m2) mixed with angiotensin II (1.5-10 micrograms/min) was infused into the hepatic artery in 33 patients with hepatocellular carcinoma. Simultaneously, sodium thiosulfate (10-50 g) was administered intravenously in order to reduce the systemic toxicity of CDDP. Over 50 per cent reduction in tumor size was obtained in 18 patients (55%). Complete response was achieved in 4 patients (12%). Serum alpha-fetoprotein (AFP) levels decreased by more than 75 per cent in 10 of 18 patients in whom the previous AFP level was more than 200 ng/ml. The one year survival rate was estimated at 61 per cent by the Kaplan-Meier method. Alimentary symptoms (nausea, vomiting) were mild or non-existent in nearly 90 per cent of treatments. Peptic ulcer and abdominal pain were manifested in small numbers. Severe changes in the laboratory data were not observed. High dosage arterial infusion of CDDP and angiotensin II and intravenous injection of sodium thiosulfate was well tolerated and gave effective therapy in hepatocellular carcinoma.     

Combined effects of exercise and restriction of energy intake on moderately obese women.

The current study was designed to assess the contribution of dietary-induced weight reduction on improvements in functional capacity in moderate obesity. Twelve females (means age = 29 yr, means fat percentage = 37%) served as subjects for the study. Subjects trained on a cycle ergometer 30 min.day-1, six day.wk-1 for three or six weeks at 75 to 85 per cent of maximum heart rate (HR max). Improvements in maximal oxygen uptake (delta VO2 max I.min-1) and functional capacity (delta VO2 max ml.kg-1 min-1) were compared in an attempt to separate out training and dietary effects respectively. Measurements were also taken on both the cycle ergometer and treadmill to test for any specificity of training effects. Changes in body composition were assessed by densitometry. Following three weeks of training, there was an average increase in VO2 max ml.kg-1 min-1 on the cycle ergometer and the treadmill of 14 and 19 per cent respectively. By six weeks, this had increased to 18 and 26 per cent respectively. The contribution of weight reduction to the improvements in functional capacity was calculated to range from 20 to 33 per cent. Thus, both energy restriction and exercise training appear to be effective means of improving functional capacity in moderately obese women.     

豫南罗索线虫防制纹腿库蚊现场试验研究

1989—1990年在昆明市郊32条水沟及5个水坑内释放豫南罗索线虫寄生前期幼虫2000—4000条/m~2。结果在水质较清洁的水体中纹腿库蚊幼虫的感染率为53.7—92.8％,但在水质混浊或表面形成膜状物的水体中效果较差,蚊幼虫感染率仅为30％左右。     

指末端毛细血管血检测CMV抗体的研究

本文用ELISA方法对110名住院病儿指末端毛细血管血和静脉血配对血标本中巨细胞病毒(CMV)抗体进行了对照研究。配对血标本检测CMV IgM、IgG抗体的一致性分别为99.09％和96.36％;敏感性分别为87.5％和95.58％;特异性分别为100％和98.48％。反复多次重复检测配对血标本中CMV抗体,结果均呈正相关。本结果表明:指末端毛细血管血可代替静脉血检测儿科病血中CMV抗体.这对儿科CMV感染病儿进行动态血清学监测具有重要意义。     

Does the repair capacity of skin change with repeated exposure to X-rays?

A sensitive experimental design and data analysis were used to test rigorously whether the repair capacity in the skin of the mouse foot changes during a course of repeated 240 kVp X-ray doses. Any such changes might reflect saturation or induction of repair enzymes resulting from progressive radiation damage, but most importantly this assumption of equal effect per dose fraction is central to all analyses of multiple-fraction radiation treatments, and remained to be demonstrated conclusively in skin. An X-ray dose of 2.5 Gy was given two, eight, 14 or 20 times with an interfraction interval of 8 h. Individual skin reactions for each mouse were analysed separately, giving 139 estimates of the effectiveness of 2.5 Gy (approximately 35 in each of the four fractionation schedules). Regression analysis of effect per fraction versus number of fractions showed that there was no significant trend, i.e. the damage per fraction was constant regardless of the number of fractions used. The mean damage per fraction was 3.75 +/- 0.15 per cent (95 per cent CL) of the full underlying damage equivalent to transient moist desquamation, and the slope of this plot was 0.0075 per cent +/- 0.022 per cent (95 per cent CL) per fraction. It was concluded that the assumption of equal effect per fraction was not invalidated in mouse skin. Shorter interfraction intervals would not allow full repair between fractions, and this could be misinterpreted as a progressive loss of repair capacity in this type of experiment. This was tested in skin by giving 2.5 Gy doses two, eight and 14 times with a 1-h interfraction interval. Effect per fraction increased with number of fractions, by an extra 37 per cent from two to eight fractions and by a further 14 per cent from eight to 14 fractions, giving the illusion of loss of repair as predicted. This confirms the need to check that where loss of repair capacity is suspected, this is not due artifactually to incomplete repair between fractions in slowly repairing systems.     

The effect of about one third craniectomy on the cerebrospinal fluid flow rate as estimated by radionuclide cisternography in normal rabbits

Since, the effect of a large cranial defect on the cerebrospinal fluid (CSF) flow rate is still not clear, this study was designed to evaluate the effect of craniectomy in rabbits by using a radionuclide technique, under in vivo physiologic conditions. Eleven male New Zealand white rabbits were examined. After the injection of technetium-99m-diethylene-triaminepenta-acetic acid into the fourth ventricle of each rabbit, dynamic acquisition for 60 min (1 min per frame) was performed pre-op followed by about one third craniectomy to each animal. Injection of the radiopharmaceutical and the imaging steps were repeated at 24 h (post-op 24 h) and at 7 days (post-op 7 d) after craniectomy. The region of interest (ROI) was drawn around the injection site and a time activity curve was generated. Slopes of each curve were calculated to detect the flow rate of the radiopharmaceutical from the injection site during 60 min. Besides, the count decreased ratio (ROIcounts of the last frame ROI counts of the first frame X100) was calculated. Our results showed that the pre-op values of the slope of the time-activity curve and the count decreased ratio were decreased 24 h and 7 d post-op but statistically significant was only the difference between the above values pre-op and 7 d post-op (P=0.04, P=0.01 respectively). In conclusion, the data of the present study indicate that the CSF flow rate in rabbits decreased 7 d after one third craniectomy.     

Postoperative irradiation of glioblastomas. Results in a randomized series.

A material of 108 patients with glioblastoma is presented. The series was randomized in two groups: cases only operated upon and cases with postoperative irradiation in addition. Patients dead within 2 months after operation were excluded in estimating the real value of the postoperative irradiation. The irradiated cases had a 6-month survival rate of 64 per cent and a one-year survival rate of 19 per cent; the non-irradiated cases a 6-month survival rate of 28 per cent and a one-year survival rate of 0 per cent.     

胃粘膜幽门螺杆菌感染密度在消化性溃疡诊断和治疗中的意义

作者从1987年开始通过内镜对幽门螺杆菌(Helicobacter pylori简称HP)感染密度与消化性溃疡的关系进行了研究。内镜确诊的消化性溃疡(peptic ulcer,简称pu)766例中,有24.8％的患者胃窦粘膜检出了不同密度的Hp感染,从而支持该菌是消化性溃疡病原的学说。胃窦Hp感染的密度分布,O级25.20％(193/766),Ⅰ级为45.95％(352/766),2级为15.27％(117/766),3级为13.58％(104/766)。作者采用治疗Pu及清除Hp相结合,局部治疗与系统治疗相结合的综合治疗。结果PU治愈率100％,其中Pu治愈伴细菌清除者为88.88％,其中11.12％Pu治愈而Hp仍存在,其Hp感染密度皆为3级。而HP继续存在的病例,PU累积一年复发率为5.74％,在193例无Hp感染的Pu患者中,有5例复发,复发率为2.59％(5/193累积1年复发率)。Hp感染密度分析表明:Hp感染可能是Pu的病原,治Pu与Hp结合,局部治疗与系统疗法相结合,是短程高效及低复发率的根本。