肠结核的影像学诊断

目的 探讨肠结核的CT与肠道X线造影的诊断价值及局限性,优化影像学组合检查。方法 收集经病理证实的肠结核22例,所有病例均经CT及肠道X线检查包括胃肠钡餐造影（GI）18例、十二指肠低张造影2例、小肠双对比造影3例、结肠双对比造影8例,分析两种检查的影像学表现。结果 CT对肠结核病灶检出的敏感性和定性论断如肠道X线检查,不易判断十二指肠水平段及空回肠病灶,但易于检出合并腹内肠外结核（特别是对诊断有帮助的特征性淋巴结结核）及侵犯肠道的肠外结核灶。肠道X线检查对肠结核的肠粘膜破坏和溃疡形成情况、肠道的累及范围、肠腔的狭窄程度及瘘管的显示有重要诊断价值。结论 各种影像学检查均有其优点及不足之处,根据肠结核不同部位行局部腹部CT扫描加相应的肠道X线检查中明显提高该病的诊断准确性。     

肝脏感染性疾病的影像学诊断

肝脏感染性疾病包括化脓性、寄生虫性、真菌性、结核性、病毒性及其他罕见感染性疾病，如HIV感染和猫抓病。肝脏感染性疾病的早诊断、早治疗对改善预后具有重要价值。影像学检查是早期发现及鉴别诊断的重要手段。笔者就肝脏感染性疾病的计算机体层摄像及磁共振成像表现进行综述，希望对临床诊断有所帮助。     

影像学技术在诊断肝纤维化中的应用

影像学检查是无创诊断肝纤维化的重要手段之一。但由于肝纤维化各期、乃至早期肝硬化往往缺乏特异性影像表现，因此用传统的方法常难以明确诊断和鉴别。近年来，随着现代医学设备和技术的不断发展，各种成像技术对肝纤维化的诊断能力已有很大提高。     

艾滋病合并肺结核35例CT征象分析

目的 分析艾滋病合并肺结核35例患者的临床资料及CT征象分析,总结其CT影像特点,提高对艾滋病合并肺结核的影像诊断水平.方法 收集35例艾滋病合并肺结核患者的临床资料及CT征象,分析和探讨艾滋病合并肺结核的CT特点.结果 艾滋病合并肺结核患者,其临床症状重,但胸部影像表现多不典型:(1)双肺不典型血播多见,表现为双肺弥漫粟粒结节影并广泛间质增厚,部分融合成小片状.(2)1～2个肺段的片团状实变多见,出现干酪坏死少见.(3)双肺毛玻璃影多见.(4)合并多浆膜腔积液(双侧胸腔积液及心包积液)多见.(5)空洞少见.结论 艾滋病合并肺结核的临床表现不典型,CT表现有一定特点,早期临床医生应该高度重视,提高其诊断率.     

4例肝淀粉样变性的临床特点和分析

目的对已确诊病例的临床特点进行总结和分析,以提高对本病的认识,减少误诊率。方法经肝、肾组织学检查及特异性组织学染色明确诊断为肝淀粉样变性的4例住院患者。住院期间检测肝功、血脂、尿常规等化验,腹部彩超、腹部CT或腹部核磁,肝脏、肾脏的活体组织病理检查及特异性组织学染色（刚果红染色）。结果患者均有肝大,肝功生化检查AKP及r-GT明显增高,低蛋白血症,高脂血症。肝脏彩超和CT显示肝脏增大,肝密度低,回声细密,类似脂肪肝的表现。肝穿及肾穿病理见大量粉红色淀粉样物质沉积,刚果红染色（＋）,病理结论为肝、肾淀粉样变性。结论对临床上高度怀疑为肝淀粉样变性的患者,作肝肾活体组织检查及特异性组织学染色（刚果红染色）,可证实为肝淀粉样变性。     

艾滋病合并继发肺结核患者的影像学特征分析

目的探讨AIDS合并继发肺结核与单纯肺结核患者的影像学特征差异。方法选取2015年2月—2018年3月在我院治疗的AIDS合并继发肺结核患者74例作为观察组,同时选取单纯肺结核患者92例作为对照组,比较2组患者的CT表现,并检测观察组患者的CD4+T细胞水平。结果观察组患者病变部位CT表现为肺上野、左肺全肺野和多肺野受累比例分别为74.32%、37.84%和37.84%,明显高于对照组(P均<0.05);观察组弥漫性粟粒影、多发空洞和多肺叶多肺段渗出的比例分别为75.68%、68.92%和70.27%,明显高于对照组(P均<0.05),而钙化比例为2.70%,明显低于对照组(P <0.05);观察组中CD4+T细胞<100/mm3患者弥漫性粟粒影、多发空洞和多肺叶多肺段渗出的比例分别为90.91%、87.88%和84.85%,明显高于CD4+T细胞≥100/mm3患者(P均<0.05)。结论 AIDS合并继发肺结核与单纯肺结核患者的影像学特征有明显差异,合并感染者弥漫性粟粒影、多发空洞和多肺叶多肺段渗出的比例较高,且CD4+T细胞水平越低的合并感染者影像学改变越明显。     

Immunological diagnosis of aspergillosis in patients with pulmonary tuberculosis

The informative value of a number of immunological tests, such as the routine tests of lymphocyte blast cell transformation and indirect hemagglutination, and the original tests of cytotoxic effect and neutrophil damage was studied in diagnosis of aspergillosis. 94 patients with fibro-cavernous tuberculosis and 18 patients with lung aspergillosis along with tuberculosis were examined. It was shown that the tests provided diagnosis of aspergillosis in the tuberculosis patients. The diagnostic efficiency of the tests was studied. The test of neutrophil damage proved to be the most informative. Diagnostic tables for interpretation of the immunological examination results were developed.     

Ultrasonic diagnosis of pleurisy in patients with pulmonary tuberculosis

Ultrasound proved helpful in diagnosis of pleurisy in tuberculous patients. It is able to localize exudate, to determine its volume, size and characteristic features as well as to show structure of the pleural layers, the existence of pleural adhesions. Echography differentiates changes in the adjacent pulmonary tissue and pleura though it is difficult in patients with rapidly progressive tuberculosis, especially in caseous pneumonia because affected pulmonary tissue is also hypoechogenic. Ultrasound is superior to X-ray in low volumes of the liquid in the pleural cavity or atypical position of the pleural exudate. Ultrasonic investigation is also used in dynamic control of treatment effectiveness without radiation load on the patient.     

肝性皮质盲12例临床分析

目的探讨肝性皮质盲的临床特点、发病机制及诊治措施。方法对12例肝性皮质盲患者的发病诱因、临床特点、治疗及转归加以分析。结果 12例肝性皮质盲均在重型肝炎或肝硬化基础上发生,其发病率2.05%,起病前多有劳累、消化道出血、高蛋白饮食、不当应用药物等诱因;临床以一过性视觉丧失,可伴有不同程度意识障碍,强光照射及外界恐吓性刺激时眼睛无闭合反应,双侧瞳孔大小相等、对光反应存在,眼底、视觉通路及颅内无器质性病变为特征;积极治疗肝性脑病可100%好转。结论肝性皮质盲发病率低,临床较为罕见,易于漏诊或误诊,一旦罹发,可视为肝性脑病的特殊表现之一     

以肝占位为表现的4例肝结核临床诊治体会

<正>肝结核是全身结核的一部分,因缺乏特异性的临床症状和影像学特征,难与其他肝脏疾病相鉴别,容易造成漏诊、误诊。本文通过收集肝结核患者的临床资料,结合相关文献报道,分析肝结核的诊治经验,以期加强对肝结核的认识,提高诊断率。1临床资料1.1一般资料收集2008年-2015年遵义医学院附属医院收治的4例肝结核患者,其中男3例,女1例,年龄46~53岁,平均48.6岁,病程3周~12个月。均无结核家族史。1例曾因"肺结核"经     

Characteristics of patients with delayed diagnosis of infectious pulmonary tuberculosis

OBJECTIVE: The aim of this study was to identify patient and disease characteristics associated with delayed diagnosis of infectious pulmonary tuberculosis (TB). METHODOLOGY: A retrospective analysis of 375 adult patients with culture-positive pulmonary TB and cough, treated at the Singapore Tuberculosis Control Unit (TBCU) in 2000, was carried out using data extracted from the TB notification registry and clinical records of the TBCU. Demographic, social, clinical and disease characteristics of patients with reported cough of duration less than, and exceeding, the median duration for the study population were compared. RESULTS: The median duration of cough reported at TB notification was 4 weeks (range, 1-156 weeks). By multivariate analysis, patients with cough > 4 weeks were more likely to be < 65 years old (adjusted odds ratio (OR), 1.8; 95% CI, 1.1-2.9; P = 0.02), of Chinese ethnicity (adjusted OR, 2.0; 95% CI, 1.2-3; P = 0.004), more likely to be sputum acid-fast bacilli smear-positive (adjusted OR, 1.7; 95% CI, 1.1-2.7; P = 0.016), and to have weight loss (adjusted OR, 2.6; 95% CI, 1.7-4; P < 0.01). CONCLUSION: Further studies are needed to identify the possible reasons for delayed diagnosis of TB among those < 65 years old, in the Chinese population in Singapore.     

Chemotherapeutic evaluation of pulmonary tuberculosis patients with a complication of hepatic dysfunction

A retrospective study on the evaluation of antituberculous drugs for patients with hepatic dysfunction was undertaken to clarify treatment regimens. The values of GOT, GPT and T. Bil were used as indicators of liver function, and the "deterioration" in the liver function was defined as a level greater than 1.5 times the initial value. Of total 538 cases of active pulmonary tuberculosis, 103 cases (19.1%) had abnormalities in liver functions before chemotherapy, and 21 of 103 cases showed the deterioration in their liver functions during chemotherapy. There was little relationship between the initial status of liver functions and the incidence of their deteriorations after chemotherapy. Nine of 21 cases did not exceed the 3 times of normal ranges of liver functions. These nine cases could tolerate the same regimens of chemotherapy, and showed satisfactory clinical responses to chemotherapy with two exceptions: one died of tuberculosis and the other cerebrovascular disease. On the other hand, of 12 cases with elevated values of hepatic function greater than 3 times the normal limits, 6 cases discontinued chemotherapy. One case, however, died of hepatic failure related to chronic active hepatitis. Eight of 12 cases showed the rapid improvement of liver dysfunctions. These results suggest that antituberculous drugs are acceptable to patients with hepatic dysfunction as long as the elevations of GOT, GPT and T. Bil stay within 3 times of normal limits. Further chemotherapy could be continued under careful monitoring of liver functions even if the cases exhibit elevated levels of liver functions greater than 3 times the normal ranges.     

结核性胸膜炎患者并发结核性脑膜炎的早期诊断体会

目的 通过对结核性胸膜炎患者并发结核性脑膜炎的临床分析,提高其早期诊断和治疗水平.方法 对139例结核性胸膜炎初治患者并发结核性脑膜炎的临床资料进行回顾性分析.采取6HRZ(E) S/30HRE抗结核治疗方案,并观察3、6、12、24、36个月(疗程末)临床症状好转率、脑脊液(常规+生化)实验室检查指标、肺部和头颅MRI检查结核病灶吸收好转率和后遗症.结果 139例结核性胸膜炎患者中,胸腔积液量300～500 ml 65例,胸腔积液量500～ 800 ml 38例,胸腔积液＞ 800 ml 36例.3种不同胸腔积液量患者结核性脑膜炎发生率分别为15.38％(10/65)、36.84％(14/38)和75.00％ (27/36);疗程末临床症状好转率分别为94.5％、82.5％和72.7％,脑脊液(常规+生化)实验室检查指标的好转率分别为85.2％、75.6％和70.3％;肺部和头颅MRI检查结核病灶吸收好转率分别为97.1％、82.5％和77.7％.胸腔积液量300 ～ 500 ml的患者未出现后遗症,38例胸腔积液量500～ 800 ml的患者中,有6例(15.79％)患者出现不同程度脑实质损害和脑神经功能障碍,癫痫、失语及半身偏瘫等后遗症;36例胸腔积液＞800 ml患者中,有6例(16.67％)患者出现死亡,死因为脑疝、脑梗死和呼吸循环衰竭.结论 结核性胸膜炎患者出现结核性脑膜炎的发生率、误诊和延误诊断率较高,早期诊断和治疗能明显提高治愈率,减少后遗症.     

Delayed diagnosis of tuberculosis in patients with human immunodeficiency virus infection

PURPOSE: To determine the frequency with which the diagnosis of tuberculosis is delayed in patients with concomitant human immunodeficiency virus (HIV) infection, and to identify reasons for such delays. PATIENTS AND METHODS: We reviewed medical records of 52 consecutive HIV-infected patients with culture-proven tuberculosis seen at a 1,900-bed general hospital serving a predominantly indigent population in Los Angeles, where the prevalences of HIV infection and tuberculosis are high. The late-treatment (LT) group consisted of 25 patients in whom tuberculosis was untreated prior to death (n = 6) or treated more than 22 days after presentation (n = 19). The early-treatment (ET) group comprised 27 patients in whom antituberculous therapy was begun less than 16 days after presentation. RESULTS: Symptoms, physical and laboratory findings, chest roentgenographic abnormalities suggestive of tuberculosis (hilar adenopathy, pleural effusion, miliary pattern, cavitation, predominant upper lobe infiltrate), and frequencies of concomitant nontuberculous disease were similar in LT and ET groups. Delayed diagnosis of tuberculosis was attributable to errors in management in 21 (84%) of 25 LT group patients. The most common error was failure to obtain at least three sputum samples for acid-fast smear and mycobacterial culture in patients with clinical and chest roentgenographic findings compatible with tuberculosis (15 cases). Acid-fast sputum smears were positive in 25 (61%) of 41 cases of pulmonary tuberculosis. Acid-fast smears of stool were positive in eight (42%) of 19 cases. Blood cultures yielded Mycobacterium tuberculosis in 18 (38%) of 48 cases. CONCLUSIONS: Delayed therapy of tuberculosis in HIV-infected patients at our medical center was common and was not due to atypical manifestations of tuberculosis. In most cases, delays could have been avoided if adequate numbers of sputum samples for acid-fast smear and mycobacterial culture had been obtained, and if empiric antituberculous therapy had been given to symptomatic patients in whom chest roentgenographic findings were suggestive of mycobacterial disease.