颅内海绵状血管瘤30例的临床和影像学特点

目的探讨颅内海绵状血管瘤（cavernousangiomas，CA）的临床与其MRI，CT和DSA表现特点及其诊断价值。方法回顾性分析经临床及影像学综合诊断（30例CA全部做MRI检查，26例同时作CT检查，12例同时作DSA检查）的CA30例。结果27例脑内型CA患者CT共发现病灶25个。CA的MRI平扫表现为T1WI呈等或低信号9个，高信号7个，混杂信号3个；T2WI呈高低混杂信号8个，26个病灶周围伴有低信号环，无占位效应；单发23例，占76．6％。病灶分布：颞叶7个，额叶9个，枕叶2个，顶叶1个，脑干1个，小脑半球1个，左侧侧脑室前角处1个，海绵窦3个，本组首发癫痫19例（63％），出血8例（27％），视蒙5例，反复出血者7例。本组手术切除病灶病理证实18例，在外院行λ刀治疗1例，术后癫痫有效控制6例，治愈出院12例。结论CA临床表现显示该病青中年较多，起病急且易复发。CA有典型影像表现，CT和MRI平扫对明确诊断具有重要意义，MRI优于CT，是首选和最佳影像学方法。除对于无症状CA患者行保守治疗外，有症状的患者一经诊断，可行手术治疗。     

12例脑深静脉血栓影像表现分析

目的探讨脑深静脉血栓（DCVT）的影像学表现及其诊断价值。方法回顾性分析12例临床诊断为DCVT的CT（12例）、MRI平扫（12例）、MR静脉成像（MRV,3D-时间飞跃法,8例）及数字减影血管造影（DSA,8例）表现,评估其直接征象（静脉异常）及间接征象（脑实质表现）,4例进行了MRI及MRV复查。结果CT表现为正常3例,深静脉“绳索征”9例,深静脉回流区（丘脑、基底节区及脑深部白质）梗塞3例。12例MRI显示脑深静脉血栓T1WI及T2WI呈等或高信号,深静脉回流区水肿、梗塞或出血性梗塞8例,8例MRV及8例DSA显示与MRI一致。4例MRI复查显示了深静脉的再通。结论CT平扫脑深静脉“绳索征”可以提示DCVT。MRI对DCVT的直接征象及间接征象均很敏感,结合MRV可以准确地作出DCVT的诊断。     

颅内静脉性血管瘤10例MRI诊断分析

目的:评价MRI平扫及增强对颅内静脉性血管瘤的诊断价值.方法:经DSA证实的颅内静脉性血管瘤10例.全部行MRI平扫加增强检查.结果:10例患者中有3例病变血管周围见出血灶,余通过MRI平扫与增强显示了其余所有病灶,表现为条状或放射状低信号排列,扩张的中央静脉呈粗大流空影.结论:MRI平扫加增强是诊断和随访颅内静脉性血管瘤的有效方法,对无症状病例的筛选,MRI平扫是首选.     

脑内型海绵状血管瘤的CT、MRI和DSA综合诊断

目的：探讨脑内型海绵状血管瘤的CT、MRI及DSA的表现。方法：回顾经手术病理证实的脑内型海绵状血管瘤20例，均行CT扫描、MRI检查，5例DSA检查。结果：脑内型海绵状血管瘤CT表现为稍高密度或高密度，MRI为低信号环围绕的桑葚状混杂信号灶，大多数病灶周围无水肿带，DSA检查未见异常染色。结论：脑内型海绵状血管瘤在MRI上有比较特异性，诊断时应综合CT、MRI及DSA的表现。     

颅内海绵状血管瘤的CT和MRI诊断

目的对比分析脑内、外海绵状血管瘤(CA)的CT、MRI影像,进一步提高对颅内海绵状血管瘤的认识.方法回顾性分析43例颅内CA患者的CT、MRI影像,其中脑内型37例,脑外型6例.CT平扫/增强为30/18例,MRI平扫/增强43/20例.结果脑内型CA:CT平扫为混杂颗粒状稍高密度(22/25),3例呈高密度出血灶;MRI平扫可表现为Zabramskin Ⅰ型(11.9%)、Ⅱ型(83.4%)、Ⅲ型(4.7%),多呈短或等T1、稍长T2混杂信号且周边常伴明显短T2信号环;增强扫描病灶轻、中度强化或无强化.脑外型CA:6例全部位于鞍旁区.CT平扫为等密度(2/5)或稍高密度(3/5);MRI平扫为等T1或稍长T1、明显长T2信号;增强均明显强化,呈"揉面团"样,可为特有的渐进性、向心性强化.结论颅内CA无论脑内型还是脑外型多数都具有典型的CT、MRI表现,少数脑内型CA以出血为首发表现,应予重视.     

颅内静脉窦血栓形成的早期影像学特征

目的探讨颅内静脉窦血栓形成（CVST）的早期头部CT、MRI及磁共振静脉成像（MRV）影像学特征,为诊断CVST的影像学检查的选择提供依据。方法回顾性分析2009年1月-2013年1月经临床和影像学检查确诊的46例CVST患者的临床资料及头部CT、MRI、MRV影像学特征。结果头部CT显示CVST的直接征象15例（32．6％）,间接征象8例（17．4％）;MRI显示CVST的表现17例（68．0％）;MRI＋MRV检查的阳性率为87．5％,MRI＋MRV与DSA的符合率为84．6％。结论根据临床病史高度怀疑CVST患者的头颅CT可作为筛查手段,MRI合并MRV检查对明确CVST的诊断有较高价值。     

脑内海绵状血管瘤的影像学分析

目的:探讨脑内海绵状血管瘤的影像学(CT、MRI及DSA)表现.方法:回顾性分析21例脑内海绵状血管瘤患者,均做MRI检查,9例并作了MRI增强扫描;11例同时曾做CT检查,3例增强CT扫描;曾同时5例作CTA/MRA+DSA检查,7例曾作手术治疗和病理检查,对各例的CT、MRI及DSA的影像学表现进行分析.结果:脑内海绵状血管瘤CT表现为稍高密度或高密度影;MRI中T1WI大部分为高信号,T2WI为低信号环围绕的桑葚状混杂信号灶,大多数病灶周围无水肿带;CT和MRI增强扫描无或轻度增强;CTA/MRA/DSA检查未见异常.结论:脑内海绵状血管瘤在影像学诊断时,应综合CT、MRI及DSA的表现,其影像学的表现对诊断脑内海绵状血管瘤有特异性.     

颈动脉体瘤的比较影像学诊断

目的描述颈动脉体瘤不同影像表现,探讨不同影像检查方法优缺点。方法回顾分析30个颈动脉体瘤的不同影像特点。结果30个颈动脉体瘤均位于颈动脉分叉处,26例单侧性（14左/12右）,2例为双侧,平均直径5 cm,CT/ MRI平扫以等密度或中等信号为主,增强扫描呈明显迅速强化,超声及DSA也显示其呈富血供表现。结论超声、CT、MRI及DSA影像检查可对颈动脉体瘤提供早期诊断提供补充信息。     

脑静脉窦血栓的影像学检查

目的评价脑静脉窦血栓形成(CVST)的影像检查方法。方法回顾性分析18例CVST患者的综合影像资料,18例均行常规CT和MRI平扫,6例行减影法多层螺旋CT脑静脉成像(MSCTV),13例行磁共振对比增强三维脑静脉减影法成像(3D CE-MRV),12例行DSA检查。结果 18例CVST患者中,经影像学检查发现上矢状窦CVST 8例,横窦2例,乙状窦4例,直窦2例,上矢状窦及乙状窦均受累2例。6例(33.3%)CT平扫可提供重要的影像表现,尤其是MSCTV更为直观。18例CVST患者MRI检查均可清晰显示脑静脉窦血栓形成导致的流空效应消失,静脉窦内出现各期血栓的不同信号,13例可见脑水肿、脑梗死、脑出血等间接征象。15例3D CE-MRV检查均发现CVST的血栓征象(静脉窦充盈缺损或中断)。12例行DSA检查均能获得明确诊断。结论 影像综合检查对CVST的早期发现、确诊及制订治疗方案具有重要价值。     

超顺磁性氧化铁(SPIO)增强MRI对原发性肝癌的诊断价值

目的：检验SPIO增强MRI对原发性肝癌的定位，定量，定性诊断价值。方法：选取经螺旋CT增强，MR平扫，SPIO增强扫描检查且有手术或穿刺活检病理或DSA血管造影资料并经随访，实验室生化检查及临床资料证实为原性肝癌者20例。结果：SPIO增强T2MRI检出79个病灶，其中经手术，穿刺活检病理证实或DSA血管造影显示有肿瘤血管团和/或肿瘤染色的原发性肝癌病灶69个；另有10个为异常信号灶，SPIO增强MRI较CT增强及MR平扫病灶检出率分别增加66%和59%，病灶-肝脏对比噪声比增加52%（P=0.004)。结论：（1）SPIO增强T2WI病灶-肝脏对比噪声比显著增加；（2）病灶检出率明显高于MR平扫及螺旋CT增强影像；（3）结合MR平扫影像，SPIO增强MR影像对肝癌病灶的定位。定量及定性诊断有重要意义；（4）SPIO增强MR影像对肝脏良恶性肿瘤的鉴别诊断有重要意义。     

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征（LQTS）、短QT综合征（SQTS）、Brugada综合征（BrS）和儿茶酚胺敏感性多形性室性心动过速（CPVT）,总结它们在发病机制及诊治方面的进展。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

Organ Preservation: Current Concepts and New Strategies for the Next Decade

SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.     

2017年呼吸疾病主要进展

2017年,国内外学者在呼吸系统疾病的临床和基础领域均进行了深入研究,不仅对相关指南进行了更新,并且针对一些临床热点、难点问题达成专家共识,现就2017年呼吸疾病相关进展作一简单介绍。     

家族性噬血细胞性淋巴组织细胞增生症1例并文献复习

目的加强对家族性噬血细胞性淋巴组织细胞增生症（familially hemophagocytic lymphohistiocytosis,FHL）的认识。方法报道确诊为FHL的新病例1例,结合国内外报道的FHL的病例,对该病的临床特点进行汇总分析。结果FHL2常与PRF1基因突变相关,约20%~40%的患者存在穿孔素基因突变。结论对于有阳性家族史,基因诊断明确,应尽早行化疗或者造血干细胞移植。若无家族史,未发现与继发性HLH相关的原发病因,可考虑行基因筛查以明确是否存在FHL的可能。     

COVID‐19 and COVID‐19 vaccine‐related dermatological reactions: An interesting case series with a narrative review of the potential critical and non‐critical mucocutaneous adverse effects related to virus,therapy, and the vaccination

This narrative review article was conducted to lay out a summarized but exhaustive review of current literature over mucocutaneous manifestations in 4 dimensions of SARS‐CoV‐2 pandemic: virus itself, treatment‐related, vaccine‐induced, and alteration of chronic dermatologic diseases following infection. Virus and vaccine‐related were mainly self‐limited and non‐severe. Treatment‐related reactions could be life‐threatening.     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

Real‐life effectiveness of biological therapies on symptoms in severe asthma with comorbid CRSwNP

BackgroundWe aimed to evaluate the effectiveness of different antibody therapies on nasal polyp symptoms in patients treated for severe asthma.MethodsWe performed a retrospective analysis of patients with severe asthma and comorbid CRSwNP who were treated with anti‐IgE, anti‐IL‐5/R or anti‐IL‐4R. CRSwNP symptom burden was evaluated before and after 6 months of therapy.ResultsFifty patients were included hereof treated with anti‐IgE: 9, anti‐IL‐5/R: 26 and anti‐IL‐4R: 15 patients. At baseline median SNOT‐20 was similar among groups (anti‐IgE: 55, anti‐IL‐5/R: 52 and anti‐IL‐4R: 56, p = 0.76), median visual analogue scale (VAS) for nasal symptoms was 4, 7 and 8 (p = 0.14) and VAS for total symptoms was higher in the anti‐IL‐4R group (4, 5 and 8, p = 0.002). After 6 months SNOT‐20 improved significantly in all patient groups with median improvement of anti‐IgE: −8 (p < 0.01), anti‐IL‐5/R: −13 (p < 0.001) and anti‐IL‐4R: −18 (p < 0.001), with larger improvement in the anti‐IL‐4R group than in anti‐IgE (p < 0.001) and anti‐IL‐5/R (p < 0.001) groups. VAS nasal symptoms improved by median anti‐IgE: 0 (n.s.), anti‐IL‐5/R: −1 (p < 0.01) and anti‐IL‐4R: −3 (p < 0.001), VAS total symptoms by anti‐IgE: −1 (n.s.), anti‐IL‐5/R: −2 (p < 0.001) and anti‐IL‐4R: −2 (p < 0.001).ConclusionsTreatment by all antibodies showed effectiveness in reducing symptoms of CRSwNP in patients with severe asthma, with the largest reduction observed in anti‐IL‐4R‐treated patients.     

经颅黑质超声诊断帕金森病的临床评价

目的 通过对帕金森病患者及正常对照组进行经颅超声(transcranial sonography,TCS)检查,结合帕金森病患者的Hoehn Yahr（H Y）分级及帕金森病统一评分量表评分结果,了解我国大陆地区帕金森病患者有无黑质(substantia nigra, SN)回声增强表现。方法 对入选对象进行TCS检查,并对检查结果进行评价。结果 帕金森病患者 SN阳性率明显高于正常对照者（P＜0.05）。帕金森病SN异常组 H Y 分期明显高于帕金森病SN正常组(P＜0.05),表明帕金森病患者SN高回声面积与H Y分期相关。TCS检查对帕金森病的敏感性为80.5%,特异性为79.9%。结论 我国帕金森病患者SN强回声检出率显著高于对照组,说明我国帕金森病患者也存在SN回声增强这一现象,与国内外报道相一致。TCS检查对帕金森病的诊断具有一定的意义,敏感性及特异性较高。