臂丛神经节前损伤的脊髓造影后CT诊断

目的 评价脊髓造影后CT扫描(CTM)诊断臂丛神经节前损伤的临床应用。方法 27例臂丛神经损伤患者术前做脊髓造影后，使用GE CT／e单排螺旋CT机薄层螺旋扫描，骨重建获取影像。由高年资医生阅片做CTM影像诊断，临床臂丛神经探查术及术后随访结果作为金标准计算CTM诊断的准确性。结果 臂丛神经节前损伤CTM的直接征象是：椎管内不同节段患侧颈神经根充盈缺损连续性消失，共91个。间接征象为：(1)假性脊膜膨出：患侧硬膜囊失去正常形态，为片状高密度影替代，并可沿椎间孔向外延伸，形成神经根鞘膜囊肿，与蛛网膜下腔间有细线状分隔44个。(2)蛛网膜囊肿：硬膜囊一侧膨大变形呈囊样扩张，与蛛网膜下腔间无细线状分隔17个。(3)蛛网膜下腔不对称：一侧腔变窄，脊髓有或无移位27个。(4)硬膜囊壁不完整：一侧囊腔闭锁，脊髓表面部分裸露3个。直接征象阳性，加上间接征象之一，则诊断为臂丛神经节前损伤。27例患者CTM共检出神经根128个，诊断神经根损伤91个，正常37个。手术及随访证实真阳性84个，假阳性7个，真阴性34个，假阴性3个。CTM检查的敏感度、特异度及准确度分别为96．6％、82．9％及92．2％。结论 CTM可以清楚显示臂丛神经节前段并准确诊断其损伤和部位。     

椎管内臂丛神经根损伤及损伤类型MRI诊断价值研究

目的 将MRI与CTM进行对比,探讨Balance SSFP序列在臂丛椎管内神经根损伤及损伤类型诊断中的临床应用价值.方法 可疑椎管内臂丛神经根损伤的病例中挑选符合条件315例进行MRI与CTM对比分析,其中297例行常规锁骨上探查臂丛神经根.结果 315例有疑患侧神经根1575个,MRI诊断椎管内神经根损伤的灵敏度为84.35％,特异度为95.79％,总符率为89.13％.部分型中单纯前根或后根完全撕脱73个,前根和/或后根部分撕脱的有63个神经根,MRI仅诊断出108个,符合率为79.41％,CTM显示神经根断裂型损伤43个,MRI诊断31个,符合率为72.09％.结论 MRI-Balance SSFP序列作为无创性检查在臂丛神经根损伤的患者中起到重要作用并可作为首选筛查诊断方法.     

脊髓造影与CTM诊断腰椎间盘突出影像对比(附200例报告)

目的评价脊髓造影与CTM在诊断腰椎间盘突出症方面的影像价值.方法200例临床诊断为腰椎间盘突出症患者均先行脊髓造影后,又行CTM检查.结果经手术证实,脊髓造影诊断符合率为86%;CTM诊断符合率为98.5%.结论CTM检查诊断腰椎间盘突出症的准确率较脊髓造影高.     

3.0T MRI在臂丛神经疾病诊断中的价值

目的:探讨3.0T MRI对臂丛神经疾病的临床应用价值。方法:使用GE signa HDx 3.0T超导磁共振仪,GEADW 4.3工作站进行图像后处理,磁共振脉冲序列:常规序列、三维超快速稳态进动成像序列(3D-FIESTA-c)及短时反转恢复脉冲序列(STIR),对20例临床怀疑臂丛神经受累的患者行磁共振检查。将所得数据进行图像后处理,分析臂丛神经疾病的影像学特点及MRI对臂丛病变的诊断价值。结果:20例怀疑臂丛神经受累的患者中,创伤性臂丛神经损伤13例,其主要征象包括:正常神经根消失或离断、连续性中断,创伤性脊膜囊肿、"黑线征",神经根袖形态失常;神经根增粗。7例非创伤性病变,分别为1例神经纤维瘤病(Ⅱ型),2例臂丛神经鞘瘤,1例神经纤维瘤,1例脊膜瘤,1例囊肿,1例神经根鞘囊肿,STIR序列能够清晰显示病变的位置及与神经的关系。结论:磁共振可以清晰地显示臂丛神经的节前纤维、节后纤维的解剖结构,并对累及臂丛神经的疾病作出比较准确的诊断,是诊断臂丛神经疾病的一种无创、有效的影像学检查方法。     

臂丛神经根损伤的诊断:颈段椎管造影CTM和MRI的对比研究

本文研究13例经手术证实的臂丛神经根损伤患者的椎管碘水造影、CTM 和MRI 影像学特点,比较三种检查方法的阳性检出率和诊断正确率,探讨三种检查方法的利弊,其中MRI 对臂丛神经根损伤的发现率与诊断正确率最高,但在MRI 尚未普及时,则椎管碘水造影与CTM 结合应用为诊断臂丛神经根损伤的最佳选择。     

脊髓造影CT诊断臂丛神经节前损伤

目的 探讨脊髓造影CT诊断臂丛神经节前损伤的影像表现及其诊断价值。资料与方法 对18例臂丛神经损伤患者作常规腰穿脊髓造影,而后采用高分辨率CT薄层扫描。全部患者以手术探查所见和电生理学检查结果作为标准。结果 臂丛神经节前损伤的主要征象是神经根缺失及走行异常;创伤性脊膜囊肿;脊髓移位;脊髓变形与“黑线征”。本组共检出33个受损神经根,其诊断的敏感性、特异性及准确性分别为93．9％、75．0％及90．2％。结论 脊髓造影CT可以显示椎间孔周围神经根的情况,对臂丛神经节前损伤的定性定位可做出准确判断。     

臂丛神经损伤的磁共振诊断及分型

目的:探讨臂丛神经损伤的MRI表现、分型及应用价值.方法:70例臂丛损伤患者(59例手术,11例经临床随访)术前行MR检查,将术中所见、肌电图及随访结果与MRI结果比较.结果:47例节前损伤患者的196对受损神经根中MR检出176对,准确度、敏感度及特异度为89.1％、89.8％、84.8％.节前损伤征象:①椎管内神经...     

MRI在臂丛神经节前损伤诊断中的应用

目的 探讨臂丛神经节前损伤的MRI表现及其诊断价值.方法 回顾性分析20例临床诊断为臂丛神经节前损伤患者的临床和影像资料.所有患者手术前均行MR检查,后行锁骨上手术探查及术中肌电图(EMG)检查,将手术探查所见、EMG检杳结果与MRI结果比较,并统计MRI诊断臂丛神经节前损伤的准确性、敏感忡及特异性.结果 20例患者计入统计的73对受损神经根中MRI 共检出63对,诊断的准确性、敏感性及特异性分别为86.5/(83/96)、86.3/(63/73)、87.0/(20/23).臂丛神经节衣前损伤的直接征象包括:(1)椎管内神经根消失或离断54 X4(85.7/);(2)脊神经前后根增粗、迂曲、走行僵硬无法连续追踪至椎间孔处9对(14.3/).间接征象包括:(1)椎管内脑脊液囊性聚集,假性脊膜膨出 46对(73.0/);(2)神经根袖形态异常13 对(20.6/);(3)脊髓变形、移位50对(79.4/);(4)脊柱旁肌信号异常19例.结论 MRI可很好地显示椎管内及椎间孔区神经根结构,对臂从神经节前损伤町作出准确诊断,为早期诊断臂从神经节前损伤提供可靠参考.     

64层CT脊髓造影多平面重组对颈神经根损伤的诊断价值

目的前瞻性研究64层CT的脊髓造影（CTM）多平面重组（MPR）在颈神经根损伤中的诊断价值及其替代直接扫描横断面图像及常规X线脊髓造影的可能性。方法对26例临床诊断为颈神经损伤患者进行X线脊髓造影和64层CT各向同性扫描，然后进行MPR成像，并进行MPR多方向调整，使病变显示于冠状、矢状和横断面上。其中26例（54个神经根）进行了手术探查并有术后诊断结果，就其冠状、矢状断面MPR图像、直接扫描CT横断面图像、脊髓造影平片对病变的诊断符合率进行对比，并比较横断面MPR与直接扫描横断面CT的图像数量。结果以患侧蛛网膜下腔内颈神经根前后支走行区和神经孔处充盈缺损消失，连续性无神经根显示为直接征象，CTM发现神经根损伤31个。间接征象表现为：（1）创伤性脊膜膨出：椎管内患侧硬膜囊膨大、变形，呈柱形高密度影，并可沿椎间孔向外延伸，形成神经根鞘膜囊肿，与蛛网膜下腔间有低密度的细线状分隔，在撕裂水平可见29个膨出。（2）蛛网膜囊肿：硬膜囊一侧膨大变形，呈囊样扩张，病变未经椎间孔向外延伸，与蛛网膜下腔间有细线状分隔26个。（3）蛛网膜下腔不对称：一侧腔变窄，脊髓有不同程度的移位，多层面显示各神经根走行区未见连续性充盈缺损17个。64层CT多向调整的冠状面MPR对病变的诊断符合率为92，6％（50／54个），高于直接扫描CT横断图像（77.8％，42／54个）及平片（68．5％，37／54个），3种影像方法与术后诊断结果进行Kappa一致性检验比较，X线平片、CTM横断面和曲面冠状MPR的Kappa值分别为0．686、0．772、0．920，P值均〈0．05。可见曲面冠状MPR与手术诊断结果高度一致。而图像数量明显少于横断面CT（MPR50幅图像，横断面CT400幅图像）。结论多向调整的冠状面MPR解决了多层CT图像数量庞大的问题，该方法省时、易行，可直观清晰显示颈神经根损伤范围，提高了诊断符合率。     

动态MRI对臂丛根性损伤和颈髓损伤的鉴别诊断意义

目的探讨动态MRI诊断臂丛神经根性损伤的影像学表现及其诊断价值，以及在与颈髓损伤的鉴别诊断中的临床意义。方法对8例臂丛神经根性损伤患者行动态MRI检查，结合CT薄层扫描和肌电图随访；所有8例患者均手术证实为臂丛根性损伤。结果本组患者在伤后早期1～2d内均无位于椎间孔及椎间孔外的创伤性脊膜囊肿、神经根断裂等支持臂丛根性损伤的MRI异常表现；4例患者有颈椎骨折或颈髓损伤的MRI表现。伤后7～15d（平均10d）后，再次行颈椎MRI检查，出现典型的MRI臂丛根性损伤表现：椎间孔及椎孔外臂丛神经走行处T2WI高信号的创伤性脊膜囊肿、脊髓移位和神经根缺失及走行异常等。结论动态MRI检查对臂丛根性神经损伤具有损伤节段定位准确、椎管外部分同样能够显示、无创、操作简单、准确性高等特点；其短期内特征性的动态变化易于诊断臂丛根性损伤，同时又能与颈髓损伤相鉴别。     

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.