肝血管瘤周围灌注异常的多层螺旋CT评价

目的 探讨肝血管瘤周围灌注异常(HPD)现象的多层螺旋CT特点.资料与方法 回顾性分析220例患者共 386个肝血管瘤的多层螺旋CT表现,观察肝灌注异常形态、位置,分析其与血管瘤大小及强化速度的关系.结果 386个血管瘤中出现灌注异常114个(29.5%).快速强化型血管瘤出现HPD现象的发生率(48.8%)远远大于慢速强化型(8.2%)(P<0.001);直径≤2 cm小血管瘤HPD的发生率(35.3%)高于直径>2 cm大血管瘤(18%)(P<0.005).结论 灌注异常现象在肝血管瘤中并不少见,更常见于快速强化型小血管瘤.     

肝动脉栓塞联合瘤体内博莱霉素注射治疗少血供性肝血管瘤

目的 探讨少血供性肝海绵状血管瘤经肝动脉栓塞后进行瘤体内注射博莱霉素治疗的疗效和安全性.方法 前瞻性研究9例少血供性肝海绵状血管瘤患者经肝动脉栓塞结合经皮经肝瘤体内药物注射治疗情况.对于CT/MRI明确诊断的肝海绵状血管瘤(直径＞5 cm),且CT增强扫描时仅有点状或少许斑片状强化而大部分无强化且延迟扫描时仍然如此表现的9例患者,先行肝动脉插管栓塞术,栓塞剂为超液化碘油(10 m1)与博莱霉素(8 mg)混悬剂,实际用量为5～10 ml.栓塞后4 d开始行经皮经肝瘤体内穿刺多点注射博莱霉素8～16 mg,间隔3～4 d再次注射,连续2～3次,1个月后复查CT,以后3、6个月及1年不定期复查CT.结果 9例患者DSA上所见血管瘤染色与CT增强扫描表现一致,碘油沉积呈散在点状分布,治疗后1个月瘤体均明显缩小,以后继续缩小,1年后复查基本稳定不再缩小.2例患者出现急性胆囊炎,对症处理后痊愈.1例出现栓塞后胆汁瘤,随访观察未进一步进展,未作特殊处理.结论 经肝动脉栓塞联合瘤体内博莱霉素注射治疗少血供性肝血管瘤是简便、安全并有效的方法 .     

兔VX2肝肿瘤射频消融疗效评价——超声造影、增强CT与病理对比研究

目的 探讨超声造影(CEUS)与增强CT检查在评价肝肿瘤VX2肝肿瘤模型射频消融(RFA)疗效方面的作用. 资料与方法 9只兔VX2肝肿瘤模型作RFA治疗后1周同时作CEUS与增强CT检查,与病理作对照,比较CEUS与增强CT在评价RFA疗效的准确性. 结果 9只中8只病理发现残留肿瘤灶,1只完全消融,残留灶在CEUS与增强CT上均可见强化.3只炎性反应带能被CEUS正确评价,而增强CT将其中2只误认为是残留灶.1只残留灶位于肋骨下未能被CEUS检出.CEUS、增强CT、两者联合诊断的敏感率、特异性和诊断准确率分别为86%、88%、86%,90%、78%、85%,94%、75%、91%.三组之间差异均无统计学意义(P<0.05). 结论 CEUS与增强CT均能较可靠评价RFA疗效,两者具有良好的相关性和一致性; CEUS与增强CT联合评价可提高评价准确率.     

肝血管瘤CT影像与B超对照(附50例分析)

目的评价 CT 与 B 超对照诊断肝血管瘤的价值。材料和方法 50例肝血管瘤病人经 CT、B 超对比检查。结果本组50例肝血管瘤病人 B 超检出率为100%,CT 与 B 超诊断完全符合者36例,B 超发现病灶不能定性者8例,B 超发现1cm 以下病灶而 CT 未能检出者4例,CT 不能定性者2例。结论 B 超对肝血管瘤病灶检出率优于 CT,CT 常规应用"两快一慢"增强扫描技术,依据 CT 诊断血管瘤的三条标准,在病灶定性方面优于 B 超。二者对照并结合诊断肝血管瘤是可取的。     

弥漫型脂肪肝内局灶性病变的CT诊断

目的 研究在弥漫型脂肪肝背景下肝局灶性病变的CT特征,以提高对其诊断的准确率.资料与方法 回顾性分析40例弥漫型脂肪肝合并局灶性病变(35例)或残存肝岛(5例)患者的CT资料,观察脂肪肝对肝局灶性病变CT表现的影响.结果 40例弥漫型脂肪肝中,26例合并多发局灶性肝病变,9例合并单发病变,5例残存肝岛. 35例肝局灶性病变中,转移瘤18例 ,肝细胞癌(HCC)术后复发2例,血管瘤8例,多发囊肿5例,多发腺瘤及单发局灶性结节增生(FNH)各1例.CT平扫肝局灶性病变相对密度随脂肪肝程度而异,边界多不清,增强后强化方式则与无脂肪肝背景的肝内病变相似.结论 弥漫型脂肪肝内局灶性病变,其CT表现与正常背景下有所差异,增强检查尤其是动态增强对病变的诊断与鉴别具有重要意义;对不典型病例,随访对比有助于正确诊断.     

肝脏增强CT与MRI在检查肝癌临床价值分析

目的探讨肝脏增强CT与MRI在诊断肝癌准确率方面的差异。方法对收治58例肝癌患者采用肝脏增强CT和MRI检查,比较两种检查的准确率。结果 MRI对肝内病灶检出数量及肝内病灶阳性检出率91.38%均明显高于增强CT检查72.41%,且差异具有统计学意义。另外,对比两种检查方法对不同大小肿瘤的诊断结果发现MRI对不同肿瘤大小患者的诊断准确率93.10%,明显高于增强CT检查77.59%,且差异具有统计学意义。分析发现MRI尤其对直径≤3cm的肿瘤患者诊断准确率92.11%,明显高于增强CT检查71.05%,且差异具有统计学意义;而两种检查方法对直径3cm的肿瘤患者诊断准确率无明显差异。结论 MRI对肝癌的诊断准确率明显高于肝脏增强CT,尤其是针对直径≤3cm的肝癌患者具有更高的准确率,值得临床推广使用。     

多层螺旋CT、数字减影血管造影、碘化油CT对肝内富血管肝癌检出率的比较研究

目的 比较多层螺旋CT双期增强扫描、数字减影血管造影、碘化油CT对肝内富血管肝细胞肝癌结节的检出率.方法 收集诊断明确的结节型原发性肝细胞癌28例,所有患者均先行多层螺旋CT双期增强扫描,然后行肝动脉灌注碘化油栓塞术,术前行肝动脉数字减影血管造影,并于术后3～4周内行多层螺旋CT平扫(碘化油CT).采用盲法对3种影像学方法对肝内富血管肝细胞癌结节的检出率进行统计,并对3种方法对不同大小的肝癌结节的检出率进行比较.结果对＞2 cm的肝癌结节,3种方法具有相同的检出率;对＞1 cm、＜2 cm的结节,3种方法检出率的差异没有统计学意义;对于＜1 cm的结节,多层螺旋CT双期增强扫描检出47个,碘化油CT检出27个,数字减影血管造影只检出16个＜1 cm的结节,与多层螺旋CT双期增强扫描和碘化油CT检出率相比,其差异均有统计学意义.结论 对＜1 cm的肝内富血管肝细胞肝癌结节,多层螺旋CT双期增强扫描和碘化油CT 2种方法可以相互补充.     

动态增强CT在鉴别诊断肝脏血管肉瘤和血管瘤中的价值

目的:探讨动态增强CT在鉴别诊断肝脏血管肉瘤和血管瘤中的价值.方法:对4例临床病理证实的肝血管肉瘤(21个)和12例临床明确诊断的肝血管瘤(30个)的CT资料进行回顾性分析,所有患者均行CT平扫及三期增强扫描.结果:51个病灶在增强扫描早期阶段表现为多种强化模式.两种肿瘤的影像学特征中增强早期阶段的强化方式(非周边性强化)和合并动静脉短路这2个特征在两组间的差异有统计学意义(P＜0.05),而延迟期强化的特点在两种肿瘤间的差异无统计学意义(P＞0.05).结论:增强扫描早期瘤结节内非周边性强化和合并动静脉短路的特点是鉴别肝血管肉瘤和血管瘤的重要指标,尤其是在鉴别迟期强化的肝血管肉瘤和血管瘤中有重要意义.     

超声波断层不能识别的肝海绵状血管瘤

作者对超声波不能识别的2例肝海绵状血管瘤的原因加以探讨。1例肝左叶海绵状血管瘤,与邻近肝组织具有强度相同的回波,以致超声波无法识别。应用选择性腹腔动脉造影后,明确了本病的诊断。另1例是以慢性胰腺炎入院的患者,CT扫描显示肝右叶后部有一直径2.0cm的低密度区,增强CT显示了典型的海绵状血管瘤表现。作者发现肝海绵状血管瘤的回波强度与血管瘤的管腔直径有     

多层螺旋CT双期增强扫描对肝微小细胞癌的诊断价值

目的探讨多层螺旋CT双期增强扫描对原发性肝微小细胞癌的诊断价值。方法对36例肝微小细胞癌的患者,分别采用CT平扫及双期增强扫描对患者进行检查,所有患者均经病理组织证实;分析平扫和增强扫描病灶的密度和边缘表现,并对小肝癌检出率及不同扫描时相肿瘤与肝脏密度差值的变化情况进行比较。结果肝微小细胞癌的病灶范围在1.3~2.0cm之间。CT平扫病灶呈类圆形低密度影者占83.3%,等密度者占16.7%,增强后瘤内密度均匀者占58.3%,瘤内密度不均匀占41.7%,增强后病灶边界清楚者占66.7%,边界模糊者占33.3%;动脉期的检出率为91.7%,门脉期的检出率为80.6%,而CT平扫的检出率为63.9%,差异具有统计学意义(P0.05);门脉期肿瘤与肝脏密度的差值最大,而平扫期肿瘤与肝脏密度的差值最小,门脉期与动脉期及平扫的差值均有统计学意义(P0.05)。结论螺旋CT双期增强扫描对肝微小细胞癌的检出率高,诊断准确可靠,具有较高的诊断价值。     

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.