不伴肝硬化的病毒性肝炎相关性胸腔积液的临床特点

 目的 探讨不伴肝硬化的病毒性肝炎相关胸腔积液的临床特点。方法 回顾性分析2003-01至2018-03在北京积水潭医院收治的不伴肝硬化的病毒性肝炎合并胸腔积液患者的临床资料,包括生命体征、血生化及微生物学检查,胸部影像学检查,胸腔积液的生化、常规、微生物学检查,行胸腔镜检查的患者,以及病理学检查结果。结果 共有132例病毒性肝炎合并胸腔积液病例入选,排除因心、肺、肾等脏器病变,以及肝硬化、结核、肿瘤、风湿等引起的胸腔积液后,剩余6例。胸腔积液为渗出液,单侧或双侧,少量至中量。其中2例行胸腔镜检查,壁层胸膜纤维素性渗出、局部充血,少量粘连。壁层胸膜病理检查发现:纤维细胞和纤维母细胞增生,被覆纤维素性渗出及坏死;有散在的淋巴细胞浸润;大片新鲜和陈旧性出血。结论 未出现肝硬化和低蛋白血症的病毒性肝炎也可引起胸腔积液。病毒性肝炎治愈或好转后,胸腔积液可以吸收或好转。     

恶性肿瘤合并肺栓塞的CT肺动脉造影及临床表现分析

目的 探讨恶性肿瘤合并肺栓塞的CT肺动脉造影(CT pulmonary angiography,CTPA)和临床表现.方法 收集88例经CTPA诊断的肺栓塞病例,按是否伴有恶性肿瘤分成恶性肿瘤组(28例)和非肿瘤组(60例),分别测量肺动脉直径,左右心室的最大短轴直径及其比值,血栓密度,计算栓塞指数,记录栓塞部位、胸腔积液和肺内渗出性病变的发生情况.对恶性肿瘤组,按肿瘤部位分类统计,并对肺栓塞(PE)发生时间和临床表现作记录.结果 本组资料中央性肺栓塞恶性肿瘤组有22例(78%),非肿瘤组有34例(57%),P<0.05,显示恶性肿瘤合并肺栓塞者栓塞容易发生于中央性肺动脉;出现胸腔积液和肺内渗出性病变的几率恶性肿瘤组亦高于非肿瘤组;血栓密度、栓塞指数以及反映右心功能的指标2组无统计学差异.合并肺栓塞的恶性肿瘤以腺癌最多见,特别是进展期已发生转移的恶性肿瘤.结论 恶性肿瘤伴肺栓塞具有一些影像和临床特征,提高相关认识有助于临床诊断和进一步治疗.     

胸膜间皮瘤胸腔灌注顺铂后胸腔积液内出现嗜酸细胞增多1例

患者 ,男 ,即往无特殊病史。胸闷、气短 1周。检查 :心率1 0 2次 /min。心电图示心房纤颤、T波低平 ,倒置。B超示大量心包积液 ,左、右胸腔积液。CT检查胸腔积液 ,部分胸膜可见增厚。首次行心包穿刺抽出 2 75 ml血性液体 ;胸腔穿刺抽出 5 0 0 ml血性液体。抽出液 :蛋白定量 42 0～ 460 mg/L。乳酸脱氢酶 (LDH) 5 40～ 5 70 U/L;有核细胞计数 1 2 5 0个 /mm3;涂片瑞氏紫色后镜检 ,间皮细胞 0 .66,中性粒细胞0 .2 5 ,淋巴细胞 0 .0 9。 CEA 5μg/L,AFP 1 2μ/L,铁蛋白3 64μ/L,LDH 1 1 3 U/L,ESR 78mm/h。末梢血 :白细胞 6.4× 1 0…     

特发性慢性嗜酸粒细胞肺炎的CT诊断

目的:探讨特发性慢性嗜酸粒细胞肺炎(ICEP)CT表现特点,以提高对该病的认识。方法:搜集10例经临床病理证实的特发性慢性嗜酸粒细胞肺炎临床和CT资料,作回顾分析。结果:10例均有咳嗽、咳痰史,其中伴发热5例,胸闷气促3例,胸痛2例。10例外周血、支气管肺泡灌洗液和痰液内均见嗜酸性粒细胞增高。10例病灶累及两肺9例,其中病灶位于两肺中外带7例;累及右肺1例。10例中CT表现为小斑片状5例,大片状1例,结节状1例,肿块型1例,混合型2例;伴磨玻璃影5例,伴空洞2例;糖皮质激素治疗后CT复查见病灶明显吸收好转7例,病灶无明显吸收好转2例,病灶增多1例。结论:ICEP有一定CT特点,结合外周血或支气管肺泡灌洗液嗜酸粒细胞增高,可提高诊断率。     

胸腔积液49例相关指标测定的鉴别诊断意义

20 0 1～ 2 0 0 2年 ,我们对胸腔积液 4 9例进行了乳酸脱氢酶 (LDH )、胆碱酯酶 (CHE)、异柠檬酸脱氢酶 (ICDH)、亮氨酸脱氢酶 (LAP)、谷氨酸脱氢酶(GLDH)等 5项指标的联合检测 ,以探讨这些指标对病因诊断的价值。结果表明 ,5种不同疾病所致胸腔积液的检测结果有明显差异 ,可以作为对胸腔积液进行鉴别诊断的依据。1临床资料1 1　一般情况　 4 9例中 ,结核性胸膜炎 2 1例 ,心衰 6例 ,炎症 5例 ,肝硬化 8例 ,恶性肿瘤 9例。均诊断明确。1 2　仪器　日立 70 2 0全自动生化分析仪。1 3　试剂　LDH试剂为上海科华产品 ,其余为长春佳诚。…     

36例致死性肺血栓栓塞临床病理分析

目的　进一步提高对致死性肺血栓栓塞症临床特点的认识。方法　回顾分析 1982年 11月～ 2 0 0 1年 2月经尸检证实的致死性肺血栓栓塞症 36例。结果　生前诊断仅 6例 ,合并有COPD、心血管疾病或恶性肿瘤的肺栓塞生前诊断率更低。有 4例患者无风险因素存在。临床多表现为呼吸困难突然发作或加重、晕厥、猝死 ,而胸痛及咯血少见 ,2 5 %的患者出现循环衰竭。对 4例采取了预防血栓栓塞的措施。结论　常见的与肺血栓栓塞相关的临床表现并不能作为致死性肺血栓栓塞的诊断依据 ,其原因主要是病人缺乏典型的症状及体征 ,并且存在交流困难(例如昏迷或麻醉 )、猝死以及与其他疾病共存等问题     

20例肺动脉栓塞螺旋CT增强扫描的影像分析

目的:研究肺动脉栓塞螺旋CT增强扫描的影像表现,充分认识肺栓塞的CT征象,提高肺栓塞的诊断水平。方法:共20例,男14例,女6例。使用东芝Xpress/SXCT扫描机作造影增强螺旋CT扫描。统计分析肺叶及肺叶以上肺动脉栓塞CT增强的综合表现。结果:肺动脉栓塞原发病以下肢深静脉血栓形成最为多见,有7例。下肢深静脉血栓有2例是由桑拿浴引起。将肺栓塞的程度分为轻度栓塞、中度栓塞、重度栓塞和完全栓塞。轻度栓塞为栓塞面占肺动脉管径<30%;中度栓塞为栓塞面30%～50%;重度栓塞为栓塞面>50%,周围仍见对比剂显影或通过;完全栓塞的栓塞面周边无对比剂显影通过。肺动脉栓塞直接征象是栓塞部位不强化,呈充盈缺损改变。此外,还见9个继发征象:肺动脉总干增宽,右心室和右心房增大。肺叶透亮度增加,肺血管纹理稀疏、细小。肺静脉变小,基底静脉变小,边缘不整,呈干藤样改变。左心房变小。左心室亦变小,室间隔向左后移位。肺组织实变,呈三角形。胸腔积液和心包积液。结论:肺动脉栓塞胸部螺旋CT增强扫描的表现是一组综合征象,笔者称为肺栓塞10联征。充分认识10联征,能大大提高肺栓塞的诊断水平。肺动脉栓塞有多种原发病,以下肢深静脉血栓形成最多见,桑拿浴可引起下肢深静脉血栓,可能是肺栓塞的一个诱因。     

胸膜恶性黑色素瘤18F-FDG PET显像一例

患者男 ,4 5岁。咳嗽 2 0余天 ,活动后憋气、乏力 7d入院。入院前先后从右侧胸腔抽出黄色微混胸腔积液 2 0 0 0ml,其实验室检查示 :细胞数 5 0个 高倍视野 ,其中中性粒细胞5 8% ;黎氏检查 (± ) ;血糖 7.12mmol L ;抗酸杆菌、癌细胞均( - )。胸部CT示右侧胸腔内大片状低密度影 ,右肺下叶受压 ,容积缩小 ,余肺内未见异常。血红细胞沉降率 (ESR) 2 5mm 1h。既往胸部X线片检查曾发现肺内钙化灶 ,疑为陈旧性结核。吸烟 2 0年 ,2 0支 d ,现戒烟已 1年余。其母亲有“结核”病史 ,否认遗传病家族史。入院时体格检查 :背部多处激光术后瘢痕 ,右…     

肺血栓栓塞症CTPA假阳性诊断常见原因分析及影像表现

目的:分析肺血栓栓塞症(PTE)CT肺动脉成像(CTPA)假阳性诊断的常见原因,以降低PTE的误诊率。方法:搜集我院62例PTE假阳性诊断病例的CTPA资料,观察肺动脉CTPA表现,分析误诊原因并对其进行分型,统计各型的发生率。结果:肺血栓栓塞CTPA假阳性诊断的常见原因包括：(1)呼吸运动及心脏传导搏动伪影引起的假阳性诊断(17.74%,11/62),假性栓子表现为紧贴肺动脉管壁一侧的窄带状稍低密度影,常累及多支血管;(2)上腔静脉内高浓度对比剂引起的硬射线伪影导致假阳性诊断(8.06%,5/62),表现为上腔静脉内对比剂浓度较高,周围见放射状分布的条纹状低密度影,累及邻近右肺动脉或右肺上叶肺动脉;(3)将肺门淋巴结误诊为栓子(12.90%,8/62),假性栓子常位于肺动脉分叉处,邻近肺动脉管壁轮廓光整,未见明显充盈缺损;(4)肺血管阻力局限性增高所致假阳性诊断(27.42%,17/62),表现为肺动脉期肺动脉管腔内条片状低密度影,主动脉期该条片状低密度影消失,邻近肺组织内常见慢性炎症或伴有同侧胸腔积液;(5)心血管功能差、肺循环减慢所致假阳性诊断(16.13%,10/62),CTP...     

腓骨骨折后致肺血栓栓塞症1例

1　病例报告患者男 ,4 8岁 ,2 0 0 1年 9月 7日因间歇性左胸痛、胸闷 1天就诊。半月前因车祸致左腓骨骨折卧床休养。既往无高血压、心脏病及糖尿病病史。查体 :未发现明显阳性体征。血气分析 :pH 7 4 4 ,PCO2 38mmHg ,PO2 5 7mmHg ,SO290 % ,HCO-3 2 6mmHg ,ABE 2mmol/L。心电图 :窦性心动过速 ,左心室高电压。X线胸片 :左下肺后基底段斑片阴影 ,左胸腔少量积液。D 二聚体 0 95mg/L。核素肺灌注扫描见左肺多肺段灌注损伤。其余检查正常。诊断 :左肺血栓栓塞症 (骨折后 )。经吸氧、抗炎、低分子肝素抗凝、对症治疗 1周后出院。2　…     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.