椎管内肠源性囊肿1例

男，38岁，因右下肢麻木17月加重伴左下肢麻木2月余而就诊。查体：两大腿内侧及肛剧感觉减退，右下肢肌力Ⅳ^＋。右侧膝腱反射及跟腱反射亢进。MRI检查示L1～2椎体水平椎管内椭圆形异常信号影，呈略短T1稍长T2信号，大小约15mm×11mm×47mm，边界清楚。邻近神经根受压呈半圆形围绕在病灶两侧和后部。增强后病变无强化，压脂像上病灶仍呈高信号（见图1～3）。     

胸腰段椎管内副神经节瘤1例

患者 男,58岁,以腰部疼痛,右下肢无力3月,加重3月入院.疼痛劳累后加重,休息后可缓解.体格检查:脊柱活动正常,双侧直腿抬高实验(一),右下肢肌力4级,双下肢皮肤感觉未见异常,病理征(一).血液生化检查正常.腰椎X线正侧位片未见明显骨质破坏.MRI表现:T12～L2椎体水平椎管内可见长约90 mm长圆形等T1信号影,压脂T2像呈混杂高信号影(图1,2),增强扫描病变明显强化,其内可见斑片状低信号影(图3,4).     

椎弓单发性骨软骨瘤一例

病例资料　患者 ,男 ,50岁。无诱因下出现胸背部疼痛伴下肢麻木、无力 3年 ,加重 1年 ,行走不稳易跌倒。曾在多家医院诊断为椎管内占位性病变。体检 :胸背部压痛 ,骶尾部、下肢前后内外及足底感觉减退。影像学检查 :X线胸椎正侧位片示T6 ～T7椎体后缘一不规则高密度影。CT扫描示T6 椎弓板内缘有一带蒂的菜花状高密度影突向椎管内 (图 1 ) ,表面密度与骨皮质相似 ,内有不规则斑点状钙化影 ,其基底与椎弓板相连。相应部位脊髓受压 ,硬膜囊前脂肪间隙消失。MRI示T6 ～T7椎体平面脊髓后方一低信号肿块影突向椎管内 ,局部脊髓受压 ,椎管狭窄…     

椎管内神经鞘瘤合并副脾1例

1病历简介患者，女，57岁。半年前因腰痛及左下肢放射痛来我院就诊。CT诊断L4-5及L5～S1椎间盘突出。1997年4月4日行腰椎间盘髓该清除术，术后出现双侧小腿麻木，大小便功能障碍。查体：双下肢肌力Ⅲ～Ⅳ级，L4－以下痛觉减退，病理反射未引出。MRI检查：L4-5椎板及棘突骨质缺损。T12及L1椎体水平椎管内发现实质性占位病变，脊髓圆锥受压向右移位，冠状位扫描见左肾上极不规则中等信号影（图1，2）。MRI诊断：（1）图1冠状位T1加权像：SE序列．可见椎管内椭圆形实质性肿瘤，脊髓圆锥受压，脾脏内下侧隐约可见不规则略高信号影．疑左…     

椎管内外沟通性孤立性纤维瘤1例

患者 女,43 岁.入院前 3 个月无明显诱因出现胸背部及左季肋部疼痛,多于弯腰及体力活动后间歇性发作,平卧休息可缓解,专科查体无异常.MRI 表现(图 1～4):T4～T5 椎体层面椎管内髓外及左侧脊柱旁沟、左侧附件区、左侧胸腔内不规则软组织团块影,T1 WI 呈等信号,T2 WI 及 T2 压脂呈高低混杂信号,增强...     

骨嗜酸性肉芽肿的MRI表现

目的 :探讨MRI常规扫描、DWI、SWI及增强扫描在骨嗜酸性肉芽肿(EGB)诊断中的价值。方法 :回顾性分析经病理证实的9例EGB的MRI常规检查、DWI、SWI及增强扫描表现。结果:9例中,多发1例,单发8例。颅骨病变3例,表现为颅骨穿凿样骨质破坏,并软组织肿块,呈哑铃状改变,无骨膜反应。四肢长骨病变3例,骨干为主,局限性骨皮质破坏,出现以病灶为中心超出其范围的层状连续性骨膜反应,骨髓及软组织水肿显著。四肢非长骨病变局限性骨皮质缺损,轻度膨胀,骨髓水肿。脊椎病变2例中,1例早期椎体高度无改变,椎体内及周围软组织肿块,软组织肿块与正常椎体界限清楚,见低信号边,椎体骨髓水肿显著;中晚期椎体成楔形或铜钱样改变,T1WI呈等低信号,T2WI呈混杂高信号,椎间盘不受累。结论 :EGB的高场MRI表现有一定特异性,DWI、SWI对疾病的病理分期有一定价值,SWI对病变内出血的诊断有一定价值。     

请分析病变性质

患者女,65岁.反复发作腰痛10年,近3年加重,且伴左下肢麻木无力.体检:L3～S1棘突处叩压痛,直腿抬高试验:左侧10°( ),右侧45°( ).CT显示L4椎体变扁,局部骨质虫蚀样破坏,且病变累及椎旁软组织;MRI示L4椎体明显压缩变扁,外形似呈"蝴蝶结"状,而相邻椎间盘未见受累,病椎信号强度异常,T1WI呈低信号(图1),T2WI呈低于骨质信号而高于肌肉信号(图2),短时反转恢复序列(STIR)呈稍高信号(图3),病椎两侧可见软组织肿块形成,其后方椎管内亦见受累(图4),MR诊断纤维肉瘤可能性大.腹主动脉DSA:示双侧第4腰动脉明显增粗,左侧更明显,病变区见肿瘤血管及肿瘤染色;ECT示L4椎体呈团块状异常放射性浓聚区.     

椎体骨巨细胞瘤MRI表现（附3例报告及文献复习）

目的:描述椎体骨巨细胞瘤的MRI表现及其诊断价值.材料和方法:回顾性分析3例经病理证实的椎体骨巨细胞瘤临床资料与MRI表现.结果:3例病灶均累及椎体和附件.2例发生于腰椎,呈多囊融合囊实性混杂信号影,其中1例可见液-液平面.另1例发生于胸椎,信号呈相对均一的等T1稍短T2影,无囊性改变.增强扫描后病灶有不均一中等度增强,囊性部分无增强.结论:椎体骨巨细胞瘤MRI表现具有一定的特征性,典型病例可做到术前诊断.     

脊髓圆锥髓内支气管源性囊肿1例

患者 女,29岁.近7年无明显诱因出现腰痛,双下肢疼痛,以右侧为著,走路自觉无力,大小便不畅.体格检查:左上肢、左下肢、右上肢肌力Ⅴ级,右下肢肌力Ⅳ级,肌张力正常. MRI检查示:T12～L2椎体水平脊髓圆锥髓内可见一囊性扩张性占位性病变,T1 WI呈低信号(图1),T2 WI以高信号为主(图2),其内信号欠均匀,轴位T2WI上可见分层现象(图3),大小约2.1cm×1.7 cm×6.5 cm,边界尚清,相应节段马尾及终丝向前推压移位,增强扫描MRI示椎管内病灶无明显强化(图4).     

颅内不典型孤立性纤维瘤1例

正患者女,77岁。因左下肢乏力伴行走不稳4月,左上肢活动不灵,视物重影就诊。查体:神清,左下肢肌力3级,左上肢肌力4级,左侧感觉性共济失调。MRI示:右顶叶类圆形团块影,T1WI呈等信号,其内见血管流空影(图1),T2WI呈以等信号为主的混杂信号影,周围见水肿带,占位效应明显(图2),增强扫描病灶不均匀强化,见"脑膜尾征"(图3)。手术及病理:术中见病灶与脑组织黏连密切,血运丰富,     

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.