复合性心脏畸形动脉导管未闭超声漏、误诊原因分析

对复合性心脏畸形病例中动脉导管未闭(PDA)的超声检出率进行了分析.旨在找出引起PDA漏、误诊的原因和克服措施,进一步提高PDA超声诊断符合率.1 资料与方法本组151例,男81例,女70例;年龄3～37岁,平均10岁.分两组,一组为复合畸形组,共104例(其中合并PDA者39例),另一组为单纯导管组,共47例,所有病例均行超声检查,并经手术证实.采用VINGMED800型彩色多普勒超声显像仪,探头频率3.5MHz.常规行胸骨旁左室长轴,胸骨旁大血管短轴及四腔等切面扫查.以二维超声测量各心腔大小,观察心内结构,重点观察降主动脉与肺动脉间有无PDA及肺动脉内径有无增宽.二维结合彩色多普勒技术测量未闭导管的直径及长度,     

肺动脉瓣狭窄合并动脉导管未闭的超声诊断

目的:探讨肺动脉瓣狭窄(PS)合并动脉导管未闭(PDA)的超声诊断方法。材料和方法:超声测量16例PS+PDA及16例单纯PS患儿的主动脉瓣口峰值流速(Vp),平均流速(Vm)及流速时间积分(VTI)。除常规在胸骨旁短轴切面扫查外,应用二维、彩色及脉冲多普勒于胸骨旁肺动脉分叉切面,胸骨上主动脉弓长轴切面以及剑突下短轴切面探查PDA。结果:16例PS+PDA患儿检出PDA12例,漏诊4例。PS+PDA的主动脉瓣口Vp略高于单纯PS患者。结论:探查PS患儿胸骨旁肺动脉分叉切面,胸骨上主动脉弓长轴切面以及剑突下短轴切面有助于发现PDA。PS患儿主动脉瓣口Vp增高时提示可能存在PDA。     

先天性血管环的超声心动图诊断价值分析

目的 探讨先天性血管环(vascular ring,VR)的彩色多普勒超声心动图对VR的诊断价值。方法 回顾性分析247例经心外科手术诊断为VR患者的超声心动图检查资料。结果 本组双主动脉弓127例、右位主动脉弓伴迷走左锁骨下动脉及左侧动脉导管未闭/韧带88例、肺动脉吊带29例、左位主动脉弓伴迷走右锁骨下动脉及右侧动脉导管未闭/韧带2例、无名动脉压迫1例。本组单纯性血管环68例,合并其他心血管系统畸形179例,常见的合并畸形有室间隔缺损88例、房间隔缺损/卵圆孔未闭64例、左侧上腔静脉残存29例、动脉导管未闭21例、肺动脉瓣狭窄15例、法洛四联症14例、Kommerell憩室12例。247例患者中,超声诊断符合201例(81. 38%);漏误诊46例(18. 62%),其中41例漏诊,5例误诊。结论 多普勒超声心动图技术可以比较准确地诊断VR,但容易漏、误诊,必要时需行心脏CTA检查明确诊断。     

彩色多普勒超声心动图诊断主动脉缩窄

目的:探讨多普勒超声心动图对主动脉缩窄的诊断价值。方法:回顾性分析10例主动脉缩窄患者多普勒超声心动图检查结果与手术所见。结果:10例患者术前超声心动图检查诊断正确8例,漏诊2例(其中升主动脉管性缩窄1例,主动脉嵴部缩窄1例)。结论:彩色多普勒超声心动图能准确显示主动脉缩窄部位;动脉导管未闭(PDA)患者应常规探查主动脉弓及降主动脉。     

室间隔缺损合并动脉导管未闭105例超声诊断

室间隔缺损合并动脉导管未闭１０５例超声诊断１１００１５沈阳沈阳军区总医院邓东安侯传举迟永辉韩秀敏张玉威关键词室间隔缺损；动脉导管未闭；超声中国图书资料分类号Ｒ４４５．１室间隔缺损合并动脉导管未闭（ＶＳＤ＋ＰＤＡ）临床并不罕见。两种畸形并存，常以一种畸...     

肺动脉瓣缺如的产前超声心动图诊断价值分析

探讨超声心动图对肺动脉瓣缺如(absent pulmonary valve,APV)的产前诊断价值。方法选取并分析22例经胎儿MRI或出生后超声心动图诊断为APV的产前超声资料。结果 APV声像图主要表现为肺动脉瓣叶缺如或发育不良、瓣环狭窄、总干及分支瘤样扩张、肺动脉内双期双向血流。本组合并法洛四联症13例(59.09%),合并其他畸形9例(40.91%),包括室间隔缺损3例、肺动脉狭窄3例、右室双出口2例、三尖瓣下移畸形1例。22例胎儿中动脉导管缺失14例(63.64%),合并动脉导管未闭8例(36.36%);室间隔缺损18例(81.82%),室间隔完整4例(18.18%)。22例胎儿超声诊断正确20例,占90.91%;漏诊2例,占9.09%。结论联合应用四腔心切面、心室流出道切面及三血管气管切面,多普勒超声心动图可以比较准确地诊断胎儿肺动脉瓣缺如,但容易漏诊,需要与单纯肺动脉瓣狭窄鉴别。     

Berry综合征的超声心动图诊断价值分析

目的：分析Berry综合征彩色多普勒超声心动图图像特征,评价多普勒超声心动图对Berry综合征的诊断价值,分析超声心动图漏误诊的原因,旨在提高超声心动图技术对Berry综合征诊断的准确性。方法21例经心外科手术或经核磁共振（M RI）检查明确为Berry综合征的患儿为研究对象,对其超声心动图检查结果进行回顾性分析。结果Berry综合征畸形主要包括远端主肺动脉间隔缺损（21例）、右肺动脉异常起源于升主动脉（21例）、主动脉弓离断（A型19例）及主动脉缩窄（2例）、室间隔完整（21例）;最常见的合并畸形有肺动脉高压（21例）、动脉导管未闭（19例）、房间隔缺损（9例）、卵圆孔未闭（4例）、主动脉瓣狭窄（1例）、二尖瓣狭窄（1例）。21例患儿中,超声诊断符合17例（占81．0％）;超声漏、误诊4例（占19．0％）,其中2例漏诊右肺动脉异常起源于升主动脉、1例漏诊主肺动脉间隔缺损及右肺动脉异常起源于升主动脉;1例主动脉弓中断A型误诊为B型。结论多普勒超声心动图技术可以较准确地诊断Berry综合征的各种组合畸形,但容易漏诊,必要时可行M RI检查。     

完全性大动脉转位的多普勒超声心动图诊断

目的:分析多普勒超声心动图诊断完全性大动脉转位(C-TGA)的准确性,提高超声心动图的首次检出率。方法:经外科手术证实为C-TGA的118例患者为研究对象,回顾性分析其超声心动图表现。结果:118例患者中,心房正位,心室右袢大动脉右转位112例,占94.9%;心房反位,心室左袢大动脉左转位6例,占5.1%。常见的合并畸形有房间隔缺损/卵圆孔未闭85例(72.0%)、动脉导管未闭68例(57.6%)、室间隔缺损35例(29.7%)、肺动脉狭窄29例(24.6%)、不典型冠状动脉13例(11.0%)。超声诊断正确者113例,占95.8%;误诊5例,占4.2%。在合并畸形中,误诊、漏诊不典型冠状动脉7例(53.8%)、动脉导管未闭2例(2.9%)。结论:多普勒超声心动图技术可以比较准确地诊断完全性大动脉转位。     

动脉导管未闭的MRI临床诊断价值

目的评价MRI在动脉导管未闭(PDA)诊断中的作用。材料与方法经手术或心血管造影(CAG)证实的各种先心病325例，其中PDA65例。所有病例均行0.3TMRI和经胸心脏超声(TTE)检查。结果MRI诊断PDA的灵敏度和特异性分别为95.4％和99.2％，对PDA形态分型诊断正确率为90.3％。结论MRI对PDA是一种有效的诊断方法；在青少年或成人的PDA及PDA合并室间隔缺损或艾森门格综合征的诊断中，MRI的诊断能力明显优于TTE。     

经胸和多平面经食管超声心动图与X线球囊导管检测成人动脉导管未闭的研究

目的：探讨经胸和多平面经食管超声心动图检测成人动脉导管未闭的价值。材料和方法：动脉导管未闭31例,于封堵术前行常规经胸和多平面经食管超声心动图检查,观察降主动脉和肺动脉之间的异常通道和彩色多普勒分流血流束,测量动脉导管内径。在封堵术中用球囊导管探测动脉导管内径。将经胸和多平面经食管超声心动图与球囊导管的测值进行对照。结果：经胸和多平面经食管超声心动图的测值与球囊导管测值均呈高度正相关,分别为r=0．84 (P＜0．01)和r=0．93(P＜0．01)。多平面经食管超声心动图的测值更接近于球囊导管的测值,二维图像和彩色多普勒血流显像更为清晰。结论：对于经胸超声心动图显示受限的成人动脉导管未闭,多平面经食管超声心动图是较好的补充诊断方法,并可为封堵治疗提供更多的定量诊断信息。     

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.