飞行人员颈椎病误诊一例

一、临床资料患者 ,男性 ,37岁 ,直 - 9空勤机械师 ,飞行时间 140 0 h。2 0 0 0年 12月 17日来我院疗养 ,入院大体检述颈肩部酸痛不适伴一过性眩晕、胸闷、心悸并四肢发冷两年余。两年多来 ,上述症状曾多次发作 ,先后 3次住院治疗 ,分别诊断为“高血压病 期”、“植物神经功能紊乱”。行头颅CT、MRI、颈椎 MRI、椎动脉彩色超声及2 4h动态心电等检查均未见异常改变。查体 :颈曲直 ,颈 4棘突左偏 ,棘旁左侧压痛 ( ) ,压痛放射痛 ( ) ;颈棘上韧带剥离、压痛 ( ) ,颈 4、颈 5左侧关节囊肿胀 ,大小约为 1.0 cm× 1.2 cm,压痛 ( ) ;双侧肱二…     

颈椎间盘突出症停飞一例

一、临床资料患者男性,汉族,38岁,歼7飞行员,飞行总时间为2 32 0h。患者自诉2 0 0 2年12月初,无明显诱因出现颈部疼痛伴头晕、头痛、双上肢放射痛,右上肢无力。颈椎X线片示:颈4椎体后下角增生后突,颈5 6椎间隙变窄。颈椎CT示:颈5 6椎间盘突出。2 0 0 2年12月、2 0 0 3年2月两次在我科住院治疗,诊断为:颈椎间盘突出症(C5 6) ,给予颈部手法、牵引、颈椎旋转复位、中药热敷等治疗,好转后出院。飞行结论:飞行暂不合格,地面观察2个月。2 0 0 3年7月2日返院复查,查体:颈部活动明显受限,前屈约2 0°,后伸约15°,左右侧屈均为15°,左旋转4 0°,右…     

自发性脊髓硬膜外血肿1例

1　病历简介患者女 ,43岁 ,因颈痛伴右侧肢体活动欠灵活 10小时而入院 ,患者于入院当日凌晨时刻睡眠过程中突然出现剧烈颈痛 ,向左肩部放散 ,随后左侧肢体活动欠灵活 ,左上肢抬举困难 ,走路不稳 ,急诊入院。内科一般检查及颅神经检查未发现异常 ,颈椎棘突 ( 1-7)有压痛 ,颈部活动受限 ,颈部以下痛觉减退 ,但触觉存在 ,左肩部感觉过敏 ,左上肢肌力 3～ 4级 ,左肱二头肌反射 ( ) ,肱三头肌反射 ( ) ,腹壁反射 ( -) ,左足趾反射( -) ,桡骨膜反射 ( -) ,左侧踝阵挛 ( ) ,双侧未引出病理反射 ,既往无高血压及糖尿病史 ;头部ＣＴ检查未见异常 ;…     

多发性骨髓瘤误诊为颈椎病一例

患者，男，54岁。因颈项部件右肩背疼痛及双上肢麻木二月余入院。患者二个月前无明显诱因出现左上肢桡侧麻木，以左手桡侧三指麻木为著，在当地医院经颈椎MRI检查确诊为“颈椎病”，一个月后出现右肩背部及右上臂疼痛，逐渐出现右上肢桡侧麻木感及左肩背疼痛，经牵引、理疗，封闭等治疗症状未见缓解。查体，颈曲直，颈椎活动略受限，C5，8棘突序列欠佳，压痛（＋），压颈试验左（±），右（＋）臂丛牵拉试验：（），肱二头，三头肌腱反射对称存在，双上肢肌力V0，双上肢皮肤痛觉对称灵敏。颈椎平片示：预曲直，C3，5序列略差，其后缘可见…     

颈椎畸形伴外伤性寰枢半脱位外科治疗一例报告

1　临床资料患者 ,女 ,30岁。1 996年 7月 3日乘公共汽车时急刹车 ,颈部过屈位受伤后头晕、恶心、呕吐一次 ,颈部不适、疲劳、疼痛、活动受限 ,于 1 996年 1 0月 2 1日入院 ,查体 :颈部压痛、活动明显受限、发直 ,以屈曲受限为主 ,肩部皮肤痛觉减退 ,双上肢肌力 级 ,右膝腱反射消失。左侧腹壁较右侧痛觉减退 ,左跟腱反射消失、双足趾背伸无力 ;X线拍片及断层片示寰枢畸形及颈 2、3椎体畸形融合 ,寰齿间隙 >5mm,寰枢椎半脱位 ,核磁及 CT示寰枢椎半脱位 ,脊髓轻度受压。2　手术方法备 4孔普通钢板 2副 ,中间拧成 90°角 ,枕颈角弯成 1 0 …     

颈椎椎管内孤立性纤维瘤1例

<正>患者女,32岁。因"颈肩部疼痛伴双上肢麻木半年"入院。查体:颈4～6棘突及椎旁肌压痛、叩击痛。双侧中、环、小指夹纸试验(+)。CT和MR表现:颈5-6椎体水平左侧、髓外硬膜下一椭圆形软组织肿块,大小约28. 6mm×16. 8mm×15. 2mm,边界清楚,肿块向左侧椎间孔内生长,左侧椎间孔稍扩大,邻近椎体后缘压迫性骨质吸收,肿块包绕左侧椎动脉(图1～5),脊髓受压右移,相应蛛网膜下腔增宽。CT平扫肿块呈稍低密度,增强后明显不均匀强化。MRI表现:肿块T_1WI呈低信号、T_2WI呈等高信号,脂肪抑制序列呈稍     

彩色多普勒超声诊断臂丛神经根性撕脱伤2例

例1,男,37岁,因外伤术后左上肢感觉恢复差,主动活动功能丧失2月余,于2010-03-31入院。专科检查：颈部正常,双侧颈椎旁无压痛,左上肢肌力0级,萎缩肌肉有少许恢复,左面部及左侧肢体感觉减退。超声所见：左侧C5、C6未见神经根显示,C7、C8、T1根部膨大,锁骨下动脉旁臂丛神经干水平可见瘤样改变,横截面积较对侧增大。     

先天性双侧高肩胛症1例

患者,女,4岁。先天性双侧高肩胛症4年。查体:颈部较饱满,颈短而粗,肩颈线减少,弧度平坦,双上肢外展、上举受限,颈椎前突增加。X线检查:前后位胸片所见,胸廓基本对称,双侧肩胛骨位置升高,肩胛上角均越过锁骨上方。左侧肩胛骨更靠近内侧,同侧肩胛上缘达第6颈椎水平。右侧肩胛上缘     

优秀男子业余拳击运动员颈椎损伤流行病学调查及X线特征分析

目的:研究优秀男子业余拳击运动员颈椎损伤情况,分析其常见症状、体征的分布特征及X线特征。方法:以国家拳击队、河南省拳击队61名优秀男子业余拳击运动员为研究对象,由运动创伤专业医师对其进行颈部损伤的症状调查和体征检查;并为其中30名有头部受重击受伤史且伴有颈痛症状者拍摄颈椎X线正侧位、双斜位片进行观察和测量。对所获数据进行统计分析。结果:共计61例样本中,有头部受重击史49人,占80.3%。列前4位的症状依次是颈痛(68.9%)、颈性头晕(62.3%)、颈性头痛(49.2%)和颈部活动受限(39.3%)。C2棘突旁压痛、C2-3小关节压痛、枕下三角压痛等3个阳性体征出现频率最高,皆为38人(62.3%);颈性头痛、颈性头晕、颈痛、颈部活动受限、枕下三角压痛、C2棘突压痛、C2-3小关节压痛等7个症状和体征的发生与头部受重击密切相关。30例X线样本中,棘突偏离中线以C2最多(96.7%),棘突偏歪整体分布自上而下逐渐减少;小关节双边征以C3-4分布频率最高(53.3%);颈曲均值为26.59±1.93°,明显小于正常人群;椎间孔狭窄以C3-4最多(40%)。结论:优秀男子业余拳击运动员颈椎损伤特点是上位颈椎损伤几率较高;X线特征是棘突偏歪自上而下逐渐减少,小关节双影以C3-4出现率最高,颈椎曲度明显小于普通人群,C3-4和C4-5椎间孔狭窄发生率较高;头部受重击是拳击运动员颈椎损伤的主要致病因素之一。     

幼儿颈3棘突巨大骨软骨瘤1例

患者 ,男 ,6岁 ,颈后部包块并逐渐增大 3个月于 2 0 0 1-0 7- 18入院。体检 :一般情况好 ,心肺正常 ,颈后皮肤正常色 ,颈后上方后突出呈丘性突起 ,颈 3棘突偏左侧可触及一约 3ｃｍ× 3ｃｍ大小包块 ,质硬 ,压痛不明显 ,包块周界清楚 ,不移动 ,颈椎活动度尚可。颈椎Ｘ线片及ＣＴ提示 :颈 3、4、5棘突后方密度较高阴影 ,密度近似颈椎棘突 ,呈椭圆形 ,根部似来源于颈 3、4、5棘突。入院初步诊断 :颈 3、4、5棘突骨软骨瘤。 2 0 0 1- 0 7- 2 0在全麻下行瘤体切除术 ,经颈后正中入路 ,见包块概位于颈 3棘突左侧分叉顶端 ,体部突向下方 ,于颈 4、5…     

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.