动态增强CT检查对肾上腺腺瘤与非腺瘤的鉴别诊断价值

目的探讨动态增强CT检查技术对肾上腺腺瘤与非腺瘤的鉴别诊断价值并优选出有意义的参数，以进一步明确两者的鉴别诊断标准。资料与方法对44例共49个肾上腺肿瘤先平扫再行动态增强CT检查，观察以肿瘤的CT绝对值、绝对开始廓清率及相对开始廓清率作为标准鉴别肾上腺腺瘤与非腺瘤的诊断价值。结果延时3min，以36％的绝对开始廓清率或35％的相对开始廓清率分别与CT绝对值58HU相结合作为标准，对腺瘤有较高的诊断价值，对于腺瘤中的乏脂质性腺瘤与非腺瘤的鉴别诊断也具有同样的价值。结论以肿瘤的廓清率与延时增强后的CT绝对值作为联合标准，能明显提高腺瘤的诊断价值。     

CT平扫最小CT值对肾上腺乏脂性腺瘤的诊断价值

目的探讨平扫最小CT值(minimum attenuation values,minAVs)对肾上腺乏脂性腺瘤的诊断和鉴别诊断价值。方法回顾分析经临床及病理证实的38例38枚肾上腺乏脂性腺瘤(平均CT值10HU)和45例49枚非腺瘤的CT平扫资料,以minAVs≤0HU的个数≥2作为诊断乏脂性腺瘤的标准,并与CT直方图负值像素≥10%对照,分析二者在腺瘤和非腺瘤中的分布,以及计算二者对乏脂性腺瘤诊断的敏感度、特异度、阳性预测值和准确度。结果 minAVs≤0HU的个数≥2及CT直方图负值像素≥10%在腺瘤与非腺瘤中分别占63.2%(24/38)和2.0%(1/49)(X~2=39.038,P=0.000)、36.8%(14/38)和0%(0/49)(X~2=21.515,P=0.000),二者诊断腺瘤的敏感度、特异度、阳性预测值和准确度分别为63.2%、98.0%、96.0%、82.8%和36.8%、100%、100%、72.4%。结论与CT直方图负值像素≥10%比较,minAVs≤0HU的个数≥2的特异度和阳性预测值略低,但具有更高的敏感度和准确度,为减少不必要的手术创伤提供重要的依据。     

肾上腺腺瘤和非腺瘤的动态增强CT检查

目的采用规范化的动态增强CT检查技术,对大样本病例进行深人地多角度评价．使肾上腺肿瘤动态增强CT检查能够在临床上广泛应用。资料与月法经手术和临床证实的70例共79个肾上腺肿块（腺瘤44个．非腺瘤35个）分别以相同的扫描条件行CT平扫和动态增强检查（静脉注人对比剂后30s开始扫描）,然后延时1、2、3、5．7min扫描。剂量1．2ml／kg体重,注射流率2．5ml／s。分析评价肾上腺肿块的T—D曲线和廓清率Wash（相对廓清率Washr和绝对廓清率Washa）。结果T—D曲线分为5种类型,即A、B、C、D和E各型。腺瘤的特征曲线为A、C型,非腺瘤为B、D、E型（P=0．000）。Washr和Washa于腺瘤和非腺瘤间存在显著性差异（P=0．000）,腺瘸的Washr和Washa均高于非腺瘤,并且Washr诊断效果优于Washa。7min延时点诊断价值较大．Washr≥34HU提示为腺瘤．反之提示为非腺瘤。结论肾上腺CT动态增强检查能够对腺瘤和非腺瘤尤其对乏脂性腺瘤与非腺瘤的鉴别诊断具有较大价值。     

CT值在肾上腺腺瘤诊断中的应用价值及其阈值选择

目的：评价平扫CT值在肾上腺腺瘤诊断中的应用价值,并优化选择鉴别阈值。方法：回顾性分析经手术及病理证实的肾上腺肿瘤61例（63个病灶）,其中腺瘤33个,非腺瘤30个,分别测量肿瘤的平扫CT值并计算不同CT值阈值鉴别腺瘤与非腺瘤的敏感性、特异性、准确性、阳性预测值及阴性预测值。结果：33个腺瘤平扫CT值-9.0～42.6HU（10.6±11.4）HU,30个非腺瘤平扫CT值18.2～48.7HU（36.1±7.3）HU,两者的平均平扫CT值差异有显著性意义（t=10.436,P=0.000）。使用15HU作为鉴别域值时诊断腺瘤的敏感度73%,特异度100%,准确度86%,阳性预测值100%,阴性预测值77%;而使用20和25HU作为域值时的敏感度更高,分别为85%和91%,但特异度降低,分别为93%和90%。结论：平扫CT值在肾上腺腺瘤鉴别诊断上有重要价值,以≤15HU作为腺瘤的诊断标准是比较合适的,特异度高,敏感度也相对较高。     

肿瘤廓清率在动态增强MRI检查中对肾上腺肿瘤的鉴别诊断价值

目的　探讨应用动态增强MRI检查技术 ,以肿瘤的廓清率为标准 ,再结合该时间点的信号增加比 ,对肾上腺腺瘤与非腺瘤进行鉴别诊断的临床价值。方法　 3 6例共 41个肾上腺肿瘤均先行常规SE序列T1 WI及T2 WI成像 ,再利用屏气快速多层面破坏性梯度回波序列 (fastmultiplanarspoiledgradient-echo ,FMPSPGR)行轴位扫描 ,先平扫 ,再以同样条件行MRI动态增强检查 ,观察病变的增强程度并分别测量肿瘤实质部分的信号值。分别比较腺瘤与非腺瘤的廓清率及信号增加比 ,明确其鉴别诊断价值。结果　延时 5min并以廓清率 2 2 %为阈值时 ,诊断腺瘤的敏感性 74% ,特异性 73 % ,准确性 73 % ;若将延时 5min时肿瘤的廓清率 (2 2 % )与信号增加比(<0 .48)相结合 ,则诊断腺瘤的敏感性、特异性、准确性明显提高 ,分别为 95 %、91%、93 %。结论　利用动态增强检查技术 ,以肿瘤的廓清率为标准 ,再结合该时间点的信号增加比 ,可在最短的时间内提高肾上腺腺瘤与非腺瘤的鉴别诊断水平     

肾上腺肿瘤的MSCT多期增强扫描应用价值

目的 探讨MSCT多期增强扫描对肾上腺肿瘤的诊断及鉴别价值.方法 收集经病理证实的肾上腺肿瘤患者70例共72个病灶的资料,包括醛固酮腺瘤23个、皮质醇腺瘤18个、嗜铬细胞瘤17个及转移瘤14个.结果 醛固酮腺瘤平扫CT均值≤20 HU,21个呈轻度均匀强化.皮质醇腺瘤平扫CT均值≤25 HU,12个呈中度均匀强化;15个嗜铬细胞瘤呈重度不均强化;12个转移瘤呈中度不均强化.动脉期强化率:醛固酮腺瘤＞嗜铬细胞瘤＞皮质醇腺瘤＞转移瘤;静脉期强化率:醛固酮腺瘤＞皮质醇腺瘤＞转移瘤,嗜铬细胞瘤＞转移瘤;相对造影剂清除率:醛固酮腺瘤＞皮质醇腺瘤＞嗜铬细胞瘤＞转移瘤.结论 肾上腺4种常见肿瘤的MSCT平扫、增强密度特征及其强化率、清除率存在差异,可作为这些肿瘤诊断及鉴别诊断的参考指标.     

肾上腺腺瘤和非腺瘤动态增强CT表现与血管生成相关性的初步研究

目的探讨肾上腺腺瘤和非腺瘤血管生成[微血管密度（MVD），血管内皮生长因子（VEGF）]特点与动态增强CT表现的相关性，以阐述其动态增强机制。方法经手术病理证实的42例46个肾上腺肿块（腺瘤23个、非腺瘤18个、增生结节5个）均行动态增强CT检查和病理学检查。首先评价肾上腺腺瘤和非腺瘤动态增强CT表现，而后分析肾上腺肿块动态增强CT表现特征[时间-密度（T-D）曲线、廓清率（Wash）]与血管生成之间的相关关系。结果腺瘤与非腺瘤间T—D曲线类型和7min延时点相对廓清率（Washr）和绝对廓清率（Washa）差异均存在统计学意义（P=0．000）。肾上腺肿块T—D曲线廓清迅速组（A、C型）与廓清缓慢组（B、D、E型）间、7min延时点Washr≥34％组与〈34％组间、Washai≥43％组与〈43％组间MVD、VEGF表达水平差异均有统计学意义（P〈0．05）。肿块廓清曲线为A、C型，和（或）Washr≥34HU，和（或）Washai≥43％组均提示为腺瘤，反之提示为非腺瘤。T—D曲线廓清迅速组、7min延时点Washri≥34％组和Washa≥143％组MVD、VEGF表达水平分别高于廓清缓慢组、〈34％组和〈43％组；由此提示动态增强CT表现特征与MVD、VEGF表达存在相关性。另一方面，腺瘤和非腺瘤间MVD和VEGF表达存在显著不同。结论MVD和VEGF可能是导致腺瘤和非腺瘤具有不同的T—D曲线类型和廓清率的主要因素之一。     

CT纹理分析在鉴别肾上腺乏脂性腺瘤与肝细胞癌肾上腺转移瘤的价值

目的 探讨CT图像纹理分析在鉴别肾上腺乏脂性腺瘤与肝细胞癌（HCC）肾上腺转移瘤的价值。方法 选取我院经病理或临床证实的HCC肾上腺转移瘤和乏脂性腺瘤患者的临床和影像资料,采用Image软件于动脉期、静脉期轴位图像肿瘤最大层面手动绘制ROI,提取病灶的GLCM纹理参数,比较两组肿瘤各参数的差异,并分析各参数的诊断效能。结果 动脉期GLCM纹理参数中熵和能量组间差异有统计学意义（P<0.05）,静脉期熵和能量组间差异有统计学意义（P<0.05）,且乏脂性腺瘤组动脉期、静脉期的熵值均小于HCC肾上腺转移瘤组,能量均大于HCC肾上腺转移瘤组,其中静脉期熵的诊断效能最佳,其AUC为0.862,以6.577为临界值,敏感度和特异度分别为88.4%、69.7%。结论 CT增强图像纹理分析有助于鉴别肾上腺乏脂性腺瘤与HCC肾上腺转移瘤,其中静脉期的熵是最佳鉴别参数。     

良、恶性乏脂质性肾上腺肿瘤的动态MRI检查

目的：探讨MRI动态增强检查技术对乏脂质性肾上腺肿瘤良、恶性的鉴别诊断价值。方法：经手术和临床证实的29例共33个乏脂质性肾上腺肿瘤行MRI平扫并于注药后1min、2min、3min、5min、7min和9min时间点行动态增强检查,分别观察病变的增强程度并获取乏脂质性肾上腺肿瘤的廓清率（Wash）和时间-信号强度曲线（T-S curve）,以评估良、恶性肿瘤间是否存在统计学差异。结果：T-S曲线分Ⅰ~Ⅴ五种类型。良性乏脂质性肿瘤的特征曲线为Ⅰ、Ⅱ型和Ⅳ型;恶性乏脂质性肿瘤的特征曲线为Ⅲ型和Ⅴ型（P=0.000）,肾上腺良性乏脂质性肿瘤的廓清率高于恶性肿瘤,两者之间差异有统计学意义（P=0.006）,在5min延迟点诊断价值较大,Wash≥23%提示为良性肿瘤。结论：MRI动态增强检查技术对乏脂质性肾上腺肿瘤良、恶性的鉴别诊断具有较高价值。     

ROC曲线分析在肾上腺肿瘤的动态增强CT、MRI检查中的应用

目的 探讨应用受试者操作特性(ROC)曲线评价以肿瘤廓清率为标准利用动态增强CT、MRI检查鉴别肾上腺肿瘤的价值及其这两种检查方法的相关性.资料与方法 25例共28个肾上腺肿瘤均先行平扫及动态增强CT检查,之后再行平扫及动态增强MRI检查,以肿瘤的廓清率为鉴别标准,利用ROC曲线对所选取的诊断标准进行评价,通过ROC曲线下面积(AZ值)来确定所选择诊断标准的价值,并对这两种检查方法行相关性分析.结果 在延迟5～35 min时间点,以肿瘤的廓清率为标准对肾上腺肿瘤的鉴别诊断价值较大(AZ值均在0.7以上),两者之间差异无统计学意义(P＞0.05),再通过对两组变量,即两种检查方法中的廓清率进行分析,认为在延迟5～50 min时,两组变量对肾上腺肿瘤的鉴别诊断均具有高度相关性.结论 以肿瘤的廓清率为诊断标准,无论是利用动态增强CT还是动态增强MRI检查,均可提高肾上腺肿瘤的鉴别诊断水平,两种检查方法对于肾上腺肿瘤的鉴别诊断价值差异无统计学意义,且检查结果具有一致性.     

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.