体表乳突面积的测量方法

目的:探讨体表乳突面积的测量方法,测量正常乳突面积。方法:①评价CT影像测量相关结构的正确性,采用64层螺旋CT对4具干颅标本进行扫描,在矢状位乳突显示最大截面分别测量乳突厚度(即外耳道下壁最低点至乳突后缘水平距离)和乳突高度(即外耳道下壁最低点至乳突尖的垂直距离);按影像层面对上述距离行实体测量。影像测量均值与实体测量均值的差异行显著性检验;②在体研究:随机入选无耳部疾患的118人(236侧),其中女性63例(126侧),男性55例(110侧),在体表上测量乳突厚度(设外耳门后缘最凸点为A点,自A点向后方引水平线与乳突后缘相交于B点,A、B两点间的直线距离代表乳突厚度)和乳突高度(以乳突尖为C点,自C点向AB线引垂直线,相交于D点,则CD两点间的直线距离代表乳突的高度),然后行颌面部扫描面CT扫描。以研究第一部分的方法选择层面,并测量乳突厚度和乳突高度,以乳突厚度与高度乘积的1/2定义乳突面积,同时在体表乳突测量值与影像乳突测量值之间行直线相关和回归分析。结果:①实验部分:各项指标的影像测量值与实体测量值差异无统计学意义(P0.05);②在体研究:各项指标测量结果侧别差异无统计学意义(P0.05),性别差异有统计学意义(P0.05)。体表乳突测量值和影像乳突测量值之间呈正相关,且相关有统计学意义(P0.001)。结论:此测量方法简单、可重复性强,可利用体表乳突面积评估颞骨内部乳突面积。     

先天性颅颌面骨常见畸形的MSCT诊断

目的:总结先天性颅颌面骨常见畸形的多层螺旋CT(MSCT)表现,提高诊断水准.方法:回顾性分析40例先天性颅颌面骨畸形的MSCT征象.结果:颅面裂畸形共14例,MSCT示均累及唇腭部,表现为上唇部唇弓区软组织崩裂伴邻近硬腭部骨质缺损,鼻中隔明显偏曲,9例同时伴有颌骨发育不良或偏颌畸形;半面短小症共7例,均累及单侧颅面部,MSCT示患侧下颌骨髁突、下颌支短小变细,耳廓、咬肌缩小并周围脂肪间隙变薄,下颌骨位置上移及左右面部不对称;眶距增宽症共9例,MSCT示两眼眶内侧间骨性距离增宽,双侧眶外壁夹角和视神经夹角增大伴眼球突出,鼻外形宽大扁平并软组织增厚,筛窦横径增宽、窦腔扩大伴过度气化,鼻甲肥大、颧面部骨质肥厚外凸及间距增宽;颅缝早闭症共10例,MSCT示颅骨不规则状突出,其中5例头颅向一侧倾斜,3例头颅呈舟状,2例头颅前部呈三角状,7例同时伴有颅板多发指压迹样改变.结论:各型先天性颅颌面骨常见畸形均具有典型的影像学征象,多层螺旋CT及其三维成像能清晰显示颅颌面骨畸形的特征性表现,能为临床诊断及治疗提供帮助.     

X线下显示颅底卵圆孔的新方法及其临床价值

目的：探究颅底卯圆孔显示新方法，为临床提供透视下准确穿刺卵圆孔的解剖影像学依据。方法：对37例（74侧）颅底骨标本，将卯圆孔涂钡（造影组）及不涂钡（平片组），在透视下观察卵圆孔与周围骨性结构的关系，寻找能显示卵圆孔的规律性；头颅湿标本13例（26侧），进行靶点验证穿刺。结果：发现在头颅侧轴位片上，中颅凹骨骼在卵圆孔前后方各形成一条弧形线影，分别与卯圆孔前后缘相连（简称中颅凹弧形线），卵圆孔正好位于两弧线相交点。在平片组卵圆孔前后两线的相交点可清晰分辨。74侧例标本卵圆孔显示最佳时，球管所倾斜的角度分别在30～39°（34．50±2．06），总体均数的95％的可信区间为（34．02，34．98），左右两侧进行了配对t检验，得左右两侧差异无统计学意义（P=0．716〉0．05）；26侧例标本靶点验证，卯圆孔穿刺成功率100％。结论：利用“中颅凹弧形线”这一骨性标志，可在头颅侧轴位准确显示颅底卵圆孔。使用此定位方法可在透视下实时观察、准确穿刺卯圆孔。     

面神经管骨折的CT诊断：附25例报告

目的：分析２５例面神经管骨折高分辨率ＣＴ所见，探讨各类型骨折与面神经管各段损伤的关系。材料与方法：对２５例面神经管骨折患者均采用高分辨率ＣＴ横断面及冠状面扫描，２例除横断及冠状面扫描外并行直接矢状面ＣＴ扫描。结果：面神经管迷路段损伤６例，占１３．８％；鼓室段损伤１４例，占４８．３％；乳突段损伤１１例，占３７．９％。结论：高分辨率ＣＴ可为外伤性面瘫提供可靠的诊断依据，对临床手术及估计预后有重要价值。     

《请您诊断》病例110答案：颅内巨大侵袭性神经内分泌肿瘤

病例资料患者,女,60岁,2个月前无明显诱因出现头痛伴走路不稳,一周前出现左腿麻木,言语较前不清,头晕、头痛较前加重,既往有高血压病史1年。胸部 X 线片、CT 平扫、腹部 B 超及血生化检查均未见异常。颅脑 CT 增强扫描示中颅窝底占位性病变。颅脑 MR 增强扫描示左侧斜坡岩锥、颞骨鳞部骨质明显吸收破坏,周围见5．8 cm×5．3 cm×6．4 cm 大小肿块,以长 T1、短 T2信号为主,病灶内见小片状、多发点状长 T1、短 T2信号,增强后明显强化,邻近脑膜明显强化,病变上缘至颅内颞叶,下缘经卵圆孔向颅底突入,周围脑组织受压见片状水肿,病灶局部向左侧咽后壁突入。左侧听神经、面神经受压,局部消失,脑桥、左侧大脑脚、海马、对应脑室均明显受压变形,左内耳受侵,鼓室、鼓窦及听小骨均未见明确显示,左侧乳突小房气化不良,其内黏膜增厚,呈斑片状稍长 T1、长 T2信号影,左侧三叉神经显示清晰（图1a～e）。影像学诊断：中颅窝底占位性病变,软骨肉瘤可能性大。手术所见：颞枕部颅骨骨质受侵蚀,部分颅骨已缺失,部分硬膜受侵袭。肿瘤位于硬膜下,呈红色,血供较丰富,质地不均匀,部分较硬,类似骨质改变,部分质地中等。肿瘤基底位于中颅窝底,肿瘤与脑组织间尚存在分界线,沿边界小心分离,可见肿瘤侵及天幕上下,同时侵及岩骨,已累及颈内动脉岩骨段,切除的肿瘤大小约4 cm×4 cm×4 cm。术后病理：可见异型细胞,呈圆形或卵圆形,核大深染,轻度异型,呈小巢状排列,间质血管丰富充血。（中颅窝底）免疫组化结果支持神经内分泌肿瘤（G1）,浸润性生长,生物学行为为恶性,不排除转移（图1f）。     

正常活体肾脏多层螺旋CT成像研究

目的通过对正常活体肾脏在多层螺旋CT(MSCT)图像上一些指标的观测分析,提供相应的正常值范围为临床和教学服务。方法收集腹部多层螺旋CT扫描正常肾脏123例,并行三维成像,观察左、右侧肾脏上、下极平椎体的位置,并同时比较同一个体左、右侧肾脏的高低。测量左、右侧肾脏上、下端距脊柱中线的距离及长轴与短轴的长度;测量左、右侧肾脏长轴与矢状面(侧夹LS)及冠状面(前夹LC)的夹角;测量肾门中点至对应的肾脏外缘最突点的连线与冠状面的夹角(前倾CL),并进行统计学处理。结果左肾高于右肾的百分率明显大于右肾高于左肾的百分率。左、右肾上极大部分都平T12,左肾上极高于T11的例数较右肾多,双侧肾脏下极大部分都平L2下份至L3下份。左、右侧肾脏各CT测量指标的统计结果除男前倾、男前夹、女前夹、总前夹、总侧夹外,大部分左侧肾脏测量指标大于或接近于右侧,并且有男宽、总长、总宽、总上距具有显著统计学意义(P<0.05)。男性大部分测量指标都大于女性,并且男、女的侧夹角及上、下距具有显著统计学意义。结论本研究获得了正常活体肾脏的位置、大小、形态的数据,可供临床诊断、治疗以及教学时参考。     

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.