螺旋CT多期增强扫描对诊断肝细胞癌和肝转移瘤的评价

目的：评估螺旋CT多期增强扫描对肝细胞癌与肝转移瘤的诊断价值。方法：回顾分析经手术病理证实的35例肝细胞癌与肝转移瘤螺旋CT多期增强扫描表现。结果：12例巨块型肝癌平扫为低密度，增强扫描动脉期均明显不均匀强化，特点为肿瘤供血血管强化，结节型8例表现为病灶斑片状及边缘强化，肿瘤供血血管不明显，小肝癌5例为动脉期全瘤强化．强化后CT值可增加40HU以上，肝转移瘤动脉期病灶无明显强化。静脉期呈环形轻度强化，呈现典型“牛眼征”。结论：螺旋CT多期增强扫描对明确肿瘤血供和肿瘤生长方式与小肝癌诊断有重要的意义。     

肾脏孤立性纤维性肿瘤MSCT表现分析

目的 分析肾脏孤立性纤维性肿瘤(SFT)的MSCT表现及病理学特征,提高对本病影像学表现的认识.方法 搜集经病理证实的7例肾脏SFT的MSCT影像资料,分析病变良恶性、部位、数量、大小、形态、边缘、密度、强化程度和方式、供血血管等.结果 CT诊断良性6例,恶性1例,与病理符合率100％.7例均为局灶型,最大直径2.8～11.2 cm,4例位于左肾,3例位于右肾.良性肿瘤呈类圆形及不规则形各3例,其中1例肿瘤伴有钙化及坏死,余呈稍高均匀密度软组织肿块,边界清楚,呈膨胀性生长;恶性病变呈类圆形囊实性肿块,密度不均,实质部分稍高于肾实质,边界不清,呈浸润性生长.CT增强皮质期肿瘤实质呈轻中度斑片状不均匀强化,实质期强化更明显,呈进行性强化方式.后处理显示肾动脉分支参与供血.病理示肿瘤由梭形细胞、纤维及血管组成.结论 肾脏原发性SFT罕见,CT表现具有一定特征性且与临床病理密切相关,CT可以用于鉴别其良恶性.     

肝脏恶性纤维组织细胞瘤的影像学表现

目的提高对肝脏恶性纤维组织细胞瘤影像学表现的认识。方法回顾性分析4例经手术或活检病理证实的肝脏恶性纤维组织细胞瘤的影像学特点，其中包括CT4例，MRI2例，肝动脉DSA1例。结果4例肿瘤均位于肝右叶，肿瘤呈浸润性生长，与周围肝实质分界不清，3例侵犯肝包膜。4例CT平扫均表现为不规则形低密度灶，CT值28—36HU，其中2例可见片状稍高密度出血灶；增强扫描动脉期肿瘤实质呈轻度强化，CT值52—70HU，静脉期呈中度强化，CT值75—98HU，病灶内部中央坏死显著。2例表现为T1WI低信号，与肌肉信号相当，其中1例病灶内见片状等高信号影，T2WI为较高信号。1例DSA表现为肝动脉分支走行呈“抱球状”，实质期可见不规则肿瘤染色。结论肝脏恶性纤维组织细胞瘤的影像学表现主要为肿瘤向外浸润明显，边界不清，肿瘤内部坏死显著，实质部分所占比例很小，瘤内出血常见。     

CT finding of rare primary malignant tumor of the liver

目的:探讨肝脏少见原发性恶性肿瘤的CT表现特点.方法:回顾性分析经病理证实的8例肝脏少见原发性恶性肿瘤的CT表现并复习相关文献.结果:血管肉瘤3例(巨块结节型2例,弥漫多结节型1例),平扫呈不均匀低密度,2例内部见云絮状稍高密度影;增强扫描动脉期,巨块结节型主灶呈斑片状不均匀强化,弥漫多结节型呈结节状强化,门脉期及延迟期病灶均呈持续向心性强化.恶性纤维组织细胞瘤4例,平扫以等密度为主,夹杂条带状低密度区;3例增强扫描动脉期轻度不均匀强化,门脉期及延迟期强化程度下降,另1例动脉期呈轻度强化,门脉期强化程度增高,延迟期强化度减低.上皮样血管内皮瘤1例,CT平扫呈较均匀低密度影;增强扫描动脉期呈不规则环形强化,门脉期强化程度增高且向中央扩展,延迟期肿瘤均匀强化且程度降低.结论:CT平扫+三期增强扫描并结合临床资料可提高肝脏少见原发性恶性肿瘤的诊断率,确诊仍需依靠病理学检查.     

原发性肝脏血管肉瘤的螺旋CT表现

目的分析原发性肝脏血管肉瘤(PHA)的螺旋CT表现,提高其诊断符合率。资料与方法回顾性分析6例经病理证实的PHA,进行上腹部螺旋CT平扫和三期动态增强扫描,使用GE Light Speed 16层螺旋CT机。评估病灶的数目、大小、形态、密度特点及动态增强后的强化程度。结果 6例中,弥漫多结节型4例,巨块型2例。6例CT平扫均呈低密度,均匀或不均匀。增强扫描动脉期,弥漫多结节型病灶大部分呈中心斑点状强化,少数病灶呈边缘结节状强化,随后病灶强化区域明显扩大而呈典型的渐进性强化特点;延迟扫描部分或全部病灶与肝实质呈等密度强化。巨块型病灶多呈小片状不均匀渐进性强化,整个病灶的强化程度低于肝实质及周围的血管。结论 PHA的CT表现为中心斑片状渐进性强化的特点,不典型时需与肝海绵状血管瘤及原发性肝细胞癌鉴别,最终确诊还需依靠病理及免疫组织化学。     

肝脏原发性血管肉瘤的CT表现(附3例报告及文献复习)

目的探讨肝脏原发性血管肉瘤的CT诊断特点及鉴别诊断。资料与方法对经手术病理证实的3例肝脏原发性血管肉瘤的CT表现进行回顾性分析,并结合文献分析肝脏原发性血管肉瘤的CT表现特点。结果 2例表现为巨块型,并周缘见子病灶,1例表现为弥漫多结节型,平扫均表现为不规则低密度区,无明显边界,增强扫描动脉期病灶内呈轻度不均匀强化,门静脉期可见不规则条状及斑片状强化,延迟期病灶呈向中心充填式强化;肝内外胆管均未见扩张,1例伴双肺转移瘤。结论肝脏原发性血管肉瘤的CT表现具有一定特点,结合临床病史及体征,不难与肝血管瘤、肝癌及肝转移癌鉴别。     

肝脏少见原发性恶性肿瘤的CT表现

目的:探讨肝脏少见原发性恶性肿瘤的CT表现特点。方法:回顾性分析经病理证实的8例肝脏少见原发性恶性肿瘤的CT表现并复习相关文献。结果:血管肉瘤3例(巨块结节型2例,弥漫多结节型1例),平扫呈不均匀低密度,2例内部见云絮状稍高密度影;增强扫描动脉期,巨块结节型主灶呈斑片状不均匀强化,弥漫多结节型呈结节状强化,门脉期及延迟期病灶均呈持续向心性强化。恶性纤维组织细胞瘤4例,平扫以等密度为主,夹杂条带状低密度区;3例增强扫描动脉期轻度不均匀强化,门脉期及延迟期强化程度下降,另1例动脉期呈轻度强化,门脉期强化程度增高,延迟期强化度减低。上皮样血管内皮瘤1例,CT平扫呈较均匀低密度影;增强扫描动脉期呈不规则环形强化,门脉期强化程度增高且向中央扩展,延迟期肿瘤均匀强化且程度降低。结论:CT平扫+三期增强扫描并结合临床资料可提高肝脏少见原发性恶性肿瘤的诊断率,确诊仍需依靠病理学检查。     

直肠间质瘤的螺旋CT表现

目的:探讨直肠间质瘤的CT表现特征。方法:回顾性分析经手术和病理证实的10例直肠间质瘤的临床及CT检查资料。结果:10例直肠间质瘤中恶性7例,交界性3例。肿瘤均位于直肠中下段,肿块最大径3~9cm,平均5.8cm。CT表现为盆腔内边界清楚的类圆形肿块,呈腔内外膨胀性生长,实性部分中度强化,肿块局部与直肠壁相连,其中8例呈锁征,6例病灶内可见低密度坏死灶,坏死区与肿块实质区分界模糊。10例均未见腹盆腔肿大淋巴结及肝或腹膜转移。结论:直肠间质瘤具有相对特征性的CT表现:肿块呈腔内外膨胀性生长,边界清楚;肿块部分与直肠关系密切,呈锁征。掌握这些CT表现有利于提高直肠间质瘤的诊断正确性。     

恶性蝾螈瘤肺转移1例报告并文献复习

目的分析恶性蝾螈瘤(MTT)肺转移CT平扫及增强表现,结合文献探讨有关MTT的临床、影像表现、病理学特征及鉴别诊断。方法分析1例恶性蝾螈瘤肺转移病人的临床病史及CT资料,并复习MTT的相关文献。结果 CT平扫示右肺上叶可见一类圆形肿块,其密度较均匀,CT值39~46 HU;边缘光整,界限清晰,大小约为9.9 cm×9.3 cm×6.8 cm,周围肺组织受压;增强CT检查肿块呈轻度不均匀强化,边界清晰,其30 s、60 s及90 s强化CT值分别为39~50 HU、40~56 HU、50~61 HU。右肺上叶病灶CT导向经皮穿刺活检,病理组织学结合免疫组化:Vimentin(+)、SMA(+)、Desmin(+)、S-100灶区(+)、CK(-)、TTF-1(-)、CK5/6(-)、34βE12(-)、Syn灶区(+)CD56(+),符合恶性MTT肺转移。结论 MTT影像表现无特异性,需结合临床资料、组织病理学及免疫组化明确诊断。     

CT对钙化性肝脏肿瘤的诊断价值

目的 探讨伴有钙化的肝脏肿瘤的CT表现及诊断价值.资料与方法回顾性分析31例行腹部CT平扫,其中12例行增强扫描并经穿刺活检或手术病理证实的伴有钙化的肝脏病变患者的影像学资料.结果原发性肝脏恶性肿瘤13例;转移瘤16例;良性肿瘤2例.病灶单发17例,多发14例.钙化呈砂粒状16例,不规则斑片状5例,斑点状10例;钙化位于病灶中心28例,病灶边缘3例.结论肝内钙化可见于多种良性或恶性病变,螺旋CT对肝内钙化病变具有重要的诊断价值.     

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.