超声鉴别儿童穿孔与非穿孔性阑尾炎

目的 评价超声鉴别儿童阑尾炎是否穿孔的价值。方法 收集有明确病理结果的急性阑尾炎患儿193例,所有患儿均在手术治疗前接受超声检查。超声观察并记录阑尾最大直径、脓肿、阑尾腔内结石、阑尾黏膜下层、腹腔游离液体、阑尾周围脂肪组织等。以手术所见为标准、判断是否存在阑尾穿孔。分析超声各指标鉴别阑尾是否穿孔的价值,评判其特异度和敏感度。结果 <9岁患儿阑尾穿孔率（24/39,61.54%）远高于≥9岁患儿（52/154,33.77%;χ²=10.05,P=0.002）。提示阑尾穿孔意义较大的超声指标包括脓肿形成[敏感度38.16%（29、76,特异度99.15%（116、117）]<9岁患儿阑尾黏膜下层缺失[敏感度100%（24/24）,特异度66.67%（8/12）]及阑尾腔内结石[敏感度90.91%（20/22）,特异度77.00%（9/12）]。结论 超声对于鉴别儿童阑尾炎是否穿孔有较高价值。     

穿孔性阑尾炎CT征象

目的 探讨阑尾穿孔具有诊断价值的CT征象。方法 回顾性分析205例经手术病理证实的穿孔性和非穿孔性阑尾炎患者的CT图像。观察12项急性阑尾炎的CT征象,采用χ²检验筛选可用于鉴别诊断穿孔性与非穿孔性阑尾炎的CT征象,评价这些征象的敏感度、特异度和准确率。采用Logistic回归分析法分析阑尾穿孔最具诊断价值的CT征象。结果 205例中,40例(40/205,19.51%)阑尾穿孔与165例(165/205,80.49%)阑尾未穿孔患者间,脓肿、阑尾壁强化缺损、蜂窝织炎、阑尾腔外积气、阑尾腔外粪石差异均有统计学意义(P均<0.05),各征象鉴别诊断穿孔性和非穿孔性阑尾炎的敏感度、特异度和准确率依次分别为:脓肿80.00%(32/40)、97.58%(161/165)、94.15%(193/205),阑尾壁强化缺损50.00%(20/40)、98.79%(163/165)、89.27%(183/205),蜂窝织炎37.50%(15/40)、95.76%(158/165)、84.39%(173/205),阑尾腔外积气27.50%(11/40)、99.39%(164/165)、85.37%(175/205),阑尾腔外粪石5.00%(2/40)、100.00%(165/165)、81.46%(167/205),Logistic回归分析显示脓肿、阑尾壁强化缺损与阑尾穿孔相关(Wald=33.21、16.19,P均<0.001)。结论 脓肿、阑尾壁强化缺损是阑尾穿孔最有诊断价值的CT征象。     

Intramesosigmoid hernia: preoperative diagnostic MDCT findings

Internal hernias, protrusion of abdominal viscera into an intraperitoneal fossa, are uncommon causes of bowel obstruction, and preoperative diagnoses are difficult. We report a rare case of a 47-year-old female with strangulated small bowel obstruction secondary to an intramesosigmoid hernia preoperative diagnosis by multi-detector row computed tomography. We highlight the preoperatively diagnosed value and findings of MDCT in intramesosigmoid hernia.     

Unusual perforated appendicitis within umbilical hernia: CT findings

We present the first imaging report of perforated appendicitis in an umbilical hernia. Computed tomography demonstrated a gas-forming abscess within an umbilical hernia and the cecum was found inside the hernial sac, with an inner relation to the abscess. Computed tomographic findings suggested appendicitis as possible diagnosis, which was confirmed at surgery. Physicians must consider appendicitis within the differential diagnosis of an abdominal abscess located near to the cecum, even at an unexpected location.     

Clinical findings, diagnostic approach, and outcome of Brucella melitensis epididymo-orchitis

We have studied 912 patients with brucellosis. Of these, 631 (69.2%) were male and 48 had epididymo-orchitis, giving an incidence of epididymo-orchitis of 7.6%. The duration of symptoms before diagnosis was 52.5 +/- 70 days. All the patients had fever, swelling, and scrotal pain, but only 2 (4.2%) reported urinary symptoms. Seven patients (14.5%) had leukocyte figures above 11 x 10(9)/L, and urine analysis was normal in 69% of the patients. Blood cultures were positive in 65.8% of cases. A total of 33 patients (68.8%) received a combination of doxycycline plus streptomycin and 13 (27.1%) doxycycline plus rifampin. The overall percentage of failure or relapse was 8.8%: 7.1% in the doxycycline plus streptomycin group and 20% in the doxycycline plus rifampin group. None of the patients required surgery. Pending clinical trials to confirm the results, conservative management with a combination of doxycycline for 2 months and streptomycin for 14 to 21 days appears to be adequate and could avoid unnecessary orchiectomy.     

腹腔镜治疗急性穿孔性阑尾炎的价值评估

目的对比分析开腹阑尾切除与腹腔镜下阑尾切除手术方式的疗效,评估腹腔镜下阑尾切除术的临床应用价值。方法根据手术方式将患者分为开腹手术(OA)组与腹腔镜手术(LA)组,分析两组手术方式术中术后的各项指标,利用统计学方法研究两者的差异。结果两组患者均无围手术期死亡病例,无肠漏、术后出血等严重并发症。与OA组比较,LA组的手术时间、肠道功能恢复时间、术后腹痛持续时间及住院时间较短,术中出血量、切口感染率减少明显,差异均有统计学意义(P<0.05),而两组术后腹腔脓肿发生率比较差异无统计学意义(P>0.05)。结论腹腔镜下阑尾切除术治疗急性穿孔性阑尾炎较传统开腹手术方式具有临床优势。     

MDCT of acute appendicitis: value of coronal reformations

Acute appendicitis is the most common cause of abdominal pain requiring urgent surgery in the United States. The clinical diagnosis can be difficult in patients with atypical presentations and, over the past several decades, computed tomography (CT) has been increasingly utilized to improve diagnostic accuracy. Helical CT has proven to be an excellent tool in the work-up of acute abdominal pain with a diagnostic accuracy for acute appendicitis of 93–99%. However, occasionally there are equivocal or false positive or negative cases, often due to non-visualization of the appendix. The development of multi-detector row CT and recent advancements in reconstruction software has allowed rapid, high-resolution imaging of the entire abdomen and pelvis resulting in multiplanar reformations (MPR) with a spatial resolution similar to that of the axial plane. This article reviews the utility of CT in suspected acute appendicitis and the potential added diagnostic value of coronal reformations in confirming or excluding the diagnosis.     

Pathologic continuum of acute appendicitis: sonographic findings and clinical management implications

Appendicitis is one of the most common causes of the acute abdomen often requiring emergent surgery. Delayed diagnosis leads to the progression of uncomplicated appendicitis to complicated (gangrenous, perforated) appendicitis, often changing clinical management. Computed tomography and ultrasound are imaging modalities of choice to preoperatively diagnose appendicitis. Recent concerns of radiation exposure and cost have renewed interest in using ultrasound as an initial, diagnostic study. A sonographic pictorial and histopathologic review of the continuum of appendicitis is presented. A comprehensive sonographic examination of the appendix should investigate the size (maximal diameter), the echogenic submucosal layer integrity, the mural color Doppler signature, the presence of a fecalith, and the periappendiceal changes. Features of an uncomplicated appendicitis include size greater than 6 to 7 mm, hyperemia on color Doppler, mural thickening, and an intact echogenic submucosal layer. Gangrenous appendicitis is characterized by loss of the echogenic submucosal layer with absent color Doppler flow. Loculated pericecal fluid, prominent pericecal fat, and circumferential loss of the submucosal layer are suggestive of perforation. Sonographic staging can triage management of appendicitis by directing urgent laparoscopic appendectomy for uncomplicated appendicitis, open appendectomy for complicated appendicitis, and conservative management (antibiotics with percutaneous drainage) for perforated appendicitis with abscess formation.     

隐匿性足Lisfranc损伤的临床特征及多层CT表现

目的:探讨隐匿性足轻微Lisfranc损伤的临床特征及多层CT的特征性影像改变。方法:从医院PACS系统中近1年内进行足CT检查的706例中统计出因足扭伤就诊而患者CR片显示阴性的轻微Lisfranc损伤图像,回顾性分析多层CT的多平面重组图像,分析其临床及影像学特征。结果:本研究中285例CR检查未见明显异常的患者,占全部足CT检查的41.4%,其中轻微隐匿Lisfranc损伤(不同部位的撕脱或裂纹骨折)82例,累及后足或单纯后足微细骨折41例,CR片对足跗骨及跖骨基底微细骨折的漏诊率达39.6%。轻微Lisfranc损伤以撕脱骨折为主,占70.9%,其次为裂纹骨折;跖底侧损伤占53.1%。临床特征包括疼痛(100%)和足肿胀(73.2%,60/82)。结论:足部隐匿性Lisfranc损伤在临床中非常常见,常规CR片很难准确诊断,多层CT对足部撕脱骨折及裂纹骨折等微细隐匿性损伤的诊断非常明确。     

穿孔性阑尾炎的临床表现及CT表现

目的 比较穿孔性和非穿孔性阑尾炎的CT及临床表现,探讨CT对穿孔性阑尾炎的诊断价值.方法 术后回顾性分析109例阑尾炎患者,将其分为穿孔性阑尾炎和非穿孔性阑尾炎2组,分析及比较二组临床症状、体征、实验室检查及CT征象.结果 症状持续超过3d、右下腹痛性包块,CT上阑尾管壁缺损、阑尾周围积气、阑尾腔外结石、腹腔脓肿、蜂窝组织炎等对于穿孔性阑尾炎的诊断具有较大的特异性,而反跳痛、腹肌紧张及CT上阑尾直径、阑尾周围肠壁增厚在穿孔性阑尾炎组中出现的概率也高于非穿孔性阑尾炎组(P＜0.05).结论 结合CT征象及临床表现可提高穿孔性阑尾炎的诊断,对于手术方案的选择具有较大的意义.     

Acute perforated appendicitis after blunt abdominal trauma: A report from a 7-year-old

Individually, trauma and appendicitis are some of the most common conditions in clinical practice, particularly in emergency medicine. In rare cases, trauma and appendicitis may co-exist, imposing a dilemma of whether these are only coincidence or appendicitis develops because of trauma. We report here a case of acute perforated appendicitis after a blunt abdominal trauma caused by a horse hoof kick to the abdomen in a 7-year-old boy. We also discussed the potential pathophysiologic mechanisms behind and reviewed the literature on this rare condition.     

脑钩端螺旋体病的影像学表现与临床

目的 探讨脑钩端螺旋体病(简称脑钩体病)的影像学及临床表现。方法 回顾性观察23例脑钩体性病的CT、MRI表现及临床资料。结果 脑钩体病以脑内神经系统损害为突出表现，影像学表现复杂多样、类似于其它颅内感染及脑血管意外的表现，其临床表现也多样。结论 CT、MR泽脑钩体病的诊断有重要临床意义。     

Spectrum of the inferior vena cava: MDCT findings

Inferior vena cava (IVC) abnormalities are not uncommon. Congential anomalies, thrombosis, neoplasms, and obstructive lesions can involve IVC. With the wide use of multidetector CT, it has demonstrated its ability to display the abnormalities of IVC. Congenital anomalies, thrombosis, neoplasms, and stenosis or obstructive diseases and other abnormalities can be demonstrated by MDCT. We present a pictorial essay to illustrate its roles in detecting and defining the nature of lesions of IVC, from the anatomy to disease spectrum of IVC.     

Clozapine induced myopericarditis: early recognition improves clinical outcome

Clozapine is an atypical dibenzodiazepine antipsychotic used for resistant schizophrenia. Uncommonly, it is associated with myocarditis. We report a case of myopericarditis masquerading as an acute myocardial infarction based on presenting electrocardiogram and cardiac markers. Emergent coronary angiography confirmed the absence of epicardial coronary occlusion and revealed severe left ventricular systolic dysfunction. Immediate discontinuation of the clozapine, along with aggressive supportive care resulted in complete recovery to baseline. Cardiovascular health professionals should be aware of this uncommon but serious side effect of clozapine since failure to recognize the association may result in adverse clinical outcome and inappropriate therapy.     

Mathematical analysis of the diagnostic relevance of clinical findings

1. The process of diagnosis by elimination in terms of probabilities is analysed mathematically. 2. A piece of evidence which is only associated with a small number of differential diagnoses is of particular importance. 3. To deal with a differential diagnosis, a feature is required which occurs commonly in a postulated diagnosis but rarely in its rivals, irrespective of its frequency in those already discriminated against. 4. By using this analysis, inadequate evidence may be identified, new tests developed, and their effectiveness assessed in a logical and efficient way. 5. The approach is illustrated by considering the differential diagnosis of localized right lower quadrant abdominal pain.     

穿孔性阑尾炎手术切除后是否腹腔引流的近期预后分析的随机对照试验

目的腹腔脓肿是穿孔性阑尾炎(PAP)最常见的并发症,阑尾切除术后是否行腹腔引流取决于阑尾炎症严重程度,但是很大程度上还是取决于术者的专业知识和个人习惯,国际上并未就穿孔性阑尾炎术后是否常规行腹腔引流达成共识。本试验评估阑尾炎伴穿孔患者术后是否腹腔引流的近期预后并比较预后的差异,同时比较腹腔镜阑尾切除术(LA)及开腹阑尾切除术(OA)预后的差异。方法本试验为随机对照试验(RCT),纳入自2012年3月收入我科术中诊断为穿孔性阑尾炎患者540例,采取简单随机分组方法将患者分为试验组(腹腔引流)和对照组(不行腹腔引流),采用χ2检验和t检验对相关资料进行分析。结果 2012年3月2日至2015年4月30日,本试验共纳入540例穿孔性阑尾炎患者并完成阑尾切除术。试验组与对照组术后总并发症发生率分别为11.5%(31/270)和35.2%(95/270),术后腹腔脓肿发生率分别为5.2%和14.8%,术后腹痛发生率分别为0%和13.7%,组间差异有统计学意义(P均<0.05),而切口感染率(5.6%vs.6.3%,P=0.175)以及术后残端瘘(0.7%vs.0.4%,P=0.563)组间差异无统计学意义;两组患者术后再次干预发生率(14.1%vs.32.6%)、经皮/直肠腹腔穿刺引流发生率(0.7%vs.7.8%)以及术后抗生素使用(13.0%vs.23.0%),差异有统计学意义(P均<0.05);术后再次手术和术后住院时间两组患者差异无统计学意义(P=0.102,P=0.094)。LA与OA预后指标比较,两组患者术后并发症发生率分别为35.1%(87/248)和14.6%(34/233),差异有统计学意义(P<0.000 1),术后再次干预发生率分别为19.3%(45/233)和30.2%(75/248),差异有统计学意义(P=0.006),两组患者术后住院时间差异无统计学意义(4.4 d vs.4.2 d,P=0.117)。结论穿孔性阑尾炎术后行腹腔引流可有效降低术后并发症以及术后再次干预发生率,显著提高近期疗效。LA近期疗效优于OA。     

Pediatric appendicitis: pathophysiology and appropriate use of diagnostic imaging

Evaluating children for appendicitis can be extremely difficult, and various strategies have been developed to improve the precision of preoperative diagnosis. Among these, ultrasound and computed tomography (CT) are now widely used but remain controversial. Although CT scanning is superior to ultrasound in terms of diagnostic accuracy for appendicitis, the large dose of ionizing radiation from CT and the risk of subsequent radiation-induced malignancy (RIM) are of particular concern in pediatric patients. This article reviews the literature on the pathophysiology, morbidity and mortality of appendicitis, summarizes the data regarding pediatric imaging in appendicitis, provides a practical approach to imaging for clinicians who evaluate pediatric patients, and makes recommendations for reducing the risk of RIM in pediatric patients.     

MDCT of the duodenum: technique and clinical applications

Computed Tomography (CT) is useful for evaluation of both benign and malignant pathology involving the duodenum. CT can detect and stage duodenal malignancies as well as detect inflammatory conditions such as duodenitis. Careful CT technique is necessary to optimize detection of abnormalities. This includes the use of oral contrast, preferably water, as well as i.v. contrast. 3D imaging can improve disease detection and help with surgical planning. This article reviews the current role of CT in duodenal imaging, describes appropriate CT protocols and illustrates a wide variety of duodenal pathology.