在X线、CT导引下经皮椎弓根穿刺胸腰椎椎体活检术的价值

目的 探讨在X线、CT导引下经皮椎弓根穿刺胸腰椎椎体活检术在胸腰椎椎体疾病中的应用价值.资料与方法 选择2003年9月至2007年10月间在X线、CT导引下经皮椎弓根穿刺胸腰椎椎体活检术患者26例,其中在X线导引下穿刺腰椎6例,在CT导引下穿刺腰椎16例、胸椎4例.结果 26例全部穿刺成功,穿刺成功率100%,无严重并发症发生.结论 胸椎采用CT导引,腰椎采用X线或CT导引,行椎体经椎弓根穿刺活检术是一种简便、微创、有效的检查方法,可提高对椎体病变的确诊率,为椎体病变的进一步治疗提供有效的帮助,临床价值极大.     

MR导引胸腰椎病变穿刺活检术的护理

目的探讨0.23T开放式磁共振介入引导下胸腰椎病变穿刺活检的护理准备及术后观察和护理。方法对53例胸、腰椎病变行经皮穿刺活检术患者,术前给予辅助检查、心理疏导、用物准备、体位管理、疼痛护理及术后并发症观察和护理。结果 53例胸、腰椎病变穿刺活检术均一次穿刺成功,诊断准确率为94.3%,患者无严重不良反应及并发症。患者及本科医生对护理工作满意。结论合理的护理准备和细致的观察及护理是胸腰椎病变穿刺活检术成功的重要保障。     

CT引导下经椎弓根穿刺活检对椎体病变的诊断价值

目的 :评价CT引导下经椎弓根穿刺活检对椎体病变的诊断价值。方法 :回顾性分析 17例椎体病变经椎弓根穿刺活检的病理结果 ,随访结果 ,外科手术结果及穿刺并发症。结果 :恶性病变总的穿刺成功率为 10 0 % (10 / 10 ) ,其中首次穿刺成功率为 80 % (8/ 10 ) ,第二次穿刺成功率为 10 0 % (2 / 2 ) ;良性病变穿刺成功率为 5 7 1% (4/ 7) ;所有病例均未发生严重穿刺并发症。结论 :CT引导下经椎弓根穿刺活检对椎体病变的诊断有较高的准确性 ,并发症较低 ,值得推广。     

CT引导下经皮椎体病变穿刺活检的临床研究

目的评价CT引导下经皮椎体病变穿刺活检的成功率、诊断正确性及临床应用价值。方法85例椎体病变患者经皮穿刺活检,病变位于颈椎3例,胸椎26例,腰椎37例和骶椎19例。影像学上表现57例为溶骨性病变,19例成骨性病变,9例溶骨性与成骨性病变共存。穿刺标本行细胞学及组织学检查。临床怀疑感染性病变时行细菌学检查。对穿刺标本进行诊断的正确性分析。结果CT证实85例穿刺活检针均位于病灶内,81例取得病变组织,活检成功率95%。活检标本包括29例骨组织标本,5例软组织标本,47例骨组织与软组织混合标本,4例未取得标本;病理结果包括44例转移瘤,17例原发性骨肿瘤,18例感染性病变,2例正常椎体组织。79例诊断正确,诊断正确性97.5%。结论CT引导下经皮椎体病变穿刺活检是对椎体病变作出正确诊断的重要手段,为临床提供了可靠的组织学依据,且穿刺部位正确、三维定向好、损伤小,可以作为诊断不明确的溶骨性及溶骨与成骨混合性椎体病变拟行椎体成形术术前常规。     

颞下间隙病变磁共振导引下经皮活检术

目的 研究颞下间隙病变磁共振(MR)导引下经皮活检术的临床应用。方法 借助开放式0．2T MR对7例颞下间隙肿块病灶进行穿刺活检。结果 磁共振导引下经皮活检靶中率100％，活检正确率85．7％，无并发症出现。结论 磁共振导引下经皮活检术有助于颞下间隙病变的诊断。     

CT导引下的纵隔病变穿刺活检

目的探讨CT导引纵隔病变穿刺活检技术及其临床意义。方法35例纵隔病变在CT导引下行穿刺活检。结果35例纵隔病变穿刺活检病灶成功率100%。诊断准确率94.2%(33/35),其中恶性病变诊断准确率100%(21/21),良性病变为85.7%(11/14)。并发气胸3例(8.6%),纵隔出血1例(2.9%)。结论CT导引下穿刺活检术对于纵隔病变诊断的正确率高,对纵隔病变的诊治具有很大的帮助。     

开放式MRI导航系统导引行肺病变穿刺活检137例

目的 探讨MRI导引下肺穿刺活检术的可行性、准确性及其临床应用价值.方法 应用配备iPath 200光学追踪系统的低场开放式MR仪,对137例肺内结节或肿物患者行穿刺活检术,其中肺内孤立性结节或肿物103例,肺内多发病灶34例;病灶最大径≥3.5 cm的57例、1.5～3.4 cm的71例、≤1.4 cm的9例.结果 病灶最大径≥3.5 cm组、1.5～3.4 cm组、≤1.4 cm组及总的穿刺成功率分别为100.0%(57/57)、98.6%(70/71)、77.8%(7/9)、97.8%(134/137);穿刺组织病理检查诊断恶性肿瘤98例,良性39例;MRI导引肺穿刺活检的敏感度为94.2%(98/104),特异度为100.0%(33/33),准确性为95.6%(131/137),阳性预测值为100.0%(98/98),阴性预测值为84.6%(33/39).结论 开放式MRI导引肺穿刺活检术具有较高的安全性、准确性和有效性,值得在临床进一步推广和应用.     

CT导引下穿刺活检对胰腺占位性病变的诊断价值

目的 探讨CT导引穿刺活检胰腺占位性病变的诊断价值.方法 回顾性分析CT导引细针穿刺胰腺占位性病变68例,其中胰头区病变49例、胰体12例和胰尾7例.病灶直径2～7 cm,<3cm 10例,3～7 cm 58例.术前均作CT平扫和增强扫描,均采用前路进针,使用20 G细针穿刺.活检标本送病理科作组织病理检查.结果 68例患者均安全地穿刺到病变内,活检成功率为100%.穿刺活检诊断率为恶件病变46例,良性17例,5例未见病变.5例中2例经临床和CT随访均无异常,另3例最终证实胰腺囊腺癌2例和胃癌转移1例.穿刺活检总正确率、灵敏度和特异度分别为96%、95%和100%.CT导引活检对恶性、良性病变的正确率为94%和100%(P>0.05).较大肿块病灶(≥3.0 cm 97%,<3 cm90%)和病变位于胰尾(胰尾100%,胰头96%,胰体92%)的正确率稍高,但经统计学检验正确率差异并无统计学意义(P>0.05),未发现严重的并发症.结论 CT导引经皮细针穿刺活检胰腺占位性病变是一种安全的有效的诊断和鉴别诊断的方法.     

CT导向经皮穿刺椎体活检术在椎体病变中的诊断价值

目的探讨CT导向下经皮穿刺椎体活检技术及其对椎体病变定性诊断的价值。资料与方法62例椎体病变患者,男45例,女17例,单椎体病变38例,两椎体病变14例,多椎体病变10例。其中颈椎2例,胸椎28例,腰椎25例,骶尾椎7例。颈椎病变患者取仰卧位,胸、腰、骶椎病变患者取俯卧位。在CT横断扫描导向下,对病变部位穿刺活检,穿刺标本送病理学检查。结果62例患者均穿刺成功,52例(80.8%)成功取得病理组织并得到明确的病理结果,6例未取得病理组织,3例病理诊断不明确,1例不相符。行免疫组织化学检查10例,得到了明确的组织学诊断,4例恶性病变因细胞组织太少仍不能明确组织学特征。结论CT引导下椎体穿刺活检术,具有微创、安全、取材准确、可靠、方便等优点,是脊柱病变活检的理想方法,可以为临床提供可靠的组织学依据。     

CT导引穿刺活检对纵隔病变的诊断价值

目的 评估CT导引经皮细针穿刺活检对纵隔病变的诊断价值.方法 回顾性研究CT导引经皮穿刺纵隔病变104例.活检部位包括前纵隔73例、中纵隔29例和后纵隔2例.病灶大小2.31 cm×1.11 cm～14.5 cm×10.3 cm,病灶直径＜3.0 cm 16例,3.1～5.0 cm 39例,＞5 cm 49例,使用18～20 G穿刺针作穿刺抽吸活检.结果 穿刺活检成功率100%,穿刺活检诊断为恶性病变67例、良性27例、假阴性8例,假阳性2例.穿刺活检正确率、灵敏度和特异度分别为90%、92%和100%.病变大小和病变良恶性对活检正确率差异无统计学意义(P＞0.05).并发症为轻度气胸(6例)、咯血(2例)和纵隔气肿(1例).结论 CT导引经皮细针穿刺活检纵隔病变是安全可行的诊断方法.     

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.