双核素阳性显像评价肺癌原发耐药

目的探讨99Tcm-甲氧基异丁基异腈(MIBI)和201Tl双核素阳性显像评估原发性肺癌原发耐药的可靠性.方法对80例原发性肺癌患者行99Tcm-MIBI 和201Tl 肺双核素SPECT显像,定量计算99Tcm-MIBI和201Tl早期及延迟显像的摄取比值、清除率和残留比值,并进行临床化疗前后比较.化疗疗效判断标准显效病灶缩小>50%;改善病灶缩小30%～50%;无效病灶缩小<30%或不缩小;恶化病灶扩展.结果①201Tl各参数与化疗疗效无明显相关性.②以心肌为本底的延迟显像99Tcm-MIBI摄取比值、清除率及残留比值对化疗疗效评估好于以对侧肺为本底的相应参数.99Tcm-MIBI残留比值稳定,显效、改善、无效、恶化组分别为0.24±0.08、0.20±0.11、0.16±0.08、0.14±0.05.③以99Tcm-MIBI清除率>20%为耐药阳性阈值时,阳性预测值、阴性预测值最佳,分别为71.2%和64.3%;以99Tcm-MIBI残留比值<0.21为耐药阳性阈值时,阳性预测值、阴性预测值最佳,分别为79.3%和72.7%.结论 99Tcm-MIBI 肺阳性显像对原发性肺癌耐药判断可靠性高,其残留比值为肺癌耐药判断的最佳参数.     

99Tcm-MIBI SPECT/CT同机融合断层显像对肺癌及其转移淋巴结的诊断价值

目的探讨99Tcm-MIBI SPECT/CT同机融合断层显像对肺癌及其转移淋巴结的诊断价值.方法以术后病理诊断为依据,对57例肺部占位性病变患者的99Tcm-MIBI SPECT/CT显像结果分良性和肺癌两组进行分析,计算其5min、60min平面以及60min SPECT/CT三维融合断层显像的摄取比值(UR);以肺部良性病灶组UR值的+1s为诊断阈值,对肺癌原发灶及其转移淋巴结的诊断效能进行评价.结果17例肺部良性病灶组其5min和60min平面以及60min SPECT/CT三维融合断层显像的摄取比值(UR)分别为1.05±0.16、0.97±0.22、1.51±0.39,而40例肺癌组其UR值分别为1.41±0.22、1.37±0.23、2.18±0.61同组两时相比较P>0.05,而组间两时相比较P<0.05.以良性结节+1s为诊断阈值,99Tcm-MIBI对肺癌诊断的灵敏度、特异度和准确度分别为90%(36/40)、82.35%(14/17)和87.72%(50/57);假阳性率和假阴性率分别为17.65%(3/17)和10%(4/40);阳性预测值和阴性预测值分别为 92.31%(36/39)和77.78%(14/18).40例恶性病变患者共检出转移淋巴结19个,其CT/SPECT断层融合图像的UR值为1.82±0.37.结论99Tcm-MIBI SPECT/CT同机融合断层显像对肺癌及其转移淋巴结具有较高的诊断价值.     

99Tcm-PPM及99Tcm-MIBI肺显像诊断原发性肺癌

目的 探讨99Tcm－培普利欧霉素（PPM）及99Tcm-甲氧基异丁基异腈（MIBI）肺显像诊断原发性肺癌的临床价值。方法 对28例临床诊断肺肿瘤患者进行99Tcm-PPM ey 99T0-MIBI肺肿瘤显像并进行比较。结果 肺癌与良性病变对99T -PPMey 99T-MIBI观的摄取差异有显著性（P＜0．01）,以肺癌晚期显像摄取比值（T／NT,X－S）作为判断良恶性阈值,99Tcm-PPM及99Tcm-MIBI对肺癌诊断的灵敏度,准确性分别为90％,89．3％,和80％,82．1％,两者结合显像阳性率为95％,病灶对放射性药物的摄取与肿瘤大小无明显相关（P＞0．05）,结论 99Tcm-PPM ey 99T-MIBI肺显像对肺癌的诊断,鉴别诊断有一定的临床价值。两者联合应用可提高肺癌的阳性检出率,单独使用99Tcm-PPM优于99Tcm-MIBI。     

纵隔血管脂肪瘤99Tcm-MIBI SPECT/CT显像一例

笔者报道了一例纵隔血管脂肪瘤患者的99Tcm-MIBI SPECT/CT显像情况,分别从临床症状、CT及99Tcm-MIBI SPECT/CT亲肿瘤阳性显像、病理诊断等方面介绍该病的特点,并通过文献复习加深了对纵隔血管脂肪瘤的认识。研究结果显示,纵隔血管脂肪瘤99Tcm-MIBI SPECT/CT亲肿瘤阳性显像未见明显摄取,提示术前多种影像学检查有利于观察纵隔血管脂肪瘤的生长方式、内部成份等,有助于临床诊断与鉴别诊断。     

99Tcm-HL91显像、CT和血清肿瘤标志物测定联合应用诊断肺癌

目的探讨Tc^m-4，9-二氮．3，3，10，10-四甲基十二烷-2，11-二酮肟(HL91)显像、CT、血清肿瘤标志物[癌胚抗原(CEA)、细胞角蛋白19片断(CYFRA21-1)、神经元特异性烯醇酶(NSE)]测定联合应用对肺癌的诊断价值。方法46例疑为肺癌患者在1周内进行^99Tc^m-HL91 SPECT显像、CT检查和血清肿瘤标志物测定。计算每种方法及三法联合应用诊断肺癌的灵敏度、特异性及准确性。结果最终经病理检查或细胞学诊断证实肺癌26例，经病理检查或治疗后影像学随访确诊肺部良性病变20例。^99Tc^m-HL91 SPECT显像、CT及血清肿瘤标志物测定诊断肺癌的灵敏度、特异性及准确性分别为77％、80％、78％，96％、60％、80％及50％、60％、54％。三法联合应用诊断肺癌的灵敏度、特异性及准确性分别为100％、90％、96％，其综合诊断效能明显优于其中任何一种检查方法。结论^99Tc^m-HL91显像、CT、血清肿瘤标志物测定联合应用在肺部肿瘤良恶性鉴别诊断中有较大价值。     

99Tcm-MIBI显像与钼靶X线对乳腺癌诊断的比较研究

目的 比较99Tcm-MIBI SPECT/CT显像和钼靶X线对女性乳腺癌的诊断价值。 方法 女性患者83例, 先行99Tcm-MIBI胸部SPECT/CT早期显像和延迟显像, 并以延迟显像阳性为判定标准, 再行乳腺钼靶X线摄影, 并与最终的病理结果进行对照。 结果 延迟显像的阳性患者为52例(T/NT值>3.33), 阳性与阴性病灶的早期、延迟显像分别比较, 差异均有统计学意义, 且以延时2 h结果更为显著, 最终病理结果证实45例为恶性病灶。99Tcm-MIBI显像结果的灵敏度为93.33%、特异度为73.68%、阳性预测值为80.77%、阴性预测值为90.32%;而钼靶X线对于相同病灶的灵敏度、特异度分别为64.44%、73.68%, 阳性、阴性预测值分别为74.36%、63.63%。99Tcm-MIBI显像对乳腺癌诊断价值优于钼靶X线(χ2=4.11, P < 0.05), 但两种方法的一致性较差(Kappa=0.217, P < 0.05)。 结论 99Tcm-MIBI显像较之钼靶X线的结果判定更为客观, 而两种方法同时运用则能提高乳腺癌的检出率, 显著提高影像学对于乳腺癌的早期诊断。     

99Tcm-MIBI甲状腺显像对甲状腺癌诊断价值的再评价

目的 评价99Tcm-甲氧基异丁基异腈(MIBI)甲状腺显像对甲状腺癌的诊断价值.方法 167例甲状腺"冷(凉)"结节患者进行了甲状腺99Tcm-MIBI显像.所有患者均依据病理或穿刺活组织检查诊断.99Tcm-MIBI显像早期相甲状腺结节完全或部分放射性填充视为阳性,轻度或不填充视为阴性;早期相放射性浓聚区与正常组织边界分明者视为分界清楚,否则为模糊;延迟相99Tcm-MIBI从浓聚区清除慢于正常组织者视为清除慢,快于或相同者视为清除快.计算99Tcm-MIBI显像的阳性和阴性预测率,以显像阳性病灶边界模糊和放射性清除慢为标准预测甲状腺癌的发生率.结果 99Tcm-MIBI显像对甲状腺癌的阳性预测率为23.5%(19/81),对甲状腺良性病变的阴性预测率为97.7%(84/86).显像阳性者单独用边界模糊预测甲状腺痛的发生率为36.2%(17/47),单独用清除速度慢预测甲状腺癌的发生率为43.9%(18/41).若放射性浓聚区边界模糊和清除速度慢二者都有时,其预测甲状腺癌的发生率为73.9%(17/23).结论 99Tcm-MIBI甲状腺显像阴性对甲状腺良性结节具有较大的诊断价值;阳性对甲状腺癌的诊断价值不大,但如果同时结合放射性浓聚区边界模糊和清除速度慢,则可提高其诊断价值.     

肺癌CT征象与肿瘤标志物的关系及其联合检测的诊断价值

目的 探讨肺癌CT形态学特征与其血清肿瘤标志物癌胚抗原(CEA)、细胞角质素片段抗原(CYFRA21-1)、神经元特异性烯醇化酶(NSE)的表达关系和2种检测方法联合应用在肺癌诊断中的价值.方法 对52例经病理证实的肺部恶性病变和52例良性病变患者行CT扫描和血清肿瘤标志物CEA、CYFRA21-1、NSE检测.分析CT表现并记录影像学特征,将CT特征与血清肿瘤标志物进行对照分析.并对良恶性病变血清肿瘤标志物进行比较.结果 肺癌组肿瘤标志物检测值高于良性病变组,二者有统计学意义(P＜0.05);CT扫描和肿瘤标志物联合检测优于单项检测;血清肿瘤标志物CEA、CYFRA21-1、NSE与肿瘤的毛刺征、空泡征、空洞征、胸膜凹陷征、支气管截断征、胸腔积液、淋巴结转移无统计学意义,CYFRA21-1、NSE与肿瘤的深分叶征、肿瘤大小无统计学意义(P＞0.05),CEA与肿瘤的深分叶征、肿瘤大小有统计学差异(P＜0.05).结论 CT征象和血清肿瘤标志物联合检测,可进一步提高肺癌诊断的准确性及检出率;肺癌的深分叶征、大小与CEA浓度呈一定相关性.     

CA_(125)、CA_(199)、CEA在肺癌、消化系统肿瘤测定的临床意义

目的　评价 CA1 2 5 、CA1 99、CEA、AFP对肺癌、消化系肿瘤的诊断价值。　方法　采用 RIA法测定血清 CA1 2 5 、CA1 99、CEA、AFP、以 CA1 2 5 >35 U/ ml、CA1 99>30 U / ml、CEA>15 ng/ m l、AFP>2 5 ng/ ml为阳性。　结果　 CA1 2 5 在肺癌、肝癌 ,结肠直肠癌的阳性诊断与对照组相比均有显著意义 (P<0 .0 5 )。 CA1 99在肺癌、消化系统肿瘤中阳性诊断均有显著意义。在肝癌诊断中 AFP与 CA1 2 5 、CA1 99灵敏度比较有显著差异 (P<0 .0 1) ,CA1 99 AFP,CA1 99 CA1 2 5 AFP与其它单项检测的灵敏度比较 ,差异也有显著意义 (P<0 .0 1)。　结论　血清 CA1 2 5 、CA1 99有助于诊断肺癌、肝癌、结肠直肠癌。在肺癌、肝癌诊断中 CA1 2 5 、CA1 99、AFP(CEA )两项联合检测很必要 ,但 CA1 2 5 、CA1 99对肺癌的检出特异性较差     

99Tcm-MIBI动态血流灌注显像和双时相核素显像对甲状腺冷结节良恶性的诊断价值研究

目的 探讨99Tcm-MIBI动态血流灌注显像和双时相显像对甲状腺冷结节良恶性的诊断价值.方法 回顾性分析甲状腺冷结节行手术治疗的患者28例,所有患者使用配备低能高分辨准直器的SPECT仪行99Tcm-MIBI动态血流灌注、30 min早期相及120 min延迟相静态平面显像,并用T/NT值等综合分析显像结果.结果 9例甲状腺癌患者在动态血流灌注、30 min早期相和120 min延迟相显像中阳性数分别为5例、6例、7例;19例良性病变患者在动态血流灌注、30 min早期相和120 min延迟相显像中阴性数分别为14例、11例、16例.99Tcm-MIBI动态血流灌注显像诊断甲状腺癌的灵敏度为55.56%,特异度为73.68%,准确率为67.85%;30 min早期相显像诊断甲状腺癌的灵敏度为66.67%,特异度为57.89%,准确率为67.85%;120 min延迟相显像诊断甲状腺癌的灵敏度为77.78%,特异度为84.21%,准确率为82.14%.结论 99Tcm-MIBI的双时相显像对甲状腺冷结节的诊断和鉴别诊断具有一定价值,通过对动态血流灌注和99Tcm-MIBI的双时相显像中T/NT值等综合分析,可以降低假阳性和假阴性的发生.     

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.