复方倍他米松注射液皮损内注射的疗效评价

近4年来，我科用复方倍他米松注射液(得宝松)皮损内注射治疗瘢痕疙瘩、结节性痒疹、限局性顽固性斑秃，取得了较满意的临床疗效，现将结果报道如下。     

局限性脓疱型银屑病93例临床分析

脓疱型银屑病包括阵发性脓疱型银屑病和限局性脓疱型银屑病，我们总结了93例限局性脓疱型银屑病患者的临床资料，报告如下：     

限局性手术治疗肱骨髁间骨折31例疗效分析

限局性手术治疗肱骨髁间骨折３１例疗效分析武警北京一总队医院外二科（北京１０００２７）孟武庆，张海森，安士信，赵志栋，杨林峰，左进步，王平利，刘英男关键词肱骨髁间骨折，限局性手术，内固定肽骨髁间骨折是一种极严重的关节内骨折，在治疗方法上历来分歧较大，且...     

慢性肺炎性肿块CT表现与病理对照的探讨

目的：探讨肺炎性肿块的CT表现与病理类型的关系及CT在诊断中的价值。方法：回顾性分析了48例经病理组织学或细胞学证实的肺炎性假瘤(24例)、限局性机化性肺炎(18例)以及限局性化脓性肺炎(6例)的临床、CT资料。结果：24例炎性假瘤中，20例直径在2～5cm之间，多呈圆形或类圆形，80％肿块密度均匀；3例行增强扫描，1例呈均匀强化，2例周边强化，中心低密度，5例可见“桃尖征”。18例限局性机化性肺炎中，16例邻近胸膜面，病变形态不规则，13例见向心性弓形凹陷及尖角状突起，3例可见气管血管束向病灶聚拢。6例限局性化脓性肺炎均邻近胸膜面，2例见小圆形透光区，无气液平面，3例行增强扫描，1例周边强化，2例除低密度区及空洞外，实性部分呈厚壁强化，6例均未见气管血管束聚拢征象。结论：肺部炎性肿块结合临床及CT表现大多数可做出正确诊断，表现不典型者，可行CT导引下穿刺活检。     

结核性缩窄性心包炎的CT诊断

缩窄性心包炎(CP)和限局性心肌病有相同的病生理紊乱(心脏的舒张期充盈受损)和相似的临床表现,作者研究了212例经手术证实并有临床表现的缩窄性心包炎和/或限局性心肌病患者的CT影象,认为心包增厚是CT诊断缩窄性心包炎唯一必要的征象,也是区分缩窄性心包炎与限局性心肌病的关键,CT测量缩窄性心包炎的心包增厚于成人大于3mm,儿童大于2mm,2mm已作为区分缩窄性心包炎(>2mm)和限局性心肌病(<2mm)的标准,(心包厚度于2～3mm者有必要行活检进一步确诊)。心包增厚无论局限性或弥漫性均为典型表现,在作者的病例中,局灶性增厚多数为右室心包增厚(64%)。在极少数心包局灶性增厚病     

肺炎不同转归的影像学表现

肺炎是常见病，肺炎的影像诊断一般并不困难。但影像检查对于肺炎病原诊断比较困难，肺炎不同转归的某些影像表现与肺结核、肺癌的鉴别有时也较困难。笔者根据文献和经验对于肺炎不同转归的某些影像诊断进行讨论。一、限局性机化性肺炎限局性机化性肺炎、肺泡腔内渗出物，...     

镇银膏外用治疗寻常型银屑病703例

方剂组成牛黄、麝香、知母、黄连、由藓皮、鲜花椒、青黛、山楂、川芎、甘草等.制法：除牛黄和麝香扮外，其它几味药均用植物油炸至焦黑，滤去药渣，再加入牛黄、麝香粉，然后取油浓缩调成膏状。用法治疗前要清洗皮肤，然后视皮损大小将药均匀涂抹在病灶上，厚约1～2mm，以不见皮损为废。再用无毒聚乙烯薄膜将敷药处包封。头部皮损者，先剪去头发，再按同法处理。每隔5d换药一次，2个月为一疗程。疗效判定标准及结果痊愈：皮损全部消退；显效：皮损消退95％以上；有效：皮损消退50％以上；无效；未达上述标准或加重。703例患者，痊愈669例，…     

大肠Crohn病X线诊断

术语:大肠Crohn病在文献中有称肉芽肿性结肠炎,结肠限局性肠炎,全层性结肠炎,限局性结肠炎,节段性结肠炎,回肠结肠炎,瘢痕性肠炎,限局性肠炎,限局性肠结肠炎等。Sutcliffe主张在疾病性质尚未真正清楚之前,还是用Crohn病这一术语为妥。事实上,文献报告亦多用Crohn病之称。发病率:1932年Crohn等报告限局性回肠炎时曾强调这是一种只限于远端小肠的特有疾病,而将发生于大肠的非特异性肉芽肿则认为是属于另外一种性质的疾病。但过去40多年已经证明:虽然这种肉芽肿性炎症好发于回肠未部,但包括从口腔至肛门的全消化道的任何部位均可患病,并且累及大肠者颇常见。Farmer等报告615例Crohn病中,     

颈内动脉瘤IV DSA的并发症

作者分析了102例静脉数字减影血管造影(DS-A)检查后的并发症。分为全身性,神经系及限局性。限局性并发症3次,均较轻微和短暂,包括两次抗凝治疗中的小血肿,1次为插入导管时造影剂在肩部外溢;中枢神经系并发症17次,10次症轻微     

航空航天医药目次

论　　著中草药合并针刺治疗限局性硬皮病疗效的序贯性研究商　刚　果乃华　陈淑敏等　 1…………………………………青光眼阀植入术治疗难治性青光眼张骜坤　陶　源　卜秀荣等　 3………………………………………………………非络地平缓释片治疗高血压病的疗效观察刘　雷　张　彬　丁昌玲等　 7………………………………………………应用ARROW导管进行锁骨下静脉穿刺置管的评价万鹏程　李建辉　 9…………………………………………………四种外翻矫形术的疗效分析鲁世荣　马　林　 1 1………………………………………………………………     

Adenocarcinoma of the esophagus in patients with scleroderma

Three cases of patients with esophageal involvement by scleroderma, chronic reflux esophagitis, and adenocarcinoma of the distal esophagus are presented. An underlying columnar metaplasia (Barrett esophagus) was identified in two patients and postulated in the third. It is believed that scleroderma patients with symptomatic chronic gastroesophageal reflux should be investigated for Barrett epithelium. If it is present, these patients should be followed and considered as having an increased risk for development of adenocarcinoma of the esophagus.     

Bronchioloalveolar carcinoma: two clinical entities with one pathologic diagnosis.

Bronchioloalveolar carcinoma may present with a variety of radiologic and clinical patterns. Two types of this primary carcinoma of the lung have been recognized: a solitary lesion and a diffuse form. Charts and radiographs of 61 cases of bronchioloalveolar carcinoma were reviewed as well as the pertinent literature. Our experience indicates that the localized form seldom, if ever, becomes diffuse and has a good prognosis following appropriate surgery (lobectomy or pneumonectomy). If the lesion is diffuse, death almost invariably results within 3 years. Based on available clinical information, we suggest that at least two primary tumors of the lung have the histologic pattern of bronchioloalveolar carcinoma: one of these tumors is diffuse and the other is solitary.     

Osteolysis of the calcaneus in a child with localized scleroderma

In a young girl with localized scleroderma a circumscribed area of lysis developed in the calcaneus beneath the involved skin and soft tissues of the foot. A biopsy revealed vascular changes characteristic of scleroderma associated with infarction and severe resorption of the bone. A geographic pattern of bone destruction in a child with localized scleroderma has not previously been reported.     

螺旋CT多期扫描技术对胰腺癌的诊断价值

目的：探讨螺旋CT多期扫描对胰腺癌的诊断价值。方法：搜集行SCT动脉期、胰腺期、肝脏期三期扫描的胰腺肿块75例，均经手术病理证实，其中胰腺癌53例，局限性胰腺炎22例，比较肿瘤与炎症在SCT增强扫描各期中的表现。结果：本组胰腺癌53例，其中胰头癌33例，胰颈癌4例、胰体癌14例，胰尾癌2例。局限性胰腺炎22例，头、颈、体、尾分别为17例、2例、2例、1例。增强扫描，动脉期胰腺癌低密度43例，等密度10例，胰腺炎低密度2例，等密度20例；胰腺期胰腺癌低密度51例，等密度2例，胰腺炎低密度1例，等密度21例；肝脏期胰腺癌低密度42例，等密度11例；胰腺炎22例均为等密度。结论：胰腺螺旋CT动脉期、胰腺期、肝脏期三期增强扫描在胰腺癌诊断中具有非常重要的临床价值。     

Importance of comparison of current and prior mammograms in breast cancer screening

PURPOSE: To retrospectively determine the influence of comparing current mammograms with prior mammograms on breast cancer detection in screening and to investigate a protocol in which prior mammograms are viewed only when necessary. MATERIALS AND METHODS: Institutional review board approval was not required. Participants gave written informed consent. Twelve experienced screening radiologists read 160 soft-copy screening mammograms twice, once with and once without prior mammograms. Eighty mammograms were obtained in women in whom breast cancer was diagnosed later; the other 80 mammograms had been reported as normal or benign. All cancers were visible in retrospect. Readers located potential abnormalities, estimated likelihood of malignancy for each finding, and indicated whether prior mammograms were considered necessary. The effect of prior mammograms on detection was determined by computing the mean lesion localized fraction in a range of low fractions of nonlesion locations corresponding to operating points in screening. Scores for both reading sessions were combined to assess the effect of making prior mammograms available only when requested. Data were analyzed by comparing the number of localized lesions between the two reading conditions with a paired two-tailed Student t test and applying a linear mixed model to test differences in average mean lesion localized fraction between reading conditions. P values less than .05 indicated statistical significance. RESULTS: Without prior mammograms, significantly more annotations were made. When only positive cases were considered, no difference was observed. Reading performance was significantly better when prior screening mammograms were available. At fixed lesion localized fraction, nonlesion localized fraction was reduced by 44% (P<.001) on average when prior mammograms were read. Performance was also increased for combined reading mode (ie, when prior mammograms were available on request only). However, this increase was smaller than that when prior mammograms were always available. Prior mammograms were requested in 24%-33% of all cases and were requested more often in positive cases. CONCLUSION: Comparison with prior mammograms significantly improves overall performance and can reduce referrals due to nonlesion locations. Limiting the availability of prior mammograms to cases selected by the reader reduces the beneficial effect of prior mammograms.     

大剂量增强MR检查对脑部病变的诊断价值

探讨大剂量增强ＭＲ检查对显示脑部隐匿性小病灶以及改善病灶的显示和诊断的准确性。材料与方法：７４例脑部病变包括肺癌脑转移,乳腺癌脑转移,爱滋病脑弓形体病,胶质母细胞瘤,脑膜瘤,分别进行标准剂量和大剂量增强ＭＲ检查,两次查间隔时间不超过３天。     

钼靶X线定位穿刺留置导丝活检对乳腺微小病灶的诊断价值

目的探讨乳腺X线定位穿刺留置导丝活检术对乳腺微小病灶的诊断价值。方法回顾分析临床触诊阴性而乳腺钼靶X线片显示的微小病灶28例,采用乳腺钼靶X线定位下穿刺,留置导丝于微小病灶区,引导手术将病灶切除活检。结果28例微小病灶均一次性定位成功,定位满意率93%,手术切除完整。病理检查:恶性病变9例,其中浸润性导管癌5例,导管内癌伴早期浸润1例,导管内癌2例,髓样癌1例;良性病变19例。结论乳腺钼靶X线定位穿刺留置导丝活检术,定位准确,诊断明确,能确定乳腺微小病灶的性质,是目前诊断早期乳腺癌的有效方法。     

肺炎性假瘤的CT诊断

目的:探讨肺炎性假瘤的CT诊断价值。方法:回顾性分析经穿刺活检和/或手术病理证实的肺炎性假瘤12例的CT表现。结果:本组12例中病灶圆形4例,椭圆形2例,纺锤形3例,锥形2例,不规则形1例;明显均匀强化8例,仅边缘强化2例,未见明显强化1例。肺炎性假瘤多位于胸膜下,病灶基底较广泛贴于胸膜,伴局部胸膜增厚。病灶边缘有粗毛刺。血管向病灶集中。病灶可密度不均匀,有空洞。结论:CT诊断肺炎性假瘤有较高价值。     

Diagnostic imaging of gastrointestinal leiomyosarcoma. Experience with 12 cases

PURPOSE: Gastrointestinal (GI) leiomyosarcoma is an uncommon malignant cancer arising in the smooth muscle of the alimentary tract. It is known for its widely variable patterns and aspecific symptoms and signs preventing correct clinical assessment in the majority of cases. We will illustrate the key role of diagnostic imaging in the detection and staging of this lesion, describing the most suggestive imaging findings for the correct diagnosis. MATERIAL AND METHODS: January, 1990, to June, 1998, we examined 12 patients with GI leiomyosarcoma; they were 10 men and 2 women whose age ranged 42 to 85 years (mean: 63.7 years). Four lesions were found in the stomach, 3 in the jejunum and ileum, and 2 in the rectum. Due to the difficult clinical assessment of this type of lesion and to the development of emergency conditions, we could plan no diagnostic protocol in advance; thus, the most suitable diagnostic imaging approach was decided on the spot for studying the supposedly involved GI portions. Double contrast studies, US, CT and endoscopy were performed and each patient underwent at least two examinations. RESULTS: Barium contrast studies were performed in 9 patients: the lesion was detected in 7 cases and tumor site and extent were defined in 5, while the double contrast study of the colon allowed to exclude large bowel involvement in 2 ileal tumors. In all 9 cases US and US-guided endoscopy permitted better assessment of extra-luminal spread and involvement of adjacent organs. CT, which is essential to staging, provided useful information suggesting the lesion nature: a round, inhomogeneous mass in continuity with the intestinal wall, with irregular margins, peripheral enhancement after i.v. injection of contrast material and a central necrotic area. Histology confirmed CT diagnosis in 7/9 cases while an aspecific diagnosis of large retroperitoneal and abdominal lesion was made in 2 cases. CT did not allow to define the origin of 2 large exophytic lesions in the stomach and jejunum and missed peritoneal metastases in 3 cases. CONCLUSIONS: Although the aspecific and quite variable clinical patterns make it extremely difficult to plan a correct diagnostic protocol, in our experience all diagnostic imaging techniques played a fundamental role in identifying and staging alimentary tract leiomyosarcoma. Particularly, CT showed high sensitivity and specificity in characterizing and staging this lesion but exhibited rather poor sensitivity in recognizing peritoneal spread.     

Pathological fracture in non-ossifying fibroma with histological features simulating aneurysmal bone cyst

A 12-year-old-girl presented with a fracture of an osteolytic lesion of the distal radius. A 7-year-old girl presented with a fracture of an osteolytic lesion of the femoral shaft. In both cases it was a non-ossifying fibroma with fracture misdiagnosed at pathology as aneurysmal bone cyst. Fractures through non-ossifying fibromas may alter the histological pattern of the initial lesion in two ways: firstly, by the presence of blood pigments due to the fracture, and secondly, by formation of new bone. Radiological–pathological correlation is essential to avoid histological errors after pathological fracture in a non-ossifying fibroma. Received: 27 January 1998; Revision received: 17 June 1998; Accepted: 25 July 1998