镰旁脑膜瘤的手术治疗

大脑镰旁脑膜瘤起始于大脑镰，深埋于大脑纵裂中，并可向大脑镰两侧生长，占颅内脑膜瘤的7．86％‘门。由于肿瘤往往为双侧性，纤维型较多，质地常较硬，使切除比较困难卜J。我们于1995年以来，手术治疗大脑镰旁脑膜瘤对例，取得较好疗效，现报道如下。至临床资料1．1一般资料本组对例，男15例，女18例，年龄18－73岁，病程20天一8年。1．2临床表现引例患者有不同程度的头昏、头痛等颅内压增高的表现，其中对侧下肢感觉、运动障碍问例，癫痫4例，视野缺损1例，另有2例因无明显症状，在体格检查中发现。1．3辅助检查主要根据CT、磁共振（MR…     

成人大脑镰旁硬膜下血肿（附3例报告）

成人外伤性大脑镰旁或大脑半球间硬膜下血肿(ISHs)是一种少见的急性硬膜下血肿(ASDH),自1940年Aring和Evans首次报道以来,仅有数十例较详细的病例报道[1].本文报道3例ISHs并进行文献复习.     

外伤性特殊部位硬膜下血肿的CT诊断价值分析

目的：探讨CT诊断外伤性特殊部位硬膜下血肿的临床价值。方法：选取莎车县人民医院2020年2月—2023年2月收治的76例外伤性特殊部位硬膜下血肿患者作为研究对象,均应用CT影像检查,分析CT影像结果。结果：76例患者的CT影像检查结果显示,单侧血肿者46例,双侧血肿者30例。其中,22例患者为脑挫裂伤后引发脑内血肿,并伴有小脑幕急性硬膜下血肿;7例患者为大脑镰及小脑幕血肿,且合并颅脑凸面硬膜下血肿;12例患者为蛛网膜下腔出血,并伴有大脑镰及小脑幕血肿;13例为大脑镰及小脑幕血肿;11例为单纯小脑幕血肿;11例为单纯大脑镰血肿。CT影像可见有小脑幕硬膜下血肿,形状为片状或新月形,显示条索状、条带状高密度影。通过CT影像检查确诊者71例,诊断准确率为93.42%。结论：CT影像检查外伤性特殊部位硬膜下血肿的诊断准确率较高,临床可用于鉴别大脑镰及小脑幕硬膜下血肿的诊断,具有较高的临床价值。     

特殊类型硬膜下血肿的再认识及临床意义

目的提高对特殊类型硬膜下血肿影像的再认识，为临床正确治疗提供可靠依据。方法回顾性分析60例特殊类型硬膜下血肿的CT、MRI影像表现，并比较两种不同方法的影像特征。结果大脑镰硬膜下一侧血肿42例，CT表现为条索状或粗带状，MRI表现为线状低信号影（大脑镰）旁见条索状或粗带状短T1信号影，血肿近硬膜缘平直，外缘呈不规则或呈波浪状，3例血肿发生于两侧大脑镰硬膜下，MRI表现为线状低信号影两侧见条状短T1信号影，形成“双轨样”改变；单侧小脑幕下血肿9例，轴位CT表现呈片状或扇形高密度，MRI为短T1信号影，小脑幕并大脑镰硬膜下血肿6例，3例双侧小脑幕并大脑镰硬膜下血肿呈“Y”型，3例单侧呈“镰刀”型，结论通过60例特殊类型硬膜下血肿的影像分析，进一步认识到此种类型硬膜下血肿的影像特点，避免不必要的手术。MR检查在定位方面优于CT。     

特殊类型硬膜下血肿的再认识及临床意义

目的：提高对特殊类型硬膜下血肿影像的再认识，为临床正确治疗提供可靠依据。材料与方法：回顾性分析60例特殊类型硬膜下血肿的CT、MRI影像表现，并比较两种不同方法的影像特征。结果：大脑镰硬膜下一侧血肿42例，CT表现为条索状或粗带状，MRI表现为线状低信号影（大脑镰）旁见条索状或粗带状短T1信号影，血肿近硬膜缘平直，外缘呈不规则或呈波浪状，3例血肿发生于两侧大脑镰硬膜下，MRI表现为线状低信号影两侧见条状短T1信号影，形成“双轨样”改变；单侧小脑幕下血肿9例，轴位CT表现呈片状或扇形高密度，MRI为短T1信号影，脑幕并大脑镰硬膜下血肿6例，3例双侧小脑幕并大脑镰硬膜下血肿呈“Y”型，3例单侧呈“镰刀”型。结论：通过60例特殊类型硬膜下血肿的影像分析，进一步认识到此种类型硬膜下血肿的影像特点，避免不必要的手术。MR检查在定位方面优于CT。     

急性大脑镰旁和小脑幕下硬膜下血肿的CT诊断

目的:总结大脑镰旁和小脑幕下硬膜下血肿的CT影像特征,提高大脑镰旁和小脑幕下硬膜下血肿的诊断准确率。方法:回顾性分析上海市松江区泗泾医院2019年3月—2021年3月间收治的27例经手术证实为大脑镰旁及小脑幕下硬膜下血肿患者的颅脑CT平扫图像,查阅文献资料。结果:大脑镰旁硬膜下血肿CT平扫征象为沿大脑镰局限或弥漫分布的条状高密度影,血肿大脑镰邻接面边缘平直,脑组织邻接面呈弧形或波浪状;小脑幕下硬膜下血肿CT平扫征象为岩锥以上层面小脑幕处局限性条片状高密度影,其外侧缘边界清晰,内侧缘边界略模糊,MPR冠状位重建表现为与小脑幕紧密相连的镰状高密度影像。结论:大脑镰旁及小脑幕下硬膜下血肿CT平扫征象具有诊断意义,仔细分析CT平扫图像征象可以准确诊断。     

小脑幕大脑镰硬膜下血肿的CT诊断及误诊分析

目的：探讨小脑幕、大脑镰硬膜下血肿的CT特征及误诊原因。方法：回顾性分析12例小脑幕、大脑镰硬膜下血肿的CT表现特征。结果：12例中大脑镰硬膜下血肿7例，CT表现为内缘平直、外缘弧形或波浪形的带状高密度影；小脑幕硬下血肿5例，CT表现为小脑幕区的片状或扇形影2例、新月状高密度影1例；对称或不对称的U或Y形高密度灶2例，本组中误诊5例，其中3例误诊为蛛网膜下腔出血，2例误诊为正常大脑镰钙化。结论：小脑幕、大脑镰急性硬膜下血肿的CT表现具有特征性，CT多平面重建及复查对其诊断和鉴别诊断有重要意义。     

自发性大脑镰硬膜下血肿1例报告并文献复习

成人大脑镰旁或大脑半球间硬膜下血肿（interhemispheric subdural hematoma,ISH）是一种少见的硬膜下血肿,因其解剖结构特殊,血肿的CT表现为特征性大脑镰内内缘平直、外缘弧形或波浪形的带状高密度影。以往由于对该病的认识不足,常常误诊为蛛网膜下腔出血。本文报道1例自发性ISH并进行文献复习。     

外伤性颅内血肿及其并发症CT平扫分析

目的 分析外伤性颅内血肿及其并发症CT平扫表现。方法回顾1999年～2001年经CT平扫诊断和部分经临床手术证实的外伤性颅内血肿及其并发症120例。结果男97例，女23例，年龄3岁～76岁，外伤性颅内血肿及其并发症CT平扫的类型、例数、形态、密度、中线移位不同表现。结论提出了正确识别出血部位的重要性：有些病例的CT表现是比较特殊的，如巨大硬膜下积液、大脑镰旁积液(水瘤)等。     

大脑镰、小脑幕硬膜下血肿的CT诊断

目的 探讨大脑镰、小脑幕硬膜下血肿的CT诊断价值，分析误诊原因。方法回顾性分析17例大脑镰、小脑幕硬膜下血肿的CT和临床资料。结果17例中大脑镰硬膜下血肿10例，CT表现为内缘平直、外缘弧形或波浪形的带状高密度影；小脑幕硬膜下血肿7例，CT表现为高密度片状影2例、U形影2例，累及大脑镰后部3例，呈Y形或镰刀样改变。结论大脑镰、小脑幕硬膜下血肿CT表现具有特征性，CT复查对其诊断和鉴别诊断有重要意义。     

A rapid simple in situ hybridization method for herpes simplex virus employing a synthetic biotin-labeled oligonucleotide probe: A comparison with immunohistochemical methods for HSV detection

We examined 28 paraffin-embedded tissue specimens with histologic evidence of herpes virus infection by in situ hybridization (ISH) utilizing manual capillary action technology (Micro Probe Staining System) and a 21 base synthetic multibiotinylated oligonucleotide probe from the HSV glycoprotein C region. The results were compared to a rapid simple immunohistochemical (IHC) protocol for detection of HSV proteins. HSV was detected by ISH and IHC in all but one specimen which was shown to be positive for varicella zoster virus by direct fluorescent antibody studies. Hybridization signal was confined to the nucleus in all cases. Staining was identified in cells with early as well as late cytopathic effect. IHC produced intense nuclear and/or cytoplasmic signal in infected cells and stained in areas of necrosis which were otherwise spared by ISH. HSV was detected by IHC and/or ISH in 3/5 specimens with histology suggestive of, but not diagnostic for, HSV infection. Both techniques were sensitive and specific for HSV, resulted in rapid detection of the pathogen in routinely processed tissues, and may be useful in cases where the histologic impression is equivocal for HSV infection. ISH for HSV may be preferred because it can identify early HSV infection, which in turn can be treated with antiviral agents. © 1994 Wiley-Liss, Inc.     

Combined in situ hybridization and immunohistochemistry for automated detection of cytomegalovirus and p53

Background: Cytomegalovirus (CMV) infection has been shown to be associated with p53 overexpression in coronary artery restenosis. We investigated the occurance of this association in other forms of CMV infection using an automated in situ hybridization (ISH) technique.Methods and Results: We performed ISH for CMV using digoxigenin-labeled or biotinylated probes followed by avidin-alkaline phosphatase and nitroblue tetrazolium color substrate. Immunohistochemistry (IHC) was then performed using an anti-p53 antibody utilizing streptavidin-immunoperoxidase and 3,3-diaminobenzidine tetrahydrochloride as a chromogen. Sixteen cases with characteristic cytomegalic inclusions from a variety of body sites were examined. All 16 cases were positive for CMV by ISH. Nine of sixteen expressed nuclear p53. Six of these nine cases showed viral cytopathic effect in the cells with p53 expression. In an illustrative case, double colocalized staining for CMV and p53 protein was demonstrated in individual cytopathic cells. When microwave antigen retrieval was necessary, ISH was performed before IHC, and our standard microwaving time was reduced by two-thirds.Conclusions: The colocalization of p53 protein overexpression with CMV within single cells adds further evidence that this overexpression is a viral-induced phenomenon. The combined ISH and IHC assay can be carried out in a rapid automated mode, increasing the ease of investigating relationships between message and protein expression within single cells in a wide variety of settings. (Mol Diagn 1996 Dec;1(4):291-296)     

成人外伤性脾破裂的选择性非手术治疗

目的总结成人外伤性脾破裂的选择性非手术治疗经验。方法回顾性分析45例成人外伤性脾破裂的非手术治疗临床资料,探讨非手术治疗的病例选择、治疗方法和注意事项。结果45例外伤性脾破裂的非手术治疗中,成功43例(成功率95.6%);继续出血1例,并发脾脓肿1例,均行脾切除。结论Ⅰ~Ⅱ级外伤性脾破裂可在严密观察下行选择性非手术治疗。     

儿童外伤性硬膜外血肿的临床特点和救治

目的总结儿童外伤性硬膜外血肿的临床特点和救治经验。方法回顾性分析我院自2002年4月～2006年4月儿童外伤性硬膜外血肿的临床资料75例。结果开颅手术36例,其中去骨瓣减压10例,保留骨瓣26例;钻孔引流15例;保守治疗24例。痊愈64例,中／重残10例,死亡1例。结论儿童外伤性硬膜外血肿有其临床特点,容易误诊漏诊,及早发现和治疗,效果良好,否则易造成严重后果。     

胰腺横断伤的治疗体会(附11例报告)

目的:探讨胰腺横断伤的手术方式选择和并发症的防治。方法:回顾性分析11例胰腺横断伤手术治疗方法、术后和并发症的治疗。结果:治愈10例,死亡1例,发生胰瘘2例,创伤性胰腺炎2例,肠道菌群比例失调2例,小肠梗阻及胆汁性腹膜炎各1例。结论:胰腺横断伤是腹部外伤中较严重的损伤,常合并其他脏器损伤,对危及生命的合并伤应首先进行妥善处理。受伤原因、胰腺横断部位、损伤程度、有无十二指肠及胆道损伤对手术方式选择有密切关系。术中彻底清创、严密止血、缝合技术、通畅有效的引流、术后生长抑素和TPN 使用等综合措施有利于并发症的防治。     

Interhemispheric subdural hematoma

A case of interhemispheric subdural hematoma (ISH) following closed head injury is reported. Our patient had seizures and mental status changes. Cranial computed tomography (CT) demonstrated areas of increased density along the right side of the falx cerebri and over the right leaf of the tentorium cerebelli. Conservative treatment was chosen and the patient recovered. Ten other patients with ISH were compared with ours. Head injury is the leading cause of ISH. Most patients display confusion, lethargy, or a "falx syndrome," with a delayed interval of prominent neurological deficits from the time of injury until presentation. Although patients with ISH can be successfully treated by medical management, surgical intervention may be required.     

A non–traumatic interhemispheric subdural haematoma: presented with headache as the sole complaint

Due to their localisations and symptoms, interhemispheric subdural haematomas (ISH) compose a distinct category. Altered level of consciousness and hemiparesis are the most frequent symptoms. We report a case of ISH who presented with headache as the sole complaint. Left cerebellar haematoma and ISH were found in cranial MRI and cranial computed tomography Cranial MR angiogram was normal. Haemogram and coagulation parameters were within normal limits. ISH should be considered among the diagnostic possibilities in elderly patients who present with headache as the sole symptom without other clinical features such as meningeal irritation signs, focal neurological symptoms and alteration of consciousness. Cranial imaging studies should be done in such cases.     

56例外伤性脾破裂的选择性非手术治疗

目的:总结外伤性脾破裂的选择性非手术治疗经验。方法:对56例非手术治疗的外伤性脾破裂的临床表现和治疗结果作回顾分析,探讨非手术治疗的病例选择、治疗方法和注意事项。结果:非手术治疗56例脾破裂中,治疗成功53例(94.6%),继续出血3例(5.4%),行脾切除。结论:外伤性脾破裂可选择性地在严密监测下行非手术治疗。     

创伤性膀胱破裂38例治疗体会

目的探讨创伤性膀胱破裂的诊治方法。方法回顾性分析38例创伤性膀胱破裂患者的临床资料。本组36例患者行手术治疗,手术包括膀胱修补术、膀胱造瘘术;对合并后尿道损伤者,根据受伤时间行相应处理;对肠破裂或膀胱直肠贯通伤者行肠修补或结肠造瘘术。2例行保守治疗,留置导尿管引流。结果 34例手术治疗患者术后排尿正常,其中2例因损伤严重于术后24 h内死亡。结论膀胱灌注实验结合腹腔穿刺检查及膀胱逆行造影是膀胱破裂简单而可靠的诊断方法。早期诊断、及时救治是救治成功的关键。