外伤性颞浅动脉-眼静脉瘘影像诊断1例报告

男,41岁,半年前车祸外伤后左侧耳鸣,安静时明显。头颅CT未见骨折与颅内损伤。4个月前耳鸣逐渐感受不到。3个月前轻度眼球突出,结膜充血。50 d前眼球突出突然加重,夜间休息时感左侧额颞部肿胀感,起立活动后减轻,进行性下睑上静脉增粗。头颅MR I及MRA显示左眼球突出,眼肌轻度肥大,左眼球后见一粗大异常血管影,明显流空效应,与颈外动脉之颞浅动脉分支关系密切,但双侧海绵窦未扩大(图1~3)。脑血管造影显示双侧颈内动脉系统和椎动脉系统正常,左颞浅动脉明显增粗,其额眶支有一瘘口,与左眼上静脉主干直接交通,左眼上静脉迂曲、增粗(图4)。确诊…     

颈内动脉海绵间窦瘘一例

患者　男 ,39岁 ,因外伤后 7个月 ,右侧搏动性突眼伴双耳杂音 5个月入院。体检 :右侧搏动性突眼 ,球结膜充血 ,外展不能 ,视力 0 .5 ,视乳头边缘不清 ,听诊吹风样杂音 ,与心跳一致 ,压迫右颈总动脉杂音不消失 ,压迫左颈总动脉杂音消失。左眼正常。右颈内动脉造影见海绵窦无显影 ,大脑中、大脑前和对侧大脑前动脉显影良好。左颈内动脉造影 ,正位片见造影剂经海绵间窦早期充盈右侧海绵窦 ,造影剂呈团状 ;侧位片见造影剂经增粗的右眼上静脉引流 ,右海绵窦明显扩张 ,左海绵窦未显影 ,有1个较小瘘口 ,瘘口远端颈内、大脑中和大脑前动脉不显影 ,呈…     

颈内动脉海绵窦瘘介入栓塞全麻术中心跳骤停1例

临床资料 患者女,42岁,因“车祸后视物重影,右眼红,眼突出2个月余”收治入院.体检眼球突出度:右16 mm,左13 mm,右眼各方向活动均受限,球结膜充血,结膜下血管扩张迂曲,角膜透明,对光反应正常.右眼B超提示:右眼轻度玻璃体混浊,右眼眼上静脉扩张.头颅CTA三维重建提示:“双侧颈内动脉海绵窦瘘”.入院诊断为创伤性颈动脉海绵窦瘘.择期在全麻下行“右颈内动脉海绵窦瘘介入栓塞术”.     

硬脑膜动静脉瘘合并双侧脑膜-眼动脉变异一例

患者　男 ,5 5岁。双侧耳鸣 ,双眼视力下降 18个月。查体 :右乳突区可闻及搏动性杂音。左右眼视力分别为 0 8和 0 6。眼底检查示双侧视乳头水肿 ,其他检查无异常。脑血管造影显示 :右侧横窦的硬脑膜动静脉瘘由右侧枕动脉、右脑膜中动脉的岩鳞支、右咽升和耳后动脉供血 ,经横窦引流。同时发现右侧眼动脉从右脑膜中动脉发出 ,而右颈内动脉无眼动脉发出 (图 1)。左侧颈外动脉造影显示左侧眼动脉亦从脑膜中动脉发出 (图 2 ) ,晚期可见左眼脉络膜的新月形染色 (图3)。左颈内动脉亦无眼动脉发出 (图 4)。用聚乙烯醇 (ＰＶＡ)颗粒经右枕动脉、咽…     

外伤性颅内多发假性动脉瘤并动静脉瘘一例

患者　男 ,47岁。车祸致头颅外伤后 8天。头晕、头痛 ,左眼失明 ,间断出现左侧鼻腔大出血。体检见左眼睑青紫 ,眼球无外突 ,头颅多处皮外伤 ,左额颞部可闻及血管杂音 ,考虑为颅底骨折、外伤性颈内动脉海绵窦瘘。用Ｓｅｌｄｉｎｇｅｒ技术行右股动脉穿刺插管 ,导管先后置于左颈内、外动脉行ＤＳＡ检查 ,可见左颈内动脉尚通畅 ,左眼动脉起始部呈一突出的囊袋状影 ,眼动脉未显示 ,海绵窦未显影 ,颈内动脉其他分支显示正常 (图 1,2 )。左颈外动脉主干通畅 ,脑膜中动脉中段前外侧于动脉期可见一囊袋状影 ,副脑膜动脉亦可见小分支至其中 ;脑膜中动…     

大脑大静脉动脉瘤样畸形1例报告

患者女,5岁半。出生后逐渐发现头颅比同龄儿童大,经常出现头痛,发育稍迟缓。体检:身上有多处“红斑”。右眼光反射消失、视力消失;左眼光反射灵敏、视力正常。心电图:窦性心动过速。影像学检查:MRI的表现为大脑大静脉池类圆形低信号流空血管影(图1);MRA显示Galen大脑大静脉显著扩张呈类圆形,并与异常增粗、迂曲的左大脑后动脉血管相连,引流静脉血管紊乱粗大,且与异常血管团汇入直窦(图2)。DSA血管造影显示为:左胼周、胼缘动脉向Galen大脑大静脉供血,该静脉呈瘤样扩张,大小约20mm×18mm,直窦存在并明显扩张;左大脑后动脉与Galen大脑大静…     

永存原始三叉动脉供血颈动脉-海绵窦瘘1例北大核心CSCD

1临床资料患者女,51岁。因“左侧头部及面部搏动性疼痛伴头晕、耳鸣2个月”入院。患者既往身体健康,查体可闻及左侧眼球后搏动性血管杂音,左侧眼球突出伴球结膜水肿。患者入院后行全脑血管造影见左侧永存原始三叉动脉供血的颈动脉-海绵窦瘘(carotid-cavernous sinus fistula,CCF),原始三叉动脉两端分别与左侧颈内动脉海绵窦段及左侧小脑上动脉相连,左侧小脑上动脉远端未见显影,主要经眼上静脉、岩上窦、基底窦、直窦引流(图1)。     

可脱球囊孤立术治疗颈内动脉海绵窦瘘

病例报告男性，58岁，1991年10月16日入院。患者1987年5月不慎跌入河中，2周后出现颅内杂音，左眼球突出，左眼视力下降。查体：左眼球搏动性突出，球结膜充血、水肿，仅有光感，活动受限。CT及脑血管造影示左侧颈内动脉海绵窦疾。11月3日在局麻下经股动脉插管行全脑血管造影，见左侧颈内动脉明显向海绵窦、左侧大脑中静脉瘤流。因疫口小，故用同轴导管将国产球囊1枚置于预内动脉C。段，用。mnipaque0．5ml充盈球囊后观察20min，病人右侧肢体肌力V级，语言正常，眼球胀痛消失。后于第一球囊的近心端又放一充盈球囊。右侧颈动脉造影见双侧…     

颈动脉海绵窦瘘的临床及影像学诊断

目的:分析颈动脉海绵窦瘘的临床及影像学特征。方法:回顾性分析25例具有完整临床资料的颈动脉海绵窦瘘患者的临床、全脑血管造影及10例螺旋CT表现。结果:临床表现为颅内杂音、不同程度的搏动性突眼、眼球运动障碍,视力减退或伴有复视、结膜水肿和充血。CT表现为眼球突出、眼上静脉增粗、海绵窦扩大、密度增高、眼球边缘模糊、眼睑肿胀。全脑血管造影表现为对比剂自颈内动脉或颈外动脉分支溢入海绵窦,形成一团浓密的不规则阴影,海绵窦及眼静脉等早期显影而颈内动脉床突上段和大脑前、中动脉不易充盈,并且可观察到瘘口位置、大小及侧支循环情况。结论:根据颈动脉海绵窦瘘的临床表现和CT征象可以诊断颈动脉海绵窦瘘,脑血管造影是其诊断的金标准,并为进一步选择治疗方案提供依据。     

创伤性颈内动脉海绵窦瘘合并巨大动脉瘤及血管畸形一例报告

创伤性颈内动脉海绵窦瘘合并巨大动脉瘤及血管畸形,在颅脑损伤中较为少见。我院从1973—1988年收治198例重型颅脑损伤中,见到1例。报告如下: 患者,男,27岁。1982年12月曾被木棒击伤头部,伤后昏迷7天,当时左侧鼻腔、外耳道流血,同侧眼球外突。1983年9月在某医院行左侧颈动脉造影。诊断颈内动脉海绵窦瘘,行肌肉填塞放风筝手术,术后头痛、突眼无改善。84年10月9日饮酒以后,头痛突然加重,恶心呕吐,发烧,失语、呈嗜睡状态,于10月14日入院。检查:意识模糊,混合性失语Kernig氏征( ),左眼球明显外凸,伴有视神经萎缩,球结合膜及眼睑血管怒张、水肿,触诊有震颤,眼球及颞部可闻及连续性杂音,压迫患侧颈总动脉杂音减弱。右侧肢体肌力Ⅳ级,Babinski氏征( )。10月19日行左侧颈总动脉连续造影。见:颈内动脉粗直径9mm,同侧海绵窦内大量造影剂充盈,眼静脉粗直径10mm,眼动脉粗直径4mm,大脑中动脉分叉部以前有一直径3.5cm囊状动脉瘤,伴有同侧皮层及深部血管畸形,范围10×6×5.5cm,瘤蒂未能显示。(见图1-3)。10月21日突然出现意识丧失,双侧瞳孔散大,光反射消失,去脑强直,考虑为动脉瘤破裂,结扎颈总动脉。紧急开颅手术,见额颞骨有陈旧性骨折。硬膜下凝血块约40ml,脑内有凝血约70ml,大脑中动脉分叉     

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.