肾包虫囊肿的CT诊断(附3例报告)

本文报告经手术证实的3例肾包虫囊肿的CT表现。其特征性表现是:(1)卵圆形或圆形水样密度囊肿。(2)母囊内有子囊。(3)囊膜剥离征象。(4)囊壁钙化。并讨论了本病的破裂感染和与先天性肾囊肿的鉴别诊断。     

肝囊性包虫病的影像学诊断与分型

目的：探讨肝囊性包虫病在不同影像学检查中的图像特征和影像学诊断分型。方法：收集1984年1月至2000年12月经手术治疗的2039例肝囊性包虫病患者术前B超,CT（909例）和磁共振成像（MR1,24例）检查资料,对照手术病理所见进行分析。结果：影像学检查不仅可检测出包虫寄生部位,类型,大小及性状,并能显示出各种并发症病理形态改变的典型图像,影像学诊断可划分为7型,即单发型（1625例,79．70％）,多发型（414例,20．30％）,子囊型（1114例,54．63％）,钙化型（186例,9．12％）,实变型（28例,1．37％）,感染型（391例,19．18％）和破裂型（298例,14．62％）,结论：首次提出与临床相结合的肝囊性包虫病影像学诊断的分型名称,分型的确定有助于选择手术方案,提高手术治愈率。     

肝包虫病的螺旋CT诊断

目的:提高对肝包虫病的螺旋CT表现的认识。方法:回顾分析经本院螺旋CT检查及手术病理证实的21例肝包虫病螺旋CT表现。结果:囊型包虫病18例,其中单纯囊肿8例,表现为圆形水样密度区。多子囊型10例,表现为在一个大囊内可见数量不等的更低密度小圆形低密度区,边界清晰。钙化14例,为囊壁壳状钙化囊内不定形条片状钙化。包虫囊肿合并感染4例,表现为囊壁增厚,强化明显。泡型包虫病3例,呈不规则及不均匀密度影,所有病灶内均有钙化灶,其中1例病灶边缘有晕样改变区。所有病例CT均诊断正确。结论:螺旋CT可以很好显示肝包虫病病灶,对肝包虫病具有较高的诊断率。     

Continuous long-term albendazole therapy in intraabdominal cystic echinococcosis

Ａｌｂｅｎｄａｚｏｌｅｈａｓｂｅｅｎｗｉｄｅｌｙｕｓｅｄｉｎｔｈｅｔｒｅａｔｍｅｎｔｏｆｃｙｓｔｉｃｅｃｈｉｎｏｃｏｃｃｏｓｉｓ ,ｂｕｔｒｅｌａｔｉｖｅｌｙｆｅｗｌｏｎｇ ｔｅｒｍｆｏｌｌｏｗ ｕｐｒｅｓｕｌｔｓａｒｅａｖａｉｌａｂｌｅｔｏｅｖａｌｕａｔｅｌｏｎｇ ｔｅｒｍｅｆｆｉｃａｃｙａｎｄｓａｆｅｔｙ Ｉｎｔｈｉｓｓｔｕｄｙ ,ｗｅｆｏｌｌｏｗｅｄｕｐ 15ｐａｔｉｅｎｔｓｗｈｏｒｅｃｅｉｖｅｄｃｏｎｔｉｎｕｏｕｓｌｏｎｇ ｔｅｒｍａｌｂｅｎｄａｚｏｌｅｔｈｅｒａｐｙ ;ｃｌｉｎｉｃａｌｔｈｅｒａｐｅ…     

Treatment of intracranial hydatid cysts

Background  Echinococcosis is still endemic in many countries, including China, where it is especially prevalent in the northwest. The aim of this study was to enrich the international literature about the treatment of intracranial hydatid cysts.

Methods  We retrospectively reviewed the clinical features, radiological manifestations, and surgical outcome of 97 patients with intracranial hydatid cysts, who received surgical treatment at the Neurosurgical Department of First Affiliated Hospital of Xinjiang Medical University from 1985 to 2010 and followed up the patient via sending a questionnaire or telephone contact. Clinical outcome was evaluated using the Karnofsky Performance Scale Index.

Results  Headache and vomiting were the most common initial symptoms in our patients. Neurological deficits caused by the mass effect of the cysts were seen in 82 cases. On the X-ray, significant bone erosion was seen in only two cases with epidural hydatid cysts. Round-shaped and thin-walled homogeneous low-density cystic lesions without surrounding edema and enhancement were the main findings on computerized tomography (CT) in 95 patients with intraparenchymal hydatid cysts, while two cases with epidural hydatid cysts presented as a heterodensity lesions. On magnetic resonance imaging (MRI), hydatid cyst presented as a round-shaped low signal lesion in T1-weighted images and high signal lesion in T2-weighted images, without enhancement after contrast media injection, while the two cases with epidural cysts presented as mixed signal masses. Surgical removal of cyst was performed in all cases. Total removal was achieved in 93 cases without rupturing the cyst wall. Only two cysts ruptured during the dissection, resulting in two surgery-related mortalities. There was no other additional neurological deficit caused directly by surgery. In 97.2% of the patients, the Karnofsky Performance Scale score was 80 to 90 at the last follow-up.

Conclusions  Intracranial hydatid cyst is still a main cause of increased intracranial pressure among the patients in endemic areas for echinococcosis. CT and MRI are the best diagnostic methods and surgery is the treatment of choice for intracranial hydatid cysts.

     

肝脏及肺部泡状棘球蚴病CT表现（附11例肝肺病例报告）

目的分析肝脏及肺部泡状棘球蚴病的CT表现，探讨肝脏及肺部泡状棘球蚴痛的CT诊断及鉴别方法分析临床及手术病理证实的9例肝脏及2例肺脏泡状棘球蚴病螺旋CT表现。结果2例肺泡状棘球蚴病CT均表现为实性病灶，边缘清楚，未见钙化影。9例肝脏泡状棘球蚴病中5例表现为中心以实性为主周围伴有多发性小空泡征的圆形、椭圆形阴影，边缘光滑，其中3例囊肿壁有不同程度环形钙化。2例为实性病灶，部分囊壁环形钙化，囊内无小空泡征（小囊肿）。2例CT表现为斑块状低密度影，分界不清，中间散在分布斑点钙化影。结论螺旋CT可以很好显示肝肺泡状包虫病病灶，对肝肺泡状包虫病具有较高的诊断率。     

血管内皮生长因子与转化生长因子的协同作用诱导兔骨髓间充质干细胞分化

目的 研究血管内皮生长因子(vascular endothelial growth factor,VEGF)和转化生长因子(transforming growth factor-β1,TGF-β1)的协同作用对兔骨髓间充质干细胞(bone marrow-derived mesenchymal stem cells,BMSCs)成骨分化的影响及其可能机制.方法 将细胞分为4组:对照组、腺相关病毒(adeno-associated virus,AAV)-VEGF组、AAV-TGF-β1组和VEGF+ TGF-β1组.穿刺法抽取兔骨髓液,分离培养原代BMSCs,分别构建AAV-VEGF和AAV-TGF-β1腺病毒载体转染BMSCs,Western blot检测各组细胞中VEGF、TGF-β1的蛋白表达.流式细胞术检测细胞凋亡情况,CCK8法检测细胞增殖能力,Western blot检测髓核细胞标志SOX-9、Ⅱ型胶原和蛋白聚糖的表达,以及P38MAPK信号通路相关蛋白P38、MAPKAPK2和HSP27的表达.加入P38MAPK的特异阻滞剂SB203580预处理BMSCs,检测VEGF和TGF-β1对BMSCs增殖、凋亡、分化及相关蛋白表达的影响.结果 VEGF和TGF-β1可通过调节P38MAPK信号通路抑制BMSCs凋亡,促进BMSCs增殖,并向类髓核细胞分化,且在其协同作用下效果显著.抑制P38MAPK信号通路可反转VEGF和TGF-β1对BMSCs增殖分化能力的促进作用.结论 VEGF和TGF-β1的协同作用能增强BMSCs增殖和分化的能力,提高胶原蛋白和蛋白聚糖等细胞外基质的表达,从而促进退变椎间盘的修复和再生.     

Radiological appearances of hydatid disease in Wales

Thirty six patients with hydatid disease have been investigated in the Radiology Departments of Cardiff hospitals between June 1973 and June 1984; thirty two of these patients are likely to have acquired the disease in Wales. There were 16 hepatic cysts, 3 renal cysts, 2 cerebral cysts, 15 pulmonary cysts, 1 pleural cyst, 1 recurrent spinal cyst, and 1 cyst of the broad ligament. The radiological features are discussed. These patients emphasize the higher incidence of hydatid disease in Wales, compared with other regions of the United Kingdom, and the need to consider this diagnosis in Welsh patients from rural areas, who have large pulmonary opacities, or hepatic, renal, or cerebral cystic abnormalities.     

11例肝包虫外囊剥除术临床初步观察

目的：探讨肝包虫外囊剥除术治疗肝包虫病的疗效。方珐：采用肝包虫外囊剥除术治疗11例肝包虫病患者。结果：全组病人术后恢复良好，无胆瘘、出血、感染等并发症。结论：肝包虫外囊剥除术治疗肝包虫病是一种合理而可行的新术式，可解决以往传统的内囊摘除术由于囊液外溢导致的复发问题，远期临床疗效尚需积累更多的病例和进行更长期的随访以进一步观察。     

肝脏泡状棘球蚴病的CT MRI表现

目的 分析肝脏泡状棘球蚴病CTMRI表现，评价CTMRI对肝包虫病的诊断价值。方法 回顾分析15例经CTMRJ诊断及手术病理证实的肝包虫病影像学资料。结果 15例共发现肝包虫囊肿17个。CT表现边界清晰或稍模糊的圆形或椭圆形不均匀密度减低区；大部分病灶可见钙化。MRI表现在T1加权像上边界清晰或稍模糊的圆形或椭圆形不均匀的低信号影，其内散在分布不规则的更低信号影。在T2加权像上，病灶呈不均匀高信号。病灶内的钙化在T1和T2加权像上呈条状、点状、斑片状无信号区（钙化）。增强扫描强化不明显。结论 CTMRI对肝包虫病有较高的诊断价值。     

大豆苷元对人乳牙牙髓干细胞增殖和成骨分化的影响

目的 探讨大豆苷元对人乳牙牙髓干细胞(SHED)增殖和分化的影响.方法 对体外培养的第3代SHED用浓度分别为0.1、1、10、100 μM的大豆苷元培养基进行培养,采用MTT法检测细胞生长曲线,通过碱性磷酸酶(ALP)试剂盒、放免法和TGF-β1 Elisa试剂盒检测大豆苷元对SHED碱性磷酸酶(ALP)活性、骨钙素(OCN)以及TGF-β1表达的影响.结果 0.1 μM的大豆苷元能够显著促进SHED的增殖,而高浓度(100μM)的大豆苷元则对SHED的增殖具有明显的抑制作用.大豆苷元剂量依赖性地促进了SHED ALP、OCN和TGF-β1的表达.结论 大豆苷元对SHED的增殖和成骨分化具有促进作用,其促成骨分化机制可能与增加TGF-β1表达有关.     

RUNX2/LAPTM5在小鼠颅骨前成骨细胞矿化诱导中的表达

目的 探讨RUNX2/LAPTM5在矿化诱导过程中的表达与成骨及溶酶体的相关性。方法 矿化诱导MC3T3-E1,对照组不做处理,茜素红染色检测矿化情况,碱性磷酸酶染色检测成骨分化情况。RT-qPCR及Western blot检测分化0-5 d RUNX2及LAPTM5的基因及蛋白表达。过表达与干扰RUNX2/LAPTM5的表达后,Western blot检测RUNX2、LAPTM5的表达。过表达与干扰LAPTM5的表达后,Western blot检测成骨相关基因碱性磷酸酶、骨钙素 的表达。结果 倒置显微镜下观察,茜素红染色矿化结节计数随时间变化逐渐增多,矿化结节的大小也逐渐变大;碱性磷酸酶染色蓝紫色颗粒计数随时间逐渐增加。RT-qPCR及Western blot结果显示RUNX2及LAPTM5的表达,其在成骨矿化过程中呈上升趋势（P<0.001）。过表达与干扰RUNX2影响LAPTM5表达（P<0.05）;过表达与干扰LAPTM5对RUNX2的影响不显著。过表达与干扰LAPTM5影响了成骨的表达（P< 0.01）。结论 RUNX2/LAPTM5可能参与了成骨细胞分化调节,RUNX2可能参与LAPTM5的表达调控。RUNX2/LAPTM5可能在溶酶体参与成骨矿化的过程中起到桥梁作用。     

雷公藤甲素通过调节TGF-β1信号通路和Hippo信号通路影响肾小管上皮细胞的上皮-间充质转化

目的:研究雷公藤甲素（TP）对肾小管纤维化抑制作用的机制。方法:将HK-2分成3组,阴性对照组不做处理,TGF-β1组用 TGF-β1处理,TGF-β1+TP组用TGF-β1和TP处理,培养48 h观察细胞的形态,利用RNA 测序技术检测各组中mRNA的表达,通过KEGG基因富集筛选相关通路,用Western blot检测EMT相关蛋白及富集所得信号通路中重要蛋白的表达。结果:TP处理可致HK-2形态改变。RNA测序和KEGG富集分析显示,TP显著影响TGF-β信号通路和Hippo信号通路相关基因的表达。Western blot结果表明TP可影响HK-2细胞EMT相关蛋白、TGF-β1信号通路和Hippo信号通路中的重要指标蛋白的表达。结论:TP可通过调节TGF-β1信号通路和Hippo信号通路抑制肾小管上皮细胞发生上皮-间充质转化。     

CDH17调节TGF-β自分泌影响胃癌细胞侵袭作用的研究

目的 探讨转化生长因子(TGF)-β自分泌在钙黏蛋白17(CDH17)调节胃癌细胞侵袭性中 的作用及可能机制.方法 构建siRNA-CDH17并转染入胃癌细胞系MKN-45,沉默其表达.通过免疫荧光染色、 Western blot、ELISA检测CDH17沉默前后细胞TGF-β表达及培养上清液中TGF-β水平变化,观察TGF-β的自分 泌情况.同时采用Western blot检测TGF-β/Smad3信号通路活化情况,并通过Transwell侵袭实验观察在给予 信号通路抑制剂后,胃癌细胞侵袭力的变化,评价TGF-β自分泌及相关信号通路活化在CDH17调节胃癌细胞侵袭 性中的作用.结果 转染siRNA-CDH17沉默MKN-45细胞CDH17表达后,细胞TGF-β表达较未转染组明显下降,其培 养上清液中TGF-β水平也显著减少[(510±55.0)pg/mL vs.(115±20)pg/mL,P<0.05].Western blot显示 CDH17沉默后Smad3磷酸化水平也明显降低,而给予TGF-β/Smad3信号通路抑制剂SIS3(10 μmol/L)也可抑制 CDH17高表达时的Smad3磷酸化水平.同时,沉默CDH17及抑制Smad3磷酸化均可明显降低MKN-45细胞侵袭性 (P<0.05).结论 CDH17可能通过促进自分泌TGF-β活化TGF-β/Smad3信号通路参与调节胃癌细胞侵袭性.     

Clinics in diagnostic imaging (102)

A 19-year-old man presented with cough and haemoptysis of ten days duration. He also had mild right hypochondrial pain. Chest radiograph and computed tomography (CT) showed a rounded soft tissue density opacity with an air crescent sign. CT showed multiple cystic lesions in the liver with a daughter cyst in its lateral wall. Diagnosis of hydatid disease of lung and liver was made. The contents of the liver cyst were aspirated, hypertonic saline instilled, re-aspirated, and absolute alcohol injected. Hydatid disease is endemic in certain parts of the world. Although the lungs and liver are most frequently affected, the disease can arise in any part of the body and should be kept in differential diagnosis whenever a cystic lesion is encountered. Hydatid cysts typically demonstrate characteristic imaging findings, however, the appearances may become complicated due to cyst rupture or secondary infection. Ultrasonography is the imaging modality of choice particularly in hepatic disease. CT best demonstrates cyst wall calcification and cyst infection.     

Uncommon locations of hydatid cysts

Human echinococcosis remains a complex problem that may affect several organs, and requires mostly surgical management. We present two cases with uncommon locations of hydatid cysts that were successfully managed in our hospital during the last two years. The first case was a 62-year-old woman with a multicystic lesion in her right thigh that was radically excised, and histology confirmed the diagnosis of echinococcosis. The second case was a 78-year-old man with multiple large intraabdominal hydatid cysts that required a complex operation, including splenectomy, partial removal of the liver cyst wall and evacuation of the content, and excision of pelvic, mesenteric cysts, and suprahepatic cysts. Both cases have not shown any sign of recurrence to date. Since the disease is still endemic in certain parts of the world and pharmaceutical agents are not radical, specific surgical procedures remain the treatment of choice with good results and acceptable morbidity, mortality and recurrence rates.     

Clinical Experience in Treating Intracranial Hydatid Cysts: Report of 97 Cases

Background: Echinococcosis is still endemic in many countries, including China, especially in its north-west part, but the world literature which describes the Chinese experience in treating the cerebral hydatid cyst is still lacking. In this report, clinical manifestations, radiological features and surgical outcomes of 97 patients with intracranial hydatid cysts were analyzed and the transmission pattern, preoperative diagnosis, treatment methods and long-term outcome were discussed. Methods: We retrospectively reviewed the clinical features ( neurological symptoms and signs), radiological manifestations( X-ray, CT, MRI) and surgical outcome of 97 patients with intracranial hydatid cysts whom received surgical treatment at the neurosurgical department of Xinjiang Medical University between the year 1985 to 2010.We have followed up the patients via sending questionnaire or telephone contact. Clinical outcome was evaluated by using Karnofsky Performance Scale Index (KPSI). Results: Headache and vomiting were the most common initial symptoms in our patients. Neurological deficits caused by the mass effect of the cysts were seen in 82 cases, which include hemiparesis, visual deficit, diplopia and aphasia. Epilepsy was occurred in five patients with hemispheric hydatid cysts. On X-Ray, significant bone erosion was seen in only two cases with epidural hydatid cysts. Round shaped and thin walled homogeneous low-density cystic lesion without surrounding edema and enhancement were the main findings on CT in 95 patients with intraparenchymal hydatid cysts, while two cases with epidural hydatid cysts were manifested as a heterodensity lesions. On MRI, Hydatid cyst was manifested as a round low signal lesion in T1-Weighted images and high signal lesion in T2-weighted images, without enhancement after contrast media injection, while the two cases with epidural cysts were manifested as mixed signal masses. Surgical removal of cyst was performed in all cases. Total removal was achieved in 93 cases without rupturing the cyst wall. Only two cysts ruptured during the dissection, resulted in two surgery related mortality. There was no other additional neurological deficit caused directly by surgery. Patient outcome was 97.2% with Karnofsky Performance Scale score 80 to 90. Conclusion: Intracranial hydatid cyst is still a main cause of increased intracranial pressure among the patients in endemic areas. CT and MRI have been proven to be the best diagnostic modality for diagnosing intracranial hydatid cyst. Surgery is the treatment of choice for intracranial hydatid cyst whenever possible.     

昆明种小鼠棘球蚴病感染动物模型的建立

目的建立细粒棘球蚴病和多房棘球蚴病小鼠的动物实验模型。方法4周龄昆明种小鼠60只,分为细粒棘球蚴病组和多房棘球蚴病组（每组20只）,并各设空白对照组（10只）,均雌雄各半。分别腹腔注射人源细粒棘球绦虫原头蚴悬液或鼠源泡球蚴原头蚴混悬液0．2mL（含庆大霉素250IU·mL^-1,原蚴头500个·mL^-1）,空白对照组腹腔注射0．2mL,含庆大霉素250IU·mL^-1,PBS液。通过病检和腹外观察,了解小鼠包囊的生长情况、重量、数量、直径和不育囊率。结果两种包虫病的感染率均为100％。第350天剖杀细粒棘球蚴原头节感染的昆明小鼠,不育囊率为100％,所有细粒棘球蚴包囊内未见原头蚴,雌、雄小鼠体内包囊的直径和数量差别无统计学意义;而第90天剖杀的泡球蚴感染小鼠动物模型不育囊率平均为15％,85％的感染泡球蚴病灶内含原头蚴。雌、雄小鼠体内泡球蚴包囊的体积大小和重量差异有统计学意义（P〈0．01）。结论雌鼠对多房棘球蚴感染比雄鼠更敏感,多房棘球蚴在小鼠体内生长快,适宜保种;雌鼠和雄鼠对细粒棘球蚴的敏感性无明显区别,细粒棘球蚴在小鼠体内生长慢,不宜保种。     

肺包虫囊肿的影像学诊断

本文总结了４５８例肺包虫囊肿影像学诊断经验。典型Ｘ线征除罕见的环形囊壁鲈化外,只有破裂后形成液平面,上有漂浮膜或内囊周围有液体及气体形成双液平面。ＣＴ扫描包虫囊肿密度均匀,ＣＴ值２０Ｈｕ以下,偶见囊中之囊。Ｂ超声囊肿呈圆形或椭圆形无回声区。     

国产甲苯咪唑(微粒型)试验治疗鼠体继发性棘球蚴感染的初步观察

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