骨肉瘤亚型影像诊断(附4种亚型8例报告)

目的探讨骨肉瘤亚型的临床、影像学特征,以提高对骨肉瘤亚型的认识。方法结合文献回顾性分析经临床、病理证实的4种亚型8例骨肉瘤的影像学表现。结果3例毛细血管扩张型分别位于股骨上段、股骨下段和肱骨远段,X线显示骨质呈膨胀性、溶骨性破坏,软组织肿块,其中1例类似动脉瘤样骨囊肿;3例骨旁型位于肩胛骨、股骨中段和股骨下段,X线显示骨致密性骨块为主要表现,骨髓腔内未见异常,突起骨块与骨皮质之间见有透光带;1例骨膜型位于股骨下段,CT显示骨皮质轻度破坏,骨髓腔内未见病灶,有巨大的软组织肿块,肿块密度不均;1例髓内高分化型位于肱骨中上段,X线显示骨质囊状破坏,界限清楚,髓腔扩张,骨皮质变薄。结论该4种亚型各自具有一定影像特征,有助于诊断。     

骨原发性恶性纤维组织细胞瘤影像诊断

目的探讨骨原发性恶性纤维组织细胞瘤(BMFH)影像表现及诊断要点。方法回顾性分析6例经病理确诊为BMFH的X线、CT及MRI表现。结果4例侵犯单骨,2例侵犯多骨。溶骨型4例,混合型2例。股骨下端3例,肱骨上端1例,楔骨1例,横突1例,共侵犯12个骨骼。6例均有骨及骨皮质明显破坏,以溶骨性破坏为主,2例病灶周围有轻度骨硬化。全部病例均有软组织肿块,巨大肿块2例,局限性肿块4例,1例肿块内可见散在小钙化影。全部病例未见骨膜反应,3例合并病理性骨折。结论原发性BMFH好发于长骨干骺端或骨端,多见于股骨下端及胫骨上端。虫蚀状或大片状溶骨性骨质破坏,巨大软组织肿块,无骨膜反应,是其影像学特点,诊断需密切结合临床和病理。     

低级别中心型骨肉瘤影像诊断及鉴别诊断

目的 探讨低级别中心型骨肉瘤的影像学表现,以期提高对本病的认识和诊断水平.方法 回顾性分析6例经病理证实的低级别中心型骨肉瘤的影像学表现,6例患者均行X线检查,1例行CT检查,4例行MRI平扫和增强检查.结果 肿瘤位于股骨3例,胫骨、腓骨及肱骨各1例.X线或CT表现,单纯骨质硬化1例,溶骨性骨质破坏伴粗大骨小梁1例,溶骨性骨质破坏伴纤细骨小梁1例,骨质硬化与溶骨性骨质破坏并存1例,2例骨质破坏合并病理性骨折,3例存在骨膜反应.MRI表现,4例均有骨皮质突破、骨髓腔受侵及瘤周水肿,3例合并软组织肿块,增强扫描均为不均匀强化.结论 低级别中心型骨肉瘤是骨肉瘤较罕见的一种亚型,较易误诊,X线与MRI结合对该疾病的诊断有重要意义.     

毛细血管扩张型骨肉瘤的影像表现及其与病理的关系

目的:分析毛细血管扩张型骨肉瘤影像学表现与病理的关系,以提高诊断准确性.方法:回顾性分析经手术病理证实的毛细血管扩张型骨肉瘤9例,术前分别经X线平片、CT平扫、MR SE T1WI、T2WI和T1WI增强扫描,仔细复习影像征象并和手术病理作对照.结果:9例毛细血管扩张型骨肉瘤中,位于股骨5例,胫骨3例和髂骨1例.位于长管状骨者,5例位于干骺端,2例位于骨干,1例接近骨端.肿瘤直径6.3～11.8 cm.所有肿瘤均为溶骨性骨质破坏,破坏区呈椭圆形5例,不规则地图形4例.病灶呈囊状9例,7例病灶境界不清,7例病变见骨膜增生,伴软组织肿块8例,所有病例软组织肿块境界清楚.5例行CT检查,病灶密度低于肌肉或与肌肉相仿,CT显示骨膜增生及软组织肿块较平片清楚,增强扫描软组织明显强化.4例行MR检查,T1WI为混杂信号3例,低信号1例;T2WI为低、等和高信号混杂4例.T2WI 4例均可见明显囊状改变和液-液平面,均可见软组织成分,软组织构成囊壁和分隔,部分呈不规则肿块结节,T2WI软组织信号高于肌肉.结论:毛细血管扩张型骨肉瘤好发于长管状骨干骺端,呈卵圆形或地图样溶骨性破坏,容易呈多囊状坏死,但肿瘤内常见软组织成分,常伴骨膜增生和骨外软组织肿块,CT增强扫描和MR有助于显示病灶的软组织成分.     

长骨骨巨细胞瘤二例报告

长骨以溶骨破坏改变的主骨巨细胞瘤文献报道较少,且易误诊为骨肉瘤[1],本文对2例已经手术及病理证实的长骨溶骨型骨巨细胞瘤进行报道如下。例1　女,36岁,干部。因右下肢麻木伴疼痛5个月,加重2天并活动受限就诊。体检:右股骨下段内侧略有肿胀,压痛明显,过伸、过屈时疼痛加剧,局部皮肤温度正常,不红。Ｘ线表现:右股骨下段干骺端可见一类球形宽度减低的骨质破坏区,边缘模糊,密度不均匀,其前部骨皮质有中断,局部软组织肿胀,软组织内有少许骨样组织,未见骨膜反应,病变未及关节。Ｘ线诊断:右股骨下段恶性骨肿瘤(考虑骨肉瘤可能性大)(图1)。手术所…     

骨原发性淋巴瘤的影像学特点

目的 探讨骨原发性淋巴瘤的影像特点.方法 回顾性分析6例经临床和病理证实的非霍奇金淋巴瘤病例的X线、CT和MR表现.结果 6例平均发病年龄51岁,发生于长骨骨干近干骺端和骨盆.影像学表现为溶骨性或者虫蚀样骨质破坏,周围软组织肿块形成,且范围超过了骨破坏的范围.骨皮质常表现为虫蚀样不连续.结论 骨的原发性淋巴瘤具有一定的发病年龄和影像学特点.     

毛细血管扩张型骨肉瘤三例

我院自 196 3～ 1998年经病理确诊的骨肉瘤共 10 8例 ,其中毛细血管扩张型骨肉瘤仅 2例 ,加上外院 1例共 3例 ,结合文献报告如下。例 1　男 ,6岁。 1个月前左下肢受伤后疼痛 ,逐渐肿胀并出现跛行。体检 :左大腿肿胀 ,内侧可触及拳头大小的肿块 ,质硬、固定、压痛、表面光滑 ,局部皮温略高。Ｘ线表现 :左股骨下段内侧有界限不清的斑片状、溶骨性骨质破坏 ,内侧部分骨皮质边缘破坏 ,并有骨膜增生 ,可见Ｃｏｄｍａｎ三角征 ,髓腔破坏、增大 ,呈轻度膨胀性改变 ,局部有一软组织肿块 ,皮下脂肪层混浊 (图 1)。手术及病理所见 :自左股骨内髁上方取…     

原发性骨淋巴瘤的影像表现分析

目的探讨原发性骨淋巴瘤(primary lymphoma of bone,PLB)相关影像表现特点,以提高对该病的诊断和鉴别诊断能力。方法回顾性分析经穿刺细胞学或手术病理证实的7例PLB患者的X线、CT及MRI影像表现。结果 7例患者2例单骨发病,5例多骨发病,最常累及股骨、髂骨,骨质破坏以浸润型为主,骨皮质可见T2WI高信号"肿瘤通道",周围软组织肿块多巨大,累及关节者,关节间隙保持正常。结论 PLB与其它恶性骨肿瘤鉴别困难,但具有以下特点:全身症状轻、溶骨型骨质破坏(尤其长骨远端)伴或不伴骨膜反应及骨皮质增厚、软组织肿块明显而骨质破坏轻微、病变有包绕关节趋势(关节间隙保持正常)。     

毛细血管扩张型骨肉瘤影像与病理对照分析

目的　探讨毛细血管扩张型骨肉瘤影像与病理表现特征。方法　分析 12例毛细血管扩张型骨肉瘤临床、影像及病理资料。结果　临床特征为肿瘤好发于长骨干骺端 ,下肢多见 ,少有血清碱性磷酸酶增高。X线、CT特征为溶骨性与膨胀性骨破坏 ;肿瘤破坏区和软组织肿块内多发小囊变和液 -液平面 ;皮质变薄 ,多发筛孔样破坏 ;骨膜反应及放射状骨针较常见。病理组织学特征为典型骨肉瘤肿瘤细胞和多发血窦及“彩带样”结构。结论　毛细血管扩张型骨肉瘤具有一定的临床、影像及组织学特征     

神经母细胞瘤并多发骨转移1例

患者男,2岁。左膝肿胀、活动受限1月来诊。查体:左膝内缘股骨下部触及硬性肿块,不能活动,皮温高,左中腹部可触及一包块,位于左肾区。患者父母自述,患儿既往体健,1月来,左膝内下缘肿胀迅速,疼痛,患儿哭闹不安,不能站立行走。X线检查:左股骨内下缘干骺端见溶骨性骨破坏,并突破骨皮质,侵及周围软组织,形成肿块,周缘见放射状骨针,肿块上方后内缘皮质见轻度层状骨膜反应,病变对侧缘骨皮质中断,呈病理性骨折改变;左胫骨上端干骺端松质骨呈筛孔样骨破坏(图1,2),骨纹理稀疏,见细小纵行透亮区。作多部位骨骼摄影:见双侧股骨股骨颈下缘松质骨见筛孔样…     

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.