多层螺旋CT对门静脉海绵样变的诊断价值

目的:分析门静脉海绵样变(CTPV)的多层螺旋CT(MSCT)表现和特征,探讨MSCT对该病的诊断价值.方法:使用16排MSCT对30例CTPV患者,行上腹部CT平扫、动态增强扫描,采用多平面重组(MPR)、最大密度投影(MIP)、容积再现 (VR)等图像后处理技术显示异常的门静脉及侧枝血管情况.结果:CTPV的MSCT平扫示门静脉结构不清,肝门区可见多发的结节状软组织影.增强扫描示动脉期10例有肝实质灌注异常;门静脉期18例患者门静脉主干和(或)左右分支增粗,内可见充盈缺损,4例门静脉显示不清;8例门静脉主干和(或)左右分支在正常范围内;1例门静脉主干变细.胆管周围静脉丛(100%)、胆囊静脉(60%)及胃左静脉(23.3%)呈点状、簇状扩张.MPR、MIP、VR可直观地显示各曲张血管的走行及曲张程度.结论:MSCT及图像后处理系统对CTPV诊断具有重要价值,门静脉栓塞及其周围纡曲扩张的侧枝静脉为其特征性表现.     

多层螺旋CT评价门静脉海绵样变的血流动力改变

目的 探讨多排螺旋CT增强扫描在评价成人门静脉海绵样变的血流改变中的应用价值.方法 对25例门静脉海绵样变(CTPV)组病人及20例有门脉高压但不伴CTPV及肝癌的肝硬化对照组1行螺旋CT动态增强及血管重建,观察门脉侧枝血管的出现率,测量门脉主干及肝固有动脉的径线,观察肝实质异常灌注的出现率,并比较2组数值差异.另对25例临床及CT动态增强扫描均无异常的对照组2行血管重建,测量肝固有动脉的径线,比较以上3组的肝固有动脉径线值的差异.结果 CTPV的门脉主干因形成原因不同可出现闭塞或明显扩张.CTPV的主要侧枝循环包括胆系侧枝与胃系侧枝,胆系侧枝中胆囊周围静脉显示16/22例(72.7%),胆管周围静脉丛显示25/25例(100%),胆系侧枝的出现率明显大于对照组1﹙P＜0.05﹚.CTPV组胃系侧枝中胃左静脉显示22/25例(88.0%),胃右静脉显示20/25例(80.0%),胃系侧枝的出现率较对照组1无明显差别(P＞0.05).CTPV组肝固有动脉直径为(4.49±1.45) mm,对照组1肝固有动脉直径为(3.43±1.15) mm,对照组2肝固有动脉直径为(3.09±0.71) mm,三者之间有明显统计学差异﹙P＜0.05﹚.CTPV组肝实质异常灌注的出现率为76.0%,明显大于对照组1(P＜0.05﹚. 结论多排螺旋CT增强扫描及血管重建能较全面地评价门静脉海绵样变的血流改变.     

CT对肝硬化后期门静脉高压的诊断价值

目的:探讨螺旋CT血管造影对肝硬化后期门脉高压患者的诊断价值。方法:通过对33例肝硬化门脉高压患者进行门静脉CT血管成像(CTPV)增强检查。结果:33例患者均成功地实施了门静脉CTPV,所有患者全有门静脉主干曲张外,以脐周静脉、腹膜后静脉、食管周围静脉曲张和奇静脉扩大为主,部分有门静脉-肝动脉瘘和门静脉栓子形成。结论:CTPV可显示肝硬化门脉高压患者的门体静脉之间侧支循环血管曲张及早期诊断肝硬化的深远意义。     

肝硬化患者CT门静脉血管成像中门静脉侧支血管的表现

目的 分析肝硬化患者在16排螺旋CT门静脉血管成像(CTPV)上门静脉侧支血管的表现.方法 对36例经临床、肝功能和影像学检查诊断为肝硬化门静脉高压的患者行腹部CTPV检查,经图像后处理,获得门静脉系统及侧支血管三维重建图像.结果 CTPV可以直观地显示门静脉系统及整个门静脉侧支循环系统.36例病例中显示胃左静脉曲张29例(80.6%),食管下段静脉曲张18例(50.0%),胃短/W后静脉曲张15例(41.7%),食管旁静脉曲张9例(25.0%),胃-肾/脾-肾分流8例(22.2%),门静脉海绵样变7例(19.4%),脐静脉与腹壁静脉曲张6例(16.7%),椎旁静脉分流4例(11.1%).结论 CTPV能很好地显示肝硬化患者门脉高压侧支循环的开放部位、范围及严重程度,对判断病情、选择治疗方案及估计预后有重要的临床应用价值.     

门静脉海绵状变性的MRI检查：继发性胆管改变和门脉侧支形成

目的：用MRI检查评价门静脉海绵状变性患者的门脉侧支及其继发性胆管异常。方法：观察34例血管造影或MR—血管造影证实的海绵状变性患者，行MRI检查，并分析判断门脉侧支形成的分布模式以及肝内外胆管管壁增厚、狭窄、扩张和管壁的不规则性改变。结果：34例海绵状变性患者中23例(67．6％)发现有继发性胆管周门脉侧支形成，其中22例(64．7％)可见明显血管腔，8例(23．5％)发现总胆管周门静脉侧支。34、例中24例(70．5％)显示门脉侧支形成所致的继发性胆管改变，8例(23.5％)由此而导致胆管狭窄及远端扩张。余7例(20．5％)患者胆管壁不规则，且11例(32．3％)胆管壁增厚，4例(12．9％)胆囊壁增厚。结论：MRI可识别门静脉海绵状变性患者的门脉侧支，它常易导致胆管继发性改变，因此必须考虑到门脉侧支存在时胆管改变的鉴别诊断。     

门静脉海绵样变的64层CT诊断

目的探讨64层CT增强扫描及门静脉血管成像在门静脉海绵样变(cavernous transformation of the por-tal vein,CTPV)诊断中的价值。资料与方法回顾性分析35例CTPA患者的CT和临床资料,按门静脉阻塞部位、程度和范围进行分型。结果本组CTPV病因中,肝硬化17例(合并肝癌7例),肝细胞癌12例,胆管细胞癌1例,胃癌4例,胰腺癌2例,胰腺炎1例,肝内胆管结石2例,十二指肠癌1例;另2例病因不明。所有病例门静脉阻塞周围均可见细小、扩张的门-门侧支血管影;15例出现胆管扩张,33例均出现胃食管静脉曲张;11例出现肝脏异常血流灌注征象。CTPV按门静脉阻塞部位分为肝内型4例,肝外型7例,肝内外混合型24例;按阻塞程度分为狭窄3例,闭塞32例;按门静脉累及范围分为节段性9例,弥漫性26例。结论 64层CT可用于评价CTPV的病因、门静脉阻塞情况、侧支血管及伴随的并发症,对诊断CTPV具有重要临床价值。     

MDCT血管成像对肝硬化门脉高压侧支血管分流途径的研究

目的 应用16层螺旋CT肝门静脉成像(CTPV)技术,探讨肝硬化门脉高压侧支血管分流途径及其临床意义.方法 收集并分析我院16层螺旋CT肝门静脉成像145例.进行常规平扫及三期增强扫描,三维重建方法采用MIP、VR、MPR.结果 仅向上腔静脉引流45例(31％);仅向下腔静脉引流11例(7.7％);分别向上、下腔静脉引流89例(61.3％).结论 CTPV可显示肝硬化门脉高压患者的门-体静脉之间各种侧支循环血管,有助于对门脉高压患者上消化道出血等合并症选择合理治疗方案及进行疗效随访.     

门静脉系统血栓的64层螺旋CT诊断价值

目的 探讨门静脉系统血栓(portal vein thrombosis,PVT)的64层螺旋CT表现特征.资料与方法 15例PVT行64层螺旋CT平扫和双期增强扫描,采用最大密度投影(MIP)、容积再现(VR)及多平面重组(MPR)观察其影像学特征.结果 15例中,血栓发生于门静脉(PV)主干13例,右支6例,左支7例,脾静脉(SV)3例,肠系膜上静脉(SMV)9例,其中血栓同时累及PV主干和SMV 8例,同时累及PV左右支、主干和SMV 4例,累及PV主干和右支6例,累及PV主干和左支6例,累及SV和SMV 2例,PV主干、SV、SMV三岔口处血栓1例.Yerdel分级:Ⅰ级1例,Ⅱ级10例,Ⅲ级3例,Ⅳ级1例;血栓呈高密度10例,等密度2例,低密度3例;血栓为部分偏心性栓塞12例,呈小条状、"柴捆"状;附栓管壁均连续光滑、无外突结节,局部PV管壁呈典型的线样"强化征"或"轨道征";出现食管胃丛及脾丛侧支循环12例,胆管丛及胆囊丛侧支循环4例,无一例出现肝动脉.门静脉瘘.结论 64层螺旋CT能够清晰、立体地显示PVT的部位、累及范围,具有特征性,是PVT重要的检查方法.     

MRI对门静脉海绵样变性的诊断价值

目的 分析门静脉海绵样变性(CTPV)的MRI表现与特征,探讨MRI对CTPV的诊断价值.资料与方法 回顾性分析29例经手术、数字减影血管造影(DSA)证实的CTPV患者的资料,所有病例均行腹部MRI平扫及增强扫描.结果 CTPV的MRI平扫可见门静脉闭塞,闭塞门静脉周围可见由侧支静脉形成的团块状、网状异常软组织信号影(29例).MRI增强动脉期见肝实质灌注异常(18例),门静脉期见异常侧支静脉强化(29例).结论 CTPV具有特征性的MRI表现,对CTPV的诊断具有重要价值.     

门静脉海绵样变的CT、MR诊断价值

目的:探讨门静脉海绵样变的CT、MR诊断价值。方法:回顾性分析15例经手术病理(6例)或经肠系膜上动脉行间接门静脉造影(9例)证实的门静脉海绵样变(CTPV)患者的影像及临床资料。结果:①3例患者行脾切除,余12例患者均有不同程度脾脏体积增大;②7例原发性肝癌中5例可见明显门脉癌栓;③15例患者CT及MR平扫可见门静脉主干及其分支失去正常形态,边缘呈波浪状;④增强扫描动脉期门静脉主干及其分支影像学变化较平扫未见明显变化,2例患者可于肝脏实质边缘区见到异常带状密度增高影,而肝门区密度相对较低(肝脏异常灌注);⑤增强扫描门静脉期显示肝门静脉主干及其分支走行区域内可见数个扭曲扩张的静脉血管影像。结论:CT、MR具有无创、快速、可重复的优点,对诊断CTPV有较大的价值。     

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.