儿童良性部分性癫痫SPECT显像特点

目的探讨儿童良性部分性癫痫（ＢＰＥ）的ＳＰＥＣＴ显像特点。方法２１例ＢＰＥ患儿，在ＥＥＧ监测下，分别在觉醒期（棘波发放间期）和睡眠期（棘波发放期）进行ＳＰＥＣＴ显像，减影处理后重建断层影像。用脑血流功能变化率（ＢＦＣＲ％）数学模型进行定量分析。结果ＥＥＧ监测显示患儿觉醒期背景活动基本正常，睡眠期棘波发放频率明显增多。ＳＰＥＣＴ共见１１７个痫灶，平均每例５６±１６个。ＳＰＥＣＴ显像特点为：①多灶性镜像分布；②主要位于Ｒｏｌａｎｄｉｃ区；③“环形征”；④觉醒期的多处放射性减低区，睡眠期放射性明显填充。ＳＰＥＣＴ与ＥＥＧ的符合率为９３１％（１０９／１１７）。痫灶的ＢＦＣＲ％皆高于对应正常局部脑自然变化的范围（９９％可信区间）。棘波发放频率和ＢＦＣＲ％之间无相关性（ｒ＝０４５，Ｐ＞００５）。结论ＢＰＥ痫灶异常放电时，可致局部脑血流灌注和功能异常     

门电路心肌显像傅立叶分析评价左心功能

用９９ｍＴｃ－甲氧基异丁基异腈（ＭＩＢＩ）对２０例患者及６例健康志愿者进行门控心肌显像和傅立叶分析，同时进行平衡法核素心室显像．将２０例患者的左室心肌分为１０６个节段，两种显像（门控心肌和心血池）振幅之间有９１个节段相符（８５．８％），所测得的左室射血分数（ＬＶＥＦ）平均值分别为４２．３％±１０．４％和４４．０％±１５．９％（Ｐ＞０，０５）；６例正常人两种显像振幅完全相符，ＬＶＥＦ平均值分别为５８．８％±１０．２％和６４．０％±１１．０％（Ｐ＞０．０５）；正常人与患者间用相同方法所测得的ＬＶＥＦ间有显著差异（Ｐ＜０．０１）．所有２６例受检者两种方法所测得的ＬＶＥＦ值之间有良好的相关性（ｒ＝０．９４，Ｐ＜０．００１）本研究结果表明，９９ｍＴｃ－ＭＩＢＩ门控心肌显像可同时获得心肌血流灌注和左心功能的信息．     

选择性经皮冠脉腔内成形术逆转冠心病左室重构疗效观察25例

为探讨经皮冠脉腔内成形术（ＰＴＣＡ）能否逆转冠心病（ＣＨＤ）患者的左室重构（ＬＶＲＭ），对实施选择性ＰＴＣＡ的２５例冠心病患者，应用二维超声心动图（２ＤＥ）动态观察其围ＰＴＣＡ期左室射血分数（ＬＶＥＦ）、每搏量（ＳＶ）、左室舒张末容积（ＬＶＥＤＶ）及左室收缩末容积（ＬＶＥＳＶ）的演变。结果发现扩大的左室容积在围术期中明显缩小。其中１５例心肌梗死后有ＬＶＲＭ者７例，其术后ＬＶＥＳＶ首先回缩（Ｐ＜００５），随后ＬＶＥＳＶ及ＬＶＥＤＶ均显著缩小（均Ｐ＜００１）；而无ＬＶＲＭ者（ｎ＝８），ＬＶＥＳＶ及ＬＶＥＳＶ则无变化（均Ｐ＞００５）。无论有无ＬＶＲＭ，围术期ＬＶＥＦ及ＳＶ均无变化（均Ｐ＞００５）。提示在选择性ＰＴＣＡ围术期中，ＬＶＲＭ可明显减轻；也表明在反映ＬＶ功能的２ＤＥ指标中，ＬＶＥＳＶ及ＬＶＥＤＶ较ＬＶＥＦ及ＳＶ更敏感     

活动平板运动试验多项指标分析在冠心病诊断中的意义

目的：通过对活动平板运动试验（ＴＥＴ）多项指标进行分析，旨在评价ＴＥＴ在冠心病诊断中的价值。方法：对２４５例患者按Ｂｒｕｃｅ方案进行了ＴＥＴ检查，把阳性患者分为疼痛组（Ａ组）和无症状组（Ｂ组），两者进行比较，并与试验阴性组（Ｃ组）比较。结果：运动时间，最大心率Ａ组＜Ｂ组＜Ｃ组（Ｐ＜０．０５～０．０１）。运动血压Ｃ组＞Ａ组（Ｐ＜０．０１）。Ａ组与Ｂ组、Ｂ组与Ｃ组比较无差异（Ｐ＞０．０５）。ＳＴ段下移级别Ｂ组＞Ａ组（Ｐ＜０．０１），下移深度Ａ组＞Ｂ组（Ｐ＜０．０１）。结论：ＴＥＴ多项指标判断冠心病的准确性明显提高。     

下体负压晕厥前症状下事件相关电位变化特征

目的探讨下体负压晕厥前症状（ＰＳＳ）下事件相关电位（ＥＲＰｓ）的Ｐ３潜时（Ｐ３Ｌ）变化特征，为飞行员加速度性晕厥的医学鉴定提供实验方法和依据。方法用下体负压方法（ＬＢＮＰ）诱发ＰＳＳ，观察ＥＲＰｓ的Ｐ３Ｌ变化特征。结果出现ＰＳＳ时，ＥＲＰｓ的Ｐ３Ｌ由３４３．３５±１４．７２ｍｓ延长至５０６．８７±３７．４４ｍｓ（Ｆ（６，４８）＝１４．９６，Ｐ＜０．０５，ＯＺ电极），相关任务反应时（ＲＴ）由５０８．６５±１１．１３ｍｓ延长至６３１．２５±２９．１６ｍｓ（ｔ＝２．９７，Ｐ＜０．０５），靶刺激反应错误率由（４．００±１．６７）％增加至（４３．３８±３．５４）％（ｔ＝３．０６，Ｐ＜０．０５）。ＰＳＳ后第５ｍｉｎ，Ｐ３Ｌ仍明显高于基线值（Ｐ＜０．０５）。而ＲＴ、错误率与基线值已无显著差异（Ｐ＞０．０５）。结论ＥＲＰｓ的Ｐ３Ｌ结合ＲＴ、错误率等指标对飞行员加速度性晕厥的研究有潜在应用价值。     

部分脾栓塞治疗难治性原发血小板减少性紫癜

目的：探讨ＰＳＥ治疗难治性原发血小板减少性紫癜的临床应用价值。方法：对６２例经内科治疗无效的ＲＩＴＰ，采用Ｓｅｌｄｉｎｇｅｒ′ｓ法，经股动脉穿刺，脾动脉置管，注射明胶海绵作部分脾栓塞治疗，以期提高患者周围血小板计数，治愈或减轻出血症状。结果：本组６２例ＲＩＴＰ经ＰＳＥ治疗后，获ＣＲ３９例（６２．９％）；ＰＲ１３例（２１．０％）；总有效率８３．９％。１年后复查，复发率２９．０％。结论：ＰＳＥ治疗ＲＩＴＰ与脾切除无显著性差异（Ｐ＞０．０５），可作为脾切除的替代手术。     

门控~（99m）Tc－MIBI心肌灌注断层显像测量室壁收缩分数的方法学研究

建立门控９９ｍＴｃ-甲氧基异丁基异腈心肌灌注断层显像的定量分析方法．方法：计算室壁收缩分数（ＷＣＦ）和功能低下面积（ＤＦＡ），直接反映心脏整体和局部的心肌收缩功能，并以ＷＣＦ功能曲线及其靶心图显示．结果：ＷＣＦ和ＤＦＡ的测定重复性很好，ＣＶ分别为３．３０％和３．６％．ＷＣＦ、几何法测量的ＥＦ和ＤＦＡ呈负相关（ｒ分别为-０．８５６３和-０．８３９０）．门控心肌断层显像法与心室显像计数法测量的ＥＦ值相关性好（ｒ＝０．８９０７）．正常人、冠心病和心肌梗塞患者的ＷＣＦ值分别为０．４３８±０．０３０、０．３０６±０．０８１和０．２８９±０．０９５．左前降支、右冠状动脉、左冠状动脉回族支和多支冠状动脉分布区灌注低下患者的ＷＣＦ值分别为０．２８１±０．０７７、０．３１９±０．０７１、０．３０３±０．０６６和０．２４８±０．１０６．前三者之间差异无显著性（Ｐ＞０．０５），但后者低于前三者（Ｐ＜０．０５）．平衡心室显像测量ＥＦ值、门控心肌显像测量ＥＦ值和ＷＣＦ值对冠心病的诊断灵敏度分别为７２．４％、４８．３％和８２．８％．结论：门控心肌断层显像测量ＷＣＦ值、ＷＣＦ功能曲线及其靶心图能全面客观地评价心脏收缩功能．     

~（99m）Tc－MIBI门控平面心肌显像评价心肌梗塞区存活心肌──与~（99m）Tc─MIBISPECT及~（18）F－FDGPET结果比较

为评价９９ｍＴｃ－甲氧基异丁基异腈（ＭＩＢＩ）平面门控心肌显像（ＥＧＰ）在心肌梗塞患者存活心肌判断中的准确性，对２１例心肌梗塞患者进行了静息ＥＧＰ、静息和运动９９ｍＴｃ－ＭＩＢＩ心肌单光子发射计算机断层（ＳＰＥＣＴ）显像及饥饿时静息１８Ｆ－脱氧葡萄糖（ＦＤＧ）正电于发射计算机断层（ＰＥＴ）显像．在２１例患者共１０５个心肌节段中，有１５个节段运动ＳＰＥＣＴ半定量分析局部９９ｍＴｃ－ＭＩＢＩ放射性分布大于左室峰计数的８０％（即正常节段），从本研究中排除．其余９０个节段中有７７个节段ＰＥＴ显像ＦＤＧ摄取明显，１３个节段无ＦＤＧ摄取．以ＦＤＧＰＥＴ为标准，ＥＧＰ在存活心肌判断中的灵敏度和特异性分别为９６％和７７％，而静息ＳＰＥＣＴ的灵敏度及特异性分别为９６％及６９％．两种显像方法在存活心肌判断中差异无显著性，同时两者在心肌节段间计分比较中有良好的一致性（ｒ＝０．８６）．提示ＥＧＰ在存活心肌判断中与ＭＩＢＩＳＰＥＣＴ相似．     

bcl－2蛋白在乳腺癌组织中表达的临床病理意义

应用ＬＳＡＢ免疫组化法，观察乳腺癌组织中ｂｃｌ－２蛋白表达，探讨其临床病理意义。结果显示，ｂｃｌ－２表达的阳性率为４２．７％，阳性反应物质位于细胞浆或核膜上，胞核中偶有表达。ｂｃｌ－２在乳腺癌组织中的表达与病人年龄、月经情况、肿瘤大小及淋巴结转移无明显关系（Ｐ＞０．０５）。浸润性小叶癌及浸润性导管癌之间，ｂｃｌ－２表达串的差异无显著性意义（Ｐ＞０．０５）。观察还发现，ｂｃｌ－２表达与显示预后好的某些病理形态学特征关系密切，浸润性导管癌不同病理分级组间，ｂｃｌ－２表达率有极显著性差异（Ｐ＜０．０１）；核分裂≥２１／１０高倍视野组，ｂｃｌ－２表达率明显低于０～１０／１０高倍视野组（Ｐ＜０．０１）；有肿瘤坏死者的ｂｃｌ－２表达率明显低于无肿瘤坏死者（Ｐ＜０．０１）。另外还观察到，ｂｃｌ－２与ｐ５３表达之间呈负相关（Ｐ＜０．０１），与ｃ－ｅｒｂＢ－２、ＭＤＲ１、ＧＳＴ－、ｎｍ２３及ＰＣＮＡ之间均无显著关系（Ｐ＞０．０５）。     

大鼠感染性脑水肿时NMDA受体的变化

测定百日咳菌液（ＢＰ）所致大鼠感染性脑水肿（ＩＢＥ）对３ＨＭＫ８０１与大脑皮层神经细胞特异结合的影响。从大鼠左颈总动脉注入ＢＰ，制备ＩＢＥ模型。雄性ＳＤ大鼠随机分３组：①对照组（ＮＳ，ｎ＝１１）；②ＩＢＥ组（ＢＰ，ｎ＝１２）；③ＭＫ８０１＋ＢＰ预处理组（ＭＫ８０１，ｎ＝４）。０２ｍｌ／ｋｇ体重生理盐水或ＢＰ注入左颈总动脉作为ＮＳ或ＢＰ组；每天腹腔注射０５ｍｇＭＫ８０１／ｋｇ体重，共２天，然后注入ＢＰ为ＭＫ８０１组。注射ＢＰ２４小时后断头取脑。Ｎ甲基Ｄ天冬氨酸（ＮＭＤＡ）受体与３ＨＭＫ８０１的特异结合用放射配体结合分析法测定，Ｓｃａｔｃｈａｒｄ作图。结果，ＮＳ及ＢＰ组的Ｂｍａｘ分别为０６２３±００８２和０６０６±００８７ｐｍｏｌ／ｍｇ蛋白质（ｔ＝０４８，Ｐ＞００５），Ｋｄ分别为４３１±４２和３０５±３０μｍｏｌ／Ｌ（ｔ＝７８，Ｐ＜００５）。ＭＫ８０１预处理减少ＮＭＤＡ受体的特异结合。表明在此脑水肿模型中ＮＭＤＡ受体总数未发生变化，但亲和力明显增高，其增高能被预先腹腔注入的ＭＫ８０１抑制。     

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.