肺原发性平滑肌肉瘤1例

1　病例报告患者女 ,35岁。 1个月前无明显诱因发热 ,下午为甚 ,体温 37.838℃ ,伴咳嗽 ,咯粘液痰 ,呼吸困难 ,于 1999年 3月19日入院。查体 :左肺下叶呼吸音减弱 ,右肺呼吸音清 ,全身浅表淋巴结不大 ,肝脾未触及 ,子宫及双侧附件未扪及肿块。ＣＴ示左肺下叶后基底段块影 ,直径约 11ｃｍ ,密度均匀 ,有钙化 ,边缘清。临床诊断 :( 1)肺隔离症 ;( 2 )错构瘤。行左下叶肺切除术。手术见肿块位于左下叶肺内 ,呈实性。病理检查 :肺叶后基底段可见 11ｃｍ× 10ｃｍ× 9.5ｃｍ椭圆形肿块 ,有假包膜 ,与肺分界清。切面灰白与灰红相间 ,编织状 ,质中…     

圆形肺不张一例

患者 ,男 ,61岁。因胸闷、咳嗽 ,发热 10天而入院。入院胸片检查右侧中等量胸腔积液 ,诊为结核性胸膜炎。经抗结核治疗 1个月 ,胸水已基本吸收 ,正位胸片发现右下肺有一卵圆形病灶。胸部ＣＴ平扫见右下肺后基底段有一 7ｃｍ× 6ｃｍ× 5ｃｍ大小的肿块 ,并右侧胸腔少量积液、胸膜肥厚 ,肿块内侧、外侧边缘清晰锐利 ,前部可见有条索状肺血管影及支气管影弯向肿块 ,肿块后部与胸膜成锐角且有粘连 ,以至于前后缘较模糊 ;肿块周边密度较高 ,内可见含气支气管 ,邻近肿块的肺组织呈过度膨胀 (图 1、2 )。诊为右下肺圆形肺不张可能。经Ｂ超引导下经…     

CT诊断肺隔离症一例

患者　女,50岁。因胸痛不适3个月,伴胸闷、心悸而就诊。查体:两肺呼吸音稍粗糙,未闻及干湿性罗音。胸部正侧位Ｘ线片示:左肺下叶后基底段脊柱旁有一类圆形肿块,直径约5.5ｃｍ,边缘尚光整。胸部ＣＴ检查:平扫示左肺下叶后基底段主动脉旁一类圆形肿块,最大径约6.5ｃｍ,有包膜,其内低密度,均匀,ＣＴ值为15ＨＵ(图1)。增强扫描示包膜强化,但其内低密度处不强化,并见胸主动脉左后方有一分支伸向肿块(图2、3)。ＣＴ诊断为左肺下叶肺隔离症。手术所见:左肺下叶一鸡蛋大小肿块,内有囊液。病理所见:组织块大小8.0ｃｍ×0.5ｃｍ×4.5ｃｍ,灰暗红色,胸…     

肺隔离症一例

病例资料　患者 ,男 ,2 7岁。因体检胸片发现左下肺肿块行ＣＴ检查 ,自诉无胸部不适及呼吸道症状。ＣＴ平扫 :左下肺后基底段类圆形实性肿块 ,密度均匀 ,ＣＴ值 3 5ＨＵ ,边界尚清楚 ,横断面范围 3 .0ｃｍ× 3 .5ｃｍ ,周围血管纹理明显增粗、增多 ,于肿块内侧隐约见一血管影与降主动脉相连 (图 1ａ) ;增强扫描及血管重建成像清晰显示肿块供血动脉来自降主动脉 ,并见分支血管附于肿块边缘 (图 1ｂ、ｃ) ,静脉回流至左下肺静脉 ,肿块本身无明显强化。ＣＴ诊断肺隔离症(叶内型 )。讨论　肺隔离症是一种肺的先天发育畸形 ,组织学上为一发育不良…     

双侧胸腔肾合并主动脉和食管右位1例

1　临床资料　患者 ,女 ,85岁。因“咳嗽、咳痰 4天”入院。胸片发现右位主动脉弓和降主动脉 ,右下胸内半圆形软组织块影 ,密度均匀 ,大小约 5 .5ｃｍ× 1.5ｃｍ ,上半部边界清晰 ,下半部位于膈下界限不清 ;侧位片示块影靠后与胸椎重叠下缘亦欠清楚。Ｘ线拟诊 :①先天性右位主动脉畸形。②右下肺肿物 ,性质待定。胸部ＣＴ扫描所见 :主动脉弓、降主动脉和食管胸段位于右侧。胸腰椎右旁相当于Ｔ11～Ｌ3水平以及胸椎左旁相当于Ｔ11～ 12 分别可见大小约为 10ｃｍ× 7ｃｍ× 12ｃｍ和 8ｃｍ× 5ｃｍ× 4ｃｍ的软组织密度影 ,ＣＴ值为 3 4ＨＵ ,…     

似肝脏脂肪瘤的血管脂肪瘤1例报告

患者　女 ,37岁。因“阵发性室性早搏”行Ｂ超检查时发现“左肝实质性占位”2 5ｄ。查体未见异常。实验室检查肝肾功能正常 ,ＡＦＰ阴性。Ｂ超检查 :左肝外叶见 6.5ｃｍ× 5 .6ｃｍ大小的实质增强回声 ,形态规则 ,边界清楚 ,血管纹理不清晰。考虑肝脏良性病变 ,建议穿刺活检。ＣＴ检查 :左肝外叶见大小约 3.9ｃｍ× 4.9ｃｍ的低密度影 ,边界清楚 ,ＣＴ值约 -60ＨＵ左右 ,密度略有不均 (图 1)。考虑肝脏脂肪瘤。　　ＭＲＩ检查 (外院 ) :肝左外叶见约 5 .2ｃｍ× 5 .0ｃｍ×4.0ｃｍ大小肿块影 ,Ｔ1ＷＩ(图 2 )和Ｔ2 ＷＩ(图 3)均呈高信号 ,边…     

多发局限型胸膜间皮瘤一例

患者　女 ,42岁。发现双下肺肿块2个月 ,无呼吸道症状。既往体健 ,无结核史、外伤史。全身浅表淋巴结无肿大。实验室检查无异常。后前位胸片 ,见双下肺密度均匀 ,边缘清楚的肿块影 (图 1)。切线位片 ,示右下肺偏后肋膈角区分叶状肿块影 ,约7ｃｍ× 5ｃｍ大小 ,侧后肋角填塞 ;左下肺稍偏前见椭圆形肿块影 ,约 7ｃｍ× 6ｃｍ大小 ,肿块上缘与胸壁夹角成锐角 ,2个肿块密度均匀 ,边缘清楚。Ｘ线诊断 :双下肺肿块多系囊性病变。ＣＴ平扫 :右下后胸壁 3 5ｃｍ×4 0ｃｍ× 7 0ｃｍ肿块 ;左下侧胸壁5ｃｍ× 7ｃｍ× 9ｃｍ肿块 ,密度均匀 ,边缘光滑 ,…     

颅骨动脉瘤样骨囊肿MR诊断一例

患者　男 ,1岁 10个月。足月顺产 ,既往体健 ,无头部外伤史。因头顶部肿物进行性增大 2周入院。查体 :头顶正中头皮隆起 ,局部皮肤无发红、发热 ,无搏动。肿物质软 ,轻触疼痛 ,基底宽而固定 ,大小为 3ｃｍ× 3ｃｍ× 2ｃｍ ,听诊未闻血管性杂音。ＭＲ使用ＳｉｅｍｅｎｓＩｍｐａｃｔ 1.0Ｔ ,ＳＥ序列 ,Ｔ1ＷＩ 5 0 0ｍｓ/ 15ｍｓ ,Ｔ2 ＷＩ 30 0 0ｍｓ/ 90ｍｓ。矩阵 192× 2 5 6 ,视野 18ｃｍ× 2 1ｃｍ。顶骨正中不规则形异常信号影 ,横断面病变的边缘呈分叶状或波浪状。Ｔ1ＷＩ低信号的囊腔与中等信号影相间 ,可见多个小的液 液面 ,上部…     

气管低分化平滑肌肉瘤合并曲菌感染一例

患者　男 ,36岁。反复咳嗽、胸闷、气促 3个多月 ,以过敏性哮喘入院。临床症状 :自觉气管有阻塞感 ,气促 ,咯粘稠黄痰 ,偶有血丝。查体 :桶状胸 ,双肺布满哮鸣音。实验室检查 :ＡＦＰ(- ) ,ＣＥＡ 32 .9,ＥＢ 1∶10 (+) ;查痰 :2次找癌细胞(- ) ,但有大量曲菌菌丝及孢子。胸部正侧位Ｘ线片示 :气管中下段 (Ｔ2～ 4 水平 )后壁一 4.0ｃｍ× 5 .0ｃｍ× 2 .6ｃｍ中等密度肿物影 ,气管管腔狭窄 (图 1) ;胸部气管额状面断层片示 :肿物位于气管下段 ,呈椭圆形 ,边界清楚 (图 2 )。ＭＲ检查 :Ｔ1ＷＩ、Ｔ2 ＷＩ均示肿物为不均匀高信号 ,且已侵犯食…     

肺内软骨肉瘤一例

患者　男 ,5 0岁。左侧胸痛 3月余 ,以左侧卧位时为甚。患者无咳嗽、咯痰、咯血等呼吸道症状。体检及实验室检查无异常。患者曾于 1年前摄胸部正侧位片示左肺下野有一 4.6ｃｍ× 5 .0ｃｍ× 5 .6ｃｍ不规则软组织肿块影 ,密度均匀 ,边界清晰、锐利 ,示“分叶征”及“脐样切迹”。Ｘ线检查 :左肺舌段与下叶前基底段横跨于斜裂部见一6 .0ｃｍ× 6 .0ｃｍ× 6 .3ｃｍ类圆形软组织肿块影 ,较 1年前明显增大 ,其内密度均匀 ,边缘更光滑、清晰 ,略有“分叶征”(图 1)。Ｘ线诊断 :左肺肿瘤。 ( 1)肺癌 ;( 2 )肺内转移瘤。手术切除病理诊断 :肺内未…     

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.