兔慢性肺动脉血栓栓塞模型的建立及其64层螺旋CT表现

目的：建立兔的慢性肺动脉血栓栓塞模型,研究其64层CT肺动脉成像表现。方法：健康家兔28只,体量2.0-2.5 kg。栓塞组20只,假栓塞组8只。栓塞组兔肺动脉多次注入自体血栓,血栓直径为1-2 mm,长3-5 mm,每次栓塞量约3-5条,栓塞前后和12周时64层螺旋CT平扫和CT肺动脉成像扫描,分析其影像学表现特点。结果：栓塞组20只动物,死亡4只,存活并符合实验要求动物16只,成功率80%;假栓塞组无动物死亡。兔肺动脉栓塞后血浆D-二聚体在急性期明显增高,约增加80%,在慢性期降至正常水平。栓塞组16例CT肺动脉成像均发现肺动脉栓塞直接征象并经过病理证实。慢性肺动脉栓塞的间接征象中,肺动脉直径增粗的发生率为87.5%,肺梗死发生率为18.8%,斑片状实变影和胸膜增厚的发生率为12.5%,肺少血的发生率为6%。结论：兔自体血栓反复注射法建立慢性肺血栓栓塞模型有较高的可行性,64层CT肺动脉成像能清楚显示肺动脉栓塞的直接征象和间接征象,有助于肺动脉栓塞的诊断。     

MSCT肺血管成像对肺动脉栓塞的诊断价值

目的:探讨多层螺旋CT肺血管成像对肺动脉栓塞的诊断价值.方法:对24例肺动脉栓塞病例行多层螺旋CT肺动脉成像检查,图像采用1.0mm层厚、0.7mm层间距和0.75mm层厚、0.5mm层间距进行重建,CTPA后处理采用容积再现(VRT)、最大密度投影(MIP)和多平面重建(MPR),对重建的图像进行对照分析、比较优缺点.结果:24例病例中,病变共累及76支肺动脉,其中,主肺动脉6支、肺叶动脉36支、肺段动脉27支、亚段动脉7支.肺动脉栓塞病变显示,1.0mm及0.75mm层厚重建无显著性差异意义.结论:多层螺旋CT肺动脉成像具有安全、快速、无创优点,对肺动脉栓塞诊断特异性强、敏感性高,可作为肺动脉栓塞的首选检查方法.     

螺旋CT肺动脉造影诊断肺小动脉血栓的实验研究

目的：评价螺旋CT肺动脉造影（spiral CT pulmonary angiography，CTPA）诊断犬肺小动脉血栓栓子（直径2.5-3.5mm）的应用价值。方法：23条实验犬行CTPA空白对照后，制成犬自体血块肺动脉栓塞模型，先后行CTPA与X线肺动脉造影（X-ray pulmonary angiography，XPA）检查，由2名医生在工作站上分析所获图像，并与犬肺病理解剖结果对照，评价CTPA与XPA对肺动脉血栓栓塞的诊断价值。结果：22条犬完成实验全过程，病理解剖发现肺动脉内栓子110个，与人工注入栓子数目相符，均位于肺动脉的段或亚段水平，其中107个位于扫描野内。CTPA发现栓子90个，诊断肺动脉内小血栓栓子的敏感度为84.1％，阳性预测值为93.8％；XPA发现栓子82个，敏感度为76.6％，阳性预测值为94.3％。结论：CTPA对实验性肺小动脉血栓栓子有较高的诊断价值。     

螺旋CT肺血管造影对老年人肺栓塞的临床诊断价值

目的 评价螺旋CT肺血管造影(CTPA)对老年人肺栓塞的诊断价值.方法 对64例临床疑诊为肺栓塞的老年患者行螺旋CT 血管造影及二维或三维重建.CTPA 扫描参数取层厚2.0 mm,螺距1.5,用SmartPrep 软件对比剂智能触发技术获得最佳延迟扫描时间.结果 64例临床疑诊肺栓塞中,40例确诊为肺栓塞,共累及肺动脉850支.CTPA确诊36例,4例共5个亚段肺动脉的栓子漏诊.CTPA 诊断肺栓塞的特异性90.9%,敏感性90.5%,准确性90.6%,阳性预测值95.0%,阴性预测值83.3%.结论 螺旋CT血管造影在老年人肺栓塞的诊断中非常重要.     

64排螺旋CT肺动脉成像对肺动脉栓塞的诊断价值

目的 探讨64排螺旋CT肺动脉成像对肺动脉栓塞的诊断价值.方法 回顾性分析18例临床确诊为肺动脉栓塞的CT肺动脉成像资料,所有病例均行64排螺旋CT肺动脉成像,并用最大密度投影(MIP)、多平面重建(MPR)、容积显示(VR)等方法不同角度显示肺动脉.结果 18例肺动脉栓塞中中央肺动脉(主肺动脉及左、右肺动脉)合并肺叶及肺段动脉栓塞2例,肺叶及肺段动脉栓塞13例,段及亚段肺动脉栓塞3例.检出的最大肺动脉血栓直径为29.4 mm,最小栓子直径为1.8 mm.结论 64排螺旋CT肺动脉成像是一种无创性成像方法,在肺动脉栓塞的诊断及治疗中发挥着重要作用.     

CT肺动脉造影评价慢性血栓栓塞性肺动脉高压的血流动力学

目的 探讨多层螺旋CT肺动脉造影 (CT pulmonary angiography,CTPA)与慢性血栓性肺动脉高压血流动力学关系.方法 回顾性纳入2006-01-2009-10慢性肺栓塞患者55例,评价CT肺动脉栓塞指数(CT pulmonary artery obstruction index, CTPAOI)及CTPA参数.根据CTPA图像采用Qanadli栓塞指数和Mastora栓塞指数计算 CTPAOI.CTPA参数均在轴位图像测量,包括主肺动脉直径、主肺动脉与升主动脉直径比、右室左室直径比等.结果 55例CTEPH患者Qanadli栓塞指数为(37.60±15.22)%,Mastora栓塞指数为(30.02±16.43)%,Qanadli 栓塞指数高于Mastora栓塞指数, Z=-6.296,P=0.000;但二者显著正相关,r =0.875,P=0.000.无论Qanadli栓塞指数还是Mastora栓塞指数与血流动力学参数之间均无显著相关性(P>0.05).CTPA参数与血流动力学参数相关分析显示右室左室直径比与肺动脉收缩压(r=0.240,P=0.021)、肺动脉舒张压(r=0.255,P=0.014)、平均肺动脉压(r=0.217,P=0.037)、肺毛细血管嵌压(r=0.318,P=0.002)、肺血管阻力(r=0.369,P=0.000)呈正相关;右肺动脉干直径、右室与左室比、右室前壁厚度为平均肺动脉压的独立因素.结论 采用Qanadli栓塞指数和Mastora栓塞指数不能反映慢性血栓性肺动脉高压血流动力学变化,但CTPA参数能够从不同方面反映血流动力学状态.     

64层CT肺动脉造影对肺栓塞诊断及治疗后复查的应用研究

目的:探讨64层CT肺动脉造影(CTPA)对肺栓塞的诊断效果及治疗后复查的价值。方法:对32例肺动脉栓塞的患者采用64层CT行CTPA检查,并进行多平面重建(MPR)、最大密度投影及容积重建处理。患者复查采用相同CT检查及后处理重建。结果:32例患者中15例有下肢静脉栓塞、4例有恶性肿瘤、3例有近期手术病史,2例有近期外伤史。CTPA对肺动脉主干、左右肺动脉及叶、段、亚段动脉显示良好,32例患者中显示受累肺动脉221支,其直接征象为肺动脉血管内充盈缺损,间接征象包括肺梗死实变、肺野少血征、胸腔积液等。肺栓塞治疗后复查有24例患者1月内肺动脉栓子消失或明显吸收缩小(占75%);6例患者吸收不明显(占18.7%);2例死亡。结论:64层CT能清楚地显示肺栓塞的形态、部位及其它间接征象,并能有效监测治疗效果,为临床提供有益帮助。     

64层螺旋CT肺血管造影在肺栓塞诊疗中的应用价值

目的 探讨64层螺旋CT在肺栓塞诊断及治疗中的指导作用.方法 63例患者均行64层螺旋CT肺血管造影(CTPA),并进行多种形式的图像重建结合轴位图像分析.结果 64层螺旋CTPA对63例患者肺动脉各级管腔内的栓子均明确显示,共累及肺动脉303支;图像分析结果伞部显示肺栓塞的直接征象为:主肺动脉和(或)左右肺叶、段、亚段血管腔内充盈缺损和血管阻塞;部分显示肺栓塞的间接征象为:马赛克征、右心房及右心室肥厚及扩张、肺动脉扩张、胸腔积液、肺不张及实变(肺梗死)等.62例患者经溶栓治疗后复查CTPA,其中,栓子完全消失者47例,栓子明显缩小者11例,溶栓治疗效果差者3例,考虑为慢性肺栓塞.结论 64层螺旋CTPA是临床最有效的诊断肺栓塞及溶栓后疗效评价的无创性方法之一.     

64层螺旋CT肺动脉造影在肺动脉栓塞诊断中的应用

目的 探讨64层螺旋CT肺动脉造影(CT pulmonary angiography,CTPA)对肺动脉栓塞(pulmonary embolism,PE)的诊断价值.方法 回顾分析24例肺动脉栓塞患者的64层螺旋CT增强图像,将原始图像复制到EBW4.0工作站,对肺动脉主干及分支进行多平面重建(MPR),最大密度投影(MIP)及容积重建(VR)分析.结果 24例患者中,共检出了76处肺动脉及其分支的栓子.其中,左、右肺动脉主干14处(右主干10处、左主干4处),肺叶动脉24处,肺段动脉26处,亚肺段动脉12处.CT表现为肺动脉主干或分支内混合性、附壁性、中心性充盈缺损,可分为完全性或部分性.结论 64层CTPA具有准确、高效、无创等优点,可直观、立体地观察到肺动脉血栓的大小、分布、范围及类型,是临床诊断及观察疗效的首选方法,有望成为肺动脉栓塞检查的“金标准”.     

64层螺旋CT血管成像在肺动脉栓塞中的诊断价值

目的:探讨64层螺旋CT血管成像在诊断肺动脉栓塞中的价值。方法:回顾性分析19例临床确诊为肺动脉栓塞的64层螺旋CT肺动脉成像资料,并用最大密度投影(MIP)、多平面重组(MPR)、容积再现(VR)等方法显示肺动脉。结果:19例患者中,其中左右肺动脉栓塞有8支,叶肺动脉栓塞27支,段及亚段肺动脉栓塞56支。偏心型41支,闭塞型38支,中央型8支,附壁环形型4支。结论:64层螺旋CT肺动脉成像可作为肺动脉栓塞诊断的首选方法。     

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.