以肢体无力、无意识障碍伴认知功能损害为表现的3例巴洛病患者的临床与影像特征

目的：探讨巴洛病的临床与影像学特征，以提高神经科医师对巴洛病的认识。方法：报告3例2003/2004首都医科大学宣武医院收治的巴洛病患者的临床与影像表现，并结合文献总结其在病理生理、临床及影像学方面的特点。结果：3例患者，发病年龄26～44岁，其中两例亚急性起病，1例急性起病；3例均有肢体无力的表现，均无意识障碍，其中两例伴有不同程度的认知功能的损害；1例在影像上有典型的“煎蛋”样表现，两例经活检证实；3例经治疗后症状均有缓解或得到控制。结论：巴洛病并非总是表现为急性进行性重症大脑损害，后者亦非是其主要诊断的关键。典型的影像学表现，往往能作出生前诊断，患者的预后也非极羞或致死性的，免疫抑制治疗有一定疗效。     

急性播散性脑脊髓炎的临床特征和转归

目的:探讨急性播散性脑脊髓炎的临床特征、临床治疗及转归。方法:对3例急性播散性脑脊髓炎患者的临床表现及相关辅助检查结果进行详细分析,并对其治疗后的情况进行随访。结果:3例患者均为中年,急性起病,脑和脊髓损害的表现重叠出现,有脑脊液及影像学检查的改变,在急性期采用甲基强的松龙冲击治疗,结合神经营养及支持治疗,均好转。结论:急性播散性脑脊髓膜炎临床表现多样,是神经内科临床较易误诊及漏诊的疾病,早期诊断后激素治疗效果良好,可使其预后大大改善。     

不典型肺结核61例影像表现分析

目的探讨不典型肺结核的影像学特点,以提高诊断及鉴别诊断水平。方法收集61例不典型肺结核患者的临床资料,分析其影像学特征。结果 61例首次诊断均不能确定,其中26例按一般肺部炎症治疗2周后未见好转,改行抗结核治疗后有效而确诊为肺结核;19例经纤支镜活检病理证实为肺结核;9例经肺穿刺活检病理证实,7例痰结核菌阳性而确诊。所有病例均经正规抗结核治疗后痊愈或病情趋于稳定。影像学表现:肺叶、肺段实变或肺不张26例,结节及肿块阴影23例,肺门及纵隔淋巴结增大12例。结论不典型肺结核影像学表现多种多样,应充分运用多种检测手段进行综合分析,结合临床做好鉴别诊断。     

脑肿瘤卒中误诊为出血性脑梗死12例分析

目的:探讨脑肿瘤卒中误诊为出血性脑梗死的原因。方法:回顾性分析本院2006/2008年收治的12例误诊为出血性脑梗死的脑肿瘤卒中患者临床资料和影像资料。结果:12例脑肿瘤卒中病例均为急性起病,其早期头颅CT平扫改变与出血性脑梗死表现相似,但在治疗后平扫及增强CT等影像学检查均提示有脑肿瘤卒中可能,分析临床资料或影像学资料后确诊为脑肿瘤卒中。结论:脑肿瘤卒中临床表现及影像学改变不典型时,临床上容易误诊为出血性脑梗死,通过合理的影像学检查及细致的临床分析,能够降低误诊率。     

重新认识肺脓肿的临床特点(附18例误诊报告)

目的:分析肺脓肿误诊的原因,总结误诊防范措施.方法:对我院2005～2007年误诊的18例肺脓肿临床资料进行分析.结果:本组急性起病与亚急性或隐匿性起病各9例.均有咳嗽、咯痰表现,其中咯脓痰9例;畏寒、发热13例,其中高热8例;消瘦4例.18例误诊为肺结核14例,误诊为肺炎或肿瘤4例.结论:肺脓肿的误诊与临床症状及影像学表现不典型、抗感染治疗不规范等因素有关,故应多角度、全面认识肺脓肿的临床表现及影像学特征,重视痰细菌学标本的检测及纤维支气管镜检查,注意病灶痰液的引流并加强基础护理.     

腹茧症的影像及临床诊断

目的提高对腹茧症的认识及影像学诊断能力.方法分析经手术病理证实的9例腹茧症患者的临床及影像诊断资料.结果临床表现为腹痛9例,腹胀5例,腹部包块4例,7例术前均未明确诊断,分别误诊为卵巢肿瘤蒂扭转2例,急性弥漫性腹膜炎1例,慢性阑尾炎1例,急慢性肠梗阻3例.2例CT检查诊断为腹茧症.术中发现大网膜短缩4例,缺如5例,全部或部分小肠被一层灰白色致密坚韧的纤维膜包裹.胃肠造影典型表现为小肠聚集成团,呈菜花状或M形排列,且长时间形态不变;典型CT表现为新月形或半圆形低密度(纤维包膜).均行手术治疗.术后病理确诊为腹茧症.结论该病临床表现无特异性,术前诊断困难,影像学检查对该病有一定诊断价值,最后确诊需手术及病理.     

糖尿病性骨关节病的影像学分析

目的总结24例糖尿病性骨关节病的影像学表现,以提高其诊断水平。方法对24例糖尿病性骨关节病患者的临床资料及DR、CT影像表现进行回顾性分析。结果 24例患者均存在骨质疏松;19例患者有较明显的骨质萎缩,骨干对称性变细;关节旁皮质骨缺损13例,呈磨尖铅笔畸形;骨性关节炎8例;夏科关节1例;局部软组织肿胀19例,其中6例见小血管钙化影。结论糖尿病性骨关节病的诊断须密切结合临床,影像学主要表现为骨质疏松、骨性关节炎及周围组织肿胀等,根据其表现早期做出诊断和鉴别诊断,为临床治疗提供依据。     

猫抓病淋巴结炎的影像学表现及文献回顾

目的:探讨猫抓病淋巴结炎影像学表现,提高对猫抓病淋巴结炎的认识。方法:回顾性分析2例经手术病理证实的猫抓病淋巴结炎患者影像表现,并复习相关文献。结果:两例均行CT检查,共评价6个淋巴结,短径约0.9~3.7 cm。1例CT示左下颌淋巴结肿大,环形强化;第2例患者CT示右侧腋窝见5个肿大淋巴结,淋巴结边缘模糊;同时行MR检查,MR示右侧腋窝多发肿大淋巴结影,T1WI呈等信号,T2WI呈稍高信号,DWI呈高信号,ADC图呈稍低信号,淋巴结边缘模糊,周边见网格状长T2WI信号。结论:猫抓病淋巴结炎影像学表现有一定特征性,熟悉影像学表现对猫抓病的早期诊断有重要价值。     

Menetrier′s病的影像诊断

目的 :探讨钡餐造影和CT对Menetrier′s病的诊断价值。材料与方法 :对Menetrier′s病的临床特点、生化检查、胃镜及影像学改变进行了综合分析 ,3例患者均行钡餐造影检查 ,其中 1例行CT检查。结果 :Menetrier′s病钡餐造影的典型表现为局限性或广泛性胃黏膜粗大 ,病变区域胃壁柔软 ,CT上可见胃浆膜面光滑 ,周围结构清晰。本组 3例患者均诊为Menetri er′s病。结论 :影像学检查是诊断Menetrier′s病的重要手段 ,与临床资料相结合可提高诊断率     

肺隐球菌病临床和影像学分析

目的分析肺隐球菌病(PC)的临床特点和影像学表现以提高对该病的认识。方法回顾性分析我院2000-2004年间28例PC的临床、相关检查资料及影像学表现,并对所有PC患者的临床与影像学表现进行对照分析研究。结果28例PC,男性19例,女性9例,中青年为24例;7例有基础疾病;9例无任何症状,其余18例有咳嗽、咳痰、低热等轻度呼吸道症状;所有病例均经手术、肺穿刺、经纤支镜肺活检(TBLB)病理和细菌学确诊,其中26例行苏木素伊红和组织化学染色,均有隐球菌阳性提示;13例行核医学肺显像检查,12例诊断为恶性病变。28例PC影像学表现分为3种类型:肺结节、肿块(16例),肺炎样改变(7例),混杂性改变(5例);临床和影像学分析:(1)PC影像学表现为结节、肿块病变者临床症状较轻,而表现为炎症样改变和混杂性改变者临床症状较重。(2)有基础病变的PC患者多呈炎症样改变或混杂性改变,并且其临床症状相对较重。结论肺隐球菌病的临床和影像学表现不典型,临床应重视PC的存在,认识此病的特征,以提高对此病的诊断能力,并应积极开展病灶经皮肺穿刺及TBLB检查,减少开胸手术率。     

NO and HNO donors,nitrones, and nitroxides: Past,present, and future

The biological effects attributed to nitric oxide (^?NO) and nitroxyl (HNO) have been extensively studied, propelling their array of putative clinical applications beyond cardiovascular disorders toward other age‐related diseases, like cancer and neurodegenerative diseases. In this context, the unique properties and reactivity of the N‐O bond enabled the development of several classes of compounds with potential clinical interest, among which ^?NO and HNO donors, nitrones, and nitroxides are of particular importance. Although primarily studied for their application as cardioprotective agents and/or molecular probes for radical detection, continuous efforts have unveiled a wide range of pharmacological activities and, ultimately, therapeutic applications. These efforts are of particular significance for diseases in which oxidative stress plays a key pathogenic role, as shown by a growing volume of in vitro and in vivo preclinical data. Although in its early stages, these efforts may provide valuable guidelines for the development of new and effective N‐O‐based drugs for age‐related disorders. In this report, we review recent advances in the chemistry of NO and HNO donors, nitrones, and nitroxides and discuss its pharmacological significance and potential therapeutic application.     

Lipid messenger, diacylglycerol, and its regulator, diacylglycerol kinase, in cells, organs, and animals: history and perspective

Diacylglycerol kinase (DGK) metabolizes diacylglycerol (DG), a glycerolipid containing two acyl chains, to convert phosphatidic acid. DG is produced through phosphoinositide turnover within the membrane and is well known to act as a second messenger that modulates the activity of protein kinase C in the cellular signal transduction. Recent studies have revealed that DG also activates several proteins, including Ras guanine-nucleotide releasing protein and ion channels such as transient receptor potential proteins. Therefore, DGK is thought to participate in a number of signaling cascades by modulating levels of DG. Previous studies have disclosed that DGK is composed of a family of the isozymes, which differ in the structure, enzymological property, gene expression and localization, subcellular localization, and binding molecules. The present review focuses on the stories of phosphoinositide turnover and DG, including historical views, structural features, metabolism, and relevant cellular phenomena, together with the characteristics of DGK isozymes and the pathophysiological findings on animal studies using knockout mice and models for human diseases. Now it is being revealed that the structural and functional diversity and heterogeneity of and around DGK support the proper arrangement of the complex signal transduction machinery.     

Heat, cold, noise, and vibration

Exposure to a cold environment induces a number of physiological alterations, the most serious being hypothermia. This state can occur in all individuals, but the very young and the elderly are more susceptible. Environmental and industrially generated high ambient temperature can place further stress on aged individuals and workers, resulting in a complex symptom picture. Morbidity and death may result from such exposures. Causative factors have been identified. Noise exposure induces hearing losses above those secondary to the aging process. Psychophysiological effects during noise exposure are considered to result from the sympathetic activity secondary to a general stress reaction. Vibration from the use of power tools results in Raynaud's phenomenon. However, modification of power tools has reduced the symptoms associated with vibration exposure. Termination of exposure to vibration appears eventually to reduce symptoms related to white-finger spasms. Interaction between these stressors has not been clarified because of the complex effects of each. The need for additional information about the response to these stressors is evident.