多发性和多房性脑脓肿的临床特点分析

目的探讨多发性脑脓肿和多房性脑脓肿的细菌学特征、诱发因素、感染途径、临床表现、治疗选择和预后等。方法回顾性分析1991-2010年收治的85例脑脓肿患者的临床资料,其中单发性脑脓肿52例,多发性脑脓肿15例,多房性脑脓肿18例。结果多发性脑脓肿和多房性脑脓肿占全部脑脓肿的比例分别为17.6%和21.2%。血行感染为常见的感染类型(分别为73.3%和50.0%);体温升高、头痛、恶心呕吐为最常见的症状;细菌培养阳性率高于单发脑脓肿且金黄色葡萄球菌为最常见致病菌;立体定向脓肿穿刺引流术为最常用的治疗方法;30.8%的多房性脑脓肿需重复治疗,而单发性脑脓肿为2.2%;3例多发性脑脓肿患者死亡,但均与治疗前病情危重或其他原因有关。结论多发性脑脓肿和多房性脑脓肿临床并不少见,其感染途径及临床表现与单发性脑脓肿有所不同,立体定向脓肿穿刺引流术仍是各种脑脓肿的首选治疗方法,但部分多房性脑脓肿需重复治疗。脑脓肿的预后与治疗前的病情严重程度有关。     

CT导向微创穿刺自制微泵控制持续冲洗引流治疗脑脓肿的临床研究

目的研究脑脓肿的微创治疗新方法. 资料与方法采用医用高分子材料制造的带可储存药物胶囊的可控微泵,与北京万特福公司生产的YL-Ⅰ型血肿粉碎穿刺针连接.在CT导引下对33例脑脓肿行微创穿刺药物持续灌注治疗. 结果本组33例,31例一次引流治愈,其中7例多房性脓肿作两点穿刺同时冲洗引流,治愈率为93.9%;1例小脑厚壁脓肿,经引流症状改善后行脓肿切除;另1例因败血症合并癫痫持续状态而死亡,死亡率为3%.32例随访3个月～4年,平均2年4个月,均无脓肿复发,仅有1例仍留有轻度肢体运动障碍. 结论 CT导向微创穿刺自制微泵控制持续冲洗引流治疗脑脓肿操作简单、安全有效,可成为大多数脑脓肿的首选治疗方法.     

微创穿刺引流治疗颅内脓肿27例疗效分析

目的:探讨微创穿刺治疗颅内脓肿的治疗方法及疗效.方法:应用YL-1型一次性颅内血肿穿刺针治疗脑脓肿,一次性穿入颅内脓肿,置入穿刺针,吸净脓液,持续引流,术后配合联合应用抗菌素.结果穿刺成功率100％,治愈率96.30％,无病死例数,出院时行头颅CT和MRI复查,显示脓腔消失.所有患者术后随访时间6个月～3年,平均1年6个月,均无脓肿复发.结论:YL-1型一次性颅内血肿粉碎穿刺针技术治疗颅内脓肿,操作简单、创伤小、术后并发症少,降低了颅内脓肿患者的病死率和致残率,不失为基层神经外科治疗颅内脓肿的一种有效手段.     

非典型脑脓肿邻近脑膜异常强化的MR诊断

目的 回顾性分析16例非典型脑脓肿临近脑膜异常强化的MR表现,探讨其诊断价值. 资料与方法 16例不典型脑脓肿均经手术病理证实,所有病人术前均行MR平扫及增强扫描.其中5例术前行CT平扫. 结果 单房性脑脓肿12例,多房性脑脓肿4例.其中脓肿腔＞3 cm者13例,有12例MR平扫可见脓肿壁呈中等信号＂暗带＂,另4例中等信号脓肿壁显示不连续或模糊不清.16例增强后均呈环形强化,其中7例脓肿壁厚薄不均,5例脓腔形态不规则,4例在脓肿壁上可见结节状强化.16例增强后在脓肿邻近脑膜均见强化. 结论 认识不典型脑脓肿的MR表现特别是邻近脑膜强化对诊断很有价值.     

立体定向囊腔穿刺纵裂池分流术治疗囊性脑肿瘤（附5例报道）

颅内囊性肿瘤多采用手术或组织内照射治疗。对于复发的脑肿瘤病人,若患者拒绝开颅手术或同位素来源受限时,采用立体定向囊腔穿刺纵裂池分流术加常规放疗,能获得与上述治疗方法相同的疗效。现报道如下:1　临床资料本组5例病人,男2例,女3例。年龄9～45岁,平均17.6岁。其中,颅咽管瘤4例,胶质母细胞瘤1例。治疗前曾行开颅手术二次者2例,一次者2例。32P组织内照射1例。肿瘤呈多囊性改变者2例,另3例为单囊。头痛、呕吐、视物不清者4例,肢体偏瘫者2例,嗜睡,多饮多尿者1例,经采用立体定向囊腔穿刺纵裂池分流术后,5例病人的症状和体征均在次日迅速得…     

高血压脑出血立体定向手术与内科保守治疗疗效对比分析

目的分析高血压脑出血患者立体定向外科手术与内科保守治疗的疗效。方法回顾性分析2002年6月-2009年10月经立体定向手术治疗的100例高血压脑出血患者的临床资料,并与同期80例经内科保守治疗的高血压脑出血患者的治疗结果进行对比分析。两组出血部位、出血量、入院时意识状况相匹配。结果立体定向手术组病死率21.0%,内科治疗组30.0%。平均血肿消除时间立体定向手术组为4.2d,内科治疗组为15.1d。随访6个月,立体定向手术组痊愈或轻度病残比例(37%)明显高于内科治疗组(26%),重度病残比例(23%)明显低于内科治疗组(37%),差异均有统计学意义(P<0.01),而两组中度病残比例(分别为40%、37%)差异无统计学意义(P>0.05)。结论立体定向手术治疗高血压脑出血在病死率以及提高患者生存质量方面优于内科保守治疗。     

CT引导下肝脓肿穿刺置管引流术的探讨

目的 探讨CT引导下肝脓肿穿刺引流术的方法和疗效.方法 本组20例肝脓肿患者,均经临床、生化和影像学(CT)检查确诊为肝脓肿,行CT引导下定位穿刺抽吸并置管引流.脓肿位于肝左叶6例,肝右叶9例,肝2叶5例.结果 14例为单个脓肿,6例为多发脓肿,单个脓肿经1次抽吸后脓肿完全消失9例,1例经2次抽吸基本消失,多发或多房脓肿穿刺先抽较大脓肿,后抽较小脓肿,或分次抽吸,20例均放置引流管并冲洗,平均引流置管时间为19.2 d,所有患者至随访截止日未见复发.结论 CT引导下穿刺抽吸引流足治疗肝脓肿的非常有效的方法.     

无框架立体定向机器人治疗高血压脑出血的应用研究

目的 探讨无框架立体定向机器人穿刺外引流治疗高血压脑出血的技术要点和临床效果.方法 回顾性分析2012年1月-2014年6月采用无框架立体定向机器人治疗的68例高血压脑出血患者的临床资料,并与同期采用有框架立体定向穿刺抽吸治疗的45例患者进行对比,对手术结果、并发症和临床预后进行分析.结果 无框架立体定向机器人治疗患者的平均年龄为53.3(36～80)岁,术前格拉斯哥评分均＞5分.术后1个月内死亡7例,其中肺部感染3例、脑水肿2例、再出血2例.术后6个月恢复良好率(ADL Ⅰ-Ⅲ级)为77.9％(53/68),疗效优于有框架立体定向穿刺抽吸术(术后6个月恢复良好率为60.0％,P＜0.05).结论 运用无框架立体定向机器人治疗高血压脑出血具有操作简单、侵袭性小、手术定位准确、治疗效果确切、安全有效等优点,值得临床推广.     

机械臂立体定向引导下锁孔切除颅内微小病变

探讨用机械臂立体定向系统引导，行锁孔开颅切除脑内微小病变。术前将MRI扫描数据传入机械臂立体定向系统计算机工作站、行三维建模、标记靶点定位坐标数据及皮肤切口、颅骨钻孔角度、手术入路、靶点距切口的距离和病变的大小范围，术中机械臂立体定向引导下切除脑内微小病变.行机械臂立体定向引导下锁孔切除颅内微小病变9例；其中小脑膜瘤2例、小脓肿2例、囊虫胞囊1例、海绵状血管瘤1例、转移瘤1例、肉芽肿1例、金属异物1例。本组颅内微小病变及重要神经解剖结构定位准确，机测定位病灶误差很小，术中病变全部找到并完整切除，术后病人恢复良好，无死亡和病残。提示由于手术导航系统的出现，机械臂立体定向系统的临床应用，使用锁孔开颅，能准确切除脑内微小病变。     

18F-FDGPET定位致痫灶在癫痫外科治疗中的价值

目的评价18F-脱氧葡萄糖(FDG)PET定位致痫灶在癫痫外科治疗中的作用.方法对30例难治性癫痫患者行EEG、MRI、PET检查,根据PET检查结果并参考EEG、MRI选择外科治疗方法(开颅手术,X刀治疗,立体定向手术).开颅手术者,术中行皮层脑电图(ECoG)检查,术后送病理检查.所有患者均观察术后疗效.结果致痫灶位于颞叶22例,颞叶外6例,额颞区2例.30例患者中16例行开颅手术,10例X刀治疗,4例立体定向手术.术后除2例癫痫发作无明显改善外,余28例发作明显减少或消失.结论18F-FDGPET检查术前定位致痫灶有助于选择手术方式,提高手术治疗效果.     

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.