超声心动图诊断肺动脉瓣四叶畸形并肺动脉瓣上隔膜1例

1 病例简介 男,33岁,体格检查、实验室检查及心电图均无明显异常.超声心动图(图 1)示:各房室腔大小正常,大动脉关系及发育未见异常;房、室间隔连续完整,未见动脉导管未闭;二、三尖瓣及主动脉瓣未见异常;于常规大动脉短轴切面见主肺动脉略扩张,内径2.9 cm,肺动脉瓣环内径正常,瓣上0.8 cm处探及隔膜样回声,长0....     

下腔静脉平滑肌肉瘤的影像学表现

目的探讨下腔静脉平滑肌肉瘤的影像学表现,提出诊断和鉴别诊断要点。方法从2009年~2013年,我院诊治下腔静脉平滑肌肉瘤患者5例,其中2例在术前行MR检查,3例行CT检查,5例均行下腔静脉造影检查。回顾性分析其影像表现,并对比相关文献分析。结果 5例中有2例表现为腔内病变伴下腔静脉阻塞,分别累及下腔静脉中段及下段。3例表现为腹膜后肿块,腔内外均受累且侵犯周围组织,其中2例病变范围较大,跨越下腔静脉两段分布,1例分布在下段。腹膜后病变主要表现为巨大,边界不清的软组织肿块影,呈低密度(CT)或稍长T1混杂稍长T2信号(MR),增强后不均匀强化。腔内肿瘤表现为低密度软组织肿块伴下腔静脉管腔扩张,增强后呈边缘强化。全部病例均形成广泛侧支循环,而无腹膜后淋巴结转移。与腹膜后病变相比,腔内肿瘤的预后较好。结论影像学表现有利于对此少见病的术前准确诊断。     

应用血管造影鉴别诊断误诊为巴德-吉亚利综合征的隐匿性缩窄性心包炎

目的探讨应用血管造影技术鉴别诊断误诊为巴德-吉亚利综合征的缩窄型心包炎患者。 方法回顾性分析378例以"巴德-吉亚利综合征"为早期诊断的病例,对所有病例均进行常规血管造影检查和术中测压。 结果在所有病例中有5例患者血管造影检查显示下腔静脉和肝静脉管腔通畅,但压力明显高于正常,右心房压力也明显高于正常,定期随访1～24个月,这5例患者均发现不同程度心包钙化,最终进行心包部分或全部剥离术。病理结果:结核性心包炎4例,化脓性心包炎1例,支持缩窄型心包炎诊断。 结论缩窄性心包炎部分临床病例症状不典型易误诊,建议有条件单位可应用血管造影技术进行下腔静脉、肝静脉、心脏各房室造影和测压明确有无上述血管疾患。     

产前超声诊断3例脐带囊肿

1病例简介病例1:女,36岁,孕22周,10年前生育一健康男孩。常规产前超声排畸检查示:心胸面积比例明显增大,正常大血管交叉关系消失,心底部探及2个并排的大血管均开口于右心室,主动脉位于左前、肺动脉位于右后,肺动脉瓣口狭窄伴狭窄后扩张,四腔心显示心内膜垫十字交叉结构消失,缺失约0.72 cm(图1A),呈共同房室瓣,心率152次/min,     

高原地区液气胸,气胸治疗方法的进一步简化

液气胸、气胸是高原拉萨地区的常见病,通过介入方法给予治疗在西藏地区尚未见报告,针对高原地区缺医少药的特点,我们将传统的方法进一步简单化,采用Ｓｅｌｄｉｎｇｅｒ技术,用图1所示的简单介入器械(包括穿刺针、短导丝、3～4Ｆ扩张器及连接三通)给予治疗,取得了非常满意的疗效。现将具体操作方法介绍如下,并就其与传统内外科方法比较所具有的独特优势,着重加以讨论。1　典型病例及操作方法如图2～4所示病例,男,25岁,藏族,主因咳嗽及胸闷7ｄ入院。Ｘ线示左侧液气胸,左全肺不张伴纵隔轻度右移。保守治疗无效。于1999年2月22日给予介入治疗。…     

布加综合征血管病变的彩色多普勒超声研究

目的:研究布加综合征患者肝静脉和下腔静脉血管形态病变和血流动力学变化,探讨彩色多普勒超声诊断布加综合征的价值。方法:彩色多普勒超声检查84例布加综合征,均经介入手术或下腔静脉造影证实。重点观察3支肝静脉和下腔静脉的走行、内径、人口、血流方向、血流频谱和流速,并追踪扩张的肝小静脉和肝内外交通支的血流方向。结果:布加综合征患者血管病变复杂多样。本组患者均合并下腔静脉病变,血管病变类型主要为短段性狭窄、短段性闭塞、长段性狭窄、长段性闭塞,左、中、右肝静脉合并受累者分别为62、75、71例(分别占总病例数的73.8%、89.3%和84.5%)。肝内外均见不同类型的交通支,并见代偿扩张的肝右后下静脉和尾叶静脉,均引流血液进入下腔静脉,肝外交通支主要为腹膜后、膈下、脾肾之间交通支以及脐旁静脉重开。结论:彩色多普勒超声可以提供布加综合征血管病变形态和血流动力学的详细资料,对诊断、分型和手术方案制定均有价值,且无创、价廉,应成为布加综合征的首选影像检查技术。     

下腔静脉病变的多层螺旋CT诊断

目的 探讨下腔静脉病变的MSCT表现.方法 回顾性分析经手术病理或临床资料证实的69例下腔静脉病变的MSCT表现特征.结果 双下腔静脉8例,MSCT表现为肾静脉水平以下左右下腔静脉分别位于腹主动脉两侧;左位下腔静脉1例,表现为肾静脉水平以下下腔静脉位于腹主动脉左侧;布-加氏综合征1例,主要表现为下腔静脉肝上段狭窄;下腔静脉癌栓44例,表现为管腔内充盈缺损,无或轻中度强化,邻近脏器可见原发灶;血栓8例,表现为管腔内无强化的充盈缺损;静脉内平滑肌瘤病2例,平滑肌肉瘤4例,肉瘤样癌1例,均为管腔内充盈缺损,轻度或明显强化.结论 下腔静脉先天变异MSCT表现具有一定特征,其他性质病变多表现为腔内无/不同程度强化的充盈缺损、管腔扩张增粗及侧枝循环形成等.     

纵隔原发胚胎癌1例

1病例简介男,18岁,体格检查发现纵隔肿物10 d。胸部数字X线摄影正侧位示右中上纵隔见团块状密度增高影,边界清晰,其内密度均匀(图1A、B)。CT示右前中上纵隔血管前间隙见一类圆形软组织肿块,最大层面范围约7.2 cm×8.4 cm,边界尚清晰,其内密度不均匀,见斑片状钙化及少许略低密度影;增强扫描呈轻度不均匀强化,肿块邻近血管周围脂肪间隙消失,向左侧推挤升主动脉、上腔静脉、右心房,向右侧     

下腔静脉后输尿管1例

患者男性,63岁。右侧腰胀并隐痛15年,加重1年,近3个月来感右侧腰胀痛及血尿而就诊。查体右侧腰部扣击痛,实验室检查除血尿(+++)外,其它均为正常。静脉肾盂造影显示右侧输尿管于第四腰椎上缘平面弯曲,向内走形,侧为见输尿管后缘贴近椎体前缘,上段输尿管、肾盂扩张积水(图1,2)。CT横断面显示右侧输尿管位于下腔静脉后     

食管下段憩室并发平滑肌瘤1例

1病例简介患者女,48岁,胸骨后疼痛,吞咽不适2年。食管吞钡检查:食管下段右侧见大小约6 cm×5 cm囊袋影状物突出腔外,边缘清晰,黏膜襞与食管相连;其左侧见半圆形充盈缺损影,大小约2.5 cm×2.5 cm,贲门口开放正常(图1A)。CT扫描前将胃管下至气管隆突处并接氧气袋,扫描开始前5 s向食管内充气至扫描结束。CT扫描示气管隆突处5 cm左右见大小约     

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.