下腔静脉与奇静脉或半奇静脉异位连接两例报告

下腔静脉与奇静脉或半奇静脉异位连接,是一种下腔静脉胚胎发育的畸形。由于下腔静脉的肝段与肾前段未能连接,或是肝段缺如,因此肾前段以下的体静脉血流需经奇静脉引流到上腔静脉,或半奇静脉引流到水存左上腔静脉。我们在1986年9月～12月间作心导管检查及心血管造影中发现2例,现报告如下。     

经皮肝穿刺肝静脉造影与下腔静脉造影、B超对Budd-Chiari综合征的诊断

目的：研究经皮肝穿刺肝静脉（ＰＴＨＶ）造影在Ｂｕｄｄ－Ｃｈｉａｒｉ综合征（ＢＣＳ）诊断和治疗中的价值。方法：采用经皮肝穿刺肝静脉造影对５３例Ｂｕｄｄ－Ｃｈｉａｒｉ综合征患者进行了检查，并与下腔静脉造影及Ｂ超检查结果进行回顾性对比。结果：依据造影可分为以下类型，１．主肝静脉出口部阻塞，下腔静脉通畅１９例。２．主肝静脉扩张而开放，下腔静脉膜性阻塞２２例。３．肝静脉及下腔静脉均闭塞１２例。结论：作者认为与下腔静脉造影和Ｂ超检查相比，ＰＴＨＶ对肝静脉及侧枝循环的显示有显著的优越性，对ＢＣＳ诊断，治疗及预后的判断均有重要的临床意义     

下腔静脉畸形的64层螺旋CT表现

目的 探讨64层螺旋CT下腔静脉畸形的影像表现.方法 回顾性分析6986例受检者的腹部64层螺旋CT增强扫描资料,共发现25例下腔静脉先天畸形.分析下腔静脉畸形的影像表现.结果 25例下腔静脉畸形中包括左下腔静脉6例,CT表现为肾下段腹主动脉左侧上行的下腔静脉.双下腔静脉10例,CT表现为肾下段腹主动脉两侧上行的下腔静脉.左肾静脉畸形5例,CT增强扫描横断面显示腹主动脉后和环主动脉走行的左肾静脉.肝下段下腔静脉中断伴奇静脉延续2例,胸腹部CT增强扫描显示肝段至肾上段下腔静脉缺如,肾段下腔静脉由奇静脉延续回流人上腔静脉,而肝静脉直接回流右心房.腔静脉血管造影见对比剂经增粗的奇静脉和半奇静脉通过上腔静脉回流右心房.肝下段下腔静脉中断伴门静脉延续1例,增强CT显示下腔静脉直接与门静脉在肝门部连接,肝门部门静脉呈瘤样扩张.左下腔静脉伴半奇静脉延续1例,增强CT可见左下腔静脉与半奇静脉连接,上行汇入奇静脉.结论 64层螺旋CT可清晰显示下腔静脉及其属支的畸形,可成为下腔静脉畸形的重要诊断方法.     

下腔静脉与奇静脉异位连接镜像右位心、房间隔缺损一例

下腔静脉与奇静脉异位连接镜像右位心、房间隔缺损一例林琳，章韵，张维娥，赵先仙，陆方林患者男，２４岁。因体检发现心脏异位伴杂音入院。查体：心尖搏动位于右锁骨中线第５肋间，胸骨右缘第２、３肋间可闻及收缩期杂音。超声提示：右位心，房缺，完全性内脏转位。ｘ线...     

Budd-Chiari综合征的CT与超声、静脉造影对比研究

目的：评价ＣＴ、超声、静脉造影对Ｂｕｄｄ－Ｃｈｉａｒｉ综合征的诊断价值。方法：回顾性分析４４例Ｂｕｄｄ－Ｃｈｉａｒｉ综合征的ＣＴ、超声、静脉造影表现,比较三种检查方法显示肝脏的形态、肝静脉、下腔静脉、肝内外的侧枝血管情况。结果：ＣＴ显示肝尾叶增大４２例（９５％）,肝脏密度不均或呈低密度表现,１９例（４３％）显示有肝内侧枝血管,４２例（９５％）见有肝外侧枝血管,其中奇静脉扩张３５例（８０％）,半奇静脉扩张３９例（８９％）,下腔静脉钙化７例（１６％）。超声显示３８例（８６％）有下腔静脉狭窄或阻塞,１６例（３６％）有肝静脉狭窄或阻塞,３７例（８４％）显示有肝内侧枝血管,１６例（３６％）显示有肝外侧枝血管。静脉造影显示下腔静脉狭窄或阻塞２３例（５３％）,肝静脉狭窄或阻塞５例（１１％）,其余１６例（３６％）同时累及下腔静脉和肝静脉,３８例（８４％）显示有肝内侧枝血管,４４例（１００％）见有肝外侧枝血管。结论：ＣＴ对显示肝脏形态、下腔静脉钙化、肝外侧枝血管尤其是奇静脉和半奇静脉扩张有优势,超声则对显示下腔静脉和肝静脉狭窄或阻塞、肝内侧枝血管有优势,ＣＴ、超声和静脉造影相互补充有助于本病的正确诊断     

下腔静脉中断的X线诊断

本文报道25例经心血管造影证实的先天性下腔静脉中断经奇静脉或半奇静脉回流病例。该畸形的胸部平片表现主要有奇静脉半奇静脉影扩大,侧位胸片下腔静脉影消失,双侧形态学左支气管等。     

奇静脉异常的CT诊断及临床意义

奇静脉是连接上腔静脉和下腔静脉的重要通道，沿途接收椎体静脉、食管静脉、肋间后静脉及心包静脉的血流。当上腔静脉或者下腔静脉发生阻塞时，此侧支循环可以作为正常循环的通道。CT扫描可以直观清晰地显示奇静脉的解剖学结构，用以了解奇静脉是否发生异常的改变，     

Budd-Chiari综合征侧支循环的血管造影表现

目的探讨ＢｕｄｄＣｈｉａｒｉ综合征（ＢＣＳ）侧支循环的血管造影表现及与介入治疗的关系。方法回顾性分析了３０例ＢＣＳ的血管造影表现，有膜性狭窄闭塞２２例，节段狭窄闭塞８例，病程４个月至２５年。行下腔静脉和楔嵌肝静脉造影。结果侧支循环分为肝内侧支、肝外侧支及肝内外侧支。肝内侧支有：（１）肝静脉藉包膜下侧支与体循环交通；（２）肝内叶间交通；（３）未确定型。肝外侧支有：（１）腰升静脉－奇静脉及半奇静脉通道；（２）腹壁浅静脉通道；（３）左肾静脉－半奇静脉通道；（４）左肾静脉－膈下静脉通道；（５）门静脉途径。结论侧支循环的解剖学变化取决于阻塞的部位，对ＢＣＳ介入治疗的选择和判断疗效具有重要意义     

CT观察奇静脉的临床应用

目的　观察奇静脉的CT影像表现 ,评价奇静脉异常的临床意义。资料与方法　随机抽取 10 0名正常人胸部的CT扫描资料 ,行增强扫描者均由上肢浅静脉注入对比剂 ,观察测量奇静脉的正常大小和强化特点 ,选择不同的层面分别测量奇静脉弓、奇静脉干和半奇静脉的血管直径 ,同时对比增强后奇静脉系统与主动脉的强化程度。回顾对照 9例奇静脉异常的影像变化 ,其中门脉高压 4例 ,上腔静脉梗阻 4例 ,1例系左侧头臂干静脉梗阻。结果　正常人奇静脉CT测量血管直径为 6～ 10mm ,奇静脉弓部最粗可达 12mm。增强 4 5s后扫描见轻度或中度均匀强化 ,CT值略低于同层面主动脉。奇静脉直径 >10～ 12mm者可视为异常增粗 ,增强时CT值超过同层面主动脉者即为异常强化。结论　奇静脉增粗常见于奇静脉与门静脉或上下腔静脉之间形成侧支回流 ,而异常强化则因上腔静脉系统血液回流受阻 ,由上肢注入的对比剂直接经侧支回流至奇静脉。观察奇静脉的变化有助于临床确诊血管性疾病的部位和程度 ,了解病变与门静脉、上下腔静脉之间的关系。同时提示临床早期发现部分无症状的隐性疾病     

体静脉连接异常的心血管造影诊断

目的评价心血管造影对体静脉连接异常的诊断价值。方法回顾分析371例经手术证实的体静脉连接异常患儿的心血管造影。结果左上腔静脉残存共190例,其中左上腔静脉回流入冠状窦171例,左上腔静脉回流入左房9例,左上腔静脉经无顶冠状窦回流入左房10例;右上腔静脉缺如3例;下腔静脉异常连接42例,其中40例为下腔静脉中断伴奇静脉回流,1例为下腔静脉回流入左房,1例为双下腔静脉。无名静脉异常共136例。结论体静脉连接异常在先天性心脏病的患者中并不少见,先心病术前通过心血管造影了解体静脉的连接关系对手术有重要的指导意义。     

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,     

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.     

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.     

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.