CT对侵袭性与非侵袭性胸腺瘤诊断和判断预后价值分析

目的 探讨胸腺瘤的CT征象与Masaoka临床-病理分期以及预后影响因素的相关性.方法 回顾性分析45例经手术病理证实为胸腺瘤患者术前的CT资料和一般临床资料,比较侵袭性与非侵袭性胸腺瘤的CT表现,并对7例复发患者的CT征象进行相关性分析.结果 45例中,非侵袭性胸腺瘤11例,侵袭性胸腺瘤34例,CT上二者在形态不规则、边缘毛糙/不清、肿瘤内有囊变/坏死或钙化、纵隔脂肪层浑浊/消失、大血管浸润、心包受侵以及不均匀强化中有显著差异(P<0.05).7例患者术后出现复发或转移,与边缘毛糙/不清、淋巴结肿大、胸膜受侵、大血管浸润及其他脏器受侵有显著相关性(P<0.05).结论 CT有助于术前鉴别侵袭性与非侵袭性胸腺瘤,为设计合理治疗方案以及术后判断预后提供有价值的信息.     

MSCT对胸腺上皮肿瘤WHO简化病理分型的鉴别诊断价值

目的探讨多层螺旋CT(MSCT)对低危型、高危型胸腺瘤及胸腺癌的鉴别诊断价值。方法回顾性分析经病理(穿刺或手术)证实的67例胸腺上皮肿瘤,基于WHO病理分型简化为低危型胸腺瘤、高危型胸腺瘤及胸腺癌三组,并对其CT征象进行统计分析。结果67例TETs中,低危型胸腺瘤30例(A型3例、AB型20例、B1型7例),高危型胸腺瘤22例(B2型11例、B3型11例),胸腺癌15例。高危型胸腺瘤、胸腺癌较低危型胸腺瘤易表现为边缘分叶或不规则(P均<0.05)及易出现对心包侵犯(P均<0.05);胸腺癌较低危型胸腺瘤易出现增强后密度不均、囊变坏死及胸膜转移(P均≤0.003);胸腺癌较低危型、高危型胸腺瘤易出现纵隔淋巴结肿大(P均≤0.002);纵隔大血管侵犯在三组间两两比较均有统计学差异(P均<0.05)。结论MSCT对TETs的WHO简化病理分型鉴别诊断具有重要价值。     

无症状胸腺瘤CT影像特点与其型别的相关性研究

目的探讨无症状胸腺瘤CT影像特点与其型别的相关性。方法回顾性分析2013年2月~2017年2月收治的18例无症状胸腺瘤患者临床资料。依据2004年WHO组织分型标准,将18例患者分为低危组(A、AB和B1)、高危组(B2、B3)和胸腺癌(C)3个亚型组。分析CT表现与WHO组织分型的相关性。结果本组18例胸腺瘤患者包括A型1例(5.56%),AB型2例(11.11%),B1型4例(22.22%),B2型5例(27.78%),B3型4例(22.22%),胸腺癌2例(11.11%)。低危组、高危组9例和胸腺癌组在强化平均CT值、肿块边缘、肿块密度、侵犯纵隔胸膜、侵犯血管结构、侵犯心包和淋巴结转移方面比较存在显著性差异(P0.05)。结论胸腺瘤的CT表现与WHO组织分型具有十分紧密的关系,可通过CT表现肿瘤的边界、密度、周围组织侵犯和强化平均CT值等指标用于无症状胸腺瘤的WHO组织分型鉴别。     

恶性胸腺瘤WHO病理分类及其CT表现

目的:分析恶性胸腺瘤的CT表现,以便于分类、分期和选择治疗。方法:分析21例手术及病理证实的WHO分类恶性胸腺瘤的CT表现,与手术病理相对照。结果:恶性胸腺瘤WHO分类B1型3例,B2型6例,B3型4例,C型(胸腺癌)8例。CT表现:心脏大血管受侵11例,主要表现肿块的心脏大血管接触面(mass-cardiovascular inferface,MCI)呈灌铸型生长。纵隔胸膜-肺受侵13例,主要表现为肿块-肺接触面(mass-pulmonary interface,MPI)增厚呈尖角或锯齿征。胸膜种植3例。肺门、肺内转移4例。C型(胸腺癌)更具侵袭性,远处转移多见。结论:CT能准确显示恶性胸腺瘤周围侵犯范围、胸膜种植及远隔转移。可准确分期和决定治疗方案,并对分类及预后作出评估。     

MSCT对低危型、高危型胸腺瘤及胸腺癌的鉴别诊断价值

【摘要】目的：探讨MSCT对低危型、高危型胸腺瘤及胸腺癌的鉴别诊断价值。方法：将68例经穿刺或手术病理证实的胸腺上皮性肿瘤（TETs）,按WHO简化病理分型分为低危型胸腺瘤、高危型胸腺瘤和胸腺癌三组,对三组的MSCT征象进行统计学分析。结果：68例TETs中,低危型胸腺瘤31例（A型4例、AB型19例、B1型8例）、高危型胸腺瘤15例（B2型9例、B3型6例）、胸腺癌22例。高危型胸腺瘤、胸腺癌均较低危型胸腺瘤更易表现为肿瘤边缘不规则或分叶（P均<0.05);高危型胸腺瘤、胸腺癌均较低危型胸腺瘤更易出现对胸膜/心包、邻近大血管侵犯（P均<0.05）;增强后密度不均及囊变坏死率在胸腺癌和低危型胸腺瘤间均具有显著性差异（P均<0.001）;胸腺癌出现纵隔淋巴结转移较低危型、高危型胸腺瘤更为常见（P<0.05）;而瘤内钙化在三者间两两比较均无明显统计学差异（P均>0.05）。结论：MSCT对WHO简化病理分型的TETs具有一定的鉴别诊断价值。     

胸腺上皮性肿瘤WHO简化病理分型的MSCT表现

目的:分析胸腺上皮性肿瘤(TET)的多层螺旋CT(MSCT)表现及多平面重组(MPR)特征,并探讨其与WHO简化病理分型之间的相关性。方法:回顾性分析40例经手术病理证实的TET患者术前MSCT及MPR图像,并与WHO简化病理分型[低危型胸腺瘤(A、AB、B1)、高危型胸腺瘤(B2、B3)与胸腺癌]进行比较。结果:高危型胸腺瘤与胸腺癌MSCT及MPR征象表现为肿瘤边缘不光整或分叶、形态不规则且强化后瘤内密度不均,以及对邻近结构侵犯,与低危型胸腺瘤有统计学差异﹙P<0.05﹚,胸腺癌纵隔淋巴结增大及远处转移较两组胸腺瘤更为常见,而患者的年龄、性别、肿瘤体积以及瘤内钙化在三组间比较均无明显统计学差异。结论:MSCT扫描及MPR技术对TET的WHO简化病理分型鉴别诊断具有重要价值,为临床治疗方案的选择及判断预后提供信息。     

MSCT在鉴别≤3cm的低、高风险胸腺瘤及胸腺癌中的价值

目的 探讨多层螺旋CT(MSCT)对最大径≤3 cm的胸腺上皮肿瘤(TET)诊断价值.方法 回顾性分析56例经病理证实的最大径≤3 cm的TET病例的病理、影像学资料,根据WHO 2004标准进行组织学分型,将病例分为低风险胸腺瘤组(A/AB/B1型)、高风险胸腺瘤组(B2/B3型)、胸腺癌组(C型),分析各组TET的CT征象,包括病灶的形状、边缘是否光滑、是否伴有棘状突起、是否伴有瘤周小结节、强化程度、胸膜侵犯征象、周围脂肪间隙等.各类型间比较采用χ2检验,样本量过小时,采用Fisher精确试验.结果 低风险胸腺瘤(27例)较高风险胸腺瘤(23例)及胸腺癌(6例)更常表现为规则的类圆形的形态(χ2=73,P<0.001;χ2=116,P<0.001),纵隔-肺界面更易呈膨隆状(χ2=3.41,P=0.046;χ2=7.39,P=0.01);高风险胸腺瘤、胸腺癌较低风险胸腺瘤更常见边缘模糊、棘状突起、胸膜侵犯等征象(P<0.001);胸腺癌较高风险胸腺瘤更常见边缘模糊、棘状突起、胸膜侵犯等征象(χ2=11.5,P=0.009);B2型胸腺瘤与胸腺癌之间的差异有显著性意义(χ2=31.52,P<0.001),然而B3型胸腺瘤与胸腺癌之间无统计学差异(χ2=6.96,P=0.07).结论 MSCT可准确显示病灶的形态、边缘、瘤周情况、强化程度及胸膜侵犯情况,在一定程度上可预测胸腺瘤的组织学分型,可为术前诊断及预后评估提供依据.     

胸腺上皮性肿瘤组织学分型与CT征象的相关性研究

目的探讨胸腺上皮性肿瘤(TET)组织学分型与CT征象的相关性。方法选取64例经病理确诊为TET患者的临床及影像资料,根据WHO 2015年标准进行组织学分型,然后分析不同组织学类型的TET CT特点。结果 64例TET患者中,A型8例(12.5%)、AB型6例(9.4%)、B1型15例(23.4%)、B2型22例(34.4%)、B3型8例(12.5%)、胸腺癌5例(7.8%)。胸腺癌组病灶体积普遍大于低、高危组(P 0.05),高危组及胸腺癌组较低危组相比病灶形态更不规则(P 0.05),胸腺癌组较其他组比较边界多不清晰,且更易侵犯周围组织和发生淋巴结及远处转移(P 0.05),而低危组与高危组差异无统计学意义(P 0.05),三组间强化程度、囊变坏死率、钙化发生率无明显差异(P 0.05)。结论 TET组织学分型与CT征象间存在一定相关性,可通过分析病灶大小、形态、边界、与周围组织的关系及转移情况来判断肿瘤的侵袭性和组织学分型。     

胸腺瘤的CT和平片分析

目的　探讨胸腺瘤的X线与CT诊断价值。方法　分析 30例经手术病理证实的胸腺瘤X线和CT表现 ,并与病理对照。结果　 18例非侵袭性胸腺瘤 ,胸片仅发现 15例 ,CT扫描 10例 ,均为前纵隔软组织肿块 ,边界清楚 ,密度均匀。 12例侵袭性胸腺瘤 ,肿瘤侵犯邻近器官 ,CT显示纵隔胸膜受侵 3例 ,心包受侵 2例 ,大血管结构受侵 2例 ,胸膜种植 3例 ,胸腔积液 2例 ,腹腔受侵和纵隔淋巴结转移各 1例 ;胸片仅能显示 1例肿瘤侵犯纵隔胸膜和 1例胸膜种植。结论　CT扫描在胸腺瘤的发现和判别侵袭性方面明显优于X线平片并且是可靠预测胸腺瘤侵袭性的检查方法。     

胸腺瘤的CT诊断

目的评估CT诊断良恶性胸腺瘤的价值.材料和方法分析31例经外科和病理证实的胸腺瘤的CT表现.结果良性胸腺瘤10例,除1例与左肺动脉局部有粘连外,其余边界均清晰.侵袭性胸腺瘤12例,胸腺癌9例,除1例鳞癌外,CT均为不规则肿块,血管间隙均受侵,前者心包受侵8例,胸膜受侵7例,后者心包受侵5例,胸膜受侵5例,肺转移4例,双肾上腺转移1例,胸骨破坏1例.结论CT能准确鉴别良性恶性胸腺瘤,显示恶性胸腺瘤的浸润范围,并对侵袭性胸腺瘤和胸腺癌进行鉴别.     

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.