恶性脑膜瘤的CT与MRI诊断

目的 分析恶性脑膜瘤的CT、MRI表现,提高其术前定性诊断率.方法 回顾性分析10例恶性脑膜瘤的CT、MRI表现.结果 10例肿瘤均为单发,大脑凸面4例,大脑镰旁3例, 海绵窦旁、矢状窦旁及蝶骨嵴各1例.密度、信号不均匀者9例,肿瘤邻近颅骨骨质破坏3例,其中1例局部形成软组织肿块并突向颅外.9例表现为不均匀增强;2例出现粗细不规则的"脑膜尾征".结论 恶性脑膜瘤术前定性有一定困难,关注影像学特征有利于提高恶性脑膜瘤的术前诊断率.     

小型凸面脑膜瘤颅骨受侵MRI特征探讨

目的分析小型凸面脑膜瘤侵犯颅骨的MRI表现特征,为制定手术方案提供准确信息。方法收集20例小型凸面脑膜瘤单纯颅骨受侵患者术前MRI资料进行分析。结果本组20例脑膜瘤肿块。术后病理分型为纤维型8例,血管瘤型3例,砂粒体型2例,过度细胞型2例,上皮型3例,微囊型2例。MRI上位于大脑凸面18例,矢状窦旁者2例。20例均有颅骨受侵,无瘤周水肿。结论小型凸面脑膜瘤颅骨侵袭的MRI表现具有一定特征性,即单纯颅骨内板增厚,瘤体组织呈结节状、蘑菇状、匍匐状侵及内板、板障,且沿板障侵袭性生长,可使颅骨骨质完全破坏,向颅外累及头皮。     

5例颅底囊性脑膜瘤的MRI表现

囊性脑膜瘤多见于儿童,约占儿童颅内肿瘤的10%～19%,而成人发病率为2%～4%[1].肿瘤多发生于大脑半球凸面、镰旁或矢状窦旁,而位于颅底部较为少见[2～7].本研究搜集1996-02～2004-05手术病理及免疫组化检查证实颅底囊性脑膜瘤5例,分析其MRI表现,并结合文献探讨其MRI特点和鉴别点,以期提高其MRI诊断水平.     

双源CT静脉造影对上矢状窦旁脑膜瘤显微手术的价值探讨

目的 探讨脑双源CT静脉造影(CTV)显示上矢状窦旁脑膜瘤与上矢状窦关系、显示中央沟静脉和代偿回流静脉情况,从而为神经外科制定手术方案提供重要信息.方法 32例上矢状窦旁脑膜瘤患者行脑CTV检查,在工作站重建三维图像,术前判断肿瘤与静脉窦关系、显示中央沟静脉和代偿回流静脉并与术中情况对照.结果 根据CTV显示的窦腔狭窄程度,将上矢状窦旁脑膜瘤分为三型:Ⅰ型,瘤体与一侧静脉窦壁外层附着,静脉窦壁正常或轻度受压,窦腔通畅;Ⅱ型,肿瘤沿静脉窦壁生长,窦壁不规则增厚,窦腔变窄但尚通畅;Ⅲ型,瘤体长人静脉窦内或跨越生长,静脉窦腔内形成充盈缺损,窦腔闭塞,同时有静脉侧支循环建立.本组Ⅰ型8例,Ⅱ型15例,Ⅲ型9例.术中观察到代偿扩张的浅静脉以及肿瘤与中央沟静脉、上矢状窦的关系均与CTV结果相符.本组无术后严重神经功能受损和死亡病例.结论 上矢状窦旁脑膜瘤患者术前行CTV检查可以明确肿瘤部位、矢状窦阻塞程度及引流静脉代偿情况,为手术人路的选择及手术方案的制定提供重要信息,在全切肿瘤的同时减少并发症的发生,提高患者的生活质量.     

脑膜瘤数字减影血管造影的诊断价值

目的 探讨脑膜瘤数字减影血管造影(DsA)的诊断价值。方法 115例脑膜瘤行股动脉穿刺插管脑血管DSA。有76例行选择性颈外动脉分支栓塞术。结果 分布在大脑凸面、矢状窦旁、大脑镰旁等较表浅部位的脑膜瘤主要以颈外动脉系统供血为主，颌内动脉的脑膜中动脉参与供血最多。分布在嗅沟、前颅凹、鞍区、蝶骨嵴、中颅凹、后颅凹等颅底部位的脑膜瘤主要以颈内动脉供血为主，颈内动脉的分支眼动脉和海绵窦段参与供血最多。颈外动脉、颈内动脉和椎基动脉之间可有危险吻合存在。结论掌握脑膜瘤的DsA特点对于脑膜瘤的手术和术前血管内栓塞治疗有重要意义。     

仿真开颅手术显示大脑浅静脉及其与脑膜瘤关系的应用价值研究

目的 评价仿真开颅手术在显示大脑浅静脉及其与大脑凸面、矢状窦旁及大脑镰旁脑膜瘤关系中的作用.方法 应用仿真开颅手术和三维对比增强MR静脉成像技术(3D CE-MRV)前瞻性地检查49例大脑凸面、矢状窦旁及大脑镰旁脑膜瘤,并进行图像后处理.采用t检验比较两种技术对大脑浅静脉显示数量的差异;评价仿真开颅手术重组图像显示脑膜瘤-大脑浅静脉关系的能力;对影响仿真开颅手术重组效果的脑膜强化与否、肿瘤大小和位置等因素采用Wilcoxon符号秩和检验进行分析.结果 仿真开颅手术和3D CE-MRV显示脑膜瘤周围大脑浅静脉分别为(4.4±1.9)和(5.1±2.7)支,差异有统计学意义(t=3.131,P＜0.05).仿真开颅手术能清楚显示脑膜瘤与大脑浅静脉关系,总平均得分为(2.5±0.7)分.有脑膜强化(12例)和无明显脑膜强化(37例)患者的主观评分分别为(1.5±0.5)、(2.8±0.3)分,无脑膜强化的图像质量明显优于有脑膜强化(Z＝-3.093,P＜0.05);小脑膜瘤组(31例)和大脑膜瘤组(18例)的主观评分分别为(2.7±0.5)、(2.2±0.9)分,小脑膜瘤组明显优于大脑膜瘤组(Z=-2.057,P＜0.05);窦镰组(39例)和凸面组(10例)主观评分分别为(2.6±0.6)、(2.2±0.9)分,两组间差异无统计学意义(Z=-0.604,P＞0.05).结论 仿真开颅手术仅显示大脑浅静脉(SCVs),避免了大脑深静脉和头皮静脉的重叠,对大脑浅静脉评价更加准确;仿真开颅手术能较好地显示脑膜瘤与大脑浅静脉的关系,为脑膜瘤术前选择颅骨开窗位置、术中定位以及保护大脑浅静脉提供帮助.     

64层螺旋CT多期扫描在脑膜瘤术前评估中的应用

目的 探讨64层螺旋CT多期扫描在脑膜瘤术前评估中的价值. 资料与方法 21例脑膜瘤患者,均经64层螺旋CT平扫、增强动脉期和静脉期扫描,并行动脉期、静脉期和动静脉混合期减影.所得数据采用容积再现(VR)、最大密度投影(MIP)、多平面重组(MPR)行肿瘤、血管和颅骨成像,计算肿瘤体积,观察肿瘤部位、血供和邻近关系. 结果 21例中,大脑镰旁8例,蝶骨嵴5例,桥小脑角4例,大脑凸面2例,小脑幕旁1例,多发脑膜瘤1例.肿瘤体积5～86 cm3.肿瘤动脉期呈轻、中度强化,静脉期显著强化,3例中心可见不规则囊变区.颈内动脉供血5例,颈外动脉供血14例,双重供血2例.颈内动脉被包绕受侵2例,静脉窦受侵5例,颅骨受侵9例,其余邻近血管受推压. 结论 64层螺旋CT多期扫描能直观、清楚地显示肿瘤与血管、颅骨的关系,对临床诊断及手术方案制定具有重要指导作用.     

恶性脑膜瘤的CT、MR及病理研究

目的：探讨恶性脑膜瘤CT、MR表现及其病理学特点。方法：分析11例经临床和病理证实的恶性脑膜瘤CT、MR表现及其病理学改变。探讨CT、MRI诊断恶性脑膜瘤的临床价值。结果：11例恶性脑膜瘤中，顶部镰旁4例，额部镰旁3例，颞极1例，大脑凸面3例。边缘光滑者4例，边缘呈不规则分叶状者7例；密度及信号均匀者4例，混杂密度及信号者7例，内部可见囊变、坏死。灶周无水肿2例，轻度水肿2例，中度水肿4例，重度水肿3例；增强后见硬膜尾征4例，形态光整1例，结节状增厚3例；邻近颅骨破坏3例；1例胸腰椎多发转移，骨质破坏。结论：恶性脑膜瘤CT、MRI具有较为特殊的影像学特点。术前正确认识其表现，有助于制订手术方案。     

非典型脑膜瘤的MRI诊断

目的:分析非典型脑膜瘤的MRI表现及病理基础,以提高对该肿瘤的认识.方法:回顾性分析经手术病理证实的15例非典型脑膜瘤的MRI表现,探讨肿瘤的部位、形态、有无出血囊变、瘤体占位效应、瘤周水肿、瘤体信号及强化特点,并行病理对照分析.结果:本组15例非典型脑膜瘤,部位典型者13例(86.7%),典型部位以大脑镰、矢状窦旁、...     

几种少见病理类型脑膜瘤的MRI表现与病理相关性研究

目的分析几种少见病理类型脑膜瘤的MRI表现,探讨其MRI表现与病理相关性。方法回顾性分析病理证实的微囊型脑膜瘤、透明细胞型及血管瘤型脑膜瘤的临床及MRI资料,10例均行MRI平扫及增强。结果肿瘤发生于大脑半球凸面5例,前颅窝嗅沟1例,上矢状窦旁2例,大脑镰旁2例。8例肿瘤轮廓光整,边界清晰,与邻近颅骨呈宽基底改变。2例肿瘤轮廓不光整,边界不清。8例肿瘤周围见轻度水肿带,1例水肿较明显,1例无明显水肿。6例微囊型脑膜瘤MRI平扫呈长T1、长T2信号,增强后呈网格状强化,2例透明细胞型脑膜瘤MRI平扫表现为长T1、长T2信号,与脑脊液信号接近,增强后呈不均匀环状强化,2例血管瘤型脑膜瘤MRI平扫为稍长T1、长T2信号,肿瘤中可见流空的血管信号,增强后呈显著明显强化。结论微囊型、透明细胞型、血管瘤型脑膜瘤MRI表现与病理改变有明显相关性。     

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.