Pattern recognition in five-phase bone scintigraphy: diagnostic patterns of reflex sympathetic dystrophy in adults

The objective of this study was to assess qualitative and quantitative patterns of tracer accumulation to increase the diagnostic utility of bone scintigraphy in reflex sympathetic dystrophy (RSD). Of 120 patients with high clinical suspicion for RSD, 96 were confirmed as having RSD during follow-up, while the remaining 24 were used as controls. Clinical parameters were measured and correlated to five activity ratios (0–30 s, 0.5–5 min, 5–15 min, 3 h, 24 h) and five scintigraphic signs. Monitoring three dynamic phases revealed different tracer kinetics of potential diagnostic utility; however, the 24-h bone phase offered no additional diagnostic contribution and can be omitted. Quantification provided objective parameters for the duration of symptoms, pain and impairment of movement but not for surface temperature differences, swelling and impairment of physical force. It is of limited use for diagnosis except for the exclusion of disease. Discriminant analysis revealed the combination of three signs (diffuse uptake in carpus/tarsus+diffuse uptake in all small joints+increased activity ratio in the late blood pool phase) to be the pattern with the highest diagnostic accuracy independent of localisation, sex, age and precipitating factors. It is concluded that the scintigraphic confirmation of RSD is based on lateralisation in the late blood pool phase and the described pattern in the early bone phase.     

偏瘫后肩手综合征关节松动术疗效观察

 目的 通过观察关节松动术治疗偏瘫后肩手综合征(RSD)的疗效,并对其原理进行分析探讨.方法 脑卒中偏瘫患者38例,均出现肩痛等症状,符合RSD诊断,所有患者随机分为2组,每组19例,实验组除进行常规理疗外,还接受关节松动术治疗,对照组只进行常规理疗.所有病例均接受整体感知疗效(global perceived effect, GPE)、视觉模拟量表(visual Analog Scale, VAS)和肩关节被动活动度(ROM)评定.结果 实验组VAS、GPE和ROM改善优于对照组,有统计学差异;2组组内治疗后症状有改善,有统计学差异.结论 疼痛和交感神经系统失调可能是RSD形成的关键因素,通过关节松动术可以缓解疼痛,调节交感神经,综合其他常规理疗,从而打破这种恶性循环,最终达到治疗目的 .     

四肢离断再植29例临床分析

目的探讨创伤后上下肢离断29例再植手术的临床疗效及治疗体会。方法选取2004年1月~2014年11月收治的29例四肢离断伤患者,男性23例,女性6例;年龄23~47岁,平均35岁。其中电锯伤9例,砍伤6例,旋转撕脱伤3例,挤压碾轧伤11例;离断平面:上肢损伤9例,包括手掌部离断1例,前臂离断5例,上臂离断3例;下肢损伤19例,包括足部离断3例,踝部离断8例,小腿离断7例,双踝部完全离断1例。结果 29例共离断30肢,其中5例术后因血管危象行血管探查修复,2例发生感染导致再植肢体坏死,进而截肢;9例术后一次性成功;18例术后伤口部分皮肤坏死,行创面换药及二次植皮手术伤口愈合,成活率93.1%。按照断肢再植术后功能评定标准:上肢:Ⅰ级3例,Ⅱ级4例,Ⅲ级1例,1例再植失败;下肢:Ⅰ级9例,Ⅱ级9例,Ⅲ级1例,1例再植失败。结论综合考虑患者的全身情况,选择再植的适应证,合理全面的清创固定,及时正确的修复血管、神经、肌肉、肌腱等组织,术后合理的康复锻炼及功能锻炼,是提高断肢再植成活率及功能康复的重要因素。     

断指再植573例体会

目的:探讨断指再植术前、术中、术后的处理要点及术中操作技巧,以提高再植成活率。方法:对断指分肉眼和镜下两次彻底清创,单根或交叉克氏针或微型钛板固定指骨,"U"形法缝接屈肌腱,内"8"字法缝接伸肌腱,据不同情况先吻合动脉、神经或静脉,无张力下缝合皮肤。术后常规应用低分子右旋糖酐、罂粟碱,不常规应用肝素,不用烤灯。发生血管危象及时探查。结果:2007-02～2012-03共再植573例623指,成活615指,成活率98.7%。术后随访6～12月,断指感觉、运动、外形恢复满意。结论:只要指体完整的断指均应尽量再植;必须重视断指再植的每一环节,并要因患者、因伤情而制宜,才能有效提高成活率。     

多微脑回畸形的MRI表现及其分型(附39例报告)

目的 分析多微脑回畸形的MRI分型及各型的MRI特征,以提高对本病的认识.方法 回顾性分析39例多微脑回畸形的临床及MRI资料.结果 多微脑回畸形在MRI上分为5型,其中,外侧裂周围型22例(56.4％),额叶型8例(20.5％),合并脑室周围灰质异位型3例(7.6％),弥漫型2例(5％)及矢状窦旁顶枕叶型1例(2.5％).另有3例病人未能列入上述5型分类中,称为少见类型,其中2例病变位于顶枕叶,1例病变位于颞叶.结论 MRI检查是诊断多微脑回畸形的最佳方法,可对其进行准确分型.     

脑颜面血管瘤综合征的MRI诊断(附5例报告)

目的 研究脑颜面血管瘤综合征的MRI表现，并探讨其诊断脑颜面血管瘤综合征的价值。方法 回顾性分析5例脑颜面血管瘤综合征的临床及影像资料。全部病例均有面部三叉神经分布区皮肤血管瘤或伴有颅内相关的病理改变。结果 MRI平扫可显示患侧脑萎缩及侧脑室内脉络丛球增大。MRI增强的优势则主要体现在对软脑膜血管瘤畸形及伴发的血管性异常的准确显示上。结论 在脑颜面血管瘤综合征的影像学诊断上，MRI增强扫描提供了最为重要的依据。     

Ulnar distribution of reflex sympathetic dystrophy due to compression of the brachial plexus by a primary venous malformation

An atypical variant of reflex sympathetic dystrophy (RSD) is presented in a 45 year old female with a vascular malformation of the right arm and chest wall. The mechanism was thought to be compression of the brachial plexus by the malformation. The unique scintigraphic features of this presentation of RSD in the ulnar arterial distribution are illustrated.     

Radiological appearances of metastatic Marjolin ulcer in a chronic pressure sore: a case report and literature review

Marjolin ulcer is a type of aggressive ulcerating squamous cell skin tumor that typically develops in areas of previously traumatized, burned, chronically inflamed, or scarred skin. It typically occurs following a period of dormancy. We present a rare case of Marjolin ulceration with an unusual combination of continued non-compliance after diagnosis and 40 years of unusually long latency.     

A single fracture in the atlas ring: report of two cases and a review of the literature

Atlas fractures commonly present more than two breaks in its ring structure because of the unique anatomy and the mechanism of injury. The incidence of a single break in the atlas ring is exceedingly rare. However, we encountered two cases of a single fracture of the atlas. One patient was struck by a falling tree on the right side of the head and the other was involved in a motor vehicle accident. Radiographs of the cervical spine failed to show a single fracture or other abnormalities. Computed tomography demonstrated the single fracture. The patients were treated conservatively with a cervical collar, and they both recovered completely. In this article, we present two cases of a single fracture of the atlas with a review of the literature.     

距下关节截骨缓慢延长治疗陈旧性跟骨骨折

目的 伴有距下关节损伤的陈旧性跟骨骨折,目前主要是采用距下关节原位融合术和距下关节牵伸骨块植入融合术治疗,在此介绍一种新手术方式,距下关节截骨外固定支架缓慢延长手术,并评估其疗效.方法 12例15足(单足9例,双足3例)陈旧性跟距关节骨折脱位,年龄16～53岁,平均33.6岁.闭合性7例(10足),开放型性5例(5足)...     

72例SARS的胸部X线影像分析

目的 研究严重急性呼吸综合征(SARS)患者X线胸片的改变和影像动态变化。方法对72例SARS的X线表现进行分析，包括X线胸片异常出现的时间、病变最为严重的时间及病变吸收的时间和影像形态。结果胸部X线异常出现的时间多在发病后的4～7d(53例，73．6％)，X线表现最为严重的时间多在发病后的8～14d(54例，75．0％)，多数病变吸收的时间多为发病后的15～21d(37例，51．4％)，病变的主要特点是以双侧或单侧的单发或多发大片状模糊影(58例，80．6％)，最严重时期变化快。部分病人病变呈游走性改变。X线片上病变吸收后1个月内CT证实肺内仍具有病变者占55．0％(11／20例)。结论胸部X线片可反映SARS患者病变的动态变化，但对病变的细微改变显示有限度。     

毛细胞黏液型星形细胞瘤影像表现二例

例1 女,13岁.反复头痛伴有恶心呕吐1个月,加重7 d,体检无明显阳性体征.CT平扫见右侧丘脑凸向右侧脑室内的等低混杂密度肿块,肿块位于丘脑部分为低密度,凸向侧脑室内部分为等密度.     

MRI appearances mimicking the dural tail sign: a report of two cases

We report two cases in which the MRI appearances mimicked the dural tail sign; a glioma extending into the subarachnoid space, and a meningioma extending to the subdural space. They indicate that tumour invasion into the subarachnoid or subdural space, should be considered when prominent linear enhancement is observed along the dura mater adjacent to tumours. Received: 31 March 1999/Accepted: 21 July 1999     

经口咽前路寰枢椎复位钢板系统的设计及其即时复位作用(附5例临床报告)

目的 研制经口咽前路寰枢椎复位钢板系统（TARP）,并评价其术中即时复位作用。方法 设计一种新型的经口咽前路寰枢椎复位铜板系统,应用于临床治疗5侧难复型寰枢稚脱位患者．经口咽前路松解减压．联合应用寰枢椎复位器和钢板完成寰枢椎脱位的复位和固定过程,寰枢外侧关节间植骨。结果 TARP系统具有即时复位机制,5例患者在术中均能达到良好的即时复位．术后随访平均95个月,伤口愈合良好,无感染,四肢麻痹消失．肌力恢复．病理反射消失．钢扳螺钉未松动。结论 临床应用表明．TARP设计新颖独到,手术操作简便台理．能即时复位,固定效果好．具有良好的应用前景。     

Mucopolysaccharidosis type IV: report of 5 cases of Morquio Syndrome

Mucopolysaccharidosis type IV or Morquio Syndrome, is a lysosomal deposit disease, of autosomal recessive inheritance with a similar incidence in men and women. The clinical picture is of variable expressiveness, its phenotype is characterized by skeletal dysplasia that includes neck and short trunk, short stature, keel thorax, kyphosis, scoliosis, genus valgus, flat foot, coxa valga, gait disorders, instability of the cervical spine and wedge or ovoid vertebrae. The treatment is symptomatic, with enzyme replacement. We present a series of 5 cases, the product of 2 couples, with a confirmed diagnosis of Mucopolysaccharidosis type IV, and different clinical presentation.     

低颅压综合征的MRI表现(附5例报告)

目的 探讨低颅压综合征的MRI表现.资料与方法 回顾性分析5例低颅压综合征的影像学表现,其中1例行头颅CT平扫、头颅和脊柱MRI平扫及增强扫描、头颅MRV扫描,3例行头颅MRI平扫及增强扫描,1例行脊柱MRI平扫及增强扫描.结果 1例头颅CT扫描未见异常.4例头颅MRI扫描均显示硬脑膜弥漫性增厚并明显强化,1例出现脑下垂.1例头颅MRV显示上矢状窦、直窦、横窦扩张.2例脊柱MRI扫描显示硬脊膜广泛增厚并明显强化.结论 硬脑(脊)膜弥漫性增厚强化是低颅压综合征的特征性影像学表现,MRI增强扫描是诊断低颅压综合征的敏感影像学检查方法.     

A single fracture in the ring of vertebrae below the atlas: report of four cases

A single fracture of the ring of a vertebra is a rare injury of the spine. In this report, we present five single fractures of the posterior ring of the cervical spine below the atlas from four patients after motor vehicle accidents. Initial radiographs failed to show any of these fractures; all were detected by computed tomography. Single ring fractures are stable and none of our patients presented with a neurological deficit. Patients were treated conservatively with a cervical collar or a cervicothoracic brace. They all recovered without any neurological abnormalities.     

Radiological signs of primary sarcoma of the kidney in adults : a report on 5 cases (author's transl)

Primary sarcomas of the kidney are extremely uncommon and the results of their angiographic study are rarely reported. A study of five cases that were confirmed histologically demonstrates the absence of specific clinical and urographic findings. Arteriographic appearances are variable and not related to the histological type. The poorly vascularized forms are traditionally the most frequent (2 out of 5 cases) but are not fundamentally different from adenocarcinomas. The diagnosis can be suspected, however, when there is an infiltrating peripheral tumor extending well beyond the capsule. The hypovascularized pseudocystic forms raise the same arteriographic problems as the adenocarcinomas. Arteriography can diagnose malignancy, but the diagnosis of sarcoma is usually impossible before operation.     

Partial transient osteoporosis of the hand

Objective. To describe the radiographic and scintigraphic findings of partial transient osteoporosis (PTO) of the hand. To discuss the relationship of PTO and other localized demineralizing diseases. Design and patients. Three patients with PTO that affected two or three digits of the hand are reported. Two patients were middle-aged women and the third was a young man. All presented with a history of trauma to the hand. All patients experienced localized burning pain, swelling and vasomotor changes including redness of the skin, hyperhidrosis and signs of vasomotor instability of the involved fingers. Plain radiography and bone scanning were used in the diagnosis and follow-up of these cases. Results. All patients had a radial distribution of the osteoporosis that involved adjacent rays. In all patients two rays were involved. The radiographic changes manifested as minimal patchy osteoporosis involving the cortical, cancellous, subarticular and subperiosteal bone with no articular involvement. The increased uptake on scintigraphy coincided with the radial distribution of the osteoporosis. All patients improved on physical therapy and were symptom-free approximately 6 months after the initial injury. These patients were followed up for more than 2 years. Conclusion. PTO of the hand is an uncommon disease with typical clinical and radiographic findings. Bone scintigraphy confirms the partial involvement of the hand. Received: 27 February 1998 Revision requested: 18 June 1998 Revision received: 4 March 1999 Accepted: 15 April 1999     

Radiological findings of the urinary tract in hypospadias: a report of 110 cases.

One hundred and ten patients with hypospadias underwent excretory urography and micturating cysto-urethrography before surgical correction. Urographic studies revealed abnormalities in 50 patients (45%), mainly anomalies of ascent and rotation of the kidneys. None of these patients required corrective surgery. Voiding cysto-urethrography disclosed disease of the urinary tract in 65 of 110 patients (59%). Meatal stenosis was found in 38 patients and a rudimentary vagina or a prostatic utricle was revealed in 11 others. Vesico-ureteral reflux was present in 14 patients, seven of whom had meatal stenosis as well. Cystitis was found in eight and a stricture of the membraneous urethra in one patient. The voiding cysto-urethrogram is able to demonstrate functionally significant meatal stenosis, genital abnormalities and vesico-ureteral reflux. It can also serve as a useful baseline for comparison with postoperative studies. We therefore consider that it should be included in the preoperative work-up of every patient with hypospadias. Excretory urography, however, is perhaps indicated only in those with urinary tract infection, or in patients otherwise symptomatic.