高原阑尾炎119例临床分析

目的:分析高原阑尾炎病例的特点、发病原因、治疗及预后。方法:采集2002~2005年3月3年间收治的高原阑尾炎119例,进行临床诊断分析。结果:本组119例急性单纯性阑尾炎及化脓性阑尾炎,均经急诊手术或择期手术治愈。有并发症者经保守治疗或再次手术治疗而痊愈。其中肠瘘1例,死亡1例。结论:高原地区人烟稀少、交通不便,加之风俗习惯及迷信思想的误导,致使误诊误治。故应加强宣传教育、破除迷信,改善医疗条件,提高医务人员责任心和业务水平积极为少数民族防病治病。     

不同频率超声探头在高原地区急性阑尾炎诊断中的应用

目的：探讨低频、高频、阴道探头相结合的方法在高原地区急性阑尾炎诊断中的价值。方法：回顾性分析2010-05-2012-05间临床怀疑阑尾炎的113例患者的超声检查结果,并与手术结果进行对照分析;每位患者术前分别用3种探头经腹检查1次,可经阴道检查的女性再行经阴道检查。结果：113例中,超声提示阑尾炎的98例中手术证实96例,仅高频探头诊断45例（46.9%）,低频探头诊断12例（12.5%）,阴道探头诊断（包括经腹和经阴道扫查）16例（16.7%）,其中经腹诊断11例,经阴道扫查的45例共诊断5例;23例为2种或3种方法同时诊断。误诊2例,1例为小儿肠系膜淋巴结炎,1例为盆腔炎;超声检查呈阴性的15例中,手术证实5例为阑尾炎。本研究的超声诊断敏感性为95.0%,特异性83.3%,准确性93.8%,阳性预测率98.0%,阴性预测率66.7%。结论：阴道探头与低频探头、高频探头相结合的方法对急性阑尾炎具有较高的诊断价值,超声检查已成为高原地区诊断急性阑尾炎不可缺少的影像检查方法。     

经脐单切口与传统腹腔镜诊治小儿急性阑尾炎效果比较

 目的 探讨经脐单切口腹腔镜技术在小儿急性阑尾炎诊断和治疗的安全性及可靠性。方法 回顾2013-03至2015-03收治的小儿急性阑尾炎112例病历资料,分为经脐单切口与传统腹腔镜诊断和手术治疗两组。手术时年龄为生后2 h～16岁,平均随访时间13.7个月(3～24个月),其中单纯性阑尾炎28例,化脓性阑尾炎58例,坏疽阑尾炎26例。结果 通过比较单切口腹腔镜组及传统腹腔镜组治疗小儿阑尾炎,手术时间前者较后者有明显缩短[(35.9±10.0)min vs (41.7±15.1)min,P<0.05],在术中出血量、术后肠功能恢复时间、住院时间、术后并发症方面两组差异无统计学意义。结论 经脐单切口腹腔镜技术是诊断、治疗小儿急性阑尾炎的安全、可靠的方法,术后近期疗效满意,为小儿急诊外科诊治提供了新的途径。
     

影像学在典型及非典型急性阑尾炎诊断中的临床价值

目的探讨影像学检查技术在诊断典型及非典型急性阑尾炎过程中的临床价值。方法回顾性分析经手术及病理证实的典型和非典型急性阑尾炎患者各20例的术前影像学检查的影像学表现。结果20例典型急性单纯性阑尾炎患者中,超声检查共诊断出17例,CT检查共诊断出18例;20例非典型急性化脓性阑尾炎患者中,超声检查共确诊14例,CT检查共确诊16例。结论对于临床症状不典型的急性阑尾炎患者,应及时准确地选择影像学检查技术以尽快诊断及治疗,而对于典型急性阑尾炎,不需要过度强调影像学检查确诊,以免延误手术时机,带来并发症。     

彩色多普勒超声诊断不同病理类型小儿阑尾炎的价值分析

目的探讨彩色多普勒超声在诊断不同病理类型小儿急性阑尾炎中的应用价值。方法本研究选取2014年1月~2016年1月宝鸡市妇幼保健院儿外科收治的急性阑尾炎患儿372例,对所有患儿采用彩色多普勒超声进行检查,并将其检查结果与病理诊断结果进行对比研究,分析彩色多普勒超声对不同病理类型小儿急性阑尾炎的诊断符合率。结果 372例经手术及病理确诊的急性阑尾炎患儿经超声检查确诊361例,彩色多普勒超声检查符合率为97.25%。结论彩色多普勒超声对小儿急性阑尾炎在疾病诊断和病理分型诊断中准确率高,具有安全、无创、可重复性强等优点。     

高位急性阑尾炎的临床及CT诊断分析

目的 :探讨CT诊断高位急性阑尾炎的价值,进一步提高对本病的认识和CT诊断水平。方法 :收集我院20例经手术证实的高位急性阑尾炎患者,回顾性分析其临床及CT资料。结果:20例中,5例阑尾根部位置平脐;11位于脐上;4例位于脐下,但其头部向后上走行至肝脏下方。CT表现为阑尾增粗20例,阑尾积液13例,阑尾结石12例,阑尾周围炎性渗出14例,阑尾炎性包块3例,阑尾穿孔2例,盆腹腔少量积液3例。结论:临床上对不典型右上腹或中上腹部疼痛患者应考虑高位阑尾炎的可能,及早行CT检查有助于高位急性阑尾炎的早期诊断,以减少并发症和指导临床治疗。     

彩色多普勒超声诊断急性阑尾炎124例分析

目的:分析急性阑尾炎的超声声像图特征及漏诊原因,以进一步提高急性阑尾炎的超声诊断水平。方法:总结分析2009-02～2012-04的124例经手术及病理证实为急性阑尾炎的超声检查结果,着重讨论各型阑尾炎的超声特征及漏诊原因。结果:124例急性阑尾炎的患者,均经手术及病理证实。急性化脓性阑尾炎62例,急性坏疽性阑尾炎并穿孔30例,急性单纯性阑尾炎26例,阑尾周围脓肿4例,误诊2例。超声诊断符合率83.1%。结论:了解急性阑尾炎的声像图特征及漏诊原因,全面仔细的超声检查,对提高急性阑尾炎的超声诊断率有重要意义。     

高原急性阑尾炎32例

急性阑尾炎是最多见的急腹症,一般经手术治疗后可获良好预后。然而,高原阑尾炎却有其自身特点,如病情危重,合并症、并发症多,预后相对较差,甚至危及患者生命。我部在执行任务期间,驻守海拔3100m以上的高原地区,20个月中共收治急性阑尾炎患者32例。笔者对这32例急性阑尾炎的特点回顾性分析如下。     

儿内科急性阑尾炎诊治探讨

目的 探讨儿内科小儿急性阑尾炎的诊治特点。方法 对儿内科就诊的79例急性阑尾炎病例进行回顾性分析。结果 首次于儿内科就诊的79例急性阑尾炎病儿，均于就诊后24h内转入儿外科治疗，临床以腹痛、发热、末梢血白细胞及中性粒细胞增高为主要表现。74例经手术治疗后证实为急性阑尾炎，其中化脓性阑尾炎45例，坏疽性阑尾炎12例，蛔虫性阑尾炎1例，单纯性阑尾炎16例。36例发生阑尾穿孔，21例并发弥漫性腹膜炎。5例未手术治疗。结论 首次于儿科内科就诊的腹痛患儿，伴有发热、周围血白细胞或／和中性粒细胞增高，尤其有右下腹固定压痛者，鉴别除外儿内科常见腹痛性疾病，应考虑阑尾炎，并及时与儿外科医生联系，早期诊断，及时处理，减少并发症。     

急性阑尾炎的CT漏诊及误诊分析

目的:探讨急性阑尾炎CT诊断漏诊、误诊的原因.材料和方法:对23例经手术及病理证实的急性阑尾炎病例的术前CT资料进行回顾性分析,重点对CT漏诊、误诊原因进行分析.结果:23例急性阑尾炎中,14例(60.9%)CT于术前确定急性阑尾炎诊断,8例(34.8%)漏诊,1例(4.3%)误诊.8例漏诊中,5例诊断时对急性阑尾炎CT表现认识不足或完全忽略;2例分别为单纯性阑尾炎及慢性阑尾炎急性发作,CT表现轻微;3例右下腹缺乏脂肪比衬,影像学诊断困难;2例CT扫描范围不足,未完全覆盖病变区域.1例阑尾脓肿因忽略脓腔中粪石征而误诊.结论:熟悉急性阑尾炎的各种CT表现、改善扫描方法并密切结合临床应可帮助提高术前诊断率.     

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.