中西医结合治疗乳腺炎1122例疗效分析

乳腺炎是哺乳期妇女的常见病和多发病，是导致母乳喂养率降低的主要原因，所以研究乳腺炎的治疗效果以及预防措施非常必要。     

冠状动脉CT血管造影联合静息心肌透壁灌注指数诊断冠心病的临床价值研究

目的探讨冠状动脉CT血管造影（CCTA）联合静息心肌透壁灌注指数（TPR）诊断冠心病（CHD）的临床价值。方法162例临床疑诊CHD的患者,CCTA后2周内完成冠状动脉血管造影（CAG）检查。利用CCTA的原始数据进行TPR分析,以CAG结果为参照,评价CCTA联合TPR对CHD的诊断价值。结果CCTA、TPR单独或两者联合均可用于诊断CHD（字2=94.42、14.25、48.30,均P＜0.01）,ROC曲线下面积分别为0.899、0.589、0.701。CCTA单独诊断CHD的灵敏度为85.6%（95/111）,特异度为94.1%（48/51）,阳性预测值（PPV）为96.9%（95/98）,阴性预测值（NPV）为75.0%（48/64）。TPR单独诊断CHD的灵敏度为82.9%（92/111）,特异度为45.1%（23/51）,PPV为76.7%（92/120）,NPV为54.8%（23/42）。联合CCTA及TPR诊断CHD的灵敏度为99.1%（110/111）,特异度为41.2%（21/51）,PPV为78.6%（110/140）,NPV为95.5%（21/22）。结论联合CCTA及TPR可用于诊断CHD并可明显提高CHD诊断灵敏度。     

成人白血病中枢神经系统并发症的CT与MRI表现

目的 探讨成人白血病中枢神经系统并发症(CNSCL)的CT和MRI表现及其诊断价值.方法 回顾性分析18例经临床及手术病理证实的成人CNSCL的CT和MRI表现,其中急性淋巴细胞白血病7例,急性非淋巴细胞白血病10例,慢性粒单细胞白血病1例.CT平扫11例,其中增强1例;MR平扫16例,其中增强11例.结果 颅内受累14例:(1)颅内出血7例,其中脑内血肿4例,脑内血肿合并微出血1例,微出血2例.脑内血肿均为多发病灶.CT表现为团状高密度影;MRI表现为T1WI低信号或高低混杂信号,T2WI高信号或等高信号伴环状低信号环,病灶呈环形强化或无明显强化.脑微出血在磁敏感加权成像(SWI)上表现为多发斑点状及小条状低信号,其病灶检出率明显优于CT及MRI其他常规序列检查;7例中,伴脑梗死及蛛网膜下腔出血各1例.(2)颅内肿块5例:其中左额部内板下梭形病灶或跨颅板肿块2例,T1WI呈低信号,T2WI呈高低混杂信号,并有明显均匀强化,均见脑膜尾征;鞍区肿块1例,CT示鞍区高密度影,MRI示鞍区T1WI稍低信号,T2WI高信号,有不均匀强化;右侧脑室体旁肿块1例,T1WI、T2WI均呈等信号,有明显均匀强化.左额顶叶壁厚囊性肿块1例,呈环形强化.(3)梗阻性脑积水1例,表现为中脑导水管以上脑室系统扩张.(4)脑膜病变1例,MRI表现为广泛脑膜增厚伴明显均匀强化.椎管内病变4例:其中胸腰椎左侧椎旁软组织肿块2例,侵犯椎管内,伴邻近肋骨骨质破坏1例;椎管内肿块1例,表现为胸椎管后方梭形T1WI等高信号,T2WI等低信号灶,无明显强化;胸髓信号异常1例,表现为胸髓条状T2WI及液体衰减反转恢复(FLAIR)序列高信号影.结论 成人CNSCL影像表现多种多样,CT与MRI对该病的诊断价值相辅相成;白血病患者疑脑内病变者,建议常规使用SWI检查,以尽早发现脑微出血,降低脑内血肿发生的风险.

Abstract：

Objective To evaluate the CT and MRI findings and their diagnostic value of central nervous system complications of leukemia (CNSCL). Methods The CT and MRI findings of 18 adult patients with CNSCL proved by clinical features or pathology were retrospectively analyzed. Among 18 cases,7 were acute lymphocytic leukemia, 10 acute non-lymphocytic leukemia and 1 chronic myelomonocytic leukemia. Eleven cases underwent plain CT scan with one of them also receiving contrast-enhanced CT scan enhancement, 16 cases underwent plain MR scan with 11 of them receiving contrast-enhanced MR scan.Results Intracranial lesions in 14 cases: (1)intracranial hemorrhage was found in 7 cases, including intracerebral hematoma in 4 cases, micro-haemorrhage in 2 cases, and intracerebral hematoma accompanying by multiple intracerebral micro-haemorrhage foci in 1 case. All cases with intracerebral hematoma showed multiple lesions, which demonstrated high-density on CT images, and low or mixed signal on T1 WI, high- or intermediate signal with low-signal rim on T2 WI and ring enhancement or no evident enhancement. Microhaemorrhage manifested as multiple mini-mottling and strip hypointense foci on susceptibility weighted imaging, on which the detection rate of micro-haemorrhage foci was much higher than that on CT and other sequences of MRI. Among the 7 cases, one also had cerebral infarction and one subarachnoid hemorrhage.(2) Intracranial mass was found in 5 cases, among which two appeared as masses under or bestride cranium in the left frontal region with hypointensity on T1 WI, mixed signal on T2WI, strong homogeneous enhancement and dural tail sign;one showed a mass in saddle area, with high density on CT, slightly low signal on T1WI, high signal on T2WI and heterogeneous enhancement; one case displayed a mass near lateral ventricle with iso-intensity on T1 WI and T2WI and strong homogeneous enhancement; and one case manifested as cystic mass in the left fronto-apical lobe, with thick wall and ring enhancement (3)Obstructive hydrocephalus was found in 1 case, manifesting dilation of ventricles above the aquaeductus mesencephali. (4) Meningopathy was found in 1 case, manifesting diffuse thickening of meninges with strong homogeneous enhancement on MRI. Pathological changes of spinal canal was found in 4 cases among which two showed para-spinal mass involving vertebral canal and causing bone destruction of adjacent ribs; one case showed fusiform mass posterior to vertebral canal with high and intermediate signal on T1 WI and low and iso-signal on T2WI without enhancement; one showed zonale leison in thoracic cord with high signal on T2WI and fluid attenuated inversion recovery. Conclusion The radiologic manifestations of adult CNSCL are various and the role of CT and MRI for the diagnosis of CNSCL may complement each other. SWI is suggested as routine examination for patients of leukemia, in whom intracerebral lesions were suspected in order to find micro-haemorrhage as early as possible and reduce the risk of intracerebral hematoma occurrence.     

湿热敷配合海普林软膏涂搽保护血透血管效果观察

目的 保护血液透析患者直接动静脉穿刺(直穿)血管,减轻患者痛苦.方法 将46例维持性血液透析直穿血管患者随机分为观察组与对照组各23例.对照组患者透析后24 h,直穿局部进行湿热敷.观察组患者在湿热敷基础上将海普林软膏涂搽直穿局部,并辅以按摩.结果 观察组血管弹性、血流量显著优于对照组(均P＜0.05),穿刺局部并发症发生率显著低于对照组(P＜0.05).结论 湿热敷配合海普林软膏涂搽穿刺局部对直穿血管有较强保护作用.     

彩超诊断子宫直肠陷凹积液300例分析

目的探讨彩超诊断子宫直肠陷凹积液的临床价值。方法我院自2007年10月～2009年3月采用TOSHIBA-7000、TOSHIBA-Xario型超声显像仪,检查诊断子宫直肠陷凹积液300例,分析病理性子宫直肠陷凹积液及生理性子宫直肠陷凹积液的超声声像图特点。结果 300例子宫直肠陷凹有积液者与疾病有关的264例,占88.0%。病理性子宫直肠陷凹积液98例,生理性子宫直肠陷凹积液202例。结论彩超诊断子宫直肠陷凹积液具有直观、方便、无损伤的优点,同时结合病史、临床资料及其他相关检查或动态随访,对明确子宫直肠陷凹积液的诊断具有重要的临床诊断价值。     

住院糖尿病患者的健康教育

HEALTHY EDUCATION METHOD The subject is population and population guide is performed.Healthy education was given to patients every week and prevention, treatment nutrient,parmacy and notice items of DM were instructed to the patients.Through blackboard,wallpaper,prevention manual of DM, the patients were told to control blood glucose by adjusting diet.Education direction were aimed at individuals.According to conditions,educational levels,sex,age and familial status,the nurses communicated with the patients and carefully answer their questions to receive confidence,understanding and support and promote confidence of defeat diseases.     

睾丸鞘膜腔结石的超声表现

睾丸鞘膜腔结石较罕见,文献报道较少,仅凭症状、体征临床难以诊断。现将我院十余年经手术证实的l1例睾丸鞘膜腔结石的声像图资料分析报告如下。     

注射用头孢匹胺钠与川威注射液存在配伍禁忌

注射用头孢匹胺钠(国药准字H20054491,山东罗欣药业股份有限公司生产,商品名罗航)为白色或类白色疏松块状物,每瓶0.5g;川威注射液(国药准字H20040356,天津红日药业股份有限公司生产,商品名法舒地尔)为无色或几乎无色的澄明液体,每支2ml(30mg)。配药前查阅了厂方提供的说明书,未提及上述两种药品有配伍禁忌。但在临床工作中发现,注射用头孢匹胺钠续接川威注射液时,滴壶内瞬间出现白色混浊物,立即停止输液并更换输液器,告知医生,以0.9%生理盐水间隔静脉滴注后,再输入川威注射液,未发生不良反应。为证实两种药物的配伍禁忌,我们进行了实验观察:将注射用头孢匹胺钠0.5g溶于5ml0.9%生理盐水,用5ml注射器抽取注射用头孢匹胺钠1ml,再抽取川威注射液1ml,使两者充分混合,随即出现白色混浊物。实践证明头孢匹胺钠与川威注射液存在配伍禁忌,并且与药物的浓度无关。提示如需联合用药时,两种药物之间应使用其他液体间隔输注或用生理盐水进行冲管,以防发生配伍反应。注射用头孢匹胺钠与川威注射液存在配伍禁忌@贾学仟$哈尔滨医科大学附属第一临床医学院脑外科二病房!哈尔滨150001 @程丽欣$哈尔滨医科大学附属第一...     

针灸治疗产后尿潴留24例报告分析

2003年6月~2005年6月,我院采用针灸治疗产后尿潴留24例,效果满意。现报告如下。1临床资料本组24例,均为产后尿潴留经其他诱导排尿失败者。患者仰位、半屈膝位,使腹部放松,用28号2寸毫针直刺中极、关元、阳陵泉、足三里、三阴交等穴位。手法用补法,腹部穴位刺激要轻,肢体部位刺激要重,得气后留针20min,下肢部穴位针刺配艾条灸,以患者皮肤潮红,感到热气入腹内为度,1根/次。2结果参照《中华人民共和国中医药行业标准》制定的疗效标准,治愈:小便通畅,症状体征消失;好转:症状和体征改善;无效:症状无变化。本组治愈23例,好转1例。产后尿潴留多因难…     

胰腺原发性恶性纤维组织细胞瘤CT和MRI表现一例

患者男,76岁.体重下降半年,体检B超发现胰腺占位性病变.体检:中腹部可触及一个9.0 cm×10.0 cm的质硬肿块,活动度差,无明显压痛.实验室检查未发现明显异常.