恶性胃间质肿瘤肝转移1例

患者男性，68岁。1989年6月22日行胃肿瘤切除术，病理报告为：胃壁大弯神经鞘瘤，低度恶性，淋巴结无转移（0／l）。术后未行其它治疗。1994年10月11日B超检查示：①肝内多发占位（最大位于左叶1053mmX91．lmm），考虑为转移癌合并液化坏死；②腹腔内肿大淋巴结；③少量腹水。中药治疗近1年，病情进展缓慢，B超、CT复查：肝内占位缓慢增大，于1995年8月15日死亡。临床诊断：恶性神经鞘瘤肝转移可能性大。病理检查尸检：呈高度恶病质，血性腹水约2500ml，肝脏体积明显增大，重约33509，表面可见多个结书状肿物，大者10cmX8cm，小者IcmXlc…     

中国汉族正常成人视束的高分辨率MRI测量

Objective To explore the morphological characteristics of optic tracts in healthy Chinese Han adults on the high-resolution MRI and fill the database of Chinese standard brain with morphological data of optic tracts.Methods Cerebral MRI scans with T1 WI 3D MPRAGE sequence of 1000 healthy Chinese volunteers from 15 hospitals were divided into five stages, ranging in age from 18 to 70.With the technique of multi-baseline, structure and morphology of optic tracts were displayed optimally on the images with multiplanar reconstruction.Data were measured as following: transverse distance of the cisternal optic tract (TD1) and peri-crural optic tract (TD2), length from the cisternal optic tract to the peri-crural optic tract (L) ,angle between optic tract(AOT) and height of optic tract from its first segment to plane of anterior commissure (H) including H1, H2, H3, H4 and HS.The measurements of optic tracts between sexualities and among age groups were compared by anasis of covariance; those among five age groups were compared pairwisedly by least significant difference analysis (LSD); and the differences of measurements between left and right optic tracts were analyzed using paired t test.Results (1) Comparisons of optic tract structures between male and female: the mean optic tract length of male [(11.69±1.45),(11.56±1.44) mm] was significant longer than that of female [(10.58±1.29),(10.40±1.34) mm] (F=22.236, 29.703, P=0.000); the mean H1 of male [(2.56±0.28),(2.60±0.29) mm] and female [(2.57±0.31 ), (2.63±0.32) mm] were significantly different ( F =11.130,7.805, P = 0.000, 0.005).No significant differences of the other measurements were found between male and female ( P > 0.05 ).(2) Comparisons among age groups: among 5 age groups, TD1 of both sides [left TD1 :(4.64±0.51 ), (4.64±0.57), (4.55±0.58), (4.39±0.53), (4.36±0.58)mm;right TD1 :(4.84±0.53) ,(4.80±0.60), (4.77±0.65), (4.60±0.59), (4.57±0.59) mm] and the right TD2[(3.33±0.45),(3.34±0.41),(3.33±0.36),(3.23±0.38),(3.23±0.39) mm] had statistical differences ( F = 3.458, 2.735, 4.711, P = 0.008,0.028, 0.001 ).The LSD analysis found that the 50 years old group was the watershed with significant differences ( P < 0.05 ).The results also showed that the L of both sides had statistical differences among 5 age groups ( F = 14.510,14.532, P = 0.000).The LSD analysis found that the 60 years old group was the watershed with significant differences (P <0.05).Left TD2 and the H1-H5 of both sides had no significant differences among age groups ( P >0.05).(3) Comparisons of the measurements between left and right optic tracts: TD1 of bilateral optic tracts were (4.52±0.57)and(4.72±0.60) mm respectively; H1 of bilateral optic tracts were (2.56±0.30)and (2.61±0.30) mm respectively; H2 of bilateral optic tracts were (2.66±0.30)and (2.70±0.30) mm respectively; and L of bilateral optic tracts were ( 11.14±1.47 ) and ( 10.98±1.50 )mm respectively.There were significant differences in these measurements between left and right optic tracts( t =12.460, - 6.013,5.595,4.784, P = 0.000 ), while there were no significant differences in TD2, H3, H4 and H5( P > 0.05 ).Conclusions With high-resolution MR1 and 3D reconstruction, optic tract can be displayed clearly and measured accurately.There are definite differences in anterior segments of optic tracts between sexualities, sides and among ages in normal Chinese Han adults, while the posterior segments of optic tracts keep stable.Normal reference values of optic tracts in Chinese Han adults are provided to clinical practices and scientific researches, which are valuable for building of Chinese standard brain.     

原发性开角型青光眼前视路形态变化及与视网膜神经纤维层厚度的关系

目的 探讨原发性开角型青光眼(POAG)患者视束、视交叉的形态变化特征,分析其与视网膜神经纤维层厚度(RNFLT)的关系。 方法 对37例POAG患者(POAG组)行全脑磁共振T1加权三维磁化强度预备快速梯度回波序列扫描,利用多基线、多平面重建技术显示视束、视交叉结构,测量视束脑池段横径(TD1)及高径(H1)、视束大脑脚周段横径(TD2)及高径(H2)、视交叉横径(OC-TD)、高径(OC-H)及前后径(APD)。以1000名健康志愿者作为对照组。采用两样本t检验比较两组各径线测量值,采用Pearson检验对POAG组各径线与RNFLT进行相关性分析。 结果 ①POAG组双侧TD1、H1、TD2、H2均小于对照组(P均＜0.05)。②POAG组OC-TD、OC-H小于对照组(P均＜0.05),而两组APD差异无统计学意义(P＞0.05)。③POAG组双侧TD1之和、H1之和、TD2之和及H2之和均与双眼RNFLT之和呈正相关性(r＝0.77、0.77、0.81、0.77,P均＜0.05)。④POAG组OC-TD、OC-H与双眼RNFLT之和呈正相关(r＝0.44、0.60,P均＜0.05),而APD与双眼RNFLT之和无相关性(r＝0.10,P＞0.05)。 结论 POAG患者视束、视交叉萎缩与视网膜神经纤维缺损有关。     

原发性脑淋巴瘤的CT、MRI诊断

目的:探讨原发性脑淋巴瘤的CT、MRI表现特征。材料和方法:回顾性分析9例经手术或穿刺并病理证实的原发性脑淋巴瘤的CT、MRI表现。结果:原发性脑淋巴瘤肿瘤呈单发6例、多发3例,幕上分布5例。病灶呈类圆形3例、不规则团片状6例。8例CT平扫呈高密度及混杂密度5例、低密度2例、等密度1例;5例增强扫描均匀增强3例,1例环形增强,1例未增强。CTA及DSA检查共4例,3例无异常血管征象,1例有少量肿瘤样血管。MRI平扫T1WI呈低信号5例、4例呈等信号,T2WI均呈高信号,增强扫描5例均匀增强4例。轻度至中度占位效应和瘤周水肿带,无钙化和出血征象。术后近期复查80%复发,复发水肿带加重。结论:原发性脑淋巴瘤CT和MRI有一定特征性,并可提示性诊断。     

左侧胸椎旁非何杰金氏淋巴瘤1例

1 病历简介 患者,男,28岁.因左背部包块伴明显疼痛20天入院.发病以来无发热、咳嗽、咯血.查体:浅表淋巴结不肿大,左背部肤色不红,扪及约鸡蛋及拳头大小包块质硬、压痛不明显,边界欠清,活动度稍差,余体查无异常发现.实验室检查:白细胞记数正常,中性粒细胞0.80,结核抗体实验阴性.胸部侧位片示左下胸椎背侧扁丘状块影突向胸腔,前缘光整,密度较均匀,后缘界限模糊(图1).正位为心影重叠.     

fMRI视网膜皮质映射图的测量及技术进展

fMRI视网膜皮质映射图技术的应用及发展仅约20年历史,但已获得了很多精确的人类视网膜皮质映射图,并在此基础上广泛开展了各功能分区间联系的研究,目前皮质功能的研究已深入到细胞群。就fMRI视网膜皮质映射图的应用价值、测量、技术进展及研究前沿予以综述。     

中国汉族正常成人视束的高分辨率MRI测量

Objective To explore the morphological characteristics of optic tracts in healthy Chinese Han adults on the high-resolution MRI and fill the database of Chinese standard brain with morphological data of optic tracts.Methods Cerebral MRI scans with T1 WI 3D MPRAGE sequence of 1000 healthy Chinese volunteers from 15 hospitals were divided into five stages, ranging in age from 18 to 70.With the technique of multi-baseline, structure and morphology of optic tracts were displayed optimally on the images with multiplanar reconstruction.Data were measured as following: transverse distance of the cisternal optic tract (TD1) and peri-crural optic tract (TD2), length from the cisternal optic tract to the peri-crural optic tract (L) ,angle between optic tract(AOT) and height of optic tract from its first segment to plane of anterior commissure (H) including H1, H2, H3, H4 and HS.The measurements of optic tracts between sexualities and among age groups were compared by anasis of covariance; those among five age groups were compared pairwisedly by least significant difference analysis (LSD); and the differences of measurements between left and right optic tracts were analyzed using paired t test.Results (1) Comparisons of optic tract structures between male and female: the mean optic tract length of male [(11.69±1.45),(11.56±1.44) mm] was significant longer than that of female [(10.58±1.29),(10.40±1.34) mm] (F=22.236, 29.703, P=0.000); the mean H1 of male [(2.56±0.28),(2.60±0.29) mm] and female [(2.57±0.31 ), (2.63±0.32) mm] were significantly different ( F =11.130,7.805, P = 0.000, 0.005).No significant differences of the other measurements were found between male and female ( P > 0.05 ).(2) Comparisons among age groups: among 5 age groups, TD1 of both sides [left TD1 :(4.64±0.51 ), (4.64±0.57), (4.55±0.58), (4.39±0.53), (4.36±0.58)mm;right TD1 :(4.84±0.53) ,(4.80±0.60), (4.77±0.65), (4.60±0.59), (4.57±0.59) mm] and the right TD2[(3.33±0.45),(3.34±0.41),(3.33±0.36),(3.23±0.38),(3.23±0.39) mm] had statistical differences ( F = 3.458, 2.735, 4.711, P = 0.008,0.028, 0.001 ).The LSD analysis found that the 50 years old group was the watershed with significant differences ( P < 0.05 ).The results also showed that the L of both sides had statistical differences among 5 age groups ( F = 14.510,14.532, P = 0.000).The LSD analysis found that the 60 years old group was the watershed with significant differences (P <0.05).Left TD2 and the H1-H5 of both sides had no significant differences among age groups ( P >0.05).(3) Comparisons of the measurements between left and right optic tracts: TD1 of bilateral optic tracts were (4.52±0.57)and(4.72±0.60) mm respectively; H1 of bilateral optic tracts were (2.56±0.30)and (2.61±0.30) mm respectively; H2 of bilateral optic tracts were (2.66±0.30)and (2.70±0.30) mm respectively; and L of bilateral optic tracts were ( 11.14±1.47 ) and ( 10.98±1.50 )mm respectively.There were significant differences in these measurements between left and right optic tracts( t =12.460, - 6.013,5.595,4.784, P = 0.000 ), while there were no significant differences in TD2, H3, H4 and H5( P > 0.05 ).Conclusions With high-resolution MR1 and 3D reconstruction, optic tract can be displayed clearly and measured accurately.There are definite differences in anterior segments of optic tracts between sexualities, sides and among ages in normal Chinese Han adults, while the posterior segments of optic tracts keep stable.Normal reference values of optic tracts in Chinese Han adults are provided to clinical practices and scientific researches, which are valuable for building of Chinese standard brain.     

异烟肼联合丁胺卡那氧气雾化治疗支气管内膜结核

目的：观察异烟肼0．05g,丁胺卡那0．1g,生理盐水20ml雾化吸人治疗支气管内膜结核的有效性。方法：88例支气管内膜结核住院患者分成治疗组和对照组。对照组给予全身化学治疗,治疗组在全身化学治疗的基础上给予雾化吸入治疗。结果：8个月后治疗组痰菌阴转44例（100％）,对照组痰菌阴转36例（81．8％）,两组差异有显著性;8个月后治疗组肺不张治愈率100％,明显高于对照组77．2％;治疗组胸片病灶有效率为95．2％,明显高于对照组68．2％。提示治疗组比对照组痰菌阴转率高,胸片病灶有效率及肺不张治愈率高,疗效较好。？支气管镜复查结果比较：治疗组经2个月强化期治疗,局部治疗,支气管病灶治愈率高,对照组经强化期治疗疗效仍不满意。结论：雾化吸人是支气管内膜结核的重要辅助治疗手段,早期配合雾化吸人治疗,疗效显著。支气管内膜结核在全身化学治疗基础上给予雾化吸人治疗支气管结核是一种安全有效、患者无痛苦,易于接受,疗效高,效果显著的治疗方法。     

血清免疫球蛋白测定的临床意义

免疫系统受抗原刺激后,B淋巴细胞转化为浆细胞,浆细胞分泌免疫蛋白(Ig)并释放入血液,使机体产生相对的抗原的体液免疫。抗体是指能与相应抗原特异性结合,并且有免疫功能的免疫球蛋白,但不是所有的免疫球蛋白都具有抗体活性,人体内含有5类Ig,即IgG、IgA、IgM、IgD、IgE     

20例慢性胃炎舌象观察及护理

舌诊是四诊中望诊的主要内容 ,是中医诊法的一个重要部分 ,它是通过对舌质、舌苔的观察以测知脏腑气血的病变 ,察舌辨证 ,辨证施护是中医护理学的一大特点 ,并体现了中医护理的主要内容。慢性胃炎为内科常见病之一 ,其病因主要是饮食不调、情志刺激、素体阳虚和复感外寒等因素而致胃气郁滞、失于和降。临床上慢性胃炎与舌质、舌苔的关系甚为密切 ,前人曰“苔为胃气之熏蒸也。”故观察舌象变化对慢性胃炎的护理尤为重要。本人在工作实践中观察了 2 0例慢性胃炎的舌象变化 ,以下是一点粗浅体会。1　临床资料2 0例患者中 ,男 14例 ,女 6例 ,年…