等密度硬膜下血肿的CT诊断(附47例分析)

本文分析了47例等密度硬膜下血肿的CT表现,观测的各种CT征象,发现(1)bolus增强扫描显示的血肿、血肿膜及表面移位血管;(2)中线结构的特征性偏移;(3)表面脑回聚拢内移;(4)脑灰白质界面内移;(5)侧脑室变形和脑—脑室指数变小,对等密度硬膜下血肿的诊断和鉴别诊断有重要意义。     

The biomechanics of vibration and low back pain

This work is a review of the mechanical factors related to low back pain production in a vibration environment. The sitting posture is an extreme orientation for the lumbar intervertebral disc that 1) increases its internal pressure, 2) increases its anteroposterior shear flexibility, while: 3) decreasing its resistance to buckling instability and 4) stressing the posterior region of the disc. Vibration is an additional mechanical stressor. Several studies suggest that the following preventive measures be taken to reduce the risk of low back pain due to driving: 1) minimize the vibration reaching the driver, 2) avoid lifting or bending immediately following driving, and 3) walk around for a few minutes following driving. © 1993 Wiley-Liss, Inc.     

Incremental Value of Three-Dimensional Echocardiography Over Transesophageal Multiplane Two-Dimensional Echocardiography in Qualitative and Quantitative Assessment of Cardiac Masses and Defects

In the present study, we compared three-dimensionally (3-D) reconstructed images with multiplane two-dimensional (2-D) transesophageal echocardiographic (TEE) images in 17 patients with various cardiac masses and defects. To overcome the problem of making measurements from 3-D reconstructed images, we carefully "dissected" the 3-D dataset using paraplane and anyplane 2-D sections, which were then used to obtain the maximum sizes of the cardiac masses and defects. Of the 15 vegetations and 9 abscesses detected by 3-D TEE in 7 patients, only 8 (53%) vegetations and 4 (44%) abscesses were detected by multiplane 2-D TEE (P < 0.02). Also, the exact anatomical location, shape, geometry, and extent of various cardiac masses and defects were more clearly delineated by 3-D than 2-D TEE. The maximum dimensions of cardiac masses and defects were larger by 3-D than by 2-D TEE in 17 (89%) of the 19 lesions available for comparison (P < 0.002). In addition, 3-D TEE correlated more closely than 2-D TEE when compared to surgical measurements in three patients in whom they were available. Thus, it would appear that in several instances, the exact size of the cardiac lesion could only be assessed by analysis of the 3-D volumetric dataset. Out preliminary study has demonstrated the superiority of transesophageal 3-D reconstruction over multiplane 2-D TEE in both qualitative and quantitative assessment of various cardiac mass lesions and pathological defects.     

Cardiac MIBG scintigraphy is a sensitive tool for detecting cardiac sympathetic denervation in Parkinson's disease.

[(123)I]Metaiodobenzylguanidine ([(123)I]MIBG) cardiac scintigraphy could be helpful to differentiate Parkinson's disease (PD) from multiple system atrophy (MSA), demonstrating that, in PD with autonomic failure but not in MSA, there is a myocardial postganglionic sympathetic dysfunction. To investigate whether this method is more sensitive than standard autonomic testing to detect early involvement of sympathetic cardiac efferent, we analyse MIBG myocardial uptake in 8 PD patients with normal autonomic testing (nondysautonomia PD group, NDPD) in comparison with 10 PD patients with abnormal autonomic testing (dysautonomia PD group, DPD) and 10 MSA patients. Global MIBG uptake was assessed using the ratio of [(123)I]MIBG uptake in the heart to the upper mediastinum (H/M) on planar scintigraphic data. Regional MIBG uptake was determined on two single photon emission tomography scans in regions of the left ventricle. The mean H/M ratios were significantly different among the three groups (P < 0.0001). H/M ratios of both NDPD and DPD patients groups (H/M = 1.83 +/- 0.50 and 1.24 +/- 0.40, respectively) were significantly lower than in MSA patients (H/M = 2.52 +/- 0.60). However, in NDPD patients, H/M was significantly higher than in DPD patients. When compared to MSA patients, NDPD patients showed a regional reduction in MIBG uptake in all left ventricle regions markedly in the apex and the inferior wall. Our results suggest that MIBG myocardial scintigraphy (analysis of both H/M ratio and regional MIBG uptake) may be more sensitive than standard autonomic testing for the early detection of silent autonomic dysfunction in PD.     

Left ventricular fibroma in an aged patient: Report of a case

We report herein the case of a 77-year-old man with a left ventricular tumor originating from the papillary muscle of the left ventricular wall, in whom a successful tumor resection with mitral valve replacement was performed. The pathological diagnosis of the tumor was confirmed as cardiac fibroma. His postoperative course was uneventful and he is currently well with no signs of recurrence 2 years after surgery.     

Hepatobiliary scintigraphy in a patient with bilhemia

A 4-year-old child referred for acute jaundice following percutaneous needle biopsy of the liver underwent hepatobiliary scintigraphy. Although all conventional liver tests suggested preservation of hepatocyte function, the tracer uptake in the liver appeared dramatically reduced at scintigraphy and the blood pool activity did not decrease significantly until the end of the study. Visualization of the bile ducts indicated, however, that the tracer was taken up by the hepatocyte and further excreted into the biliary tree. There was no tracer pooling in the biliary tree although no bowel activity was observed, even on delayed images. The association of persistent blood pool activity, bile duct visualization without tracer pooling, and nonvisualization of the bowel was caused by a continuous recirculation of the tracer from the biliary tree into the bloodstream. The presence of a biliovenous fistula was further proven by percutaneous transhepatic cholangiography performed 24 h later. Since 1975, only 16 cases of bilhemia have been reported. To the best of our knowledge the scintigraphic pattern of this rare but lifethreatening complication has not previously been reported.     

Comparison of Tympanic, Esophageal and Blood Temperatures during Mild Hypothermic Cardiopulmonary Bypass: A Study using an Infrared Emission Detection Tympanic Thermometer

Objective. Tympanic temperature can be obtained instantaneously using an infrared emission detection (IRED) thermometer. Its accuracy has been documented in a variety of clinical settings, but its performance at low body temperatures is still unknown. In this study we evaluated its performance during coronary artery revascularization surgery in which mild hypothermic cardiopulmonary bypass (CPB) was used. Methods. Thirty adult patients undergoing coronary artery bypass graft surgery were enrolled in the study. Tympanic temperature obtained using IRED thermometry (Tt1) was compared with core temperatures from the esophagus (Te), and venous blood of CPB (Tv) before, during, and after CPB. We also measured tympanic temperature using a thermocouple probe (Tt2) in 16 of the 30 patients in order to study the agreement between the two methods. Values for correlation coefficients and limits of agreement were computed to assess the degree of agreement among the temperatures obtained. Results. The highest agreement with Tv during CPB was obtained from Tt1 (r = 0.94, 0.41 ± 1.73, limits of agreement) and from Te (0.91, 0.36 ± 2.46). Tt1 also showed good agreement with Tt2 during surgery. Conclusions. Infrared tympanic thermometry is a reliable, alternative method to measure tympanic temperature and may be useful to assess core temperature in both normothermic and mild hypothermic conditions.