实验性脑脓肿影像学改变的病理基础研究

目的：明确不同时期动物脑脓肿的影像学特征及其相应的病理学改变。方法：制备脑脓肿狗动物模型１４只，采用ＣＴ、ＭＲＩ检查结合多项病理学观测进行动态分析。结果：脑炎期ＭＲＩ对炎症坏死区及水肿范围的显示较ＣＴ扫描更为清晰准确。包膜形成期：ＣＴ上脑脓肿包膜强化是炎症区血脑屏障破坏和新生血管形成所致；ＭＲＩＴ２加权成像上包膜的低信号“暗带”与包膜上的巨噬细胞堆积有关，延迟扫描和ＭＲＩ均能有效地区分脑脓肿的急性脑炎期和包膜形成期，但ＭＲＩ更加准确、迅速。结论：脑脓肿的ＭＲＩ特征与其临床分期及病理学变化的相关性较好，能更加准确、简便、迅速地区别脓肿的脑炎期和包膜形成期，可作为临床诊治脑脓肿的有力参考。     

持续皮下胰岛素输注和胰岛素每日多点注射治疗2型糖尿病的成本效果分析

Objective To observe the cost-effectiveness of using continuous subcutaneous insulin infusion (CS Ⅱ) and multi-point daily insulin injections (MDI) in controlling blood sugar in the newly hospitalized type 2 diabetes patients. Methods Retrospective analysis on 86 cases taking CS Ⅱ and 103 cases using MDI on a 'blood sugar control program' among the newly hospitalized patients with type 2 diabetes. The period for observation was 2 weeks, using cost-effectiveness analysis methods to evaluate the two treatment programs. Results After two weeks of treatment, the effectiveness in the control of blood sugar in CS Ⅱ group was similar to the MDI group, with no significant difference(P<0.05) and the adverse reactions were similar. Costs in the CS Ⅱ program (Yuan/person) was less than in the MDI program (1478.34 vs. 1620.46), with significant differences (P< 0.05). The cost-effectiveness ratios (C/E) were 15.07 in the CS Ⅱ group, and 16.34 in the MDI group, with no significant difference (P>0.05). In order to further reduce the cost of CS Ⅱ group as a reference, the incremental cost-effectiveness ratio (△C/ △E)ofthe MDI group was 129.20. Conclusion Costs-effective of the CS Ⅱ program was better than the MDI one in treating the newly hospitalized patients with type 2 diabetes, suggesting that CS Ⅱ program might be a better choice for hospitals to carry on an intensive insulin therapy program.     

Mammary tuberculosis: percutaneous treatment of a mammary tuberculous abscess

It is currently very rare to find mammary involvement in cases of tuberculosis, in either primary or secondary form. Diagnosis is classically clinical and microbiological, and the basic techniques used in imaging diagnosis are mammography and ultrasound. Computed tomography may define the involvement of the thoracic wall in those cases which present as mammary masses adhering to deep levels, and is also able to evaluate accompanying pulmonary disease, if it is present. Traditionally, treatment has consisted of quadrantectomy and specific antibiotic therapy. We present a case of tuberculous mammary abscess secondary to pulmonary disease, which was treated by percutaneous drainage controlled by CT and specific antibiotic therapy. We revise the diagnosis, differential diagnosis and treatment of mammary tuberculosis. Received: 27 July 1998; Revision received: 2 February 1999; Accepted: 20 April 1999     

Subarachnoid Haemorrhage as Initial Symptom of Multiple Brain Abscesses

The case of evolving multiple brain abscesses which became symptomatic with a sudden hemianopsia and the clinical and radiological signs of a subarachnoid haemorrhage, is reported. A common pathomechanism which could explain both the sudden focal neurological deficit and the subarachnoid bleeding is discussed.     

Hypereosinophilic Syndrome: CT Findings in Patients with Hepatic Lobar or Segmental Involvement

Objective

The purpose of this study was to describe the CT findings of hepatic hypereosinophilic syndrome in which hepatic lobes or segments were involved.

Materials and Methods

Seven patients with hypereosinophilic syndrome with hepatic lobar or segmental involvement were included in our study. In all seven, diagnosis was based on liver biopsy and the results of corticosteroid treatment. CT findings were retrospectively reviewed by three radiologists, who reached a consensus. Biopsy specimens were examined, with special reference to portal and periportal inflammation.

Results

CT demonstrated well-defined, homogeneous or heterogeneous low attenuation with a straight margin limited to a hepatic lobe (n = 2), segments (n = 3), or subsegments (n = 2), particularly during the portal phase. Where there was subsegmental involvement, lesions were multiple, ovoid or wedge-shaped, and showed low attenuation. In two patients with lobar or segmental involvement, segmental portal vein narrowing was observed. Histopathologic examination disclosed eosinophilic infiltration in the periportal area, sinusoids and central veins, as well as portal phlebitis.

Conclusion

Hypereosinophilic syndrome may involve the presence of hepatic lobar, segmental, or subsegmental low-attenuated lesions, as seen on CT images. Their presence may be related to damage of the liver parenchyma and to portal phlebitis.     

Salmonella enteritidis brain abscess: case report and review

Intracranial infections are unusual manifestations of salmonellosis. Even with adequate medical and surgical interventions these infections are often associated with significant morbidity and mortality. We report a case of brain abscess caused by Salmonella enteritidis associated with a brain neoplasm and review previous reports in the literature.     

早期手术治疗阑尾周围脓肿63例分析

目的 探讨阑尾周围脓肿早期手术的疗效。方法 对63例1990—2005年阑尾周围脓肿行早期阑尾切除，脓肿清除，肠粘连松解，回盲部修补和右半结肠切除术进行回顾性研究，分析其术中情况、手术方法、并发症以及治疗结果。结果 所有患者均在术后3周内痊愈出院，手术发生并发症10例，发生率15．87％。结论 阑尾周围脓肿早期手术切实可行。     

胰岛素泵在糖尿病酮症治疗中的应用

目的评价胰岛素泵连续皮下输注(CSII)和静脉连续胰岛素输注(CVII)在糖尿病酮症治疗中的疗效差异。方法120例糖尿病酮症患者分为两组,CSII组和CVII各60例,观察两组不同方法的治疗效果。结果两组治疗后血糖明显下降,尿酮体均能恢复正常,CSII组优于CVII组,差异有统计学意义(P<0 05);CSII组平均胰岛素用量为(42.5±6.3)U/d明显少于CVII组(57.8±6.6)U/d(P<0 05);CSII组尿酮体恢复正常所需时间为(18.5±5.9)h明显短于CVII组(39.8±8.4)h(P<0 01);CSII组低血糖发生率为(0.41±0.13)次/例,显著低于CVII组的(0.96±0.45)次/例(P<0 05)。两组均无死亡病例。结论CSII模拟胰岛素的生理分泌模式,能更快、更有效地纠正代谢紊乱,控制高血糖,提高生活质量。     

中西医结合治疗细菌性肝脓肿临床观察

目的：观察抗生素、厌氧治疗、局部穿刺引流合用中药“银鱼角消脓汤”治疗细菌性肝脓肿的疗效。方法：对临床诊断细菌性肝脓肿患者66例随机分为两组。治疗组44例用中西医结合治疗，对照组22例用单纯西医治疗。观察两组总有效率及体温复常、疼痛消失、血象复常、脓肿消失、住院时间五项临床指标。结果：治疗组总有效率95．5％，明显高于对照组的77．3％（P〈0．05），临床五项指标治疗组均优于对照组。结论：中西医结合治疗细菌性肝脓肿比单纯西医治疗更有效。