新生儿肺透明膜病及湿肺病的分类决策诊断

目的应用分类决策树(classification and regression tree,CART)算法构建胸片鉴别新生儿透明膜病及湿肺病的诊断模型,探讨多种临床及影像因素对肺透明膜病及湿肺病的诊断价值。方法病例为2008年1月～2010年12月间经过临床及影像证实的新生儿肺透明膜病43例、湿肺病48例。分别提取和上述两种疾病有关的6个临床指标和7个影像学指标作为CART预测新生儿肺透明膜病及湿肺病的变量。用CART建立两者鉴别诊断的分类决策模型,并通过交互验证方法计算该模型的诊断可靠性。同时比较高年资医师与CART诊断结果的一致性。结果建立的CART诊断模型共有九条诊断路径,能够比较可靠区分新生儿肺透明病及湿肺病;模型揭示对区分两者最具价值的X线征象是:支气管气像、孕周、毛玻璃样改变和水平裂的出现。另外,统计分析显示,CART模型和高年资医师对两种疾病诊断的一致性分别是中度一致(湿肺病,Kappa值为0.553)和较高度一致(肺透明膜病,Kappa值为0.628)。结论分类决策树算法可以应用于新生儿的肺透明病及湿肺病的鉴别诊断。     

不同胎龄早产儿肺透明膜病的X线征象特点

目的 提高对不同胎龄早产儿肺透明膜病的X线征象特征性的认识,增强早期诊断的能力.方法 回顾性分析40例早产儿肺透明膜病的患儿首次X线分级和患儿胎龄、发病时间、出生时体重与患儿临床预后关系.结果 患儿首次胸片Ⅳ级5例（死亡3例）,Ⅲ级15例（死亡1例）,Ⅱ级10例（死亡1例）,Ⅰ级10例.胎龄、出生体重均与首次胸片等级有差异（P =0.0119,P=0.0324）.X线分级与胎龄、体重、发病时间呈负相关,而与临床预后呈正相关.结论 X线摄影是临床诊断早产儿肺透明膜病的最重要的影像方法,应结合临床不断提高对HMD的早期诊断的能力.     

新生儿肺透明膜病的X线胸片与病理对照研究(附9例分析)

目的：通过对新生儿肺透明膜病的X线与病理对照研究，提高对该病X线征象的认识。方法：9例新生儿肺透明膜病患者均摄胸部正位及水平侧位X线片，井将其表现与尸检病理所见进行对照分析。结果：轻度2例，X线主要表现为两肺内中带有小颗粒和／或网状小结节影；中度3例，X线主要表现为细小颗粒状或网状小结节状影逐渐融合呈斑片状影;重度4例，两肺大片实变呈“白肺”状。结论：新生儿肺透明膜病的X线表现有其特征性，正确认识该病X线表现有助于早期诊断及治疗。     

新生儿肺透明膜病的多层螺旋CT与X线平片对照

目的 分析对比多层螺旋CT与X线平片在新生儿肺透明膜病中的诊断价值.方法 回顾性分析经临床确诊的26例新生儿肺透明膜病,对照其多层螺旋CT与X线平片表现.结果 CT阳性26例(100%),其中I级17例、II级0例、III级9例、IV级0例,X线平片阳性22例(85%),其中I级12例、II级2例、III级6例、IV级2例.CT显示肺部小颗粒状影、毛玻璃征、支气管充气征、气胸、肺出血和肺炎分别为26、26、15、5、4、 7例,X线平片分别为13、15、10、1、1、6 例.经过χ2检验,CT和X线平片在显示小颗粒状影、毛玻璃征、支气管充气征、肺出血、气胸方面,两者差异有统计学意义(P<0.05),CT较X线平片有优势,CT和X线平片在阳性率和显示肺炎方面,两者差异无统计学意义(P>0.05).结论 多层螺旋CT较X线平片对早期诊断新生儿肺透明膜病和显示病灶细节方面更具有价值.     

新生儿肺透明膜病的临床及X线诊断（附40例报告）

目的：研究新生儿肺透明膜病临床及X线诊断。40例患儿中，男28例，女12例，顺产19例，剖宫产21例，本组均为早产儿，病例中死亡18例。方法：对该40例患儿胸部表现进行分析，结果X线表现两肺透光度减低40例，合并颗粒状阴影22例，毛玻璃样改变合并支气管充气征越出心脏轮廓为35例，两肺普遍呈云絮状影—白肺8例。结论：X线胸片是诊断肺透明膜病的主要方法，能够做出早期诊断，并得到合理有效的治疗，减少病死率。     

支气管充气征在肺透明膜病中的临床价值

目的:探讨支气管充气征在新生儿肺透明膜病诊断中的临床价值.方法:回顾分析250例新生儿肺透明膜病的床旁及DR影像表现.结果:肺内支气管充气征197例(占78.8%),肺野透亮度降低240例,肺野内细颗粒状或网格状影133例,肺野磨破璃密度影89例,肺野致密呈"白肺"60例(占24.0%),其中DR片中91.4%(32/35)的"白肺"有支气管充气征,高于床旁片的28.0%(7/25),两者差异有统计学意义(χ2=25.79,P＜0.01).结论:支气管充气征是诊断新生儿肺透明膜病最可靠的征象."白肺"内支气管充气征是重度新生儿肺透明膜病的特征.     

肺透明膜病的动脉导管未闭:胸部 X 线表现

作者连续观察了45例有呼吸障碍的新生儿的连续胸片。19例为透明膜病、16例为其它病原的肺浸润、3例新生儿有短暂的呼吸急促,7例胸片上无病变。19例透明膜病中的10例和16例肺浸润中的1例,从临床和X 线上有动脉导管未闭的证据。3例经手术证实,2例尸检证实.在10例肺透明膜病婴儿的动脉导管未闭中8例由于肺衰竭而证实肺多血,发生在3—5天。另2例在提示肺多血前的3—5天,透明膜病已完全清晰。除肺多血外其它动脉导管未闭的征象包括:心     

新生儿肺透明膜病的X线诊断及固尔苏治疗后的影像学观察

目的探讨新生儿肺透明膜病（hyaline membrane disease,HMD）胸部X线表现和固尔苏治疗后X线征象的动态变化。方法对2例经临床和X线确诊并使用固尔苏治疗后痊愈的HMD进行回顾性分析。结果2例均摄一系列床旁胸部X线片。首次X线显示例1为两侧“白肺”及空气支气管征;例2为弥漫性网状、细颗粒状及斑片状影,肺野透亮度低、呈磨玻璃状,两下肺有支气管充气征。使用固尔苏治疗后,例1次日一侧肺恢复正常,5日后两侧肺均恢复正常。例2次日两侧肺恢复正常。结论支气管充气征是诊断新生儿肺透明膜病的典型的X线特征。固尔苏治疗前后系列胸部X线检查可及时观察肺内病变治疗后转归过程,对临床治疗和预后估计有重要意义。     

新生儿非典型气胸的X线诊断体会

随着辅助通气的广泛应用，使新生儿呼吸窘迫征群的生存率有了显著的提高，然而气胸的发生率也在逐年上升。床边胸片被列为新生儿监护病室(NICU)迅速确诊气胸首选的影像检查方法。X线检查往往采取仰卧位摄影，典型的气胸临床征象比较明显，气体分布于胸腔内肺的上外侧，可见透亮的气体影和肺压缩边缘，X线诊断并不困难。所谓非典型气胸，系指临床体征不十分明确，气体分布于肺的前方、内方、下方和其它不易发现的位置，以致产生一些特殊的X线表现。认识和熟悉这些征象对早期诊断、挽救患儿生命是非常重要的，现综述如下：     

新生儿肺透明膜病的计算机X线摄影表现与临床分析

目的探讨新生儿肺透明膜病（hyaline membrane disease,HMD）的计算机X线摄影（CR）表现、分级与临床多种因素的相关性。方法回顾性分析我院2009年7月至2011年1月经临床证实HMD198例患儿的X线表现及临床资料,根据其X线表现将其分为不同等级,比较X线等级与临床多种因素的相关性。进行统计学处理。结果198例中首次胸片正常5例,x线征象有：①肺野透亮度减低;②网粒状、结节状影,融合呈“白肺”;③支气管充气征;④心缘膈面模糊;⑤小泡状透亮影与气胸征、纵隔气肿征。按胸部X线表现最严重时分Ⅰ级91例,Ⅱ级52例,Ⅲ级37例,Ⅳ级18例。有并发症129例,其中〉12种并发症63例。死亡43例。出生体重、胎龄、宫内缺氧,出生窒息、32种并发症、死亡率各与X线分级比较存在显著性差异（均P〈0．01）。结论在现有分级中,可将首次检查为正常胸片归为0分级：胸部CR检查对HMD诊治及预后的判断具有重要价值。     

电子软性膀胱镜的临床应用(附379例报道)

目的总结电子软性膀胱镜的临床应用体会,探讨电子软性膀胱镜的临床应用价值。方法应用电子软性膀胱镜对379例患者进行膀胱镜检查、辅助操作及治疗。记录软性膀胱镜检查耗时、患者疼痛的视觉模拟评分(VAS)并调查满意程度。36例男性患者先后进行硬性及软性膀胱镜检查对比,并对两种膀胱镜检查后患者的疼痛评分及满意率进行统计分析。结果软镜检查共发现各种疾病223例。软镜检查用时7·80±0·27min,男性患者中位数疼痛评分为2·9分,在镜头经过尿道膜部时疼痛最剧烈,患者满意率为99%;女性患者中位数疼痛评分为1·3分,满意率为100%。36例先后进行硬性及软性膀胱镜检查的男性患者,行硬性膀胱镜检查时中位数疼痛评分为5·7(1·0～10·0)分,满意率为61·1%(22/36);软镜检查中位数疼痛评分为2·1(0·5～4·5),满意率为100%(36/36)。两种检查方式比较,疼痛评分差异有显著性(P<0·01)。应用软镜进行各种操作及治疗74例次均获成功。结论软性膀胱镜的优点突出,在泌尿系统疾病,特别是膀胱和尿道相关疾病的诊断和治疗中作用肯定,值得推广。     

Emerging roles for transthoracic ultrasonography in pulmonary diseases

As a result of many advantages such as the absence of radiation exposure, non-invasiveness, low cost, safety, and ready availability, transthoracic ultrasonography (TUS) represents an emerging and useful technique in the management of pleural and pulmonary diseases. In this second part of a comprehensive review that deals with the role of TUS in pleuropulmonary pathology, the normal findings, sonographic artifacts and morphology of the most important and frequent pulmonary diseases are described. In particular, the usefulness of TUS in diagnosing or raising suspicion of pneumonia, pulmonary embolism, atelectasis, diffuse parenchymal diseases, adult and newborn respiratory distress syndrome, lung cancer and lung metastases are discussed, as well as its role in guidance for diagnostic and therapeutic interventional procedures. Moreover, the preliminary data about the role of contrast enhanced ultrasonography in the study of pulmonary pleural-based lesions are also reported. Finally, the limits of TUS when compared with chest computed tomography are described, highlighting the inability of TUS to depict lesions that are not in contact with the pleura or are located under bony structures, poor visualization of the mediastinum, and the need for very experienced examiners to obtain reliable results.     

Emerging roles for transthoracic ultrasonography in pleuropulmonary pathology

As a result of many advantages, such as absence of radiation exposure, non-invasiveness, low cost, safety, and ready availability, transthoracic ultrasonography (TUS) represents an emerging and useful technique in the management of pleural and pulmonary diseases. In this first part of a comprehensive review dealing with the role of TUS in pleuropulmonary pathology, the examination technique, limits, normal findings, and sonographic artefacts and morphology of the most important and frequent pleural diseases are described. In particular, this first part deals with the capability of TUS in detecting pleural effusion and differentiating pleural fluid from pleural thickening; its usefulness in detecting pneumothorax on the basis of the changes in the artefacts detectable in the normally aerated lung and the appearance of pathologic artefacts; and its role in detecting pleural-based lesions and classifying them into extrapleural, pleural, and parenchymal lesions. Finally, the limits of TUS when compared with computed tomography of the chest are described, highlighting the inability of TUS to depict lesions that are not in contact with the pleura or are located under bony structures, poor visualization of the mediastinum, and the need for very experienced examiners to obtain reliable results.     

Nd∶YAG激光对牙体根尖封闭效应的初步研究

目的　探讨Nd∶YAG激光在牙髓病及根尖周病治疗方面的临床适用性。方法　应用连续Nd∶YAG激光对新鲜离体牙进行不同能量及方式的照射,结合微渗漏实验和扫描电镜分析,对激光照射后的牙体根尖封闭效应进行评估。结果　Nd∶YAG激光无论经根管外还是于根管内照射根尖孔,均可熔融玷污层和牙本质,形成栓塞物,封闭根尖孔。结论　Nd∶YAG激光对于促进根尖封闭有显著效果,为探讨牙髓病及根尖周病的新疗法提供了理论与实验依据。     

The value of computed tomography and ultrasound in cases of inflammatory aneurysms of the abdominal aorta

In a retrospective study 344 CT examinations of patients with suspected aneurysms of the abdominal aorta were evaluated with respect to the inflammatory character of the aneurysm. In 207 cases surgical therapy was conducted. In 144 of those 207 cases preoperative ultrasound examination results were also available. Frequency of inflammatory aneurysms, as classified by CT, was 10.2% (35/344) and in the subgroup of surgically treated aneurysms, 14.0% (29/207). Sensitivity and specifity of CT to realise the inflammatory type of aneurysm was 86.2% and 97.2%. The respective figures for ultrasound examinations on the basis of 144 surgically treated aneurysms were 26.1% and 100%. We conclude that even in cases of sonographically unequivocal abdominal aneurysms CT should be performed because ultrasound is not sufficiently sensitive to realise an inflammatory character of the aneurysm, which can have great impact on surgical strategy. Correspondence to: E. Rinast     

MRI不同序列在膝关节骨损伤中的应用

目的:评价自旋回波(SE)序列及梯度-短时反转回复(GE-STIR)序列对急性骨损伤的诊断价值.方法:回顾性分析50例膝关节外伤后行MRI检查的病例.所有病例均行SE序列矢状面T1WI及T2WI加权、GE-STIR序列矢状面扫描,分析不同序列显示骨挫伤的大小、范围、信号均匀性、边界以及伴随的半月板、软骨、韧带损伤及关节积液的表现,比较不同序列之间的差异.结果:50例病例中有45例显示有骨挫伤水肿,共有54处,其中6例伴有软骨损伤.伴有关节积液31例,半月板损伤23例,韧带损伤6例,其中前交叉韧带5列,外侧副韧带1例.在骨挫伤病例中,SE序列、T1WI显示43处,T2WI显示47处,GE-STIR序列显示54处.STIR序列在显示骨挫伤的大小、边界中敏感性均高于SE序列,两者之间差异有显著性意义(P＜0.05).在关节积液,半月板损伤、韧带损伤中,SE序列与GE-STIR序列比较,两者差异无显著性意义(P＞0.05).结论:GE-STIR序列在膝关节骨挫伤显示中有极大价值,明显优于SE序列.     

Imaging of diseases of the axial and peripheral skeleton

Musculoskeletal complaints are common in the elderly population. The main concerns in geriatric orthopedics are the increased incidence of trauma, degeneration, and malignancy, commonly compounded by comorbidities and the effects of ageing. Imaging of common and important diseases of the axial and peripheral skeleton in the elderly is reviewed in this article.     

一家系2例遗传性压迫易感性神经病报道

目的 报道一家系2例遗传性压迫易感性神经病(HNPP),以提高对本病的认识及诊断水平。方法 2例均行详细肌电图、运动及感觉神经传导速度、运动神经远端潜伏期测定。1例行腓肠神经活检,标本分别在光镜或电镜下观察。结果 例1临床表现为反复的压迫或牵拉后肢体无力和麻木。例2为例1父亲,临床无发病,查体有周围神经病表现。2例电生理检查示广泛性神经传导速度减慢,特别是周围神经嵌压部位运动传导速度减慢更明显,运动神经远端潜伏期延长,包括临床未受累的神经。腓肠神经活检电镜见大多数有髓纤维髓鞘增厚,有的髓鞘向轴索内突出,轴索未见异常。无葱皮样改变。无髓纤维未见显变。结论 神经电生理检查是诊断HNPP重要的筛选手段,确诊有赖于腓肠神经活检的典型病理表现。     

Reversible focal splenial lesions

Reversible focal lesions in the splenium of the corpus callosum (SCC) have recently been reported.They are circumscribed and located in the median aspect of the SCC. On MRI, they are hyperintense on T2-W and iso-hypointense on T1-W sequences, with no contrast enhancement. On DWI, SCC lesions are hyperintense with low ADC values, reflecting restricted diffusion due to cytotoxic edema. The common element is the disappearance of imaging abnormalities with time, including normalization of DWI. Clinical improvement is often reported. The most established and frequent causes of reversible focal lesions of the SCC are viral encephalitis, antiepileptic drug toxicity/withdrawal and hypoglycemic encephalopathy. Many other causes have been reported, including traumatic axonal injury. The similar clinical and imaging features suggest a common mechanism induced by different pathological events leading to the same results. Edema and diffusion restriction in focal reversible lesions of the SCC have been attributed to excitotoxic mechanisms that can result from different mechanisms; no unifying relationship has been found to explain all the pathologies associated with SCC lesions. In our opinion, the similar imaging, clinical and prognostic aspects of these lesions depend on a high vulnerability of the SCC to excitotoxic edema and are less dependent on the underlying pathology. In this review, the relevant literature concerning reversible focal lesions in the SCC is analyzed and hypotheses about their pathogenesis are proposed. This paper is one of a series of invited reviews.     

血液病腰椎骨髓的MRI鉴别诊断价值（附94例分析）

目的探讨血液和造血系统疾病的MRI鉴别诊断价值。方法选择经骨髓穿刺或活检证实的血液和造血系统疾病94例行MRI检查。全部病例均行腰骶椎矢状面T1WI和T2WI扫描。观察腰椎骨髓的MRI信号及形态改变,同时测量其T1值。结果38例急性白血病和8例地中海贫血T1WI均表现为均匀低信号,T2WI均匀等信号;平均T1值均延长,分别为（972.5±36.5）ms和(879.6±98.56)ms,两者间差异无显著性意义（q=1.52,P>0.05）。16例再生障碍性贫血T1WI4例呈均匀高信号,12例呈不均匀的高信号,T2WI14例呈等信号,平均T1值缩短,为（279.42±54.19）ms;3例急性造血功能停滞T1WI、T2WI均为等信号,平均T1值变化不明显,为（418.65±32.49）ms,两者平均T1值差异具有显著性意义（q=6.67,P<0.01）。20例多发性骨髓瘤15例有椎体骨质破坏及变形,呈多发斑片状病灶,T1WI呈不均匀低信号,T2WI呈不均匀高信号;3例骨髓异常增生综合征T1WI呈等或不均匀低信号,T2WI呈等信号;6例骨髓纤维化在T1WI和T2WI均表现为均匀低信号。结论（1）观察MRI信号改变可对急性白血病与再生障碍性贫血、多发性骨髓瘤、骨髓纤维化进行鉴别;（2）MRI比较容易区别临床难以鉴别诊断的再生障碍性贫血和急性造血功能停滞;（3）部分血液造血系统疾病的MRI鉴别诊断还需结合临床资料进行综合分析。