极重度骨髓型和肠型急性放射病合并真菌感染的临床治疗

目的研究探讨极重度骨髓型放射病和肠型放射病合并真菌感染的诊治经验。方法2004年10月24日收治极重度骨髓型放射病和肠型放射病两例患者，行HIA相合及半相合造血干细胞移植成功并顺利恢复造血。病程中2例均反复并发严重的多部位、多种类真菌感染。结果采用联合抗真菌治疗及对症支持，病例A效果不好，病例B真菌明显控制，但2例最终死于急性放射病、严重感染及多脏器衰竭。结论真菌感染是放射病严重的合并症，多药联合抗真菌治疗放射病合并严重真菌感染，治疗有效，未见明显毒性增加，值得借鉴。     

极重度骨髓型与肠型急性放射病的救治进展

极重度骨髓型与肠型急性放射病(ARS)一直是医学难以攻克的热点问题。本文从4个方面概括ARS治疗的新进展:①WR-2721作为细胞防护剂的机制和早期应用,可能阻断组织器官的不可逆性放射损伤;②细胞因子治疗放射病的新进展,提出重视造血恢复后患者的免疫重建;③造血干细胞移植的适应证,骨髓间充质干细胞对放射病有重要治疗意义;④放射病的抗感染防护和治疗,临床真菌感染症状出现前,抗真菌用药的适应证。     

异基因外周血造血干细胞移植治疗极重度骨髓型和肠型急性放射病的临床报告

目的 探讨异基因外周血造血干细胞移植在肠型和极重度骨髓型放射病救治中的作用和地位.方法 山东"10·21" 60Co 辐射事故中2例病人受到意外照射,病例A受照射剂量20～25Gy,诊断为"肠型放射病",病例B受照射剂量9～15Gy,诊断为"极重度骨髓型放射病".经联合环磷酰胺、抗淋巴细胞球蛋白和氟达拉滨预处理,2例分别行HLA半相合及全相合外周血造血干细胞移植.采用环孢霉素A和骁悉方案(病例A加用CD25单抗和供者间充质干细胞)预防移植物抗宿主病(GVHD).结果 2例均移植成功,供体完全存活,移植后9～11天白细胞开始恢复,2周后白细胞恢复正常、骨髓造血重建成功.2例均未发生移植排斥和GVHD.病例A照射后33天死于败血症和多器官功能衰竭.病例B照射后75天死于心衰为主的多器官功能衰竭.结论 HLA相合及半相合外周血造血干细胞移植救治极重度骨髓型和肠型急性放射病是完全可能和可行的,联合免疫抑制剂预处理对促进供体稳定植入是必要的,环孢霉素A、骁悉和CD25单抗及供者间充质干细胞对预防GVHD有重要作用.     

山东"10·21"辐射事故2例急性放射病患者超敏C-反应蛋白的测定及临床意义

目的 观察血清超敏-C反应蛋白(hs-CRP)在急性放射病患者中的的变化及其临床意义.方法 2例病人分别被诊断为极重度急性骨髓性放射病(病例B)和肠型急性放射病(病例A).hs-CRP采用比浊法全自动定量测定.结果 hs-CRP升高贯穿于2例患者疾病的全过程,患者出现严重细菌感染时hs-CRP均快速、大幅度升高升高,但当有效治疗后sCRP会快速下降.病例A共有3个hs-CRP高峰期,其hs-CRP最高升至188.8mg/L.病例B有4个hs-CRP高峰期,hs-CRP最高达377.2mg/L.此外,病人合并脏器功能损伤和严重的皮肤组织损伤时hs-CRP也会轻度升高,但幅度较小较轻.结论 hs-CRP对判断急性放射病患者合并细菌感染及判断其感染轻重和治疗效果有重要意义,感染越重sCRP升高越明显,但放射损伤等也会有hs-CRP轻度升高.     

中子辐射致骨髓损伤及治疗研究进展

中子相对生物效应较高,能对机体产生十分严重的损伤.骨髓是中子辐射高度敏感的器官,低剂量中子照射即可对骨髓造成严重的辐射损伤,产生骨髓型急性放射病,出现外周血血象改变、造血细胞和骨髓基质细胞损伤等一系列改变.中子辐射致骨髓损伤治疗的难度大,以综合对症治疗为基础,细胞因子的适时应用及对极重度中子骨髓型放射病则实施造血干细胞移植.     

深低温保存造血干细胞移植治疗急性放射损伤

极重度骨髓型和部分肠型急性放射病,用一般抗辐射药物加综合治疗难以奏效。近年来,国内外普遍重视造血干细胞移植的研究。这对加速造血功能的恢复和免疫系统的重建是一项关键性治疗措施,造血干细胞来源已经从单纯骨髓中采集,发展为从外周血和胚胎肝中获取的三条途径。从新鲜造血干细胞移植发展为冰冻保存造血干细胞移植治疗急性放射损伤。     

一例极重度骨髓型急性放射病的临床救治

目的通过对山东济宁“10．21”^60Co源辐射事故病例B的诊治经过的回顾，积累资料，总结经验。方法剂量估算采用染色体畸变及微核分析、物理模拟、电子自旋共振（ESR）测量并结合尸检病理。临床诊断根据受照剂量、临床过程及实验室结果进行综合分析。治疗上给予全环境保护，HLA相合的异基因外周血造血干细胞移植（PBSCT），积极抗感染及对症支持洽疗，维护脏器功能。结果病例B诊断为极重度骨髓型急性放射病，受照后7d进行了HLA完全相合的PBSCT，移植后9d三系造血逐步恢复，并获持续稳定的完全供者型植入，无移植排斥及移植物抗宿主病（GVHD）发生。由于病人的放射损伤继续发展，并逐渐发生严重肺部混合感染，心功能不全，照后45d行气管切开、呼吸机辅助呼吸，75d发生多脏器功能衰竭死亡。结论极重度骨髓型放射病应尽早分类诊断及实施全环境保护，可经异基因PBSCT使造血重建，为延长存活奠定基础。需加强抗感染及多脏器维护；促进免疫重建及组织损伤修复是今后极重度骨髓型急性放射损伤研究的难点及重点。     

一例多部位急性极重度放射损伤伴全身放射病的救治

一例多部位急性极重度放射损伤伴全身放射病的救治孙向黎杨文峰杨志祥刘如辉朱家凌１９９６年１月７日，我院收治了１例受１９２Ｉｒ放射源大剂量极不均匀外照射所致双下肢、双手及前臂的重度放射损伤伴全身中度骨髓型急性放射病。现将临床救治报告如下：１临床治疗１．１...     

山东济宁60Co辐射事故受照人员的临床救治

目的总结和探索肠型放射病和极重度骨髓型放射病临床诊治经验。方法中国山东济宁^60Co辐射事故中2例病人受到意外照射。综合估算，病例A受照剂量20～25Gy，诊断为“肠型放射病”；病例B受照剂量9～15Gy，诊断为“极重度骨髓型放射病”。经联合预处理，2例分别行单倍体和HLA相合外周血造血干细胞移植。结果2例患者均移植成功，供体完全植活，三系血细胞和骨髓造血重建成功，均无移植排斥和移植物抗宿主病。病例A于照后33d（d33）死于败血症和多脏器功能衰竭，病例B于d75死于心衰为主的多脏器功能衰竭。结论骨髓和外周血染色体及牙齿ESR检查等对超大剂量放射病诊断有重要价值。HLA相合及半相合外周造血干细胞移植救治急性放射病是完全可能和可行的。感染和多脏器功能衰竭仍然是病人的主要死亡原因。应加强对促进辐射损伤修复和多脏器功能衰竭的救治研究。     

自身外周血干细胞移植对1000拉德照射狗的疗效观察

现有资料表明,重度和重度以下的骨髓型急性放射病,应用对症综合支持疗法或伍用现有的抗放药物可使多数患者治愈。然而极重度骨髓型或轻度肠型放射病则只有在对症综合治疗的基础上移植造血干细胞,才能取得满意效果,这说明造血干细胞移植在放射病治疗中占有重要的地位。造血干细胞主要存在于哺乳动物胚胎时期的肝脏中和成年期的骨髓中。1962年Good-man等发现哺乳动物外周血中也存在着具有     

巨淋巴结增生（附五例分析）

目的：探讨巨淋巴结增生的X线及CT诊断。材料和方法：5例（8个病灶）经手术及病理证实巨淋巴结增生，3个病灶有正侧位胸片，1个病灶有副鼻窦瓦氏位及柯氏位片。8个病灶均有CT扫描（其中平扫2个，直接增强扫描5个，平扫加增强扫描1个）。结果：胸片检查3个病灶，椭圆形肿块2个，类似胸腔大量积液1个。CT扫描8个病灶，椭圆形肿块7个，类圆形肿块1个。8个病灶边界锐利，密度均匀。6个病灶显著强化。结论：呈良性肿瘤表现且显著强化是巨淋巴结增生CT特点，CT检查对其诊断有一定价值。     

糖尿病性骨病：附37例分析

This paper reported the result of clinicoradiologic analysis of 37 patients with diabetic osteopathy. The site of predilection was the bony ends of the extremities, especially the foot (91.9%). The main clinical manifestation was the presence of a non-healing chronic ulcer, whereas diabetic gangrene of bone constituted the chief x-ray finding, which was characterized by osteolytic destruction at the bony ends of metatarsals and phalanges, with minimal periosteous reaction if any. The bony articular surfaces were usually preserved. The chief distinction to be made is osteomyelitis. The mechanism of diabetic osteopathy is most probably systemic metabolic disorders resulted from disturbance of carbohydrate metabolism with secondary neurovascular changes. Infection probably plays the role of enhancing effect in gangrene of bone.     

Heterotaxy syndrome (polysplenia) in an adult

We present the case of a 63-year-old woman with heterotaxy syndrome and polysplenia who presented with clinical signs and symptoms of recurrent acute pancreatitis in which the biliary origin had been seen in the most recent episode. This syndrome is rare in adult patients because it is associated with congenital heart defects. It is important to know the visceral anomalies that are common in this syndrome to avoid confusing them with pathological processes.     

动脉DSA在颅内病变诊断中的价值：附600例动脉DSA分析

Intracranial vessels were evaluated in 600 patients with IADSA. Among them, 100 cases were studied with both conventional angiography and IADSA. The advantages of IADSA are: (1) Good image quality; (2) Examination time shortened; (3) Very useful for interventional neuroradiology, hence it can replace conventional cerebral angiography for preoperative evaluation in most cases.     

Using diplopia as a warning of an inappropriate visual (ocular) accommodative response (WIVAR)

BACKGROUND: Over-accommodation, a tendency to focus at a distance closer than the desired distance, has been previously shown to occur when using a head-up display (HUD). METHODS: A simple system was developed as a warning of an inappropriate visual accommodative response (WIVAR) during flight training. Two lines, which are seen as four low-contrast lines (physiological diplopia) if the user is focused in the distance due to the link between convergence and accommodation, are projected onto the pilot's HUD combiner. RESULTS: The results show that by using the WIVAR system the accommodative response can be kept more distant when viewing forward-looking infra-red imagery (by 0.12 +/- 0.04 D; p < 0.05), performing a high cognitive workload task (by 0.07 +/- 0.03 D; p < 0.05) and especially when viewing in a Ganzfeld (by 0.41 +/- 0.12 D; p < 0.01). CONCLUSION: While collimated HUD imagery stimulates the user to a more distant focus, the use of the WIVAR lines can cause additional relaxation of accommodation.     

MRI of focal nodular hyperplasia (FNH) with gadobenate dimeglumine (Gd-BOPTA) and SPIO (ferumoxides): an intra-individual comparison

PURPOSE: To compare the efficacy of two different MR contrast agents for the detection and diagnosis of focal nodular hyperplasia (FNH). MATERIALS AND METHODS: Fifty patients with 83 FNH lesions detected on spiral CT were studied in two different MRI sessions with Gd-BOPTA (MultiHance) and ferumoxides (Endorem). MRI with Gd-BOPTA was performed precontrast (T1wGRE and T2wTSE sequences) and during the dynamic and late (1-3 hours) phases after injection (T1wGRE sequences only). MRI with ferumoxides (T1wGRE and T2wTSE sequences) was performed before and at least 30 minutes after injection. Hyper- or isointensity of FNH in the late phase was considered typical for Gd-BOPTA, while isointensity or lesion hypointensity was considered typical for ferumoxides. RESULTS: With Gd-BOPTA, 83 FNH lesions (100%) appeared hyperintense during the arterial phase of dynamic MRI. All but one lesion was iso- or slightly hyperintense in the portal-venous and equilibrium phases. In the late phase, 81 FNH lesions were hyper- or isointense to the surrounding parenchyma, with two lesions appearing slightly hypointense. With ferumoxides, a significant (P < 0.001) number (21/83, 25.3%) of FNH lesions (mean diameter = 16.8 +/- 6.6 mm) were not visible. Of the visible FNH lesions, 38/62 were slightly hyperintense, and 24/62 were isointense to the surrounding parenchyma on the T2wTSE images. On the T1wGRE images, 42/62 lesions were isointense, 19/62 were slightly hyperintense, and one lesion was slightly hypointense. Seventeen lesions in 12 patients with previous neoplasia were all detected after Gd-BOPTA administration, whereas only nine of these 17 lesions (52.9%) were detected after ferumoxide administration. Two of these nine lesions showed atypical enhancement features. CONCLUSION: Gd-BOPTA-enhanced MRI is significantly better than ferumoxide-enhanced MRI for the identification and characterization of FNH.