骨盆软骨肉瘤的影像学表现

[目的]探讨骨盆软骨肉瘤的影像学特点,提高影像诊断的准确性.[方法]回顾分析17例经病理证实骨盆软骨肉瘤的影像学资料,其中15例行DR(digital radiography)拍片,14例行CT检查,12例患者行MRI(magnetic resonance imaging)检查.[结果]15例DR检查中13例DR片清晰显示不规则骨质破坏,11例DR片清晰显示病灶内有大小不一钙化.14例CT表现骨质呈溶骨性或膨胀性破坏,周围不均匀密度软组织肿块,可见不规则钙化或骨化.12例MRI表现为骨质破坏,周围软组织肿块,边界不清;T1WI呈低信号,T2WI呈高、低混杂信号,脂肪抑制序列T2WI呈混杂高信号,增强扫描呈周边强化或分隔样强化.[结论]软骨肉瘤影像学特征表现为骨质不规则破坏,伴软组织肿块内钙化.DR、CT、MRI三者相结合有助于骨盆软骨肉瘤的诊断.     

MRI对腹膜后良性神经源性肿瘤的诊断价值

目的 探讨MRI常规T1WI、T2WI、弥散加权成像（DWI）结合增强扫描对腹膜后良性神经源性肿瘤的诊断价值。方法 回顾性研究34例腹膜后良性神经源性肿瘤的MRI常规T1WI、T2WI、DWI及增强表现,所有病变均经手术病理证实,包括神经鞘瘤15例,副神经节瘤11例,节细胞瘤8例。结果 神经鞘瘤、副神经节瘤、节细胞瘤患者发病年龄、肿瘤大小无统计学差异（P>0.05）,均易产生囊变,神经鞘瘤囊变多位于病灶中心,副神经节瘤囊变多位于病灶周边,神经鞘瘤出血明显多于其他两者（P<0.05）,神经鞘瘤及副神经节瘤呈类圆形或椭圆形,节细胞瘤在形态上呈不规则形;三种病例在DWI上均呈稍高信号,部分囊变出血呈混杂信号,DWI信号强度及ADC值差异无统计学意义（P>0.05）。副神经节瘤强化最明显,神经鞘瘤其次,节细胞瘤轻度强化。结论 MRI增强扫描对腹膜后良性神经源性肿瘤的鉴别诊断具有重要作用,常规T2WI及T1WI对病灶形态、大小显示较好,T2WI对显示囊变、T1WI对显示出血具有优势,DWI鉴别价值不高。     

肾上腺节细胞神经瘤的CT及MRI诊断

目的 总结分析肾上腺节细胞神经瘤的CT和MRI表现,提高对本病的认识.方法 回顾性分析经手术病理证实的5例肾上腺节细胞神经瘤患者的CT和MRI表现.3例患者行CT平扫及增强扫描,2例患者行MRI平扫及增强扫描.结果 5例病灶均为单发,位于右侧肾上腺者3例,左侧肾上腺者2例.病灶呈圆形、椭圆形或不规则形,边界清楚.CT平扫密度低于肌肉组织,增强扫描动脉期无明显强化,静脉期、延迟期呈轻度强化;2例肿块见条状、点状钙化.2例行MRI扫描的病例中,病灶T1WI呈低信号,T2WI呈高或稍高信号,增强扫描动脉期病灶无明显强化,静脉期、延迟期呈轻度强化.结论 CT、MRI能很好地显示肾上腺节细胞神经瘤的影像学特点,并能清晰显示病灶与周围组织结构的关系,有助于和肾上腺其他病变的鉴别.     

儿童节细胞神经瘤的CT及MRI表现

目的探讨儿童节细胞神经瘤的CT和MRI特点。方法回顾性分析23例经手术病理证实的节细胞神经瘤患儿的临床及影像学资料。23例患儿均接受CT平扫,其中早期增强扫描21例,延迟扫描9例;7例接受MR平扫,其中4例接受MR增强扫描。结果 23例节细胞神经瘤中,17例位于腹膜后,5例位于后纵隔,1例位于颈部。CT和MR显示所有病灶边缘清楚,呈椭圆形、梭形或半月形。CT平扫表现为较低密度,CT值范围22～38HU（中位数28HU）。肿瘤MR平扫T1WI表现为低信号,T2WI呈不均匀高信号;CT和MR增强后早期均无或轻度强化,延迟期呈显著强化。结论 CT平扫密度较低、MR T2WI不均匀高信号以及延迟期明显强化是儿童节细胞神经瘤的影像学特点。     

CT和MRI术前评估颞骨段面神经鞘瘤

目的探讨CT及MR检查术前评估颞骨段面神经鞘瘤的应用价值。方法回顾性分析9例经手术病理证实的颞骨段面神经鞘瘤的患者临床资料,9例患者均接受MR平扫及增强扫描,其中3例同时接受CT平扫及增强扫描。结果 9例面神经鞘瘤患者6例位于左侧,3例位于右侧,病变单独累及迷路段2例,鼓室段1例,乳突段1例;累及迷路段+鼓室段3例,鼓室段+乳突段2例。1例肿瘤与面神经可见分界,余8例均未见明显分界,2例可见乳突及外耳道软组织肿块。CT主要表现为面神经走形区边缘规则或不规则的软组织肿块,伴不同程度不规则或虫蚀状骨质破坏及面神经管增粗,部分可见骨质硬化;MRI表现为T1WI呈等信号,T2WI呈等或稍高信号的肿块影,增强扫描呈明显均匀或不均匀强化。结论 CT及MRI相互结合可准确地显示颞骨段面神经鞘瘤的位置和形态及周围情况,可作为面神经鞘瘤术前评估的首要检查方法。     

伴发副肿瘤天疱疮的腹盆部Castleman病MRI表现

目的分析伴发副肿瘤天疱疮的腹盆部Castelman病的临床特点及MRI表现。方法回顾经病理证实的5例伴发副肿瘤天疱疮的腹盆部Castelman病,分析肿瘤部位、形态、大小、数量、边缘、周围结构、平扫及动态增强扫描MRI特点。结果 5例腹盆部Castleman病均为透明血管型,4例位于腹膜后,1例位于右侧髂窝;均为单发肿块,呈卵圆形,边界清楚,T1WI为等或略低信号,T2WI为高信号。动态增强扫描的动脉晚期肿块呈中度强化(n=1)或高度强化(n=4);平衡期及延迟期均呈持续强化。1例动态增强扫描表现为均匀强化;4例不均匀强化;肿瘤内裂隙状或斑片状低信号区在平衡期及延迟期逐渐缩小或消失。结论 MRI对伴发副肿瘤天疱疮腹盆部Castelman病的检出及定性诊断具有重要价值。     

骨骼肌内黏液瘤的MRI与CT影像学表现及其诊断价值

目的:探讨骨骼肌内黏液瘤的MRI与CT影像学表现及其诊断价值。方法:将进行MRI检查的26例骨骼肌内黏液瘤患者(行增强扫描21例)设定为观察组,进行CT检查的16例患者设定为对照组,比较两组的检查准确率。结果:42例经手术病理证实13例为腓肠肌内黏液瘤,8例为腓骨长肌内黏液瘤,18例为股内侧内黏液瘤以及3例为肩胛舌骨肌内黏液瘤,两组病灶部位无差异。观察组MRI检查肌肉内有占位病变,T1WI信号低,T2WI信号高,脂肪抑制成像高,具有较为清楚的边界;21例MRI增强后病灶呈不均匀强化15例,病灶周围可见脂肪信号带,同时部分病灶周围肌肉内出现水肿信号;结节并厚壁强化4例,未出现明显强化2例。对照组肿瘤呈现低密度囊性肿块,增强后11例可见环形强化,内部不均匀强化。相较于对照组,观察组的诊断异常率明显更高。结论:MRI与CT对骨骼肌内黏液瘤均具有诊断价值,但MRI的诊断更为准确。     

椎管内髓外肿瘤的MRI定位定性诊断

目的:提高MRI对椎管内髓外肿瘤的诊断水平。方法:回顾性分析44例经手术病理或临床资料证实的椎管内髓外肿瘤患者的MRI表现。结果:(1)神经源性肿瘤T1WI多为低信号,T2WI多为高信号,信号多数均匀,部分囊变者信号不均,肿瘤多位于硬膜下,部分骑跨硬膜内外,呈哑铃形;(2)脊膜瘤T1WI和T2WI趋向等信号,大部信号均匀,强化明显,但强化程度不如神经源性肿瘤,可见脊膜尾征;(3)脂肪瘤的MRI信号具有特征性,多位于腰段硬膜下,部分伴脊髓拴系;(4)畸胎瘤信号混杂,增强扫描多不强化;(5)转移瘤多位于硬膜外,伴有椎体及附件的骨质破坏。结论:MRI对椎管内髓外肿瘤有较高的定位定性诊断价值。     

侵袭性纤维瘤病的MRI表现及其临床病理

目的 分析侵袭性纤维瘤病（AF）的临床、磁共振成像（MRI）表现及其病理,评价MRI在AF诊断及术前评估中的价值.方法 回顾性分析25例经手术及病理检查证实的AF的临床及MRI表现,并与手术、病理结果对照分析.结果 25例AF呈类圆形、梭形改变,其中21例瘤体边界不清,无包膜,向周围浸润生长;4例见不完整假包膜.肿块在T1WI上以等及稍高信号为主,在T2WI上以高信号为主,信号低于脂肪组织,夹杂斑片状及条状低信号区;少数病例信号均匀（4/25）.增强扫描病变呈不均匀强化21例,均匀强化4例,侵犯肌肉、邻近脂肪组织、血管神经束和邻近骨分别为20例、13例、12例和5例.肿瘤由不同比例增生活跃的成纤维细胞、纤维细胞和胶原纤维束组成,细胞无异型性.结论 AF有特征性的临床、MRI表现,MRI对提高AF的正确诊断率及术前评估具有重要作用.     

脑胶质肉瘤的MRI表现与病理对照分析

目的探讨脑胶质肉瘤(GS)的MRI表现及相关病理学基础。方法回顾性分析22例经手术病理证实为GS的患者临床、MR及病理检查资料。结果 20例发生于大脑凸面,2例发生于深部脑白质;16例肿块呈圆形或类圆形,6例呈不规则形。22例肿瘤MRI均表现为不均匀团块状异常信号;20例为囊实性,2例为实性。4例为GS合并出血。肿瘤T2WI 21例呈以稍高信号或高信号为主的混杂信号,1例呈等信号;T1WI 18例呈不均匀稍低信号,4例呈不均匀低信号。21例可见瘤周水肿,1例瘤周无水肿。增强扫描表现为不均匀厚壁环状或花环状明显强化17例,壁结节强化7例,瘤内栅栏状强化14例。GS病理表现主要为胶质母细胞瘤成分与肉瘤成分呈间隔交替存在或肉瘤将胶质母细胞瘤分隔呈岛屿状。结论脑胶质肉瘤多位于大脑凸面,呈厚壁环形或花环状强化、壁结节及栅栏状强化是其特征性MRI表现,确诊仍需依靠病理学检查。     

深圳市某两所小学流行性腮腺炎突发疫情的流行病学分析

目的：通过对深圳市某两所小学发生的流行性腮腺炎突发疫情的流行病学特点及差异性进行分析,为制定科学、高效的防控策略提供科学依据。方法2013年5～7月深圳市大鹏新区某两所小学爆发流行性腮腺炎,以学校为整体研究对象,分别标记为学校A（24个班,学生1210例）和学校B（27个班,学生1274例）,对比两所小学的疫情流行病学差异性。结果分析发现,学校A流行性腮腺炎发病率为4.30%,发病班级所占比54.17%,均较学校B1.73%和29.63%高,对比差异有统计学意义（P＜0.05）;分析显示学校A学生出现疫病平均年龄为（11.2±1.1）岁,较学校B（9.34±1.0）岁,对比差异明显（P＜0.05）;且两组疫病患儿在接种疫苗率对比上差异无统计学意义（P＞0.05）;但疫情发生时,学校B疫苗紧急接种率明显高于学校A,对比差异有统计学意义（P＜0.05）。结论小学作为流行性腮腺炎爆发的主要场所之一,疫病爆发高峰季节前,针对易感染人群给予相应的疫苗接种等预防控制措施,同时加强流行性腮腺炎的监测,对于降低感染人群数量,减轻、遏制疫情有着积极的意义,值得相关防控部门重视。     

主动脉窦瘤破裂外科治疗的临床研究

目的　探讨主动脉窦瘤破裂局部病理改变及其合并主动脉瓣关闭不全的手术方法。方法　 3 6例主动脉窦瘤破裂 (RASV)合并主动脉瓣关闭不全 (AI) 15例、室间隔缺损 (VSD) 2 6例。补片修补 3 5例 ,其中合并VSD的均以一片法修补 ,合并AI的主动脉瓣置换 (AVR) 6例 ,主动脉瓣成形 4例。手术取材作病理检查 5例。结果　本组 3 6例中手术死亡 2例 ( 5 .6% )。存活的 3 4例病人均经门诊复查或通信随访 0 .3～ 18年 ,其中 2例死亡。病理检查见RASV合并VSD的瘤壁为纤维素样坏死或玻璃样变性。结论　主动脉窦壁纤维素样或玻璃样变性可能是其形成的病理基础。合并主动脉瓣关闭不全时应探查其病变程度 ,酌情一期矫正 ,瓣膜损伤明显时宜行主动脉瓣置换 ,对主动脉瓣环细小的病例 ,可借修补VSD和RASV的补片扩大主动脉瓣环。     

不同方法重建指尖离断静脉回流的疗效分析

目的：探讨不同方法重建指尖离断静脉回流的疗效。方法：2008年3月-2013年2月收治指尖离断患者80例,38例吻合指侧方静脉重建回流,术中吻合动静脉比例1：1或1：2或2：2,平均1：2;22例吻合指腹静脉重建回流,术中吻合动静脉比例1：1;20例未吻合静脉,术中仅吻合1条动脉,行侧切口或甲床放血。观察各组治疗效果。结果：吻合指侧方静脉组手指全部成活,无一例发生回流障碍;吻合指腹静脉组19例发生静脉危象,其中4例手指坏死;未吻合静脉组20例均发生回流障碍,其中6例手指坏死。58例获随访,随访时间6~28个月。吻合指侧方静脉组32例,指尖外形佳、指腹饱满;吻合指腹静脉组14例,指体轻度萎缩,指甲生长不平整;未吻合静脉组12例,指体萎缩明显。吻合指侧方静脉组指甲生长近平整,长度长于其他两组[（14.4±3.2）mm比（12.5±2.3）mm和（12.2±2.2）mm],远侧指间关节活动度大于其他两组[（63±5）°比（48±3）°和（45±7）°],两点分辨觉小于其他两组[（4.6±0.4）mm比（7.1±1.2）mm和（7.3±0.6）mm],感觉级别高于其他两组[S（3.45±0.39）级比S（2.57±0.42）级和S（2.55±0.49）级],差异均具有显著性（P〈0.05）。吻合指腹静脉组和未吻合静脉组在指甲长度、运动和感觉方面差异无统计学意义（P〉0.05）。结论：吻合指侧方静脉能有效解决指尖再植静脉回流问题,可避免回流障碍,成活率高,促进指甲生长,可恢复 DIPJ 活动度及感觉。     

Frequency of complications of manipulation of the spine

Summary A survey of all members of the Swiss Medical Association of Manual Medicine was undertaken for the year 1989. Informative data were given by 425 respondents on the frequency of complications of manipulation as related to the spine. The number of thoraco-lumbar manipulations during 1989 (225 working days) was 805 for each respondent, and the number manipulations of the cervical spine 354. Thus, the total number of thoraco-lumbar manipulations was 342 125, and the total number of cervical manipulations was 150 450. The overall incidence of side-effects of transient complications due to cervical spine manipulation such as disturbance of consciousness or radicular signs was 1: 16716. Seventeen patients (ratio 1: 20 125) after manipulation of the lumbar spine presented, in addition to increased pain, a transient sensorimotor deficit with precise radicular distribution. Nine of the 17 patients (ratio 1: 38013) developed a progressive radicular syndrome with sensorimotor defict and radiologically verified disc herniation and had to be referred for surgery. Side effects and complications of cervical and lumbar spine manipulation are rare. Taking in to account the yearly number of manipulations performed by a single physician in Switzerland and the rate of complications, it can be calculated that a physician practicing manual medicine will encoutner one complication due to manipulation of the cervical spine in 47 years and one complication due to lumbar spine manipulation in 38 years of practice. However, it is important that a careful clinical assessment is carried out to avoid complications due to manipulation carried out on the basis of inappropriate indications. Furthermore, the decision as to which technique is indicated for any particular functional disorder of the spine should be made on the basis of rational criteria resting on a knowledge of clinical biomechanics, functional anatomy and neurophysiology. The authors recommend a prospective morbidity study to be carried out among physicians, chiropractors, osteopaths and physiotherapists, taking into account the different indications and therapeutic techniques in relation to complications.     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7–, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20–, MUC2–). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

静脉皮瓣成活过程的实验研究

我们以兔为实验动物，通过微循环观察及血管内灌注填充剂，研究静脉皮瓣的成活过程。这一过程可分为２个阶段。第一阶段（术后７２小时内）为静脉血营养期：静脉血由静脉干通过小静脉吻合支、微静脉干间吻合支及终末微静脉吻合支回流至另一静脉。术后４８小时内毛细血管内无血液运动。第二阶段（术后７２小时～６周）为动脉血营养及血管改造期：术后７２小时新生血管开始向皮瓣内生长。术后７２无皮瓣动脉同主要来自皮瓣周围正常组织内的新生血管吻合使动脉血分布于整个皮瓣，这是静脉皮瓣成活的关键     

Oddi括约肌肌电活动实验模型的建立

目的建立研究Oddi括约肌肌电活动的动物模型和实验方法。方法将双极金属钩状电极通过浆膜层置入Oddi括约肌，记录不同条件干预下家兔的Oddi括约肌肌电活动信号，调整电生理实验参数并经放大、滤波及计算机处理后，对其大小、波形、幅度进行分析。结果不同条件干预下的家兔Oddi括约肌的肌电活动在波形、频率、幅度等方面均有明显的不同，具有明显的规律性。重复实验可得到相似的结果。结论使用双极金属钩状电极配以合理的电生理实验参数调整可以稳定地采集到在体的家兔Oddi括约肌肌电活动信号。这为今后广泛、深入地研究Oddi括约肌肌电活动搭建了一个技术平台。     

骨盆骨折的治疗进展

对于骨盆骨折的治疗 ,传统方法以卧硬板床 ,股骨髁上持续骨牵引 ,骨盆兜等保守治疗为主 ,常常引起下肢不等长 ,骶髋痛 ,步态失常等而严重影响生活质量 ,同时长期卧床易引发肺部感染、褥疮、应激性溃疡、泌尿系统结石等并发症而危及生命。下面就骨盆骨折的治疗进展作一综述。1     

Management of sequelae of septic arthritis of hip

A nine years old boy, who had suffered septic arthritis at the age of two years and presented now with a limp, hip instability, leg length discrepancy. The patient was treated by adductor tenotomy and upper tibial pin traction. When head remnant reached the level of the acetabulum, open reduction and Pemberton osteotomy was done to achieve cover of the femoral head. The purpose of this report is to highlight the six years followup of reconstruction of sequale of septic arthritis of hip joint.     

Catamnestic study of childless patients of the Department of Andrology of Hamburg-Eppendorf University Hosptal

By means of a questionnaire, we carried out a catamnestic study of 1419 patients with a complaint of infertility. 27 per cent of the replying patients reported about the birth of children. 343 patients (38%) reported about one or more conceptions. Compared with previous studies, this investigation shows better results of therapies. We interprete this to be caused in better possibilities of therapy, esp. the Kallikrein therapy.