左乙拉西坦对癫痫患儿骨代谢与认知功能的影响

目的 研究左乙拉西坦对癫痫患儿骨代谢与认知功能的影响.方法 选取于我院接受过癫痫治疗的患儿68例,随机分为观察组和对照组各34例,观察组采取左乙拉西坦进行治疗,对照组的患者采取丙戊酸治疗对其治疗,分别对患者治疗前后的神经认知功能进行测评,同时对其骨代谢指标进行检查,并分析疗效情况及检测结果.结果 治疗后,观察组认知功能中的语言智商(VIQ)、操作智商(PIQ)及短时视觉记忆与对照组相比均有明显好转,两组相比差异具有统计学意义(P<0.05),另外观察组患者治疗后的复杂部分性发作、简单部分发作、强直阵挛发作、肌阵挛发作都要明显低于对照组患者的情况,两组差异具有统计学意义(P<0.05);且观察组治疗后的血磷离子、血钙离子、甲状腺激素、碱性磷酸酶与对照组相比具有统计学意义(P<0.05).结论 左乙拉西坦对患儿的骨代谢影响极小,且有助于提高患者的认知功能及改善患者的生活质量.     

多层螺旋CT结肠病变的诊断

目的 评价多层螺旋CT结肠成像技术的临床应用价值.方法 回顾性分析我院收治的经手术或结肠镜活检病理证实的20例结肠病变患者的影像学资料.16排MSCT对20例患者进行容积扫描和MPR、CTVC、SSD、Raysum等图像后处理.结果 20例中12例结肠癌、1例非霍奇金淋巴瘤、1例残胃癌累及横结肠,CT横断面、MPR、SSD、CTVC、Raysum图像均清晰显示.结肠息肉4例(共12枚),CT横断面显示7枚较大息肉,MPR、SSD、Raysum图像各显示10枚,CTVC清晰显示1 2枚.3例结肠炎症由CT横断面图像,结合MPR、CTVC而诊断.结论 在MSCT结肠成像检查时合理应用后处理技术,有助于结肠病变的诊断.     

胸膜孤立性纤维瘤CT影像表现(附两例报告)

目的提高对胸膜孤立性纤维瘤CT影像表现的认识。方法报告2例经手术病理证实的胸膜孤立性纤维瘤的CT影像表现,并复习文献。结果2例病变CT影像均表现为右侧胸腔巨大肿块,边界清楚呈分叶状,与胸壁间间隙清楚;密度不均匀,可见斑点状钙化;增强扫描动脉期显示肿块内较多肿瘤血管,实质期肿块不均匀强化呈"地图样";邻近肺组织受压不张,纵隔移位;右侧少量胸腔积液。其中一例伴有右侧第7后肋受压骨质吸收,第7/8肋间孔扩大,肿块向椎管内扩展。结论胸膜孤立性纤维瘤具有相对特征性的CT表现。CT在定位定性诊断方面有重要价值。     

16层螺旋CT对中央型肺癌支气管动脉成像技术的探讨

目的：探讨16层螺旋CT中央型肺癌支气管动脉血管成像技术。方法：对本院57例中央型肺癌（直径3-5cm）患者行16层MSCT胸部CT血管造影检查，其中实验组29例，采用对比剂示踪触发扫描技术（SureStart）；对照组28例，采用经验时间法，扫描延时为（25＋2）s。采集层厚1mm，螺距15，扫描速度0．5s／r。非离子型对比剂（300mgl／mL），注射剂量1．5mL／kg，注射速率4～5mL／s。支气管动脉三维重建后处理技术采用遮盖容积重建、多平面重建和曲面重建、最大密度投影重建。结果：实验组29例共显示支气管动脉93条，平均为3.21条／例；对照组28例共显示支气管动脉31条，平均为1．11条／例。经统计学分析，实验组与对照组的支气管动脉显示成功率及平均显示数目有显著差异（P〈0．05）。结论：16层MSCTA扫描是一种安全无损害，简便有效的支气管动脉显示方法；利用SureStart技术能更好地显示支气管动脉血管图像。     

小儿胸腺淋巴体质猝死1例

<正>患儿,女,2岁5个月。因发热12 h于22:20到本院急诊科就诊。家长诉患儿流涕2 d,发热6 h,轻微咳嗽,无呕吐、腹泻,亦无抽搐。患儿既往身体健康,无传染病接触史和变应史。体格检查:T 39.6℃,体质量14 kg。神清,皮肤黏膜未见皮疹,咽部充血,颈无抵抗。双肺呼吸音粗糙,心音有力,未闻及心脏杂音。血WBC 16.3×10~9/L。临床诊断:上呼吸道感染。拟收     

肺郎格汉斯细胞组织细胞增生症的HRCT影像表现及病理基础文献复习

目的提高对肺郎格汉斯细胞组织细胞增生症(PLCH)的高分辨CT(HRCT)影像表现的认识。方法回顾性分析9例PLCH患者的HRCT影像资料,结合文献分析其病理基础。结果 9例患者胸部HRCT均表现为星芒状结节、"空洞"结节、厚壁囊腔、薄壁囊腔及不规则形囊腔等五种形态病灶,间隔以正常肺组织,部分结节显示为长形结构。其中6例星芒状结节多见,6例厚壁囊腔多见,8例薄壁囊腔多见,4例不规则形囊腔多见,所有病例"空洞"结节少见。4例病灶多数分布于两侧中上肺,余5例两肺病灶广泛分布;其中3例两侧中上肺囊性病灶较多,而两下肺病变多为结节病灶;1例以两肺广泛结节病灶为主;1例以两肺广泛纤维化囊性病灶为主,且部分囊壁呈"火焰"状改变。8例患者两上肺可见大量薄壁囊腔病灶,其中7例出现自发性气胸。结论 HRCT可清晰显示PLCH病灶的形态及分布,且具有特征性的影像表现。正确理解PLCH病灶的病理基础有助于提高对该病HRCT影像表现的认识。     

沙市地区蚕豆病10例临床分析

蚕豆病是G—6PD缺陷症中最常见的一种临床类型。它起病急,主要表现为急性溶血、贫血。现将近2年来我院收治10例蚕豆病患儿总结如下。临床资料:本组男9例,女1例,年龄11个月～6岁,祖籍湖北,病源来自市郊农村,发病季节5、6月,为新鲜蚕豆上市季节;发病时间,食蚕豆6～48小时。主要临床症状:面色苍白10例,皮肤巩膜黄染6例,酱油色尿8例,浓茶色尿2例,发热3例,肝脾肿大5例,腹痛1例,少尿3例。     

西沙必利与吗叮啉治疗新生儿胃轻瘫的比较

目的：比较西沙必利和吗叮啉治疗新生儿胃轻瘫的疗效。方法：新生儿胃轻瘫78例随机分为2组各39例，分别经胃管注入西沙必利和吗叮啉各1mg/Kg，每日2次，3天1疗程。结果：西沙必利组临床有效率97%，吗叮啉组为69％（P＜0．05）。结论：西沙必利治疗新生儿胃轻瘫临床效果优于吗叮啉，是治疗新生儿胄轻瘫的首选药。     

双相气道正压无创机械通气时阻塞性睡眠呼吸暂停综合征患者上呼吸道影像分析

Objective Multislice spiral CT scanning was used for radiological imaging of upper airway under various ventilation in obstructive sleep apnea syndrome (OSAS) patients in order to study whether bi-level positive airway pressure (BiPAP) noninvasive mechanical vetilation can overcome upper airway resistance and provide effective ventilation under general anesthesia and non-spontenuous breathing.Methods Ten OSAS patients scheduled for uvulopalatopharyngoplasty were enrolled in the study. General anesthesia inducing sleep was routinely performed before operation. Computer tomography of cephal-neck in orthophofic and lateral position was performed under spontaneous respiration (lucid interval) , nonconsciousness after sleep induction (induction period), and noninvasively ventilation with BiPAP for 5 min (ventilation period). Narrowest transverse and anteroposterior diameters of transverse section, and correlative cross section areas over each soft tissue region of upper respiratory tract [retropalatal (RP) ,retroglossal (RG) and epiglottal (EPG) region] were tested. Noninvasive blood pressure (NIBP), oxygen saturation by pulse oximeter (SpO2) , heart rate (HR) and spontaneous respiratory rate (RR) during scanning were monitored. Results In orthophoric position, transverse diameter and anteroposterior diameter of RP and EPG regions shortened during anesthesia induction. Cross section area of all regions decreased during anesthesia induction [RP region: 0.00(0.00, 0.60) mm2 vs 38.34(10.57, 72.76) mm2, RG region:145.16(0.00, 183.72) mm2 vs 177.79(111.05, 216.27) mm2, EPG region: 39.02(7.55, 86.36) mm2 vs 154.69 (124.74, 322.00) mm2, all P＜0.05]. The diameters shortened and area decreased as well under BiPAP ventilation when comparing with those in spontaneous respiration (all P＞0.05) , however, no statistical significance was found when comparing with those in induction period (all P＞0.05). In lateral position, diameters and areas under BiPAP ventilation were smaller than those during spontaneous respiration except for transverse diameter of RG region[areas, BP region: 0.00(0.00, 18.74) mm2 vs 61.46(36.77, 141.46) mm2, RG region: 69.75 (35.74, 214.83) mm2 vs 287.68 (197.01, 393.18) mm2, EPG region: 17.28 (4.37, 65.45) mm2 vs 293.76(254.63, 374.83) mm2, all P＜0.05] The transverse diameter,anteroposterior diameter and transverse section area during BiPAP ventilation decreased also when comparing with those in spontaneous respiration, however, transverse section area increased significantly during induction period (all P＞0.05). Neither NIBP nor HR changed both in orthophoric and lateral position. RR at induction period was obviously inhibited and SpO2 decreased (all P＜0.05). Though RR and SpO2 during ventilation period improved as compared to induction period, however no statistical significance was observed (all P＞0.05), none of them returned to normal range (all P＜0.05). Conclusion The ventilation of upper airway is not smooth after sleep induction in OSAS patients, though their heads are in lateral postion. By BiPAP noninvasive ventilation, effective ventilation still can not be achieved since airway resistance is not relieved, so special handling is advised to ensure safety.     

肺原发性滑膜肉瘤的影像表现

肺门及纵隔淋巴结肿大;1例行MR/显示右上肺肿瘤在T1WI上呈等信号,T2WI呈高信号,增强后呈环状厚壁强化,肿瘤侵犯邻近胸壁、肋骨、椎体和附件,部分病变组织侵入椎管,浸润并包绕胸髓,椎管狭窄;PET-CT显示右上肺恶性肿瘤,标准摄取值(SUV)为12.3.免疫组织化学(简称免疫组化)结果 显示波形蛋白(Vim)、细胞角蛋白(CK)、上皮膜抗原(EMA)阳性,4例均检测到SYT-SSX融合基因表达.结论 肺原发性滑膜肉瘤的影像表现具有相对特征性表现,确诊需要依靠病理、免疫组化和SYT-SSX融合基因检查.