经直肠超声造影指导前列腺穿刺活检的临床价值

目的对比超声造影与常规超声引导穿刺活检结果,探讨经直肠超声造影对引导前列腺穿刺活检的优势。方法 195例可疑前列腺癌患者行前列腺穿刺活检,随机分为造影组60例,经直肠超声造影指导前列腺穿刺;对照组135例,经直肠超声引导前列腺穿刺。对比两组前列腺癌检出率、穿刺针数及单针阳性率。结果造影组60例患者,恶性42例,良性18例,前列腺癌诊断率为70.0%,共接受穿刺716针,平均12针;阳性针数352针,阳性率为49.2%。对照组135例患者,恶性95例,良性40例,前列腺癌诊断率为70.4%,共接受穿刺1431针,平均11针,阳性针数466针,阳性率为32.6%;两组前列腺癌诊断率和平均穿刺针数,差异无统计学意义(P0.05),造影组针数阳性率高于对照组(P0.01)。结论应用超声造影引导对前列腺可疑部位进行经直肠穿刺活检,能明显提高诊断前列腺癌的敏感性和穿刺的单针诊断率。     

经直肠超声引导前列腺系统活检在前列腺疾病诊断中的应用

目的　探讨经直肠超声引导下前列腺多点系统活检术在前列腺疾病诊断中的应用价值。方法　对 46例前列腺特异抗原 (PSA) >4ng ml或经直肠超声发现前列腺有结节的患者 ,行经直肠超声引导 6针系统活检加结节处1～ 2针活检。结果　 46例经直肠引导前列腺活检 ,检出前列腺癌 16例 ( 3 4.8%) ;恶性淋巴瘤 1例 ( 2 .2 %)。随PSA增高 ,前列腺癌检出率增高。术中及术后严重并发症。结论　经直肠超声引导前列腺多点系统活检术 ,可明显提高前列腺癌的临床检出率 ,有助于前列腺疾病的诊断和鉴别诊断。     

超声引导下经直肠前列腺活检的临床应用

目的 探讨经直肠超声引导下前列腺穿刺活检在诊断前列腺疾病中的临床应用。方法对36例前列腺特异性抗原（PSA）〉4ng／ml或直肠指检（DRE）有结节或经直肠超声发现有异常的患者，行经直肠超声引导6针系统活检加异常区域处1～2针活检。结果36例经直肠超声引导前列腺穿刺活检，检出良性前列腺增生20例，占55．6％，前列腺癌9例，占25％，前列腺轻度不典型增生4例，占11．1％，前列腺良性增生合并前列腺炎性改变3例，占8．3％。无严重的并发症。结论经直肠超声引导前列腺穿刺活检术有助于前列腺疾病的诊断和鉴别诊断，为临床进一步诊治提供了依据。     

经直肠超声引导前列腺13点系统穿刺活检术诊断前列腺癌

目的 探讨经直肠超声引导前列腺13点系统穿刺活检术诊断前列腺癌的临床价值。方法 共160例直肠指诊阳性和（或）前列腺特异抗原（PSA）值＞4ng/ml的患者接受了经直肠超声引导前列腺13点系统穿刺活检术,即按照Eskew描述的方法,在标准的经直肠超声引导前列腺6点系统穿刺活检术的同时,增加在前列腺的中间部位及前列腺两侧旁正中线远侧的穿刺点数,共穿刺活检13点。将增加的7点活检部位的病理结果与标准的6点穿刺活检技术进行比较。结果 160例患者中有56例确诊为前列腺癌（56／160）,占35％。56例前列腺癌患者若仅采用标准的经直肠超声引导6点前列腺穿刺活检术,将有12例患者漏诊,占21％。所有接受直肠超声引导前列腺13点系统穿刺活检术的无一例出现严重的并发症。结论 经直肠超声引导前列腺13点系统穿刺活检术可明显提高前列腺癌的临床检出率,是一种安全、有效的前列腺系统穿刺活检术式,值得在临床推广应用。     

前列腺穿刺局部压迫止血垫的制作与应用

目前,在前列腺疾病的临床治疗过程中,经常需要组织活检,活检时,使用直肠超声引导自动活检枪穿刺前列腺,活检枪从病人肛门穿入,经过直肠和前列腺周围组织,刺入前列腺,当活检枪抽出后,穿刺点会出血.轻微的出血通常采用填塞干纱布压迫止血,将碘伏纱条置入直肠内压迫止血,出血量较大时通常采用经直肠指压出血点进行止血.     

经直肠超声引导前列腺穿刺并发直肠大出血及其处理

目的　探讨经直肠超声 (transrectal ultrasound,TRUS)引导前列腺穿刺活检引起的直肠大出血及其处理方法。方法　回顾性总结 10 96例次 TRUS引导前列腺穿刺活检引起的 11例直肠大出血的临床资料。结果　在 11例患者中 ,前列腺癌 (prostatic carcinoma,PCA) 5例 ,良性前列腺增生 (benign prostatic hyperplasia,BPH) 4例 ,前列腺上皮内肿瘤 (prostatic intraepithelial neoplasm ,PIN) 1例 ,前列腺炎 1例 ;7例直肠大出血自行停止 ,4例出血不止 ,并出现生命体征异常 ,需要局部止血和输血。结论　尽管 TRUS引导前列腺穿刺活检可能引起多种并发症 ,但一般不需处理 ,即便并发直肠大出血也能有效地治疗 ,因此 ,它仍然是诊断前列腺癌的可靠方法。     

超声引导下经直肠前列腺穿刺活检术的围操作期处理

目的:探讨直肠超声引导下经直肠前列腺穿刺活检的围手术期处理。方法:2006年1月～2009年1月在直肠超声引导下行经直肠前列腺10点穿刺510例,术前2d使用肠道消炎药物;术前清洁洗肠,预防性使用抗菌素1次。穿刺均成功。术后常规直肠压迫止血。结果:术后病理检查前列腺癌145例,PIN10例,前列腺炎66例;术后1d～2d出现败血症12例,血尿116例,直肠出血14例,予抗炎压迫止血后均治愈。结论:做好充分的术前准备,及时处理术中、术后出现的并发症,对降低经直肠前列腺穿刺活检并发症的发生率具有极其重要的临床意义。     

经直肠前列腺穿刺活检术并发症的观察与护理

前列腺穿刺活检是术前诊断前列腺癌最重要的手段，经直肠指引前列腺穿刺活检与经直肠超声引导前列腺穿刺活检是两种常用的活检方法。前列腺穿刺活检的常见并发症有出血、感染、排尿症状、疼痛及血管迷走神经反射。我科自2003年7月至2007年12月共采用上述两种方法行前列腺穿刺活检165例，并加强穿刺术前、术中、术后并发症的防治及护理，无大出血、败血症和极度疼痛等严重并发症，效果满意，现将护理措施报道如下。     

经直肠超声引导下前列腺活检术患者围术期护理

目的:探讨经直肠超声引导下前列腺活检术患者的围术期护理方法和效果。方法:回顾性分析2014年1月~2015年3月470例经直肠超声引导下前列腺活检术患者的临床资料,探讨围术期护理对减少前列腺活检术后并发症的重要性。结果:470例患者前列腺活检均一次成功,确诊为前列腺癌患者238例;术后发生轻微肉眼血尿或镜下血尿60例,肉眼血尿12例,直肠出血10例,发热11例,急性尿潴留6例,无败血症等严重并发症发生。结论:经直肠超声引导下的前列腺活检术是一种安全、有效的检查方法,加强围术期护理,有利于减少前列腺活检术后患者并发症的发生,是前列腺活检成功的重要保障。     

经直肠超声引导经会阴前列腺穿刺活检术安全性评估

目的评价经直肠超声引导下经会阴前列腺穿刺活检术的安全性.方法对60例临床疑前列腺癌患者行经直肠超声引导经会阴前列腺穿刺活检术并随访分析术后并发症情况.随访内容包括术中疼痛和术后感染、血尿、血精、血便、排尿困难等.结果 60例患者术后出现并发症的36例(60%).其中单纯血尿28例(77.7%);血尿伴血精3例(8.3%);血尿伴排尿困难3例(8.3%);血尿伴会阴穿刺处出血2例(5.6%).60例患者术中出现明显疼痛的7例(11.7%).结论经直肠超声引导经会阴前列腺穿刺活检术是一种安全可靠的前列腺活检方法,与经直肠穿刺方法相比,该法降低了术后感染和直肠出血等严重并发症的发生率.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.