MSCT扫描对肺孤立性结节的诊断价值

肺孤立性结节(SPN)是指肺内单个、圆形或卵圆形、直径<3cm的实质性病灶.产生肺孤立性结节的原因很多,最常见的是小肺癌,其次是结核瘤,还有炎性假瘤、错构瘤等.肺孤立性病灶的早期定性诊断对患者意义重大,多层螺旋CT(MSCT)扫描在孤立性结节定性方面具有重要价值. 1 资料与方法 选取SPN患者35例,其中男23例,女12例,年龄35～70岁,平均55.5岁.结节最小径1.5cm,最大径3.0cm,平均2.3cm.采用PHILIPS16排螺旋CT扫描,层厚、层间距2mm,行多平面重建(MPR).35例患者中原发性肺癌18例(腺癌9例,鳞癌7例,小细胞癌2例),肺转移癌5例,结核球6例,炎性假瘤4例,错构瘤2例.全部病例均作增强检查.     

MSCT增强扫描在RCC肺转移与原发性肺癌鉴别诊断中的应用

目的:探讨MSCT增强扫描测量CT值在肾细胞癌(renal cell carcinoma,RCC)肺转移与原发性肺癌鉴别诊断中的应用价值.方法:回顾性分析75例RCC肺转移患者,男48例,女27例,年龄20～83(56.9±10.0)岁;91例原发性肺癌患者,男40例,女51例,年龄33～82(63.8±9.2)岁.所有患者均行胸部CT平扫及增强扫描.结果:RCC肺转移组的CT值为(75.2±39.7) HU,高于原发性肺癌组CT值(48.1±15.3) HU(t=3.750,P=0.002).结论:MSCT增强扫描在RCC肺转移与原发性肺癌鉴别诊断中具有重要临床意义.     

薄层CT与18F-FDG PET/CT联合运用可提高肺孤立性结节定性诊断的准确性

目的 探索如何将病灶SUVmax与薄层CT相结合,提高18F-FDG PET/CT对肺孤立性结节的定性诊断准确性.方法 回顾性分析267例经手术病理检查或临床随访证实的SPN患者的18F-FDG PET/CT及薄层CT显像结果,依据薄层CT将SPN分为实性结节与非实性结节.分别采用标准1 (SUVmax≥2.5)和标准2(SUVmax结合薄层CT综合分析)诊断肺癌,以病理和临床随访为金标准,分析两种标准对肺孤立性结节的诊断效能.结果 采用两种标准诊断肺癌的灵敏度和准确性分别为80.4％、76.4％(标准1)和91.0％、87.2％(标准2)(均P＜0.05).在非实性结节中,良、恶性病灶的SUVmax无明显显著性差异(P＞0.05),而病灶大小和分叶征、含气支气管征或空泡征以及病灶内有无粗大血管等CT征象对鉴别诊断有意义(均P＜0.05).40例PET表现为低代谢的肺癌患者,均被误诊为良性病变,结合薄层CT图像,纠正了其中50％(20/40)的诊断.采用标准1诊断肺癌,灵敏度为40.0％,而采用标准2诊断肺癌,灵敏度为90％,标准2对非实性结节诊断的灵敏度明显高于标准1(P=0.000),但特异性无显著性差异(75.2％vs58.3％,P=0.667).然而,对实性结节,薄层CT对于诊断结果无明显影响(均P＞0.05).结论 对于肺孤立性结节,仅依据SUVmax≥2.5诊断肺癌,诊断效能并不理想.对非实性结节,须依据SUVmax和薄层CT所见进行综合分析.     

高分辨率CT应用于肺内孤立性结节的诊断分析

目的探讨高分辨率CT应用于肺内孤立性结节的诊断。方法采用GE Synergy螺旋高分辨率CT扫描机,对50例肺内孤立结节扫描,观察各层高分辨率CT图像中结节的类型、形态及分布特点等征象。结果周围性肺癌空泡征、毛刺征、分叶、纵隔淋巴结增大与其他三种疾病比较有显著性差异(P0.05),部分出现不规则厚壁空洞;结核瘤卫星灶、钙化、空洞发生率高(P0.05),表现为薄壁空洞、环形及沙粒状钙化、增强后典型的环形强化;炎性假瘤病灶表现为空气支气管征、邻近胸膜反应性;肺错构瘤表现为爆玉米花样钙化。结论高分辨率CT显示肺内孤立性结节内部结构、形态等方面优于常规螺旋CT扫描,是区分良恶性孤立性肺结节的有效方法。     

CT对恶性肿瘤患者的肺内孤立结节的诊断意义

恶性肿瘤患者肺内发生孤立结节临床并不少见,而肺内孤立结节通常包括原发性肺癌、孤立性肺转移瘤和良性病灶3种情况,临床上确定肺内孤立结节的性质对恶性肿瘤的分期、治疗和预后评价都有重要意义[1]。本文回顾性分析49例肺外恶性肿瘤患者的胸部CT影像学资料,以探讨CT对恶性肿瘤     

恶性孤立性肺结节螺旋CT诊断

目的:探讨恶性孤立性肺结节(SPN)的螺旋CT表现.方法:回顾性分析100例经手术病理或随访证实为肺癌且影像资料齐全的孤立性肺结节.CT资料着重观察:病灶的形态、边缘征象、内部征象、邻近结构改变及强化特性,并比较各病理类型的特征表现及随访变化.结果:100例恶性SPN中病灶呈类圆形占96%;边缘清楚占95%;分叶或脐凹征显示率达74%;毛刺占76%(长毛刺:19%,短毛刺:65%;二者同时存在8%);棘状突起占26%;含气支气管征占20%;空泡征达13%;空洞占13%(均为不规则厚壁、偏心空洞);血管纠集征占23%;胸膜凹陷征占43%;局限胸膜黏连、增厚占16%.细支气管肺泡癌(Bronchioloalveolar carcinoma,BAC)空泡征、含气支气管征、晕征显示率高于非细支气管肺癌(NBAC)(P＜0.05).鳞癌空洞显示率高于其他恶性结节(P＜0.05).鳞癌增强后,不均匀强化率比非鳞癌结节不均匀强化率高(P＜0.05).结论:在螺旋CT扫描中,恶性孤立性肺结节可出现多种征象,其中分叶征和毛刺征的诊断价值较高.根据结节的各种征象和强化方式,结合各种CT检查技术有助于病变的定性诊断.     

血管集束征在CT诊断周围型小肺癌中的价值

目的:探讨肺血管集束征在小肺癌CT 诊断中的价值.方法:对2004年3月至2006年3月间本院45例3 cm内的孤立性肺结节行螺旋CT扫描,观察肺结节与周围血管的关系.结果:血管集束征在周围型小肺癌中的出现率为72.4%(21/29),在良性病灶的出现率为18.6%(3/16).良恶性病灶之间差异有非常显著性(χ2＝9.87,P＜0.005).结论:肺血管集束征在小肺癌CT诊断中具有重要的参考价值.     

CT引导下行孤立性肺结节穿刺活检的临床运用

目的:探讨孤立性肺结节在CT引导下穿刺活检术的临床运用价值.方法:对32例孤立性肺结节患者在CT引导下进行皮肺穿刺活检术,将所有的活检组织进行病理检查,并将所有病理资科与影像学诊断资料作对比分析.结果:32例孤立性肺结节穿刺成功率达100％,经病理学检查证实肺癌共23例,炎性假瘤5例,结核3例,1例取得坏死组织无法定性;在对孤立肺结节的定性诊断方面,穿刺活检的病理学诊断明显优于影像学诊断.结论.CT引导下经皮肺穿刺活检术是一种微创、安全的检查方法,它对孤立性肺结节病灶定性诊断率较高,临床应用价值较大.     

多排螺旋CT在肺孤立性结节病灶诊断中的应用价值分析

目的分析多排螺旋CT在肺孤立性结节病灶诊断中的应用价值。方法收集2016年2月-2017年7月本院诊治的肺孤立性的结节病灶90例的临床资料,所有患者均应用多排螺旋CT检查。结果于肺孤立性结节病灶90例患者中,其中恶性肺结节所占比例为60.00%,良性肺结节所占比例为40.00%,且两者于支气管充气征、胸膜凹陷征等CT征象上对比差异显(P0.05)。多排螺旋CT在肺孤立性结节病灶的诊断准确率为99.00%;恶性肺结节者于净增强和增强峰CT值(47.84±4.67)HU和(80.24±10.50)HU均比良性肺结节高,两者差异显著,具统计意义(P0.05)。结论对肺孤立性结节病灶患者应采用多排螺旋CT检查,有利于鉴别肺结节病灶的良、恶性,具较高推广价值。     

肺尖孤立性结节的CT诊断与鉴别诊断

目的探讨肺尖孤立性结节的CT影像表现与鉴别诊断。方法回顾性分析56例经手术及病理证实的肺尖结节患者的CT影像资料。结果 56个病灶中有32个肺癌,16个肺结核,8个炎性假瘤。发生率最高的是肺癌,占57%(32/56),其次为肺结核,占29%(16/56)。肺癌毛刺征、分叶征、胸膜凹陷征、支气管集束征发生率较肺结核及炎性假瘤高。而肺结核空洞、钙化的发生率较肺癌及炎性假瘤高。肺癌、肺结核、炎性假瘤三者的各CT平扫征象发生率差异有统计学意义(P<0.05)。CT增强扫描提示肺癌及炎性假瘤以轻-中度强化为主,肺结核表现为轻度或无强化。肺癌、肺结核、炎性假瘤在CT增强扫描时,三者在CT增加值幅度<20 HU、21~40 HU、41~60 HU,>60 HU的发生率差异有统计学意义(H=12.463,P=0.002)。结论 CT在肺尖孤立性结节诊断与鉴别诊断中具有重要临床价值。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.