彩色多普勒超声诊断甲状腺乳头状癌的临床价值(附217例报告)

目的 探讨彩色多普勒超声对甲状腺乳头状癌的临床诊断价值.方法 回顾性分析217例经手术病理证实的甲状腺乳头状癌的超声图像特点及诊断.结果 217例超声声像图中,93.5%(203/217)表现为低回声实性结节;56.7%(123/217)形态不规整,边界模糊,浸润性生长;72.3%(157/217)结节内见多发点状、簇状砂粒样钙化;48.8%(106/217)颈部探及肿大淋巴结,其中69.8%(74/106)诊断为淋巴结转移.术前超声诊断甲状腺癌152例,符合率70.0%(152/217),其中术前超声诊断微小癌70例,符合率79.5%(70/88);术前超声诊断伴颈部淋巴结转移74例,符合率93.7%(74/79).结论 甲状腺乳头状癌的超声表现具有一定特异性,超声检查可为临床早期诊断、手术治疗提供重要依据.     

高分辨率超声在甲状腺乳头状癌微钙化诊断中的应用

目的:探讨高分辨率超声在甲状腺乳头状癌微钙化诊断中的应用效果.方法:选取2018年4月～2020年3月某院收治的甲状腺乳头状癌患者96例为研究对象,所有患者均行常规超声及高分辨超声检查,以病理检查为"金标准",分析高分辨超声下甲状腺乳头状癌微钙化表现,评估常规超声、高分辨率超声及两者联合在甲状腺乳头状癌微钙化中的诊断效...     

超声下钙化类型与甲状腺癌关系的再研究

目的：探讨高频超声图像探测甲状腺结节钙化与其病理结果的相关性。方法回顾性分析420例甲状腺结节手术患者的临床资料。结果根据术后病理结果,将420例患者分为恶性结节组151例及良性结节组269例。恶性结节组的钙化率高于良性结节组,差异有统计学意义（P〈0.05）,且微钙化在恶性结节组中的发生率最高,与良性结节组相比,差异有统计学意义（P〈0.05）。微钙化对于甲状腺癌的阳性预测值为77.67%,灵敏度为54.30%。151例甲状腺癌中,以乳头状癌所占比例最高,占72.79%;而髓样癌微钙化及钙化的比例最高。结论钙化及微小钙化是甲状腺癌重要的危险因素,采用高频超声对甲状腺结节检查时应对钙化给予足够的重视,保障患者的诊断质量。     

甲状腺结节伴钙化与甲状腺癌

近年来甲状腺癌的发病率明显上升,随着高频超声检查的广泛应用,甲状腺结节伴钙化与甲状腺癌的关系日益得到重视。甲状腺结节伴钙化既可见于良性甲状腺疾病,亦可见于甲状腺癌,但后者更为常见。在各种类型的钙化中,微钙化与甲状腺癌,特别是甲状腺乳头状癌的关系最为密切,而且微钙化被认为是超声检查诊断甲状腺癌的特异性指标之一。甲状腺癌结节伴钙化,尤其是微钙化的机制目前尚未完全明确。对甲状腺结节伴钙化的诊断受超声仪器,探头频率及操作者的影响。虽然超声检查诊断对甲状腺癌特异性高,发现甲状腺结节伴钙化时,需结合其他参数才能提高诊断的准确性,必要时行细针穿刺活检。     

高频超声及彩色多普勒超声对甲状腺癌的诊断与分析

目的探讨高频超声与彩色多普勒超声(CDFI)对甲状腺癌的诊断价值。方法对经手术病理证实的24例甲状腺癌和36例甲状腺腺瘤的高频超声图像与彩色多普勒特征进行对比分析。结果甲状腺癌的高频超声声像图多数为实性低回声肿块及无回声肿块内实质部分有沙砾状钙化或粗糙的钙化光团,少数表现为增强及杂乱回声肿块。彩色多普勒血流成像(CDFI)显示肿块内血流阻力指数较高,平均为0.70。结论应用高频超声及彩色普勒超声对甲状腺癌的诊断具有很大的临床应用及指导价值,有较高的诊断符合率。     

常规超声结合超声造影对甲状腺微小癌的诊断价值

目的分析甲状腺微小癌的声像图及超声造影特点,总结高频超声结合超声造影对甲状腺微小癌的诊断价值。方法选择自2011年12月至2012年12月经手术病理证实的小于1.0 cm的甲状腺微小癌33例,分析甲状腺微小癌的声像图表现及超声造影特点。结果 33例经病理诊断为甲状腺癌的患者发现癌结节34个,超声诊断正确为30例,符合率为88.2%,甲状腺微小癌结节超声特点为：结节呈极低回声,边界模糊,无包膜,形态欠规则,沙砾样钙化,后方回声衰减,部分结节内部血流不丰富。超声造影特点：甲状腺微小癌的结节表现为不均匀弱增强,在整个增强过程中程度较正常甲状腺组织低。结论甲状腺微小癌的超声表现及造影具有典型特征,常规超声结合超声造影能够提高对甲状腺微小癌的诊断。     

微钙化在甲状腺癌的高频声像图中的意义

目的：评估甲状腺癌高频声像图中的微钙化的意义。方法：对44例甲状腺癌高频声像图中进行回顾性分析。结果：44例甲状腺癌中检出钙化24例（54．5％），微钙化20例，粗钙化4例，有微钙化的甲状腺癌中15例为乳头状癌，结论：高频声像图中的微钙化是诊断甲状腺癌的一个特异性指标，也是甲状腺乳头状癌的一个特征性表现。     

亚急性甲状腺炎与甲状腺乳头状癌彩色多普勒超声的鉴别诊断

目的探讨彩色多普勒超声对亚急性甲状腺炎与甲状腺乳头状癌的鉴别诊断价值。方法回顾性分析我院应用多普勒超声诊断的187例亚急性甲状腺炎,53例甲状腺乳头状癌的声像图特征及鉴别要点。结果本组亚急性甲状腺炎诊断符合率85.0%,误诊率15.0%,甲状腺乳头状癌诊断符合率86.8%,误诊率13.2%。结论彩色多普勒超声对亚急性甲状腺炎和甲状腺乳头状癌诊断具有一定的特征性差异,亚急性甲状腺炎病变基础上合并微钙化,应注意与甲状腺乳头状癌的鉴别诊断。     

高频超声显像对甲状腺癌的诊断价值

目的 探讨高频超声显像在甲状腺癌诊断中的应用。方法对66例已经手术病理证实为甲状腺癌的高频超声声像图特征与病理对照分析。结果66例甲状腺癌超声检出率93．9％，误诊6．1％。其中乳头状腺癌49例，滤泡状腺癌11例，髓样癌4例，未分化癌2例。甲状腺癌有特征性声像图表现：（1）肿块形态不规则；（2）境界不清；（3）无晕环征；（4）后方衰减；（5）内部回声不均匀，出现弥漫性砂粒样钙化。结论高频超声显像可提高甲状腺癌的检出率。当甲状腺内出现不均质低回声肿块且伴有砂粒样钙化，同时伴有同侧颈部淋巴结肿大时，要警惕甲状腺癌的可能。     

彩色多普勒超声检查对不同病理类型甲状腺腺癌的诊断价值比较

目的 比较彩色多普勒超声检查对不同病理类型甲状腺腺癌的诊断价值.方法 对62例甲状腺腺癌患者进行彩色多普勒超声检查,与病理检查结果进行对照,并比较不同病理类型甲状腺腺癌的超声影像图特征.结果 超声检查显示,乳头状腺癌内部低回声31例、边界不清28例、存在钙化31例,滤泡状腺癌分别为6例、6例、12例,两者差异均有统计学意义(x2=27.884、20.545、13.964,均P=0.000),两者形态规则性、后方回声性质、收缩期最高流速及阻力指数等差异均无统计学意义(P =0.427、0.338、0.110、0.872).乳头状腺癌病理符合率为80.0％,滤泡状腺癌病理符合率为70.4％.结论 彩色多普勒超声检查对不同病理类型甲状腺腺癌有一定的鉴别诊断价值,与病理检查诊断符合率较高.     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

基层医院护士在临床合理用药中的作用

目的充分利用护士在医师和患者间的特殊地位和作用,促进基层临床合理用药。方法从护士的工作性质出发,论述护士参与促进合理用药的方便和优势。结果通过实践,护士在促进合理用药中的作用得到有效发挥,基层合理用药环境得到极大改善。结论充分利用护士与医师和患者间的特殊桥梁作用,在基层医院促进合理用药,规范医师用药行为,防止药物滥用,引导患者安全用药,降低药源性疾病。