兔VX2肝癌MSCT评价及病理特征

目的探讨兔VX2肝癌的CT表现及其病理特征。方法采用开腹瘤块包埋法建立兔VX2肝癌模型,分别于接种后2周和3周,应用Philips64层螺旋CT对实验兔进行CT平扫和增强双期扫描,CT检查完成后处死实验兔,进行病理学检查。结果16只兔均接种成功,在CT平扫,瘤灶表现为低密度,增强扫描,瘤灶在肝动脉期表现为不同程度的环形强化,门脉期呈低密度,与周围肝组织分界清楚;病理学检查见肿瘤呈结节状,突出于肝表面,部分有包膜,切面呈灰白色,与周围正常肝组织分界清楚;光镜下,癌细胞呈巢状分布,细胞较大,形态不规则,排列紊乱,血窦多,胞核大而深染,胞质量少。结论兔VX2肝癌病理表现呈结节状,与正常肝组织分界清楚,光镜下癌细胞呈巢状分布,异型性明显;MSCT可以准确地监测其生长情况。     

螺旋CT双期常规移床式扫描对肝细胞癌的诊断价值

目的：探讨螺旋CT双期常规移床式扫描对肝细胞癌（HCC）的诊断价值。材料与方法：81例HCC患者均经手术病理或临床综合资料证实。先行全肝常规移床式平扫,确定病灶兴趣层面,再经肘前静脉团注对比剂,3ml/s,共100ml,于30s时开始对病灶兴趣层面动脉期扫描,55s开始全肝门脉期扫描。结果：本组肿瘤动脉期呈高密度63例,门脉期呈低密度79例;境界清77例,其中49例可见包膜;动脉期51例异常供血动脉,69例见瘤区异常强化血管,大血管癌栓占46例;瘤周肝段62例见异常灌 注,28例见子灶;5例见肝包膜凹陷征。结论：螺旋CT双期常规移床式扫描地HCC诊断提供可靠依据。     

螺旋CT双期动态扫描对肝转移瘤的诊断价值

目的:探讨肝转移瘤双期动态增强扫描的CT征象。方法:应用螺旋CT对67例肝转移瘤病人分别进行平扫、增强后肝动脉期和门静脉期扫描,观察瘤灶双期动态扫描的CT征象。结果:(1)67例中29例肝动脉期瘤灶边缘部出现环形强化,其强化密度高于正常肝,低于主动脉。门静脉期瘤灶边缘部的环形强化范围不扩大,其中27例密度仍可高于或等于正常肝,2例密度低于正常肝。(2)67例中22例肝动脉期和门静脉期瘤灶边缘部和瘤内均无明显强化,密度低于正常肝。(3)67例中7例肝动脉期瘤灶出现全瘤均匀性或不均匀性强化,密度高于正常肝;门静脉期瘤灶密度下降,密度等于或低于正常肝。(4)67例中8例肝动脉期多发的肝转移瘤中,一部分瘤灶出现全瘤均匀性或不均匀性强化,或边缘部环形强化,密度高于正常肝;门静脉期密度下降至等于或低于正常肝。另一部分瘤灶则动、门脉双期均始终未见强化。结论:肝转移瘤CT双期动态增强扫描的主要征象是:(1)动脉期瘤灶边缘部出现密度高于正常肝的环形强化,门静脉期此环形强化范围无扩大,密度仍高于或等于正常肝。(2)双期扫描瘤灶均无强化,呈低密度。(3)双期扫描部分瘤灶强化,另一部分瘤灶则始终未见强化。     

巨块型肝细胞癌螺旋CT双期增强扫描的诊断价值

目的:探讨巨块型肝细胞癌螺旋CT双期增强扫描的诊断价值。材料和方法:对53例巨块型肝细胞癌进行全肝螺旋CT平扫及双期增强扫描,分析有关的CT征象。结果:①肿瘤实质均呈不均匀性强化,并可出现3种基本形态的肿瘤血管,它们与瘤内“密度更低区”有一定的关系;②部分肿瘤边缘部或包膜分别或同时在动脉期及门脉期出现环形强化;③91.9％的巨块型肝细胞癌肝内转移性子灶只在动脉期才被检出。结论:①巨块型肝细胞癌螺旋CT双期增强扫描的强化特点及动脉期瘤内出现肿瘤血管,不但是巨块型肝细胞癌的主要特征,而且具有重要的鉴别诊断价值;②部分巨块型肝细胞癌边缘部或包膜存在肝动脉、门脉或动、门脉双重血供;③巨块型肝细胞癌术前必须进行全肝范围的动脉期增强扫描,以利于发现占大多数平扫及门脉期均呈等密度的肝内转移性子灶。     

脾脏炎性肌纤维母细胞瘤的CT与病理对照分析

目的探讨脾脏炎性肌纤维母细胞瘤(SIMT)的CT和病理学特点,提高对该病的认识与诊断水平。方法搜集经手术病理证实SIMT 5例,回顾分析其CT表现及病理学特征。结果 5例CT扫描均提示脾脏单发肿块,呈类圆形,2例边缘见浅分叶;CT平扫呈等、稍低密度,内见不规则地图样更低密度影,边缘显示不清,三期动态增强扫描显示实质部分轻、中度渐进性强化,程度低于正常脾脏组织,边界显示渐清,其中3例显示低密度包膜,内部低密度坏死影无强化。病理学上本组病例以增生的血管和纤维细胞为主要成分,其中散在淋巴细胞、浆细胞及单核细胞等,组成慢性非特异性炎性表现,伴有大片凝固性坏死,其中1例可见多处灶性出血;肿块周围有异常增生的纤维组织包膜与正常脾组织分界。结论 SIMT常为单发病灶,CT上以实质部分渐进性强化、地图样坏死及低密度包膜环为特征,能够较准确反映其病理特点,对该病的诊断及鉴别诊断具有一定的特异性。     

射频毁损后正常兔肝脏CT与病理变化的相关性研究

目的探讨CT在评价正常肝脏射频消融后病理学动态变化中的价值。方法对20只正常兔肝脏进行射频消融后,将每5只随机分为4组：消融即刻,1周,2周,4周分别进行CT平扫及增强检查后,处死并取出肝脏进行大体病理和镜下病理学检查。结果消融即刻病灶中心为凝固性坏死,CT动脉期周边可见环形强化,病理消融灶周围肝窦充血;1～2周消融灶周围出现稍低密度环,密度低于其外围的肝实质,增强扫描可见环形强化,4周仍可见低或等密度环,但增强动脉期、实质期可清晰显示包膜强化程度减轻。结论螺旋CT多期扫描可反映消融的病理学变化,从而可用于评价肝脏肿瘤射频治疗的效果。     

周围型肺腺癌、鳞癌的CT、病理表现与血管内皮生长因子(VEGF)表达的相关性研究

目的研究周围型肺腺癌、鳞癌的CT征象、病理表现与VEGF阳性表达的相关性。方法对67例经手术病理证实的肺癌术前进行CT平扫,其中54例平扫后行动态增强扫描,并对手术切除肿瘤标本进行PV-6000二步法免疫组织化学染色,检测其VEGF的表达。分析周围型肺腺癌、鳞癌的病理表现、CT征象与VEGF的表达之间的关系。结果肿瘤的分化程度、有无肺门和（或）纵隔淋巴结转移及某些CT征像与VEGF阳性表达相关。结论VEGF表达程度是反应肿瘤的恶性程度及肿瘤浸润转移的重要指标,某些CT征像可以评价肿瘤的恶性生物学行为。     

肝脏局灶性结节增生CT 7例分析

对我院1998-04～2006-02肝脏局灶性结节增生（focall nodular hyperplasia FNH）手术病理证实7例分析如下. 　　1 临床资料 　　1.1 一般资料本组男2例,女5例,年龄17～64岁. 　　1.2 方法术前均进行了螺旋CT平扫加增强扫描.其中2例行16层CT平扫加动态增强.采用飞利浦公司PQS螺旋CT机和GE公司Light speed 16 CT扫描机,先行全肝平扫,层厚5～10 mm,然后经肘静脉以3 ml/s快速团注欧乃派克100 ml,分别于注射开始后20～30 s行动脉期扫描,60～75 s行静脉期扫描,5～7 min后行延迟扫描.     

胆管错构瘤的CT表现(附5例报告)

目的 探讨胆管错构瘤的CT表现,旨在提高对本病的认识.方法 回顾性分析经穿刺活检病理证实的5例胆管错构瘤患者的CT表现,并结合文献,对本病的病理、临床以及CT表现特点进行讨论.结果 CT平扫显示病灶呈多发低密度,大小不等,形态各异,边缘部分清楚,部分不清,增强扫描后无强化.其中1例行MRI平扫,病灶呈长T1、长T2信号.MRCP显示肝内多发类囊状高信号病变,与胆管树不相通,肝内胆管树分支未见异常.结论 正确认识胆管错构瘤的CT表现特点,对本病的诊断以及鉴别诊断有较大的帮助,最终确诊有赖于采取活体组织进行病理学检查.     

原发性肝细胞癌动态增强MR门脉期环形强化机制

目的 探讨原发性肝细胞癌(HCC)于三维动态增强MR门脉期环形强化的机制.方法 采用Propeller肝脏加速容积采集序列(LAVA)对 HCC患者行多期动态增强扫描,观察门脉期病灶周边环形强化的状况及动脉期病灶有无动脉供血.对大体标本的病灶中心层面取中心组织2块及边缘组织4块,行常规HE染色,判定病灶有无包膜及病理分级.结果 本组共38个HCC病灶,32个病灶门脉期表现为边缘环形强化,28个病灶动脉期表现有动脉供血;病理切片观察发现34个病灶可见包膜存在.统计结果 表明:① HCC门脉期环形强化与包膜存在密切相关性(P<0.05);②HCC门脉期环形强化与动脉供血的相关性无统计学意义(P>0.05);③HCC门脉期环形强化与病变分化程度无明显相关性(P>0.05).结论 ①三维动态增强MR门脉期的病灶周边环形强化是HCC的特征性表现之一;②三维动态增强MR门脉期肿瘤周边环形强化的形成与病灶周边包膜的存在密切相关,同时还可能与病灶的动脉供血密切相关.     

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.     

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.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.     

Advance Care Planning

Predictors of patient wishes and influence of family and clinicians are discussed. Research findings on patient decision-making relating to preferences in end-of-life care are described. Advance directives and durable powers of attorney are defined and differentiated. Most patients have not participated in advance care planning and the need for more effective planning is documented. Appropriate times for discussions of such planning are described. Scenarios discussed include terminal cancer, chronic obstructive pulmonary disease, AIDS, stroke, and dementia. Patient satisfaction is discussed, as is a structured process for discussions about patient preferences. Results of patient responses to hypothetical scenarios are described. Invasiveness of interventions, prognosis and other factors that favor or discourage patient preferences for treatment are discussed. Findings resulting from research funded by the Agency for Healthcare Research and Quality (AHRQ) are discussed. This research can help providers offer end-of-life care based on preferences held by the majority of patients under similar circumstances.     

Spiritual Dimensions of Nursing Practice. edited by V. B. Carson

The Cochrane Library of Systematic Reviewsis published quarterly. Issue one for 2004 of the library was published in February 2004. This issue contains 3,329 reviews and protocols of which 1,921 are fully published reviews. The trials database now stands at over 400,000 records with an additional 4,427 one-page summaries of non-Cochrane reviews in the NHS database of reviews of effectiveness (DARE). This version of the library contains the results of an extensive search for RCTs on EMBASE. The latest library contains 84 new reviews, seven are considered relevant to practitioners in pain and palliative care. References are published in the same format as the citation for Cochrane reviews.     

Évaluation,par l’imagerie ultrasonore,du recrutement musculaire,de la force motrice et de la détente verticale du quadriceps après électromyostimulation (cas de 15 étudiants de l’INJS)

The increase of strength seems to be an element of performance in some sports.