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1.
目的探讨低张水灌肠64层螺旋CT在早、中期直肠癌诊断及分期中的临床应用价值。方法回顾性分析2008年1月至2009年12月经手术病理证实的41例早、中期直肠癌患者的CT表现,其中男23例,女18例,与术后病理结果进行对照,分析CT诊断及分期与病理对照的符合率,评价低张水灌肠螺旋CT检查的临床应用价值。结果低张水灌肠64层螺旋CT扫描对41例早、中期直肠癌患者的诊断准确率为92.68%。诊断直肠癌侵犯浆膜外脂肪的敏感度、特异度、假阳性、假阴性分别为66.67%、76.47%、23.53%、33.33%。CT分期和病理分期为DukesA及B期的符合率分别为78.57%、66.67%,总符合率为71.05%。结论低张水灌肠64层螺旋CT检查对于早、中期直肠癌的诊断和浆膜外脂肪侵犯的检出有重要价值,是早、中期直肠癌检查中的一种重要的影像检查手段。  相似文献   

2.
目的:以术后病理诊断结果为对照,探讨术前CT诊断对直肠癌的诊断价值。材料与方法:于2011年1月~2015年12月,选取该阶段内我院收治的150例疑似直肠癌患者作为此次研究的对象,所有患者均进行手术治疗,手术前对这150例疑似患者进行CT检查,对获得的CT图像进行分析,并作出诊断。以术后病理诊断结果作为直肠癌的诊断金标准,计算术前CT检查对直肠癌的诊断敏感性、特异性以及准确性,并计算CT检查对癌细胞侵及浆膜外脂肪、盆腔淋巴结转移以及肿瘤TNM分期的诊断符合率。结果:CT检查对直肠癌的诊断敏感性、特异性、准确性、阳性预测值、阴性预测值分别为88.79%、83.72%、87.33%、93.14%、75.00%。Kappa=0.719,表示术前CT检查与术后病理诊断的一致性良好。CT检查对癌细胞侵及浆膜外脂肪、盆腔淋巴结转移的诊断符合率分别为84.71%、82.69%,CT对肿瘤TNM I期、II期、III期的诊断符合率分别为55.56%、70.69%、92.50%。结论:术前CT检查对直肠癌的诊断准确性较高,可有效反映出癌细胞对浆膜外脂肪的侵犯情况以及盆腔淋巴结的转移情况,但其对直肠癌分期的判断准确性还有待提高。  相似文献   

3.
64排螺旋CT结肠成像评价结直肠癌术前TN分期   总被引:4,自引:0,他引:4  
目的 分析探讨64排螺旋CT结肠成像(CTC)对结直肠癌术前TN分期的价值.方法 对168例疑诊结直肠病变者进行CT扫描,其中91例有手术病理、增强CT扫描等完整资料,将影像诊断TN分期结果 与手术病理TN分期结果进行对比分析.结果 T分期总准确率为92.31%(84/91),评价肿瘤浆膜外侵犯的灵敏度、特异度分别为98.57%(69/70)和85.00%(17/20),阳性预测值和阴性预测值分别为95.83%(69/72)和94.44%(17/18).N分期总的准确率为82.42%(75/91),评价淋巴结转移的灵敏度、特异度分别为87.80%(36/41)和96.00%(48/50),阳性预测值和阴性预测值分别为94.74%(36/38)和90.57%(48/53).结论 64排螺旋CTC对结直肠癌的术前分期有重要价值.  相似文献   

4.
目的探讨S-Detectd的诊断效能及其临床应用价值。 方法选取2019年4月至7月于北京大学肿瘤医院乳腺中心超声室接受超声诊断及S-Detect检查的患者378例,共计390个病灶进行回顾性分析。以组织病理诊断为金标准,应用诊断试验四格表分别计算超声医师及S-Detect对乳腺病灶良恶性诊断的敏感度、特异度、准确性、阳性预测值及阴性预测值,采用Kappa检验对S-Detect及超声医师与病理诊断结果的一致性进行分析;对S-Detect判断不确定的病灶进行假设判定,假设判定均为恶性为S-Detect 1、均为良性为S-Detect 2,并分别计算S-Detect 1与S-Detect2的诊断敏感度、特异度、准确性、阳性预测值及阴性预测值。 结果病理结果提示,378例患者共计390个病灶中恶性病灶260个,良性病灶130个。S-Detect的诊断敏感度、特异度、阳性预测值、阴性预测值与准确性分别为94.6%、56.2%、81.2%、83.9%、81.8%。超声医师的诊断敏感度、特异度、阳性预测值、阴性预测值与准确性分别为100.0%、9.2%、71.0%、100.0%、69.7%。Kappa分析结果显示:S-Detect与病理诊断结果的一致性较超声医师与病理诊断结果的一致性好(Kappa值:0.553 vs 0.119,P<0.05)。将S-Detect判断不确定的69个病灶进行假设判定,结果显示,S-Detect 1的诊断敏感度、特异度、阳性预测值、阴性预测值和准确性分别为94.6%、56.2%、81.2%、83.9%、81.8%;S-Detect 2的诊断敏感度、特异度、阳性预测值、阴性预测值和准确性分别为79.6%、79.2%、88.5%、66.0%、79.5%。 结论S-Detect技术对乳腺病灶具有一定的诊断价值,尤其对于良性病灶的诊断符合率优于超声医师,但在临床应用中仍存在部分病灶判断不明确等局限性,如何在临床中更加恰当地结合使用S-Detect还需要更深入的数据研究加以证实。  相似文献   

5.
目的探讨128层螺旋CT结肠成像(CTC)在结直肠癌诊断中的临床应用价值。方法选择82例疑似结直肠癌患者进行CTC和结肠镜检查,以结肠镜病理结果为标准,分析CTC诊断结直肠癌的灵敏度、特异度、阳性预测值、阴性预测值、定位、分型;其中16例手术的结直肠癌患者,以手术病理分期为标准,分析CTC在结直肠癌T分期中的准确度。结果以结肠镜病理结果为标准,CTC诊断结肠癌的灵敏度为100%,特异度90.91%,阳性预测值90.48%,阴性预测值100%,定位准确度100%,大体分型准确度为88.09%。以手术病理分期为标准,CTC结直肠癌T分期准确度为87.00%。结论 128层螺旋CTC在结直肠癌的定位、定性诊断及T分期上具有较高的准确度,可作为结直肠癌筛查的有效手段和术前常规检查。  相似文献   

6.
目的 探讨宫腔镜及CT/MR检查在术前诊断子宫内膜癌宫颈受累中的价值.方法 回顾性分析124例术前被诊断为子宫内膜癌患者的临床资料,比较术前宫腔镜检查、CT/MR检查与手术病理分期结果 ,分析两种方法 判断子宫内膜癌宫颈受累的敏感性、特异性等指标.比较术前临床分期与手术病理分期符合率.结果 宫腔镜检查诊断子宫内膜癌宫颈受累的敏感度为73.53%,特异度为88.89%,阳性预测值为71.43%,阴性预测值为89.89%.CT/MR检查诊断子宫内膜癌宫颈受累的敏感度为55.89%,特异度为76.67%,阳性预测值为47.50%,阴性预测值为82.14%,两者比较,特异度及阳性预测值差异有统计学意义(P<0.05).宫腔镜及CT/MR平行检查诊断子宫内膜癌宫颈受累的联合敏感度为79.41%,特异度为72.22%;系列检查的联合敏感度为50%,联合特异度为93.33%.结论 宫腔镜检查在术前诊断子宫内膜癌宫颈受累的价值优于CT/MR,其排除宫颈受累的价值突出,可作为制订治疗方案的依据.但在确定宫颈受累方面不足,还需探索更为准确的联合检查方法 .  相似文献   

7.
目的:探讨使用开塞露进行肠道准备对直肠癌磁共振术前T1和T2分期的意义。材料与方法回顾经手术病理证实为T1或T2分期的直肠癌患者81例,男51例,女30例,平均年龄(64.2&#177;12.2)岁。其中,45例(男30例,女15例)使用开塞露,36例(男21例,女15例)未使用开塞露。分别分析两组MRI术前分期与手术病理分期结果的一致性,计算并比较两组MRI T1、T2分期的敏感度、特异度、准确度、阳性预测值、阴性预测值和T1+T2分期的敏感度。结果 Kappa检验证实两组MRI术前分期与手术病理分期结果的一致性均为中等,K值分别为使用开塞露组0.693,未使用开塞露组0.537。使用开塞露组直肠癌磁共振T分期的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为T1分期:76.5%、92.9%、86.7%、86.7%、86.7%;T2分期:78.6%、76.5%、86.7%、84.5%、68.4%;T1+T2分期的敏感度为:77.8%。未使用开塞露组直肠癌磁共振T分期的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为T1分期:57.1%、95.5%、80.6%、88.9%、77.8%;T2分期:77.3%、57.1%、69.4%、73.9%、61.5%;T1+T2分期的敏感度为:69.4%。统计分析证实使用开塞露组T1分期的敏感度及T2分期的特异度、准确度高于未使用开塞露组(P〈0.05,单侧)。结论使用开塞露进行肠道准备能够明显提高直肠癌磁共振T1分期的敏感度、T2分期特异度及准确度,同时在一定程度上提高T1和T1+T2分期的诊断准确性,建议作为直肠癌磁共振检查的肠道准备常规应用。  相似文献   

8.
目的研究食管癌外侵的CT特点。方法对35例手术病理证实的食管癌的CT资料进行回顾性分析,结合文献复习,评价其CT表现及诊断意义。结果本文35例手术切除病例,术前CT表现为管壁不规则增厚,食管癌侵犯周围组织,术前CT诊断主动脉受侵20例,敏感度、特异度及正确诊断指数(约登指数)分别为86.7%、65.0%、0.517;气管-支气管、心包受侵分别为13例、4例,正确率为60%及50%;淋巴结增大75枚,灵敏度为56.2%,特异度3.1%,阳性预测值17.3%,阴性预测值16.7%;术前CT分期Ⅱ期10例,Ⅲ期10例,Ⅳ期15例。结论CT有助于判断食管癌是否侵犯邻近组织结构,便于指导临床采取相应的治疗措施。  相似文献   

9.
目的:探讨多层螺旋CT增强扫描及多平面重组技术在喉癌患者术前分型、分期中的诊断价值,并分析影响CT诊断的因素。方法:对41例电子喉镜检查并经术后病理证实为喉癌的患者,行术前CT扫描及多平面重组,根据图像资料进行临床分型、分期,并与术中所见及术后病理结果对照比较。结果:CT诊断肿瘤侵犯范围总的符合率为81.9%,假阴性率为9.3%,敏感性为90.7%。术前T分期的符合率分别为T1期80.0%、T2期66.7%、T3期52.6%、T4期72.7%;术前N分期的符合率分别为N1期58.3%、N2期100%。结论:螺旋CT平扫、增强扫描及多平面重组图像能够很好地显示喉癌的形态、大小、侵犯范围及淋巴结转移等,对肿瘤术前分型、分期及制定合理的治疗方案具有指导意义。  相似文献   

10.
目的比较超声与正电子发射型计算机断层成像(PET/CT)技术在乳腺癌早期诊断中的应用价值。方法选取2014年2月至12月在北京协和医院行乳腺病变切除活检术的患者38例,共40个病灶,分别行超声及PET/CT检查,以病理诊断为"金标准"分别统计自动乳腺全容积成像系统(ABVS)及PET/CT的敏感度、特异度、准确性、假阳性、假阴性、阳性及阴性预测值。结果超声对乳腺癌诊断的敏感度95.65%、特异度70.59%、准确性85.00%;PET/CT技术对乳腺癌诊断的敏感度86.96%、特异度82.35%、准确性85.00%;两者联合应用的诊断敏感度86.96%、特异度94.12%、准确性90.00%。10例乳腺癌淋巴结转移的患者中,PET/CT技术对转移淋巴结诊断的敏感度、特异度及准确性分别为90.0%、92.8%、92.1%,超声对转移淋巴结诊断的敏感度、特异度及准确性分别为70.0%、96.4%、89.5%。结论超声与PET/CT检查对乳腺癌的诊断均为有效的方法。两者联合应用可显著提高诊断的特异度与准确性。PET/CT对淋巴结转移灶敏感度较高,有利于临床分期,对临床治疗方案的选择及患者的预后有重要意义。  相似文献   

11.
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.  相似文献   

12.
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.  相似文献   

13.
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.  相似文献   

14.
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.  相似文献   

15.
目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4%(55/72)]明显高于成功组[31.7%(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3%(42/72)]高于成功组[38.1% (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9% (28/72)]高于成功组[23.8%(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大<6 cm、胎头位于坐骨棘上及宫口开大8~10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1%(44/72)]高于成功组[38.9%(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2%(52/72)]明显高于成功组[34.1 %(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.  相似文献   

16.
Ranganath C  Heller AS  Wilding EL 《NeuroImage》2007,35(4):1663-1673
Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.  相似文献   

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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.  相似文献   

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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.  相似文献   

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