原发性脑淋巴瘤与脑转移瘤的MRI鉴别诊断

目的对照分析脑内原发性恶性淋巴瘤和脑转移瘤的MRI不同表现特点。方法回顾分析经病理证实的脑内原发性恶性淋巴瘤25例、肺癌脑转移瘤119例的MRI资料,所有病例均行MRI平扫及增强检查。结果前者单发18例(72%),多发7例(28%),幕上33例,幕下4例,MRI平扫T1WI呈边缘模糊的等或稍低信号,T2WI呈高信号,增强均见肿瘤均匀或不均匀强化,瘤周多为轻、中度水肿,占位效应轻,出血少见。后者单发43例(36%),多发76例(64%),脑内血行播散灶258个,幕上和脑干216个,幕下42个,MRI平扫为T1WI低信号,T2WI高信号,增强可见环形、结节状强化,中、重度水肿,占位效应明显,可见出血和坏死。结论脑内原发性恶性淋巴瘤与脑转移瘤影像表现各具特征性,但相互间具较多交叉,仔细分析能提高今后诊断准确性。     

MRI对原发性中枢神经系统淋巴瘤的诊断价值

目的:探讨脑内原发性淋巴瘤的MRI特征,以提高其术前的诊断水平。方法:回顾性分析12例经手术后病理证实的脑内原发性淋巴瘤的MRI表现。结果:所有病例均为弥漫大B细胞淋巴瘤。单发10例,多发2例,共16个病灶,其中幕上12个,幕下4个。圆形或类圆形为主,占位效应轻,轻或中度水肿(75.0%)。在T1WI上呈等或稍低信号,在T2WI上大部分病灶为等或稍高信号,少数病灶为高信号,FLAIR上为等或稍高信号。增强后大部分明显均匀强化,少部分病灶内可见无强化的坏死区。结论:中枢神经系统原发性淋巴瘤的MRI表现具有一定的特征性,结合特定的发病部位和发病年龄,大部分可以获得正确的术前诊断。     

原发性脑淋巴瘤MRI表现及其病理基础

目的探讨原发性脑淋巴瘤的MRI表现及病理基础,提高对脑原发性淋巴瘤的认识。方法回顾分析2010年1月-2012年5月28例确诊为脑原发性淋巴瘤的MRJ影像特征及临床病理资料。结果28例患者,共发现36个病灶,幕上病灶34个,幕下病灶2个;MRI平扫;32个病灶在T1WI、T2WI肿瘤实质表现为等信号;4个病灶内出现液化坏死（其中1个病灶呈明显囊变）,信号不均。MRI增强扫描：35个肿瘤病灶实质部分均匀强化,1个病灶呈环形强化。病理类型均为弥漫性大B细胞非霍奇金淋巴瘤。结论原发性脑淋巴瘤具有较典型的MRj影像特征,可在术前明确诊断。     

脑内原发性淋巴瘤CT、MRI表现

目的分析脑内原发性淋巴瘤的CT、MRI表现。方法回顾分析25例经病理证实的脑内原发性淋巴瘤的CT、MRI资料,所有病例均行平扫及增强扫描。结果病灶单发18例,多发7例;幕上33例,幕下4例。CT平扫表现为等或稍高密度,MR平扫T1WI等或稍低信号,T2WI呈高信号;增强扫描均见肿瘤均匀或不均匀强化,瘤周多为轻中度水肿。结论原发性脑淋巴瘤影像表现具有一定的特征性,但与其他颅内病变有重叠及类似之处,认真分析其特点,可提高诊断的准确性。     

脑原发性淋巴瘤的MRI诊断

目的探讨脑原发性淋巴瘤的MRI表现特征。方法回顾性分析经病理证实的20例脑原发性淋巴瘤的MRI表现。结果脑原发性淋巴瘤加例共52个病灶，位于脑深部近中线区域占78.8％，形态不规则占71．2％，内部发生囊变占15．4％，周围水肿占84．6％，未见钙化、出血；T1WI呈低信号（30．7％）等信号（63．5％），T2WI呈等信号（69．3％）高信号（26．9％），增强扫描均呈显著性强化。结论脑原发性淋巴瘤MRI有特征性表现，熟悉其MRI特点有助于对本病作出正确的诊断。     

脑内原发性恶性淋巴瘤的MRI诊断

目的 探讨MRI对原发性脑内恶性淋巴瘤的诊断价值。方法 回顾性分析8例经手术和病理证实的脑内恶性淋巴瘤患者的MR表现。结果 MRI表现为：①T1WI呈等或稍低信号灶，T2WI为等或稍高信号，多数肿瘤轻至中度水肿和占位效应；②Gd-DTPA增强扫描肿瘤呈均匀或不均匀强化。结论 MRI的多轴位成像及Gd-DTPA应用有助于脑内恶性淋巴瘤的诊断与鉴别诊断并有助于减少误诊。     

MRI对原发性中枢神经系统淋巴瘤的诊断价值

目的:探讨脑内原发性中枢神经系统淋巴瘤的MRI特征,提高其术前的诊断水平.方法:回顾性分析15例经手术后病理证实的原发性中枢神经系统淋巴瘤的MRI表现.结果:病灶圆形或类圆形为主,占位效应轻,轻或中度水肿(73.6%).在T1WI上呈等或稍低信号、T2WI上多数病灶为等或稍高信号,少数病灶为高信号、FLAIR上为等或稍高信号.增强后大部分明显均匀强化,少部分病灶内可见无强化的坏死区.结论:原发性中枢神经系统淋巴瘤MRI表现具有一定的特征性,结合特定的发病部位和发病年龄,对原发性中枢神经系统淋巴瘤的发现具有一定的提示作用.     

原发性脑淋巴瘤的病理与MRI表现的相关研究

目的:探讨免疫功能正常状态原发性脑淋巴瘤的MRI特征及其MRI表现的病理基础。材料与方法:回顾性分析13例未经治疗的免疫功能正常状态原发性脑淋巴瘤患者的临床、病理及MRI表现。MR扫描序列包括SE T1WI、FSE T2WI、EPI DWI及增强SE T1WI。结果:13例患者共计19个病灶,其中5例(38%)有多发病灶。T1WI病灶为等、低信号,其中3个病灶伴有局灶性高信号;12个病灶在T2WI上为等、低信号;14个病灶在DWI上为等、高信号,病灶增强部分的ADC值为0.59×10-3~0.91×10-3mm2/s,均值及标准差为(0.71±0.20)×10-3mm2/s,对侧正常脑组织白质的ADC值为(0.85±0.08)×10-3mm2/s。所有病灶均有强化,12个病灶为均匀强化。大多数病灶病理上表现为瘤细胞密集、高核浆比,瘤细胞沿血管周围排列呈“袖套”样改变,血管增生不明显,病灶内出血坏死少见。结论:免疫功能正常状态原发性脑淋巴瘤的MRI表现与其病理亚型无关,但与其细胞密集、高核浆比及有无出血坏死密切相关。     

原发性脑淋巴瘤的CT、MRI影像表现与鉴别诊断

目的探究CT、MRI对原发性脑淋巴瘤的鉴别诊断效果及影像表现。方法选择我院2017年1月～2017年12月收治的原发性脑淋巴瘤患者17例,所有患者均经手术病理证实为B细胞型非霍奇金淋巴瘤,以手术病理检查结果作为金标准,回顾性分析和对比CT、MRI对原发性脑淋巴瘤诊断的准确率,并对比患者的CT与MRI影像学资料。结果17例原发性脑淋巴瘤病例中,幕上15例、幕下2例,3例多发病灶,14例单发病灶;MRI对原发性脑淋巴瘤诊断准确性88.2%、特异性100%,均显著高于CT诊断76.5%、80.0%,组间比较差异有统计学意义(P0.05);病灶的CT影像表现多为稍高密度或肿块等密度,MRI影像表现为T1WI信号较低,T2WI呈高或等信号,病灶病灶、水肿现象较轻。结论对原发性脑淋巴瘤采用CT、MRI影像诊断,都具有一定的影像特征性,但部分特征与转移瘤、脑膜瘤、胶质瘤具有一定的相似性,易造成误诊,MRI对这些相似肿瘤鉴别诊断的效果优于CT,因此,可优先采用其对原发性脑淋巴瘤患者进行诊断。     

MRI对原发性中枢神经系统淋巴瘤的诊断价值

目的 探讨脑内原发性中枢神经系统淋巴瘤(PCNSL)的MRI特征,以提高其术前的诊断水平.方法 回顾性分析15例经手术后病理证实的PCNSL的MRI表现.结果 所有病例均为弥漫大B细胞淋巴瘤;单发11例,多发4例;共19个病灶,其中幕上15个,幕下4个;圆形或类圆形为主,占位效应轻,轻、中度水肿占73.6%;T1WI呈相等或稍低信号,T2WJ示大部分病灶为相等或稍高信号,少数病灶为高信号,FLAIR上为相等或稍高信号,增强后大部分明显均匀强化,少部分痛灶内可见无强化的坏死区.结论 PCNSL的MRI表现具有一定的特征性,结合特定的发病部位和发病年龄,对PCNSL的发现具有一定的提示作用.     

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.     

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.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.