超声引导经皮Nd:YAG激光光凝固术治疗原发性肝癌的初步临床研究

作者等在前期离体和在体实验研究的基础上，对9例原发性肝细胞癌患者11个肿瘤在超声引导下经皮穿刺进行了Nd：YAG激光光凝术治疗。患者在局麻下经超声引导将18GPTC针插入瘤体，激光照射功率3～5W，经400μm光纤传输，照射时间10～20分钟。根据瘤体大小采用单点或两点照射，或分次治疗。术中超声监测影像改变，术后定期观察超声影像、肝功、甲胎蛋白及活俭病理学检查。经短期随访观察，认为该方法安全有效，具有应用价值。     

Nd:YAG激光照射大鼠皮肤组织的温度实验

目的验证激光与组织光热效应预示模型和计算结果，考查激光功率密度和照射时间与组织温度和损伤的定量关系，获得组织热效应的温度数据。方法连续Nd：YAG激光照射活体皮肤组织，组织为全身麻醉状态下大鼠腹部皮肤，每次实验同时测量三路信号：表面照射点辐射温度、皮下1mm的内部温度和环境温度。为了获得不同条件下的温度数据，根据照射功率和时间进行分组。结果得到连续Nd：YAG激光相同照射时间（t=1s）时不同功率（P=2、3、4、5w）、相同功率（P=5W）时不同照射时间（t=0．5、0．8、1．0s）以及照射功率较高时（t=0．5s，P=5、10、15w）的大鼠皮肤组织皮下1mm的温度。温度随着功率和照射时间的增加相应升高，温度响应形状相似，温度上升时间与照射时间相关。结论Nd：YAG激光表面辐射温度远远低于皮下温度，对热效应研究意义不大。热电偶所测内部温度能够很好地反映激光功率、照射时间的变化，可用来验证相关模型和数值模拟结果。     

GaAlAs，InGaAs，Nd：YAG三种激光热凝固效应的比较

目的 比较GaAlAs和InGaAs半导体激光与Nd：YAG激光热凝固效应。方法 GaAlAS、InGaAs、Nd：YAG激光以石英光纤输出，照射鸡蛋蛋清，每种激光照射10点，测量蛋白凝固团的直径和高度。光纤输出端功率10w，芯径1mm光斑、直径2mm，照射时间30s。结果 三种波长的激光照射活性蛋白形成凝固的体积大小差异明显，其中InGaAs激光热凝固最强，Nd：YAG激光次之，GaAlAs激光最弱。结论 三种激光的热凝固效应有差异。     

Nd∶YAG激光照射大鼠皮肤组织的温度实验

目的验证激光与组织光热效应预示模型和计算结果,考查激光功率密度和照射时间与组织温度和损伤的定量关系,获得组织热效应的温度数据。方法连续Nd∶YAG激光照射活体皮肤组织,组织为全身麻醉状态下大鼠腹部皮肤,每次实验同时测量三路信号:表面照射点辐射温度、皮下1mm的内部温度和环境温度。为了获得不同条件下的温度数据,根据照射功率和时间进行分组。结果得到连续Nd∶YAG激光相同照射时间(t=1s)时不同功率(P=2、3、4、5W)、相同功率(P=5W)时不同照射时间(t=0·5、0·8、1·0s)以及照射功率较高时(t=0·5s,P=5、10、15W)的大鼠皮肤组织皮下1mm的温度。温度随着功率和照射时间的增加相应升高,温度响应形状相似,温度上升时间与照射时间相关。结论Nd∶YAG激光表面辐射温度远远低于皮下温度,对热效应研究意义不大。热电偶所测内部温度能够很好地反映激光功率、照射时间的变化,可用来验证相关模型和数值模拟结果。     

超声引导下两种激光对离体甲状腺组织间光凝效应的比较

目的:比较980nm半导体激光与Nd∶YAG激光对离体甲状腺组织间光凝的效果,为临床光凝治疗中激光参数的选择提供实验依据。方法:以新鲜离体甲状腺组织为实验对象,采用10MHz的线阵超声探头做影像学引导,将75mm长的21G脊髓穿刺针插入甲状腺组织进行光凝,并实时观测组织内的超声影     

GaAlAs,InGaAs,Nd∶YAG三种激光热凝固效应的比较

目的比较 GaAlAs和 InGaAs半导体激光与 Nd∶ YAG激光热凝固效应. 方法 GaAlAS、 InGaAs、 Nd∶ YAG 激光以石英光纤输出 ,照射鸡蛋蛋清 ,每种激光照射 10点 ,测量蛋白凝固团的直径和高度.光纤输出端功率 10 W,芯径 1 mm光斑、直径 2 mm,照射时间 30 s. 结果三种波长的激光照射活性蛋白形成凝固的体积大小差异明显 , 其中 InGaAs激光热凝固最强 ,Nd∶ YAG激光次之, GaAlAs激光最弱. 结论三种激光的热凝固效应有差异.     

1.44μm脉冲Nd:YAG激光对犬膀胱组织作用的比较研究

目的 通过比较1.44μm与1.06μm脉冲Nd:YAG激光对犬膀胱组织作用的异同点,评价1.44μm脉冲Nd:YAG激光的组织效应特点、临床应用的可能性与特异性.方法 采用脉宽640μs,频率5Hz的1.44μm与1.06 μm脉冲Nd:YAG激光,按单脉冲能量0(对照)、200、500和800 mJ与每次照射脉冲数1、5、10、20、40和80进行分组.两个波长、由相同单脉冲能量指标构成的12个剂量组和一个对照组在一个膀胱后壁不同部位进行活体照射,全部实验完成一遍共3只犬,重复5遍.取照射处膀胱壁制作组织切片,显微镜观察,计算机成像与测量,获取气化宽度、气化深度、凝固宽度与凝固深度数据,进行数据处理与分析.结果 1.44μm脉冲Nd:YAG激光对膀胱组织的气化能力远大于1.06 μm脉冲Nd:YAG激光,同时其凝固作用足以产生良好的止血效果.结论 1.44μm脉冲Nd:YAG激光对犬膀胱黏膜有较强气化与凝固止血作用,作为手术刀应用于膀胱手术,其切割效果远高于1.06 μm脉冲Nd:YAG激光,并能在切割手术同时表现出良好的止血功能.     

Nd：YAG激光辐射对大白鼠颌下腺及颌下淋巴结的影响

作者研究Nd:YAG激光辐照口腔颌面部软组织,以大白鼠颌下腺及颌下淋巴结为实验对象。激光输出功率17～18瓦,观察组织反应及超微结构变化,结果表现为碳化、汽化、组织凝固坏死,空泡性变及组织液化。颌下腺组织及淋巴结经激光照射后,不仅局部发生变化,在整个腺体内均有不同程度的反应。产生这种变化的原因,有待进一步研究。电镜下观察Nd:YAG激光照射引起颌下腺腺泡的早期损伤主要为细胞膜结构的破坏,如核膜、线粒体膜等。颌下腺及颌下淋巴结对Nd:YAG激光的早期反应不完全相同,颌下腺主要为空泡性变,细胞变性;淋巴结内淋巴细胞主要为细胞液化及淋巴管渗出。     

脉冲Nd:YAG激光照射唇部静脉湖温度场分布模型的建立和验证

正目的:探讨脉冲Nd:YAG激光照射唇部静脉湖后热传输的特点,提供脉冲Nd:YAG激光作用唇部静脉湖后组织热效应的有效预测平台。方法:建立唇部静脉湖有限元分析模型,模拟不同照射时间(2、3、5和7 s)Nd:YAG激光照射唇部静脉湖模型后的温度响应。建立Nd:YAG激光照射唇部静脉湖生物模型,获取激光照射过程中生物模型温度的变化规律,验证有限元分析模型的准确性。     

脉冲Nd：YAG激光对牙齿硬组织作用的实验研究

目的研究不同能量和不同频率脉冲Nd:YAG激光照射后牙齿的形态变化。方法在数学模型下选择一致性较好的离体牙150颗分为5组，用牙用高速转头制备各类洞型，然后分别用磷酸腐蚀和4组不同能量和频率的脉冲Nd:YAG激光进行照射，在扫描电镜下观察表面特征并测各组牙本质，牙釉质凹坑的直径和深度并与理论计算深度值进行比较。结果脉冲Nd:YAG激光照射牙齿可以进行打毛处理，在特定参数下，效果比磷酸腐蚀为好，能够增加表面凹坑的大小，有利于增加牙齿和复合树脂之间的粘结力。结论用脉冲Nd:YAG激光代替磷酸进行牙齿表面打毛处理形态变化显著。     

Sexual homicide: Brief review of the literature and case report involving rape,genital mutilation and human arson

The objective of the current paper is to report a new case of sexual murder involving human arson and summarize the literature on the phenomenon of sexual homicide. The present case study is unprecedented in Greece and a rarity in international literature due to the fact that the victim suffered genital mutilation and incineration while still alive. The evaluation consisted of 176 articles; 53 were reviewed by the authors. The results revealed sparse, but significant, research findings. The authors discuss the limitations regarding research, incidence of the phenomenon, crime-scene patterns, offender characteristics (killing methods, motive inferences, sociodemographic data, classifications, psychopathology, modus operandi), and victim selection. The incidence of the phenomenon is unclear (1–4%) due to non-standardized criteria. It is an expression of displaced anger or sexual sadism and/or a way to elude detection (ancillary benefit). Most offenders (in their first kill) and victims were in their late 20s to early 30s and belong to Caucasian populations. Personal weapons were commonly used against women, strangulation is the prevalent killing method against children, and firearms against men. Most of the sexual homicide perpetrators are non-psychotic at the time of the attack, but experience personality pathology, primitive defenses, pathological object relations, and withdrawal into fantasy in order to deal with social isolation.     

Extension du modèle puissance–temps limite pour estimer la production d’énergie aérobie et anaérobie lors de l’exercice intense

Aim

Examine how the modelling of the relation between power and time to exhaustion can provide an estimation of the production of aerobic and anaerobic energy during intense exercise.

Current knowledge

The hyperbolic model made it possible to define the critical power corresponding to the maximal rate of energy renewed by aerobic metabolism. A new model distinguishing the critical power from the maximal aerobic power has been built to estimate more precisely the anaerobic contribution. Data from middle distance runners and subjects tested on cycle ergometer showed a relative contribution of anaerobic metabolism arising from critical power and increasing until around 10 % of total power when aerobic energy production reaches its maximum.

Prospects

Considering the slow component of oxygen uptake would provide a more precise analysis of energy production and transformation during exercise at high intensity.     

Beziehungen zwischen Aufprallgeschwindigkeit,Fahrzeugbeschädigungen,Frakturen und „Wurfweite” bei 50 tödlichen Fußgänger-PKW-Unfällen

Zusammenfassung Aus 160 Obduktionen von Fußgängern, die durch PKW getötet worden waren, sind 50 nach folgenden Gesichtspunkten ausgewählt worden:Auffahrunfälle Erwachsener mit gesicherten Angaben in den Gerichtsakten über Fahrzeugbeschädigungen, Zusammenstoßstellen, Endlage der Fußgänger und Bremsspuren. Aus diesen Daten wurden Ausgangs- und Aufprallgeschwindigkeiten berechnet sowie die Wurfweite der Fußgänger gemessen.Die Ausgangsgeschwindigkeiten, nach der Berechnung zwischen 32 und 95 km/h, lagen meistens etwas höher als die angegebenen Geschwindigkeiten. Zwischen Ausgangs- und Aufprallgeschwindigkeiten waren die Differenzen größer. Ab 12 km/h Aufprallgeschwindigkeit kam es bereits zu tödlichen Verletzungen. Auffallend ist die zweigipfelige Verteilung der Häufigkeit sowohl bei der Einteilung nach den Aufprallgeschwindigkeiten als auch nach den Deformationsarbeiten (Aufprallgeschwindigkeit: 26% bei 51–60 km/h und 22% bei 21 bis 30 km/h; Deformationsarbeit: 34% bei 39–200 kpm und 30% bei 701–1000 kpm).Bei Aufprallgeschwindigkeiten über 50 km/h wurden doppelt so viel Knochenbrüche an der Wirbelsäule und am Becken als bei Aufprallgeschwindigkeiten unter 50 km/h festgestellt.Bei 44 Fußgängerunfällen lag ein Drittel innerhalb der Erwartungsgrenze der Wurfweite nach Fiala, je ein Drittel aber darüber bzw, darunter.Das Beschädigungsbild und die Anstoßverletzungen geben Hinweise zur Ermittlung der Aufprallgeschwindigkeit, vor allem wenn weitere Berechnungsgrundlagen fehlen.

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Summary Fifty cases were selected from 160 autopsies performed on pedestrians who were accidentally killed by private motorcars; the cases were selected according to the following criteria:The cases were confined to impact accidents involving adults in which reliable evidence could be gathered from the Court records in relation to damage to the car, the place of collision, the final position of the injured pedestrian and the extent of skidmarks. The initial and collision speeds of the cars were calculated from these facts and the distance of projection of the pedestrians were measured.The initial speeds, calculated between 32 and 95 km/h, were, in most cases, higher than the declared speeds. The differences between initial and collision speeds were larger. Fatal injuries could arise from a collision velocity of only 12 km/h. A striking feature of the analysis was the distribution of two peaks of frequency whether these were classified according to the collision speeds or according to the deformation of the vehicle (collision speed: 26% at the speed of 51 to 60 km/h and 22% at the speed of 21 to 30 km/h; deformation work: 34% at the deformation work of 39 to 200 kpm and 30% at the deformation work of 701 to 1,000 kpm).Twice as many fractures of the vertebral column and pelvis were sustained at collision speeds over 50 km/h as were sustained under 50 km/h.In one third of 44 pedestrian accidents, the distance of projection was within the expected range described by Fiala; in one third the distance was above and in one third below the expected range.If additional data for calculation were lacking, the patterns in injury arising from the impacts gave indications from which it was possible to estimate the collision speed.

Stipendiat der Alexander v. Humboldt-Stiftung, Dozent Dr. med. S. Kamiyama, Dept. of Legal Medicine, School of Medicine, Chiba University, 313 Inohanacho, Chiba, Japan.     

Hip and pelvic injuries in the elderly

Fractures of the hip and pelvis are frequent and serious injuries in elderly patients. Due to the aging population, their incidence should double by 2050. Therefore, the social and economical implications of these fractures are significant. Delay in diagnosis increases the associated morbidity and mortality. The purpose is to review the imaging features of these fractures, the imaging techniques (projections, CT) to depict them and their classification based on severity.     

利用256iCT对左心室解剖结构和功能定量研究

目的应用256iCT对正常人左心室结构和功能相关指标进行定量研究,分析各指标与年龄和性别的关系。方法搜集506例行256iCT冠状动脉CTA结果正常的患者的影像资料;所有患者近6个月无心血管疾病病史。对原始图像进行多期重组,确定左心室舒张末期及收缩末期,分别对左心室舒张末期和收缩末期的室间隔厚度(septal wall thickness,SWT)、左室后壁厚度(posterior wall thickness,PWT)、左室宽径(LV inner diameter,LVID)、舒张末期容积(end-diastolic volume,EDV)、收缩末期容积(end-systolic volume,ESV)、每搏输出量(stroke volume,SV)和射血分数(ejection fraction,EF)进行测量和计算,并进行相关统计学处理。结果左心室舒张末期SWT、PWT、LVID 95%参考值范围分别为:4.4～12.1 mm,4.0～14.0 mm,28.1～60.8 mm。左心室收缩末期SWT、PWT、LVID 95%参考值分别为:6.2～15.7 mm,7.9～20.8 mm,18.1～46.3 mm。EDV、ESV、SV、EF 95%参考值范围分别为:55.9～165.7 ml,20.9～75.9 ml,25.8～98.6 ml,39.8%～78.3%。收缩期LVID和舒张期LVID值不同年龄组之间差异有统计学差异(P<0.05),并且随着年龄增长有增大趋势。收缩期SWT、舒张期SWT、收缩期PWT、舒张期PWT以及EF值有随着年龄增长而增大的趋势,同时EDV、ESV、SV值随着年龄增长有减小的趋势,但以上各指标在不同年龄组之间的差异均无统计学意义(P>0.05)。不同性别组分析显示除EF值无统计学差异以外,其余各指标均有统计学差异(P<0.05),且男性组各参数均大于女性组。结论初步制定了左心室形态、功能相关参数的正常参考值,为临床诊断、危险评级及预后判断提供有意义信息。     

ASL与DSC-PWI成年烟雾病患者中的对比研究

目的 将动脉自旋标记成像(ASL)与动态磁敏感对比增强灌注成像(DSC-PWI)进行对比分析,探讨ASL在烟雾病患者中的临床应用价值.方法 对32例烟雾病患者同时行ASL与DSC-PWI检查并获得ASL及PWI灌注伪彩图.在半卵圆中心、丘脑、小脑幕平面分别观察双侧大脑前动脉、大脑中动脉、大脑后动脉供血区灌注情况并进行评分(正常记为0,显示低灌注记为1).比较ASL-CBF与PWI-CBF、MTT、TTP诊断低灌注的差异.结果 Spearman检验显示,ASL-CBF低灌注得分(209)与PWI-CBF(206)、MTT(223)、TTP(215)之间高度相关(相关系数分别为0.78、0.83、0.86,P值均＜0.001).以TTP为标准,ASL诊断低灌注的敏感性为92.6％,特异性为93.5％,准确性为92.9％.结论 ASL技术可较真实地反映烟雾病患者的脑血流灌注状态.     

Extraosseous calcified plasmacytoma causing thoracic myelopathy

We report on a rare, calcified, plasma cell tumor of the spine causing progressive myelopathy. Other unusual features were the lack of an osseous lesion at the site of the mass, considerable calcified amyloid within the mass but no identifiable amyloid elsewhere, and normal serum immunoelectrophoresis. Received: 12 February 1999 Revision requested: 18 March 1999 Revision received: 19 April 1999 Accepted: 20 April 1999