Esophageal varices before and after endoscopic variceal ligation: evaluation using helical CT

The purpose of this study was to demonstrate the utility of helical CT in assessing the therapeutic effects of endoscopic variceal ligation (EVL). Twenty-four patients with esophageal varices were examined. Helical scanning was initiated 60 s after intravenous injection (Iopamidol 300 mgI/ml, total 120 ml, 3 ml/s) was started. Esophageal varices were clearly depicted as high-density areas. Multiplanar reformation and 3D images demonstrated collateral circulation three-dimensionally. After EVL, mucosal high-density areas had diminished markedly, but collateral veins around the esophagus, and gastro- and/or spleno-renal shunts, were unchanged in all patients. Of 21 patients with collateral circulation, esophageal varices recurred endoscopically in 6 patients within 12 months. In 3 patients without collateral circulation, esophageal varices did not recur within 12 months. From these findings, we conclude that helical CT is a useful method for assessing the therapeutic effects of EVL. Received: 2 July 1998; Revised: 1 December 1998; Accepted: 12 February 1999     

多层螺旋CT胆管MPR与MRCP 的初步对照研究

目的评价多层螺旋CT胆管多平面重建成像(MSCTC-MPR)的临床应用价值。方法63例胆道病变患者,分别行MSCTC和MR I检查,其中有48例在MSCT检查时做MSCTC-MPR成像,51例患者MR I检查时做MRCP成像,共36例同时进行了2项检查,对检查结果作统计学分析。结果MSCTC-MPR和MRCP的成像成功率各为100%(48/48),92.2%(47/51);二者的定位诊断准确率均为100%;定性为肿瘤病变及非肿瘤病变的诊断准确率均各为95.8%,95.7%;MPR对胆道结石诊断的敏感度、特异度及准确度为74.1%、100%和85.4%,MRCP为96.2%、81.0%和89.4%。结论MSCTC-MPR与MRCP对胆道病变的诊断价值相近,二者各有优势。     

Clustered randomized controlled trial of a clinic-based problem-solving intervention to improve adherence in adolescents with cystic fibrosis

BackgroundIn Cystic Fibrosis (CF), adherence to pulmonary medications is about 50% and decreases during adolescence. Effective interventions have not been integrated into CF care. This effectiveness study tested a brief, clinic-based behavioral intervention to improve adherence.MethodsiCARE (I Change Adherence and Raise Expectations) was a pragmatic, clustered, 2-arm randomized controlled trial at 18 CF Centers. 607 adolescents with CF, ages 11–20 years, participated. Centers were randomized to IMPACT (n = 9; 300 adolescents), a brief problem-solving + education intervention, or standard care (SC; n = 9; 307 adolescents). IMPACT was delivered during a regularly scheduled clinic visit by a member of the clinical care team. The primary outcome was composite pulmonary medication possession ratio (cMPR); secondary endpoints were lung function, Body Mass Index percentile, courses of IV antibiotics, and health-related quality of life at 12 months.ResultsEffectiveness of the intervention was tested using mixed models, generalized estimating equations comparing IMPACT to SC. Fifty-eight percent of problem-solving sessions targeted barriers to airway clearance, exercise or nutrition, while 18% addressed pulmonary medications. Average intervention fidelity score was 67% (SD = 14%; Range = 25–100%). No significant intervention effects were found for cMPR or any of the secondary outcomes compared to SC.ConclusionsThe IMPACT intervention did not improve medication adherence or health outcomes over 12 months. Challenges to implementing the intervention as intended during busy clinic visits were identified.Trial RegistryClinicalTrials.gov; No.: NCT01232478; URL: www.clinicaltrials.gov.     

螺旋CT及多平面重建技术在小儿支气管异物诊断中的价值

目的探讨多排螺旋CT(multi-slice spiral CT,MSCT)及多平面重建(multiplanarreformation,MPR)技术、曲面重建(curve multiplanar reformation,CPR)技术在小儿支气管异物影像诊断中的价值。方法确诊支气管异物患儿10例,男孩9例,女孩1例,年龄为(1.2~10.0)岁;在常规螺旋CT检查的基础上,再结合MPR,CPR显示支气管狭窄、异物及其所在的位置,以及异物阻塞所致的间接征象。结果螺旋CT检查结果提示,支气管异物并经支气管镜检确诊,位于右侧主支气管者8例,位于左侧主支气管者2例;低密度异物8例,包括花生米3例、开心果皮、玉米粒、瓜子仁、蚕豆和肉丝各1例,高密度异物,如牙齿和鱼刺残留各1例;螺旋CT检查结果显示,肺炎7例,肺不张4例,肺气肿3例,纵隔气肿4例,皮下气肿4例,气胸2例。结论螺旋CT加MPR/CPR技术对小儿支气管异物的显示率高,定位准确,并可显示各种合并症,对气道异物的诊断和鉴别诊断有极重要的价值。     

Three-dimensional Computed Tomography Image of Small Pulmonary Lesions

To evaluate diagnostic imaging of small lesions in the peripherallung, three-dimensional (3D) reconstruction CT images were usedto study 36 cases (including which had been 19 resected) ofpulmonary nodules > 3 cm in diameter. Rapid scanning wasemployed in 17 cases and helical scanning (in which the X-raytube rotates continuously with simultaneous table sliding) in19 cases. The rapid scanning could not be evaluated in two casesbecause respiratory motion resulted in discontinuous image data.We were able to evaluate 34 cases. The addition of 3D imagesto the conventional iamges made it possible for us to obtainuseful information on visualizing relations between nodulesand vascular structures in 32% (11/34) of the cases. The 3Dimages enabled us to visualize the lesions and pulmonary vesselsthree-dimensionally. It was, however, difficult to evaluatelesion shape since we were able to obtain useful informationin only 3% (1/34) of the cases. In helical scanning, data areacquired from an extensive area within a short time, providingconsecutive axial-slice images remain free of any respiratoryartifacts. In this regard, helical scanning is suitable forgenerating 3D images. A diagnostic procedure based on 3D lesionanalysis should be developed and standardized.     

MDCTE在诊断克罗恩病中的价值

收集临床确诊的克罗恩病患者56例,其中男33例,女23例,年龄15~70岁,中位年龄37岁。患者均行多排CT小肠成像检查。将数据经1.25 mm重建后传至AW 4.4工作站,采用多平面重组、CT血供成像对病变肠壁和肠周病变情况进行观察。50%的患者病变节段数大于4段；56例患者的肠壁厚度自4~17 mm,平均9.2 mm,其中以环形增厚为主；25%的肠壁为均匀强化,13%的患者为混合强化；“梳状征”25例；22例并发症患者中有10例为肠粘连。     

Somatic loss of heterozygosity,but not haploinsufficiency alone,leads to full-blown autoimmune lymphoproliferative syndrome in 1 of 12 family members with FAS start codon mutation

We describe a family with 12 members carrying a heterozygous germline FAS c.3G > T start codon mutation leading to FAS haploinsufficiency. One patient had autoimmune lymphoproliferative syndrome (ALPS), one had recovered from ALPS, and ten mutation-positive relatives (MPRs) were healthy. FAS-mediated apoptosis and surface expression of FAS in single-positive T cells were lower for MPRs but did not discriminate between them and the ALPS patient. However, double-negative (DN) T cells of the ALPS patient had no FAS expression due to somatic loss of heterozygosity. Our results in this kindred suggest that FAS haploinsufficiency does not cause ALPS-FAS, but that modifying genetic events are crucial for its pathogenesis. FAS surface expression on DN T cells should be assessed routinely and FAS haploinsufficient patients should be followed as its potential for lymphomagenesis is not well defined and a second hit might occur later on.     

多层螺旋CT对颌面部复杂性骨折的诊断价值分析

目的探讨采用多层螺旋CT（MSCT）对颌面部复杂性骨折的诊断价值。方法选择湖南省株洲市中心医院2010年1月-2011年1月接待的33例颌面部外伤患者作为研究对象,采用MSCT对其面部复杂性骨折进行诊断,其中扫描采用的是高分辨率CT（HRCT）,扫描后利用工作站进行图像后处理,采用MPR（多平面重建）、VR（容积再现法）及3D-SSD（三维表面遮盖显示）进行重组观察,最后将观察结果同CT横断面图像进行对比分析。结果经MSCT诊断后发现33例颌面部外伤患者中,有18例下颌骨复杂性骨折,百分比为54.55%;有11例颧弓、颧骨、上颌窦各壁、眼眶各壁两处或者以上联合骨折,百分比为33.33%;有2例鼻骨、鼻中隔及筛骨骨折,百分比为6.06%;有2例上颌骨LefortⅠ型或Ⅱ型骨折,百分比为6.06%。经过几种重组观察可知,MSCT诊断后MPR成像可以清晰显示患者所有颌面骨折及其周围软组织的损伤情况,尤其在微骨折与深部骨折方面要明显优于VR与3D-SSD成像;而VR与3D-SSD成像则可以将骨折部位、骨折线走行及骨折碎裂程度与移位情况立体与直观显示出来。结论对于面部复杂性骨折而言,采用MSCT诊断能取得较好的效果,行HRCT扫描后,若能采取多种重组观察,那么效果更佳,除了可以将复杂性骨折情况显示出来,还能将骨折碎裂程度、移位情况等立体显示,值得临床推广及应用。     

MSCT多平面重建（MPR）对窦口鼻道复合体解剖变异及鼻窦炎的临床应用价值

目的探讨MSCT多平面重建（MPR）对窦口鼻道复合体（OMC）解剖变异的临床应用价值,评价其在临床手术治疗中的重要性。方法回顾性分析经MSCT扫描的63例解剖变异伴副鼻窦炎症患者的影像资料,先行轴位薄层容积扫描,并将原始数据在工作站上行多平面重建,重点观察窦口-鼻道复合体解剖变异的影像特点及其与鼻窦炎症发生的关系。结果 （1）解剖变异：钩突偏移17例,其中向内偏移9例,向外偏移8例;中鼻甲过度充气20例;中鼻甲反向7例;筛泡过度气化7例;Hallor气房6例。（2）鼻旁窦炎症表现：上颌窦炎26例（左侧10例,右侧11例,双侧5例）;筛窦炎19例（左7例,右6例,双侧6例）;上颌窦并筛窦炎15例（左5例,右6例,双侧4例）;右侧鼻旁窦炎合并左侧上颌窦炎1例,左侧鼻旁窦炎合并右侧筛窦炎2例。结论MSCT多平面重组（MPR）着重OMC细节的显示,构建鼻道引流通道,提供治疗方案的影像学信息。