肝细胞癌扩散至右肾上腺的CT表现及其解剖学基础

目的分析肝细胞癌(HCC)扩散至右肾上腺的CT增强表现特征，探讨扩散的途径和解剖学基础，为临床提供全面的影像学信息，帮助选择治疗方案。资料与方法经临床、病理证实的HCC连续性病例中，回顾性分析肿瘤扩散至右肾上腺患者39例，另选择临床确诊为HCC，但右肾上腺形态、密度无异常者5例作为对照组。全部病例均采用螺旋CT动、门脉双期增强扫描。重点观察病灶部位、大小、密度，肝裸区是否受侵犯，肝内病灶与右肾上腺之间的毗邻关系，右肾上腺形态、轮廓、密度，右肾上腺区域有无软组织密度肿块及其强化特征。结果39例肝内病灶经裸区侵犯右肾上腺，其中10例右肾上腺区未形成软组织肿块，但右肾上腺与肝内肿块分界不清、正常轮廓消失，动脉期其密度低于左肾上腺，门静脉期密度不均匀；29例右肾上腺区见软组织肿块或结节且与肝内肿块分界不清，右肾上腺正常轮廓消失或完全被肿块包埋。右肾上腺区肿块，CT增强扫描动脉期呈不均匀明显强化或轻度强化，门脉期密度降低，其强化时相及特征与肝内原发病灶一致。结论HCC可通过肝裸区直接侵犯右肾上腺。根据CT增强动、门脉双期扫描右肾上腺形态、密度有无异常及右肾上腺区软组织肿块密度、强化时相和特征，可判断HCC是否扩散至右肾上腺。     

住院肿瘤患者知情需求调查研究

目的:了解住院肿瘤患者对医疗护理信息的需求愿望高低(求知率)和探讨知情权内容的程度(知情率)及影响知情欲望的因素,以便更好地落实患者的知情同意权。方法:采用自制问卷调查法。结果:住院肿瘤患者对医疗护理信息的求知率为78.82%,对知情权内容范围的知情率为70.12%;患者的性别、年龄、职业和文化程度对知情需求没有显著影响。结论:20%的住院肿瘤患者缺乏知情的欲望;有知情欲望的患者对医疗护理信息的知情率也较低,对30%的内容不了解。应提高医患双方对知情权的认识和相互沟通。     

The neural basis of egocentric and allocentric coding of space in humans: a functional magnetic resonance study

The spatial location of an object can be represented in the brain with respect to different classes of reference frames, either relative to or independent of the subject's position. We used functional magnetic resonance imaging to identify regions of the healthy human brain subserving mainly egocentric or allocentric (object-based) coordinates by asking subjects to judge the location of a visual stimulus with respect to either their body or an object. A color-judgement task, matched for stimuli, difficulty, motor and oculomotor responses, was used as a control. We identified a bilateral, though mainly right-hemisphere based, fronto-parietal network involved in egocentric processing. A subset of these regions, including a much less extensive unilateral, right fronto-parietal network, was found to be active during object-based processing. The right-hemisphere lateralization and the partial superposition of the egocentric and the object-based networks is discussed in the light of neuropsychological findings in brain-damaged patients with unilateral spatial neglect and of neurophysiological studies in the monkey.     

国产牛颈静脉带瓣管道重建右室流出道

目的:探讨国产牛颈静脉带瓣管道(VBJV)在右室流出道重建术中的应用和术后早期临床疗效。方法:6例病人使用了完整牛颈静脉带瓣管道重建右室流出道。记录术后并发症,术后3个月用心脏超声对移植的牛颈静脉进行功能评价,检查新建肺动脉瓣跨瓣压、移植牛颈静脉管道直径和有无瘤样扩张远端吻合口压差等。结果:所有患者住院期间均无栓塞等带瓣管道相关并发症发生,恢复顺利出院。术后3个月超声检查均提示移植的管道通畅,2例新建的肺动脉瓣轻度反流。结论:国产牛颈静脉带瓣管道易于获取,型号较齐全,移植后早期临床疗效满意,可作为一种右室流出道重建的替代材料。     

导管射频消融治疗右室流出道室性心律失常

目的评价导管标测及射频消融治疗右室流出道室性心律失常的临床疗效。方法选择48例临床症状显著,抗心律失常药物治疗无效,无器质性心脏病的右室流出道室性心律失常患者,射频消融术前动态心电图记录室性早搏(16900.6±7094.9)次/24h。分为两组:常规消融组18例按射频消融常规术式行置管、标测与消融,单导管消融组30例采用单导管射频消融术。所有患者均采用起搏标测,以起搏与自然发作室早或室性心动过速12导联心电图QRS波形至少有11个导联相同作为消融靶点。结果消融术后动态心电图记录早搏(857.9±2605.6)次/24h,常规消融组与单导管消融组消融后室早分别为(824.6±2485.1)次/24h和(877.8±2716.9)次/24h,与术前比较差异均有统计学意义(P<0.001)。两组消融成功率分别为88.8%和90%,相比无统计学意义(P>0.05)。结论导管射频消融右室流出道室性心律失常安全有效,采用单导管消融术式同样安全有效,且操作更为简捷。     

BNP在急性肺栓塞中的变化及意义

目的探讨BNP水平在急性肺栓塞（APE）的变化及其意义。方法33例经肺螺旋CT＋肺动脉造影或数字减影肺动脉造影确诊为APE患者，分为右室功能不全组和无右室功能不全组，采用干式快速定量心衰诊断仪测定血脑钠肽（BNP）后比较两组差异和观察比较两组患者临床表现、病死率、需要机械通气支持差异。结果右心室功能不全组BNP水平（2884-102pg／m1）明显高于无右心室功能不全组（614-32pg／m1）（P〈0．05）；前者严重临床表现晕厥、低血压或休克高于后者（P〈0．05）；前者表示右室功能指标：肺主动脉内径和压力、右室内径、右室活动度与后者比较也有显著差异（P均〈0．05）；前者病死率、需要机械通气率高于后者。结论BNP水平对判断APE时右心室功能有一定价值，从而可以帮助APE患者危险分层及预后判断。     

组织多普勒成像评价ASD封堵术后右心室长轴收缩功能的变化

目的探讨房间隔缺损(ASD)封堵术后右心室长轴收缩功能变化及其临床价值。方法对行ASD封堵术的34例患者应用组织多普勒成像(TDI),测定在封堵术前、术后1周和3个月的右心室侧壁处三尖瓣环收缩期峰值运动速度(SM)、位移(DS)、收缩前期时间(PCTM)、收缩时间(CTM)及PCTM/CTM。结果ASD患者封堵术后1周,SM(14.80±2.50)cm/s、DS(2.34±0.30)cm较术前SM(17.90±3.30)cm/s、DS(2.67±0.36)cm,显著减少(t=2.20、4.12均P<0.05);CTM(280.00±22.00)ms及PCTM/CTM0.32±0.13较术前CTM(261.00±23.00)ms及PCTM/CTM(0.29±0.08)显著增加(t=3.48、2.25,均P<0.05);术后3月SM(14.10±2.40)cm/s、DS(2.17±0.23)cm较术后1周进一步减小(t=2.18、2.62,均P<0.05)。结论封堵术后ASD患者右心室长轴收缩功能改善,TDI为评价ASD患者右心室功能提供了一个无创、简便和准确的新途径。     

Remodelling of the right ventricle after early pulmonary valve replacement in children with repaired tetralogy of Fallot: assessment by cardiovascular magnetic resonance.

AIMS: Correct timing of pulmonary valve replacement (PVR) is crucial for preventing complications of pulmonary regurgitation and right ventricular (RV) dilatation after repair of tetralogy of Fallot. We sought to assess the remodelling of the RV after early PVR in children, using cardiovascular magnetic resonance (CMR). METHODS AND RESULTS: Twenty children with severe pulmonary regurgitation and RV dilatation and mean age 13.9 +/- 3 years underwent CMR evaluation 5.6 +/- 1.8 months before and 5.9 +/- 0.6 months after PVR. PVR was performed when the RV end-diastolic volume exceeded 150 mL/m(2), as measured by CMR. The time interval between primary repair and PVR was 12 +/- 3 years. Post-operative CMR demonstrated a significant reduction of the RV end-diastolic volume from 189.8 +/- 33.4 to 108.7 +/- 25.8 mL/m(2) (P < 0.0001), of the RV end-systolic volume from 102.4 +/- 27.3 to 58.2 +/- 16.3 mL/m(2) (P < 0.0001), and of the RV mass from 48.7 +/- 12.3 to 35.8 +/- 7.7 g/m(2) (P < 0.0001). The RV ejection fraction did not change significantly. CONCLUSION: Prompt RV remodelling, with reduction of RV volume and mass, is observed after performing PVR if the RV end-diastolic volume exceeds 150 mL/m(2). Early PVR may prevent the detrimental complications of severe pulmonary regurgitation.     

超声心动图评价右心功能的新进展

超声心动图是评价心功能的重要手段 ,但由于右心室是一种不规则的新月型结构 ,具有一个相对独立的流出道 ,肌小梁粗大 ,对其难以进行标准的几何学假设 ,故用传统的二维超声心动图难以进行精确的右心功能评价。随着不基于几何构形假设的超声心动图 (三维超声心动图、心肌运动指数、声学定量 )的应用 ,使得右心功能的检测更准确