小细胞肺癌的CT分型与影像特征分析

目的探讨小细胞肺癌(SCLC)特征性CT表现。方法回顾性分析经病理证实的53例SCLC患者的CT图像,将SCLC分为肺门肿块(I型),肺门肿块伴同侧纵隔淋巴结肿大(II型),肿块与淋巴结分界清晰(IIa)或不清晰(IIb),肺门肿块伴双侧纵隔淋巴结肿大(III型),肿块与同侧淋巴结分界清晰(IIIa)、不清晰(IIIb)或与双侧淋巴结融合(IIIc),周围型肿块(IV型)。结果53例中IIb和IIIb与IIIc共22例,占41.5%。病变多累及支气管,伴有支气管狭窄或梗阻40例(75.5%),中央型SCLC常见病灶侵犯血管32例(60.4%)、胸膜22例(41.5%)、肺实质34例(64.2%)等表现。通过Pearson相关性分析得出血管受累、胸膜病变及肺内伴随表现均与肿瘤的位置及纵隔浸润程度呈正相关。结论小细胞肺癌特征性CT表现就是肺门肿块伴纵隔融合性肿块。中央型SCLC大多累及支气管、大血管与胸膜。     

超声造影微血管成像与常规超声靶向引导前列腺癌穿刺活检的比较研究

ObJective To evaluate the value of contrast-enhanced ultrasonography microflow imaging (MFI) in detecting prostate cancer. Methods Sixty-five patients with serum prostate-specific antigen levels higher than 4.00 μg/L were evaluated with transrectal gray-scale,power Doppler,and MFI ultrasonography and then biopsy guided by ultrasonography. Biopsy was performed at twelve sites in the base,the mid gland and the apex in each patient. In these three transverse sections, when any of the three methods showed abnormality,the biopsy site was directed to the abnormal foci. Diagnostic efficiency of the three methods for prostate cancer detection was compared based on biopsy results according to patient and biopsy site. Results Overall prostate cancers were detected in 230 (29.5 %) of 780 specimens in 36(55.4%) of 65 patients. MFI could detect more patients(34) than gray-scale(26) and power Doppler(28) (P = 0.021, P = 0.031), 6(16.7%)of the 36 patients diagnosed with cancer were identified only by MFI. By biopsy site, MFI had higher sensitivity and overall accuracy (80.0% and 83.0%) than gray-scale (47.0% and 76.8%) and power Doppler (37.4% and 74.6%) ultrasonography(P <0.001, P<0.001 ; P = 0.001, P <0.001), while the specificity of MFI was 84.4%, lower than gray-scale (89.3%) and power Doppler (90.2%) ultrasonography(P = 0.009, P < 0.001). Conclusions MFI could detect more patients and improve sensitivity and overall accuracy by biopsy site than conventional uhrasonography.     

不同剂量氯胺酮对兔严重烧伤早期全身炎症反应的影响

目的：比较不同剂量氯胺酮对严重烧伤兔早期炎性细胞因子的影响,初步探讨其对创伤应激早期炎症反应的调节作用。方法选择健康雄性新西兰兔40只,按随机数字表法分正常对照组、烫伤模型组、氯胺酮镇痛组和氯胺酮麻醉组。烫伤前用戊巴比妥钠麻醉后分别经颈内静脉和颈内动脉置管备用,24 h后制备兔背部和臀部30%Ⅲ度烫伤模型,氯胺酮镇痛组于伤后0.5 h静脉注射（静注）氯胺酮负荷量0.5 mg/kg,然后持续静脉泵注氯胺酮9μg·kg-1·min-1共24 h;氯胺酮麻醉组伤后0.5 h静注氯胺酮1.5 mg/kg,然后持续静脉泵注氯胺酮45μg·kg-1·min-1共4 h维持全身麻醉;正常对照组和模型组仅给予静脉输液处理。记录各组补液量及氯胺酮镇痛组和麻醉组的氯胺酮总用量。分别于烫伤前和烫伤后0.5、6、12、24 h进行动脉血气分析,并检测血清白细胞介素（IL-1、IL-6）及肿瘤坏死因子-α（TNF-α）水平。结果4组血气分析指标虽然有所变化,但均在正常范围,说明呼吸功能在正常范围,间接反映循环功能也在正常范围,排除了呼吸和循环功能因素的影响对细胞因子的评判。4组烫伤前IL-1、IL-6及TNF-α水平比较差异均无统计学意义（均P＞0.05）。伤后0.5 h起,烫伤模型组IL-1（ng/L：30.27±0.93比13.79±1.11）、IL-6（ng/L：47.22±1.49比46.31±4.12）及TNF-α（ng/L：243.39±20.85比190.95±14.97）水平即均显著高于正常对照组（均P＜0.05）,并持续到伤后24 h;伤后6 h起氯胺酮镇痛组和麻醉组上述指标均较烫伤模型组明显降低,于伤后12 h起氯胺酮镇痛组上述指标的降低程度较氯胺酮麻醉组更显著〔IL-1（ng/L）：19.28±2.51比40.12±10.31,IL-6（ng/L）：52.10±4.23比72.20±10.11, TNF-α（ng/L）：246.03±20.74比313.71±27.34,均P＜0.05〕。结论小剂量氯胺酮镇痛和氯胺酮麻醉对兔严重烧伤后早期炎性细胞因子的表达和释放有一定抑制作用,且长时间小剂量氯胺酮镇痛效果更明显。     

组织谐波显像在胰腺囊性病变诊断中的价值

目的　探讨组织谐波显像在胰腺囊性病变诊断中的临床价值。方法　经手术病理证实的 3 0例胰腺囊性病变患者行二维超声及组织谐波显像检查 ,对组织谐波显像 (THI)与基波显像 (FI)对比分析。结果　组织谐波显像对囊壁边界及内部回声结构的显示均优于基波显像。结论　组织谐波显像能显著提高图像质量 ,提高胰腺疾病的显示率和诊断的准确性。     

肠系膜占位性病变实时超声定位诊断价值

目的 探讨实时超声显像对肠系膜占位性病变定位诊断的价值.方法 分析19例肠系膜占位性病变的实时超声表现,观察实时超声检查过程中改变体位时病变的移动性.所有病例均与CT检查结果对照,并经手术和病理证实.结果 19例肠系膜占位性病变中,16例肿块可在脊柱两侧移动,超声定位诊断符合率84.21%,CT定位诊断符合率42.10%.结论 实时超声检查可动态观察肿块的移动性,对肠系膜占位性病变的定位诊断有较大参考价值.     

Syndecan-1表达缺失促进胃癌淋巴结转移

目的:探讨Syndecan-1基因在胃癌及癌旁组织中的表达及其与癌淋巴结转移的关系。方法:将44例胃癌手术病例分为伴淋巴结转移组和不伴淋巴结转移组,以相应的癌旁正常组织为对照。应用RT-PCR及免疫组化技术检测Syndecan-1的表达,并同时检测p53表达水平的改变。结果:所有癌旁正常组织均有Syndecan-1基因的表达,而44例胃癌组织中只有10例有表达,阳性表达率为22.7%(10/44),癌旁正常组织中Syndecan-1基因表达率显著高于胃癌组织(χ~2=9.14.P<0.05)。35例伴有淋巴结转移的胃癌组织中,2例有Syndecan-1基因表达,阳性表达率为5.7%(2/35),不伴淋巴结转移的9例胃癌组织中有8例检测到Syndecan-1 mRNA的表达,阳性表达率为88.9%(8/9),伴有淋巴结转移的胃癌组织中Syndecan-1 mRNA的表达率显著低于不伴淋巴结转移者,两组间差异明显(χ~2=23.66,P<0.05)。p53表达阳性的胃癌组织Syndecan-1 mRNA的表达低于p53表达阴性的胃癌组织(χ~2=6.18,P<0.05)。结论:Syndecan-1 mRNA表达缺失促进了胃癌生成及淋巴结转移。     

超声诊断闭合性胸外伤合并膈疝1例

<正>患者男,55岁,因触电后高处坠落致胸痛、胸闷1 h入院。诉右侧胸痛,右上肢活动障碍。体格检查:气管稍左偏,右侧胸壁压痛,胸廓挤压征阳性,右中、下肺呼吸音消失,右上肢活动受限。超声检查:右侧胸腔内可探及类肝脏回声的实性结构,与腹腔内肝左叶相连,位置较固定,不随呼吸运动而滑动,其内血管扩张、走行扭曲,右上方可见胆囊样无回声(图1)。胸、腹     

超声造影微血管成像与常规超声靶向引导前列腺癌穿刺活检的比较研究

ObJective To evaluate the value of contrast-enhanced ultrasonography microflow imaging (MFI) in detecting prostate cancer. Methods Sixty-five patients with serum prostate-specific antigen levels higher than 4.00 μg/L were evaluated with transrectal gray-scale,power Doppler,and MFI ultrasonography and then biopsy guided by ultrasonography. Biopsy was performed at twelve sites in the base,the mid gland and the apex in each patient. In these three transverse sections, when any of the three methods showed abnormality,the biopsy site was directed to the abnormal foci. Diagnostic efficiency of the three methods for prostate cancer detection was compared based on biopsy results according to patient and biopsy site. Results Overall prostate cancers were detected in 230 (29.5 %) of 780 specimens in 36(55.4%) of 65 patients. MFI could detect more patients(34) than gray-scale(26) and power Doppler(28) (P = 0.021, P = 0.031), 6(16.7%)of the 36 patients diagnosed with cancer were identified only by MFI. By biopsy site, MFI had higher sensitivity and overall accuracy (80.0% and 83.0%) than gray-scale (47.0% and 76.8%) and power Doppler (37.4% and 74.6%) ultrasonography(P <0.001, P<0.001 ; P = 0.001, P <0.001), while the specificity of MFI was 84.4%, lower than gray-scale (89.3%) and power Doppler (90.2%) ultrasonography(P = 0.009, P < 0.001). Conclusions MFI could detect more patients and improve sensitivity and overall accuracy by biopsy site than conventional uhrasonography.