经尿道等离子双极电切术治疗良性前列腺增生症100例

目的：探讨经尿道等离于双极电切术（TUPKRP）治疗良性前列腺增生症（BPH）的有效性和安全性。方法：2005年8月-2007年8月采用TUPKRP治疗BPH患者100例。结果所有患者术中出血少，无前列腺电切综合征（TURS）等严重并发症发生，术后随访1-6个月，最大尿流率（Qmax）由术前平均5．6ml／s升高至术后17．3ml／s，国际前列腺症状评分（IPSS）由术前平均28．2分降至术后平均9．6分，生活质责评分（QOL）由术前平均4．9分降至术后平均2．1分。结论：TUPKRP治疗BPH安全性高，并发症少，疗效确切。     

经尿道前列腺电汽化术联合经尿道前列腺电切术治疗前列腺增生症

目的总结经尿道前列腺电汽化术结合经尿道前列腺电切术治疗前列腺增生症的临床意义。方法回顾性分析540例经尿道前列腺电汽化术加电切术治疗的前列腺增生症患者的临床资料。结果536例患者手术成功，最大尿流率17．3-21．2mL／s，平均最大尿流率18.3mL／s，IPSS评分7-14分，平均7．2分。无尿失禁和死亡病例。结论经尿道前列腺电汽化术加经尿道前列腺电切术治疗前列腺增生症出血少，经尿道手术综合征减少；手术创面光整，减少腺体组织残留，利于术后创面愈合。     

经尿道汽化切割加电切治疗前列腺增生症(附526例报告)

目的：探讨经尿道汽化切割加电切治疗前列腺增生症的效果。方法：应用铲状汽化切割电极行经尿道前列腺汽化切割（TUEAVP）加经尿道前列腺电切术。结果：平均时间45min，平均出血50ml，膀胱冲洗时间12-48h，术后留置尿管3－5d，术后平均住院5d，无电切综合征发生。417例随访3个月－2年，最大尿流率由术前6．3ml/s上升至术后3个月的19．1ml/s，IPSS症状评分术前23．1，术后3个月降至4．1（P＜0．001）。结论；经尿道汽化切割加电切治疗BPH可综合两者的优点，安全生高，疗效显著，患者恢复快，术后并发症少，生活质量明显提高，是治疗BPH的有效方法。     

前列腺增生合并腹股沟疝同期手术治疗

目的探讨前列腺增生并腹股沟疝同期手术效果。方法经尿道前列腺(汽化)电切术,同时无张力疝修补术治疗前列腺增生并腹股沟疝36例。结果本组患者均顺利出院,无切口感染和手术死亡病例。随诊6~36个月,无疝复发,术后排尿通畅,术后最大尿流率(15 ml/s,国际前列腺症状评分0~8分。结论同期经尿道前列腺(汽化)电切及腹股沟疝无张力修补术是安全有效的手术方法。     

经尿道汽化加电切治疗前列腺增生症240例临床分析

目的：探讨经尿道治疗前列腺增生症的有效方法。方法：利用经尿道汽化加电切治疗前列腺增生症240例。结果：均获成功，无重大并症。术后1个月随访，11例合并尿道外口狭窄，经扩张后排尿通畅。术后3个月随访，均排尿通畅，剩余尿量＜40ml;IPSS评分3－15分，平均8分；生活质量评分0－3分，平均2．3分。结论：经尿道汽化加电切治疗前列腺增生症是一种新的腔内治疗方法，疗效好，安全性高，能拓宽手术适应症。值得临床推广应用。     

经尿道前列腺电汽化术联合经尿道前列腺电切术治疗前列腺增生症(附263例分析)

目的探讨经尿道汽化术联合电切术治疗前列腺增生症(BPH)的临床效果。方法联合交替应用经尿道前列腺电汽化术(TUVP)和前列腺电切术(TURP)治疗BPH263例。结果263例患者手术过程顺利,无严重并发症,术后留置尿管3￣7d,随访0.5￣2.0a,拔除尿管后排尿通畅,临床症状明显改善,IPSS由术前(28.9±1.1)分(P<0.01),下降至术后(12.2±1.1)分(P<0.01),最大尿流率(Qmax)由术前5.3mL/s增加至术后16.2mL/s(P<0.01)。结论经尿道电汽化术联合电切术治疗BPH具有安全、出血少、并发症少、易掌握的特点,是治疗BPH较理想的手术方法。     

双极等离子前列腺电汽化切除术42例

目的：介绍双极等离子前列腺电汽化切除术的体会。方法：利用GYRUS双极等离子电汽化设备行经尿道双极等离子前列腺电汽化切除术治疗BPH患者42例。结果：手术时间15～90min，平均37min。切除腺体组织重量10～48g，平均32g。无术中、术后输血患者，无电切综合症发生。术后3～5天拔除导尿管，均排尿通畅。术后继发出血一例，尿外渗一例，无尿失禁及尿道狭窄出现。结论：双极等离子前列腺电汽化切除术出血少，安全，并发症少，可做为手术治疗BPH的常规方法。     

经尿道前列腺双极等离子电切术治疗前列腺增生260例

目的 观察经尿道前列腺双极等离子电切术治疗良性前列腺增生症的治疗效果及安全性.方法 回顾性分析260例经尿道双极等离子前列腺电切术治疗良性前列腺增生症病例资料,评价手术前后临床症状、国际前列腺症状评分以及生活质量评分、最大尿流率、残余尿量的变化情况.结果 术中切除组织重量45.6±7.2g,手术时间62.7±21.4分,无电切综合征发生,住院时间5.6±1.7天.随访3～6个月,与术前相比,尿频、尿急等症状明显好转,国际前列腺症状评分降低17.8±3.4分;生活质量评分降低2.0±0.8分;最大尿流率升高14.6±3.8ml/s;残余尿量降低61.1±15.8ml,差异均有统计学意义(P＜0.05),术后,无永久性尿失禁.结论 经尿道前列腺双极等离子电切术治疗良性前列腺增生症具有安全、有效、并发症少等优点.     

经尿道等离子体双极电切术治疗前列腺增生

目的探讨经尿道等离子体双极电切术治疗良性前列腺增生的安全性和疗效。方法回顾性分析经尿道等离子体双极电切治疗前列腺增生120例临床资料。结果术中出血少，无前列腺电切综合征，无永久性尿失禁，术后随诊1-9个月，最大尿流率由术前8．6mL／s升至术后19．8mL／s，国际前列腺症状评分由术前26分降到术后9．6分，剩余尿由73mL降至10mL。结论经尿道等离子体前列腺电切术具有安全性高、并发症少、疗效确切等优点。     

经尿道电汽化并用电切术治疗前列腺增生症

目的　探讨前列腺增生症 (BPH)更为有效的腔内手术治疗方法。方法　采用经尿道前列腺汽化电切 (TUVP)并用电切术 (TURP)治疗BPH患者 94例。结果　 91例排尿通畅 ,另 3例继续留置尿管 3～ 5d后排尿正常。术后平均 3～ 5d出院。经 3个月至 1年的随访 ,IPSS由术前 2 7 8± 2 5分 ,降至术后 7 8±0 3分 (P <0 0 1) ,MFR由术前平均 6 4± 1 8ml/s ,术后增加为 17 5± 2 5ml/s。B超测残余尿 (R)术前平均15 0± 2 4 5ml,术后平均为 19 5ml。结论　经尿道电汽化并用电切术治疗BPH取两者的优点 ,手术安全、顺利 ,创伤小 ,并发症少 ,且疗效显著。是目前治疗BPH最为有效的方法     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.