Clinical and imaging findings in patients with severe acute respiratory syndrome

Objective To investigate the clinical and imaging characteristics of severe acute respiratory syndrome(SARS), and to study their relationship.Methods Forty-six SARS confirmed patients were admitted to our hospital from February to April,2003. X-ray examination documents were available in all cases and chest CT scanning was acquired in 6 cases, which were analyzed retrospectively, accompanied by their clinical features.Results Fever was found in 97. 8% of the patients. Clinical symptoms were mild, but X-ray and CT findings were distinct. CT scanning demonstrated ground glass like lesions and large patchy exudation and consolidation at the early stage in 6 cases. Different findings on radiography and CT were related to the different phases of the disease. After treatment, most lesions were absorbed completely, but slowly in patients with multi-lobe consolidation and/or extensive interstitial infiltration.Conclusion Special clinical and imaging findings could be found in SARS cases. The prognosis of SARS patients is related to the degree of lesions detected by radiography and CT.     

Giant cell interstitial pneumonia: unusual lung disorder and an update

Background Giant cell interstitial pneumonia （GIP） was a rare form of pneumoconiosis,associated with exposure to hard metals,which had been reported mostly as isolated case reports.We described eight cases of GIP diagnosed in our hospital during the past seven years,with particular reference to new findings.Methods Eight patients with GIP confirmed by biopsy in the Nanjing Drum Tower Hospital affiliated to Medical School of Nanjing University from 2005 to 2011 were retrospectively analyzed.For each patient,the occupy histories and medical records were thoroughly reviewed and clinic data were extracted.Two radiologists,without knowledge of any of the clinical and functional findings,independently reviewed the HRCT scans of all patients.Follow-up data were collected.Results Among the eight patients,seven had a history of exposure to hard metal dusts,one denied an exposure history.The most common manifestations were cough and dyspnea.One patient initiated with pneumothorax and another pleural effusion,both of which were uncommon to GIP.The main pathologic appearances were the presence of macrophages and multinucleated giant cells in the alveolar space.The clinical symptoms and radiographic abnormalities were obviously improved after cessation of exposure and receiving corticosteroid treatments,recurrences were observed in two patients when they resumed work.In spite of exposure cessation and corticosteroid treatment,one patient developed pulmonary fibrosis at seven years follow-up.Conclusions Awareness of the patients＇ occupational history often provided clues to the diagnosis of GIP.Histopathologic examinations were necessary to establish the right diagnosis.Exposure cessation was of benefit to most patients; however,pulmonary fibrosis was possible in spite of exposure cessation and corticosteroid treatment.Better ways should be found out to improve the outcome and quality of life.     

特发性间质性肺炎高分辨率CT征象特点的量化比较分析

目的 通过量化比较分析特发性肺纤维化(IPF)、非特异性间质性肺炎(NSIP)、隐源性机化性肺炎(COP)的高分辨率CT(HRCT)征象特点,探讨这3种特发性间质性肺炎(IIPs)相鉴别的特征性HRCT表现.方法 回顾性分析1998年1月至2008年1月北京朝阳医院46例经肺活检病理证实的特发性间质性肺炎患者HRCT表现,其中IPF 19例、NSIP 14例、COP 13例.男29例、女17例,年龄25～76(50±10)岁.观察者在不知道诊断结果的情况下,将几种常见的影像学征象在出现频率、累及肺叶范围、分布等方面进行定量评价,并通过总体及分层组间的比较,分析相互之间的差异.结果 磨玻璃影、支气管血管束增粗、小叶间隔增厚在本组病例中出现的频率最高(＞50%).IPF组与NSIP、COP组比较,蜂窝影累及肺实质范围较广、细支气管扩张的肺段多,实变影累及的范围较少.COP与IPF、NSIP组比较前者磨玻璃影累及肺实质范围明显少于后两者(P＜0.05),气腔实变影累及肺实质范围较广(P＜0.05).结论 3种IIPs各自具有区别于其他类型IIPs的特征性HRCT征象,借助HRCT可以作出较为准确的诊断,但是NSIP征象易与IPF和COP重叠,有时需要结合其他征象才能作出鉴别.

Abstract：

Objective To analyze the high-resolution computed tomographic (HRCT) findings of IPF (interstitial pulmonary fibrosis), NSIP (nonspecific interstitial pneumonia) and COP (cryptogenic organizing pneumonia) retrospectively through quantification methods and to explore their distinguishing features. Methods Observers with no prior knowledge of the diagnosis evaluated the frequency, extent and distribution of various thin-section CT findings in 29 males and 17 females. The mean age was 50 ± 10 years old ( range: 25 - 76). They had a histological diagnosis of IPF ( n = 19), nonspecific interstitial pneumonia (NSIP) (n = 14) and cryptogenic organizing pneumonia (COP) (n = 13). Results Ground-glass opacity,thickening of bronchovascular bundles and interlobular septal thickening were frequent features of IPF and NSIP. The frequency and extent of honeycombing and bronchiolectasis were more found in IPF than in NSIP and COP ( P ＜0. 05). The frequency and extent of air space consolidation were more found in COP than IPF ( P ＜ 0. 05 ). There were more number of segments with traction bronchiectasis and less extent of air space consolidation in IPF than NSIP and COP. The number of segments with traction bronchiectasis was less in NSIP than that of IPF and COP. Conclusion The various subtypes of idiopathic interstitial pneumonias often have the distinguishing characteristics easily identified on HRCT. Bronchiolectasis and honeycombing are valuable features for IPF; air space consolidation is a valuable feature for COP. The features of NSIP are also found in both IPF and COP so that additional features are required for both.     

Clinical Features and Prognosis in 21 Patients with Extrinsic Allergic Alveolitis

Objective To assess the spectrum of causes, clinical features, differences between disease phases, and prognosis of extrinsic allergic alveolitis （EAA）. Methods Patients with EAA diagnosed at Peking Union Medical College Hospital from August 1983 to May 2007 were analyzed retrospectively. Their medical records were examined to gather clinical, laboratorial, radiological, and histopathological data. Patients were divided to three phases （acute, subacute, and chronic） according to clinical presentations. Follow-up data regarding treatment response, subsequent radio- logical and pulmonary function studies, and clinical outcomes were collected. Results A total of 21 cases were enrolled. Among them, 11 were subacute, 10 were chronic. The most common exposure was pet birds （6 cases, 28.6%）. The primary abnormality of pulmonary function was restriction and/or reduction in diffusing capacity （12 cases, 63.2%）. The most common findings on high-resolution computed tomography （HRCT） were ground-glass opacities （13 cases, 68.4%） and centri- lobular nodules （8 cases, 42.1%）. Airway obstruction in pulmonary function test, emphysema, hmg cysts, and fibrosis on HRCT were more frequently seen in chronic than in subacute patients, though the differences were not statistically significant. Bronchoalveolar lavage fluid （BALF） showed lymphocytosis. The total＇cell count and the percentage of neutrophils were significantly higher in subacute than in chronic patients （P〈0.05）. Nonnecrotizing granulomas were seen in 8 （47.1%） cases. Improvement or normalization in symptoms, radiography, and pulmonary function test after treatment were seen in all 18 patients with avail- able follow-up data. Five patients recurred. Conclusions The characteristic abnormalities of pulmonary function, findings on HRCT, and pa- thology are essential for all phases of EAA, and the atypical manifestations such as obstruction and fibrosis can also be present frequently, particularly in chronic cases. Differential cell counts of BALF are related to the phase of the disease. The treatment response and prognosis of EAA are good.     

Intra-operative frozen section diagnosis of breast lesions: a retrospective analysis of 13 243 Chinese patients

Background Although cytological methods for breast oncology have been used in recent decades, intra-operative frozen section has been playing a vital role in making therapeutic decisions. We analyzed a large series of frozen section diagnoses for Chinese cases of breast lesion within the last 15 years. The experience was expected to increase the diagnostic accuracy of cases with breast lesions. Methods The data from consecutive 13243 cases of breast lesions diagnosed with intra-operative frozen sections between 1988 to 2002 were compared with paraffin sections in a case by case manner. The causes of false negative and positive diagnoses as well as delayed diagnoses were analyzed. Results One hundred and seventeen cases （0.9%） were falsely diagnosed, with one false positive case and 116 false negative cases. The diagnosis of 47 cases （0.4%） was delayed. The proportion of several lesions had the features of the patients＇ ages. Six types （false invasion, peri-papUloma, adenoma of nipple duct, florid adenosis, sclerosing adenosis, and granulose cell tumor） of lesions may lead to false positive, and four types （morphological changes responding chemotherapy, well differentiated papillary carcinoma, invasive Iobular carcinoma, and tubular carcinoma） to a false negative. Gross and microscopic findings may be inconsistent in two types of lesions （radial scar and florid adenosis） microscopic and clinical findings in three types （ganulomatous mastitis mammary, duct ectasia, and fat necrosis）, and three types （abundant fat or sclerous tissues; borderline lesions and changes of post-chemotherapy） were likely wrongly classified. Conclusions Intra-operative frozen section can accurately identify breast lesions in many instances, leading to fewer errors on account of more diaanostic experience and understandina of diaanostic limitations.     

Pathological and High Resolution CT Findings in Churg-Strauss Syndrome

Objective To investigate the Churg-Strauss syndrome (CSS) associated lung involvement,concentrating on clinical characteristics,pathological findings of lung involvements,response to treatment,and prognosis.Methods We retrospectively analyzed the characters of the clinical manifestations,thin-section CT and pathological findings of CSS.The study involved 16 patients.Clinical data were obtained by chart review.All patients underwent transbronchial lung biopsy (TBLB).Six of them underwent surgical lung biopsy as well.Results The patients included 7 men and 9 women,aged from 14 to 61 years (median,47.5 years).Extrathoracic organs involved included nervous system (7/16) and skin (5/16).Respiratory symptoms included cough (12/16),exertional dyspnea (11/16),hemoptysis (4/16),and chest pain (3/16).CT findings included bilateral ground-glass opacities (12/16),bilateral patchy opacities (12/16),and centrilobular nodules (6/16).The pathological findings of TBLB demonstrated increased eosinophils (3/16),vasculitis (3/16),and interstitial pneumonia (16/16).The pathological findings of surgical lung biopsy of 6 cases showed necrotizing vasculitis in 4 cases,capillaries in 5,eosinophilic pneumonia in 3,granulomas in 2,and airway abnormalities in 3.All patients improved in symptoms after therapy during the study period (range,3 to 51 months;median,15 months).Conclusions Asthma may be present in CSS patient when there is bronchial involvement.Ground-glass opacities and consolidation seen on high-resolution CT reflect the presence of eosinophilic pneumonia,vasculitis,and pulmonary alveolar hemorrhage.TBLB has significant limitations for the diagnosis of CSS.Early diagnosis and therapy can result in satisfactory prognosis.     

Radiological analysis of image on geriatric pulmonary tuberculosis

Objective： To evaluate the radiological features in the cases with geriatric pulmonary tuberculosis（GPTB）. Methods： One hundred and two elderly patients with tuberculosis were studied in this paper. All patients had an examination on chest X-ray, and 63 of them had a chest scan of CT. Results： The pulmonary tuberculosis infiltration, caseous pneumonia and cavitary lesions were found in 85, 11 and 19 cases with GPTB respectively. Acute miliary tuberculosis was diagnosed in 2 cases. Pleural effusion was in 26 cases. In addition, Hilar and mediastinal lymphadenopathy was presented in the other 13 cases. Conclusion： Radiological findings of GPTB were atypical in general.     

Human infection with a novel avian-origin influenza A （H7N9） virus： serial chest radiographic and CT findings

Background Rapidly progressive pneumonia infection with H7N9 virus is a novel disease,and limited information is available concerning serial chest radiographic and computed tomography （CT） findings.The aim of this study was to evaluate the changes in serial radiologic findings in patients with H7N9 pneumonia.Methods The two institutional ethics review boards approved this retrospective study.This study included 10 patients with H7N9 pneumonia.All patients underwent chest radiologic examinations at different time points.Serial radiologic images were systematically analyzed.Results All patients showed abnormal results on initial chest radiography and CT.The initial radiographic abnormalities were unilateral （n=9） and bilateral （n=1）,including ground-glass opacities （GGOs） （n=5） and consolidation （n=5）.The initial CT findings consisted of unilateral （n=6） and bilateral （n=4）,including consolidation （n=10）,GGOs （n=10）,reticular opacities （n=2）,and pleural effusion （n=3）.Follow-up radiologic findings showed rapid development of consolidation or GGOs within two weeks after illness onset.Pneumomediastinum with secondary subcutaneous emphysema and pneumothorax were noted in two patients.Follow-up high resolution computed tomography （HRCT） after two weeks showed slow improvement in both size and opacity of the lesions.On HRCT after discharge,patients had substantial residual lesions such as irregular linear opacities,reticular opacities,parenchymal bands,traction bronchiectasis,and cystic lesions.Conclusions The most common radiologic findings at presentation are multifocal or diffuse areas of consolidation and GGOs in H7N9 pneumonia.HRCT in sequence can show more changes in rapid progression of disease and a slow decrease of both size and opacity of the lesions plays an important role in the evaluation of H7N9 pneumonia.     

Pulmonary sarcoid-like granulomatosis induced by aluminum dust: report of a case and literature review

Awide range of pulmonary pathology is attributed to aluminum dust exposure, including interstitial fibrosis^1-5 desquamative interstitial pneumonia^6 and pulmonary alveolar proteinosis^7 To our knowledge, granulomatous lung disease induced by aluminum dust is rare, only two cases were reported in literatures^8.9 We had the opportunity to make a diagnosis of pulmonary sarcoid-like granulomatosis in a patient exposed to aluminum dust. Herein, we report the clinical history, radiographic and histopathological findings in this patient, and the detailed mineralogical analyses performed on lung tissue obtained by open lung biopsy.[第一段]     

Bedside chest radiography of novel influenza A （H7N9） virus infections and follow-up findings after short-time treatment

Background Influenza A （H7Ng） virus infections were first observed in China in March 2013.This type virus can cause severe illness and deaths,the situation raises many urgent questions and global public health concerns.Our purpose was to investigate bedside chest radiography findings for patients with novel influenza A （H7Ng） virus infections and the followup appearances after short-time treatment.Methods Eight hospitalized patients infected with the novel influenza A （H7Ng） virus were included in our study.All of the patients underwent bedside chest radiography after admission,and all had follow-up bedside chest radiography during their first ten days,using AXIOM Aristos MX and/or AMX-Ⅳ portable X-ray units.The exposure dose was generally 90 kV and 5 mAs,and was slightly adjusted according to the weight of the patients.The initial radiography data were evaluated for radiological patterns （ground glass opacity,consolidation,and reticulation）,distribution type （focal,multifocal,and diffuse）,lung zones involved,and appearance at follow-up while the patients underwent therapy.Results All patients presented with bilateral multiple lung involvement.Two patients had bilateral diffuse lesions,three patients had unilateral diffuse lesions of the right lobe with multifocal lesions of the left lobe,and the remaining three had bilateral multifocal lung lesions.The lesions were present throughout bilateral lung zones in three patients,the whole right lung zone in three patients with additional involvement in the left middle and/or lower lung zone（s）,both lower and middle lung zones in one patient,and the right middle and lower in combination with the left lower lung zones in one patient.The most common abnormal radiographic patterns were ground glass opacity （8/8）,and consolidation （8/8）.In three cases examined by CT we also found the pattern of reticulation in combination with CT images.Four patients had bilateral and four had unilateral pleural effusion.After a short period of treatment the pneumonia in one patient had significantly improved and three cases demonstrated disease progression.In four cases the severity of the pneumonia fluctuated.Conclusions In patients with influenza A （H7N9） virus infection,the distribution of the lung lesions are extensive,and the disease usually involves both lung zones.The most common imaging findings are a mixture of ground glass opacity and consolidation.Pleural effusion is common.Most cases have a poor short-time treatment response,and seem to have either rapid progressive radiographic deterioration or fluctuating radiographic changes.Chest radiography is helpful for evaluating patients with severe clinical symptoms and for follow-up evaluation.     

环肺静脉电隔离联合左心房线性消融治疗阵发性心房颤动的临床研究

目的 探讨环肺静脉电隔离联合左心房线性消融治疗阵发性心房颤动(PAF,简称房颤)的临床效果与安全性.方法 选择23例PAF患者,应用Ensite3000 Navx系统和Lasso电极指导下行环肺静脉电隔离及左房顶部线、峡部线消融.消融终点为:在消融过程中房颤终止,且肺静脉电位消失,或房颤不终止,但肺静脉电位消失;若在窦律下消融,肺静脉电位消失;左心房顶部及峡部线达到完全阻滞.结果 23例PAF患者均顺利完成手术,手术时间234～297 min,平均(277±41)min,X线暴光时间29～55 min,19例患者术中出现房颤,其中14例在消融过程中房颤终止且达到肺静脉电隔离,另外5例消融过程中房颤未终止,但肺静脉完全隔离.4例患者在窦性心律下完成了肺静脉电隔离.左心房顶部线全部达到完全阻滞,峡部线有2例未能达到完全阻滞.随访期间发现3个月后有86.9%的患者房颤消失或明显减少.结论 环肺静脉电隔离联合左心房线性消融治疗PAF 安全、可靠. Abstract： Objective To study the clinical efficacy and safety of circumferential pulmonary vein isolation of paroxysmal atrial fibrillation(PAF) combined with left atrial linear lesion. Methods Twenty-three PAF patients were performed circumferential pulmonary vein isolation combined linear lesion of left atrial isthmus and loof with Ensite 3000 Navx and Lasso electrodes guiding. Radiofrequency end point, atrial fibrillation stopped and pulmonary vein potentials(PVPs) disappeared, or atrial fibrillation did not stop, but PVPs disappeared. PVPs disappeared if atrial fibrillation was ablated during sinus rhythm. Left atrium loof and isthmus line were complete block.Results Twenty-three PAF patients were performed ablation, operation times were from 234 to 297 minutes, X ray time was from 29 to 55 minutes, 19 atrial fibrillations occurred during operation, of which 14 atrial fibrillations stopped with pulmonary vein isolation and linear lesion, the other 5 atrial fibrillations didn't stop, but which pulmonary veins were isolated. Tour patients were performed pulmonary vein isolation during sinus rhythm. All roof lines were completely block, and 2 left atrial isthmus lines were not completely block. 86.9% patients' atrial fibrillation disappeared or decreased significantly.Conclusions It is safe and efficient to treat PAF with circumferential pulmonary vein isolation combined with left atrial linear lesion.     

压缩雾化吸入可必特治疗慢性阻塞性肺疾病急性加重期35例疗效观察

目的 探讨压缩雾化吸入可必特对慢性阻塞性肺疾病急性加重期的疗效和不良反应.方法 将75例患者随机分为两组,对照组30例采用常规治疗,治疗组35例在常规治疗基础上加用雾化治疗,观察两组治疗效果和解除主要症状、体征的时间和住院时间.结果 治疗组住院时间和喘憋、肺部喘鸣音的持续时间均明显短于对照组(P＜0.05).结论 压缩雾化吸入可必特治疗慢性阻塞性肺疾病急性加重期疗效确切,方法简便,不良反应小,值得推广. Abstract： Objective To explore the effect of compressed nebulized inhalation combivent on chronic obstructive pulmonary disease with acute exacerbation. Mehods Seventy-five patients were randomly divided into two groups,the control group(30 cases) with conventional treatment, the treatment group (35 cases) on the basis of conventional therapy plus treatment with the spray were observed lifting of the main symptoms and signs of the time and hospital stay.Results The treatment group hospitalization time and asthmatic lungs duration of wheezing were significantly shorter than the control group (P<0.01). Conclusions Compression combivent aerosol inhalation treatment of chronic obstructive pulmonary disease with acute exacerbation is simple, side effects are little and are worth promoting.     

螺旋CT平扫及动态增强扫描对肺孤立性结节病变的诊断价值

目的 探讨螺旋CT动态增强扫描对肺孤立性结节病变的良、恶性鉴别诊断价值.方法 经病理证实的62例肺孤立性结节,平扫后,以2 ml/s速率注入造影剂后1、2、3、4、5 min薄层扫描.分析强化值、时间-密度曲线及强化形态对良、恶性结节的鉴别价值.结果 恶性结节的强化值(49±15)Hu明显高于良性结节(18±16)Hu(P＜0.01).周围型肺癌的主要强化形态是完全性强化及周围性强化.恶性结节增强后CT值立即升高,2 min形成强化高峰,然后逐渐下降,而良性结节特别是结核球增强后CT值缓慢上升,无明显峰值出现.结核球的主要强化形态是无强化及包膜样强化,占92.3%.结论 强化值≤15 Hu提示良性结节;强化值＞20 Hu考虑恶性结节.动态增强CT对周围型肺癌与结核球的鉴别有较高价值. Abstract： Objective To analyze the feature of the solitary pulmonary nodules at dynamic contrast-enhanced spiral CT. Methods Sixty-two patients with solitary pulmonary nodules proved by pathology were studied. Thin-section CT scans were obtained before and after enhancement 1,2,3,4 and 5 minutes. Results Malignant nodules enhanced (49±15)Hu significantly more than benign nodules (18±16)Hu. The major enhancement pattern of peripheral lung carcinoma was complete enhancement, a little show peripheral enhancement. Tuberculoma show capsular enhancement or non enhancement. Conclusions Absence of significant lung noldue enhancement (≤15 Hu) at CT is strongly predictive of benignity.Malignant nodules enhanced significantly more than benign nodules. Dynamic contrast enhanced CT is useful in the differential diagnosis of lung carcinoma and tuberculoma.     

无创正压通气对慢性阻塞性肺疾病致慢性肺源性心脏病合并全身水肿患者尿量的影响

目的 观察无创正压通气治疗对慢性阻塞性肺疾病致慢性肺源性心脏病合并全身水肿患者尿量的影响.方法 2007年1月至2008年8月入住我科的慢性阻塞性肺疾病致慢性肺源性心脏病合并全身水肿患者55例,均给予氧疗、抗感染、化痰、扩张气道治疗.除上述治疗外,其中19例(A组)接受无创正压通气治疗每天16 h以上;16例(B组)给予口服利尿剂氢氯噻嗪25 mg/d加螺内酯40 mg/d(B组);其余20例(C组)患者未接受无创正压通气或口服利尿剂.观察入选患者住院期间尿量,计算出每例患者的日平均尿量并做记录(单位ml/24 h).将三组记录作比较.结果 A组尿量为(1972±110)ml/24 h,B组为(1750±125)ml/24 h,C组为(1408±117)ml/24 h,三组结果相比差异有统计学意义(P＜0.01).结论 无创正压通气治疗能明显增加慢性阻塞性肺疾病致慢性肺源性心脏病合并全身水肿患者的尿量,达到减轻水肿的目的 ,较口服利尿剂效果更明显. Abstract： Objective To observe the effect of noninvasive positive pressure ventilation (NPPV)on urinary volume in patients with chronic cor pulmonale combined with general dropsy caused by chronic obstructive pulmonary disease.Methods From January 2007 to August 2008,55 patients with chronic cor pulmonale combined with general dropsy caused by chronic obstructive pulmonary disease were enrolled in this study.All patients received oxygen therapy,anti-infection,dissipate phlegm and to airway dilation,and they were randomly divided into three group. Patients in group A(19 cases)received noninvasive positive pressure ventilation for more than 16 hours per-day;Patients in group B(16 cases)were given hydrochlorothiazide 25 mg/d and spironolactone 40 mg/d.Patients in group C(20 cases) didn't received NPPV or oral diuretics.Observe urinary volume of all the enrdled patients,and daily mean urinary volume of each patient was calculated and recorded(ml/24 hour).Compare the records between three groups.Results The wrinary volume in group A was(1972±110)ml/24 h,(1750±125)ml/24 h in group B and(1408±117)ml/24 h in group C.There were significant differences between the three groups(P＜0.01).Conclusions NPPV may increase urinary volume obviously of the patients with chronic cor pulmonale combined with general dropsy caused by chronic obstructive pulmonary diseaes,so can lessen edema,and the effect is more obvious than oral diuretic.     

双水平无创正压通气在慢性阻塞性肺疾病并发呼吸衰竭中的抢救作用

目的 观察双水平无创正压通气(BiPAP)在慢性阻塞性肺病(COPD)并发呼吸衰竭患者的抢救作用.方法 50例COPD伴Ⅱ型呼吸衰竭患者在常规治疗同时,用BiPAP呼吸机进行无创通气治疗,观察治疗前后的临床及动脉血气变化.结果 46例患者经机械通气治疗后意识恢复正常,动脉氧分压逐渐升高,动脉二氧化碳分压明显下降(P<0.01);1例放弃治疗,3例死亡.结论 BiPAP对COPD并呼吸衰竭疗效肯定,无严重不良反应. Abstract： Objective To estimate the efficacy of noninvasive positive pressure ventilation for chronic obstructive pulmonary disease (COPD) with severe respiratory failure. Methods Fifty cases of COPD with severe respiratory failure were treated by Bi-level noninvasive positive pressure ventilation and routine treatment. Observation was made on the clinical symptoms and changes of arterial blood gas before and after ventilation treatment. Results After ventilation, patients' symptoms of pulmonary encephalopathy and unconsciousness improved markedly and PaO2 improved significantly. Among forty-six cases, one patient dropped off and 3 cases died. Conclusions In COPD patients with severe respiratory failure, Bi-level positive airway pressure (BiPAP) noninvasive ventilation is effective with few serious complications.     

家庭无创正压通气在慢性阻塞性肺疾病稳定期患者中的疗效

目的 研究稳定期慢性阻塞性肺疾病并慢性呼吸衰竭患者家庭氧疗加用无创正压通气与单独应用家庭氧疗治疗的疗效.方法 慢性阻塞性肺疾病稳定期并慢性呼吸衰竭患者使用家庭氧疗加无创正压通气与单纯长期家庭氧疗患者比较在治疗1年中的病情恶化次数、住院次数、住院时间以及治疗前与治疗12个月后的血气指标和肺功能参数的变化和症状、体征.结果 随访12个月后,家庭氧疗加用无创正压通气治疗组病情恶化次数和住院次数均较单纯氧疗组明显减少.在治疗12个月随访时,家庭氧疗加用无创正压通气治疗组的动脉血氧分压(PaO2),动脉血二氧化碳分压(PaCO2),血液pH与单纯氧疗组比较均有显著改善,差异有统计学意义(P<0.05).结论 无创正压通气是慢性阻塞性肺疾病稳定期并慢性呼吸衰竭患者积极和有效的治疗措施. Abstract： Objective To study the clinical value of home non-invasive positive pressure ventilation(NIPPV) in patients with stable-phase chronic obstructive pulmonary disease(COPD)and chronic respiratory failure.Methods Stable COPD patients complicated with chronic respiratory failure received Bi-level positive airway pressure ventilation.The frequency of acute exacerbation,admissiontimes-admission expending,blood gas analysis were compared in these patients with those received long term oxygen therapy. Results After one year home non-invasive positive pressure ventilation,PaCO2,HCO-3 were decreased,while pH and PaO2 increased.Compared with patients received long term oxygen therapy,PaCO2 was greatly ameliorated and the frequency of acute exacerbation,admission times and admission expending declined.Conclusions Home non-invasive positive pressure ventilation will do good to COPD patients with hypercapnic respiratory failure during stable phase.     

16层螺旋CT对肺孤立性结节与胸膜关系的相关性分析

目的 通过16层螺旋CT分析肺孤立性结节与胸膜的关系,以提高对孤立性肺结节的诊断和鉴别诊断.方法 回顾性分析56例已被手术或临床回访证实的肺外围孤立性结节与邻近胸膜关系的影像学资料.结果 56例中肺癌29例,炎性结节11例,结核球8例,错构瘤4例,转移瘤2例,硬化性血管瘤1例,腺瘤1例.肺孤立性结节与邻近胸膜的改变主要包括胸膜增厚、粘连及胸膜凹陷,其中肺癌病例中有典型胸膜凹陷12例,胸膜呈大范围增厚5例,小范围增厚6例,小范围增厚并有多处粘连6例.11例炎性结节中典型胸膜凹陷2例,胸膜呈大范围增厚5例,小范围增厚并有胸膜粘连4例.结核球有胸膜粘连8例,胸膜小范围增厚1例,1例无胸膜改变.错构瘤、转移瘤、硬化性血管瘤及腺瘤邻近胸膜均无改变.结论 MSCT多层面重建显示肺孤立性结节与胸膜关系对孤立性肺结节诊断和鉴别诊断有很大临床应用价值. Abstract： Objective To analyse the relationship between solitary pulmonary nodules and pleural relationship by 16-slice spiral CT,and to improve the diagnosis of solitary pulmonary nodules and differential diagnosis. Methods A retrospective analysis of 56 cases had been confirmed by surgery or clinical returning to isolate peripheral lung nodules and pleura between adjacent image data. Results In 56 cases, lung cancer of 29 cases, inflammatory nodules of 11 cases, 8 cases of tuberculoma, 4 cases of hamartoma, metastatic tumors, 2 cases of sclerosing hemangioma of a tumor, adenoma in 1 case. Solitary pulmonary nodules and adjacent pleural changes include pleural thickening, adhesions, and pleural indentation. Which lung cancer cases with typical pleural indentation in 12 cases, showed a wide range of pleural thickening in 5 cases,small-scale thickening in 6 cases, small-scale thickening and multiple adhesions in 6 cases. Eleven cases of inflammatory nodules typical pleural indentation, 2 cases showed extensive pleural thickening in 5 cases, small-scale thickening and a pleural adhesions in 4 cases. TB the ball eight cases of pleural adhesions, pleural thickening and one cases of small-scale, 1 patients without pleural change. There was no change in hamartoma, metastatic tumors, sclerosing hemangioma or adenoma in adjacent pleura. Conclusions MSCT multiplanar reconstruction shows solitary pulmonary nodules and pleural relations between the solitary pulmonary nodule diagnosis and differential diagnosis of great clinical value.     

吸入沙美特罗/氟替卡松联合噻托溴铵对稳定期慢性阻塞性肺疾病患者的疗效观察

目的 观察长期吸入沙美特罗/氟替卡松及噻托溴铵治疗稳定期慢性阻塞性肺疾病(COPD)患者的疗效.方法 将95例稳定期COPD患者随机分为三组:A组吸入沙美特罗/氟替卡松和噻托溴铵;B组吸入沙美特罗/氟替卡松;C组吸入噻托溴铵.治疗半年,评估肺功能1秒钟用力呼气容积(FEV1)、FEV1与用力肺活量的比值与治疗满意度.疗效比较采用优势检验.结果 全部病例完成半年随访,吸入沙美特罗/氟替卡松和噻托溴铵可明显减缓肺功能的恶化,同时发现吸入沙美特罗/氟替卡松和噻托溴铵组有着明显的治疗满意度.结论 吸入沙美特罗/氟替卡松和噻托溴铵在改善症状方面优于噻托溴铵,具有较好的依从性. Abstract： Objective To observe therapeutic effects of inhaling salmeterol/fluticasone and tiotropium bromide for stable COPD patients. Methods Ninety-five cases of stable COPD patients were divided randomly into three groups, group A inhaling salmeterol/fluticasone and tiotropium bromide, group B inhaling salmeterol/fluticasone, group C inhaling tiotropium bromide. All were for half a year. Lung function(FEV1,FEV1/FVC) and AECOPD manifestations and therapeutic satisfaction were evaluated. Therapeutic effects were compared with advantage test. Results All follow-ups of half a year were completed. It was found that inhaling salmeterol/fluticasone and tiotropium bromide could decrease obviously worsening of lung function. And meanwhile there was more satisfactory therapy than another two groups.Conclusions Inhaling salmeterol/fluticasone is better than inhaling tiotropium bromide in improving symptoms and with better compliance.     

四种抗体联合检测在SLE患者中的诊断价值

目的 探讨抗双链DNA(dsDNA)抗体、抗Smith(Sm)抗体、抗核小体抗体(AnuA)、抗组蛋白抗体联合检测在系统性红斑狼疮(SLE)患者中的诊断价值.方法 抗dsDNA抗体、抗Sm抗体、AnuA、抗组蛋白抗体均采用欧蒙斑点法测定98例SLE患者(分为活动期和稳定期)、90例其他结缔组织病患者及40例健康人血清中的四种自身抗体.结果 98例SLE患者中抗dsDNA抗体、抗Sm抗体、AnuA、抗组蛋白抗体阳性率分别为45.9%、 29.6%、 57.1%、33.6%,特异性分别为100%、99.2%、98.5%、89.2%;抗dsDNA抗体和AnuA在活动期SLE中的敏感性与稳定期相比差异有统计学意义(P<0.05);抗dsDNA抗体和AnuA以及四种抗体联合检测时阳性率分别为70.4%和79.6%,明显高于其中任何单项检测的阳性率,且明显高于疾病对照组,差异有统计学意义(P<0.05).结论 所检测的四种抗体在SLE中都具有很高的特异性和敏感性,其中抗dsDNA抗体和AnuA对活动期SLE具有很好的诊断价值,抗体的联合检测可较大程度提高SLE检测阳性率,四种抗体有明显的互补作用,尤其抗dsDNA抗体和AnuA的联合检测具有很好的组合价值. Abstract： Objective To investigate the diagnostic significance of combined detection of anti-double stranded DNA antibody(anti-dsDNA),anti-Smith antibody(anti-Sm)and antinuclesome antibody(AnuA) and anti-histone antibody in systemic lupus erythematosus(SLE),and evaluate the significance of combined detection of these autoantibodies in the diagnosis of SLE. Methods Ninety-eight cases of SLE patients who were divided into active and stable stage group and 90 disease controls and 40 healthy people were detected with Euro immunoblot assay.Results In the assays mentioned above. The serum positive rates of anti-dsDNA,anti-Sm, AnuA and anti-histone antibody were 45.9%,29.6%,57.1% and 33.1% in SLE, and the specificities were 100%,99.2%,98.5% and 89.2% respectively in patients with SLE.The positive rates of anti-dsDNA and AnuA in active SLE group were 57.5%,65.1%,which was apparently higher than that in the stable stage group;The sensibility of combined detection of anti-dsDNA and AnuA was 70.4%, four autoantibodies combined detection in SLE was 79.6%, which was apparently higher than any single autoantibodies, the difference had statistical significance. Conclusions These four autoantibodies have very high sensibility and specificity respectively, combined detection of four autoantibodies can markedly raise the relevance ratio in SLE, while their specificity didn't have a visual reduction. Especially, the sensibility of combined detection of anti-dsDNA and AnuA can markedly increased in active SLE patients. This compose can raise effectively the diagnosis of active SLE.So the detections of the four antibodies are complementary for the diagnosis of SLE.     

骶管阻滞复合全麻喉罩通气对小儿血液动力学的影响

目的 探讨骶管阻滞复合全麻喉罩通气对小儿血液动力学的影响.方法 择期下腹部、会阴部或下肢手术小儿60例,ASA I或II级.随机分为单纯气管插管组(T组),骶管阻滞复合气管插管组(CT组),骶管阻滞复合喉罩通气组(CL组),每组20例.分别于诱导前(T0)、插管即刻(T1)、手术开始(T2)、手术开始后30 min(T3)、手术开始后60 min(T4)监测心率(HR)、血压、脉搏氧饱和度、呼气末CO2分压,记录平均动脉压(MAP),中心静脉压,丙泊酚、瑞芬太尼的用量及术后不良反应的发生情况.结果 T组、CT组在T1时点MAP、HR明显高于CL组(P<0.05);CL组、CT组丙泊酚及瑞芬太尼的用量明显少于T组;CL组术后不良反应最少.结论 骶管阻滞复合全麻喉罩通气对小儿的血液动力学影响最小,不良反应少. Abstract： Objective To investigate the effects of caudal block with laryngeal mask airway(LMA) ventilation on the hemodynamics of children undergoing elective surgery under general anesthesia. Methods Sixty ASA Ⅰ or Ⅱ children undergoing selective lower abdominal surgery were randomly divided into 3 groups (n=20):Group T:endotracheal intubation. Group CT:caudal block and endotracheal intubatio. Group CL:caudal block and laryngeal mask airway(LMA) ventilation. HR,BP,MAP,CVP,SpO2,PetCO2 were monitored during anesthesia.HR,MAP,CVP were recorded at proinduction (T0),intubation(T1),operation(T2),30 min after operation(T3) and 60 min after operation (T4).Recording the dosage of propofol,remifentanil and adverse reactions of postoperation. Results MAP,HR at T1 were significantly higher in group T and group CT than that in group CL.The dosage of propofol and remifentanil were significantly less in group CT and group CL than that in group T. Conclusions Caudal block with LMA ventilation have little side effects on hemodynamics of the children undergoing slective surgery with general anesthesia.