多层螺旋CT胰腺最佳扫描时相的选择

【目的】探讨3ml/s的对比剂注射流率下胰腺多层螺旋CT扫描胰腺实质的最佳扫描时相。【方法】随机选取胰腺正常的病人55例,以3ml/s的对比剂注射流率注射对比剂,行胰腺同层动态螺旋CT增强扫描,得出胰腺实质强化的时间-密度曲线,找出每个病人胰腺的强化峰值及达到峰值的时间,计算出平均值。【结果】胰腺的强化峰值为76Hu,达到峰值的时间为44s。【结论】在3ml/s的对比剂注射流率下,胰腺实质最佳强化期在43～49s,多层螺旋CT胰腺实质期延迟时间定为43s较佳。     

多排螺旋CT双期扫描对胰腺癌的诊断价值

目的 探讨多排螺旋CT双期扫描在胰腺癌诊断中的价值。方法 30例经手术病理或综合影像学及临床资料证实的胰腺癌，在胃十二指肠充盈满意、部分低张、薄层扫描的基础上行双期（胰腺期＋肝脏期）增强扫描，扫描延迟时间分别为40s、80s，造影剂注射速率为4．0ml／s。观察胰腺癌与正常胰腺组织在不同时相的强化情况并进行比较。结果 胰腺期扫描正常胰腺实质强化达峰值，与瘤灶的CT差值最大，平均达69HU，肝脏期扫描正常肝实质强化达与转移灶间CT差值平均达36HU，同时还有利于观察下腔静脉、门静脉、后腹膜淋巴结转移。结论 多排螺旋CT双期扫描对胰腺癌的诊断及转移灶的检出具有重要价值。     

多层螺旋CT双期增强扫描对小胰腺癌的诊断

目的：观察多层螺旋CT双期增强扫描对小胰腺癌的诊断。方法：5例小胰腺癌患行多层螺旋CT动脉期、门脉期、双期增强扫描，扫描延迟时间分为25s和65s、对比剂用量80－100ml，注射速率3ml/s。结果：5例小胰腺癌双期增强病灶均不强化呈低密度，局部无浸润，邻近血管无受侵，无肝脏及远处转移。结论：多层螺旋CT双期快速扫描依靠胰腺癌的血供特点能够显示出病灶与正常胰腺之间的密度差异，使胰腺癌早期诊断变为现实。     

多排螺旋CT的肝脏灌注时间的研究

目的利用多层螺旋CT观察肝脏在不同条件下的血流灌注情况。方法45个健康志愿者分三组,A组:速率2ml/s,剂量30ml;B组:速率4ml/s,剂量30ml;C组:速率4ml/s,剂量60ml。注射后10s在肝门区行8排螺旋容积扫描,间隔2s,至120s。分别测肝门区同一解剖层面主动脉、肝动脉、门静脉和肝实质的增强前后的CT值,将每组内各时间点的强化CT值平均,得到它们强化的平均峰值及到达峰值的平均时间和肝实质平衡时的平均CT值及到达的时间。并绘出它们的时间—强化曲线图。结果主动脉、肝动脉、门静脉、肝实质平均到达峰值时间分别为22.5s,25s,37.5s,45s在A组和C组,20s,22.5s,30s,35s在B组。肝实质到达平衡期的平均时间A组、B组、C组时分别为60s,40s,60s。结论肝及血管强化程度受对比剂量正比影响;剂量相等时,肝、血管强化到达的峰值时间与注射速率成反比;注射时间相等,强化峰值与注射速率成正比,但到达的峰值时间不变;注射速率相同时,注射时间的延长,峰值时间随之落后。建议在4ml/s速率下,多排螺旋CT肝脏检查,动脉期、门脉期及平衡期时间窗的选择设定在注射对比剂后25,40,65s为宜。     

胰腺癌瘤体强化程度与其恶性度的对照分析

目的探讨胰腺癌瘤体CT强化程度与其恶性度的关系。方法42例胰腺癌患者术前均行螺旋CT增强扫描,扫描延迟时间分别定为30s(胰腺实质期)、70s(门脉期)和180s(延迟期),以2.5～3.0ml/s速度团注对比剂100ml,观察胰腺癌胰实质期瘤体强化的程度和形式,结合胰腺癌病理组织学分级,对胰腺癌胰腺实质期的CT强化情况和病理级别作对照分析。结果胰腺高分化腺癌14例,平均胰腺-瘤体CT值差为(9.64±2.84)Hu,中分化腺癌16例,平均胰腺-瘤体CT值差(31.44±5.98)Hu,低分化腺癌12例,平均胰腺-瘤体CT值差(44.08±5.33)Hu,胰腺实质期病灶基本呈等密度强化13例,稍低密度强化15例,低密度强化伴小囊样改变9例,低密度强化伴大片坏死5例。胰腺癌实质期强化程度和形式与其病理分级有显著相关性,其秩相关检验结果为r=0.664(P<0.001)。结论胰腺癌实质期可以得到肿瘤的最大胰腺-瘤体密度差值,其瘤体强化程度和形式与其病理分级有显著相关性,即胰腺癌恶性度与其瘤体强化程度成反比。     

螺旋CT双期增强扫描在早期胰腺癌诊断中的价值

目的研究螺旋CT胰腺期、门脉期双期增强扫描在早期胰腺癌诊断中的价值。方法对21例早期胰腺癌患者行螺旋CT胰腺期及门脉期双期增强扫描,扫描时间分别为注射对比剂后35s和65s,对比剂用量1.5ml/kg,注射速度3ml/s。观察早期胰腺癌在两期的增强情况,对胰腺期、门脉期胰腺CT增强值以及肿瘤-胰腺增强差值采用均数±标准差(x±s)表示。结果肿瘤-胰腺对比胰腺期和门脉期分别为(45.16±18.23)HU和(23.15±12.44)HU(t=2.13,P<0.01)。结论对胰腺进行螺旋CT双期增强扫描,可分为胰腺期和门脉期,其中胰腺期能更加清晰地显示早期胰腺癌,有利于早期胰腺癌的诊断。     

螺旋CT在胰腺癌诊断中的应用——肿瘤-胰腺密度差的价值

目的　评价螺旋CT双期增强扫描在胰腺癌诊断中的应用价值。方法　螺旋CT双期增强扫描胰腺癌27例,先平扫,再以3ml/s速度团注对比剂150ml,分别行动脉期（注射后25s）和门脉期（注射后60～70s）扫描。并测量各扫描期肿瘤和正常胰腺组织的CT值,计算出肿瘤-胰腺密度差。结果　肿瘤的平均CT值在动脉期和门脉期分别是48±8　HU、72±6　HU,正常胰腺组织的CT值是125±18　HU、98±11　HU,肿瘤-胰腺密度差为73±21　HU、25±12　HU,二者之间有显著差别。结论　动脉期可得到最大的肿瘤-胰腺密度差值,对胰腺癌的诊断有重要的参考价值。     

16排螺旋CT胸部增强扫描的优化选择

目的探讨16层螺旋CT胸部增强扫描最佳的对比剂注射流率。方法80例CT胸部增强扫描随机分为两组,每组40例。组1、2注射流率分别为3．5ml／s、4ml／s;自肺尖向膈肌扫描。对比剂300mg 1／ml,总量90ml。扫描延迟18S,平均扫描时间6．4s。扫描范围平均200mm。评价主动脉和肺动脉增强CT值和患者不适感。结果各组大血管强化CT值均数在250HU以上3．5ml／s组和4ml／s组,其大血管总体增强程度均差异无显著意义（P〉0．05）。对比剂注射流率增加,伪影亦增加（P〈0．05）。结论以3．5ml／s注射流率从肺尖向膈肌部扫描,是16排螺旋CT胸部增强扫描较好的扫描方式。     

螺旋CT双期增强扫描诊断胰腺癌65例分析

目的探讨螺旋CT胰腺期、门脉期双期增强扫描在胰腺癌诊断中的影像学特征。方法 65例胰腺癌患者均行螺旋CT双期增强扫描,扫描延迟时间分别定为30 s（胰腺期）和70 s（门脉期）,造影剂用量100 ml（非离子型）,高压注射器团注,速率2.5~3 ml/s。观察并比较肿瘤及正常胰腺在两期的增强情况,根据CT征象对肿瘤可切除性进行评价。结果 65例中肿瘤位于胰头颈部34例,钩突部18例,体尾部13例。发现小胰腺癌3例,直径均小于2 cm。增强扫描肿瘤在胰腺期、门脉期的增强值比较,差异无统计学意义（P〉0.05）;正常胰腺组织在胰腺期增强值明显高于门脉期（P〈0.05）;肿瘤-胰腺对比在胰腺期与门脉期比较,差异有统计学意义（P〈0.05）。胰周大血管受侵占不可切除性肿瘤的62%,胰周小静脉迂曲扩张占40%,肝脏转移灶占38%。结论运用螺旋CT进行胰腺期和门脉期双期增强扫描,能更好地发现病灶,有助于胰腺癌的及时诊断。     

低流率团注高浓度对比剂在兔脑CTA成像中的效果

目的 探讨低流率团注高浓度对比剂在脑CT血管成像(CTA)中的可行性.方法 18只新西兰白兔随机分为3组,实验组使用A方案(碘迈伦400 mgI/ml,流率0.5 ml/s);对照组分别使用B方案(300 mgI/ml,流率1.0 ml/s)或C方案(400 mgI/ml,流率1.0 ml/s),每次注射对比剂含碘量为0.5 g/kg体重,行脑CT同层动态扫描,获得兔大脑中动脉强化的时间-密度曲线.对比各方案兔大脑中动脉强化峰值到达时间(PT)及到达峰值时大脑中动脉的CT值.结果 大脑中动脉平均强化峰值分别为(164.67±5.16)HU、(163.00±7.13)HU、(193.50±5.13)HU,C方案高于A、B方案(P<0.01),A、B方案之间差异无统计学意义(P=0.63).三组方案测得大脑中动脉PT分别为5 s、5 s、4 s,C较A、B方案提前.结论 在兔脑CTA扫描中,使用高浓度对比剂,可以大大降低注射流率而对血管强化效果无明显影响;在注射流率相同情况下,应用高浓度对比剂可使血管显示更清晰.     

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.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.