胎儿脊柱畸形——半椎体诊断中三维成像的应用

目的探讨胎儿脊柱畸形（半椎体）诊断中三维成像的应用价值。方法选取我院2007年2月至2012年11月来我院进行检查并且初诊为可疑脊柱畸形胎儿的359例孕妇,随机分为观察组和对照组,观察组孕妇采用二维超声进行检查,对照组采用三维超声进行检查;观察两组患者检测结果的检出例数和检出率。结果观察组患者胎儿出生或引产后发现有35例为脊柱畸形,三维超声检测出34例,仅漏诊1例,检出率为97．14％;对照组患者胎儿出生或引产后发现有37例为脊柱畸形,二维超声检测出29例,漏诊8例,检出率为78．38％。其中半椎体畸形5例,胎儿半椎体畸形发生在胸段3例;腰段2例,经二维超声检查疑似有胎儿脊柱椎体畸形病例,再行三维超声图像重建。结果4例胎儿脊柱异常三维超声冠状面可清晰显示脊柱椎体形态,部分脊柱呈现侧弯,出现问题部位一侧的骨化中心缺失,病变处显示椎体排列不整齐,三维超声显示病变椎体骨化中心回声模糊或缺失,通过肋骨及脊柱的关系可定位病变椎体,图像直观逼真。结论三维超声能在二维诊断基础上提供更多病变椎体的诊断信息,有一定的优势,井能发挥其重要的临床应用价值,提高对胎儿脊柱畸形的诊断率。     

胎儿颜面部畸形的产前超声诊断(附31例分析)

目的探讨胎儿颜面部超声显示方法与声像表现,提高产前超声对胎儿颜面部畸形的认识。方法采用立体空间扫查法,对3517例胎儿每例颜面部均进行横切面、矢状切面及冠状切面超声平扫及斜扫。结果产前超声共检出胎儿颜面部畸形26例共27处,总检出率为79.41%,胎儿颜面部畸形产前超声诊断的敏感性、特异性、阳性预测值和阴性预测值分别为83.87%、99.88%、86.67%和99.86%。结论熟悉正常胎儿颜面部的各种切面超声声像图并行多切面立体扫查,能提高胎儿颜面部畸形的检出率。     

三维超声诊断胎儿丹迪-沃克综合征的价值

目的探讨三维超声线断层成像、任意平面成像诊断胎儿丹迪一沃克综合征的价值。方法对二维超声初步诊断为丹迪一沃克综合征的30例胎儿,进一步应用三维线断层成像及任意平面成像检查,对比所需标准切面的显示率。结果二三维超声线断层成像、任意平面成像与二维超声相比在小脑侧冠状切面、小脑正中矢状切面显示率明显改善。结论二维超声初步诊断为丹迪一沃克综合征时,应进一步行三维超声线断层成像或任意平面成像检查,二者能快速、准确地获得所需的系列标准切面。     

三维彩色多普勒超声在胎儿畸形诊断中的应用

目的探讨实时动态三维超声在产前胎儿畸形诊断中的应用价值。方法对45例孕中期经二维超声检查后可疑畸形的胎儿,在征得孕妇同意后进一步行三维彩超检查：应用西门子Acuson Antares三维彩色多普勒超声诊断仪,采用表面模式和透明模式成像,对可疑畸形部位多方位扫查;明确诊断的畸形胎儿,产后及引产后对照、统计,对骨骼畸形的胎儿做X线检查。结果45例胎儿中发现畸形43例（复合畸形6例）,均经引产或产后证实;上述胎儿畸形中,实时三维超声成像对于唇裂、体表赘生物、内脏外翻、脊柱裂、四肢及脊柱等畸形均可清晰而直观地显示,而对于其他胎儿畸形如多囊肾、肾积水、小脑发育异常等则无法显示。结论实时三维超声成像技术在产前畸形诊断中有一定的优势,是二维成像技术的补充,而不能替代二维成像,在临床诊断唇裂、内脏外翻、脊柱裂、四肢和脊柱畸形等方面有非常重要的价值。     

三维超声表面成像在鉴别颈动脉硬化斑块的应用

目的 探讨三维超声表面成像对鉴别颈动脉粥样硬化斑块的应用价值.方法 收集2009年7月至2013年6月期间在我院就诊,怀疑存在颈动脉硬化斑块病变的患者325例,先进行二维超声扫查,再行三维超声表面成像,对比两种方法的检出率,以及在评价斑块性质方面的价值.结果 二维超声诊断出现斑块人数261例,斑块发生率80.31％,三维超声表面成像诊断出斑块人数283例,发生率87.08％,两者差异无统计学意义（P＞0.05）;二维超声检出斑块总数658节,三维超声表面成像检出斑块786节,两者差异有统计学意义（P＜0.05）;两种检查方法对不同性质的斑块的检出率,经配对卡方检验,差异有统计学意义（P＜0.05）;三维超声表面成像对软斑的检出率（29.01％）略高于二维超声（22.34％）.结论 三维超声表面成像拥有强大的图像后处理方法,实现了病灶的三维观察,使图像更清晰、更直观,诊断信息更为丰富.     

胎儿颜面部畸形的产前超声诊断

目的探讨胎儿颜面部超声显示方法与声像表现，提高产前超声对胎儿颜面部畸形的认识。方法采用立体空间扫查法，对3517例胎儿每例颜面部均进行横切面、矢状切面及冠状切面超声平扫及斜扫。结果产前超声共检出胎儿颜面部畸形26例共27处，总检出率为79．41％，胎儿颜面部畸形产前超声诊断的敏感性、特异性、阳性预测值和阴性预测值分别为83．87％、99．88％、86．67％和99．86％。结论熟悉正常胎儿颜面部的各种切面超声声像图并行多切面立体扫查，能提高胎儿颜面部畸形的检出率。     

胎儿半椎体畸形超声表现

目的探讨产前超声在胎儿半椎体畸形诊断中的应用价值。方法回顾性分析19例胎儿半椎体畸形的产前二维及三维超声图像,并与引产后影像学检查及病理结果进行对照。结果 19例研究对象中半椎体畸形3例发生在胸椎,12例发生在腰椎,2例发生在骶尾部,2例胸段和腰段同时发生;矢状面显示脊柱前排排列整齐,后排椎体形态失常,椎间隙变宽,继发脊柱自然曲度变化,冠状切面显示病变椎体呈楔形或三角形,排列不整齐,脊柱侧弯或成角。横切面显示椎体一侧骨化中心缺失或椎体边缘模糊形态不规则,三维超声模式下更直观显示病变。结论产前超声能够清晰显示胎儿半椎体畸形,观察其形态、部位,脊柱有无侧弯或成角,为产前诊断咨询提供重要的临床信息。     

超声检查在胎儿全前脑畸形中的应用分析

目的探讨超声在产前诊断胎儿全前脑畸形中的应用价值。方法先用二维超声对胎儿进行检查，按顺序、连续、多切面及多角度进行观察，然后对检出有全前脑畸形胎儿进行面部实时三维成像，并将产前诊断与引产后病理诊断进行跟踪对照。结果在检出10例全前脑畸形中有4例无叶全前脑、6例半叶全前脑；畸肜胎儿的孕龄在15～32w之间；全部病例均伴有颜面部畸形，漏诊1例；5例伴有其它系统的畸形。结论三维超声提供逼真胎儿图像，对二维超声具有重要的补充作用；如超声医生能熟练掌握胎儿正常及异常的颅脑结构的超声特征，能在较早妊娠中期准确诊断无叶全前脑及半叶全前脑病变。     

二维与三维超声联合应用对胎儿畸形的产前诊断价值

目的 探讨超声成像在胎儿畸形诊断中的临床应用价值。方法对联合应用二维、三维超声检出的90例胎儿畸形进行回顾性分析,并将超声诊断与临床诊断进行比较。结果二者联合应用诊断总符合率高达100％,三维超声可以弥补二维超声的不足。结论二维超声联合三维超声可以准确诊断胎儿畸形,提高检出率。     

三维超声产前筛查对胎儿先天性心脏病的检出情况分析

目的 探讨三维超声产前筛查对胎儿先天性心脏病(CHD)的检出效果.方法 150例进行产前筛查的孕妇,均行常规二维超声及三维超声检查.比较二维及三维超声对胎儿心脏切面的显示情况;以引产解剖及产后随访结果作为金标准,计算二维及三维超声对胎儿CHD的诊断准确率、漏诊率、误诊率,并进行比较.结果 二维及三维超声对四腔切面的显示...     

左氧氟沙星联合丁胺卡那治疗肺部感染52例

目的：观察左氧氟沙星联合丁胺卡那霉素治疗肺部感染的疗效。方法：测定52例肺部感染患白细胞，病原菌，动脉血气分析，取患痰液，涂至羊血SS中国皿板上培养，见菌落生长后提取细菌作菌株分型鉴定。给予左氧氟沙星和丁胺卡那霉素治疗1个疗程。结果：痰培养显示革兰氏阴性杆菌占71．2％，革兰氏阳性菌占28．8％，应用左氧氟沙星加丁胺卡那霉素治疗，细菌清除率和有效率均达92．3％，治疗后PaO2升高，PaCO2下降，与治疗前比较P＜0．01，结论：左氧氟沙星联合丁胺卡那治疗肺部感染疗效良好。     

肺癌椎体转移的磁共振成像表现对患者预后评价

目的评价磁共振成像(MRI)技术在肺癌椎体转移诊断中的作用,研究肺癌转移灶的病理征象能否预测患者的预后。方法收集病理及临床证实的肺癌椎体转移患者60例(椎体病灶病理活检证实20例,核素扫描及临床证实40例),60例患者病理均证实有原发肺腺癌,行脊柱MR扫描。均采用常规自旋回波(SE)T1WI、脂肪抑制序列(SPIR)序列、增强T1WI行矢状及横断面扫描。结果60例肺腺癌患者,MRI下均可见椎体信号异常。单发灶与多发灶组在椎体转移灶出现后患者的生存时间差异有统计学意义(t=10·63,P<0·01);无椎体附件受累与有椎体附件受累组间的患者生存时间差异有统计学意义(t=12·23,P<0·01);无椎旁软组织肿块与有椎旁软组织肿块组间的患者生存时间差异有统计学意义(t=12·50,P<0·01);无脊髓受压与有脊髓受压组间的患者生存时间差异有统计学意义(t=14·36,P<0·01)。结论MRI能够显示肺癌椎体转移的病理改变,MRI表现可以前瞻性地预测肺癌患者的病程。     

Practical issues with amisulpride in the management of patients with schizophrenia

Amisulpride is an atypical antipsychotic with a significantly greater effect size than first-generation, typical antipsychotics, and efficacy at least similar to that of olanzapine and risperidone in large-scale clinical trials in schizophrenia. Amisulpride provides greater improvement in positive and negative symptoms of schizophrenia, a better long-term outcome than typical antipsychotics, and distinct tolerability advantages over typical antipsychotics, which are reported to cause extrapyramidal symptoms (EPS) in 20-50% of patients. In addition, amisulpride is associated with significantly less weight gain than olanzapine and risperidone, does not increase body mass index, and favourably influences lipid profiles. In many patients with schizophrenia, adverse events impair adherence to treatment, and switching from typical or atypical antipsychotic therapy to amisulpride may be clinically appropriate. Observational drug-utilization studies suggest that many physicians switch to amisulpride because of fewer EPS and/or less weight gain and improved patient adherence. Cross-tapering (over 4 weeks), rather than abrupt cessation of pre-switch treatment, is preferred. Amisulpride has a low risk of drug-drug interactions, and, during cross-tapering, patients can remain on concurrent treatments (e.g. anticholinergics and antiparkinsonian agents) until the effective dosage has been reached. An appropriate amisulpride starting dose is 800 mg/day for patients with acute psychotic exacerbations, 400-800 mg/day for patients with predominantly positive symptoms, and 100-300 mg/day for predominantly negative symptoms. Amisulpride may be particularly suitable for clozapine-augmentation therapy in patients with refractory schizophrenia. Indeed, amisulpride is more effective than quetiapine as augmentation therapy in patients partially responsive to clozapine, and several prospective open-label studies and case series have reported promising results for amisulpride/clozapine combination therapy. In three prospective studies, addition of amisulpride 200-800 mg/day to clozapine significantly reduced mean scores on the Brief Psychiatric Rating Scale (BPRS) total (-33% to -35%), Clinical Global Impression (CGI)-Severity scale (-31%), Positive and Negative Syndrome Scale total (-22%), and Scale for the Assessment of Negative Symptoms (-34%). The proportion of responders (CGI score > or =3 or BPRS improvement >20%) was 71-86%. Retrospective case-series analyses have also reported improved psychopathological state, reduced adverse events, and lower clozapine dosage requirement with use of this combination. The pharmacological and clinical profiles of amisulpride suggest that this agent is a viable clinical option when a change of antipsychotic therapy is required in patients with schizophrenia because of lack of efficacy, adverse events and poor adherence to treatment, or for augmentation of clozapine in treatment-resistant illness.     

腹腔镜联合胆道镜双镜治疗胆囊结石合并胆总管结石价值分析

目的探讨腹腔镜联合胆道镜双镜治疗胆囊结石合并胆总管结石的临床价值。方法选择2017年2月～2018年7月本院收治的胆囊结石合并胆总管结石患者80例,按照随机数字表法分为两组,均为40例。所有患者均在全身麻醉气管插管下实施手术治疗,手术方法上,观察组行腹腔镜联合胆道镜进行,对照组行开腹胆囊切除联合胆道探查及T管引流。比较两组手术相关数据,如手术时间、术中出血及术后肛门排气时间,统计两组围术期并发症,如胆漏、胆道出血、严重疼痛及切口感染等并发症的整体发生率,比较两组手术前后肝功能相关指标,如谷丙转氨酶、直接胆红素及间接胆红素水平变化情况。结果观察组手术时间短于对照组(P <0.05),术中出血少于对照组(P <0.05),术后肛门排气时间早于对照组(P <0.05),观察组发生胆漏、胆道出血、严重疼痛及切口感染等并发症的整体发生率低于对照组(P <0.05),干预后观察组谷丙转氨酶、直接胆红素及间接胆红素水平低于对照组(P <0.05)。结论针对胆囊结石合并胆总管结石者,使用腹腔镜联合胆道镜治疗,其手术创伤小,术后恢复快,并发症少,更利于患者术后肝功能恢复,从而显著提高临床治疗效率。     

高通量血液透析器串联灌流器透析治疗尿毒症患者皮肤瘙痒

目的探讨高通量透析器(HFHD)串联灌流器(HP)透析对尿毒症皮肤瘙痒的影响。方法将36例透析患者随机分为2组,A组(HFHD+HP)、B组(HFHD),在试验前及试验3个月后分别对2组患者瘙痒症状进行评分,同时检测透前血肌酐(Cr)、尿素氮(BUN)、血磷、全段甲状旁腺激素(i PTH)、血浆白蛋白水平(ALB)、超敏C反应蛋白(hs-CRP)等指标并进行比较。结果 A、B组在治疗后皮肤瘙痒程度、分布范围、对睡眠干扰均有改善(P<0.05),A组皮肤瘙痒程度、对睡眠干扰较B组减轻更为明显(P<0.05);A、B组在治疗3个月后血磷、i PTH、hs-CRP均明显下降(P<0.01),A组与B组相比血磷、i PTH差异有统计学意义(P<0.05)。结论 HFD+HP能减轻患者的皮肤瘙痒,降低炎症指标,改善营养不良,进而可能会提高血液透析患者的生存质量。     

Stimulation of the acid secretion of the stomach in rats with and without antrectomy in the perfusion test with betazole]

In the perfusion test of the stomach of rats the stimulation of acid secretion by betazol (Histalog) after one or repeated injections was studied. The experiments yielded the following results: 1. The i.v. injection of 20 mg/kg b.w. betazol was followed by a maximun acid secretion. 2. Another infusion two hours later intensified this effect. The same acid secretion was seen after a small initial dose (5 mg/kg b.w.) half an hour before the infusion of betazol. 3. The i.v. infusion of 30 mg/kg b.w. betazol showed in the intact rat stomach a smaller acid dsecretion response than did the dose of 20 mg/kg b.w. In comparison there was a significant higher stimulation with 30 mg/kg b.w. betzaol in the rat after a distal gastrectomy (antrectomy). 4. One s.c. injection of 50 mg/kg b.w. betazol showed a significant acid response of the parietal cells with a duration of at least 7 h on a percentage comparison.     

Cost effectiveness of esomeprazole compared with omeprazole in the acute treatment of patients with reflux oesophagitis in the UK

BACKGROUND: Clinical studies have demonstrated that esomeprazole is superior to omeprazole for the acute treatment of reflux oesophagitis. OBJECTIVE: To compare the cost effectiveness of esomeprazole 40mg once daily with omeprazole 20mg once daily in patients with reflux oesophagitis. METHODS: Pooled data were used from three 8-week clinical trials comparing the efficacy and safety of esomeprazole 40mg once daily and omeprazole 20mg once daily for the acute treatment of reflux oesophagitis. A simple decision analysis model, using UK direct medical costs, compared the cost effectiveness of the two treatments. Healing probabilities derived from the clinical studies using the Life Table method were used to estimate the effectiveness and cost of treating 100 patients with reflux oesophagitis. Patient management assumptions were based on a clinical management survey involving 25 UK physicians. PERSPECTIVE: UK National Health Service. RESULTS: After 4 weeks' therapy, the Life Table estimated the oesophageal healing rate to be 77.7% in esomeprazole 40mg once-daily recipients (n = 2446), compared with 67.6% in omeprazole 20mg once-daily recipients (n = 2431; p < 0.001). The corresponding values after 8 weeks' treatment were 93.4% and 86.2%, respectively (p < 0.001). The model predicted that when considering healing probabilities over 8 weeks, esomeprazole 40mg once daily produced total direct cost savings of pound1290 (14%) when compared with omeprazole 20mg once daily. When considering the cost of treating patients who had failed treatment (defined as patient not healed as assessed by endoscopy) after 8 weeks, the cost advantage for esomeprazole was even greater. CONCLUSION: Esomeprazole 40mg once daily is cost effective compared with omeprazole 20mg once daily in the acute treatment of patients with reflux oesophagitis; esomeprazole provides greater effectiveness at a lower cost.     

安特尔联合万艾可治疗糖尿病性勃起功能障碍的临床研究

目的探讨安特尔联合万艾可治疗DED的有效性和安全性。方法将DED患者90人随机分为对照组和研究组,观察治疗前、治疗后3个月时的IIEF-5评分、PADAM评分及血清睾酮等变化。结果2组治疗后3个月较治疗前IIEF-5评分显著提高（P〈0．05）,PADAM评分显著降低（P〈0．05）;研究组血清睾酮明显升高（P〈0．01）,对照组血清睾酮无明显变化（P〉0．05）;IIEF-5评分,PADAM评分及血清睾酮等变化表明研究组疗效优于对照组。结论万艾可联合安特尔可纠正DED的低睾酮水平而显著提高了疗效,两者联合应用安全、有效。