螺旋CT双期扫描对急性胰腺炎的诊断价值

目的 评价螺旋CT双期扫描对急性胰腺炎的诊断价值。方法 回顾性分析64例经临床证实的急性胰腺炎CT平扫和增强扫描资料。结果 64例中，急性水肿型胰腺炎40例，CT表现为胰腺肿大，胰周脂肪层模糊或消失，肾前筋膜增厚，部分见少量胸水。急性出血坏死型胰腺炎24例，其中坏死型21例，化脓型2例，出血型1例，CT表现为胰腺内点状、片状或大范围无增强效应的低密度坏死灶，胰周间隙渗出及积液，蜂窝织炎，胰内或外出现气体或高密度出血灶。结论 螺旋CT双期扫描对急性胰腺炎的分型，临床治疗方案的选择，以及判断预后有重要诊断价值。     

急性胰腺炎多排螺旋CT诊断价值探讨

目的分析急性胰腺炎的多排螺旋CT表现,探讨多排螺旋CT对急性胰腺炎的分型、病因及并发症的诊断价值。方法采用平扫、动脉期(28秒)、静脉期(60秒)对21例急性胰腺炎患者进行多期扫描,分析其形态学及动态扫描CT表现。结果坏死型9例,水肿型12例;伴胆道结石或胆囊炎13例,伴肝脓肿1例,系统性红斑狼疮病史1例,腹部外伤2例,分裂胰腺1例;并发症中,假性动脉瘤1例,静脉栓塞1例,胰性腹腔积液7例,胸腔积液4例,右下叶肺不张1例。结论多排螺旋CT动态扫描能准确区分急性水肿型胰腺炎及急性出血坏死型胰腺炎,能全面观察急性胰腺炎的病因及并发症,对急性胰腺炎的诊断具有重要意义。     

急性坏死性胰腺炎59例CT分析

目的:通过对59例急性坏死性胰腺炎的螺旋CT表现分析,进一步探讨2mm薄层动态增强扫描诊断急性坏死性胰腺炎的价值。方法:59例经手术病理或CT复查确诊急性坏死性胰腺炎进行回顾性分析。全部病例采用螺旋CT平扫并薄层动态增强扫描。管电流140mAs,层厚2mm,床速1～2mm/s,螺距1/2。结果:CT平扫确定坏死灶17例(34%)。其中10例在薄层动态增强扫描时病灶数量增加,11例病灶范围扩大。全部59例经螺旋CT2mm薄层增强扫描都明确显示出坏死灶的范围、数量及胰腺周围情况。结论:螺旋CT2mm薄层增强扫描能明确坏死灶的部位、范围、程度及胰腺周围病理改变,对CT分级、病理变化、临床诊治及预后有重要意义。     

急性胰腺炎的CT诊断

目的探讨CT对急性胰腺炎的诊断价值。方法回顾性分析2007年3月2009年10月收治的35例急性胰腺炎患者的CT照片。结果 35例患者中CT诊断为急性水肿型胰腺炎26例（74.3%）,急性坏死型胰腺炎9例（25.7%）。CT主要表现胰腺体积增大31例,其中胰头增大10例,胰体、尾单独或同时增大21例,4例胰腺表现基本正常。单侧或双侧肾前筋膜水肿增厚27例（77.1%）,胰腺边缘模糊、部分脂肪层消失20例（57.1%）,胆囊增大胆总管扩张17例（48.6%）,胰周蜂窝组织炎6例（17.1%）,合并左侧胸腔积液5例（14.3%）,伴有少量腹水2例（5.7%）。结论 CT检查可以显示胰腺自身肿大、坏死、出血,还能够显示胰外的腹腔、腹膜后腔以及肾筋膜的受累情况,可为临床制定合理的治疗方案并作出预后的判断提供依据。     

急性胰腺炎的CT诊断（附20例分析）

目的：探讨急性胰腺炎的CT表现及其应用价值。方法：对20例急性胰腺炎病人进行CT检查，取层厚5mn，平扫 增强扫描。结果：单纯性14例，坏死性6例，合并出血2例。CT表现为胰腺肿大，密度改变，胰周渗液，并发症。结论：CT是急性胰腺炎最有效的影像诊断方法，增强扫描对胰腺坏死范围、程度、定量、定性的判断有很大价值，有助于临床诊断及治疗。     

螺旋CT对急性胰腺炎的诊断价值

目的：探讨螺旋CT平扫急性胰腺炎病变的表现特点。方法回顾性分析38例急性胰腺炎患者的影像学资料,分析其CT表现及特征。结果胰腺局限性或弥漫性肿大32例;胰腺坏死灶18例,出血灶4例;水肿、蜂窝组织炎、坏死、积液等胰周改变21例;肾周筋膜增厚33例;胃壁增厚3例,肠系膜密度增高6例,肠腔扩张积气8例;形成假性囊肿5例;胸腔积液及肺炎3例;脂肪肝13例,胆囊炎12例,胆结石7例。结论螺旋CT检查对急性胰腺炎诊断及鉴别诊断具有一定优势,可为临床早期诊断及治疗提供参考依据。     

螺旋CT增强扫描诊断急性胰腺炎的价值

目的评价螺旋CT增强扫描诊断急性胰腺炎的价值。方法回顾性分析68例急性胰腺炎螺旋CT扫描及临床资料。结果68例中螺旋CT诊断为急性水肿型胰腺炎22例,急性坏死型胰腺炎46例。表现为胰腺体积变化及胰腺实质坏死,肾周筋膜水肿增厚、腹膜后和（或）腹腔积液及其他实质性脏器受累。结论螺旋CT增强检查可准确诊断急性胰腺炎,准确判断病变的范围和程度,全面显示其原发病及并发症。     

急性胰腺炎的CT诊断与临床

目的提高对急性胰腺炎的CT诊断水平和临床认识。方法分析经临床证实的急性胰腺炎67例,全部行CT常规扫描和增强扫描。结果急性水肿型胰腺炎60例,急性坏死型7例,急性胰腺炎表现为单纯胰腺体积增大60例,体积增大并密度改变及胰腺内坏死或出血7例。结论急性胰腺炎具有较典型的CT表现,CT扫描不仅能明确诊断,鉴别其病理类型,而且有助于临床定量,发现并发症和判断预后。     

MSCT对急性胰腺炎及并发症诊断和预测预后的价值

目的:通过多对50例急性胰腺炎患者CT图像的分析,以探究MSCT(多层螺旋CT)对急性胰腺炎及并发症诊断和预测预后的价值。方法:选择至我院就诊的急性胰腺炎患者50例作为本次的研究对象,时间段为2016.8.15-2017.8.12,对所有患者均给予MSCT平扫及增强扫描,对其检查结果进行分析。结果:主要表现为肾筋膜受累增厚、胰腺肿大及胰周渗出改变等征象;10例患者胰腺的形态与大小基本正常,24例实质局限性肿大,16例弥漫性肿大,边缘不规则,呈羽毛状改变;35例胰周水肿,表现为周围脂肪组织密度增高,胰周间隙较为模糊,与胰腺之间的分界不清晰;10例存在胰周积液,8例胰腺与胰周组织存在出血坏死现象;2例胰腺脓肿患者,以不同形态与大小的低密度液体积聚为局限性特征,11例可对肾旁后间隙造成累及,表现为局部脂肪积液、水肿、吉氏筋膜增厚等。结论:对急性胰腺炎患者给予MSCT诊断方式的价值显著,便于有效判断其并发症情况,预测其预后,辅助疾病的治疗。     

急性胰腺炎的CT诊断与临床

目的提高对急性胰腺炎的CT诊断水平和临床认识。方法分析经临床证实的急性胰腺炎67例,全部行CT常规扫描和增强扫描。结果急性水肿型胰腺炎60例,急性坏死型7例,急性胰腺炎表现为单纯胰腺体积增大60例,体积增大并密度改变及胰腺内坏死或出血7例。结论急性胰腺炎具有较典型的CT表现,CT扫描不仅能明确诊断,鉴别其病理类型,而且有助于临床定量,发现并发症和判断预后。     

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.