彩色多普勒超声诊断主动脉夹层动脉瘤的价值

目的评价彩色多普勒超声对主动脉夹层动脉瘤的诊断价值。方法回顾性分析12例主动脉夹层动脉瘤的超声特征，并与手术对照。结果Debakey Ⅰ型2例、Debakey Ⅱ型5例、Debakey Ⅲ型5例。术前正确诊断10例（83％），漏诊2例。结论彩色多普勒超声是临床诊断主动脉夹层动脉瘤的有效手段。     

彩色多普勒超声在急诊主动脉夹层动脉瘤中的应用

目的：评价彩色多普勒超声诊断急性主动脉夹层动脉瘤的临床价值。方法：对2000年8月～2002年2月间应用彩色多普勒超声技术诊断的6例急性主动脉夹层动脉瘤患者进行总结分析。结果：除1例超声诊断为Debakey Ⅰ型的患者在未能做其它检查前死亡外，另外5例Debakey Ⅲ乙型经血管造影证实，行支架型人工血管置入术治疗，1例Debakey Ⅲ乙型经增强CT扫描证实。结果：彩色多普勒超声检查对急性主动脉夹层动脉瘤的诊断及治疗方案选择具有重要的临床价值。     

彩色多普勒超声在主动脉夹层动脉瘤诊断中的价值

【目的】探讨彩色多普勒超声诊断主动脉夹层动脉瘤的临床价值。【方法】对采用彩色多普勒超声检查诊断的49例主动脉夹层动脉瘤患者进行回顾性总结分析。【结果】DebakeyⅠ型21例、DebakeyⅡ型11例、DebakeyⅢ型17例;术前正确诊断46例(93.88%),漏诊3例;经彩色多普勒超声诊断的主动脉夹层动脉瘤与CT、MRI、DSA检查诊断的符合率高。【结论】彩色多普勒超声检查对诊断主动脉夹层动脉瘤具有重要的临床价值。     

腔内隔绝治疗胸主动脉夹层动脉瘤19例临床观察

目的探讨腔内隔绝术（EVGE）治疗DebakeyⅢ型胸主动脉夹层动脉瘤的经验。方法对2002年6月至2009年6月19例胸主动脉夹层动脉瘤患者的治疗经过行回顾性分析。结果19例患者均为DebakeyⅢ型胸主动脉夹层动脉瘤,均采用EVGE治疗。18例破口封堵成功无内漏,1例出现Ⅰ型内漏,术后1例患者12h内出现脑梗死。19例随访3～36个月,1例女性患者于术后3个月再次发生DebakeyⅡ型夹层而死亡。其余患者无明显不适症状情况良好。结论EVGE治疗主动脉夹层动脉瘤使治疗更为微创,减小了手术风险。     

急诊经胸超声心动图对主动脉夹层动脉瘤的诊断价值

目的 探讨急诊经胸超声心动图诊断主动脉夹层动脉瘤的临床应用价值。方法 应用HP 5500及Vivid7彩色超声诊断仪，诊断主动脉夹层动脉瘤患者28例，并将其超声检查结果与CT、MRI、DSA、介入及外科手术结果进行比较。结果 主动脉夹层动脉瘤经胸超声心动图与CI、MRI、DSA及手术结果的符合率在98％以上（P〉0．05）。结论 急诊经胸超声心动图诊断主动脉夹层动脉瘤可靠、准确，能清楚鉴别真腔与假腔，显示内膜破口并分型，对指导临床选择最佳治疗方案起着重要意义。     

主动脉夹层14例外科治疗分析

目的探讨主动脉夹层的适宜手术时机,不同分型的手术对策。方法回顾性总结所有夹层（包含马凡综合征2例）病例的治疗时间安排和手术方式。结果手术13例无早期死亡,DebakeyⅠ型4例,行全弓及升主动脉置换;马凡综合征2例采用BENTALL术式;DebakeyⅢ型7例,早期2例采用常温下病变主动脉切除人造血管置换,目前采用直视下植入CROUNS术中支架;还有1例采用了介入经皮支撑型人工血管植入术。DebakeyⅠ型1例未手术死亡。（手术组与非手术组t检验P〈0.05）。结论主动脉夹层外科干预有效,不同分型的夹层（瘤）手术方法和时机迥异。     

经胸超声心动图对主动脉夹层的诊断价值

目的评价经胸超声心动图对主动脉夹层的临床诊断价值。方法回顾性分析36例病人资料,所有患者经PHILIPS 5500及PHILIPS 7500超声诊断仪检查,并经CT、MRI或手术确诊为主动脉夹层。结果所有患者中,De Bakey Ⅰ型16例,Ⅱ型10例,ⅢA型4例,ⅢB型6例。超声心动图正确诊断主动脉夹层31例（87％）,漏诊2例,另有3例分型错误。结论超声心动图是一种简便、怏捷、无创和有效的检查方法。尤其对急性主动脉夹层的危重患者可床边检查,应作为该病首选检查方法。     

马凡综合征并主动脉夹层1例

马凡综合征（Marfan＇s syndrome，MFS）是一种常染色体显性遗传性结缔组织疾病，主要累及骨骼、眼及心血管系统。心血管系统中常见有主动脉进行性扩张、主动脉瓣关闭不全，主动脉中层囊样坏死而引起的主动脉窦瘤、夹层动脉瘤。当夹层动脉瘤破裂时，可导致患者猝死。现就马凡综合征并发主动脉夹层动脉瘤破裂1例报告如下。     

DebakeyⅢ型主动脉夹层保守治疗的护理

急性主动脉夹层分离是一种不常见，但具有潜在性灾难性的疾病，死亡率极高。主动脉夹层病理分型，有Debakey分型，stanford分型，DebakeyⅢ型（StandfordB型）主动脉夹层指内膜破裂于左锁骨下动脉远端降主动脉，范围达腹主动脉分叉处。近两年来，我科采用保守治疗，使DebakeyⅢ型主动脉夹层的死亡率明显下降。自2004年5月-2005年11月8例，DebakeyⅢ型夹层动脉瘤患者保守治疗，效果显著，生活质量明显提高。现将护理报告如下。     

经食管超声心动图在胸主动脉瘤血管内带膜支架置入治疗中应用的初步体会

目的：初步总结经食管超声心动图（TEE）在胸主动脉瘤血管内带膜支架（ESG）置入治疗中的应用价值。方法：3例DeBakeyⅢ型亚急性主动脉夹层动脉瘤和1例假性胸主动脉瘤ESG置入后1年残余漏患者，全麻状态下，采用多平面TEE对整个ESG置入或补漏ESG再置入手术过程连续动态检测。结果：所有4例患者均成功地置入了ESG，在整个手术过程中TEE对主动脉夹层入口或支架置入后残余漏口的定位，血流和分流状态观察，支架释放过程监测，球囊再扩张效果评估及血管造影辅助观察等多方面均起到了重要作用，其中对夹层入口，血流状态，ESG置入后形态与封堵效果的关系等细节的显示有独到之处。结论：TEE在胸主动脉病变的ESG置入治疗中具有重要和独到的应用价值。     

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.