子宫内膜厚度及绝经时间预测阴道出血及子宫内膜癌的价值

目的探讨绝经后子宫内膜厚度及绝经时间对内膜癌的预测价值。方法127例绝经后阴道出血患者内膜活检术前采用经阴道超声测量子宫内膜厚度,比较良、恶性组患者的发病年龄、平均内膜厚度,并对子宫内膜癌与内膜厚度及绝经时间的关系进行分析。结果127例患者(良性病变115例、内膜癌12例)经阴道超声测量,内膜癌组的平均内膜厚度(14.3±7.3)mm大于内膜良性病变组(7.0±4.4)mm(P<0.01)。其中内膜厚度≥10mm者内膜癌9例(9/45);内膜厚度≤5mm者无一例内膜癌。绝经后1～5年阴道出血者内膜厚度≤8mm、绝经5～15年阴道出血者内膜厚度≤6mm、绝经15年以上阴道出血内膜厚度≤5mm者发生内膜癌的可能性较小。结论内膜厚度及绝经时间与内膜癌的发生有相关性,随着绝经时间及内膜厚度的增加其发病率也增加。超声测量内膜厚度可减少绝经后阴道出血患者的内膜活检率。     

经阴道彩色多普勒超声扫查子宫内膜癌声像图特征及其在病理分期中的应用价值

目的探讨经阴道彩色多普勒超声(TVCDS)诊断子宫内膜癌的声像图特征及其在病理分期中的应用价值。方法收集经病理检查确诊的168例子宫内膜癌患者(子宫内膜癌组)和190例子宫内膜增生患者(子宫内膜增生组)的声像图资料,比较两组患者的声像图特征差异,评价TVCDS测定指标(子宫内膜病变回声厚径值和血流参数)对子宫内膜癌分期与病理分期的相关性和一致性。结果子宫内膜癌组绝经前和绝经后发病患者的子宫内膜病变回声厚径值分别为(19.61±5.22)mm和(20.85±5.90)mm,均高于子宫内膜增生组(12.90±3.82)mm和(9.36±3.11)mm,差异均有统计学意义(均P0.05)。子宫内膜癌组中共159例患者探及血流信号,其中20.24%呈高阻力血流,低于子宫内膜增生组(70.00%),差异有统计学意义(P0.05);子宫内膜癌组中33.93%患者呈低阻力血流、40.48%患者为高低阻力并存,均高于子宫内膜增生组(5.79%、16.32%),差异均有统计学意义(均P0.05)。相关性分析结果显示TVCDS检查分期结果与病理分期结果显著相关(r=0.893,P0.01);一致性分析结果显示TVCDS检查分期与病理分期结果高度一致(Kappa=0.673,P0.01)。结论 TVCDS可以较好地观察子宫内膜癌的血流阻力特征和子宫内膜厚度,其术前TVCDS检查分期与病理分期具有较高的相关性和一致性。     

经阴道彩色超声对绝经后子宫内膜病变的诊断

目的：探讨经阴道彩色超声对绝经后子宫内膜病变的诊断价值。方法：采用经阴道彩色超声回顾性观察200例绝经后子宫出血患者的超声图像特征、子宫内膜厚度及血流阻力指数。结果：子宫内膜癌的内膜厚度明显高于子宫良性病变的内膜厚度,且子宫内膜癌的内膜厚度均〉5 mm;子宫内膜癌的血流阻力指数明显低于良性病变,两项均有统计学差异（P〈0.05）。结论：经阴道彩色超声检查是诊断子宫内膜疾病的常规首选方法。     

经阴道彩色多普勒超声对绝经后子宫内膜癌的诊断效能分析

目的:探讨经阴道彩色多普勒超声对绝经后子宫内膜癌的诊断价值。方法:选取2019年3月—2022年3月间贵州省人民医院收治的绝经后子宫内膜病变患者144例,所有患者术前均进行经阴道彩色多普勒超声检查,根据手术病理诊断结果分为子宫内膜癌组和子宫内膜息肉组,对比两组患者彩色多普勒超声定量参数差异,采用受试者工作特征(ROC)曲线评估彩色多普勒超声定量参数联合检查对绝经后子宫内膜癌的诊断效能。结果:144例受检者经手术病理诊断显示子宫内膜癌32例,子宫内膜息肉112例。子宫内膜息肉组二维超声特征表现为病灶与肌层界线清晰、内部回声均匀、子宫内膜厚度较薄,与恶性组差异有统计学意义(P<0.05);子宫内膜癌组患者平均血流速度(TAMV)、搏动指数(PI)、血流阻力指数(RI)等彩色多普勒超声参数均显著低于良性组(P<0.05)。ROC曲线分析显示,PI参数曲线下面积(AUC)最大[0.952 (0.916～0.988)],诊断灵敏度为91.1%,特异度为90.6%;RI次之,AUC为0.933 (0.893～0.973),诊断灵敏度为78.6%,特异度为96.6%;TAMV最小,AUC...     

经腹和经阴道彩色多普勒超声诊断绝经后子宫内膜病变的比较

【目的】探讨彩色多普勒超声检查绝经后阴道流血患者子宫内膜病变的价值。【方法】比较经腹及经阴道超声检查绝经后阴道流血患者的子宫内膜病变的影像特点,重点观察子宫内膜的厚度,血流分布情况,阻力指数(RI)值。【结果】所有患者均经诊刮有病理结果,不同的子宫内膜病变均有其声像特征。但经阴道彩色多普勒检查内膜病变的病理诊断符合率明显优于经腹彩色多普勒检查。【结论】经阴道彩色多普勒对绝经后妇女子宫内膜出血的病因诊断有重要的临床应用价值。     

绝经后子宫出血患者阴道超声影像学特点与其病理关系的探讨

目的 探讨子宫内膜超声影像学特点在绝经后子宫出血(PMB)中的临床诊断价值.方法 对照分析2002年10月至2011年10月在广州市妇女儿童医疗中心就诊的247例PMB患者诊断性刮宫病理结果与阴道超声所测子宫内膜厚度及其他超声影像学特点的相互关系.结果 PMB病因依次是萎缩性子宫内膜46.15%,子宫内膜增生19.03%,子宫内膜息肉15.79%,绝经后子宫内膜炎11.74%,子宫内膜不典型增生及恶性病变仅占8.50%;良性病变同不典型增生及恶性病变患者的子宫内膜厚度、血流阻力指数(RI)相比差异均有统计学意义(P<0.01);不同病变类型的患者其声像图特征各异;如内膜癌主要表现为子宫内膜不均匀增厚,内部回声杂乱不均,可见丰富血流信号,且走行紊乱,其RI多低于0.5(RI=0.38±0.02).结论 彩色多普勒超声检测子宫内膜可作为绝经后子宫异常出血的有效辅助检查或筛查手段,在绝经后功血的保守治疗中可视为随诊观察的指标.     

经阴道彩色多普勒超声对绝经后阴道出血子宫内膜病变的诊断价值

目的探讨经阴道彩色多普勒超声(TVCDS)检查对绝经后阴道出血子宫内膜病变的诊断价值。方法选取2018年9月至2019年8月在吴川市人民医院治疗的60例绝经后出血子宫内膜病变患者,所有患者均进行经阴道彩色多普勒超声检查,以病理诊断结果为基准,分析阴道超声诊断的符合率。结果子宫内膜息肉、子宫内膜复杂性增生患者的血流阻力明显高于子宫内膜癌患者,宫腔积液比例明显低于子宫内膜癌患者(P<0.05)。子宫内膜息肉患者的有血流显示比例、子宫内膜增厚>10 mm比例均明显低于子宫内膜复杂性增生、子宫内膜癌(P<0.05)。TVCDS诊断子宫内膜息肉的符合率为92.50%(37/40),诊断子宫内膜复杂性增生符合率为100.00%(8/8),诊断子宫内膜癌符合率为91.67%(11/12)。结论对子宫内膜病变患者进行TVCDS诊断符合率较高,值得推广。     

TVCDS诊断子宫内膜癌的声像特征及在病理分期中的价值

【】 目的 探讨经阴道彩色多普勒超声(TVCDS)诊断子宫内膜癌的声像特征及在子宫内膜癌病理分期中的价值。方法 选取2013年1月至2016年7月在我院经病理学检查证实的子宫内膜癌患者168例、190例子宫内膜增生患者的超声声像资料进行研究,对比两组患者的声像特征差异,并以病理学结果作为标准评价TVCDS对子宫内膜癌分期的价值。结果 绝经前和绝经后的子宫内膜患者的子宫内膜病变回声厚径值均高于子宫内膜增生患者,差异具有统计学意义(P<0.05)子宫内膜患者高阻力血流患者比例20.24%低于子宫内膜增生组的70.00%(P<0.05),子宫内膜患者低阻力血流患者比例33.93%、高低阻力并存40.48%均高于子宫内膜增生组的5.79%、16.32%(P<0.05),两组未探及血流信号患者比例差异无统计学意义(P>0.05);TVCDS检查分期结果与病理学分期结果相关性分析：Spearman r=0.893,P<0.001;TVCDS检查分期与病理学分期结果的一致性分析：kappa值=0.673,P<0.001。结论 TVCDS可以较好观察子宫内膜不同疾病的血流阻力特征、子宫内膜厚度,TVCDS术前分期与病理学分期具有高度的相关性和一致性。     

子宫内膜癌的阴道超声诊断与临床价值

目的探讨经阴道超声诊断子宫内膜癌的临床价值。方法对45例子宫内膜癌患者经阴道超声检查,测量子宫内膜厚度,观察内部回声、边缘轮廓及与周围组织的关系,彩色多普勒超声检查内部及周围血流情况。结果经阴道超声检查子宫内膜癌声像图为子宫内膜增厚、呈等回声或增强回声、轮廓不清晰、不同时期对肌层有不同程度的浸润改变。彩色多普勒测得内部点状或条索状快速低阻血流信号,与病理结果对照,超声诊断率为86.7%。结论阴道超声及彩色多普勒超声诊断子宫内膜癌具有较高符合率,可与其他子宫内膜病变作出鉴别诊断,并可判断内膜癌对肌层的浸润程度,具有重要的临床诊断价值。     

应用彩色多普勒诊断内膜型子宫内膜癌的初步评价

本文报告我院近年来经手术、病理证实11例内膜型子宫内膜癌,术前经彩色多普勒超声诊断,目的在于探讨彩色多普勒超声对该疾病的诊断价值。 资料和方法 本文11例内膜型子宫内膜癌(IEA)患者为绝经后妇女,年龄46～57岁,平均年龄51.5岁。11例内膜型子宫内膜癌均经手术、病理证实。临床表现为绝经后不规则阴道出血,体征无特殊发现。 应用美国Acuson 128XP/10_c型电脑彩超仪,探头频率4MHz。首先采用二维超声探测子宫大小,并仔细观察子宫内膜及宫壁等,测量子宫内膜厚度以纵切子宫测其内膜厚度(包括前后内膜),继之使用彩色多普勒超声观察病变内膜血流分布情况,显示彩色血流信号并记录多普勒频谱及计算阻力指数(RI),若病灶内未能清晰显示血流信号,则用脉冲多普勒作仔细扫查。     

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.