直径≥30mm大肠侧向发育型肿瘤的临床病理分析

目的探讨直径≥30 mm大肠侧向发育型肿瘤(LST)的临床病理特点。方法采用回顾性研究的方法,收集2013年1月至2018年10月中南大学湘雅医学院附属海口医院收治的109例大肠LST患者,并根据病变大小分为直径≥30 mm及直径30 mm两组,记录并对比分析两组患者的年龄、性别构成比、病变大小、病变部位、内镜下形态学分型、组织病理类型等。结果两组患者在性别及年龄方面差异均无统计学意义(P 0.05);在病变部位、内镜下分型、组织病理及上皮内瘤变方面差异均具有统计学意义(P 0.01),病变直径≥30 mm的大肠LST好发于直肠(75.4%,43/57),而直径30 mm的大肠LST多发于直肠(36.5%,19/52)及近端结肠(44.4%,21/52);直径≥30 mm的大肠LST以结节混合型为主(61.4%,35/57),直径30 mm的大肠LST则主要是颗粒均一型(51.9%,27/52);病变直径≥30 mm的大肠LST多为绒毛状腺瘤及绒毛管状腺瘤(89.5%,51/57)伴低级别上皮内瘤变(57.9%,33/57),而直径30 mm的大肠LST则主要是绒毛管状腺瘤(78.8%,41/52)伴低级别上皮内瘤变(84.6%,44/52),病变直径≥30 mm的大肠LST拥有更高的恶性潜能(高级别内瘤变+浸润癌的百分比分别为42.1%(24/57)和15.4%(8/52)(P 0.05)。结论 LST是一种特殊类型的大肠肿瘤,与大肠癌发生关系密切。LST直径≥30 mm时好发于直肠,内镜下形态学类型以结节混合型为主,组织中绒毛成分较多,恶变潜能更高,值得临床重视和研究。     

内镜下黏膜切除术治疗平坦型大肠肿瘤的护理

大肠平坦型病变是指发生于大肠粘膜浅层,病变高度小于直径1/2的病灶.根据病变的起源途径和预后将其分为轻微隆起型、凹陷型及侧向发育型(LST)[1],特别是LST病变与大肠癌的发生有密切联系[2].内镜下黏膜切除术是一种安全、有效且简单易行、副作用小的现今治疗大肠平坦型肿瘤的常用方法[3].近年来本科在此方面取得了较大进展,本文总结内镜下黏膜切除术治疗平坦型大肠肿瘤的护理经验.     

内镜下黏膜切除术治疗平坦型大肠肿瘤的护理

大肠平坦型病变是指发生于大肠粘膜浅层，病变高度小于直径1／2的病灶。根据病变的起源途径和预后将其分为轻微隆起型、凹陷型及侧向发育型（LST），特别是LST病变与大肠癌的发生有密切联系。内镜下黏膜切除术是一种安全、有效且简单易行、副作用小的现今治疗大肠平坦型肿瘤的常用方法。近年来本科在此方面取得了较大进展，本文总结内镜下黏膜切除术治疗平坦型大肠肿瘤的护理经验。     

早期平坦凹陷型大肠肿瘤的内镜治疗

平坦凹陷型早期大肠肿瘤系指非隆起型生长，病变组织高度＜长径的５０％的大肠良恶性肿瘤［１］，由于患者常缺乏早期症状，且病变在内镜下表现不明显，内镜检查时易漏诊。１９８９年１月～１９９８年１０月共内镜诊断并治疗早期平坦凹陷型大肠肿瘤１７例，现总结如下：１...     

原发性大肠恶性淋巴瘤

目的 :探讨原发性大肠恶性淋巴瘤内镜表现特征及结肠镜检查对本病的诊断价值。方法 :总结近 5年来我院经手术及病理证实的 7例原发性大肠恶性淋巴瘤的临床和内镜资料。结果 :位于盲肠占 57.1 % ,直肠占2 8.6 % ,病灶呈局限性分布 6例 ,累及肠管平均 7.6cm长 ,1例为多发性跳跃式分布 ;内镜下表现为弥漫型 4例 ,息肉型 3例 ,溃疡 2例 ,结肠镜检查 (结合病理学诊断 )确诊率达 75 .0 % ,明显高于 (P <0 .0 1 )钡灌肠诊断。结论 :本病好发于盲肠 ,其次是直肠 ;内镜下以弥漫型多见 ,病变累及范围广 ,粘膜皱褶肥厚如脑回状、病灶复合多发等表现颇具特征性 ;结肠镜检查是诊断本病的主要方法 ;内镜活检至粘膜下、多点取材和加做免疫组化检查能提高内镜诊断的准确性。     

超声指导冠脉旋磨术和药物洗脱支架植入术治疗冠脉内膜严重钙化的价值

目的:探讨超声指导冠脉旋磨术和药物洗脱支架植入术治疗冠脉内膜严重钙化的效果。方法:回顾性分析2018年2月—2023年2月在本溪市中心医院行超声指导冠脉旋磨术和药物洗脱支架植入术治疗的60例冠脉内膜严重钙化患者临床资料,观察病变特点、手术情况以及治疗前后影像学结果等。结果:60例患者男性35例、女性25例,平均年龄(65.20±6.13)岁,左心室射血分数(64.56±5.10)%,三支病变22例、双支病变29例、单支病变9例;旋磨靶血管中前降支44例、回旋支5例、右冠脉11例,旋磨头/靶血管直径比值为(0.51±0.09),植入支架直径(2.83±0.56) mm,最小支架面积(5.90±1.15) mm²;干预前最小管腔直径、病变血管狭窄程度、管腔有效面积分别为(1.98±0.56) mm、(75.34±6.79)%、(4.56±1.14) mm²,干预后分别为(2.70±0.77) mm、(10.10±2.43)%、(7.10±1.88) mm²,干预前后比较差异均有统计学意义(P<0.05);术中未出现冠脉...     

内镜黏膜下剥离术治疗直肠侧向发育型肿瘤的疗效分析

目的:评估内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗直肠侧向发育型肿瘤(laterally spreading tumors,LSTs)的疗效及安全性。方法:回顾分析20例直肠LSTs患者的临床资料。根据内镜下直肠黏膜表面形态对LSTs进行分型,统计肿瘤大小、形态特征、病理特点以及ESD治疗的切除率和手术时间,并且随访分析手术后的并发症和复发情况。结果:20例中,LSTs分型为颗粒型8例,非颗粒型12例;腺瘤伴有低级别瘤变18例,高级别上皮内瘤变2例;管状绒毛状腺瘤7例,管状腺瘤13例;平均病变直径为(33.9±11.5)mm;ESD治疗时整块、完整切除率为100%,平均手术时间为(40±15)min。手术后,出血发生率为10%(2/20),无穿孔发生;在平均12.6个月随访时间内,未发现复发。结论:ESD治疗直肠LSTs病变的整块切除率高,并发症发生率低。因此,ESD是治疗直肠LSTs(尤其是病变直径大于2 cm、具有较高恶变潜能的LSTs)的一种安全有效的方法。     

大肠息肉的病理与内镜下特点185例分析

目的:研究大肠息肉的病理和内镜下特点.方法:回顾性分析185例大肠息肉患者的临床症状、息肉的分布、大小及病理结果.结果:40岁以上占87.6%.临床症状中以便血多见(65.4%),乙状结肠是大肠息肉的最常见部位(31.4%),直肠(25.1%).腺瘤型息肉是最常见的息肉类型(54.3%).结论:乙状结肠和直肠是大肠息肉的好发部位,腺瘤型息肉是最常见的息肉类型.     

平坦及凹陷型早期大肠肿瘤的内镜诊断与治疗

1 定义及分类1.1 定义 顾名思义,平坦型肿瘤是指非隆起型生长的肿瘤,英文称之为Superficial-type or flat-type colorectalneoplasms;日文称之为表面型大肠肿瘤。平坦凹陷型肿瘤包括腺瘤和癌。需要指出的是平坦凹陷型癌的来源有两条途径:一是由平坦凹陷型腺瘤演变而来,另一途径则为‘原位发生’(denovo)。denovo一词源于法语,意指病变并非来自或经由特定的良性病变或癌前病变发展而来,而是从正常粘膜直接发生的恶性肿瘤。所谓早期平坦型肿瘤的判定标准是指病变组织的高度     

放大染色内镜技术诊断早期大肠癌的临床分析

目的评价大肠上皮表面腺管开口分型对诊断早期大肠癌以及癌前病变的临床应用价值。方法 2009年6月～2012年3月采用结肠镜检查1280例,应用内镜下黏膜染色技术,对部分病变部位结合放大内镜及实体显微镜观察腺管(pit分型),并与病理学诊断进行对照,pit分型应用工藤分型。结果 170例患者发现大肠隆起、扁平等不同病变共195个,共检出早期大肠癌10例,进展期癌52例,Ⅱa、IIb、II c、Ⅱa+Ⅱc病变76个。侧向发育型肿瘤(LST型)病变有23个,直径为15～108mm,其中Ⅱ型2个,ⅢL5个,Ⅳ型8个,VA型1个,VN型3个。非肿瘤性息肉主要以I、Ⅱ型腺管开口为主,占80.45%;而腺瘤性息肉则主要以Ⅲ、Ⅳ型腺管开口为主,占82.48%;黏膜腺管开口破坏无结构为进展期癌的主要表现,为VN型;10例早期癌中有6例腺管开口为V型,其中VA型1个,VN型3个。结论大肠上皮表面腺管开口分型对判断肿瘤性、非肿瘤性病变及早期大肠癌具有重要意义以及临床应用价值,可用于指导及时的内镜治疗或者手术治疗。     

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.