成人肺结核胸部CT特征分析

目的 探讨成人肺结核的CT特征，提高临床诊断率。方法 搜集经临床确诊肺结核69例，回顾性分析病灶的分布、形态以及肿块或结节的强化特征。结果 本组54例（78．3％）呈多个肺段病变，15例（21.7％）表现为单个肺叶或肺段病变。常见上叶尖后段及下叶背段发病56例（81．2％），支气管播散12例（17．4％），胸腔积液7例（10．1％），以孤立肺结节表现4例（5．8％），小空洞或斑片影45例（65．2％），肿块影5例，直径5～8mm、边缘模糊小结节39例（56．5％）。9例结节或肿块做增强扫描，其中1例轻度强化，5例边缘强化，3例不强化，增强后CT值增加约15HU。结论 常见部位（上叶尖后段及下叶背段）为主的多发及多种（干酪渗出纤维条索等）病灶、肿块或结节少强化及多钙化为肺结核特征表现，小叶中心性结节或分支线样征、树芽征及小叶间隔增厚，小叶性实变、空洞及边缘模糊结节是活动性肺结核表现。     

CT和胸片对原发性肺癌及其局部淋巴转移病变的诊断评价

本文用ＣＴ扫描和Ｘ线胸片对１４０例肺癌病人作了诊断率的比较，ＣＴ对肺癌的诊断率为９７．１％，胸片为８９．３％，并分析了１５例肺癌在普通胸片上未能显示和显示不清楚的原因是被纵隔、横隔所掩蔽及其他病变影响等。本文又对１４０例中作了肺癌剖胸手术的２８例病人作了胸片和ＣＴ扫描对局部淋巴结转移与肺部手术所见的比较，ＣＴ扫描对纵隔和肺内有淋巴结转移的显示率高于一般胸片，但ＣＴ也显示了４例假阳性。根据以上分析，     

糖尿病合并肺结核的CT表现（附25例分析）

目的探讨糖尿病合并肺结核的影像特点。方法回顾性分析25例糖尿病患者合并肺结核的临床和CT表现。结果本组25例肺结核患者中，常见部位9例，少见部位3例，13例呈多个肺段发病。糖尿病合并肺结核的CT表现为斑片和大片融合性实变9例，空洞影包括多发小空洞12例，支气管播散6例。结论病变分布范围广，肺实变和空洞是糖尿病合并肺结核较为特征性的CT表现。     

295例肺上叶阴影病变纤维支气管镜检查与临床分析

目的：探讨上叶肺部阴影性质与肺段分布的关系。方法：复习该院1981－1999年295例纤维支气管镜检查的肺上叶部阴影住院病例,对病变的具体部位与患者年龄,性别以及病理诊断之间的关系等进行回顾性分析。结果：295例病人中肺癌194人,其中鳞癌105例,肺结核66例,肺结核并肺癌2例,肺部肿瘤所占比重随年龄增大由30％到80．25％,男性肺癌所占比率为女性1．46倍,上叶尖,后阴影病变134例中肺癌93例（69．48％）,结核29（21．66％）,94例上叶前段阴影病例中,肺部肿瘤53例（61．70％）,结核20例（21．30％）,结论．肺上叶阴影中肿瘤居多,且随年龄增大所占比率上升,鳞癌占首位,男性肺癌所占比率高于女性;病变性质与所处肺段相关性不似文献所述明显。结核性病变在纤维支气管镜下具有校特异性表现;肺结核可以与肿癌并存。     

支气管黏液嵌塞的CT 诊断

目的 研究支气管黏液嵌塞的ＣＴ表现,以提高对其诊断水平。方法 本组１４例,包括现癌５例,支气管扩张４例,支气管肺曲菌病３例,肺炎和肺结核各１例。全部病历均有Ｘ线胸部平征及常规胸部ＣＴ扫描和１０例做了ＨＲＣＴ。结果 ＣＴ见支气管黏液嵌塞表现为树枝状占７１．４％,小棒状１４．３％,串珠状１４．３％。其显著特点是主轴指向肺门,且与支气管走向一致,伴有支气管扩张。结论 ＣＴ扫描是发现和诊断支气管黏液嵌塞的     

螺旋高分辨率CT 对肺内结节定性诊断价值

目的：评价螺旋－高分辨率ＣＴ扫描（ＨＲＣＴ０对肺内孤立结节性病灶（ＳＰＮ）定性诊断的价值。方法 收集３５例肺内结节病变（２．５ｃｍ）,术前做了常规螺旋ＣＴ扫描与病灶局部ＨＲＣＴ扫描,有手术、病理结果,重点对病灶位置、病变形态、大小、边缘、内部结构等征象的显示率进行统计、比较、分析。结果 与常规螺旋ＣＴ扫描比较,ＨＲＣＴ扫描在显示病变特异性征像（病变轮廓、病灶内部结构等）方面敏感性为９０％以上。结论 ＨＲＣＴ扫描检查对肺内结节病灶的定性诊断有很高价值。     

鼻咽癌上行性蔓延的CT研究

目的：探讨鼻咽癌上行性蔓延的ＣＴ表现，着重研究颅底骨受侵的部位、范围、形态的ＣＴ表现。材料与方法：对１３６例鼻咽癌上行性蔓延的ＣＴ图像和临床资料作回顾性分析，其中男性１０６例，女性３０例。全部病例均经病理证实。ＣＴ扫描以ＯＭＬ为基线向上扫描至颅底，向下扫描包括鼻咽癌及颈部。结果：鼻咽癌上行性蔓延的首发症状为头痛，占６６．２％，发生了预后壁的肿瘤最多见，占７２．１％。颅底骨破坏包括溶骨性破坏（４４．     

肺吸虫病的临床与CT表现

目的 认识肺吸虫病的ＣＴ表现。方法 收集实验室检查证实为肺吸虫的患者２４例,男性１５例,女性９例。年龄在２３－７５岁之间,平均年龄３４．４岁。全部作胸部ＣＴ平扫,部分加作增强扫描,并分析其ＣＴ表现。结果 肺吸虫病肺内ＣＴ表现包括：（１）单侧或以 肺野出现斑片状、结节状影,边缘模糊,部位、状态易变,少数病例可见特征表现的“隧道”征;（２）肺门影增大,肺纹理紊乱或病灶呈成簇状窟穴状影;（３）胸腔只液常     

支气管哮喘的肺部HRCT

目的：回顾分析２８例支气管哮喘病人的肺ＨＲＣＴ表现,并与胸部平片比较。方法２８例临床诊断的支气管哮喘患者,年龄２０－７５岁,平均３７．５岁,男性９例,女性１９例,所有病人均有Ｘ线平片和ＣＴ扫描,ＨＲＣＴ采用１．１．５ｍｍ层厚,高频率重建算法和吸气末扫描。另７例加扫呼气末ＨＲＣＴ,肺窗条件窗宽１５００Ｈｕ,窗位－６７０－７００Ｈｕ,记录Ｘ线平片及ＨＲＣＴ表现并对比分析。结果Ｘ线平片见肺容积增加和肺透     

经纤维支气管镜肺活检在肺部粟粒状病变诊断中的意义

３２例胸片显示两肺粟粒状病变的病人经纤维支气管镜肺活检（ＴＢＬＢ）检查，组织学确诊２６例，确诊率为８１．３％，包括粟粒型肺结核，特性性肺纤维化，肺泡细胞癌，矽肺及其它少见肺粟粒状病变，经ＴＢＬＢ确诊的２６例中，未作ＴＢＬＢ术前误诊１１例，误诊率高达４２．３％。这些结果提示应特别强调ＴＢＬＢ对提高肺部粟粒状病变确诊率的重要性和必要性。     

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.     

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.     

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.     

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.