输尿管囊肿的超声诊断与分型

报告资料完整经手术和病理证实的27例输尿管囊肿的超声诊断结果,其中4例为双侧病变共计31个囊肿,囊肿直径为0.4cm～4.2cm,超声诊断符合率为96.8％(30/31个)。作者根据超声所见输尿管囊肿的大小、形态和动态观察囊肿的变化,并结合手术和病理诊断结果,将输尿管囊肿分为三种类型:Ⅰ型:小型囊肿,直径0.4cm～1cm,外形似乳头状,本组共4例7个;Ⅱ型:圆形或椭圆形囊肿,其张力较高,本组共15例(15个),Ⅲ型:低张力型囊肿,外形呈长形或扁形,囊肿可随尿流向后尿道移动或不同程度阻断尿流,共8例9个。本文就输尿管囊肿的病理与超声显像的关系及超声鉴别诊断等问题进行了讨论。     

超声诊断先天性胆管囊肿及其癌变的价值

目的 探讨超声诊断先天性胆管囊肿及其癌变的临床价值。方法 先天性胆管囊肿22例，男10例，女12例。超声检查观察囊肿的部位、大小、形态、合并炎症、结石与癌变等情况，并与手术病理检查结果进行对比研究。结果 超声检查诊断为先天性胆管囊肿22例，其中肝外型胆管囊肿54．5％(12／22)、混合型胆管囊肿45．5％(10／22)。其中单纯囊肿22．7％(5／22)，囊肿合并炎症77．3％(17／22)，合并结石54．5％(12／22)，癌变22．7％(5／22)。与手术病理对照，结果 除1例超声诊断为先天性胆总管囊肿而手术证实为肝总管囊肿，其部位略有差异外，其余全部符合。结论 超声检查不仅是诊断先天性胆管囊肿的可靠方法，而且对明确囊肿有无合并炎症、结石，特别是癌变，有重要的临床实用价值。     

超声显像对卵巢囊腺瘤的诊断及鉴别诊断价值

目的探讨超声显像对卵巢囊腺瘤的诊断及鉴别诊断价值。方法应用超声显像诊断卵巢囊腺瘤并与手术病理结果作对照。结果超声诊断卵巢囊腺瘤37例，41个囊腺瘤，与手术病理诊断符合率为95．1％(39／41)。结论超声显像对卵巢囊腺瘤具有重要诊断价值，但应注意与卵巢囊性畸胎瘤及卵巢巧克力囊肿作鉴别。     

超声显像对甲状腺癌诊断价值的探讨

目的 评价超声显像对甲状腺癌的诊断价值。方法 应用超声显像检测甲状腺癌的超声图像特征，并与手术病理结果对照。结果 27例甲状腺癌与手术病理对照符合率为51．85％(14／27)，其中18例甲状腺微小癌(病灶＜1．5cm)与手术病理对照符合率为38．9％(7／18)。结论 超声显像对甲状腺癌的诊断缺乏有力的依据，对甲状腺微小癌的早期诊断有待于进一步深入研究。     

超声显像对结肠肿瘤的诊断价值及鉴别诊断意义

目的评价超声显像对结肠肿瘤的诊断价值及鉴别诊断意义。方法对经腹部超声诊断的34例结肠肿瘤并有手术病理结果的病例进行分析。结果根据局限性“假肾征”超声表现，结肠肿瘤的正确诊断率85．3％(29/34)，对结肠癌的正确诊断率为93．1％(27/29)。结论超声显像对结肠肿瘤的诊断具有重要价值。     

超声显像对先天性巨输尿管症的诊断价值

目的 探讨先天性巨输尿管症（下称巨输尿管症）的病理生理学改变与声像图表现的关系。方法 对16例（20例）经静脉肾盂造影、手术和病理证实的巨输尿管症的超声显像结果进行分析。结果 16例（20侧）巨输尿管症输尿管内径最小2.0cm，最大4.7cm。超声显像诊断符合率95％（19／20）。根据16例（20例）巨输尿管症的病变累计范围和声像图不同，大致将其声像图表现分为三种类型：（1）圆柱型8例（10侧），输尿管全程均呈圆柱状显著扩张，其中6例（8侧）伴有迂曲；（2）纺锤型6例（8侧），以输尿管下段扩张为主，功能性狭窄段输尿管外形呈纺锤状；（3）鼠尾型2例(2侧），输尿管中下段扩张，张力输低的输尿管末端呈鼠尾状。结论 巨输尿管症的声像图表现与其病理生理学改变关系较密切，超声显像及该病有重要诊断价值。     

组织谐波显像技术在上尿路梗阻引起肾积水的超声诊断价值

目的探讨上尿路梗阻引起肾积水的超声诊断临床应用价值。方法采用组织谐波显像技术（THI）对126例肾积水超声诊断的声像图特征与手术病理结果进行回顾性分析。结果126例上尿路梗阻引起肾积水，THI超声诊断符合率98．4％（124／126）。其中输尿管结石85例，占67．5％（85／126）；肾结石22例，占17．5％（22／126）；妊娠10例，占7.9％（10／126）；输尿管肿瘤4例，占3．2％（4／126）；肾结核3例，占2．4％（3／126）；炎症2例，占1．6％（2／126）。结论组织谐波显像技术在上尿路梗阻引起肾积水的超声诊断与寻找病因方面的应用，优于二维超声诊断，即基波（F1），其方法简便、易行、无创伤、无痛苦、可重复性，具有重要临床应用价值。     

肾上腺皮质肿瘤的超声显像诊断与鉴别诊断价值

目的：评估超声显像对肾上腺皮质肿瘤定位与定性及其鉴别诊断价值。方法：应用超声显像诊断81例肾上腺皮质肿瘤，经手术与病理证实为柯兴氏症腺瘤33全,腺癌4例，醛固酮症腺瘤31例，性征异常症皮质腺癌7例，无功能性腺瘤6例。结果：超声显像诊断结果与手术和病理诊断结果对比，超声定位诊断符合率占95．1％（77／81）；定性诊断符合率占90．1％（73／81）。结论：超声显像对肾上腺皮质肿瘤的定位与定性诊断价值较大。但由于不同病理性质肾上腺皮质肿瘤的声像图表现缺乏特异性，因此熟练掌握其超声显像技术、诊断与鉴别诊断方法十分重要。     

先天性胆总管囊肿的超声诊断

目的：探讨超声对先天性胆总管囊肿的诊断价值。方法：分析21例先天性胆总管囊肿．采用超声观察囊肿的部位、大小、形态、结石与癌变情况。所有病例均经手术和病理证实。结果：肝外型胆总管囊肿18例，混合型胆管囊肿3例．合并胆总管结石5例，癌变3例。超声诊断符合率为95．2％(20／21)，结论：超声检查不仅是诊断先天性胆总管囊肿的可靠方法．而且对明确囊肿有无结石、特别是有无癌变，以及确定手术治疗。方案具有重要实用价值。     

超声显像在肾上腺转移癌诊断中的应用价值

目的 探讨超声显像对肾上腺转移癌的诊断价值。方法 回顾性分析近二十年来我院经超声显像检查并经手术与病理证实的29例肾上腺转移癌患者的声像图特点。结果 29例肾上腺转移癌声像图显示肿块直径为1．8～10．3cm，肿块呈不规则形者18例，呈椭圆形者11例；肿块内部回声分布不均匀，呈低回声者11例，弱回声6例，较高回声4例，弱、低回声与较高回声混合者8例；超声显像诊断与手术和病理诊断相符者27例，符合率为93．1％（27／29）。结论 肾上腺转移癌具有一定的超声声像罔特征，超声显像对肾上腺转移癌的诊断具有重要临床应用价值，可作为临床诊断的首选方法。     

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.