黄色肉芽肿性胆囊炎的影像学表现-附15例报告

目的:分析黄色肉芽肿性胆囊炎的影像学表现特点.方法:回顾性分析经手术、病理证实的15例黄色肉芽肿性胆囊炎患者的影像学表现.结果:15例可见胆囊壁不同程度增厚;增强后3例呈环状强化、12例呈"夹心饼干"征.MRT2WI上壁内结节呈稍高-高信号6例.动态增强,壁内T2WI上稍高信号结节早期呈轻度强化,晚期明显强化,但高信号结节无强化.13例显示胆囊黏膜线完整,2例中断.结论:黄色肉芽肿性胆囊炎具有典型的CT及MRI表现,可以为临床诊断提供帮助.     

原发性中枢神经系统淋巴瘤MRI表现

目的探讨原发性中枢神经系统淋巴瘤(PCNSL)的MRI表现。方法回顾性分析29例接受MR平扫+增强检查,且经手术病理证实,具有完整临床资料的PCNSL病变的MRI表现,观察病灶的部位、大小、形态、边缘轮廓、瘤周水肿、占位效应、MRI平扫信号特点,重点观察增强后病灶的典型及非典型强化特点。结果 29例中单发者16例,多发者12例(30个病灶),共46个病灶,弥漫浸润型1例。肿瘤好发于胼胝体、基底节区等深部脑组织(35/46,76.09%)。瘤周水肿多为中度(15/46,32.61%)或重度(27/46,58.70%),未见出血及钙化。肿瘤T1WI多呈等低信号(30/46,65.22%)或等信号(14/46,30.43%),T2WI多呈等信号(14/46,30.43%)或等高信号(29/46,63.04%),DWI多为高信号(42/46,91.30%)。增强扫描表现出多种强化方式:典型强化方式包括均匀一致团块状或结节状强化、"裂隙征"、"蝶翼征"、"皮层下刻痕征"、以及"卫星灶征";不典型强化方式包括环形强化、"开环样"强化、4脑室匍匐贴壁生长病灶,沿软脑膜弥漫分布粟粒结节样病灶。结论 PCNSL的MRI表现具有一定的特征性,对PCNSL的诊断及鉴别诊断具有重要的价值,但确诊仍有赖于病理。     

肝上皮样血管内皮细胞瘤的影像学表现

目的探讨肝上皮样血管内皮细胞瘤的影像学表现。方法回顾性分析2012年7月至2016年8月期间于四川大学华西医院接受手术并经术后病理学检查证实的15例肝上皮样血管内皮细胞瘤患者的影像学资料,分析肿瘤的位置、边界、密度/信号、强化等征象。结果 15例患者中,单发型4例,多发型5例,融合型6例。13例以肝包膜下分布为主,均伴"肝包膜回缩征"。14例见"棒棒糖征",7例见"核心模式"。CT平扫表现为肝内稍低密度的结节、团块影;MRI平扫表现为T1稍低信号,T2稍高信号。增强扫描可表现为轻度强化、边缘环形强化及渐进向心性强化。结论肝上皮样血管内皮细胞瘤的CT和MRI影像学表现差异大,"肝包膜回缩征"、"棒棒糖征"及"核心模式"有一定特征性。     

囊性脑转移瘤的MR诊断及鉴别诊断

目的探讨囊性脑转移瘤的MR诊断及鉴别诊断。方法回顾性分析经手术病理或临床证实的15例囊性脑转移瘤患者的MR平扫、增强、DWI及ADC图表现。结果15例共22个囊性转移灶,囊壁在T1WI、T2WI呈等或低信号,囊液T1WI信号稍高于脑脊液,T2WI信号亦高于脑脊液;增强扫描肿瘤呈环形强化,部分病灶可见强化壁结节;DWI图呈低信号,ADC图呈高信号,平均ADC值为（1.87±0.24）×10-3mm2/s。结论囊性脑转移瘤DWI图、ADC图、囊内信号、囊壁增强的MR表现有助于其诊断和鉴别诊断。     

前列腺外周带短T2信号结节的磁共振诊断及病理基础

目的 回顾性分析前列腺外周带T2WI低信号结节的影像学资料,评估MRI检查对其良恶性质的鉴别诊断价值.方法 65例患者于病理检查前均进行了3.0T腹部MRI平扫及增强扫描.其中外周带低信号结节共91个,对照病理结果,癌灶结节(PCa) 34个(PCa组),非癌灶结节57个(NCa组).应用正态齐性检验、Wilcoxon秩和检验描述低信号结节的统计学意义.结果 PCa组T2WI多表现为小类圆形低信号,NCa组则多数表现为条片状低信号灶.PCa组和NCa组的强化模式差异具有统计学意义(P＜0.001).结论 MRI检查有助于提高外周带T2WI低信号结节的良恶性鉴别.     

黄色肉芽肿性胆囊炎的MRI表现(附7例报道)

目的探讨MRI诊断黄色肉芽肿性胆囊炎(XGC)的临床价值,同时分析其影像学表现的病理学基础。方法回顾性分析2013年1月至2015年11月期间在四川省人民医院行上腹部MRI检查且经术后病理学检查证实为XGC的7例患者的MRI图像资料。所有患者均接受了完整的MRI序列检查。每例患者重点观察胆囊壁增厚及强化情况、胆囊壁内结节、胆囊黏膜线是否完整、胆囊结石、胆囊周围组织改变等情况。结果 7例XGC患者的胆囊壁均增厚,其中2例呈局限性增厚,5例呈弥漫性增厚;4例见典型的"夹心饼干征";6例胆囊黏膜线连续,1例不连续;5例胆囊壁内见结节影,在T1WI图像上呈低信号,在T2WI图像上呈高信号;6例并发胆囊结石;7例见胆囊周围脂肪间隙模糊、肝实质与胆囊分界不清;增强扫描时所有病例均出现动脉期胆囊周围肝实质斑片状一过性强化,1例并发肝脓肿;2例肝门部胆管狭窄、肝内胆管扩张,2例(1例伴有胆总管下端结石)肝内外胆管均轻度扩张;3例伴发肝囊肿,4例见单或双肾囊肿;7例均未发现腹腔内及腹膜后肿大淋巴结。结论 MRI检查可以准确描述XGC的各种影像学特征,对XGC的诊断具有重要价值。     

骶管内蛛网膜囊肿的MRI表现及诊断价值

目的 探讨骶管内蛛网膜囊肿的MRI特点及其诊断价值.方法 28例骶管内蛛网膜囊肿经手术病理证实.其中其中男19例,女9例,年龄16～70岁,平均41.6岁.所有病例均行MR检查.结果 囊肿位于骶管内,呈卵圆形、不规则形、串珠形.囊肿境界清楚,囊壁薄,囊液信号与脑脊液信号相似,T1WI囊液呈低信号,T2WI囊液呈高信号,其中4例囊肿内可见细条状神经根影,6例增强扫描囊液、囊壁无强化.结论 MRI是最好的影像学诊断方法;骶管内蛛网膜囊肿的发生,主要是先天的硬膜缺陷所致.     

脑胶质肉瘤的MRI表现与病理对照分析

目的探讨脑胶质肉瘤(GS)的MRI表现及相关病理学基础。方法回顾性分析22例经手术病理证实为GS的患者临床、MR及病理检查资料。结果 20例发生于大脑凸面,2例发生于深部脑白质;16例肿块呈圆形或类圆形,6例呈不规则形。22例肿瘤MRI均表现为不均匀团块状异常信号;20例为囊实性,2例为实性。4例为GS合并出血。肿瘤T2WI 21例呈以稍高信号或高信号为主的混杂信号,1例呈等信号;T1WI 18例呈不均匀稍低信号,4例呈不均匀低信号。21例可见瘤周水肿,1例瘤周无水肿。增强扫描表现为不均匀厚壁环状或花环状明显强化17例,壁结节强化7例,瘤内栅栏状强化14例。GS病理表现主要为胶质母细胞瘤成分与肉瘤成分呈间隔交替存在或肉瘤将胶质母细胞瘤分隔呈岛屿状。结论脑胶质肉瘤多位于大脑凸面,呈厚壁环形或花环状强化、壁结节及栅栏状强化是其特征性MRI表现,确诊仍需依靠病理学检查。     

腰椎间盘MRI局限性高信号对下腰痛诊断的临床意义

目的 分析腰椎间盘MRI局限性高信号区的影像学表现与临床对照,以提高对该征象的临床意义。方法 回顾分析35例下腰痛患者伴有腰椎间盘MRI局限性高信号区的影像学表现特征进行分析、诊断,对照临床资料及手术病理对照。结果 腰椎间盘MRI局限性高信号区MR矢状位T2WI图像呈圆形（71.4%）,弧形（20.0%）或放射状（8.6%）,病灶表现以圆形常见。轴位像为条状或梭形,与椎间盘纤维环破裂一致;高信号出现的位置与临床症状相符合。结论 腰椎间盘MRI局限性高信号区对诊断腰椎间盘性下腰痛有一定的特异性,出现该征象可提示椎间盘纤维环撕裂,为下腰痛患者的诊治提供参考。     

骨骼肌内黏液瘤的MRI与CT影像学表现及其诊断价值

目的:探讨骨骼肌内黏液瘤的MRI与CT影像学表现及其诊断价值。方法:将进行MRI检查的26例骨骼肌内黏液瘤患者(行增强扫描21例)设定为观察组,进行CT检查的16例患者设定为对照组,比较两组的检查准确率。结果:42例经手术病理证实13例为腓肠肌内黏液瘤,8例为腓骨长肌内黏液瘤,18例为股内侧内黏液瘤以及3例为肩胛舌骨肌内黏液瘤,两组病灶部位无差异。观察组MRI检查肌肉内有占位病变,T1WI信号低,T2WI信号高,脂肪抑制成像高,具有较为清楚的边界;21例MRI增强后病灶呈不均匀强化15例,病灶周围可见脂肪信号带,同时部分病灶周围肌肉内出现水肿信号;结节并厚壁强化4例,未出现明显强化2例。对照组肿瘤呈现低密度囊性肿块,增强后11例可见环形强化,内部不均匀强化。相较于对照组,观察组的诊断异常率明显更高。结论:MRI与CT对骨骼肌内黏液瘤均具有诊断价值,但MRI的诊断更为准确。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.