影响中晚期原发性肝癌远期疗效的因素———以肝动脉化疗栓塞术为主的多模式治疗

目的 评价影响中晚期原发性肝癌（以肝动脉化疗栓塞术（ＴＡＣＥ）为主的多模式治疗）远期疗效的因素。方法 对曾采用ＴＡＣＥ在内的多模式治疗的８９例中晚期原发性肝癌,选择１５个变量,行Ｃｏｘ回归模型分析影响远期疗效的因素。结果 单因素Ｃｏｘ回 肝内侵犯范围、肿瘤直径、组织类型及ＴＡＣＥ次数有显著意义（Ｐ〈０．０５）。Ｋａｐｌａｎ－Ｍｅｉｅｒ法计算累积中位生存期为４５个月,１￣５年生存率分别为：７７．０６％、６３．３１％、５１．６９％、２３．１９％、１４．５９％。单纯ＴＡＣＥ组总的生存率,长于手术＋ＴＡＣＥ组（Ｐ〈０．０５）。结论 多因素分析和单因素分析均包含了肿瘤在肝内侵犯范围和肿瘤直径两项因素,说明此两项指标是影响原发性肝癌多模式治疗预后的重要因素。     

经肝动脉化疗栓塞在中晚期肝癌治疗中的作用

目的：进一步提高中晚期肝癌的综合治疗水平。方法：综合我院１９９４年６月～１９９９年６月中晚期肝癌２６７例,通过经肝动脉化疗栓塞（ＴＡＣＥ）等综合治疗后行肝癌切除５６例,并进行加顾性分析,结果：通过ＴＡＣＥ及手术肝切除等综合治疗期１、２、３、４、５ａ的生存率分别为８０％、５５％、４２％、１６％和５％。结论：ＴＡＣＥ在中晚期肝癌的综合治疗中是一种行之有效的方法。在掌握好适应证,选择好手术时机及积极围手     

彩色多普勒超声引导经皮经肝动脉分支穿刺栓塞化疗治疗原发？…

目的 评价彩色多普勒超声（ＣＤＵ）引导经皮经肝动脉分支穿刺塞化疗（ＴＡＥ）治疗原发性肝癌（ＨＣＣ）的可行性和临床价值．方法 以８例中、晚期ＨＣＣ行１２例ＣＤＵ引导下ＴＡＥ治疗。结果 依靠ＣＤＵ技术准确识别肿瘤供血动脉,对≥２ｍｍ肝内动脉结构经皮细针穿刺成功率为１００％。术后ＣＴ扫描结果分析,证实栓塞准确进入病变区域。且术后无严重并发症发生,平均生存期为７．５月,最长１例存活１３个月,仍健在。结论     

肝癌行肝动脉插管化疗栓塞后的观察与护理

原发性肝癌位居国人恶性肿瘤发病率第２位,每年死亡率达２０万。外科手术是治疗肝癌的首选方法［１］。近年来,由于影像医学的迅速发展,导管技术和导引穿刺技术的进步,肝动脉插管化疗栓塞（ＴｒａｎｓＡｒｔｅｒｉａｌＥｍｂｏｌｉｚａｔｉｏｎ,简称ＴＡＥ）已开辟了治疗肝癌的一条新途径。它能延长那些不能手术切除的肝癌患者的生存期,也可使部分病人获得二期手术切除的机会。然而ＴＡＥ后常会出现一系列的不良反应,如恶心、呕吐、发热、腹痛;甚至发生出血、血栓形成、异位栓塞等并发症［２,３］。这些都直接影响了ＴＡＥ的治疗效…     

彩色多普勒超声引导经皮经肝动脉分支穿刺栓塞化疗治疗原发性肝癌

目的评价彩色多普勒超声（ＣＤＵ）引导经皮经肝动脉分支穿刺栓塞化疗（ＴＡＥ）治疗原发性肝癌（ＨＣＣ）的可行性和临床价值。方法对８例中、晚期ＨＣＣ行１２次ＣＤＵ引导下ＴＡＥ治疗。结果依靠ＣＤＵ技术准确识别肿瘤供血动脉,对≥２ｍｍ肝内动脉结构经皮细针穿刺成功率为１００％。术后ＣＴ扫描结果分析,证实栓塞剂准确进入病变区域。全组术后无严重并发症发生,平均生存期为７．５个月,最长１例存活１３个月,仍健在。结论彩色多普勒超声引导经皮经肝动脉分支穿刺栓塞化疗治疗ＨＣＣ是一种简便、安全和实用的新技术,值得深入研究和探讨。     

化疗栓塞术治疗中晚期原发性肝癌３５例分析

目前,对于不能手术的中晚期原发性肝癌经导管肝动脉化疗栓塞术（ＴＡＣＥ）是首选治疗方法,我１９９３－１９９７年收治的原发性肝癌实施ＴＡＣＥ共３５例,现报告如下。     

超声引导经皮穿刺注射酒精联合肝动脉化疗栓塞治疗原发性肝癌疗效分析

超声引导经皮穿刺注射酒精联合肝动脉化疗栓塞治疗原发性肝癌疗效分析彭莘之①鲍洛文②对因各种原因不能手术切除的原发性肝癌（ＨＣＣ）患者，超声引导经皮穿刺注射酒精（ＰＥＩ）和肝动脉化疗栓塞（ＴＡＥ）二项治和疗手段已在临床上广泛应用，但单独使用以上任一方法均...     

肝癌介入治疗的临床分析

目的：探讨肝动脉内化疗栓塞（ＴＡＣＥ）对老年人肝癌的疗效,并对ＴＡＣＥ术后死亡原因予以分析。材料与方法：回顾性分析８３例老年人肝癌行ＴＡＣＥ的治疗疗效,治疗一个月内死亡者列为ＴＡＣＥ术后早期死亡组,术后一个月以上死亡者列为后期死亡组。比较两组的病死率。结果：总有效率３８．５％,１、３、５年生存率分别为５０．６％、２４％、１９．３％。死于５ＴＡＣＥ并发症者５例,非并发症者６０例。结论：ＴＡＣＥ是目前治疗中晚期肝癌安全的、有效的微创疗法,伴门脉主干的癌栓并非ＴＡＣＥ绝对禁忌症。     

肝动脉插管栓塞化疗后血糖变化及机制

肝动脉插管栓塞化疗（ＴｒａｎｓｃａｔｈｅｔｅｒＬｉｐｉｏｄｏｌ－ｍｅｄｉａｔｅｄＣｈｅｍｏｔｍｂｏｌｉｚａｔｉｏｎ;ＴＡＣＥ）是治疗不能切除原发性肝癌（Ｐｒｉ－ｍａｒｙＨａｐａｔｉｃＣａｒｃｉｎｏｍａ;ＰＨＣ）的有效手段。术后可出现发热、胰腺损伤［１...     

220例肝癌患者肝动脉栓塞术前后肝动脉血流动力学的超声影像分析

应用彩色多普勒超声（ＣＤＦＩ）对２２０例原发性肝癌（ＨＣＣ）患者肝动脉化疗及栓塞术（ＴＡＥ）前后肿瘤血供，肝动脉血流动力学改变进行了观察。结果表明：①肝癌主要由肝动脉供血，少部分由门静脉供给；②ＴＡＥ后肿瘤内部及周边动脉血流明显减少（Ｐ＜０．０５）；③肝动脉收缩期最大流速（Ｖｍａｘ）、舒张期最小流速（Ｖｍｉｎ）均明显下降（Ｐ＜０．０５），阻力指数（ＲＩ）和肝动脉直径改变不明显（Ｐ＞０．０５）；④ＴＡＥ后瘤体明显减小（Ｐ＜０．００１）。认为在行ＴＡＥ前后，应用ＣＤＦＩ对肿瘤血供、肝动脉血流动力学进行观察分析，可给ＴＡＥ预后提供重要指标，给重复治疗提供依据。ＣＤＦＩ是目前肝癌肝动脉栓塞治疗前后最好的影像学检查方法     

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.     

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.