艾滋病合并肺结核病患者的影像分析

目的对艾滋病（AIDS）合并肺结核病患者进行影像学分析,为认识和诊断AIDS合并肺结核提供依据。方法回顾分析2008年1月一2011年1月21例确诊AIDS合并肺结核患者（观察组）的临床及影像学资料,并与30例单纯肺结核患者（对照组）对比。结果21例AIDS合并肺结核中17例累及2个或以上肺段,14例影像学表现为磨玻璃影,7例伴弥漫粟粒性病灶,8伴肺门和（或）纵隔淋巴结肿大,5例伴有肺外结核;而30例单纯肺结核中,20例仅累及1个肺段,21例影像表现为实变影或斑片影,20例伴有纤维增殖灶,16例有1个或多个空洞;以上影像学特征发生率两组差异有统计学意义。两组胸腔积液发生率差异无统计学意义。结论AIDS合并肺结核与单纯肺结核在影像学表现上有明显差别,且具有一定影像学特征,主要表现多种性质的病灶共存、多形态、多叶、段分布,了解其相关临床影像表现特征有利于AIDS并发肺结核的早期诊断和治疗。     

艾滋病合并肺结核的 CT 征象及其与 CD4＋T淋巴细胞计数的关系

目的：探讨艾滋病（ AIDS）合并肺结核的CT征象及其与CD4＋T淋巴细胞计数的相关性。方法回顾性分析临床确诊的42例AIDS合并肺结核患者CT扫描资料以及流式细胞仪对CD4＋T淋巴细胞的检测结果,分析CT征象与CD4＋T淋巴细胞计数的关系。结果本组典型肺结核13例（30.95％）,CD4＋T淋巴细胞计数（143.15±64.28）个/μl;不典型肺结核29例（69.05％）,CD4＋T淋巴细胞计数（72.53±26.55）个/μl,两者比较差异有统计学意义（P＜0.05）。随着CD4＋T淋巴细胞数目的下降,右肺中叶及双肺下叶病变发生率明显增加（ P＜0.05）;CT征象表现为斑片实变影、多发结节影、多发空洞形成、并发淋巴结肿大,与CD4＋T淋巴细胞数目呈负相关（ P＜0.05）,单发空洞形成与CD4＋T淋巴细胞数目呈正相关（ P＜0.05）。结论 AIDS合并肺结核患者的CT征象多不典型,这与CD4＋T淋巴细胞计数明显降低有关。     

两种肺结核的电子计算机X射线断层扫描技术图像对比分析

目的通过对比分析单纯性肺结核与肺结核合并糖尿病患者的电子计算机 X 射线断层扫描技术（CT ）检查图像的差异,提高诊断正确率。方法选择四川省革命伤残军人医院2011年1～8月住院及门诊的单纯性肺结核患者40例及肺结核并糖尿病患者40例做胸部 CT 检查,分析两者之间的影像学差异。结果两者的 CT影像图对比分析发现,在病变部位、病变类型和病变累及范围方面差异均有统计学意义。结论在判读 CT 表现时应抓住这两种疾病的特点,提高诊断正确率。     

艾滋病合并肺结核的影像学分析

目的：探讨艾滋病（AIDS）合并肺结核（PTB）的影像学表现。材料与方法：回顾性分析21例AIDS合并PTB的影像学表现。21例均行X线胸片检查，其中9例行CT检查。结果：21例中浸润型肺结核15例，血行播散型肺结核4例，原发型肺结核2例；病变多为大片状、斑片状或小片状渗出实变阴影，其中可有小结节、空洞、肺门和／或纵隔淋巴结肿大等病灶阴影混杂存在，境界模糊，呈双肺多叶、段受累的随机分布，病灶多有融合趋势。结论：艾滋病合并肺结核后，多种性质的病灶共存，多形态表现，多叶、段分布，确诊有赖于HIV血清抗体试验及痰细菌学检查。     

艾滋病合并肺结核的CT影像学诊断

目的:研究CT影像学应用于诊断艾滋病合并肺结核的效果。方法:以2014年6月-2019年6月为时间段,选择此时间段内在我院就诊的50例艾滋病(AIDS)合并肺结核患者设置为实验组,并选择同期就诊的50例单纯肺结核患者设置为对照组,全部患者均接受CT检查,对比两组的病灶部位,分析AIDS合并肺结核的CT影像特征。结果:(1)两组在淋巴结或胸膜受累方面有明显差异,P<0.05;在其他病灶部位方面无显著差异,P>0.05;(2)AIDS合并肺结核有多种CT影像特征,多种征象既能单一出现,也能叠加出现,其中最为常见的斑片状影(74.00%)、纵隔淋巴结增大(66.00%),而以空洞(8.00%)、钙化(8.00%)较为少见。结论:对AIDS合并肺结核患者行CT检查,能区分单纯肺结核,疾病特征突出,可为治疗提供指导依据。     

艾滋病合并肺结核的X线平片分析

目的探讨艾滋病（AIDS）合并肺结核（PTB）的胸部X线影像表现。方法回顾性分析42例AIDS合并PTB的正侧位X线胸片，42例均有胸部CT检查资料。结果42例中浸润型肺结核30例，其中合并胸腔积液8例，血行播散型肺结核7例，原发型肺结核5例；肺部阴影多为大片状或小片状互相融合状，边缘模糊，其中可有空洞；肺门、纵隔淋巴结肿大多见；病灶分布广泛，常常双肺多叶多段同时受累。结论胸部X线检查对艾滋病合并肺结核的诊断以及在确定病变的范围与程度、抗结核治疗动态效果评价等方面具有重要价值。     

艾滋病合并卡氏肺孢子虫肺炎分型影像学特点及鉴别诊断

目的探讨艾滋病（AIDS）合并肺孢子虫肺炎（Pneumocystis Carinii Pneumonia,PCP）各型的影像学特点及鉴别诊断。方法回顾性分析35例经临床及病理证实的AIDS合并PCP患者的CT表现,总结各型的影像学特点。结果 35例AIDS患者合并肺孢子虫肺炎磨玻璃型17例,CT表现为双侧基本对称磨玻璃样改变;网状或网织结节型9例,CT表现为双肺弥漫网格状或网织结节状影;间质实变型5例,CT表现为兼有间质病变和实质病变;斑片-大片型4例,CT表现为双肺野内斑片状,大片状实变影,14例合并肺气囊。结论 AIDS合并PCP各型的影像学表现不同,结合临床本病可明确诊断。     

艾滋病合并肺结核与单纯性肺结核CT表现研究

目的:研究艾滋病合并肺结核与单纯性肺结核CT表现。方法:选取2016年4月-2018年3月四川省凉山彝族自治州昭觉县人民医院收治的艾滋病合并肺结核患者53例,设为观察组,选取同时期该院收治的单纯性肺结核患者53例,设为对照组,对两组患者均实施CT检查诊断,比较两组患者的CT表现。结果:观察组患者的双肺均受累、两叶或两叶以上病变、同时上叶尖后段及下叶背段病变病变率,与对照组患者对比,无显著差异,P0.05;观察组患者的累及胸膜或淋巴结病变,与对照组患者对比,差异显著,P0.05;观察组患者的斑片或大片实变影、大片实变合并多发空洞、纵膈内淋巴结增大、胸腔积液、心包积液的病变性质与对照组对比,差异显著,P0.05;观察组患者的单纯空洞和多发结节影病变性质与对照组对比,无明显差异,P0.05。结论:CT可以观察到艾滋病合并肺结核的各种影像特征,且病变部位累及的范围较大,大片状实变、纵膈内淋巴结肿大、胸腔积液、心包积液等疾病的出现率高于单纯性肺结核。     

15例AIDS并发肺结核患者胸部CT表现

目的总结AIDS并肺结核患者的胸部CT影像特征。方法回顾性分析15例AIDS并肺结核患者的胸部CT影像资料。结果10例发生在肺结核非好发部位,5例发生在肺结核好发部位;CT表现为粟粒性肺结核者6例,大片融合实变影4例,斑片影3例,空洞样病变2例;并发纵隔及肺门淋巴结肿大10例,胸腔积液5例,心包积液3例;7例伴有肺外结核,表现为颈部、腹膜后淋巴结肿大3例,腋窝淋巴结肿大3例,脾结核1例。结论AIDS并发肺结核患者病变部位多不典型、病灶多种形态共存、纵隔及肺门淋巴结肿大多见,合并肺外结核为其常见表现。     

肺炎支原体肺炎患儿的胸部CT影像学特点及临床诊断

目的:探讨CT检查用于小儿肺炎支原体肺炎临床诊断价值及胸部CT影像学特点。方法:选取2018年4月-2019年5月在本院诊治的40例肺炎支原体肺炎患儿作为观察组,选取同期在本院体检的40名健康儿童作为对照组,给予两组入选者胸部CT检查,观察两组检查结果及胸部CT影像学显示情况。结果:对照组检查结果显示肺部均无异常,观察组患儿均存在相关异常,主要表现为磨玻璃样改变(62.50%)、肺实变(40.00%)、胸膜增厚(22.50%)、支气管扩张(25.00%)、胸腔积液(12.50%),组间对比差异有统计学意义(P<0.05);影像学特点方面,患儿通常表现为单侧病变,婴幼儿、学龄前、学龄患儿胸部CT扫描影像学分别以散在斑片影、斑片状及斑点状实变影、大片实变影为主。结论:胸部CT检查用于肺炎支原体肺炎患儿临床诊断可有效显示肺部病灶位置,且不同年龄段患儿表现出显著成像特点,对疾病临床诊断及治疗具有重要参考价值。     

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.