18F-FDG显像在诊断结直肠癌术后不同部位转移复发中的应用

目的:研究18F-FDG显像在结直肠癌术后不同部位转移复发中的诊断价值.方法:采用”F-FDG双探头符合线路显像,同机图像融合.结果:18F-PET/CT诊断结直肠癌术后吻合口复发的敏感度为100％,阴性预测值为100％,明显高于CT的61.5％和84.1％,18F-FDG PET/CT诊断结直肠癌术后周围淋巴结及远处转移的敏感度为97.9％,特异性为85.7％,准确性为94.1％,阳性预测值为93.9％,阴性预测值为94.7％.明显高于强化CT的66.0％、47.6％、60.3％、73.8％和38.5％(P＜0.05).结论:18F-FDG显像能明显提高结直肠癌转移复发的检出率,在不同部位转移复发的诊断中较常规影像学检查更有价值.     

18F-FDG hPET/CT显像诊断结直肠癌术后复发转移

目的 评价^18F-FDG hPET／CT代谢显像对结直肠癌患者术后复发转移的诊断价值。方法 对81例结直肠癌术后临床可疑肿瘤复发或转移的患者采用GEHAWKEYE符合线路SPECT进行^18F-FDG显像，获得经X线衰减校正后的三维断层图像，由计算机完成各断层图像的融合，以目测法进行诊断分析，并与CT、病理学检查、临床随访作出的最后诊断进行对比。结果 ^18F-FDG hPET／CT代谢显像对结直肠癌术后复发、转移诊断的灵敏度为93％（57／61），特异性为80％（16／20），阳性预测率为93％（57／61），阴性预测率为80％（16／20）；而常规CT对结直肠癌术后复发转移诊断的灵敏度、特异性、阳性预测值、阴性预测值分别为67％（37／55）、73％（19／26）、84％（37／44）、51％（19／37）；^18F-FDG hPET／CT代谢显像共检出病灶126个，65例相同视野hPET／CT代谢显像与诊断CT常规影像检查复发转移病灶检出数分别为91个和46个。结论 ^18F-FDG hPET／CT显像对结直肠癌术后复发转移的诊断价值优于CT；通过与同机定位CT图像融合可有效地对病变进行定性定位。     

^18F-FDG代谢显像对肿瘤骨骼侵犯的诊断价值

目的探讨氟代2-脱氧葡萄糖（^18F—FDG）双探头符合线路骨代谢显像（DHCI）及^99m锝-亚甲基二膦酸盐（^99mTc—MDP）骨骼显像对肿瘤骨骼侵犯的诊断价值。方法21例不明原因腰背部疼痛和35例CT或MRI发现骨骼病变疑似恶性肿瘤侵犯共56例患者行^99MTc—MDP骨骼显像及^18F—FDGDHCI,最终结果与病理以及其它影像学结果作对照。并将^99mTc—MDP骨骼显像和^18F—FDGDHCI做对比研究。结果56例中确诊为恶性肿瘤49例（病灶193个）,其中成骨性病灶135个,溶骨性病灶58个。^99mTc—MDP骨骼显像对肿瘤骨骼侵犯诊断的灵敏度、特异性、准确率分别为89．5％,14．2％和81．3％,阳性预报价值为97．8％,阴性预报价值为89．5％。^18F—FDGDHCI对肿瘤骨骼侵犯诊断的灵敏度、特异性、准确率分别为98．3％,100％和98．4％,阳性预报价值为100％,阴性预报价值为87．5％。两者对骨骼病灶的诊断效能相比,^18F-FDGDHCI高于^99mTe—MDP骨骼显像,差异有显著性（x^2=9．77,P〈0．05）。结论^18F—FDGDHCI和^99mTc—MDP骨骼显像对原发骨骼恶性肿瘤及骨骼转移灶均有较好的诊断价值,但前者对恶性肿瘤骨骼侵犯的灵敏度、准确率、特异性均高于^99mTc—MDP骨骼显像。^18F—FDGDHCI除可探测骨骼转移灶外对原发病灶也有很好的探测价值,并较准确地确定恶性肿瘤临床分期。     

18F-FDG显像联合CEA在诊断结直肠癌术后转移复发中的价值

目的:探讨18F-FDG显像联合CEA检测诊断结直肠癌术后复发的鉴别诊断价值.方法:采用18F-FDG双探头符合线路显像,同机图像融合,并检测CEA.结果:CEA阳性组18F-FDG PET/CT显像的灵敏度为93.3％(28/30),阳性预测值为96.6％(28/29),恃异度为85.7％(6/7),阴性预测值为75.0％(6/8),准确性91.9％(34/37).CEA阴性组18F-FDG PET/CT显像的灵敏度84.6％ (11/13),阳性预测值57.9％(11/19),特异性为20％(2/10),阴性预测值50％(2/4),准确性97.3％(13/23).结论:18F-FDG显像联合血肿瘤标志物检测能明显提高结直肠癌复发的检出率.     

18F-脱氧葡萄糖正电子发射计算机断层显像CT检查在前列腺癌诊断和分期中的应用价值

目的 评价18F-脱氧葡萄糖(18F-FDG)正电子发射计算机断层显像CT检查(PET/CT)在前列腺癌诊断和分期中的应用价值.方法 经手术或穿刺活检病理证实为前列腺癌患者40例,年龄52 ～ 78岁,平均67岁.其中T24例,T316例,T420例.行18F-FDG PET/CT及99Tcm-MDPECT骨显像检查,统计PET/CT显像对前列腺癌原发灶、淋巴结转移及骨转移诊断的敏感性,对比分析PET/CT显像及99Tcm-MDPECT骨显像对骨转移的诊断效果.结果 40例患者中,18F-FDG PET/CT检查显示前列腺局部结节状放射性浓聚17例,对原发灶诊断敏感性为43％.17例淋巴结转移患者中CT检查发现8例,18F-FDG PET/CT检查发现15例,诊断敏感性为88％,其中5例患者因PET/CT检查改变了临床分期以及治疗方案.18F-FDG PET/CT对骨转移诊断的敏感性与99Tcm-MDP骨显像相近,但特异性(95％)和准确率(96％)均明显高于99Tcm-MDP骨显像,其中6例患者因PET/CT检查改变了临床分期,2例改变了治疗方案.结论 18F-FDG PET/CT对前列腺癌淋巴结转移和骨转移有较高诊断价值,对前列腺的分期具有特殊优势,可为临床医生制定治疗方案提供可靠依据.     

99m Tc-MIBI显像在乳腺癌及腋淋巴结转移诊断中的应用

目的:通过~(99mm)Tc-MIBI显像研究术前乳腺肿块及其腋窝淋巴结是否转移,取得一种术前较好评估乳腺肿块及腋淋巴结状况的方法。方法:收集2001年5月～2002年7月住院病例共59例,均为女性,年龄25～65岁,平均43.6岁。发病到就诊时间7天～5年,肿块大小1.0～9.0cm。常规在术前1周作~(99m)Tc-MIBI显像。结果:本组59例乳房肿块中,乳腺癌44例,显像阳性40例,阴性4例。良性肿块15例中,显像阳性3例,阴性12例。~(99m)Tc-MIBI显像对乳腺癌的敏感性为90.9％,特异性为80.0％,阳性预测值93.0％,阴性预测值75.0％,准确率88.1％。病理证实的腋淋巴结阳性的30例中有29例~(99m)Tc-MIBI显像为阳性;淋巴结阴性的14例中有1例~(99m)Tc-MIBI显像阳性。对腋淋巴结是否转移的敏感性为96.7％,特异性为92.9％,阳性预测值96.7％,阴性预测值92.9％,准确率95.5。结论:本组结果显示~(99m)Tc-MIBI显像在检测乳腺癌和腋淋巴结转移具有较高的诊断准确性。     

SPECT显像在脑损伤后症候群中的应用

目的探查SPECT脑血流灌注显像和CT、MRI脑显像在脑损伤后症候群患者中的应用价值.方法 126例有脑损伤后症候群的患者均用99mTc-ECD行SPECT脑血流灌注显像;同时,其中80例行CT显像,其余46例行MRI显像.结果 126例患者中,SPECT检查阳性113例,阳性率为89.7%;CT和MRI检查阳性52例,阳性率为41.3%,二者差异明显P＜0.01.结论 SPECT脑血流灌注显像检查脑损伤后症候群的灵敏度高于CT或MRI,而CT或MRI 在定位和微小病灶探查上优于SPECT,临床运用中应进行有机地结合.     

^18F-FDG PET—CT对上消化道肿瘤手术和放化疗后复发转移的评估

目的评估^18F—FDGPET—CT对上消化道肿瘤手术加放化疗后复发转移的诊断价值。方法回顾性分析51例上消化道肿瘤（食管癌21例．胃癌30例）手术和放化疗后的PET-CT显像资料．图像分析采用目视法及半定量分析法（最大标准摄取值,SUVmax）。结果51例患者PET-CT显像阳性32例．其中单纯局部复发为7例．单纯远处转移11例,局部复发并转移为14例。PET—CT诊断局部复发的敏感度为100％（18／18）,特异度为90．9％（30／33）;诊断远处转移的敏感度为92．6％（25／27）,特异度为100％（25／25）。结论ISF—FDGPET—CT对上消化道肿瘤手术加放化疗后复发或转移具有较高的诊断价值。     

双模式PET／CT显像在肝门胆管癌术前评估中的应用

Li J,Kuehl H,Grabellus F等于2004年6月至2007年12月期间对17例肝门胆管癌患者于术前行双模式（18）F-FDGPET／CT显像并做了统计报告;其中7例接受了肿瘤根治性切除,10例接受了手术探查。该报告用肿瘤-淋巴结-转移（TNM）分期系统将每一例患者的影像学检查结果与术后的病理检查结果进行了比较。PET／CT检测原发性肿瘤的敏感性是58．8％（T2、T3及T4期肿瘤分别为25％、70％和66．7％）,检测淋巴结转移的敏感性及特异性为41．7％及80％,检测远处转移的敏感性及特异性为55．6％％和87．5％。     

乳腺肿块Sono CT高频超声显像与钼靶X线诊断对照研究

目的 分析比较Sono CT高频超声显像与钼靶X线摄影法对乳腺肿块的临床诊断价值。方法 193例乳腺肿块患者，其中乳腺癌58例，良性肿块135例，在术前1周内同时行Sono CT高频超声显像和钼靶X线摄影检查。结果 超声诊断早期乳腺癌46例，其敏感性79．31％，特异性94．81％，准确性90．16％。钼靶诊断早期乳腺癌47例，其敏感性和特异性为81．03％和89．63％，准确性为87．05％。超声对于良性肿瘤分类诊断的敏感性、特异性和准确性均高于钼靶。结论 Sono CT高频超声与钼靶X线摄影比较，发现前者对早期乳腺癌的敏感性和阴性预测值近于后者，特异性和阳性预测值则高于后者，而对于良性肿瘤的分类诊断前者优于后者。     

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.     

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.     

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.