卵巢勃勒纳瘤的CT表现：附5例报道

目的 观察卵巢勃勒纳瘤的CT表现,以提高对该病的认识及诊断能力.方法 回顾性分析经病理证实的5例卵巢勃勒纳瘤的CT表现,对肿块的位置、大小、结构、增强程度、钙化及转移情况进行分析.结果 5例患者共7个病灶,单侧3例,双侧2例,其中左侧3个病灶,右侧4个病灶,肿瘤大小为1.52～16.25 cm,平均7.36 cm;4例5个病灶为良性,1例双侧病灶为恶性;CT扫描4例5个病灶(71.43%)表现为实性肿块,病灶边界均较清晰,并见钙化,1例两个病灶(28.57%)表现为囊实性,以囊性为主,病变内部可见分隔;增强扫描病变呈不均匀性中等程度强化.其中1例良性伴有大量胸腔积液及腹腔积液.结论 卵巢勃勒纳瘤CT多表现为实性肿块,内有钙化,CT检查结合临床有助于诊断.     

原发性卵巢恶性肿瘤的CT诊断

目的：分析原发性卵巢恶性肿瘤的CT表现特征，以提高对该病的诊断水平。方法：回顾性分析手术厦病理证实的19例原发性卵巢恶性肿瘤的CT表现，重点观察肿瘤部位、内部密度、分隔、瘤壁、囊内外赘生物、软组织成分、腹水、腹膜．网膜种植及淋巴结转移等。结果：（1）19例原发性卵巢恶性肿瘤中双侧者5例（26％）；（2）病灶与附件区关系密切；（3）病灶直径多〉5cm，共18例（95％）；（4）病灶多有分叶表现，共13例（68％）；（5）病灶以囊实性多见，共15例（79％），其中Ⅱa型4例，Ⅱb型8例，Ⅱc型3例；（6）实性病灶厦病灶的实性部分可有弧形、点状、结节状钙化，共3例（16％）；（7）实性病灶厦病灶的实性部分有较明显的强化；（8）转移多表现为腹水及临近器官结构受侵。结论：CT扫描对原发性卵巢恶性肿瘤有重要诊断价值。     

16排螺旋CT对卵巢浆液性肿瘤的诊断价值

目的:通过对卵巢浆液性肿瘤CT表现分析,探讨16排螺旋CT对其诊断的价值。材料与方法:回顾分析28例经手术及病理证实的卵巢浆液性肿瘤的影像特征,其中良性浆液性肿瘤13例,交界性3例,恶性肿瘤12例,全部经CT平扫和增强扫描,并重建动脉期MPR。结果:良性病灶以单房囊为主,囊壁小结节2例,11例出现分隔,6例呈现多房状,囊壁、分隔及小结节出现轻度强化。恶性肿瘤呈囊实性,边界不清,内部密度不均匀,分隔厚薄不均匀,可见大小不等壁结节,早期增强后囊壁及壁结节明显强化,2例伴随腹水。2例囊壁稍厚,未见明确壁结节,病理证实为浆液性囊腺癌。结论:浆液性囊腺瘤多见于单囊且囊壁强化不明显;浆液性囊腺癌以混杂的囊实性为主,具有较明显的早期强化表现;运用16排CT扫描有助于判断卵巢浆液性肿瘤的性质。     

卵巢硬化性间质瘤的CT诊断价值

目的：探讨卵巢硬化性间质瘤（SST）的CT表现,以提高对该肿瘤的诊断水平。方法：回顾性分析经病理证实的12例卵巢SST患者的CT表现。结果：12例卵巢SST患者中,7例发生于左侧,5例发生于右侧。瘤体最大直径为3.6~12.1 cm。CT平扫显示所有瘤体均表现为囊实混合性,其中以实性密度为主的10例（83%）,以囊性密度为主的2例（17%）。4例（33%）可见钙化。增强扫描后不均匀明显强化,其表现为：按照强化范围,12例（100%）瘤体实性部分均表现为渐进性强化,似“肝海绵状血管瘤样”,而瘤体囊性部位始终无强化。按照强化程度分为两种类型：①早期快速-持续强化：7例（58%）病变实性部分强化呈“山峰型”,但囊性部分始终无强化。其中2例动脉期边缘可见明显强化的走行迂曲的粗大血管。②渐增性强化：5例（42%）病变实性部分强化呈“上升型”,但囊性部分始终无强化。其中2例病变呈多房状,可见不规则增厚的间隔及囊壁。结论：卵巢SST CT表现具有一定特征性,CT检查结合临床表现有助于该疾病的诊断。     

64排CT增强扫描诊断卵巢良恶性浆液性肿瘤的探讨

目的通过64排CT来判断卵巢浆液性肿瘤的良恶性。方法经手术和病理证实的卵巢浆液性肿瘤58例,其中良、恶性肿瘤各25例,交界性肿瘤8例。全部行CT平扫和增强扫描,重点分析肿瘤强化特征和内部结构等。结果良性瘤灶以单房囊为主,囊壁及囊内未见强化或囊壁轻度强化（21／25例,84％）,囊壁出现中度强化4例;恶性肿瘤呈囊实性,边界不清,形态不规则,分隔厚薄不均匀,可见壁结节,增强后实性部分明显强化（22／25例,88％）,3例无明显强化。交界性肿瘤8例仅1例无强化,其余7例出现程度不等的强化。结论浆液性囊腺瘤多见于单囊且囊壁强化不明显,提示瘤灶缺乏血供或血供甚微;浆液性囊腺癌以混杂的囊实性为主,具有较明显的强化表现;交界性肿瘤强化程度略低于恶性瘤灶而但高于良性瘤灶。运用64排CT扫描有助于判断卵巢浆液性肿瘤的性质。     

卵巢硬化性间质瘤的CT诊断

目的 总结卵巢硬化性间质瘤（SST）的CT表现,以提高对其在CT影像学上的认识,掌握其诊断要点及主要鉴别诊断,降低误诊率.方法 分析3例经手术和病理证实的卵巢硬化性间质瘤CT表现及其特点.结果 3例均为单发,病灶与卵巢关系密切,病灶边界清晰,不侵犯周围临近器官,病灶密度多不均匀,多呈囊实性改变,动态增强病灶实性部分动脉期强化明显,静脉期继续强化,呈＂海绵状血管瘤样＂渐进性强化,囊性部分不强化,肿瘤壁多呈厚薄不均、结节状改变.结论 卵巢硬化性间质瘤在CT动态增强扫描时具有延迟强化特征性表现,肿瘤壁有结节样强化特点,在动态增强上具有一定的特征.     

胰腺囊性肿瘤的多层螺旋CT表现

目的:分析胰腺囊性肿瘤的多层螺旋CT(MSCT)表现,探讨MSCT对胰腺囊性肿瘤的诊断价值。方法:回顾性分析手术病理证实的35例胰腺囊性肿瘤的MSCT表现。结果:35例胰腺囊性肿瘤中,8例浆液性囊腺瘤:2例中央可见星芒状钙化,增强后分隔强化;6例表现为单房囊性病灶,增强后病变无强化。黏液性囊腺瘤5例,2例表现为单房囊性病灶。4例呈多房分隔囊性病灶,增强后壁有强化。囊腺癌5例,肿瘤呈多房分隔囊性病灶,其中4例伴肝脏转移及1例伴邻近血管受侵征象。实性假乳头状瘤10例,3例为囊实混合性,4例以实性为主,3例以囊性为主。其中2例肿瘤有钙化。增强后实性部分静脉期延时强化;囊性部分无强化。导管内乳头状黏液性肿瘤2例,囊性病变与扩张胰管相通,病灶内可见壁结节。胰腺癌伴囊变4例及胰腺囊性转移瘤1例。结论:MSCT及后处理技术能很好显示胰腺囊性肿瘤内部结构及邻近脏器、血管受累改变情况,对其诊断及确定手术方案有重要价值。     

卵巢Sertoli-Leydig细胞瘤的影像表现(附3例报道及文献复习)

目的探讨卵巢Sertoli-Leydig细胞瘤的影像表现及临床特征,以提高对该肿瘤的认识及诊断水平。材料与方法搜集经病理证实的3例卵巢SertoliLeydig细胞瘤的CT、MRI影像资料,观察病变的影像学特征,并分析病变的影像学特征与预后的关系。结果 3例患者(17岁,71岁,58岁)共发现3个肿瘤,其中2例位于左侧卵巢,1例位于右侧卵巢,病变于CT、MRI均表现为边界清楚的实性或囊实性肿块,实性部分于T2WI呈等或稍高信号,囊性部分多位于实性部分内部,呈T2WI高信号,DWI病变呈高信号。增强扫描,病变实性部分呈明显强化。3例患者中有2例雄激素水平升高,临床呈男性化表现。结论卵巢Sertoli-Leydig细胞瘤有一定的影像学特征,若发现卵巢实性或以实性成分为主的囊实性肿瘤,且实性成分于T2WI呈等或稍高信号时,结合患者临床病史,应考虑到该肿瘤的诊断。     

Krukenberg瘤的磁共振诊断

目的:比较Krukenberg瘤与原发性卵巢肿瘤的MRI特点,探讨Krukenberg瘤的影像学特征。方法:回顾性分析经手术病理证实的24例Krukenberg瘤和60例原发性卵巢肿瘤的MRI表现。依据MRI信号将肿瘤分为3型:实性为主型、囊实性及囊性为主型。结果:24个Krukenberg瘤患者共发现39个病灶,发生于双侧卵巢15例、单侧9例。39个病灶中,实性为主型20个、囊实性11个、囊性为主型8个;增强后病灶实性成分和(或)囊壁明显强化。60例卵巢原发肿瘤患者共发现87个病灶,发生于双侧卵巢27例、单侧33例。87个病灶中,16个实性为主,19个囊实性,52个囊性为主。19个囊实性肿块增强后有4个(4/19,21.0%)囊肿壁明显强化。结论:当双侧卵巢出现实性或囊实性肿块,尤其肿块中囊肿壁出现明显强化时,应考虑Krukenberg瘤的可能。     

卵巢甲状腺肿的影像学特征及误诊分析

目的:探讨卵巢甲状腺肿的影像学表现特点并分析误诊原因。方法:回顾性分析经手术病理证实的9例卵巢甲状腺肿的临床和影像学资料,重点分析其影像学特征及误诊原因。结果:9例患者年龄26～47岁,中位年龄36岁,均为卵巢单发多房囊实性肿块,左侧3例,右侧6例,呈不规则形或卵圆形,边界清晰,直径5.0～13.5cm,平均8.4cm;CT平扫2例患者均可见高密度囊腔,CT值55-90Hu;9例患者MRI平扫T2WI和脂肪抑制T2WI肿块各囊腔信号多样,均可见极低信号灶为其特征表现;增强扫描肿块囊壁和分隔强化,分隔厚薄不均,实性成分呈甲状腺样明显强化,囊性成分未见强化。1例伴左侧卵巢成熟型畸胎瘤,1例伴肿瘤蒂扭转。术前考虑为卵巢囊肿1例,巧克力囊肿1例,卵巢囊腺瘤1例。结论:卵巢甲状腺肿的影像学表现具有一定的特征,即附件区边界清晰、体积较大,CT病灶内含高密度囊腔,MRIT2WI序列见极低信号病灶的多房囊实性肿块。误诊主要原因是对卵巢甲状腺肿的影像学表现认识不足。     

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.     

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.     

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.     

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.