16层螺旋CT血管造影在下肢动脉硬化性病变中的临床应用

目的:探讨16层螺旋CT血管造影成像检查(MSCTA)在下肢动脉硬化性病变诊断中的临床应用价值.方法:回顾性分析23例下肢动脉血管造影成像检查资料,使用三维重建方法包括最大强度投影(MIP)、多平面重建(MPR)、表面遮盖成像(SSD)、容积成像(VRT)及CT仿真内窥镜成像(CTVE).结果:所有病例血管重建图像显示良好,病变的MSCTA表现为血管管腔不规则,单发或多发狭窄或闭塞,局部侧支血管形成,部分管壁钙化.其中肾动脉以下腹主动脉狭窄3例,闭塞1例;髂动脉狭窄7例,闭塞2例;股动脉狭窄10例,闭塞8例;腘动脉狭窄8例,闭塞10例;小腿动脉狭窄11例,闭塞12例.23例均显示有动脉管壁钙化.结论:下肢动脉MSCTA检查可清楚地观察下肢动脉的血管形态,了解下肢动脉狭窄程度及闭塞情况,且能观察下肢动脉壁的钙化斑块,对下肢动脉硬化性闭塞性病变的术前评价诊断和筛选有较大的帮助.     

多层螺旋CT扫描结合三维重建诊断原发性输尿管癌11例分析

目的探讨多层螺旋CT扫描结合三维重建对原发输尿管癌的诊断价值。方法收集经手术病理证实的原发输尿管癌患者11例。所有患者常规行全尿路CT平扫及增强扫描,延迟8～120min行多次全尿路扫描,薄层重建数据应用AW4.3软件进行MPR、CPR、MIP及VR重建及三维成像,CPR选取动脉期、MIP及VR选取延迟期效果较好。结果 CT全部检出病灶。平扫显示病灶为输尿管腔内软组织肿块、管壁增厚及不同程度的扩张积水,增强扫描动、静脉期可见病灶呈不同程度强化。MPR从不同角度显示病变本身及病变与周围组织器官的关系。CPR通过动脉期重建对输尿管完整显示使病变整体形态范围变得更清晰。MIP、VR在延迟期能立体多方位显示输尿管充盈情况、局部梗阻形态等。结论多层螺旋CT扫描结合三维重建基本上对原发输尿管癌做出正确诊断,提高小病灶检出率,为临床手术治疗提供可靠的信息,是很好的影像学检查方法。     

64层螺旋CT血管成像评价胰腺直接供血动脉的价值

目的 探讨64 层螺旋CT 血管成像对胰腺直接供血动脉的显示价值.方法 对91 例非胰腺器质性病变行胰腺供血动脉64 层螺旋CT 造影检查,应用腹部容积扫描程序,采用最大密度投影法(MIP)和容积再现(VR)技术获得胰腺直接供血动脉图像,并以DSA 造影结果为金标准进行比对,观察分析MIP、VR 对胰腺直接供血动脉的显示率,并对其显示真实性、可靠性及收益进行评价;采用卡方检验比较两种方法间的差异性.结果 MIP 和VR 对胰腺直接供血动脉的显示率不同,MIP对胰十二指肠上前动脉、胰十二指肠上后动脉、胰十二指肠下前动脉、胰十二指肠下后动脉、胰背动脉、胰横动脉、胰大动脉显示率明显优于VR,经卡方检验,差异有统计学意义(P ＜0.05).MIP 对胰尾动脉显示率与VR 间差异无统计学意义.而且MIP 方法可提高胰腺直接供血动脉显示的敏感度、正确诊断指数和阳性预测值;但其对显示的特异度及阴性预测值与VR 比较差异无统计学意义.结论 64 层螺旋CT 血管成像是一种简便、快速、无创显示胰腺供血动脉检查手段,能够显示胰腺直接供血动脉,并可为临床提供有价值的参考依据;MIP 多角度三维重建能比VR 更准确显示胰腺直接供血动脉解剖结构.     

电子束CT在主动脉疾患诊断中的作用

目的:探讨电子束CT(EBCT)及其后处理技术在主动脉疾患诊断中的价值。方法:采用单层序列增强扫描(SSM)或连续容积增强扫描(CVS)方式行CT血管造影。三维重建方法分别采用最大密度投影法(MIP)、多层面或曲面重组法(MPR?CPR)、容积显示法(VRT)。CT仿真内窥镜技术(CTVE)用于显示血管内腔。结果:24例主动脉病变中,主动脉夹层16例,真性动脉瘤5例,假性动脉瘤3例。断层图像清晰显示主动脉夹层的内膜片、破口、分支动脉起源以及动脉瘤的形态、破口位置和瘤内血栓;三维重建技术可立体显示内膜片走行,主动脉全貌,动脉瘤大小、位置及其与周围组织关系;仿真内窥镜技术可动态观察血管内腔情况如破口、内膜片走行等。结论:EBCT诊断主动脉疾患尤其胸主动脉病变有重要价值,三维重建及仿真内窥镜图像对临床手术有重要指导作用。     

多层螺旋 CT后处理对输尿管病变的临床应用价值

[目的]探讨多层螺旋 CT(MSCT)各种后处理方法对输尿管病变的临床应用价值.[方法]应用MSCT对59例患者共64处输尿管病变做平扫及多期增强扫描 ,并作多平面和曲面(MPR、CPR)、最大密度投影(MIP)和容积再现(VR)等三维重建后处理 ,观察MSCT各种成像方法显示和诊断病变的能力.[结果]62例病变MSCT横断面结合MPR、CPR、MIP、VR能很好地显示输尿管病变的部位、大小、形态和分布范围及尿路梗阻的情况 ,其中 31 例手术患者 ,输尿管病变在CT图像上的表现与手术所见有很好的一致性.[结论]MSCT及后处理对输尿管病变的显示和诊断具有很高的临床应用价值.     

多排螺旋CT下肢CTA多种重建方式对下肢动脉阻塞性疾病临床诊断价值的研究

目的探讨多排螺旋CT下肢多层螺旋CT血管成像(CTA)多种重建方式对下肢动脉阻塞性疾病的临床诊断价值。方法回顾性分析2017年6月至2019年3月保定市第一中心医院收治的88例可疑下肢动脉阻塞性疾病患者,所有患者均给予CTA检查,并分别采取最大密度投影(MIP)、容积再现(VR)、曲面重组(CPR)三种重建方法,记录分析三种重建方法所显示膝以上血管、膝以下血管节段数以及血管狭窄程度,随后将三种重建方式相互结合观察血管节段数狭窄程度并与DSA检查相比较。结果 CPR、MIP以及VR三种重建方法显示,膝以上血管节段数比较(763个vs. 762个vs. 766个),差异均无统计学意义(P0. 05);膝以下血管节段数比较,CRP明显优于MIP和VR(454个vs. 405个vs. 387个),而MIP又明显优于VR(405个vs. 387个),差异均具有统计学意义(P 0. 05);全部下肢血管节段数比较,CPR亦优于MIP和VR(1 217个vs. 1 167个vs. 1 153个),差异具有统计学意义(P 0. 05)。CTA与DSA检查血管狭窄程度比较,差异无统计学意义(P 0. 05)。结论下肢CTA的三种重建方法均能准确显示膝以上血管,CPR显示膝以下血管具有明显优势,临床工作中对膝以下血管诊断时应三种重建方法相互结合进行综合诊断,以准确评估血管狭窄程度。     

螺旋CT三维重建方法在颞骨影像学的对比研究

目的:探讨成人颞骨螺旋CT三维重建技术。方法:对正常30耳,慢性化脓性中耳炎41耳行螺旋CT检查,把扫描所得的容积数据进行三维重建,包括最大密度投影法(MIP)、最小密度投影法(MinIP)、仿真内窥镜法(CTVE)和容积再现法(VR)。结果:MIP、MinIP、CTVE和VR可以从不同的方面对颞骨内结构进行三维显示。结论:对于颞骨内结构的显示,VR是目前较好的三维重建方法。     

16层螺旋CT血管成像诊断锁骨下动脉盗血综合征15例分析

目的：探讨16层螺旋CT血管成像技术在锁骨下动脉盗血综合征中的应用价值。方法：采用16层螺旋CT薄层扫描，利用三维重建技术，显示并记录15例患者病变血管及部位。结果：15例患者锁骨下动脉均有闭锁或狭窄，CT后重建图像能清晰显示病变血管。结论：16层螺旋CT血管成像分辨率高，图像立体感强，病变显示清晰，是锁骨下动脉盗血综合征最有价值的诊断方法之一。     

64层螺旋CT后处理技术评价下肢血管损伤

目的 探讨64层螺旋CT后处理技术显示下肢血管损伤的优缺点及应用价值。方法 分析行64层螺旋CT血管造影(CTA)检查的下肢血管损伤的30例患者的血管重组图像,比较各种图像后处理技术对下肢动脉损伤的显示效果,30例患者包括16例单纯动脉损伤,10例假性动脉瘤,4例动静脉瘘,其中8例为下肢骨折内固定术后。10例假性动脉瘤患者同时行数字减影动脉造影(DSA)检查及破口修复术,15例单纯动脉损伤经手术证实,其余5例病例经磁共振血管造影(MRA)等检查和随访证实。比较各种图像后处理技术对下肢动脉损伤的显示效果。结果 30例患者CTA都能清晰显示下肢动脉损伤,与原始轴位和MPR/CPR相比,MIP及VR诊断动脉狭窄的准确性分别为70.59%(12/17),58.82%(10/17)。CTA对血管损伤的诊断与DSA、手术所见及MRA等相关检查随访完全相符,但CTA对下肢动脉损伤后血栓形成诊断的准确率为60.71%(17/28)。结论 64层螺旋CTA可准确、直观显示下肢动脉损伤情况。各种下肢血管后处理成像技术中,MPR/CPR结合原始轴位对下肢血管损伤显示最佳,VR对手术定位有很好的辅助作用。     

256层螺旋CT血管成像对脑血管病变的应用价值

目的:探讨256层螺旋CT血管成像在颅内血管性病变的应用价值。方法:80例疑脑血管病变患者进行256层螺旋CT脑血管成像检查,对图像进行后处理,包括:容积再现(VR)、最大密度投影(MIP)等技术,实时三维重建脑血管图像。结果:80例检查中发现动脉狭窄20例,动脉变异23例,烟雾病7例,动静脉畸形10例,动脉瘤20例。螺旋CT脑血管成像(SCTA)能很好显示大脑前、中、后动脉主干及近端大分支,能很好显示动脉瘤的形态、大小、位置;也能很好显示动静脉畸形的畸形血管团,以及供血动脉和引流静脉;80例中颅底Willis环都显示清晰。结论:256层螺旋CT脑血管成像是一种最佳的脑血管疾病的诊断方法,此种方法快速、无创,能为临床的治疗选择提供帮助。     

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.