超声造影在壶腹周围癌诊断及鉴别诊断中的应用价值

目的 探讨超声造影对壶腹周围癌的诊断及鉴别诊断的应用价值.方法 对33例高度怀疑壶腹周围占位患者进行常规二维超声及超声造影检查,记录病变造影时的增强模式、始增时间、峰值时间等,分别于造影前与造影后静脉相测量病灶大小,并分别与术后切除病灶大小相比较.结果 25例手术病例中22例为壶腹周围癌.22例病灶在注入造影剂后早期均有不同程度的增强,始增时间为9～17 s,达峰时间为14～33 s.22例手术切除病灶大小与造影前、后所测病灶大小之间均无统计学意义,P>0.05.超声造影静脉相发现1例肝脏多发转移.结论 壶腹周围癌在超声造影动脉相均有增强,为壶腹周围病变的诊断及鉴别诊断提供了有用的影像学信息.     

宫颈癌超声造影表现及其临床意义

目的探讨宫颈癌的超声造影表现及其临床意义。方法对25例宫颈癌患者进行超声造影检查,观察其超声造影表现及周围组织病变浸润情况。结果25例宫颈癌均经病理证实。超声造影确诊浸润癌21例,其中准确判定有无邻近组织侵犯18例。4例镜下早期浸润癌未能检出。宫颈浸润癌超声造影表现为动脉期病灶区灌注早于子宫肌层呈均匀或不均匀高增强,后期周边部呈稍高增强而内部呈低增强,可显示病灶范围及周围组织浸润情况。结论超声造影有助于宫颈癌的诊断及病变浸润范围的评价,可为临床分期及制定治疗方案提供有用信息。     

不同临床分期宫颈癌的超声造影表现

目的 总结不同临床分期宫颈癌的超声造影表现.方法 应用反向脉冲谐波超声造影技术,联合时间-强度曲线(TIC),分析48例经病理证实的不同临床分期宫颈癌患者的超声造影资料,总结宫颈癌超声造影增强方式.结果 宫颈癌超声造影表现为增强早期病变内造影剂灌注明显早于子宫肌层,呈均匀或不均匀增强;增强晚期造影剂消退早于子宫肌层,与正常宫体形成明显的界限,可清晰显示病变轮廓及对周围组织的浸润程度.结论 超声造影能较准确地判断宫颈癌分期及肿瘤浸润范围,在一定程度上弥补常规超声在宫颈癌诊断和分期中的不足.     

不同临床分期宫颈癌的超声造影表现

目的 总结不同临床分期宫颈癌的超声造影表现.方法 应用反向脉冲谐波超声造影技术,联合时间-强度曲线(TIC),分析48例经病理证实的不同临床分期宫颈癌患者的超声造影资料,总结宫颈癌超声造影增强方式.结果 宫颈癌超声造影表现为增强早期病变内造影剂灌注明显早于子宫肌层,呈均匀或不均匀增强;增强晚期造影剂消退早于子宫肌层,与正常宫体形成明显的界限,可清晰显示病变轮廓及对周围组织的浸润程度.结论 超声造影能较准确地判断宫颈癌分期及肿瘤浸润范围,在一定程度上弥补常规超声在宫颈癌诊断和分期中的不足.     

不同临床分期宫颈癌的超声造影表现

目的 总结不同临床分期宫颈癌的超声造影表现.方法 应用反向脉冲谐波超声造影技术,联合时间-强度曲线(TIC),分析48例经病理证实的不同临床分期宫颈癌患者的超声造影资料,总结宫颈癌超声造影增强方式.结果 宫颈癌超声造影表现为增强早期病变内造影剂灌注明显早于子宫肌层,呈均匀或不均匀增强;增强晚期造影剂消退早于子宫肌层,与正常宫体形成明显的界限,可清晰显示病变轮廓及对周围组织的浸润程度.结论 超声造影能较准确地判断宫颈癌分期及肿瘤浸润范围,在一定程度上弥补常规超声在宫颈癌诊断和分期中的不足.     

实时超声造影在胸膜下肺肿块中的应用价值

目的探讨实时超声造影在胸膜下肺肿块中的应用价值。方法收集影像学检查发现存在胸膜下肺肿块的病例70例,首先行常规超声检查观察,病灶大小、形态、回声、血流信号及边界等特征,再经超声造影检查观察,病灶的增强方式、增强程度、增强均匀度。结果 70例病灶中,良性38例,恶性32例。常规超声良性病变多呈楔形,树枝状血流,恶性病变多呈不规则形或类圆形,点状或不规则血流(P<0.05),病灶的大小、回声、边界、支气管征无统计学意义(P>0.05);良性病变造影剂到达病灶时间及病灶-肺组织时间差均低于恶性病变(P<0.05),但良恶性病变中造影剂到达肺组织时间差异无统计学意义(P>0.05),良性病变多呈树枝状、均匀性增强,恶性病变多呈不均匀枯枝状或棉花状增强(P<0.05)。结论实时超声造影可为胸膜下肺肿块的诊断提供重要信息。     

超声造影对脾实性占位性病变的诊断价值

目的 探讨实时灰阶超声造影技术在脾实性占位性病变良恶性鉴别诊断中的价值.方法 采用超声造影剂SonoVue对32例脾实性占位性病变进行超声造影检查(良恶性病灶各16例),实时动态地观察病灶的增强时相与增强方式.结果 脾恶性病变组在增强时间上与良性组相比表现为"快退"特征,恶性病灶增强强度达高峰时及开始减退所用的时间分别为(19.7±4.5)s、(29.7±10.9)s,而良性病灶组造影时的相应时间分别为(24.2±4.4)s、(50.9±10.9)s,恶性病灶造影剂开始减退时间较良性病灶快,差异有统计学意义(P＜0.05).良恶性病灶在增强方式上的差异无统计学意义(P＞0.05).超声造影能够发现更多的病灶,造影前共检出111个病灶,造影后共检出142个病灶.结论 超声造影有助于提高对脾实性占位性病变的诊断准确性.     

低机械指数连续超声造影在宫颈癌中的应用探讨

目的探讨超声造影在宫颈癌诊断及临床分期中的价值。方法对31例宫颈癌患者进行声诺维超声造影检查，观察肿瘤造影增强特点并对周围组织受侵犯情况进行评估。结果超声造影确诊宫颈癌26例，5例镜下早期浸润癌未能被超声造影识别。宫颈癌超声造影表现为动脉期病灶区灌注早于子宫肌层，呈均匀或不均匀高增强；后期病灶内部造影剂消退早于肌层呈低增强，周边部消退较慢呈稍高增强，可清晰显示病灶范围及周围组织浸润情况。结论超声造影有助于宫颈癌的诊断及浸润范围的评价，可为临床分期及制定治疗方案提供有用信息。     

肝结核球患者常规超声和超声造影表现:与细菌性肝脓肿患者对照的临床研究

目的 分析肝结核球患者常规超声和超声造影表现,并与细菌性肝脓肿患者相对照,探讨常规超声及超声造影对肝结核球的诊断价值.方法 对10例肝结核球患者(15个病灶)和16例细菌性肝脓肿患者(16个病灶)行常规超声检查后,对每个病灶行超声造影检查,分析每个病灶造影动态增强特点,同时定量分析时间-强度曲线,并记录造影剂开始增强时间及达峰时间.结果 15个肝结核球病灶常规超声均表现为低回声,超声造影动脉期增强均呈高增强,其中11个病灶呈环状增强,4个病灶呈弥漫性增强,造影剂开始增强时间为12.3～16.8 s,平均(14.1±1.9)s;达峰时间为23.5～32.3 s,平均(27.7±2.7)s.16个细菌性肝脓肿病灶中,10个常规超声表现为低回声,6个表现为不均质高低混合回声,超声造影动脉期增强均呈高增强,其中10个病灶为蜂窝状增强,4个病灶为周边环状增强,2个病灶为弥漫性增强,造影剂开始增强时间为13.3～21.3 s,平均(16.2±2.5)s;达峰时间为28.6～53.9 s,平均(35.6±8.6)s.所有病灶超声造影动脉期迅速增强至高峰后,增强逐渐消退持续至门脉期及延迟期,病灶呈现低回声或无回声.结论 肝结核球与肝脓肿常规超声及超声造影表现既有相似之处,也有其特征性表现,结合临床及病理改变可提高其诊断的准确性.     

胃肠超声造影对胃癌患者术前分期及病灶转移情况的诊断价值

目的探讨胃肠超声造影对胃癌患者术前分期及病灶转移情况的诊断价值。方法回顾性分析2018年1月至2019年1月某院收治的60例胃癌患者的临床资料,所有患者均已接受胃肠超声造影检查,手术后将病理产物送至病理科进行病理学检查,比较胃肠超声造影与病理T分期、癌及癌周围组织造影指标、病灶转移情况。结果以病理T分期为金标准,胃肠超声造影对T1期的诊断符合率为100%,对T2期的诊断符合率为92.31%,对T3期的诊断符合率为93.33%,对T4期的诊断符合率为80.00%,总体诊断符合率为90.00%;经胃肠超声造影检查发现,癌内组织显影时间(AT)、达峰时间(TTP)、峰值强度(PI)均低于癌周围组织,差异有统计学意义(P<0.05);经病理学检查发现,病灶转移7例,其中2例腹膜转移,3例肝脏转移,2例腹腔远隔脏器转移,而胃肠超声造影检查漏诊1例腹腔远隔脏器转移,诊断符合率达85.71%。结论胃肠超声造影对患者术前分期诊断符合率高,可评估癌内造影指标,有效检出病灶转移情况。     

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.     

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.