超声引导下经皮穿刺微波治疗骨肿瘤临床研究

为了探讨超声引导微波介入治疗骨肿瘤可行性和疗效 ,本研究对 12例骨肿瘤患者进行了临床研究 ,现报道如下。资料与方法1998年 8月至 2 0 0 1年 12月 ,12例骨肿瘤患者 15个肿块接受了超声引导经皮穿刺微波治疗。男 7例 ,女 5例 ,年龄2 8～ 73岁 ,平均 43岁。肿瘤位于肩胛骨 3例 ,股骨 2例 ,肱骨2例 ,肋骨 2例 ,胫骨 1例 ,腓骨 1例 ,髂骨 1例。病理类型 :骨肉瘤 5例 ,转移性骨肿瘤 7例。肿瘤大小 2～ 6ｃｍ ,平均 3.6ｃｍ。均有局部疼痛 ,肢体活动受限 ,因各种原因不能手术治疗。仪器 :Ａｃｕｓｏｎ 12 8ＸＰ超声仪 ,探头频率 3.5～ 5 .0ＭＨ…     

超声引导经皮穿刺微波凝固治疗周围型肺癌的临床研究

目的探讨超声引导经皮穿刺微波凝固治疗(PMCT)周围型肺癌的可行性及其疗效.方法对12例周围型肺癌患者的16个肿瘤结节行超声引导PMCT,一般先用60W、100s,然后30～40W、300～600s,直径≥3 cm的肿瘤一次多点凝固.结果治疗后肿瘤结节均有不同程度缩小,内部血流信号消失或减少;增强CT检查9个肿瘤结节无强化,7个部分强化;治疗后4例活检治疗区肿瘤完全坏死;治疗后1个月5例临床症状消失,7例症状减轻;随访6～40个月(平均20个月),7例存活;无严重并发症发生.结论超声引导PMCT治疗周围型肺癌是一种安全、可行、有效的方法.     

超声引导经皮微波凝固治疗原发性肝癌的观察及护理

目的报告20例超声引导经皮微波凝固治疗原发性肝癌的观察及护理体会。方法根据微波凝固治疗的特点和要求,提出了治疗前的准备、治疗中的观察及治疗后的护理。结果20例病人1～2周B超显示肿块血流信号消失,增强CT检查无强化,AFP2～4周明显下降,无因护理不当并发症。结论超声引导经皮微波穿刺凝固类球体原位灭活治疗肝癌方法简单、安全,治疗效果确切,做好治疗前、治疗中、治疗后的护理,不失为肝癌治疗的又一新手段。     

超声引导下微波介入治疗大肝癌的实验研究及临床应用

目的进一步探讨超声引导下微波治疗大肝癌的可行性和疗效。方法采用分次多点多部位由深到浅低功率长时间分段微波凝固,对10个65斤重的猪肝和2只狗进行了实验研究;60例大肝癌患者进行了超声引导下微波治疗。结果微波治疗后两个或多个坏死区叠加,凝固坏死区加大。离体猪肝坏死区达到6cm×6cm,狗肝坏死区为5cm×6cm。所有病例治疗后肿块缩小,肿瘤内血流消失或减少;22例CT检查,肿块缩小,18例无强化;28例超声引导下活检大片坏死。治疗后全身情况好转,AFP和肝功能改善,生活质量提高。无严重并发症发生。随访3～28个月,51例存活。结论实验研究表明改进微波治疗方法,坏死区加大,超声引导微波治疗大肝癌也有较好的疗效。     

超声引导经皮穿刺微波治疗恶性肿瘤的临床研究

目的探讨超声引导微波消融治疗恶性肿瘤的疗效和可行性。方法373例实体瘤(肝癌、肺癌和骨肿瘤等)进行超声引导下经皮穿刺微波消融治疗。结果所有病例治疗后全身情况好转,症状减轻或消失,患者饮食明显增加,生活质量、生存率提高,肿块缩小,肿瘤内血流消失或减少。27例超声引导下活检肿瘤完全坏死。≤5cm肝癌治疗后有效率(CR PR)83.2%,1,2,3,5年生存率分别是88.8%,68.5%,60.9%,38.6%,一次完全消融率60.9%。>5cm肝癌有效率(CR PR)61.9%,1,2,3,5年生存率分别是67.8%,51.7%,39.8%,24.6%,一次完全消融率36.9%。微波联合TACE治疗大肝癌1,2,3,5年生存率分别是88.6%,71.4%,60.0%,42.9%;肺癌微波治疗有效率(CR PR)64.7%,一次完全消融67%;骨肿瘤微波治疗有效率(CR PR)100%,一次完全消融率64.7%,疼痛减轻或消失,肢体功能恢复。无其他严重并发症发生。结论超声引导微波消融治疗肝、肺和骨肿瘤等实体瘤安全、可行、有效。     

超声引导微波凝固治疗原发性肝癌：附120例临床疗效分析

目的分析超声引导微波凝固治疗原发性肝癌（ＨＣＣ）的疗效。方法１２０例ＨＣＣ经皮穿刺植入单导或双导微波天线对肿瘤进行一次整体覆盖原位凝固灭活治疗。结果治疗后随访３～６０个月,肿块内血流信号消失率９０．４％,增强ＣＴ或ＭＲＩ治疗后无强化率９１．５％,ＡＦＰ转正常水平占８６．２％,肿块缩小率６１．１％,再活检肿瘤完全坏死率９０．６％,局部及全身免疫均明显增强,总生存率７８．３％。结论超声引导经皮穿刺微波凝固一次整体原位灭活治疗肝癌方法简单、省时、安全,微波热场可控、凝固效果确切,其增强免疫的效果可能为改善远期疗效的重要原因。     

超声引导下微波凝固治疗肝癌的临床应用

目的探讨超声引导下经皮肝穿刺微波凝固治疗肝癌（PMCT）的疗效和可行性。方法应用ECO-100微波治疗仪对24例患者41个肝肿瘤进行微波凝固治疗。每个点微波输出功率60．80W,作用时间15～20min。术后分别观察肿瘤大小、内部血流变化,肝功能、AFP变化及并发症。结果治疗后超声检查示肿块出现不同程度的缩小,其内部回声增强,彩色血流明显减少或消失,CT平扫及增强示密度减低,增强无强化。所有患者术后有不同程度的肝功能异常,对症治疗后好转。术后21例出现轻至中度发热,23例出现伤口疼痛,1．3d后缓解。结论就近期疗效看,PMCT是一种安全、可行、有效、副作用小的非手术治疗方法。其远期疗效的评价,有待于进一步增加病例数和延长随访时间。     

超声引导经皮微波凝固治疗原发性肝癌的观察及护理

目的：报告20例超声引导经皮微波凝固治疗原发性肝癌的观察及护理体会。方法：根据微波凝固治疗的特点和要求,提出了治疗前的准备、治疗中的观察及治疗后的护理。结果20例病人1－2周B超显示肿块血流信号消失,增强CT检查无强化,AFP2－4周明显下降,无因护理不当并发症。论：超声引导经皮微波穿刺凝固类球体原位灭活治疗肝癌方法简单、安全、治疗效果确切,做好治疗前、治疗中、治疗后的护理,不失为肝癌治疗的又一新手段。     

超声引导微波凝固治疗原发性肝癌12例临床疗效分析

目的分析超声引导微波凝固治疗原发性肝癌的治疗方法。方法12例原发性肝癌经皮穿植入单导或双导微波天线对肿瘤进行一次整体覆盖原位凝固灭活治疗。结果治疗后随访3．60个月，肿块内血流信号消失率90．4％，增强CT或MRI治疗后无强化率61．6％，再活检肿瘤完全坏死率90．6％，局部及全身免疫均明显增强。结论超声引导经皮穿刺微波凝固一次整体灭活治疗肝癌方法简单、省时、安全，微波热场可控、凝固效果确切，其增强免疫的效果可能为改善远期疗效的重要原因。     

超声引导下经皮穿刺硬化治疗肾囊肿的临床应用价值

目的 总结超声引导下经皮穿刺硬化治疗肾囊肿的临床疗效及方法,探讨临床应用价值.方法 选择在彩色多普勒超声引导下经皮穿刺抽吸及医用无水乙醇硬化治疗的460例肾囊肿患者,观察临床疗效.结果 460例508个囊肿共穿刺514次,穿刺成功率100％,术后随访3个月～3年,完全消失496个,明显缩小12个,治愈率97.6％,有效率100％.结论 超声引导下经皮穿刺硬化治疗肾囊肿,方法简便易行,并发症少,疗效确切,具有较高的临床应用价值.     

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.     

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.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。