乳腺实性肿块超声诊断与病理学结果对照分析

目的：探讨超声诊断乳腺实性肿块的临床意义。方法：以高频二维声像图为基础，结合彩色多普勒血流特征，将137例乳腺实性肿块的超声诊断结果分成四组与病理学结果进行回顾性对照分析。结果：纤维腺瘤组与病理符合率93％；乳腺癌组与病理符合率81％；乳腺增生组与病理符合率87％；其他组超声诊断未明确，病理学结果良性肿块69％，恶性肿块31％。结论：根据高频二维声像图及彩色多普勒血流特征诊断和鉴别诊断乳腺实性肿块的良恶性有一定的临床应用和研究价值；将乳腺实性肿块的超声诊断结果与病理学结果对照分析，能对乳腺实性肿块的良恶性特征更进一步加深认识，不断提高超声诊断技术。     

高频彩色多普勒超声诊断乳腺实性肿块的价值研究

目的 探讨高频彩色多普勒超声在乳腺实性肿块良恶性鉴别诊断中的价值。方法 对27例乳腺良性肿块和44例乳腺癌肿块进行彩色多普勒超声检查,分析病灶的声像图特点,并与病理结果进行对照。结果彩色多普勒超声对良、恶性肿块的诊断符合率分别为89％、93％。良、恶性肿块在二维灰阶声像图及彩色多普勒血流分级方面比较差异均有统计学意义（P〈0．05）。结论 二维灰阶声像图结合彩色血流成像的典型表现,可以判断其性质,对一些非典型病例,还应结合病史综合分析,以便做出正确判断。     

二维结合彩色多普勒血流成像对乳腺良恶性肿瘤的诊断价值

目的探讨乳腺良恶性肿瘤的二维及彩色多普勒血流成像的特点,提高乳腺良恶性肿瘤鉴别诊断的准确率。方法对经手术病理证实的42例乳腺癌及38例乳腺良性肿瘤的二维及彩色多普勒血流成像特点进行回顾性分析。结果乳腺良恶性肿块声像图的鉴别以肿块边界特征最为重要,彩色多普勒显示乳腺癌内的血流较良性肿瘤丰富(P0.01);乳腺癌的血流分布特征异常,血流阻力指数(RI)与乳腺良性肿瘤之间差异有统计学意义(P0.05)。结论二维超声声像图结合彩色多普勒血流成像对乳腺良恶性肿瘤的诊断和鉴别诊断有重要价值。     

彩色多普勒超声在乳腺良恶性病变诊断中的应用

目的探讨彩色多普勒超声在诊断乳腺良恶性病变中的应用,提高彩色多普勒超声对乳腺肿块的诊断准确率。方法运用彩色多普勒超声对124例乳腺肿块进行超声检查,将所得的二维及彩色多普勒声像图特征与手术病理结果对照分析。同时根据超声检测结果将124例患者分为良性组及恶性组,分析比较两组二维超声像图特征、血流信号检出率。结果 90例病理诊断为良性肿块的超声检出准确率为95.6%;34例病理诊断为恶性肿块的超声检出准确率为94.1%;乳腺良恶性肿块彩超声像图鉴别特征:肿块边界、包膜、形态、内部回声、后方衰减及腋窝淋巴结特征组间差异明显,两组在各级血流信号显示例数间差异显著。结论彩色多普勒超声对乳腺肿块的检出率高,对乳腺良恶性病变的诊断具有较高的应用价值。     

乳腺癌彩色多普勒超声的诊断及鉴别诊断

目的探讨彩色多普勒超声在乳腺癌诊断与鉴别诊断中的应用价值。方法回顾性分析经手术病理证实的68例乳腺癌患者与67例乳腺良性肿块患者声像图资料,对乳腺癌二维超声图像与彩色多普勒血流图像(CDFI)特点进行总结,并将超声与病理结果相对照。结果乳腺恶性肿块与乳腺良性肿块的二维声像图存在差别;彩色多普勒血流图检查恶性肿块血流显示率为96%,良性肿块血流显示率为48%;恶性肿块多表现为穿入性动脉血管(76%),并呈高阻血流信号(RI>0.7)。结论彩色多普勒血流的分布特点与频谱变化是反映乳腺新生血管的一个重要特征,二维超声与彩色多普勒血流图结合能进一步提高乳腺癌的诊断率。     

二维及彩超在乳腺良恶性肿块鉴别诊断中的价值

目的 探讨二维及彩超在乳腺良恶性肿块鉴别诊断中的价值。方法 45例肿块经二维超声了解其形态、边界、边缘、内部回声、有无后方衰减及侧方声影；然后用彩色多普勒检查，观察肿块内部血流丰富程度，并根据其丰富程度分成4个等级，并测量阻力指数。结果 良恶性乳腺肿块二维声像特征存在一定重叠；二者血流丰富程度及阻力指数有助于鉴别诊断。结论 二维声像图与彩色多普勒相结合，在乳腺良恶性肿块的鉴别诊断中，有着重要的诊断价值。     

彩色多普勒超声对乳腺肿块的诊断价值

目的：探索彩色多普勒超声对乳腺肿块的诊断及鉴别诊断价值。方法：应用彩色多普勒超声观察肿块的二维声像图特征及肿块内部及周围的血流动力学特征,全部结果均与术后病理结果对照。结果：88例恶性肿块中,超声诊断83例,超声诊断符合率94.3%,误诊5例。32例良性肿块中,超声诊断29例,超声诊断符合率90.6%,误诊3例。结论：将肿块的二维声像图特征与血流动力学改变的综合性指标相结合,有助于提高乳腺良恶性肿瘤诊断的准确率,为临床制定手术方案提供重要依据,具有较高的临床应用价值。     

彩色多普勒超声在乳腺良恶性肿瘤鉴别诊断中的应用价值

目的:回顾性分析乳腺良恶性肿块的高频二维及彩色多普勒血流表现以提高乳腺恶性肿瘤的早期诊断率。方法:回顾性分析经手术病理证实的167例乳腺肿块患者的超声检查结果,比较并总结良恶性肿瘤的彩色多普勒超声特征。结果:本组超声诊断乳腺恶性肿瘤39例中,在二维声像图上绝大部分有典型的恶性特征,但少部分由于肿块细小超声表现不典型而导致漏误诊(本组漏误诊5例,符合率为87.2%)。良性肿块128例,超声明确诊断113例,符合率为88.3%。乳腺良恶性肿瘤在包膜、形态、边界、内部回声、砂粒状钙化、彩色多普勒血流情况等方面具有明显差异。结论:高频彩色多普勒超声是鉴别诊断乳腺良恶性肿瘤的有效方法,可提高乳腺癌的临床诊断符合率,有利于临床制定合理的治疗方案。     

彩色多普勒超声对乳腺肿块鉴别诊断的应用价值

目的：评价彩色多普勒超声对乳腺肿块鉴别诊断的应用价值。方法：应用彩色多普勒超声比较72例乳腺良、恶性肿块的声像图特点。结果：根据肿块的二维超声图像特征鉴别诊断乳腺肿块的敏感度为97.5%,特异度为60%,准确度为78.3%,联合CDFI血流信号分级,RI／0.7,PI／1.1鉴别诊断乳腺肿块的敏感度为86.7%,特异度为70%,准确度为78.3%。结论：彩色多普勒超声明显提高了诊断恶性乳腺肿块的正确率。     

乳腺肿块的彩色多普勒超声诊断分析

对乳腺良恶性肿块的诊断和鉴别诊断已有较多报道。本组回顾性分析了40例乳腺实质性肿块的二维、彩色多普勒超声的声像图特征,旨在为乳腺良恶性肿块的诊断与鉴别提供有价值的依据。     

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.