磨玻璃结节样多灶性肺腺癌CT征象与病理对照

目的 探讨磨玻璃结节样多灶性肺腺癌（MLA）的CT征象并与病理结果进行对照。方法 收集16例（共36个病灶）经病理证实的MLA患者资料,并依据病理结果将病灶分为浸润前病变组（n=7）、微浸润腺癌组（n=20）、浸润性腺癌组（n=9）,对3组病灶的CT征象进行分析并与病理结果对照。结果 36个病灶中,圆形/类圆形19个（52.78%）,分叶征19个（52.78%）,毛刺征12个（33.33%）,空泡征13个（36.11%）,血管集束征12个（33.33%）,瘤肺界面清晰32个（88.89%）。浸润前病变组7个（7/7,100%）病灶均表现为纯磨玻璃结节;微浸润腺癌组12个（12/20,60.00%）病灶表现为纯磨玻璃结节,8个（8/20,40.00%）病灶表现为部分实性结节;浸润性腺癌组仅有1个（1/9,11.11%）病灶表现为纯磨玻璃结节,余8个（8/9,88.89%）病灶表现为部分实性结节。3组间纯磨玻璃结节、毛刺征、空泡征及血管集束征差异均有统计学意义（P均<0.05）。浸润前病变组与浸润性腺癌组间纯磨玻璃结节、毛刺征、血管集束征差异有统计学意义（P=0.001、0.003、0.001）;微浸润腺癌与浸润性腺癌毛刺征、空泡征及血管集束征差异有统计学意义（P=0.014、0.014、0.001）。结论 综合分析多发磨玻璃结节的CT征象,有助于术前诊断MLA。     

基于CT影像组学模型预测肺原位腺癌及微浸润腺癌与浸润性腺癌

目的 探讨基于CT影像组学预测肺腺癌中的原位癌（AIS）和微浸润腺癌（MIA）以及浸润性腺癌（IAC）的价值。方法 回顾性分析542例经手术病理确诊且病理亚型明确的肺腺癌患者，将AIS及MIA归为第1组，IAC为第2组。比较2组患者性别和年龄差异。采用特征提取软件提取病灶三维纹理特征参数，分析组间差异明显的影像组学特征，筛选最佳影像组学特征构建预测模型。按2：1比例将数据分为训练集和验证集，采用6种机器学习算法对5倍交叉验证数据集进行分类，选择最佳分类器；以之分析5倍交叉验证数据集、训练集和验证集，获得模型预测肺腺癌病理分型的ROC曲线及相应AUC、特异度、敏感度及准确率。结果 第1组235例，第2组307例，组间性别和年龄差异均无统计学意义（χ²=0.56、t=-0.19，P=0.63、0.98）。共提取病灶1 766个三维纹理特征参数，其中988个影像组学特征存在明显组间差异，最终以10个最佳影像组学特征构建预测模型。以Perceptron分类器为最佳分类器。模型预测验证集病理分型的AUC为0.95，准确率、特异度、敏感度分别为0.88、0.87、0.84。结论 基于CT影像组学模型能有效预测肺腺癌中的AIS及MIA与IAC。     

MRI鉴别诊断表现为磨玻璃结节的早期浸润性肺腺癌

目的 探讨MRI鉴别诊断表现为磨玻璃结节的早期浸润性肺腺癌的价值。方法 回顾性分析34例表现为肺部磨玻璃结节的肺腺癌患者的MRI资料,根据病理结果将其分为非浸润性腺癌组（包括不典型腺瘤样增生、原位腺癌和微浸润性腺癌,n=15）和浸润性腺癌组（n=19）。测量并比较2组病变的最大径、T2WI信号强度和ADC值,绘制ROC曲线,评价其鉴别诊断浸润性腺癌的效能。结果 非浸润性腺癌组病变最大径小于浸润性腺癌组[（9.91±2.63）mm vs（13.12±2.71）mm,P<0.01]。非浸润性腺癌组病变T2WI信号强度低于浸润性腺癌组（92.97±8.33 vs 113.57±22.88,P<0.01）。非浸润性腺癌组病变ADC值低于浸润性腺癌组[（0.98±0.22）×10^-3 mm²/s vs（1.34±0.31）×10^-3 mm²/s,P=0.01]。ROC曲线分析结果显示,病变最大径诊断浸润性腺癌与非浸润性腺癌的AUC为0.791,临界值为11.52 mm,敏感度为73.72%,特异度为73.33%。结论 病变最大径、T2WI信号强度、ADC值对鉴别诊断表现为磨玻璃结节的浸润性与非浸润性肺腺癌具有一定价值。     

含不同实性成分比例磨玻璃密度病灶肺腺癌侵袭性分析

目的 探讨含不同实性成分比例磨玻璃密度病灶（GGO）肺腺癌的侵袭性差异。方法 回顾性分析59例含GGO、经手术病理证实为肺腺癌患者的CT及病理资料。分析病灶薄层CT影像征象,根据肿瘤内实性成分最大径与肿瘤最大径比值将患者分为GGO为主组即G_G组和实性成分为主组即G_C组,比较两组肿瘤CT征象和侵袭性差异。结果 病灶平均直径（2.71±1.08）cm;纯GGO 8例,混杂GGO 51例;43例病灶内见空泡征及含气支气管征（43/51,72.9%）,53例病灶边界清晰（53/59,89.83%）。G_G组19例、G_C组40例。CT征象：两组病灶直径、部位、形状及边界是否清晰差异均无统计学意义（P均>0.05）;G_C组边缘分叶和（或）毛刺比例、空泡征及胸膜凹陷征比例均明显高于G_G组（P均<0.05）。病理结果：G_C组与G_G组淋巴结转移、脉管癌栓发生率差异均无统计学意义（P均>0.05）;G_C组胸膜侵犯率和病理分期高于G_G组（P均<0.05）。结论 表现为GGO的肺腺癌随肿瘤实性成分比例增高,出现恶性CT征象比例和肿瘤侵袭性升高。     

能谱CT平扫多参数成像判断纯磨玻璃密度肺腺癌病理亚型

目的 探讨能谱CT平扫多参数成像判断纯磨玻璃密度结节（pGGN）肺腺癌病理亚型的价值。方法 回顾性分析45例接受能谱CT平扫并经病理证实的pGGN肺腺癌，将其分为A组[非IAC组，21例，包括9例原位腺癌（AIS）和12例微浸润腺癌（MIA）]和B组[浸润性腺癌（IAC）组，24例]。基于联合40%自适应统计迭代重建（ASIR-V）技术重建的70 keV单能水平图像评估pGGN的CT征象，包括分叶征、毛刺征、空泡征、空气支气管征及胸膜凹陷征和异常血管征；获取定量分析成像参数，包括40~140 keV单能量CT值、水基值（WC）、有效原子序数（Eff-Z）及能谱曲线斜率k1~k3（分别为40~70 keV、71~100 keV、101~140 keV段能谱曲线斜率）。结果 B组异常血管征出现率高于A组（P<0.05）。组间分叶征、毛刺征、空气支气管征、空泡征及胸膜凹陷征差异均无统计学意义（P均>0.05）。B组k1低于A组（P<0.05），而组间k2、k3差异均无统计学意义（P均>0.05）。B组WC高于A组（P<0.05），但2组间Eff-Z差异无统计学意义（P>0.05）。结论 能谱CT平扫多参数成像可在显示pGGN形态学表现的基础上提供多种定量参数和较常规CT更多的诊断信息，有助于判断pGGN肺腺癌的病理亚型。     

对比观察炎性肺癌与渗出为主型肺结核CT表现

目的 对比观察炎性肺癌与渗出为主型肺结核的CT表现。方法 回顾性分析84例炎性肺癌（肺癌组）和93例渗出为主型肺结核（结核组），比较2组病变CT表现（实变数目、单发实变分布、实变影密度、实变影内充气支气管征和含气腔隙、实变影周围磨玻璃密度（GGO）、伴随结节影、胸腔积液及纵隔淋巴结是否肿大及钙化）的差异。结果 2组实变数目差异无统计学意义（χ²=0.30，P>0.05）。结核组单发实变影双肺分布大致相同，以上叶多见；肺癌组中以右肺及下叶多见。2组充气支气管征发生率差异无统计学意义（χ²=0.33，P>0.05）；肺癌组以枯枝型多见，结核组以青枝型多见（χ²=24.67，P<0.05）。结核组实变影中含气腔隙发生率高于肺癌组（χ²=10.13，P<0.05），含气腔隙内分隔多见于肺癌组（χ²=22.42，P<0.05）。相比结核组，肺癌组病灶密度多不均匀，GGO多见（χ²=5.27，20.43，P均<0.05）而伴随结节影少见（χ²=4.53，P<0.05）。结论 炎性肺癌与渗出为主型肺结核CT表现存在一定差异；实变影密度不均伴枯枝型充气支气管征及有分隔的含气腔隙、同时存在GGO时，需高度警惕炎性肺癌。     

超微血管成像技术鉴别乳腺良恶性病变

目的 探讨超微血管成像（SMI）技术鉴别诊断乳腺良恶性病变的应用价值。方法 回顾性分析经病理证实的281例乳腺病变患者（300个病灶）的二维超声、CDFI及SMI图像,对所有病灶进行Adler血流分级,比较CDFI与SMI检出血流的能力,观察乳腺病灶在CDFI及SMI下血管形态分布特征,并对乳腺病灶血管分布模式进行分型,比较良恶性病变的差异。结果 CDFI对乳腺病灶血流检出率为78.33%（235/300）,SMI为90.33%（271/300）,差异有统计学意义（χ²=116.066,P<0.001）。CDFI及SMI对良性与恶性病变血流Adler分级差异有统计学意义（P均<0.001）。CDFI与SMI模式间乳腺病灶血流Adler分级差异有统计学意义（Z=-9.722,P<0.001）。CDFI及SMI检测良恶性乳腺病变间血管形态差异均有统计学意义（P均<0.001）,良性病灶多表现为乏血管型、线性或曲线型以及树枝状,恶性病灶多表现为血管粗大扭曲、蟹足状。结论 SMI可以提高乳腺病灶的血管检出率,以SMI观察病灶Adler血流分级和血管形态特征有助于鉴别乳腺良恶性病变。     

不同影像学检查方法对原发性甲状旁腺功能亢进症患者甲状旁腺病灶的定位诊断价值

目的 探讨不同影像学检查方法对原发性甲状旁腺功能亢进症（PHPT）的诊断价值。方法 回顾性分析经病理学检查证实的109例PHPT患者的临床资料,将其超声、MRI、CT、⁹⁹Tc^m-MIBI检查定位诊断结果与手术后病理学结果比较分析。结果 109例PHPT中,甲状旁腺癌11例（11/109,10.09%）,增生16例（16/109,14.67%）,甲状旁腺瘤82例（82/109,75.23%）,包括单发病灶74例（74/109,67.89%）,双侧腺瘤8例（8/109,7.34%）。腺瘤、增生、腺癌组病灶发生部位的差异有统计学意义（χ²=36.151,P<0.001）。⁹⁹Tc^m-MIBI、MRI、CT、超声术前检查定位的准确率分别为83.50%（81/97）、72.22%（13/18）、68.51%（37/54）、67.67%（67/99）,差异无统计学意义（χ²=4.826,P=0.185）;超声明显低于⁹⁹Tc^m-MIBI检查（χ²=6.638, P=0.001）,CT明显低于⁹⁹Tc^m-MIBI检查（χ²=4.562,P=0.033）,CT与MRI的定位诊断准确率差异无统计学意义（χ²=1.153,P=0.283）。对于术后病理诊断直径<1 cm的病变,⁹⁹Tc^m-MIBI、超声、CT、MRI术前检查定位的准确率分别为77.27%（17/22）、35.00%（7/20）、61.53%（8/13）、66.67%（2/3）,差异有统计学意义（χ²=7.881,P=0.049）,⁹⁹Tc^m-MIBI的定位准确率高于超声（χ²=7.664,P=0.006）,但与CT、MRI的差异无统计学意义（χ²=2.154,P=0.175）。结论 对PHPT进行定位诊断时,超声仍是首选检查,⁹⁹Tc^m-MIBI双时相显像的诊断价值最高。     

99m锝-甲氧基异丁基异腈SPECT/CT显像对慢性肾病继发甲状旁腺功能亢进甲状旁腺病灶的诊断效能

目的 探讨SPECT/CT术前准确定位慢性肾病（CKD）继发性甲状旁腺功能亢进（sHPT）患者甲状旁腺病灶的价值。方法 52例甲状旁腺切除术sHPT患者均于术前2周内接受^99m锝-甲氧基异丁基异腈（⁹⁹Tc^m-MIBI）双时相平面显像和延迟相SPECT/CT检查。以病理结果为金标准,计算并比较⁹⁹Tc^m-MIBI平面显像、SPECT、CT和SPECT/CT术前检出甲状旁腺病灶的灵敏度、特异度和准确率。结果 经手术病理证实,52例共检出172个甲状旁腺病灶,其中甲状旁腺瘤（PM）13个、腺瘤样增生（AH）26个、甲状旁腺增生（PH）133个。⁹⁹Tc^m-MIBI平面显像、SPECT、CT、SPECT/CT诊断甲状旁腺病灶的灵敏度分别为55.81%（96/172）、70.35%（121/172）、79.65%（137/172）和81.40%（140/172）,特异度分别为92.05%（81/88）、90.91%（80/88）、76.14%（67/88）和93.18%（82/88）,准确率分别为68.08%（177/260）、77.31%（201/260）、78.46%（204/260）和85.38%（222/260）。SPECT/CT的灵敏度明显高于SPECT（χ²=17.053,P<0.001）及⁹⁹Tc^m-MIBI平面显像（χ²=44.000,P<0.001）,特异度明显高于CT（χ²=10.316,P=0.001）,准确率高于CT（χ²=13.136,P<0.001）、SPECT（χ²=14.815,P<0.001）和⁹⁹Tc^m-MIBI平面显像（χ²=39.706,P<0.001）。结论 SPECT/CT术前定位诊断sHPT患者甲状旁腺病灶的价值明显优于单一⁹⁹Tc^m-MIBI平面显像、SPECT或CT。     

CT纹理特征分析鉴别诊断表现为肺部亚实性结节的微浸润腺癌和浸润性腺癌

目的 评估CT纹理特征术前鉴别表现为亚实性肺结节的微浸润腺癌（MIA）和浸润腺癌（IAC）的价值。方法 回顾性收集胸部CT表现为亚实性肺结节、经手术病理证实为MIA或IAC的100例患者,包括43例MIA和57例IAC。选择4个CT主观征象（密度、大小、分叶、形态）构建诊断MIA与IAC的CT主观征象模型。提取896个CT纹理特征,并构建CT纹理特征模型。绘制ROC曲线评估纹理特征模型、CT主观征象模型鉴别诊断MIA和IAC的效能。结果 CT主观征象中,亚实性结节的密度和大小的一致性非常好,选择密度征象[优势比=8.177,95%CI（1.142,58.575）]为CT主观征象模型的独立预测因子;于896个纹理特征中,选择4个纹理特征构建模型。训练集中纹理特征模型诊断MIA与IAC的敏感度为0.85（33/39）,特异度为0.90（28/31）,AUC为0.94[95%CI（0.88,0.99）];验证集中纹理特征模型的敏感度为0.89（16/18）,特异度为1.00（12/12）,AUC为0.97[95%CI（0.92,1.00）]。结论 CT纹理特征有助于提高术前鉴别诊断表现为亚实性肺结节的MIA和IAC的效能。     

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.