阴茎海绵体造影对静脉性阳痿的诊断价值

目的 探讨阴茎海绵体造影对静脉性阳痿的诊断价值。方法 对１０例正常人及９８例罂粟碱实验阴性患者进行阴茎海绵体造影,对比观察造影结果。结果 正常组：两侧阴茎海绵体呈均匀高密度显影,边缘光滑,对称,海绵体之间见一条状、宽窄一致的低密度影,为海绵体间隔,尿道海绵体未见显影。病变组：Ⅰ型：浅层静脉系显影８例（８．２％）;Ⅱ型：中层静脉系显影３１例（３１．６％）;Ⅲ型：深层静脉系显影１８例（１８．４％）;Ⅳ型：混合性静脉系显影４１例（４１．８％）。结论 阴茎海绵体造影是诊断静脉性阳痿的可靠方法,可准确显示静脉瘘的部位,指导临床治疗。     

阳痿的超声诊断分析

目的应用多普勒超声（DUS）技术观察阳痿（ED）患者阴茎血流情况,并进行诊断分型,为临床治疗提出指导性建议。方法对32例国际勃起功能评分（IIEF-5）为12．1-15．7（13．6±5．1）的ED患者,测定双侧海绵体动脉及阴茎背静脉内径、阴茎海绵体动脉收缩期最大血流速度（PSV）、舒张期最低血流速度（EDV）、阻力指数（RI）。阴茎海绵体内一次性注射（ICI）罂粟碱30mg＋酚妥拉明1mg 10min后,再次测定双侧海绵体动脉及阴茎背静脉内径、阴茎海绵体动脉PSV、EDV、RI、阴茎背静脉流速。应用SPSS12．0统计软件进行统计学分析。结果非血管性ED8例阴茎海绵体动脉PSV均≥35cm／s,RI≥1．0;阴茎背静脉常为间断低速静脉血流;15例为动脉性ED,阴茎海绵体动脉PSV均〈25cm/s,阴茎背静脉见间断低速静脉血流;6例为静脉性ED,阴茎海绵体动脉EDV均〉0cm／s,阴茎背静脉见持续静脉血流;3例为动静脉混合性ED,阴茎海绵体动脉PSV均〈25cm／s,阴茎背静脉见持续静脉血流。结论DUS检测阴茎海绵体动脉和阴茎背静脉血流并结合国际勃起功能评分（IIEF-5）是诊断阳痿疾病及其分型的有效方法。     

16层螺旋CT胆囊动脉血管成像初探

目的探讨16层螺旋CT血管成像（CTA）对胆囊动脉的显示能力。方法采用16层螺旋CT对100例良性胆囊疾病患者行胆囊动脉CTA检查,经两位高年资医生分别通过CT原始图像及MPR、MIP重建图像,观察胆囊动脉的起源、支数及走行。结果CTA图像上,95例显示胆囊动脉,5例未显示。胆囊动脉起源于肝右动脉83例、肝左动脉9例、肝固有动脉3例;1支分支71例,2支分支24例;14例在胆囊三角外走行,81例在胆囊三角内走行。结论16层螺旋CT可以显示胆囊动脉的起源、分支及走向,对减少腹腔镜胆囊切除术中出血及胆管、血管损伤有重要的指导价值。     

彩色多普勒超声对血管性阳痿及其分类的研究

目的探讨各类血管性阳痿的彩色多普勒血流特点.方法给36例各类血管性阳痿的阴茎海绵体内注入一定剂量的罂粟碱后,对其阴茎海绵体动脉和阴茎背静脉的彩色多普勒血流进行检测和分析,并把检测正常的10例非血管性阳痿设为正常对照组.结果 ①正常对照组阴茎海绵体动脉收缩期最大血流速度(PSV)均≥35 cm/s,阴茎背静脉常为间断低速静脉血流,当PSV>80 cm/s,特别是伴阴茎背静脉无血流显示时, 要特别提防阴茎异常搏起并发症的发生;②动脉性阳痿时阴茎海绵体动脉PSV均<35 cm/s,阴茎背静脉均见间断低速静脉血流;③静脉性阳痿时阴茎海绵体动脉PSV均≥35 cm/s,阴茎背静脉均见持续静脉血流;④混合性阳痿时阴茎海绵体动脉PSV均<35 cm/s,阴茎背静脉均见持续静脉血流.结论彩色多普勒超声检测阴茎海绵体动脉和阴茎背静脉血流对诊断各类血管性阳痿,以及提防阴茎异常搏起严重并发症的发生具有较为重要的价值.     

三维彩色能量血管造影成像在中老年动脉性阳痿中的应用

目的 探讨三维彩色能量血管造影成像在中老年阳痿患者诊断中的实用价值。方法 应用三维彩色能量血管造影成像于注射前列腺素E1前及注药后5min，对398例中老年阳痿患者及15例正常对照者的阴茎动脉进行检查。结果 注射药物后5min对照组阴茎动脉走行较直，空间结构清楚；阳痿患者的阴茎动脉走行纡曲，增宽，呈串珠状，且空间结构紊乱。结论 三维彩色能量血管造影成像能较清楚地显示阴茎动脉的走行情况，立体反映阴茎动脉分布特点，对阳痿的诊断及鉴别诊断有益。     

64层螺旋CT诊断下肢动脉闭塞性疾病的临床应用研究

目的：探讨64层螺旋CT血管造影在诊断下肢动脉疾病中的临床价值。材料和方法：对63例临床诊断为下肢动脉疾病病人行64层螺旋CT血管造影检查。其中52例做了DSA检查,11例行手术治疗并有术后病理。以CT横断面图像为基础,结合VR、MPVR图像,对病变进行分析然后将分析结果与DSA和手术与病理进行对照。结果：64层螺旋CT血管造影显示了所有检查动脉,其中动脉硬化性闭塞症51例（16例合并血栓形成）,血栓闭塞性脉管炎6例,动脉栓塞4例,多发性大动脉炎并动脉硬化性闭塞症2例。与DSA对比,64层螺旋CT血管造影显示主干血管的狭窄与闭塞,符合率达100%。对2级及其以上股动脉分支血管病变显示的阳性预测值为100%,阴性预测值为98.04%,灵敏度为97.22%,特异度为100%,符合率为98.84%。结论：64层螺旋CT血管造影能够清晰显示下肢动脉病变范围、形态、管腔内及管壁情况,还能对血管管腔狭窄程度进行分级,具有很高的临床应用价值。     

高流量性阴茎异常勃起的彩色多普勒与实时超声造影表现

目的通过研究高流量性阴茎异常勃起的彩色多普勒与实时超声造影表现,探讨其血流动力学变化和发病机制。方法观察6例高流量阴茎异常勃起患者的海绵体、窦状隙及海绵体动脉的超声表现,寻找假性动脉瘤部位。实时超声造影检查动脉瘘口,确定血液的高流入方式,分析阴茎海绵体的血流动力学变化。结果高流量性阴茎异常勃起的表现为：阴茎海绵体肿大,回声减低;窦状隙扩张,彩色血流信号增多;海绵体动脉呈高速低阻型血流频谱;假性动脉瘤形成,内可见涡流及喷射状血流信号。实时超声造影可直观显示瘘口处的喷射状血流,以及造影微泡流入阴茎海绵体的顺序,治疗后再次行超声造影可直观显示动静脉瘘和侧支循环形成。结论彩色多普勒超声和实时超声造影可明确高流量性阴茎异常勃起的诊断。     

不同输入参考动脉对CT灌注图像参数的影响研究

目的：探讨头CT灌注成像图像后处理中输入不同参考动脉对灌注参数的影响。资料与方法：收集35例行头CT平扫及头CT灌注成像的患者，包括8例正常者，27例单侧大脑中动脉区缺血患者，行常规头CT平扫后进行CT灌注成像，在图像后处理中，每例患者均进行3次图像后处理，3次后处理分别选择大脑前动脉、健侧（缺血患者）或左侧（正常组）大脑中动脉及患侧（缺血患者） 或右侧（正常组）大脑中动脉作为输入动脉，3次均选择上矢状窦作为输出静脉，分别在双侧皮质区绘制感兴趣区（ROI），记录3次生成的灌注图像各ROI的血流量值（CBF）、血容量值（CBV）及平均通过时间值（MTT），所得3组数据进行单因素方差分析。结果：在正常者中，3次后处理所获得的各参数值之间没有统计学差异（P>0.05），而在单侧大脑中动脉缺血的患者中，3次后处理所获得CBF及MTT值之间具有统计学差异（P<0.05），CBV值之间没有统计学差异（P>0.05）。结论：进行头CT灌注成像的后处理，在正常者中可以选择脑内任意较大的动脉，而在单侧大脑中动脉缺血患者中要尽量选择正常的大脑前动脉作为输入动脉。     

64层螺旋CT支气管动脉成像在原发性肺癌治疗中的临床价值

目的利用64层螺旋CT血管成像研究原发性肺癌患者的支气管动脉（BA）影像特征及其临床价值。方法搜集均经病理证实为原发性肺癌37例。采用64层螺旋CT胸部增强扫描获得原始图像,用容积显示（VR）、多平面重建（MPR）、最大密度投影（MIP）等后处理技术对肺癌的支气管动脉进行观察和分析。结果37例肺癌中有36例40支气管动脉能清楚显示,显示率为97．3％;分别有3支（7．5％）来源于主动脉弓;33支（82．5％）来源于降主动脉,4支（10％）与肋间动脉共干。均显示肺癌侧的支气管动脉管径和截面积较健侧增大。结论64层螺旋CT血管成像是一安全、无损伤、简便有效地支气管动脉影像显示方法;能真实显示肺癌的供血支气管动脉起源、数目、形态和走行。在原发性肺癌的诊断和治疗中具有重要价值。     

多层螺旋CT头颈部动脉血管成像35例分析

目的：探讨16层螺旋CT头颈部动脉血管造影技术。方法：头颈部CT血管造影35例,对比剂注射速率4 ml/s,薄层重叠重建,进行多平面重建（MPR）、曲面重建（CPR）、最大密度投影（MIP）、容积重建（VR）等图像后处理,显示头颈部动脉。结果：35例头颈部动脉血管显示良好,足以达到诊断要求。结论：选择合适的对比剂剂量、注射流率及扫描参数,熟练应用各种后处理方法可满意显示头颈部动脉。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.