Utility of stress cardiography to identify myocardial ischemia

BACKGROUND: The dobutamine echocardiography takes more and more an important place in diagnosis, prognosis and therapeutics strategies of the coronary disease. AIM: We prospectively enrolled 130 consecutive patients followed for a coronary insufficiency METHODS: the aim of determinating the diagnostic value of the dobutamine echocardiography in the myocardial ischemia compared with the classic means as the exercise test and the myocardial scintigraphy. RESULTS: Our results are comparable to the data of the literature, the dobutamine echocardiography is more specific than the exercise test and the myocardial scintigraphy (96 %, 61% and 53 %), more sensitive than exercise test (75 % versus 47 %) but less sensitive than the myocardial scintigraphy (75 % versus 96 %). The stress echocardiography has the best diagnosis precision 87% against 72 % for the scintigraphy and 56 % for the exercise test. The dobutamine echocardiography is a very feasible, tolerated well exam and especially very reliable in term of detection of the coronary disease in the feminine population, with a sensibility at 66,7 %, a specificity at 100 % and a diagnostic precision at 92 %, also in patient with hypertension the stress echocardiography is much more specific and reliable than the exercise test (100 % vs 22 % and 93 % vs 54 %, respectively),and it's superior to the exercise test in the presence of electric signs of systolic excess load and to the myocardial scintigraphy in case of left ventricular hypertrophy. The dobutamine echocardiography can be considered as safety and reliable means of investigation of the coronary insufficiency .     

CT原始数据的临床应用价值

目的:探讨CT原始数据的临床应用价值.方法:对374例CT资料进行回顾性分析,利用CT的原始数据,通过改变兴趣区(ROI)大小、图像算法、层厚等进行重建处理,得到优化的CT显示数据,总结CT原始数据在临床及科研中的应用价值.结果:156例图像部分超出视野外的病例,重建后154例能完全显示;180例兴趣区结构细小、空间分辨率低的病例,重建后均得到满意的图像;38例发现扫描部位以外的病变,重建后30例得到了完整的病变区图像.结论:利用CT原始数据可以对CT图像进行优化,提高图像质量,为诊断提供更多信息,避免患者二次扫描,减少辐射计量,提高球管利用率.     

子宫输卵管造影实时动态的临床观察

目的:评价子宫输卵管造影(HSG)实时动态观察对提高临床诊断符合率的作用。方法:选择HSG后接受宫腹腔镜手术的不孕症患者95例共190条输卵管,比较实时动态观察与常规读片对异常图像的诊断率及诊断符合率。结果:实时动态观察能够显著提高子宫充盈缺损(P=0.030)以及输卵管显影缓慢(P=0.005)的诊断率。诊断子宫内膜息肉的敏感度由27.8%提高到72.2%(P=0.008),伞端阻塞诊断特异度由90.8%提高到97.8%(P=0.003)。结论:HSG自动推注实时动态观察能够明显提高子宫充盈缺损等微小异常诊断率,降低输卵管伞端阻塞假阳性率,有助于诊断输卵管显影缓慢等动态指标,提高摄片质量,提高诊断符合率。     

Impedance cardiography signal denoising using discrete wavelet transform

Impedance cardiography (ICG) is a non-invasive technique for diagnosing cardiovascular diseases. In the acquisition procedure, the ICG signal is often affected by several kinds of noise which distort the determination of the hemodynamic parameters. Therefore, doctors cannot recognize ICG waveform correctly and the diagnosis of cardiovascular diseases became inaccurate. The aim of this work is to choose the most suitable method for denoising the ICG signal. Indeed, different wavelet families are used to denoise the ICG signal. The Haar, Daubechies (db2, db4, db6, and db8), Symlet (sym2, sym4, sym6, sym8) and Coiflet (coif2, coif3, coif4, coif5) wavelet families are tested and evaluated in order to select the most suitable denoising method. The wavelet family with best performance is compared with two denoising methods: one based on Savitzky–Golay filtering and the other based on median filtering. Each method is evaluated by means of the signal to noise ratio (SNR), the root mean square error (RMSE) and the percent difference root mean square (PRD). The results show that the Daubechies wavelet family (db8) has superior performance on noise reduction in comparison to other methods.     

DR非晶态硅探测器的临床应用价值探讨

目的:通过对比和讨论CR、DR设备的成像质量,分析非晶态硅探测器的临床应用价值。方法:随机选取我科采用非晶态硅探测器的DR设备存储的受检者胸部图像853例,CR图像853例,所选取的资料均为体检科正常者,比较其图像质量。结果:图像质量在肺门结构(x2=3.621,P=0.057)、纵隔(x2=2.002,P=0.157)、肋膈角(x2=1.001,P=0.317)等方面,DR相比CR设备就有明显优势,但不具有统计学意义(P>0.05);肺纹理(x2=4.038,P=0.044)、肺段(x2=7.448,P=0.006)方面具有显著优势,具有统计学意义(P<0.05)。CR图像评定中:甲级(88%),乙级(10%),丙级(2%),DR图像评定中:甲级(91.2%),乙级(5.1%),丙级(3.7%)。结论:非晶态硅平板探测器具有较高的图像质量,同时对于延长X线管使用寿命,减少X线对患者及工作人员的辐射都具有重要意义。     

胎儿侧脑室轻度增宽的临床价值

目的探讨超声诊断胎儿侧脑室轻度增宽的临床预后。方法回顾性分析71例妊娠期超声诊断的胎儿侧脑室10~12 mm病例,部分病例产前诊断胎儿染色体分析或核磁共振(MRI)检查,定期进行超声复查,并对所有病例进行随访。结果71例侧脑室增宽病例36例(50.70%)接受染色体检查,8例(11.27%)行无创DNA检测,44例中染色体异常1例(2.27%);28例在产前或产后进行了MRI的检查,均未见其他异常;65例(91.55%)正常分娩,其中63例(96.92%)随访正常。结论产前超声检查能够敏感地检出轻度侧脑室增宽的胎儿,孤立性轻度侧脑室增宽者染色体异常概率较低,预后较好。     

内窥式负压吸宫术的临床价值

目的:探讨内窥式负压吸宫术在非高危人群中的临床应用价值。方法:选择2010年1月～2011年9月自愿选择内窥式负压吸宫术的早孕妇女300例(可视人流组),选取同期要求实施传统负压吸宫术的非高危人流者300例(传统人流组),分析两组产妇的术中疼痛、术中出血、术后出血天数、并发症及手术满意度情况。结果:①可视人流组术中疼痛明显轻于传统人流组(P<0.05);②两组术中出血量比较差异无统计学意义(P<0.05),但可视人流组术后出血天数明显少于传统人流组(P>0.05);③两组无子宫穿孔发生,两组人流综合征、人流不全、宫腔感染、宫颈粘连及月经失调比较差异无统计学意义(P>0.05)。④可视人流组手术满意度明显好于传统人流组(P<0.05)。结论:内窥式负压吸宫术值得在临床推广应用。     

经皮下肾盂膀胱分流术的临床应用价值

目的 前瞻性评估经皮下肾盂膀胱分流术对改善经皮肾造瘘术患者生活质量的应用价值.方法 选取16例患者接受23侧经皮下肾盂膀胱分流术.输尿管替代品选取巴德公司分流套件,从肾盂经皮下隧道走行进入膀胱.所有患者每3个月随访1次,共15个月或直至死亡.生活质量评价使用癌症患者生活质量测量表（EORTC QLQ-C30）,并采用超声或静脉尿路造影来观察套件的位置及是否通畅.结果 所有病例均未发生手术失败或急性并发症.平均随访7.3个月,12例患者在平均6.1个月时死于原发肿瘤,4例患者在研究结束时仍存活.所有病例术后生活质量和满意度得到了改善.结论 相比经皮肾造瘘术,经皮下肾盂膀胱分流术显著提高了输尿管梗阻的晚期肿瘤患者的生活质量.     

Cardiac output by impedance cardiography during head-out water immersion

This study was undertaken to ascertain the suitability of impedance cardiography for qualifying cardiac output during water immersion where the electrodes were wet. The cardiac output was compared during wet and dry immersion with the head above water by breath holding briefly at 3 lung volumes. For dry immersion, the subjects were protected from contacting water during immersion by enveloping the whole body in a thin plastic bag. For wet immersion, the subject went into the water wearing only trunks. Eleven healthy males served as subjects. Both basal thoracic impedance and the minimum rate of impedance change decreased during wet immersion. These changes were specific, which insignificantly influenced the computation of stroke volume as compared to dry immersion. Our results showed no statistical differences between wet and dry immersions, and between measurements made at total lung capacity functional residual capacity, or residual volume. It is concluded that impedance cardiography is applicable directly in wet conditions without having to protect the subject from getting wet.