B超联合宫腔镜在子宫内膜癌诊断中临床研究

目的探讨宫腔镜联合B超检查在子宫内膜癌诊断中的价值。方法将术前诊断子宫内膜癌并经手术治疗的35例患者分为诊刮组(17例)、宫腔镜B超组(18例),在宫腔镜下行分段诊刮术,同时B超观察宫壁厚度、宫壁回声、肌层浸润程度等。比较2组术前诊断和手术-病理分期符合率。结果诊刮组和宫腔镜B超组术前诊断与术后病理诊断符合率分别为52.9%和88.9%,2组比较有显著性差异;2组术前分期为Ⅰ期、Ⅱ期患者中,宫腔镜B超组术后经病理证实符合率分别为92.3%和100%,高于诊刮组的69.2%和75.0%,诊断符合率有显著性差异。结论 B超联合宫腔镜检查有助于提高子宫内膜癌患者术前诊断和临床分期的准确性。     

宫腔镜检查诊断子宫内膜癌的准确性评价

目的：评价宫腔镜检查诊断子宫内膜癌的准确性和判断宫颈是否受累的可靠性。方法：对６４例子宫内膜癌进行了宫腔镜检查和分段诊刮，将宫腔镜检查结果、分段诊刮结果与术后标本病理结果相比较。结果：６４例子宫内膜癌中，宫腔镜检查无１例漏诊，而分段诊刮漏诊率为１２．５％；宫腔镜检查判断宫颈受累情况相符率为９６．９％，而分段诊刮相符率为７３．５％，Ｐ＜０．０５。结论：宫腔镜检查结合定位活检是诊断子宫内膜癌和判断宫颈是否受累的可靠方法。     

宫腔镜对子宫内膜癌肌层浸润程度的判断价值

目的 探讨宫腔镜对子宫内膜癌肌层浸润程度的判断价值.方法 51例子宫内膜癌患者行宫腔镜检查,判定子宫内膜癌肌层浸润程度,以术后病理为金标准,评价宫腔镜对肌层浸润程度的判断价值.同时结合经阴道超声联合检查浸润深度.结果 宫腔镜下病灶范围与手术病理肌层浸润深度有明显的相关性,KaPpa系数为0.486(P=0.000).宫腔镜对子宫内膜癌浸润肌层判定的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为55.5%、92.9%、86.3%、62.5%和90.7%;对深肌层的判定为70.4%、83.3%、76.5%、82.6%和71.4%;对宫颈浸润的判定均为100%.联合经阴道超声检查,可使诊断符合率提高到91.2%和85.4%.结论 宫腔镜对子宫内膜癌肌层浸润程度有较好的判断价值,可以进一步提高经阴道超声检查判断肌层浸润程度的诊断符合率.     

宫腔镜联合B超检查诊断异常子宫出血104例临床分析

目的探讨宫腔镜联合B超检查在各种异常子宫出血中的诊断价值。方法我院应用宫腔镜联合B超检查异常子宫出血104例，术前均行B超检查，术中行定位取材或诊断性刮宫。结果在异常子宫出血病因诊断中，宫腔镜联合B超检查诊断子宫内膜增生症12例，与病理诊断的符合率为70．59％；子宫内膜息肉26例，符合率为92．86％；子宫黏膜下肌瘤13例，符合率为92．86％；慢性子宫内膜炎30例，符合率为93．75％。结论对异常子宫出血的病因诊断中，宫腔镜联合B超检查提高子宫内膜息肉及子宫黏膜下肌瘤的诊断率，尽管对子宫内膜增生症及子宫内膜癌需经病理诊断，但因镜下可以定位诊刮，亦提高了诊断率。宫腔镜联合B超检查是诊断各种异常子宫出血的有效且有价值的方法。     

子宫异常出血的病理与B超宫腔镜检查对照分析

目的：探讨B超与宫腔镜检查在子宫异常出血中的应用价值。方法回顾性分析2012－06～2013－06住院的子宫异常出血患者345例,均B超检查后再做宫腔镜检查,并进行诊刮做病理诊断,病理诊断结果作为标准,对B超检查、宫腔镜检查资料进行统计学分析。结果 B超诊断子宫内膜增殖症与病理符合率大于宫腔镜的符合率;宫腔镜检查诊断子宫内膜息肉、子宫黏膜下肌瘤、子宫内膜癌与病理符合率大于B超检查诊断,二者差异均有统计学意义（P＜0．05）。结论内膜增殖症宜B超结合诊刮进行诊断。子宫内膜癌及区分黏膜下肌瘤及息肉宜宫腔镜结合诊制进行诊断。     

宫腔镜下诊刮及单纯诊刮在诊断子宫内膜息肉中的比较

目的：探讨宫腔镜下诊刮在诊治子宫内膜息肉中的临床应用价值。方法：对97例因子宫异常出血行B超检查拟诊为子宫内膜息肉的患者，分别行宫腔镜及单纯诊刮，比较两种诊刮标本病理诊断的符合率。结果：宫腔镜下诊断性刮宫病理结果符合率为80．3％，单纯诊断性刮宫病理结果符合率为55．2％，两者相比差异有显著性（P〈0．05）。结论：宫腔镜下诊刮是诊断子宫内膜息肉的有效方法。其准确性高于单纯诊刮，但其费用高及操作较复杂。     

宫腔镜联合B超检查对子宫内膜癌的诊断价值

目的 探讨宫腔镜联合B超检查对子宫内膜癌及癌前病变的诊断价值。方法 采用宫腔镜联合B超检查与病理组织学检查相结合的方法，对987例不规则子宫出血患者的出血原因进行分析。结果 发现子宫内膜癌11例，宫腔镜联合B超诊断与病理组织学检查的符合率为90．90％；子宫内膜非典型增生14例，符合率为64．28％；子宫颈癌3例，符合率为75．00％。结论 采用宫腔镜联合B超检查技术，结合病理组织学检查，能早期确诊子宫内膜癌及癌前病变，对预防子宫内膜癌的发生、发展具有积极作用。宫腔镜检查是一种操作方便、安全有效、使用价值较高的方法。     

宫腔镜联合B超定位活检与诊断性刮宫对绝经后子宫出血的诊断价值比较

目的　探讨绝经后子宫出血的原因 ,比较宫腔镜与B超联合定位活组织检查 (联合定位活检 )与传统的诊断性刮宫 (诊刮 )对绝经后子宫出血的诊断价值。方法　 10 5例绝经后子宫出血患者 ,5 4例联合定位活检、5 1例诊刮 ,术后比较病理检查结果。结果　萎缩性子宫内膜炎是引起绝经后子宫出血的主要原因 ,子宫黏膜下肌瘤、子宫内膜息肉、子宫内膜增生样病变、子宫内膜癌亦是绝经后子宫出血的常见原因 ,联合定位活检病理检查的符合率 (88. 89% ) ,诊刮病理检查的符合率 (6 2 .75 % ) ,差异有显著性意义 (P <0 . 0 5 )。结论　宫腔镜与B超联合定位活检具有安全、可靠、准确的优点 ,是绝经后子宫出血的最佳诊断手段 ,值得推广应用。     

宫腔镜联合B超检查在诊断异常子宫出血中的作用及临床观察

目的：探讨宫腔镜联合B超检查在诊断异常子宫出血中的作用。方法：选择2000年5月－2000年12月我院176例经宫腔镜联合B超检查并行组织病理诊断的异常子宫出血患者，分析宫腔镜联合B超检查与病理诊断的符合情况。结果：176例宫腔镜联合B超检查与病理诊断的总符合率为83.00%，与初诊总符合率（29.50%）及单纯B超检查总符合率（59.10%）比较均有显著性差异（P＝0.000）。176例宫腔镜联合B超检查中子宫粘膜下肌瘤（3／3）、宫颈肌瘤（3／3）、宫颈息肉（7／7）、宫腔内胚胎残留（13／13）病理诊断的符合率均为100.00%，子宫内膜息肉为95.60%（43／45）、慢性子宫内膜炎为86.00%（43／50）、子宫内膜增生过长为63.04%（29/46）、子宫内膜癌为50.00%（1／2）。结论：宫腔镜联合B超检查可明显提高异常子宫出血症状诊断的准确性，但不能取代组织病理学诊断。     

子宫内膜癌检查中应用宫腔镜下活检及分段诊刮术的临床意义

目的探讨在子宫内膜检查中,应用宫腔镜下活检及分段诊刮术的临床意义。方法回顾性分析2008年5月~2016年5月收治的194例子宫内膜癌患者,其中对照组93例患者术前行单纯分段诊刮术,观察~．101例患者术前行宫腔镜下活检及分段诊刮术,比较两组的诊断符合率。结果对照组患者手术前后病理诊断符合率为84．95％,对照组宫颈受累的诊断准确性为88．2％;观察组分别为98．02％和96．O％。两组间的差异均具有统计学意义（P〈O．05）。结论子宫内膜癌检查中应用宫腔镜下活检以及分段诊刮术可以提高术前诊断的准确性。     

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.