脑结节性硬化CT及MRI表现

目的分析结节性硬化在脑部的CT及MRI表现特点以降低误诊率.方法分析14例确诊为结节性硬化患者的CT、MRI病灶表现形式及分布特点.结果CT表现为脑室室管膜下结节状钙化10例,3例伴有室管膜下等密度肿块,直径2～3 cm,3例表现为大脑皮层及白质钙化结节,1例小脑钙化.MRI表现为室管膜下结节,室壁呈波浪状改变者9例,12例表现为大脑皮层、白质的多发线样、球形稍长T1、稍长T2信号灶,2例小脑有异常信号.结论CT、MR表现是脑结节性硬化确诊的主要依据,二者互相结合对明确诊断及分析病情有着重要的临床意义.     

颅内结节性硬化的CT诊断

结节性硬化是一种极少见的常染色体显性遗传性疾病。临床上以癫痫、智力障碍和皮脂腺腺瘤作为诊断依据。本文报告了经CT证实的颅内结节性硬化15例,发现室管膜下结节15例,皮质结节5例,白质病灶4例。作者认为CT扫描为颅内结节性硬化的临床诊断提供了有力的影像学依据。     

结节性硬化28例CT和MRI诊断分析

目的探讨结节性硬化(TS)的CT和MRI表现特征。方法回顾性分析28例经临床确诊的TS患者影像资料。结果室管膜下结节28例,皮层及皮层下结节9例,脑白质异常6例,CT表现钙化结节为高密度,其他为等或低密度,MRI表现T1WI为低信号、T2WI低或高信号。10例行MRI增强,室管膜下结节呈中等强化,皮层及皮层下结节和脑白质异常信号均未见强化。结论 CT和MRI能较好显示TS脑部改变,CT显示钙化结节敏感,MRI显示皮层及皮层下结节和脑白质改变敏感。     

超声联合磁共振成像诊断胎儿结节性硬化症

目的探讨结节性硬化症（TCS）胎儿超声及磁共振成像（MRI）特征。 方法对2013年7月至2014年12月在湖北省妇幼保健院产前超声、MRI检查及引产胎儿尸检和出生后随访证实为结节性硬化症10例胎儿的影像学特征进行分析。 结果产前超声筛查的996例胎儿中超声显示心室内、心室壁近室间隔或心房内圆形或结节状均质高回声结节18例（单发4例,多发14例）,均未发现脑部结节;18例胎儿中MRI显示心脏横纹肌瘤4例;脑部室管膜下结节10例,均呈T₁WI稍高信号,T₂WI低信号的小结节,自侧脑室壁突出于室管膜表面;其中合并脑皮质结节3例,表现为皮质及皮质下T₂WI低信号病变,形态不规则。产前超声及MRI联合诊断胎儿结节性硬化症10例（心脏结节和颅内结节并存）。影像学检查后9例终止妊娠（2例尸检诊断胎儿心脏横纹肌瘤伴颅内结节）,1例出生后随访诊断为结节性硬化症。 结论产前超声易于显示胎儿心脏横纹肌瘤而不能显示颅内结节;MRI易于显示胎儿颅内结节但仅能显示部分心脏结节;超声与MRI联合检查优势互补,为明确诊断胎儿结节性硬化症提供更多影像学依据。     

脑结节性硬化的CT和MRI诊断（附22例报告）

报告２２例脑结节性硬化的ＣＴ和ＭＲＩ诊断。其中ＣＴ扫描１９例，ＭＲ扫描３例。主要发现有室管膜下结节，皮质结节，白质异常和脑萎缩。１例合并胶质瘤。结合文献，作者讨论了结节性硬化的ＣＴ、ＭＲＩ表现特点以及与脑囊虫病，脑结核的鉴别，并比较了ＣＴ和ＭＲＩ对脑结节性硬化的诊断价值。     

脑结节性硬化症的MRI诊断

目的：探讨MRI对脑结节性硬化症的诊断价值。方法：回顾分析经临床病理证实的17例脑结节性硬化（TS）的临床表现及MRI影像学特征。结果：MR表现室管膜下多发结节,T1WI呈低等信号、T2WI呈等信号,增强无强化;皮质下及脑白质错构瘤,T1WI为低等信号、T2WI为高低混杂信号,增强部分轻度强化;室管膜下巨细胞瘤,呈长T1、长T2信号,增强明显强化。结论：脑结节性硬化症发病部位具有一定特点,MR信号能反应病变的病理特征,对临床诊断和中枢神经系统损害程度的评价有重要意义。     

CT和MRI对室管膜下巨细胞型星形细胞瘤的诊断价值

目的 探讨CT和MRI对室管膜下巨细胞型星形细胞瘤(subependymal giant-cell astrocytoma, SEGA)的诊断价值.方法 回顾性分析5例经临床病理证实为SEGA的CT和MR3表现及临床资料.结果 本组全部5例SEGA均伴发结节性硬化,CT表现为室间孔或侧脑室前角类圆形略高密度结节(边界清楚,多呈明显均匀强化),室管膜下结节状钙化,脑实质错构瘤.MRI表现为室间孔或侧脑室前角类圆形结节(T1WI呈等低信号,T2WI呈稍高信号),室管膜下、皮质和皮质下多发稍长T1稍长T2病灶.结论 CT和MRl相结合是SEGA的最佳影像检查方法,结合患者特征性临床表现,可作出较明确诊断.     

儿童脑结节性硬化临床与CT分析

目的　探讨儿童脑结节性硬化的临床与CT特点。方法　对以癫痫为主诉症状的 185 9例患儿进行CT扫描 ,3 3例确诊为脑结节性硬化 ,分析其临床与CT表现。结果　脑结节性硬化临床上有癫痫、智力低下、皮脂腺瘤典型的三联征 ,但并不一定每一位患者都全部具备 ;CT上有室管膜下钙化结节和皮质结节特征性表现。结论　CT结合临床 ,可对本病做出明确诊断。     

脑皮质及白质内结节性硬化的CT诊断

本文报道了16例结节性硬化；16例均显示室管膜下结节，10例显示皮质结节，6例显示白质病灶。重点讨论了皮质结节及白质病灶的CT表现。     

结节性硬化症的CT诊断（附34例报告）

目的 探讨结节性硬化症的CT特点及CT对本病的诊断价值。方法 回顾性分析34例经CT诊断，临床证实(包括手术病理证实)的结节性硬化症的CT表现。13例做平扫及增强扫描，21例平扫。结果 室管膜下结节34例共234个结节主要分布侧脑室前角、体部及三角区外侧壁上。皮质和皮质下结节11例，共58个结节，主要分布额叶、顶叶、颞叶。白质低密度灶4例。室管膜下巨细胞星形细胞瘤4例。均位于室间孔区，增强扫描明显均匀强化。钙化结节表现为多个类圆形或不规则形，直径大小3～9mm，周围无水肿及占位效应。结论 结节性硬化的CT表现有一定特征性，对临床疑TS的患者，CT检查很有必要。     

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.