全自动尿液有形成分分析仪检测浆膜腔积液时出现“管型”信息的意义

目的探讨Sysmex UF-1000i全自动尿液有形成分分析仪检测浆膜腔积液时出现"管型"信息时的临床意义,分析该仪器对浆膜腔积液常规细胞计数的可靠性。方法分别采用UF-1000i全自动尿液有形成分分析仪和传统显微镜计数法,对215例浆膜腔积液标本的细胞成分同时进行计数,并将标本离心、涂片、染色、镜检后进行有核细胞分类,比较两种方法对红细胞和有核细胞的计数差异,计算仪器出现"管型"信息时诊断浆膜腔积液中存在肿瘤细胞的灵敏度、特异度、阳性预测值、阴性预测值。结果 215例浆膜腔积液标本中213例标本的UF-1000i红细胞计数与显微镜计数法相比差异无统计学意义(中位数分别为443.00、466.00个/μL,四分位数间距分别为2 507.00、3 053.75个/μL,Z=-1.719,P=0.086),UF-1000i对浆膜腔积液中有核细胞计数与显微镜计数法相比差异亦无统计学意义(中位数分别为122.50、126.00个/μL,四分位数间距分别为479.00、514.00个/μL,Z=-1.552,P=0.121);其余2例为脓胸标本,存在大量细菌而影响细胞计数,未纳入总体统计。46例标本离心涂片染色镜检可见胞体较大的肿瘤细胞、间皮细胞或吞噬细胞的标本中,以仪器"管型"计数≥5个/μL为阈值,诊断浆膜腔积液中含有恶性肿瘤细胞的灵敏度、特异度、阳性预测值、阴性预测值分别为77.78%、94.59%、73.68%、95.63%。结论 UF-1000i全自动尿液有形成分分析仪适用于大部分浆膜腔积液的常规细胞计数。当"管型"计数≥5个/μL时,恶性肿瘤细胞存在的可能性明显增大,提示人工镜检时必须涂片染色并仔细查找有无肿瘤细胞。     

浆膜腔积液脱落细胞学检测对恶性肿瘤的诊断价值

目的探讨浆膜腔积液脱落细胞学检测对恶性肿瘤的诊断价值。方法对350例不明原因的浆膜腔积液标本常规检测后离心取沉淀推片,瑞氏-吉姆萨染色后观察细胞。结果血性和非血性积液恶性肿瘤检出率比较差异无统计学意义(P>0.05)。350例浆膜腔积液中检出恶性肿瘤细胞89例,对恶性肿瘤的诊断灵敏度为87.1%、特异度为99.2%、阳性预测值为98.9%、阴性预测值为96.7%、总有效率为94.3%。结论浆膜腔积液脱落细胞学检测对恶性肿瘤的诊断具有重要价值。     

2240例胸腹心包腔积液细胞形态学分析

目的对胸腹心包腔积液标本进行细胞形态学诊断分析,探讨其细胞形态学诊断价值。方法浆膜腔积液常规检查的制片采用推片法,以瑞吉复合染色法鉴定细胞性质。结果2240例胸腹心包腔积液常规细胞形态学分析,检出恶性细胞342例,与临床最终诊断恶性肿瘤的符合率为98.8%;检出44例可疑恶性细胞与临床最终诊断恶性肿瘤的符合率为88.6%;122例核异质细胞中确诊为恶性肿瘤71例,与临床确诊符合率为58.2%;检出恶性淋巴瘤细胞14例、白血病细胞5例、恶性间皮瘤2例,与临床终诊符合率为100%;此外对2240例积液中其他细胞形态变化资料分析:其中中性粒细胞增多(>80%)330例、淋巴细胞增多(>80%)376例、嗜酸性细胞增多(>10%)43例、浆细胞增多10例、噬菌细胞26例、淋巴细胞岛188例、血细胞粘附肿瘤细胞75例、朗罕氏细胞1例。结论在浆膜腔积液常规检查中,开展细胞形态学检查十分重要,对于临床诊断及治疗有重要意义。     

2240例胸腹心包腔积液细胞形态学分析

目的对胸腹心包腔积液标本进行细胞形态学诊断分析,探讨其细胞形态学诊断价值.方法浆膜腔积液常规检查的制片采用推片法,以瑞吉复合染色法鉴定细胞性质.结果2240例胸腹心包腔积液常规细胞形态学分析,检出恶性细胞342例,与临床最终诊断恶性肿瘤的符合率为98.8%;检出44例可疑恶性细胞与临床最终诊断恶性肿瘤的符合率为88.6%;122例核异质细胞中确诊为恶性肿瘤71例,与临床确诊符合率为58.2%;检出恶性淋巴瘤细胞14例、白血病细胞5例、恶性间皮瘤2例,与临床终诊符合率为100%;此外对2240例积液中其他细胞形态变化资料分析:其中中性粒细胞增多(＞80%)330例、淋巴细胞增多(＞80%)376例、嗜酸性细胞增多(＞10%)43例、浆细胞增多10例、噬菌细胞26例、淋巴细胞岛188例、血细胞粘附肿瘤细胞75例、朗罕氏细胞1例.结论在浆膜腔积液常规检查中,开展细胞形态学检查十分重要,对于临床诊断及治疗有重要意义.     

浆膜腔积液恶性细胞学检查分析

目的检查和分析浆膜腔积液中恶性细胞，探讨其临床诊断价值。方法临床抽取浆膜腔积液立即送检，行瑞氏-姬姆萨染色，镜检。结果1848例浆膜腔积液中检测到恶性细胞362例，阳性率19．6％。最多见于胸腔积液(218例，占60．2％)，其次为腹水(117例，占32．3％)，心包积液最少(27例，占7．5%)；其中腺癌286例(占79．0％)，鳞癌28例(占7．7％)，未分化癌11例(占3．0％)，恶性淋巴瘤15例(占4．1％)，恶性间皮瘤6例(占1．7％)。结论浆膜腔脱落细胞学的检查对于在临床上难以找到诊断依据的胸腔积液、腹水定性具有重要的指导意义。     

常规浆膜腔积液中转移性肿瘤细胞的形态学分析

目的分析常规浆膜腔积液中转移性肿瘤细胞的形态特征,探讨形态学的诊断价值。方法常规浆膜腔积液经浓缩、沉渣推片、瑞特-姬姆萨复合染色后摄制细胞涂片,寻找其中的肿瘤细胞,结合文献及教材分析总结肿瘤细胞的形态特点。结果经临床最后诊断为恶性肿瘤212例,占积液总量的13.1%,其中胸腔积液154例,腹腔积液51例,心包积液7例;所有转移性肿瘤细胞中,腺癌细胞最多占86.1%,鳞癌和未分化癌较少见。结论正确把握肿瘤细胞的形态特征有助于诊断及鉴别肿瘤细胞的来源,为临床诊断提供有利依据。     

浆膜腔淋巴瘤21例临床病理分析

目的回顾性分析21例浆膜腔积液中细胞学诊断为淋巴瘤的临床病理学特征、免疫表型、诊断与鉴别诊断及治疗与预后。方法收集西京医院2014-01—2016-05间由浆膜腔积液诊断为淋巴瘤者21例,对其进行常规涂片、染色、离心包埋切片、免疫细胞化学染色,及对部分病例进行基因重排分析,并对照其细胞学诊断和活检组织病理诊断的符合率。结果 21例中,男性14例,女性7例,年龄2~87岁,中位年龄64岁。14例为胸腔积液,6例为腹腔积液,1例为心包积液。21例全部为非霍奇金淋巴瘤。细胞学经免疫细胞化学染色或基因重排明确分型的13例,2例淋巴浆细胞样淋巴瘤,3例弥漫性大B细胞性淋巴瘤,1例原发性渗出性淋巴瘤,2例浆母细胞淋巴瘤,1例血管免疫母细胞性淋巴瘤,1例T淋巴母细胞性淋巴瘤,1例B淋巴母细胞性淋巴瘤,2例小淋巴细胞性淋巴瘤。其余8例中4例因有淋巴瘤病史,未行免疫细胞化学染色,2例经免疫细胞化学染色证实为B细胞性淋巴瘤。结论浆膜腔积液中淋巴瘤病例较少见,临床症状不典型,易误诊为转移癌或结核性浆膜腔积液。对浆膜腔积液进行仔细的形态学观察,同时离心包埋做免疫细胞化学染色和基因重排检测可有助于诊断和分型。     

血液分析仪XT-4000i筛检浆膜腔恶性积液的应用

目的:探讨血液分析仪XT-4000i体液模式对浆膜腔积液标本检测结果的应用价值及仪器提示恶性肿瘤标本的临界值设定。方法:采用血液分析仪XT-4000i检测168份浆膜腔积液标本,并用显微镜人工观察细胞形态及肿瘤免疫标记确定阳性标本。结果:经镜检和肿瘤免疫标记确认,168份标本中32例为恶性肿瘤。通过受试者工作特征(ROC)曲线分析,参数HF-BF#(×106/L)、HF-BF%的检测临界点分别为0.019和3.6。参数HF-BF#对恶性细胞检出的灵敏度为100%,特异度为60.29%,阳性预测值为37.21%,阴性预测值为100%,准确率为67.86%。参数HF-BF%对恶性细胞检出的灵敏度为93.75%,特异度为42.65%,阳性预测值为27.78%,阴性预测值为96.67%,准确率为52.38%。结论:血液分析仪XT-4000i能有效地对浆膜腔积液标本进行肿瘤细胞筛查,筛选出的标本应进一步行细胞学检查以明确诊断。     

浆膜腔积液脱落细胞学诊断

目的 观察良性浆膜腔积液和恶性浆膜腔积液细胞学改变并进行脱落细胞学诊断、分型.方法 浆膜腔积液离心沉淀涂片用瑞氏-姬姆萨复合染液进行诊断,临床、病理组织学诊断作对照.结果 脱落细胞学在恶性浆膜腔积液中的诊断敏感性63.5%.其中腺癌最多,占87%.查见鳞癌、小细胞癌、淋巴瘤、肉瘤等细胞成份.结论 浆膜腔积液送检次数越多检出率越高;淋巴细胞的大量存在提示结核性浆膜腔积液;恶性肿瘤患者积液细胞学诊断敏感性偏低,受多方面影响;几种类型恶性肿瘤细胞在积液中有其单独的形态学表现.     

多指标检测对恶性浆膜腔积液的诊断价值

目的探讨核仁组成区相关嗜银蛋白(AgNOR)、癌胚抗原(CEA)、铁蛋白(Ft)定量分析在良、恶性浆膜腔积液中的鉴别诊断价值。方法采用HPIAS-1000高清晰度图像分析系统定量测定57例良、恶性浆膜腔积液中脱落细胞的AgNOR颗粒12项参数,并对AgNOR形态进行观察分型;同时采用化学发光法测定CEA和Ft水平。结果AgNOR定量分析12项参数有9项参数良、恶性组比较,差异有统计学意义(P<0.01),形态分型有助于诊断,特别是聚集型的出现更具诊断价值,发现了汉字样AgNOR异型颗粒。AgNOR、CEA、Ft的敏感性分别为100.0%、57.1%、52.4%,特异性分别为96.2%、88.5%、69.2%,阳性预测值分别为95.5%、80.0%、57.9%,阴性预测值分别为100.0%、71.9%、64.3%,尤登指数(J)分别为0.96、0.46、0.12。结论浆膜腔积液核仁组成区相关嗜银蛋白(AgNOR)、CEA的联合测定对于良、恶性积液有重要的鉴别诊断价值。     

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.