小儿外伤性脑梗塞的CT分析

目的:探讨小儿外伤性脑梗塞的特点、机理及动态CT检查的必要性。方法:回顾性分析26例小儿外伤性脑梗塞的CT资料。结果:脑叶梗塞4例,占15.4%,基底节区梗塞22例,占84.6%。18例伴豆状核钙化。伤后2个月CT复查6例,病灶均呈软化灶。结论:小儿外伤性脑梗塞多见于婴幼儿,致伤因素较轻,梗塞灶多见于基底节区且多伴豆状核钙化。CT检查发现梗塞灶的最佳时间是伤后1~6天,动态CT检查不仅可以发现梗塞灶,而且可以观察梗塞灶的变化过程。     

外伤性脑梗塞的CT诊断

目的 :提高对外伤性脑梗塞的诊断水平。方法 :对 2 5例颅脑外伤病人采用GECT 90 0 0型 /GEHis peedFX /i螺旋CT行头颅平扫。结果 :轻微脑外伤患者 7例 ,均为儿童 ,CT显示基底节内囊区腔隙性梗塞灶 6例 ;严重脑外伤患者 18例 ,成人多见 ,CT显示梗塞灶发生在基底节内囊区 9例 ,脑叶区 6例 ,两者同时存在 3例 ;首次CT扫描发现脑梗塞 5例 ,复查CT发现脑梗塞 2 0例 ,其中术后 4例。结论 :CT是诊断外伤性脑梗塞的首选方法 ,当首次CT扫描未发现脑梗塞时 ,应根据病情需要行CT复查 ,尤其是外伤后偏瘫患者 ,更应做CT复查 ,明确是否出现脑梗塞     

外伤性脑梗死的CT诊断和临床分析

目的：结合文献分析外伤性脑梗死的发病机制及CT表现,提高对本病的临床诊断和治疗水平。方法：回顾性分析65例外伤性脑梗死患者的临床资料。结果：轻微外伤者梗死灶多位于基底节区及其附近部位,临床预后较好。严重外伤者,CT表现为基底节区和（或）脑叶梗死及颅脑损伤征象,梗死范围较大合并脑疝者,死亡率极高。结论：CT对外伤性脑梗死有很大的诊断价值,临床进行合理诊疗可以取得良好的疗效。     

小儿外伤性脑梗塞的诊治

目的：结合文献分析探讨了小儿外伤性脑梗塞的发病机制、治疗和预后。方法：总结21例头颅CT证实的小儿外伤性脑梗塞病例的临床表现、治疗结果及预后。结果：小儿外伤性脑梗塞多发生于一侧基底节区，少数发生大面积梗塞、腔隙性梗塞者治疗效果、预后好，大面积梗塞者预后差。结论：小儿外伤性脑梗塞机制是由于小儿基底节区供血的血管直角从主干分出,细长迂曲，发育不成熟，调节能力差，在头部外伤时易损伤形成血栓，其次血液动力学改变，微循环障碍也是重要因素。     

小儿外伤性脑梗塞36例分析

目的：探讨小儿外伤性脑梗塞的发病机制、临床特点及治疗与预后。方法：36例小儿外伤性脑梗塞行头CT扫描,药物保守治疗,其中24例辅以高压氧治疗。结果：CT扫描梗塞均位于基底节区,其中6例有双侧豆状核钙化。全部患儿均治愈出院,随访6个月－1年均无复发。结论：CT扫描和及时复查对本病有重要的临床价值。小儿所处的特殊发育阶段、基底节区供血动脉的特殊解剖结构、豆状核钙化、外伤后血液流变学改变和脑血管痉挛为本病形成的主要原因,药物治疗与高压氧治疗是有效的方法,本病预后良好。     

220例基底节区腔隙性脑梗塞的CT表现

目的：探讨基底节区腔隙性脑梗塞的CT表现及诊断价值。方法：分析220例基底节区腔隙性脑梗塞的CT表现。结果：220例腔隙性梗塞病例共292个梗塞灶均为0．25～1．5cm大小的圆形、椭圆形低密度灶，平均CT值为15Hu，33例行增强扫描病灶均无强化。结论：对基底节区腔隙性脑梗塞病例要密切注意其发病时间及进行第二次CT复查，运用薄层扫描技术，以提高基底节区腔隙性脑梗塞的早期诊断。     

外伤性脑梗塞的CT诊断(附28例分析)

目的 探讨外伤性脑梗塞的CT表现特征及诊断价值。方法 回顾性分析了自1998-09至2003-03月经临床、CT证实的外伤后脑梗塞28例。使用GE Hispeed FX／i螺旋CT扫描机，扫描条件：120KV，200MA，时间为1．0s，窗宽90，窗位40，骨窗1000／400。其中l例行增强检查。结果 28例外伤性脑梗塞，23例可见原发颅脑损伤；4例首次CT检查阴性．24-72hCT复查证实；l例首次CT检查即表现为脑梗塞。其中儿童6例(约占21.4％)，发生于手术后8例(约占28．6％)。结论 CT扫描对外伤性脑梗塞可作出准确诊断和估计病变程度。     

27例外伤性脑梗死的CT诊断分析

目的探讨外伤性脑梗死的CT表现特征。方法分析27例外伤性脑梗死的临床特点与CT表现。结果所有患者伤后到院就诊时均立即行头颅CT检查,有12例颅脑表现为正常,另外15例出现颅内损伤、出血等改变。患者均于伤后7d内出现脑梗死神经定位症状。复查CT均于基底节区或脑叶内新发现低密度梗塞灶,有2例为基底节区与脑叶梗死并存。结论外伤性脑梗死在CT表现上具有一定的特征性,结合病史比较容易诊断,CT对外伤性脑梗死的诊断敏感性、准确性均较高。     

小儿外伤性脑梗死31例分析

目的：探索小儿外伤性脑梗死的发病机理、临床特点、治疗和预后。方法：回顾总结31例确诊的小儿外伤性脑梗死的临床表现、影像学征象、治疗措施和结果。结果：小儿外伤性脑梗死均有较轻的头部外伤史，多见于大脑深部、好发于基底节区，CT检查均有梗塞灶；采用非手术综合治疗；3—12个月完全恢复。结论：小儿外伤性脑梗死发病机理与小儿血管尤其是基底节区血供的解剖特点，伤后局部血管痉挛、移位与压迫、牵拉，微循环障碍，以及脱落的外伤性颈内动脉栓子等多因素有关；诊断依靠CT检查；综合治疗预后良好。     

外伤性脑梗塞的MRI早期诊断

外伤性脑梗塞（Traumatic Cerebral Infarction, TCI）是颅脑外伤患者少见的并发症。局灶性TCI多预后良好,合并严重颅脑损伤的广泛性TCI是颅脑外伤患者的死亡原因之一。由于外伤性脑梗塞临床表现缺乏特异性,仅凭临床表现难以早期诊断。以往,CT是外伤性脑梗塞主要方法。近年来,由于磁共振成像（MRI）、磁共振造影（MRA）、MRI液体衰减反转恢复（FLAIR）和磁共振波谱（MRS）检查在临床上的逐渐应用,外伤性脑梗塞的早期诊断率明显提高。我们应用磁共振成像诊断外伤性脑梗塞12例,取得了较好的早期诊断效果,报道如下。1资料与方法     

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.