介入治疗子宫肌瘤47例远期疗效分析

目的：评价子宫动脉栓塞术（TUAE）治疗子宫平滑肌瘤的远期疗效及安全性。方法：对47例子宫平滑肌瘤患者进行超选择性双侧子宫动脉栓塞术，观察其中长期临床疗效、并发症和肌瘤的再发情况。结果：随访12～60个月，月经量过多症状改善占97．4％（38／39），下腹压迫症状改善100％（23／23），B超复查TUAE后1a、3a、5a肌瘤平均体积缩小率为59．8％、63．2％、64．6％，子宫平均体积缩小率分别为51．3％、52．4％、55．6％（P〈O．001）。肌瘤栓塞后3a再发率4．25％（2／47），2例患者2次怀孕分娩。结论：TUAE治疗子宫动脉栓塞肌瘤远期疗效肯定、安全。子宫肌瘤栓塞后有一定的再发率。     

超选择子宫动脉栓塞治疗子宫肌瘤的临床研究

目的 研究超选择子宫动脉栓塞治疗子宫肌瘤的临床疗效及近期、远期并发症。方法 于2001年6月-2005年6月对56例子宫肌瘤患者进行双例子宫肌瘤供血动脉的栓塞治疗，栓塞后定期B超及妇科检查，评价临床疗效，分析近期及远期并发症。结果插管栓塞成功率100％，随访6～48个月，B超示术后1个月肌瘤体积平均缩小25％。随访6个月，7例粘膜下子宫肌瘤患者肌瘤消失，肌瘤体积平均缩小66％，术后12个月肌瘤体积缩小达74％，18个月时肌瘤体积缩小达82．6％。症状缓解率达84．4％-100％，以月经量减少最明显。8、9％患者有卵巢功能衰竭，均为绝经期前后妇女。结论 子宫肌瘤的介入治疗疗效肯定，严重并发症少。对粘膜下子宫肌瘤及有剖宫产、子宫肌瘤剔除术史者尤为适宜。     

子宫动脉栓塞治疗子宫肌瘤初探

目的探讨子宫动脉栓塞治疗子宫肌瘤的临床疗效。方法采用Seldinger技术，行双侧髂内动脉-子宫动脉造影，了解子宫肌瘤的血供关系，再行相关选择性栓塞子宫肌瘤的供血动脉。结果24例患者中21例由双侧子宫动脉供血，占87．4％，3例由单侧子宫动脉供血，占12．6％。栓塞肌瘤供血动脉后患者原有症状消失。1、6、12个月后B超复查肌瘤，平均缩小41．57％、59．40％、70．04％，子宫体积缩小43．49％、63．08％、71．29％。总有效率为100％。结论子宫肌瘤供血动脉的栓塞是目前治疗子宫肌瘤的有效方法。     

超选择子宫动脉栓塞术对症状性子宫肌瘤患者生活质量的影响

目的：评价超选择子宫动脉栓塞术治疗症状性子宫肌瘤对患者生活质量的影响。方法：对22例症状性子宫肌瘤患者行超选择性子宫动脉平阳霉素碘油乳剂灌注。术后随访6个月，主要观察临床症状、肌瘤大小和子宫体积以及生活质量评分的变化。结果：患者术后6个月生活质量评分明显提高；术后2个月，14例患者月经量明显减少。术后6个月、22例患者月经周期均恢复正常，5例合并压迫症状者症状完全消失，合并严重痛经的9例患者症状明显改善，22例患者的血红蛋白含量均在100g／L以上；子宫体积平均缩小52．1％，肌瘤体积平均缩小了60．8％；无严重的并发症发生。结论：超选择子宫动脉栓塞术治疗症状性子宫肌瘤是一项安全、有效的新技术，可以提高患者的生活质量和生命活力。     

海藻酸钠微球颗粒子宫动脉栓塞治疗子宫肌瘤的疗效分析

目的:探讨应用海藻酸钠微球颗粒(KMG)行子宫动脉栓塞术治疗子宫肌瘤的疗效。方法:35例子宫肌瘤患者接受子宫动脉栓塞治疗。子宫动脉栓塞方法为经导管双侧子宫动脉注入KMG,栓塞后随访复查,随访时间全部为6个月以上,观察子宫肌瘤的缩小及临床症状改善情况。结果:35例全部完成双侧超选择子宫动脉插管,技术成功率为100%。在有症状的29例中,25例(86.2%)症状有不同程度改善,其中月经症状改善最为显著。至栓塞后6个月时,肌瘤体积平均缩小49.3%,子宫体积平均缩小42.1%,所有患者随访期内肌瘤缩小后未再增大。术后最常见副反应即栓塞后综合征,所有病例随访期内均未出现其他严重副反应或并发症。结论:应用KMG行子宫动脉栓塞术是一种有效、可靠的治疗子宫肌瘤的治疗方法。     

子宫动脉栓塞术在子宫肌瘤治疗中的价值

目的探讨经导管子宫动脉栓塞术（UAE）治疗子宫肌瘤的临床价值。方法选取症状性子宫肌瘤患者20例,行双侧子宫动脉插管,经导管注入聚乙烯醇颗粒行子宫动脉栓塞。术后随访观察6～18个月,了解症状改善及子宫和肌瘤大小变化。结果UAE术后2～6个月患者症状均有明显改善或消失,术后6～18个月B超显示肌瘤体积缩小30％～85％,平均缩小60％;子宫体积缩小25％～70％,平均缩小50％。没有严重并发症发生。结论UAE治疗子宫肌瘤是一项安全、有效的措施,值得在临床进一步推广。     

双侧子宫动脉栓塞术在子宫肌瘤中的应用132例分析

目的评价双侧子宫动脉栓塞术治疗子宫肌瘤的临床疗效。方法采用双侧子宫动脉栓塞术治疗132例子宫肌瘤患者,栓塞材料选用PVA颗粒或真丝微粒。结果血管造影示子宫肌瘤均由双侧子宫动脉供血,栓塞后肌瘤血供完全阻断;子宫肌瘤术后随访1~6个月,经B超测量术后6个月时肌瘤体积缩小均达66%以上。结论双侧子宫动脉栓塞术治疗子宫肌瘤创伤小,近期疗效显著。     

PVA微粒子宫动脉栓塞治疗子宫肌瘤(附16例分析)

目的 探讨子宫动脉栓塞术（UAE）治疗子宫肌瘤的技术方法并评价临床疗效。方法 用直径为350－500μm的PVA微粒及自制大小1mm左右的明胶海绵颗粒对16例诊断明确的子宫肌瘤患者进行双侧子宫动脉栓塞，术后随访至少6个月，观察其临床症状及肌瘤大小变化。结果 所有以月经量增多为主要症状的患者术后月经量基本恢复正常；术后子宫体积平均缩小48.9%，肌瘤体积平均缩小49.2%，无严重并发症发生。结论 UAE能有效地消除临床症状，缩小肿瘤体积，是一种较好的治疗手段，易被患者所接受。     

子宫动脉栓塞治疗子宫肌瘤49例临床分析

目的 观察经双侧子宫动脉栓塞治疗子宫肌瘤的临床疗效。方法选择子宫肌瘤患者49例，采用seldinger技术行双侧子宫动脉DSA造影插管。确认超选到子宫动脉后，注入PVA栓塞颗粒，阻断肌瘤血液供应，术后3个月、6个月观察疗效。结果子宫动脉栓塞术后，肌瘤及子宫体积缩小约45％-55％，月经恢复正常，贫血改善，其相伴的压迫症状减轻或消失。结论子宫动脉栓塞术治疗子宫肌瘤，方法简单，创伤小，且能完整保留子宫功能，近期疗效明显，是子宫肌瘤新的微创治疗方法。     

选择性子宫动脉栓塞术治疗子宫肌瘤的探讨

目的评价选择性子宫动脉栓塞术治疗子宫肌瘤的临床疗效及应用价值。方法19例子宫肌瘤患者均采用经右侧股动脉穿刺双侧子宫动脉超选择性插管,使用聚乙醇＋明胶海绵颗粒栓塞双侧子宫动脉,阻塞肌瘤血供。结果全部病例随访3～24个月,8例肌瘤体积缩小大于50％,9例肌瘤体积缩小20％-50％,月经量和月经周期恢复正常,1例缩小〈20％,临床症状明显改善,1例无明显变化。治疗后3个月18例患者血红蛋白升至105g/L以上。无1例严重并发症发生。结论选择性子宫动脉栓塞术治疗子宫肌瘤是一种安全、简便、创伤小、疗效高的治疗方法,具有较高的临床应用价值。     

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.