乳腺肿物~(99m)Tc-MIBI显像、钼靶X线诊断对照分析

目的 :分析比较99mTc -MIBI(甲氧基异丁基异腈)乳腺显像与钼靶X线摄影法对乳腺肿块的临床诊断价值。方法 :40例单侧乳腺肿块患者 ,包括良性病变29例 ,恶性病变11例 ,在1周内同时接受99mTc -MIBI乳腺显像和钼靶X线摄影检查。钼靶X线片结合放大镜观察钙化点的情况分析 ,99mTc -MIBI显像取感兴趣区(ROI) ,求出肿块与正常组织中放射性比值(T/NT)。结果 :99mTc-MIBI显像T/NT放射性比值 ,恶性为1 98±0 22(n=12) ;良性为1 16±0 10(n=28) ;两者有显著性差异(P<0 01)。99mTc-MIBI显像与钼靶X线摄影法诊断乳腺癌的灵敏度和特异性分别为83 3%、92 8%和90 9 %、24 1%。结论 :钼靶X线摄影发现乳腺恶性病变敏感性高而特异性低 ;99mTc-MIBI显像对乳腺肿块诊断特异性和准确性明显优于钼靶X线摄影 ,两种影像方法各有所长 ,如果结合应用 ,可提高诊断的准确性     

99mTc—MIBI乳腺显像与乳腺钼靶X线照相在乳腺癌诊断中的应用

目的：比较99mTc—MIBI乳腺显像与乳腺钼靶X线照相在乳腺癌诊断中的准确性，以找到一种乳腺癌诊断正确率更高的方法。方法：135例女性乳腺疾病患者术前均行乳腺钼靶X线照相和99mTc—MIBI乳腺显像检查，诊断结果与术后病理结果进行对照。结果：根据与术后病理结果比较99mTc—MIBI乳腺显像检测乳腺肿块的灵敏度93.3％、特异性90．3％、准确性92．6％，钼靶照相检测乳腺癌的灵敏度83．7％、特异性93．5％、准确性85．9％。结论：99mTc—MIBI乳腺显像与乳腺钼靶X线照相诊断乳腺肿块的准确性差异无统计学意义，但联合应用两种方法可以提高诊断乳腺肿块的准确性。     

高频超声联合钼靶X线摄影诊断乳腺肿块价值

目的探讨高频超声联合乳腺数字化钼靶X线摄影在乳腺肿块诊断中的价值。方法乳腺肿块患者116例(121个肿块),均于术前7d行乳腺高频超声、钼靶X线摄影检查,与手术或超声引导下穿刺活检组织病理结果进行对照,比较高频超声、钼靶X线单独及联合诊断乳腺肿块的准确性、敏感性、特异性。结果组织病理诊断良性肿块37个,恶性肿块84个;高频超声诊断良性肿块42个,恶性肿块79个;钼靶X线诊断良性肿块64个,恶性肿块57个;高频超声联合钼靶X线诊断良性肿块46个,恶性肿块75个;以组织病理结果为标准,高频超声诊断乳腺肿块的准确性为62.8%、敏感性为70.2%、特异性为45.9%、阳性预测值为74.7%、阴性预测值为40.5%、假阳性率为54.1%、假阴性率为29.8%,钼靶X线分别为56.2%、52.4%、64.9%、77.2%、37.5%、35.1%、52.4%,高频超声联合钼靶X线分别为76.0%、77.4%、73.0%、86.7%、58.7%、27.0%、22.6%;高频超声联合钼靶X线诊断乳腺肿块的准确性、敏感性、阳性预测值和阴性预测值高于高频超声、钼靶X线,特异性高于高频超声、假阳性率低于高频超声,差异均有统计学意义(P0.05)。结论高频超声和钼靶X线在乳腺肿块诊断中各具优势,二者联合可优劣互补,提高诊断准确率。     

99mTc-奥曲肽显像和X线钼靶诊断乳腺癌

目的 比较99mTc-奥曲肽显像和X线钼靶诊断乳腺癌的临床应用价值. 方法 32例临床怀疑乳腺癌的女性患者,均进行99mTc-奥曲肽显像和X线钼靶摄影,以手术病理结果为标准,比较二者对乳腺癌的诊断效能. 结果 99mTc-奥曲肽显像和X线钼靶摄影诊断乳腺癌的灵敏度分别为91.67%、66.67%(χ2=4.54,P<0.05),特异性分别为100%、37.50%(χ2=4.65,P<0.05),准确性分别为93.75%、59.38%(χ2=10.54,P<0.05),阳性预测值分别为100%、76.19%(χ2=5.93,P<0.05),阴性预测值分别为80.00%、27.27%(χ2=3.92,P<0.05).联合两种方法诊断的灵敏度、特异性、准确性、阳性预测值和阴性预测值分别为95.83%、100%、96.88%、82.14%和47.06%. 结论 99mTc-奥曲肽显像对乳腺癌的诊断效能高于X线钼靶摄影,两者联合可进一步提高诊断效能.     

超声联合弹性成像与常规超声、钼靶X线摄影对触诊阴性乳腺病灶诊断价值的对比分析

目的分析常规超声、钼靶X线摄影、超声弹性成像和常规超声+超声弹性成像对触诊阴性乳腺病灶的诊断价值,以提高早期乳腺癌的检出率。方法对触诊阴性乳腺病灶的238例患者(266个肿块,其中恶性79个肿块、良性187个肿块)的术前常规超声、钼靶X线摄影、超声弹性成像和超声+超声弹性成像的诊断结果进行分析,并与术后病理结果作对照。结果钼靶X线摄影的敏感性、特异性和准确性分别为79.8%、75.9%和77.1%;常规超声的敏感性、特异性和准确性分别为77.2%、86.1%和83.5%;超声弹性成像的敏感性、特异性和准确性分别为82.3%、87.2%和85.7%;超声+弹性成像敏感性、特异性和准确性分别为92.4%、93%和92.9%。敏感性:超声+超声弹性成像均高于常规超声、钼靶X线摄影和超声弹性成像(均P<0.05);常规超声、钼靶X线摄影和超声弹性成像的敏感性比较差异无统计学意义(均P>0.05)。特异性及准确性:超声、超声弹性成像均高于钼靶X线摄影(均P<0.05);超声+超声弹性成像均高于常规超声、钼靶X线摄影和超声弹性成像(均P<0.05);超声与超声弹性成像比较差异无统计学意义(P>0.05)。结论常规超声无创、可重复性强,敏感性及特异性较高,可作为检查乳腺疾病的首选检查手段;钼靶X线摄影发现微小钙化优势显著;超声弹性成像有助于提高超声乳腺检查的准确性。超声联合弹性成像的综合应用,是评估触诊阴性乳腺病灶良、恶性的新方法,可提高早期乳腺癌的检出率。     

MRI联合钼靶X线摄影在乳腺疾病中的诊断价值

目的:探讨MRI联合钼靶X线摄影在乳腺疾病中的诊断价值。方法:以我院2020年7月至2021年2月期间收治的125例乳腺疾病患者为研究对象,所有患者均行乳腺MRI及乳腺钼靶X线摄影检查,最终以病理结果为诊断依据,分析不同检查方法的诊断结果。结果:在125例受检者中,病理结果确诊乳腺癌90例,其他良性病变35例;MRI阳性检出率为93.33%,钼靶X线阳性检出率为88.89%,联合诊断检阳性检出率为98.89%,组间比较存在统计学差异(P<0.05);钼靶X线的诊断敏感性、特异性、准确性、阳性预测值分别为77.78%、71.43%、76.00%、87.50%;MRI的诊断敏感性、特异性、准确性及阳性预测值分别为81.11%、68.57%、77.60%、86.90%;联合诊断的诊断敏感性、特异性、准确性及阳性预测值分别为96.67%、94.29%、96.00%、97.75%;组间比较存在统计学差异(P<0.05)。结论:MRI联合钼靶X线摄影可有效提高乳腺疾病的阳性检查率及诊断效能,可为临床确立治疗方案提供有力的参考依据,值得在乳腺疾病诊断中应用推广。     

高频彩色多普勒超声在乳腺癌钼靶X线摄影阴性诊断中的应用价值

目的评价高频彩色多普勒超声在乳腺癌钼靶X线摄影阴性诊断中的应用价值。方法将2936例女性乳腺检查中发现病变并经手术或超声引导下穿刺活检病理证实的56例乳腺癌病灶的术前钼靶X线摄影结果与超声检查结果进行对比分析,采用双盲法,检查结果依照BI-RADS标准评判分级,并与病理结果作对照。结果56例中,术前超声诊断乳腺癌53例(53/56),超声表现为不规则的低回声肿物图像,部分肿物可见穿入性血流信号及高阻血流频谱;超声呈假阴性3例,超声声像图未见肿物图像,在钼靶X线摄影则表现为恶性钙化,无明确肿块。乳腺钼靶X线摄影诊断乳腺癌47例(47/56),主要影像表现为毛刺样肿块及恶性钙化,呈假阴性9例,肿块最大直径范围约1.5~0.4cm。结论超声诊断肿块型乳腺癌有较高的准确性,尤其可检出钼靶X线不能检出的较小的乳腺癌肿块。     

乳腺微小肿块的影像学诊断对比研究

目的探讨常规超声联合弹性成像及钼靶X线在乳腺微小肿块诊断中的应用价值。方法回顾性分析39例经手术及病理确诊的乳腺微小肿块患者的常规超声、弹性成像及钼靶X线检查图像资料,以病理结果为金标准,比较常规超声联合弹性成像、钼靶X线及三者联合诊断乳腺微小肿块的敏感性、特异性、阳性预测值、阴性预测值、误诊率、漏诊率及一致性。结果常规超声联合弹性成像诊断乳腺微小肿块的敏感性、特异性、阳性预测值、阴性预测值、误诊率、漏诊率及准确率分别为72.2%、85.7%、81.3%、78.3%、14.3%、27.8%及79.5%;钼靶X线诊断的敏感性、特异性、阳性预测值、阴性预测值、误诊率、漏诊率及准确率分别为55.6%、76.2%、66.7%、66.7%、23.8%、44.4%及66.7%;三者联合诊断的敏感性、特异性、阳性预测值、误诊率、漏诊率及准确率分别为94.4%、90.5%、89.5%、95.0%、9.5%、5.6%及92.3%。超声与钼靶X线联合检查准确率较单纯应用超声或钼靶X线高,差异均有统计学意义(均P0.05)。结论超声联合弹性成像对乳腺微小肿块的诊断价值高于钼靶X线,三者联合检查可以进一步提高准确率,值得推广普及。     

全数字化钼钯对乳腺肿瘤良恶性的鉴别诊断

目的:通过分析乳腺肿瘤的钼靶X线表现特征,提高乳腺肿瘤的术前诊断水平,以提高其术前指导价值。材料与方法:对经术后病理检查证实的140例乳腺肿瘤全数字化钼靶X线表现特征进行对照分析,其中恶性94例,良性46例。结果:良恶性肿瘤X线诊断准确率分别为86·34%和90·56%。X线诊断的敏感性、特异性、准确性分别为96·34%,91·45%和95·21%,阳性预测值96·03%,阴性预测值91·04%。毛刺状肿块、细微簇样钙化是乳腺恶性肿瘤特异性X线征象。结论:乳腺钼靶摄影是鉴别良恶性肿瘤的有效影像学方法。     

乳腺肿块的超声弹性成像、多普勒超声及X线钼靶检查

目的探讨超声弹性成像、多普勒超声及X线钼靶成像对乳腺肿块的良恶性鉴别诊断价值。方法应用超声弹性成像、多普勒超声及X线钼靶成像对276例患者获手术病理证实的286个乳腺病灶进行检查。结果良性207例共215个病灶,恶性69例共71个病灶,超声弹性成像诊断恶性病变敏感性为88.7%,特异性为96.3%,准确性为94.4%;彩色多普勒血流显像诊断乳腺恶性肿瘤的敏感性为71.8%,特异性为73.5%,准确性为73.1%;脉冲多普勒血流显像诊断乳腺恶性肿瘤的敏感性为73.3%,特异性为58.0%,准确性为64.2%;X线钼靶成像诊断乳腺恶性肿瘤的敏感性为57.8%,特异性为87.4%,准确性为80.1%。结论超声弹性成像鉴别乳腺肿瘤良恶性的准确性较多普勒超声及X线钼靶成像高。     

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.