胆囊癌的CT诊断

作者回顾了总结了９例胆囊癌的ＣＴ表现，并与手术病理检查进行了对照研究。主要ＣＴ表现包括：胆囊不规则增厚３３．３％，腔内肿块２２．２％，肝区和／或胆囊窝肿块４４．４％，常伴有胆管系统扩张５５．５％，邻近器官受侵犯２２．２％。ＣＴ诊断早期胆囊癌仍有一定困难，但对中晚期胆囊癌的诊断与确定病变范围很有帮助。     

原发性胆囊癌B超误诊原因分析

本文分析经Ｂ超检查并手术和病理证实的３０例原发性胆囊癌的误诊原因，其中假阳性２５例，假阴性５例。误诊原因有：（１），充满型胆囊结石因弧形光带伴宽声影，掩盖了肿瘤声像不能显示；（２）只满足于发现胆囊结石，对伴有胆囊癌未引起重视，又缺乏多体位、多切面扫查，造成误诊；（３）胆囊不显像，无法判明胆囊的情况造成误诊；（４）将胆囊腔内蛔虫残体的声像误诊为胆囊癌；（５）因胆囊炎症致囊壁增厚且凸凹不平误诊为厚壁型胆囊癌；（６）胆囊腔内除见两块结石强光团外，还可见２．８×１．９ｃｍ较强光团但不伴声影，超声诊断为胆囊结石伴胆囊癌，手术证实不伴声影的较强光团系胆囊结石外周包裹了结缔组织所致；（７）Ｂ超与ＣＴ均诊断为胆囊癌伴胆囊周围癌浸润，手术和病理证实为胆固醇肉芽肿，胆囊壁由于炎症致使增厚并与周围肝组织粘连。     

原发性胆囊癌的超声诊断及漏误诊分析

目的分析原发性胆囊癌的超声特点及误诊原因,提高超声对胆囊癌的诊断正确率。方法回顾性分析26例经手术和病理证实的胆囊癌的超声资料,分析胆囊癌超声表现及误诊为胆囊其他疾病的胆囊癌的超声影像学特点。结果26例胆囊癌中超声诊断18例（69．2％）,漏误诊8例（30．8％）。胆囊癌的超声影像学表现分成4种类型：①囊壁局部或弥漫性增厚型11例（42．3％）;②肿块型6例（23．1％）;③乳头结节型8例（30．8％）;（9胆囊增大型1例（3．8％）。结论原发性胆囊癌超声表现多样化,易诊断为胆囊其他疾病,细致观察胆囊声像图,综合应用二维超声与彩色多普勒超声检查,有助于提高对早期诊断胆囊癌的诊断率。     

原发性胆囊癌的CT诊断

研究胆囊癌的ＣＴ诊断。对照病理回顾分析５６例胆囊癌的ＣＴ表现。结果；胆囊壁不规则增厚３２％；胆囊腔内结节２１％；胆囊区肿块４６％；肝侵犯５２％，胆管扩张５３％；胆结石２７％；淋巴转移３４％。结论：１，胆囊癌ＣＴ分型为厚壁型，腔内结节型，肿块型，各型为病理发展中不同的阶段。２．直接侵犯肝脏及胆管受侵扩散为胆囊癌主要转移方式。３，ＣＴ对诊断中晚期胆囊癌衣判断浸润范围有价格，尤其是增强扫描。     

原发性胆囊癌的CT诊断（附20例分析）

目的为了提高对胆囊癌的ＣＴ的诊断水平。方法２０例胆囊癌,全部经手术、病理证实。全部作ＣＴ检查,其中１５例加做增强扫描。男９例,女１例。以５０－７０岁最多见。结果ＣＴ表现为胆囊区肿块,胆囊壁不规则增厚,胆囊腔内结节,并常伴有胆囊结石,易发生肝浸润转移及胰头周围淋巴结转移。结论ＣＴ是诊断胆囊癌的有效方法,对中晚期胆囊癌诊断及判断浸润、转移范围有明显价值,增强扫描是必不可少的。     

原发性胆囊癌的CT诊断及与B超检查结果比较

目的： 评价ＣＴ对胆囊癌的诊断价值。材料与方法： 收集３２ 例胆囊癌的ＣＴ资料进行回顾性分析, 并对其诊断结果与Ｂ超检查结果进行比较。结果： ３２ 例胆囊癌中, 肿块型１４ 例, 腔内型８ 例, 厚壁型１０ 例。ＣＴ诊断准确率为８７－５％ , Ｂ超诊断准确率为５３－１％ 。结论： ＣＴ能较好地显示胆囊癌的类型、大小, 邻近脏器受侵范围及转移等表现, 且定性诊断优于Ｂ超检查。     

彩色多普勒超声在胆囊腺瘤与胆囊癌鉴别诊断中的应用研究

目的：研究彩色多普勒超声在胆囊腺瘤与胆囊癌鉴别诊断中的应用效果。方法：选取2017年11月—2021年5月广州市越秀区白云街社区卫生服务中心接诊的胆囊腺瘤与胆囊癌患者90例进行分析,其中50例患者为胆囊腺瘤,40例患者为胆囊癌。90例患者均采用彩色多普勒超声进行诊断检查,以手术病理诊断检查结果为参考,分析两种疾病患者检查后的检查结果、检查满意度。结果：彩色多普勒超声检查胆囊腺瘤患者的壁内结石检出率高于胆囊癌患者,差异具有统计学意义（P <0.05）;胆囊腺瘤患者的浆膜层完整率显著高于胆囊癌患者（P <0.05）;胆囊腺瘤患者的血流显示丰富率低于胆囊癌患者,差异具有统计学意义（P <0.05）;胆囊腺瘤患者的检查满意度与胆囊癌患者相比,差异无统计学意义（P> 0.05）。结论：对90例患者使用彩色多普勒超声检查能够清晰呈现患者胆囊内情况,准确判断患者疾病,为后期临床治疗提供科学依据,建议研究应用。     

胆囊癌的CT诊断(附32例分析)

胆囊癌因早期无明显症状和体征,又易与其它胆囊病变相混淆,故早期胆囊癌的诊断率较低,笔者回顾分析了３２例经手术证实的病例,对其ＣＴ征象分析如下。１资料与方法 年龄４０－８３岁,平均６６岁。男９例,女２３例,采用Ｐｉｃｋｅｒ１２００ＳＸ型ＣＴ机,层厚、间距均为１０ｍｍ,部分局部薄层扫描,层厚、间距为５ｍｍ。其中２１例常规平扫加增强扫描。２结果 平扫及增强扫描显示ＣＴ直接征象：胆囊壁不规则或局限增厚型１２例,占３７．５％（图１）。胆囊内肿块型９例,占２８． １％。胆囊窝肿块型 １１例,占 ３４． ４％。 平…     

原发性胆囊癌的CT诊断与B超检查结果比较

目的：评价ＣＴ对胆囊癌的诊断价值。材料与方法：收集３２例胆囊癌的ＣＴ资料进行回顾性分析，并对其诊断结果戌Ｂ检查结果进行比较。结果：３２例胆囊癌中，肿块型１４例，腔内型８例，厚壁型１０例，ＣＴ诊断准确率为８７．５％，Ｂ超诊断准确率为５３．１％。结论：ＣＴ能较好地显示胆囊癌的类型、大小、邻近脏器受侵范围及转移等表现，且定性诊断估于Ｂ超检查。     

彩色多普勒血流显像对原发性胆囊癌的诊断意义

目的 观察胆囊壁或胆囊内肿物的异常高速血流信号,探讨彩色多普勒血流显像对原发性胆囊癌的诊断意义。方法 以彩色多普勒血流显像对２２例原发性胆囊癌患者和３０名正常人的胆囊动脉进行检测。所用指标为：最大流速、最低流速、平均流速、搏动指数（ＰＩ）、阻力指数（ＲＩ）和最大流速和低流速之比,结果 ２２例原发性胆囊癌口才扣１７例测到胆囊动脉血流频谱,与正常组比较,Ｖｍａｘ、Ｖｍｉｎ、Ｖｍｅａｎ均明显增快,ＲＩＰ     

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.