细支气管肺泡癌的高分辨CT表现

目的：探讨细支气管肺泡癌的高分辨CT（HRCT）征象。方法：回顾分析经病理证实的41例细支气管肺泡癌的HRCT表现，分析有助诊断的HRCT征象及病理基础。结果：孤立结节型18例，其中15例位于肺外周或胸膜下，磨玻璃密度影10例，形态不规则或斑片状影8例，空泡征和/或空气支气管征14例，胸膜凹陷征12例；弥漫型14例，其中均匀实变7例，蜂房征4例，磨玻璃密度8例,支气管气像6例,腺泡样结节6例。结论：HRCT是细支气管肺泡癌的诊断及鉴别诊断的重要手段之一。     

84例细支气管肺泡癌的影像学分析

目的回顾性分析细支气管肺泡癌的CT表现和误诊原因,提高影像诊断准确率。方法 84例经病理证实的细支气管肺泡癌,根据CT表现分为孤立结节型、实变型和多结节型,分别为46、32和6例,其中误诊24例。结合文献资料分析各型肺泡癌的CT征象。结果孤立结节型细支气管肺泡癌主要表现为：结节位于肺外围,有分叶、毛刺、空泡征或支气管气相、密度不均、胸膜牵引和毛玻璃影;实变型细支气管肺泡癌可为单叶或段实变、多叶或段实变、支气管气相、囊状影、毛玻璃影和叶间胸膜膨出;多结节型细支气管肺泡癌较少见,表现为以中下肺野分布为主的弥漫性腺泡结节,部分见空泡。误诊24例中,20例为实变型,主要原因是对细支气管肺泡癌的重视和认识不够。结论熟悉细支气管肺泡癌各型CT征象,必要时借助穿刺活检和纤支镜检,能提高细支气管肺泡癌的诊断准确率,减少误诊。     

囊泡状肺癌的螺旋CT诊断

目的:分析含单囊、多囊泡状肺癌的CT影像特征,提高对具有此类特征性病变的认识,争取早期诊断,为临床治疗赢得时间。材料与方法:搜集29例行多层螺旋CT胸部扫描发现肺内单囊、多囊泡状肿瘤的病例,进行密切随访观察,并将病理类型与CT图像对比,进行总结分析观察囊腔形成的病理基础。结果:本组病例共计29例,其中包括:中—低分化腺癌11例,单纯细支气管肺泡癌8例,腺癌与支气管肺泡癌混合型9例;小细胞癌1例。光镜下,可见肿瘤内部坏死形成囊腔,或为肿瘤沿肺泡壁生长,肺泡壁结构破坏融合形成囊腔。2例含囊腔的肺内结节经6个月追随,囊腔消失,结节实变。结论:含囊泡状腔的肺内肿瘤,大部分为肺癌,CT图像上多具有周围型肺癌的典型征象,囊泡形成的病理机制大致分为两类,一类为肿瘤沿肺泡壁生长,肺泡壁破坏融合形成含气囊腔,另一类为肿瘤内部坏死,经细支气管排出而形成的薄壁空洞。含囊腔的肺肿瘤,特别是周围型肺癌,囊泡通常代表肿瘤生长的某一种早期阶段征象,病变继续发展,会形成肺内实性结节或肿块。且大部分囊泡的形成是在GGO(包括pure-GGO,mixed-GGO,fnGGO)的生长演变中形成的,囊泡也可能在肿瘤生长过程中慢慢消失、闭塞,而成为实性软组织影。     

细支气管肺泡癌的CT诊断

目的：提高细支气管肺泡癌的CT诊断水平。材料与方法：回顾性分析14例经手术及病理证实的细支气管肺泡癌的CT表现。结果：根据CT表现,细支气管肺泡痛分3种类型;肺炎型（8例）,多发给节型（3例）,沿肺纹理分布斑点状影（3例）。结论：注意分析各型CT表现特点及转移病灶,短期复查可提高其诊断正确率。     

细支气管肺泡细胞癌影像表现与病理对照研究

目的:探讨细支气管肺泡细胞癌(BAC)的影像表现并与病理结果作对照研究,提高影像诊断的正确率。材料和方法:回顾性分析40例病理证实为BAC患者的胸部X线、CT及病理资料。结果:单发结节或肿块型21例,实变型13例,弥散结节型6例。单发结节或肿块型BAC周围型18例,中央型3例,主要征象:胸膜牵引征18例(85.7%),血管聚束征18例(85.7%),毛刺征16例(76.2%),分叶征11例(52.3%),支气管征11例(52.3%),空泡征5例(23.8%)。实变型BAC单肺段/叶实变6例,多肺段/叶实变7例,主要征象:含气支气管征9例(100%),蜂房征8例(88.9%),毛玻璃征4例(44.4%),叶间裂膨突3例(33.3%),血管聚束征3例(33.3%)。弥散结节型BAC 6例,主要征象:两肺不对称、不均匀弥漫分布大小不等结节,结节融合倾向6例,结节中心透亮区(空泡征)4例(66.7%),融合结节灶内支气管征2例(33.3%),血管聚束征5例(83.3%),胸膜牵引征5例(83.3%),毛刺征4例(66.7%)。结论:细支气管肺泡细胞癌影像表现复杂,充分认识细支气管肺泡细胞癌的各种征象能提高其影像诊断的准确率。     

细支气管肺泡癌48例CT特征与病理分析

目的：探讨细支气管肺泡癌（BAC）的螺旋CT特征与病理对照。方法：对48例BAC患者的螺旋CT表现特征与病理对比进行回顾性分析。结果：结节型的中心小低密度区（69.2%）、磨玻璃征和晕征（30.7%） 弥漫型病灶中心小低密度区（38.4%） 炎症型边缘磨玻璃密度或多发结节（66.7%）、病灶内空泡征或蜂房状（55.6%）。结论：BAC的螺旋CT征象有其特征,螺旋CT是BAC的临床首选检查手段。     

视网膜母细胞瘤的CT与病理诊断对照研究

目的：探讨视网膜母细胞瘤的CT表现与病理诊断的关系及其诊断、鉴别诊断价值。方法：回顾性分析49例经手术病理证实的视网膜母细胞瘤的临床资料、CT表现及病理结果，并进行对照研究。结果：49例眼眶CT检查均显示为眼球内高密度软组织肿块，密度均匀27例，不均匀22例，眼球内钙化45例（91．8％），眼球增大11例，视神经增粗8例，病变侵犯眶内6例、颅内2例。病理分型：未分化型28例，分化型21例。镜下见肿瘤细胞排列成菊花状或假菊花状，绝大部分肿瘤内可见钙化，部分肿瘤细胞出现变性、坏死。两型的CT表现在肿块密度上有显著性差异（P＜0．01）。CT定性诊断准确率95．9％（47／49例）。结论：CT可以显示肿瘤的形态、大小、内部特征及其累及范围，对定性诊断具有重要意义。     

肺乳头状腺癌影像学表现的病理学基础分析

目的　分析肺乳头状腺癌影像学表现与病理组织学基础之间的关系。方法　将同期手术、病理证实的2 6 1例原发性肺腺癌中的 10例肺乳头状腺癌的影像学表现与病理组织学表现进行对照分析。结果　影像学上表现的结节或肿块征象在病理组织学上为乳头状的肿瘤以及肺组织被扭曲、破坏的结构 ;影像学上病变周围出现的磨玻璃状阴影 ,在病理组织学上则反应肿瘤细胞沿肺泡壁生长或阻塞肺泡引起的阻塞性肺炎改变 ;影像学上出现的卫星结节对应病理组织学上的阻塞性肺炎、细支气管炎或细支气管脓肿。结论　肺乳头状腺癌作为肺腺癌的一个亚型发生比例比较少。生长方式与支气管肺泡癌相似 ,容易被误诊 ,尤其在细胞活检时更容易误诊     

肺癌的CT诊断（附45例分析）

目的：总结45例肺部的CT表现，探讨肺癌的影像诊断。方法：回顾分析经手术病理证实的45例肺癌的临床表现和CT检查结果。结果：45例肺部中央型22例，周围型19例，细支气管肺泡癌1例，纵隔型肺癌3例。病理分型：鳞癌22例，腺癌19例，小细胞肺癌4例。癌瘤的主要CT征角是肿块，肿块有分叶征、束突征，空泡征和偏心性空间，还有脐样凹隐，环形透亮带等征象，纵隔窗显示较清楚。肺不张、阻塞性肺炎、阻塞性肺气肿、毛刺征、支气管充气征和血管中征等肺窗较清楚。肺癌肿块CT值为12－96．7Hu。结论：肺癌CT征象是发现肿块，肿块有其特征性，其他还有肺不张、阻塞性肺炎、阻塞性肺气肿等要结合临床综合分析，纤支镜帮经皮肺穿刺活检有助于明确诊断。     

弥漫性细支气管肺泡癌CT特征

目的评价表现为弥漫性病变细支气管肺泡癌的CT特征。方法对7例经病理证实的细支气管肺泡癌CT表现进行分析。结果特征性CT表现包括：（1）双肺多发实变伴支气管气相，充气支气管延伸至胸膜下或壁不规则、僵直；附近伴有成堆小结节影。（2）双肺弥漫颗粒或结节影，或伴血管支气管束增粗、紊乱，或伴胸膜下结节呈弧形排列。结论认识弥漫性细支气管肺泡癌的CT表现，有利于肺弥漫性病变的鉴别。     

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.     

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.