自制体表定位器在CT引导下经皮肺穿刺活检术中的应用

探讨自制体表定位器在505例CT引导下经皮肺穿刺活检术患者中的应用。一次穿刺成功率98.42%,穿刺标本合格率100%,术后并发小量气胸(肺萎缩30%)2例(0.4%),痰中带血3例(0.59%),少量咯血(每日咯血量100 ml)1例(0.2%),并发症经及时处理后好转。认为自制体表定位器应用于CT引导下经皮肺穿刺活检术中定位准确,可以提高穿刺成功率,减少并发症发生率,值得在临床工作中推广使用。     

经皮细针肺穿刺的技巧问题

X线、CT和磁共振已成为诊断肺部病变的重要方法 ,但有时定性困难 ;纤维支气管镜检查大多可获得定性诊断 ,但对肺周边或支气管外的病灶活检亦有失败的可能。经皮细针肺穿刺可弥补上述检查方法的不足 ,正确诊断率高、并发症少、费用低 ,为治疗提供可靠的依据 ,所以熟练掌握肺穿刺术实属必要。 1992年以来 ,我们经皮细针肺穿刺 36 2例 ,正确诊断率为 94 % ,现结合临床经验谈谈肺穿刺的技巧问题 ,供同道参考。1　肺小病灶穿刺定位肺部大病灶容易穿刺定位 ,在X线、CT及B超引导下均可进行。若病灶较小 (<2cm) ,位于肋骨、肩胛骨或血管下方 ,垂…     

自制经皮穿刺椎间盘切吸术定位器的应用

笔者 1998年 3月以来，应用自制定位器行经皮穿刺椎间盘切吸术 (APLD)共 32例，临床效果满意，现报告如下。 1 方法介绍 自制 APLD定位器由铝金属加工制作。由可调角度定位器和支架两部分组成。 (1)可调角度定位器：由带导管的可调角度的直角量角器和滑槽构成。主要用于指导穿刺定位及角度。 (2)支架：主要用于调节固定可调角度定位器。 自制 APLD定位器使用方法： (1)术前患者摄俯卧位 CT片，在 CT片上测出最佳穿刺角度及穿刺点并据此调节好自制 APLD定位器导管角度及滑槽上穿刺小孔。 (2)在 C臂电视 X线机帮助下，将患者病变椎…     

彩色多普勒超声引导下外周型肺占位病变自动穿刺活检的临床研究

目的探讨彩色多普勒超声引导下外周型肺占位病变自动穿刺活检的成功率、并发症和临床价值.方法应用内槽切割式自动活检装置,在彩色多普勒超声引导下对54例经X线及CT等影像学检查并为超声显示的外周型肺占位病变患者进行穿刺活检.结果穿刺成功率100%,经与手术切除后病理结果对照,组织病理学符合率92.5%.结论该方法具有操作简便,成功率高,并发症少,安全准确无X线损伤,值得广泛推广.     

无X线引导下经纤维支气管镜肺活检对肺部周围性病灶的诊断价值

目的：评价在无X线引导下经纤维支气管镜肺活检（简称经纤支镜肺活检）对肺部周围性病灶的诊断价值。方法：在无X线引导下对42例肺部周围性病人进行经纤支镜肺活检。结果：42例共行经纤支镜肺活检50次，诊断率为81．0％（34／42），其中肺癌诊断率为82．8％（24／29），肺结核诊断率为71．4％（5／7）。全组并发症发生率为44．0％（22／50），均为痰中带血，无大咯血、气胸及其它严重并发症情况发生。结论：无X线引导下经纤支镜肺活栓对肺部周围病灶有较高的诊断率。     

肺下叶结核45例X线诊断误诊分析

目的：分析肺下叶结核X线误诊原因,提高对本病的诊断能力。方法：通过对经证实的45例肺下叶结核患者的X线表现及相关临床症状、体征进行分析,总结其X线表现特点及诊断要点。结果：肺下叶结核的X线表现有一定的特点,病灶形态多样（新旧病灶共存）,本组病例初诊误诊率达62.22%（28/45）。结论：肺下叶结核易发生误诊,但掌握肺下叶结核的X线表现和临床特点,重视X线表现、临床表现及实验室检查的结合,是减少或避免误诊的关键。     

CT引导下经皮肺穿刺活检术的临床应用价值

目的：评价CT引导下经皮肺穿刺活检术对肺外周占位病变的诊断价值。方法对43例肺外周占位病灶行CT引导下经皮肺穿刺活检术,分析穿刺成功率、确诊率及并发症。结果穿刺成功率100%,疾病确诊率90.7%（43例患者中39例确诊,其中恶性病变28例）,发生并发症8例（气胸5例,咯血3例）。结论 CT引导下经皮肺穿刺活检术对肺外周占位病变确诊率高,并发症低,安全有效。     

运用CT透视引导经皮肺穿刺活检

目的：探讨CT透视引导肺穿刺活检技术及其临床应用价值。方法：运用CT透视技术引导经皮肺穿刺82例。结果：82例穿刺成功率100％，诊断准确率96．3％，并发气胸11例，占13．4％。结论：CT透视技术集合了X线透视和常规CT二者的优点，对肺内病灶穿刺成功率和诊断准确率均较高，具有重要的临床应用价值。     

经纤维支气管镜纵镉、肺针吸活检

目的：评价经纤维支气管镜纵隔,肺针吸活检技术的安全性及应用价值。方法：采用X线透视定位,或结合及CT片解剖学标志进行定位应用Olympus NA-IC活检针经纤维支气管镜对病灶进行穿刺活检,结果：15例中有13例均能作出定性诊断;鳞癌5例,腺癌4例,小细胞未分化癌2例,检出恶性细胞1例,倾向于淋巴瘤1例,1例未能确诊,后行经皮肺穿刺活检确诊为结核,另有1例结合CT,病史及随访确诊为纵隔包裹积液,除4例可见穿刺针孔少量溢血外所有病例均无其他并发症,结论：经纤维支镜纵隔,肺针吸活检是一种安全的活检技术,可为大气道旁的纵隔或肺部病灶的诊断提供有意义活组织标本。     

X线引导下经纤维支气管镜肺活检38例临床分析

目的 探讨X线引导下经纤维支气管镜肺活检术的临床应用.方法 对38例经影像检查提示周围型肿块的患者,在X线引导下行经纤维支气管镜肺活检术.结果 病理明确诊断肺癌29例,肺结核3例,诊断检出率84.2%(32/38).另6例病理结果为:正常肺组织1例,肺部炎症3例,2例取出物为坏死组织,未能做出诊断;病灶大小和痛灶部位与诊断阳性率相关.直径>2 cm病灶诊断率明显高于直径≤2 cm的病灶,位于近肺门区和中间区的病灶诊断率明显高于肺外用区痛灶.并发症中气胸4例,痰中带血3例.结论 X线引导下经纤维支气管镜肺活检术定位准确,诊断率高,并发症少,操作安全,是一种值得推广的肺部疾病诊断技术之一.     

磁共振评价躯体病变的定位研究与应用

背景：以往的医学影像检查手段只限于检查病变,对病变影像定位、定性等,而不能做到直观表面定位,为了更好的帮助临床准确定位就需要一种装置,在检查病变同时做到准确定位。目的：分析磁共振检查躯体骨骼及软组织病变定位器准确性。方法：检索磁共振检查躯体骨骼及软组织病变的定位研究与应用的相关研究文献,检索词为＂磁共振（magnetic resonance imaging,MRI）,定位（location）,诊断（diagnosis）,躯体病变（bodylesions）,占位性病变（space-occupying lesions）,定位器（locator）,神经系统疾病（nervous system disease）,神经外科（neurosurgery）＂,语言分别设定为中文和英文。结果与结论：磁共振扫描前将定位器固定于可疑病变部位,透过该定位器进行扫描,扫描完成后做好表面定位,患者在定位下分别实施穿刺、手术、放疗。使用磁共振检查躯体病变定位器均能快速定位,准确性高,且能避开大血管、神经及韧带等重要功能区;对手术或穿刺治疗起到重要指导作用。磁共振检查肢体病变定位器操作简单、使用灵活,固定方便、使用安全,结构合理,技术创新,能确定病变的精确空间位置,克服了手术中寻找病灶难的问题,有利于查找微小的病变,或者是在某个序列不能很好显示的病变。     

Errors as a result of metal in the near environment when using an electromagnetic locator with freehand three-dimensional echocardiography.

BACKGROUND: Quantitative ventriculography by freehand 3-dimensional (3D) echocardiography with an acoustic spatial locator has been proven to provide highly accurate reproducible measurements of left ventricular volume, mass, and function. It has been shown to be 2 to 3 times better than conventional 2-dimensional echocardiographic techniques. Although accurate, the acoustic spatial locator uses a spark gap to generate hypersound for locating and is somewhat bulky. The Bird direct current electromagnetic locator (Ascension Technology Corp, Burlington, Vt) is a notable alternative locator for the freehand 3D system because it is small and easily portable. However, conductive metals in the near environment may adversely affect electromagnetic locator accuracy. To determine the feasibility of using the electromagnetic locator in a freehand 3D echocardiographic system in the conventional hospital environment, a series of experiments was carried out assessing the accuracy of such a system under various conditions of exposure to conductive metal. METHODS: Using tissue equivalent ellipsoid phantoms of known volumes, we compared volume measurement accuracy of the freehand 3D echocardiographic system equipped with the standard Bird or miniBird electromagnetic locator systems with our freehand acoustic spatial locator 3D echocardiographic system in 3 experiments: (experiment 1) no metal within 30 in (76.2 cm) of the phantoms and electromagnetic locator; (experiment 2) phantoms placed on a standard metal hospital stretcher with conductive metal less than 10 in (25.4 cm) from the phantoms and electromagnetic locator and with the echocardiographic machine greater than 30 in (76.2 cm) from the electromagnetic locator; and (experiment 3) phantoms placed on the same stretcher with conductive metal less than 10 in (25.4 cm) from the phantoms and electromagnetic locator and with the echocardiographic machine in its usual position approximately 10 in (25.4 cm) from the electromagnetic locator. RESULTS: For experiment 1 there was no significant volume error (<1%) by any system; no significant difference among the 3 locator systems (acoustic, Bird, or miniBird). For experiment 2 there was significant volume underestimation error by both electromagnetic locator systems (-10.9%, P <.05). For experiment 3 there was significant and greater volume underestimation error by both electromagnetic locator systems (-14.7%, P <.05) in close proximity to the echocardiographic machine. Interobserver variability was 5.1%. CONCLUSION: For quantitative ventriculography by a freehand 3D echocardiographic system, electromagnetic locator systems should not be used if conductive metal is in the near environment (<30 in [76.2 cm] from the locator). Accurate quantitative ventriculography may be performed with an electromagnetic locator system if the near environment is free of conductive metals.     

The Physiotherapy Evidence Database (PEDro) has better free full-text access than PubMed: An observational study

BackgroundAccess to full-text articles is an essential element of evidence-based practice.ObjectiveEstimate the percentage of articles in the Physiotherapy Evidence Database (PEDro) that have free full-text access and compare free access between PEDro and PubMed. Secondary objectives for access via PEDro: determine if publication year and geographic location impact on free access; determine if adding a link to a portable document format (PDF) locator website would improve free access; and evaluate the association between article characteristics and free access.MethodsThis observational study used a random sample of 200 articles published in 2000–2019 and indexed in PEDro. Data collectors in Australia, Brazil, Nepal, and Spain attempted to access free full text for each article via PEDro. One data collector attempted to access free full text via PubMed. One data collector attempted to access full text via a PDF locator (http://www.pdfsearchengine.net/). The percentage (95% confidence interval [CI]) of articles with free full-text access from PEDro, PubMed, and the PDF locator website were calculated. Logistic regression was used to evaluate the association between free full-text access and article characteristics.ResultsFree full text could be accessed via PEDro for 51% of the articles (95% CI: 44, 58). PEDro had 4% higher free access than PubMed (95% CI: 1, 7). Access via PEDro did not vary systematically with time, geographic location, or article characteristics. Access improved by 9% (95% CI: 6, 14) by adding a PDF locator website.ConclusionsPEDro is a good source of free full-text articles for physical therapists and other rehabilitation professionals. Evidence resources, professional organisations, employers, researchers, and research agencies could all help to increase access to free full text.     

临床根管工作长度的测定

目的 :探讨根尖X线片法、痛感法和电测法在根管工作长度测量中的可靠性。方法 :随机从临床收治病人中 ,选择前牙根管可扩通的 6 5例病人 ,10 5个根管 ,分别用上述三种方法测量根管工作长度 ,并与根管插牙胶尖所测根管工作长度进行比较。结果 :电测法的准确率 :93.3% ;痛感法准确率 2 8.6 % ;常规根尖X片准确率 14 .3%。结论 :常规根尖X线片和痛感法只能作为测量根管工作长度的辅助方法 ,电测法准确性高 ;牙髓状况、根尖周病变范围和根管渗出对电测法影响不大     

Radiographic and non-invasive determination of the hip joint center location: effect on hip joint moments

OBJECTIVE: To determine which of four non-invasive measures is most accurate in locating the hip joint center. BACKGROUND: The location of the joint centers must be accurately determined in three dimensions for calculation of the moments of force during gait. It is not known which of the several non-invasive methods available for location of the hip center is most accurate. DESIGN: Hip center location was determined using standardized X-rays and four non-invasive methods which utilized measured distances between bony landmarks in 10 healthy subjects. Hip moments during gait were obtained from optical tracking, force plate and anthropometric data. RESULTS: The most accurate non-invasive method of locating the hip center was by taking the midpoint of a line connecting the antero-superior iliac spine and the symphysis pubis and moving inferiorly 2 cm. Using this approach the hip center was located 0.7 cm medial and 0.8 cm superior to its true location determined using the standardized X-rays. The 95% confidence interval of the maximum error difference in moments measured between this method and the standardized X-rays ranged from -0.15 to 0.4 Nm/kg in the frontal plane, -0.03 to 0.07 Nm/kg in the sagittal plane and -0.05 to -0.03 Nm/kg in the transverse plane. CONCLUSIONS: Locating the hip center based on the distance between the antero-superior iliac spine and the symphysis pubis is a valid technique for estimating the hip center in routine gait analysis.     

NICU深静脉置管感染相关因素分析及护理干预

目的探讨NICU深静脉置管感染相关因素以及护理干预的意义。方法将入住NICU并进行深静脉置管患者的年龄、性别、病因、置管部位、糖尿病,合并呼吸系统和(或)泌尿系统感染进行分析,进而找到护理干预点。结果置管部位、糖尿病,合并呼吸系统和(或)泌尿系统感染是深静脉感染的相关因素。结论护理应着重对置管部位、糖尿病,合并呼吸系统和(或)泌尿系统感染进行干预。     

磁源性影像对脑海绵状血管瘤伴发癫痫的术前评价

目的：探讨磁源性影像（MSI）对脑海绵状血管瘤（CA）伴发癫痫患者的癫痫灶定位价值,为癫痫外科手术提供依据。方法：对13例脑CA伴发癫痫的患者进行了MRI和MSI检查。观察CA与MSI所确定的癫痫灶之间的位置关系。所有13例患者均经手术治疗。结果：13例患者中,11例CA位置与MSI所确定的癫痫灶位置距离<2cm,2例>2cm。按照Engel分级标准,所有患者均为1级,术后（6～53个月）随访12例患者术后癫痫未发作,1例癫痫发作1次。结论：MSI能明确CA与癫痫灶之间的位置关系,对术前制定手术计划有重要意义。     

Physical properties of the human trunk as determined by computed tomography

The purpose of this study was to determine the center of mass of the trunk in living subjects by using computed tomography (CT), thus providing more accurate data to aid scientists in their effort to describe human motion quantitatively. This advanced x-ray was used to analyze the trunk segment of four subjects, two men and two women, ranging in age from 46 to 68 years. Scans were taken at 1 cm intervals, from the level of the superior surface of the pubic symphysis to the suprasternal notch. Data were processed by an on-line computer, with the object represented on photographic film as a gradient image of gray levels. The intensity of the gray scale in each cross-sectional scan corresponded to a particular density of human body tissue. The computer program was capable of interpreting this information, thereby providing values for the center of mass, tissue density, segmental mass, and volume. The study's conclusions are based on data obtained from living subjects which may be representative of the general adult population. We found that the mean center of mass of the trunk segment was 49.35% of the total length as measured from the line joining the greater trochanters across the superior surface of the pubic symphysis to the suprasternal notch. Furthermore, the segmental mass of the trunk segment was found to be 52.58% of total body weight. These data differ from trunk cadaveric studies already published.     

Burn centers should be involved in prevention of occupational electrical injuries

Electrical injuries are uncommon, comprising 10% of our regional burn center admissions during a 9-year period. The purpose of this study was to determine the incidence, type, and location of occupation-related electrical injuries in an attempt to focus our injury prevention and outreach efforts. We retrospectively reviewed the medical records of patients with electrical injuries admitted to our burn center from January 1992 through March 2000, with focused analysis on those patients admitted with occupation-related electrical injuries. Of the 95 patients admitted for electrical burns, 81% (n = 77) were occupational injuries. This rate of injury suggests that prevention efforts should be directed at work sites and partnerships should be developed between burn centers and businesses to reduce the incidence of injuries.     

胸部和腰椎CT扫描定位方法的探讨

目的：探寻胸部和腰椎ＣＴ定位像量化定位的方法。材料与方法：以胸骨颈切迹和髂前上棘为胸部和腰椎定位像定位点,扫描７４例为量化组;用大概定位法扫描７４便为非量化组。对两组进行质量评定及统计分析。结果：量化组和非量化组甲组片（率）胸部分别是２３例（１００％）和２３例（７２％）;腰椎分别是４１例（９８％）和３０例（７１％）。经卡方检查,Ｐ〈０．０１,故量化组甲组片率高于非量化组。结论：胸部和腰椎ＣＴ定位像