二维超声在急性胰腺炎诊断分型中的价值探讨

目的探讨二维超声在胰腺炎的诊断价值并试图分型。方法对116例急性胰腺炎进行一次或多次B超检查。结果B超分型①急性水肿型73例(63％)，超声表现为胰腺弥漫性肿大，边缘清晰，实质回声减低。其中4例手术后，病理主要表现为胰腺间质的水肿、充血。超声表现与病理大致吻合；②出血坏死型21例(18％)，超声表现为胰腺增大，边缘模糊，回声减低且不均匀，其中16例手术，病理主要为胰腺实质的局灶性或融合性坏死，细胞结构消失。超声表现与病理吻合。结论二维超声根据超声表现，结合临床，对急性胰腺炎初步分型，能为临床提供有价值的参考。     

急性胰腺炎的螺旋CT表现

目的：分析急性胰腺炎的螺旋CT表现。方法：回顾性分析38例经临床确诊的急性胰腺炎患者的临床和CT资料。结果：临床诊断轻型胰腺炎28例，重症胰腺炎10例。CT胰腺未见异常4例，重症胰腺炎中9例胰腺弥漫性肿大或4例体尾部肿大，10例胰腺周围不同程度液体聚集，10例可见胰腺内坏死，9例并发假性囊肿，1例并发脓肿，5例并发蜂窝组织炎，15例少量胸水。结论：螺旋CT对急性胰腺炎具有一定的诊断意义。     

急性坏死性胰腺炎的CT诊断

目的 探讨急性坏死性胰腺炎CT诊断价值。方法 回顾分析23例急性坏死性胰腺炎患者临床与CT检查资料。结果 急性坏死性胰腺炎主要CT表现有：(1)胰腺弥漫性或局限性肿大伴胰内单个或多个小斑片状无强化低密度灶；(2)胰周脂肪间隙模糊混浊，肾前筋膜和胃后壁增厚；(3)胰内和／或胰外单发或多发渗漏积液；(4)合并胰腺出血、脓肿和假性囊肿形成。结论 CT对急性坏死性胰腺炎的诊断及患者预后判断具有重要价值。     

急性胰腺炎的超声诊断

目的探讨急性胰腺炎的超声诊断及其应用价值。方法56例经CT扫描、临床及手术病理证实的急性胰腺炎,就超声表现、分型和诊断价值加以分析。结果56例急性胰腺炎患者中,超声诊断为急性胰腺炎42例(75%),急性水肿型31例(73.8%),超声表现为胰腺弥漫性肿大,边界清晰,实质回声减低。急性出血坏死型11例(26.2%),超声表现为胰腺增大,边缘模糊,回声减低且不均匀,漏诊14例(25%)。结论超声对急性胰腺炎的检出率较高,并能做出分型诊断,具有较高的临床应用价值。     

CT跟踪对重症急性胰腺炎的诊断价值

目的探讨CT跟踪对重症急性胰腺炎的诊断价值。方法回顾性分析重症急性胰腺炎22例。结果发病后48~96小时就可以进行Balthazar CT分级。CT影像均有不同程度的胰腺肿大;部分病例有胰腺密度减低、低密度坏死灶和胰腺周围积液。CT跟踪证实了Balthazar CT分级随着病情变化而改变。结论CT跟踪和Balthazar CT分级可以作为监测胰腺及其周围结构改变的首选方法,也为手术治疗重症急性胰腺炎提供了最重要的依据。     

急性坏死性胰腺炎的CT诊断价值

目的 探讨急性坏死性胰腺炎的CT诊断价值。方法 回顾性分析，26例经临床手术病理证实的急性坏死性胰腺炎的CT表现。结果 26例CT平扫均见胰腺增大、轮廓饱满、形态不规则。随着病程进展，胰周脂肪间隙模糊，密度不均；胰腺局部或大部密度减低，其间散在小点片状高密度灶。15例加做增强扫描，坏死区无强化。结论 CT平扫 增强对诊断急性坏死性胰腺炎有较高价值。     

螺旋CT双期扫描对急性胰腺炎的诊断价值

目的 评价螺旋CT双期扫描对急性胰腺炎的诊断价值。方法 回顾性分析64例经临床证实的急性胰腺炎CT平扫和增强扫描资料。结果 64例中，急性水肿型胰腺炎40例，CT表现为胰腺肿大，胰周脂肪层模糊或消失，肾前筋膜增厚，部分见少量胸水。急性出血坏死型胰腺炎24例，其中坏死型21例，化脓型2例，出血型1例，CT表现为胰腺内点状、片状或大范围无增强效应的低密度坏死灶，胰周间隙渗出及积液，蜂窝织炎，胰内或外出现气体或高密度出血灶。结论 螺旋CT双期扫描对急性胰腺炎的分型，临床治疗方案的选择，以及判断预后有重要诊断价值。     

螺旋CT对急性胰腺炎的诊断分析

目的分析急性胰腺炎的螺旋CT表现,评价螺旋CT在急性胰腺炎诊断中的价值.方法回顾性分析38例经临床确诊的急性胰腺炎患者的临床和CT资料.结果临床诊断轻型胰腺炎28例,重症胰腺炎10例.CT胰腺未见异常4例,重症胰腺炎中9例胰腺弥漫性肿大或4例体尾部肿大,10例胰腺周围不同程度液体聚集,10例可见胰腺内坏死,9例并发假性囊肿,1例并发脓肿,5例并发蜂窝组织炎,15例少量胸水.结论螺旋CT对急性胰腺炎具有重要的诊断价值.     

慢性胰腺炎的CT诊断分型及其对鉴别诊断的意义

目的探讨慢性胰腺炎CT表现特征,试图就其不同CT表现进行分型并探讨分型的意义。方法59例慢性胰腺炎,男43例,女16例,平均年龄40岁。36例有急性胰腺炎病史。常规上腹部CT平扫加增强,重点观察胰腺及病灶的大小、形态、密度等。结果27例(46%)表现为全胰腺萎缩型,均伴有不同程度胰实质钙化;13例(22%)表现为单发囊肿型伴囊壁不定型钙化;7例为多发囊肿型(12%)表现为胰腺及其周围多发假性囊肿;7例(12%)表现为单纯胰管扩张型;5例(8%)为肿块型,表现为局限性胰腺软组织样肿块,边缘清楚。结论慢性胰腺炎的CT表现可分为萎缩型、单发囊肿型、多发囊肿型、胰管扩张型和肿块型5型,CT诊断的分型对鉴别诊断及其病因的分析有一定的意义。     

急性胰腺炎的CT诊断

目的探讨CT对急性胰腺炎的诊断价值。方法回顾性分析2007年3月2009年10月收治的35例急性胰腺炎患者的CT照片。结果 35例患者中CT诊断为急性水肿型胰腺炎26例（74.3%）,急性坏死型胰腺炎9例（25.7%）。CT主要表现胰腺体积增大31例,其中胰头增大10例,胰体、尾单独或同时增大21例,4例胰腺表现基本正常。单侧或双侧肾前筋膜水肿增厚27例（77.1%）,胰腺边缘模糊、部分脂肪层消失20例（57.1%）,胆囊增大胆总管扩张17例（48.6%）,胰周蜂窝组织炎6例（17.1%）,合并左侧胸腔积液5例（14.3%）,伴有少量腹水2例（5.7%）。结论 CT检查可以显示胰腺自身肿大、坏死、出血,还能够显示胰外的腹腔、腹膜后腔以及肾筋膜的受累情况,可为临床制定合理的治疗方案并作出预后的判断提供依据。     

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.     

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.     

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.     

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.