慢性肾功能衰竭合并肺结核的CT影像学误诊分析

目的探讨慢性肾功能衰竭合并肺结核的CT影像学表现,减少肺部影像学误诊率。方法 6例误诊为肺部其他感染的患者,均经临床证实为慢性肾功能衰竭合并肺结核,结合文献分析CT表现。结果 6例患者中,双肺弥漫性斑片影伴肺实变3例;肺内多叶多段形态不规则的结节影和团块影2例;双肺多发斑片影、磨玻璃影和结节影1例;伴有纵隔淋巴结肿大者5例、胸腔积液4例。误诊为细菌性肺炎5例,真菌性肺炎1例。结论慢性肾功能衰竭合并肺结核的胸部CT影像学表现多样,应结合临床表现和实验室检查作出正确诊断。     

肾移植术后肺部感染的影像学分析

目的：探讨肾移植术后并发肺部感染的X线、CT表现及分类，旨在提高对本病的诊断水平。材料与方法：回顾性分析108例肾移植患者并取具有代表性的27例，其中26例摄有胸部X线平片；单纯CT扫描1例；8例同时行胸部X线及CT检查。结果：粟粒型肺结核表现16例，其中4例合并纵隔淋巴结结核；X线、CT示双肺野广泛分布细小结节状的密度增高影，分布较均匀，密度及大小不均匀，3例病人CT显示双下肺内病灶有部分融合；霉菌性肺炎4例；表现为小结节状、斑片状及棉团状度增高影并有部分融合为特征，1例并发有少量胸腔积液；巨细胞病毒、绿脓杆菌及其它病菌感染7例；主要表现为大片状及斑片状融合实变影并不按肺叶、肺段分布。结论：X线及CT检查是诊断肾移植术后肺部感染的主要方法，影像学上部分有其特征性且可做出明确诊断。     

艾滋病并肺部机会性感染X线表现初步分析（附55例报告）

【目的】提高艾滋病（AIDS）机会性胸部感染的诊断准确率。【方法】回顾性分析AIDS机会性胸部感染55例的相关临床资料及X线胸片表现。【结果155例来源于AIDS高危人群,有HIV传播途径历史,并有相应的全身及肺部的临床表现,HIV抗体检测均阳性。X线表现为：肺结核24例（43％）,其中小片状融合的渗出性病灶及条索影12例,两肺弥漫性小结节影7例,胸内淋巴结肿大5例;卡氏肺囊虫肺炎18例（33％）,其中两侧肺门及中下肺野网眼状、小片状或斑片状影10例,两肺弥漫性或局限性毛玻璃影8例;细菌性感染7例（13％）,其中片状实变影4例,段或叶分布的局灶性实变2例,空洞1例;真菌性感染6例（11％）,其中肺间质网状影3例,胸腔积液2例,肺门淋巴结肿大1例。【结论】AIDS机会性胸部感染的X线表现缺乏特异性,对于其高危人群有久治难愈的肺部症状,应首先考虑肺部机会性感染,确断还必须结合相应的临床症状与体征与和HIv检测结果。     

肾移植术后肺部感染的CT诊断

目的:探讨肾移植术后肺部感染的CT表现及特征。方法:动态跟踪分析19例肾移植术后肺部感染患者的CT图像。结果:肾移植术后肺部感染的CT表现复杂多变。主要为:(1)两肺散在磨玻璃样淡薄影;(2)两肺弥漫网络状密度增高影;(3)大片状实变影;(4)间质性肺炎。结论:CT对肾移植术后肺部感染的诊断具有重要价值。     

骨髓移植术后并发急性间质性肺炎的CT表现

目的探讨骨髓移植术后并发急性间质性肺炎的CT表现。方法方法分析总结60例接受骨髓移植术后出现肺部并发症患者的胸部CT资料。结果发现急性间质性肺炎15例,肺部表现主要有:(1)磨玻璃影,6例;(2)团片状影,6例;(3)小结节影,3例。结论骨髓移植术后与其它病因引起的急性间质性肺炎的胸部CT表现无明显特异性,螺旋CT是评价诊断该病的有效方法和手段。     

CT对白血病肺部浸润的诊断价值

目的探讨白血病肺浸润的CT影像学表现及诊断价值。方法回顾性分析11例骨髓穿刺证实的白血病患者胸部浸润的CT表现及临床特征,并复习文献。结果白血症患者肺部浸润CT表现有多种,主要为：两肺小叶间隔线样或结节样增厚、外周支气管血管束增粗、多发斑片状影、多发结节影,毛玻璃样改变或肺实变影,且常并发霉菌感染。结论白血病患者出现胸部症状时,应考虑到肺浸润的可能,CT有助于肺浸润的诊断,但应与其他并发症如感染相鉴别。     

肾移植术后相关性卡氏肺囊虫肺炎的影像学表现

目的探讨肾移植术后相关性卡氏肺囊虫肺炎的影像学表现。方法对18例经实验室证实的卡氏肺囊虫肺炎患者的胸部X线及CT片进行回顾性分析。结果X线表现：胸部X线14例呈弥漫性改变，其中12例磨玻璃样改变，10例磨玻璃样改变中见网格样改变，2例伴有片状渗出或融合实变，另2例仅表现网状或网织结节状影。CT表现：18例中16例表现为磨玻璃密度，10例同时伴有网状或网织结节状影，2例同时伴有小淡片影。另2例表现为间质改变，1例合并肺囊肿。18例患者治疗后，病情明显好转。结论肾移植术后PCP的影像学表现具有一定的特征，为临床准确诊断和及时治疗提供了良好的依据，对提高肾移植患者的生存时间和生活质量具有十分重要意义。     

肾移植术后巨细胞病毒肺部感染13例X线与CT诊断分析

目的：探讨肾移植术后巨细胞病毒肺部感染的X线与CT表现,旨在提高本病的诊断与鉴别诊断水平。方法：对本院肾移植术后巨细胞病毒肺炎13例进行回顾性分析。全部病例均摄胸部X线及螺旋CT扫描检查。结果：3例X线表现为双肺纹理增强,10例出现沿肺纹理分布小斑点状影,7例为斑片及大片状影。CT表现为两肺弥漫分布毛玻璃影5例,弥漫微小结节影2例,斑片影7例,片状实变影2例,小叶间隔增厚3例。结论：肾移植术后2-4个月X线及CT出现上述征象,结合临床表现,应首先考虑巨细胞病毒感染。     

艾滋病合并播散性马尔尼菲青霉菌胸部感染的CT诊断

目的探讨艾滋病合并播散性马尔尼菲青霉菌胸部感染的CT表现及其诊断价值。方法回顾性分析经临床确诊的6例艾滋病合并播散性马尔尼菲青霉菌感染患者的胸部CT扫描的资料。结果肺部片状实变影4例;结节影3例;支气管壁增厚3例;支气管血管束增粗2例;弥漫性粟粒小结节影1例;纵隔及肺门淋巴结肿大3例;胸膜炎4例。结论艾滋病合并播散性马尔尼菲青霉菌胸部感染胸部CT主要表现为肺部片状实变影、结节影、纵隔淋巴结肿大、胸膜炎性反应。胸部CT检查有利于本病临床诊断及治疗。     

原发性肺隐球菌病的胸部CT分析

目的分析原发性肺隐球菌病的临床与胸部CT表现,提高对本病的认识。方法回顾性分析7例经病理证实的原发性肺隐球菌病患者的临床及胸部CT表现。结果7例原发性肺隐球菌病患者,临床主要表现为咳嗽,气喘,咯血,胸痛和低热。CT主要表现单发结节影1例;多发结节影5例,其中4例与斑片状实变影混合存在;多发的段或叶实变影1例。2例在结节影和实变影有厚壁空洞。上述病灶多位于肺外带及胸膜下。结论原发性肺隐球菌病肺部异常影像表现多样性,CT表现也缺乏特异性。当肺部阴影诊断不明时在鉴别诊断上应考虑此病,是早期诊断的关键;确诊主要依赖病理学检查。     

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.     

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.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。