高频超声对缩窄性心包炎的心包显像研究

目的:为了更精确地显示心包的病变,作者设计用高频率超声显示心尖部心包的结构。方法:随机选择缩窄性心包炎9例,均经外科心包剥离术证实。30例正常对照组。用高频率超声探查心尖部和靠近心尖部的右心室前壁心包厚度。使用的仪器是Vivid-5和Sequoia C256,线阵探头频率7-10 MHz。结果:高频率超声显示正常对照组心尖部心包的厚度为0.68-0.95 mm;(0.75±0.10)mm,缩窄性心包炎组为2.00-5.50 mm,(3.53±1.25)mm,缩窄性心包炎组心包的厚度与正常对照组的差异有非常显著的统计学意义(P<0.001)。结论:高频率超声能精确地显示心尖部和右心室前壁区心包的厚度,能将心包组织与心包外脂肪层和/或少量的心包积液明确地区分开来。此技术利用高频率超声的良好空间和时间分辨率弥补了超声心动图探查心包厚度的技术缺陷,心尖部和右心室前壁区心包的厚度超过2.0 mm可能是缩窄性心包炎最重要的诊断指标。     

缩窄性心包炎的三种影像诊断比较分析

【目的】评估三种影像学检查方法对诊断缩窄性心包炎的诊断价值。【方法】对比分析59例X线胸片、CT、B超检查缩窄性心包炎的心脏增大、房室增大、心包增厚、心包钙化、肺淤血、心包积液、上下腔静脉增宽、房室功能受限、室间隔变形和矛盾运动方面的差异,其中40例与手术结果进行了比较。【结果】心脏增大、心包增厚、心包钙化、心包积液的CT检查结果优于X线胸片和B超;观察肺淤血以X线胸片最佳;而心脏房室增大、房室功能受限、室间隔变形和矛盾运动的观察B超具有明显优势;上下腔静脉增宽B超也稍优于CT。与手术结果比较：CT阳性率为95．0％,B超阳性率为85．0％,X线胸片阳性率为67．5％。【结论】缩窄性心包炎的影像诊断应以CT为主,如辅以B超和X线检查,则诊断准确率可以到98．31％。     

慢性缩窄性心包炎44例临床及影像学表现分析

目的 提高对慢性缩窄性心包炎临床及影像学特征的认识能力.方法 分析44例慢性缩窄性心包炎的临床表现及影像学特征.结果 临床表现为呼吸困难、心搏减弱、奇脉.影像学表现:X线检查:心影轻中度扩大者34例,27例出现心包钙化,心脏B超检查:心室舒张末径缩小35例,44例均见心包膜增厚粘连.CT检查可明确显示心包增厚及钙化.结论 慢性缩窄性心包炎的影像学特征是心缘僵直,搏动减弱,心包膜增厚、钙化.     

老年人缩窄性心包炎6例临床病理分析

近10年收治经手术证实的缩窄性心包炎75例,60岁以上老年人6例(8％)。老年人缩窄性心包炎的特点:误诊率和房颤发生率高,分别为100％(6/6)和66.7％(4/6),但心包钙化率与文献报告相似。 老年人缩窄性心包炎临床表现与冠心病相似,本文讨论了两者的鉴别诊断。     

二维及多普勒超声心动图诊断缩窄性心包炎

本文介绍用二维及多普勒超声心动图诊断缩窄性心包炎5例,经手术对照证实:二维超声心动图可准确判断心包厚度、钙化、缩窄部位及范围。多普勒超声可显示主、肺动脉瓣口峰值血流速度减慢,提示心室舒张充盈障碍,射血减少。     

缩窄性心包炎患者心包切除术后病因分析

【目的】探讨缩窄性心包炎心包切除术后的病因诊断,以提高其临床诊断水平。【方法】回顾性分析2000年1月至2005年6月行心包切除术并有病理检查结果的62例缩窄性心包炎患者病历资料。【结果】结核性18例(29.0%),化脓性4例(6.5%),非特异性改变40例,其中2例为创伤性、1例为放射性,其他37例(59.7%)原因不能确定。与非特异性组比较,结核性心包炎患者的病程较短(P<0.01),有发热、急性心包炎、中至大量心包积液和心脏压塞病史者较多(P分别<0.01、0.05、0.01和0.05)。【结论】缩窄性心包炎多数病例病因不明,在已知的病因中,以结核多见。     

缩窄性心包炎35例心电图表现及其与心包病变关系的探讨

缩窄性心包炎患者的心电图表现不但能帮助诊断,还可能提示心包缩窄的严重程度及其进展情况,从而对手术处理及预后估计具有一定价值。本文报道1959～1979年来我院经手术及病理检查证实的缩窄性心包炎35例,并对本组病例心电图表现的特点及其与术中所见心包病变的关系,作一初步探讨。     

结核性与非特异性缩窄性心包炎53例临床特征分析

目的探讨结核性与非特异性缩窄性心包炎的临床特征,为临床诊断提供参考。方法回顾性分析2012年11月-2019年5月诊断为缩窄性心包炎患者的临床资料,依据心包病理检查结果,分为结核性缩窄性心包炎组(42例)与非特异性缩窄性心包炎组(11例)。结果两组比较,男性、年龄大、病程短、发热史、结核中毒症状、合并肺/其他部位结核活动、结核菌素纯蛋白衍生物(PPD)皮试阳性、结核分枝杆菌抗体IgG阳性、结核感染T细胞检测阳性、心包积液腺苷脱氨酶40 U/L,这10项临床特征在结核性缩窄性心包炎中更常见,差异有统计学意义(P0.05)。结论结核性缩窄性心包炎患者在性别、发病年龄、临床表现、实验室检查等方面有着自身特点,这些临床特征能为鉴别结核性与非特异性缩窄性心包炎提供一定的诊断价值。     

缩窄性心包炎外科治疗15例分析

缩窄性心包炎是临床常见疾病，心包增厚、纤维化及钙化是不可逆的，内科治疗效果差，手术剥脱缩窄的心包是解除心脏机械压迫惟一有效的方法。我院2000／2007年手术治疗缩窄性心包炎15例，分析如下。     

缩窄性心包炎的超声、CT与MRI联合研究分析

目的:探讨缩窄性心包炎的超声、CT与MRI联合诊断效果。方法:回顾性分析2015年1月~2016年12月在我院行手术和病理组织确诊的52例缩窄性心包炎患者临床病例资料,所有患者均行超声心动图、CT、MRI检查,并予以对比分析,手术后通过超声心动图对手术疗效进行随访。结果:超声心动图对缩窄性心包炎诊断符合率为76.9%,CT诊断符合率为73.1%,超声心电图、CT联合MRI诊断符合率为92.3%,超声心电图、CT联合MRI诊断符合率明显高于超声心电图或CT诊断符合率,组间比较差异无统计学意义(P0.05),术后心动图检查显示患者左心室舒张功能显著改善。结论:超声心电图是临床诊断缩窄术细胞源的重要和首选方法,CT和MRI能为术前和术后病情评估提供重要信息,三种联用有助于减少误诊和漏诊率。     

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.