石棉致胸膜斑的发病情况和X线鉴别诊断

石棉致胸膜斑的发病情况和Ｘ线鉴别诊断山西省职业病医院（０３００１２）张维城，苏兆武，温广云，袁刚，梁兆林，黄燕，郭秀媛胸膜斑对石棉肺的定性诊断及其严重度的期别诊断有重要意义。但是常有一些属于正常结构或其他因素所致胸膜病变的ｘ线表现，与石棉致胸膜斑的ｘ线表现相类似，易造成误诊。我们对石棉致胸膜斑的发病情况进行了调查、并与非石棉作业工人的ｘ线胸片进行对照分析。资料和方法某石棉制品厂所用原料为温石棉，粉尘浓度平均为７０ｍｇ／Ｍ３，直接石棉作业一年以上的工人１０９太原石棉制品厂人，年龄范围１９～６９岁，实际接触石棉尘的时间１～３６年。阅读统计１９８６年至１９９１年５年间所拍摄的Ｘ线胸片，统计结果见表１、２。表中接触石棉尘时间指的是实际接尘时间；接触石棉尘后总时间指的是实际接尘５年以上，从初始接尘至今的时间，包括脱离石棉作业的时间。从表１可知、仅有胸膜改变者和胸膜、肺均有改变者共２８人，此２８人的胸膜斑长度在１～４个侧肋间之间、其厚度和单侧情况见表２。为了对照和探讨鉴别诊断，我们特阅读记录了与石棉无关单位职工的体检胸片１５０份，从中检出前锯肌和腹外斜肌影１４例（占９％）、胸壁脂肪影１０例（占７％），上述两者并存的７例     

严重急性呼吸综合征胸部X线诊断初探

目的：探讨严重急性呼吸道综合征(SARS)患者胸部X线表现特征。方法：54例SARS患者进行胸部X线检查及分析。结果：41例(占75．93％)患者在发病后2～7d肺部可表现为毛玻璃样阴影，且单侧肺出现较多见。33例(占61．11％)以右肺中叶及左肺舌叶出现最早，继而双肺出现或表现为游走现象。在重症组13例患者中，有10例(占18．52％)双肺同时出现沿肺纹理走向的局灶性浸润影和(或)斑片状浸润影。3例(占5．55％)为单肺出现局限病灶后，蔓延至双肺。本组预后较差，病死率较高。结论：本病胸部X线表现特点为发病早期肺内即出现异常，表现为肺间质病变，且较呼吸症状出现早。肺内病变常累及多叶，重症者多弥漫双肺，很少累及肺尖。未见合并空洞及肺门淋巴结肿大，无胸膜渗出性改变。在缺乏可靠的血清学检查之前胸部x线检查对SARS的诊断至关重要。     

小儿支原体肺炎X线诊断

目的 为提高对小儿支原体肺炎的诊断水平.方法 回顾性分析160例小儿支原体肺炎的临床及X线资料.结果 肺部X线表现为小片状及大片状阴影,肺纹理增多增生呈网状及小结节状,肺门阴影增大,纵隔阴影增宽,胸膜反应及胸腔积液,结论支原体肺炎X线表现呈多样性,如患儿肺部出现上述X线改变时,密切结合临床表现特点,应当想到支原体肺炎可能.     

彩超在诊断石棉肺患者胸膜改变中的应用

目的：探讨彩超在石棉肺患者胸膜变化中的诊断价值。方法对本组石棉肺患者行胸部彩超检查,总结各期石棉肺患者胸膜的变化情况。结果各期石棉肺患者中共有41例胸膜增厚者,发生率为39.81%,其中弥漫性胸膜增厚者16例,占胸膜增厚患者的39.02%。结论彩超可动态观察石棉肺患者胸膜的损害程度,能为全面诊断石棉肺提供形态学上的依据。可作为石棉肺患者胸膜病变观察及诊断的首选方法。     

肺挫伤的影像诊断与分析

目的探讨肺挫伤及其并发症的影像学表现及诊断价值。方法回顾分析了48例肺挫伤的临床资料及影像学表现。结果X线平片表现为肺纹理粗而模糊,伴斑点状模糊影23例,或斑片状、大片状的实变阴影13例;伴有肺门影增大、模糊11例,Kerley氏线出现6例,胸膜增厚、模糊4例及胸腔积液2例,单纯表现为肺门影增大、模糊4例,出现Kerley氏线3例,胸膜影增厚、模糊3例,胸腔积液3例。结论影像学检查对肺挫伤及其并发症可作出正确诊断,提高对肺挫伤并发症影像征象的重视,进一步应用CT检查,可提高肺挫伤诊断的阳性率。     

卷烟作业工人职业危害调查研究

本文报道了卷烟厂工人受职业危害情况。该厂各车间内空气中烟草尘时间加权平均浓度为42．12mg／M^3，飘尘中游离SiO2含量在4％以下，分散度小于5um 86．7％。216名接触烟草尘．工龄在8年以上的工人中明确诊断烟草尘肺5例检出率为2．3％。X线表现主要为间质性改变，3例以不规则S，t阴影改变为主，分布在两中下肺区，密集度为Ⅰ级，2例以类圆形阴影为主，分布在上，中、下六个肺区，密集度为Ⅱ级。肺活量降低者的占10．2％，最大通气量降低者的占13．89％，第一秒时间肺活量降低者约占10．2％，流速——容量曲线显示V25改变的占32．4％。提示烟草尘对工人健康有一定程度危害，做好防尘工作，确保工人身体的健康。提高生产率是非常必要措施。     

小儿支原体肺炎25例临床分析

目的提高对支原体肺炎的认识和诊断水平。方法回顾性分析25例支原体肺炎患儿的临床及X线表现等资料。结果25例中8例表现为小斑、片状阴影或斑片阴影互相融合或密度不均片状影，6例表现为节段或大叶分布的致密影，11例表现为下肺野及肺门周围局部透亮度减低、结构模糊，3例表现为胸膜增厚或胸腔少量积液。X线表现与胸部体征不同步。结论X线征象结合临床及实验室检查对确诊支原体肺炎有重要价值。     

25例尘肺病的X线诊断与分析

目的探讨尘肺病的X线诊断方法 ,减少临床误诊率,指导临床治疗,提高患者的生活质量。方法 25例患者皆为后前位胸部高千伏摄影检查。结果 (1)13例患者诊断为Ⅰ期尘肺。(2)10例患者诊断为Ⅱ期尘肺。(3)2例患者双肺见密集度达3级的小阴影、大阴影呈融合趋势,并呈"倒八字"分布于两肺中上部,双肺门上提,双下肺透亮度增强,双侧壁胸膜增厚、见钙化斑。结论 (1)要改善粉尘接触工的工作环境,减少粉尘的吸入;(2)加强对粉尘接触者的健康普查,以做到对尘肺患者的早期诊断;(3)积极治疗尘肺,防止并发症的发生,以提高患者的生活质量。     

系统性红斑狼疮的肺、胸膜损害

目的：探讨系统性红斑狼疮(SLE)的肺胸膜损害。方法：回顾性分析106例住院SLE患者的胸部X线片结果。结果：发现肺胸膜改变76例，占71．7％。76例中表现为胸膜炎48例，占63．2％；急性狼疮性肺炎20例，占26．3％，其中有8例合并有胸腔积液；弥漫性间质性肺炎11例，占14．5％；肺不张3例，占3．9％；SLE性尿毒症性肺水肿2例，占2．6％。结论：肺胸膜是一个富含结缔组织和血管的脏器，常可因免疫复合物的沉积而形成免疫损伤。因此，SLE患者应常规定期胸部X线检查，以便早期发现肺胸膜改变，及时治疗。     

高千伏X线胸片在尘肺病诊断中的应用价值

目的讨论高千伏X线胸片在尘肺病诊断中的应用价值。方法对我科四年内的经过病理诊断为尘肺病的患者资料进行回顾性诊断分析,记录影像的诊断细节,评价图像质量。结果本组102患者中,X线片中,出现小阴影的87例(共计284处);大阴影37例(共计77处);胸膜肥厚35例(共计41处);胸膜黏连37例(共计64处);胸膜钙化57例(共计78处);肺门改变86例,71例伴有不同程度的点状高密度影;82例患者具有不同程度的肺纹理紊乱表现。胶片影像质量评价,一级片61张,占59.8%;二级片35张,占34.3%;三级片6张,占5.8%;没有四级片。结论高千伏摄影能够清晰显示尘肺病患者的图像细节,影像信息量明显增多,影像层次丰富,可提高人体组织的层次对比,并且缩短曝光时间,提高影像的清晰度,同时结合激光打印胶片,减少环境的污染。     

Select mortality and cancer incidence among residents in various U.S. communities that received asbestos-contaminated vermiculite ore from Libby, Montana

In response to the significantly elevated asbestosis mortality rates found in Libby, Montana, in 2000, this analysis evaluated whether other communities throughout the United States that received asbestos-contaminated vermiculite ore from Libby experienced similar excess rates of asbestos-related diseases. Standardized mortality ratios were calculated using state death certificates, and standardized incidence ratios were calculated using cancer registry records for populations living near facilities that processed or received Libby vermiculite. This analysis focused primarily on diseases that are directly associated with asbestos exposure (e.g., asbestosis; cancer of the peritoneum, retroperitoneum, and pleura, including mesothelioma; and mesothelioma). Lung cancer and cancers of the digestive system, also associated with asbestos exposure, were not included in the analysis because they have additional risk factors for which exposure information was not available. Data from 70 unique sites in 23 states were evaluated. No statistically significant excesses of asbestosis mortality similar to those in Libby were noted; however, 11 sites (plus a state with 6 pooled sites that were counted as 1 site) had excess rates of mesothelioma and cancer of the peritoneum, retroperitoneum, and pleura. Further investigation should be conducted at these sites with excess rates of mesothelioma and cancer of the peritoneum, retroperitoneum, and pleura by participating state health departments to determine whether exposure to Libby vermiculite might have been a contributing factor.     

Select Mortality and Cancer Incidence Among Residents in Various U.S. Communities that Received Asbestos-Contaminated Vermiculite Ore from Libby,Montana

In response to the significantly elevated asbestosis mortality rates found in Libby, Montana, in 2000, this analysis evaluated whether other communities throughout the United States that received asbestos-contaminated vermiculite ore from Libby experienced similar excess rates of asbestos-related diseases. Standardized mortality ratios were calculated using state death certificates, and standardized incidence ratios were calculated using cancer registry records for populations living near facilities that processed or received Libby vermiculite. This analysis focused primarily on diseases that are directly associated with asbestos exposure (e.g., asbestosis; cancer of the peritoneum, retroperitoneum, and pleura, including mesothelioma; and mesothelioma). Lung cancer and cancers of the digestive system, also associated with asbestos exposure, were not included in the analysis because they have additional risk factors for which exposure information was not available. Data from 70 unique sites in 23 states were evaluated. No statistically significant excesses of asbestosis mortality similar to those in Libby were noted; however, 11 sites (plus a state with 6 pooled sites that were counted as 1 site) had excess rates of mesothelioma and cancer of the peritoneum, retroperitoneum, and pleura. Further investigation should be conducted at these sites with excess rates of mesothelioma and cancer of the peritoneum, retroperitoneum, and pleura by participating state health departments to determine whether exposure to Libby vermiculite might have been a contributing factor.     

Asbestos-related benign disease and cancer: symptoms and treatment

Long lasting occupational exposure to asbestos dust may cause skin corns, benign pleural effusion, hyaline plaques of the parietal pleura, diffuse thickening of the pulmonary pleura, and asbestosis, i.e. diffuse interstitial pulmonary fibrosis. Malignant disorders include lung cancer and mesothelioma of the pleura, peritoneum and pericardium. In general, many years elapse from first exposure to the appearance of symptoms. Almost all these diseases are the result of dusty working conditions more than 20 years ago. In spite of the fact that the general public is invariably exposed to small amounts of the material, asbestos is not a public health problem. Even living in a building containing sprayed asbestos is calculated to produce a lifetime risk of death which is negligible. There is no evidence to indicate that ingested asbestos fibres represent a major health problem.     

Systematic review: distribution of advanced neoplasia according to polyp size at screening colonoscopy

Background The impact of not referring sub‐centimetre polyps identified at CT colonography upon the efficacy of colorectal cancer screening remains uncertain. Aim To determine the distribution of advanced neoplasia according to polyp size in a screening setting. Methods Published studies reporting the distribution of advanced adenomas in asymptomatic screening cohorts according to polyp size were identified by MEDLINE and EMBASE searches. Predefined outputs were the screening rates of advanced adenomas represented by diminutive (≦5 mm), small (6–9 mm), sub‐centimetre (<10 mm) and large (≧10 mm) polyp sizes. Results Data from four studies with 20 562 screening subjects met the primary inclusion criteria. Advanced adenomas were detected in 1155 (5.6%) subjects (95% CI = 5.3–5.9), corresponding to diminutive, small and large polyps in 4.6% (95% CI = 3.4–5.8), 7.9% (95% CI = 6.3–9.4) and 87.5% (95% CI = 86–89.4) of cases respectively. The frequency of advanced lesions among patients whose largest polyp was diminutive, small, sub‐centimetre and large in size was 0.9%, 4.9%, 1.7% and 73.5% respectively. Conclusions Based on this systematic review, a 6‐mm polyp size threshold for polypectomy referral would identify over 95% of subjects with advanced adenomas, whereas a 10‐mm threshold would identify 88% of cases. Aliment Pharmacol Ther 31 , 210–217     

局灶性机化性肺炎的CT诊断与鉴别诊断

目的分析局灶性机化性肺炎的CT征象,提高对该病的正确诊断率。方法搜集临床资料完整并经手术及病理证实的22例病变,进行回顾性分析其影像表现。结果局灶性机化性肺炎的CT表现:①病变呈多形态广基底贴于胸膜,伴局限性胸膜粘连增厚,无胸水及钙化征象;②密度均匀或不均匀;③病灶边缘粗长毛刺;④病变周围密度较淡的模糊斑片状影,位于非胸膜侧。结论对肺部病灶形态、边缘、密度、病灶周围及胸膜改变的综合分析,能提高对本病的正确诊断率,并能与周围型肺癌,结核瘤作出鉴别诊断,减少误诊。     

多体位CT胸膜腔造影检查57例报告

目的:研究多体位CT胸膜腔造影(MP-CTP)检查的临床应用价值。方法:在普通CT胸膜腔造影(CTP)的基础上,加用胸水扩容造影、病灶局部薄层及多体位CT扫描的方法,对于57例非包裹性胸腔积液患者进行前瞻性研究,其结果与普通CTP相对比。结果:54例渗出性胸水中,普通CTP所示的胸膜病变MP-CTP均能显示,且后者检出更多病灶,尤其位于非低垂部位的结节影、胸膜不规则增厚和胸膜粘连等病灶。31例恶性渗出性胸水中,MP-CTP检出胸膜结节、胸膜不规则增厚和胸膜粘连者分别为20例、15例和8例;以上病灶在23例良性渗出性胸水中检出者分别为5例、4例和14例。结论:MP-CTP检查可提高胸膜病变的检出率,并可以初步鉴别良性及恶性渗出性胸水。     

Light-induced deterioration test of carboplatin under clinical settings

Chemotherapeutic drug dosages are calculated precisely based on the patient's height, body weight, and renal function, etc. To ensure safe and favorable outcomes of treatment, dosing solutions are prepared by appropriate mixing of the drug solutions based on such calculations. The package inserts for many injectable preparations include a warning for storing the product "shielded from light." However, there are no reports of stability assessment of a mixed product against light exposure or the residual amount of active ingredient in the dosing solution during or at the end of treatment. We evaluated the stability of carboplatin from the time of mixing of the dosing solution until the end of drug infusion in a clinical-like setting. With 4-hour exposure to outdoor scattered light, the dosing solution began to show discoloration by 1 hour, becoming dark yellow by 4 hours, with reduction of the percent residual carboplatin to about 23%. To identify the optimal light-shielding shade, the dosing solution was shielded from outdoor scattered light with 1 of 3 protective covers: aluminum foil, yellow plastic shade, and brown plastic shade. The yellow plastic shade prevented any changes of the appearance of the dosing solution during the 4-hour exposure period. The percent residual carboplatin, determined by HPLC, in the dosing solution shielded with a yellow plastic shade was about 85.2% at 2 hours and 78.6% at 4 hours. Thus carboplatin dosing solution should be completely shielded from light until infusion is completed.     

藏药“俄色”的薄层色谱研究

目的:建立藏药"俄色"的薄层色谱鉴别方法。方法:通过对提取试剂及展开系统进行系统的考察,建立以根皮素对照品为对照、以氯仿-甲醇-甲酸(8:2:0.1)为展开系统的薄层色谱鉴别方法。结果:不同批次俄色药材在与对照色谱相应的位置上,显相同颜色的荧光斑点,能够有效的对"俄色"进行鉴别。结论:首次建立了藏药"俄色"的薄层鉴别方法,该方法的Rf值适中,斑点清晰,具有较好的适应性,重现性好,为完善其质量标准奠定了基础。     

Pulmonary toxicity of carbon nanotubes and asbestos — Similarities and differences

Carbon nanotubes are a valuable industrial product but there is potential for human pulmonary exposure during production and their fibrous shape raises the possibility that they may have effects like asbestos, which caused a worldwide pandemic of disease in the20th century that continues into present. CNT may exist as fibres or as more compact particles and the asbestos-type hazard only pertains to the fibrous forms of CNT. Exposure to asbestos causes asbestosis, bronchogenic carcinoma, mesothelioma, pleural fibrosis and pleural plaques indicating that both the lungs and the pleura are targets. The fibre pathogenicity paradigm was developed in the 1970s–80s and has a robust structure/toxicity relationship that enables the prediction of the pathogenicity of fibres depending on their length, thickness and biopersistence. Fibres that are sufficiently long and biopersistent and that deposit in the lungs can cause oxidative stress and inflammation. They may also translocate to the pleura where they can be retained depending on their length, and where they cause inflammation and oxidative stress in the pleural tissues. These pathobiological processes culminate in pathologic change — fibroplasia and neoplasia in the lungs and the pleura. There may also be direct genotoxic effects of fibres on epithelial cells and mesothelium, contributing to neoplasia. CNT show some of the properties of asbestos and other types of fibre in producing these types of effects and more research is needed. In terms of the molecular pathways involved in the interaction of long biopersistent fibres with target tissue the events leading to mesothelioma have been a particular area of interest. A variety of kinase pathways important in proliferation are activated by asbestos leading to pre-malignant states and investigations are under way to determine whether fibrous CNT also affects these molecular pathways. Current research suggests that fibrous CNT can elicit effects similar to asbestos but more research is needed to determine whether they, or other nanofibres, can cause fibrosis and cancer in the long term.     

不规则抗体筛查在微柱凝胶配血中的应用

目的对微柱凝胶技术(MGT)在不规则抗体筛选中的应用情况进行分析和探讨。方法选取2011年1月至2011年12月期间,在我院拟输血治疗及手术备血的11556例患者,其中6688例为男性,4868例为女性,年龄为1d~83岁。对其血浆不规则抗体筛查情况进行了回顾性分析。结果微柱凝胶法和凝聚胺检测五种标准抗血清结果完全相同。微柱凝胶法对不规则抗体的筛查结果为86例(0.74%)阳性;凝聚胺法只提示62例(0.54%)为不规则抗体阳性。结论使用微柱凝胶法对不规则抗体进行筛选灵敏度好、结果精确、稳定性强等优点,能够充分避免ABO之外的抗体导致溶血性输血反应,值得在临床上推广应用。