CT三维成像与传统钡餐诊断胃癌的比较研究

目的研究螺旋CT三维成像(3D CT)包括仿真胃镜(CTVG)、表面遮盖法(SSD)和透明法(Raysum)在胃癌诊断中的价值,并与上消化道钡餐(UGI)比较.方法 43例胃癌患者(37例进展期胃癌、6例早期胃癌)均经手术病理证实,2位阅片者盲法阅片,对这43例患者4种成像方法(CTVG、SSD 、Raysum、UGI)的172套图像分别进行如下4方面的评价图像质量、伪影情况、病变的诊断可信度、Borrmann分型.根据手术和病理结果计算各种方法检出病变的敏感度和对进展期胃癌Borrmann分型的敏感度,将3D CT的结果分别与UGI结果进行比较.结果 2位阅片者在CTVG、SSD、Raysum、UGI上的检出病灶敏感度分别为98%、67%、60%、84%与98%、70%、70%、88%,进展期胃癌Borrmann分型的敏感度分别为76%、49%与38%、49%与78%、51%、35%、43%.2位阅片者均认为CTVG、SSD、Raysum的图像质量与UGI类似(P>0.05),CTVG和UGI在检出进展期胃癌(诊断可信度≥3)的敏感度方面差异无显著意义(χ2值为0.50与0.25,P>0.05),而SSD、Raysum检出病灶的敏感度均低于UGI(P<0.05,χ2值为4.17、7.11与5.14、4.17).2位阅片者均认为CTVG对胃癌Borrmann分型的敏感度高于UGI(χ2值为4.90与4.92,P<0.05), 而SSD、Raysum的分型敏感度与UGI间则差异无显著意义(P值均>0.05).CTVG检出早期胃癌的敏感度高于UGI,但差异无显著意义(χ2=2.25,P>0.05).影响诊断的严重伪影(占6.1%)来源于多量潴留液及患者的呼吸运动.结论 CTVG在进展期胃癌的检出上与UGI相仿,对进展期胃癌的分型优于UGI,并有发现早期癌的潜能.SSD、Raysum单独应用,对胃癌的临床诊断价值有限.     

溃疡型胃癌螺旋CT诊断:与钡餐、胃镜及标本比较研究

目的　与胃钡餐造影 (GI)、纤维胃镜 (FG)及手术标本对照 ,明确螺旋CT(SCT)成像技术对溃疡型胃癌的诊断价值。资料与方法　经手术病理证实的 40例溃疡型胃癌行胃产气后SCT检查 ,其中 32例行胃气钡双重造影检查 ,2 6例有手术标本和胃镜录像。由 2位放射科医师对SCT及GI图像分别进行盲法阅读 ,评价病变的探测、Bor rmann分型及分析诊断可信度 ,阅片者间的一致度采用k检验。结果　 40例溃疡性病变手术病理共检出 49个病灶 ,2位阅片者SCT各检出 47个 ,32例GI检查者 ,病理证实 40个溃疡病灶 ,2位阅片者GI各明确检出 16和 15个溃疡病灶。BorrmannⅡ、Ⅲ型癌的鉴别CT仿真胃镜 (CTVG)准确性为 92 .39%,GI准确性为 2 6 .92 %(P <0 .0 5 )。结论　SCT对胃部溃疡性病灶的显示及Borrmann分型优于GI。     

仿真胃镜与钡餐比较评价胃部溃疡性病灶:ROC曲线分析

目的：与上消化道钡餐(UGl)比较研究CT仿真胃镜(CTVG)对胃部溃疡性病变诊断的价值。方法：经胃镜证实为溃疡性病变的患者39例，手术病理证实29例为胃癌，10例为良性溃疡。所有患者均在3天内行螺旋CT及UGI检查，两位阅片者对所有的CTVG及UGI图像进行主观性盲法阅片。图像质量的评价分3级，检出的可信度、良恶性溃疡的鉴别及恶性溃疡分型的鉴别评价分5级，后两项采用ROC曲线进行分析。结果：两位阅片者均认为对于图像质量、病灶检出率、溃疡病灶的良恶性鉴别，CTVG与UGI类似(P＞0.05)；对于溃疡型胃癌分型的准确性，CTVG明显优于钡餐(P＜0．05)。结论：CTVG对溃疡型胃癌分型的判断优于UGI，但对溃疡病灶的良恶性鉴别，CTVG与UGI无明显差异；胃部螺旋CT扫描是一种简便、有效的检查方法，值得进一步研究。     

人工气腹法螺旋CT对胃癌分期的评价

目的评价人工气腹法螺旋CT(SCTPP)对胃癌术前分期的诊断价值及临床意义。方法对52例体瘦胃癌病人先后进行常规SCT和SCTPP检查,并与手术病理进行对照。结果常规SCT和SCTPP对T分期的准确性分别为72%和96%(χ2=8.0,P<0.005),对N分期的准确性分别为85%和93%(χ2=0.006,P>0.05),对M分期的敏感性分别为61%和100%(χ2=0.04,P<0.05),对TNM分期的准确性分别为81%和96%(χ2=6.03,P<0.05)。结论SCTPP对胃癌术前分期的准确性明显高于常规SCT,对胃癌选择治疗方案具有重要的指导意义。     

胃癌采用320排容积CT进行术前分型及TNM分期价值

目的分析胃癌术前Borrmann分型和TNM分期采用320排容积CT的临床价值。方法选取我院2019年3月～2020年3月收治的72例胃癌患者,所有患者均接受320排容积CT扫描和超声内镜检查,72例患者均接受外科手术治疗,以术后病理为标准,计算320排容积CT和超声内镜对胃癌Borrmann分型和TNM分期的准确率,并将统计数据进行组间比较。结果 320排容积CT检查和超声内镜对Borrmann分型(84.45%vs 90.91%)、T分期(86.67%vs90.00%)的诊断准确率差异无统计学意义(x~2=1.138、0.069,P=0.286、0.703); 320排容积CT检查胃癌N分期(93.06%vs 80.56%)、M分期(94.44%vs 83.33%)诊断准确率高于超声内镜(x~2=4.911、4.500,P=0.027、0.034),差异均有统计学意义。结论 320排容积CT在胃癌术前Borrmann分型和TNM分期中具有较高的准确率,有利于选择合适的手术治疗方式,提高患者治疗效果。     

胃癌的螺旋CT诊断进展

论述了螺旋CT(SCT)在胃癌的检出、T分期、N分期及M分期中的应用;评价了多平面重组、三维重组、实时内镜的优缺点.指出胃癌的SCT检查利于胃癌的检出、定性、分期与预后评估,是一种有价值的检查方法.     

16排CT三维成像在胃癌诊断中的临床应用

目的:研究16排螺旋CT三维成像(3D CT)包括表面遮盖法(SSD)、仿真胃镜(CTVG)在胃癌诊断中的价值。方法:123例胃癌患者(121例进展期胃癌,2例早期胃癌)均经胃镜活检病理证实,121例手术证实(2例进展期胃癌伴肝转移而未能手术)。使用GE Lightspeed Ultra 16排CT行全胃扫描,扫描条件层厚1.25 mm,1.375∶1,0.8 s/r,120 kV,300 mA,扫描总时间6~8 s。对123例胃癌用2种常用的成像方法检查,评价图像质量、病变检出率、Borrmann分型等,并与胃镜和手术结果比较。结果:16排CT的SSD和CTVG的图像质量均显示满意;SSD和CTVG的病变检出率分别为93.50%(115/123)、94.31%(116/123);进展期胃癌Borrmann分型的敏感度均为95.04%(115/121)。16排CT扫描克服了腹部呼吸运动伪影的影响,明显提高了三维图像质量。结论:16排CT三维成像大幅提高了图像质量和病变检出能力,为胃癌的术前准确评价提供了可信依据。     

16排CT三维成像技术在胃癌诊断中的临床价值分析

目的探索16排CT三维成像技术在胃癌诊断中的临床应用价值,包括了仿真胃镜(computed tomograply virtual gastroscopy,CTVG)和表面遮盖显示(shaded surface display,SSD)。方法选取112例经胃镜活检病理证实的胃癌患者,其中2例为早期胃癌,110例为进展期胃癌。对患者使用GE Lightspeed Ultra 16排CT进行了全胃扫描,条件为:层厚度1.25mm,1.375:1,120kV,300mA,0.8s/r,时间为6~8s。用两种成像方法检查此112例胃癌患者,评价包括Borrmann分型、病变检出率、图像质量等,并且和胃镜及手术结果比较。结果 16排CT的SSD像和CTVG像的显示效果均达到满意,明显提高了三维图像质量。SSD像和CTVG像病变检出率分别为94.64%和96.63%,这两者对于进展期的胃癌Borrmann分型敏感度则均为96.36%。结论 16排CT三维成像技术大幅度提高病变检出能力和图像的质量,给胃癌术前的准确评价提供可靠依据。     

胃癌的螺旋CT诊断进展

论述了螺旋CT(SCT)在胃癌的检出、T分期、N分期及M分期中的应用；评价了多平面重组、三维重组、实时内镜的优缺点。指出胃癌的SCT检查利于胃癌的检出、定性、分期与预后评估，是一种有价值的检查方法。     

螺旋CT对胃癌Lauren''s分型诊断价值的研究

目的探讨螺旋CT(SCT)对胃癌Lauren's分型的诊断价值. 资料与方法对40例进展期胃癌患者行SCT平扫及三期动态增强扫描.40例均于检查后1周内施行全胃或部分胃切除手术、剖腹探查术.术后标本行常规石蜡包埋及5μm切片. 结果胃壁低密度层增厚程度在肠型胃癌和弥漫型胃癌分别为1.55mm±0.55mm和7.71mm±2.33mm;强化程度在肠型胃癌和弥漫型胃癌分别为51.98HU±9.35HU和87.95HU±18.79HU,两组比较,差异均具有统计学意义(P＜0.05,P＜0.05). 结论 SCT对胃癌Lauren's分型有一定价值.     

Dealing with cancer--conversations with radiotherapy patients

Thirty in-patients treated by radiotherapy were questioned in qualitative interviews about the information they had received from the physicians and their way to deal with the disease and the physicians. Furthermore 18 persons out of this group were accompanied continuously. The confidential relationships between the patients and the author of the study brought about spontaneous conversations showing some new aspects of the way to experience disease and therapy. Despite a poor prognosis and an initially insufficient information, the patients formulated their questions openly. Generally they desired a clearer communication. They criticized above all the lack of information and attention from the physicians. A need for confidence, frankness, and the conveyance of a justified hope was expressed. The physician's stress and resulting lack of time was complained of. During the time of accompanying which lasted several weeks, it became evident that information means a way to deal with the disease to which the patient can make his individual contribution. The majority of questions as well as emotional reactions as fear or depression came from those patients who seemed to be quiet persons.     

Radiochemotherapy with temozolomide for patients with glioblastoma

Background

The objective of this retrospective analysis was to assess long-term outcome and prognostic factors of unselected patients treated for glioblastoma (GB) at a single center with surgery, standard radiotherapy (RT), and concomitant temozolomide (TMZ). From 1999?C2005, the institutional protocol included surgery and RT with TMZ. From 2005 on, adjuvant TMZ was routinely added.

Patients and Methods

Between April 1999 and September 2009, 181 patients with GB were treated with RT (60 Gy in 30 fractions) and concomitant TMZ (75 mg/m²/day throughout RT). Biopsy only had been performed in 53 patients (29.3%), 128 patients (70.7%) had undergone resection, which was complete based on postoperative MRI in 51 patients (28.2%). Adjuvant TMZ was applied in 67 of 181 patients (37%).

Results

Median overall survival (OS) and progression-free survival (PFS) were 15.0 (95% CI, 13.1?C16.8) and 7.2 months (95% CI, 5.9?C8.5), respectively. After complete resection, partial/subtotal resection and biopsy, median OS was 23.20, 14.75, and 7.89 months (p < 0.001), respectively. In multivariate Cox proportional hazards regression models, extent of resection (p < 0.0001), Karnofsky??s performance score (p < 0.0001) and adjuvant TMZ (p = 0.001) were significant independent prognostic factors for OS. RT with concomitant TMZ was well tolerated in the majority of patients and could be completed as scheduled in 146 patients (80.7%), while 11 patients (6.1%) discontinued RT. Another 35 patients (19.3%) interrupted concomitant chemotherapy.

Conclusion

RT with concomitant TMZ is a feasible regimen with acceptable toxicity in routine practice. Our data are compatible with a beneficial effect of adjuvant TMZ on OS and PFS.     

湿润烧伤膏与手术联合治疗褥疮的护理

目的 :减少溃疡期褥疮的术前准备时间 ,缩短褥疮的总病程。方法 :将 1996年 5月至 2 0 0 2年 5月收住院的 4 2例溃疡期褥疮病人按随机原则分为 2组 ,2 1例术前用湿润烧伤膏纱换药处理 ,为A组 (试验组 ) ;2 1例用庆大霉素紫草油纱布换药处理 ,为B组 (对照组 )。 2组病例的年龄、性别、发病原因、病灶部位、病灶范围等经统计学处理 ,无显著性差别 ,有可比性。两组病人均换药至创面新鲜行皮瓣转移手术 ;比较两组平均术前换药时间 ,及换药 +手术的总住院日。术前术后两组患者均运用护理程序施行整体护理。结果 :A组术前平均换药时间为 8 4 9± 2 2 3天 ,B组为 15 6 0± 6 70天 ;A组平均治愈时间为 2 0 5 0± 4 81天 ,B组为 35 31± 7 70天。结论 :湿润烧伤膏换药与庆大霉素紫草油纱布换药比较 ,前者可明显缩短褥疮手术的术前准备时间及病人的总住院天数。     

Bronchogenic carcinoma: staging with MR compared with staging with CT and surgery

Thirty-three patients suspected of having bronchogenic carcinoma were studied prospectively using magnetic resonance (MR). In this group, 30 underwent examination with computed tomography (CT), 15 underwent thoracotomy, six had mediastinal biopsy procedures performed, and eight underwent bronchoscopy. MR studies, which included transaxial spin-echo imaging (TR, 0.5 and 2.0 sec; TE, 28 and 56 msec) of all patients and sagittal or coronal imaging of 18, were performed without knowledge of CT findings, using only plain radiographs as a guide. CT and MR studies were interpreted separately. CT and MR provided comparable information regarding the presence and size of mediastinal lymph nodes. MR better discriminated mediastinal nodes from vascular structures. However, in two of 11 patients who had multiple mediastinal lymph nodes that were normal in size at CT examination and surgery, MR suggested a confluent abnormal mass, probably because of its poorer spatial resolution. MR was superior to CT in showing enlarged hilar lymph nodes, but CT was better for demonstrating bronchial abnormalities. In three of four patients who had a proved hilar mass with distal obstructive pneumonia, MR (TR, 2.0 sec) helped distinguish between the mass and collapsed lung.     

多虑平、雷尼替丁治疗消化性溃疡81例临床观察

1995年 1月～ 1 998年 2月 ,我们采用多虑平、雷尼替丁治疗消化性溃疡 (ＰＵ) ,并与雷尼替丁为对照组进行治疗观察 ,疗效满意 ,现总结报告如下。1　临床资料1 1　一般资料　本组 81例ＰＵ均因上腹痛、返酸、腹胀及食欲不振等症状 ,经胃镜诊断为溃疡活动期患者。病程 2个月～ 5ａ,平均 1 7ａ。伴有焦虑、抑郁及夜眠欠佳等症者59例。随机分为 2组 :治疗组 4 1例 ,男 3 8例 ,女 3例 ;年龄 1 8～ 3 6岁 ,平均 2 4岁。其中胃溃疡 1 1例 ,十二指肠球部溃疡 3 0例。对照组 4 0例 ,男 3 7例 ,女 3例 ;年龄 1 9～ 3 5岁 ,平均 2 4 5岁 ;胃溃疡 1 2…     

臭氧治疗船员下肢损伤89例

2006年10月至2007年4月,我科采用引进的德国赫尔曼Medozon型臭氧发生装置系统产生的臭氧治疗船员下肢损伤89例,疗效满意.现报告如下.     

Tumor Burden Assessment with Positron Emission Tomography with

Objective: In patients with advanced cancer, total tumor burden affects the likelihood of tumor response and has important implications for prognosis. The aim of this study was to select the optimum 2-[F-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG PET) tumor uptake parameter to accurately measure tumor burden in advanced metastatic renal cell cancer, in comparison with volumes measured with computed tomography (CT), as a reference test.Materials and Methods: Six patients with metastatic renal cell carcinoma measurable on CT were studied. CT and FDG PET scans were carried out on all patients within 4 weeks prior to their entry into a phase I-II radioimmunotherapy trial. CT-based evaluation of disease extent (tumor volume) and 4 PET-based measurements (standardized uptake value[SUVmax], SUVav, volume, and total lesion glycolysis [TLG]) were performed independently by a radiologist (VN) and a nuclear medicine physician (TA). The degree of correlation between conventional (CT) extent of disease and parameters describing tumor concentration of FDG was then determined.Results: Fifty-seven CT-measurable metastatic lesions in lung, abdomen, and scalp were evaluated in 6 patients. There was a high correlation between CT and FDG PET volume estimates for lesions greater than 5 cm(3) in size. However, a PET-derived parameter that embodies both FDG uptake and lesion size, the TLG, correlated better with CT-derived tumor volume than did FDG PET volume alone.Conclusion: Using CT volume as a gold standard, the optimal PET-based estimate of total tumor burden in patients with metastatic renal cancer is the sum over all lesions of the total lesion glycolysis.     

MEBO药纱门诊治疗烧(烫)伤71例的体会

作者报道用MEBO药纱敷盖门诊治疗烧（烫）伤71例，均获治愈。经随访1年，深Ⅱ度创面疤痕发生率为15％（3／20），浅Ⅲ度创面疤痕发生率为38．9％（7／18）。