经胸超声心动图在先天性心脏病封堵术中的应用价值

目的：探讨超声心动图在常见先天性心脏病封堵术中的应用价值。方法：本组先天性心脏病152例中,ASD77例、PDA21例及VSD54例,经胸或/和经食道超声心动图检查符合条件而行经导管以封堵器封堵术治疗。结果：152例中,除3例患者因双孔或单ASD最大伸展径较大（〉34mm）而放弃封堵外,余149例患者在超声指导下封堵成功,均无残余分流,成功率为98.03%（149/152）。结论：采用封堵器封堵治疗常见先天性心脏病时,超声心动图对于术前病例选择、术中指导监测、封堵器型号的选择以及术后疗效评价等,均有较大的临床价值。     

急性胰腺炎的多层螺旋CT诊断价值

目的:探讨急性胰腺炎的多层螺旋CT诊断价值。方法:分析70例急性胰腺炎患者的临床资料和CT扫描征象。结果:52例胰腺呈弥漫性增大,12例呈局限性增大,14例胰腺密度改变,16例胰腺周围液体聚集,17例胰腺内坏死、出血。53例为急性水肿性胰腺炎,17例为急性出血坏死性胰腺炎,出血坏死性胰腺炎的病情显著重于急性水肿性胰腺炎(P<0.05)。结论:多层螺旋CT扫描为明确急性胰腺炎的类型、判断预后以及制订治疗方案提供了准确的依据,具有重要的临床价值。     

多层螺旋CT在妇科急腹症诊断中的临床探讨

目的 探讨多层螺旋CT(MSCT)在妇科急腹症诊断中的临床价值。方法 选取60例疑似妇科急腹症患者为研究对象,患者采用多层螺旋CT探查,包括黄体破裂、卵巢囊肿破裂、卵巢囊肿蒂扭转、子宫破裂及宫外孕等病症,以手术病理检查为金标准,观察多层螺旋CT的确诊率。结果 60例疑似妇科急腹症患者中,经临床手术病理诊断56例确诊为妇科急腹症,其他4例（2例急性阑尾炎,2例肠梗阻）。妇科急腹症包括黄体破裂10例,卵巢囊肿破裂12例,卵巢囊肿蒂扭转11例,盆腔脓肿15例,宫外孕8例;多层螺旋CT检查有54例[54/56(96.43%)]确诊为妇科急腹症患者,其中黄体破裂10例,卵巢囊肿破裂11例,卵巢囊肿蒂扭转11例,盆腔脓肿14例,宫外孕8例,比较差异无统计学意义（P>0.05）。结论 多层螺旋CT检测妇科急腹症有较高的确诊率,具有安全、便捷的辅助检测特点,是探查急腹症最有效的影像诊断方法,有助于临床治疗的选择,值得临床推广与应用。     

多层螺旋CT和磁共振成像在浸润性宫颈癌术前分期中的价值分析

目的 探讨多层螺旋CT(MSCT)、磁共振成像（MRI）在浸润性宫颈癌术前分期的临床价值。方法 选取60例浸润性宫颈癌患者为研究对象,患者均行MSCT、MRI进行检查,其中病理学诊断结果作为浸润性宫颈癌检查的金标准,比较MSCT、MRI对术前分期的诊断符合率,并分析其图像表现。结果 MRI诊断阴道浸润准确率高于MSCT,而MSCT诊断子宫体侵犯、盆腔淋巴结转移的准确率高于MRI(P<0.05);经术后病理分期确诊,A期20例,B期28例,C期12例;分析MSCT的图像表现,可见宫颈有不同程度的增大,宫旁可见增粗的条索状影,病灶范围可见超过子宫颈间质环。大部分患者输尿管末段均显示模糊的脂肪间隙,且盆壁被侵犯。部分患者直肠、膀胱受到侵犯,扫描可见直肠、膀胱增厚;脏器壁厚度增加,不均匀,肿瘤向直肠突出;部分淋巴结转移患者,可见淋巴结增大,且边缘不清晰;增强扫描时,可见病灶中心有低密度区。分析MRI的图像表现,可见T2WI序列扫描时有不规则肿块、稍高信号,与正常宫颈相比,病灶区域呈等信号,且界限模糊;B期患者可见累及宫颈外,同时可见低信号基质环被中断,突出部分显示中等高信号;周围脂肪间隙...     

多层螺旋CT血管造影在小儿肾血管性高血压诊断中的应用

目的探讨多层螺旋CT血管造影(MSCTA)在儿童肾血管性高血压诊断中的临床价值。 方法山东大学山东省立医院儿科2002年以来,经MSCTA肾动脉成像确诊为血管性高血压的患儿8例，8例行彩色多普勒超声肾血流检查，6例行X线血管造影(XRA)检查，将MSCTA检查结果与彩色多普勒超声肾血流和XRA检查结果进行比较。MSCTA扫描参数取准直075mm,螺距1,管电压为90~120kV,管电流为120~150mA。扫描结束后对每一病例均行曲面重建(CPR)、多平面重建(MPR)、容积再现(VR)和最大强度投影(MIP)重建。 结果8例中MSCTA显示10条肾动脉狭窄，左侧6条，右侧4条，其中2例为两侧肾动脉狭窄;8条为起始段狭窄，2条为肾动脉中段狭窄;狭窄长度02~10cm，Ⅰ级狭窄1条，Ⅱ级狭窄6条，Ⅲ级狭窄3条。MSCTA尚可见6例肾缩小，平均长径为71cm，低于健肾15cm以上;1例伴有腹主动脉壁增厚，管腔狭窄，直径约10cm;6例行腹主动脉或选择性肾动脉造影者与MSCTA显示肾动脉狭窄部位和程度完全一致。8例行彩色多普勒超声检查者，亦可见6例肾缩小，但仅5例显示肾动脉狭窄，左侧2条，右侧3条。 结论MSCTA能准确地显示肾动脉狭窄的程度和部位，清晰地显示肾动脉壁及其腔内的情况，作为无创、简便、安全、价廉的检查方法，在一定程度上可替代有创伤性的选择性肾动脉造影。     

儿童感音神经性耳聋20例内耳多层螺旋 CT特征及应用分析

目的    探讨儿童感音神经性耳聋（SNHL）内耳多层螺旋CT（MSCT）特点及其对诊断的价值。方法    选取2008年1月至2010年12月中国医科大学附属盛京医院经脑干听觉诱发电位（BAER）诊断儿童SNHL患儿65例,均行内耳MSCT扫描,然后行冠状面多平面重建（MPR）。结果    20例（33只耳,45例次）存在内耳畸形,其中12只耳多种畸形并存,包括耳蜗畸形伴内耳道畸形5只耳;耳蜗畸形伴前庭导水管扩大3只耳;前庭畸形伴内耳道畸形2只耳;半规管畸形伴前庭导水管扩大1只耳;内耳道畸形伴前庭导水管扩大1只耳。45例次畸形中耳蜗畸形10例次［包括Michel型1例次、共同腔畸形2例次、耳蜗未发育1例次、耳蜗发育不全1例次、不完全分隔Ⅰ型2例次、不完全分隔Ⅱ型（Mondini畸形）3例次］、前庭畸形7例次、半规管畸形5例次、内耳道畸形8例次、前庭导水管扩大15例次。结论    根据MSCT检查结果显示多数SNHL患儿存在内耳畸形。内耳横断面MSCT扫描和冠状面MPR可对儿童先天性SNHL内耳畸形进行全面评估,从而为进一步指导治疗及预后提供有力依据。     

超声心动图的四腔心切面产前诊断胎儿先天性心脏病的价值

目的 探讨超声心动图的四腔心切面（四腔心切面）产前诊断胎儿先天性心脏病（先心病）的价值。方法 回顾性分析780例妊娠16-36周通过四腔心切面进行产前诊断是的孕妇及其新生儿的临床资料。结果 780例胎儿中,94.6%,(738/780)的胎儿可以获取满意的四腔心切面,其中3例胎儿异常,1例为三尖瓣下移畸形（Ebstein综合征）,1例为严重的室间隔缺损,1例为单心房单心室和主动脉狭窄,例1和例3分别于出生后行尸体解剖和新生儿超声心动图检查,均符合产前诊断,例2出生后超声心动图检查证实为单心房和单心室,其余777例新生儿中,出生后身体检查并追踪至产后6周,发现3例先心病,其中1例室间隔缺损,1例房间隔缺损,1例房间隔缺伴肺动脉狭窄,四腔心切面诊断胎儿先心病的敏感性为50%,特异性为100%。结论 四腔心切面可以显示胎儿心脏的大部分结构,探测成功率高,对先心病的宫内诊断有较高的敏感性和极高的特性,可将胎儿四腔心切面作为常规的产检查项目。     

经胸超声心动图在继发孔型房间隔缺损介入治疗中的作用

目的研究经胸超声心动图(TTE)在继发孔型房间隔缺损(ASD)介入治疗的病例筛选及封堵器选择方面的应用价值。 方法回顾分析2002-03—2006-03于山东大学山东省立医院小儿心脏科行介入治疗的54例继发孔型ASD患儿，统计其术前TTE所测的ASD的形态、大 小、边缘情况等，对术前TTE测得的ASD最大径、X线测得的球囊腰径及TTE测得的球囊径分别与所用封堵器型号大小进行统计学分析比较，并进 行TTE测得的ASD最大径与封堵器型号大小的相关性分析，计算回归方程。 结果54例均成功封堵，手术时间20~145(57.64±24.89)min，曝光时间3.1~31.5(9.22±7.41)min，住院天数3~10(5.74±1.72)d。其中有15例患 儿存在ASD单一边缘不够标准，均封堵成功。术前TTE测得的ASD最大径［4~33mm,(16.31±7.34)mm］、术中X线测球囊腰径［6.7~28mm,(19.80± 7.24)mm］及TTE测球囊径［9.6~24.8mm,(19.92±6.38)mm］与封堵器大小［5~36mm,(18.85±7.89)mm］差异均无显著性意义(P>0.05)。且术前 TTE测得的ASD最大径与封堵器型号有良好的线性相关(r=0.945，P<0.05)，计算回归方程为：封堵器型号=1.015×(TTE测得的ASD最大径)+2.3mm 。 结论TTE的应用，使ASD介入治疗病例的筛选得到了保证。作为一种无创性影像学诊断方法，对ASD封堵器选择的评估有重要的应用价值。     

16层螺旋CT对老年腰椎退行性病变的诊断价值

目的:探讨16层螺旋CT对老年腰椎退行性病变的诊断价值。方法:回顾性分析我院2009年3月～2011年9月在我院住院120例老年腰椎退行性病变患者的CT资料,分析其CT表现特点。结果:120例老人腰椎退行性病变中椎体骨质增生45例、椎间盘膨出13例、椎间盘突出11例、"真空现象"10例、周围型侧隐窝狭窄10例、椎小关节病变19例、退变性脊椎滑脱12例;各类型腰椎退行性病变CT表现有特异性。结论:16层螺旋CT能明确反映老年腰椎退行性病变各种影像变化,可以准确地诊断、评价腰椎退行性病变。     

Relationship between HPV typing and abnormality of G1 cell cycle regulators in cervical neoplasm

OBJECTIVE: In tumorigenesis, loss of function of the G1 pathway (p16-CDK4/cyclinD1-pRB pathway (RB pathway) and p14-MDM2-p53 pathway (p53 pathway)) is a theoretically essential event. The simultaneous analysis of all components of the RB and p53 pathway may be able to explain cervical tumorigenesis. However, there are no reports in which all components of the G1 pathway and HPV typing were examined simultaneously in cervical cancer. METHODS: We examined HPV typing and the status of the G1 pathways simultaneously by PCR-SSCP, multiplex PCR, methylation-specific PCR, and immunohistochemical techniques in cervical neoplasia. A total of 105 samples (normal, 10; cervical intraepithelial neoplasm (CIN), 42; invasive cancer (IC), 53) were included. RESULTS: Abnormality of the RB pathway tended to be more frequent in ICs (60.4%) than in CINs (31.0%) (P = 0.069). The primary target was p16 (CIN, 14.3%; IC, 43.4%; P = 0.032). Abnormality of the p53 pathway was detected in ICs (56.6%) and in CINs (40.5%) (P = 0.1494). In particular, strong expression of MDM2 was higher in ICs (32.1%) than in CINs (7.1%) (P = 0.0045). Abnormalities of the RB and p53 pathways were higher in low-risk and negative HPV than in high-risk HPV (81.3% vs 51.4%, P = 0.0657; 81.3% vs 45.9%, P = 0.0328). Seven HPV-negative cases had abnormalities in the RB or p53 pathways. CONCLUSION: In conclusion, abnormality of the G1 pathway may be one of the important mechanisms for carcinogenesis of low-risk and negative HPV cases.     

A comparative analysis of human papillomavirus types 16 and 18 and expression of p53 gene and Ki-67 in cervical,vaginal, and vulvar carcinomas

This study aimed to investigate the correlation between HPV positivity, p53 overexpression, and cell proliferative activity in cervical, vaginal, and vulvar squamous cell carcinoma. METHODS: Sixteen vaginal and 31 vulvar squamous cell carcinomas were examined retrospectively for overexpression of p53 gene and Ki67 antigen by immunohistochemistry and for the presence of HPV types 16 and 18 DNA using a polymerase chain reaction (PCR) method. The results were compared with those obtained from 40 cervical squamous cell carcinomas. RESULTS: HPV type 16 or 18 DNA was detected in 21 (52.8%) of 40 cases of cervical carcinomas and p53 overexpression in one (2.5%), while HPV DNA sequences were detected in seven (43.7%) of 16 cases of vaginal carcinoma and p53 overexpression in three (18.7%). With regard to vulvar carcinoma, HPV was harbored in four (12.8%) of 31 cases and p53 overexpression in 19 (61.2%). These results indicated statistically significant inverse correlations between HPV positivity and p53 overexpression (R = -0.999, P < 0.0001). Overexpression of Ki-67 was detected in 28 (70.0%) of 40, 12 (75.0%) of 16, and 21 (67.7%) of 31, cervical, vaginal, and vulvar carcinomas, respectively. There was no significant difference among the three groups. CONCLUSIONS: In cervical carcinoma, HPV types 16 and 18 might play a common causal role, and in vulvar carcinoma, p53 gene mutations might be a main causal factor for carcinogenesis. Vaginal carcinoma, on the other hand, is considered to have transitional characteristics between cervical and vulvar carcinoma.     

人宫颈鳞癌和宫颈上皮内瘤变组织内HPV16 DNA及p53基因变异的研究

目的 本文采用常规PCR技术对40例宫颈鳞癌组织学标本和200例宫颈上皮内瘤变（CIN）Ⅰ～Ⅱ级的宫颈分泌物标本的HPV16 DNA及P53基因5～6，7～8外显子变异进行了研究，方法 采用常规PCR技术检测HPV16 DNA和p53基因及免疫组织化学方法检测P53基因。结果 在40例宫颈鳞癌标本中HPV16 DNA阳性检出率有20例（50％）；200例CIN标本中有76例（38％）。P53基因在40例宫颈鳞癌标本中有20例出现变异（50％），其中外显子5缺失10例（50％），外显子6缺失1例（5％），外显子7缺失3例（15％），外显子8缺失6例（30％）。200例CIN标本均未检出p53外显子5～6，7～8的变异，宫颈鳞癌HPVl6DNA阳性与p53基因变异的符合率为80％。结论HPVl6I）NA与宫颈鳞癌的发生有密切的相关性，p53基因在宫颈鳞癌组织中确实存在着变异。本研究认为常规PCR技术作为辅助诊断方法是一种快速、简单、适用于临床的方法。     

Pretreatment assessment of prognostic indicators in endometrial cancer

OBJECTIVE: The object of this study was to assess the association of histologic, cytokinetic, and molecular variables in preoperative endometrial samples with extrauterine disease, recurrence, and survival among patients with endometrial cancer. STUDY DESIGN: In a case-cohort study of 125 women, ploidy, S-phase fraction, proliferative index, deoxyribonucleic acid index, proliferating cell nuclear antigen, MIB-1 proliferation marker, p53 tumor suppressor gene, and cytoplasmic HER-2/neu oncogene and bcl-2 expressions were quantitated. RESULTS: A model with only one independent term predicted progression-free survival; that variable was p53 (P <. 0001; relative risk, 5.60). A model with two independent terms predicted disease-related survival; these variables were p53 (P =. 0002; relative risk, 7.39) and MIB-1 (P =.03; relative risk, 3.27). Among patients with tumors with both p53 and MIB-1 expression exceeding 33%, a total of 32% had died of disease by 2 years. A model for predicting extrauterine disease selected two independent variables: p53 (odds ratio, 3.20; P =.01) and ploidy (odds ratio, 2. 16; P =.04). An advanced surgical stage was encountered in 26% to 35% of cases in which either the p53 expression exceeded 33% or the deoxyribonucleic acid content was nondiploid and in 53% of cases in which both variables were unfavorable. CONCLUSIONS: Preoperative evaluation of quantifiable cytokinetic and molecular variables can assist in identifying tumor types that are predisposed toward a more aggressive clinical course.