CT增强对不同大小密度孤立性肺结节的诊断价值

目的 探讨肺部CT增强对不同大小、密度孤立性肺结节(SPN)的诊断价值。方法 回顾性调查病理确诊孤立性肺结节患者204例,以病理结果为参考标准,比较CT增强峰值在不同大小、不同密度SPN良恶性分布差异,并探讨其在不同病理类型SPN中的鉴别诊断价值。结果 CT增强在实性和/或直径在2~3 cm的SPN鉴别诊断价值较高(OR值分别为5.15,95%CI:2.62~10.14和5.39,95%CI:1.89~15.39),在部分实性、直径≤2的结节中良恶性鉴别能力较差;CT增强峰值是否≥15 HU在不同病理类型SPN中的差异具有统计学意义;CT增强阳性率随着直径增大及密度变实而逐渐增加。结论 在孤立性肺结节的鉴别诊断中,应参考结节的密度、直径及可能的病理结果,合理选择CT增强扫描。     

曲安奈德联合5-氟尿嘧啶治疗瘢痕疙瘩疗效观察

目的观察曲安奈德联合5-氟尿嘧啶局部注射治疗瘢痕疙瘩的疗效及安全性。方法选取瘢痕疙瘩患者120例,随机分为观察组和对照组,每组60例。观察组给予曲安奈德联合5-氟尿嘧啶以及利多卡因治疗,对照组给予曲安奈德和利多卡因治疗,比较两组临床疗效。结果治疗后观察组疗效优于对照组,差异有统计学意义(P0.05)。两组不良反应发生率比较差异无统计学意义(P0.05)。治疗组复发率低于对照组(P0.05)。结论曲安奈德联合5-氟尿嘧啶治疗瘢痕疙瘩,疗效显著,复发少,值得临床推广应用。     

FOLFOX4、SOX化疗方案治疗晚期胃癌的疗效及对血清生物活性因子及预后的影响

目的探讨奥沙利铂+亚叶酸钙+5-氟尿嘧啶(FOLFOX4)、奥沙利铂+替吉奥(SOX)化疗方案治疗晚期胃癌的疗效及对血清基质金属蛋白酶9(MMP9)、CD44v6、血管内皮细胞生长因子C(VEGFC)、转化生长因子-β1(TGF-β1)水平和预后的影响。方法根据治疗方法不同将112例晚期胃癌患者分为对照组与观察组,每组56例。对照组患者采用FOLFOX4方案化疗,观察组患者采用SOX方案化疗。比较两组患者的近期疗效、远期生存情况、不良反应发生情况,并对两组患者治疗前后的血清MMP9、CD44v6、VEGFC、TGF-β1水平进行比较。结果治疗结束后,两组患者的疾病控制率、客观缓解率比较,差异均无统计学意义(P﹥0.05)。化疗过程中,两组患者白细胞减少、血小板减少、乏力、恶心、呕吐、口腔黏膜炎、肝肾功能不全、神经功能异常的发生率比较,差异均无统计学意义(P﹥0.05)。两组患者治疗后的血清MMP9、CD44v6、VEGFC、TGF-β1水平均明显低于本组治疗前(P﹤0.01);观察组患者治疗后的血清MMP9、CD44v6、VEGFC、TGF-β1水平均低于对照组治疗后(P﹤0.05)。观察组患者的2年生存率高于对照组(P﹤0.05)。结论SOX化疗方案治疗晚期胃癌的远期疗效优于FOLFOX4方案,可能与降低血清MMP9、CD44v6、VEGFC、TGF-β1水平有关。     

CT灌注曲线形状的量化及对乳腺癌的诊断价值——计算机模拟和乳腺灌注

目的 探讨血流动力学参数及参数组合对CT灌注时间-密度曲线(TDC)形状的影响,寻找定量评价TDC形状的方法,并应用于乳腺癌的前瞻性灌注研究.方法 在Excel 2003中构建算式,并编写相应程序代码以实现自动卷积、去卷积算法,其中推动剩余函数采用Weibull函数,在固定其他参数的情况下,分别以连续递增的血流量(BF)、平均通过时间(MTT)、血流量与平均通过时间之比(BF/MTT)、Weibull函数的形状参数和一个固定的动脉输入函数卷积,得到一系列TDC;考察上述指标对TDC形状的影响,筛选出能够定量描述TDC形状的变量.对28例乳腺肿块患者行CT灌注扫描,按TDC的形状分为速升速降型、持续上升型、平台型,以术后病理诊断为金标准,用受试者工作特性曲线(ROC)分析BF、MTT、血容量(BV)、BF/MTT、TDC形状分型在乳腺癌诊断中的价值.结果 ①Weibull函数的形状参数对TDC的影响轻微;BF影响TDC的高度,BF越大TDC高度越大;MTT影响TDC的高度和峰值时间,MTT越大TDC高度越大同时峰值时间推后;BF/MTT决定TDC的形状,取值偏大时TDC呈速升速降型,取值偏小时呈持续上升型,取值在两者之间时呈平台型;②乳腺灌注BF/MTT与TDC形状分型相关;③乳腺灌注各指标ROC曲线下面积由高到低依次为BF/MTT、BF、TDC形状分型、BV、MTT,前三者大于对角线下面积(P<0.05),可鉴别乳腺肿块的良恶性.结论 BF/MTT能够定量描述CT灌注TDC的形状,以非线性的方式整合BF和MTT的诊断信息,在乳腺癌的诊断中有重要的参考价值.     

MRCP结合薄层T_2WI对胆系结石的诊断价值

目的探讨MRCP及薄层T_2WI脂肪抑制序列对胆系结石的诊断价值。方法对56例可疑胆系结石患者行常规上腹部MRI及MRCP,且对兴趣区行薄层T_2WI脂肪抑制序列扫描。与ERCP或手术结果对照,比较分析增加薄层扫描前后对胆系尤其是胆总管下段结石的诊断符合率。结果增加薄层扫描后对胆系结石的诊断率明显提高,常规MRCP与增加薄层扫描后诊断符合率分别为83.9%、96.4%。将不同部位结石进行合并,增加薄层扫描前后所得数据用配对卡方检验,两者有显著性差异(P0.05)。结论在常规扫描的基础上加行兴趣区薄层扫描有助于小结石的直接显示,降低术中胆道损伤和术后残留结石的发生率。     

Stressors and counseling needs of undergraduate nursing students in Ibadan, Nigeria

Existing evidence suggests that nursing students have high levels of stress and that counseling and other support services should be made available to them. However, the stressors and counseling needs of undergraduate nursing students in Nigeria have yet to be explored. This study used a questionnaire to investigate the stressors, counseling needs, and desired counseling facilities of undergraduate nursing students at the University of Ibadan. Common stressors included excessive schoolwork, financial problems, inadequate recreational facilities, and overcrowded accommodations. There was an association between reporting inconsiderate, insensitive lecturers as stressors and evidence of psychological distress. Nearly 60% of the respondents felt counseling would help them, and most desired counseling for academics, finances, and relationships. Most (78%) of the respondents preferred an independent facility with trained counselors. Desired characteristics for the services included accessibility, affordability, confidentiality, and a friendly atmosphere. Educators and administrators should use this information to design counseling facilities for students.     

Acinic cell carcinoma of the parotid in children

The imaging findings of two children with acinic cell carcinoma of the parotid gland are presented. Ultrasonic features are emphasized. One of these children, a 6-year-old boy, suffers from the oculocerebrorenal syndrome of Lowe, a rare congenital, inherited condition manifested by defects of the nervous system (mental retardation, hypotonia), eyes (cataracts, glaucoma) and kidneys. To date, no known association exists between these two rare entities. The other child, a 10-year-old girl, was otherwise well. The ultrasound findings of both cases demonstrate features more classic for a benign intraparotid mass than for a potentially malignant lesion. The possibility of acinic cell carcinoma should be considered if a well-defined, relatively homogenously hypo-echoic intraparotid mass is encountered in a child, especially if cystic spaces are present.     

鼻咽癌局部复发分次立体定向放射治疗

目的　探讨分次立体定向放射治疗技术 ,在局部复发晚期鼻咽癌再程放疗中的应用。方法　 1997年 7月到 2 0 0 0年12月 ,采用分次立体定向放射治疗局部复发鼻咽癌 2 3例。所有病例均采用 6MVX线照射 ,设 1～ 3个中心 ,80 %剂量曲线将靶区完全包含。总剂量DT2 4～ 64Gy(中位剂量 5 2 .2Gy) ,单次剂量DT4～ 8Gy(中位剂量 6.4Gy)。 结果　局部复发鼻咽癌经分次立体定向放射治疗后 ,1年生存率为 78.3 % (18/2 3 )、2年生存率为 69.6% (16/2 3 )。 3 9.1% (9/2 3 )的患者随访期内死亡 ,其中死于局部复发 1例 ,死于远处转移 5例 ,鼻咽大出血 3例。结论　分次立体定向放射治疗用于局部复发鼻咽癌的治疗是安全有效的 ,但单次剂量和总剂量值得进一步研究。     

Ovarian cancer in Ibadan: characteristics and management.

Ovarian cancer has the highest case fatality rate among gynaecological cancers worldwide because of lack of effective screening methods and non-specific early warning symptoms with late presentation. A reinvigorated study is necessary in the developing countries because of a projected increase in its incidence. The decreasing fertility rate and increasing use of ovulation induction drugs are some of the reasons. The Ovarian Cancer Service of the Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Oyo State, Nigeria commenced the first longitudinal study of this malignancy from 1 December 1998 in order to establish a regional management and research centre. It is a questionnaire survey detailing the demography, clinical and staging laparotomy findings and histology of all confirmed cases. Twenty-one staging laparotomy and histologically confirmed ovarian cancer cases were managed from 1 December 1998 to 31 July 2002, about 1.5% of the 1387 gynaecological admissions. It is the third most common of the gynaecological cancers, representing 9.8% of the 214 cases. More than 60% of the patients were 50 years or younger. Only 19% were nulliparous, with 47.6% having had five or more deliveries. Only two patients (9.5%) had used the oral contraceptive pill, for a maximum period of 1 month. Only one patient (4.8%) had a positive family history of cancer. Abdominal swelling was the most common presenting symptom. Eighty-one per cent of the patients presented in Stages III and IV. Epithelial ovarian cancer constituted about 76.2% of the cases. Only 23.8% had adjuvant therapy, consisting of combination chemotherapy using cisplatin-based regimes. The case fatality rate 6 months after surgery was 76%. The ovarian cancer patients in this environment are younger and of higher parity than expected. The risk factors for this disease require further study.     

子癎前期发病类型与血栓前状态的关系

目的探讨子前期发病类型与血栓前状态的关系。方法选择2007年5月至2008年3月在中国医科大学盛京医院产科住院的105例子前期患者为研究对象,检测49例早发型子前期(早发组)、56例晚发型子前期(晚发组)患者及同期正常妊娠妇女52例(对照组)入院时纤维蛋白原(FIB),D-二聚体(DD),总蛋白(TP),白蛋白(A),丙氨酸转氨酶(ALT),天冬氨酸转氨酶(AST),血清肌酐(Scr),血清尿素氮(BUN),24h尿蛋白量(UP)等相关指标。结果(1)早发组与晚发组比较:FIB(g/L)(6.20±1.40对5.50±0.80),DD(μg/L)(454.93±326.72对390.67±123.47),ALT(U/L)(80.22±148.41对18.46±17.91),AST(U/L)(146.90±296.36对23.81±14.022),24hUP(g)(4.22±6.09对1.18±1.83),TP(g/L)(60.07±8.60对55.85±6.01),A(g/L)(32.30±4.23对31.07±3.05)均有升高(P<0.05)。(2)对照组FIB、DD、TP、A、ALT、AST、Scr(μmol/L)、BUN(μmol/L)、24hUP分别为4.27±0.90,378.05±242.25,61.22±5.19,34.49±2.60,8.37±3.08,16.01±3.88,57.01±6.95,3.05±0.82,0,早发组与之比较:FIB,DD,ALT,AST,Scr(67.6±13.57),BUN(4.28±1.66),24h尿蛋白量升高,TP、A均降低(P<0.05)。(3)晚发组与对照组比较:FIB,DD,Scr(71.09±31.85),BUN(4.47±1.61),24hUP升高,TP、A降低(P<0.05)。结论子前期患者都存在着血栓前状态和多脏器功能受损,其中早发型子前期的改变更为显著。