兰州市口腔诊所空气消毒效果监测

目的了解口腔诊所治疗过程中室内空气质量状况,以便采取有效的防控措施。方法采用自然沉降法对兰州市部分口腔诊所消毒前后的空气进行采样和检测。结果兰州市口腔诊所室内空气在消毒处理前采样50份,合格11份,平均总合格率为22.0%。在消毒处理后采样55份,合格54份,平均总合格率为98.2%。结论口腔诊所室内空气污染严重,采取消毒措施处理后可明显改善空气质量。     

DWI结合时间-信号强度曲线评价乳腺病变性质的研究

目的：探讨MR扩散加权成像结合时间-信号强度曲线在评价乳腺病变性质上的应用价值。方法：对117例乳腺病患者的134处病灶同时行MR扩散加权成像（b值=800s／mm^2）和多时相增强MRI扫描。分别总结依据ADC值和时间-信号强度曲线评价乳腺良、恶性病变的统计学意义。统计综合考虑ADC值和时间-信号强度曲线类型评价乳腺良、恶性病变的敏感度、特异度和准确度。结果：以1．20×10^-3mm^2／s作为界值评价乳腺病变的性质,具有明显的统计学意义（P〈0．05）;以Ⅰ型曲线诊断乳腺良性病变,以Ⅱ、Ⅲ型曲线诊断乳腺癌,具有明显统计学意义（P〈0．05）。如单纯以ADC值≤〉1．20×10^-3mm^2／s且时间-信号强度曲线上表现为Ⅱ、Ⅲ型曲线来判定乳腺癌,而以ADC值〉1．20×10^-3mm^2／s且时间-信号强度曲线上表现为Ⅰ型曲线来判定乳腺良性病变,敏感度为82．7％,特异度69．8％,准确度77．6％。结论：应用DWI和时间-信号强度曲线对乳腺病变的良恶性进行评价具有重要价值。     

计算机辅助检测系统在乳腺癌X线诊断上的应用价值

目的:通过比较计算机辅助检测(computer-aided detection,CAD)系统对不同临床经验的放射科医生诊断准确率的影响程度,评价CAD系统在乳腺癌X线诊断上的应用价值.方法:选择131例患者的251幅数字化乳腺X线影像,采用ROC曲线在应用CAD和不应用CAD系统两种条件下,分别统计中级、初级影像诊断医生对乳腺癌的诊断符合率.结果:中级、初级影像诊断医生在使用CAD进行辅助检测之后的诊断符合率分别提高2.39%和7.57%;ROC曲线提示,中级、初级影像诊断医生应用CAD前后的乳腺X线摄影BI-RADS分级准确率分别提高2.5%和10.8%.结论:应用CAD技术能够极大地提高影像诊断医生,特别是初级影像诊断医生的乳腺X线摄影诊断的准确度,具有突出的临床应用价值.     

增强MR对脑转移瘤诊断的作用

目的通过MR增强扫描对脑转移瘤影像表现的分析,提高MR增强对脑转移瘤珍断重要性的认识.方法 MR成像使用ELSCINT0.5T超导磁共振系统,头线圈.收集30例平扫及增强后不同影像表现脑转移瘤作回顾性分析.结果平扫发现脑转移瘤25例,占83%(25/30).增强扫描均出现异常对比增强病灶.结论脑转移瘤是颅内常见恶性肿瘤.MRI增强扫描可以清楚地显示转移灶.     

术前MRI检查在乳腺癌治疗上的应用价值

目的探讨术前MRI检查在乳腺癌治疗上的应用价值。方法选择76例（77个乳腺）经病理证实为乳腺癌的患者,术前均进行了乳腺MRI检查,根据MRI提供的信息制定手术方案并实行手术。结果根据MRI提供的信息,对77个乳腺中的15个实行了保乳手术,62个实行了乳腺全切术;经病理证实MRI诊断了4个假阳性病灶,从而导致本可以保乳的3个乳腺实行了乳腺全切术。结论尽管MRI诊断存在假阳性会导致术式选择不合理,但在绝大多数情况下,乳腺癌术前MRI检查能够提供可靠的信息,对手术方案的制定具有重要的临床指导价值,应广泛应用于乳腺癌的术前检查。     

小儿人工晶体植入术的护理

小儿人工晶体植入术的护理樊绍华，赵英杰，尚琢（第一临床学院眼科）关键词儿童；白内障；人工晶体由于白内障的种类和程度不同，手术的时机及效果也不同，随我院开展了在吸皮质的基础上植入人工晶体手术，本文介绍我们的护理体会。１一般资料１９９３年６月～１９９４年...     

创伤性关节积脂血征的CT及MRI诊断

目的 分析创伤性关节积脂血征的CT及MRI表现特点，探讨CT及MR／对创伤性关节积脂血征的诊断价值。方法 回顾性分析50例创伤性关节积脂血征患者的CT及MRI的影像学特征。其中膝关节36例、髋关节8例、肘关节4例及肩关节2例。所有患者均于受伤后1h至4d内行CT及MRI检查。结果 50例创伤性关节积脂血征患者均存在关节内骨折，创伤性关节积脂血征的CT及MRI表现为在关节囊内特征性的单液-液平面或双液-液平面积液征象。其中22例表现为单液-液平面积液征象，28例表现为双液-液平面积液征象。构成单液-液平面上、下2层液体和双液-液平面的上、中、下3层液体有明显不同的CT值和所有扫描序列中MRI信号强度。结论 创伤性关节积脂血征的CT及MRI检查均有特征性表现，CT及MRI检查可明确诊断创伤性关节积脂血征，创伤性关节积脂血征与关节内骨折并存，可以作为关节内骨折的可靠的间接征象。     

多层螺旋CT在闭合性甲状软骨损伤诊断中的价值

目的 探讨多层螺旋CT(multi-slice spiral computed tomography,MSCT)扫描在闭合性甲状软骨损伤诊断中的成像方法及应用价值.方法 对闭合性甲状软骨损伤5例患者进行MSCT扫描,重建数据在Advantage Workstation 4.0工作站进行二维、三维图像处理.其中联合应用多平面重组(multi-planar reconstruction,MPR)4例次,容积重建(3D-volume reconstruction,3D-VR)3例次,仿真喉镜成像(computed tomography virtual laryngoscope,CTVL)1例次.结果 5例患者中发现甲状软骨左板骨折4例,右板骨折1例;其中合并环状软骨骨折1例,合并上气道狭窄1例.利用窄窗宽低窗位技术有助于显示软骨结构,本组4例利用MPR图像进行多角度观察,对显示骨折线的走行及移位能取得满意的效果.3例利用3D-VR图像显示软骨结构的空间改变,其立体效果能为临床医牛选择治疗方案提供依据.1例运用CTVL技术对上气道狭窄及狭窄程度做出明确诊断.结论 MSCT扫描能够清晰地显示闭合性甲状软骨骨折及上气道狭窄,选择合适的后处理技术或多种技术联合运用能够提供准确、直观的图像.     

院内急救气管插管138例分析

目的 总结院内急救气管插管的效果及经验.方法 138例根据不同病情、使用不同方法、应用辅助药物及特殊器械经口急救插管患者的临床资料分析.结果 138例院内急救经口气管插管均成功(成功率100％).6 min内129例,6 min以上9例；明视法126例,盲探法11例,使用气管镜光纤诱导1例；其中应用辅助药物30例,使用特殊器械13例.抢救成功58例(42％).结论 医院应全员培训,以经验丰富的麻醉医师为后援,在第一时间根据患者的病情选择正确的插管方法、合理使用辅助药物及特殊器械可提高气管插管的成功率,为院内急救赢得宝贵的时间.     

低能量放电下标测无室性早搏的流出道室性心动过速

Objective This study reported initial experience of a new mapping method for ablation of syncope-caused ventricular tachycardia (VT) without combining frequent premature ventricular contraction (PVC). Methods All 11 recruited patients were female, mean age (39. 9 ± 13.7)years. They had experienced at least 1 syncope episode and were refractory to 2 or more antiarryhthmic agents in the past 1 to 3 years. Results ( 1 ) Clinical arrhythmia characteristics: In 5 patients, PVC or VT was induced by programmed stimuli without intravenous isoproterenol in right ventricular outflow tract(RVOT). In these patients, Holter monitoring recorded more PVCs ( mean 3678 beats/24 hours) with ventricular bigeminy or trigeminy, but less VT (mean 5. 8 episodes/24 hours). These patients suffered more transient amaurosis than syncope except one older woman combining hypertension. While in other 6 patients, VT could not be induced with programmed stimuli unless isoproterenol was administrated. These patients all suffered syncope in their medical history, their Holter monitoring recorded more VT (mean 15.5 episodes/24 hours)less PVC (mean 1208 beats/24 hours )with few ventricular bigeminy or trigeminy. (2) Electrophysiologic mapping and catheter ablation: Induced PVC or VT were frozen on monitor screen as reference, ablation catheter was posited on expected area of RVOT, pace mapping was performed firstly and Low Radio Frequency(LRF) energy( 15 ～20 W)was delivered at sites that paced VT morphology identical to reference VT in all 12 leads of ECG. Once the sites was found that VT morphology induced by LRF was identical to reference VT in all 12 leads of ECG,the radiofrequency energy would be increased to 35 ～50 W(50 ～55℃ )on same site until VT was eliminated. Then enlarge ablation area to about 1 cm2 around this site. All 11 patients were induced identical VT during low radiofrequency energy. ( 3 ) No VT/PVC was induced through program stimuli or intravenous isoproterenol repeatedly after ablation was considered as successful end point. Ten patients reached the end of ablation in the procedure ,9 targets located at sepal or posterior wall in RVOT, 1 did base of right coronary cusp. The only failure one also could be induced frequent matched VT by LRF, activating mapping found the earliest activated site located in inferior of left coronary cusp. However,PVC couldn't be eliminated,which suggested the target may locate at the pericardial layer.(4)No syncope or amaurosis was observed in 3 ～ 14 months of follow-up. Conclusions Low energy stimuli mapping can be used as a new mapping method as well as active mapping, pace mapping and spike potential mapping, especially to those patients suffer from repeat syncope or amaurosis induced by VT without combining frequent premature ventricular contraction.