社区精神病患者免费服药情况的调查

深圳市是国家"九五"精神病防治康复工作试点地区,从1999年开始开展社区精神病防治康复工作以来,精神病患者常规药物治疗均由社区健康服务中心免费提供.     

经导管动脉内温热化疗治疗卵巢癌疗效评估

目的探讨卵巢癌经导管动脉内热化疗的疗效。方法卵巢癌36例,均为失去手术机会或术后复发患者。随机分为治疗组(n=20)和对照组(n=16),治疗组经导管动脉内灌注加热至62℃化疗药液,对照组经导管灌注常温25℃的化疗药液。对比分析2组近期疗效、CA125动态变化,以及介入治疗后的毒副反应。结果治疗后,2组CA125均下降(Ρ<0.05),但治疗组下降更明显(Ρ<0.05)。治疗组有效率(70%)优于对照组(50%),但无统计学差异(Ρ>0.05)。白细胞Ⅰ～Ⅱ度下降等是动脉内化疗的主要不良反应,治疗组发生率20%(4/20),对照组31.3%(5/16),无统计学差异(Ρ>0.05)。结论经导管动脉内热化疗可进一步提高卵巢癌疗效,毒副反应轻。     

成人白血病中枢神经系统并发症的CT与MRI表现

目的 探讨成人白血病中枢神经系统并发症(CNSCL)的CT和MRI表现及其诊断价值.方法 回顾性分析18例经临床及手术病理证实的成人CNSCL的CT和MRI表现,其中急性淋巴细胞白血病7例,急性非淋巴细胞白血病10例,慢性粒单细胞白血病1例.CT平扫11例,其中增强1例;MR平扫16例,其中增强11例.结果 颅内受累14例:(1)颅内出血7例,其中脑内血肿4例,脑内血肿合并微出血1例,微出血2例.脑内血肿均为多发病灶.CT表现为团状高密度影;MRI表现为T1WI低信号或高低混杂信号,T2WI高信号或等高信号伴环状低信号环,病灶呈环形强化或无明显强化.脑微出血在磁敏感加权成像(SWI)上表现为多发斑点状及小条状低信号,其病灶检出率明显优于CT及MRI其他常规序列检查;7例中,伴脑梗死及蛛网膜下腔出血各1例.(2)颅内肿块5例:其中左额部内板下梭形病灶或跨颅板肿块2例,T1WI呈低信号,T2WI呈高低混杂信号,并有明显均匀强化,均见脑膜尾征;鞍区肿块1例,CT示鞍区高密度影,MRI示鞍区T1WI稍低信号,T2WI高信号,有不均匀强化;右侧脑室体旁肿块1例,T1WI、T2WI均呈等信号,有明显均匀强化.左额顶叶壁厚囊性肿块1例,呈环形强化.(3)梗阻性脑积水1例,表现为中脑导水管以上脑室系统扩张.(4)脑膜病变1例,MRI表现为广泛脑膜增厚伴明显均匀强化.椎管内病变4例:其中胸腰椎左侧椎旁软组织肿块2例,侵犯椎管内,伴邻近肋骨骨质破坏1例;椎管内肿块1例,表现为胸椎管后方梭形T1WI等高信号,T2WI等低信号灶,无明显强化;胸髓信号异常1例,表现为胸髓条状T2WI及液体衰减反转恢复(FLAIR)序列高信号影.结论 成人CNSCL影像表现多种多样,CT与MRI对该病的诊断价值相辅相成;白血病患者疑脑内病变者,建议常规使用SWI检查,以尽早发现脑微出血,降低脑内血肿发生的风险.

Abstract：

Objective To evaluate the CT and MRI findings and their diagnostic value of central nervous system complications of leukemia (CNSCL). Methods The CT and MRI findings of 18 adult patients with CNSCL proved by clinical features or pathology were retrospectively analyzed. Among 18 cases,7 were acute lymphocytic leukemia, 10 acute non-lymphocytic leukemia and 1 chronic myelomonocytic leukemia. Eleven cases underwent plain CT scan with one of them also receiving contrast-enhanced CT scan enhancement, 16 cases underwent plain MR scan with 11 of them receiving contrast-enhanced MR scan.Results Intracranial lesions in 14 cases: (1)intracranial hemorrhage was found in 7 cases, including intracerebral hematoma in 4 cases, micro-haemorrhage in 2 cases, and intracerebral hematoma accompanying by multiple intracerebral micro-haemorrhage foci in 1 case. All cases with intracerebral hematoma showed multiple lesions, which demonstrated high-density on CT images, and low or mixed signal on T1 WI, high- or intermediate signal with low-signal rim on T2 WI and ring enhancement or no evident enhancement. Microhaemorrhage manifested as multiple mini-mottling and strip hypointense foci on susceptibility weighted imaging, on which the detection rate of micro-haemorrhage foci was much higher than that on CT and other sequences of MRI. Among the 7 cases, one also had cerebral infarction and one subarachnoid hemorrhage.(2) Intracranial mass was found in 5 cases, among which two appeared as masses under or bestride cranium in the left frontal region with hypointensity on T1 WI, mixed signal on T2WI, strong homogeneous enhancement and dural tail sign;one showed a mass in saddle area, with high density on CT, slightly low signal on T1WI, high signal on T2WI and heterogeneous enhancement; one case displayed a mass near lateral ventricle with iso-intensity on T1 WI and T2WI and strong homogeneous enhancement; and one case manifested as cystic mass in the left fronto-apical lobe, with thick wall and ring enhancement (3)Obstructive hydrocephalus was found in 1 case, manifesting dilation of ventricles above the aquaeductus mesencephali. (4) Meningopathy was found in 1 case, manifesting diffuse thickening of meninges with strong homogeneous enhancement on MRI. Pathological changes of spinal canal was found in 4 cases among which two showed para-spinal mass involving vertebral canal and causing bone destruction of adjacent ribs; one case showed fusiform mass posterior to vertebral canal with high and intermediate signal on T1 WI and low and iso-signal on T2WI without enhancement; one showed zonale leison in thoracic cord with high signal on T2WI and fluid attenuated inversion recovery. Conclusion The radiologic manifestations of adult CNSCL are various and the role of CT and MRI for the diagnosis of CNSCL may complement each other. SWI is suggested as routine examination for patients of leukemia, in whom intracerebral lesions were suspected in order to find micro-haemorrhage as early as possible and reduce the risk of intracerebral hematoma occurrence.     

基因及免疫制剂瘤内注射并射频容式加热治疗肺癌

目的 评价CT引导下肺癌瘤体内直接穿刺注射基因及免疫制剂合并射频容式加热治疗肺癌的安全性和疗效.方法 中晚期周围型肺癌31例,临床Ⅲ～Ⅳ期,均无手术指征.在CT导引下,经皮穿刺瘤内注射H101和IL-Ⅱ液剂,第8、29、35、57、64天再次穿刺治疗,作为1个疗程.介入治疗期间辅以体外容式射频热疗,2次/周,共12次/人.1个疗程结束后4周,观察TSGF及瘤体的影像学变化,评价近期疗效.结果 近期疗效: CR 0例、PR 22例,NC 6例,PD 3例,近期有效率71%(22/31).治疗后,TSGF定量和阳性率均有下降,与治疗前相比,有显著统计学差异(P < 0.01).介入治疗术后4～48 h,患者均有不同程度的发热,出现率100%(31/31);局部胸痛,出现率54.8%(17/31).射频热疗中除有3人次胸背部出现脂肪硬结外,未见其他不良反应.结论 CT引导下瘤内直接穿刺注射基因、免疫制剂并容式射频加热治疗不能手术的中晚期肺癌,简便易行、副作用小、近期疗效良好.     

家兔饥饿死亡过程中肝脏~(31)P MRS磷代谢物变化特征与病理改变相关性研究

目的:探讨家兔饥饿死亡过程中肝内~(31)P磁共振波谱学(MRS)磷代谢物变化特征与病理改变相关性.方法:建立家兔饥饿死亡模型22只,分成2组,即病理组和MRS检测组.病理组12只:分成4个亚组,即正常对照组、过度饥饿组、濒临死亡组和死亡组,每组3只,取肝组织作病理检测.MRS检测组10只:分别于饥饿前、过度饥饿期、濒临死亡期及死亡期行~(31)P MRS检测4个阶段的磷代谢物含量变化,检测内容包括磷酸单脂(PME)、无机磷(Pi)、磷酸二脂(PDE)、三磷酸腺苷(ATP)的相对值,并与病理检测结果作对照分析.所有数据采用Kruskal-wallis H统计学方法进行非参数χ~2检验,并用Sperman方法进行等级相关性检验.结果:家兔饥饿死亡过程分的4个阶段,即从正常-饥饿-濒临死亡-死亡,4种肝内磷代谢物相对量从正常至死亡过程中均出现明显变化,经统计学分析均有显著性差异, χ~2值为23.13～35.41,P值均 < 0.01;ATP相对值与疾病严重程度呈负相关,即随着病程加重呈明显下降趋势至最后耗尽,其相对值分别为2.54±0.53、1.73±0.14、0.88±0.23、0.05±0.08,经等级相关性检验,r_s=1.0,P<0.01;而PDE和Pi相对值均呈正相关,即随着病程加重呈明显上升趋势,死亡后最高,PDE相对值分别为1.25±0.54、2.76±0.23、3.33±0.49、3.87±0.43,Pi相对值分别为0.42±0.02、0.65±0.05、0.89±0.15、0.99±0.08.经等级相关性检验,r_s= 1.0,P<0.01;PME相对值与病程无明显相关性,经等级相关性检验,r_s=0.4,P=0.6.家兔从正常-饥饿-濒临死亡-死亡4个阶段的病理改变为:肝细胞形态逐渐变小、数量减少;肝细胞肿胀、变性逐渐加重,并最终出现不同程度肝出血和肝细胞坏死.结论:~(31)P MRS可动态监测并准确反映家兔从饥饿到死亡过程中磷代谢变化特征,肝细胞的损伤程度与多种磷代谢物含量变化有明显相关性.