经静脉二次谐波超声造影对正常兔肝造影分期的声学定量分析

目的　利用声学定量技术对正常兔肝的超声造影分期进行探讨。方法　对 10只健康大白兔进行二次谐波超声造影 ,观察经耳缘静脉注射造影剂时 ,门静脉主干血流阻断前后 ,肝组织声学定量 (AD)曲线形态及测值变化 ;及经耳缘静脉和经肠系膜静脉注射造影剂时 ,肝组织AD曲线形态及测值变化。结果　经耳缘静脉注射造影剂 ,正常兔肝组织AD曲线形态呈单峰形 ,近似直角三角形 ,可分为上升段、高峰段和下降段 ,峰值密度(PI)值为 (18.4± 1.7)dB。上升段为肝动脉期 ,高峰段和下降段均为门静脉期 ;门静脉主干血流阻断后 ,肝组织AD曲线形态与阻断前基本相似 ,但峰值略减低 ,其PI值平均减低 2dB。经耳缘静脉注射造影剂后 10～ 15s再经肠系膜静脉注射造影剂 ,肝组织AD曲线呈“驼峰征” ,第二个峰高于第一个峰。结论　正常兔肝声学造影肝动脉期短暂 ,门静脉期长。肝组织回声增强主要由于肝动脉来源造影剂所致 ,门静脉来源造影剂增强幅度低 ,仅起次要作用     

甘露醇作为口服对比剂用于小肠MR检查的技术研究

目的探讨甘露醇作为对比剂用于小肠MRI的价值。方法将20名志愿者随机分为两组,每组10人,分别口服目前研究较多的甘露醇混合液和2.5%甘露醇,行MR扫描,从扩张度、图像质量、不良反应几个方面对两组进行对比。结果从小肠平均扩张度和不良反应方面两者无显著统计学意义(P>0.05),从4、5、6段小肠的扩张度和图像质量方面对比,甘露醇混合液较2.5%甘露醇效果好,两者有统计学意义(P<0.05)。结论甘露醇作为对比剂用于小肠MR检查效果较好,甘露醇混合液对小肠的扩张效果和图像质量较2.5%甘露醇好。     

A Retrospective Review of the Frequency of Infections and Patterns of Antibiotic Utilization on a Palliative Care Unit

Various disease-related and therapy-induced factors make cancer patients susceptible to infections. The epidemiology and management of infections in neutropenic cancer patients and patients with primary hematological malignancies has been widely reported, but very few studies have characterized infections and their management in palliative care patients. We conducted a retrospective review of 100 consecutive admissions to an acute palliative care unit with the objective of assessing overall and site-specific frequencies of infections, the pathogens involved and their antibiotics sensitivities, and the pattern of antibiotic utilization. The mean age was 64 ± 11.5 years, the mean length of stay was 29.8 ± 28.2 days, and 70% of patients died on the unit. Only one case of neutropenia was identified. Fifty-five of the 100 patients were diagnosed with a total of 74 separate infections. The most frequent sites of infections were the urinary tract (39.2%), the respiratory tract (36.5%), skin and subcutaneous tissues (12.2%), and blood (5.4%). Fifty-four culture-positive infections were identified. Overall, the most common organisms were Escherichia coli (22.9%), Staphylococcus aureus (20%), and Enterococcus (11.4%). Fifty-three of the74 (71.6%) infections were treated with antibiotics. The decision-making process regarding treatment versus nontreatment of an infection can be complex in terminally ill patients and needs to be individualized. Symptom control is the primary objective in the majority of cases. The appropriate management of infections, with specific attention to measures that would improve patients’ quality of life, should be a research priority in patients with advanced cancer.     

自制脂质类超声造影剂肾增强效果的实验研究

目的探讨自制脂质类超声造影剂对正常兔肾的增强效果,以及不同显像方式、造影剂量对造影效果的影响与变化规律.方法 5只健康新西兰大白兔经耳缘静脉注射不同剂量的自制脂质类超声造影剂,剂量分别为0.01、0.03、0.05、0.08、0.10、0.13、0.15 ml/kg,每只兔各剂量均注射2次.用基波显像(FI)和实时造影匹配成像(CnTi)两种显像方式观察肾实质造影效果.结果 7种剂量水平均可使肾实质回声增强.CnTi随造影剂量增加肾实质增强强度提高,且增强时间延长.FI在上述各剂量水平肾实质峰值视频强度及增强时间均显著低于CnTi(P＜0.001).结论自制脂质类超声造影剂能够实现显著的肾实质增强效果,剂量-效应关系在CnTi造影中变化敏感,在FI造影中变化不敏感.     

自制脂膜氟碳声学造影剂对肾髓质血流灌注的评价及潜在价值

目的 探讨自制脂膜氟碳声学造影剂“脂氟显”评价肾髓质血流灌注的可行性及潜在价值。方法 10只健康家兔经耳缘静脉团注0．0lml／kg的脂氟显，采用视觉评分和视频分析，观察肾髓质的二维灰阶增强效果，并与皮质比较。结果 脂氟显能明显增强肾髓质的灰阶显像，但与皮质(持续52′)比较，持续时间较短(约2′20″)。结论 脂氟显可评价肾髓质的血流灌注，具有潜在的诊断价值。     

声诺维对心内膜缘显像的增强作用评价

目的：评价外周静脉注射造影剂声诺维(SonoVue)对心内膜缘显像的增强作用。方法：分别在基础和非线性成像条件下，对30例患者注射声诺维，用二维超声进行观察心内膜缘显像的改善。结果：造影剂在右心腔显影后立即在左心腔显影，原来显示欠清的左、右室心内膜缘得到满意的显影，且对心电图、血压、心率、血象、尿常规、肝肾功能、凝血酶原时间及活动度等均无影响，无不良事件发生。结论：声诺维是一安全的跨肺循环的的声学造影剂，可增强心内膜缘的显影。     

Analysis of focal spared areas in fatty liver using color Doppler imaging and contrast-enhanced microvessel display sonography.

OBJECTIVE: The purpose of this study was to investigate whether focal fatty sparing (FFS) formation in the liver relates to aberrant blood flow. METHODS: Sixty-three FFSs of the liver in 52 patients were examined by color Doppler flow imaging and contrast-enhanced microvessel display sonography. The 63 FFSs included 16 FFSs in the porta hepatis, 14 FFSs around the gallbladder fossa, and 33 other FFSs. The control group included patients with a diagnosis of fatty liver but no FFSs or focal lesions near the porta hepatis. RESULTS: Fourteen of 16 FFSs in the porta hepatis showed venous blood toward those areas that were differentiated from the portal and hepatic veins. Focal fatty sparings in the hilus hepatis correlated with aberrant veins, having a statistical significance compared with the control group (P < .0001). Seven of 14 FFSs around the gallbladder fossa contained blood vessels, 5 of them veins and the remaining 2 arteries. Two FFSs were located around hemangiomas. Three FFSs were located around maldeveloped vessels. CONCLUSIONS: The blood supply to an FFS in the porta hepatis may be correlated with aberrant veins. Focal fatty sparings around the gallbladder fossa may be associated with aberrant blood flow.     

肝海绵状血管瘤不同超声造影表现机制初探

目的探讨肝海绵状血管瘤(cavernous hemangiomas of the liver,CHL)超声造影(contrast enhance ultrasound,CEUS)不同强化形式产生的机制。方法经左肘静脉团注造影剂SonoVue2.4ml,观察5min,重点观察强化形式、时相、有无消退。结果37例44个病灶,根据强化形式分为4型,分别为型:结节状环形渐进性强化。型:细环状非渐进性强化。型:快速整体强化无消退。型:稀疏树枝状强化略消退。CHL造影表现与血流动力学密切相关,而血流动力学改变源自病理特征。当CHL窦腔大小不一时,CEUS呈环形渐进性强化,即所谓“早出晚归“的典型强化表现。因多数病例窦腔大小不等,故造影多呈此种表现。若CHL为均一细小血窦(直径&lt;50μm),常为高血流动力学改变,呈整体快速强化。当CHL窦腔明显增大,或窦腔内血栓形成、纤维化、透明样变、钙化时,CHL内血流量明显减少,甚至窦腔内无血流进入。窦腔间有小动脉穿行,强化时呈“树枝“状改变。结论CHL窦腔的大小是否均一,有无纤维化钙化等病理特点及由此产生的血流动力学改变,是CEUS不同强化形式产生的基础。     

合肥市54株产CTX-M型ESBLs大肠埃希菌和肺炎克雷伯菌耐药性分析

目的 了解合肥市产CTX—M型ESBLs大肠埃希菌和肺炎克雷伯菌耐药性。方法将我省细菌耐药性监控中心保留的54株产CTX-M型ESBLs的临床分离株大肠埃希菌和肺炎克雷伯菌与受体菌E．coli C600进行转移接合试验后，按照2004年NCCLS推荐标准，用琼脂稀释法分别测定野生株和转移接合子对14种不同抗菌药物的MIC，比较并分析两者的不同。结果24株大肠埃希菌和30株肺炎克雷伯菌分别有22株和30株接合成功，野生株的MIC结果显示对哌拉西林、头孢呋辛、头孢曲松钠的耐药率最高，达到100％，对亚胺培南全部敏感；转移接合子的耐药性较野生株有所下降，对氟喹诺酮类的敏感性明显增加。结论合肥市这些菌株所产生的CTX—M型ESBLs对头孢曲松钠和头孢噻肟钠具有超强水解能力，经转移接合试验后，接合子的水解能力有所下降，提示本地区产CTX—M型ESBLs大肠埃希菌和肺炎克雷伯菌中存在着多种耐药机制。