病毒性重症肝炎临床与病理分型比较——附12例报告

本文通过12例重肝的临床、病理诊断分型对照,发现单凭临床资料或肝脏穿刺法的病理学检查,在诊断上都有明显的失误。由于二者均可能受到片面性和局限性的影响,因此认为,只有根据临床和病理等多方面准确资料,综合判断,其结果最为可靠。     

Mr geometric distortion correction for improved frame-based stereotaxic target localization accuracy

We present a method to correct the geometric distortion caused by field inhomogeneity in MR images of patients wearing MR-compatible Stereotaxic frames. Our previously published distortion correction method derives patient-dependent error maps by computing the phase-difference of 3D images acquired at different TEs. The time difference (ΔTE = 4.9 ms at 1.5 T) is chosen such that the water and fat signals are in phase. However, ΔTE is long enough to permit phase wraps in the difference images for frequency offsets greater than 205 Hz. Phase unwrapping techniques resolve these only for connected structures; therefore, the phase difference for fiducial rods may be off by multiples of 2 π relative to the head. We remove this uncertainty by using an additional single 2D phase-different image with ΔTE = 1 ms (during which time no phase-wraps are typically expected) to determine the correct multiple of 2m for each rod. We tested our method in a cadaver and in a patient using CT as the gold standard. Targets in the frame coordinates were chosen from CT and compared with their locations in MR. Localizing errors using MR compared with CT were as large as 3.7 mm before correction and were reduced to less than 1.11 mm after correction.     

婴幼儿桡动脉穿刺的应用解剖学研究

目的：积累婴幼儿桡血管的解剖学资料，为临床婴幼儿桡动脉穿刺提供形态学基础。方法：在20例40侧婴幼儿尸体上肢防腐标本上和32例64侧婴幼儿活体上肢上，分别解剖和超声观测桡动脉、桡静脉和桡神经浅支的位置关系及血管的内径。结果：（1）桡动脉两侧有伴行桡静脉，桡神经浅支偏向桡动脉的外侧；超声诊断仪显示桡动脉、桡静脉无重叠现象。（2）桡动脉在前臂前区下1／3部变浅，可供穿刺的桡动脉暴露长度为（50．6±5．1）mm。（3）桡动脉、桡静脉的内径18～24月龄及25～36月龄分别为（1．43±0．08）mm、（1．52±0．07）mm及（0．78±0．07）mm、（0．87±0．12）mm。（4）皮肤表面距桡动脉前壁的深度18～24月龄及25～36月龄分别为（5．21±0．19）mm及（5．54±0．19）mm。结论：穿刺部位宜选在桡动脉暴露段上1／3处。     

A schematic atlas of the cerebellum of the rat

Thirty-two sagittal and 22 frontal sections of the albino rat cerebellum are shown. The illustrations are based on stained sections which were redrawn with help of a microprojector. The selection of sections emphasizes areas of the cerebellum which contain the cerebellar nuclei. Each section is provided with stereotaxic coordinates.     

Neurosurgical lasers for tumour removal

The early 1970s saw the birth of microscopic neurosurgery and the late 1970s the birth of laser neurosurgery. For more than 10 years now, laser radiations have been used during neurosurgical procedures: mostly for tumoral removal concerning essentially benign lesions. The reference laser has been and still is the CO₂ laser, which has a limited penetration into CNS tissues. Until recently the Nd-YAG laser was used with its normal spectral transition, 1.064 m. Because of its important diffusion in the CNS, it cannot be widely used except for shrinking large vascularized tumours such as meningiomas. The technological evolution has brought the laser specialists—physicists, medical doctors and surgeons—new concepts and new wavelengths which will progressively broaden laser applications and surgical procedures towards greater effectiveness, security and simplification. Holmium-YAG (2.1 m), Erbium-YAG (2.9 m) or long Nd-YAG wavelengths (1.44 or 1.32 m) have been studied by different teams. The 1.32 m Nd-YAG transition has been clinically used for about 2 years by a few neurosurgical teams (Beck in Munich, Roux in Paris, and more recently Lombard and Fasano in Torino, Ascher in Gratz).Laser radiations can be useful essentially during the removal of benign tumours, mostly if they are well vascularized and placed near functional structures such as the brain stem, the cranial nerves, the spinal cord: the CO₂ laser is most efficient for vaporization; 1.06 Nd-YAG is effective for coagulation; 1.32 Nd-YAG provides very satisfactory photoevaporation effects if used with a superpulsed emission, and/or with a focusing handpiece, it also has good haemostatic properties with a c.w. output.The development of new optic fibre conducted wavelengths appears to be a possible answer to new requisites which should lead to the development of endoscopic neurosurgery (intraventricular tumours, discal herniations) and sterotaxic laser surgery (deep-seated intra-cerebral lesions).     

CT引导胸椎旁阻滞治疗胸壁疼痛

目的：研究CT引导下胸椎旁阻滞治疗胸壁疼痛的扫描技术和治疗效果。方法：35例胸壁疼痛患者,术前均服用阿片类药物缓解疼痛,在CT扫描确认穿刺针达到椎旁间隙后,注射阿霉素,观察近期和远期疗效。对继续服用阿片类药物次数和不良反应,进行统计学处理。结果：CT扫描引导穿刺定位,注射阿霉素后,以再服用阿片类药物的减少量为疗效标准。停用和减少服用阿片类药物超过50％者,分别占62．86％和22．86％,结论：CT引导的胸椎旁阻滞,能使术者准确掌握进针方向和进针深度,通过注射造影剂能够观察药物分布范围,治疗胸壁疼痛,疗效显著,部分地代替了阿片类药物,使服用阿片类药物产生的副作用明显减少。     

CT导引下经皮穿刺治疗腰椎间盘突出症

本文着重介绍了ＣＴ导引下经皮穿刺治疗腰椎间盘突出的手术步骤及术前术后处理，认为这是一咱既简便、又安全的治疗方法；同时扩大ＣＴ介入治疗范围，充分发挥ＣＴ机效益的好途径。     

三级医院实行儿科穿刺会诊制度的效果分析

目的 利用穿刺会诊制度提高儿科护士穿刺的成功率,提升穿刺技术水平,减少患者投诉以及增加患者满意度.方法 选取2006年3月至2010年3月儿科门诊穿刺患儿200例,随机分为干预组和对照组各100例,干预组采取会诊制度,而对照组则不采取会诊制度.比较2组穿刺成功情况、患儿家属投诉及满意度情况.结果 干预组采用儿科穿刺会诊制度明显地提高了儿科护士穿刺的成功率、提升了儿科护士穿刺的技术水平、减少了患儿家属的投诉以及增加了其满意度,与对照组相比差异显著.结论 三级医院儿科穿刺会诊制度不但可以明显增加儿科患儿家长的满意度,同时也可以帮助提高医院儿科护士的穿刺水平和专业技术,具有良好的社会效益.     

CT三维重建辅助经皮肾镜取石术穿刺定位

目的探讨螺旋CT三维重建在经皮肾镜取石(PCNL)穿刺定位中的应用价值。方法从2006年7月至2007年5月,对36例复杂性肾结石患者术前行多层CT尿路造影,于肾盂相期行造影剂增强扫描,数据被分析后进行三维重建,以确定最佳穿刺径路。结果CT尿路造影可提供肾盂肾盏集合系统的清晰图像,并可发现结石和明确结石与肾盂肾盏集合系统关系,与常规图像相比较,三维重建更有利于确定经皮肾穿刺的部位。全部患者行经皮肾镜取石术,结石清除率为89.5%,无严重并发症发生。结论CT三维重建可准确预测结石数量、大小及其所在部位,对经皮肾镜取石术穿刺定位具有指导意义。     

经皮冠状动脉介入治疗后穿刺部位并发症的循证护理

经皮冠状动脉介入治疗(Percutaneous transluminal coronary intervention,PCI)是通过导管术将诊断或治疗用的各种器材送入心脏或者血管内,进行疾病诊断及治疗的方法。冠状动脉介入性治疗包