术前选择性血管栓塞减少脊柱转移瘤术中出血

目的:改变脊柱转移瘤治疗长期以来采用的姑息、保守的治疗方法。手术切除脊柱肿瘤后,给予坚强的内固定,辅以术后放化疗,可延长病人的生命,使病人无痛生存,提高了病人的生活质量。但由于脊柱转移瘤切除术中出血异常多,使手术切除肿瘤椎管减压内固定较难进行,为解决这一问题我们于1991年始用下述方法治疗脊柱转移瘤。方法:应用术前选择性脊柱血管栓塞,肿瘤切除椎管减压,内固定器材固定治疗脊柱转移瘤16例,取得了满意的效果。16例病人均为胸腰段转移瘤,均在术前48h行相应脊柱血管,胸段选择相应肋间动脉,腰段选择相应腰动脉进行栓塞,然后行胸段、胸腰段、腰段前路或后路肿瘤切除,椎管减压、内固定术。结果:16例病人术中出血平均900ml,出血量最少者仅600ml,出血量较未行血管栓塞病例明显减少,术野更为清晰、使术者更易操作;术后病人脊髓及神经根受压症状明显减轻,16例脊髓及脊神经根受压症状明显减轻,16例病人中8例脊髓及脊神经受压症状完全解除。结论:术前脊柱血管栓塞,手术切除肿瘤椎管减压内固定明显减少了术中出血、降低了手术风险、缩短了手术时间,是治疗脊柱转移瘤的安全有效的方法。     

Quantification of atherosclerotic plaque components using in vivo MRI and supervised classifiers.

In this work we aimed to study the possibility of using supervised classifiers to quantify the main components of carotid atherosclerotic plaque in vivo on the basis of multisequence MRI data. MRI data consisting of five MR weightings were obtained from 25 symptomatic subjects. Histological micrographs of endarterectomy specimens from the 25 carotids were used as a standard of reference for training and evaluation. The set of subjects was divided in a training set (12 subjects) and an evaluation set (13 subjects). Four different classifiers and two human MRI readers determined the percentages of calcified tissue, fibrous tissue, lipid core, and intraplaque hemorrhage on the subject level for all subjects in the evaluation set. Quantification of the relatively small amounts of calcium could not be done with statistical significance by either the classifiers or the MRI readers. For the other tissues a simple Bayesian classifier (Bayes) performed better than the other classifiers and the MRI readers. All classifiers performed better than the MRI readers in quantifying the sum of hemorrhage and lipid proportions. The MRI readers overestimated the hemorrhage proportions and tended to underestimate the lipid proportions. In conclusion, this pilot study demonstrates the benefits of algorithmic classifiers for quantifying plaque components.     

经皮血管内栓塞颅内动静脉畸形（附38例治疗效果观察）

经皮血管内采用氰基丙烯酸异丁脂（ＩＢＣＡ）栓塞治疗３８例颅内动静脉畸形（ＡＶＭ）病人。其中８例达到１００％完全栓塞，栓塞面积大于７５％的１０例，大于５０％者１１例；余下９例栓塞面积小于５０％，１９例以出血为首发症状，１１例以癫痫为首发症状，６例神经功能障碍，２例以头痛为主要症状。栓塞术后发生并发症５例，占１３％，无死亡病例。本文讨论了超选插管技术问题、Ａｍｙｔａｌ试验假阴性、导管粘连及正常灌注压突破。     

介入神经放射治疗43例

１９８５～１９９３年对４３例脑血管病及脑肿瘤患者应用介入神经放射治疗方法进行了５１次治疗，包括外伤性颈内动脉海绵窦瘘的球囊栓塞治疗８例；脑、脊髓血管畸形的栓塞治疗１７例；各种脑肿瘤术前栓塞７例；经皮穿刺血管内成型治疗脑供血动脉狭窄３例和脑胶质瘤超选择化疗８例，效果良好，介入神经放射治疗已成为重要的临床治疗手段，是某些脑血管疾病的首选治疗方法。     

Clinical course and outcome of cycloid psychotic disorder: a three-year prospective study

The course and outcome of cycloid psychotic disorder was explored by means of a prospective three-year follow-up of a sample of patients fulfilling the diagnostic criteria for the disorder provided by Perris & Brockington, compared to patients with a diagnosis of affective or schizoaffective disorder. The most striking difference between cycloids and affectives was the lack of manic episodes during the follow-up period in the former group. Moreover, the mean age at onset was lower in cycloids. No difference between these patient groups was observed with regard to outcome. Compared to schizoaffectives, cycloids showed several differences in the clinical picture during the index episode, and their symptomatological pattern was more consistent from one episode to another during the follow-up. Moreover, the outcome of cycloids was significantly more favourable than that of schizodepres-sives.     

关于卫生监督医疗纠纷类图书归类探析

指出第四版《中图法》中有关卫生监督、医疗事故、医疗纠纷等类目中存在的一些问题和不足,并提出具体改进措施和分类建议。     

Three-dimensional color Doppler sonography and uterine artery arteriography of fibroids: assessment of changes in vascularity before and after embolization.

OBJECTIVE: To assess the accuracy of three-dimensional color Doppler sonography and uterine artery arteriography in depicting changes in fibroid vascularity before and after embolization. METHODS: Preembolization and postembolization three-dimensional color Doppler sonography and selective uterine artery arteriography were retrospectively compared in 15 patients who underwent uterine artery embolization for treatment of symptomatic fibroids. Three-dimensional color Doppler sonography was performed by using a scanner with color power angiographic imaging capability. Vascularity was quantified by using an estimation of power-weighted pixel density as described by our group in previously published studies. Uterine artery arteriography was performed by using a standard selective microcatheter embolization technique. For purposes of comparison, fibroids were classified as either hypervascular or hypovascular relative to myometrial vascularity before and minutes to several hours after uterine artery embolization. Changes in fibroid vascularity (i.e., from hypervascular to hypovascular) as depicted by three-dimensional color Doppler sonography were compared with those shown on uterine artery arteriography and classified as being in agreement or disagreement. RESULTS: In 13 (87%) of 15 patients there was agreement; in 2 (13%) of 15 there was disagreement. In both cases of disagreement, three-dimensional color Doppler sonography showed collateral flow not depicted by uterine artery arteriography The mean reduction in quantitated vascularity after uterine artery embolization was 44% (range, 19%-78%). CONCLUSIONS: Three-dimensional color Doppler sonography accurately depicts fibroid vascularity and in some cases can reveal collateral flow not depicted by uterine artery arteriography.     

A Bayesian approach to subvoxel tissue classification in NMR microscopic images of trabecular bone

NMR microscopy is currently being used as an investigational tool for the evaluation of micromorphometric parameters of trabecular bone as a possible means to assess its strength. Since, typically, the image voxel size is not significantly smaller than individual trabecular elements, partial volume blurring can be a major complication for accurate tissue classification. In this paper, a Bayesian segmentation technique is reported that achieves improved subvoxel tissue classification. Each voxel is subdivided either into eight subvoxels twice the original resolution, or up to four subvoxels along the transaxial direction and the subvoxels optimally classified as either bone or marrow. Based on a statistical model for partial volume blurring, the likelihood for the number of marrow subvoxels in each voxel can be computed on the basis of its measured signal. To resolve the ambiguity of the location of the marrow subvoxels, a Gibbs distribution is introduced to model the interaction between the subvoxels. Neighboring subvoxel pairs with the same tissue label are encouraged, and pairs with distinct labels are penalized. The segmentation is achieved by maximizing the a posteriori probability of the label image using the block ICM (iterative conditional mode) algorithm. The potential of the proposed technique is demonstrated in real and synthetic NMR microscopic images.     

应用单克隆抗体(MoAb)对白血病免疫分型的临床研究

报告了应用单克隆抗体对25例淋巴细胞白血病、5例慢性粒细胞白血病及15例急性非淋巴细胞白血病进行免疫分型并与AB分型作比较,结果提示免疫分型可以弥补FAB分型的不足,它有助于白血病临床诊断、鉴别诊断、指导治疗和判断预后。     

Colonoscopic classification of internal hemorrhoids: Usefulness in endoscopic band ligation

Background:  Bleeding is one of the main symptoms of internal hemorrhoids. However, the conventional Goligher's classification of internal hemorrhoids does not consider the severity of bleeding. We intended to establish a useful method for evaluating internal hemorrhoids using a colonoscope that reflected the severity of the symptoms.
Methods:  Using a colonoscope in the retroflexed and forward viewing position, 104 patients with symptomatic internal hemorrhoids were evaluated based on the criteria of range, form and red color signs (RCS). Range was determined by the circumferential distribution of internal hemorrhoids and scaled from 0 to 4. Form was determined by size and scaled from 0 to 2. The presence of RCS was also evaluated. Symptoms were determined by interview and scaled from 0 to 3. Patients were treated by endoscopic band ligation (EBL) and were examined endoscopically before and 4 weeks after the treatment.
Results:  Before the treatment, range, form and RCS were significantly correlated to bleeding ( P <  0.01), and form was significantly correlated to prolapse ( P <  0.05). The endoscopic classification scores at 4 weeks after EBL improved significantly (range from 3.25 ± 0.05–0.56 ± 0.08 [ P <  0.01] and form from 2.81 ± 0.04–0.56 ± 0.07 P <  0.01).
Conclusion:  The new endoscopic classification of internal hemorrhoids proved to be closely correlated to symptoms, particularly bleeding, and thus highly useful in evaluating the effectiveness of the treatment.