Benefits of the DICOM Structured Report

Recently, the digital imaging and communications in medicine (DICOM) standard introduced rules for the encoding, transmission, and storage of the imaging diagnostic report. This medical document can be stored and communicated with the images in picture archiving and communication system (PACS). It is a structured document that contains text with links to other data such as images, waveforms, and spatial or temporal coordinates. Its structure, along with its wide use of coded information, enables the semantic understanding of the data that is essential for the Electronic Healthcare Record deployment. In this article, we present DICOM Structured Report (SR) and discuss its benefits. We show how SR enables efficient radiology workflow, improves patient care, optimizes reimbursement, and enhances the radiology ergonomic working conditions. As structured input significantly alters the interpretation process, understanding all its benefits is necessary to support the change. Biography Rita Noumeir is a professor at the Department of Electrical Engineering of the University of Quebec, école de Technologie Superieure in Montreal. A founding member of the Imaging, Vision, and Artificial Intelligence Laboratory (LIVIA), her main research interest is the Healthcare Information Technology, specifically, Interoperability, Electronic Patient Record, Security, Information Confidentiality, and Image Processing. As a member of both Technical and Planning International IHE Radiology Committees, Dr. Noumeir took part over the last 5 years in developing many Integrating the Healthcare Enterprise (IHE) Integration Profiles in Radiology and in organizing several Integration Demonstrations. She is a cofounder of IHE Canada. Dr. Noumeir contributed to many research and development projects in collaboration with several Canadian and international companies in medical imaging and healthcare information. Currently, she collaborates with the Diagnostic Imaging Team of Canada Health Infoway to define the principles and architecture for sharing imaging information between multiple healthcare institutions. She plays a leading role in the development of this solution that is published as an IHE Integration Profile for which she is the editor. Rita Noumeir holds a Ph.D. and a Masters degree in Biomedical Engineering from école Polytechnique of Montreal specializing in Medical Imaging. She is a professional engineer, and a member of the Ordre des ingénieurs du Québec.     

NSCLC患者血清肿瘤标志物水平与肿瘤骨转移之间关系的研究

目的:探讨非小细胞肺癌患者治疗前血清肿瘤标志物水平与肿瘤骨转移之间的相关性。材料和方法:受检患者58名治疗前均行血清Cy21-1、SCC、NSE、CEA和CA15-3测定和SPECT全身骨显像。结果:血清Cy21-1和CA15-3水平与全身骨显像结果相关。(P<0.05),血清SCC,NSE及CEA水平则无相关(P>0.05)。结论:血清中Cy21-1和CA15-3升高水平与肿瘤骨转移之间存在正相关关系,尤以Cy21-1为著。     

Hospital visiting in obstetrics and gynecology: a tool for the advancement of training.

OBJECTIVE: To assess the improvement of obstetric and gynecologic training brought about by peer influence in Europe. METHODS: In 1996, the European Board and College of Obstetrics and Gynecology (EBCOG) initiated a visiting process by international and local peers to improve training and decrease differences in health care standards. RESULTS: A large number of visits of obstetrics and gynecology departments have been conducted across Europe at teaching hospitals by the Hospital Visiting Committee. Compliance with the structured approach of the visiting policy and problems met during these visits are reported. CONCLUSION: The program focuses on the continuous improvement of the competencies of all persons trained in the obstetrics and gynecology departments of teaching hospitals throughout Europe. It also increases the understanding of diversity in training methods and can gradually lead to the convergence of training and health care standards in Europe.     

住院患者精神药品使用情况调查分析

目的:了解我院住院患者应用精神药品的现状及趋势,为临床合理用药提供参考。方法:对我院住院患者2001年~2005年精神药物的销售金额、用药频度(DDDs)、药品限定日费用等进行统计分析。结果:精神药品销售金额和用药频度逐年增加,年增长率分别为25.76%、37.58%、87.03%、145.61%,药品限定日费用逐年上升。结论:应用精神药物人数增加较快,销售金额增加明显,对现有的精神药品应加强不良反应监测。     

扶正调平汤减轻化疗毒副反应的临床观察

目的研究在化疗过程中运用扶正调平汤对减轻肿瘤患者的骨髓抑制，消化道症状等化疗副反应的作用。方法通过临床对60例手术及非手术胃癌患者随机分成两组，即治疗组和对照组，观察化疗前后两组的血象变化、消化道反应情况，及其生活质量进行评定，比较、分析。结果实验证明化疗同时配合扶正调平汤对改善化疗副反应的作用显著化于对照组（P〈0．05）。结论说明扶正调平汤对减轻化疗毒副反应方面具有较好的临床疗效。提高了患者生活质量，使惠者顺利完成化疗疗程。     

4例着色于皮病伴发鳞状细胞癌临床病理分析

目的：探讨着色干皮病（xeroderma pigmentosum，XP）伴发鳞状细胞癌（squamous cell careinoma，SCC）的临床病理特点。方法：采用组织病理学方法对1993年～2004年间收集的XP伴发SCC患者进行分析。结果：4例中，男性1例，女性3例。发病年龄最小1岁，最大4岁，平均2．5岁。并发肿瘤年龄，最小7岁，最大18岁，平均12．8岁。其中有明确近亲婚配者2例（50％）。4例患者临床症状及病理结果均典型。结论：XP为常染色体隐性遗传性皮肤病，是一种癌前病变，以早年并发恶性肿瘤为其特征，其中以鳞状细胞癌和基底细胞癌最为常见。与皮肤损害和紫外线损伤程度密切相关。     

Action of intravenously administered talipexole on the rat striatal neurons receiving excitatory input from nigral dopamine neurons

Electrophysiological studies using rats anesthetized with chloral hydrate were performed to elucidate whether or not intravenously injected talipexole acted as a D₂ receptor agonist on the striatal neurons in comparison with the action of bromocriptine. The activities of the striatal neurons were extracellularly recorded using a glass microelectrode attached along a seven-barreled micropipette, each barrel of which was filled with talipexole, bromocriptine, SCH23390 (D₁ antagonist), domperidone (D₂ antagonist), glutamate or 2 M NaCl. These drugs were iontophoretically applied to the immediate vicinity of the target neuron being recorded. The effects of talipexole and bromocriptine were examined on the neurons, whose spikes (induced by the stimulation of the substantia nigra pars compacta) were inhibited by the iontophoretic application of domperidone. Iontophoretic application of talipexole or bromocriptine increased spontaneous firing of these neurons and this increase in firing was also inhibited by iontophoretically applied domperidone. In the same neurons, intravenously administered talipexole (0.01, 0.02 and 0.04 mg/kg) dose-dependently increased firing, and this increase was inhibited by microiontophoretically applied domperidone, but not by SCH23390. On the other hand, the intravenous injection of bromocriptine (0.1, 0.2 and 0.4 mg/kg) also increased the firing rate. However, the increase was not dose-dependent and fluctuated; the firing transiently decreased during the increase in firing with intravenously administered bromocriptine. However, the bromocriptine-induced increase in firing was also suppressed by domperidone, and decrease in firing was inhibited by SCH23390. These findings suggest that talipexole acts as a D₂ agonist on the striatal neurons receiving input from substantia nigra pars compacta and increases firing when intravenously applied. However, intravenously administered bromocriptine appears to act as both a D₂ agonist and probably as a D₁ agonist on the striatal neurons to increase and decrease firing, respectively.     

中西医结合治疗慢性肾炎疗效观察及其与血液流变学和微循环的相关意义分析

本文对比观察了中西医结合治疗与单纯西药治疗慢性肾炎的临床疗效,结果表明,前者缓解率及总有效率分别为79.8%和92.1%,显著高于对照组(均P<0.01)。治疗组各临床类型及各中医证型的疗效亦均明显高于对照组相对应的各型肾炎(P<0.05～0.01)。治疗组各型肾炎之血液流变学及甲皱微循环改善均较对照组为显著。两组中完全缓解加基本缓解者,该两类检查指标改善极为显著(P<0.05～0.01),而好转及无效者则无明显改善(P>0.05)。提示临床疗效与之密切相关。     

FRANTZ'S TUMOUR: PAPILLARY AND CYSTIC CARCINOMA OF THE PANCREAS

Frantz's tumour (papillary and cystic tumour) of the pancreas is a rare neoplasm usually seen in young women. It is of low grade malignancy and deserves special note among pancreatic malignancies as it is frequently amenable to local resection and has a good long-term survival rate after excision. Three such cases have been treated at Westmead Hospital, one young male and two females. In two the disease was confined to the pancreas. In one, local invasion outside the pancreas and trans-coelomic spread to the ovaries was present at the time of diagnosis. Complete surgical removal of macroscopic disease was achieved in all three and all remain disease free between 2 and 4 years post-surgery. All have good exocrine and endocrine pancreatic function. These cases are discussed in detail. The need to be aware of this uncommon variant of pancreatic cancer is stressed. Investigation and treatment options are reviewed. The role of cytology studies in diagnosis and the potential for long-term surgical control of this tumour are highlighted on the basis of our limited experience and that presented in recent surgical literature.     

Strecker stent in stenotic hemodialysis Brescia-Cimino arteriovenous fistulas

Flexible tantalum stents (Strecker) were used as an adjunct to percutaneous transluminal angioplasty (PTA) in the treatment of stenotic arterial or venous limbs of Brescia-Cimino hemodialysis fistulas. The diagnostic procedure was performed using retrograde fistulography. After PTA with unsatisfactory results, stents were placed in 5 patients with significant residual stenoses and poor fistula function. Within the mean follow-up period of 6.4 months (range 3–10 months) all fistulas were functioning. We conclude that Strecker stent is useful in the treatment of stenotic hemodialysis arteriovenous fistulas as an adjunct to PTA.