MSCT灌注成像在前列腺癌诊断中的初步研究

目的分析前列腺癌多层螺旋CT灌注成像的特点,探讨其在前列腺癌诊断中的初步临床应用价值.方法临床或手术病理证实的前列腺癌34例,前列腺增生65例,行病变中心层面灌注扫描,得到各组PF、PEI、TTP、BV值和TDC曲线,并对各组灌注值进行对比分析.结果 PC各灌注参数的平均值:PF为(32.5±10.86)mL/(min.mg)、PEI为(27.43±10.49)HU、TTP为(22.4±3.29)s、BV为(523.11±257.38)mL/g.与BPH组比较差异有统计学意义(P<0.05).平均PF>21 mL/(min.mg)PC组数量多于平均PF<21 mL/(min.mg)组,平均TTP<25 s PC组数量明显多于平均TTP>25 s组,差异具有统计学意义(P<0.05).结论 PC组呈现高灌注、早期强化特点;PF、TTP可以提供有价值的血流动力学信息,对PC的诊断及鉴别诊断具有一定的意义.     

超选择性脑动脉内插管灌注尿激酶治疗急性脑梗塞

采用超选择性脑动脉内插管灌注尿激酶溶栓治疗急性脑梗塞患者１１例，结果５例再通，６例部分再通。治疗前肌力０度者５例，Ⅱ度者２例，Ⅲ度者４例。治疗后肌力提高Ⅰ￣Ⅱ度者３例，提高Ⅲ度者２例，提高Ⅴ度者１例，肌力恢复正常者３例，死亡３例，总有效率７２．７％。并发颅内出血２例。     

Prone positioning improves distribution of pulmonary perfusion: noninvasive magnetic resonance imaging study in healthy humans

The purpose of this study was to evaluate the effects of prone positioning on pulmonary perfusion using flow-sensitive alternating inversion recovery (FAIR), a noninvasive magnetic resonance imaging technique that requires no contrast medium. Seven healthy volunteers were studied in the supine and prone positions under three respiratory conditions: normal breathing of room air, unassisted breathing of 45% O₂, and controlled mechanical ventilation (CMV) with positive end-expiratory pressure. Signal intensities (SIs) were obtained from ventral, middle, and dorsal regions on sagittal lung images and dependent/nondependent SI ratios were calculated to evaluate pulmonary perfusion distribution. In the supine position, SIs increased significantly from the ventral to dorsal region under all three respiratory conditions and prone positioning inverted the perfusion distribution under all conditions. Right lung SI ratios were 2.34 ± 0.29, 2.74 ± 0.66, and 2.42 ± 0.73 in the supine position and 1.68 ± 0.48, 1.78 ± 0.36, and 1.92 ± 0.21 in prone for room air, 45% O₂, and CMV, respectively. The difference between supine and prone positions was statistically significant. The left lung showed a similar pattern and the difference was significant only under CMV. No difference was observed between the different respiratory conditions in both lungs. This study demonstrated that the distribution of pulmonary perfusion was more uniform in prone than in the supine position.     

腰大池灌注林格氏液加脑室外引流治疗脑室出血的实验研究

目的 探讨腰大池恒压灌注林格氏液加侧脑室外引流治疗脑室内出血的安全性、可行性及疗效。方法 选用纯种比格犬10条做成脑室内出血的模型，模型建立后4h开始治疗，实验组5条，以2．96kPa(1kPa＝7．5mm Hg)的压力经腰大池灌注林格氏液，同时行侧脑室外引流；对照组5条，用侧脑室外引流的方法。两组在治疗过程中均严格监测颅内压(ICP)及生命体征，记录引流量及灌注量，经12h的治疗后处死动物并收集脑室内全部残余积血，比较两组标本含铁血红蛋白的吸光度值。结果 两组动物从模型建立后至处死前生命体征平稳颅内压波动不太。经12h的治疗，实验组的引流量明显多于对照组(P＜0．05)，实验组脑内残余积血量明显少于对照组，两组差异有显著性(P＜0．05)。结论 以2．96kPa的压力恒压灌注林格氏液于腰大池内，同时行侧脑室外引流治疗脑室内出血的方法安全可行，能更快地消除脑室内积血。     

Intra abdominal hypertension and the abdominal compartment syndrome

The patho-physiological significance of raised intra-abdominal pressure, known as Intra Abdominal Hypertension, with subsequent organ dysfunction and failure, known as Abdominal Compartment Syndrome, has recently been demonstrated to occur relatively frequently in mixed populations of critically ill patients. Clinical diagnosis is unreliable, so routine measurement of intra abdominal pressure should be undertaken, particularly in specific groups of patients known to be at high risk. Whilst definitive therapy requires surgical abdominal decompression, less invasive therapies have been investigated and, if initiated early, may help to minimise progression of the condition. Clearly defined indications for surgical intervention remain elusive however and require prospective investigation. This review summarises the patho-physiology of the syndrome, its diagnosis and surveillance, and current management strategies, both medical and surgical.     

Perfusion computed tomography could be a new tool for single-session imaging of ureteric obstructive pathology: an experimental study in rats

Background/Purpose

Perfusion imaging redefines computed tomography (CT) as a technique that can now depict vascular physiology in addition to detailed anatomy. The major clinical applications of perfusion CT are in acute stroke and oncology. Currently, there are very limited data on the application of perfusion CT in urology. The aim of the present study is to investigate the potential value of perfusion CT in anatomic and functional evaluation of obstruction in a single session on experimental hydronephrosis model in rats. Thus, we evaluate the perfusion CT in a new clinical application.

Methods

Twenty-eight rats were randomly allocated into 4 groups each consisting of 7 rats. At the third week of experimental intervention, postoperative renogram curves and perfusion parameters of the right kidneys' cortex and pelvis were assessed by CT. The right ureter was sutured as proximal complete obstruction in group 1, as distal complete obstruction in group 2, and as proximal partial obstruction in group 3. Group 4 served as the sham control group. Computed tomography was performed with single-slice tomography. Dynamic examination was performed with the help of perfusion software through contrast-enhanced tomography examination.

Results

In all study groups, the aorta time/density curves showed a rapid increase after a rapid decrease, and the duration to reach peak concentration in the normal kidney cortex was observed to be later than the aorta as expected. In groups 1, 2, and 3, the duration to reach peak concentration lengthened and the peak concentration values decreased. The time/density curves gradually increased as a result of the accumulation of the contrast agent in the pelvis, and a peak was observed at the end of the procedure in all study groups. In groups 1, 2, and 3, a statistically significant decrease (P = .01, P = .01, and P = .01, respectively) was observed in the peak concentration values of the contrast agent in comparison to group 4. The flow and blood volume values gradually decreased as the grade of the obstruction increased and the localization of the obstruction or grade of obstruction moved closer to the kidney.

Conclusion

In conclusion, perfusion CT technique, performed in a single session, is a useful method for anatomic visualization, together with functional evaluation, in the diagnosis of ureteric obstructive pathology of experimental hydronephrosis model.     

吡柔比星与其他灌注化疗药物预防膀胱肿瘤复发疗效比较的Meta分析

目的 比较吡柔比星与其他灌注化疗药物预防膀胱肿瘤复发的疗效. 方法检索Medline、EMBase、CBMDisc等文摘数据库以及PubMed、ScienceDirect、Lww、Springer、中国期刊全文数据库、中文科技期刊数据库等全文数据库,收集并按照纳入和排除标准筛选已发表的关于吡柔比星与其他膀胱灌注化疗药物预防膀胱肿瘤术后复发疗效比较的对照研究,提取纳入研究中关于复发的数据进行Meta分析. 结果共获得15个符合标准的研究.其中10个研究比较了吡柔比星和丝裂霉素的疗效,Meta分析显示,吡柔比星预防膀胱肿瘤复发的疗效显著优于丝裂霉素(OR=0.41,95%CI0.27～0.61,P＜0.01);6个研究分别比较了吡柔比星与噻替哌(OR=0.35,95%CI 0.11～1.13,P＞0.05)、阿霉素(OR=0.15,95%CI 0.03～0.76,P＜0.05)、表阿霉素(OR=0.53,95%CI 0.23～1.23,P＞0.05)、羟基喜树碱(OR=0.25,95%CI 0.10～0.64,P＜0.05)等药物以及空白对照组的疗效,统计学分析显示吡柔比星疗效显著优于羟基喜树碱、阿霉素以及空白对照组,而与噻替哌和表阿霉素疗效的差异无统计学意义. 结论吡柔比星能有效预防膀胱肿瘤术后复发,其疗效优于丝裂霉素、羟基喜树碱、阿霉素等药物,是新的可选择的膀胱肿瘤灌注化疗药物.     

肝脏体外灌流中直接灌流与间接灌流效果的比较研究

目的在体外肝脏灌流（ECLP）实施技术研究中，对直接灌流和间接灌流孰优孰劣一直存在争议。本实验拟就临床应用对这两种方法进行评价。方法实验动物供体均为普通健康长白猪，体重在20～30kg，雌雄不拘。一组受体是普通健康长白猪，标准与供体相同；另一组受体是普通健康狗，体重在20～30kg，雌雄不拘。随机分为2组，直接灌流受体为肝衰猪，间接灌流受体为肝衰狗：A组（直接灌流组，n=5）体外肝脏与受体间直接进行血液交换；B组（间接灌流组，72-4）体外肝脏用猪血液进行ECLP循环，受体血液自循环，两个循环间的血液通过中空纤维管进行物质交换。A、B两组进行ECLP灌流时间均为4h，肝衰时间为8h，8h后处死。观察体外肝脏和受体一般情况，体外肝脏的胆汁生成量、耗氧率等，受体的血氨、肝脏酶谱和血凝情况等指标。结果A、B两组在体外肝脏的胆汁生成量、耗氧率和受体方面均没有明显的差异（P〉0．05）。结论虽然直接灌注和间接灌注两者在体外肝脏的存活和灌注效果方面没有明显的差异，但考虑到间接灌注在异种灌注中具有伦理学压力较小的诸多优点，而临床应用又以异种灌注为主，故临床应用时仍推荐应用间接灌注。     

改良式供肝获取在原位肝移植中的临床应用

目的 介绍改良式供肝获取的方法及经验,完善供肝获取技术,提高供肝质量.方法 自1999年1月～2006年8月共在35例次新鲜尸体上采用改进的方法获取供肝,其中26例次为模拟实验,灌洗液全部应用0～4℃乳酸林格氏液.5例次实施背驮式肝移植术,4例次实施经典式肝移植术.腹主动脉插管灌洗后,立即结扎肠系膜上血管,减少灌洗液的分流;根据不同时限调整门静脉灌注UW液的速度,延长灌注时间;修肝过程中再缓慢灌注0～4℃UW液1000ml.结果 35例次所获取的供肝均颜色苍白,质地柔软,各种管道均满足手术吻合需要.热缺血时间为5～8min.9例肝移植病人无手术死亡,供肝功能发挥良好,节约UW液用量约1000ml.结论 供肝获取的改良式方法较常用的经典式方法有明显优越性.