阴茎海绵体造影对静脉性阳痿的诊断价值

目的 探讨阴茎海绵体造影对静脉性阳痿的诊断价值。方法 对１０例正常人及９８例罂粟碱实验阴性患者进行阴茎海绵体造影,对比观察造影结果。结果 正常组：两侧阴茎海绵体呈均匀高密度显影,边缘光滑,对称,海绵体之间见一条状、宽窄一致的低密度影,为海绵体间隔,尿道海绵体未见显影。病变组：Ⅰ型：浅层静脉系显影８例（８．２％）;Ⅱ型：中层静脉系显影３１例（３１．６％）;Ⅲ型：深层静脉系显影１８例（１８．４％）;Ⅳ型：混合性静脉系显影４１例（４１．８％）。结论 阴茎海绵体造影是诊断静脉性阳痿的可靠方法,可准确显示静脉瘘的部位,指导临床治疗。     

阳痿的超声诊断分析

目的应用多普勒超声（DUS）技术观察阳痿（ED）患者阴茎血流情况,并进行诊断分型,为临床治疗提出指导性建议。方法对32例国际勃起功能评分（IIEF-5）为12．1-15．7（13．6±5．1）的ED患者,测定双侧海绵体动脉及阴茎背静脉内径、阴茎海绵体动脉收缩期最大血流速度（PSV）、舒张期最低血流速度（EDV）、阻力指数（RI）。阴茎海绵体内一次性注射（ICI）罂粟碱30mg＋酚妥拉明1mg 10min后,再次测定双侧海绵体动脉及阴茎背静脉内径、阴茎海绵体动脉PSV、EDV、RI、阴茎背静脉流速。应用SPSS12．0统计软件进行统计学分析。结果非血管性ED8例阴茎海绵体动脉PSV均≥35cm／s,RI≥1．0;阴茎背静脉常为间断低速静脉血流;15例为动脉性ED,阴茎海绵体动脉PSV均〈25cm/s,阴茎背静脉见间断低速静脉血流;6例为静脉性ED,阴茎海绵体动脉EDV均〉0cm／s,阴茎背静脉见持续静脉血流;3例为动静脉混合性ED,阴茎海绵体动脉PSV均〈25cm／s,阴茎背静脉见持续静脉血流。结论DUS检测阴茎海绵体动脉和阴茎背静脉血流并结合国际勃起功能评分（IIEF-5）是诊断阳痿疾病及其分型的有效方法。     

16层螺旋CT胆囊动脉血管成像初探

目的探讨16层螺旋CT血管成像（CTA）对胆囊动脉的显示能力。方法采用16层螺旋CT对100例良性胆囊疾病患者行胆囊动脉CTA检查,经两位高年资医生分别通过CT原始图像及MPR、MIP重建图像,观察胆囊动脉的起源、支数及走行。结果CTA图像上,95例显示胆囊动脉,5例未显示。胆囊动脉起源于肝右动脉83例、肝左动脉9例、肝固有动脉3例;1支分支71例,2支分支24例;14例在胆囊三角外走行,81例在胆囊三角内走行。结论16层螺旋CT可以显示胆囊动脉的起源、分支及走向,对减少腹腔镜胆囊切除术中出血及胆管、血管损伤有重要的指导价值。     

彩色多普勒超声对血管性阳痿及其分类的研究

目的探讨各类血管性阳痿的彩色多普勒血流特点.方法给36例各类血管性阳痿的阴茎海绵体内注入一定剂量的罂粟碱后,对其阴茎海绵体动脉和阴茎背静脉的彩色多普勒血流进行检测和分析,并把检测正常的10例非血管性阳痿设为正常对照组.结果 ①正常对照组阴茎海绵体动脉收缩期最大血流速度(PSV)均≥35 cm/s,阴茎背静脉常为间断低速静脉血流,当PSV>80 cm/s,特别是伴阴茎背静脉无血流显示时, 要特别提防阴茎异常搏起并发症的发生;②动脉性阳痿时阴茎海绵体动脉PSV均<35 cm/s,阴茎背静脉均见间断低速静脉血流;③静脉性阳痿时阴茎海绵体动脉PSV均≥35 cm/s,阴茎背静脉均见持续静脉血流;④混合性阳痿时阴茎海绵体动脉PSV均<35 cm/s,阴茎背静脉均见持续静脉血流.结论彩色多普勒超声检测阴茎海绵体动脉和阴茎背静脉血流对诊断各类血管性阳痿,以及提防阴茎异常搏起严重并发症的发生具有较为重要的价值.     

64层螺旋CT诊断下肢动脉闭塞性疾病的临床应用研究

目的：探讨64层螺旋CT血管造影在诊断下肢动脉疾病中的临床价值。材料和方法：对63例临床诊断为下肢动脉疾病病人行64层螺旋CT血管造影检查。其中52例做了DSA检查,11例行手术治疗并有术后病理。以CT横断面图像为基础,结合VR、MPVR图像,对病变进行分析然后将分析结果与DSA和手术与病理进行对照。结果：64层螺旋CT血管造影显示了所有检查动脉,其中动脉硬化性闭塞症51例（16例合并血栓形成）,血栓闭塞性脉管炎6例,动脉栓塞4例,多发性大动脉炎并动脉硬化性闭塞症2例。与DSA对比,64层螺旋CT血管造影显示主干血管的狭窄与闭塞,符合率达100%。对2级及其以上股动脉分支血管病变显示的阳性预测值为100%,阴性预测值为98.04%,灵敏度为97.22%,特异度为100%,符合率为98.84%。结论：64层螺旋CT血管造影能够清晰显示下肢动脉病变范围、形态、管腔内及管壁情况,还能对血管管腔狭窄程度进行分级,具有很高的临床应用价值。     

三维彩色能量血管造影成像在中老年动脉性阳痿中的应用

目的 探讨三维彩色能量血管造影成像在中老年阳痿患者诊断中的实用价值。方法 应用三维彩色能量血管造影成像于注射前列腺素E1前及注药后5min，对398例中老年阳痿患者及15例正常对照者的阴茎动脉进行检查。结果 注射药物后5min对照组阴茎动脉走行较直，空间结构清楚；阳痿患者的阴茎动脉走行纡曲，增宽，呈串珠状，且空间结构紊乱。结论 三维彩色能量血管造影成像能较清楚地显示阴茎动脉的走行情况，立体反映阴茎动脉分布特点，对阳痿的诊断及鉴别诊断有益。     

高流量性阴茎异常勃起的彩色多普勒与实时超声造影表现

目的通过研究高流量性阴茎异常勃起的彩色多普勒与实时超声造影表现,探讨其血流动力学变化和发病机制。方法观察6例高流量阴茎异常勃起患者的海绵体、窦状隙及海绵体动脉的超声表现,寻找假性动脉瘤部位。实时超声造影检查动脉瘘口,确定血液的高流入方式,分析阴茎海绵体的血流动力学变化。结果高流量性阴茎异常勃起的表现为：阴茎海绵体肿大,回声减低;窦状隙扩张,彩色血流信号增多;海绵体动脉呈高速低阻型血流频谱;假性动脉瘤形成,内可见涡流及喷射状血流信号。实时超声造影可直观显示瘘口处的喷射状血流,以及造影微泡流入阴茎海绵体的顺序,治疗后再次行超声造影可直观显示动静脉瘘和侧支循环形成。结论彩色多普勒超声和实时超声造影可明确高流量性阴茎异常勃起的诊断。     

不同输入参考动脉对CT灌注图像参数的影响研究

目的：探讨头CT灌注成像图像后处理中输入不同参考动脉对灌注参数的影响。资料与方法：收集35例行头CT平扫及头CT灌注成像的患者，包括8例正常者，27例单侧大脑中动脉区缺血患者，行常规头CT平扫后进行CT灌注成像，在图像后处理中，每例患者均进行3次图像后处理，3次后处理分别选择大脑前动脉、健侧（缺血患者）或左侧（正常组）大脑中动脉及患侧（缺血患者） 或右侧（正常组）大脑中动脉作为输入动脉，3次均选择上矢状窦作为输出静脉，分别在双侧皮质区绘制感兴趣区（ROI），记录3次生成的灌注图像各ROI的血流量值（CBF）、血容量值（CBV）及平均通过时间值（MTT），所得3组数据进行单因素方差分析。结果：在正常者中，3次后处理所获得的各参数值之间没有统计学差异（P>0.05），而在单侧大脑中动脉缺血的患者中，3次后处理所获得CBF及MTT值之间具有统计学差异（P<0.05），CBV值之间没有统计学差异（P>0.05）。结论：进行头CT灌注成像的后处理，在正常者中可以选择脑内任意较大的动脉，而在单侧大脑中动脉缺血患者中要尽量选择正常的大脑前动脉作为输入动脉。     

64层螺旋CT支气管动脉成像在原发性肺癌治疗中的临床价值

目的利用64层螺旋CT血管成像研究原发性肺癌患者的支气管动脉（BA）影像特征及其临床价值。方法搜集均经病理证实为原发性肺癌37例。采用64层螺旋CT胸部增强扫描获得原始图像,用容积显示（VR）、多平面重建（MPR）、最大密度投影（MIP）等后处理技术对肺癌的支气管动脉进行观察和分析。结果37例肺癌中有36例40支气管动脉能清楚显示,显示率为97．3％;分别有3支（7．5％）来源于主动脉弓;33支（82．5％）来源于降主动脉,4支（10％）与肋间动脉共干。均显示肺癌侧的支气管动脉管径和截面积较健侧增大。结论64层螺旋CT血管成像是一安全、无损伤、简便有效地支气管动脉影像显示方法;能真实显示肺癌的供血支气管动脉起源、数目、形态和走行。在原发性肺癌的诊断和治疗中具有重要价值。     

多层螺旋CT头颈部动脉血管成像35例分析

目的：探讨16层螺旋CT头颈部动脉血管造影技术。方法：头颈部CT血管造影35例,对比剂注射速率4 ml/s,薄层重叠重建,进行多平面重建（MPR）、曲面重建（CPR）、最大密度投影（MIP）、容积重建（VR）等图像后处理,显示头颈部动脉。结果：35例头颈部动脉血管显示良好,足以达到诊断要求。结论：选择合适的对比剂剂量、注射流率及扫描参数,熟练应用各种后处理方法可满意显示头颈部动脉。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.