骨髓活检切片与涂片同步分析对诊断非霍奇金淋巴瘤骨髓浸润意义的探讨

非霍奇金淋巴瘤(NHL)是淋巴干细胞克隆性增殖性肿瘤,常常发生骨髓浸润(bone marrow infiltration BMI).临床将有BMI者归纳为Ⅳ期[1],对治疗方案的选择及判断预后均有重要意义.     

集体急性食物中毒的急救护理

1997年 1月至 1999年 12月 ,我院急救中心对 3批集体急性食物中毒 10 3例患者的抢救中 ,进行科学管理 ,采取迅速出诊、组织管理好病员、准确估计病情、就地抢救、安全运送、分组抢救、快速分流、妥善安置的急救措施 ,提高了工作效率 ,效果满意 ,10 3例患者无 1例死亡 ,现报告如下。1　临床资料本组共 3批 ,一批最多 6 0例 ,最少 12例 ,共 10 3名患者。其中男 6 8例 ,女 35例。最大 70岁 ,最小 6岁 ,平均 38岁。其中急性有机磷农药中毒 6 0例 ,毒蘑菇中毒 31例 ,急性毒鼠强中毒 12例 ,均为误食引起中毒。2　急救护理2 .1　迅速出诊医护人员接…     

护理干预对动静脉内瘘术的影响

自体动静脉内瘘是目前最常用的血液透析永久性血管通路,术前及术后医护人员和患者配合不当,将影响内瘘术的成功率.我科2008年1月～2010年5月对60例行动静脉内瘘术的病人进行护理干预,提高了内瘘术的成功率,减少并发症的发生,获得了较好的效果.现将体会介绍如下.     

子宫全切术与子宫次全切术对女性盆底功能的影响比较

目的比较子宫全切术与子宫次全切术对盆底功能的影响。方法选取全子宫切除术的患者40例(A组),次全子宫切除术的患者30例(B组),采用低频盆底肌诊疗仪,对两组患者进行盆底肌力测定,比较两组间盆底功能障碍的发生率。结果子宫全切术盆底肌力Ⅳ级以下18例(45.00%),明显高于次全子宫切除术组的4例(13.33%)。结论子宫全切术后盆底功能障碍的发生率明显高于子宫次全切除术;对确需行子宫切除的患者,应全面权衡宫颈去留的利弊,对没必要切除的宫颈,不要轻易切除,以提高患者术后的生活质量。     

磁共振弥散加权成像评价肝纤维化的临床病理对照研究

Objective To evaluate the clinical practical value of apparent diffusion coefficient (ADC) measurements based on diffusion-weighted MR imaging (DWI) for quantification of liver fibrosis and inflammation for hepatitis viral infection.Methods Diffusion-weighted MRI with parallel imaging was prospectively performed on 85 patients with chronic hepatitis and on 22 healthy volunteers within a single breath-hold using a single-shot spin-echo echo-planar sequence at b values of 100, 300, 500,800 and 1000 s/mm2 respectively. ADC values of liver were measured with five different b values. The inflammation grades and fibrosis stages were evaluated histologically by biopsy. One-way analysis of variance and Spearman' s rank correlation test were used for statistical analysis. Receiver operating characteristics analysis was used to assess the performance of ADC in predicting the presence of stage ≥2 and stage ≥3 hepatic fibrosis, and grade ≥1 hepatic inflammation. Results There was moderate negative correlation between hepatic ADC values and fibrosis stage. And the best correlation was obtained for a b value of 800 s/mm2 (r = - 0. 697, P=0.000). At all b values there was a significant decrease in hepatic ADC in patients with stage ≤1versus stage ≥2 fibrosis and stage ≤2 versus stage ≥3 fibrosis (P <0. 05). Hepatic ADC was a significant predictor of stage ≥2 and ≥3 fibrosis. The areas under the curve were 0. 909 vs 0. 917, sensitivity 76. 6% vs 80. 0% and specificity 88. 3% vs 91.5% (ADC with a b value of 800 s/mm2, 1.26 × 10<'3> mm2/s or less and 1.19 × 10-3 mm2/s or less). There was weak to moderate negative correlation between ADCs and inflammation grade. Hepatic ADC was a significant predictor of grade ≥1 inflammation with an area under the curve of 0. 781, sensitivity of 60. 0% and specificity of 86. 4% (ADC with a b value of 500 s/mm2, 1.54 × 10-3 mm2/s or less). Conclusion The D WI measurement of hepatic ADC can be used to quantify liver fibrosis and inflammation. It will be a new approach for early diagnosis and therapeutic follow-up of hepatic fibrosis.     

磁共振弥散加权成像评价肝纤维化的临床病理对照研究

Objective To evaluate the clinical practical value of apparent diffusion coefficient (ADC) measurements based on diffusion-weighted MR imaging (DWI) for quantification of liver fibrosis and inflammation for hepatitis viral infection.Methods Diffusion-weighted MRI with parallel imaging was prospectively performed on 85 patients with chronic hepatitis and on 22 healthy volunteers within a single breath-hold using a single-shot spin-echo echo-planar sequence at b values of 100, 300, 500,800 and 1000 s/mm2 respectively. ADC values of liver were measured with five different b values. The inflammation grades and fibrosis stages were evaluated histologically by biopsy. One-way analysis of variance and Spearman' s rank correlation test were used for statistical analysis. Receiver operating characteristics analysis was used to assess the performance of ADC in predicting the presence of stage ≥2 and stage ≥3 hepatic fibrosis, and grade ≥1 hepatic inflammation. Results There was moderate negative correlation between hepatic ADC values and fibrosis stage. And the best correlation was obtained for a b value of 800 s/mm2 (r = - 0. 697, P=0.000). At all b values there was a significant decrease in hepatic ADC in patients with stage ≤1versus stage ≥2 fibrosis and stage ≤2 versus stage ≥3 fibrosis (P <0. 05). Hepatic ADC was a significant predictor of stage ≥2 and ≥3 fibrosis. The areas under the curve were 0. 909 vs 0. 917, sensitivity 76. 6% vs 80. 0% and specificity 88. 3% vs 91.5% (ADC with a b value of 800 s/mm2, 1.26 × 10<'3> mm2/s or less and 1.19 × 10-3 mm2/s or less). There was weak to moderate negative correlation between ADCs and inflammation grade. Hepatic ADC was a significant predictor of grade ≥1 inflammation with an area under the curve of 0. 781, sensitivity of 60. 0% and specificity of 86. 4% (ADC with a b value of 500 s/mm2, 1.54 × 10-3 mm2/s or less). Conclusion The D WI measurement of hepatic ADC can be used to quantify liver fibrosis and inflammation. It will be a new approach for early diagnosis and therapeutic follow-up of hepatic fibrosis.     

CD3+ CD41+的急性白血病一例

患者,女,49岁,因浅表淋巴结肿大二月伴发热一月于2002年11月2日入院.患者于2003年9月不明原因的颈部、腋下及腹股沟淋巴结肿大,无痛,10月起伴发热37.6～38.2℃.     

磁共振弥散加权成像评价肝纤维化的临床病理对照研究

Objective To evaluate the clinical practical value of apparent diffusion coefficient (ADC) measurements based on diffusion-weighted MR imaging (DWI) for quantification of liver fibrosis and inflammation for hepatitis viral infection.Methods Diffusion-weighted MRI with parallel imaging was prospectively performed on 85 patients with chronic hepatitis and on 22 healthy volunteers within a single breath-hold using a single-shot spin-echo echo-planar sequence at b values of 100, 300, 500,800 and 1000 s/mm2 respectively. ADC values of liver were measured with five different b values. The inflammation grades and fibrosis stages were evaluated histologically by biopsy. One-way analysis of variance and Spearman' s rank correlation test were used for statistical analysis. Receiver operating characteristics analysis was used to assess the performance of ADC in predicting the presence of stage ≥2 and stage ≥3 hepatic fibrosis, and grade ≥1 hepatic inflammation. Results There was moderate negative correlation between hepatic ADC values and fibrosis stage. And the best correlation was obtained for a b value of 800 s/mm2 (r = - 0. 697, P=0.000). At all b values there was a significant decrease in hepatic ADC in patients with stage ≤1versus stage ≥2 fibrosis and stage ≤2 versus stage ≥3 fibrosis (P <0. 05). Hepatic ADC was a significant predictor of stage ≥2 and ≥3 fibrosis. The areas under the curve were 0. 909 vs 0. 917, sensitivity 76. 6% vs 80. 0% and specificity 88. 3% vs 91.5% (ADC with a b value of 800 s/mm2, 1.26 × 10<'3> mm2/s or less and 1.19 × 10-3 mm2/s or less). There was weak to moderate negative correlation between ADCs and inflammation grade. Hepatic ADC was a significant predictor of grade ≥1 inflammation with an area under the curve of 0. 781, sensitivity of 60. 0% and specificity of 86. 4% (ADC with a b value of 500 s/mm2, 1.54 × 10-3 mm2/s or less). Conclusion The D WI measurement of hepatic ADC can be used to quantify liver fibrosis and inflammation. It will be a new approach for early diagnosis and therapeutic follow-up of hepatic fibrosis.     

钆贝葡胺(Gd-BOPTA)增强MRI对肝脏局灶性结节增生(FNH)的诊断价值

目的 分析肝脏局灶性结节增生(focal nodular hyperplasia,FNH)在钆贝葡胺(gadobenate dimeglumine,Gd-BOPTA)增强MRI检查中的影像表现,评价Gd-BOPTA增强MRI对FNH的诊断价值.方法 采用GE Signal 1.5T磁共振扫描仪对15例FNH病例行Gd-BOPTA增强MRI检查.平扫行SE序列T1W1、FSE序列T2W1及FMPSPGR T1W1扫描.Gd-BOPTA静脉团注后先进行3个回合的FMPSPGR,序列动态增强T1W1扫描,并在团注后60min行肝细胞特异期FMPSPGR序列T1W1扫描1次.观察平扫、动态增强期及肝细胞特异期病灶的信号特征并分析FNH的影像特点.结果 15例FNH均为单发,大小为0.6cm～45cm.SE T1W1上10个为低信号,4个呈等信号,1个为略高信号;FSE T2W1上14个呈略高信号,1个呈等信号.动态增强动脉期13个病灶明显强化,1个轻度强化,门脉期和延迟期病灶均为等或略高信号,其中1个病灶在延迟期出现环形强化的假包膜.1个病灶动脉期无明显强化,门脉期呈略低信号,延迟期呈等信号.肝细胞特异期,6个病灶为略高信号,6个病灶呈等信号,3个为稍低信号.共8个病灶显示中心瘢痕,其中以肝细胞特异期显示率最高.结论 Gd-BOPTA增强MRI检查能反映病灶的血供特点,增强后60分钟肝细胞特异期的扫描更能为诊断提供重要的补充信息,进一步增强诊断的信心.     

多发性脾肿瘤的CT和MR诊断

目的探讨多发性脾脏肿瘤的影像学表现，提高多发脾占位病变良恶性的鉴别诊断水平。方法回顾性分析经临床、手术病理证实的32例多发性脾肿瘤的CT和MR表现，原发性肿瘤13例，转移瘤19例。结果恶性肿瘤CT常表现为实质性或囊实性低密度肿块，增强后原发性肿瘤呈实质部分明显或中度以上强化，转移瘤以边缘强化为主；MR表现：淋巴瘤结节于T1、T2大多均呈等信号，有时可表现为他低信号；增强后早期为低信号结节，延迟呈等信号。转移瘤T2WI极少数呈低信号。良性肿瘤以血管瘤和脉管瘤常见，CT多表现为低密度或囊性病变，增强后均匀强化或边缘呈晕状强化，血管瘤具特征性延迟强化。MR明显优于CT和动态增强CT，增强T2WI具有典型的“白炽灯”征。脉管瘤MR显示病变内含低信号分隔影，T1、他均呈高信号，增强无强化或部分边缘强化。结论认识多发性脾肿瘤的CT和MR表现，有助于临床鉴别诊断良恶性肿瘤或非肿瘤性病变。