18F-FDG PET/CT显像监测胃癌术后复发转移的价值

Objective PET with 18F-fluorodeoxyglucose (FDG) has been used to beth detect and stage a variety of malignancies. The aim of this retrospective study was to evaluate the clinical value of 18F-FDG PET/CT for recurrence and metastasis in gastric carcinoma patients after total gastrectomy. Methods A total of 45 gastric carcinoma patients who underwent total gastrectomy were included. PET/CT scans were obtained for restaging. The " gold standard" of 18F-FDG PET/CT diagnostic accuracy was based on either histopathology or clinical follow-up. By using the t-test from SPSS 11.5, the cut-off of maximum standard-ized uptake values (SUVmax) from 18F-FDG to differentiate benign from malignant lesion at stomach were determined and calculated. Results (1) Of the 45 patients, 22 were suspicion recurrent lesion at stomach. Of the 22 patients, 12 were confirmed to have recurrent lesions. The diagnostic accuracy were 100.0% (12/ 12) for sensitivity, 70.0% (7/10) for specificity, and 86.4% (19/22) for accuracy, respectively. A higher SUVmax in malignant than benign lesion was noted (6.27 ± 3.42 vs 3.92 ± 2.24), though not reached to the significance (t = 1. 862, P > 0.05). (2) For extra-gastric lesion detection, the sensitivity, specificity, and accuracy for region lymph nodes were 78.9% (15/19), 92.3% (24/26), and 86.7% (39/ 45), for peritoneal spreading were 6/9, 97.2% (35/36), 91. 1% (41/45), and for distant sites were 86.7%(13/15), 93.3% (28/30), 91.1% (41/45). (3) False positive were found in eight sites. All were either inflammatory or physiological uptake at intestine. False negative were found in nine sites. Either due to small in size (less than 1.0 cm in diameter), well differentiation of the tumor cell or with a nature of signet ring. Conclusion 18F-FDG PET/CT had a potential to detect local, regional, and distant metastasis in gastric cancer.     

肺癌原发灶FDG摄取预测转移的初步研究

目的:观察分析肺癌患者原发灶脱氧葡萄糖(fluorodeoxyglucose,FDG)摄取与诊断时的淋巴结及远处转移状态的关系.方法:共收集到确诊为肺癌并治疗前行FDG-PET/CT检查患者208例,确定其原发灶大小(CT测量的最大径)、FDG;摄取值(最大标准化摄取值,即SU-Vmax)和转移状态.并分为无转移组、仅淋巴结转移组和远处转移组,分析原发灶FDG摄取与原发灶大小和转移情况等的关系,采用Logistic回归分析影响转移的因素.结果:原发灶大小与SUVmax呈正相关性,r=0.613,P:0.000.3组的原发灶大小差异无统计学意义(P=0.078).而SUVtnax差异有统计学意义.P=0.008;其中无转移组SUVmax小于仅淋巴结转移组(P=0.041)和远处转移组(P=0.002),后两组间差异无统计学意义,P=0.298.Logistic回归分析表明,SUVmax是唯一影响转移的因素.SUV-max每增加1单位,发生转移的风险增加1.112倍,P=0.032.结论:肺癌原发灶SUVmax增高则发生淋巴结或远处转移的风险增加,提示FDG摄取值可能作为一个预测转移的指标.     

Correlations of 99Tcm-HL91 SPECT hypoxia imaging with HIF-1α and VEGF expression in non-small cell lung cancer

Objective 99Tcm-HL91(99Tcm labeled 4,9-diaza-3,3,10,10-tetramethyldodecan-2,11-dione dioxime)is a potential noninvasive marker of tumor hypoxia.It has been reported that 99Tcm-HL91 has validity for hypoxia imaging in non-small cell lung cancer(NSCLC).The aim of this study was to evaluate the 99Tcm-HL91 SPECT hypoxia imaging of NSCLC,the expression of inducible hypoxia factor-1α (HIF-1α)and vascular endothelial growth factor(VEGF),and to analyze their correlations with clinicopathological characteristics.Methods Twenty NSCLC patients who underwent radical resection were enrolled into this study prospectively.99Tcm-HL91 SPECT scanning was performed in all patients at one or two days before surgery.After intravenous injection of approximately 740 MBq 99Tcm-HL91,anterior,posterior and lateral planar images were collected at 2,4 and 6 hours,respectively.Regions of interest (ROls)were drawn in the tumor and the contralateral normal lung tissue,and the radioactivity ratio of tumor to normal tissue(T/N)was calculated.Immunohistochemistry was used to detect the expression of HIF-1α and VEGF in sequential histological sections of specimens.Results Among the 20 NSCLC patients,13 showed positive expression of HIF-1α and 15 had positive expression of VEGF,with a positive rate of 65.0% and 75.0%,respectively.The uptake of 99Tcm-HL91 was strongly correlated with the expression status of HIF-1α.No correlation between HIF-1α and VEGF expression levels was observed.The HIF-1α expression level was not correlated with histological subtype,but with lymph node involvement.The expression levels of HIF-1α and VEGF were positively correlated with tumor stage.Conclusion The result of 99Tcm-HL91 SPECT hypoxia imaging is found to be positively correlated with expression of HIF-1α in the non-small cell lung cancer.HIF-1α expression is positively correlated with VEGF expression.Furthermore,both HIF-1α and VEGF expressions are increasing with the increase of tumor stage.     

电子鼻咽喉镜直视下环杓关节拨动复位术治疗环杓关节脱位的疗效分析

目的 探讨电子鼻咽喉镜直视下环杓关节拨动复位治疗的疗效,为环杓关节脱位的治疗提供参考.方法 回顾性分析2016年9月—2021年3月收治17例明确诊断为单侧环杓关节脱位并在局部麻醉下经电子鼻咽喉镜直视下环杓关节拨动复位术的患者临床资料,比较拨动复位前后电子鼻咽喉镜检查、发声障碍指数量表(VHI-10)及听觉感知(GRA...     

瑞芬太尼与芬太尼在全身麻醉中应用对比分析

目的:研究并探讨瑞芬太尼与芬太尼在全身麻醉中的应用效果。方法:选择我院2012年2月-2013年2月间确诊收治的100例各类外科手术患者,按数字随机分为对照组与观察组各50例,从麻醉诱导、麻醉维持到术后镇痛,对照组患者采用芬太尼6μg/kg,观察组患者采用瑞芬太尼1μg/kg,观察两组患者的平均动脉压、心率以及苏醒时间等,并对结果进行对比分析。结果:研究结果显示,观察组患者诱导期和术中平均动脉压以及心率波动均小于对照组,术后苏醒、拔管时间以及术后需镇痛病例均少于对照组,组间相比差异具有统计学意义(P0.05)。结论:相比芬太尼,瑞芬太尼在手术麻醉中的用量较少,起效快,术后患者意识恢复快,效果更优。     

对口腔医疗标准化收费方法的设想

随着医疗卫生事业改革的深入,医疗服务收费的标准化管理已成为经济学家和医院管理人员瞩目的问题。如何能让病人花最少的支出得到康复,达到医院社会效益和经济效益的统一,是我们从事医院管     

麻醉后恢复室病人常见并发症的原因分析及处理

目的 探讨麻醉后恢复室（PACU）病人常见并发症的原因及处理.方法 回顾性分析PACU记录完整的1575例次发生并发症的原因及处理.结果 PACU并发症发生率为31.63%,其中并发症以循环不稳定、心律失常、舌后坠、恶心呕吐、寒战、躁动发生率高,其原因主要与术前准备欠佳、麻醉操作管理不完善、恢复室处理欠妥等有关.结论 充分的术前准备、完善的麻醉管理、妥当的PACU处置,有利于降低PACU并发症的发生率及死亡率,对提高恢复室病人的安全性有重要意义.     

18F-FLT联合18F-FDG PET/CT显像对纵隔淋巴结良恶性的诊断价值

目的 评价18F-FLT联合18F-FDG PET/CT显像对肺部恶性肿瘤患者纵隔淋巴结良恶性的诊断价值.方法 回顾性分析2009年4月至2011年10月全国11个PET/CT中心18F-FLT与18 F-FDG PET/CT显像的患者资料,选择行肺部恶性肿瘤切除和纵隔淋巴结清扫、获得病理检查结果的患者共41例,其中男28例,女13例,年龄(56.1 ±12.2)岁.对18F-FLT与18F-FDG PET/CT淋巴结的显像结果分别进行视觉分析和半定量分析,采用,检验比较各方法的诊断效能.结果 (1)41例患者手术共检出533枚淋巴结,经病理检查证实恶性192枚,良性341枚(炎性增生淋巴结或正常淋巴结);(2)以18 F-FDG SUV≥2.5和18F-FLT SUV≥2.0为诊断恶性淋巴结的阈值,18F-FDG和18F-FLTPET/CT对纵隔淋巴结良恶性诊断的灵敏度、特异性、准确性、阳性预测值及阴性预测值分别为91.67％ (176/192)、80.94％ (276/341)、84.80％(452/533)、73.03％(176/241)、94.52％(276/292)和81.25％ (156/192)、92.96％(317/341)、88.74％ (473/533)、86.67％ (156/180)、89.80％ (317/353),两者灵敏度、特异性及阳性预测值差异均有统计学意义(x2=8.897、21.722和11.495,均P＜0.05),准确性和阴性预测值差异均无统计学意义(x2=3.604和3.712,均P＞0.05);18F-FDG联合18 F-FLT诊断纵隔淋巴结的灵敏度、特异性、准确性、阳性预测值及阴性预测值则分别提高至93.75％(180/192)、94.43％ (322/341)、94.18％ (502/533)、90.45％ (180/199)、96.41％(322/334).结论 18F-FDG诊断纵隔淋巴结良恶性的灵敏度高于18F-FLT,但特异性及阳性预测值明显低于FLT,两者联合诊断可明显提高诊断准确性.     

母乳性黄疸儿脑干听觉诱发电位检测分析

本文对30例母乳性黄痘(breast milk jaundice,BMJ)的婴儿进行脑干听觉诱发电位(BAEP)检测,以观察BMI对中枢神经系统是否有影响.结果显示BAEP总异常率为60%,随黄疸加重,BAEP异常率越高,轻、中、重度黄疸之间异常存在差异(x2=6.068,P<0.05).轻、中度黄疸表现为Ⅲ、V波潜伏期、I-Ⅲ、Ⅲ-V、I-V峰间期延长为主,重度黄痘表现为Ⅲ、V波缺失为主.因此认为BMJ无论胆红素高低,均有引起脑损伤的危险,应尽早干预.