双期多层螺旋CT对胆囊癌手术可切除性评价

目的 探讨多层螺旋CT(MSCT)双期扫描三维重建预测胆囊癌手术可切除性的价值.方法 40例临床和超声检查疑为胆囊癌的患者接受前瞻性MSCT双期扫描,其中剖腹探查行胆囊癌根治性切除术和姑息性切除术35例.剖腹探查患者MSCT双期扫描的图像行3D容积再现重建和多平面重建,根据其表现进行分期、评估血管侵犯情况和血管解剖、预测手术可切除性,并与手术结果对照.结果 根据CT表现,13例为可切除,22例为不可切除. 手术可切除17例,不可切除18例.CT分期偏高4例.手术可切除敏感性为76.5%, 特异性100%,阳性预测值100%,阴性预测值为81.8%,准确性为88.6%.肝脏、血管、胆管侵犯,腹主动脉淋巴结转移,CT诊断与手术的符合率为100%.CT显示9例血管变异,6例在根治性切除术中证实.结论 MSCT双期扫描三维重建有助于预测胆囊癌手术可切除性和制定根治性手术血管入路.     

国产表阿霉素为主的联合方案治疗非霍奇金淋巴瘤临床观察

目的观察国产表阿霉素治疗非霍奇金淋巴瘤的疗效和毒副反应.方法治疗组37例采用环磷酰胺(CTX)750 mg/(m2·d),静脉滴注,d1;国产表阿素(EPI)70 mg/(m2·d),静脉推注,d1;长春新碱(VCR)1.4 mg/(m2·d),静脉推注,d1;强的松(Pred)60 mg/(m2·d),口服,d1～5.每21 d为一个疗程,每例患者至少接受4个周期的化疗.对照组以进口表阿霉素替代国产表阿霉素,治疗非霍奇淋巴瘤38例,进行随机对照,观察两组的疗效及毒副反应.结果国产表阿霉素为主的方案组,完全缓解率为43.2%(16/37),部分缓解率为37.8%(14/37),总有效率为81.1%.与进口表阿霉素为主的对照组比较,疗效相似,差异无显著性(P＞0.05).两组毒副反应主要为Ⅰ～Ⅱ度,治疗组与对照组白细胞减少发生率分别为59.5%和60.5%;恶心呕吐发生率分别为 67.6%和68.4%;心脏毒性轻微,发生率分别为 8.1%和7.9%;脱发发生率分别为94.6%和94.7%,对肝肾功能影响均较轻微.结论国产表阿霉素治疗非霍奇金淋巴瘤的疗效和毒副反应与进口表阿霉素相似,值得临床应用.     

右冠-右室瘘误诊为冠心病

1　病例资料男 ,6 0岁。因心律不齐 1年余 ,阵发性心前区不适、左肩部疼痛 10个月入院。既往无高血压、糖尿病史 ,血脂轻度增高。患者 1年前无明显诱因自觉心慌 ,每日发作数次 ,不伴有胸闷、胸痛 ,曾在外院就诊。心电图示频发室性早搏 ,ＳＴ Ｔ无异常改变。心电图运动平板试验 (+)。诊断为冠心病、频发室早。予口服胺碘酮等药物治疗 ,症状减轻。 10个月前上述症状再次出现 ,同时伴阵发性心前区不适和 (或 )左肩背部疼痛 ,偶伴胸闷、微汗 ,经常于活动初始感左肩背酸痛 ,调整速度或稍事休息可缓解 ,每次发作可持续数分钟至数小时不等 ,常规冠…     

异环磷酰胺治疗恶性肿瘤临床试验观察

我院自1994年12月～1997年12月用江苏连云港制药厂生产的异环磷酰胺联合化疗治疗各种恶性肿瘤共100例,取得满意的近期疗效,现报道如下:材料与方法一　临床资料　病例入选标准:经病理学确诊的癌症患者,活动状态(ＥＣＯＧ标准)0～3级,预计生存期≥3月,主要脏器功能基本正常...     

腹腔动脉CT血管成像固定毫安秒低剂量技术探讨

Objective To characterize the feasibility of low-dose CT angingraphy on 16-slice multislice computed tomography (16-MSCT), and its relationship to the noise in the pre-contrast image and enhancement value.Methods Forty-three consecutive patients (male 21, female 22, mean age 59 years, median age 56 years) underwent abdominal 16-MSCT (Toshiba Aquilion 16) with constant scanning parameters including 120 kVp, a 0.5-second gantry rotation time, a pitch of 0.938: 1, and 16×1-mm detector collimation.The mA was set at 200 in the pre-contrast scan and 160 in the contrast-enhanced scan.The arterial phase images were retrospectively reconstructed with 1-mm slice thickness, 0.8 mm interval.The pre-contrast noise was defined as the standard deviation (SD) of the aorta at the level of right posterior crura of diaphragm.The enhancement of aorta was also measured at level of celiac artery.The volume rendering of CT angiography was made and classified into three grades (excellent, good, bad).Receiver operating characteristic curve (ROC) was used to evaluate the relationship between the image quality of CT angiography and noise in the pre-contrast image and enhancement value.Results Twenty-five cases had the aorta enhancement between 300.0--400.0 HU.The sensitivity and specificity of excellent CTA image was 75% and 62%, respectively when the SD was 12.00.Eighteen cases had the aorta enhancement more than 400.0 HU.The sensitivity and specificity of excellent CTA image was all 100% when the SD was 12.25, and 100% and 75%, respectively when the SD was 13.35.The area under curve of CTA image quality and enhancement in receiver-operated characteristic analysis was O.907.The enhancement was more than 356.7 HU when the sensitivity and specificity of excellent CTA image was 100% and 60%, respectively, and 389.8 HU when 78% and 80%.When the enhancement was more than 442.4 HU, the specificity of excellent CTA image was 100%.Conclusions MSCT angiography with low radiation dose is feasible.Good CT angiography demands great enhancement, and then, the needed mAs is lower when the SD is smaller.     

碘油及碘油合剂在肝癌治疗中的疗效分析

目的：观察碘油及碘油合剂在肝癌瘤区的沉积情况。方法：通过随机两组肝癌患者的沉积情况对比。结果：两侧沉积效应不尽相同。结论：单纯碘油灌注栓塞效果较好。     

胃癌螺旋CT强化与微血管密度表达关系的研究

目的：探讨探讨术前胃癌螺旋CT强化与CD105标记的血管密度的关系,评价螺旋CT增强扫描对胃癌的临床意义。方法：对70例经病理证实为胃癌患者术前行CT增强扫描,术后用免疫组织化学染色方法检测CD105标记的血管密度,探讨其表达的关系及不同临床特征的意义。结果：螺旋CT分期与TNM临床分期完全符合率为84．28％,不同浸润深度、不同临床分期及有无淋巴结转移的比较中,螺旋CT扫描的强化值与血管密度的表达差异显著,且胃癌中螺旋CT扫描的强化值及血管密度的表达呈正相关。结论：胃癌患者术前行螺旋CT强化具有重要的意义,可能对早期判断患者预后及指导治疗有重要意义。     

环境空气中氡检测实验室间比对及其结果评价

[目的]建立环境空气中氡检测实验室间比对方法,有助于实验室发现检测结果的系统误差,从而提高技术水平,确保检测结果准确可靠。[方法]通过对被测环境空气氡浓度稳定性试验和均匀性试验,选择适合比对试验的稳定条件。6家实验室的7台氡检测仪,分别依据国家标准《环境空气中氡的标准测量方法》（GB／T 14582--1993）和卫生部行业标准《空气中氡浓度的闪烁瓶测量方法》（GBZ／T155--2002）及《利用实验室间比对的能力验证——第1部分：能力验证计划的建立和运作》（GB／T15483．1—1999）规定的比对程序进行环境空气中氡浓度检测,比对结果采用稳健统计方法进行评价。[结果]比对试验统计结果显示中位值（M）217Bq／m^3、稳健变异系数（RobustCV）14．3％、标准四分位间距（NormIQR）31．1Bq／m^3、最大值（MAX）236Bq／m^3、最小值（删）85Bq／m^3、变动范围（R）151Bq／m^3。7台氡检测仪中,有5台比对结果满意,1台结果有问题（Z比分数-2．28）,1台结果不满意（Z比分数-4．24）。[结论]环境空气中氡浓度检测实验室间比对结果表明．不同检测方法、不同型号检测仪器的枪测结果具有可咖．性．     

腹腔动脉CT血管成像固定毫安秒低剂量技术探讨

Objective To characterize the feasibility of low-dose CT angingraphy on 16-slice multislice computed tomography (16-MSCT), and its relationship to the noise in the pre-contrast image and enhancement value.Methods Forty-three consecutive patients (male 21, female 22, mean age 59 years, median age 56 years) underwent abdominal 16-MSCT (Toshiba Aquilion 16) with constant scanning parameters including 120 kVp, a 0.5-second gantry rotation time, a pitch of 0.938: 1, and 16×1-mm detector collimation.The mA was set at 200 in the pre-contrast scan and 160 in the contrast-enhanced scan.The arterial phase images were retrospectively reconstructed with 1-mm slice thickness, 0.8 mm interval.The pre-contrast noise was defined as the standard deviation (SD) of the aorta at the level of right posterior crura of diaphragm.The enhancement of aorta was also measured at level of celiac artery.The volume rendering of CT angiography was made and classified into three grades (excellent, good, bad).Receiver operating characteristic curve (ROC) was used to evaluate the relationship between the image quality of CT angiography and noise in the pre-contrast image and enhancement value.Results Twenty-five cases had the aorta enhancement between 300.0--400.0 HU.The sensitivity and specificity of excellent CTA image was 75% and 62%, respectively when the SD was 12.00.Eighteen cases had the aorta enhancement more than 400.0 HU.The sensitivity and specificity of excellent CTA image was all 100% when the SD was 12.25, and 100% and 75%, respectively when the SD was 13.35.The area under curve of CTA image quality and enhancement in receiver-operated characteristic analysis was O.907.The enhancement was more than 356.7 HU when the sensitivity and specificity of excellent CTA image was 100% and 60%, respectively, and 389.8 HU when 78% and 80%.When the enhancement was more than 442.4 HU, the specificity of excellent CTA image was 100%.Conclusions MSCT angiography with low radiation dose is feasible.Good CT angiography demands great enhancement, and then, the needed mAs is lower when the SD is smaller.     

血清肌钙蛋白Ⅰ在诊断急性心肌梗死中的应用价值

目的:研究肌钙蛋白I(cTnI)的检测在急性心肌梗死(AMI)中的诊断价值。方法对56例AMI患者进行血清cTnI和肌酸激酶同工酶(CK-MB)检测,正常对照组40例。结果诊断AMI,cTnI敏感性为100%,特异性97.5%(39/40),准确性99%(95/96);CK-MB的敏感性为85.7%(48/56),特异性为60%(24/40),准确性为75%(72/96)。cTnI持续阳性的平均时间为7d,而CK-MB在发病平均3天后就恢复正常。结论cTnI对于AMI有很高的敏感性和特异性,诊断AMI有重要意义。