Objective To investigate the CT manifestations of acute pancreatitis (AP) and its complications and to evaluate the imaging modalities for staging the severity of AP. Methods Literatures on CT manifestations of AP and its complications and severity staging of AP were reviewed.Results CT has shown an early overall detection rate of 90% for pancreatic necrosis with close to 100% sensitivity 4 days after episode. The CT severity index has shown a bly positive correlation with the development of local complications and mortality of AP.Conclusion Contrastenhanced CT is the imaging modality of choice to help detect pancreatic necrosis, stage the severity of the inflammatory processes, and depict local complications.
目的 總結多發性骨髓瘤（multiple myeloma, MM）的發病特征及臨床特征，分析比較不同治療方案對MM的療效及不同類型與不同臨床特征的MM治療效果。 方法 回顧性分析2003年1月-2008年1月128例MM患者的發病和臨床特征，以及與治療效果的關系，并對不同治療方案、不同類型間的療效進行比較。 結果 MM患者發病的中位年齡為59歲，臨床上以不明原因的骨痛、貧血、感染和球蛋白增高為主要表現。128例患者中行方案一（馬法蘭、強的松/地塞米松、反應停）的總有效率為53.3%（32/60）；方案二（環磷酰胺、長春新堿、馬法蘭、強的松、卡氮芥、阿霉素）為44.4%（8/18）；方案三（長春新堿、阿霉素/表阿霉素/脂質體阿霉素、地塞米松）為68.5%（24/35），方案四（硼替佐米、地塞米松/反應停）的總有效率為86.6%（13/15）。方案一和方案二間、方案三和方案四間療效差異無統計學意義（Pgt;0.05），方案三、方案四的療效均優于方案一和方案二（Plt;0.05）。IgG型總有效率為63.2%（48/76），IgA型為60.9%（14/23），kappa輕鏈型為42.8%（6/14），lammda輕鏈型為46.2%（6/13）。IgG型和IgA型間的療效差異無統計學意義（Pgt;0.05），但IgG型、IgA型的療效均優于kappa輕鏈型和lammda型（Plt;0.05）。不同類型及使用不同方案的患者，其中位生存期及3年和5年的生存率差異無統計學意義（Pgt;0.05）。 結論 MM患者發病高峰年齡介于40～70歲，骨痛和貧血是最常見的首發癥狀。長春新堿、阿霉素/表阿霉素/脂質體阿霉素、地塞米松以及硼替佐米、地塞米松/反應停方案總體療效相當，但后者完全緩解率高于前者。
【摘要】 目的 采用多柔比星（doxorubicin，DOX）制備心肌損傷動物模型，評價各種檢測心功能變化方法的意義。 方法 14只新西蘭大白兔，DOX耳緣靜脈注射，每周3 mg/kg，共10周。分別于給藥前、第4周末及實驗結束時測定血清肌鈣蛋白Ⅰ（cTnI）和腦鈉肽（BNP）水平，彩色多普勒超聲心動圖檢測心功能變化，并觀察心肌組織病理形態學改變及心肌細胞凋亡情況。 結果 使用DOX前后對比，血清cTnI和BNP濃度升高（Plt;0.05）；左室射血分數（LVEF）和左室短軸縮短率（LVFS）下降（Plt;0.05）；心肌組織病理顯示心肌細胞出現不同程度的空泡變性與水腫，細胞間隙明顯增寬，大量炎性細胞浸潤。心肌細胞凋亡明顯增加。 結論 結合心臟超聲檢查和血清cTnI、BNP指標檢測可判斷心肌損傷程度。【Abstract】 Objective To observe the changes of heart function caused by doxorubicin in rabbits. Methods A total of 14 New-Zealand white rabbits were intravenous-injected with doxorubicin with a dosage of 3 mg/kg intravenously once a week, and the accumulative dose was 30 mg/kg. Before the medication and at the 4th and 10th weekend after the medication, the serum levels of cardiac troponin I (cTnI) and brain natriuretic peptide (BNP) were measured; left ventricular ejection function (LVEF) and left ventricular fractional shortening (LVFS) were performed on the rabbits respectively. At the 10th weekend, the pathological changes of cardiac tissue and the apoptosis of myocardial cell were detected. Results The levels of cTnI and BNP significantly increased (Plt;0.05), and the LVEF and LVFS markedly decreased (Plt;0.05) after the administration of doxorubicin. Uneven vacuolar degeneration and edema of cardiocytes could be observed with a wide cell spaces and inflammatory cell infiltration in the histopathological slices. Conclusion The combined application of heart sonography with the detection of the serum levels of cTnI and BNP can evaluate the degree of myocardial damage of the rabbits models very well.
Objective To retrospectively assess the importance and imaging appearance of the signal intensity， the signal noise ratio (SNR), the contrast noise ratio (CNR) and enhancement patterns of early arterial phase in diagnosis and differential diagnosis of small hepatic nodular lesions on MRI. Methods Conventional spin-echo T2W, 2D GRE T1W plain scan and Gd-enhanced 3D-VIBE multi-phasic (early arterial, late arterial and portal venous phase) acquisitions were performed for 68 consecutive patients with 102 lesions on MRI. Native T2W and 2D GRE T1W were acquired first, then 3D-VIBE fast scanning at early arterial, late arterial and portal venous phase respectively. The SNR, CNR, signal intensity and enhanced pattern of the nodular lesions appearances on plain scan and eariy arterial phase were carefully observed. Results There were hyperintense in 102 (100%) lesions in T2W and hypointense in 95 (93.1%) lesions in T1W in plain scan. There were differences among the SNR, CNR of hepatic cyst, cavernous hemangioma, neoplasm metastasis and small hepatocellular carcinoma in T2W (P＜0.05)，the highest SNR and CNR of lesions were hepatic cyst. The SNR of small hepatocellular carcinoma and the CNR of hepatic cyst were highest in all the type diseases in T1W, there was significantly difference as compared with the other type diseases (P＜0.05). The enhancement rate of small hepatic nodular lesions was 76.5% in early arterial phase. The enhancement rate of small hepatocellular carcinoma and hepatic metastasis were 100% and 87.9% respectively. The non-enhancement rate of hepatic cyst were 100%. The common enhancement patterns of early arterial phase were peripheral enhancement which were 36 lesions (35.3%). The even enhancement and uneven enhancement were 22 lesions (21.6%) and 20 lesions (19.6%) respectively. Conclusion Qualitative and quantitative evaluation of MR signal intensity combined with the enhancement patterns of early arterial phase will help for qualitation and differential diagnosis of small hepatic nodular lesions on MRI.
Objective To investigate the CT manifestation and clinical significance of the gastrointestinal tract involvement in acute pancreatitis (AP). Methods Two hundreds CT scans in 131 patients with acute pancreatitis between Jan. 1, 2009 and Jun. 30, 2009 were included into the study. Two radiologists analyzed the images retrospectively, paying attention to the CT features of the gastrointestinal tract involvement, such as the style, distribution, and so on. The correlation between gastrointestinal tract involvement and CT severity index, clinical severity grading, and turnover of acute pancreatitis were studied using a SPSS 14.0 for windows statistics software. Results The CT images in 109 (83.2%) patients showed gastrointestinal tract involvement, which distributing mainly stomach, duodenum, jejunum, and transverse colon, and showing mainly the gastrointestinal tract wall thickening and distension. The gastrointestinal tract involvement had positive correlation with CT severity index, clinical severity grading, and turnover of acute pancreatitis (r=0.689， P=0.000; r=0.584， P=0.000; r=0.346， P=0.000). Conclusions The gastrointestinal tract involvement is common complication in acute pancreatitis and concerns with severity and prognosis of the disease. As other extrapancreatic organs involvement, the gastrointestinal tract involvement has important value for severity assessment, prognosis evaluation, and therapeutic effect monitoring of acute pancreatitis.
Objective To investigate the value of multislice spiral CT （MSCT） findings in the diagnosis of hepatic tuberculosis. Methods MSCT imaging data, including both plain and contrast-enhanced CT scan, of 14 patients with hepatic tuberculosis confirmed by surgery (5 patients), aspiration biopsy (4 patients), or clinic follow-up (5 patients) were collected for the study. MSCT findings were analyzed with correlation of pathological changes. Results Hepatic tuberculosis was classified into 2 types. ①The parenchymal type (12 patients), which was further divided into 4 subtypes: Miliary subtype (2 patients) showed multiple tiny hypodense dots with faint border and had no enhancement; Nodular subtype (5 patients) showed blurring border on plain CT scan, 2 patients had no enhancement, 2 had peripheral rim-like enhancement, and peripheral rim enhancement mixed with no enhancement in 1 patient; Abscess subtype (4 patients) showed central hypodense area with peripheral zone-like enhancement in 2 patients, or patchy like slight enhancement in 2 patients; Fabric and calcific subtype (1 patient) depicted enplaque calcification. ②The serohepatic type (2 patients) showed thickened hepatic capsule, sub-capsule nodules with slight enhancement, and local subcapsular fluid collection. Other signs included hepatomegaly, tuberculous lymphadenopathy, splenic tuberculosis, and tuberculosis of pancreas, adrenal glands, intestine and thorax. Conclusion MSCT plays an important role in diagnosis of hepatic tuberculosis, by reflecting underlying pathological changes.
Objective To investigate the accurateness and rapidity of information on SARS , and to provide evidence for decision-making in the construction of the public health information system of China, including information collection, identification and release. Method SARS related information was systematically collected, from ① databases including Medline, CBMdisc and Cochrane Library; ② official websites including WHO, MOH and CDC; ③ non-governmental websites including Sina, Sohu, Yahoo; ④ eleven Chinese Journals and ⑤ gray literatures, These evidence were graded based on their scientific sense, and were analyzed according to their rapidity of release. Results A total of 11 955 pieces of related information were collected. Non-governmental websites were the agents that released the largest number of information (46.7%). Regarding the scientific sense of evidence, hand searched journal was at the top of the evidence pyramid, and followed by Medline, gray literature, CBMdisc, official and non-governmental websites. Regarding the rapidity, official website achieved the most rapid information release, which was followed by nongovernmental website, journal, and database. 71.8 percent of information from official websites was in Chinese, while 65 percent was from database. Conclusions The SARS information from China has contributed enormously to the global information release. Although the amount and rapidity of the information were satisfied, management and deep processing of information should be improved.
ObjectiveTo evaluate the value of spiral CT in diagnosing ischemic bowel changes in systemic lupus erythematosus (SLE) patients presenting with acute abdominal pain. MethodsThe clinical data and spiral CT imaging files of 23 SLE patients presenting with acute abdominal pain were retrospectively reviewed. Sixteen had contrastenhanced spiral CT scanning of the abdomen, the rest had plain CT study. Observation emphasis was placed on the changes of bowel wall (wall thickness, enhancement pattern, lumen size) and mesentery (mesenteric edema, engorgement of mesenteric vessels and their abnormal arrangement pattern). Other abnormal findings (e.g. fluid accumulation, changes of abdominal solid organs, lymphadenopathy) were also observed. ResultsNineteen patients had intestinal wall thickening (19/23, 82.6%), with the “target sign” in 12 patients (12/16, 75.0%); Bowel lumen dilatation was present in 16 patients (16/23, 69.6%). Mesenteric swelling with increased density of adipose tissue was noticed in 21 patients (21/23, 91.3%); 18 patients had engorgement of mesenteric vessels (18/23, 78.3%), with comb like arrangement in 4 patients (4/16, 25.0%). Other abnormal findings included ascites, hydrothorax, hydropericardium, hepatosplenomegaly and so on. ConclusionThe most common CT findings in SLE patients presenting with acute abdominal pain are the signs associated with ischemic bowel disease. Contrastenhanced spiral CT is a preferable imaging method for both the diagnosis and differential diagnosis of ischemic bowel disease associated with SLE.
Objectives Re-evaluation the clinical evidence of. anti-virus medicines for virosis communicable respiratory disease on the effectiveness, safety and health economy. Methods To search CL (2003 Issue 1), Medline (1966-2003.5), CCOHTA, SBU, NICE and NCCHTA and collect all CSRs and HTA with computer . The quality of evaluation partly based on QUOROM will be done before results analysed. If heterogeneity does not exist in CSRs and HTA, a Meta-analysis will be re-conducted. Results 4 CSRs (38 RC, n=22 835) and 5 HTA (28 RCT, n=139 281) were included. Due to the significant heterogeneity between these studies, further Meta-analysis could not be conducted, and descri ptive conclusions were conducted only. Conclusions Neuraminidase inhibitors (zanamivir and oseltamivir) are more effective than placebo in reducing the duration of symptoms of patients with basic disease, and have limited effectiveness in health adults. But, both are well tolerated and reduce the rate of contracting influenza in all individuals. For prevention, neuraminidase inhibitors cost more and are not suitable as first-line drug. 2. Diamantane is more effective than placebo in reducing the duration of having fever, and effectively prevents the influenza A. Amantadine and rimantadine have comparable effectiveness in the prevention, although rimantadine induces fewer adverse effects than amantadine. 3. The number of the childrenpatients of upper respiratory tract infection prevented and treated by ribavirin is too small to draw any conculsion now.