子宫肉瘤的超声征象与病理学对照研究

目的探讨子宫肉瘤的彩色多普勒超声声像图特点、病理学基础及超声诊断价值。方法回顾性分析60例经病理证实的子宫肉瘤超声表现,总结病变数目、位置、形态、边界、液化、结构及内部回声类型等超声征象,结合病理结果探讨病理学基础。结果超声显示的病灶体积、形态及结构与病理大体一致性好,单发、边界模糊、不规则形态、蜂窝样结构及囊性变是较为典型的超声征象;超声征象与病变组织学类型、分化程度及临床分期密切相关。结论子宫肉瘤声像图表现与病理组织学特征密切相关,超声对典型子宫肉瘤的诊断具有明确的临床应用价值。     

子宫恶性苗勒管混合瘤的彩色多普勒超声诊断

目的 探讨子宫恶性苗勒氏管混合瘤(MMMT)的彩色多普勒超声特点及病理学基础.方法 回顾性分析10例经病理证实的MMMT的超声表现,总结病变形态学及彩色多普勒血流等超声征象,并探讨其病理学基础.结果 单发、边界模糊、不规则形态、蜂窝样结构、囊性变及丰富血流是MMMT较为典型的超声征象;病变超声征象与组织学分化程度及临床分期密切相关.Logistic回归分析提示病灶血流丰富程度与囊性变的程度和类型呈负相关.结论 MMMT具有较为特征性的声像图表现,其超声征象与组织病理学特征密切相关.     

超声对子宫肉瘤与子宫肌瘤鉴别诊断的临床应用价值

目的 探讨彩色多普勒超声鉴别诊断子宫肉瘤与子宫肌瘤的临床应用价值.方法 分析病理证实的60例子宫肉瘤和150例子宫肌瘤的超声表现,比较二者的病变数目、位置、形态、边界、液化、结构、回声类型及彩色多普勒血流分布等超声征象的差异.结果 子宫肉瘤和肌瘤患者的平均年龄和年龄分布特点的差异有统计学意义(P＜0.05).阴道出血、阴道脱垂物等症状是子宫肉瘤较特异的症状.超声显示病灶体积、形态及内部结构与病理一致性好.肉瘤病灶体积显著大于肌瘤病灶(P＜0.01).典型恶性病变为体积较大的蜂窝样混合回声、边界模糊,形态不规则或分叶状.典型良性病变、为边界清晰的圆或椭圆形漩涡状中低回声,质地均匀,液化灶少见.单发病灶、形态不规则、蜂窝状混合回声和不规则液化结构对恶性病变的诊断意义较大(P＜0.05).彩色多普勒超声显示肉瘤病灶多血流丰富,内部及周边分布可呈"镶嵌样",肌瘤多为规则分布的点条状血流(P＜0.01).部分临床分期、组织学分化程度较好的子宫肉瘤与合并液化坏死的不典型子宫肌瘤的超声征象相互重叠,鉴别诊断较为困难.结论 彩色多普勒超声对子宫肌瘤和子宫肉瘤鉴别诊断有临床应用价值,综合分析灰阶及彩色多普勒征象可提高诊断准确率.     

彩色多普勒超声鉴别子宫肉瘤与子宫肌瘤的价值

目的探讨子宫肉瘤的彩色多普勒超声特点,提高超声检出率。方法回顾性分析病理证实的50例子宫肉瘤与100例子宫肌瘤的声像图特点。结果两组病例在发病年龄、病灶数目、部位、内部回声、边界、形态、血流分布及血流丰富程度等方面有统计学差异(P<0.05)。病灶单发,边界模糊,形态不规则,呈混合性或蜂窝样回声,内部及周边探及Ⅱ~Ⅲ级血流信号,是子宫肉瘤较为典型的超声征象。结论子宫肉瘤声像图特点与子宫肌瘤有较大差异,充分认识子宫肉瘤的声像图特征,多因素综合分析,有利于提高其超声检出率。     

子宫内膜病变的超声表现及病理探讨

目的分析子宫内膜病变的超声声像图特征及病理特点,进一步研究子宫内膜病变的超声改变。方法对135例子宫内膜病变声像图特点,结合病理进行综合分析。结果超声诊断子宫内膜息肉诊断符合率91.3%,子宫内膜增生诊断符合率88.7%,子宫内膜癌诊断符合率72.2%。结合病理特点,更有利于对超声的声像图特征进行分析。结论子宫内膜病变的病理学改变使其形成特定的形态特点,也构成声像图上独有的特征,可作为相互鉴别诊断点。     

子宫内膜间质肉瘤超声表现的初步探讨

目的：探讨子宫内膜间质肉瘤（ESS）的超声声像图特征及其诊断价值。方法：回顾性分析14例ESS患者二维及彩色多普勒超声结果,并与病理结果对照,分析肿瘤的发生部位、数目、形态、边界、内部回声、血流分布等特征。结果：根据超声所见病变发展不同时期的病灶位置及声像图特点,将其声像图表现分为以下3型：Ⅰ：宫腔型;Ⅱ：宫壁型;Ⅲ：宫腔及宫壁型。结论：通过对该病进行超声分型,并与相应疾病进行鉴别诊断,有助于提高该病的超声诊断准确性。     

超声对子宫肉瘤诊断的初步探讨

目的 探讨二维超声对子宫肉瘤的诊断价值。方法 对2例子宫肉瘤的超声声像图进行分析。结果 本组子宫肉瘤表现为子宫明显增大,宫腔内见低回声近似无回声的结节。结论 超声检查结合临床病理可对本病作出诊断。     

子宫内膜间质肉瘤超声误诊分析

目的分析子宫内膜间质肉瘤的超声声像图特点及其误诊原因,以降低超声检查的误诊率。方法回顾性分析经手术及病理学检查证实的6例子宫内膜间质肉瘤的超声声像图特征。结果6例患者中,2例超声图像表现为宫腔内单发的等回声占位,超声诊断内膜病变;2例表现为子宫肌层偏高回声占位,超声误诊为子宫肌瘤;1例表现为子宫肌层不均匀增厚,超声误诊肌腺症;1例表现为盆腔内巨大混合回声肿块,超声误诊为卵巢肿瘤合并子宫肌瘤。结论子宫内膜间质肉瘤的超声表现可分为四种类型:息肉生长型、肌层肿块型、肌层弥漫生长型、盆腔肿块型。在不规则出血的妇女中,尤其在绝经前期的妇女,若超声发现以上表现者,应考虑子宫内膜间质肉瘤病变的可能。     

子宫癌肉瘤的超声表现与病理特征

目的分析子宫癌肉瘤的超声声像图表现及病理组织学特点，提高对本病的认识。 方法回顾性收集2009年1月至2018年12月首都医科大学附属复兴医院收治并经病理证实的6例子宫癌肉瘤患者的临床资料，分析其超声声像图表现与病理组织学特点。 结果6例子宫癌肉瘤患者均为绝经后女性，临床表现为绝经后不同程度的阴道出血。超声表现：绝经后子宫测值增大，6例患者子宫三径之和132～248 mm，平均（199.7±36.8）mm，宫腔回声明显增厚呈息肉样，内呈不均质中高或中低回声，最大径14～81 mm，最大径平均值（47.2±21.3）mm；肿瘤部分边界清晰，可见“亮边”，形态欠规则，部分与肌层分界不清；血流评分3例4分，2例3分，1例2分，均可测及动脉血流频谱（阻力指数：0.15～0.59）。病理检查：3例为中分化子宫癌肉瘤，3例为低分化子宫癌肉瘤；镜下病理见瘤体内血管丰富；6例均伴有肌层浸润。 结论子宫癌肉瘤多表现为绝经后阴道出血伴体积较大的息肉样病变，基底部粗大的供养血管多提示肌层浸润，宫腔镜检查可获得病理诊断。     

子宫内膜息肉、黏膜下肌瘤、内膜癌超声及病理鉴别诊断

目的分析子宫内膜息肉与黏膜下肌瘤、内膜癌的超声及病理鉴别诊断。方法分析子宫内膜病变患者98例的声像图特征,并对比手术病理诊断证实超声诊断的准确度。结果子宫腔内病变患者98例中,超声诊断子宫内膜息肉48例,诊断符合率93.75%;子宫黏膜下肌瘤41例,符合率87.80%;子宫内膜癌9例,符合率88.89%。临床总符合率为90.81%。各种病变在彩色多普勒超声图像上均有特征性的表现。结论经阴道彩色多普勒超声检查对子宫腔内病变具有独特的声像图特征,典型疾病的声像图与手术标本切面之间存在规律性的对应关系,诊断准确度较高,值得临床应用和推广。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.     

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.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

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.