超声检查诊断女性甲状腺癌价值探讨

目的探讨甲状腺癌的二维和彩色多普勒超声图像特点，提高早期诊断女性甲状腺癌的准确性。方法应用高频超声诊断仪对46例女性甲状腺占位性病变经手术与病理证实为甲状腺癌的声像图进行分析，着重分析肿块内部回声的特点、边缘、彩色血流丰富程度、频谱多普勒中的多项测量指标的变化以及与周围组织的关系。结论肿块形状不规则、轮廓不清晰、向周围组织浸润，内部为实质不均质低回声，可见多发散在的点状、微粒状强回声是超声诊断甲状腺癌的重要声像图特征，而彩色血流丰富情况与颈静脉周围和锁骨上窝内淋巴结肿大有助于超声提高甲状腺癌的诊断准确性。     

彩色多普勒高频超声对甲状腺癌的诊断价值

目的 探讨高频超声与彩色多普勒超声对甲状腺癌的诊断价值。方法通过对35例经手术病理证实为甲状腺癌的高频超声图像特征与彩色多普勒进行分析。结果本病的高频超声声像图多数实质肿块及囊性肿块内实质部分有沙粒状钙化或粗糙钙化光团，少数表现为增强及杂乱回声肿块。彩色多普勒血流成像（CDFI）：肿块内血流阻力指数较高，平均为0．75。结论应用高频超声及彩色普勒超声对甲状腺癌的诊断具有较大的临床价值。     

26例微小甲状腺癌的超声诊断分析

目的 :探讨二维及彩色多普勒超声对微小甲状腺癌的诊断价值。方法 :对经手术病理证实的 2 6例微小甲状腺癌的超声诊断结果进行分析。结果 :高频超声对肿块检出率 10 0 %,超声诊断符合率 73 %( 19/ 2 6) ,细粒样钙化和低回声在微小甲状腺癌诊断中的特异性较高。彩色多普勒超声对肿块彩色血流检出率 42 %,而彩色血流丰富程度、收缩期流速增高 ,阻力指数减低 ,缺乏特异性。结论 :高频声像图中的钙化和低回声是诊断微小甲状腺癌的重要指标 ,而彩色血流丰富程度及频谱多普勒中的各项指标 ,尚缺乏有力依据 ,还需进一步探讨     

乳腺纤维腺瘤声像图及彩色多普勒血流特征与病理对照分析

目的　对乳腺纤维腺瘤的高频声像图及彩色多普勒血流的表现进行探讨 ,并与病理对照分析。方法　对 3 6例经手术、病理证实的乳腺纤维腺瘤的高频声像图及彩色多普勒血流进行了回顾性分析。结果　典型乳腺纤维腺瘤表现为 :形态规则 ,椭圆形或圆形 ,纵横径比值 <0 .8,边界清晰 ,有完整包膜 ,内部回声均匀 ,后方回声增强。非典型乳腺纤维腺瘤表现为 :形态不规则 ,内部回声不均匀 ,可见粗钙化 ;部分肿块呈结节状或分叶状融合。彩色多普勒血流测及RI <0 .8。结论　高频声像图特征及彩色多普勒血流表现为超声诊断乳腺纤维腺瘤提供了重要依据     

肾占位性病变的能量多普勒超声诊断

目的探讨能量多普勒超声在肾脏占住性病变中的诊断价值。方法对21例肾脏占位性病变分别进行二维超声,彩色及能量多普勒超声检查,并与临床病理结果相对照。结果肾脏占位性病变在二维声像图上多表现为低回声,能量多普勒较彩色多普勒血流显像更易显示肾脏占位性病变的血流信号。结论能量多普勒超声可提高肾占位性病变的血流信号显示率,结合二维超声图像及,隘床表现可有利于肾透明细胞癌的早期发现。     

高频超声在足部软组织肿块中的诊断价值

[目的]探讨彩色多普勒超声在足部软组织肿块中的诊断价值.[方法]回顾性分析经病理证实的足部软组织肿块162例的二维及彩色多普勒超声表现,并与病理结果对照,分析高频超声在足部软组织肿块中的诊断价值.[结果]足部软组织肿块162例中腱鞘囊肿67例,超声诊断准确率100%,声像图表现为低-无回声,血流Alder分级0级.血管瘤24例,其中1病例因肿瘤体积过小,超声特征不明显,而漏诊,超声诊断准确率为95.8%(23/24),其声像图表现为紊乱管状低回声异常区的13例,呈蜂窝样结构的11例.血流Alder分级:19例为Ⅲ级,5例为Ⅱ级.腱鞘巨细胞瘤42例,误诊病例5例,其中3例经病理证实为血管瘤,2例经病理证实为腱鞘纤维瘤,超声诊断准确率为88.1%(37/42),声像图表现为均匀一致的中等偏低异常回声区,边界清;血流Alder分级:0级35例,Ⅰ级4例,Ⅱ级3例.血管球瘤2例,超声诊断准确率为100%,肿瘤均呈均匀一致的实性低回声区,血流Alder分级均为Ⅲ级.足底筋膜纤维瘤病16例,超声诊断准确率100%,均发生于足底筋膜,其中13例声像图表现为均匀一致的中等偏低异常回声区,3例表现为混合性回声异常区,病变区可见丰富血流信号;血流Alder分级:Ⅰ级5例,Ⅱ级11例.神经鞘瘤6例,超声诊断准确率为100%,声像图表现为均匀一致的实性低回声,为椭圆形或梭形,边界清晰,内部回声均匀;血流Alder分级:0级5例,Ⅰ级1例.神经纤维瘤8例,超声诊断准确率为100%,其声像图表现与神经鞘瘤相似,但肿块一般不与神经连续、多发,呈串珠样排列,内部可间少许彩色血流信号;血流Alder分级:0级6例,Ⅰ级2例.[结论]足部软组织肿块有典型超声图像特征,其可用于明确肿块类型、鉴别肿块的性质,是诊断足部肿块有效的影像学方法.     

彩超在乳腺占位性病变临床诊断中的应用研究

目的分析研讨彩色多普勒超声在乳腺占位性病变诊断中的临床应用价值。方法选取我院2015年1月～2017年12月收治的100例乳腺占位性病变患者。患者均接受彩色多普勒超声检查,且经手术病理确诊,比较分析彩色多普勒超声检查结果与病理结果,并测量血流动力学,分析其血流特征。结果彩色多普勒超声检查显示,肿块形态不规则、边界不清、呈"毛刺"或"蟹足样",纵横比多大于1,肿块边缘可见"高回声晕",肿块内部回声不均匀,内可见微钙化、肿块后方多衰减,恶性肿瘤超声测量的肿块大小较临床触诊的肿块小、可有乳房后间隙消失、导管征、腋窝淋巴结肿大等;良性肿瘤彩色多普勒超声显示:形态规则,呈类圆形或圆形,边界清楚,可有完整包膜,内部回声多数均匀,少数可见粗大钙化,纵横比小于1,后方回声可增强。结合彩色多普勒超声血流特点:恶性病变血管分布面积、血管分布密度、血管数高于良性病变患者,差异有统计学意义(P0.05)。彩色多普勒超声检查诊断结果中有78例与病理诊断结果相符合,彩超诊断符合率高达78%。结论彩超在诊断乳腺占位性病变的良、恶性诊断中的临床价值较高,值得临床推广应用。     

乳腺肿块的高频彩超诊断与病理基础分析

目的探讨高频彩超诊断乳腺良恶性肿块的声像图特征及其诊断价值。方法对经病理证实的乳腺良性肿块22例和恶性肿块20例的高频彩超声像图进行回顾性分析。结果本组大多数恶性肿块形态不规则,边界不清,内部回声不均匀,以低回声为主,部分后方有衰减,肿块纵横比〉1。彩色多普勒血流分级大多数为-级;PI值〉1.2,RI值〉0.70。8例（36.3%）同侧腋窝淋巴结肿大,血流丰富。乳腺良性肿块大多表现为：形态规则,边缘光整,内部回声均匀,侧缘回声减弱,纵横比〈1;彩色多普勒血流分级大多数为0-级;PI值〈1.2RI值〈0.70。结论高频彩超对乳腺肿块的检出率高,高频二维超声特征接合彩色多普勒表现对乳腺良恶性肿瘤的鉴别诊断具有较高的临床应用价值。     

乳腺表皮样囊肿的超声表现

目的：探讨乳腺表皮样囊肿的高频超声图像特征。方法：对18例因乳腺肿块就诊,经术前超声及手术病理证实为表皮样囊肿患者的病例资料进行回顾性分析。在灰阶声像图上观察肿块位置、形状、大小、边界、内部回声及后方回声。应用彩色多普勒成像（CDFI）观察病灶内部及周围血流分布和供应情况。结果：灰阶声像图显示肿块多位于乳腺皮下或皮下脂肪层;16例呈圆形或椭圆形,2例形态不规则;肿块最大长径8～55mm;14例边界清晰,可见薄的包膜回声,4例边界部分不清;15例肿块内部回声不均匀,呈高低回声相间,可伴无回声（2例肿块内见微小钙化）,3例为相对均匀低回声;15例肿块后方回声增强,3例后方回声无明显改变。CDFI检查,16例肿块内部及周边均未探及血流信号,2例肿块边缘可探及血流信号。结论：乳腺表皮样囊肿声像图有一定的特征性,高频超声具有较高的诊断价值。     

高频彩色多普勒超声在甲状腺乳头状癌诊断中的应用

目的探讨高频彩色多普勒超声对甲状腺乳头状癌定性诊断的价值。方法对95例经术后病理证实的甲状腺乳头状癌的高频二维超声和彩色多普勒声像图进行回顾性分析。结果 63例以实性密集低回声为主,边界不规则,呈蟹足样或有明显毛刺状,可见有砂砾样钙化。32例以混合回声为主,可有液性或混合性暗区,暗区周边不光滑。95个病例中,术前二维超声和彩色多普勒超声诊断为甲状腺癌63例,结节性甲状腺肿20例,甲状腺腺瘤11例,弥漫性毒性甲状腺肿（甲状腺功能亢进）1例,术前超声诊断与病理符合率为66.3%。结论甲状腺癌超声表现具有一定的特异性,高频二维和彩色多普勒超声对甲状腺恶性肿瘤的定性诊断有较高的应用价值。     

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.     

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.     

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.