多层螺旋CT诊断双侧肾上腺肿瘤价值

目的:探讨多层螺旋CT诊断双侧肾上腺肿瘤的价值。方法:回顾性分析16例经穿刺活检或手术病理确诊为双侧肾上腺肿瘤患者的多层螺旋CT影像资料。结果:转移瘤CT表现为不均匀强化肿块或结节;腺瘤CT表现为形态规则、边界清楚、较均匀低密度结节,薄层扫描可见近脂肪样密度,增强扫描为轻、中度均匀强化;淋巴瘤CT表现为不均质强化肿块,合并有腹主动脉周围淋巴结肿大;皮质腺癌CT表现为边缘不规则,伴有坏死的不均匀强化肿块;嗜铬细胞瘤表现为边界清晰、密度不均肿块,增强后可见明显强化;髓样脂肪瘤表现为边缘光整、密度低而不均匀,内有较多脂肪密度区,增强后可见轻度强化;肾上腺囊肿CT表现为无强化边界清晰的囊状水样密度病灶。结论:双侧肾上腺肿瘤的多层螺旋CT表现具有一定特异性,有助于正确诊断。     

腮腺少见病变的CT诊断

目的 分析腮腺少见病变的CT征象.方法 回顾性分析17例经临床、实验室及手术病理证实的腮腺少见病变包括腮腺淋巴结结核9例、肌上皮瘤3例、肌上皮癌2例、干燥综合征2例、转移癌1例的CT表现.结果 腮腺淋巴结结核9例CT平扫肿块呈均匀密度5例,不均匀密度4例,增强病变呈均匀性、不均匀性、环状及花边状强化表现.肌上皮瘤3例CT平扫肿块均呈稍高密度,其中1例边缘模糊,增强病变呈显著强化2例,中等度强化1例.肌上皮癌2例CT平扫肿块密度不均匀,边缘较模糊,增强肿块实性部分呈中等度强化.干燥综合征2例CT平扫双侧腮腺呈散在多发结节样稍高密度影,部分结节有融合,增强腮腺内结节影不强化或轻度强化.转移癌1例CT平扫肿块密度不均匀,增强病变实性部分显著强化.结论 腮腺少见病变均有各自的CT表现特点.CT平扫加动态增强扫描对诊断有重要价值,确诊仍依靠临床、实验室检查及病理.     

肾上腺少见肿瘤CT表现

目的 回顾性总结肾上腺少见肿瘤的CT表现特征,以提高诊断水平.方法 回顾性分析16例经手术和病理证实的肾上腺少见肿瘤,观察其CT表现特征.结果 16例中,肾上腺节细胞神经瘤3例,均匀较低密度,轻度强化;肾上腺血管瘤及肾上腺神经鞘瘤各2例,密度混杂,增强扫描肾上腺血管瘤不均匀明显强化,肾上腺神经鞘瘤呈轻至中度强化;肾上腺淋巴瘤4例,单侧或双侧较均匀密度软组织肿块,增强扫描具有延迟强化特点,肿瘤较大者周围血管可被包埋;肾上腺皮质癌5例,单侧密度不均匀软组织肿块,增强扫描见肿瘤血管影及邻近脏器受侵犯、下腔静脉癌栓、腹膜后淋巴结转移等恶性征象.结论 肾上腺少见肿瘤各具有一定的CT表现特点及诊断价值.     

多层螺旋CT诊断双侧肾上腺转移瘤价值

目的探讨多层螺旋CT动态增强扫描对双侧肾上腺转移瘤的诊断价值。方法回顾性分析43例双侧肾上腺转移瘤患者的多层螺旋CT影像资料。结果多层螺旋CT诊断双侧肾上腺转移瘤40例,2例误诊为双侧肾上腺嗜铬细胞瘤,1例误诊为双侧肾上腺结核;CT平扫发现双侧肾上腺病灶86个,双侧瘤体大小不等,与肾上腺长轴一致;4个病灶瘤侧可见残存肾上腺结构;平扫呈实性密度40个,CT值25～55 Hu,呈囊实性密度46个,CT值10～35Hu。增强扫描32个病灶呈轻中度均匀强化,36个病灶呈不均匀逐渐强化,18个病灶呈厚环状强化,囊变、坏死区强化不明显。结论多层螺旋CT平扫与增强扫描对双侧肾上腺转移瘤有诊断价值。     

原发性肾上腺淋巴瘤的CT表现

目的探究原发性肾上腺淋巴瘤(PAL)的CT特征,评估CT对PAL的诊断价值。方法回顾性分析7例经病理证实的PAL的临床特征及增强CT图像,重点观察病灶的大小、形态、边界、平扫密度、强化特点及与毗邻组织的关系等。结果双侧5例,单侧2例,共12个病灶。病灶体积较大,中位最大直径为54.35 mm,7个为圆形、类圆形,2个为类三角形,3个呈浅分叶状,肿块边界均较清晰。10个病灶CT平扫呈均匀的等或稍低密度,增强后基本表现为均匀的渐进性强化,动脉期仅轻度强化,静脉期呈轻中度强化,延迟期持续强化;仅2例体积较大的单侧病灶,内见片状稍低密度坏死区且增强后未见明显强化,肿瘤呈不均匀强化。2例体积较大者可见肾脏、胰腺、脾动脉受压移位及同侧肾动脉包绕,而未见侵蚀破坏。2例可见腹膜后多发肿大淋巴结。所有病灶均未见出血、钙化等表现。本组PAL主要表现为双侧发生、体积较大的肾上腺区软组织肿块,平扫密度较均匀,增强后呈轻中度渐进性强化,强化均匀。6例血清乳酸脱氢酶水平出现不同程度升高。结论 PAL具有典型的CT征象,结合临床检查有助于术前诊断。     

胸内甲状腺的CT特征与诊断价值(附七例分析)

通过对手术病理证实7例胸内甲状腺的CT特征与诊断价值的研究,认为:(1)肿块与颈部甲状腺相延续;(2)肿块密度不均匀或伴钙化;(3)平扫肿块CT值接近或高于胸壁肌肉,增强后明显强化且有延迟增强表现;(4)对纵隔大血管及气管的典型推移表现,对诊断胸内甲状腺有肯定的价值。     

肾上腺神经节细胞瘤的影像诊断与鉴别诊断

目的：分析肾上腺神经节细胞瘤的CT与MRI影像学表现,以提高诊断水平。资料与方法： 回顾性分析自2004年5月～2010年4月间14例经手术病理证实的肾上腺神经节细胞瘤的CT与MRI资料。结果：14例均发生于单侧,右侧8例,左侧6例,CT平扫多呈低密度,其中合并囊变和钙化各3例;CT增强动脉期无强化或轻度强化,实质期、延迟期呈均匀或不均匀强化。MRI平扫肿瘤呈均匀或不均匀长T1、长T2信号改变,可见漩涡状表现。Gd-DTPA增强肿瘤常呈均匀或不均匀显著强化。肿瘤有钻缝生长及包绕血管而不侵犯血管的特点。结论：肾上腺神经节细胞瘤的影像表现有一定特异性,结合临床资料一般可明确诊断。     

多层螺旋CT及磁共振成像在肾上腺髓质脂肪瘤中的诊断价值

目的 探讨肾上腺髓质脂肪瘤(AML)的多层螺旋CT(MsCT)及磁共振成像(MRI)诊断价值.方法 回顾性分析28例经手术病理证实的AML的MSCT及MRI表现.结果 MSCT扫描显示肾上腺区低密度肿块14例,混杂密度肿块11例,实性肿块2例,双侧肾上腺多发混杂密度肿块1例,12例有钙化,5例有出血及坏死,其中有2例患者混杂密度肿块内既有钙化又有出血及坏死,13例增强扫描无明显强化;19例做MRI检查的患者中,有11例MRI表现为右侧肾上腺区肿决T1wI、TW2I呈均匀或不均匀高信号影,7例表现为左侧肾上腺区肿块T1wI、TW2 I呈均匀或不均匀高信号,1例双侧肾上腺多发病灶者表现为右侧肾上腺T1WI、TW2 I混杂高信号影,左侧多发病灶T1WI、TW2 I呈混杂信号.结论 MSCT及MRI在AML中诊断及鉴别诊断方面具有重要的价值.     

纵隔节细胞神经瘤的CT诊断价值

目的 探讨纵隔节细胞神经瘤的CT表现特征,以提高其诊断准确性.方法 回顾性分析经手术病理证实的纵隔节细胞神经瘤9例,术前均行CT平扫及增强扫描.结果 纵隔节细胞神经瘤的CT表现为边缘光滑清晰的肿块影,多呈类圆形或椭圆形,密度低且均匀,平扫密度低于胸大肌,部分肿块内可见点状钙化灶（3/9）,增强扫描多数肿块呈轻度均匀强化（8/9）,强化后密度仍低于胸大肌,少数可见条带状不均匀强化（1/9）.结论 纵隔节细胞神经瘤CT表现具有一定特征性,有助于术前诊断及手术方案的制定.     

螺旋CT在新生儿肾上腺出血诊断中的应用——附18例报告

目的：总结新生儿肾上腺出血（NAH）的螺旋CT表现,探讨螺旋CT对NAH的诊断价值。方法：回顾性分析18例NAH患儿的螺旋CT平扫及增强扫描结果。结果：18例患儿CT平扫均显示肾上腺区单发圆形、椭圆形或不规则肿块,均单侧发生。肿块位于右侧15例,左侧3例,大小10mm×8mm～41mm×50mm。肿块呈均匀低密度占位3例,高低密度混杂占位4例,均匀高密度占位1例,囊性占位10例。肿块边缘清晰,光滑。18例患儿CT增强扫描均未见肿块内容物强化,可见边缘强化5例,受压的肾上腺强化7例。随访7d～3个月CT复查示肿块体积较前明显缩小、密度降低4例,随访3个月时CT示血肿消失1例,余14例于10d-1年行B超复查,结果示肿块完全消失10例,肿块范围明显缩小4例。结论：螺旋CT平扫对诊断NAH有重要价值,结合CT增强扫描有助于与肿瘤等鉴别,影像学随访有助于NAH的确诊。     

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.     

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.     

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.     

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.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

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.