预激综合征合并急性前壁心肌梗死1例

病例女性,60岁.阵发心悸20年,加重伴心前区疼痛1w,心悸8 h入院.入院时心电图显示:阵发性室上速,心率188 次/min,急性前壁心肌梗死.入院后给予倍他乐克注射液5 mg,静推后室上速终止,心电图显示:A型预激综合征.     

钆喷酸葡胺致严重过敏反应一例

病例资料 患者,男,40岁.平素健康,无药物过敏史.因头痛2天,伴呕吐、意识模糊1天入院.因患者不配合,MRI检查前给予安定10 mg静脉注射,入睡后扫描.     

氯胺酮麻醉后诱发癫(癎)样持续抽搐1例

1 病例报告 患儿男,3岁2个月.患者以左斜疝嵌顿入院.查体:心肺无异常,左腹股沟有-4 cm×3 cm×3 cm肿块,局部红肿,不能回纳,有明显压痛.术前常规肌内注射东莨菪碱0.1 mg、苯巴比妥钠30 mg.入手术室后建立输液通道、吸氧,于手术开始时静脉注射氯胺酮25 mg、咪达唑仑1 mg.术中患儿肢体微动时,...     

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病例46 病例资料 患儿,女,2个月.无明显诱因出现腹胀1个月,进行性加重入院.既往体健.查体:神清,颈软,心肺(-),腹膨隆,腹胀明显,全腹散在压痛,无反跳痛,腹壁静脉紧张,肠鸣音减弱.实验室检查:WBC 16.1×109/l,CRP 146 mg/l.     

前列腺骨外尤文肉瘤/原始神经外胚层肿瘤一例

病例资料 患者,男,45岁,因排便困难伴血便入院.外院电子结肠镜提示前列腺-直肠瘘形成.肛门指诊:前列腺Ⅲ度肿大,指套退出后可见脓性及血性分泌物.实验室检查:前列腺特异性抗原(prostate spe-cific antigen ,PSA )浓度为2 .386mg/mL.     

依达拉奉注射液致严重肝损害1例

病例 男性,81岁,因头晕、血压升高伴下肢行走不利1个月入院。根据患者病史、查体及CT检查结果,入院诊断为：腔隙性脑梗死、脑梗死后遗症、冠心病。入院查血常规、肝肾功、电解质均正常,给予口服拜阿斯匹林100mg 1次／d,硫酸氯吡格雷片75mg 1次／d,胞磷胆碱钠片200mg 3次／d,单硝酸异山梨酯缓释片60mg 1次／d,静滴依达拉奉注射液30mg＋0．9％氯化钠注射液250ml,拟定疗程14d,     

全麻拔管后喉痉挛致负压性肺水肿1例

病例 女,36岁,体重58 kg,因发现胆囊结石1个月余入院.入院诊断:胆囊结石伴胆囊炎,拟在全麻下行经腹腔镜胆囊切除术.患者术前胸片、ECG、生化及凝血、血常规检查均在正常范围,查体心肺未发现阳性体征.既往体健,无慢性病史,8年前曾行剖宫产手术.入室后常规开放静脉通道,行无创BP、ECG、SpO2监测.麻醉诱导给予咪唑安定3 mg,芬太尼0.1 mg,维库溴铵5 mg,丙泊酚100 mg,地塞米松10 mg,麻醉诱导平稳,插管顺利.麻醉期间生命体征平稳,手术顺利,为时45 min,术中出血5ml,输液复方乳酸林格液1000 ml.术毕患者自主呼吸及咽反射恢复,出现呛咳、躁动,呼唤能睁眼,吸痰后拔除气管导管.拔管后患者出现喉痉挛,无法吸气,随即出现口唇发绀.立即托下颌面罩加压给氧,发现呼吸阻力较大,SpO2进行性下降到65％.     

急性胰腺炎误诊为不稳定型心绞痛1例

1病例报告患者男,83岁。既往有心绞痛型冠心病、胆石症等病史。因发作性心前区闷痛2h入院,入院前2h在家看电视时突发心前区闷痛伴大汗,无腹痛、腹胀、腹泻、恶心、呕吐、发热等症状。干休所医师立即测量血压120/60mmHg,给予硝酸甘油1mg含服,心前区闷痛无缓解。遂给予阿司匹林300mg嚼服、罂粟碱30mg肌内注射、硝酸甘油持续静脉滴注,心前区闷痛有     

胃复安致锥体外系反应1例

病例 女,21岁,汉族,因停经52d,下腹疼痛2d入院。入院诊断：异位妊娠。立即急诊行“剖腹探查术”,术后明确诊断为：异位妊娠。既往无药物、食物过敏史。术后2d,患者诉恶心难忍,即给予肌肉注射胃复安10mg。     

碳酸氢钠注射液与盐酸胺碘酮注射液存在配伍禁忌

病例男,81岁,因频发性室性早博、代谢性酸中毒入院,遵医嘱给予碳酸氢钠注射液（250 ml/支,昆明宇斯药业有限责任公司生产,国药准字号H53020839）2000 mg静滴,盐酸胺碘酮注射液（商品名：可达龙,规格0．15g／3ml,杭州赛诺菲安万特民生制药有限公司生产.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

磁共振DWI和动态增强鉴别颅底脊索瘤和侵袭性垂体瘤的应用

目的 探讨磁共振扩散加权成像(DWI)和动态增强在颅底脊索瘤和侵袭性垂体瘤(IPA)鉴别诊断中的应用价值.方法 搜集经手术病理证实且影像学有鞍区破坏的颅底脊索瘤患者15例、向鼻咽部侵犯的IPA患者20例.测量二者的表观扩散系数(ADC)值,绘制受试者工作特征曲线(ROC),分析动态增强曲线的类型,统计达峰时间(TTP)、增强峰值(EP)和最大对比增强率(MCER),分析各个参数在鉴别诊断中的价值.结果 颅底脊索瘤的ADC值为(1.274±0.07)×10-3mm2/s,高于IPA ADC值(0.672±0.03) ×10-3 mm2/s(P ＜0.001),ADC阈值为0.964×10-3mm2/s时,ROC曲线下面积为0.997,敏感度为93.3％,特异度为100％.颅底脊索瘤时间-信号强度曲线(TIC)Ⅰ型14例,TICⅢ型1例,此例TICⅢ型者TTP约40 s;IPA TIC Ⅰ型7例,TICⅢ型13例.颅底脊索瘤和IPA的EP、MCER差异均有统计学意义(P ＜0.001).结论 ADC值和TIC的类型及其相关参数(EP,MCER)有助于颅底脊索瘤和IPA之间的鉴别.     

Treatment of intrahepatic arteriovenous fistula in hepatocellular carcinoma with N-butyl-2-cyanoacrylate

Primary hepatocellular carcinoma (HCC) continues to be one of the most common malignancies with an incidence of approximately one million cases per year and a dismal prognosis; some authors have reported a median survival of 1 ～ 2 months after diagnosis. Although surgery remains the only hope for cure, few patients are candidates[1,2].     

U50,488H对正常及缺氧心肌细胞L型钙电流的作用

目的 探讨心脏阿片受体和β-受体相互作用的机制。方法 采用全细胞膜片钳技术,观察U50,488H(β-阿片受体选择性激动剂)对正常和缺氧心肌细胞L型钙电流的作用。结果 U50,488H剂量依赖性(0．1～100μmol／L)抑制正常心肌细胞的L型钙电流及异丙肾上腺素(0．1μmol／L)激动的钙电流,而细胞缺氧后,这一抑制作用减弱;U50,488H对Forskolin(10μmol／L)激动的L型钙电流无明显影响。结论 β-阿片受体对β-受体信号的负性调节作用在细胞缺氧后减弱,其作用位点可能发生于β-受体与腺苷酸环化酶环节之间。     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.