超声诊断粪石梗阻性阑尾炎伴穿孔1例

患者男,12岁。右下腹痛3d就诊。使用Toshiba-340A超声仪3.5MHz和7.5MHz探头检查。检查方法:疼痛点加压、逆时针旋转扫查,高频探头逐级扫查。超声所见:腹腔内肠管节段性扩张,蠕动减弱,膈肌呼吸运动减弱,右下腹可见一腊肠样囊腔,大小约6.5cm×2.0cm×2.0cm,壁厚约0.2cm,内可见一强回声团,伴声影,大小约1.0cm×0.5cm(图1,2),囊腔周围及膀胱直肠凹可见不规则液性暗区,最7.5MHz探头,ST:粪石图1肿胀的阑尾及粪石声像图3.5MHz探头,ST:粪石图2肿胀的阑尾及粪石声像图大厚度约1.0cm,右下腹超声试验阳性。超声诊断:1.粪石梗阻性阑尾炎伴穿孔;2.…     

经软腭超声引导细针穿刺诊断咽旁间隙肿瘤

目的探讨经软腭彩色多普勒超声(CDFI)诊断咽旁间隙肿瘤的应用价值.方法应用7.0 MHz腔内彩色多普勒超声探头对CT或MRI发现的40例(43个)咽旁间隙内可疑病变行软腭CDFI扫查.观察病变形态、大小、内部回声及血流情况,并行超声引导下细针穿刺(FNA)病理细胞学诊断.结果40例经CDFI扫查显示病变43个,FNA细胞学诊断良性病变6个,恶性病变32个,5个病变内未见癌细胞,其中2个病变CDFI检查高度怀疑为恶性病变,经鼻咽活检病理确诊为鼻咽癌.结论经软腭超声引导细针穿刺细胞学诊断是一种诊断鼻咽部肿瘤的新方法.当病变局限于咽旁间隙内时,FNA是对常规鼻咽活检一种有益的补充,可以提高鼻咽癌的早期诊断率.     

自制侧卧式定位床联合X线引导下真空辅助旋切术对乳腺钙化活检的应用价值

目的:探讨侧卧位X线引导下对乳腺钙化进行真空辅助旋切活检的应用价值。方法:选取桂林市中医医院2015年4月至2020年4月,侧卧式定位床联合X线引导下真空辅助旋切对乳腺钙化活检64例,侧卧式定位床联合X线引导下导丝定位对乳腺钙化进行外科切除活检64例,对比两种方法的切口大小、手术时间、旋切刀槽/定位导丝距病灶距离、术后愈合时间、定位满意率及一次切检率等。结果:两种活检方法切检成功率为100%,真空辅助旋切活检组切口小、平均手术时间短、出血量少、术后愈合时间短。结论:两种活检方法都能对乳腺钙化进行准确切检,但真空辅助旋切活检在减少组织创伤、保持乳房的美观方面优于导丝定位引导外科切除活检。     

乳腺X线三维立体定位真空辅助活检技术要点探析

目的:探讨乳腺X线三维立体定位真空辅助活检系统对乳腺内可疑恶性成簇钙化病变穿刺活检的技术要点。方法:回顾并分析天津医科大学肿瘤医院2017年11月—2018年10月49例乳腺内有成簇钙化病变的患者行X线三维立体定位真空辅助活检的临床资料。结果:49例患者中2例因乳房压迫厚度较薄无法实施旋切、1例因乳房压迫后病变距离乳头位置较近而放弃手术,最终完成手术46例。39例应用针槽20 mm旋切探针,7例应用针槽12 mm旋切探针;1次压迫乳房检出钙化灶26例,经改变体位压迫乳房检出钙化灶5例,未改变体位但重复压迫乳房检出钙化灶15例;进针后定位准确43例,定位不准确3例;旋切后标本组织X线摄影后均显示钙化。除术中出血外未出现严重并发症以及术后感染。结论:乳腺X线三维立体定位真空辅助活检操作中乳腺的摆位、定位点的选择、曝光条件、曝光次数的选择、旋切探针型号的选择、旋切中方向的侧重及并发症的处理是技术关键,对病变的准确切除、患者接受X线剂量的多少、术中及术后并发症的发生起决定性作用。     

液体隔离法在乳腺表浅良性结节真空辅助旋切术中的应用

目的探讨液体隔离法在超声引导乳腺表浅良性结节真空辅助旋切术中的应用价值。方法选取86例乳腺表浅良性结节(与皮肤间距0.5 cm)患者,采用液体隔离法增加结节与皮肤间的距离,超声实时引导下真空辅助全自动乳腺微创旋切系统切除结节,分析所有患者治疗效果及安全性。结果 86例患者89个病灶均一次性成功切除,成功率100%;术后3个月超声复查无残留及复发;术后6个月超声检查原病灶区复发1例,复发率1.16%;术后无1例皮肤出现损伤;术后24～48 h扫查术区,71例(82.56%)出现小血肿,其中59例术后1个月消失,余12例术后3个月消失;术后1周12例(13.95%)皮肤出现凹陷,8例(9.30%)皮肤出现瘀斑,均于1个月内恢复正常。结论超声引导下真空辅助旋切术切除乳腺表浅良性结节时应用液体隔离法安全、有效。     

人工智能系统评估BI-RADS 4类乳腺肿块的应用价值

目的探讨人工智能（AI）系统在乳腺影像报告与数据系统（BI-RADS）4类乳腺肿块良恶性鉴别诊断中的价值。 方法回顾性选取2018年1月至2020年2月于青岛市市立医院超声科初诊为BI-RADS 4类乳腺肿块的女性患者226例。所有患者均行常规超声检查,并经手术或穿刺活检取得病理结果。AI系统与不同年资乳腺超声专科医师（2、4、6年）分别对乳腺肿块超声图像进行分析并判断良恶性,应用四格表计算AI系统及不同年资医师对乳腺癌的诊断准确性,采用χ²检验比较AI系统与不同年资医师对不同大小乳腺癌肿块的诊断准确性。 结果226例乳腺肿块均经病理证实,其中良性病灶96例,恶性病灶130例。AI系统诊断乳腺恶性肿块的敏感度、特异度、阳性预测值、阴性预测值和准确性分别为93.84%、92.71%、94.57%、91.75%、93.36%,均高于不同年资医师。AI系统与不同年资医师诊断≤0.5 cm、＞0.5~1.0 cm、＞1.0~1.5 cm的乳腺癌肿块,其诊断准确性差异均有统计学意义（P=0.029、0.011、0.002）;诊断＞1.5~2.0 cm、＞2.0 cm的乳腺癌肿块,其诊断准确性差异均无统计学意义（P=0.117、0.668）。AI系统与2年资医师诊断≤0.5 cm、＞0.5~1.0 cm、＞1.0~1.5 cm的乳腺癌肿块,其诊断准确性差异均有统计学意义（P=0.006、0.002、0.001）。 结论AI系统在BI-RADS 4类乳腺肿块良恶性判断中具有较高的诊断价值,尤其对直径≤1.5 cm的乳腺癌的诊断;其可辅助低年资超声医师提高乳腺癌的诊断率。     

术中超声引导置入定位针在脑海绵状血管畸形切除术中的应用

目的 探讨术中超声引导下放置定位针在脑海绵状血管畸形切除术中的应用价值.方法 对术前MRI和(或)CT诊断为脑海绵状血管畸形的14例患者14处病变在术中超声引导下置入定位针定位后进行手术切除.结果 14处脑海绵状血管畸形均在术中超声引导下放置定位针精确定位,手术顺利完整切除.病变距离脑皮层表面1.5～2.9 cm,病变大小0.8～2.8 cm.14处病灶彩色多普勒超声显示内部可见少许点状血流.结论 术中超声引导置入定位针能够准确定位切除脑海绵状血管畸形.

Abstract：

Objective To explore the value of the located needles guided by intraoperative ultrasound in resection of brain cavernous malformations. Methods Fourteen patients diagnosed as brain cavernous malformations confirmed by preoperative CT and MRI. Detected by the located needles under intraoperative ultrasound guidance, 14 lesions were excised. Results Intraoperative ultrasound-guided needles accurately located 14 cases of patients with brain cavernous malformations. Fourteen lesions were removed successfully. The distances between lesions and the dura mater were 1.5-2.9 cm,the sizes of lesions were 0.8-2.8 cm. Fourteen lesions by color Doppler flow imaging showed point-like blood flow. Conclusions Brain cavernous malformations can be accurately detected by the located needles under intraoperative ultrasound guidance.     

透明隔腔的产前超声研究进展

透明隔腔（cavumseptumpellucidum,CSP）是标志胎儿中枢神经系统正常发育的一个重要指标。美国超声医学会（AmericanInstituteofUltrasoundinMedicine,AlUM）最新指南规定,胎儿中枢神经系统（centralnervoussystem,CNS）扫查时需对d,N、脉络膜丛、小脑延髓池、侧脑室、大脑镰及透明隔腔等颅内结构进行扫查,并将透明隔腔扫查纳入胎儿中枢神经系统必须检查的项目之一。随着超声仪器分辨率的不断提高及超声工作者扫查经验的不断丰富,超声医师正逐渐将透明隔腔扫查列为常规扫查项目。     

超声造影导向活检在常规超声检查阴性前列腺癌的应用价值

目的 评价超声造影匹配成像(CnTI)技术在靶向引导常规超声无可疑前列腺癌病灶前列腺穿刺活检中的临床应用价值。方法 对56例因血清前列腺特异性抗原(PSA)升高(≥4.00 ng/ml)而常规超声未发现明确病灶的患者在穿刺前行经直肠前列腺CnTI实时扫查。在超声引导下对患者行底、中、尖三切面10点穿刺,如相应穿刺点有可疑病灶,则直接对病灶进行活检。统计分析CnTI实时扫查图像结果与病理结果。结果 56例患者共穿刺560针,穿刺病理诊断为前列腺癌11例(11/56,19.64%)共39针(39/560,6.96%),CnTI实时扫查检出7例(7/11,63.64%)共22针(22/39,56.41%)。在4例CnTI实时扫查假阴性病例中,2例仅有1针穿刺点阳性,1例2针穿刺点阳性,1例3针穿刺点阳性,其Gleason分值均为6分。CnTI实时扫查真阳性与假阴性前列腺癌穿刺点Gleason分值差异无统计学意义(6.9 vs 6.6, P=0.134)。结论 对血清PSA升高但常规超声未发现明确前列腺癌病灶的患者,经直肠前列腺CnTI实时扫查有助于检出前列腺癌可疑病灶并指导前列腺穿刺活检。     

超声引导下乳腺良性肿块旋切治疗术后血肿形成因素分析

目的分析超声引导下乳腺肿块旋切术后血肿形成影响因素。方法回顾性分析2011年1月至2015年12月在萧山医院行超声引导下乳腺肿块旋切术的412例患者共516个肿块。采用χ2检验进行超声引导下乳腺肿块旋切术后血肿形成风险因素的单因素分析。采用Logistic回归分析进行超声引导下乳腺肿块旋切术后血肿形成风险因素的多因素分析。结果术后1周复查,肿块切除完全,有43个肿块切除后形成了长径≥1.0 cm的血肿;术后6个月所有血肿均完全吸收。不同粗细旋切针,不同切割针数,肿块不同大小、血流分级、深度、切除个数及不同术后绷带有效压迫时间的血肿发生率差异均有统计学意义(χ2=16.917、14.548、39.971、23.333、29.137、36.819、39.864,P均0.001)。旋切针粗细、切割针数、肿块大小、深度、切除个数及术后绷带有效压迫时间是乳腺肿块旋切术后血肿形成多因素风险因素。结论旋切针粗细、切割针数、肿块大小、深度、切除多个肿块、术后绷带有效压迫时间是超声引导下乳腺良性肿块旋切术后血肿形成的危险因素,可通过筛选纳入手术的患者和采取针对性的措施提前预防血肿的发生。     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。