肝细胞腺瘤的超声表现1例

患者女,28岁.因右上腹隐痛不适2天,于2007年7月14日就诊.超声检查(图1):于肝左内叶探及一个大小约6.6 cm×5.5 cm×5.0 cm的实性低回声肿块,边界清楚,形态不规则,周围无声晕,内部回声尚均匀,彩色多普勒超声检查:病灶周边及内部可见点状血流信号.超声诊断:肝左内叶实质低回声肿块,性质待诊.于两天后行经超声引导下肝左内叶实质低回声肿块穿刺活检(Bard 16G针).术后病理诊断为:肝细胞腺瘤.     

B超诊断腹壁结核性脓肿2例报告

患者女,右上腹包块半年就诊,无压痛及其它临床症状,B超检查:右上腹见有3.8×2.7cm液性暗区,暗区内见密集光点回声,边界厚,壁发毛,见与肝右前叶相邻,肝右前叶见5.4×2.3cm低回声;边界不清,内部回声不均匀。B超提示:①肝右前叶占位(考虑肝结核);②右上腹壁结核性脓肿。经手     

超声造影诊断原发性肝脏T细胞淋巴瘤1例

<正>患者男,26岁,因体检发现肝内血管瘤来我院进一步检查。体格检查:一般情况良好,腹部无肿胀、压痛,皮肤无黄染,浅表未触及肿大淋巴结。常规超声检查:肝右前叶见一1.8 cm×1.4 cm略高回声结节,边界尚清,内部回声欠均匀,其内未见明显血流信号(图1A);超声提示:肝内异常回声结节。超声造影检查:肝右前叶略高回声结节于动脉相10 s开始快速灌注呈不均匀高增     

原发性肝脏淋巴瘤1例

患者男,62岁,主因"腹胀、右上腹痛2周"就诊.近1年体质量减少10公斤.20余年前患黄疸性肝炎,经治疗后好转.查体:右上腹轻压痛.实验室检查未见异常.HBSAg阴性.超声示肝实质回声均匀,左肝内叶可见7.8 cm×7.2cm不均匀低回声区,边界尚清晰(图1).上腹部可见4.8 cm×3.6 cm边界清楚、形态不规则的低回声团块.CT:平扫左肝内叶多结节互相融合状不规则肿块呈稍低密度,范围约6.5 cm×7.5 cm×8.0 cm.     

超声诊断肝动脉假性动脉瘤致胆道梗阻1例

患者女,78岁,因皮肤黄染就诊.超声检查见:肝脏大小正常,表面光滑,实质回声略不均匀,肝内2级胆管普遍扩张,左叶、右叶2级胆管内径0.3～0.5 cm,左右肝管内径1.2 cm ,胆总管上段内径1.6 cm.     

B超诊断肝脏畸胎瘤1例

患者女,36岁.查体:一股情况良好,心肺未见异常,肝功能各项指标均在正常范围.B超检查肝右叶可见3.9cm×4.1cm大小囊性异常回声有包膜,腔内容物有一较明显的分界线,上层呈密集点状强回声,堆积成片,下层为无回声区.在腹部加压或体位改变时上层点状回声可漂动,为典型“脂液分层”表现.B超诊断:肝右叶囊性占位性病变:考虑囊性畸胎瘤.后经B超引导下穿刺细胞学检查:上层为粘稠脂类物质;下层为稀薄浆液.证实     

脾窦岸细胞血管肉瘤超声表现1例

患者女,27岁.因反复上腹闷痛,体检发现:肝,脾多发实性叶位入院.查体仅见:脾左肋下可触及1.5cm.超声检查:脾大小13.0 cm×4.7cm.左肋下2.0 cm;肝,脾分别可见多个实性低回声团,较大者直径4.3 cm,边界清.形态规整,内部回声欠均匀,中心可见少量不规则液化坏死区, (图1、2);CDFI:结节周边低回声区可见较丰富血流信号.     

肝脏炎性假瘤超声表现1例

正患者女,65岁。因胆囊结石多年行常规超声检查,于肝右前叶探及大小约10.2 cm×9.2 cm的实性低回声,边界清晰,形态较规则,内部回声不均质,内可见少许点片状无回声;CDFI:内部可见短棒状血流信号,周边可见环状血流信号(图1)。超声提示:肝右叶实性占位(恶性可能性大)。入院检查:甲胎蛋白和糖类抗原阴性,肝功正常;CT提示肝右叶低密度强化影,考虑肝内     

肝脏未分化胚胎性肉瘤一例

1病例资料 女,17岁.因右上腹痛伴发热、消瘦50d,肝脏CT检查示肝右叶巨大囊性肿物20d就诊.50d前出现右上腹痛伴发热、消瘦,当地医院肝脏CT检查示肝右叶巨大囊性肿物,肝功能及血清甲胎蛋白(AFP)正常,超声引导下经皮经肝穿刺置管引流术引出淡血性液体1200 ml,经引流管注射无水乙醇3次,仍持续发热,20d后复查肝脏CT仍示肝右叶巨大囊性肿物,入我院.既往体健.查体:生命体征平稳.心肺检查未发现异常.腹部平坦,未见胃肠型,腹软,肝脾肋下未触及,全腹无明显压痛,仅肝区轻度叩痛.超声检查示肝右叶一16 cm ×10 cm大小实性为主混合回声肿物,内含大小不等不规则无回声区;CT检查示肝右叶巨大囊性占位病变,不除外感染?     

肝细胞腺瘤超声表现一例

患者女，28岁。因有上腹隐痛不适2d入院检查。体检未发现异常。超声检查：于肝左内叶探及一大小约6．6cm×5．5cm×5．0cm实质低回声肿块，边界清楚，形态不规则，周围无声晕，内部回声尚均匀，彩色多普勒超声显示病灶周边及内部可见点状血流信号。超声提示肝左内叶实质低回声肿块，性质待定，建议穿刺活检。采用Bard 16G针在超声引导下行肝左内叶实质低回声肿块穿刺活检。术后病理诊断为：肝细胞腺瘤。     

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.     

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.     

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.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."