剖腹术后切口愈合不良的超声表现

目的：探讨剖腹手术后切口愈合不良的声像图表现。方法：应用B超高频探头对95例剖腹手术患的手术切口进行局部超声探查。结果：95例中，病灶局限于腹壁脂肪层63例；病灶局限于肌层10例；脂肪层及肌层均有病灶5例；腹壁与腹腔内低回声病灶并存5例；腹壁窦遭回声12例。以不规则低回声、无回声、混合性回声区或窦道回声等为共同声像图表现。结论：高频超声观察手术切口所发现的异常声像图，对提示切口愈合不良有一定临床价值。     

睾丸结核的临床与超声影像学特征分析

目的探讨睾丸结核的临床及超声影像学特征。 方法回顾性分析2013年1月至2020年10月西藏自治区人民医院37例临床诊断为睾丸结核的患者的临床及超声影像学资料,总结其特征。 结果37例患者中单侧睾丸结核26例,双侧睾丸结核11例。临床症状以阴囊肿大、慢性肿胀疼痛为主。超声检查表现多样,以片状低回声及混合回声（17/37,45.9%）、粟粒样结节（18/37,48.6%）、结节或肿块（6/37,16.2%）、窦道形成（8/37,21.62%）为主要超声表现,部分患者可多种征象并存。32例患者同时伴发附睾结核声像图改变,表现为附睾弥漫性增大、结节或脓肿。 结论睾丸结核的临床表现及超声声像图表现多样。详细了解相关病史,熟练掌握其超声声像图特征及鉴别诊断要点,有助于做出正确诊断。     

超声在子宫内膜结核诊断中的应用价值

目的探讨女性子宫内膜结核的超声声像图特征及诊断意义。 方法回顾性分析经手术及病理证实为子宫内膜结核的患者47例。所有患者均行经阴道彩色多普勒超声检查,总结分析子宫内膜形态特征、内部回声及血流等情况的超声声像图特征和表现,并对子宫内膜结核患者盆腹腔内的其他超声表现及术中所见进行分析。 结果经阴道超声检查47例患者的子宫内膜厚度,单层内膜厚度平均为（0.31±0.15）cm。根据超声影像特点,子宫内膜表现为不同特征,其中15例（31.9%）主要表现为子宫内膜回声不均匀,12例（25.5%）主要表现为宫腔内结节样病灶,8例（17.0%）主要表现为宫腔内的强回声灶,12例（25.5%）主要表现为单纯的子宫内膜薄。子宫内膜结核患者盆腹腔内的其他超声表现有：43例（91.5%）伴有输卵管炎性表现,11例（23.4%）伴有输卵管系膜囊肿,9例（19.1%）伴有盆腔包裹性积液;术中所见有：45例（95.7%）伴有盆腹腔组织粘连,23例（48.9%）伴有盆腹腔粟粒样结节。 结论子宫内膜结核超声表现多样,但缺乏特异性的征象,需结合患者病史及进一步的临床检查,才能明确诊断,合并输卵管异常的超声征象对提高其诊断率具有一定的参考价值。     

胸壁结核53例的超声影像学表现及临床分析

目的 探讨胸壁结核的超声影像学表现,分析结核发展阶段.方法 对53例胸壁结核的超声声像图表现进行分析,结合临床找出规律.结果 53例胸壁结核的声像图表现可分为(1)实性回声型13例,占25%;(2)液性透声型19例,占36%;(3)液实混合型21例,占40%.所有病例均经局部穿刺或手术证实,超声诊断符合率100%.结论 超声检查对胸壁结核有很好的显示率,根据声像图的表现可以确定胸壁结核的大小、范围;判断是否有液化和冷脓肿形成、是否累及胸腔,并可显示脓肿侵入胸腔的破口,探查结核性脓肿窦道的走行和评价手术及局部穿刺治疗的效果.     

结节性筋膜炎的高频超声特征性表现及误诊分析

摘要： 目的：探讨结节性筋膜炎高频超声声像图特征性表现,分析超声误诊原因。方法：回顾性分析25例经手术和病理证实的结节性筋膜炎患者术前超声声像图表现,总结其临床表现及高频超声声像图特征。结果：25例结节性筋膜炎高频超声声像图特征性表现为单发圆形、椭圆形及梭形,部分可见浅分叶,均无明显包膜,边界尚清,活动度较好,与周围组织无粘连;21例病灶表现为低回声,部分内部可见中高回声,3例为中等回声,1例为高回声;19例病灶后方回声增强。CDFI：19例病灶内部及周边未探及明显血流信号;4例病灶内部或周边探及点状血流信号;2例病灶可见较丰富血流信号,呈低速高阻型,并且病灶体积相对较大。25例病灶中,14例病灶发生在皮下脂肪层,8例累及皮下筋膜层,3例累及肌肉层。超声诊断皮下异常回声15例,超声误诊10例,其中5例为脂肪瘤、2例血管瘤、1例神经源性肿瘤,1例血肿,1例软组织肿瘤。结论：结节性筋膜炎高频超声表现具有一定特征性,对结节性筋膜炎具有重要的诊断价值。     

腮腺腺淋巴瘤的超声表现特征

目的 ：探讨腮腺腺淋巴瘤二维及彩色多普勒声像图表现特征。方法 ：回顾性分析经手术病理证实的57例（63个病灶）腮腺腺淋巴瘤病人的声像图资料。结果：根据腮腺腺淋巴瘤超声表现,分为均匀低回声型（11个,17.5%）;不均匀低回声型,呈＂细网格状＂结构（19个,30.2%）;混合回声型,内部见斑片状强回声及无回声（33个,52.4%）。结论：腮腺腺淋巴瘤声像图特征性表现主要基于其病理组织结构的特点。超声检查对腮腺腺淋巴瘤的诊断具有重要价值。     

肾上腺结核的超声诊断

目的 探讨肾上腺结核的声像图特点,评价超声对该病的诊断价值.方法 回顾性分析17例经临床证实的肾上腺结核患者超声表现,评估病变的大小、内部回声特点及血流情况.结果 17例肾上腺结核患者单侧受累2例,均位于右侧,双侧受累15例,共32个病灶,超声漏诊5个.依据病灶内部回声不同,声像图表现分为3型:1.混合性回声型,共5个; 2.低回声型,共15个;3.强回声型,共7个.27个病灶中彩色多普勒超声无1例探测到血流信号.结论 肾上腺结核声像图表现具有一定的特征性,超声检查有助于鉴别诊断.     

超声对儿童早期骨关节结核的诊断价值

目的通过评价儿童早期骨关节结核的超声表现,分析声像图特点,探讨超声在儿童早期骨关节结核中的诊断价值。方法回顾性分析8例经病理证实为儿童骨结核的声像图资料,记录骨破坏的位置、范围、内部回声、周围软组织及关节受累情况等二维灰阶超声表现及血流情况。结果 8例见骨质破坏,表现为强回声骨皮质呈不规则骨质破坏。6例见软组织脓肿,表现为骨破坏区内部及周围见混浊液性区。7例见死骨形成,表现为骨质破坏区内较多斑片状及斑点状强回声。5例见血流信号(3例丰富、1例较丰富、1例少量血流信号),其中2例可探及高阻力动脉血流频谱,另外3例无血流信号。4例见关节积液,表现为关节周围无回声区。3例见软组织肿胀,表现为病灶周围肌层回声减低。1例见骨膜抬高,表现为骨皮质表面完整连续的层状稍高回声。1例见骺软骨及骨骺破坏,表现为正常低-无回声骺软骨及骨骺边缘模糊、回声增高。结论儿童早期骨关节结核的声像图表现具有一定特征性,超声检查结合临床病史、实验室检查及其他影像学检查有助于明确诊断。     

超声诊断在肛门直肠周围脓肿的应用价值

目的探讨超声检查肛门周围脓肿的声像图特点及术前定位的应用价值。方法应用经腔内端式探头和（或）高频探头检查肛门周围脓肿24例，作声像图描述及术前定位。结果超声检查24例共检出32个病灶，脓肿及瘘（窦）管声像图表现为低回声、无回声或混合回声区，病灶区域未测及明显血流信号，扫查病灶周缘区可发现瘘管、瘘管的数目及瘘口位置。结论 超声检查用于直股周围脓肿的诊断，能够区分脓肿与周围组织的关系，在定位方面具有良好的直观性、对查明瘘管、瘘管的数目及瘘口位置能提供更多、更可靠的信息。     

中老年不典型肝脓肿的超声诊断

目的探讨超声检查在中老年患者不典型肝脓肿诊断中的价值。方法回顾分析72例（79个病灶）经病理证实的中老年不典型肝脓肿的超声特征和临床表现。结果本组不典型肝脓肿病灶声像图特征呈实质性低回声（24．1％）或高中低混合性实性回声（75．9％）,均未显示明确的液化区。22个病灶内探及气体强回声,7例伴门静脉血栓形成。彩色多普勒超声检测60个病灶（75．9％）周边及内部可见彩色血流信号。结论中老年患者不典型肝脓肿声像图复杂多变,动态观察有助于提高不典型肝脓肿的诊断准确率,必要时超声引导下穿刺能明确诊断。     

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.