胃部异位胰腺的超声表现

目的 分析胃部异位胰腺的超声表现及其与病理的关系.方法 回顾性分析15例经病理证实的胃部异位胰腺超声资料,观察其声像图表现特征.结果 15例均为单发病灶,最大径1.3～3.1cm,平均1.9cm.病灶呈圆形或卵圆形,与胃壁呈广基底;术前诊断正确2例,13例诊断不明确或误诊.病灶位于胃窦部11例,胃体部3例,胃底部1例;胃大弯侧10例,胃小弯侧5例.9例声像图表现均匀低回声结节,病理为胰腺腺泡组织;2例病灶内见管样结构;病理提示为残留扩张的胰腺导管;4例声像图表现不均匀低回声结节,病理以胰腺导管及增生平滑肌为主.结论 胃部异位胰腺发生部位具有特征性,声像图表现呈黏膜下病变特征;病灶回声与异位胰腺病理组成相关.     

超声诊断急性阑尾炎115例的临床价值

目的探讨超声在急性阑尾炎临床诊断上的价值。方法选取2008年2月～2009年12月在本院门诊及住院治疗的经手术及病理证实的急性阑尾炎患者115例,并对该组患者手术前超声诊断,术后病理检查,比较超声及术后病理检查的结果,分析其声像图特征。结果 115例患者中,手术病理诊断急性单纯性阑尾炎36例,超声诊断33例,诊断符合率为91.67%,漏诊2例;手术病理诊断急性化脓性阑尾炎55例,超声诊断52例,诊断符合率为94.55%,漏诊3例;手术病理诊断急性坏疽性阑尾炎16例,超声诊断16例,诊断符合率为100%;手术病理诊断穿孔型阑尾炎6例,超声诊断5例,诊断符合率为83.33%,漏诊1例;手术病理诊断阑尾周围脓性2例,超声诊断2例,诊断符合率为100%。结论超声检查对急性阑尾炎具有明确诊断及鉴别诊断的价值,其声像图变与病理改变基本一致,适用于所有具有阑尾炎临床表现的患者,有利于临床医师治疗方案的选择。     

超声诊断急性阑尾炎115例的临床价值

目的 探讨超声在急性阑尾炎临床诊断上的价值.方法 选取2008年2月～2009年12月在本院门诊及住院治疗的经手术及病理证实的急性阑尾炎患者115例,并对该组患者手术前超声诊断,术后病理检查,比较超声及术后病理检查的结果,分析其声像图特征.结果 115例患者中,手术病理诊断急性单纯性阑尾炎36例,超声诊断33例,诊断符合率为91.67%,漏诊2例;手术病理诊断急性化脓性阑尾炎55例,超声诊断52例,诊断符合率为94.55%,漏诊3例;手术病理诊断急性坏疽性阑尾炎16例,超声诊断16例,诊断符合率为100%;手术病理诊断穿孔型阑尾炎6例,超声诊断5例,诊断符合率为83.33%,漏诊1例;手术病理诊断阑尾周围脓性2例,超声诊断2例,诊断符合率为100%.结论 超声检查对急性阑尾炎具有明确诊断及鏊别诊断的价值,其声像图变与病理改变基本一致,适用于所有具有阑尾炎临床表现的患者,有利于临床医师治疗方案的选择.     

超声诊断胎儿鼻泪管囊肿一例

病例:孕妇,27岁,G2P1,孕32w+5d,既往无特殊病史,产前筛查多项致畸因子阴性,早孕期无毒害接触史。来我院行产前超声检查,使用GE VOLUSON 730 EXPERT型超声仪,频率3.5MHz探头经腹检查。二维超声显示:宫内单活胎,胎方位LOA,胎儿各生长径线如孕32w左右,羊水暗区38mm,指数122mm。胎儿颜面部见3个无回声区,分别位于鼻骨旁左,右眼眶下方及左侧眼眶内上方,大小分别为:13mm×11mm×12mm,8mm×9mm×7mm,8mm×6mm×6mm。鼻骨两旁囊性包块分别与同侧鼻腔相通,双侧眼球均受压略外移,两眼距增宽,比例45%(见图1,2)胎儿其他各系统发育未见明显异常…     

子宫腺肌病的病理超声分型研究

目的探讨子宫腺肌病的阴道超声声像图特征，旨在提高对子宫腺肌病的超声诊断准确率．方法分析82例经腹腔镜及病理确诊为子宫腺肌病的声像图分型特征．结果根据病理分析，将子宫腺肌病病理形态学特征在声像图上的表现分为三型：①局灶型53例(64．6％)．②腺肌瘤型11例(13．4％)．③弥漫型18例(22．0％)．结论经阴道超声的分型诊断有利于对子宫腺肌病超声特征的重新认识，提高诊断率．     

经阴道超声诊断异位妊娠756例声像图分析

目的探讨经阴道超声对异位妊娠的诊断价值。方法回顾性分析756例经阴道超声检查为异位妊娠的超声图像,找出其内在的声像图特征,所有病例均经腹腔镜或剖腹手术及病理证实。结果756例患者经阴道超声检查,正确诊断异位妊娠748例,诊断符合率达98.94%,其中输卵管妊娠743例,占98.28%。756例异位妊娠声像图中表现为子宫增大或轻度增大538例（71.1%）,子宫大小正常218例（28.83%）。内膜厚度在5～10mm604例（79.89%）,内膜厚度在10mm以上152例（20.1%）。其中80例阴道超声图像为附件区有完整胎囊型包块,60例见到卵黄囊、胎芽及心管搏动,664例在附件区探测到混合性、低回声或强回声包块。结论经阴道超声诊断异位妊娠准确率高,可作为异位妊娠早期诊断的首选方法。     

积乳囊肿的超声分型和声像图特征

目的 探讨积乳囊肿的超声分型、声像图特征及临床意义.方法 分析经病理证实的57例积乳囊肿的彩超表现和特点、然后依据声像图特征进行简略分型.结果 37例积乳囊肿中,单纯囊肿型17例,多囊型6例,脂液分层型5例,致密结节型12例,星光型8例,结石型3例,不规则型6例;其中2例致密型积乳囊肿误诊为纤维腺瘤.积乳囊肿的超声诊断符合率96.49%.结论 积乳囊肿的超声诊断及分型是一种简便、适用、易行的方法,能提高积乳囊肿的诊断准确性,有助于临床治疗方案的选择.     

联合应用高频及低频探头诊断急性阑尾炎的价值

目的 探讨联合应用高频及低频探头诊断急性阑尾炎的价值.方法 联合应用高频及低频探头对108例术后病理证实的急性阑尾炎声像图资料进行回顾性分析,总结声像图特点.结果 108例急性阑尾炎患者,术前超声诊断78例,检出率72.2%.其中单纯性阑尾炎58例,术前超声诊断32例,检出率为55.2%,急性化脓性阑尾炎32例,术前超声诊断28例,检出率为87.5%;坏疽性阑尾炎及阑尾周围脓肿18例,超声诊断18例,诊断率为100%.结论 超声对急性阑尾炎的术前诊断准确性较高,对临床医师的治疗方案有重要的指导作用.     

彩色超声联合多平面成像技术诊断骨化性肌炎及分期

目的研究骨化性肌炎的超声表现,分析各期特征,为临床诊疗提供有力证据。方法选择37例骨化性肌炎患者,其中男性32例,女性5例;年龄24~52岁,平均年龄28岁。应用彩色超声及多平面成像技术筛查,经实时动态超声联合精确断层技术确诊,37例均行病理检查;结合确诊后病例的声像图,总结诊断依据。结果病理诊断为骨化性肌炎。术前超声诊断准确率达100%。其于病变早期表现为局限性边界清晰非均质实性稍低回声;中期为含稍强回声的非均质等回声;后期为含钙化的非均质稍强回声。结论彩色超声联合多平面成像技术可以依据各时期声像图表现诊断骨化性肌炎并确诊病变分期;为临床指导最佳治疗时期。     

子宫腺肌病的病理超声分型研究

目的探讨子宫腺肌病的阴道超声声像图特征,旨在提高对子宫腺肌病的超声诊断准确率.方法分析82例经腹腔镜及病理确诊为子宫腺肌病的声像图分型特征.结果根据病理分析,将子宫腺肌病病理形态学特征在声像图上的表现分为三型:①局灶型53例(64.6%).②腺肌瘤型11例(13.4%).③弥漫型18例(22.0%).结论经阴道超声的分型诊断有利于对子宫腺肌病超声特征的重新认识,提高诊断率.     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

What will studies of Fulani individuals naturally exposed to malaria teach us about protective immunity to malaria?

There are an estimated over 200 million yearly cases of malaria worldwide. Despite concerted international effort to combat the disease, it still causes approximately half a million deaths every year, the majority of which are young children with Plasmodium falciparum infection in sub-Saharan Africa. Successes are largely attributed to malaria prevention strategies, such as insecticide-treated mosquito nets and indoor spraying, as well as improved access to existing treatments. One important hurdle to new approaches for the treatment and prevention of malaria is our limited understanding of the biology of Plasmodium infection and its complex interaction with the immune system of its human host. Therefore, the elimination of malaria in Africa not only relies on existing tools to reduce malaria burden, but also requires fundamental research to develop innovative approaches. Here, we summarize our discoveries from investigations of ethnic groups of West Africa who have different susceptibility to malaria.     

The universal muscular chain reaction,muscle spasm,Torsions, ruptures and extravasations. Chameleons of pathology and some manifestations of simple muscular disorders

Most bodily functions require the coordinated actions of complementary and supplementary paired muscle groups. Where this essential muscular cooperation is lacking, hollow organs may burst and others become literally screwed up, giving rise to many similar spastic diseases such as Torticollis, Twisted ovarian cyst, Torsion of the Testis, Volvulus of the intestines, Varicose Veins, Megacolon, Aortamegaly, Scoliosis, Erb's Palsy, Peyronie's Disease, Main-en-Griffe, Undescended Foot (Pes Cavus), Talipes, Strabismus. Spasm is “panenepidemic” and unclassified examples of Torsion Dystonia and Dyskinesia really are as common as debt and taxes.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

Hypo- und Hypermagnesämie aus kardiologischer Sicht

Zusammenfassung Eine Reihe pathologischer Zustände bedingen Magnesiummangel. Zustände mit Hypermagnesämie sind ebenfalls bekannt, doch wesentlich seltener. Für den Kardiologen beachtenswert ist, daß unter Therapie mit bestimmten Diuretica bei Herzinsuffizienz, bei Herzinfarkt, Kardiomyopathie, Digitalisintoxikation und bestimmten Herzrhythmusstörungen Hypomagnesämie beobachtet wurde. Leider kann in der klinischen Routine nur ein extracelluläres Magnesiumdefizit durch Serumbestimmungen gemessen werden; über Magnesiummangel einzelner Organe kann nichts ausgesagt werden. Hinweise für Magnesiummangel geben aber neben der Messung des Serumspiegels Anamnese, klinischer Befund, bestimmte EKG-Veränderungen wie auch evtl. Hypokalämie, ein Zustand, bei dem sich oft — besonders bei Aldosteronismus — parallele Veränderungen zeigten.Tierexperimente deuten darauf hin, daß infarktähnliche Läsionen unter Magnesiummangel entstehen, doch ob Herzinfarkt beim Menschen durch Magnesiummangel ausgelöst werden kann, ist noch ungeklärt. In Leichenherzen zeigte sich im Infarktgebiet neben Calciumakkumulation signifikanter Magnesiumverlust, wobei unklar blieb, ob sich Ursache oder Folge des Infarktes widerspiegelten. Falls ein ursächlicher Zusammenhang besteht, ist er im Myokardstoffwechsel selbst zu suchen, wie bei der Alkoholkardiomyopathie, wo myokardialer Magnesiummangel zumindest als pathogenetischer Teilfaktor anerkannt wird. Andererseits versucht man aber auch Beziehungen zwischen Atherosklerose, Blutgerinnung und Hypomagnesämie herzustellen, in der Meinung, daß Magnesiummangel auch über den coronaren Pathomechanismus des Herzinfarktes wirken könnte. Sicher scheint, daß gewisse EKG-Veränderungen und Herzrhythmusstörungen durch einen irritierten Magnesiumhaushalt bedingt sein können, da sie bei Gabe bzw. Entzug von Magnesium verschwinden. Daß Magnesiummangel die Glykosidtoleranz verringert, wird tierexperimentell bestätigt. Unter Hypomagnesämie bewirkt Acetylstrophanthidin eher und länger Rhythmusstörungen als ohne, außerdem lassen diese sich durch Magnesiumgaben eliminieren. Da in gewissen Fällen spontane und digitalisinduzierte Herzrythmusstörungen durch Magnesiuminjektionen beseitigt wurden, scheint Magnesium als Therapeuticum angebracht. Einsatz verschiedener Magnesiumsalze bei Angina pectoris, degenerativen Herzerkrankungen und Herzinsuffizienz ohne geprüften und offensichtlich gestörten Magnesiumhaushalt ist fragwürdig, weil keine eindeutigen klinischen Erfolgsbeweise vorliegen. Immerhin mag es aber larvierte, durch Serumbestimmungen nicht erfaßbare Mangelzustände geben. Allgemein erscheint es aus kardiologischer Sicht ratsam, den Magnesiumhaushalt zu überwachen und in entsprechenden Fällen auszugleichen, um möglichen Myokardläsionen oder fatalen Herzrhythmusstörungen entgegenzuwirken.     

Environmental risk factors and their role in the management of atopic dermatitis

Introduction: The etiology of atopic dermatitis (AD) is multifactorial with interaction between genetics, immune and environmental factors.

Areas covered: We review the role of prenatal exposures, irritants and pruritogens, pathogens, climate factors, including temperature, humidity, ultraviolet radiation, outdoor and indoor air pollutants, tobacco smoke exposure, water hardness, urban vs. rural living, diet, breastfeeding, probiotics and prebiotics on AD.

Expert commentary: The increased global prevalence of AD cannot be attributed to genetics alone, suggesting that evolving environmental exposures may trigger and/or flare disease in predisposed individuals. There is a complex interplay between different environmental factors, including individual use of personal care products and exposure to climate, pollution, food and other exogenous factors. Understanding these complex risk factors is crucial to developing targeted interventions to prevent the disease in millions. Moreover, patients require counseling on optimal regimens for minimization of exposure to irritants and pruritogens and other harmful exposures.     

Class II HLA in Georgia Caucasus Tbilisi Georgians and their Mediterranean ancestry: The Usko Mediterranean languages

Georgia (or Sakartvelo in its own language) is a South Caucasus Mts. country with its easternmost part is enigmatically named Iberia, like the Iberian Peninsula, which may refer to rivers “Kura” and “Ebro” or their valleys respectively. Most of their inhabitants speak Georgian which is included within Dene-Caucasian group and Usko-Mediterranean subgroup of languages. The latter includes Basque, Berber, ancient Iberian-Tartessian, Etruscan, Hittite, Minoan Lineal A and others. In the present paper, HLA class II -DRB1 and -DQB1 alleles has been studied and extended haplotypes calculated. Most frequent haplotypes are also of Mediterranean origin (i. e.: (A*02-B*51)-DRB1*11:01-DQB1*03:01, (A*02-B*51)-DRB1*13:01-DQB1*06:03, or (A*24-B*35)-DRB1*01:01-DQB1*05:01) and DA genetic distances show that closest world populations to Georgians are Mediterraneans. Georgians also show common extended haplotypes ((A*02-B*51)-DRB1*11:01-DQB1*03:01, (A*02-B*13)-DRB1*07:01-DQB1*02:01 and (A*03-B*35)-DRB1*11:01-DQB1*03:01) with Svan people, a secluded population in North Georgia mountains. We can conclude that Georgians belong to a very old Mediterranean substratum according to both linguistics (Usko Mediterranean languages) and HLA genetics.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.