彩色多普勒超声对甲状腺结节良恶性鉴别的价值

目的探讨彩色多普勒血流显像（CDFI）对甲状腺结节良恶性肿瘤的鉴别作用。方法用二维声像图、彩色多普勒血流显像方法检查甲状腺患者120例,共计152个病灶,按病灶的声像图特征和血流特点判定为良性和恶性,检查结果与手术后病理对照进行对比分析。结果超声对恶性病灶的检出率方面,其灵敏度、特异度、准确性分别为66.7%、79.0%和78.3%。结论彩色多普勒超声在甲状腺占位性结节的良恶性诊断中具有一定临床的价值。     

甲状腺癌钙化结节的超声研究

目的探讨超声对甲状腺癌的诊断价值.方法对304例术前超声检查并经手术病理证实的甲状腺癌患者的临床资料进行回顾性分析,对其中超声检出钙化结节的123例超声图像进行综合分析并与非癌钙化结节对比.结果123例中术前超声检出135侧甲状腺癌钙化结节,超声与病理诊断符合60侧(44.4%),超声提示为甲状腺实质性肿块45侧(33.3%),漏、误诊30侧(22.2%).甲状腺恶性病变的超声图像以低回声、实质不均质、包膜不清、边界模糊、形态不规则、周边无声晕、血流丰富的微小钙化灶为主.结论超声检查对发现甲状腺结节和鉴别甲状腺良恶性肿瘤具有重要的临床价值,综合分析甲状腺结节灰阶超声及彩色多普勒征象,可提高甲状腺癌鉴别诊断的准确性.     

甲状腺微小癌彩色多普勒超声诊断的价值及影像学特征研究

目的:研究彩色多普勒超声诊断甲状腺微小癌的价值及影像学特征。方法:将2017年10月—2020年10月我院收治的80例疑似甲状腺微小癌病例样本作为观察对象,全部进行彩色多普勒超声检查,以术后病理检查结果为参照,分析彩色多普勒超声对诊断甲状腺微小癌的价值及影像学特征。结果:彩色多普勒超声诊断符合率90.00%(72/80)与术后病理93.75%(75/80)比较无差异(P>0.05);彩色多普勒超声检查灵敏度为95.83%(69/72),特异性为75.00%(6/8);彩色多普勒超声特征:80例疑似甲状腺微小癌病例样本中,病灶多表现为实质性、低回声、边缘不规则,72例肿瘤病灶和周围可见异常丰富血流信号,其中片状样有35例(48.61%)、分支样37例(51.39%),8例未见明显血流信号;病灶血流速度峰值在10.1~38.5 c m/s之间,均值数(24.3±5.5)c m/s;阻力指数在0.65~0.80,均值数(0.7±0.12)。结论:在甲状腺微小癌的临床诊断中,采取彩色多普勒超声检查,可获得满意检出率,诊断灵敏度、特异度均较高,可为疾病诊断、治疗提供可靠参考,但是,彩色多普勒超声检查存在一定漏诊、误诊情况,为进一步提高诊断准确性,在实际检查过程中需联合进行其他检查。     

甲状腺微小癌的声像图特征及误诊分析

目的：分析甲状腺微小癌的超声声像图特征,探讨误诊原因,提高超声对甲状腺微小癌的识别及诊断率。方法：对35例经手术及病理证实的甲状腺微小癌病例术前超声诊断资料进行回顾性分析。结果：35例甲状腺微小癌患者共35个病灶,术前超声准确诊断22个（符合率62.86%）,误诊9个（误诊率为25.71%）,不确定4个（11.43%）。甲状腺微小癌大多合并甲状腺其他疾病,二维大多表现为实质性低回声,以类圆形为主,无包膜,形态不规则,内可见簇状分布的强光斑,部分伴颈部淋巴结转移,CDFI显示大多数病灶内能测及彩色血流信号,以5~10mm结节明显。结论：超声对甲状腺微小癌的诊断有重要意义,但因其病灶比较小且部分与良性病变表现相似或与良性病变共存,易导致误诊。     

彩超诊断甲状腺恶性肿瘤的特征性表现和误诊分析

目的通过高频超声和彩色多普勒超声检查,分析甲状腺癌超声声像图特征,降低超声误诊或漏诊率。方法通过对经手术后病理诊断为甲状腺癌60例的病例,进行高频声像图和彩色多普勒血流显像（CDFI）的回顾性分析,对超声漏诊和误诊原因进行归纳和总结。结果在高频二维声像图中癌病灶呈低回声和内部有细粒状钙化灶是特征性较高的甲状腺癌的超声表现,而多源性结节或者微小癌常使甲状腺癌缺乏特征性声像图表现而容易误诊。CDFI表现：甲状腺癌比较甲状腺良性病灶,内部血流更丰富,血流阻力指数（RI）和收缩期最高流速峰值（Vmax）增高,二者有显著差异（P〈0.05）。甲状腺癌的超声诊断的符合率91.6%（55/60）,其中误诊4例（4/60）,漏诊1例（1/60）。结论大多数甲状腺癌都具有特征性超声表现,结合彩色多普勒超声更有助于提高甲状腺癌诊断的准确性,以减少漏诊和误诊。     

甲状腺微小癌的二维超声表现及彩色多普勒血流显像特征

目的探讨甲状腺微小癌的二维超声表现及彩色多普勒血流显像特征。方法运用随机抽样的方法选取2008年1月至2014年9月收治的75例甲状腺微小癌(研究组)。另选取同期收治的69例(82个结节)良性结节患者为对照组。对两组患者的二维超声表现及彩色多普勒血流显像特征进行统计分析。结果研究组低回声、微小钙化、纵横比≥1、血流丰富患者的比率明显高于对照组(P0.05),彩色多普勒血流显像Ⅰ型、Ⅱ型比率均显著低于对照组(P0.05),Ⅲ型比率显著高于对照组(P0.05);二维超声对研究组患者诊断的灵敏度、特异度、阳性预测值、阴性预测值分别为86.4%(89/103)、80.5%(33/41)、91.8%(89/97)、70.2%(33/47)。103个甲状腺微小癌中,超声诊断准确89个,达到了86.4%的诊断准确率;其余14个中,被误诊为甲状腺腺瘤9个,被误诊为结节性甲状腺瘤样增生5个。结论甲状腺微小癌的二维超声表现及彩色多普勒血流显像特征具有较高的临床诊断价值,值得推广。     

亚急性甲状腺炎39例的超声诊断及误诊分析

目的：探讨高频超声及彩色多普勒血流（CDFI）对亚急性甲状腺炎（SAT）的诊断价值。方法：回顾分析39例甲状腺穿刺组织活检术检查,证实的SAT患者的声像图特征及实验室检查。结果：39例SAT患者通过超声来准确诊断的有30例,诊断符合率76.9%,9例误诊,误诊率23.1%。结论：分析SAT的高频超声及CDFI图像特征,结合临床表现和实验室结果,可提高诊断SAT的符合率。     

甲状腺癌超声误诊25例分析

目的 回顾经手术病理证实的25例甲状腺癌的彩色多普勒超声表现及对误诊原因进行分析,提高超声对其诊断的准确性.方法 应用彩色超声诊断仪对25例患者甲状腺进行二维及彩色多普勒超声检查,并与手术病理相对照.结果 25例患者表现为大小不一的占位性病变,多数边界不清,内部回声不均匀,可有砂粒样钙化,周边及内部可见血流信号,部分病例可见颈部淋巴结转移.误诊为结节性甲状腺肿14例,甲状腺腺瘤出血囊性病变3例,甲状腺腺瘤8例.结论 病灶过小、早期癌的恶性特征不明显以及甲状腺有多源性疾病存在,是造成误诊的主要原因,在检查过程中需注意鉴别诊断.     

阴道彩色超声在诊断子宫肌瘤中的意义及超声表现分析

目的:研究阴道彩色超声在诊断子宫肌瘤中的意义及超声表现.方法:选取2021年7月—9月在常州市武进第四人民医院治疗的子宫肌瘤患者60例为研究对象,所有患者均进行阴道彩色超声诊断,总结分析患者超声表现,同时对患者舒张期血流、收缩期血流、分流血流阻力指数进行观察与记录.结果:60例患者经阴道彩色超声检查显示低回声39例(6...     

彩色多普勒超声对乳腺癌诊断的价值

目的评价二维超声图像特征对乳腺恶性肿瘤诊断及鉴别诊断的意义。方法应用高频二维超声对30例乳腺肿块患者进行检查,观察肿块的部位、形态、边界、边缘、纵横比、内部回声、病灶后方回声、侧壁声影、微小钙化灶及有无腋窝肿大淋巴结;彩色多普勒血流图着重观察乳腺肿块的血流特征。所有病例均经手术,并将超声诊断与病理诊断结果进行对照。结果30例乳腺肿块术后病理诊断均为恶性,其中28例超声提示为恶性,2例为良性,超声对乳腺恶性肿块的诊断总符合率为93.3%,误诊率为6.7%。结论高频二维超声特征结合彩色多普勒表现对乳腺恶性肿瘤具有较高的诊断价值。     

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.