Carney三联征临床病理分析1例

<正>患者女性,73岁。平素体检,无意中发现腹部肿块入院。CT检查示肝脏与胃之间见一囊实性软组织密度肿块,大小约10.9 cm×8.5 cm,边界清楚;左肾与胰尾部之间见一类圆形软组织密度肿块,内见囊性低密度,大小约11 cm×11.2 cm,边界清楚。腹腔及腹膜后未见肿大淋巴结。CT诊断:腹腔多发占位性病变,考虑为肿瘤(图A)。入院后全麻下行胃体小弯旁肿物切除和腹膜后肿物切除。病理检查巨检:①胃体小弯旁肿物,结节状肿物一枚,     

超声诊断腹腔内Castleman病1例

患者男,55岁.以"发现左上腹肿物5天"入院.查体:于左中上腹触及8.0 cm×8.0 cm肿物,质韧,活动度差,轻压痛.超声检查:左中上腹后壁8.6 cm×8.1 cm×7.9 cm实性肿物,边界清,内呈不均质低回声,伴散在强回声团(图1);CDFI可检出较丰富血流信号(图2),左肾动脉及腹主动脉受压.超声提示:左中上腹后壁实性肿物.CT:左上腹(腹主动脉旁)类圆形软组织肿块,边界模糊,大小约10.0 cm×8.3 cm×8.2 cm,密度不均,可见多发点条状钙化,增强扫描病变明显强化,且不均匀,可见多发斑点状未强化区,病灶多由腹主动脉发出纡曲小动脉分支供血,左肾静脉受压,前壁局部受侵.CT提示:左上腹腹膜后占位侵及左肾静脉.术中见肿物位于左肾前下方、腹主动脉左侧,直径约10.0 cm,包膜完整,与周围组织无粘连.病理诊断:(腹腔)巨大淋巴结增生(透明细胞型Castleman病).     

腹主动脉旁异位嗜铬细胞瘤术中确诊1例分析

1病历摘要 女，43岁。因发热1周，腰痛2d入院，既往无高血压病史。查体：P80次／min，BP160／100mmHg；腹平软，未触及肿物，B超提示于腹膜后、椎体右前方、腹主动脉右侧4．1cm×5．2cm×4．1cm的囊实性回声。CT提示下腔静脉及右肾前间隙可见方4．0cm×4．2cm肿物，以实性为主，有囊性变。X线透视见升主动脉迂曲。术前诊断：腹膜后肿物。术前准备后在全麻下行剖腹探查、腹膜后肿物切除术。术中见肿物位于腹膜后椎体旁，     

腹膜后非霍奇金淋巴瘤超声表现1例

正患者男,69岁,因腹部不适并触及肿物1个月就诊,肿瘤六项均正常,乳酸脱氢酶升高(321 U/L)。超声表现:腹膜后见一12.8 cm×6.1 cm×8.6 cm低回声不均质肿块,边界较清,形态不规则,包绕腹主动脉及其主要分支(图1),肿块与双肾分界欠清,肿块内部见丰富血流信号。腹主动脉、腹腔干及肠系膜上动脉旁见2.5 cm×1.8 cm、2.2 cm×1.5 cm等多枚低回声肿块,边界清,内见淋巴门结构;脾脏回声不均匀,呈网格状。超声提示:腹膜后巨大实质性占位;腹部大血管旁淋巴结肿大;脾脏回声不均匀。增     

B超诊断非功能性胰岛细胞瘤1例

男性患者 ,38岁。以上腹饱胀不适就诊。一般状况良好 ,腹部体检发现左上腹可疑包块 ,腹水征 (— )。门诊腹部 B超检查 :肝胆脾未见异常 ,胰头与胰体形态大小正常 ,胰尾见一 5 .88cm× 5 .42 cm类圆形低回声肿块 ,边界清晰光滑 ,内部回声欠均 ,后方回声无衰减。腹腔未见游离性液性暗区 ,腹膜后未见肿大淋巴结 (图 1)。 B超提示 :胰尾部实质占位病变 (考虑非功能性胰岛细胞瘤 )。入院术前检查三大常规与血液生化均正常。术中见胰尾部有一类圆形实质性肿块 ,有包膜 ,与正常胰腺组织分界清晰 ,腹膜后大血管周围未见肿大淋巴结。手术切除肿块后…     

胰腺实性-假乳头状肿瘤1例

患者女,37岁,反复中上腹部、腰背部隐痛半年余。B超:胰腺体尾部可见7.2cm×7.4cm大小暗区,前壁局部厚1.6cm,侧壁见5cm×1.0cm增强光区,胰头厚度26mm,胰体厚度11mm。B超诊断:胰腺囊性占位为主,部分为乳头状。CT:胰颈部可见一大小约8.5cm×9.0cm×12.0cm肿块影,呈圆形,边界清楚,大部分呈囊性,周边可见多个乳头状的结节影(图1),增强后周边结节强化,囊变区未见明显强化征象(图2),胰管未见明显扩张,肿块推移周围肝脏和胃等组织,以向上生长为主。周围血管未见侵犯。腹膜后未见明显肿大的淋巴结。术中冰冻切片报告为“非功能性胰岛细胞瘤”。病理…     

十二指肠间质瘤超声表现1例

患者男,50岁。因近来乏力、黑便来我院就诊。查体:右上腹部可扪及一3 cm×4 cm大小质韧包块,边界欠清晰。超声检查:右上腹部可测及一实性偏低回声包块,边界清晰,包膜完整,大小约5.0 cm×3.6 cm(图1),位置相对固定。肿块位于胰头下部后外侧,与胰腺紧邻,与十二指肠关系密切。彩色多普勒血流显像示肿块内部有丰富血流信号,并可测及动脉血流频谱。超声诊断:右上腹腹膜后占位性病变,结合病史考虑十二指肠占位性病变。CT:十二指肠降段、水平段交界处见一约5.0 cm×3.8 cm软组织肿物,强化后明显增强。结论:右侧腹膜后占位,考虑十二指肠肿瘤可能性…     

B超误诊腹膜后侵袭性纤维瘤1例

患者女,48岁,上腹部肿物5个月,近一个月增长明显,伴有间歇性疼痛并向左腰放射。查体:左上腹可触及8.0×8.0cm肿物,边界不清,有压痛。B超所见:胰头1.5cm,胰体1.2cm,回声尚均,边界清楚,胰管不扩张。胰尾部增大,可见10.3×8.7×9.5cm低回声包块,内回声不均,可见多个不规则无回声区,边界欠规则。位于脾门、左肾前内及脾静脉前方(图)。提示:胰尾区囊实性占位(囊腺癌待除外)。CT结果:胰体尾部巨大软组织肿块,考虑胰腺囊腺癌可能性大,需进一步检查,排除胰腺炎合并假性囊肿。手术所见:左上腹可触及一大小为11×12×6cm囊实性肿物,位于后腹膜。肿     

胰腺结核1例报告

患者,男,27岁,腹部胀痛5月,发现腹部包块10天入院.查体:中上腹稍膨隆,平脐水平偏左扪及包块约10 cm×8 cm大小,质中,压痛明显,边界清楚,不活动,B超提示:肝门及胰腺尾部囊性占位,与大血管无关,胸片示双上肺浸润性结核,CT平扫检查示:胰头肿大,胰腺内及其周围多发大小不等囊性结构,腹膜后间隙主动脉旁淋巴结肿大,诊断为:①慢性胰腺炎并假囊肿②腹膜后淋巴结结核.     

小肠系膜钙化性纤维性肿瘤1例

患者女,37岁,因“下腹部隐痛不适3月余”入院.体检:右上腹可扪及质硬包块,压痛不明显,移动性可,边界清.全腹盆腔CT:平扫见肠系膜内多处病灶,大者位于右上腹(图1A),星混杂密度肿块,其内弥漫分布点片状钙化影;增强扫描软组织部分不均匀显著强化,病灶周围血管未见明显受侵征象;腹腔、肠系膜、腹膜后多发淋巴结影;CT三维重建示病灶散在分布于腹腔(图1B);考虑肠系膜恶性肿瘤.术中见小肠系膜内肿块,约20 cm×19 cm×18 cm,肿瘤包绕远端回肠约40 cm,质硬,相应肠管粘连明显;遂行肠系膜肿物切除及小肠部分切除吻合术.     

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.