乳腺MRI诊断左前胸壁低度恶性肌成纤维细胞性肉瘤1例

<正>女,33岁,发现“左乳肿块”伴左前胸壁针刺样疼痛4月余、月经时加重;既往体健。查体:于左乳区触及6.0 cm×4.0cm×6.0cm肿物,质硬,活动度差,有轻压痛;左乳外上象限皮肤呈“酒窝征”。乳腺MRI:左侧胸大肌内4.1cm×2.5cm×4.9cm不规则肿块,脂肪抑制T1WI和T2WI分别呈等及稍高信号(图1A)、弥散加权成像(diffusion weightedimaging,DWI)(b=1000s/mm2)呈高信号(图1B)、     

MRI确诊超声误诊葡萄胎合并子宫肌瘤1例

患者女,25岁,孕5产1,因"停经79天,超声提示宫腔内不均质回声5天"入院.实验室检查示血β-HCG 64 835 mIU/ml.超声;宫腔内见不均质回声,大小60 mm×37 mm,边界欠清,呈"蜂窝状"改变,距浆膜层6 mm;周边及内部可探及丰富彩色血流信号(图1);考虑妊娠滋养细胞肿瘤.MRI;子宫明显增大,前壁肌层内见41 mm×30 mm病灶,T1WI呈等信号,T2WI呈低信号,增强扫描强化明显;病灶向后压迫宫腔使宫腔形态失常并扩大,宫腔内见囊状不均匀长T1长T2信号(图2),增强扫描宫腔呈蜂窝状明显强化;MRI诊断;子宫腔内异常信号,考虑为葡萄胎;子宫前壁占位性病变,考虑子宫肌瘤.     

具有乳头状核特点的非浸润性甲状腺滤泡性肿瘤伴BRAF基因突变1例报道

<正>1临床资料患者,男,42岁。因体检发现甲状腺肿物4个月入院。专科查体:甲状腺及颈部淋巴结无异常。甲状腺超声:甲状腺右叶中下部前侧见一结节回声,约9.0mm×6.5mm,边界清,呈实质性略低回声,形状规则,内部回声均匀,边缘见粗大近环形钙化回声。见图1。甲功检查:TSH:1.24uIU/ml;FT3:5.67pmol/L;FT4:15.58pmol/L;TG:6.16ng/ml;A-Tg:13.57IU/ml;A-TPO:11.69IU/ml。肝、肾功能,离子未见异常。喉镜、肺CT均未见异常。临床诊断:甲状腺肿物(性质待定)。建议行粗     

Von Hippel-Lindau综合征2例报告并文献复习

病例 例1,女,30岁.3年前外院诊断"胰头癌、双肾癌",未治疗,无特殊不适,于2013年2月28日来我院就诊.查体:神清,颈软,呼吸音清,右腹触及一巨块,无痛,质软.肝肋下一横指.患者曾生育1子,体健.其父患脑瘤术后死亡,姑姑患胰腺肿瘤,在世.其母体健. CT平扫:胰头部巨大肿块,大小约95 mm×81 mm,密度不均,边界不清,胰腺体尾部增大,呈蜂窝状囊泡改变,最大囊直径约16 mm.双肾多发占位灶(图1a).MRI平扫:头颅MRI未见明显异常.胰头部一巨大肿块,信号不均,T1WI呈低、等信号,T2WI高信号,边界尚清,大小约141 mm×106 mm×100 mm.胰腺体尾部呈弥漫性蜂窝状改变,信号为T1WI低T2WI高.双肾多发小圆形囊灶,直径5～15 mm不等.右肾中部及左肾下部各见一实质性肿物,右侧约35 mm×26 mm,左侧约25 mm×24 mm,T2WI混杂高信号、T1WI混杂等低信号.     

超声诊断儿童甲亢合并甲状腺胸腺组织异位1例

<正>患儿女,12岁,因"发现突眼伴心慌1个月"入院。专科体检:甲状腺中度肿大,气管居中,声音无嘶哑。实验室检查:游离三碘甲腺原氨酸31.19ρmol/L,游离四碘甲腺原氨酸111.9ρmol/L,促甲状腺激素0.04μU/L,抗甲状腺过氧化物酶抗体276.3 U/ml,抗甲状腺球蛋白抗体44.9 U/ml。常规超声检查:甲状腺弥漫性肿大,实质回声增粗,分布不均匀,左侧叶中部背侧见一大小约7.7 mm×4.1 mm稍低回声病灶,边界模糊,内部见多个点状强     

超声造影误诊肝血管平滑肌脂肪瘤为肝细胞肝癌1例

<正>患者男,50岁,因"右上腹疼痛1年"就诊。自诉于1年前无明显诱因感右上腹隐痛,无恶心、呕吐、厌油、乏力等不适。体格检查:未见阳性体征。感染免疫学:乙型肝炎表面抗原(+)、乙型肝炎核心抗体(+),乙型肝炎e抗体(+);肿瘤标志物:甲胎蛋白、CA-125、CA-153、CA-199及癌胚抗原均正常;实验室检查:碱性磷酸酶113 U/L、谷草转氨酶789 U/L、乳酸脱氢酶674 U/L。CT:肝右叶多发强化灶,考虑肝癌。超声检查:肝右叶内见2个团状低回声,大小分别约40 mm×37 mm×30 mm(右后叶),     

多发性硬化弥散加权成像

目的研究脑部多发性硬化(multiple sclerosis,MS)病灶、表现正常脑白质及正常志愿者脑白质表观弥散系数(apparent diffusion coefficient,ADC)值的差异.方法对37例正常志愿者和46例MS患者进行弥散加权成像检查,分别测量T1WI低信号病灶、T1WI等信号病灶、额叶表现正常脑白质及正常志愿者额叶白质平均ADC值,比较其有无统计学差异.结果各感兴趣区平均ADC值分别为T1加权像低信号病灶1.384×10-3 mm2/s;T1加权像等信号病灶0.977×10-3 mm2/s;额叶表现正常脑白质0.762×10-3 mm2/s;正常志愿者额叶白质0.744×10-3 mm2/s.上述各组两两比较均存在显著性差异(P＜0.01).结论弥散加权成像可以分辨出MS病灶,并能够检测出MS患者表现正常脑白质的弥散异常.     

肝脏原发淋巴上皮瘤样癌1例

患者女,27岁,无明显诱因出现右侧肋缘持续性刺痛2个月,以"慢性胆囊炎急性发作"入院。查体:肝区轻扣痛。实验室检查:AFP 2.11μg/L,CEA 0.88μg/L,CA199 4.55U/ml,CA12512.7U/ml。MR平扫示肝脏右后叶S7～8段包膜下7cm×6cm肿块,边界清晰,边缘光整,T1WI呈低信号,内可见斑片状高信号,T2WI呈中、高混杂信号,包膜下少量积液;增强扫描病灶轻中度强化,可见假包膜(图1、2)。考虑肝脏恶性肿瘤。行     

彩超诊断先天性右侧甲状腺缺如并甲状腺功能亢进1例

患者女,41岁.反复心慌、手颤2年余加剧,伴多汗4d.心电图:窦性心动过速(112次／min).甲状腺功能检查:T3 2.45 ng/ml,T4 15.05 μg/dl,FT3 9.20 pg/ml,FT4 1.91 ng/dl.彩超表现:左侧甲状腺体积弥漫性增大,包膜完整,大小分别为58mm×24 mm×20 mm,实质回声增粗,增强,分布不均(图1左).彩色血流显示血供丰富呈"火海征"(图1右).峡部厚约2.1 mm,右侧甲状腺未显示(图1左).彩超提示:(1)右侧甲状腺先天性缺如?(2)左侧甲状腺声像改变符合甲状腺功能亢进表现.     

甲状旁腺嗜酸细胞癌1例

患者女,54岁,以“甲状腺占位”入院.患者偶有饮水呛咳,无明显声音嘶哑.查体:右侧甲状腺可触及约30 mm×20 mm肿物,质软,界清,左侧甲状腺触诊无明显异常.实验室检查:血清钙定量2.91 mmol/L,血清磷定量0.85 mmol/L,碱性磷酸酶236 IU/L,尿钙12.27 mmol/24 h,促甲状腺素2.78 IU/L,FT3 4.58 pmol/L,FT4 15.64 pmol/L,抗甲状腺球蛋白抗体15.29 IU/L,甲状腺球蛋白10.16 ng/ml.颈部CT:右侧甲状腺后方见约2.4 cm×1.8 cm占位性病变,密度不均匀,实质部分CT值约113 HU,低密度区CT值约21 HU(图1),甲状腺右叶受压前移.甲状腺左叶见约0.6cm×0.5cm低密度区,边缘较清,CT值75 HU.     

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.     

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.     

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.     

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."