原发性肝脏淋巴瘤1例

患者男,62岁,主因"腹胀、右上腹痛2周"就诊.近1年体质量减少10公斤.20余年前患黄疸性肝炎,经治疗后好转.查体:右上腹轻压痛.实验室检查未见异常.HBSAg阴性.超声示肝实质回声均匀,左肝内叶可见7.8 cm×7.2cm不均匀低回声区,边界尚清晰(图1).上腹部可见4.8 cm×3.6 cm边界清楚、形态不规则的低回声团块.CT:平扫左肝内叶多结节互相融合状不规则肿块呈稍低密度,范围约6.5 cm×7.5 cm×8.0 cm.     

肝脏原发性胃肠道间质瘤超声表现1例

<正>患者女,57岁,体检发现肝占位1周入院。无乙肝病史,腹部查体未见异常,实验室检查各项指标均正常。常规超声检查示左肝外叶探及5.0cm×3.5cm低回声团块(图1),边界清,似呈蜂窝状,彩色多普勒示团块外周及内部均可探及动脉血流信号。肝脏超声造影示:注射造影剂后14s左肝外叶低回声团块开始显影,之后团块呈整体不均匀快速增强,动脉期团块呈高增强(图2),静脉期及延迟期呈低增     

盆腔脾种植经阴道超声表现1例

患者女,39岁.因月经紊乱9个月,入院诊治时发现盆腔包块.8年前车祸致左肱骨骨折,脾破裂行脾切除术.妇科检查:外阴正常,阴道畅,宫颈Ⅰ度糜烂,宫体后位,如孕50 d大小,于左侧附件区扪及约6 cm×4 cm包块,质韧,活动度欠佳,无压痛,右附件区未及包块.卵巢肿瘤标志物检查无异常.经阴道超声检查:后位子宫,前壁见一低回声团块,大小约1.2cm×0.9cm,内膜不厚.双侧卵巢可见,未见明显异常,于左侧卵巢外上方可见一大小约5.6 cm×2.6 cm的实性低回声团块,形态不规则,内回声尚均质(图1),盆腔后壁见多个大小不等的实性低回声结节,部分相互融合,最大者2.3 cm×2.1cm,彩色多普勒血流显像显示上述结节血流信号极为丰富(图2),阻力指数0.55.超声诊断:①子宫肌瘤;②左侧附件区、盆腔后壁多发实性低回声结节,建议进一步检查;③双侧卵巢未见异常.CT平扫:左侧附件区及盆腔内膀胱右后方见结节状软组织密度影,CT值40 HU,增强后肿块呈明显均匀性强化,CT值73 HU.CT诊断:左侧附件区及膀胱右后方多发占位,不除外转移性病变.     

肝脏巨大恶性神经鞘瘤超声表现一例

患者男,60岁,上腹部隐痛不适半年入院.体检:上腹部压痛,肝区叩痛,剑突下触及肝脏5 cm.超声检查:肝左叶体积明显增大,形态不规则,范围约25.3 cm×20cm,肝内回声明显不均,可见不规则实性回声,间以多房囊状结构,并可见分隔稍厚且厚薄不一致.部分囊内可见致密较强点状回声,探头加压可见光点浮动.彩色多普勒血流成像(CDFI)在肿物内可探及较丰富动静脉血流信号(Vmax 21 cm/s,RI 0.6),肝右叶大小及形态结构未见异常.超声诊断:肝左叶巨大囊实性占位病变(恶性倾向).CT检查:肝左叶可见25 cm×15 cm×15 cm囊实性低密度灶,形态不规则,内密度欠均匀,CT值约15～20 Hu,边界清,增强扫描示病灶实性部分及囊壁强化且不均匀.手术所见:肝左叶巨大,占据左中上腹,其内可见2个肿块,大肿块大小21 cm×16 cm×10 cm,呈暗红色,肿块内可见多个囊腔,最大囊腔直径7 cm,小肿块大小14.5 cm×9 cm×7 cm,悬垂于大肿块下方,灰白色,表面呈结节状,经钝性分离切除左半肝.病理诊断:肝脏恶性间叶组织肿瘤(恶性神经鞘瘤).     

肝脏低级别黏液性囊性肿瘤超声表现1例

正患者男,49岁,4 d前无明显诱因出现持续低热,无皮肤、巩膜、小便黄染,无发烧畏寒、恶心呕吐及胸闷不适等。超声检查:肝右叶见大小约5.5 cm×3.7 cm无回声,边界尚清,内可见较多带状回声分隔,中央可见大小约2.4 cm×1.3 cm稍高回声,胆总管最宽处内径约1.8 cm,下段变细,内径约0.3 cm,左、右肝管内径分别约1.1 cm、0.9 cm,肝内小胆管内径约0.5 cm;CDFI于其内未探及明显血流信号(图1)。超声提示:肝右叶囊性病变,考虑肝胆管囊腺癌可能;肝内外胆管扩张。增强CT提示:肝右叶低密度灶,伴邻近扩张肝内胆管与其相连,增强扫描可见分隔及内部结节强化(图2),考虑胆管乳头状瘤可能性大。MRI提示:肝右叶囊性占位伴结节,考虑良性病变可能性大。     

左侧输尿管结石伴肝及横结肠同时性多原发性恶性肿瘤超声表现1例

患者男,53岁.3d前因左腰部痛在当地医院先后2次行肾、输尿管超声检查,诊断为“左侧输尿管上段结石伴左肾积水”,来我院门诊拟行体外碎石治疗.碎石前行超声检查:右肾大小形态正常,集合系统未见结石、积水;左肾大小约11.2cm×6.3 cm,集合系统分离2.4 cm,左侧输尿管上段见一1.0cm×0.6 cm的团状强回声,后方伴声影.右肝后叶下段见一1.0cm×0 9 cm结节状低回声,略向肝包膜外隆起,彩色多普勒显示其内及周边可见动脉血流信号,血流速度36.7 cm/s,阻力指数0.74(图1,2);于左肾上极结肠脾曲见一“假肾征”团块(图2),大小约6.9 cm×5.2 cm,形态不规则;结合其肝实质回声增粗增强,肝包膜不光滑等肝硬化声像及结肠脾曲“假肾征”团块,超声提示:①原发性小肝癌;②结肠肿瘤.     

播散性腹膜平滑肌瘤病1例

患者女,39岁,因体检发现子宫肿物18天入院.查体:左、右附件区各触及一个肿物,大小分别约7 cm×6 cm、5 cm×4 cm,界尚清,较固定,无压痛.经阴道超声:子宫无明显增大,宫壁见数个低回声结节,大者约2.6 cm×2.2 cm,界清,可见少量血流信号.盆腔见数个低回声团块,大者约7.9 cm×4.0 cm,界尚清,回声欠均匀(图1).肝、胆、胰、脾、肾均未见明显异常.超声提示:①子宫多发肌瘤;②盆腔多发团块与结节(卵巢转移性肿瘤?).盆腔MRI:子宫壁、盆腔多发病灶,考虑:①子宫肌瘤?②间质瘤?③淋巴瘤?手术所见:子宫壁多发结节,大者约3.0 cm×2.0 cm,右圆韧带结节约0.5 cm×0.5 mm,右阔韧带结节约8.0 cm×4.0cm,左骶韧带结节约6.0 cm×3.0 cm,膀胱反折腹膜结节约2.0 cm×1.5 mm,直肠壁结节约5.0cm×3.0cm,右前腹壁结节约1.0 cm×1.0 cm,左侧腹壁结节约1.0 cm×0.5cm.病理结果:子宫、右圆韧带、右阔韧带、左骶韧带、膀胱反折腹膜、直肠、肠系膜、回盲部、右结肠沟、右前腹壁、左侧腹壁平滑肌瘤.     

副脾误诊为肝脏肿瘤1例分析

对副脾误诊为肝脏肿瘤1例分析如下。 1病历摘要 女，39岁。因体检B超发现右侧肾中上极低回声占位入院。入院后无明显阳性体征。CT表现：肝右后叶下缘结节状低密度影并突出于肝表面，密度欠均匀，大小约3．0cm×2．1cm，边缘光滑；动脉期均匀强化，实质期及延迟扫描呈等密度，其内可见条状低密度区，脾脏未见明显异常。考虑为肝右后叶下缘良性结节（腺瘤或局灶性结节增生）。手术及病理：行肝右叶肿瘤切除术，术中见肿瘤位于右侧腹膜后，约4cm×3cm大小，与肝脏无明显粘连，完整切除肿瘤。病检示异位脾。     

小儿胚胎型横纹肌肉瘤1例

患儿男,2岁,主因"发现左腋下肿物1个月"人院.查体:左腋下可触及一个8 cm×5 cm肿块,延至左肩胛下缘及左侧胸部.超声:左腋下、左肩胛下及左侧胸壁皮下探及一个以实性为主的囊实性团块,其腋下深度为4.72 cm,肩胛骨处深度4.55 cm,左侧胸壁皮下深度3.95 cm,病灶边界不清,形态不规则,内部回声不均匀,其内可见低回声区及点状强回声;CDFI:病灶内可见动、静脉血流信号(图1).CT:双肺见多发结节,气管隆嵴下及左肺门淋巴结肿大.影像学提示:左腋下恶性占位性病变伴双肺及肺门、纵隔淋巴结多发转移.穿刺活检诊断为胚胎型横纹肌肉瘤.予长春新碱及放线菌素化疗后肿物明显缩小,予以手术切除,术中见肿瘤约7 cm×6 cm,有包膜,血运丰富.术后病理检查证实为胚胎型横纹肌肉瘤.     

超声检查肝神经内分泌癌1例

患者男,44岁,右上腹部隐痛不适半年;平素体键,无肝炎史.超声检查:肝左外、内叶及右后叶探及数个实性不均质略强回声团,形态欠规则,部分边界欠清,最大的4.0 cm×3.1 cm,左内叶探及5.2 cm×5.4 cm混合性包块,暗区为不规则片状;右侧腹部探及27.0 cm×11.1 cm×17.8 cm混合性包块,与肝右叶下缘无分界,随呼吸与肝同步移动,暗区为片状不规则,部分呈网络样;此包块占据右侧腹部,下达盆腔且压迫右输尿管致右肾轻度积水,余肝组织回声正常.     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征（LQTS）、短QT综合征（SQTS）、Brugada综合征（BrS）和儿茶酚胺敏感性多形性室性心动过速（CPVT）,总结它们在发病机制及诊治方面的进展。     

Organ Preservation: Current Concepts and New Strategies for the Next Decade

SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.     

2017年呼吸疾病主要进展

2017年,国内外学者在呼吸系统疾病的临床和基础领域均进行了深入研究,不仅对相关指南进行了更新,并且针对一些临床热点、难点问题达成专家共识,现就2017年呼吸疾病相关进展作一简单介绍。     

家族性噬血细胞性淋巴组织细胞增生症1例并文献复习

目的加强对家族性噬血细胞性淋巴组织细胞增生症（familially hemophagocytic lymphohistiocytosis,FHL）的认识。方法报道确诊为FHL的新病例1例,结合国内外报道的FHL的病例,对该病的临床特点进行汇总分析。结果FHL2常与PRF1基因突变相关,约20%~40%的患者存在穿孔素基因突变。结论对于有阳性家族史,基因诊断明确,应尽早行化疗或者造血干细胞移植。若无家族史,未发现与继发性HLH相关的原发病因,可考虑行基因筛查以明确是否存在FHL的可能。     

动态心电图临床操作标准化方法

动态心电图,又称Holter或Holter检查,是一种评价各种心脏病患者心电图异常的简便、高效、准确、安全的无创检查,广泛用于心律失常的相关症状评价,心肌缺血的诊断,心脏病患者的预后和日常生活能力评估,药物疗效评价,起搏器等埋藏式心脏电治疗装置监测等领域。目前动态心电图已广泛用于于临床各级医疗机构,为了更好地发挥其作用,有必要对该项技术进行规范化培训。本文参考相关指南、共识及专家建议,结合作者经验,撰写动态心电图临床操作标准化方法供临床使用时参考。     

甲状旁腺功能减退性心肌病的系统综述

目的 甲状旁腺功能减退（甲旁减）性心肌病是一种罕见的心脏疾病,为扩张型心肌病中少数可逆转的一种,常被误诊为不明原因或难治性心力衰竭。本文旨在探寻甲旁减性心肌病的规律性特征。方法 检索Pubmed、SinoMed、万方数据库中符合标准的甲旁减性心肌病病例,采用统计分组法对纳入研究的文献进行分析,依据系统综述和meta分析优先报告条目（PRISMA声明）进行报告。结果 在我们筛查出的41例患者中,女性居多（68.29%）,平均年龄为45.5岁,各年龄段均有发病。甲旁减性心肌病最常见的病因为特发性甲旁减（78.05%）,颈部手术导致的甲旁减性心肌病次之（17.07%）。患者均以心力衰竭就诊,伴不同程度的低钙血症。51%的患者有神经肌肉兴奋性增加的病史,90%的患者左心室射血分数降低。该病误诊漏诊率较高,仅36%的患者于入院后即明确诊断为甲旁减性心肌病。低血钙的纠正是治疗的关键,90%的患者心脏功能在血钙浓度正常化后恢复至正常。结论 对所有不明原因或难治性心力衰竭患者都应警惕甲旁减性心肌病的可能。     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

单核细胞/高密度脂蛋白胆固醇比值不能预测PCI术后对比剂肾病的发生

目的 探讨术前单核细胞与高密度脂蛋白比值(monocyte to high density lipoprotein cholesterol ratio, MHR)与经皮冠状动脉介入（percutaneous coronary intervention , PCI）治疗后发生造影剂肾病（contrast induced nephropathy, CIN）的相关性，为CIN的发生寻找其他可能的危险因素，为及早筛选CIN高危人群提供新的方向。方法 回顾性分析5P试验入选的我院心内一科行经皮冠状动脉介入治疗术的冠心病患者1 087例，根据在PCI术后是否发生造影剂肾病分为CIN组和非CIN组，研究CIN的相关危险因素，分析MHR与造影剂肾病的相关性，应用Logistic回归分析查看MHR是否为CIN发病的高危因素。结果 CIN组共57例，非CIN组1 030例。两组在高脂血症、BMI、左心室射血分数（LVEF）、术前尿酸及术前C 反应蛋白水平等方面比较差异有统计学意义（P＜0.05）。 Logistic回归分析显示LVEF及糖尿病与造影剂肾病的发生相关。结论 同以往研究结果不同，MHR并不能作为CIN的危险因素，但LVEF对于CIN可能具有更高的预测价值。