彩色多普勒超声对腘静脉环缩术治疗下肢深静脉返流性疾病的疗效评价

目的利用彩色多普勒超声技术通过观察术前和术后腘静脉相关指标,评价腘静脉环缩术治疗下肢深静脉返流性疾病的疗效。方法对43例行腘静脉环缩术患者分别于术前及术后检测腘静脉内径、血流速度、血流量及返流持续时间。结果腘静脉内径术后明显小于术前分别为(0.7±0.14)cm,(0.88±0.16)cm,P<0.01;腘静脉返流持续时间术后较术前明显缩短分别为(0.36±0.14)s,(1.12±0.40)s,P<0.01;腘静脉血流速度及腘静脉血流量术后较术前均略增加,但皆无显著性差异(分别P=0.058,P=0.089)。结论腘静脉环缩术通过缩窄腘静脉内径和缩短腘静脉返流持续时间,使术后的腘静脉起到了静脉瓣的作用。彩色多普勒超声技术是评价腘静脉环缩术疗效的有效方法之一。     

彩色多普勒超声对下肢深静脉瓣功能不全的术前诊断价值

目的探讨二维超声及彩色多普勒血流显像(CDFI)技术在术前诊断下肢静脉瓣膜功能不全的应用价值。方法对43例患者59条下肢和50例正常对照组62条下肢的股浅静脉和静脉内径、瓣膜返流程度、返流持续时间进行测定。股静脉瓣膜功能做Valsalva试验,静脉瓣膜功能做立位或远端小腿挤压试验。结果正常对照组返流持续时间<0.7s。患肢深静脉瓣口及静脉内均显示部分及完全的反向彩色血流,多普勒频谱均显示为逆向和单向或双向频谱,持续时间均大于1s,静脉造影对照显示,病变组瓣膜返流时间较正常组显著延长(P<0.01)。结论超声检测下肢静脉瓣膜功能可根据病变的部位、性质和程度的不同,选择不同的手术方式,对临床诊断和手术方案的选择有实用价值。     

彩色多普勒超声诊断下肢动静脉瘘一例

患者女,40岁,10年前以“右侧大隐静脉曲张“在当地医院行手术治疗,术后下肢仍肿胀、疼痛并逐渐加重而来我院就诊.查体:右下肢皮温较对侧高,右腘窝处可触及震颠,搏动感不明显,听诊可闻及粗糙“隆隆样“连续性血管杂音.彩色多普勒显示:右侧腘动静脉之间可见两个直接交通,瘘口大小分别为3.1 mm、3.4 mm;彩色多普勒血流成像(CDFI)可见两束红色血流信号自腘动脉射向腘静脉(图1,2),脉冲多普勒超声(PW)测上段瘘口最大分流速度为158 cm/s,自右侧股总动脉至腘动脉瘘口近心端动脉血流速度加快,频谱呈高速低阻型,失去原有的三相波,瘘口远端的动脉血流速度及频谱形态未见异常;腘静脉内径增宽,CDFI显示其内为彩色血流信号,流速增高,频谱为动静脉混合频谱,最大流速110 cm/s;小腿部深浅静脉均迂曲扩张,血流缓慢,可见自发显影.超声诊断:右下肢腘动静脉瘘.外科术后诊断:右下肢腘动静脉瘘.……     

超声对胸交感神经节切除术前后肱动脉血流动力学改变的探讨

目的通过彩色多普勒超声对手汗症患者在胸交感神经节切除术前后肱动脉血流动力学的检测,以探讨其在评价胸交感神经节切除效果中的意义。方法应用彩色多普勒超声对33例手汗症患者行胸交感神经节切除术前与术后肱动脉内径(D)、血流量(VOL)、收缩期峰值流速(Vmax)、舒张末期流速(Vmin)、阻力指数(RI)、搏动指数(PI)及收缩期峰值流速/舒张末期流速(Vmax/Vmin)比值等血流动力学指标进行检测与比较。结果术后肱动脉D值为(0.43±0.06)cm,较术前的(0.39±0.06)cm增大,术后VOL为(224.02±79.19)ml/min,较术前的(152.63±58.93)ml/min增多,术后Vmax与Vmin的值分别为(0.79±0.14)m/s、(0.06±0.12)m/s,亦均大于术前的(0.60±0.20)m/s、(-0.04±0.10)m/s;而术后RI、PI与Vmax/Vmin值分别为(0.93±0.14)、(3.74±2.23)、(12.51±9.27),均较术前的(1.08±0.16)、(6.81±3.64)、(22.22±10.13)显著变小,上述各值术后与术前比较P均<0.01。结论彩色多普勒超声观察肱动脉血流动力学变化可作为临床评价胸交感神经节切除效果的一种有效方法。     

彩色多普勒超声对食管胃底静脉曲张破裂出血危险性的判断价值

目的:探讨彩色多普勒超声(彩超)对门静脉高压患者食管胃底静脉曲张破裂出血危险性的判断价值。方法:根据43例门静脉高压食管胃底静脉曲张患者有无出血分为出血组19例和未出血组24例,另设健康对照组13名,将3组的彩超表现进行对比分析。结果:出血组、未出血组的门静脉充血分数分别为0.13±0.06、0.06±0.02,分别与对照组的0.034±0.015比较,均为P<0.01;出血组、未出血组的胃左静脉内径分别为(0.90±0.29)cm、(0.70±0.24)cm,分别与对照组的(0.31±0.07)cm比较,P<0.01、P<0.05;出血组和未出血组胃左静脉离肝血流速度分别为(14±6)cm/s、(11±6)cm/s,P>0.05;出血组和未出血组的食管曲张静脉内径分别为(0.52±0.12)cm、(0.34±0.11)cm,P<0.05;出血组与未出血组食管曲张静脉内血流速度分别为(19±8)cm/s、(11±6)cm/s,P<0.01。当门静脉充血分数为0.07时,其预测出血发生的敏感性为95%,特异性为86%。结论:门静脉充血分数、胃左静脉内径、食管曲张静脉内径及食管曲张静脉内血流速度对预测食管胃底静脉曲张破裂出血的危险性有价值。     

后胡桃夹综合征患者彩色多普勒超声表现

目的 分析后胡桃夹综合征患者彩色多普勒超声表现,探讨彩色多普勒超声检查对后胡桃夹综合征的诊断价值.方法 回顾性分析8例经临床和相关检查确诊的后胡桃夹综合征患者的超声声像图.应用彩色多普勒超声检查观察左肾静脉的形态、走行,测量腹主动脉后方狭窄处和腹主动脉左侧扩张处左肾静脉的前后径、血流速度,计算狭窄处与扩张处的内径和血流速度比值.结果 彩色多普勒超声可清晰显示左肾静脉自肾门处注入下腔静脉的全程.本组8例胡桃夹综合征患者经多角度、多切面扫查均见左肾静脉穿越腹主动脉后方与腰椎之间隙汇入下腔静脉,狭窄处左肾静脉内径为(1.5±0.4)mm,血流速度为(154.5±30.1)cm/s;扩张处左肾静脉内径为(8.7±1.4)mm,血流速度为(22.8±3.4)cm/s;左肾静脉内径、血流速度比值分别为1:(6.5±0.5)及1:(7.2±0.9).结论 彩色多普勒超声检查可准确评价左肾静脉走行变异导致的左肾静脉扩张及血流动力学变化,对临床诊断、治疗后胡桃夹综合征具有重要的应用价值.     

经颅二维彩色多普勒超声对脑梗死患者大脑中动脉血流速度的研究

目的探讨经颅二维彩色多普勒超声(TCCS)对脑梗死患者大脑中动脉血流速度。方法应用经颅彩色多普勒超声对临床经血管造影确诊为脑梗死的患者48例(其中18例大脑中动脉主干梗死,14例大脑中动脉分支梗死,16例颅外单侧颈内动脉梗死)和50例健康成人分别采用经颅彩色多普勒血流显像(CDF I)进行探测,测量双侧大脑中动脉舒张末期血流速度(EDV),并计算舒张末期双侧大脑中动脉血流速度比率(健侧与患侧的比值)。结果在健康成人组中,舒张末期血流速度和舒张末期比率为:(42.79±13.72)cm/s、1.25±0.31;在大脑中动脉水平段主干梗死组及大脑中动脉分支梗死组舒张末期血流速度和舒张末期比率分别为:(17.20±5.65)cm/s、3.56±1.20,(20.14±4.35)cm/s、1.82±0.46;颅外单侧颈内动脉梗死组中,梗死侧的舒张末期血流速度和舒张末期比率为:28.70±11.21(cm/s)、1.68±0.57,所有梗死组舒张末期血流速度明显低于对照组,而舒张末期比率明显高于对照组。结论经颅二维彩色多普勒对大脑中动脉(MCA)水平段血流速度和舒张末期比率的检测,有助于大脑中动脉梗死的鉴别诊断。     

经阴道彩色多普勒超声对健康生育期妇女盆腔静脉的研究

目的探讨经阴道彩色多普勒超声(TVCDS)在健康生育期妇女盆腔静脉中的应用价值。方法对30例生育期正常妇女的增生期、分泌期进行经阴道彩色多普勒检测,分别测量宫旁静脉和卵巢周围静脉的内径、流速、静脉丛范围大小。结果①增生期宫旁静脉(PUV)、卵巢周围静脉(POV)显示率分别为90.0%,83.3%,分泌期均为100%。②增生期、分泌期两组PUV、POV的内径、流速及静脉丛范围大小,左右侧间及组间均无显著性差异。③健康生育期妇女盆腔静脉内径、流速、范围分别为(0.30±0.06)cm,(9.82±2.09)cm/s,(1.88±0.35)cm×(1.51±0.32)cm。结论经阴道彩色多普勒超声是检查盆腔静脉的一种有效方法。     

彩色多普勒超声对去顶减压加带蒂大网膜包裹术治疗成人多囊肾的研究

目的　研究成人多囊肾手术前后超声显像及血流。方法　对 32例采用去顶减压加带蒂大网膜包裹术治疗成人多囊肾患者进行彩色多普勒超声检查。重点将手术前与手术后进行对照。结果　 31例术后随访 1个月～ 6年肾血流灌注及血流量增加明显。肾脏平均长径由术前 (1 9.0± 5 .5 ) cm降至术后 (1 2 .0± 2 .6 ) cm。结论　彩色多普勒超声是去顶减压加带蒂大网膜包裹术治疗成人多囊肾的最优的检查、随访方式之一。     

彩色多普勒流速剖面技术对肝硬化程度评价的探讨

目的应用彩色多普勒流速剖面技术检测门静脉右支流速和血流量,以探讨其在评价肝硬化程度中的临床价值。方法56例乙型病毒性肝炎后肝硬化患者,分为肝硬化代偿组(31例)和肝硬化失代偿组(25例)。非肝硬化患者52例作为对照组。其中36例肝硬化患者经超声引导下穿刺活检病理证实。应用彩色多普勒流速剖面技术检测门静脉右支平均流速、最高流速和血流量,分别比较各参数之间差异。结果肝硬化组门静脉右支平均流速、最高流速以及血流量分别为(11.56±0.94)cm/s,(14.70±1.27)cm/s和(387.61±30.51)ml/min,较非肝硬化对照组的(14.32±0.81)cm/s,(17.94±1.02)cm/s和(499.05±25.44)ml/min明显降低(P值均<0.01),且肝硬化失代偿组门静脉右支平均流速、最高流速以及血流量分别为(9.08±0.31)cm/s,(11.91±0.45)cm/s和(262.3±12.18)ml/min,较肝硬化代偿组的(12.11±0.52)cm/s,(15.27±0.74)cm/s和(566.49±15.22)ml/min明显降低(P值均<0.01)。结论通过彩色多普勒流速剖面技术检测的门静脉右支平均流速、最高流速和血流量,能较好地反映肝硬化代偿期和失代偿期门静脉血流动力学变化情况,对于评价肝硬化程度具有较高的临床价值。     

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.     

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."