先天性颅骨骨质缺损症一例报告

患者男性,36岁,农民,因车祸撞伤头部就医。体检:发育正常,头颅外观正常,头皮无缺损,无局部压痛及肿胀,未触及包块及凹陷现象,双侧瞳孔等大,各种生理反射存在,下颌中部可见一个约2×2cm伤口。临床诊断:脑震荡。 X线表现:头颅正侧位平片于双侧颅顶骨中后部矢状缝两旁分别见大小为1.2×1.5cm及1.2×1cm的类园形骨质缺损透光区,其内未见死骨影,周围骨质结构正常,未见骨质增生及骨质破坏。X线诊断:双侧顶骨先天性骨质缺损症。 讨论:颅骨先天性骨质缺损症较为少见,其形成机     

表现锥体外系症状的外伤性单纯性基底节出血1例

患者,男性,5岁。因在三楼玩耍不慎坠落,头部先着地,昏迷。于1991年4月28日入院。入院检查,血压18/10.6 kPa,昏迷状态,烦躁不安,右后颞顶部头皮血肿5×5cm,头皮裂伤0.5cm,右眼睑闭合不良,双侧瞳孔等大等圆,直径2.5mm,双眼球向左上斜视,口角向左侧歪斜,右侧肢体自主运动减弱,右上下肢肌张力增高,右侧巴氏征阳性,余项神经系统检查正常。GCS评分8分。实验室检查:血红蛋白,血小板,出凝血时间及血尿常规等均在正常范围。头颅平片,右侧顶骨骨折无凹陷。头颅CT:     

脑膜黑色素细胞瘤误诊为颅骨肿瘤1例分析

对脑膜黑色素细胞瘤误诊为颅骨肿瘤1例分析如下。 1病历摘要 女,4岁。发现头部肿物2a,进行性增大入院。查体：左顶部可见一大小约10cm×8cm的不规则形肿物,表面光滑,质软,边界清楚,无触痛。头颅正侧位片显示：头颅左侧顶骨可见不均匀低密度区,呈膨胀性向内向外生长,内部可见不规则高密度分隔影,边缘颅骨外板翘起、硬化,局部软组织肿。头颅CT显示：左颅顶骨大面积骨质破坏,边缘不规则,内外板障上翘,稍呈膨胀性改变,内有残留不规则的小骨片,破坏区未穿越颅缝,     

颅顶骨萎缩症影像学诊断(附3例报告)

颅顶骨萎缩症是发生于中、老年人的疾病 ,近 1 0年来国内专业杂志未见报道 ,笔者在 1 2年内遇见 3例 ,现予以报道 ,旨在提高认识。1　材料与方法收集 1 989年至 2 0 0 0年间本症患者3例 ,均为女性 ,年龄分别为 64岁、73岁、75岁。 2例摄颅骨标准Ｘ线正、侧位平片 ,1例做头颅ＣＴ扫描。临床症状不明显 ,2例因晨起梳头时梳齿断裂触摸头部发现头顶部双侧各有一槽沟来院就诊 ,1例因外伤做头颅ＣＴ检查而发现。2　结果2 .1Ｘ线平片表现　 2例正位平片均可见双侧颅顶骨对称性凹陷 ,边缘光滑整齐。板障消失 ,外板变薄 ,内板完整 ,内、外板界线不清…     

颅顶骨萎缩症的影像诊断

正颅顶骨萎缩症又称对称性颅顶骨凹陷症,属少见病,国内报道不多,对本病的影像表现缺乏认识,容易误诊。本文通过2013年01月-2015年06月间遇到的6例典型病例进行分析,并结合以往文献的研究对本病的诊断及鉴别诊断进行临床和影像方面的探讨。1典型病例患者,女62岁。三个月前无意中发现双侧顶骨凹陷,无任何不适。今日因偏头痛就诊。体检:局部皮肤毛发正常,双侧顶骨区凹陷变形,局部无压     

开放性颅脑损伤错误诊治一例

【病例】男,27岁。因头部外伤后出现右侧肢体活动障碍、言语不利12天入院。伤后在当地医院行头颅CT检查示左顶骨凹陷粉碎性骨折,诊断为急性中型开放性颅脑损伤,急诊行清创术。术后患者出现言语不利、右侧肢体无力,给予抗感染、营养神经等药物治疗,术后11天拆除头部伤口缝线时发现左顶部伤口有异常分泌物,转入我院。查体:体温37·2℃,意识清楚,言语不流利。左前额至左顶有两条纵形伤口;额部伤口长约10 cm,愈合良好;左顶部伤口长约5 cm,有黄白色分泌物,其下颅骨缺失6 cm×4 cm,骨窗膨隆,无脑脊液渗漏迹象。右侧肢体肌力Ⅲ级,双侧肢体生理反射…     

顶骨嗜酸细胞肉芽肿1例

1　病例报告女 ,74岁。因头部渐进性增大肿物 2个月入院。查体发现右顶部见约 5 .0 cm× 5 .0 cm× 3.0 cm肿物 ,质韧 ,实性 ,基部与颅骨相连 ,不可活动 ,未与头皮相连 ,边界较清 ,局部无红肿、压痛。头部 X线摄片检查见右顶骨 3.0 cm× 3.0 cm大小之穿凿样骨皮质破坏 ,破坏区骨质边缘清楚 ,无硬化 ,提示右顶骨良性骨质缺损破坏 ,考虑黄脂病可能性较大 ,头部 MRI示顶骨板障可见约 2 .5 cm× 2 .5 cm× 2 .5 cm不规则形肿块 ,边界清晰 ,信号均匀 ,向颅内及颅外突出。脑内组织无受压。临床诊断 :右顶骨占位性病变。该肿物可能为颅骨黄脂瘤、…     

颅顶骨对称性凹陷症1例报告

颅顶骨对称性凹陷症１例报告王怀娥，李振家患者女性，６５岁。半年前梳头时无意中发现右侧颅顶低平、下陷，但无任何不适感觉。２个月后，又发现左颅顶骨下陷，且呈进行性加重，双侧顶骨下陷逐渐明显。因出现头晕而就诊。检查：双侧颅顶骨对称性呈盘状下陷，尤其右侧更显...     

双侧乳癌并一侧大汗腺癌1例

患者女,65岁,因双侧乳腺肿块3月余入院,患者3个月前无意中发现左、有两侧乳腺外上象限均可触及一约蚕豆样大小肿物,无压痛,局部皮温未升高,无局部皮肤凹陷等,无乳腺癌家族史,既往无乳腺疾病史.查体:双侧乳腺外上象限均可触及肿块,左侧外上象限距乳头约7 cm可触及一直径2.5 cm的肿块,右侧外上象限距乳头约5 cm可触及一直径为2 cm的肿块.双侧肿块均为质硬,无压痛,与周围组织分界不清,不易推动,乳头无溢液,皮肤无桔皮样改变和局部凹陷,双侧腋下未触及肿大淋巴结.双侧乳腺彩超示:双侧乳腺外上象限低回声肿块,考虑乳腺癌可能;双侧乳腺小叶增生;双侧腋窝多发低回声结节,考虑增大淋巴结,双侧腋下副乳腺.     

重型颅脑伤术后并发高渗高糖非酮性昏迷1例报告

患者，男，40岁，因头部外伤昏迷7小时入院。头颅CT检查示左侧顶骨骨折，硬膜外血肿，周幅约翩ml，脑组织肿胀、脑挫伤。查体：浅昏迷，左瞳孔约5．omm，光反射消失，右瞳孔约1．smm，光反射存在，四肢肌张力亢进，双巴氏征（－），GCS计分6分，无糖尿病史。诊断：重型闭合性颅     

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.