肉芽肿性乳腺炎的声像图特征及超声分型

目的探讨肉芽肿性乳腺炎的超声分型、声像图特征及临床意义。方法分析经病理证实的31例肉芽肿性乳腺炎的彩色多普勒超声超声表现和特点,依据声像图特征进行简略分型。结果31例肉芽肿性乳腺炎中,发现混合回声结节型15例、片状低回声型9例、弥散型7例;其中3例混合回声结节型肉芽肿性乳腺炎误诊为乳腺癌,超声诊断符合率为90%(28/31)。结论超声可对肉芽肿性乳腺炎进行诊断和分型,能提高肉芽肿性乳腺炎的诊断准确性,有助于临床治疗方案的选择。     

肉芽肿性乳腺炎62例超声声像分析及鉴别诊断

目的:研究分析肉芽肿性乳腺炎的超声表现,为临床诊断与鉴别诊断提供相关参考。方法:采用回顾性病例分析方法。选取2014年10月至2016年12月收住的肉芽肿性乳腺炎患者62例,均接受手术治疗,术前行超声检查,并术后行组织细胞病理学检查。观察总结肉芽肿性乳腺炎临床特点及超声声像特征。结果:62例(82个病灶)患者均经病理学证实为肉芽肿性乳腺炎。病灶位于左侧乳房47例,右侧乳房15例;肿块大小2.4-9.6cm,平均(7.4±2.3)cm;单发42例,多发20例;伴有皮肤增厚9例,合并同侧腋下淋巴结肿大21例,伴皮下积液5例,出现窦道形成1例。2例术后病理显示W-S反应阳性,检测出特异性猫抓病病原菌。超声声像:82个病灶超声声像均呈不均质低回声,57例声像形态不规则、边界不清,其中主要表现为分叶和成角27例,主要表现为多个导管样回声延续28例,同时呈现以上2种表现2例;弥漫性腺体回声紊乱20例,其余5例病灶呈卵圆形,边界清晰。CDFI显示病灶血流丰富61例。结论:肉芽肿性乳腺炎超声声像主要表现为不规则、不均匀的低回声,且多呈分叶、成角、多个导管样回声,病灶内大多有较为丰富的血流信号。     

两种病理类型非哺乳期乳腺炎的超声影像表现

目的应用超声BI-RADS分类分析非哺乳期乳腺炎的超声影像学表现,为临床诊断和鉴别诊断提供影像学依据。方法回顾性分析88例有明确病理结果的非哺乳期乳腺炎患者的术前超声检查结果,其中肉芽肿性小叶性乳腺炎(GLM)63例,浆细胞性乳腺炎(PCM)25例。比较两者的超声BI-RADS分类及声像图表现。结果 88例慢性乳腺炎患者共累及90个乳房,术前乳腺病变超声BI-RADS分类均为4类。GLM好发于乳腺外周,40%(26/65)病灶表现为实质回声不均匀减低,33.8%(22/65)为不均匀低回声包块,15.4%(10/65)为低回声结节,4.6%(3/65)为脓肿型,6.2%(4/65)为混合型。PCM好发于乳晕区,44%(11/25)表现为实质回声不均匀减低,20%(5/25)为囊实混合性,36%(9/25)为实性肿块。周围脂肪组织回声增强更常见于GLM。结论两种类型的非哺乳期乳腺炎超声声像图表现相似,GLM更好发于乳腺外周,常表现为实质回声不均匀减低,伴有周围脂肪组织增强;PCM好发于乳晕区。超声检查能够在一定程度上对两种疾病进行鉴别。     

彩超对不同分型肉芽肿性小叶性乳腺炎的诊断价值

目的探讨超声对不同分型肉芽肿性小叶性乳腺炎的诊断价值。方法选择手术或粗针穿刺后病理确诊为肉芽肿性小叶性乳腺炎158例患者的超声表现进行回顾性研究,肉芽肿性小叶性乳腺炎依据文献分为片状回声型、结节(或)肿块型、弥散型三种类型。结果 158例肉芽肿性小叶性乳腺炎病灶中,误诊26例,超声诊断肉芽肿性小叶性乳腺炎的符合率为83.5%。结节(或)肿块型23例,超声诊断符合率为30.4%(7/23);片状回声型56例,超声诊断符合率为87.5%(49/56);弥散型79例,超声诊断符合率为96.2%(76/79)。结论超声对肉芽肿性小叶性乳腺炎的诊断具有较高的临床价值,其诊断符合率与超声分型有关。     

肉芽肿性乳腺炎的彩色多普勒超声诊断特点及误诊分析

目的探讨肉芽肿性乳腺炎二维和彩色多普勒超声表现特点,分析其误诊原因。方法回顾分析经病理证实的12例肉芽肿性乳腺炎患者的二维及彩色多普勒血流特征。结果二维超声表现为乳腺腺体内实质不均质肿块7例,多呈低回声,其内可见腺体样稍强回声,呈“假肾征”,肿块形态不规则;2例肿块内可见无回声区;2例表现为连续或不连续的不规则管状结构样低回声结构,周围可见腺体样稍强回声;1例表现为弥漫性腺体回声紊乱,皮肤增厚,皮下积液,窦道形成。9例合并同侧腋窝淋巴结肿大。CDFI示6例病灶血流分级为Ⅲ级,3例为Ⅱ级,2例为I级,1例病灶内未见血流信号,为0级。血流阻力指数0．58～0．82,平均0．72±0．01。结论彩色多普勒超声对肉芽肿性乳腺炎有重要的诊断和鉴别诊断价值,可临床推广应用。     

非特异性肉芽肿性乳腺炎的超声及X线表现

目的:回顾性分析非特异性肉芽肿性乳腺炎的X线乳腺摄影和超声表现,为这种少见的病因不明的疾病提供诊断线索。方法:15例手术病理证实的非特异性肉芽肿性乳腺炎全部经过超声检查,10例经过乳腺X线摄影检查,结合临床及病理资料,对比分析非特异性肉芽肿性乳腺炎的影像特点。结果:11例超声结果显示较周围正常腺体不同的大片不均匀低回声,其中6例病变内出现1~3cm管状更低回声区。9例X线摄影显示异常,其中限局性不对称密度6例,2例显示形态不规则、边缘模糊肿块,另1例弥漫肿胀,几乎累及整个乳房。两种方法显示6例腋下淋巴结增大,均为炎性增生。结论:在乳腺X线摄影中表现为局限性不对称密度、超声中不均匀低回声区域内出现管状结构更低回声,在除外恶性条件下,提示有非特异性肉芽肿性乳腺炎的可能,最后的诊断主要依靠手术后病理结果。     

浆细胞性乳腺炎36例超声诊断及误诊分析

目的：分析不同病理时期浆细胞性乳腺炎超声表现、分析误诊原因及预防方法。方法：回顾分析36例经手术病理证实的浆细胞性乳腺炎超声表现,并与病理结果对照。结果：浆细胞性乳腺炎声像图可归类为单纯导管扩张型、囊实混合型、实性团块型和脓肿型,超声误诊16例,误诊率44.4%。结论：囊实混合型、实性团块型易误诊,超声结合病史和体征可提高诊断准确率。     

肉芽肿性乳腺炎的超声表现及误诊分析

目的探讨肉芽肿性乳腺炎的声像图特点。方法对9例经手术病理证实的肉芽肿性乳腺炎的声像图进行回顾性分析。结果肉芽肿性乳腺炎声像图表现为病变形态不规则、边界模糊、内部回声分布不均匀,彩色多普勒血流显像(CDFI)显示中等血流信号,脉冲多普勒(PW)显示阻力指数(RI)较高。结论认识肉芽肿性乳腺炎声像图的特征,可提高超声诊断和鉴别诊断水平。     

乳腺导管内乳头状瘤的高频超声表现特征

目的：通过分析乳腺导管内乳头状瘤的高频超声表现特征,提高超声医师对该病的认识.材料和方法：回顾性分析经手术病理证实的32例乳腺导管内乳头状瘤的高频超声声像图表现.结果：本组病例的声像图特征可分为5型：Ⅰ型为导管扩张伴管腔内乳头状实性回声或实性回声充填（46.9%）;Ⅱ型为囊实混合型团块（18.8%）;Ⅲ型为局限性导管扩张,远端导管壁不规则或中断（18.8%）;Ⅳ型为导管扩张伴远端中断处实性结节或团块回声（9.4%）;Ⅴ型为腺体内低回声结节,无导管扩张（6.3%）.32例中有23例的超声诊断与手术及病理相符,诊断符合率71.9%.结论：高频超声能显示乳腺导管内乳头状瘤乳管扩张及瘤体情况,对Ⅰ、Ⅱ型病变的诊断准确率最高,Ⅳ型次之.     

二维超声及彩色多普勒超声对肝结核的诊断价值

目的探讨二维及彩色多普勒超声在肝结核中的诊断价值.方法对经病理和临床证实的18例肝结核的声像图、病理及临床资料进行回顾性对比分析.结果根据声像图表现,肝结核可分为三型:弥漫型(8例),实性团块型(8例),脓肿型(2例).结论弥漫型可能为粟粒型肝结核的声像图特点,实性团块型为结核性肉芽肿伴干酪样坏死的声像图特点,脓肿型为干酪样坏死伴中心液化的声像图特点.超声结合临床对肝结核定性诊断具有一定价值.     

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.     

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.     

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.     

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.     

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.     

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.