鼻窦畸胎癌肉瘤累及右侧视神经1例

患者,男,32岁,双眼红、卡、胀,伴右眼视力下降10天.在当地医院检查后,诊断为双眼结膜炎,予沙替加星滴眼,双眼卡、胀情况有所缓解,但右眼视力仍进行性下降.查体:右侧眼底视乳头色淡,上方水肿,便捷不清.MRI检查:蝶窦及筛窦后部可见一不规则软组织块影,大小约2.9 cm×3.4 cm×4.0 cm,部分边界清楚,呈长T1稍长T2信号(图1、2),注射造影剂后肿块呈明显不均匀强化,病变累及左侧翼板,斜坡骨质有吸收,并累及双侧眶尖部及右侧视神经(图3).     

侵袭性垂体腺瘤1例

患者女,31岁.右眼痛,头痛鼻塞1月余.临床查体及实验室检查均无阳性结果.MRI检查:蝶鞍扩大,鞍区内见一等T1、长T2的实质性占位(图1),大小约3.3 cm×2.8 cm×3.1 cm,肿块内见一小圆形长T1、长T2信号.肿块向前侵及蝶窦,向两侧侵及海绵窦,包绕颈内动脉.枕骨斜坡信号弥漫性减低,肿瘤与斜坡界限不清,但骨皮质无膨胀及破坏.增强后肿瘤和斜坡一致性明显强化,小圆形低信号无强化(图2).术后病理诊断:垂体瘤(嫌色细胞瘤).     

单发脉络丛脂肪瘤1例

患者女,76岁.头痛5天,右眼肿4天.心肺腹查体未见异常.神经系统:神志尚清,定向力、记忆力均正常.颅神经正常,双下肢肌力正常.头颅MR:平扫双侧基底节区及额叶脑白质内见多发片状长T1,长T2信号,FLAIR像为高信号,病变边界清楚.右侧脑室后角脉络丛内见小圆形短T1,长T2信号影,约0.6 cm×0.6 cm,信号均匀,边界清晰(图1A、B).T1和T2抑脂序列病变均示病变信号明显减低(图1C、D).MR诊断:双侧基底节区及额叶多发腔隙性脑梗死,右侧脑室脉络丛脂肪瘤.     

有奖阅片测验(4)

女性,53岁。头痛3个月,突发双眼视力下降1周。6年前曾行子宫肌瘤切除术。体查:一般状况好,双眼视力0.1。 CT表现 鞍区实性等密度肿块,向前、向下侵入蝶窦与筛窦,斜坡、喋鞍及双侧眶尖骨质破坏,肿块边界不清。 MRI表现 以蝶窦为中心的软组织肿块,向周围广泛侵犯,肿块侵入蝶窦、筛窦,垂体蒂受压向上、向后移位。蝶鞍、斜坡、枕骨前缘及双岩尖、眶尖骨质破坏,肿块呈T1WI低信号、T2WI高信号,强化明显。肿块包绕双侧海绵窦。     

MRI诊断筛窦癌侵入前颅窝1例

患者,男,56岁,鼻衄2年,近日鼻衄次数及每次出血量增多伴反复头晕,头痛入院。查体无明显神经系统症状。MR所见:筛窦内可见一大小约3.0cm×3.0cm×4.2cm的团块状异常信号影,边界不清,筛窦骨质结构破坏,显示不清。病灶向前与鼻骨分界不清,向后略突入蝶窦内,病灶向下累及上、中鼻甲,与下鼻甲分界尚清晰(图1)。同时可见前颅窝底一大小约5.0cm×6.1cm×6.2cm的囊实混合性病灶与筛窦肿瘤组织相连,前颅窝底局部骨质结构破坏,显示不清(图2)。病灶向后上挤压双侧额叶脑组织且与之分界不清,以左侧为重。双侧脑室前角及胼胝体膝部受压向后、向右移位。脑中线结构右移(图3)。筛窦与前颅窝病灶实性部分信号不均,T1WI呈等、稍低信号,T2WI呈等、稍高混杂信号,增强扫描呈明显不均匀强化。病灶囊性部分呈长T1长T2信号,增强扫描未见强化。病灶周围受压脑组织内可见大片状长T1长T2信号(图3、4)。MRI诊断:考虑为筛窦癌侵犯颅内可能性大,建议穿刺活检。该患者术前行筛窦肿瘤组织穿刺活检。病理结果:梭形细胞癌。3日后行前颅窝肿瘤切除术。术中可见前颅窝底一大小约5.0cm×6.0cm×6.0cm的囊实混合性肿瘤组织,囊性部...     

鼻腔原发性恶性黑色素瘤2例

<正>1 临床资料病例1:男，84岁，1月前无明显诱因出现间歇性鼻塞伴鼻出血，嗅觉渐进性下降，自行用药，具体不详，症状无缓解。MRI:右侧鼻腔内见不均匀软组织影，达鼻后孔，T1WI等信号中夹杂少许高信号，T2WI稍高信号中夹杂少许低信号影，增强呈不均匀强化；右侧筛窦、右侧上颌窦、蝶窦内见大量长T1长T2信号影填充，窦壁骨质未见破坏。     

迟发性肾包膜下血肿伴肾功能不全1例

患者男,31岁,以酒后骑摩托车摔倒致腰背、颜面疼痛1 h就诊.入院后MRI检查:左肾外侧处约10.2 cm×11.0 cm×15.5 cm大小病变,边缘清晰,分界清楚,并挤压左肾向内前轻度移位,病变部T1WI呈低信号为主的混杂信号(图1),T2WI呈稍高信号,内见局限更高的混杂信号.FLAIR序列(图2)显示病变呈高信号为主的不均匀信号,受压左肾皮髓质结构清楚,但信号强度较右侧为弱,可见肾窦旁髓质内高信号,呈等信号的皮质与外侧呈高信号的病变分界较清.考虑:①左肾外侧包裹性改变;②左肾功能下降或不全;③积血.手术见左肾旁巨大血肿,量约1000 ml左右,左肾苍白,符合缺血改变.     

鞍区恶性孤立性纤维瘤1例

患者男,29岁,因头痛3个月伴右眼视力下降7d入院.体格检查无明显异常,神经系统检查示右眼视力下降,Karnofsky评分80分.头颅MRI示右侧鞍结节区见2.9 cm×2.4 cm×2.9 cm的不规则囊实性混杂信号影,实性区呈稍短T1等T2信号,囊性区呈长T1长T2信号,病灶明显强化,前颅窝底局部脑膜增厚并可见脑膜尾征.病灶占位效应明显,中线结构局部向左侧移位.右侧颈内动脉海绵窦段受压包绕其中.     

蝶窦脓肿误诊1例

1　病例报告　　男 ,40岁。主因右眼视力下降 8a,左眼视力明显下降伴鼻塞 1个月第 2次入院。无发热、头痛、恶心、呕吐及耳鼻脓性分泌物病史 ,无多饮多食多尿、肢端肥大等内分泌紊乱症状。 8a前因右眼视力下降诊断为鞍区肿瘤 ,开颅手术治疗 ,术中发现鞍区硬膜外脓肿约 5 cm× 4cm× 4cm大小 ,未见肿瘤生长 ,术后右眼视力仍逐渐下降。头颅 CT强化扫描 :蝶窦有一约 6 .0 cm× 4.9cm× 5 .5 cm等密度肿块影 ,向颅内膨胀性生长 ,占据右侧筛窦 ,蝶窦窦壁有两侧蝶骨大小翼明显破坏 ,鞍上池受压闭塞 ,其内可见高密度钙化影 ,两侧大脑中动脉受压变…     

颅中窝海绵状血管瘤误诊3例分析

对颅中窝海绵状血管瘤误诊3例分析如下.1 病历摘要例1:女,63岁.间隙性头痛1 a余伴双眼视力减退3个月.查体:神志清,左眼视力0.4右眼视力0.7双颞侧偏盲,双侧视神经原发性萎缩,其他颅神经检查未见异常.内分泌激素水平化验室检查正常.放射学检查:颅骨平片蝶鞍扩大、鞍背鞍底骨质吸收破坏.CT平扫鞍区内可见4.1 cm×5.3 cm之稍高密度团快影,边缘欠清晰,强化后不均匀明显增强.MR扫描显示在鞍区可见占位病灶T1像稍低信号、T2 T1像为高信号,在质子密度像上为高信号,病灶内未见血管流空影,增强扫描,病灶多呈均匀明显强化,病灶部分突入到蝶窦内,冠状位肿瘤向两侧浸润,右侧海绵窦向外推移变形,右侧颈内动脉部分包绕,左侧颈内动脉大部包绕,动脉管径变窄.术前CT及MRI诊断为侵袭性垂体腺瘤.术中所见:肿瘤呈紫红色,有明显搏动,穿刺可抽出动脉血,切开后大出血,部分切除肿瘤,病理检查诊断为海绵状血管瘤.     

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."