彩色超声检查在评估胎儿宫内状况的价值

目的探讨彩色超声检查在评估胎儿宫内生长状况方面的价值。方法采用彩色超声对100例宫内的胎儿(分两组，每组50例)进行检查，尽可能在胎儿无胎动的安静情况下选定标准测定平面分别测定胎儿的大脑中动脉、肾动脉、胎盘床动脉、脐动脉血流搏动指数(PI)、阻力指数(HI)及脐动脉的S／D，其结果做详细记录并进行统计学分析。结果50例正常妊娠组，胎儿出生时体重在2500g以上，新生儿发育正常。另50例胎儿出生时体重小于2500g，其中27例新生儿虽体重较正常儿偏小，但发育正常；另23例胎儿血流动力学指标异常，提示胎儿宫内窘迫，导致异常分娩，新生儿生存率低。结论彩色超声检查应该用于常规的产科产前超声检查，对了解胎儿宫内发育生长情况、胎儿是否宫内窘迫，有着相当重要的作用，是产科检查监护中不可缺少的部分。     

胎儿宫内肠套叠的超声特征分析CSCD

目的探讨胎儿宫内肠套叠超声声像图特征。方法对2014年1月至2016年12月在首都医科大学附属北京妇产医院产前超声检出的5例宫内肠套叠胎儿的超声表现进行分析。结果 5例胎儿肠套叠直接超声征象为"同心圆征"、"套筒征"、"面包圈征"和"新月征";间接超声征象为肠梗阻及胎粪性腹膜炎等。产科处理及随访结果:3例剖宫产紧急终止妊娠,出生儿转小儿外科手术,手术检查均证实为宫内肠套叠,患儿术后均恢复良好。另2例胎儿产前继发胎粪性腹膜炎,自然分娩后转小儿外科行剖腹探查术,均证实均为肠套叠,两患儿并发肠闭锁,术后死亡。结论胎儿宫内肠套叠与肠梗阻、胎粪性腹膜炎及肠道闭锁密切相关,产前超声检查正确识别胎儿肠套叠特征性超声表现及其并发症,对指导产科处理和胎儿出生后手术治疗有重要作用。     

胎儿宫内肠套叠的超声特征分析

目的探讨胎儿宫内肠套叠超声声像图特征。方法对2014年1月至2016年12月在首都医科大学附属北京妇产医院产前超声检出的5例宫内肠套叠胎儿的超声表现进行分析。结果 5例胎儿肠套叠直接超声征象为"同心圆征"、"套筒征"、"面包圈征"和"新月征";间接超声征象为肠梗阻及胎粪性腹膜炎等。产科处理及随访结果:3例剖宫产紧急终止妊娠,出生儿转小儿外科手术,手术检查均证实为宫内肠套叠,患儿术后均恢复良好。另2例胎儿产前继发胎粪性腹膜炎,自然分娩后转小儿外科行剖腹探查术,均证实均为肠套叠,两患儿并发肠闭锁,术后死亡。结论胎儿宫内肠套叠与肠梗阻、胎粪性腹膜炎及肠道闭锁密切相关,产前超声检查正确识别胎儿肠套叠特征性超声表现及其并发症,对指导产科处理和胎儿出生后手术治疗有重要作用。     

超声多普勒监测胎盘循环的临床应用

本文用超声多普勒对40例正常妊娠和34例高危妊娠孕妇的胎盘循环进行了动态监测.并与妊娠结局进行了比较分析,认为超声多普勒胎盘循环的监测对胎儿宫内生长发育有预测价值,并对预测胎儿宫内环境,指导产科临床处理均有重要意义。     

超声诊断双胎妊娠胎儿发育异常1例

孕妇,19岁,妊娠4月时曾行产科超声检查示双胎,妊娠7月来我院产科超声检查见:宫内一大一小两胎儿(图1),甲胎儿双顶径7.0cm,头围:25.5cm,腹围:24.0cm,股骨长度:5.5cm,相当于妊娠27周,胎心率:140次/min,双肾显示正常,左肾上方,左肾上腺区见23cm×13cm实性包块(图2),形态规则,界线清晰,回声稍高,内部回声均匀,未显示该侧的肾上腺。乙胎儿:颅骨重叠,无胎心搏动,双顶径:2.5cm,头围:12.5cm,腹围:9.0cm,股骨长度:2.4cm,相当于妊娠15周,可见两胎盘声像图,羊水指数:15cm,诊断:双胎,甲胎儿右肾上方实性占位:性质待定;乙胎儿宫内死胎(纸样儿)。一周后引…     

胎儿肢体畸形的产后超声研究

目的探讨胎儿肢体畸形的超声检查方法和声像图特征。方法选用2000年8月至2003年12月在我院因肢体畸形而中止妊娠的胎儿尸体30例，将其置于盛有自来水的水盆中，对胎儿尸体的畸形肢体进行各个切面的扫查，以研究胎儿肢体畸形的最佳超声检查切面与特征性声像。结果在模拟宫内环境的条件下，采用一定的检查顺序和方法，可清楚显示大部分胎儿肢体畸形，在不同的切面上这些畸形都有各自的特征性表现。结论采用连续顺序追踪法，二维超声可以清楚显示出胎儿多种肢体畸形。     

初学者应用超声断层成像技术显示胎儿心脏结构的探索

目的探索超声断层成像（TUI）技术能否提高初学产科超声操作医师对胎儿心脏结构的显示率,了解该技术在胎儿心脏检查中的临床应用价值。方法先由一名熟练的产科超声医师（a）应用二维超声对200例正常中孕期胎儿的心脏进行检查并存储图像;再由一名初学产科超声的医师（b）应用时空关联成像（STIC）技术获取胎儿心脏的容积数据,然后应用TUI程序获得心脏检查各切面并保存;最后由一名超声医师（c）将同一胎儿心脏的二维图像与TUI重现的心脏各切面进行对比并根据切面图像的质量及诊断价值进行评分。结果200例正常胎儿心脏超声检查中,185例获得满意的容积数据。应用TUI技术能够获得胎儿心脏检查所需的切面,获取四腔心、左心室流出道、右心室流出道、三血管及胃泡切面的显示率分别为100．O％、92．2％、87．8％、98．9％及100．0％。TUI法获取各切面与常规二维切面的显示率比较,差异无统计学意义（P〉0．05）,符合产前超声检查的质量要求。结论TUI技术是一种简单易学的胎儿心脏结构超声显示方法,初学者应用该技术能够显示胎儿心脏超声检查的常用切面,该技术降低了培训超声医师检查胎儿心脏的难度,有利于超声检查胎儿心脏的推广应用。     

引产后的胎儿正常肢体的体外超声检查

目的探讨胎儿正常肢体的超声检查方法和显示切面,提高产前超声对胎儿肢体正常结构的认识.方法采用连续顺序追踪超声法(SCSA)对引产后胎儿标本行模拟宫内超声检查.结果将胎儿肢体分节段按顺序进行连续扫查,可显示胎儿肢体的完整性;充足的空间和适量的羊水有利于分辨胎儿趾(指)的数目与确定足(手)姿势.结论一定条件下,二维超声可清楚显示胎儿肢体的完整性.SCSA法是胎儿肢体检查的可靠方法.     

超声检查在基层医院胎儿畸形筛查中的困扰与思考

超声影像检查应用于产科观察胎儿并诊断胎儿疾病已有三十余年的历史,近年来发展更为迅速并成为产科不可缺少的影像诊断工具.超声不仅可以显示正常胎儿形态结构,实时观察胎儿在宫内运动、行为及血流动力学变化,且能对胎儿主要结构畸形进行筛查.在我国,虽然超声检查已广泛应用于妇产科临床,但有关基层医院胎儿产前检查的具体内容和检查规范等方面的资料较少[1-4],尚未形成统一认识.鉴于此,本文仅就国内基层医院超声检查在胎儿畸形筛查中的困扰作一初步分析,旨为提高我国产前超声诊断水平抛砖引玉.     

超声诊断胎儿足内翻

目的：探讨胎儿足内翻的声像图特征及其临床价值。方法：彩色多普勒超声检查3000例妊娠12－40周的胎儿，诊断足内翻畸形的标准为足底拇趾球和腓胫骨长轴切面在同一平面显示，不随胎儿下肢运动而改变，并将产前超声检查与胎儿尸体检查或分娩后新生儿科检查结果进行对照。结果：产前超声检查发现17例足内翻畸形，其中14例合并其他复杂畸形，3例单纯足内翻畸形，14例引产后尸体检查证实产前超声诊断，其中包括1例胎死宫内后引产证实，1例产前诊断为双足内翻，引产后尸检为单足内翻；3例足月产后新生儿科检查证实，其中2例假阳性，结论：胎儿足内翻畸形的声像图具有一定特征性，有助于指导产科处理。     

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.     

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.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.