口服超声造影诊断咽食管憩室1例

患者女,51岁。因体检时超声检查发现甲状腺结节就诊。常规超声示:甲状腺左侧叶中部显示大小7mm×7mm×6mm的不均质低回声结节,边界不清楚,形态不规则,内可见点片状强回声,后方紧邻食管前壁,未见明显血流信号。该结节与食管关系密切,疑为咽食管憩室。行吞咽和饮水试验时,结节大小及内部回声无明显变化。静脉超声造影(SonoVue造影剂与5ml 0.9%NaCl溶液配制原液,静脉团注1ml)时,结节呈极低增强,甲状腺呈均匀性高增强,诊断尚不能明确(图1a)。口服超声造影(口服2ml造影剂原液与200ml饮用水混合液)时,结节内部明显高增强,甲状腺呈无增强,可明确诊断为咽食管憩室(图1b)。     

甲状腺柱状细胞癌超声表现一例并文献复习

正患者女性,82岁,以发现颈部肿块30年为主诉收入郑州大学第一附属医院,颈部彩色超声检查显示:甲状腺右侧叶体积显著增大,轮廓不清,内未探及正常甲状腺组织回声,探及多个大小不等的实性结节,延至峡部,结节边界不清,内部回声不均匀,可见多发散在钙化,部分呈密集簇状分布,范围约62 mm×46 mm(图1)。彩色多普勒血流成像显示结节内可见线状及短棒状血流信号(图2),甲状腺左侧叶大小形态正常,内可见多个大小不等的实性     

超声微血流成像技术与常规彩色多普勒超声评价甲状腺微小癌供应血管及其对甲状腺微小癌预测价值的比较研究

目的探讨超声微血流成像技术评价甲状腺微小癌结节血流供应在其诊断中的价值。方法对术前疑似甲状腺微小癌结节(最大直径10mm)进行彩色多普勒超声和超声微血流成像的Adler血流分级评价,比较彩色多普勒超声和超声微血流成像评价的甲状腺结节Adler血流分级差异,应用ROC曲线分析彩色多普勒超声和超声微血流成像评价的Adler血流分级预测甲状腺癌的敏感性、特异性、诊断效能。结果彩色多普勒超声评价的甲状腺良性与恶性结节Adler血流分级无明显统计学差异(χ~2=2.888,P=0.409 2),超声微血流成像评价的甲状腺恶性结节Alder血流分级明显高于甲状腺良性结节,差异有统计学意义(χ~2=15.435,P=0.001 5)。与彩色多普勒超声评价的甲状腺结节血流Adler分级相比,超声微血流成像评价的甲状腺结节血流Adler分级明显更高,差异有明显统计学意义(χ~2=201.024,P0.000 1)。以常规彩色多普勒超声Adler血流分级1级为标准预测甲状腺癌的敏感性和特异性分别为27.27%、83.33%,ROC曲线下面积为0.558 (95%CI:0.477～0.637),而以超声微血管成像Adler血流分级2级为标准预测甲状腺癌的敏感性和特异性分别为36.36%、83.33%,ROC曲线下面积为0.629 (95%CI:0.549～0.704)。超声微血管成像Adler血流分级预测甲状腺癌的诊断效能明显优于常规彩色多普勒超声Adler血流分级,差异有显著性意义(Z=3.963,P=0.000 1)。结论超声微血流成像技术对甲状腺微小癌供应血管的显示率和对甲状腺癌的预测价值均明显优于常规彩色多普勒超声。     

甲状腺肉瘤样癌彩超表现1例

患者女,75岁.主因颈前肿物1个月,增大明显入院.查体:左侧颈部可触及约5 cm×6 cm质硬肿物,边界清,表面不光滑,轻微触痛,可随吞咽上下移动.颈部彩超检查:左侧甲状腺体积明显增大,正常回声几乎消失,可见82.5 mm×42.5 mm×58.5mm形态不规则、不均匀低回声肿物,似觉由数个结节互相融合而成,内可见多个不规则斑点状强回声,后方伴声影(图1).右侧甲状腺41.2 mm×10.0mm×15.6 mm形态规整,实质回声均匀,内可见数个低回声结节,最大9.2 mm×5.2 mm×9.8 mm.CDFI检查:左侧甲状腺肿物周边及内部可见散在血流信号(图2).彩超提示:左侧甲状腺实性肿物伴多发钙化.     

甲状腺淋巴瘤超声表现1例

患者男,43岁。发现左颈部肿块2个月。临床触诊:左甲状腺可及直径4cm肿块,质硬,活动差。超声检查:甲状腺光点增粗,内部回声欠均匀,左侧甲状腺外周见27mm×48mm低回声团块,外侧边界清,内侧与甲状腺组织分界模糊,内部可见少量彩色血流信号,团块与甲状腺关系密切(图1)。左侧颈部箭头所示为甲状腺组织及甲状腺包膜图1甲状腺左叶外周低回声肿块声像图可见数枚低回声结节,最大约10mm×6mm,边界清,形态饱满。超声诊断:(1)甲状腺光点增粗;(2)甲状腺左叶外周实性肿块,考虑恶性;(3)左颈部淋巴结肿大。手术所见:左侧甲状腺肿块直径4cm,质地硬,包绕左侧颈…     

超声误诊甲状腺滤泡癌1例

患者女,42岁,体检发现颈部肿物1周,无心悸、消瘦。彩超示甲状腺右叶1.0 cm×0.8 cm中、高回声结节,边界清,形态规则,周边可见低回声晕(图1)。CDFI:结节内可见条状血流信号(图2)。PWD:结节内可探及动脉血流频谱,阻力指数0.68。超声提示:甲状腺右叶实性结节,腺瘤可能性     

甲状腺颗粒细胞瘤超声表现1例

正患者女,16岁。因发现颈前无痛性肿物半个月入院。专科检查:甲状腺左侧叶触及一大小约3cm×2cm×2cm肿块,质地中等,形态尚规整,未触及明显压痛。超声检查:甲状腺左侧叶中部探及一大小约3.4cm×2.3cm×2.0cm的实性低回声结节,形态不规则,边界清,无明显包膜,内部回声不均匀,未见钙化,后方回声增强(图1),彩色多普勒于结节内探及点条状血流信号(图2),脉冲多普勒探及动脉血流频谱,阻力指数0.62。双侧颈部未探     

甲状腺原发性非霍奇金淋巴瘤超声表现1例

患者女,50岁.自觉颈部肿大,触摸有肿块1年余入院.查体:贫血貌,生命体征平稳,心肺功能正常.实验室检查:血红蛋白68 g/L.甲状腺Ⅲ度肿大.超声检查:甲状腺形态失常,包膜尚完整,左侧叶大小约69 mm×39 mm×55 mm,右侧叶大小约49 mm×39 mm×41 mm,峡部厚约22 mm,内部回声不均匀,CDFI示甲状腺实质内可见丰富血流信号.双侧颈部可测及多个低回声结节.超声提示:考虑甲状腺癌可能性大,颈部低回声结节考虑肿大淋巴结(图1).     

甲状腺孤立性纤维瘤CT及超声影像一例

正病例资料患者,男,35岁,因发现左颈部肿块两个月入院。查体:左颈部可见局部隆起,长径约2.5 cm,质硬,边界清晰,包块可随吞咽上下活动,右颈部未见明显异常。CT提示甲状腺左叶软组织密度结节,截面大小约2.1 cm×2.0 cm,边界欠清。增强扫描动脉期强化不均匀,静脉期渐进性强化,考虑结节性甲状腺肿可能(图1)。超声提示:甲状腺左叶稍低回声结节,大小约2.3 cm×2.2 cm×3.2 cm,边界欠清晰,血流信号较丰富(图2)。     

甲状腺未分化癌超声表现1例甲状腺未分化癌1例

正患者女,65岁。自觉颈部肿块3个月余就诊。查体:颈部触及肿块,质硬,可随吞咽移动,无局部红肿,无发热,双侧颈部未触及肿大淋巴结。甲状腺超声检查可见:甲状腺左叶、峡部可见数枚极低回声,较大约28.8mm×33.5mm,边界不清,形态不规则,内部回声不均匀;彩色多普勒血流成像(color Doppler flow imaging,CDFI):周边及内部均可见血流信号(图1);左侧颈部Ⅲ、Ⅳ区可见淋巴结回声,淋巴门结构不清,呈圆形,较大约5.5mm×4.9mm。超声提示:甲状腺峡部实性占位TI-RADS4c类,左侧颈部Ⅲ、Ⅳ区淋巴结增大。遂行超声引导下粗针穿刺活检,病理结果提示:丰富的淋巴组织背景内查见异型明显的未分化癌细胞,未见甲状腺组织;免疫组化:异型细胞CK (+)、Vim (+)、Ki-67%(+)、TG (-)、TTF1 (-)、HMB45 (-)、CD30 (-);LCA、CD20和CD30淋巴组织(+)(图2)。临床排除转移后,可考虑为甲状腺未分化癌。     

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.     

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.     

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.     

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.     

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.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.