高频超声与病理诊断乳腺肿块内钙化54例分析

目的总结高频超声诊断乳腺疾病的经验。方法回顾性分析54例经手术病理证实的乳腺肿块的高频超声资料并加以总结。结果 32例恶性肿块,微钙化30例,占93.75%;粗钙化2例,占6.25%。22例良性肿块,微钙化4例,占18.18%;粗钙化13例,占59.09%;弧形钙化5例,占22.73%。结论超声检查可有效识别乳腺病变内的微钙化,特别是恶性病变,其对乳腺病变的诊断与鉴别诊断具有重要临床应用价值。     

乳腺良恶性钙化的声像学特征分析

目的探讨乳腺良恶性钙化的声像学特征及其在乳腺良恶性病变鉴别诊断中的价值。方法回顾性分析64例乳腺钙化患者的术前超声表现,并与手术病理及钼靶乳腺摄片(48例)结果相对照,对比分析乳腺良恶性钙化的声像图特点及其诊断价值。结果64例乳腺钙化病灶病理诊断良性钙化30例,恶性钙化34例。恶性钙化的声像图表现为钙化伴有结节,钙化病灶小,数量多,呈点状,分布呈簇状,后方无声影,无快闪伪像。而良性钙化则钙化伴或不伴有结节,钙化病灶粗大,数量少,形状差异大,呈斑状或团块状,分布呈局灶性,后方多有声影,多有快闪伪像,乳腺微钙化检出率在良性(6/30,20.0%)与恶性(30/34,88.2%)病变间差异有统计学意义(P<0.05)。微钙化、粗钙化、斑块状钙化3种类型的分布构成比在良恶性病变间差异有统计学意义(P<0.01)。超声诊断乳腺癌的敏感性为94.1%,特异性93.3%,准确性93.8%。术前超声检查与钼靶摄片诊断符合率比较差异无统计学意义(P>0.05)。结论超声与钼靶乳腺摄影均为检查乳腺钙化的重要方法,乳腺良恶性钙化的声像学特征有助于乳腺良恶性病变的鉴别诊断。     

多发钙化的钼靶X线特征及其与乳腺良恶性疾病的分析

目的 探讨乳腺多发钙化的 X 线特征以其对鉴别良、恶性病变的临床价值。方法 选择120例乳腺病变患者为研究对象,均接受乳腺 X 线钼靶检测,观察良恶性病变多发钙化大小、合并肿块、单双侧、钙化密度、分布状态等特征。分析钙化 Le Gal 分型与乳腺良恶性病变关系。结果 乳腺恶性病变泥沙、短棒以及针尖状钙化的比例显著高于乳腺良性病变,乳腺良性病变圆点、小片及蛋壳状钙化的比例显著高于乳腺恶性病变,差异具有统计学意义（P ＜0．05）。乳腺恶性病变钙化≥10个/cm^2、等密度、节段性分布及线性分布的比例均显著高于乳腺良性病变,乳腺良性病变呈区域性分布及弥漫性分布的比例显著高于乳腺恶性病变,差异具有统计学意义（P ＜0．05）。恶性乳腺病变 Le Gal 分型Ⅳ-Ⅴ型钙化的比例显著高于良性乳腺病变,差异具有统计学意义（P ＜0.05）。良性乳腺病变 Le Gal 分型Ⅱ-Ⅲ型钙化比例显著高于恶性乳腺病变,差异具有统计学意义（P ＜0．05）。结论 乳腺钼靶 X 线摄影可以清晰的显示乳腺病变钙化的特征,对乳腺病变定性诊断具有较高的价值。     

临床未触及肿块的乳腺钼靶片内簇状钙化临床意义的研究

目的探讨临床未触及肿块由钼靶发现乳腺内簇状钙化的临床意义。方法对临床未触及肿块而钼靶摄影发现乳腺内簇状钙化经我院手术病理证实的79例病例共86个病灶，分析其大小、数量、形态及分布情况并做良恶性对照研究。结果79例病例86个乳腺内簇状钙化灶，乳腺癌41个(47．67％)，其中24个为原位癌或早期浸润性乳腺癌，14个为浸润性导管癌。良性病变45个(52．33％)。结论乳腺内钙化的X线特征可为临床估计其良恶性几率提供线索。     

新疆不同民族早期乳腺癌成簇微钙化X线特点研究

目的:探讨维、哈、汉族等到新疆文体民族乳腺癌成簇微钙化的X线特征性表现.材料与方法:收集2006年6月2009年9月行数字化乳腺X线摄影患者资料5026例,发现钙化579例,对其中经病理证实的乳腺成簇微钙化120例,恶性74例,良性45例,就钙化采用7项观察指标,分析其形态和与之关联的数目、密度、大小、一致性均匀性及分布部特点,判断其育、恶性以及在各民族间的相关性.结果:钙化的各项观察指标除均匀性及分布外在良、在性、恶性病变中有显著性差异(P＞0.05);各民族间乳腺癌微钙化的发生率、合并肿块及肿块体积大小均无显著性差异(P＞0.05).结论:乳腺X线片成簇微钙化在乳腺良、恶性病变诊断和鉴别诊断中具有重要价值.     

乳腺肿块63例高频彩超图像特点回顾性分析及新鉴别点的应用

目的探讨高频彩超诊断乳腺肿块良恶性的声像图特点及新的分析方法。方法对经病理证实的乳腺肿块（良性27例,恶性36例）声像图特点进行分析。结果本组研究的63例乳腺肿块其声像图特点基本符合传统鉴别点,同时一些新的鉴别点也同样是符合的,如良性肿块如出现钙化则多为粗钙化或斑片样钙化,而恶性肿块则更多出现细小钙化点及微钙化;在彩色多普勒方面,探头应轻提不应重压肿块更有利于肿块血流信号的显示,频谱多普勒方面,舒张期无血流信号或反向血流信号是符合恶性依据的。结论高频彩超对于乳腺肿块具有很高的检出率,结合彩色多普勒及频谱多普勒,加上新鉴别点的应用,能更好地鉴别肿块的良恶性。     

乳腺肿块微小钙化86例超声图像分析

目的探讨乳腺肿块微小钙化超声图像特征。方法观察分析82例乳腺良、恶性肿块内部微小钙化超声显示状况。结果超声检查乳腺恶性肿块内部微小钙化检出率为76.2%(48/63),良性肿块为31.6%(6/19),两者比较差异有统计学意义;恶性肿块内部微小钙化多表现为星点状、蔟状,数目较多,回声弱,而良性钙化多表现为粗点状、斑块状,数目少或单一,回声强。结论除声像图表现及彩色多普勒血流研究外,乳腺肿块内部微小钙化的检出率是乳腺癌超声诊断的一个重要指标。     

高频X线钼靶摄影对乳腺良恶性病变的探讨

目的探索乳腺良恶性病变（肿瘤）X线征象，提高钼靶X线对乳腺良恶性病变鉴别诊断水平。方法对经术后病理检查证实的106例乳腺病变钼靶X线表现特征进行对照分析，其中恶性病变73例，良性33例。结果毛刺状肿块、细微簇钙化及多种间接征象组合是乳腺恶性病变特异性X线征象。良恶性肿瘤X线诊断准确率分别为85％和90．6％。结论高频钼靶X线摄影是诊断和鉴别诊断良恶性病变的有效影像学方法。     

钼／铑靶片簇状微钙化诊断乳腺癌的价值

目的：探讨钼／铑靶乳腺片簇状微钙化对乳腺癌的诊断价值。材料与方法：57例乳腺癌和32例乳腺良性疾病，经手术病理证实，在其钼／铑靶乳腺片中皆见到簇状微钙化，对簇状微钙化的特征作了回顾性分析。结果：57例乳腺癌中簇状微钙化主要呈细棒状，泥沙状，针尖状和混合状。簇状分布，直径〈0．5mm，中低密度47例（82．46％），局限于一象限度46例（80．7％），沿导管分布9例（15．79％），伴有肿块37例（64．91％），微钙化数目〉20枚51例（89．47％），10-20枚6例（10．53％）。结论：乳腺片簇状微钙化的特征对诊断乳腺癌有重要价值，并有助于良恶性病变的鉴别。     

小乳癌高频声像图及血流显像分析

目的探讨小乳癌高频声像图及彩色能量多普勒显像特征,探寻超声诊断小乳癌的有效指标。方法采用GE Logiq9彩色超声诊断仪对49例乳腺内直径小于2cm的实质性肿块进行常规超声与彩色多普勒血流图、能量图显像,获取肿块二维影像、血流分布数量、采集病变内部恒定的动脉血流峰值流速（Vmax）、阻力指数（RI）等多参数指标,并与术后病理对照,分析良恶性小肿块可能的鉴别指标。结果恶性组显示纵横比≥0.8;边界模糊、蟹足状;肿块内探及簇状沙砾钙化。以上指标与良性组比较,差异均有显著性（P〈0.05）。良恶性病灶内血流均不明显,差异无显著（P〉0.05）。结论对小乳癌诊断需要进行多参数的综合分析,病灶纵横比值、边缘、簇状微钙化比血流测定更有鉴剐意义。     

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.     

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.     

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.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.     

Advance Care Planning

Predictors of patient wishes and influence of family and clinicians are discussed. Research findings on patient decision-making relating to preferences in end-of-life care are described. Advance directives and durable powers of attorney are defined and differentiated. Most patients have not participated in advance care planning and the need for more effective planning is documented. Appropriate times for discussions of such planning are described. Scenarios discussed include terminal cancer, chronic obstructive pulmonary disease, AIDS, stroke, and dementia. Patient satisfaction is discussed, as is a structured process for discussions about patient preferences. Results of patient responses to hypothetical scenarios are described. Invasiveness of interventions, prognosis and other factors that favor or discourage patient preferences for treatment are discussed. Findings resulting from research funded by the Agency for Healthcare Research and Quality (AHRQ) are discussed. This research can help providers offer end-of-life care based on preferences held by the majority of patients under similar circumstances.     

Spiritual Dimensions of Nursing Practice. edited by V. B. Carson

The Cochrane Library of Systematic Reviewsis published quarterly. Issue one for 2004 of the library was published in February 2004. This issue contains 3,329 reviews and protocols of which 1,921 are fully published reviews. The trials database now stands at over 400,000 records with an additional 4,427 one-page summaries of non-Cochrane reviews in the NHS database of reviews of effectiveness (DARE). This version of the library contains the results of an extensive search for RCTs on EMBASE. The latest library contains 84 new reviews, seven are considered relevant to practitioners in pain and palliative care. References are published in the same format as the citation for Cochrane reviews.     

Évaluation,par l’imagerie ultrasonore,du recrutement musculaire,de la force motrice et de la détente verticale du quadriceps après électromyostimulation (cas de 15 étudiants de l’INJS)

The increase of strength seems to be an element of performance in some sports.