创伤性迟发性颅内血肿的诊断和治疗

目的 探讨创伤性、迟发性颅内血肿的早期诊断和治疗的临床效果。方法 对22例病人的发病年龄、性别、伤因、早期诊断和治疗效果进行了回顾性分析。经过2—6个月，按GOS评定治疗效果。结果 良好者12例，中残者5例，重残者1例，植物生存者1例，死亡者3例，死亡率为14％。结论 早期诊断和治疗本病对于提高治愈率和降低死亡率至关重要，早期手术治疗本病，乃是多数病人首选的治疗方法。     

Primary malignant melanoma of the bladder

Primary malignant melanomma of bladder is extremely rare: 18 cases are reported to date. An 82 year-old man underwent trans-urethral resection of bladder for a bleeding tumor of the posterior wall. Histological diagnosis was melanoma of the bladder. There was no history of previous or regressed cutaneous malignant melanoma. Margins of the bladder lesion contained atypical melanocytes similar to those commonly seen in the periphery of primary mucous membrane lesions. Clinical studies and radiological examinations were negative for other primary site of melanoma. The patient had a bladder recurrence that was consistent with primary tumor and died of widespread disease 9 months after diagnosis.     

输尿管囊肿的X线征象分析

目的总结输尿管囊肿的X线表现,以提高对该病的认识。方法搜集1995年1月至2005年12月间经手术、病理证实的输尿管囊肿18例,回顾性分析其X线表现。结果18例输尿管囊肿中,发生在单侧者16例,双侧2例。15例出现膀胱内边界清晰的充盈缺损,16例显示“光晕征”,12例显示“蛇头征”。结论输尿管囊肿有典型的影像学表现,静脉尿路造影可明确诊断,为手术提供可靠的影像资料。     

Public and private prenatal care providers in urban Mexico: how does their quality compare?

OBJECTIVE: To evaluate variations in prenatal care quality by public and private clinical settings and by household wealth. DESIGN: The study uses 2003 data detailing retrospective reports of 12 prenatal care procedures received that correspond to clinical guidelines. The 12 procedures are summed up, and prenatal care quality is described as the average procedures received by clinical setting, provider qualifications, and household wealth. SETTING: Low-income communities in 17 states in urban Mexico. PARTICIPANTS: A total of 1253 women of reproductive age who received prenatal care within 1 year of the survey. MAIN OUTCOME MEASURE: The mean of the 12 prenatal care procedures received, reported as unadjusted and adjusted for individual, household, and community characteristics. RESULTS: Women received significantly more procedures in public clinical settings [80.7, 95% confidence interval (CI) = 79.3-82.1; P < or = 0.05] compared with private (60.2, 95% CI = 57.8-62.7; P < or = 0.05). Within private clinical settings, an increase in household wealth is associated with an increase in procedures received. Care from medical doctors is associated with significantly more procedures (78.8, 95% CI = 77.5-80.1; P < or = 0.05) compared with non-medical doctors (50.3, 95% CI = 46.7-53.9; P < or = 0.05). These differences are independent of individual, household, and community characteristics that affect health-seeking behavior. CONCLUSIONS: Significant differences in prenatal care quality exist across clinical settings, provider qualifications, and household wealth in urban Mexico. Strategies to improve quality include quality reporting, training, accreditation, regulation, and franchising.     

Comparison of diagnostic usefulness of predictive models in preliminary differentiation of adnexal masses

The purpose of this study was to compare prognostic models evaluating the probability of an ovarian cancer occurrence based on a number of clinical and ultrasonographic data in women with adnexal masses. A total of 686 women with adnexal masses underwent the examinations between 1994 and 2002. The recorded parameters included: age, menopausal status, body mass index, the grayscale and Doppler ultrasonographic examination, and selected markers concentration levels. In order to find the best combination of features, which significantly influences the probability of malignancy, stepwise logistic regression analysis, as well as artificial neural network, was used. The diagnostic efficiency of received models was estimated and compared using receiver-operating characteristics (ROC) curve. The results indicate that 431 and 255 patients had a benign and malignant ovarian tumor, respectively. Application of stepwise logistic regression analysis revealed statistically significant importance of eight features. The sensitivity and specificity for the received model were 65.71% and 77.59%, respectively. Three-layer perceptron network shows 13 features as significant predictors of malignancy. The network gave a sensitivity of 85.7% and specificity of 93.1%. Comparison of area under ROC curve for received models was 0.9679 vs 0.9716. Prognostic values of the analyzed neural model are not optimal but seem to surpass logistic regression model in terms of the predictive possibilities.     

Female pelvic floor. Descriptive anatomy and clinical exploration by transvaginal ultrasound

In order to assess the state and pathology of the woman's pelvis minor, a number of methods are commonly used among practitioners, encompassing clinical exploration, radiology, MRN, urodynamics, endoscopy and echography.

Echography has been poorly used in clinical pelvic exploration and its reliability is actually a matter of controversy 1. However, echographic surveys can provide us with valuable gynecological data on the state and pathologies of the soft pelvis, within the genital regions or even going beyond them, i.e. the rectal channel, bladder, urethra, anus, vascular plexuses, and all of their supporting tissues.

At our research unit, we have been employing Transvaginal Ultrasound echography (TVU) for a long time in conjunction with other pelvis-focused methods in order to study different kinds of pelvic alterations. TVU has proven to be friendly to use, fast, harmless and inexpensive, allowing serial explorations and producing high-quality dynamic images (loop-cinema, video-tape). Furthermore, this method is fairly aseptic in that the occurrence of faeces in the rectal ampolla is not a nuisance but a bonus in tracking the contours of the rectum walls and other topographical features which would be otherwise difficult to survey.

A complete pelvic floor TVU may add no longer than 5-8 minutes to a routine gynecological examination, can be implemented by the general gynecologist and generates data that can be further studied by the appropriate specialist for a more insightful evaluation 2.     

Prenatal screening and diagnosis of handicaps: Current state of the art

Current medical procedures used in prenatal screening and diagnosis of handicapping conditions are reviewed. These strategies include ultrasound, amniocentesis, chorionic villus biopsy, restriction enzyme analysis, maternal serum analysis, fetoscopy, and fetal serum analysis. Along with an explanation of each method, advantages, disadvantages, and risks involved with each are provided. An understanding of these procedures by medical and educational personnel is encouraged, and the potential benefits of prenatal identification of handicapping conditions are emphasized.     

CT对肝外胆管梗阻性质的鉴别诊断

目的：探讨良恶性肝外胆管梗阻病变的CT表现及其诊断意义。方法：回顾经手术病理证实的肝外胆管梗阻病变76例(良性34例，恶性42例)。结果：肝内胆管呈枯枝状轻中度扩张，肝内外胆管不一致扩张(内轻外重)，肝外胆管远段梗阻，梗阻部胆管呈削尖状狭窄，肝外胆管壁呈弥漫环形增厚，对良性梗阻的诊断有重要意义。肝内胆管呈软藤状重度扩张，肝外胆管中段梗阻，梗阻部胆管呈伴或不伴肿块的截断型或突然狭窄型，肝外胆管壁局限不规则增厚，高度揭示恶性梗阻。结论：良恶性肝外胆管梗阻病变均有特征性CT表现，通过分析胆管形态和临床资料基本能判断梗阻的性质。     

脾脏钝伤的CT诊断

本文回顾性分析了３２例脾脏钝伤ＣＴ平扫的表现；对脾损伤进行ＣＴ分类；指出腹腔积血和脾周血块（“哨兵血块征”）在诊断脾损伤方面的作用。ＣＴ平扫诊断钝性脾脏损伤是一种敏感、可靠的方法，可帮助外科医生制订治疗方案。ＣＴ平扫诊断钝性脾损伤的灵敏度为９４％，诊断正确率为９１％     

9例结石性肠梗阻的诊断与治疗

目的 探讨结石性肠梗阻的诊断及治疗。方法 比较腹部平片和B超的术前诊断率。随访患者以了解不同手术方法的得失。结果 腹部平片术前诊断率为22％,辅以B超则上升为66％。4例Ⅰ期手术和3例Ⅱ期手术患者无死亡。无胆管炎发作。结论 仅靠腹部平片易漏诊,辅以B超则能提高术前诊断率。争取回期手术切除胆囊、闭合胆肠瘘,如有困难,则动员患者6-8周后Ⅱ期手术。