腹部大血管病变的3D DCE-MRA诊断

目的 阐述3D动态增强磁共振血管造影（three-dimensional　dynamic contrast-enhanced magnetic resonance angiog-raphy,3D DCE-MRA）的原理及其在腹部大血管病变诊断中的价值。方法搜集32例腹部大血管3D DCE-MRA检查的影像资料,对其影像表现进行回顾性分析。结果（1）团注试验:对比剂通过肾动脉水平腹主动脉内的高峰时间为17-23s;（2）正常表现3例,清晰显示腹主动脉及其分支;（3）腹主动脉瘤7例,均显示主动脉受累段不规则增宽及实际的动脉腔;（4）腹主动脉夹层18例,均显示内膜片、真假两腔以及分支动脉起源的位置,显示破口12处、再破口16处;（5）动脉粥样硬化3例,均显示腹主动脉迂曲,管径粗细不均;（6）髂总静脉血栓形成1例,左髂总静脉未显影。结论3DDCE-MRA是一种非损伤性血管成像技术,对腹部大血管病变的诊断有重要意义。     

脑梗死老年患者康复治疗前后的脑血流动力学

目的　观察脑梗死老年患者康复治疗期的脑血流动力学变化。　方法　应用经颅多普勒超声仪检测30例脑梗死康复期老年患者治疗前后以及 2 0例老年健康对照组的双侧大脑中动脉 (MCA)血流参数 :收缩期血流速度 (Vs)、舒张期血流速度 (Vd)、平均流速 (Vm)、阻力指数 (RI)、搏动指数 (PI)。　结果　 (1)与对照组比较 ,脑梗死组 MCA流速 Vs、Vd、Vm显著降低 ,RI、PI显著增高 (P<0 .0 1) ;(2 )体疗组经海水浴体疗运动 4疗程后 MCA流速 Vs、Vd、Vm明显增高 (P<0 .0 1) ,RI、PI显著降低 (P<0 .0 1) ,而休养组患者则改变不明显 (P>0 .0 5 )。　结论　脑梗死老年患者恢复期脑循环及血管贮备功能尚差 ,海水浴体疗运动一定疗程后可改善患者心脑血氧供应和脑血流动力学状况。     

SURGERY OF PERIURETERIC OBSTRUCTION IN 101 CHILDREN OVER ONE YEAR OF AGE

One hundred and one children over 1 year of age have had surgery for pelviureteric obstruction over an 11 year period. The common clinical features were abdominal pain, urinary infection or haematuria, but number presented as an incidental finding. Less commonly, the patients presented with an abdominal mass or with hypertension. The diagnosis was usually made on intravenous pyelography (IVP) but in the latter part of the series, renal nuclide scan (RNS) and ultrasonography (US) were preferred. Ninety–three patients had unilateral pyeloplasty, three had bilateral pyeloplasty and five had nephrectomy or heminephrectomy. Whereas initially nephrostomy drainage was used in the majority of patients after pyeloplasty, trend away from nephrostomy evolved in the latter part of the series. With experience, the incidence of postoperative complications was also reduced and there was reduction in the period of hospitalization. Clinical results were consistently satisfactory. Postoperative assessment after pyeloplasty was made by IVP and/or RNS and also US. A review of these investigations showed that RNS provided more factual information of the result when compared with the IVP.     

从文体学角度鉴赏《礼物》一文

大学英语第一册第三课《礼物》是一篇故事短文 ,文中语言简单 ,词汇量少。学生能够在没有教师的指导下掌握文章的主要内容 ,但这并不意味着读懂该篇文章。对文本作深层的理解 ,掌握作者的写作目的 ,是大学英语精读的学习目的和要求。如何帮助学生达到对文本的真正的理解 ,这是一个一直来值得我们研究的问题。针对该文的简洁语体 ,笔者试着从文体学角度进行分析 ,在实际教学过程中 ,取得了较好的效果。在一定程度上提高了学生语篇理解和鉴赏能力。笔者试从文体语言、文体结构和修辞手段三方面分析该文的文体结构。1　文体语言1 .1　故事叙述…     

经腹及经阴道B超监测卵泡发育的评估

应用经腹及经阴道B超对68名不孕症妇女,139个月经周期进行卵泡发育及排卵监测。卵泡检出率TAUS为90.6％,TVUS为98.0％,显著高于前者,P<0.05。成熟卵泡特征影象(卵丘等)在TVUS显象率较高。TVUS监测卵泡发育更实用可靠。     

Detection of glaucomatous damage using multifocal ERG

The first‐order kernel analysis in multifocal electroretinogram (mfERG) using low contrast stimulation is suggested as a way to detect the inner retinal responses in animal studies. In this case report, this protocol is applied to human patients with glaucoma to demonstrate the possibility of using mfERG as a tool to detect glaucomatous damage. Two patients with glaucoma were recruited and had mfERG measurements with the 103‐scaled hexagonal stimulus pattern at low (50 per cent) contrast. Their responses were analysed and compared with those from normal subjects with the mfERG measured under the same condition. In the normal subjects, there were obvious oscillatory components on the ascending and descending limbs of the first‐order kernel response to 50 per cent contrast. In the glaucomatous patients, the oscillatory component on the descending limb was obviously diminished. In addition, this component was significantly diminished in the quadrant with a glaucomatous visual field defect. This suggests that the low‐contrast stimulation condition in mERG measurement may provide a good way to detect glaucomatous damage and this may help in clinical diagnosis of glaucoma.     

Glafenine-associated anaphylaxis as a cause of hospital admission in the Netherlands

Summary In 1981 generalized anaphylaxis was registered on 166 occasions in Dutch general and academic hospitals. Clinical details of 120 of those patients revealed that in 107 anaphylaxis was either probable (n=90) or possible (n=17), whereas in 13 cases some other reaction than anaphylaxis had occurred. The series of confirmed cases contained 46 men and 61 women, with mean ages of 47 y and 48 y, respectively.There was a complete recovery in 102 patients and two patients died. Hypotension was present in 79 cases (74%), dyspnoea in 34 cases (32%) and a skin reaction, mainly urticaria, erythema or angioedema, was mentioned in 62 cases (58%). Most cases of anaphylaxis were drug-induced (76%), the main causes being the analgesic glafenine and contrast media. Glafenine was mentioned as the cause in 36% of all admissions for drug-induced anaphylaxis. Only 3.7% of cases had been reported to the voluntary reporting scheme of the Netherlands Centre for Monitoring of Adverse Reactions to Drugs.On the basis of reimbursement data, the risk of developing severe anaphylaxis to glafenine was estimated at 11.7–19.3-fold relative to indomethacin, and 13.4–20.2-fold relative to oral penicillins.     

Five years experience of transrectal high-intensity focused ultrasound using the Sonablate device in the treatment of localized prostate cancer

BACKGROUND: High-intensity focused ultrasound (HIFU) is a minimally invasive technique used in achieve coagulation necrosis. We evaluated biochemical disease-free survival rates, predictors of clinical outcome and morbidity in patients with localized prostate cancer treated with HIFU. METHODS: A total of 181 consecutive patients underwent HIFU with the use of Sonablate (Focus Surgery, Indianapolis, IN, USA). Biochemical recurrence was defined according to the criteria recommended by the American Society for Therapeutic Radiology and Oncology Consensus Panel. The median age and pretreatment prostate-specific antigen (PSA) level were 70 years (range 44-88) and 9.76 ng/mL (range 3.39-89.60). A total of 95 patients (52%) were treated with neoadjuvant hormones. The median follow-up period for all patients was 18.0 months (range 4-68). RESULTS: The biochemical disease-free survival rates at 1, 3 and 5 years in all patients were 84%, 80% and 78%, respectively. The biochemical disease-free survival rates at 3 years for patients with pretreatment PSA less than 10 ng/mL, 10.01-20.0 ng/mL and more than 20.0 ng/mL were 94%, 75% and 35%, respectively (P<0.0001). Multivariate analysis identified pretreatment PSA (P<0.0001) as a independent predictor of relapse. CONCLUSION: High-intensity focused ultrasound therapy appears to be a safe and efficacious minimally invasive therapy for patients with localized prostate cancer, especially those with a pretreatment PSA level less than 20 ng/mL.     

Noninvasive Intracranial Cerebral Flow Velocity Evaluation in the Emergency Department by Emergency Physicians

Transcranial Doppler (TCD) is an accepted modality for the evaluation of cerebral blood flow velocities. OBJECTIVES: The purpose of this study was to test the feasibility of bedside TCD measurement in the emergency department (ED) with critically ill, intubated patients. METHODS: A prospective convenience sample of patients presenting to a university hospital over a two-month period underwent TCD evaluation of the middle cerebral artery. Intubated patients with head trauma and any patient requiring tracheal intubation were eligible. A 2-MHz Doppler probe was positioned over the temporal bone to acquire blood flow velocities. An emergency medicine resident and research assistant obtained measurements. Continuous TCD tracings were recorded on a video cassette recorder tape for quality assurance review and data collection. Vital signs and therapeutic interventions were also recorded. Flow velocities were measured in cm/s; the peak Resistance Index (RI) was calculated for each patient. RESULTS: A total of 30 patients were enrolled in the study. Adequate tracings were obtained in 25 patients (83%) without a disruption of resuscitation. Tracings could not be obtained in five patients; they were listed as TCD failures. However, in two of these patients, adequate flow velocity tracings were obtained after resuscitation. Four patients were evaluated during tracheal intubation. One patient was monitored successfully during cardiopulmonary resuscitation. The median time required for data acquisition was 1.9 minutes. The mean highest RI for those who expired was 0.84. For those who survived, the mean highest RI was 0.52. The difference of 0.32 was statistically significant (p = 0.04). CONCLUSIONS: Noninvasive blood flow velocity monitoring of the middle cerebral artery using TCD is feasible in the ED when performed at the bedside on intubated patients with traumatic brain injury and others during tracheal intubation and resuscitation.