糖尿病伤“心”于无声

糖尿病性心肌梗死患者约一半是无痛的,仅有胸闷、恶心、呕吐、心慌、头晕、乏力,甚至突然晕厥等。这种无痛性心梗极易误诊,是造成猝死的原因之一。     

遗忘型轻度认知损害患者海马三维磁共振影像特点

Objective To identify the characteristics of hippocampal 3-dimensional MRI in patients diagnosed as having subtypes of amnestic mild cognitive impairment(aMCI)using hippocampal surfacebased analytic technique.Methods Fifry aMCI patients and 16 healthy controls who were equivalent in age and education(NC)were recruited.Every subiect carried out a 3-dimensional MRI scan.After the imaging data were acquired.the borders of the hippocampus were manually traced in coronal vlew using the software of InsightSNAP1.4.1. Hippocampal volume was computed automatically and statistically analysed.Hippocampal 3-dimension MRI were transformed into 3-dimension parametric surface mesh models of 400×200 prids.Hippocampal radial distance measures which was the distance from the surface point to the central axis were statistically compared between two groups.The radial atrophy significance maps were acquired and adjusted for multiple comparisons.Hippocampal morphological difference maps of aMCI in contrast with NC were acquired.Results The average normalized volume of left hippocampus were(3247.5±600.2)mm3 in aMCI patients and(3467.9±451.3)mm3 in NC subjects.The average normalized volume of right hippocampus were(3416.8±699.1)mm3 in aMCI patients and(3469.1±358.9)mm3 in NC subjects.Comparison of hippocampal volume did not differ significantly between aMCI patients and NC subjects(t=1.161,P=0.255;U=0.178,P=0.859).By using hippocampal surface-based morphologic analytic technique,3-dimension hippocampal morphological difference maps between two groups were acquired,showing significant atrophy on the lateral and inferior hippocampal surface which corresponded to CA1 and subiculum hippocampal subfields bilaterally in aMCI patients compared with NC subjects. Conclusions aMCI patients do not have significant volume loss in the hippocampus. Through hippocampal surface-based morphologic analyses, partial regional atrophy of hippocampus at some degree is found, mainly localizing in the lateral and inferior hippocampal regions which correspond to CA1 and subiculum hippocampal subfields bilaterally in aMCI compared with NC. These results may reflect the early image marker in aMCI.     

皮肤软组织血管瘤的高频超声及彩色多普勒显像特点

目的探讨皮肤软组织血管瘤的声像图和彩色血流信号特点及在血管瘤诊断中的价值。方法应用高频超声及彩色多普勒超声对23例经临床及病理证实的皮肤软组织血管瘤进行观察,包括病变的大小、位置、边界、内部回声、周边及内部的血流信号密度,脉冲多普勒判断为动脉还是静脉,测血流信号速度。结果 91.3%血管瘤边界清晰,轮廓规整,显示为局限性的实性肿物图像。小的病变以低回声为主,大的病变以混合回声为主。48%(11例)显示有彩色血流信号,其中90.1%(10例)为2岁以下的婴幼儿,以动脉血流信号为主。2岁以下儿童的血管瘤体积明显大于2岁以上儿童及成年人,病变的彩色血流信号也明显较2岁以上者丰富。成人血管瘤血流信号不丰富。大的病变较小的病变血流信号丰富。结论高频超声及彩色多普勒超声是诊断血管瘤非常有效的方法。幼儿血管瘤体积较大,多为混合回声,动脉血管丰富。病变内部丰富的动脉血管可以作为婴幼儿血管瘤的特异性诊断指标。对于成人血管瘤或进入消退期的儿童血管瘤则不适用。     

脑出血致肾上腺皮质功能减退误诊1例分析

对脑出血致肾上腺皮质功能减退误诊1例分析如下。 1病历摘要 女,57岁。患者主因脑出血后意识不清0.5a余,进行性血压下降20d于2009—1005入院,患者于2009—0429无诱因出现右侧基底节大面积脑出血,行右侧去骨瓣减压血肿清除术,行高压氧治疗32次。     

胰岛素增敏剂可降低并发心血管疾病的风险

日前,美国学者对糖尿病患者口服降糖药治疗的一项研究表明,与单独应用磺脲类降糖药相比,服用噻唑烷二酮类药物（胰岛素增敏剂）可减少糖尿病患者的心肌梗死危险。并且,无论是单用噻唑烷二酮类的病人,还是服用“磺脲类＋噻唑烷二酮类”的病人,与单用磺脲类降糖药比较,发生心肌梗死的危险均显著降低。     

75岁老年妇女电除颤50余次1例报道

近年来,随着心室电风暴报道的日渐增多,其死亡率高、处理棘手及预后差等问题,已引起临床工作者越来越多的重视。如何迅速识别、及时抢救,是挽救患者生命的关键。现对1例75岁老年妇女电除颤50余次报道如下。     

交感电风暴心室颤动51次抢救成功1例报告

<正>临床资料患者女性,75岁,退休工人,因反复胸闷、憋气5个月加重2d,2009年4月5日清晨症状加重入院。既往患有高血压病20余年,最高达180/100mmHg(1mmHg=0.133kPa),用药控制在150/100mmHg左右。     

盐酸纳洛酮治疗苯丙胺类兴奋剂中毒的体会

目的 探讨盐酸纳洛酮治疗苯丙胺类兴奋剂中毒的疗效.方法 我院收治苯丙胺类兴奋剂中毒患者35例,随机分为盐酸纳洛酮组19例及维生素C组16例.维生素C组患者予吸氧、心电监护,5%葡萄糖溶液、维生素C8 g/d静脉滴注;高血压者给予卡托普利含服,烦躁、惊恐者予地西泮10 mg肌注,心动过速和(或)室性期前收缩患者予倍他乐克口服.口服中毒者予洗胃、导泻.盐酸纳洛酮组患者在上述治疗基础上加用纳洛酮0.8 mg入壶,1.2 mg静脉滴注,如无效果0.5 h后增加2.0 mg静脉滴注.结果 两组患者神经系统、心血管系统症状好转时间间差异有统计学意义(P<0.01).两组患者口中金属味、腹胀等消化系统症状无明显改善.两组均无严重不良反应.结论 苯丙胺类兴奋剂中毒治疗给予纳洛酮能有效改善患者病情.     

多数痛风不遗传

真正属先天性遗传引发的内源型痛风很少，到目前为止，仅确定两种痛风是先天性连锁性遗传。其中一种是因为黄嘌呤-鸟嘌呤核苷酸转移酶缺乏，造成次黄嘌呤生成次黄嘌呤核苷酸减少，合成黄嘌呤、尿酸量增多引起的痛风，称雷-奈综合征。另一种是5-磷酸核糖-焦磷酸合成酶活性增强，[第一段]