超声实时导航下射频消融治疗巨大脑膜瘤

目的探讨超声实时导航下射频消融治疗在巨大脑膜瘤手术中的作用。方法回顾性分析2010年11月至2011年4月经开颅手术治疗的巨大脑膜瘤29例,术中行超声实时导航、造影,其中15例患者在肿瘤切除前应用射频消融治疗。观察指标包括临床症状变化以及并发症情况。结果超声实时导航可以从多种角度、各种切面清楚地观察到肿瘤的位置、形状、大小、边界及毗邻关系,可随时显示内部及周边大血管分布、走行情况。射频消融术后,肿瘤出现凝固性坏死,切除时瘤体出血明显减少。肿瘤全切25例(86.2%),大部分切除4例(13.8%)。大多数患者临床症状明显改善。术后病理诊断为脑膜瘤WHO I级27例,WHO II级2例。结论超声实时导航以及射频消融治疗对于提高巨大脑膜瘤的切除率,减少术中出血及术后并发症具有重要作用。     

高强度聚焦超声对兔肝肿瘤微血管密度及血管内皮细胞生长因子的影响

目的 探讨高强度聚焦超声(HIFU)对兔肝肿瘤模型的肿瘤微血管密度(mircrovessel density,MVD)、血管内皮细胞生长因子(vascular endothelial growth factor,VEGF)的影响.方法用30只新西兰白兔制成VX2细胞肝癌模型,分为对照组(5只)和HIFU消融组(25只),于术后即时、1 d、3 d、7 d、16 d取材,用免疫组织化学SABC法观察并测晕肿瘤组织的MVD和VEGF的表达.结果 HIFU消融后,肿瘤组织MVD和VEGF的表达较术前明显降低(P＜0.01),但HIFU消融组内不同时间点间MVD及VEGF差异无统计学意义(P＞0.05).结论 HIFU消融可有效地破坏肿瘤组织的微血管,抑制血管形成并减少肿瘤组织的血供.     

四川省某学校一起细菌性痢疾暴发疫情调查

目的调查某学校细菌性痢疾暴发疫情发生的原因,为制定防控措施提供科学依据。方法2019-05-20,四川省茂县某乡镇小学发生一起细菌性痢疾暴发疫情,根据暴发调查步骤制定病例定义开展病例搜索,对搜索到的病例进行个案调查并描述病例的三间分布情况,再开展病例对照研究和现场卫生学调查,以寻找此次疫情发生的危险因素,明确暴发原因。利用描述流行病学方法描述病例的时间、空间和人群分布特征,罹患率差异用χ^2检验,病例对照研究中计算OR值及95%可信区间。结果该次疫情历时7 d(2019-05-20/26),共有病例97例(确诊病例25例,临床诊断46例,疑似病例26例),罹患率为30.50%(97/277);患者以腹泻、腹痛、发热和里急后重为主要临床症状;流行曲线提示本次疫情属于点源暴露,可疑暴露日期5月20-22日;不同性别之间(37.68%和32.37%,χ^2=0.86,P>0.05)、住校生和走读生之间(34.62%和35.06%,χ^2=0.06,P>0.05)、各班级之间(20.59%、42.42%、50.00%、46.16%、35.71%、26.92%、21.62%、45.45%和25.00%,χ^2=15.17,P>0.05)罹患率差异无统计学意义;病例对照研究显示,喝生水是本次疫情发生的危险因素(OR=3.77,95%CI:1.16~12.27);共采集样本85份(水样7份,血样6份,病例粪便样31份,肛拭子10份,学校环境样19份,留样食品样12份),其中25份粪便标本检出福氏Ⅵ型志贺氏菌;7份水样卫生学检测总大肠菌群、耐热大肠菌群、大肠埃希氏菌超标。结论这是一起学校生活饮用水被福氏Ⅵ型志贺氏菌污染而导致的急性细菌性痢疾暴发疫情。     

首诊眼科的全身转移性肺癌二例

眼部转移癌多发生在已知原发肿瘤的患者，少见仅有眼部症状而首诊于眼科的病例，近期我们在临床工作中发现2例以视力下降伴眼痛为首发症状而首诊于眼科的全身转移性肺癌患者，现报告如下。     

高强度聚焦超声治疗子宫平滑肌瘤的病理变化及其超声随访研究

目的通过病理穿刺及超声随访探讨高强度聚焦超声（HIFU）治疗子宫肌瘤的有效性。方法62例经HIFU治疗的子宫肌瘤患者，术前、术后1周分别进行超声引导下穿刺活检，标本行光镜和电镜观察。并分别在术后1、3、6和12个月进行超声检查，计算瘤体均径并与治疗前均径比较。结果光镜和电镜显示HIFU治疗后子宫肌瘤组织明显的细胞坏死、核固缩浓染、核碎裂溶解以及细胞器的破坏；同时可见血管的破坏以及空泡的形成。超声随访显示治疗后1个月肌瘤出现缩小，治疗后3个月瘤体明显缩小，与治疗前相比有显著差异（P〈0．05）。结论病理检查和超声随访证实HIFU治疗子宫平滑肌瘤明确有效。     

B超诊断胆囊穿孔(附1例报告)

Ｂ超诊断胆囊穿孔（附１例报告）马秀英①何光彬②患者女，６８岁，一月前无明显诱因出现右上腹持续疼痛，伴恶心呕吐，呕吐后腹痛不缓解，当时无发热，经抗感染治疗解痛效果不佳，三天后上述症状加重，伴腰背胀痛，遂来我院就诊。查体，一般情况好，体温３６．８℃，呼吸...     

实时组织弹性成像在评价肝肿瘤中的应用价值

Objective To explore the imaging features of liver tumors with real-time tissue elastography.Methods Eighty-five liver lesions in 67 cases were scanned with conventional ultrasonography and elastography using HI-Vision900 system and then assessed with grade scores.Results on ultrasound were compared with those on pathology.Results Majority of lesions with grade a-b on elastography were identified as benign on pathology, while most of masses with grade c-e on elastography were confirmed as malignant on pathology.The sensitivity, specificity and accuracy were 93.5%, 87.0% and 91.8% for elastography to detect malignant lesions,74.2% ,73.4% and 74.1% for conventional ultrasound.The Kappa value of two doctors on elastography in group Ⅰ (the depth of the lesion ≤10cm) was significantly higher than group Ⅱ (the depth of the lesion ＞10cm).Conclusions Real-time tissue elastography of liver tumors provides a new convenient,non-invasive diagnostic methods,contribute to identify the benign and malignant live tumors.     

实时组织弹性成像在评价肝肿瘤中的应用价值

Objective To explore the imaging features of liver tumors with real-time tissue elastography.Methods Eighty-five liver lesions in 67 cases were scanned with conventional ultrasonography and elastography using HI-Vision900 system and then assessed with grade scores.Results on ultrasound were compared with those on pathology.Results Majority of lesions with grade a-b on elastography were identified as benign on pathology, while most of masses with grade c-e on elastography were confirmed as malignant on pathology.The sensitivity, specificity and accuracy were 93.5%, 87.0% and 91.8% for elastography to detect malignant lesions,74.2% ,73.4% and 74.1% for conventional ultrasound.The Kappa value of two doctors on elastography in group Ⅰ (the depth of the lesion ≤10cm) was significantly higher than group Ⅱ (the depth of the lesion ＞10cm).Conclusions Real-time tissue elastography of liver tumors provides a new convenient,non-invasive diagnostic methods,contribute to identify the benign and malignant live tumors.     

便携式超声在四川汶川大地震中的应用价值

目的应用便携式超声快速诊断地震中受伤者脏器损伤情况，为分诊治疗提供依据。方法在接诊的720例地震受伤的灾民中，根据需要担架旁超声检查218例，项目包括检查两侧胸腔有无积液，腹腔脏器（肝、胆、胰、脾、双肾、膀胱及胃肠）有无损伤及有无积液，发现异常给予分诊治疗。结果218例超声检查患者中，胸、腹共诊断有异常患者62例，占28％。结论超声以其快速、方便、无创等特点，在地震创伤中发挥着不可或缺的作用。