隆突性皮肤纤维肉瘤的超声表现

目的 探讨隆突性皮肤纤维肉瘤的特征的超声表现.方法 回顾性分析25例经手术病理证实为隆突性皮肤纤维肉瘤的分布、超声图像特征及彩色多普勒血流成像特点.结果 25例隆突性皮肤纤维肉瘤患者团块均位于皮肤或皮下组织,大小约1.6 cm×0.5 cm～6.5 cm×4.5 cm;分布在躯干21(占84％)例、四肢近端2例(占8％)、头颈部2例(占8％).25例肿瘤肿块内部为较均质低回声或以低回声为主的混合回声,内部无液化或钙化且不伴有局部淋巴结转移.10例(占40％)肿瘤边界清楚,形态规则;15例(占60％)边界不清楚;13例(占52％)肿块内部彩色多普勒显示有丰富血流信号.所有患者均未见淋巴结转移.结论 隆突性皮肤纤维肉瘤有一定特征性超声表现,超声检查对协助诊断有重要的临床价值.     

超声诊断隆突性皮肤纤维肉瘤

目的 探讨隆突性皮肤纤维肉瘤(DFSP)的超声表现.方法 回顾性分析12例经手术病理证实的隆突性皮肤纤维肉瘤的分布、超声图像特征及彩色多普勒血流成像特点.结果 12例隆突性皮肤纤维肉瘤患者中,11例(91.67%)为单发,直径0.9～8.0 cm;分布在躯干66.67(8/12)、四肢近端16.67%(2/12)、头颈部16.67%(2/12);83.33%(10/12)肿瘤出现在躯干及四肢近端的皮肤与皮肤下层.91.67%(11/12)肿瘤呈不均匀弱回声,66.67%(8/12)边界清楚,形态规则,肿瘤内部无液化或钙化且不伴有局部淋巴结转移;91.67%(11/12)肿瘤内彩色多普勒显示有丰富彩色血流信号.结论 患者躯干及四肢近端的皮肤与皮下层肿块,边界清楚、形态规则、内部呈不均匀弱回声、内部血流较丰富、无局部淋巴结肿大是隆突性皮肤纤维肉瘤的超声表现.     

隆突性皮肤纤维肉瘤的高频超声表现

目的探讨隆突性皮肤纤维肉瘤的声像图特征。方法回顾性分析40例经手术后病理证实为隆突性皮肤纤维肉瘤的超声表现。结果 40例隆突性皮肤纤维肉瘤患者中,36例位于皮肤及皮下层,4例位于皮下层,病灶浅面与皮肤层无明显相连;36例边界清楚,30例病灶形态规则;27例为强弱不等的混合回声,主要表现为内部不规则的条带状强回声以及边缘不连续的带状强回声,15例周边可见环状低回声;6例为不均质的低回声,周边未见环状低回声;7例为均质的低回声,周边未见环状低回声;血流分级:7例0级,2例1级,7例2级,24例3级。结论高频超声可以清楚显示病灶位置、形态、边界、回声、血流,以及病灶与周围结构的关系等,为临床提供重要的参考价值。     

隆突性皮肤纤维肉瘤超声及临床病理分析

目的探讨隆突性皮肤纤维肉瘤的超声及临床病理特征。方法回顾性分析11例隆突性皮肤纤维肉瘤患者的超声表现和临床病理特征。结果 11例均为原发单个结节状皮肤肿物,肿物位于皮肤及皮肤下层,最大径0.9~6.8cm,分布在躯干8例(72.73%),四肢2例(18.18%),头面皮1例(9.09%),90.91%(10例)呈不均匀低回声,81.82%(9例)边界清楚,形态规则,内部未见液化或钙化,CDFI示90.91%(10例)肿瘤内具有较丰富血流信号。病理大体为淡红色结节状皮肤肿物,镜下肿瘤浸润真皮,侵及皮下组织,瘤细胞丰富且形态单一,中-高度核分裂性,CD34和Vimentin弥漫阳性表达。全部病例均无局部淋巴结转移。结论 DFSP的超声声像主要由病理组织特征决定,具有一定特征性,超声结合病理可为本病检出提供重要价值。     

隆突性皮肤纤维肉瘤的超声表现

目的 探讨隆突性皮肤纤维肉瘤(DFSP)的声像图特征,为临床提供诊断依据。方法 回顾性分析52例DFSP的超声表现,获得声像图特征。结果 52例隆突性皮肤纤维肉瘤患者肿块以躯干多见(66.7%,42/63),极少数的患者发生肺部转移(3.8%,2/52)。超声表现为肿块均位于真皮层内,且大部分突破真皮层(93.7%,59/63),直径<5 cm(81.0%,51/63),形态规则(65.1%,41/63),边界清晰(73%,46/63),内部呈低回声(84.1%,53/63),内部可见片状和/或裂隙状高回声(65.1%,41/63),内部较少出现液化(9.5%,6/63)或钙化(1.6%,1/63)。所有患者均未见局部淋巴结转移。彩色多普勒血流成像(CDFI):大部分(68.3%,43/63)肿块内部血流信号较为丰富。结论 DFSP声像图表现具有一定的特征性,具有较好的临床应用价值。     

皮肤隆突性纤维肉瘤的超声表现

目的：研究皮肤隆突性纤维肉瘤的超声表现,提高其诊断准确性。方法：回顾分析10例病理证实为皮肤隆突性纤维肉瘤患者的超声检查资料。结果：10例患者中,9例肿瘤位于皮肤浅表,紧贴皮肤,1例肿瘤位于乳腺内。其灰阶超声表现有3种：（1）＂洋葱皮型＂肿瘤6个,肿瘤平均最大径41mm,均呈卵圆形;其中4例呈分叶状,边界清晰,肿瘤内见低回声区,内部及周边见粗大分层状高回声区;（2）回声均匀型3例,肿瘤平均最大径17mm,均呈卵圆形,边界清晰,肿瘤呈低回声或稍低回声;（3）回声杂乱型1例,肿瘤最大径170mm,内见高回声及低回声区,杂乱分布。彩色超声示2个最小肿瘤无明显血流信号;其余8个血流丰富,呈网状,平均阻力指数0.57。结论：皮肤隆突性纤维肉瘤有一定特征性超声表现,超声检查有助肿瘤诊断。     

脂肪肉瘤彩色多普勒超声特征分析

目的 探讨脂肪肉瘤的超声声像图特征。方法 回顾性分析我院经手术切除病理证实为脂肪肉瘤的31例患者资料、超声声像图特征。结果 31例患者中,去分化脂肪肉瘤13例,高分化脂肪肉瘤10例,多形性脂肪肉瘤4例,粘液样脂肪肉瘤4例,肿瘤平均最大长径约(16.97±9.70)cm,病灶以等-高回声为主61.3%(19/31),回声分布不均匀90.3%(28/31),多表现为乏血供,以Adler血流分级为0级51.6%(16/31)和I级41.2%(14/31)为主。主要的病理亚型高分化脂肪肉瘤超声特征以高回声为主70.0%(7/10),去分化脂肪肉瘤则表现为低回声46.2%(6/13)和高回声30.8%(4/13)的双相模式。结论 脂肪肉瘤超声声像图表现具有一定的特征性,对于超声准确诊断该病能够提供一定的帮助。     

超声在皮肤纤维瘤诊断中的价值

目的探讨皮肤纤维瘤的声像图表现及超声在皮肤纤维瘤诊断中的应用价值。方法回顾性分析50例患者共55个经病理证实为皮肤纤维瘤病灶的临床和超声特征,包括病灶的位置、形状、深度、大小、内部回声、后方回声变化、边缘、病灶血供等。结果病灶以四肢(60.0%,33/55)多见,其次为躯干(29.1%,16/55)、颈部(10.9%,6/55)。超声表现为多数病灶呈椭圆形(60.0%,33/55),位于真皮层内(72.7%,40/55),长径为(9.61±5.22)mm,内部呈均匀低回声(80.0%,44/55),后方回声无明显变化(54.5%,30/55),侧缘与真皮分界不清(98.2%,54/55),累及皮下软组织时下缘与皮下脂肪分界不清(100%,15/15),并多呈锯齿样表现(80.0%,12/15)。病灶大部分表现为乏血供(70.9%,39/55),累及皮下软组织的病灶内出现血流信号的比例(40.0%,6/15)高于局限于真皮层内的病灶(25.0%,10/40)。结论皮肤纤维瘤的声像图表现具有一定特点,对临床明确诊断具有重要的参考价值。     

乳腺黏液癌的超声特征及病理相关性分析

目的 探讨乳腺黏液癌的超声声像特征及其与不同病理组织类型之间的关系,提高乳腺黏液癌的超声诊断率.方法 回顾性分析手术后病理证实的22例23个乳腺黏液癌病灶的声像特征,根据美国放射学会的超声BI-RADS要求分析肿块的声像特征等并于术前进行BI-RADS分类诊断;根据病理组织类型进行超声声像图分析.结果 病理组织学分类包括15个单纯型和8个混合型,前者包括7个富细胞型,8个少细胞型.所有患者均存在无假包膜的实性肿块,86.7％ (13/15)的单纯型病灶境界清楚,内部回声等于或略低于皮下脂肪回声;93.3％(14/15)的单纯型病灶后方回声增强.所有单纯型肿块方向平行于皮肤.75.0％(6/8)混合型肿块边界较模糊并细小毛刺边缘,内部回声更低(P＜0.01),混合型较单纯型更具恶性特征.总体65.2％(15/23)的病例疑恶性,提示BI-RADS 4级或5级,其中单纯型9例(60.0％),混合型6例(75.0％).结论 乳腺黏液癌尤其单纯型不具备典型乳腺癌恶性肿块的声像特征,单纯型常表现良性肿块声像改变,但均无假包膜这一良性肿块声像特征,混合型肿块较单纯型更具有恶性声像特征,建议超声以BI-RADS4级来提示乳腺黏液癌以避免延误诊断.     

隆突性皮肤纤维肉瘤37例临床病理分析

目的：探讨隆突性皮肤纤维肉瘤的临床病理特点及预后。方法：回顾性分析高淳县人民医院2004/2009年经病理确诊的37例隆突性皮肤纤维肉瘤。结果：隆突性皮肤纤维肉瘤好发于年轻人,好发病变部位为躯干和四肢,临床表现真皮内缓慢生长的无痛性结节,组织学上以形态单一的梭形瘤细胞排列呈席纹状为特征,部分肿瘤有黏液变性及纤维肉瘤变,手术不易彻底切净是其易复发的主要原因。结论：手术医师应提高对隆突性皮肤纤维肉瘤的警惕性,有条件者应对可疑病变行术中冰冻切片检查。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.