巨大肾血管平滑肌脂肪瘤并供血动脉瘤破裂出血1例

患者女,42岁,以腹痛原因待查收入院,临床查体后疑腹主动脉瘤破裂出血要求行腹主动脉CTA检查.CT平扫示右肾上极可见一最大截面12 cm×15 cm的肿块影,其内可见脂肪、软组织密度影及斑片状略高密度影,右肾后方可见出血征象(图1).增强扫描示:肿块内可见大小为2 cm×5 cm的片状高密度强化区,强化程度与腹主动脉相仿(图2).CTA示:右肾肿块内供血动脉呈瘤样扩张,腹主动脉未见异常(图3).     

免疫性动脉炎伴多发真性动脉瘤超声表现1例

患者男，26岁，低热，头痛3个月，伴下肢疼痛2个月。双侧上肢，下肢动脉及腹主动脉彩色多普勒超声表现：（1）右侧腋动脉起始部呈瘤样扩张，内膜毛糙增厚，最厚处为1.5mm（图1），瘤腔内可见湍流血流信号；（2）腹主动脉内径15mm，内膜厚5mm,     

彩色多普勒超声诊断左肾静脉走行变异并受压综合征1例

<正> 患者男,20岁。以腰痛、肉眼血尿多年,加重半月为主诉入院,尿常规检查:红细胞"+++",尿蛋白"++"。为排除左肾静脉"胡桃夹"现象,行彩超检查:经上腹横切面配合纵切面扫查,于肠系膜上动脉与腹主动脉之间未见左肾静脉,于腹主动脉与脊柱之间可见左肾静脉自左肾门汇入下腔静脉(图1)。左肾静脉在腹主动脉和脊柱夹角左侧缘(扩张段a)明显扩张,内径约6.7mm,管腔内血流色彩暗淡稀疏,     

超声诊断主动脉弓假性动脉瘤1例

正患者女,38岁。咳嗽1月,胸背部疼痛3d入院。既往无高血压、创伤、感染等病史。超声心动图:升主动脉内径约33 mm,主动脉弓处可见一瘤样凸起,瘤腔大小约66mm×45mm,与主动脉弓相通,开口处内径约12 mm,瘤体周边可见不规则低回声附着,彩色多普勒显示瘤体内双期双向血流信号(图1);提示:主动脉弓处异常瘤样凸起并瘤体内血栓形成。主动脉全程CTA(图2):主动脉弓处可见一假性动脉瘤,大小约54 mm×65 mm,瘤口大小     

彩色多普勒超声诊断DeBaKeyⅢ型主动脉夹层分离1例

患者男,66岁,高血压病史15年。因突发心前区剧痛、胸闷、气短入院。查体：主动脉 瓣区闻及舒张期杂音,血压29.3/14.6kPa。心电图：窦性心律,左室高电压。心向量图： 左房大,左室肥厚劳损。 　　应用美国Acuson ASPEN彩色多普勒超声仪(探头频率3.5MHz),于胸骨上窝降主动脉长轴切 面及主动脉弓长轴切面扫查,见主动脉弓内径30mm,降主动脉内径36mm,自左锁骨下动脉开 口处远端可见降主动脉内膜分离(图1),形成降主动脉真假腔,内膜片游离飘动,假腔最宽 处达31.2mm,真腔受压变形,最窄处仅12.6mm。CDFI见真假腔血流同时显示,其血流界面 清晰,真腔彩色鲜明,血流速度1.56m/s,假腔血流缓慢。内膜破口位于左锁骨下动脉开口 处远端,连续扫查内膜分离至腹主动脉。胸骨旁左室长轴切面可见左室肥厚扩大,主动脉瓣 中度关闭不全,升主动脉未见夹层分离。右室及右室流出道前方可见不规则液性暗区,范围 约81mm×41mm(图2),左侧胸腔内可见胸腔积液。超声诊断DeBaKeyⅢ型主动脉夹层分离,夹 层血肿破入前纵隔、左胸腔。     

锁骨下动脉瘤1例

患者女,59岁,甲状腺癌术后1年余,高血压病史15年,头晕、头痛10年.颈部超声:于横切面见左锁骨下动脉前壁瘤样结构向外突起,约8 mm×6 mm,距椎动脉开口约13 mm(图1).CDFI于瘤体内见丰富血流信号(图2).超声诊断:左锁骨下动脉瘤.CTA:左锁骨下动脉胸廓内动脉起始段局限性隆起,约0.7 cm×0.5 cm,边界清晰,距离椎动脉开口约14 mm(图3);锁骨下动脉其余部分及其分支未见明显异常.CTA诊断与超声一致.     

彩色多普勒血流显像诊断肠系膜上动脉瘤1例

患者男,56岁.主因"5天前无诱因出现上腹痛,加重2天"来我院就诊.患者自述疼痛呈间断性、针刺样,无放射痛,进食或改变体位疼痛无变化;偶有上腹胀痛、恶心;高血压史5年,慢性胃炎史10年.超声检查:扫查胰腺时,横切面探及脾静脉后方一瘤样结构向前突起(图1),纵切面与肠系膜上动脉(superior mesenteric artery, SMA)延续并与之相通(图2),瘤体距SMA开口处约57 mm,大小约30 mm×22 mm,瘤壁可见强回声钙化.     

超声诊断脾动脉瘤1例

患者女,55岁。直肠癌肝转移介入栓塞术后,无其它特殊不适。超声检查于腹主动脉左上方、胰尾后方见一类圆形囊性包块,大小约23mm×22mm×22mm,边界尚清,内部透声好,囊壁上可见小斑片状强回声附着,并可见包块与腹主动脉通过一迂曲动脉相通(图1),后经仔细扫查证实其为腹腔干及其分     

彩色多普勒超声诊断DeBaKey型主动脉夹层分离1例

患者男,66岁,高血压病史15年。因突发心前区剧痛、胸闷、气短入院。查体:主动脉瓣区闻及舒张期杂音,血压29.3/14.6kPa。心电图:窦性心律,左室高电压。心向量图:左房大,左室肥厚劳损。应用美国AcusonASPEN彩色多普勒超声仪(探头频率3.5MHz),于胸骨上窝降主动脉长轴切面及主动脉弓长轴切面扫查,见主动脉弓内径30mm,降主动脉内径36mm,自左锁骨下动脉开口处远端可见降主动脉内膜分离(图1),形成降主动脉真假腔,内膜片游离飘动,假腔最宽处达31.2mm,真腔受压变形,最窄处仅12.6mm。CDFI见真假腔血流同时显示,其血流界面清晰,真腔彩色鲜明,血流…     

彩色多普勒超声诊断肠系膜上动脉瘤并狭窄1例

病例男,38岁。5天前出现上腹痛,加重2＋天来我院就诊。患者疼痛呈间断性,间有恶心,呕吐。偶有发热,体温最高38.5℃。无特殊既往史。超声检查：上腹部横切面扫查探及肠系膜上动脉起始段呈瘤样改变,大小约16.3mm×14.8mm（图1）,纵切面瘤体长度范围约13.2mm,其末端管腔明显变窄,可见线状高回声分隔,分隔处最为狭窄,内径约1.9mm,瘤后管腔内径7.4mm（图2）。CDFI显示：瘤体末端血流束变细（图3）,流速明显加快,脉冲多普勒测值386.9cm/s（图4）。超声诊断：肠系膜上动脉起始段动脉瘤并重度狭窄,建议进一步检查。经CT血管造影及容积重建（CTA-VR）再次确认。     

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征（LQTS）、短QT综合征（SQTS）、Brugada综合征（BrS）和儿茶酚胺敏感性多形性室性心动过速（CPVT）,总结它们在发病机制及诊治方面的进展。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

Organ Preservation: Current Concepts and New Strategies for the Next Decade

SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.     

2017年呼吸疾病主要进展

2017年,国内外学者在呼吸系统疾病的临床和基础领域均进行了深入研究,不仅对相关指南进行了更新,并且针对一些临床热点、难点问题达成专家共识,现就2017年呼吸疾病相关进展作一简单介绍。     

家族性噬血细胞性淋巴组织细胞增生症1例并文献复习

目的加强对家族性噬血细胞性淋巴组织细胞增生症（familially hemophagocytic lymphohistiocytosis,FHL）的认识。方法报道确诊为FHL的新病例1例,结合国内外报道的FHL的病例,对该病的临床特点进行汇总分析。结果FHL2常与PRF1基因突变相关,约20%~40%的患者存在穿孔素基因突变。结论对于有阳性家族史,基因诊断明确,应尽早行化疗或者造血干细胞移植。若无家族史,未发现与继发性HLH相关的原发病因,可考虑行基因筛查以明确是否存在FHL的可能。     

COVID‐19 and COVID‐19 vaccine‐related dermatological reactions: An interesting case series with a narrative review of the potential critical and non‐critical mucocutaneous adverse effects related to virus,therapy, and the vaccination

This narrative review article was conducted to lay out a summarized but exhaustive review of current literature over mucocutaneous manifestations in 4 dimensions of SARS‐CoV‐2 pandemic: virus itself, treatment‐related, vaccine‐induced, and alteration of chronic dermatologic diseases following infection. Virus and vaccine‐related were mainly self‐limited and non‐severe. Treatment‐related reactions could be life‐threatening.     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

Real‐life effectiveness of biological therapies on symptoms in severe asthma with comorbid CRSwNP

BackgroundWe aimed to evaluate the effectiveness of different antibody therapies on nasal polyp symptoms in patients treated for severe asthma.MethodsWe performed a retrospective analysis of patients with severe asthma and comorbid CRSwNP who were treated with anti‐IgE, anti‐IL‐5/R or anti‐IL‐4R. CRSwNP symptom burden was evaluated before and after 6 months of therapy.ResultsFifty patients were included hereof treated with anti‐IgE: 9, anti‐IL‐5/R: 26 and anti‐IL‐4R: 15 patients. At baseline median SNOT‐20 was similar among groups (anti‐IgE: 55, anti‐IL‐5/R: 52 and anti‐IL‐4R: 56, p = 0.76), median visual analogue scale (VAS) for nasal symptoms was 4, 7 and 8 (p = 0.14) and VAS for total symptoms was higher in the anti‐IL‐4R group (4, 5 and 8, p = 0.002). After 6 months SNOT‐20 improved significantly in all patient groups with median improvement of anti‐IgE: −8 (p < 0.01), anti‐IL‐5/R: −13 (p < 0.001) and anti‐IL‐4R: −18 (p < 0.001), with larger improvement in the anti‐IL‐4R group than in anti‐IgE (p < 0.001) and anti‐IL‐5/R (p < 0.001) groups. VAS nasal symptoms improved by median anti‐IgE: 0 (n.s.), anti‐IL‐5/R: −1 (p < 0.01) and anti‐IL‐4R: −3 (p < 0.001), VAS total symptoms by anti‐IgE: −1 (n.s.), anti‐IL‐5/R: −2 (p < 0.001) and anti‐IL‐4R: −2 (p < 0.001).ConclusionsTreatment by all antibodies showed effectiveness in reducing symptoms of CRSwNP in patients with severe asthma, with the largest reduction observed in anti‐IL‐4R‐treated patients.     

经颅黑质超声诊断帕金森病的临床评价

目的 通过对帕金森病患者及正常对照组进行经颅超声(transcranial sonography,TCS)检查,结合帕金森病患者的Hoehn Yahr（H Y）分级及帕金森病统一评分量表评分结果,了解我国大陆地区帕金森病患者有无黑质(substantia nigra, SN)回声增强表现。方法 对入选对象进行TCS检查,并对检查结果进行评价。结果 帕金森病患者 SN阳性率明显高于正常对照者（P＜0.05）。帕金森病SN异常组 H Y 分期明显高于帕金森病SN正常组(P＜0.05),表明帕金森病患者SN高回声面积与H Y分期相关。TCS检查对帕金森病的敏感性为80.5%,特异性为79.9%。结论 我国帕金森病患者SN强回声检出率显著高于对照组,说明我国帕金森病患者也存在SN回声增强这一现象,与国内外报道相一致。TCS检查对帕金森病的诊断具有一定的意义,敏感性及特异性较高。