B型超声诊断胃内柿石一例

患者,女,55岁,食纳减少,左上腹隐痛伴包块月余。平素喜食柿子。于1985年10月来我院行B超检查:肝胰脾左肾未见异常,左上腹扪及包块处见一不规则增强弧形光带,伴声影,饮水800ml后,见光带位于胃内,长12.5cm,厚2.1cm,可活动,且见水在光带周围     

B型超声诊断肾上腺假性囊肿1例

患者女,21岁,因左上腹痛1周入院。无发热,尿频、尿急、尿痛及外伤史。体检:腹软,左上中腹有轻压痛,可扪及边界不清之包块,质较硬,不活动。腹部平片及肾分泌造影见双肾盂肾盏显示良好,杯口清楚。左肾向外下受压挤,肾盂肾盏稍变形,无明显破坏。提示左上腹肿瘤性质待查。B超检查:在左肾上极左后方可见大小为15.8×11.8×     

B超诊断胃重复畸形1例

病例女,34岁,车祸致腰部疼痛1h来我院就诊,来时血压平稳,无腹部压痛、反跳痛、肌紧张等急腹症体症,叩诊无移动性浊音.B超显示:左上腹季肋区可探及一大小约13.6cm×9.5cm椭圆形囊性包块,被膜光滑,后方有轻度回声增强,提高增益后包块内可见大量细密点状回声,并可显示厚薄不均的囊壁结构(图1),包块随呼吸可有轻微运动,未造成脾肾分离,肝胆脾胰双肾均未见异常,腹腔无游离性积液.     

胰腺囊性畸胎瘤1例

患者女,53岁。发现左上腹部包块6天入院。无明显自觉症状。查体:腹软,肝脾未触及,全身无黄染,浅表淋巴结不肿大,于左上腹部可触及10×8cm包块,固定,境界尚清,压痛明显。血常规及肝功能化验正常。X线钡灌肠所见:横结肠中段狭窄长达7～8cm,病变区结肠袋消失,变直,钡通过受阻。X线提示横结肠癌可能。 B超所见:在脊柱左侧,胃大弯后方,胰体尾高度可见12.3×9.9×7.2cm囊性包块伸向脾门区,有包膜,边界较模糊,内部呈大小不等多房腔结构,囊液尚清晰,包块后方回声加强。肝、胆、脾、肾声象图正常。B超提示:左侧腹膜后囊性淋巴管瘤?     

巨大腹膜后神经鞘瘤1例

患者女性,27岁,10余年前发现左上腹有一鸡蛋大小之包块,数年变化不大,近一年来生长迅速。查体,腹部平软,肝脾未触及,左上腹可触及约20×50cm大小之囊性包块,表面光滑,不活动,无触疼。临床印象:胰腺假性囊肿。B超检查所见:左上腹连续纵切与横切,在腰椎的左侧,左肾,胰腺体部、尾部的前方可探及约15×17.4×20cm的单房性液性暗区,边界光整,壁较薄,后方增强效应明显。     

肠系膜炎性肌纤维母细胞瘤伴阑尾黏液囊肿超声表现1例

患者女,55岁.因左上腹包块,4个月,申请超声检查.既往史无特殊.查体:左上腹扪及大小12.0 cm×15.0 cm的包块,质硬,活动,边界清,无压痛、反跳痛.彩超所见:(1)左上腹查见混合回声团块,大小约16.0 cm×13.0 cm×6.3 cm,边界清,未见明显包膜,内部回声不均质,强回声与低回声交替,以低同声为主,间杂索条状强回声.团块活动度大,后方与腹主动脉比邻.     

胃平滑肌肉瘤CT误诊为胰腺囊腺癌一例分析

患者,男,54岁,进食后左中上腹胀痛不适四个月。体征:腹膨隆呈肥胖型,左中上腹扪及10×9cm包块,全腹无压痛,反跳痛。AFP、CEA正常。 B超、钡餐以及腹腔动脉造影均诊断胰尾部巨大     

横结肠类癌一例报告

【病例】　男 ,3 8岁。近 1个月反复排黏液血便伴左上腹疼痛 ,拟行结肠镜检查住院。查体 :生命体征正常 ,消瘦 ,浅表淋巴结不大 ,心肺听诊未闻及异常 ,腹平坦、软 ,左上腹触及一6cm× 5cm的硬质包块 ,光滑、活动 ,无压痛。B超检查示左上腹实质性包块 ,肝、脾、腹主动脉旁未见异     

超巨大肾积水2例报告

例1,男,18岁。因左上腹包块2年余收住院。无腹痛、恶心、呕吐、无尿频尿急及肉眼血尿。体查:左上腹有约38×42cm包块,质软,表面光滑。B超示腹部包块为囊性,胸透左侧膈肌升高,IVP左肾无功能,右肾正常,腹膜后充气造影示腹膜后巨大肿物。诊断为左肾积水,左肾无功能,行左肾切除。术中见左肾盂管交接处狭窄,左肾积水,术中抽吸出积液12100ml。     

巨大肾上腺血管瘤合并心律失常1例报告

1临床资料 患者男性,75岁,未婚,因反复左上腹疼痛不适1年入院.有劳累后晕厥史3年,反复呕血、柏油样大便史1年.查体:中度贫血面容,心界向左扩大,抬举样心尖搏动,听诊节律不齐;左上腹及左下胸廓局限性隆起,左上腹触及一包块,约20cm×20cm,质地中等,表面光滑,无压痛,不能推移.腹部B超:左上腹脾肾之间见混合性团块.腹部CT:左中上腹腔内见混杂密度块状影,14.4cm×17.9cm×18.0cm,CT值17～36Hu,内有散在分布斑点状致密影,CT值为180Hu,增强后肿块边缘结节状、不规则强化,左肾、脾、胰受压变形,腹膜后未见明显肿大淋巴结.     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.