羊膜带引起胎儿畸形的超声表现分析

目的:探讨羊膜带引起胎儿畸形的超声诊断特点和临床价值,以提高产前诊断率。材料与方法:选取2012年3月至2014年3月我院明确诊断为羊膜带综合征的3例典型患者进行回顾性分析,观察超声诊断特点。结果:羊膜带综合征造成的胎儿畸形主要有3类:肢体畸形、颅裂面裂和腹壁缺损,有时可能合并心脏畸形等;通过超声检查首先发现胎儿畸形,其中最明显的为腹裂、脑膨出、开放性神经管畸形等,其次在畸形区域发现异常光带。结论:羊膜带能够引起胎儿畸形,超声诊断能够清晰的显示羊膜带的形态、胎儿畸形的类型,对诊断羊膜带综合征有着重要的临床价值和提高胎儿畸形筛查率。     

羊膜带综合征产前超声诊断及国内个案报道的统计分析

目的通过病例总结及结合国内个案报道分析,探讨羊膜带综合征胎儿畸形的产前超声诊断特点及临床价值。方法 (1)对我院明确诊断为羊膜带综合征的4例患者临床资料进行回顾分析,观察超声表现,与引产或出生后结果对照。(2)检索中文数据库羊膜带综合征个案报道相关文献,设定6大类畸形类别,分析羊膜带综合征引起胎儿畸形各类别发生率及产前超声漏诊情况。结果 (1)4例病例均在产前诊断羊膜带综合征,其中3例为不同程度肢体及肢体远端较轻微畸形,另1例为颅脑、颜面及肢体多发畸形。(2)文献个案报道合同本组病例共76例羊膜带综合征胎儿,包含32例(42.1%)颅脑畸形,25例(32.9%)颜面畸形,26例(34.2%)脊柱畸形,37例(48.7%)胸腹壁畸形,52例(68.4%)肢体畸形,7例(9.2%)其他畸形。76例病例中复合畸形54例(71.1%)。产前超声漏诊共43个类别,其中颜面畸形27.9%(12/43),肢体畸形53.5%(23/43)。结论 (1)羊膜带综合征胎儿以复合畸形较为常见,产前超声诊断不易漏诊;羊膜带综合征胎儿颜面及肢体畸形,产前超声诊断漏诊率高。(2)产前超声对不同程度畸形的羊膜带综合征诊断起着重要的作用,对选择临床处理方案及降低围产期病死率具有重要意义。     

羊膜(粘连)带综合征尸检5例临床病理分析

目的探讨羊膜带综合征(ABS)的发病机制及临床病理特点与诊断。方法对5例ABS胎儿进行尸检,结合文献讨论其发病机制、诊断方法及临床病理特点。结果 ABS主要表现为颅骨缺损、腭裂、腹壁缺损、肢体截断等多发性畸形,产后诊断依赖于胎儿和胎盘的细致检查,产前诊断主要手段为超声检查。结论羊膜带综合征的发病机制存在争议,临床病理表现多样性,产科超声检查是诊断胎儿ABS的有效方法。     

孕期羊膜片形成的超声诊断

产前超声诊断羊膜片形成的报道较少，与羊膜带综合征在声像图上容易混淆，但临床处理及预后截然不同，容易造成误诊误治。本文超声诊断羊膜片形成3例，现报道如下。     

羊膜片及羊膜带综合征的超声诊断价值

羊膜带综合征(amniotic band syndrome,ABS)是一种少见的先天性畸形综合征,患者无明显临床症状和体征,超声表现与羊膜片相似,两者鉴别诊断较难。本研究分析羊膜囊内索条状回声特点,旨在探讨超声对羊膜片及ABS的鉴别诊断价值。资料与方法一、临床资料2006年3月至2010年12月我院超声发现羊膜片孕妇8例和ABS孕妇5例,年龄21～39岁,平均28岁;孕8～39周。8例羊膜片孕妇均有不同程度的盆腔炎病史;5例ABS患者中,2例妊娠早期阴道流血、流液,2例有羊膜腔穿刺史。     

B型超声诊断羊膜带综合征

Ｂ型超声诊断羊膜带综合征刘荷一，刘明娟，冯秋红，张若麟１９９０年３月～１９９１年７月我宝应用Ｃｏｍｂｉｓｏｎ－３１０型超声仪诊断羊膜带综合征３例，经产后证实。例１，２４岁，孕２５周，产前常规检查，Ｂ超所见：胎儿颅骨光环缺如，羊水中可见４ｃｍ×３ｃｍ囊...     

胎儿羊膜(粘连)带综合征尸检1例及文献复习

目的探讨羊膜(粘连)带综合征(ABS)的诊断及临床病理特征。方法对1例羊膜带综合征进行尸检，结合文献讨论该综合征的临床表现、病理形态特点。结果本例主要表现为右上肢及头顶部缩窄环、颅骨缺损、腹裂、腹脏突出和脐带过短。结论羊膜带综合征的特点为多发畸形，每例均有不尽相同的临床表现。正确的诊断有赖于对胎儿和胎盘的细致检查及流行病学分析。     

超声对羊水内带状回声的诊断价值

目的探讨超声诊断羊水内带状回声的临床价值。方法 54例伴有羊水内带状回声的中晚期妊娠的孕妇,超声观察带状回声的超声特点及胎儿、附属物情况,询问病史并追踪随访。结果 54例羊水内带状回声中,双胎间隔膜18例,羊膜片16例,不全纵隔子宫9例,羊膜、绒毛膜未融合7例,轮状胎盘2例,羊膜带综合征2例。结论羊水内带状回声的形成有多种原因,有的为正常生理现象或良性过程,有的为严重病理现象,直接影响胎儿预后,做出正确诊断对指导临床有重要的价值。     

二维联合三维超声在中晚孕期宫腔内条索状回声诊断中的临床价值

目的 分析中晚孕期宫内条索状结构的二维及三维超声表现，提高临床对该类疾病的认识和诊断水平。方法 回顾性分析224例中晚孕期超声检查发现宫内条索状回声病例的临床资料，收集并记录正常分娩后或术中所见子宫纵隔、宫腔粘连带及胎盘情况，随访妊娠结局，结合病理组织学检查结果与声像图表现，总结不同类型条索状结构的二维及三维超声特征。结果 本研究中晚孕期宫腔内发现条索状结构的224例病例中：宫腔粘连带最多见，共170例，可出现在宫腔任意地方，三维超声可显示宫腔粘连带的数目、厚薄和形态；单纯羊膜皱襞19例，二维超声表现为羊膜边缘向羊膜腔内延伸形成条索状回声,远端呈游离状，三维超声示单纯羊膜皱褶呈薄膜状；不全纵隔子宫12例,位于宫腔底部或上部，三维超声可显示其分隔较厚，并可显示胎盘附着的位置关系；轮廓胎盘11例，二维超声示条状回声出现在胎盘边缘部，三维超声表现为胎盘边缘部环带状突起或局部山脊状突起；绒毛膜羊膜分离4例，二维超声表现为羊膜呈可飘动的线形回声，与绒毛膜分离，三维超声成像示羊膜似“薄纱”样膜状结构；斜隔4例，二维超声显示回声类似不完全纵隔子宫，但斜隔的基底部均位于宫腔侧壁，三维超声可清晰显示宫腔内斜行分隔回声；羊膜带综合征2例，二维超声表现为宫腔内多条纤细杂乱光带回声，并粘附于胎儿，与胎儿肢体分界不清。三维超声示胎儿肢体表面杂乱的膜状结构。结论 二维超声联合三维超声可全面观察中晚孕期宫腔内条索状回声，分析其不同的超声影像学表现，有利于提高对中晚孕期宫腔内条索状回声的诊断水平。     

羊膜带综合征1例

孕妇２５岁,因第一次妊娠于１９９８年３月６日就诊于本院门诊。当时怀孕１６周,常规行Ｂ超检查发现胎儿脊柱、颈、胸椎极度侧弯前凸,胎头与胸腔在同一水平面,测量胎头双顶径、胸、腹围与股骨长及羊水量与孕周相符,胎儿结构无异常。根据Ｂ超结果组织讨论诊断为羊膜带综合征（ＡＢＳ）,并征得夫妇双方同意给予终止妊娠,胎儿娩出后表现：羊膜带缠绕胎儿颈部使某扭曲,胎头极度仰伸朝向胸椎方向,同时胎儿颅骨亦与羊膜带相连而脊柱完整,尸检胎儿无畸形。该孕妇既往无妇产科异常病史。讨论：羊膜带综合征在产科临床中较为罕见,其发病率…     

Apical ballooning syndrome or aborted acute myocardial infarction? Insights from cardiovascular magnetic resonance imaging

Introduction Apical Ballooning Syndrome (ABS) is a novel acute cardiac syndrome that mimics acute myocardial infarction (AMI). This study evaluates the diagnostic utility of cardiac magnetic resonance imaging (CMR) in patients with suspected ABS. Methods and Materials Contrast-enhanced CMR was performed in 13 consecutive patients with suspected ABS on the basis of their initial clinical presentation and cardiac catheterization results. Results Ten patients (all female, mean age 71 ± 8 years) had an eventual diagnosis of ABS. CMR demonstrated left ventricle regional wall motion abnormalities (RWMA) involving the apex and mid-ventricle. Six also had right ventricular apical akinesis. There was no myocardial delayed enhancement (MDE) in these patients. The remaining three patients had initial features suggestive of ABS but were eventually determined to have AMI. Left ventriculography showed typical apical ballooning that was not explained by coronary angiography results. Two had MDE and persistent RWMA consistent with anterior AMI. One had RWMA on CMR consistent with a single vascular territory, and subsequent intravascular ultrasound showed obstructive plaque in the left anterior descending (LAD) artery. The final diagnosis in these patients was AMI with clot lysis prior to coronary angiography. Conclusion While ABS mimics AMI, AMI with spontaneous clot lysis may also mimic ABS, and at least in some patients, be mistaken for ABS. ABS is characterized by the absence of MDE and complete myocardial viability on CMR. The diagnosis of ABS can be excluded if CMR demonstrates MDE consistent with myocardial necrosis in a pattern and distribution consistent with AMI.     

梅毒荧光吸收试验在早期梅毒和先天性梅毒诊断中的价值

[目的]探讨梅毒荧光吸收实验（FTA-ABS）对早期梅毒和先天性梅毒中的诊断价值。[方法]利用FTA-ABS、TPHA和RPR同时检测88例梅毒患者、74例非梅毒患者以及82例正常体检者的血清。[结果]3种实验的特异性分别为FTA-ABS 100％、TPHA 98．1％、RPR 92、9％，FTA-ABS与TPHA比较无显著性差异（P〉0．05），但高于RPR（P〈0．01）；3种实验的敏感性分别为FTA-ABS 96．6％、TPHA 88.6％、RPR 83．0％，FTA-ABS与TPHA、RPR比较有显著性差异（P〈0．05、P〈0．01）。对一期梅毒的敏感性为FTA-ABS 100％、TPHA 87.1％、RPR 83．9％；对二期梅毒的敏感性均为100％；对三期梅毒的敏感性为FTA-ABS 92.8％、TPHA 100％、RPR 92．8％；对先天性梅毒的敏感性为FTA-ABS 87.5％、TPHA 62．5％、RPR 43．8％，FFA-ABS与TPHA、RPR比较，诊断一期梅毒和先天性梅毒具有显著性差异（P〈0.05、P〈0.01），诊断二期和三期梅毒无显著性差异（P〉0．05）。[结论]FTA-ABS是诊断早期梅毒和先天性梅毒的敏感性指标。     

Clinical diagnosis of acute bacterial rhinosinusitis, typical of experts

Background  Clinical diagnosis of acute bacterial sinusitis (ABS) is a concern when a patient presents with nasal discharge of recent onset together with facial pain or pressure. Given this presentation, the doctor would benefit from having access to software that specifies, first, what diagnostic indicators experts typically use in that diagnosis and then, upon entry of those facts, what experts' typical probability of ABS is in such a case.
Methods  We specified a set of 23 hypothetical presentations of this type by patients 20–75 years of age, involving a comprehensive set of clinical-diagnostic indicators. Members of an international expert panel independently set the probability of ABS in each of these cases. A logistic function of the diagnostic indicators was fitted to the medians of the probabilities.
Results  The fitting led to an expression of the experts' median probability of ABS as a joint function of the duration of the patient's facial pain/pressure, and indicators of the location(s) of this; indicators of exacerbation of the pain/pressure on bending forward, nasal obstruction, maxillary and/or frontal tenderness, pus from middle meatus, purulent postnasal drip, and fever; and indicators of recent upper respiratory tract infection, nasal polyposis and status post sinus surgery. This probability function is accessible at http://www.evimed.ch/ABS .
Interpretation  That probability function, made readily accessible, provides for expertly probability setting in clinical diagnosis of ABS, relevant for decisions about further diagnostics or treatment without further tests.     

Are normal coronary arteries a typical feature of apical ballooning syndrome?

Apical ballooning syndrome (ABS) is a new and uncommon, yet very interesting, clinical phenomenon regarded as one of the important elements of differential diagnosis in acute myocardial infarction. It was first described in 1990. The absence of obstructive coronary artery disease among others is a typical feature of ABS, required to make a final diagnosis. We describe a case of a woman with ultrasonographically confirmed tight stenosis in the right coronary artery, yet showing all other characteristics of ABS.     

Haemostatic actions of the folkloric medicinal plant extract Ankaferd Blood Stopper

Ankaferd Blood Stopper (ABS), a standardized mixture of five plants, has been used historically as a haemostatic agent but its mechanism of action remains unknown. This study investigated the in vitro effects of ABS on haemostatic parameters. When added to plasma or serum, ABS induced the very rapid formation of a protein network and erythrocyte aggregation. The levels of coagulation factors II, V, VII, VIII, IX, X, XI, and XIII were not affected by ABS. Plasma fibrinogen activity and antigen levels were decreased following the addition of ABS, in parallel with the prolonged thrombin time. Total protein, albumin, and globulin levels decreased after the addition of ABS. Our findings suggest that ABS stimulates the formation of an encapsulated protein network that provides focal points for erythrocyte aggregation. ABS has the therapeutic potential to be used for the management of haemorrhage and this agent should be investigated further in clinical trials.     

严重创伤与急性压疮的相关性研究

目的 探索严重创伤患临床指征与急性压疮发生的相关性。方法 对连续住ＩＣＵ的严重创伤患１３２例进行前瞻性观察。结果 急性压疮发生率在胸、腹部创伤患中较高,并且与创伤严重度评分相关,压疮组患的心率、血氧饱和度和血糖值三项生理指标与无压疮组相比较有显性差异（ｔ＝４．２４～９．８３,Ｐ〈０．０１）。结论 严重创伤患急性压疮发生率与创作部位及创伤严重度相关。心率、血氧饱和度和血糖三项指标对评估创     

Antibiotic Stewardship through the EU Project "ABS International"

The increasing problem of antimicrobial resistance requires implementation of antibiotic stewardship (ABS) programs. The project "ABS International--implementing antibiotic strategies for appropriate use of antibiotics in hospitals in member states of the European Union" was started in September 2006 in Austria, Belgium, the Czech Republic, Germany, Hungary, Italy, Poland, Slovenia and Slovakia. A training program for national ABS trainers was prepared and standard templates for ABS tools (antibiotic list, guides for antibiotic treatment and surgical prophylaxis, antibiotic-related organization) and valid process measures, as well as quality indicators for antibiotic use were developed. Specific ABS tools are being implemented in up to five healthcare facilities in each country. Although ABS International clearly focuses on healthcare institutions, future antimicrobial stewardship programs must also cover public education and antibiotic prescribing in primary care.     

免疫印迹法检测梅毒患者血清中IgG抗体临床意义及方法学评价

目的 探讨免疫印迹法检测梅毒感染患者血清中IgG抗体检测的临床意义。方法 采用免疫印迹法对临床确诊为梅毒的患者血清标本59 、正常献血员血清标本25例及生物性假阳性标本20例等进行了检测，并与梅毒特异性抗体检测的标准方法荧光梅毒螺旋体抗体吸附实验（FTA－ABS）、酶联免疫吸附实验（ELISA）和梅毒螺旋体被动明胶颗粒凝集实验（TPPA）结果相比较。结果 44例未经治疗的梅毒患者和15例经过治疗后的梅毒患者血清梅毒特异性抗体均为阳性，正常献血员和生物性假阳性患者结果均为阴性。59例梅毒患者中，除2例梅毒治疗后患者未检测出针对17KD多肽抗原抗体外，均检测出针对分子量为47KD，17KD和14KD多肽抗原抗体。针对上述3种多肽抗原抗体阳性率分别为100％，96．6％和100％。而针对90，60，33，30，25，22，45KD等多肽抗原抗体，在所有梅毒患者血清中亦检测出不同程度的阳性率。在51例非梅毒患者中，均未检测出针对47KD，17KD和14KD多肽抗原抗体，5例分别检测出一种或多种针对分子量为90，60，33，30，25，22KD和45KD等多肽抗原抗体。四种方法检测治疗前后梅毒患者结果一致性分别为100％和92．8％，四种方法检测梅毒的敏感度分别为100％，98．3％，98．3％，100％，经卡方检验，四种方法检测敏感度差异无显著性意义（P＞0．05）。免疫印迹法检测梅毒特异性抗体敏感度（100％）等于或高于其它三种同类方法，特异性（100％）与ELISA和TPPA两种方法相同，但显著高于FTA－ABS法（92．2％）。结论 免疫印迹法敏感度高，特异性好，操作简单，不需特殊仪器设备，阴阳性结果界线分明，易于判断，适应于临床广泛开展。