胎儿心内膜垫缺损的超声诊断

心内膜垫缺损，指心内膜垫等组织出现不同程度和范围的发育不良，累及下部房间隔、流出道部分室间隔和房窒瓣等组织结构，导致心内的复合畸形病变。本病尤其是完全型心内膜垫缺损是一种预后极差的心脏病，产前超声诊断胎儿心内膜垫缺损降低围生儿死亡率、优生优育具有重要的临床意义。近年来随着仪器性能的改善和产前诊断技术的进步，心内膜垫缺损的产前诊断率得到提高。本研究对经解剖证实的20例胎儿心内膜垫缺损异常声像图进行总结，旨在探讨产前超声诊断胎儿心内膜垫缺损的临床价值。     

Augmentin-induced jaundice with a fatal outcome.

OBJECTIVE: To report a case of death due to Augmentin-induced cholestatic hepatitis and discuss a possible drug interaction between Augmentin and oestrogenic steroids. CLINICAL FEATURES, INTERVENTION AND OUTCOME: An 81-year-old man, on oestrogen therapy for prostatic malignancy, presented with obstructive jaundice one week after completing a four-week course of Augmentin for recurrent urinary tract infection. Liver biopsy showed features of a drug-induced cholestatic hepatitis with bile duct injury. His clinical course was marked by progressive deterioration with increasing jaundice and the development of hepatic encephalopathy. A course of prednisolone did not result in any improvement and he died nine weeks after the onset of jaundice. CONCLUSIONS: The cholestatic hepatitis induced by Augmentin is usually reversible but may be progressive, leading to death. The concurrent administration of ethinyloestradiol, a potentially cholestatic agent, may have altered the susceptibility and/or course of the reaction in this patient.     

Spontaneous bilateral chylothorax with fatal outcome in a patient with melorheostosis

We report a case of progressive, multifocal melorheostosis in a 28-year-old woman, with involvement of the left arm, chest, spine, and impressive soft tissue involvement. In the past, she had undergone multiple vascular interventions. She presented with spontaneous massive bilateral chylothorax. After conservative treatment without success, we conducted bilateral pleurodesis. This resulted in a clear reduction of pleural effusions, but her medical condition subsequently worsened due to progressive parenchymatous infiltrates, and increased interlobal pleural effusions. She ultimately died of global respiratory insufficiency. In patients with melorheostosis, involvement of the soft tissue can result in distinctive morbidity, and whenever possible, treatment should be conservative.     

阿苯达唑脂质体治疗包虫病的初期临床观察

目的：评价阿苯达唑脂质体（L－ABZ）口服液的临床疗效及药物副作用，为该药的临床应用提供依据。方法：选择53例包虫病患者，分为3组：A组为单纯服药组（35例），连续口服L－ABZ 3－6个月；B组为包虫囊肿穿刺前后服药组（4例），穿刺前3－7d开始服药，穿刺后连服1个月；C组为手术前后服药组（14例），术前3－7d开始服药，术后可进食水后即开始服药，疗程1个月。3个治疗组服药剂量均为每天10mg/kg，2次／d。同时动态随访病人服药前后的血常规、肝肾功、胸部X线片、B超或CT以及病人对药物的毒副反应。用治愈率、有效率、部分有效率和无效率来衡量A组的疗效。以复发率（观察至少1年）来判断B、C组的疗效。结果：A组治愈16例（45．7％），有效9例（25．7％），部分有效6例（17．1％），无效4例（11．4％），总有效率88．6％；B组、C组随访时间1－3年，尚无复发。临床药物治疗的53例服药病人中，尚未见因药物的副反应而终止治疗的病例。结论：阿苯达唑脂质体（L－ABZ）口服液对包虫病病人疗效较为肯定，毒副反应轻，患者能够长期服用，尤其适用于某些不宜施行手术治疗或复杂的包虫病例。     

Cardiac disease in dialysis patients in a Jamaican hospital: echocardiographic findings that predict mortality

The aim of the study was to assess, by echocardiography, the cardiac abnormalities in a group of patients with chronic renal failure and to determine the cardiovascular predictors of mortality. The study comprised forty-five patients from the Renal Unit, University Hospital of the West Indies, Kingston, Jamaica, and was undertaken between October 1, 1998 and July 31, 2000. All echocardiography was done by a single operator. The parameters assessed were systolic dysfunction, diastolic dysfunction, ejection fraction, regional wall motion abnormalities and valvular disease. Left ventricular cavity size, septal and posterior wall thickness were measured and left ventricular mass calculated. Demographic data were obtained directly from each patient by interview. The patients were mainly of African/mixed-African origin. Their mean age was 43.2 +/- 16.0 years. The average body mass index was 23.7 +/- 6.9. Twenty-eight (60.9%) patients were male and seventeen (39.1%) female. Hypertension, chronic glomerulonephritis and diabetes mellitus were the leading causes of chronic renal failure. Blood pressure was controlled at a mean value of 145/90 mm Hg pre-dialysis and 140/90 mm Hg postdialysis. The mean duration of renal failure was 2.8 years. Echocardiographic M-mode and two dimensional apical, four chamber view measurements indicated that mean left ventricular internal diameter (LVID) diastole was 55.7 +/- 7.9 mm (normal 38-56 mm) and LVID systole was 38.9 +/- 9.8 mm (normal 24-45 mm); the mean thickness of the chamber walls was 10.3 +/- 2.8 mm and 10.6 +/- 2.4 mm for the interventricular septum (normal 6-11 mm) and left ventricular posterior wall (normal 6-11 mm) respectively. Diastolic dysfunction was seen in 15 (34%) patients and systolic dysfunction in 12 (23%) patients who had ejection fractions less than 50%. The mean left ventricular ejection fraction was 56.3% +/- 16% (normal 65-85%), mean stroke volume was 82.9 +/- 27.2 mls (normal 51-96 ml). After 21 months enrolment in the study, Kaplan Meier analysis revealed a two-year mortality of 28.3%. Cox regression analysis indicated that a history of smoking current or past, low haemoglobin level, high aorta flow velocities, severity of mitral regurgitation and a negative association with serum creatinine were independent predictors of mortality. The correction of anaemia and control of other factors that impact negatively on cardiac function in dialysis patients is vital to enhance survival.     

胎儿心脏横纹肌瘤的产前诊断及临床结局分析

目的：　探讨胎儿心脏横纹肌瘤的产前超声诊断特点与临床结局。方法：　回顾性分析2016年8月至2019年8月重庆医科大学附属第一医院产前诊断的15例胎儿心脏横纹肌瘤超声特点,并随访其临床结局。结果：　15例胎儿心脏横纹肌瘤中,8例（53.3%）为单发,7例（46.7%）为多发,好发部位以左心室最为常见,产前超声均表现为均匀的强回声团。13例（86.7%）产前超声未发现合并畸形,1例产前超声合并室间隔缺损,1例产前超声合并脑实质内多发结节。妊娠结局：9例（60.0%）引产,5例（33.3%）足月分娩,1例失访。5例足月分娩患儿中,3例患儿心脏横纹肌瘤现仍存在,并未发现结节性硬化症（tuberous sclerosis complex,TSC）;1例心脏横纹肌瘤消失且未发现其他异常,1例出现多发TSC。结论：　胎儿心脏横纹肌瘤产前超声有较典型特征,表现为心腔内单发或多发的类圆形、均匀强回声团块,边界清晰,附着于室壁或室间隔。不合并TSC时预后良好,临床工作中需加强医患沟通,结合磁共振成像（magnetic resonance imaging,MRI）和基因检测来指导其预后。     

X线平片与B型超声结合对肺棘球蚴囊肿的诊断价值

分析了20例（28个病灶）由X线平片结合B型超声诊断并经手术病理证实的肺棘球蚴囊肿的病例。X线平片对肺棘球蚴囊肿诊断的敏感性、特异性、准确度为79％、93％、72％。B型超声对肺棘球蚴囊肿诊断的敏感性、特异性、准确度为75％、95％、70％。而X线平片结合B型超声对肺棘球蚴囊肿的诊断敏感性、特异性、准确度为89％、97％、86％。X线平片结合B型超声可提高肺棘球蚴囊肿的诊断准确度。     

多系统萎缩伴致命性直立性低血压三例临床分析

背景：自主神经障碍是多系统萎缩的主要临床特点,包括直立性低血压、泌尿道功能障碍等,其中直立性低血压可严重致猝死。而多系统萎缩中帕金森综合征型早期极易与帕金森病混淆。目的：本文将对多系统萎缩-帕金森综合征型的误诊原因进行分析,并强调直立性低血压在鉴别和诊治过程中的重要性。方法：回顾性分析2018年~2020年于湖州市中心医院神经内科住院及门诊随访的3例多系统萎缩伴直立性低血压患者的临床表现、辅助检查结果和诊断与治疗过程。结果：3例多系统萎缩均表现帕金森综合征型;早期均误诊为帕金森病;均表现严重的致死性直立性低血压,其中1例伴餐后低血压;米多君小剂量疗效均欠佳;3例患者均因直立性低血压跌倒,1例跌倒猝死。结论：直立性低血压有助于临床医生及时识别多系统萎缩-帕金森综合征型,严重的直立性低血压极易导致晕厥和猝死且难治,临床医生需引起警惕并及时防护。