超声诊断胎儿尿道闭锁1例

患者女,23岁.孕1产0,孕15周,来我院行产前常规检查.超声检查示:胎儿呈左枕前位,双顶径35 mm,胎头环状回声完整,脑中线居中,颅内结构回声未见异常;胎心率148次/min,胎心结构未见异常,胸腹壁完整,未见胸腹水及全身皮下水肿;四肢可见,股骨长20 mm;最大羊水深度9.3 mm;胎儿中下腹部可见一大小约73 mm×45 mm×59 mm囊性无回声区(图1),边界清,透声好,壁较薄,内无分隔,形似巨大膀胱,彩色多普勒血流显像示其内未测及血流信号;双肾水平横切面见集合系统点状回声分离约4 mm(图2).     

Meckel-Gruber综合征超声表现1例

孕妇,21岁.孕1产0,孕34周.外院超声检查为脑膨出畸形来我院要求引产.产前超声检查:宫内单活胎,双顶径82 mm,枕部颅骨回声连续中断,局部可见一大小约23 mm×27 mm、不均匀低回声膨出.胎儿双肾体积明显增大,回声增强,右肾大小约49 mm×61 mm,左肾大小约48 mm×46 mm(图1),内见多数大小不等的无回声区;羊水指数42mm.余未见明显异常.超声提示:(1)宫内单活胎;(2)胎儿脑膜脑膨出畸形;(3)胎儿双肾囊性病变;(4)羊水过少.     

超声诊断胎儿后尿道瓣膜1例

患者女,23岁。孕24周,孕1产0。来院常规超声检查所见:胎头双顶径53.7mm,可见胎心( ),胎儿心率167次/min,胎动( ),脊柱连续完整,股骨长33.9mm。羊水最大深度64.5mm,前壁胎盘。胎儿双肾增大,轮廓不清晰,肾实质明显变薄,左肾大小约48.7mm×24.2mm,右肾大小约44.4mm×26.3mm,双肾盂肾盏明显扩张,左肾盂分离16.2mm,右肾盂分离17.7mm,双侧输尿管显示不清晰。腹腔为一巨大无回声区占据,大小为64.9mm×77.9mm,壁厚4.3mm,回声增强,后尿道明显扩张,前后径10.1mm,与无回声区相连,似“钥匙孔”样改变。超声诊断:单胎中期妊娠,胎儿畸形(后尿道瓣膜可能性…     

胎儿后尿道瓣膜超声表现1例

孕妇,35岁.孕1产0,孕31周.超声检查:胎儿颅顶光环完整,颅内结构未见异常,双顶径86 mm,脊柱排列整齐,股骨长68 mm,胎儿四腔心结构及比例正常,胎心率139次/min,胃泡大小正常,羊水指数102 mm.胎儿双肾增大,右肾大小81 mm×48 mm,左肾大小70 mm×39 mm,内可见多个暗区,相互交通;双侧输尿管全程扩张,右侧最大内径9 mm、轻度迂曲(图1),左侧最大内径7 mm;膀胱增大,大4×75 mm×51 mm.孕38周超声复查:胎儿双肾进一步增大,右肾大小97 mm×48 mm,左肾92 mm×45 mm,肾实质被挤压变薄;双侧输尿管扩张加重,右侧最大内径15mm,左侧最大内径13 mm,左侧输尿管也出现迂曲;膀胱张力增高,大小76 mm×52 mm,膀胱尿道连接部可见5 mm裂隙(图2);羊水指数21 mm,余未见异常.     

胎儿胎粪性巨大假囊肿超声表现1例

孕妇,26岁.孕1产0,孕33周.夫妇身体健康,孕期无用药史,无感染史.超声检查显示:单活胎,双顶径8.4cm,头围29.0cm,股骨长6.0cm,肱骨长5.2cm,腹围29.0cm,胎儿颅内结构、脊柱、胸腔、心肺、肝、双肾、胃泡、四肢未见异常,膀胱内可见少许无回声区,肠管未见扩张,未见腹水,胎儿中下腹部偏右侧可见一形态不规则的囊性结构回声,大小6.8cm×5.7cm×5.0cm,边界清晰,囊壁厚0.5cm,回声增强,内缘粗糙,囊内可见分隔样结构及密集的细小点状回声并分层现象(图1),CDFI示囊壁及囊内无血流信号.     

超声诊断胎儿型多囊肾1例

患者女,25岁.孕7个月,孕1产0多囊肾病、未治.孕期行常规产前超声检查见:胎头位于脐上,胎儿双顶径:69 mm,股骨长:46 mm,胎儿脊柱连续完整,胎心及胎动良好,胎盘位于子宫前壁,成熟度Ⅰ级,羊水深度最大前后径:31 mm,羊水暗区内充满点状回声,膀胱未显示.于胎儿脊柱旁探查:胎儿双肾体积增大,双肾内可探及多个无回声区,最大:15 mm×13 mm,未见正常集合系统,双肾皮髓质分界不清,实质回声增强(图1).超声诊断:(1)中孕单活胎妊娠;(2)胎儿双肾改变(考虑胎儿型多囊肾).引产后经尸检证实.     

胎儿成人型多囊肾超声表现一例

孕妇25岁，孕2产0，孕25周，非近亲结婚，否认家族遗传史。常规超声检查所见：单胎，胎儿颅骨回声完整，双顶径66mm，股骨长44mm。四腔心清晰，心率148次／min，律齐，胸腔无异常，脊柱连续性好；左肾大小30mm×15mm，实质区回声增强，未见明确无回声区；右肾较左肾明显增大，大小为46mm×25mm，实质区可见多个大小不等、互不相通的无回声区，较大者14mm×12mm，集合部受压（图1），膀胱内有少量尿液；肝、胰、脾及消化道未见异常，羊水及胎盘无异常。超声提示：胎儿右肾多囊性病变。引产后病理诊断为胎儿双侧成人型多囊肾。     

胎儿先天性十二脂肠闭锁超声表现1例

孕妇,22岁.孕1产0,孕32周.早孕期曾患感冒自服感冒药,无近亲结婚及传染病史.常规超声产前检查所见:胎儿头位,双顶径82 mm,头围301mm,股骨长径63 mm,头颅,颜面部,脊柱,心脏,四肢长骨未见明显异常回声.胎儿腹部膨隆,腹围约264mm,胎儿左上腹部横切时可见典型的"双泡征"(图1),位于左侧者为胃,大小约45 mm×16mm,右侧为扩张的十二脂肠,大小约23 mm×16mm,侧动探头时两个无回声区彼此贯通,实时观察可见无回声区的壁(胃壁)有蠕动,胎儿肝、双肾、膀胱可见,胆囊未显示,羊水明显增多,最大深度101 mm,羊水指数285mm,胎盘附于子宫前壁,成熟度1级.超声提示:(1)宫内单活胎,晚孕;(2)胎儿十二脂肠闭锁;(3)羊水过多.后经住院引产尸检证实了超声所见.     

超声诊断胎儿部分型尿直肠隔序列、右侧多囊性发育不良肾合并左侧重复肾重复输尿管1例

<正>孕妇,33岁,孕2产1,无家族遗传病史。产前血清学筛查正常。孕23周产前系统超声检查:胎儿各项生物学指标测值与孕周相符。右肾区未见正常肾形态和轮廓,见一大小3.5 cm×2.1 cm包块,由多个大小不等的囊性无回声区构成,较大无回声区大小1.5 cm×1.5 cm,内透声可,囊与囊未见交通(图1)。左肾大小1.9 cm×1.0 cm,形态结构及回声均未见异常。左侧输尿管内径0.3 cm。CDFI示右肾动脉细小,左肾动脉正常。反复探查胎儿肛门靶环征不清,较宽的结肠内径0.6 cm,可见絮状高回声肠内容物蠕动。胎儿左房室沟处见扩张的冠状静脉窦,大小0.4cm×0.3 cm,肺动脉左侧见一直径0.2 cm血管,汇入冠状静脉窦,未见无名静脉声像。羊水指数12.8 cm。超声提示:胎儿右     

超声诊断胎儿单下肢缺如并多发畸形1例

孕妇,36岁.孕22周来我院行常规产前检查.超声显示:宫内孕单胎,双顶径6.5 cm,股骨长4.7 cm,颅骨光环完整,脊柱排列整齐.胎儿心脏四腔心及左右心室流出道均可显示,胃泡可见.胎儿双肾增大,左肾6.1 cm× 2.2 cm,右肾5.2 cm×2.4 cm,肾盂肾盏扩张呈相互连通的无回声区(图1),最大前后径达2.3 cm,下腹部未见膀胱.     

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.     

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.     

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.