右耳下幼年型毛细血管瘤1例

患者女,25岁.以"右耳下肿胀1年伴疼痛4个月、右面部抽搐3个月"就诊.体检:右耳下触及约4.3cm×3.2cm×3.0cm包块,光滑、质韧,活动差,无压痛及波动感,可闻及血管杂音,右面颊部皮肤针刺觉减弱.实验室检查正常.     

甲状腺黏膜相关淋巴组织淋巴瘤1例

患者女,57岁,9个月前无意中发现右侧颈部肿块,约桂圆大小,无疼痛,无呼吸困难,无吞咽困难,无声音嘶哑等不适.肿块逐渐增大,来我院外科门诊,考虑"甲状腺肿物,甲状腺癌?"收住入院.查体:右侧甲状腺可及一肿块4cm×3 cm,质地中等,活动度佳,表面光滑,随吞咽上下移动,左侧甲状腺未及肿块.     

胸腔镜下食管囊肿切除一例

患者男,13岁,因出现急性吞咽困难半个月、呕吐伴咳嗽1周入院。病程中,患者吞咽困难进行性加重,无恶心、呕吐症状,无咳血、呼吸困难,无胸部疼痛及其他不适症状。胸部CT（图lB）：食管中下段右侧壁增厚,最大层面4．6cm×3．2cm,其内密度均匀,边缘较清晰,CT值为32HU,增强后无强化。钡透（图2A）示：食管中下段卵圆形充盈缺损,边缘光滑,随吞咽呼吸动作活动度欠佳。     

原发性喉恶性淋巴瘤一例报道及文献复习

患者男,65岁.因声嘶1个月伴刺激性咳嗽半个月于2008年12月12日人住本院耳鼻咽喉科.患者1个月前无明显诱因出现声嘶,无咳嗽、咳痰,无吞咽困难等不适,未予检查、治疗.半个月前又出现咽部异物感伴刺激性干咳,无咯血丝痰,进食后明显加重.10 d前又出现咽痛,曾在当地医院诊断为咽喉炎,口服抗生素及"喉风散"喷喉等治疗,咽痛症状有所缓解,其余症状无好转.2008年12月11日在本院门诊行纤维鼻咽喉镜检查结果:鼻咽部未见肿物,喉腔左侧见1个约2.0 cm×2.5 cm肿物,表面光滑.     

以眼结膜为首发部位的小B细胞淋巴瘤一例

患者,男,57岁.入院前9个月出现右眼结膜充血,渐出现球结膜赘生物,无疼痛及视物障碍,多次就诊眼科,考虑为结膜炎及炎性假瘤等,给予抗炎及滴眼液局部治疗,症状未见好转.1个月前发现左侧耳前一肿大淋巴结,直径约2 cm×2 cm,无疼痛,近期无明显增大.B超示双侧颌下、颈部、股沟多枚肿大的淋巴结,包膜光滑,部分皮、髓质分界不清,周边及内部均可见较丰富的血流信号,左耳前淋巴结约2.4cm×1.5 cm,界限清晰,内可见丰富粗大的血流信号.     

胃胰腺异位误诊为胃间质瘤一例并文献复习

我院收治胃胰腺异位误诊为胃间质瘤一例,复习文献报道如下. 一、临床资料 患者男,51岁,上腹部间断疼痛2个月入院.体检剑下压痛.内镜示胃窦小弯侧见一约1.0 cm隆起,表面光滑,超声内镜显示"为固有肌层低回声病变,大小约1.5 cm×1.0 cm".考虑为"胃间质瘤"行手术.术中胃窦区触及1.0 cm×1.5 cm肿块,位于胃壁内.行胃大部切除术,术后病检为"胃窦胰腺异位".术后患者症状消失.     

舌部颗粒细胞瘤1例报道

正1临床资料患者,女,12岁,以"舌部肿物2a余,渐进性增大6个月"为主诉于2018年2月8日收入院。患者2a前进食不适发现舌部肿物,因无疼痛麻木、不影响进食和言语,未经治疗。近6个月,肿物渐进性增大,影响咀嚼,遂至本院就诊。专科检查:患者面部左右对称,无畸形,张口度3.7cm,张口型"↓";左舌背前1/3处见约1.0cm×1.5cm肿块,单发,椭圆形,表面光滑,略高于舌背黏     

腹腔镜胆囊切除术后肝动脉假性动脉瘤形成1例

患者男,54岁.以"腹腔镜胆囊切除术后1个月,右上腹痛10 d,加重1 d"来我院就诊.患者1个月前因胆囊多发结石行腹腔镜胆囊切除术,10 d前无明显诱因自感右上腹不适、疼痛,未予重视,1 d前疼痛加重,期间无腰区酸胀,无畏寒发热,无黄疸.超声检查:胆囊窝未见正常胆囊回声,测及一不均质偏高团状回声,大小约4.5 cm×3.4 cm,其内可见一大小约3.0 cm×1.3 cm"葫芦状"的无回声区.该无回声区呈节律性博动,并见一交通口与其下方肝动脉相通,交通口宽度约1.5 mm(图1).     

喉不典型类癌1例

1临床资料 患者，女，74岁，因咽喉部疼痛4个月，于2008年3月11日入吉林大学第二医院。患者在4个月前无明显诱因出现咽喉部疼痛，吞咽时加剧，经口服消炎药后不缓解。纤维喉镜显示，右侧杓会厌表面见暗红色表面光滑的肿物，直径0．8cm，基底较广。双声带及室带光滑，披裂运动良好。病人无发热、无声音嘶哑，无吞咽困难。     

鼻腔血管平滑肌瘤一例

患者女,50岁,因"左鼻腔新生物3个月渐进性增大1个月"于2012年2月入院。患者3个月前无意中发现左鼻腔黄豆大小新生物,无鼻出血,无鼻塞、流涕,一直未治疗。近1个月来患者感左鼻腔新生物渐进性增大,伴持续性鼻塞,无疼痛,无流涕,无鼻出血,无头痛头晕,嗅觉正常。入科查体:一般状况好,心肺体检无异常。专科情况,鼻无畸形,鼻唇沟无变浅,前鼻镜下见左侧下鼻甲前端一淡红色、表面光滑大小约1.2cm×1.0cm×1.1cm类圆形新生物,新生物活动度可、边界清楚、质硬、触之无     

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.