脑颜面血管瘤综合征9例CT诊断和鉴别分析

目的 探讨脑颜面血管瘤综合征的CT表现特点和临床诊断价值.方法 回顾分析经临床和CT证实的9例脑颜面血管瘤综合征临床资料和CT表现.结果 9例脑颜面血管瘤综合征均有脑皮层不同程度的脑回样或条带状钙化,4例伴病侧大脑萎缩,4例伴病侧颅板增厚,1例合并眼部脉络膜血管瘤和侧脑室脉络丛增大.结论 CT能准确诊断脑颜面血管瘤综合征,为临床提供重要的诊断依据.     

磁共振检查病案精选(四十二)(骨肌系统)

软组织海绵状血管瘤，是间胚叶组织先天性发育异常的良性肿痛。病理上可分为毛细血管型、动脉型、静脉型和混合型，肢体软组织血管瘤可见于任何部位．以儿童和青年多见，可单发或多发，局限或弥漫，并逐渐增大．大多为海绵状血管瘤，即静脉窦型。临床上表现为患肢局部无痛性软组织肿块，柔韧，边缘光滑，邻近骨骼可有骨质增生或压迫吸收改变。     

脑面血管瘤病的CT诊断(附6例报告)

目的:研究脑面血管瘤病的CT征象,方法:报告脑面血管瘤病6例,全部病例均有CT资料,6例均有面部三叉神经分布区皮肤血管瘤及同侧颅内相关的病理改变.结果:CT显示患侧皮层钙化6例,脑萎缩5例,颅盖板障增厚3例,侧脑室脉络丛增大2例,增强扫描显示脉络丛明显强化,钙化灶周围脑回状强化1例,结论:CT对脑面血管瘤病的论断有重要价值.     

脑颜面血管瘤综合征影像表现

回顾性分析我院收治的9例脑颜面部血管瘤综合征患者的临床及CT资料。结果 9例患者均出现与CT特点相对性的临床表现,为脑皮层不同程度的脑回样或条带状钙化,其中伴病侧大脑萎缩4例,伴病侧颅板增厚4例,合并眼部脉络膜血管瘤和侧脑室脉络丛增大1例。脑颜面部血管瘤综合征的CT表现具体特征性,对临床上诊断具重要的意义。     

先天性血管瘤误诊为婴幼儿血管瘤临床分析

目的 探讨先天性血管瘤误诊为婴幼儿血管瘤的原因及防范措施。方法 回顾性分析2011年1月—2020年1月误诊的先天性血管瘤8例的临床资料。结果 本组误诊率为53.33%。本组因局部紫红色圆形肿物伴白晕,无明显变化入院4例;因局部紫红色肿物皮温高,表面散在毛细血管入院4例;均误诊为婴幼儿血管瘤,误诊时间为3～7(1.8±0.3)个月。8例规律应用普萘洛尔或糖皮质激素治疗后,效果欠佳,进一步行影像学及病理检查,证实为先天性血管瘤。确诊后4例给予局部压迫观察,疗程3～18个月,病情改善,病灶体积缩小;其余4例给予手术治疗,获得治愈。结论 先天性血管瘤主要表现为局部紫红色圆形或卵圆形肿物,表面可见散在毛细血管扩张,有些病变周围可见白晕,临床误诊率较高。临床医生应加强对该病的认识,接诊高度怀疑先天性血管瘤患儿时,应仔细询问病史及查体,及早行相关影像学检查,确诊还需行病理检查。     

颅面血管瘤综合征的CT诊断(附3例报告)

颅面血管瘤综合征又称斯－威氏综合征（ＳＷＳ）,是一种罕见的先天性神经、皮肤及血管发育异常。我们所见３例,有一定临床表现及ＣＴ影像特点,结合有关文献进行分析讨论。病例例１,女,１８岁。生后见右面部发红,５岁时出现抽搐,发作逐渐频繁,严重时伴有意识障碍。体检见右额、眼睑和面部有大片暗红色血管痣,右眼结膜充血,眼底水肿,反应迟钝,行走步态不稳,余无其它神经系统阳性体征。ＣＴ平扫显示右额顶枕叶见脑回样及条带状钙化,密度较高（ＣＴ值２５４ＨＵ）,双侧脑室系统略扩大,脑沟及脑池扩大增宽,钙化附近颅板稍增厚（…     

Sturge-Weber综合征1例

Sturge-Weber综合征（颅面血管瘤病）系先天性神经皮肤血管发育异常，较少见，现将我院发现的1例报告如下。     

脑内海绵状血管瘤的MR弥散成像的诊断价值

脑海绵状血管瘤为脑部血管一种先天性发育异常的非增生性血管畸形，其发生率仅次于脑动静脉畸形（AVM），而较脑静脉畸形和脑毛细血管畸形多见，由于MR检查的增多，脑海绵状血管瘤在临床中越来越多地被发现和诊断。本文通过对脑海绵状血管瘤的MR弥散成像（DWI）和常规MR影像表现的分析，初步探讨MR弥散成像对该病诊断的临床价值。     

读片窗答案

病理检查:肿块大小5cm×3.5cm×2cm,包膜完整,切面见直径2cm囊腔,内有钙化.镜下见部分毛细血管、血窦增生,呈血管瘤样改变,间质胶原增生,透明变性、钙化,大量小胆管增生(图5).病理诊断:肝间叶性错构瘤.     

我国非手术方法治疗血管瘤的概况

血管瘤是一种先天性脉管发育畸形，通常临床分为三种类型：毛细血管瘤、海绵状血管瘤、先天性动静脉疾（又称蔓状血管瘤），还有将皮肤毛细血管瘤和皮下海绵状血管瘤共存者称为混合型血管瘤。目前血管瘤非手术治疗根据不同条件大体采用以下几种方法：①冷冻、激光、同位素贴敷：仅适用于皮肤浅表、面积较小的毛细血管瘤，方法简单、安全有一定疗效，但有可能造成皮肤坏死、继发感染等缺点；②硬化剂注射：硬化剂注入瘤体后，诱发血管内膜炎症，促使血管腔闭塞，继而瘤体缩小或完全消退。操作时注入部位要准确，误入肌肉组织或用于治疗肌间血…     

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.     

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.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.