胸壁脊索瘤1例报告

病例:男,68岁,20年前偶然发现左前胸壁有一蚕豆大小包块,无触压痛,未经任何诊治,也无明显增大。近2年包块逐渐增大,入院前左前胸壁包块大小约13.0cm×l4.0cm,突出于左前胸壁,表面皮色、皮温正常,无发热、咳嗽、胸痛、胸闷、气促等症状。入院拟诊为左前胸壁纤维瘤和骨纤维异样增     

1例脊柱侧弯术后护理的几点体会

患者，男，15岁。特发性脊柱侧弯，未经任何治疗，现轻度肺不张。活动后气促、易疲劳。患者5年前无原因出现胸部弯曲畸形，左侧前胸部向前突出。右侧后背部向后侧突出，当时无胸闷气短，无胸部疼痛，近2年来，患者发现前胸部及后背部突出较前加重，同时出现胸闷，活动后呼吸困难症状，查体脊柱呈“S”畸形，胸椎向右侧明显，右侧肩胛骨明显突出畸形，右侧胸腰部肌肉痉挛，胸腰部向左侧弯曲畸形，左侧前胸部突出畸形，四肢肌力Ⅴ级，肌张力正常，四肢无明显感觉减退。     

大量胸腔积液合并头皮结节误诊为结核病一例

<正>患者女性,66岁。因"咳嗽1个月,胸闷气促2个周"于2019年4月12日入院。患者于1个月前出现咳嗽,伴乏力、消瘦、纳差,无发热及胸痛。2周前出现进行性胸闷、气促。4月12日至本院就诊。胸部CT:双侧胸腔积液,右侧较多(图1、2)。考虑结核性胸腔积液可能,转入我院感染科住院诊治。患者既往有头皮结节史1年,无不适感,近3个月头皮结节破溃(图3)。曾在外院就诊考虑良性病变。     

氨苄西林致过敏性肺炎1例

患者男,28岁,司机,因咳嗽1周,胸闷气促半天入院.患者1周前受凉后出现咳嗽,不剧,呈阵发性,无痰,伴鼻塞、咽部不适、头晕,无畏寒、发热、盗汗、胸闷、气促等症状.     

以“乳糜胸”为首发表现的肝硬化1例

患者女,78岁.因"活动后胸闷、气促1周"于2007年10月3日入院.1周前,患者无明显诱因出现活动后胸闷、气促,夜间不能平卧,无胸痛、咳嗽、咳痰、低热、盗汗,无腹痛、腹胀、黄疸、恶心、呕吐等不适,尿量无明显减少,双下肢无水肿.     

肺结核的不合理用药处方分析

患者,男,45岁。1个月前无明显诱因出现阵发性剧烈咳嗽,无明显咳痰,时伴有左侧胸痛,咳嗽时明显。2周前渐感胸闷、气促症状明     

乳房叶状囊肉瘤并肺、胸膜转移1例

患者女,48岁。因右侧胸背部胀痛伴气促1周入院。患者于2周前无明显诱因下出现胸背胀痛,当时未予以重视,自行用关节镇痛膏治疗。以后出现气促,伴少许咳嗽、咯痰,由于患者有哮喘史,在外院给予激素、喘定及抗感染治疗,气促缓解不明显,到我院就诊,摄胸片发现右     

右位主动脉弓合并感染性胸膜炎1例

患者男,53岁,体型较瘦,营养中等,因"发热伴右侧胸痛1周"于2010年8月16日入院.患者入院1周前无明显诱因下出现持续发热,体温最高达39℃,发热前无畏寒、寒战,伴右侧胸痛,与呼吸有关,无胸闷,轻咳无痰.     

胸主动脉瘤破裂误诊为肺癌1例分析

对胸主动脉瘤破裂误诊为肺癌1例分析如下. 1 病历摘要 男,41岁.因咳嗽、咳痰2个月,咯血2周入院.缘于入院前2个月前无明显诱因突然出现咳嗽、咳痰,色黄,量少,伴左胸背部疼痛,隐痛,呈阵发性,无放射痛,与体位无关,无胸闷,咯血,无心悸、气促、呼吸困难,无头痛、晕厥等.患者未引起重视.2周前患者无明显诱因下出现咯血,色鲜红,量约150 ml,当时感头晕,冷汗,无呼吸困难等不适.     

右心房巨大血管肉瘤超声表现1例

患者女 ,49岁。因进行性胸闷、气短 3个月 ,加重 1周入院。入院前 3个月无明显诱因出现咳嗽 ,无痰 ,无发热。于外院就诊Ｘ线胸片提示右侧胸腔积液 ,胸腔穿刺抽出淡黄色胸水 ,诊断为结核性胸水。给予抗结核治疗 ,其间逐渐出现胸闷、憋气等不适症状。行超声心动图检查提示 :右侧心包区囊实性肿物 ,约 3 .7ｃｍ× 2 .8ｃｍ ,右房受压 ,心包积液 ,右侧胸腔积液。患者于入院前 1周胸闷、气短明显加重 ,不能平卧 ,稍活动就有胸闷、憋气 ,复查超声心动图 :右侧心包区肿物明显增大 ,约 9.5ｃｍ× 8.9ｃｍ× 8.8ｃｍ ,呈囊实性 (周围呈不规则中等回声…     

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.