超声诊断胎儿食道闭锁合并羊水过多1例

孕妇 ,2 6岁 ,孕 1产 1,妊娠 2 9周 ,因腹部胀痛来院就诊 ,产科常规体查 ,诊断为羊水过多。应用东芝 -B2 40型黑白超声诊断仪 ,探头频率为 3 .75MHz ,超声见宫内孕单胎 ,双顶径约7.2cm ,颅骨光环完整 ,胎心搏动规律 ,胎心 15 0次 min ,脊柱排列整齐 ,股骨长 5 .0cm ,胎盘位于子宫前壁 (Ⅰ级 ) ,羊水最大深度为 12cm ,胎儿上腹部可见 1.5cm× 0 .5cm的呈“新月状”的强回声实质光带 ,未见胎儿无回声区的胃泡 ,仔细观察未见胎儿吞咽反射可见有反吐动作出现 (图 1)。建议孕妇复查三次超声所见同前。超声诊断 :①宫内妊娠单胎、活胎 ;②考虑…     

B超诊断胎盘绒毛血管瘤1例

患者初产妇,26岁。孕38周产前常规 B超检查:于耻骨联合上探及胎头,双顶径8.5cm,腹径9.7cm,股骨长6.6cm。胎盘于子宫左后壁,Ⅱ级。胎盘边缘母体面与宫壁间探及5.6×4.8cm 近园形较低回声区,界清,包膜完整。内回声不均,其间见管状无回声区。羊水暗区5.4cm,胎心、胎动好。提示:①头位单胎存活;②胎盘与宫壁间囊实性包块(胎盘绒     

B超诊断胎盘绒毛膜血管瘤1例

孕妇 ,2 3岁 ,孕 3 2周 ,G1P0。常规超声检查见 :胎头位于耻骨上 ,头颅光环完整 ,脑中线居中 ,双顶径 :7.8cm ,胎心率规整 ,胎儿发育正常。胎盘位于子宫后壁近底部 ,成熟度Ⅰ°,羊水无回声区平均深度 5 .5cm ,在胎盘边缘右上方处见一约6.6cm× 5 .5cm左右的异常回声团块 ,内为境界清楚的多房性液性无回声区 (图 1)。B超提示 :①单胎头位晚期妊娠 ;②胎盘肿块待查 (胎盘绒毛膜血管瘤可能 ) ;③建议观察。 3周后孕妇又来复查 ,B超见 :胎盘右侧边缘处异常团块同前 (图 2 )。为避免产时胎盘出血过多故生产方式选为剖宫产。产出一男活婴。后经…     

胎盘绒毛膜血管瘤超声表现1例

初产妇 ,2 6岁。孕 2 2周 ,近一个月来腹围增加明显就诊。超声检查 :胎儿脊柱、躯体及四肢未见明显异常。胎盘附着于子宫前壁厚 2 .3cm,于中段实质内见一 5 .3cm× 4 .7cm大小圆形包块 (图 1)。边界清M:肿块 ;PL :胎盘 ;AF:羊水 ;FH:胎头图 1　胎盘绒毛膜血管瘤声像图　晰 ,形态规则 ,内部回声不均匀 ,以低回声为主。与胎盘界限清楚 ,向羊膜腔突出。羊水最大深径 8.2 cm。超声诊断 :1.宫内单活胎 ;2 .胎盘内实质性占位 (胎盘血管瘤 ) ;3.羊水量偏多。四周后复查 ,见肿物增大至 7.5 cm× 6 .5 cm (图 2 )。羊水量较多。本人要求行引产术 ,…     

胎儿先天性肝纤维化伴点灶状钙化超声表现1例

孕妇,23岁。孕1产0,孕28+2周,行产前常规超声检查。超声显示:宫内孕单胎,胎头位于耻上,双顶径7.4cm,头围27.2cm,腹围24.2cm,股骨长5.0cm,心率149次/min,胎儿肝大小形态正常,实质回声分布均匀,肝左右叶交界处及肝左叶外侧可见多个斑块状强回声聚集成团,范围分别为1.2cm×0.4cm和0.6cm×0.3cm,后方伴声影,肝内胆管未见扩张;胆囊、脾及双肾未见异常;胎盘附于子宫后壁(Ⅱ级),羊水指数10.6cm。超声诊断:①单活胎,头位;②胎儿肝内钙化灶。孕31周由同一医师复查超声:胎儿双顶径8.1cm,头围29.5cm,腹围28.2cm,股骨长5.7cm,肝内两处强回声的范围增大,…     

B超诊断前置胎盘伴胎盘内出血2例

例1,孕妇,32岁,停经23周,来院做引产术,临床无腹痛及阴道出血.术前常规超声检查:胎儿颅骨光滑规则,双顶径5.7cm,股骨长3.8cm,胸腹腔内未见异常,胎心145次/分,羊水最大径5.0cm.胎盘Ⅰ级,以前壁为主,占2/3,下1/3完全覆盖子宫颈内口,厚度为3.8cm,宫颈内口上方胎盘实质内可见6.5cm×2.8cm×4.6cm不规则细弱回声区,并可观察到液体流动征象.超声提示:①宫内单活胎;②前置胎盘伴胎盘内出血可能大(图1).     

B超诊断胎儿双侧阴囊积液1例

患者女 ,31岁 ,停经 35周。因产检子宫明显大于娠月份行B超检查。B超所见 :单胎妊娠头位 ,胎头双顶径 8.2cm ,胎心胎动正常 ,胎儿脊柱、胸腹腔内扫查未见异常。胎儿阴囊部冠状切面 :胎儿双侧阴囊增大 ,大小分别为 4 .2cm× 1.7cm及3.6cm× 1.4cm ,内分别可见大小为 2 .3cm× 1.2cm及 2 .2cm×1.2cm椭圆形内部回声均匀的睾丸回声 ,两睾丸周围分别可见直径 1.2cm及 0 .7cm无回声暗区 (如图 )。胎盘附着于子宫前壁 ,为Ⅱ级胎盘 ,羊水最大无回声暗区 9.2cm。超声诊断 :①单活胎头位 ,Ⅱ级胎盘 ,羊水过多 ;②胎儿双侧阴囊积液。经足月产后证实。…     

超声诊断双子宫中期妊娠子宫及同侧附件扭转1例

孕妇28岁,停经4+月,腹痛2h,来我院妇产科急诊就诊。既往月经规律,无痛经史,孕2产0,1年前行清宫术1次。临床初步诊断：腹痛待查;孕4+月,先兆流产？胎盘早剥？超声检查：胎儿双顶径约4.5 cm,股骨长约3.1 cm,胎心搏动时有时无,胎盘位于前壁,内回声尚均匀,羊水量适中,最深约4.2cm。超声提示：宫内孕,单活胎,中孕;胎心搏动异常。住院后进行第2次超声检查：宫腔内可见胎儿回声,未见胎心搏动。胎盘位于前壁,位置较高（排除胎盘低置或前置）,内部回声尚均匀,上缘与宫壁之间可见局限性低回声,范围约1.5 cm×0.4 cm。紧邻宫颈左侧可见一低回声团,大小约9.2 cm×8.0cm×6.0 cm,形态规整,边界清晰,内部回声尚均匀,彩色多普勒血流显像可见血流信号,与宫颈分界不清（图1,2）。超声诊断：①宫颈左侧低回声团,双子宫左侧宫体可能;②宫内死胎（右侧子宫）;③胎盘与宫壁间低回声,胎盘早剥？     

胎盘悬附血管瘤1例

患者女,30岁,怀孕12周。超声检查见:胎头双顶径4.1cm,脊柱排列整齐,四肢清楚,胎心率140次,搏动规律,胎儿胸腹脏器未见异常。羊水最大深度4.5cm,透声好,胎盘位于子宫体前壁,厚2.0cm,实质回声均匀。胎盘的胎儿面可见一有完整包膜的中等回声偏低的似腊肠样光团,两端附着于胎盘子面,内部回声呈小网络状。侧动病人体位,该光团如吊床样轻微摆动,长约4.0cm,厚约1.5cm。超声提示胎盘血管瘤。20周复查,见胎盘子面附着的光团较前增大,长约5cm,厚约2.0cm。胎心率132次,搏动规律。产前复查胎盘厚3.0cm,附着的光团增大至长约6.4cm,厚约2.2cm(图)。     

超声诊断胎儿隔离肺1例

病例 孕妇,27岁,孕1产0,孕25周,来我院进行产前常规超声检查.超声描述：单胎,头位,双顶径约6.2 cm,脊柱光带完整,位于左前方,胎心搏动规则,心率约150次/min,股骨长约4.1 cm,羊水较深处约4.5 cm,羊水指数约10 cm,胎盘位于前壁,成熟度为1级,脐带未见绕颈.于胎儿左胸腔内见一大小约4.8 cm＆#215;2.5 cm均匀强回声团块,边界清楚,呈叶状（图1）.CDFI：其内见分支状血流信号,来源于腹主动脉（图2）.余胎儿未见明显异常.超声提示：①单活胎,头位;②胎儿左胸腔内强回声团块（考虑隔离肺）.     

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.     

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.