甲状腺混合性髓样-乳头状癌超声表现1例

患者女,31岁,因"发现左侧颈部包块1周"入院.查体:左侧颈部扪及一包块,质中,无压痛,随吞咽上下移动,双侧颈部淋巴结未扪及肿大.实验室检查:降钙素:＞2000 pg/mL,癌胚抗原:33.5 ng/mL.超声检查:甲状腺左侧叶见大小约2.3 cm×2.1 cm×1.9 cm的低回声,见图1,边界清,形态欠规则,其内散...     

小儿腮腺腺样囊腺癌的超声表现1例

患儿男,6.5岁.发现左面颊部包块4个月.自发现包块,无红、痛,未予治疗,2003年11 月23日来我院就诊.查体:左侧腮腺区皮肤无红、热,扪及一约2.5 cm×2.0 cm大小实性包块,质中、活动度可,颈部未扪及肿大淋巴结.临床诊断:左侧腮腺包块性质待定.超声检查:见左侧腮腺浅叶中份约2.9 cm×1.9 cm×2.3 cm大小规则实质不均匀回声包块, 内有1.4 cm×0.6 cm大小不规则液性暗区,边界清晰,无包膜线回声,后方回声增强(图1 ),颈部未发现肿大淋巴结.超声提示:左侧腮腺实质不均质包块(1.混合瘤?;2.不排除恶性肿瘤).手术、病理诊断:腮腺腺样囊腺癌.术后5个月超声复查:见左侧腮腺2.5 cm ×2.3 cm×1.6 cm实质低回声包块,边界清晰,颈部左侧血管旁见4枚0.9 cm～1.2 cm低回声结节,有融合征象,诊断左侧腮腺癌复发并颈部淋巴结转移.     

腮腺巨大腺淋巴瘤超声表现一例

患者男性,85岁,因"双侧腮腺区包块10余年"而入院.患者有30余年吸烟史.专科检查:右侧耳前区扪及约一15.0 cm×8.0 cm大小包块,质中,边界不清,表面皮肤稍红,有轻微压痛;左侧耳垂下方扪及约一5.0 cm×3.0 cm 大小包块,质中,边界清,表面皮肤正常,无压痛(图1).     

腹壁韧带样纤维瘤病超声表现1例

患者女,31岁.8月前无意中扪及左侧腹壁肿物,无明显不适.既往2年前行剖宫产术.专科检查:左侧腹壁可扪及包块,质略硬,边界清,大小约 2.0 cm×1.0 cm,活动度可,无压痛.     

超声误诊阴囊间叶性错构瘤1例

患儿男,1岁7个月.因双侧阴囊进行性增大1年余入院.查体:双侧阴囊增大,其内触及一包块,大小约7.0 cm×5.0cm×4.0 cm,质软,可移动,边界不清,透光试验(一).左侧睾丸于腹股沟扪及,右侧睾丸于阴囊内扪及.阴囊壁无红肿.超声检查:双侧阴囊内测及一包块,边缘清,大小约6.5 cm×4.5cm×4.5 cm,内部呈无回声,后壁回声增强.     

咽食管憩室超声误诊为甲状腺占位1例

患者男,64岁,因发现颈部包块3 d入院。自诉颈部包块处无疼痛,无吞咽困难及呛咳。体格检查：左侧颈部近甲状腺处轻度凸起,气管轻度向右偏斜。左侧甲状腺下极可扪及3.0 cm×2.0 cm×2.0 cm包块,质中,无压痛,表面光滑,无结节感,边界尚清,移动度小,能随吞咽上下活动。     

双侧阴囊内平滑肌瘤一例

患者男,45岁。因双侧阴囊内进行性肿大包块10余年入院。查体:心肺腹(-),阴囊皮肤无红肿、破损、肿胀;双侧阴囊内可触及2个大小不等包块,左侧阴囊内包块较大,范围约4 cm×5 cm,右侧范围约2 cm×3 cm,质中,表面光滑,活动度良好,无触痛,与双侧睾丸及附睾分界欠清,双侧腹股沟区未扪及肿大     

甲状腺平滑肌肉瘤超声表现1例

<正>患者女,78岁,因发现颈前区无痛性包块13年,呼吸困难1个月入院。4个月前甲状腺超声检查:甲状腺右侧叶肿大,大小约7.1 cm×4.8 cm×9.2 cm,其内可见弥漫分布的等回声结节(图1),并可见不规则液性无回声区,大小约3.3 cm×3.0 cm;CDFI示右侧叶内探及较丰富的彩色血流信号。甲状腺引流区未见确切肿大淋巴结声像。超声诊断:甲状腺右侧叶结节样改变。入院体格检查:甲状腺右侧叶可扪及一大小约10.0 cm×8.0 cm×     

乳腺、肺重复癌1例分析

对乳腺、肺重复癌1例分析如下。 1病历摘要 女，60岁。因左腋下转移性腺癌包块切除术后7d入院。患者1个月前发现左腋下包块，约鸽蛋大小，无明显疼痛，无红肿、发热，左侧乳头有溢液，为淡黄色液体。无咳嗽咳痰，无痰中带血，无胸痛，在外院行左腋下包块切除术，术后病理诊断：左腋下淋巴结转移性腺癌，考虑乳腺来源。人院查体：双侧乳房乳头无凹陷，表面皮肤无红肿及破溃，未见佶皮征，挤压左侧乳头可见有少量无色液体流出，双乳未扪及明显包块，右腋窝末扪及肿大淋巴结，左腋窝扪及一2cm×2cm大小肿大淋巴结，活动欠佳，无触痛。双肺听诊未见明显异常。人院后查胸片提示：右上肺球影，大小约3cm×2cm。胸部CT示：右肺上叶软组织肿块考虑为肺癌可能性大。     

右侧睾丸横跨异位畸形合并左侧睾丸鞘膜积液、左侧腹股沟斜疝1例

患儿,男,2岁6个月.左侧阴囊可复性包块2年入院.体格检查:阴茎无异常,右侧阴囊未扪及睾丸,左侧阴囊可扪及6cm×7cm×7cm大小包块,可还纳腹腔.表皮无红肿、无压痛、透光试验阳性、左侧睾丸可扪及,大小约1.5cm×1.5cm.患者一年前在外院诊断右侧隐睾,并作右侧腹股沟手术探查未找到睾丸.     

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.