超声诊断剖宫产术后腹腔残留异物1例

患者女,28岁,剖宫产术后3年,月经期左下腹疼痛2年余,无腹泻及发热,每次月经干净后腹痛即停止。外院超声检查发现左附件区见一无回声包块,考虑巧克力囊肿,包裹性积液不排除。我院超声检查:左下腹探及一83mm×50mm×103mm的囊实性混合回声包块,有包膜,边界清,包块上方紧贴腹壁肌层,包块左下方可见左侧卵巢回声,囊性部分为密集细弱回声,实性部分为条索状、团块状不均质中等回声。彩色多普勒血流成像:左下腹混合回声包块内部及周边未探及明显血流信号(图1)。超声提示:左下腹混合回声包块,性质待定,考虑子宫内膜异位。     

超声诊断输卵管系膜囊肿并输卵管扭转1例

患者女,20岁.已婚.下腹痛1 d入院,外院B超示:左附件区囊性包块.妇产科检查:左附件增厚.拟诊:左卵巢囊肿.超声检查示:子宫及右侧附件区未见明显异常回声,左附件区见一大小约6.6 cm×4.0cm的无回声区,边界清,壁薄(图1、2),与左卵巢关系紧密,但按压可见两者呈逆向运动,并且按压囊肿边缘时患者疼痛加剧.CDFI:左卵巢内部血流正常,囊肿壁未见明显彩色血流信号.盆腔可见厚约2.0cm的液性暗区.超声诊断:(1)左附件区囊性包块(考虑来源输卵管);合并蒂扭转不能排除;(2)盆腔积液.术中见左输卵管近伞端区系膜上可见1个约7 cm的囊肿并输卵管扭转3圈.术后诊断:左输卵管系膜囊肿并左输卵管扭转.     

巨大卵巢黏液性囊腺瘤超声表现1例

患者女,32岁,因自觉腹部逐渐增大8年,不明原因尿频1个月就诊.体检于下腹扪及巨大包块.超声显示:于腹盆腔扫查见一巨大囊性包块,上界平脐,左侧达腋前线,超过声窗范围,大小约180mm×140 mm×90 mm,包块从前、左、后三面包绕宫体,包膜厚薄不均,内充满液性无回声,透声尚可,包块内可见强回声带形成网状分隔;子宫及右侧附件未见异常.超声提示:盆腔巨大囊性包块(左侧卵巢多房性黏液性囊腺瘤?).术中所见:左侧卵巢增大至200 mm×180 mm×120 mm,位于左侧阔韧带后,表面光滑,几乎占满整个盆腔.     

小儿腹膜后巨大囊状淋巴管瘤疝入右侧阴囊1例

正患儿男,4岁。因右侧阴囊反复肿大2年入院。外院诊断为腹股沟疝曾行手术治疗,术后仍复发。查体:右腹股沟区至阴囊内可触及质软包块,透光试验阳性。超声检查:右侧睾丸旁探及一囊性无回声区,边界清,可见包膜及多条分隔,无回声区经腹股沟管与腹腔相通,并向上向后延伸至右肾下方。CDFI:于分隔上探及点条样血流信号(图1)。超声诊断:右中下腹腹膜后-腹股沟管-阴囊内多分隔囊性包块,考虑囊状淋巴管瘤。MRI检查:右中下腹-腹股沟管-阴囊内见多分隔囊性包块     

同侧卵巢囊性畸胎瘤合并粘液性囊腺瘤伴蒂扭转1例的超声所见

患者女,27岁。因下腹疼痛3天,加重1天来诊。妇科检查:下腹扪及一质软包块,其右侧触及一质硬包块,均可活动并有触痛,子宫扪诊欠清。超声所见:子宫、左卵巢未见异常,子宫右前上方探及一12cm×11 cm×6 cm囊性包块,其内囊液为细密的点状回声(图1);于其右上方紧邻可探及另一11 cm×9 cm×6cm,为无回声囊性包块(图1),内可见6 cm×6 cm×5 cm强回声实性包块附着于囊肿右侧壁(图2)。超声     

输卵管系膜囊肿扭转超声表现1例

患者女,23岁,下腹持续疼痛4 d,加重1 d。体格检查:下腹轻微压痛,子宫常大,左后方触及约5.0 cm×4.0 cm的包块,触痛(+)。血β-HCG检测正常。超声检查示:左卵巢见一囊肿,约1.99 cm×1.89 cm×1.74 cm;右卵巢内见一囊肿约3.62 cm×3.36cm×3.68cm;子宫左后方见一约5.30cm×4.88cm×4.31cm的囊性无回声区,边界清,形态饱满,张力佳,囊壁尚光滑,囊内透声欠佳,可见点状及带状强回声漂浮,囊性无回声区左侧可见范围约3.25 cm×2.87 cm×1.88 cm的不均质等回声与囊性无回声区相连,迂曲走行;CDFI:周边可见少量血流信号。子宫直肠窝见大小约3.57 cm×3.00 cm×1.99 cm液性无回声区,透声好(图1,2)。超声提示:①左侧附件区囊性无回声区并不规则等回     

超声诊断小儿输卵管系膜囊肿扭转1例

患者女,12岁,因无明显诱因腹部阵发性疼痛11 h 伴加重就诊。体格检查：腹平软,下腹正中及右下腹压痛,无明显反跳痛,无移动性浊音。子宫大小正常,右附件区和左附件区未扪及明显包块,无压痛、反跳痛。实验室检查：血清β-HCG 〈2 mU/ml。超声检查：子宫前位,形态大小正常,内膜厚10 mm,肌层回声分布均匀。左侧卵巢内见一无回声区,大小约55 mm×37 mm,边界清,透声欠佳。右侧附件区见一类似于卵巢的团状低回声,大小约55 mm×32 mm,边界清（图1）,其右上方见一“葫芦状”无回声区,大小约65 mm×31 mm,边界清,CDFI 于囊壁未探见明显血流信号（图2）。超声提示：右侧附件区包块（卵巢囊肿蒂扭转可能）;左侧卵巢囊肿。行腹腔镜手术示：左侧卵巢见一直径4 cm囊肿,表面光滑;右侧输卵管系膜见两个直径3 cm 囊肿,附件扭转1周,输卵管壁充血水肿。术中病理组织检查示：（右侧卵巢）部分卵巢组织伴出血,局部见囊状卵泡（图3）。     

超声诊断精原细胞瘤1例

患者,男,45岁.因下腹疼痛10余年,发现下腹肿块1个月,疼痛加重2天来我院就诊.超声检查:于左下腹探及一大小约103 mm×84 mm×92 mm,略低回声包块(图1),边界较清,内部回声不均匀,近包块边缘处呈不均匀低回声改变,嘱患者深呼吸,该包块后方与腹腔肠管未见明显相对移动,CDFI显示周边及内部可见较丰富的血流信号;余未见明显异常.超声提示:左下腹实性肿物.     

第20例年轻女性慢性腹痛伴盆腔包块一例——手术中所见及病理诊断结果

（接上期）静脉超声造影检查：注射造影剂后盆腔包块内一处中等高回声部分未见造影剂充填,另一中等高回声部分周边可见少量造影剂充填（图5,6,动态图1）。超声造影提示：符合良性囊性肿物声像图改变。超声诊断：盆腔囊性肿物,符合良性肿物声像图改变,子宫内膜异位囊肿可能性大。手术中所见：子宫如孕11周大小,表面可见炎性及咖啡色病灶,左卵巢多房囊性包块,约20cm×20cm大小,表面灰白色,内为咖啡色黏稠液体,与网膜、肠管、子宫底广泛致密粘连。右卵巢、输卵管外观正常。病理诊断：（左卵巢）囊性肿物,内含大量巧克力状液体,囊壁由纤维组织构成,符合卵巢巧克力囊肿改变。     

超声诊断巨大子宫肌瘤囊性变1例

患者 ,38岁 ,已婚。因下腹胀一年多 ,外院 B超提示盆腔囊性包块而来我院就诊。妇科检查 :下腹可触及一质软包块 ,上界平脐 ,固定 ,无压痛 ,子宫及双附件扪诊欠清。腹部超声检查 :子宫后屈 ,轮廓欠清 ,尤其见前壁 ,其浆膜层显示不清。后壁肌层回声均匀 ,宫腔线尚清 ,厚 5 mm。于子宫前方探及一 142 mm× 16 9mm× 172 mm囊性包块 ,轮廓尚清 ,其壁厚达 19mm,与子宫前壁分界不清 ,囊腔内壁欠光滑 ,包块内探及较粗呈树枝状的分隔光带 ,囊肿后方回声较增强 ,因腹部超声双侧卵巢显示欠清 ,再经阴道超声显示 ,双侧卵巢大小、回声未见异常。 B超提…     

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.