初诊类风湿关节炎患者肩关节病变高频彩超表现

目的观察初诊类风湿性关节炎（rheumatoid arthritis,RA）患者肩关节及其周围软组织病变高频彩超声像表现,探讨超声对RA肩关节病变的辅助诊断价值。方法初诊RA患者40例（80个肩关节）,均行高频彩超检查,观察骨侵蚀、肱二头肌长头肌腱（thelonghead of the biceps tendon,LBT）、肩关节滑膜囊、肩袖超声表现。结果骨侵蚀27个肩关节,超声声像表现为骨性轮廓不规则、骨表面连续性差及不规则隆起;15个肩关节滑膜增生,滑膜厚度1．3～5．7（3．10±0．29）mm,增厚的滑膜呈低回声或中等回声,内可见血流信号;11个肩关节有积液,关节腔内见不规则液性区;4个肩关节肩袖损伤（3个位于冈上肌腱,1个位于冈下肌腱）;13个肩关节有LBT病变,腱鞘增宽呈片状低回声,肌腱增粗呈弥漫性的低回声,肌腱厚度（5．2±0．2）mm。结论高频彩超可较准确地检测RA患者肩关节及其周围软组织病变情况,对RA肩关节滑膜病变有一定辅助诊断价值。     

高频彩色多普勒超声诊断膝关节滑膜炎的声像图特点及诊断价值

目的:探讨高频彩色多普勒超声对膝关节滑膜炎的应用价值。方法:选择2016年1月-2017年1月在我院确诊的膝关节滑膜炎患者60例,采用高频彩色多普勒超声探查,分析膝关节滑膜炎的声像图特点,并与X线片、核磁共振(MRI)的检查结果进行比较。结果:高频超声对滑膜增厚、关节腔积液及软骨病变有较好的分辨率,与X线片检测滑膜厚度、关节腔积液、软骨病变率比较,差异具有统计学意义(P 0. 05);与MRI的检查结果比较无明显差异(P 0. 05),其中滑膜增厚的声像图表现为滑膜增厚,厚度不均,低回声,与积液分界明显;关节腔积液表现为液性暗区及无回声区,部分膝关节出现片状或絮状图回声;软骨病变表现为厚度变薄,表面粗糙,严重者可见骨质连续性缺损,回声不均等特点。结论:高频彩色多普勒超声能够清晰显示滑膜厚度、形态,关节腔积液及软骨病变等病变类型,诊断准确率高,且简单无创,值得临床推广。     

肩关节软组织炎症与正常肩部周围软组织的声像图比较

目的比较肩关节软组织炎症患者和正常肩部周围软组织的声像图表现,探讨超声在诊断肩关节软组织炎症性病变中的价值。方法对40例肩关节软组织炎症患者(病例组)肩袖、肌筋膜、肩滑膜囊及关节囊等部位进行超声检查,另选80正常成人(对照组)检测其相同部位,结果进行对比分析。结果病例组肩部的各型异常图像以病变区受累部位测值的增大、增厚、积液区范围广泛等为主要表现,同时伴随肌腱、腱鞘回声增强,水肿、钙化,肌筋膜毛糙、增生、回声紊乱等多种异常声像。与正常对照组比较,病例组受累肌腱明显增厚,差异有统计学意义(P﹤0.05)。肌筋膜炎、肩关节周围滑囊炎及粘连性关节囊炎病变区肌筋膜厚度、滑囊积液深度及肩关节囊下壁厚度均明显大于对照组,差异均有统计学意义(P﹤0.05)。结论超声检查对肩关节软组织炎症性病变可以清晰显示,其超声表现具有一定特征性。     

超声检查在肘关节内侧副韧带损伤诊断中的价值

目的探讨超声检查在肘关节内侧副韧带损伤诊断中的价值。方法 30例经临床或手术证实为肘关节内侧副韧带损伤患者,回顾性分析肘关节内侧副韧带损伤的声像图表现。通过患侧与健侧对比,观察韧带的厚度、内部回声、连续性、肘内侧肱尺关节间隙、韧带附着处骨质情况及周边软组织情况。结果 30例肘内侧副韧带损伤患者中,2例韧带声像图未见明显异常。16例韧带厚度较健侧增厚,14例韧带内部回声减低或不均匀,19例韧带不同程度撕裂。17例前臂外翻试验患肘内侧肱尺关节间隙较对侧增大。7例韧带附着处可见碎骨片,10例合并屈肌总腱损伤,5例合并关节腔积液。结论超声检查能显示肘关节内侧副韧带损伤的各种表现,判断损伤程度,可作为肘关节内侧副韧带损伤的一种重要辅助检查手段。     

痛风性关节炎的超声表现

目的 探讨痛风性关节炎的超声特征.方法 对确诊的5例痛风性关节炎患者19个病变关节的超声表现进行回顾性分析,总结痛风性关节炎的声像图特点.结果 19个关节中第一跖趾关节5个,膝关节8个,踝关节、肘关节、腕关节各2个.17个(89.4％)关节超声表现为软骨表面回声增强,与深面的骨性关节面强回声线形成“双边征”.13个(68.4％)关节表现为不同程度的关节腔积液,积液内可见漂浮点状强回声,振动后运动明显.11个(57.9％)关节内见滑膜增厚,彩色多普勒显示滑膜内部血流信号丰富或稀少.其中1例膝关节髌上囊处滑膜呈结节状明显增厚,范围约5 cm×2 cm,内见大量强回声点,后方伴声影.6个(31.6％)关节软骨超声表现为不规则形变薄,软骨下骨面粗糙、回声中断.4个(21.1％)关节周围软组织见稍高或强回声团,后伴或不伴声影.其中3个关节同时出现邻近骨皮质回声毛糙不平滑、连续性中断或缺损.结论 痛风性关节炎具有一定的超声表现,超声可能早期提示此病,具有一定的临床应用价值.     

左膝关节滑膜骨软骨瘤病超声表现1例

患者男,63岁.左膝关节肿胀、疼痛,进行性加重半年来诊.触诊:左膝关节肿胀,髌骨上方可触及数个质硬并可移动的粒状物.超声检查:左膝关节髌上滑膜囊可见较多无回声区,囊壁增厚,回声增强,并可见结节状突起,囊内可见数个团块状强回声后方伴声影,较大团块约2.5 cm×2.0 cm.超声提示:左膝关节滑膜囊积液并游离体,考虑滑膜骨软骨瘤病(图1左).X线平片检查:左膝关节多发游离体(图1右).手术所见:左膝关节髌上滑膜囊,囊壁凹凸不平,并可见突起,共取出8枚类圆形游离体,质硬.病理结果:关节滑膜充血增厚,呈结节状增生,游离体表面光滑并可见一纤维膜包绕,内部可见骨小梁结构.符合滑膜骨软骨瘤病.     

彩色多普勒超声对坐骨结节囊肿的诊断价值

目的：探讨坐骨结节囊肿的超声声像图表现特征及诊断价值。方法：回顾性分析32例坐骨结节囊肿声像图表现、手术发现及病理结果。结果：超声诊断与手术及病理符合率为93.75%。坐骨结节囊肿的声像图表现：在坐骨结节与皮下软组织之间的大小不等的囊性肿块,其边界清,多数形态不规则,可呈扁平状、裂隙状、单房或多房,囊壁较厚、多不光滑,囊内大多为均匀细小点状低回声或无回声,有的可见絮状或团状高回声。结论：彩色多普勒超声对坐骨结节囊肿具有很重要的价值,可为临床的诊断及治疗提供重要信息。     

超声观察类风湿关节炎患者肘关节病变

目的探讨超声在类风湿关节炎(RA)肘关节病变诊断中的应用价值。方法RA患者77例,健康对照者20例,应用高频超声分别对双侧肘关节进行扫查,观察滑膜、关节腔、骨表面及关节周围软组织。彩色多普勒超声观察病变区域血流情况。结果24例(31.2%)RA患者共38个肘关节可见异常超声表现,主要为滑膜增生,其中68.4%(26/38)增生的滑膜内可见血流信号,其动脉血流阻力指数(RI)为0.61±0.15。部分病例除滑膜增生外,尚可见关节积液(7例)和骨质破坏(6例)。结论高频超声可以清楚地观察到RA患者肘关节的主要病变,在诊断肘关节病变中有较高的应用价值。     

卵巢黄体囊肿囊内出血的超声诊断

目的:研究卵巢黄体囊肿囊内出血的各种声像图特点,旨在提高超声对本病诊断率.方法:90例卵巢黄体囊肿囊内出血患者均行超声检查并经过临床证实,对其声像图资料进行综合分析.结果:卵巢黄体囊肿囊内出血在声像图表现上分为3种类型:第1类表现为内有分层或密集纤细分隔的囊性团块;第2类表现为囊内较均匀的低回声团块;第3类表现为混合回声团块,仔细观察可见其有囊肿壁.90例中,超声提示为卵巢黄体囊肿囊内出血可能47例,误诊43例.结论:卵巢黄体囊肿囊内出血易误诊,但掌握了声像图改变结合临床表现可提高超声诊断正确率,减少误诊.     

囊性肾癌的超声回顾分析

目的：总结囊性肾癌的超声特点，提高对其认识和诊断准确率。方法：我院手术病理证实的7例囊性肾癌．对其超声特点、结合手术病理及临床特点进行回顾。结果：7例囊性肾癌中，4例(4/7)超声正确诊断为肾囊性疑恶性占位性病变，1例误诊为肾结石并重度积液，2例误为肾囊肿并感染。本组声像图特点：囊壁不规则增厚，囊内见分隔，部分囊内见实性回声．囊内均见点状回声，部分囊内强光斑病理证实为钙化。结论：熟悉囊性肾癌的超声特点，结合肿块的生长速度、临床症状及其它影像学资料．可减少该病的误漏诊，对患的治疗和预后有重要意义。     

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.