超声诊断先天性晶体脱位并白内障1例分析

对超声诊断先天性晶体脱位并白内障1例分析如下。 1病历摘要 女，26岁。双眼自幼时即视力低下，视物模糊。查体：左侧瞳孔轻度上移，晶体窥不清，右侧晶体混浊，部分吸收。双眼超声探查：双侧眼球轴径分别为左26．0mm，右22．9mm，左眼正常位置未见晶体回声，左侧玻璃体内见一大小约0．8crn×0．6cm的圆形高回声光团，     

不典型Fisher综合征1例

男，40岁，主因视物成双6d入院。入院前6d无明显诱因突然视物成双。无眼睑下垂，无肢体活动障碍。视物成双逐渐加重，自觉双眼活动不灵活。门诊查头CT未见异常，收入院。内科检查无异常，神清语利。双侧瞳孔正大等圆，左：右=3：3mm，对光反射灵敏，双眼左、右视及上、下视均受限，活动度约为2mm，左视水平眼震，下视垂直眼震。无面舌瘫，颈软无抵抗，四肢肌力、肌张力正常，感觉共济无异常，双侧病理征未引出。查头MRI未见异常；颅底CT未见异常；各项生化检查未见异常；发病后10d肌电图＋重频电刺激未见异常。     

颅内炎性肌纤维母细胞瘤1例

<正>1临床资料患者,女,21岁,因双眼视物模糊15天入院。患者无明显诱因出现双眼视物模糊就诊于我院,门诊行视力及头部MRI检查后以"颅内占位性病变"收入院。查体:患者神志清醒,言语正常,双眼视物模糊,双侧瞳孔等大同圆,直径约2.0 mm,直接及间接对光放射灵敏,双侧额纹对称等深,伸舌居中,双侧肢体肌力正常,肌张力及腱反射正常,双侧     

以视力障碍为主要表现的韦格纳肉芽肿

1病例资料男,57岁。因视物模糊1年余,加重3个月入院。患者1年前无明显诱因出现视物模糊,眼前如有纱网样阴影,伴头晕,逐渐加重。先后到多家医院眼科就诊,诊断为葡萄膜炎、结膜炎等,予对症治疗无好转。3个月前视力明显下降,并出现眼球突出,查甲状腺功能未见异常,双眼MR I示双眼球后脂肪堆积。病程中无咳嗽、关节疼痛、口干、口腔溃疡。其妹有眼球突出、视物模糊,未予系统诊治。查体:鼻腔通畅,各鼻旁窦区无压痛,双眼上下睑皮肤肿胀,右眼突出度28 mm,左眼为26 mm;视力右眼1·0,左眼1·0;双眼压均为10 mmHg。鼻根处可见直径0·5 cm大小的红色皮…     

脑CT扫描对重度妊高征的临床价值—附53例分析

目的：本文分析了脑CT扫描对重度妊高征的价值。材料与方法：对1994年5月～1996年5月的53例重度妊高征患者进行脑CT扫描检查，层厚和间距均为10mm。结果：脑CT扫描结果如下：其中未发现异常32例，脑水肿12例，脑缺血8例，脑出血1例。结论：参考CT扫描结果，所有患者得到了有效的治疗，使得头晕、头痛、视物模糊等症状得到很大的改善。     

Adie瞳孔误诊1例分析

对Adie瞳孔误诊1例分析如下。1病历摘要女，38岁。因左眼视近物模糊3个月余，于2006—06—06就诊。自诉2006—03初出现左眼视近物模糊，未予治疗，自觉3个月来视物模糊渐加重。1周前曾于其他医院就诊，诊断正常眼压性青光眼，予1％毛果芸香碱眼液滴左眼，瞳孔缩小至2mm。患者因青光眼诊断焦虑不安，前来我院门诊就诊。患者就诊时左眼已停药3d。查患者右眼视力1．0，左眼视力0．8，小孔镜1．0，双眼前房深度正常，左眼瞳孔5mm，直接、间接对光反射均消失，右眼瞳孔3mm，对光反射灵敏，双眼屈光间质清，双眼底见视盘边缘清，形态、颜色正常，杯盘比0．3。     

来稿须知

患抒男．42岁。因流涎、吐词小清、视物模糊1个月人院。杏体：右侧面瘫（轻度），右上肢肌力轻度下降（V级）伴右肢感觉过敏（痛），病理征未引出。CT示：左颞顶叶脑实质内址混杂密度占位灶，大小约33mm×26mm,周围有低密度水肿区，增强扫描病灶呈不规则环状强化，左顶叶另见一稍高密度结节。     

白内障合并真性晶状体囊膜剥脱行超声乳化白内障手术1例

患者男，76岁。因双眼无痛性视物模糊逐渐加重10月余于2007年11月19日入院。患者5年前曾因右眼视物模糊，急诊发现瞳孔散大，角膜水肿，测眼压44．7mmHg（1mmHg=0．133kPa），诊断双眼急性闭角型青光眼（右眼急性发作期），     

静脉窦狭窄引起良性颅高压一例

患者男，42岁，反复发作性意识不清、肢体抽搐10个月，再次发作于2012年1月12日第三次住院。患者于2011年3月18日突发意识不清、肢体抽搐，持续约2min，自行恢复意识，醒后不能回忆发病当时情况，偶有头痛，无头晕恶心呕吐，无双眼视物模糊，于3月19日作磁共振检查，报告为脑灰白质分布正常、界面清晰，两侧脑室旁白质可见少量点状长他长T1信号，DWI序列脑实质内未见异常信号病灶。     

闭角型青光眼急性发作合并前房积血伴虹膜红变1例

<正>1病例资料患者，女，76岁。因“左眼视物模糊伴眼痛10天”收入院治疗。既往史：否认高血压、糖尿病、心脏病病史。入院检查：P72次/min,BP161/87mmHg，专科检查：右眼最佳矫正视力0.6，左眼手动50cm。眼压：右眼12mmHg(1mmHg=0.133kPa)，左眼>60mmHg。眼前节检查：右眼结膜未见充血，角膜透明，前房浅，周边前房1/4CT，瞳孔圆，药物性缩小，直径约2.0mm，对光反射（+），晶体混浊，眼底窥不见；左眼结膜充血（++），角膜水肿，前房浅，周边前房小于1/4CT，瞳孔欠圆，直径约7.0mm，对光反射迟钝，晶状体前囊可见青光眼斑，眼底视不清；房角镜检查右眼窄Ⅰ，左眼视不清。超声生物显微镜（UBM）：右眼前房深度1.56mm，左眼前房深度1.50mm，双眼房角狭窄，左眼全周房角关闭。轴长右眼21.46mm，左眼21.71mm。诊断为原发性急性闭角型青光眼（左眼急性发作期，右眼临床前期）。     

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.     

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.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.