彩色多普勒超声诊断腹主动脉、髂动脉假性动脉瘤

目的　探讨应用多普勒超声诊断腹主动脉、髂动脉假性动脉瘤的价值。方法　利用二维超声、彩色和频谱多普勒超声诊断腹主动脉、髂动脉假性动脉瘤 11例 ,9例超声检查结果经手术证实 ,其余病例经MRA检查证实。结果　腹主动脉、髂动脉假性动脉瘤 (横断面 )内彩色血流呈涡流 ;其瘤颈 (纵断面 )内的频谱呈“往复征”。结论　腹主动脉、髂动脉真性动脉瘤一般无突发的腹痛 ,动脉壁上无破口 ,瘤腔内“云雾”状血流回声不明显 ,以上特点有助于腹主动脉、髂动脉真性和假性动脉瘤的鉴别诊断 ;腹主动脉假性动脉瘤有时可以破入下腔静脉 ,形成腹主动脉下腔静脉瘘 ;超声诊断腹主动脉、髂动脉假性动脉瘤具有较高特异性。     

彩色多普勒在腹部及周围血管动脉瘤诊断中的应用

目的：总结腹部及周围血管动脉瘤的彩色多普勒超声表现。方法：对我科经彩色多普勒超声诊断的8例动脉瘤进行回顾性分析。结果：8例中腹主动脉真性动脉瘤4例，均位于肾动脉水平以下，表现为腹主动脉局部扩张。腹主动脉夹层动脉瘤1例，CDFI可识别夹层瘤的真腔和假腔。肱动脉及股动脉假性动脉瘤各1例，CDFI见动脉有破口与肿块相通，肿块内有彩色和频谱血流信号。胰头周围假性动脉瘤1例，有胰腺炎病史，CDFI见肿块中有局部动脉型高速血流。8例均经CT、MRA或手术证实。结论：彩色多普勒可准确诊断腹部及周围血管动脉瘤，它是首选的无创伤性的诊断方法。     

假性动脉瘤的彩色多普勒超声诊断及其临床价值

目的：探讨假性动脉瘤的彩色多普勒超声(简称彩超)声像图特征及其临床诊断价值。方法：应用彩超观察假性动脉瘤的内部回声、血流信号、频谱等情况．对15例假性动脉瘤进行诊断。结果：本病超声定性诊断准确率为100%。二维超声示瘤体腔内血流呈“云雾”状涡流．彩超示瘤体腔内红蓝各半涡流彩色血流信号以及瘤体破口处“双期双向”血流频潜均可作为诊断假性动脉瘤的重要依据。瘤体破口处“双期双向”血流频谱对诊断本病具有特征性。结论：彩超对假性动脉瘤有较高的诊断价值，是首选的无创伤性的诊断方法。     

股动脉穿刺后假性动脉瘤的超声诊断与治疗

目的评价彩色多普勒超声在股动脉穿刺后股动脉假性动脉瘤形成的诊断及治疗中的临床应用价值。方法回顾性分析2011年1月-2013年11月10例股动脉穿刺后假性动脉瘤形成的彩色多普勒超声声像图表现,总结在超声引导下对假性动脉瘤进行压迫治疗的操作方法,并对治疗结果追踪复查。结果 10例患者超声均查见股动脉周围无回声团块或混合回声团,并在瘤体内查见涡流血流信号及破口处出现＂双期双向＂血流频谱。10例假性动脉瘤患者行超声引导下压迫治疗,7例1次按压成功,3例重复多次按压成功。结论彩色多普勒超声诊断假性动脉瘤准确率高,是首选的检查方法。超声引导下压迫治疗股动脉穿刺后假性动脉瘤,是一种有效的治疗方法,可以作为首选。     

二维及彩色多普勒超声在动脉瘤诊断中的应用

目的 评价二维及彩色多普勒超声在动脉瘤诊断中的应用价值。方法 真、假性及夹层动脉瘤各4、11及8例。观测瘤体和受累动脉的超声表现。结果 真性动脉瘤管腔局部扩张,平均内径31cm,2例伴附壁血栓。,假性动脉瘤瘤体内见涡状血流、附壁血栓及破裂口处双期双向血流。夹层动脉瘤病变动脉内可见纤弱回声光带,假腔内血流速度缓慢,真腔内呈五彩血流信号。结论 二维及彩色多普勒超声检查不仅可以观察动脉瘤体及受累动脉情况,还可实时监测其血流动力学变化。     

彩色多普勒超声对毒品注射引起的股动脉假性动脉瘤3例诊断分析

目的：探讨彩色多普勒超声对毒品注射引起的股动脉假性动脉瘤的应用价值。方法；对3例毒品注射引起的股动脉假性动脉瘤的患者进行彩色多普勒超声检查，二维超声观察其大小、形态、边界、内部回声等特点；彩色多普勒观察其血流特征；频谱多普勒观察其血流参数；并对其进行分析。结果：3例临床疑有毒品注射引起的股动脉假性动脉瘤的患者经彩色多普勒超声检查均明确诊断。结论：彩色多普勒超声对毒品注射引起的股动脉假性动脉瘤的检出能够提供可靠的诊断依据。     

超声在诊治医源性股动脉假性动脉瘤中的应用

目的评价超声对医源性股动脉假性动脉瘤的诊断价值及超声引导下压迫治疗假性动脉瘤、注射凝血酶治疗假性动脉瘤的疗效。方法应用二维超声、彩色多普勒、频谱多普勒对28例股动脉穿刺术后临床疑诊为股动脉假性动脉瘤的患者进行检查,并在超声引导下进行压迫治疗,治疗失败者改为局部瘤腔内注射凝血酶治疗。结果28例中彩超诊断假性动脉瘤25例,3例阴性患者经临床观察排除假性动脉瘤,彩超诊断与临床符合率100%。彩超引导下压迫治疗假性动脉瘤,24例治愈,1例失败后改为瘤腔内注射凝血酶治愈。结论超声能无创、敏感地诊断股动脉假性动脉瘤,超声引导下压迫是治疗假性动脉瘤的简便、安全、可靠的方法,失败者可进行注射凝血酶等其他手段治疗。     

彩色多普勒超声诊断腹腔干动脉瘤的临床价值

目的探讨彩色多普勒超声在诊断腹腔干动脉瘤的临床价值。方法应用彩色多普勒超声对2008年4月至2014年4月我院门诊腹痛患者进行腹腔干动脉检查,主要观察腹腔干有无瘤样结构,有无内膜分离,瘤体内有无血栓等。结果腹痛患者中彩色多普勒超声共检出真性动脉瘤10例(其中1例合并血栓形成),夹层动脉瘤5例,均为主动脉夹层累及,孤立性夹层动脉瘤1例并经超声造影确诊。二维超声可见腹腔干瘤样扩张,瘤体内为红蓝相间的旋涡状血流信号,若合并血栓则可见充盈缺损;若为主动脉夹层累及则可见分离的内膜片延续至腹腔干开口。CTA证实为真性动脉瘤6例,孤立性腹腔干夹层3例,主动脉夹层累及腹腔干5例,余2例动脉瘤未进行其他影像学检查。结论彩色多普勒超声对腹腔干动脉瘤的诊断价值较高,能够准确反映动脉瘤的部位、大小和血流动力学的特征,但超声不易显示孤立性腹腔干夹层的内膜分离,需要结合超声造影或CTA进行诊断。     

彩色多普勒超声对创伤性假性动脉瘤的诊断及治疗价值

目的探讨彩色多普勒超声对创伤性假性动脉瘤的诊断及治疗价值.方法对14例创伤性假性动脉瘤患者的彩色多普勒超声检查和临床治疗结果进行回顾性分析.结果彩色多普勒超声检查诊断创伤性假性动脉瘤有明显的特征性声像图,即瘤体和相关动脉间有破口相通,破口处可探及"双期双向"血流.本组9例患者在超声引导下于体表对破口进行加压包扎治疗,5例行手术或覆膜支架置入介入治疗均获成功.结论彩色多普勒超声在创伤性假性动脉瘤的诊断及治疗方面具有重要价值,为创伤性假性动脉瘤的首选检查方法.     

Bentall术后冠状动脉吻合口漏并假性动脉瘤形成的超声诊断价值

目的 探讨二维及彩色多普勒超声在Bentall术后冠状动脉吻合口漏并假性动脉瘤形成诊断中的应用价值。方法 对本院16例Bentall术后临床诊断为冠脉动脉吻合口漏并假性动脉瘤形成患者的二维超声及彩色多普勒超声征像进行总结,并与主动脉造影结果进行对比分析。结果 16例患者人工血管周围二维超声均可探及搏动性无回声区,冠状动脉吻合口处彩色多普勒可显示异常血流信号,其中左侧9例,右侧7例。所有超声结果均与主动脉造影结果一致。结论 超声心动图可以及时、准确、无创诊断Bentall术后冠脉吻合口漏及并发的假性动脉瘤,可作为临床随访检查的首选方法。     

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.