附睾腺瘤样瘤超声表现1例

患者男,30岁.因发现左侧阴囊内肿物6个月,自觉肿物进行性增大就诊.超声检查:左侧附睾头大小约2.5 cm×1.6 cm×1.0 cm,内探及一大小约1.5 cm×1.4 cm×1.0 cm的等回声肿物,形态规则,边界清晰,内部回声均质(图1).彩色多普勒血流显示:肿物内部可见少量彩色血流信号(图2),收缩期峰值流速8.95 cm/s,阻力指数0.53,左侧附睾体、尾未见异常回声.超声诊断:左侧附睾头实性肿物(考虑附睾良性肿瘤可能性大).术中附睾头部可见一大小约1.5 cm×1.3 cm×1.0 cm的实性肿物,无完整包膜,与周围组织轻度粘连.病理诊断:左侧附睾头腺瘤样瘤.     

睾丸卵黄囊瘤并破裂超声表现1例

患者男,19岁,因撞击致左侧阴囊肿胀、睾丸疼痛4天就诊。查体:左侧阴囊明显肿胀,大小12cm×8cm×8cm,表面见紫褐色瘀斑,压痛(+);左侧睾丸、附睾未触及;左侧精索肿胀、质略硬,压痛(+)。超声:左侧睾丸肿胀,附睾与睾丸分界不清,睾丸白膜连续中断,睾丸内回声杂乱,见散在不规则无回声,部分睾丸实质可见;CDFI见实质内较丰富血流信号(图1)。超声提示:左侧睾丸肿大并杂乱回声改变(考虑睾丸挫裂伤)。     

超声诊断多睾症1例

患儿男,5岁,因发现左侧阴囊内肿物2月入院.查体:在左侧睾丸的下方可以触及大小约1 cm×1 cm的肿物,质地韧,边界清,无明显的触痛,透光试验阴性.超声检查:左侧睾丸正常,其下方可见一0.8 cm×0.6 cm实性低回声团块,包膜清晰,与同侧睾丸分界尚清,回声强度及其内血流信号与正常睾丸相似(图1).     

附睾纤维肉瘤并睾丸内转移超声表现一例

患者男,63岁,因偶然发现阴囊肿物来我院就诊。外科检查:左侧附睾尾部明显肿大,内可触及4.0cm×2.0cm×2.0cm的包块,质地较硬。超声检查:左侧睾丸略大,实质内见1.1cm×0.8cm的低回声结节(图1),边界不清,CDFI显示内无血流信号;左侧附睾尾部可见3.7cm×1.7cm的实性低回声占位(图2),边界清,与睾丸有较明显分界,肿物内部回声不均,CDFI示其内可见较丰富血流信号,RI=0.50;右侧睾丸及附睾未见异常。超声诊断:左侧附睾及睾丸实性占位,考虑为恶性肿瘤。术后病理:(左侧)附睾纤维肉瘤并睾丸转移。讨论附睾肿瘤分为原发性(包括良性和恶性)和转移性。…     

附睾畸胎瘤1例的超声表现

患者男,岁.左侧阴囊进行性增大7年,在阴囊下方可触及质硬如石、高低不平的肿物,无明显压痛,未予治疗.近年,因肿物渐大来诊.用10 MHz探头扫查:左侧睾丸大小正常,轮廓尚规整,回声尚均匀.唯附睾体尾部可见一轮廓不规整、低回声及强回声相互融合的团块,最大低回声块为27 mm×17 mm,其内有不规则的液性暗区.于其外下方可见回声欠均匀的稍强回声团块,其内还可见细小密集的强回声光点,其间有少许钙化样强回声.整个团块内未见明显彩色血流信号.于睾丸鞘膜腔可见深径15 mm的无回声区(图1).结合病史,超声诊断:(1)左侧附睾囊实混合性占位(畸胎瘤不除外);(2)左侧睾丸鞘膜腔积液.手术见左附睾体、尾部肿块约45 mm×40 mm,肿块表面高低不平,切面呈灰白色,质如骨硬,切开肿块,内见少许乳白色液体及毛发、骨骼、脂肪等组织.病理诊断(组织化学方法):左附睾畸胎瘤.     

睾丸曼氏裂头蚴病超声表现1例

患者男,24岁.发现右侧阴囊间断性胀痛半年,时轻时重,尚能忍受.半月前发现"花生米"大小肿物.查体:右侧阴囊可触及径约1 cm肿物,不活动.超声检查:双侧睾丸大小正常,实质回声不均匀,可见散在点状强回声;右侧睾丸实质内见1个无回声为主的混合回声肿物,边界清晰,无回声区内可见条索状高回声,并可见细密点状低回声,CDFI:肿物周围血流信号丰富;左侧附睾头内可见3个无回声肿物,周边界限清晰,较大的大小0.49 cm×0.43 cm,右侧附睾头内可见1个无回声肿物,周边界限清晰,大小0.32 cm×0.24 cm,CDFI:内部未见明显血流信号.     

巨大睾丸畸胎瘤恶性变彩超表现1例

患者男,41岁.因阴囊逐渐肿大伴阴囊坠胀4月余入院.8年前曾行左侧腹股沟疝修补术及左侧隐睾复位固定术.彩超检查示阴囊内为一大小约14.0cm × 8.0cm × 8.2cm囊实性团块占据,边界欠清,形态欠规则,以实性为主,实性部分内可见动脉及静脉血流(图1),动脉血流峰值流速13.2 cm/s,阻力指数0.79,肿物右后方紧贴一大小约3.0 cm ×1.7cm正常睾丸组织回声,睾丸鞘膜腔内可见不规则液性无回声区.超声提示:阴囊占位性病变(结合临床考虑来自左侧睾丸).     

附睾纤维瘤超声表现1例

患者男,32岁。主诉左侧阴囊内肿块,近来因肿块增大,无疼痛,要求入院手术治疗。入院查体:于左侧阴囊内扪及大小约2 cm×2 cm的肿块,位于附睾尾部,质硬,边界清,活动,皮肤无红肿,无压痛。超声检查显示:睾丸大小及回声正常,左侧睾丸下后方附睾尾部见2.5 cm×1.6 cm×1.4 cm的实质性等回声,边界清,有包膜,内部回声尚均匀,后伴明显声衰减(图1)。彩色多普勒血流显像:肿块周边见较丰富的血流信号,其动脉血流速度7.26cm/s,阻力指数0.49;肿块内可见稀疏的血流信号(图2)。超声诊断:左侧附睾尾部实质性肿块,不排除附睾肿瘤。后行“左侧附睾肿瘤切除术”,…     

睾丸混合性生殖细胞瘤超声表现1例

患者男,33岁.2个月前左侧阴囊无痛性逐渐增大,行静脉滴注抗炎症治疗无显效来诊.查体:左侧阴囊增大如鹅蛋大小,质韧,无触痛.右侧阴囊未见异常.实验室检查:HCG 488.5 mIU/ml(参考值:0～6.0 mIU/ml),AFP＞1 210.00 ng/ml(参考值:0～7.0 ng/ml).超声检查:左侧阴囊内未见正常睾丸回声,可见一实质性肿物,大小100 mm×70 mm,肿物形状尚规则,边界不清,内部回声不均匀,可见多个液性回声,其中较大范围约54 mm×22 mm,其内可见密集点状回声,有移动性,肿物内血流较丰富,血管走行紊乱.     

彩超诊断睾丸巨大畸胎瘤分析1例

患者男,28岁.无意间发现左侧阴囊肿大、坠胀20 d余,来我院就诊.体检:左侧阴囊明显肿大,触之质硬,阴囊皮肤颜色正常.彩色超声阴囊探查:右侧睾丸轮廓清楚,形态规则,大小约29 mm×19mm×18 mm,切面内部回声均匀,未见明显占位.左侧正常睾丸与附睾未显示,左侧阴囊内探及一40mm×35 mm的混合回声包块,以囊实性为主,内回声杂乱,内可见呈"面团样"强回声(图1),实性回声内可见少量血流信号(图2).超声诊断:左侧阴囊混合回声包块,考虑畸胎瘤.患者收住院行左侧睾丸切除术,术后病检左侧睾丸畸胎瘤.     

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.