椎管内原发上皮样血管内皮瘤1例

患者女,55岁。胸背部疼痛伴双下肢麻木3月余,曾接受后腰椎MR检查诊断为L3-4、L4-5腰椎间盘突出,介入治疗后,短暂缓解。今因症状复发并伴双下肢乏力10天入院。查体:膝关节以下痛觉消失,左下肢肌力4级,右下肢肌力3级,双侧跟腱、膝腱反射减弱。MR检查(图1~3):T10椎体层面髓外硬膜下可见一椭圆形占位,大小约2.3cm×1.2cm×0.8cm,T1WI呈等、低信号,T2WI呈不均匀高信号,增强扫描呈明显     

脑节细胞神经母细胞瘤1例

患者男,1.5岁,因左侧肢体无力25天伴呕吐入院.查体:发育正常,营养中等,左上肢肌力Ⅰ级,左下肢肌力Ⅱ级,右侧肌力正常,生理反射存在,右强握反射( ).MRI:右侧额颞叶见一巨大囊性长T1长T2信号,在DWI上呈低信号,大小约8 cm×10 cm×10 cm,境界较清楚,T2WI可见边界不规则呈锯齿状,右侧脑室及右大脑实质受压向对侧移位,中线结构左偏(图1、2).术后病理诊断:右额颞叶节细胞神经母细胞瘤,部分向胶质细胞分化.免疫组化:GFAP( ),SYN( ),CD99( ).     

成人不典型畸胎样/横纹肌样肿瘤1例

患者女,40岁.反复阵发性头痛伴左侧肢体乏力1个月余入院就诊.体检:神清,左下肢肌力Ⅳ级.MR影像学表现:右侧岛叶见一类椭圆形异常信号灶,T1WI及T2WI呈等信号,病灶上缘斑片状出血灶于T1WI上呈高信号,病灶内液化坏死区于T2WI上呈高信号.增强扫描,实性部分明显强化,囊腔位于肿瘤一侧.     

大脑半球毛细胞性星形细胞瘤1例

患者女,17岁,头痛、呕吐、左下肢无力1月余。1个月前无明显原因及诱因出现头痛,呈持续性,以双颞及项部为著,伴恶心、呕吐,呕吐为非喷射性,并逐渐出现左下肢无力,走路易跌倒。体检:左下肢肌力Ⅴ-级,右侧正常。余神经系统体征未见异常。头颅MR:平扫右侧额叶皮质下可见一约2.5cm×2.8cm×3.5cm大小的类圆形病变,T1WI呈稍低信号,病变境界较清楚,与硬脑膜关系不密切,周围可见大片状低信号水肿带,右侧侧脑室体部受压变窄,中线结构左移(图1);T2WI病变呈不均质性等信号,其内可见少许高低混杂信号灶,周围大片状指样水肿带呈高信号强度(图2)。增强…     

脑胶质增生随访1例

患者女,18岁.2003年无明显诱因,出现反复抽搐,意识丧失等症状,当地医院CT检查提示右侧额叶占位性病变.为进一步明确诊断来我院就诊.查体:左侧上肢肌力Ⅲ～Ⅳ级,右腕及右手指活动障碍.左下肢病理征弱阳性.MRI示右侧额叶近皮质下见卵圆形长T1WI、长T2WI信号病灶(图1),FLAIR像为高信号(图2),大小约3 cm×2 cm,边缘规则,边界清晰,增强后,病灶明显均匀强化(图3),灶周无明显水肿及占位效应,各脑沟、脑室显示清晰,中线结构居中.     

胸椎椎管内节细胞神经瘤1例

<正>1临床资料患者,男,52岁,3个月余前无明显诱因出现双下肢体麻木、无力,右下肢为著,于2013年10月28日来我院就诊。体检:胸部活动尚可。胸椎压痛及叩击痛(-),无放射痛,脐水平以下感觉减退,右下肢为著;双下肢肌力Ⅲ级+,双上肢肌力Ⅴ级。影像检查:MR检查示T8水平椎管内及T8-9左侧椎间孔内见结节样异常信号影(图1),大小约2.8cm×1.9cm×2.2cm,T1WI呈均匀低信号(图2),     

序贯性头部外伤分别致小儿左右基底节损害1例

1　病例报告男 ,1岁 3月龄。 3个月前从床上坠落 ,头部着地。昏迷 ,无呕吐 ,抽搐。约 1h后出现左侧肢体活动减少 ,不能持物。伤后 8h行 CT检查示 :右侧基底节区一约 0 .7cm× 0 .5 cm椭圆形低密度区 ,CT值为 2 3Hu。经药物治疗痊愈。再入院 3d前走路跌倒致额部外伤。再次昏迷。伤后右侧肢体活动减少 ,以右下肢为重 ,不能言语。查体 :神志清 ,运动性失语 ,右中枢性面瘫。右上肢肌力 级 ,右下肢肌力 ～ 级。右巴氏征阳性。入院后第 5天行 MRI检查示 :1左侧基底节区 T1 WI,T2 WI均为高信号。2右侧基底节区 T1 WI低信号 ,T2 WI高信号…     

幕下小脑神经节细胞胶质瘤合并幕上弥漫性胶质瘤1例北大核心CSCD

患儿男,13岁,头部左侧阵发性疼痛3月余,视物模糊伴听力减退2个月;既往体健。查体:左上肢指鼻试验、左下肢跟膝胫试验欠稳准。实验室检查未见明显异常。颅脑MRI:右侧额叶皮质下见0.5 cm×0.6 cm点片状T2WI/液体衰减反转恢复(fluid attenuated inversion recovery,FLAIR)高信号(图1A);左侧颅后窝见4.7 cm×5.1 cm团块状异常混杂信号,与小脑分界不清,T1WI呈等或稍低信号(图1B)。     

MRI诊断颅内血管周细胞瘤1例报告

正患者,男,28岁,因"间断头痛4月余"于2016年2月22日收入四川省人民医院神经外科。神经系统查体:双下肢肌力4级,双上肢肌力正常,四肢肌张力正常,其余未见异常。入院行头部磁共振成像(MRI)检查示左侧颞顶部见一肿块影,呈分叶状,大小约6 cm×6 cm×5 cm,T1WI呈稍长、长T1信号,T2WI呈稍长、长T2信号,可见较多血管流空影,增强扫描肿块明显强化,中央未见强化,肿块与小脑幕     

不典型婴儿促纤维增生性神经节细胞胶质瘤1例

患儿男,3岁,因"右面部撞伤致鼻出血"就诊,当地医院颅脑CT示左额叶占位,疑诊脑膜瘤;1年前患手足口病,现已治愈,否认家族遗传病史.入院查体及实验室检查均未见明显异常.头颅M RI:左额叶2. 9 cm × 2. 5 cm × 3. 2 cm类圆形不均匀异常信号,以 T1WI、T2WI等信号为主(图1A、1B) ,边界...     

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.