剖宫产术后腹内疝并发肠梗阻18例超声检查分析

目的探讨超声检查在诊断剖宫产术后腹内疝并发肠梗阻的临床价值。方法对1998-01-2010-12回顾性分析18例经手术证实的剖宫产术后腹内疝并发肠梗阻的声像图特征。结果 18例超声均提示肠梗阻,其中12例提示肠绞窄均得到手术证实,剖宫产术后腹内疝并发肠梗阻超声主要表现为膀胱与子宫之间局限性肠管突入,突入肠管扩张充液;绞窄处肠管变窄,肠内容物通过受阻;不同程度腹腔积液;梗阻部位肠壁水肿增厚,肠管蠕动减弱或消失。结论超声检查是剖宫产术后腹内疝并发肠梗阻的可靠的方法,为临床提供了准确的诊断依据。     

腹部手术后腹内疝35例分析

目的:探讨腹部手术后腹内疝所致肠梗阻的诊断、治疗、病因及预防。方法:对35例经手术证实为腹内疝患者的临床资料进行回顾性分析。结果:腹部手术后腹内疝所致肠梗阻的临床特点是易绞窄,术前很少确诊,本组病例均有肠管血液循环障碍,肠坏死18例,穿孔1例,除1例因中毒性休克、多系统器官功能衰竭死亡外,余病例均痊愈。结论:腹部手术后腹内疝所致肠梗阻临床少见,常按粘连性肠梗阻治疗,术时多数出现肠绞窄、肠坏死改变。腹部手术后引起腹内疝主要原因是腹内粘连物粘连后局部有裂隙形成,或腹部手术后局部遗漏未修复的裂隙致腹内疝发生。早期诊断、早期手术治疗是治愈的关键。     

腹外疝的超声诊断价值

目的 探讨提高腹外疝超声诊断符合率的方法及临床应用价值。方法 通过不同体位和乏氏动作改变腹内压等方法对检查116例（经手术病理证实）,并对其结果进行回顾性分析。结果 3．5MHz探头对疝外被盖较厚、疝环较大的腹外疝诊断符合率高于11MHz（P〈0．01）,11MHz探头对疝外被盖较薄、疝环较小的腹外疝诊断符合率高于3．5MHz（P〈0．01）,改变腹内压能提高可复性疝的超声诊断符合率,联合使用上述方法诊断符合率最高。结论超声检查腹外疝时应用不同频率探头和改变腹内压等综合方法,提高了腹外疝超声诊断水平。     

超声与钼靶X线诊断乳腺肿块对比分析

对５８例乳腺肿块的超声显像、钼靶Ｘ线摄影及术后病理结果进行对比分析，良性肿块４０例，超声与Ｘ线诊断敏感性分别为８５％和７８％；乳腺癌１８例，超声与Ｘ线诊断敏感性分别为８９％和８３％。对漏误诊病例分析显示，超声检查漏诊率高，而Ｘ线检查误诊率高，发病年龄＜４５岁组，超声诊断敏感性高于Ｘ线摄影，分别为１００％和７１％，年龄＞４５岁组，超声诊断敏感性低于Ｘ线摄影，分别为８２％和９１％，两种方法联合应用诊断良性肿块符合率为９２．５％，恶性肿块符合率９４％。两种方法诊断良恶性肿块的Ｘ￣２检验无显著性差异（Ｐ＞０．０５），提示：超声与钼靶Ｘ线对乳腺肿块的诊断，各具优势和局限性，如能发挥其优势来互补局限性，当能提高乳腺肿块的诊断水平。     

腹内疝病理基础及分型的多层螺旋CT诊断探讨

目的:分析腹内疝的病理基础和分型并探讨多层螺旋CT对腹内疝的诊断价值。方法:选取2017年7月至2019年7月期间于本院医治腹内疝的36例患者,均经手术证实。全部给予多层螺旋CT检查,观察患者CT表现,与手术病理结果进行对照,分析多层螺旋CT对腹内疝分型的诊断结果。结果:手术病理结果为:36例患者均被证实存在小肠梗阻,其中盲肠周围疝、大网膜裂孔疝、肠系膜裂孔疝、网膜孔疝、胃切除术吻合口后疝各2例,十二指肠旁疝8例,术后形成腹内疝有肠粘连束带疝18例。36例患者术前多层螺旋CT均有小肠梗阻表现,其中有14例有肠管绞窄。22例被诊断为腹内疝,其中盲肠周围疝和网膜孔疝各2例,十二指肠旁疝6例,肠粘连束带疝12例。以手术病理结果为金标准,多层螺旋CT的诊断准确率为61.11%。结论:闭襻性肠梗阻、血管绞窄等是腹内疝发生的主要病理基础,多层螺旋CT可以为腹内疝进行准确分型,以实现对腹内疝的准确诊治。     

经阴道超声在闭孔疝检查诊断中的应用

<正>闭孔疝罕见,多见于年老、体弱或患有腹内压增高疾病及多胎经产妇,疝内容物多为肠管,其术前确诊率低。影像学检查诊断中以CT研究报道较多,在超声诊断方面仅见个例报道。本组总结经我院诊治的7例闭孔疝术前有超声检查结果并手术证实患者进行总结报道,探讨经阴道超声在闭孔疝检查诊断中的应用,以提高对本病的认识。     

超声诊断肠梗阻临床价值探讨

为探讨超声对肠梗阻的诊断价值。方法：应用频率为３．５ＭＨｚ、５．０ＨＭｚ超声探头于腹部全方位、多切面并加压探查,超声检查结果与Ｘ线及手术病理检查结果对照。结果超声诊断完全性肠梗阻正确率为９５．２４％,不全性肠梗阻９１．６７％,总准确率为９５．１６％。结论：超声诊断肠梗阻的特异性敏感性,准确性及对梗阻病因的判断均优于其它影像学木检查,具有较大的临床实用价值。     

腹内疝致肠梗阻19例诊治分析

目的提高对腹内疝致肠梗阻的认识。方法回顾性分析19例腹内疝所致肠梗阻患者的临床资料。结果 19例术前诊断率68.42%（13/19）,术中证实并伴有肠坏死者57.89%（11/19）,病死率5.26%（1/19）。结论腹内疝术前诊断困难。对有手术史,经常腹痛或肠梗阻表现者应考虑腹内疝的可能,应早期诊断及时治疗。     

术后腹内疝23例临床分析

腹内疝是指腹腔内脏器或组织离开原有位置而进入腹腔内正常或异常的隐窝、凹陷或非常大的缺损,肠管疝人可形成嵌顿或绞窄。其发病率为0．2％～0．9％,占急性小肠梗阻的0．5％-4．1％。可分为先天性腹内疝和后天性腹内疝。后天性腹内疝常在腹部手术后发生。术后腹内疝易并发肠绞窄,致死率较高,如何早期诊断治疗及预防显得格外重要。本次研究总结23例经手术证实为术后腹内疝的诊治经验。现报道如下。     

先天性腹内疝诊断及处理(附8例报告)

目的探讨先天性腹内疝的诊断及处理。方法回顾性分析 8例有关临床资料。结果 8例术前均未明确诊断。均行急症手术 ,其中 5例肠坏死者予以肠切除 ,余 3例复位成功。其特点是突发性腹绞痛伴频呕 ,迅速出现绞窄性肠梗阻、感染性休克。结论腹部 X线检查可对本病提示诊断。如高度怀疑本病 ,应急症剖腹探查 ,对疝入之肠管应予以手法复位或肠切除 ,并缝闭裂孔及疝环。     

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.