艾滋病腹部超声的声像图改变

目的 探讨艾滋病(AIDS)腹部超声的声像图改变特征。方法 50例艾滋病患者应用超声检查，观察肝脏、脾脏、胆囊的超声表现及腹主动脉周围，然后进行分析。结果 AIDS腹部超声的声像图表现为在肝脏、胆囊、脾脏方面均有不同程度的改变及腹腔淋巴结肿大。32例脾脏有不同程度的肿大；37例出现肝脏肿大、肝回声异常；23例出现胆囊壁改变；15例有淋巴结肿大。结论 AIDS患者的肝脏、胆囊、脾脏超声均有不同程度的改变及腹腔淋巴结肿大．其中以肝脏、脾脏改变最为明显，虽然以上声像图改变无明确特异性，但是结合临床病史．可以为临床诊断治疗及分期提供有价值的诊断依据。     

转移性脾脏肿瘤13例临床分析

目的分析转移性脾脏肿瘤的临床特点.方法总结13例转移性脾脏肿瘤患者的临床资料,对其临床表现、影像学特点、来源及预后进行回顾性分析.结果转移性脾脏肿瘤常无特异性症状和体征,影像学特点为脾实质内单发或多发结节,多伴发其他脏器转移,预后一般较差.结论转移性脾脏肿瘤少见,可来源于多种恶性肿瘤,应重视病史和影像学检查的内在联系,制定以手术为主,包括放疗、化疗及免疫治疗的综合治疗方案.     

脾脏淋巴瘤误诊脾脏血管瘤破裂出血1例

患者男,50岁,因“左侧腹痛伴乏力、盗汗1周,加重2日”入院。查体:面色苍白,两下叩诊呈浊音两下肺呼吸音减低,腹软,上腹部轻度压痛,脾区轻度压痛及叩击痛,脾脏于剑突下4横指、左侧肋缘下2横指可触及,移动性浊音( )。两侧颈部各触及一大小约10cm×0.5cm肿大淋巴结。入院2日后患者无明显诱因突感左上腹胀痛明显,伴恶心、呕吐,呕吐物为胃内容。急行腹部CT扫描见脾脏巨大,下极达左侧髂嵴水平,平扫实质密度不均匀,见实质内片状不规则高低混杂密度影,部分层面脾脏边缘见弧形略高密度影,增强脾脏强化不均匀,见大片状以脾脏边缘为宽基底的低密度区(…     

弥漫性淋巴管瘤累及脾脏的MSCT表现

目的探讨弥漫性淋巴管瘤(LA)累及脾脏的MSCT表现。方法收集11例经手术及病理证实、临床综合诊断的LA患者的影像学资料。所有患者均接受MSCT检查,其中5例同时接受平扫和增强扫描。结合临床资料、手术及病理结果,分析本病累及脾脏的影像学表现。结果 11例患者的脾脏可见单发或多发薄壁囊性肿块,边界均清楚,其中2例囊内有分隔;5例增强扫描显示囊壁及分隔动脉期轻度强化,门脉期及延迟期持续强化,囊内容物无强化。所有患者均同时伴有至少1个其他部位的相似病变。结论 MSCT检查可清晰显示LA累及的脾脏影像学特征。伴有淋巴管发育不良并累及多个部位时,结合病史及临床其他检查有助于诊断。     

脾脏海绵状淋巴管瘤1例报告

患者女,22岁,体检B超,发现脾门处异常回声团,遂入院医治。影像学表现:(1)CT表现:脾脏饱满,脾脏内侧缘脾门处见一类圆形低密度影,CT值约37Hu,大小约4.5cm×4cm×4cm,中心可见多个点状钙化斑,病灶内布满稍高密度网格状分格,呈“蜂窝状或蜘蛛网状”改变,中心处可见直径约1cm小囊状     

脾占位病变2例诊治分析

例l 患者，女性，68岁。因上腹部胀痛不适2年余入院。患者于2年前始感上腹部胀痛不适，未经治疗，入院前2～3个月发现左上腹有一肿物，逐渐增大。感乏力、纳减、消瘦、无发热、无腹泻及黑便。查体：于左肋下可扪及脾脏，质地较硬，表面不光滑，伴有压痛。B超：脾大、内回声欠均，于脾脏上下极均可见强回声团块，提示脾脏多发占位。CT：     

脾脏实性血管淋巴管瘤一例

患者男,22 岁.反复头晕、左上腹部隐痛4 d,复发16 h 入院.查体:左上腹部压痛明显,无反跳痛、肌紧张,脾区无叩痛.超声检查:脾内见一大小约4.9 cm ×4.8 cm 的稍增强回声影.CT 检查(图1):脾内可见一类圆形低密度肿块,境界清楚,其内可见多发小斑片状高密度影,动态增强扫描肿块呈渐进性强化,但各期强化程度均低于正常脾脏组织,病变中心区域始终呈低密度.手术所见:全麻下行脾脏全切术,脾脏大小约7 cm ×5 cm,质地软,色正常,于脾膈面见一实性包块,脾周无腹水及其他异常肿块.病理检查:脾脏内见一大小约4 cm ×4 cm 的实性肿块,质地较硬,内无分隔及囊腔,边界较清楚,与周围组织无黏连,病理学结果为脾脏血管淋巴管瘤(hemangiolymphangioma).     

创伤性脾脏损伤72例CT平扫分析

目的 旨在进一步提高脾脏损伤的CT诊断水平。方法 采用CT平扫对72例脾脏损伤患者进行中上腹部检查，层厚l0mm，层间距l0mm，部分病例作局部3—5mm薄层扫描。结果 脾脏表面损伤合并腹腔积血4例，脾脏裂伤合并腹腔积血l例，脾内血肿及延迟性脾损伤4例，脾脏挫裂伤(脾碎裂)合并腹腔积血50例，脾脏包膜下血肿合并腹腔积血l0例，脾脏损伤合并肝脏损伤及左膈疝各l例，误诊l例。结论 腹部CT平扫在诊断早期及延迟性脾脏损伤有其独特优势，而腹腔积血则在脾脏损伤诊断有重要的意义。     

超声诊断脾脏炎性假瘤1例

患者女,59岁,左侧背部发胀。体格检查:无发热,无腹痛,体重无明显下降,腹部未触及包块,肝脏、脾脏肋下未及,血常规及各项生化结果正常,无传染病史,1个月前洗澡时曾经滑倒一次,但无明显不适。     

超声诊断腹腔淋巴管囊肿1例

患者女,28岁.腹部疼痛1个月余,无腹胀,无恶心、呕吐,无腹泻、黑便,疼痛呈阵发性间歇发作,发病以来体重无增减.查体:左下腹轻压痛,未触及明显包块.超声检查:于左肾前方、胰尾左前方、脾脏内下方可探及一大小约21.0 cm×13.0 cm×12.0 cm的无回声区,壁薄,后壁效应增强.提示为:腹腔囊性占位性病变(图1),考虑为:①腹腔淋巴管囊肿;②胰腺假性囊肿.术中所见:左上腹腹膜后可见一大小约20.0 cm×10.0 cm×10.0 cm的不规则形囊肿,囊肿与周围网膜有粘连,位于胰尾前方,结肠后方,脾脏内下方,左肾前下方,壁薄,囊腔内有淡黄色清亮液体约1000 ml.切开囊肿顶部,切除一部分囊肿壁做快速冰冻,提示良性病变,囊液淀粉酶测定提示正常.检查其他脏器未见异常.病理结果:(腹腔)符合淋巴管囊肿.     

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.