稽留流产MRI误诊为黏膜下子宫肌瘤变性1例

患者女,35岁,因“无明显诱因出现月经淋漓不尽3月余”入院.查体:子宫增大如孕8周.实验室检查:血绒毛膜促性腺激素1.76 mIU/ml.超声:子宫实性占位,肌瘤变性.MRI:子宫明显不均匀增大,宫腔内见约5.13 cm×4.62 cm类圆形异常信号,T1WI呈等低信号,其内见部分高信号(图1),T2WI呈低信号,其内夹杂线状、片状明显高信号(图2);增强后无强化(图3).     

侧脑室神经鞘瘤一例

女,29岁,间断性头痛8个月伴加重3 d。查体:颅神经检查未见异常,四肢肌张力正常,双侧肢体肌力5级,肢体无瘫痪,腱反射正常,病理征阴性。MRI检查:右侧顶部及侧脑室后角不规则囊实性信号影,大小为3.8 cm×3.4 cm×3.4cm,肿瘤实性部分呈TIWI等信号T2WI稍高信号(图1A、1B),T2 FLAIR及扩散加权成像(diffusion weighted imaging,DWI)呈稍高信号(图1C、1D),表观扩散系数(apparent diffusion coefficient,ADC)图信号未见明显降低,ADC值为0.2×10^-3 mm^2/s(图1E),囊性部分各序列与脑脊液信号相仿,内可见低信号分隔,增强扫描病灶实性部分呈明显较均匀强化,其内可见斑点状无强化区,囊壁及分隔未见明显强化(图1F、1G),周围脑组织呈TIWI稍低信号T2WI稍高信号。     

咽旁间隙海绵状血管瘤一例

病例资料患者,女,46岁,因颈背部疼入院。体格检查:双侧扁桃体Ⅰ°大,右侧软腭较左侧膨隆低垂,无明显疼痛。口咽部MRI平扫加增强示右咽旁间隙内团块状T1WI等信号(图1a)、压脂T2WI高信号(图1b),其内信号不均,见多发条状T1WI及压脂T2WI低信号影,病灶周围见环形压脂T2WI低信号影,DWI(b=800)呈高信号。     

MRI诊断胫骨血管瘤1例

患者女,43岁。左小腿反复胀痛1个月。1个月前无明显诱因左小腿胀痛,与行走无关,无夜间痛、无活动障碍,且反复发作。曾有左踝扭伤史。体检及专科检查未见异常。X线平片:左胫骨中段骨髓腔见长椭圆形稍低密度区,边缘锐利,未见硬化缘。CT检查:左胫骨中段骨髓腔见一3.0cm×1.5cm大小软组织密度影,密度均匀,边界光整,邻近骨皮质受压变薄,呈弧形压迹(图1)。MR检查:左胫骨中段骨髓腔内见1.2cm×1.2cm×3.5cm大小异常信号,T1WI呈与肌肉类似低信号(图2),T2WI呈明显高信号,其内见不规则线状低信号(图3),边界清楚;增强T1WI病变明显持续不均匀强化(…     

原发性肝脏血管肉瘤的CT及MRI表现1例

患者男,58岁,间断性右上腹胀痛半年,伴体重减轻入院.既往健康,无肝炎及肝硬化病史.体检:肝区压痛,未触及肿块.实验室检查:HBs Ag(-),AFP、CEA及CA19-9均正常. CT:平扫见肝右叶7 cm×5 cm×4 cm低密度肿块;增强扫描肝动脉期病灶中心斑点状强化,门静脉期和平衡期病灶边缘结节状强化(图1).MR:T1WI呈高低混杂信号,肿块中心斑片状高信号(图2),T2WI呈不均匀明显高信号(图2):增强扫描动脉期肿块中心呈斑点状强化,门静脉、平衡期及延迟扫描增强消退呈低信号,肿块边缘逐渐明显强化.     

MRI诊断家族性多发血管母细胞瘤1例

患者男,30岁,行走不稳半年。颅神经检查(-),昂伯症增强( )。家族史:患者父亲10年前因血管母细胞瘤去世,孪生哥哥1年前在外院诊断为血管母细胞瘤,已行手术治疗。MRI表现:小脑蚓部囊性病灶,T1WI呈低信号,T2WI呈高信号,边缘可见壁结节,T1WI为等信号,T2WI为稍高信号。双侧小脑半球多发结节状病灶,T1WI呈等信号,T2WI呈略高信号,周围可见水肿带。四脑室受压、变形,双侧侧脑室、三脑室扩大。小脑扁桃体向下移位突入枕骨大孔,颈段脊髓增粗,内见长条形异常信号,T1WI呈低信号,T2WI呈高信号(图1~3)。增强后,小脑蚓部囊性病变未见强化,壁结节…     

腰椎管内硬脊膜下神经束膜瘤1例

患者男,76岁,左下肢疼痛、麻木2个月;既往无特殊病史.查体:左下肢远端肌力2级、近端肌力5级,痛温觉减退.实验室检查未见明显异常.腰椎 M RI:L4 椎管内见 1. 9 cm × 1.3 cm × 1.0 cm结节状肿物,边界较清,呈 T1WI等、T2WI高信号,其内可见不规则T2WI低信号(图1A );增强扫描肿...     

小儿桥小脑角区实质性血管母细胞瘤1例并文献复习

<正>1病例报告患儿,男,3岁。表现为头痛,恶心呕吐,行走不稳,右耳听力下降,右侧面部周围性瘫痪。影像学检查:入院后行头颅CT、MRI及DSA检查,病灶位于桥小脑角区,形态为类圆形,CT扫描见占位性高密度影,富血供,境界清,边缘光滑(图1)。MRI扫描中的T1WI为等信号,境界清,边缘光滑(图2),T2WI呈高低混杂信号(图3),增强后见均匀强化(图4),病     

鼻腔鼻窦神经鞘瘤CT及MRI表现

目的 观察鼻腔鼻窦神经鞘瘤CT及MRI表现。方法 回顾性分析13例经病理证实的鼻腔鼻窦神经鞘瘤患者，包括12例良性、1例恶性病变；13例均接受平扫、2例接受增强CT扫描；10例接受平扫、6例接受平扫及增强MR扫描；观察病灶CT及MRI表现。结果 13例均为单发病灶，平扫CT呈不均匀软组织密度(n=11)或稍低密度(n=2),5个病灶内见不规则低密度区；8例累及鼻腔及鼻窦，邻近骨质受压变形、吸收，5例局限于鼻腔内；增强CT显示2个病灶(2/2)均呈轻度不均匀强化。10例平扫MRI显示病灶信号不均匀，8个呈等T1WI、T2WI信号，2个呈低T1WI及稍高T2WI信号；9个病灶内见混杂斑片状低T1WI、高T2WI信号，其中5个内见斑点状、条状T1WI及低T2WI信号，6个病灶边缘见不连续T2WI低信号；增强MRI显示6个病灶(6/6)均呈渐进性不均匀强化，其内散在异常信号区呈轻度强化或无强化，4个病灶边缘轻度强化、1个明显强化、1个未强化。结论 鼻腔鼻窦神经鞘瘤CT无明显特异性表现，其MRI表现则具有一定特征性。     

读片窗及答案

患者,男,61岁。反复高热20余天,查体：体温38.8。,呈恶液质状态,腹水征(+),双下肢浮肿。实验室检查：WBC2.2×109/L,RBC 4.5×1012/L,白蛋白26g/L,AFP 6ng/L,HbsAg(+)。 CT平扫：肝右叶巨大占位病变,呈混杂低密度,边缘模糊,其内多发囊变坏死区,CT值10.7～22.3Hu(图1)。 MR平扫：T1WI：病变呈混杂低信号,中心部偏右侧等信号影,周边部位多发囊性低信号区(图2);T2WI：病变呈明显高信号,对应T1WI等信号区在T2WI上呈稍低信号,并可见多发索条状低信号。边界较清晰,似可见低信号的包膜环绕(图3)。     

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.     

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.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.