超声检查小网膜囊增厚对诊断腹部疾病的临床意义

目的 评价超声检查小网膜囊增厚对胰腺和腹部疾病诊断的价值。方法 病例组58例，对照组25例。超声扫查中上腹部，检测胃胰间距，显示胰腺前方异常回声。同期做CT和淀粉酶测定。结果 对照组小网膜囊不显示。病理组小网膜囊增厚0．4－5.0cm，胃胰间出现异常回声，长4.0-10.0cm。其中急性胰腺炎47例（81.03%)，腹腔转移性肿瘤3例（5．17％），胰腺损伤3例（5．17％），胃穿孔1例，腹膜炎和腹腔结核各2例。结论 正常小网膜囊不显示，当小网膜囊增厚和出现异常回声时提示胰腺（86．20％）和腹腔异常。     

小网膜囊积液的超声诊断及临床意义

目的 :探讨超声检查小网膜囊积液对胰腺和腹部疾病的诊断价值。方法 :对 13例经手术或 CT证实的小网膜囊积液的超声声像图进行分析。结果 :胰胃间出现扁窄的不规则无回声区 ,范围约 4 .6～ 14 .6 cm× 1.6～ 6 .6 cm。其中胰腺炎 9例 ,胃穿孔 1例 ,肝挫伤 1例 ,胰腺外伤 2例。结论 :正常小网膜囊不显示 ,当小网膜囊积液时提示胰腺和腹腔异常 ,及时指导临床手术或超声引导下穿刺引流     

超声检出小网膜囊增厚对急性胰腺炎的诊断价值

目的：前瞻性评价超声检出小网膜囊增厚对急性胰腺炎的诊断价值。方法：对照组23例,病例组65例。经超声、CT和尿淀粉酶同期对照和手术证实。结果：①对照组小网膜囊不显示;②急性胰腺炎小网膜囊增厚90.76%(59/65),厚0.4cm-5.0cm,检出长度5.0cm-12cm;③小网膜囊增厚的恢复晚于淀粉酶恢复和症状消失;④小网膜囊增厚原急性胰腺炎诊断的敏感性为92.30%、特异性92%和准确性92.22%。结论：超声发现小网膜囊增厚可提高对急性胰腺炎的检出率和诊断的准确性。     

胰腺黏液性囊腺瘤术后复发囊腺癌超声表现一例

患者女,49岁,于2002年11月27日因上中腹部疼痛2 h余伴恶心呕吐入院.查体:急性面容,腹平软,上中腹部压痛(+),反跳痛(±);血淀粉酶146 U/L.超声所见:胰腺形态完整,实质点状强回声分布欠均匀,胰腺头、体、尾厚度分别为2.4 cm、2.0 cm、1.7 cm,主胰管内径0.3 cm;于胰尾部可见3.0 cm×3.0 cm无回声区,边界清晰,其囊壁增厚、呈强回声.CDFI:无回声区及囊壁未见血流信号.     

胰腺结核误诊2例分析

对胰腺结核误诊2例分析如下。1病历摘要例1:女,41岁。因反复上腹部隐痛5个月,加重伴恶心呕吐3d入院。无明显消瘦乏力。彩超示:胰尾后方见2.2cm×1.cm的低回声,形态欠规则,内回声不均匀。周边可见小的中等回声结节,右上腹腔前方见一7.0cm×4.8cm×2.0cm的中强回声,边界不清,内见小的低回声结节。CT示:胰腺体积不大边缘光整,实质内见多发点状钙化,胰管扩张。术中见大网膜右叶3cm×4cm×2cm肿块,同右侧前腹壁腹膜粘连,胰头颈部有一3cm×5cm×4cm不规则肿物,同胃后壁及小网膜形成致密粘连,胰体部有一2cm×3cm×2cm的质韧肿物。胰尾脾门区有一直…     

急性胰腺炎39例早期声像图改变与年龄的关系

目的探讨超声对早期急性胰腺炎不同年龄段的声像变化及其诊断价值。胰腺实质回声随年龄增长呈增强趋势,老年人应依据其超声测值和回声特点来判断。方法对确诊的39例急性胰腺炎的超声图像进行综合分析,并对39例急性胰腺炎胰周积液情况和其中的30例急性水肿型胰腺炎胰腺大小、回声特征分19~40岁,41~60岁,61~79岁3个年龄组重点讨论。内容包括胰腺大小、边界、内部回声、周围结构、胰周积液及病理分型等。结果39例急性胰腺炎中急性水肿型30例(76.9%),急性出血坏死型9例(23%),小网膜囊积液17例(43.6%),有30例胰腺呈弥漫性或局限性不同程度的肿大,7例大小正常,2例因肠腔气体干扰显示不清。超声诊断符合率94.9%。急性水肿型胰腺炎表现为胰腺形态饱满,22例肿大,7例回声偏低,18例弥漫性增强,边界清晰或稍显模糊,尚规则,10例小网膜囊积液,8例主胰管扩张。其中在18例回声增强中19~40岁11例回声增强2例(18.2%),41~60岁11例回声增强9例(81.8%),61~79岁8例回声增强7例(87.5%),回声高低与年龄增长有相关性;急性出血坏死型胰腺炎表现为胰腺形态欠规则或极不规则,回声强弱不均,8例肿大,以头尾肿大显著,边界模糊或清晰,7例伴有程度不等的小网膜囊窄带状,不规则片状无回声或低回声积液,2例主胰管扩张。39例急性胰腺炎胰周积液17例19~40岁13例发生3例(17.6%),41~60岁15例发生10例(58.8%),61~79岁11例发生4例(23.5%)。41~60岁年龄段小网膜囊积液发生率增高,不同年龄回声各有其特征。结论超声对不同年龄段急性胰腺炎有较高的诊断价值,但仍有一定的局限性。     

超声诊断胰腺外伤3例

病例1,男,22岁,因车祸中被钝器击中腹正中就诊,来院时上腹部有明显压痛.超声检查肝、胆、脾、肾均未见明显异常回声,扫至胰腺处示胰头厚3.0 cm,胰体厚1.5 cm,胰尾厚1.9 cm,胰头明显增大并可见范围约2.8 cm×1.5 cm实质回声减弱(图1)、杂乱不均区,被膜连续性差,可见较明显的断端及局限游离液性无回声区,胰体及胰尾回声均匀,少量饮水后示主胰管未见积液征象.超声诊断:①胰腺破裂;②腹腔局限性积液(考虑积血);③肝、胆、脾、肾、膀胱、前列腺未见异常.手术结果示:胰腺破裂头部有约2.8cm×1.0 cm挫裂口,行缝合术,检查其他脏器无异常,愈合良好.     

胰头无功能性胰岛细胞瘤的超声表现1例

患者女,18岁。偶然发现上腹部包块一周,来我院检查。体检:腹稍膨隆,上腹可触及一大小约12cm×13cm包块,质中,表面光滑,无压痛,可活动。超声检查结果:肝脏下方、胃右下方、胰头颈部及右肾前方探及一大小为13cm×13cm×8.1cm囊实性团块,边界清楚,有包膜,后方回声增强,可随呼吸轻微移动,与胰头颈部关系密切,胰腺轮廓清楚,大小:头1.8cm、体0.9cm、尾1cm,腺体回声均匀,胰管不扩张(图1)。超声提示:腹腔囊实性肿瘤(来自胰腺头颈部可能)。手术所见:于胰头部见一大小13.5cm×13cm×8.9cm囊实性肿块,边界清楚,与周围组织无粘连。病理诊断:胰头部无功能…     

胰腺假性囊肿一例漏诊

1病例资料女,69岁。因上腹部胀痛不适、食欲缺乏2年余,剑突下包块2个月入院。查体:巩膜无黄染,剑突下似触及鸡蛋大小包块,质中等,略移动,有压痛,余未见异常。血常规检查未见异常。B超检查示于肝胃间隙内可见约7.5cm×6.8cm大小的无回声区,壁薄,边缘光滑、整齐,其内未见明显分隔,后壁回声增强,肝脏、胆囊、胰腺未见明显异常。CT检查前饮纯净水600ml,采用120kV、130mA、10mm层厚和层距,仰卧位扫描示胃充盈良好,轮廓显示基本清楚,未见明显胃壁增厚及充盈缺损等异常征象,胰腺体积缩小,内部密度均匀,胰管未见扩张,胰周脂肪间隙显示不清,但未见…     

超声诊断胰腺导管内乳头状黏液性肿瘤1例

<正>患者女,因发现结肠息肉1年余,拟行结肠息肉切除术入院,患者平时无腹痛、腹胀、黄疸、消化不良等症状。体格检查无明显异常。术前行腹部常规超声检查:胰体回声不均匀,胰体部可见一大小为1.6 cm×1.1 cm的低回声,界限清,形态尚规则,内部回声均匀(图1);CDFI于其内未探及明显血流信号(图2)。超声提示:胰体占位性病变。腹部CT和MRI检查:胰胃间隙异常信号结节,考虑:(1)胃窦部肿瘤并淋巴结转移;(2)胰腺原发肿     

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.