嗅神经母细胞瘤1例

1病历摘要女,39岁。以左侧渐进性鼻塞3个月于2004-12-07入院。患者自患病以来左侧头闷痛,可忍受,伴脓涕,无涕中带血,无溢泪,无视力改变,无嗅觉障碍,饮食睡眠佳,二便正常。既往史:否认外伤手术史及其他疾病史。查体:一般状态良好;生命体征平稳;视力:右眼:1.0,左眼:1.0;双眼瞳孔等大正圆,对光反射正常;眼底未见异常;全身浅表淋巴结未触及肿大。专科检查:左鼻腔见一红色光滑肿物,质软,来源于上鼻道,双中、下鼻甲无肿大,无充血,鼻腔未见分泌物。鼻窦冠状位CT报告:左筛窦、上颌窦黏膜肥厚,左鼻腔软组织密度灶,无骨质破坏。初步诊断:(1)左鼻腔肿…     

外伤性牙脱位至鼻腔1例

1 病历摘要 男,26岁.因左侧鼻塞1个月就诊我科,1个月前因车祸致左眼视力丧失入住眼科,诊断为左眼球破裂伤、左侧鼻部、上唇挫裂伤,行左眼球修补+头面部清创缝合,术后出现睑球粘连,行左眼睑球粘连分离术,出院后感左侧鼻塞、偶有涕中带血,来我科就诊.行鼻内窥镜检查见左鼻腔前端底部见一切牙;检查口腔见左上中切牙缺失;查阅住院时头面部CT片见左侧鼻腔前端有一圆形高密度影.遂在局麻下拔除左侧鼻腔"异位牙".     

超声诊断非霍奇金淋巴瘤骨转移1例

患儿,男性,9岁。左额部外伤40天,左眼突出,视物模糊15天。体温36.5℃,心律90次/分。左额眉上局部隆起,可及 3cm × 3cm肿物,不可压缩,未闻及杂音。左眼突起,视力 0.12,眼球可活动。CT检查:左额骨肿物侵入鼻窦及左侧眼眶内。     

以视力障碍为首发症状的巨大筛窦囊肿一例

以视力障碍为首发症状的巨大筛窦囊肿一例山东淄博市中心医院［２５５０３６］尹兆富，穆大年，李道长病例：男．２６岁．二年前始有持续性左侧头痛伴左眼视物模糊．曾就诊于眼科，蝶鞍Ｘ线片及神经系检查无异常，诊为“球后视神经炎”，对症治疗，症状渐重，一年后左眼球...     

原发性副鼻窦恶性组织细胞瘤1例

原发性副鼻窦恶性组织细胞瘤１例王鹰①患者女，５２岁，左侧头痛５月，左侧鼻塞伴鼻出血、血涕２月，左眼外突１月。体检：左中鼻道可见息肉样物，表面有血痂，左上颌窦轻压痛，左眼向外下方突出，活动自如，但向左凝视时出现复视，各项常规生化检查无明显异常。副鼻窦Ｃ...     

鼻腔鼻窦骨化纤维瘤误诊1例

1病例报告 女,58岁.因鼻阻2 a,左侧头痛半个月就诊.以左鼻腔鼻窦新生物于2000-05-09入院.2 a来持续性鼻阻,左侧著,左眼流泪伴视力下降.半个月来左侧前额及颞部疼痛.     

CT诊断鼻型结外NK/T细胞淋巴瘤伴发喉NK/T细胞淋巴瘤1例

病例男,59岁。5年前出现左侧鼻塞,睡眠张口呼吸,无憋气憋醒。3周来鼻塞加重,流涕,涕中少量带血,左侧鼻腔嗅觉减退,自行口服药物不见缓解,于外院行鼻CT,提示左侧鼻腔上中鼻道软组织病变,伴局部骨质吸收,为求进一步诊治来我院,门诊以"左鼻腔占位"为诊断收入院。病来无面部麻木感,无张口受限,无耳闷、耳鸣及听力下降,无视力下降,饮食佳,睡眠可,无明显消瘦及乏力史,二便如常。     

以视力障碍为主要表现的韦格纳肉芽肿

1病例资料男,57岁。因视物模糊1年余,加重3个月入院。患者1年前无明显诱因出现视物模糊,眼前如有纱网样阴影,伴头晕,逐渐加重。先后到多家医院眼科就诊,诊断为葡萄膜炎、结膜炎等,予对症治疗无好转。3个月前视力明显下降,并出现眼球突出,查甲状腺功能未见异常,双眼MR I示双眼球后脂肪堆积。病程中无咳嗽、关节疼痛、口干、口腔溃疡。其妹有眼球突出、视物模糊,未予系统诊治。查体:鼻腔通畅,各鼻旁窦区无压痛,双眼上下睑皮肤肿胀,右眼突出度28 mm,左眼为26 mm;视力右眼1·0,左眼1·0;双眼压均为10 mmHg。鼻根处可见直径0·5 cm大小的红色皮…     

泪道义管存留15年继发鼻结石一例

【病例】男,50岁。因左侧鼻塞、呼气有异味10余年,伴左眼流泪、溢脓入院。15年前因"左眼慢性泪囊炎"于当地医院行左侧鼻腔内金属泪道义管植入术,术后不久即间断出现上述症状,期间到当地医院眼科就诊,冲洗泪道提示左侧泪道阻塞,给予抗生素眼液点眼治疗,症状无     

眼部带状疱疹并发视力下降1例

1病历摘要 女,50岁。因左眼睑疼痛、肿胀、水疱伴左侧头部额部水疱3d住院。查体：全身一般情况良好,左眼视力0.6,左侧头部额部及上下睑皮肤散在片状道瘢痕,感觉迟钝。结膜充血,角膜混浊,角膜后沉着物（＋）,瞳孔正常,直径约4 mm,直接间接对光反应迟钝。晶状体及玻璃体透明,眼底未见异常。诊断为在左眼睑带状疱疹,给予阿昔洛韦,维生素B族及能量合剂,止痛药物结合治疗,3 d后,患者出现左眼视物模糊,复查实力0.2,角膜可见水疱及溃疡。请五官科专家会诊后,调整治疗方案,给予地塞米松静脉滴注及营养神经药物治疗2周,左眼视力0.4,对光反射迟钝。     

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.