先天性阴道斜隔综合征7例超声诊断与临床分析

目的：探讨先天性阴道斜隔综合征（CVRS）的声像图特征,提高准确率以指导临床采取正确术式。方法：回顾性分析7例CVRS声像图及临床特征,总结该病的诊断要点。结果：所有患者均为双子宫、双宫颈,右侧斜隔3例,左侧斜隔4例。7例均伴斜隔侧肾缺如。Ⅰ型CVRS,其声像图特异,术前均能明确诊断,Ⅱ、Ⅲ型CVRS超声可为临床作出提示性诊断。结论：超声检查可作为诊断CVRS的首选方法。     

先天性阴道斜隔综合征7例超声诊断与分析

目的 通过对7例先天性阴道斜隔综合症(CVRS)的超声诊断与临床分析,提高对CVRS的认识.方法 对经超声检查并经临床证实的7例为CVRS的资料进行回顾性分析.结果 7例中,6例为典型双子宫,1例子宫外形为类双角子宫状.7例病例中均为双宫颈,其中右侧斜隔4例,左侧斜隔3例,7例均伴有斜隔侧肾缺如,所有患者术前诊断与术后所见均吻合.结论 超声可作为诊断CVRS的首选方法,可为临床选择治疗方案提供准确的信息.     

腔内三维超声诊断阴道斜隔综合征

目的 探讨腔内三维超声诊断先天性阴道斜隔综合征(OVSS)的临床价值。 方法 收集经手术证实的154例双子宫及完全性纵隔子宫患者的临床资料,回顾性分析其中15例OVSS的临床表现及声像图特征。 结果 15例阴道斜隔综合征中,8例首诊行二维超声检查漏误诊,后复诊时经腔内三维超声检查获得正确诊断,余7例首诊经腔内三维超声检查即获得正确诊断。OVSS声像图表现为双子宫或完全纵隔子宫、双宫颈、斜隔侧隔后阴道腔积液,14例伴斜隔侧肾脏缺如。 结论 腔内三维超声有助于提高OVSS的诊断准确率。     

超声诊断阴道斜隔综合征13例分析

目的：探讨超声在阴道斜隔综合征中的诊断价值,较少误诊率。方法：对唐山市妇幼保健院2006—01／2009-06收治的13例阴道斜隔综合征患者的声像图特点及临床特点进行回顾性分析。结果：阴道斜隔综合征患者声像图共有特点是双子宫双宫颈、一侧宫腔及宫颈下方积液、同侧肾缺如。13例中7例超声及时诊断,6例延误诊断。结论：超声是诊断阴道斜隔综合征首选可靠的方法,但对该病要有足够的认识和鉴别诊断。     

阴道斜隔综合征的超声诊断价值

目的探讨超声检查对阴道斜隔综合征的诊断价值,分析超声图像特点,提高诊断率,为临床选用最佳的手术方式提供依据。方法回顾性分析2008年1月2010年6月经手术确诊为阴道斜隔综合征的15例患者的临床资料及超声检查结果,总结阴道斜隔综合征的声像图特点。结果 15例经临床确诊为阴道斜隔综合征的患者,超声诊断14例,均表现为双子宫、双宫颈、阴道或宫颈积液/血,9例左肾缺如,5例右肾缺如。误诊1例,为单子宫伴一侧附件巨大囊肿。结论超声具有诊断准确、简便、无创、重复性好、价格实惠等优点,对于临床诊断生殖系统畸形具有十分重要的意义,应列为首选检查方式。     

先天性阴道斜隔的超声诊断与鉴别诊断

目的　评价超声诊断阴道斜隔的价值。方法　对 7例阴道斜隔患者的临床表现、声像图特点及术中所见进行分析 ,从中找出声像图特征。结果　进行性加重的痛经是各型阴道斜隔患者均有的症状 ;双子宫双宫颈畸形、宫腔及宫颈下方积液、一侧肾缺如是各型阴道斜隔患者均具有的声像图特点 ;手术可见阴道内隔膜。结论　二维超声检查应为诊断阴道斜隔首选而可靠的方法 ,但应注意提高操作技巧和识别能力。     

阴道斜隔综合征的超声诊断价值

目的 分析阴道斜隔综合征的声像图特征,以提高其超声诊断率.方法 回顾性分析6例经手术证实为阴道斜隔综合征患者的声像图特征.结果 阴道斜隔综合征声像图表现为双子宫畸形、斜隔侧宫腔积液、宫颈管扩张、阴道上段积液、肾脏缺如及同侧附件包块等.结论 超声检查对阴道斜隔综合征有较高的诊断价值.     

产前超声诊断胎儿三尖瓣下移畸形的应用价值

目的 探讨产前超声诊断胎儿三尖瓣下移畸形的临床价值。方法 回顾性分析6例经胎儿超声心动图诊断为三尖瓣下移畸形的超声诊断资料与随诊结果，总结其异常声像图特点。结果6例胎儿均经尸体解剖证实为三尖瓣下移畸形，其中三尖瓣隔叶下移2例，隔叶及后叶下移3例，隔叶、后叶及前叶下移1例。6例三尖瓣下移畸形中4例伴有功能右室缩小，合并房间隔缺损1例，肺动脉狭窄1例；4例伴有胸、腹腔及心包积液。胎儿三尖瓣下移畸形主要声像图表现为右心扩大，三尖瓣叶附着点下移，心尖到二尖瓣前叶附着点的距离与到三尖瓣隔叶附着点的距离比值≥1．8，形成典型房化右室特征；彩色血流显示三尖瓣重度反流，其反流起源点低，反流面积大，但反流速度低，平均反流速度217．0cm／s。结论 胎儿三尖瓣下移畸形具有特征性声像图表现，产前超声诊断胎儿三尖瓣下移畸形具有重要临床价值。     

先天性阴道斜隔综合征的超声诊断

目的：对阴道斜隔综合征再认识。方法：对我科6年间所有经超声检查诊断为阴道斜隔综合征的病例进行分析。结果：共诊断该综合征15例,14例为双子宫、双宫颈、双阴道,一侧阴道完全或不完全闭锁,1例为双角子宫、一侧阴道不完全闭锁;15例全部伴一侧肾脏缺如,对侧肾脏代偿性增大。结论：该先天性畸形并非少见;认识该综合征是正确诊断的重要前提;超声检查应列为首选方法。     

阴道斜隔综合征六例临床诊治分析

目的:探讨阴道斜隔综合征的临床特点和治疗方法。方法:回顾性分析我院2003～2008年间收治的6例阴道斜隔综合征的临床资料并复习相关文献。结果:本组阴道斜隔Ⅰ型3例,Ⅱ型2例,Ⅲ型1例。5例行手术治疗,术后症状缓解,无复发;1例因合并肾功能不全未行手术,仅行阴道血肿穿刺,后转他院治疗。结论:阴道斜隔综合征主要由隔后腔积血、引流不畅、梗阻而诱发一系列临床症状,只要正确认识本病,诊断不困难,手术是该病的主要治疗方法。     

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.