急诊床旁超声心动图在临床应用的价值

目的： 本文探讨急诊床旁超声心动图在临床的应用价值。方法： 我们回顾性分析了１９９８ 年 １１ 月至１９９９ 年 ４ 月进行的急诊床旁超声心动图检查共计６０ 例。结果： 床旁超声检查的诊断阳性率为８７％ （５２／６０）, 其中,冠心病２０ 例 （３３．３％ , ２０／６０, 与心电图和临床生化检查一起协助诊断急性心梗４ 例）; 单发或者合并心包、胸腔积液１３ 例 （２２％ １３／６０）; 瓣膜病１１ 例 （１８％ , １１／６０）; 外科术后患者９ 例 （１５％ , ９／６０）; 高血压心脏病４ 例 （６．７％ ,４／６０）; 心肌病４ 例 （６．７％ , ４／６０）; 肺心病３ 例 （５％ , ３／６０）; 先心病１ 例 （１．７％ , １／６０）; 夹层 ２ 例; 其他６ 例。结论： 急诊床旁超声心动图检查无论在诊断阳性率方面, 还是在对临床干预的结果方面, 均具有相当重要的临床应用价值     

注意药疗效，忽视心功能──1例肺炎输液不当导致急性左心衰

注意药疗效，忽视心功能─—１例肺炎输液不当导致急性左心衰男性，８０岁，主诉发热、咳嗽、胸痛４天。体温３８．５℃，双肺呼吸音粗，右肺底可闻及小水泡音。镇卫生院诊断为右肺炎，给予０．９％氯化钠５００ｍｌ加青霉素钠７２０万Ｕ，快速静滴（２小时内滴完），每日...     

脊柱外伤的MRI对临床诊治的

目的：了解脊柱外伤的ＭＲＩ表现与其临床价值。材料与方法：对７３例脊柱外伤的ＭＲＩ征象进行回顾性分析，并与临床和手术结果进行比较。结果：脊柱外伤的ＭＲＩ征象可分为：１）椎旁软组织损伤５例（１３．５）；２）椎后韧带损伤７例（１８．９％）；３）椎体骨折３７例（１００％）；４）椎间盘损伤７例（１８．９％）；５）椎管内异常（包括硬膜和脊髓受压，脊髓损伤）３２例（８６．５％）。临床症状的轻重和预后与脊髓损伤类     

硫酸镁对急性心肌梗塞溶栓治疗后再灌注心律失常的防治

选择急性心肌梗塞具有溶栓治疗指征思考９２例，用蝮蛇抗栓酶静脉内溶栓获冠脉再通８４例。分为硫酸镁组５２例，对照组（利多卡因）３２例。２组均在溶栓前３０ｍｉｎ给药。结果：硫酸镁组发生再灌注心律失常（ＲＰＡ）２４例（５６．１％），心衰３例（５．７％），死亡４例（７．６％）。对照组发生ＲＰＡ２７例（８４．３％），心衰４例（１２．５％），死亡４例（１２．５％），２组差异显著。作者对ＲＰＡ发生机理进行了讨论。     

系统笥硬化症肺损害52例临床分析

分析５２例系统性硬化症患者肺部病变，包括４例尸检，４２例（８０．８％）有不同程度的胸部Ｘ线异常，３２例（６１．５％）有明显肺纤维化征象，５例无肺间质纤维化而以肺动脉高压和（或）心衰为突出表现。死亡１４例均有明显的心、肺受累，死亡大多与肺部感染有关。５２例中有６例伴发恶性肿瘤。     

亚临床型甲状腺功能减退症的诊断和治疗

进修医生什么是亚临床型甲状腺功能减退症（亚临床型甲减）？它和甲状腺功能减退症（甲减）有什么区别？患病率高吗？教授亚临床型甲减是指促甲状腺激素（TSH）升高，血浆游离甲状腺素（FT４）正常的甲减。它和甲减的区别在于FT４正常，而不是降低。亚临床型甲减的患病率为２．５％～１０．４％，这种差异是由于诊断标准不同，以及被调查人群的年龄、性别和碘摄入的分布不同所致。在美国的一项有２５０００人参加的健康调查中发现，亚临床型甲减的患病率为８．５％。一般认为，女性患病率高于男性，老年女性的患病率更高。进修医生亚临床…     

彩超诊断男性不育患者亚临床精索静脉曲张及动态监测手术前后睾丸容积

本文报道彩色多普勒超声诊断３１例亚临床精索静脉曲张（ＳＶＣ）。与手术或造影结果对照，超声诊断准确性９３．５％，男性不育症中ＳＶＣ检出率５８．５％。彩超判断ＳＶＣ标准是：静态下从同一静脉床检测到３支以上静脉，其中１支≥３ｍｍ或增腹压时≥３ｍｍ伴自发性或Ｖａｌｓａｌｖａ诱发返流。依据返流是诱发或自发，ＳＶＣ分滞留型与分流型，通常以前者为主（８３．９％）。Ｖａｌｓａｌｖａ试验可致多普勒假阳性，静脉床灰阶图像和ＶＲ、ＴＲ波型定量分析是消除假阳性的有效方法。文中２１例ＳＶＣ术后与术前比较，精子数量和活动度显著增加（Ｐ＜０．０５～０．０１），左侧睾丸容积增加（Ｐ＜０．０５），其中４例恢复生育力。由此证实彩超诊断ＳＶＣ的实用价值和病因治疗重要性。     

食管上段癌临床误诊分析

食管上段癌临床误诊分析江苏省扬州市人民医院２２５００１李家驹我院１９８３年５月至１９９３年１１月共作纤维胃镜检查１７７３５例，检出食管癌７５２例（４．２５％），其中食管上段癌１６４例（ＺＩ．９％），食管中段癌３５２例（４６．９％），食管下段癌２３６例...     

动态喉镜在耳鼻科疾病中的诊疗价值

目的　探讨动态喉镜在耳鼻科疾病中的诊疗价值。方法　对临床确诊的耳鼻科疾病或疑有鼻咽部病变者８７８ 例进行动态喉镜检查与治疗。结果　鼻咽部正常８７ 例（９ ．９ ％ ） ，鼻咽癌２０３ 例（２３ ．１ ％ ） ，卡他性中耳炎（ 咽鼓管吹张）１１８例（１３ ．４ ％ ） ，其他疾病４７０ 例（５３ ．６ ％ ） 。结论　拓宽了动态喉镜应用范围，对各种疾病的诊断与鉴别诊断提供了初步依据，为鼻咽癌患者提供完整图像追踪观察资料，为鼻咽癌普查、早期诊断提供条件。图像倍数放大使局部治疗和活组织检查部位更准确。     

妊娠合并严重心脏病36例临床分析

我院从１９９３年１月－１９９９年１２月共收治妊娠合并心脏病３９６例，其中３６例为严重心脏病（９．０９％）。不论何类心脏病，定为严重心脏病的依据是：（１）曾有心力衰竭史，此次妊娠时心功能为Ⅰ－Ⅱ级者；（２）此次妊娠或临产期间，心功能曾为Ⅲ级或以上者；（３）虽无心衰，但有心房颤动或有其它严重心律失常治疗无效者。现分析如下。临床资料一、一般资料本组初产妇３１例，经产妇５例。年龄２０－３５岁，平均２６．４岁。按期产前检查３例，不按期或偶做产前检查２４例，未做产前检查９例。入院时孕周２９周～４２周。心功能…     

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.