术后读片:右侧胸腔肿物一例

病例资料 男,54岁,体检发现右下肺野肿块8年.患者自诉8年前体检发现右肺肿块,无咳嗽、咳痰,无胸闷、气促,随访肿物一直未见明确增大.近4个月来患者出现运动后乏力,外院就诊时体格检查呈贫血貌,诊断为贫血,行胸部CT及PET/CT检查示右肺巨大肿物,考虑为恶性肿瘤.既往3年前有甲状腺瘤手术史,个人史、婚育史、家族史无特殊.专科检查右下肺呼吸音减弱.实验室检查:RBC 2.26×1012/L,Hb 65 g/L;非小细胞肺癌抗原(CFRA21-1)轻度增高(3.41 ng/ml);特异性神经元烯醇化酶(NSE)及癌胚抗原(CEA)均在正常范围. 饶医生:正位胸片示一巨大肿物占据右中下肺野大部,上下缘较光滑,内侧缘与纵隔分界不清,外侧缘与右胸壁相贴,侧位胸片见肿物与心影重叠;病灶密度较均匀,未见钙化或空洞.CT检查示右侧胸腔内巨大肿块,边界较清楚,其内见多发囊变、坏死区;增强后肿块实性部分呈明显且不均匀强化,囊变、坏死区无强化;右肺中叶呈压迫性不张,增强后均匀强化.PET/CT检查示该肿块对18F-FDG呈高摄取,代谢活跃,其他部位未见异常18F-FDG高摄取灶.     

右胸腔巨大胸腺囊肿1例

患者,男,39岁。心慌、气短,伴咳嗽、潮热10年,加重1月入院,查体:右中下肺呼吸音及语颤明显降低。X线胸片示:右侧后胸壁见直径约18cm“D”形肿块影。密度均匀,肿块壁部分线样钙化。考虑右侧胸腔巨大包裹性积液伴胸膜增厚。胸部CT检查示右胸中下部紧贴侧后胸壁见16cm×15cm×10cm大小囊实性肿块,形态规则,边界清楚,壁弧形钙化,囊内CT值35～4 7Hu,邻近肺组织受压(图1)。手术所见:右侧胸腔巨大厚壁囊性包块,与右肺、膈肌及胸壁致密黏连。完整摘除包块。病理诊断:右胸内胸腺囊肿(图2 )。讨论胸腺囊肿少见,约占纵隔肿瘤(包括囊肿)的1%～2 % [1]…     

女性后纵隔精原细胞瘤1例

患者女 ,2 2岁 ,咳嗽 ,咯血 1月余。胸部正侧位X线片示 :右侧胸腔中等量积液 ,右肺中叶不张并肺门肿块。超声检查示 :心包大量积液 ,腹腔间隙少量积液 ,右侧胸腔大量积液。胸部CT示 :右侧胸腔、心包大量积液 ,纵隔少量积液 ;前纵隔、隆突下、主 肺动脉淋巴结肿大、融合成片块状 ,包绕在大血管周围 ;右后纵隔中下份内见一圆形巨大块影 ,约 9.5cm× 7.1cm× 10 .5cm大小 ,CT值为4 3.9Hu ,增强后肿块轻度强化 ,CT值为6 7Hu ,肿块向右侧生长 ,突破胸膜 ,包绕中间段及下叶支气管 ,致管腔狭窄 ,但仍可见含气支气管 ,肿块边缘清楚 ,无分叶 ,密…     

小细胞肺癌误诊为恶性间皮瘤1例

患者男,33岁,因干咳、活动后呼吸困难20天入院.于当地医院接受消炎治疗20天,效果欠佳.入院查体:一般状况良好,右侧肩胛下区触觉语颤减弱,叩诊呈浊音,呼吸音减弱.痰结核菌涂片阴性.CT示右侧肺内可见多发大小不等的团块状阴影沿胸膜分布,右肺上叶可见不规则形实变影,其内可见支气管充气征,纵隔向左移位,纵隔、肺门未见明显肿大淋巴结(图1、2).右侧大量胸腔积液.考虑右侧胸膜恶性间皮瘤,伴右肺上叶肺不张.入院后反复抽取胸水为血性,胸水常规以淋巴细胞为主,胸水中LDH升高875 IU/L,蛋白定量＞3 g/L.CT引导下穿刺病理证实为小细胞癌(图3).     

结核性纵隔炎1例报告

1　病历简介男 ,4 1岁。因右侧胸痛、胸闷伴发热、盗汗 1周收住院。既往体健。入院前曾做X线胸片未见异常。入院后查体 :T38℃ ,右肺下稍叩浊 ,呼吸音稍弱。入院后即复查X线胸片示 :右侧胸腔少量积液。ESR为 4 0mm/h。PPD实验阳性。临床考虑结核性胸膜炎 ,并予以抗结核治疗 ,胸痛、胸闷减轻 ,但未完全缓解 ,后又复查X线胸片示 :右侧胸腔积液 ,右侧纵隔积液 ,右侧叶间积液。在抗结核治疗的基础上 ,短期内积液量明显增多 ,曾考虑胸腔转移性肿瘤或胸膜间皮瘤 ,后经胸部CT检查除外上述可能 ,只提示右侧胸腔少量积液 ,纵隔大量积液 ,叶间积…     

胸腺囊肿伴胰腺异位1例

患者男性，43岁。因咳嗽，胸痛伴低热10余天入院。外院CT示右前纵隔占位性病变，恶性胸腺瘤可能性大，右侧胸腔少量积液。我院彩超示右前纵隔第2，3肋间探及一7.6cm×6.8cm×6.2cm的囊性包块，壁厚达4.8mm，形态规则，边界清，回声差。[第一段]     

肺癌引起膈肌麻痹一例误诊分析

1病例资料女,56岁。因咳嗽、咳痰、气短在外院诊断为上呼吸道感染,予抗炎对症治疗后仍觉气短,尤以卧位时明显,摄X线胸片示右侧胸腔积液,为进一步明确诊断来我院。查X线胸片示:双肺纹理清晰,右肺门影较浓,右侧膈肌抬高约2个肋间,双侧肋膈角锐利。胸腔B超示:右侧膈肌活动度消失,急促呼吸时出现横膈矛盾运动,未发现胸腔积液,考虑右侧膈肌瘫痪。行胸部CT检查,发现右肺门增大,纵隔淋巴结大,右肺下叶心缘旁可见一块影,右侧膈肌明显抬高。考虑肺癌引起膈肌麻痹。行纤维支气管镜检查见右肺中下叶开口处黏膜下隆起,黏膜局部充血,经局部取活检并进行…     

乳腺淋巴瘤胸腔积液细胞学误诊1例

患者女性,70岁。因胸闷、气喘、发现双侧胸腔少量积液入院。查体:右乳外下象限触及直径4 cm的肿块,界限清,质硬。血清学检查:CA125 135 KU/L,铁蛋白358μg/L,均升高。CT示纵隔多发性淋巴结肿大,且互相融合,诊断为右侧乳腺癌纵隔淋巴结转移。抽胸腔积液送病理细胞学检     

原发性纵隔内胚窦瘤合并胚胎癌1例

男,25岁,近半月出现乏力,咳嗽,咳痰,痰中时带有鲜红色血块及黄粘痰,稍气促,有畏寒、发热,无胸痛。体检示：右侧语颤增强,扣诊呈浊音,听诊右肺呼吸音低。胸部正侧位片示：右肺野见大片状欠均匀致密阴影,边缘尚清晰,心前三角消失,主动脉伸展,向后移位,右侧助隔角较钝。食道钡餐检查显示食道通畅,无受压移位征象。拟诊为右上纵隔肿块。CT示：右前上纵隔内见10cm×15cm×13cm团块影,呈椭圆形,境界清晰,混合密度,CT值为4－120Hu不等。肿块影与上腔静脉、心包粘连,并向左侧推移,右肺支气管受压、变窄,右侧胸腔少量积液。…     

肺内巨大支气管囊肿1例

1病例报告男,46岁。反复咳嗽、间断发热5 a伴右胸痛,时有咳浓痰,呼吸困难半个月入院,检查右侧颈静脉怒张,气管偏左,叩诊实音,右呼吸音消失。胸片示右肺囊性占位性病变。CT示:右胸腔囊肿有15 cm×10 cm×10 cm,入院后给予吸氧营养支持疗法,然后进行胸腔囊肿内穿刺减压,抽出液体600 ml,于2005-12-09在全麻下行右后外侧切口,第6肋间进胸,见囊肿与胸壁紧密粘连,吸出粘稠液体1 500 ml。充分游离暴露囊腔,术中探查右肺中叶内有15 cm×10 cm×10 cm大小,囊壁粗糙,与肺中叶胸膜广泛粘连,右肺中间气管与囊腔相通。右肺中下叶完全实变,肺与膈肌粘连较…     

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.