阴茎纤维肉瘤超声表现一例

患者男,38岁.主因阴茎中段结节,排尿困难来本院行超声检查.查体:外生殖器无畸形,阴茎中部海绵体可触及大小为2.0 cm×3.0 cm×1.5 cm质硬肿物,与周围组织无明显粘连,无压痛,睾丸、附睾无压痛.超声检查示:阴茎中段海绵体内可见一大小为1.21 cm×2.66 cm团状中强回声(图1),形态不规则,边界不清,后方回声衰减,移动度差.彩色多普勒血流成像示其内血流信号异常丰富(图2).腹股沟未见明显肿大淋巴结回声.超声提示:阴茎中段海绵体实性占位(性质待定).遂行超声引导下肿物穿刺活检,病理示:尿道海绵体纤维肉瘤.     

乳腺错构瘤超声表现一例

患者女,20岁.1年前无意中发现左乳一肿物约蚕豆大小.发病以来,肿物渐增大,轻度按压痛,无红肿.超声所见:左乳内下象限扫查到一大小约4.5 cm×1.3 cm×4.4 cm低回声实性结节,呈椭圆形,边界清晰,内见线状弱回声(图1).彩色多普勒血流显像:结节内未扫查到明显血流信号.超声提示:左乳实性结节,疑似纤维腺瘤.大体标本所见:扁圆形肿物一个,大小约4.0 cm×1.5 cm×4.0 cm,表面光滑,切面灰白,质稍韧,包膜完整.术后病理组织学镜检:瘤体内以纤维成分和腺体成分为主,脂肪成分较少(图2).病理诊断:(左乳)错构瘤.     

睾丸曼氏裂头蚴病超声表现1例

患者男,24岁.发现右侧阴囊间断性胀痛半年,时轻时重,尚能忍受.半月前发现"花生米"大小肿物.查体:右侧阴囊可触及径约1 cm肿物,不活动.超声检查:双侧睾丸大小正常,实质回声不均匀,可见散在点状强回声;右侧睾丸实质内见1个无回声为主的混合回声肿物,边界清晰,无回声区内可见条索状高回声,并可见细密点状低回声,CDFI:肿物周围血流信号丰富;左侧附睾头内可见3个无回声肿物,周边界限清晰,较大的大小0.49 cm×0.43 cm,右侧附睾头内可见1个无回声肿物,周边界限清晰,大小0.32 cm×0.24 cm,CDFI:内部未见明显血流信号.     

儿童睾丸和附睾腺瘤样瘤超声表现1例

正患者男,3岁,体检发现左侧睾丸包块就诊。体格检查:左阴囊内可扪及一大小约2.0cm×1.0cm×1.0cm的囊实质性包块,左睾丸扪及不清,无触痛压痛;患儿有左肾缺如史。超声检查:左侧睾丸稍大,内可见大小约1.3cm×0.8cm×0.8cm的混合性回声团块,边界欠清,实性部分内可见细密点状回声,囊性部分呈多房囊样分隔。CDFI示团块内可见少许星点状血流信号。左侧附睾头部可见一大小约0.6cm×0.3cm的囊性区,见图1。右侧睾丸及附睾未见明显异常。     

超声诊断附睾囊肿伴钙乳一例

患者男,20岁.偶然发现右侧阴囊内无痛性肿物1个月余,无下坠等不适.体检:右侧睾丸上方可触及一直径约1.0 cm硬结,无移动性.临床拟诊附睾肿物.超声显示:在右侧睾丸和附睾头间可见一大小约0.60cm×0.55 cm的圆形无回声小结节,边界清晰,后方回声增强.其内可见分层现象及密集的点状强回声(图1),并随体位改变而移动.     

眼眶孤立性纤维性肿瘤超声表现1例

患者女,25岁,已婚,因发现"左侧眼球突出"9个月入院.眼科检查:VOD 1.0、VOS 0.3,右眼球突出16 mm,左眼球突出23 mm,左侧上眼眶皮下未扪及包块,无红肿、压痛,左眼球向外、向上运动受限;眼前节(-),眼底(-),眼压:正常(Tn).入院诊断:左眼眶肿瘤?超声表现:双侧晶状体及玻璃体未见明显异常.左眼球后软组织内可见一大小约2.5 cm×1.8 cm×1.3 cm的实性低回声肿块(图1),形态欠规则,边界欠清楚,内部回声不均质.彩色多普勒血流显像:包块内可见较丰富的血流信号(图2),频谱多普勒探测为动脉频谱,RI:0.57.     

彩超诊断睾丸巨大畸胎瘤分析1例

患者男,28岁.无意间发现左侧阴囊肿大、坠胀20 d余,来我院就诊.体检:左侧阴囊明显肿大,触之质硬,阴囊皮肤颜色正常.彩色超声阴囊探查:右侧睾丸轮廓清楚,形态规则,大小约29 mm×19mm×18 mm,切面内部回声均匀,未见明显占位.左侧正常睾丸与附睾未显示,左侧阴囊内探及一40mm×35 mm的混合回声包块,以囊实性为主,内回声杂乱,内可见呈"面团样"强回声(图1),实性回声内可见少量血流信号(图2).超声诊断:左侧阴囊混合回声包块,考虑畸胎瘤.患者收住院行左侧睾丸切除术,术后病检左侧睾丸畸胎瘤.     

超声诊断附睾血管平滑肌瘤一例

患者男,48岁,因偶然发现左侧"睾丸肿物"就诊.无疼痛、触痛、肿胀、发热等症状.体检:左侧阴囊内触及一结节,直径约1cm,质地较硬,无活动.声像图显示双侧睾丸大小、形态正常,实质回声均匀,未见占位性病变.左侧附睾体尾交界处见一偏强回声结节,大小约0.8cm×0.7cm,边界欠清,形态规则(图1);彩色多普勒显示结节周边有血清包绕,并见一支血流从外周进入结节内;脉冲多普勒提示动脉血流频谱(图2).右侧附睾未见异常.超声印象:左侧附睾实性结节:(1)炎性病变;(2)占位性病变待除外.为明确诊断行超声引导穿刺活检(图3),病理诊断为左侧附睾血管平均滑肌瘤(图4).     

超声诊断小儿腹膜后淋巴管瘤疝入阴囊2例

例1,男,2.5岁.因阴囊肿物2年就诊.查体:一般情况良好,腹平软,未及肿物.左侧阴囊可触及一包块,大小约5.0cm×2.0 cm,透光试验(+),无压痛,不能还纳.双侧睾丸可触及.临床诊断:左侧精索鞘膜积液.超声检查:双侧睾丸大小、形态正常,回声均匀.于左侧阴囊可测及范围约6.3 cm×2.4cm×3.1 cm无回声肿块,其内可见少许纤细强回声带分隔(图1).沿左侧腹股沟管上行扫查盆腔,于左下腹可测及范围约5.6 cm×3.8 cm×4.1 cm无回声肿块,与膀胱左侧壁毗邻,形态欠规则,位置较固定,内部可见多发纤细强回声带分隔(图2).彩色多普勒血流显像(CDFI)示肿块内未检出血流信号.动态下观察左下腹肿块与阴囊肿块于左侧内环口处相连,狭细如"瓶颈样"改变(图3).超声诊断:左下腹囊性肿物疝入阴囊,腹膜后淋巴管瘤可能性大.手术所见:左侧内环口处囊性肿物呈"哑铃状",位于腹膜后,突入腹腔部分约5.5 cm×3.5 cm×4.0 cm,经内环口疝入阴囊的部分约6.0 cm×2.0 cm×3.0cm.肿物包膜完整,遂行切除.病理诊断:(腹膜后)淋巴管瘤.     

巨大睾丸畸胎瘤恶性变彩超表现1例

患者男,41岁.因阴囊逐渐肿大伴阴囊坠胀4月余入院.8年前曾行左侧腹股沟疝修补术及左侧隐睾复位固定术.彩超检查示阴囊内为一大小约14.0cm × 8.0cm × 8.2cm囊实性团块占据,边界欠清,形态欠规则,以实性为主,实性部分内可见动脉及静脉血流(图1),动脉血流峰值流速13.2 cm/s,阻力指数0.79,肿物右后方紧贴一大小约3.0 cm ×1.7cm正常睾丸组织回声,睾丸鞘膜腔内可见不规则液性无回声区.超声提示:阴囊占位性病变(结合临床考虑来自左侧睾丸).     

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.