急性胰腺炎的超声诊断

目的探讨急性胰腺炎的超声诊断及其应用价值。方法56例经CT扫描、临床及手术病理证实的急性胰腺炎,就超声表现、分型和诊断价值加以分析。结果56例急性胰腺炎患者中,超声诊断为急性胰腺炎42例(75%),急性水肿型31例(73.8%),超声表现为胰腺弥漫性肿大,边界清晰,实质回声减低。急性出血坏死型11例(26.2%),超声表现为胰腺增大,边缘模糊,回声减低且不均匀,漏诊14例(25%)。结论超声对急性胰腺炎的检出率较高,并能做出分型诊断,具有较高的临床应用价值。     

超声对急性胰腺炎的诊断与分析

目的:探讨急性胰腺炎时的超声表现。方法:分析了105例急性胰腺炎的声像图特征。结果:急性胰腺炎声像图主要表现为胰腺肿大、增粗、实质回声异常、网膜囊积液、肠管胀气及胸、腹腔积液、胆道系统异常。结论:超声对急性胰腺炎能够准确诊断,是急性胰腺炎的首选检查方法。     

162例急性胰腺炎的超声诊断体会

对162例急性胰腺炎的声像图进行测量、分析,并结合临床表现和实验室结果。162例中超声诊断为急性胰腺炎158例,漏诊4例。158例中,急性水肿型121例,超声表现为胰腺弥漫性肿大、边界清晰、实质回声减低呈不均匀的片状低回声、无回声或弱回声,夹杂有稀疏光点,少部分出现胰周少量积液。急性出血坏死型37例,超声表现为超声主要改变为胰腺体积弥漫性轻度增大,边缘模糊、回声减低且不均匀,胰腺周围积液。超声诊断急性胰腺炎方法直接、简便、无痛、无创、迅速,对制定治疗方案与评估预后,具有重要的临床应用价值,应作为首选检查手段之一。     

急性胰腺炎39例早期声像图改变与年龄的关系

目的探讨超声对早期急性胰腺炎不同年龄段的声像变化及其诊断价值。胰腺实质回声随年龄增长呈增强趋势,老年人应依据其超声测值和回声特点来判断。方法对确诊的39例急性胰腺炎的超声图像进行综合分析,并对39例急性胰腺炎胰周积液情况和其中的30例急性水肿型胰腺炎胰腺大小、回声特征分19~40岁,41~60岁,61~79岁3个年龄组重点讨论。内容包括胰腺大小、边界、内部回声、周围结构、胰周积液及病理分型等。结果39例急性胰腺炎中急性水肿型30例(76.9%),急性出血坏死型9例(23%),小网膜囊积液17例(43.6%),有30例胰腺呈弥漫性或局限性不同程度的肿大,7例大小正常,2例因肠腔气体干扰显示不清。超声诊断符合率94.9%。急性水肿型胰腺炎表现为胰腺形态饱满,22例肿大,7例回声偏低,18例弥漫性增强,边界清晰或稍显模糊,尚规则,10例小网膜囊积液,8例主胰管扩张。其中在18例回声增强中19~40岁11例回声增强2例(18.2%),41~60岁11例回声增强9例(81.8%),61~79岁8例回声增强7例(87.5%),回声高低与年龄增长有相关性;急性出血坏死型胰腺炎表现为胰腺形态欠规则或极不规则,回声强弱不均,8例肿大,以头尾肿大显著,边界模糊或清晰,7例伴有程度不等的小网膜囊窄带状,不规则片状无回声或低回声积液,2例主胰管扩张。39例急性胰腺炎胰周积液17例19~40岁13例发生3例(17.6%),41~60岁15例发生10例(58.8%),61~79岁11例发生4例(23.5%)。41~60岁年龄段小网膜囊积液发生率增高,不同年龄回声各有其特征。结论超声对不同年龄段急性胰腺炎有较高的诊断价值,但仍有一定的局限性。     

胆囊结石并发急性胰腺炎的超声诊断及价值

目的：探讨胆囊结石并发急性胰腺炎的超声诊断及价值。方法：采用超声检查32例胆囊结石并发急性胰腺炎患者,观察胆囊内结石大小与数量并进行比较,同时观察胰腺大小、形态、实质回声及周围情况。结果：胆囊结石中81.1%（26/32）为多发性结石,其中81%（21/26）为直径〈0.9cm的小结石。结论：多发性且直径小的的胆囊结石患者并发急性胰腺炎的发病率明显增高。超声检查胆囊结石可为临床提供急性胰腺炎的可能病因,并为胆囊结石患者选择性地施行胆囊切除术提供影像学诊断依据。     

胆囊结石并发急性胰腺炎的超声诊断价值

目的探讨胆囊结石并发急性胰腺炎的超声诊断价值。方法采用超声检查37例胆囊结石并发急性胰腺炎患者,观察胆囊内结石大小与数量并进行比较,同时观察胰腺大小形态、实质回声及周围情况。结果胆囊结石中83.8%（31/37）为多发性结石,其中80.6%（25/31）为直径小于0.9cm的小结石。结论多发性且直径小的胆囊结石患者急性胰腺炎的发病率明显增高。超声检查胆囊结石可为临床提供急性胰腺炎的可能病因,并为胆囊结石患者选择性地施行胆囊切除术提供影像学诊断依据。     

超声诊断急性胰腺炎的临床价值

目的探讨超声对急性胰腺炎病因及其并发症的诊断价值。方法回顾分析了２０００年－２００１年２月间由超声检查发现的急性胰腺炎２６例。结果超声对急性胰腺炎病因及并发症的诊断非常重要,尤以对局部并发症坏死、脓肿及假性囊肿的诊断,有助于急性水肿型胰腺炎和急性坏死型胰腺炎的鉴别。结论超声对急性胰腺炎病因及其并发症的诊断具有重要意义,对指导治疗、选择方案及预后提供可靠依据。     

B超在急性胰腺炎中的诊断价值

为探讨急性胰腺炎的声像图特征及超声诊断价值，本文对经B超、CT检查和临床表现、生化检查及部分手术证实的80例急性胰腺炎作一回顾性分析。80例急性胰腺炎超声正确提示75例，诊断符合率94％，超声提示胰腺无明显变化5例。超声诊断的价值在于能对急性胰腺炎提供较早期的诊断，可及早发现胆囊、胆道结石等病变而导致的胆源性胰腺炎，减少及发现并发症，为临床提供明确诊断治疗及手术时机。     

胰管蛔虫致急性胰腺炎超声观察

目的 分析胰管蛔虫致胰腺炎的超声图像改变.方法 本组7例胰管蛔虫致急性胰腺炎,采用上腹部横纵扫查及左右腰季助部斜纵扫查,观察胰腺及胰管回声.结果 本组7例胰管蛔虫致急性胰腺炎都有胰腺肿大,胰管扩张直径为0.5～1.0 cm,胰管内有索状强光带,从胰头至胰尾贯穿整个胰腺.结论 蛔虫窜入胰管内,用超声即可获得典型特异回声表现.     

超声对急性胰腺炎严重程度的判断

目的 通过将胰腺炎（AP）病人的超声检查结果与临床、实验室检查的对比研究评价超声对胰腺炎严重程度的判定价值。方法 本文总结了84例急性胰腺炎病人,按检查结果将其分为三组,A组：胰腺超声显像正常,周围无渗出：B组;胰腺表面不光,内部回声不均匀;C组：在B组的基础上伴有周围渗出。结果 三组病人在临床表现及实验室检查结果等方面存在不同程度的差异。在84例病人中,根据Ranson诊断标准判断出重症胰腺炎22例,其中19（86%）例位于C组。结论 此研究显示超声检查对急性胰腺炎病人病情程度的判断有很大帮助。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

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.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.