锁骨下动脉瘤1例

患者女,59岁,甲状腺癌术后1年余,高血压病史15年,头晕、头痛10年.颈部超声:于横切面见左锁骨下动脉前壁瘤样结构向外突起,约8 mm×6 mm,距椎动脉开口约13 mm(图1).CDFI于瘤体内见丰富血流信号(图2).超声诊断:左锁骨下动脉瘤.CTA:左锁骨下动脉胸廓内动脉起始段局限性隆起,约0.7 cm×0.5 cm,边界清晰,距离椎动脉开口约14 mm(图3);锁骨下动脉其余部分及其分支未见明显异常.CTA诊断与超声一致.     

彩超诊断颈动脉体瘤1例

患者女,31岁.因"右侧颈部无痛性肿块1年"来我院检查,超声检查示:右侧颈部皮下软组织内可见实质低回声区,大小约30 mm×37 mm,该实质低回声区包绕右侧颈总动脉分叉处,可见右侧颈外动脉及颈内动脉穿行其中(图1),彩色多普勒示:该实质低回声区内血流极丰富,呈网络状.超声诊断:右侧颈动脉体瘤.后经颈动脉血管造影证实.     

彩色多普勒血流显像诊断肠系膜上动脉瘤1例

患者男,56岁.主因"5天前无诱因出现上腹痛,加重2天"来我院就诊.患者自述疼痛呈间断性、针刺样,无放射痛,进食或改变体位疼痛无变化;偶有上腹胀痛、恶心;高血压史5年,慢性胃炎史10年.超声检查:扫查胰腺时,横切面探及脾静脉后方一瘤样结构向前突起(图1),纵切面与肠系膜上动脉(superior mesenteric artery, SMA)延续并与之相通(图2),瘤体距SMA开口处约57 mm,大小约30 mm×22 mm,瘤壁可见强回声钙化.     

左颈总动脉瘤伴分叉畸形1例的超声表现

1 临床资料 患者女，45岁。声音嘶哑、头晕来院就诊。颈动脉超声检查：左颈总动脉近分叉处见瘤样扩张，瘤体内径10.2mm，其内血流呈漩流（图1），分叉后直行的为颈内静脉，折向后下方的为颈外动脉（图2），分叉角度约120°。右颈总动脉未见异常。超声诊断：左颈总动脉瘤伴分叉畸形。经血管造影证实。     

肾实质内假性动脉瘤1例

患者男,50岁,半年前因左肾透明细胞癌行肿瘤切除术,术后情况良.外院超声检查发现左肾囊肿来院复诊.二维超声示左肾下极实质内一极低回声团块,3.12 cm×2.94 cm,内见细小弱回声,边界清,与囊肿声像图类似,但无明显囊壁回声;彩色多普勒示团块内血流信号丰富,呈红蓝相间的涡流,一侧以蓝色为主,另一侧以红色为主;频谱多普勒于瘤体一侧通道处测得收缩期为流向瘤体远端的高速动脉频谱(峰值流速115.46 cm/s),舒张期为逆向返回瘤体近端的较低流速频谱(峰值流速53.28 cm/s).超声诊断:左肾实质假性动脉瘤(图1).     

超声诊断左侧颈总动脉及颈内外动脉血栓栓塞1例

患者男,86岁,高血压病史20余年.因"高血压心脏病,脑梗死,心功能衰竭"入住心内科.体格检查:右上肢血压150/100 mm Hg(1 mm Hg=0.133 kPa),左上肢血压80/60 mm Hg,右侧桡动脉搏动明显较左侧增强.超声检查:左侧颈总动脉内中膜粗糙增厚,显示较模糊,左侧颈总动脉管壁可见多处斑片状强回声,最大范围6.5 mm×1.9 mm,后伴声影.左侧颈总动脉管腔内可见不均质中低回声充填,长约5.0 cm,延续至颈内、颈外动脉起始部管腔内.彩色多普勒血流成像(CDFI):左侧颈总动脉及颈内外动脉起始部均未探及血流信号(图1、2).右侧颈总动脉内径增宽,达8.4 mm,搏动增强,测血流频谱流速增快,峰值血流速(Vmax):93 cm/s.双侧椎动脉管径正常,右侧Vmax:58 cm/s,左侧Vmax:32 cm/s.超声诊断:①左侧颈总动脉延续至颈内外动脉起始部管腔内血栓形成,管腔闭塞;②右侧颈总动脉内径增宽,血流代偿性增加.     

CDFI及CTA诊断肾动脉瘤合并狭窄1例

患者男,38岁,反复发作头晕、头疼20余天,疼痛呈间断性,并逐渐加重;否认高血压史.体检:收缩压最高达190 mmHg.超声:上腹部横切面扫查:右肾动脉起始段探及一瘤样结构与腹主动脉相通,约22 mm×18 mm,瘤内可见絮状低回声部分充填,瘤后肾动脉管腔纤细(图1);纵切面扫查:瘤体位于肠系膜上动脉后下方(图2);CDFI:瘤体内可见腹主动脉血流进入,部分充盈,瘤体后方血流显示不清(图1);右肾下极可见动脉信号自肾外进入实质内.     

彩色多普勒超声对颈动脉体瘤的诊断价值

目的 探讨彩色多普勒超声在颈动脉体瘤诊断中的应用价值.方法 回顾分析11例患者颈动脉体瘤的声像图表现.结果 颈动脉体瘤声像图表现为颈动脉分叉处见实质性低回声肿块,边界清楚、边缘较规则、无明显包膜.肿瘤较小时,多位于颈总动脉分叉处,使颈内、外动脉间距增大;肿瘤较大时,常围绕血管生长.CDFI显示肿瘤内较丰富的血流信号,以动脉为主;用彩色多普勒能量图更能清晰地显示肿瘤内血流与颈动脉的关系;频谱多普勒显示:肿块内以动脉为主,为低速低阻型血流.结论 彩色多普勒超声是诊断颈动脉体瘤具有较大实用价值的首选方法.     

三维超声诊断胡桃夹综合征并左肾静脉瘤1例

患者女,19岁,体型消瘦(体质量指数18.2 kg/m2),因外院尿常规检查提示尿蛋白阳性来我院就诊。常规超声检查:双肾未见明显异常;左肾静脉于腹主动脉左前方呈瘤样扩张,范围约25 mm×19 mm(图1);左肾静脉于腹主动脉和肠系膜上动脉之间的夹角处明显受压,管腔纤细,内径1.0 mm;彩色多普勒超声示夹角间左肾静脉流速明显加快,峰值流速为171 cm/s(图2),左肾静脉于腹主动脉左前方流速为15 cm/s。三维超声检查:左肾静脉受压处管腔纤细,远心端呈瘤样扩张,内未见明显栓子(图3)。超声提示:①胡桃夹综合征;②左肾静脉瘤。     

彩色多普勒超声诊断颈动脉体瘤1例分析

患者:女,36岁。因左颈部间歇性搏动性疼痛3年、加重伴左侧头痛1个月入院。查体:左颈乳突下方可见明显搏动区,可触及一搏动性包块,大小2.5×3.0 cm,质中,边界清,有触痛,移动性差,无杂音及震颤。超声检查:可见以左侧颈总动脉分叉处为中心、梭形实质性较均匀回声区,大小为5.0×3.0×4.0 cm,边界清晰,颈内动脉、颈外动脉被该实质性回声包绕,该瘤上部终止于距分叉1.2 cm(如图)。脉冲多普勒于包块内记录到动脉血流频谱,彩色多普勒记录到红、兰色血流束。超声诊断:左颈动脉体瘤。手术所见:肿瘤位于以分叉为中心,包裹颈总、颈内、颈外动脉,瘤体大小5…     

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征（LQTS）、短QT综合征（SQTS）、Brugada综合征（BrS）和儿茶酚胺敏感性多形性室性心动过速（CPVT）,总结它们在发病机制及诊治方面的进展。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

Organ Preservation: Current Concepts and New Strategies for the Next Decade

SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.     

2017年呼吸疾病主要进展

2017年,国内外学者在呼吸系统疾病的临床和基础领域均进行了深入研究,不仅对相关指南进行了更新,并且针对一些临床热点、难点问题达成专家共识,现就2017年呼吸疾病相关进展作一简单介绍。     

家族性噬血细胞性淋巴组织细胞增生症1例并文献复习

目的加强对家族性噬血细胞性淋巴组织细胞增生症（familially hemophagocytic lymphohistiocytosis,FHL）的认识。方法报道确诊为FHL的新病例1例,结合国内外报道的FHL的病例,对该病的临床特点进行汇总分析。结果FHL2常与PRF1基因突变相关,约20%~40%的患者存在穿孔素基因突变。结论对于有阳性家族史,基因诊断明确,应尽早行化疗或者造血干细胞移植。若无家族史,未发现与继发性HLH相关的原发病因,可考虑行基因筛查以明确是否存在FHL的可能。     

COVID‐19 and COVID‐19 vaccine‐related dermatological reactions: An interesting case series with a narrative review of the potential critical and non‐critical mucocutaneous adverse effects related to virus,therapy, and the vaccination

This narrative review article was conducted to lay out a summarized but exhaustive review of current literature over mucocutaneous manifestations in 4 dimensions of SARS‐CoV‐2 pandemic: virus itself, treatment‐related, vaccine‐induced, and alteration of chronic dermatologic diseases following infection. Virus and vaccine‐related were mainly self‐limited and non‐severe. Treatment‐related reactions could be life‐threatening.     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

Real‐life effectiveness of biological therapies on symptoms in severe asthma with comorbid CRSwNP

BackgroundWe aimed to evaluate the effectiveness of different antibody therapies on nasal polyp symptoms in patients treated for severe asthma.MethodsWe performed a retrospective analysis of patients with severe asthma and comorbid CRSwNP who were treated with anti‐IgE, anti‐IL‐5/R or anti‐IL‐4R. CRSwNP symptom burden was evaluated before and after 6 months of therapy.ResultsFifty patients were included hereof treated with anti‐IgE: 9, anti‐IL‐5/R: 26 and anti‐IL‐4R: 15 patients. At baseline median SNOT‐20 was similar among groups (anti‐IgE: 55, anti‐IL‐5/R: 52 and anti‐IL‐4R: 56, p = 0.76), median visual analogue scale (VAS) for nasal symptoms was 4, 7 and 8 (p = 0.14) and VAS for total symptoms was higher in the anti‐IL‐4R group (4, 5 and 8, p = 0.002). After 6 months SNOT‐20 improved significantly in all patient groups with median improvement of anti‐IgE: −8 (p < 0.01), anti‐IL‐5/R: −13 (p < 0.001) and anti‐IL‐4R: −18 (p < 0.001), with larger improvement in the anti‐IL‐4R group than in anti‐IgE (p < 0.001) and anti‐IL‐5/R (p < 0.001) groups. VAS nasal symptoms improved by median anti‐IgE: 0 (n.s.), anti‐IL‐5/R: −1 (p < 0.01) and anti‐IL‐4R: −3 (p < 0.001), VAS total symptoms by anti‐IgE: −1 (n.s.), anti‐IL‐5/R: −2 (p < 0.001) and anti‐IL‐4R: −2 (p < 0.001).ConclusionsTreatment by all antibodies showed effectiveness in reducing symptoms of CRSwNP in patients with severe asthma, with the largest reduction observed in anti‐IL‐4R‐treated patients.     

Recalcitrant giant orf recurrence after amputation: A case report and review of the literature

Orf is caused by a parapoxvirus. We present a recurrent, giant digital orf case in a female patient with a history of hairy cell leukemia. In spite of shave excision, the lesion progressed and recurred after digital amputation. Treatment with topical imiquimod cream and systemic subcutaneous interferon alfa‐2a was successful.