超声诊断会阴部急性坏死性筋膜炎1例

患者,男,53岁。因肛门部肿痛半月,阴囊肿痛1周入院。体格检查:体温39℃,肛旁左侧可见皮肤红肿约10.0cm×4.0cm大小包块,延伸至阴囊,无波动感。阴囊红肿,左侧睾丸肿大。血常规:白细胞21.8×109/L,中性粒细胞89%。入院诊断:①肛旁脓肿;②睾丸炎。超声检查:双侧腹股沟区、会阴部、     

超声诊断左下肢大隐静脉血栓形成1例

患者男,65岁.无明显诱因出现左下肢肿胀、肿痛.查体:左下肢肿胀,腹股沟区压痛明显,表面皮肤温度增高,有明显压痛.超声所见:左侧大隐静脉内径增宽,内可见强弱不等回声(图1).于大隐静脉股部中上段仅见零星血流信号(图2左),中下段多处局限性增宽,最宽处内径约1.3 cm,内可见强弱不等回声,未见明显血流信号(图2右).双下肢股静脉、月国静脉内径增宽,内膜不光滑,血流充盈尚可,血流速度缓慢.     

脐尿管未闭致下腹部手术切口感染不愈的诊治一例

患者女,40岁,患者因"腹壁窦道两年余"于2011-07-03入院。两年前曾行子宫切除术(横切口),术后切口长期愈合不良,形成腹壁窦道,于多家医院行窦道引流术或窦道切除术,仍无法完全愈合。既往体健。入院查体:下腹部可见多个手术瘢痕,正中瘢痕可见约2cm×2cm窦道外口,少许浑浊渗液。辅助检查:     

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.     

肾下极隐睾合并男性乳房发育症1例

1病例报告 男,12岁.因双乳肿痛1个月就诊.病史:5 a前曾因双侧隐睾、阴茎下弯行双侧腹股沟探查术及阴茎下弯矫正术.术中未探及睾丸样组织,亦未发现明显的精索样组织.阴茎下弯矫正良好.近1个月发现双侧乳房肿痛.查体:双侧乳房B2,乳核1.0cm;双侧腋下可及无痛性淋巴结数个,直径均小于1.0 cm;下腹部可见1 cm长手术瘢痕(膀胱造瘘术后);双侧腹股沟区分别可见4 cm长手术瘢痕(腹股沟探查术后),未触及包块;双侧阴囊内空虚无睾丸;阴茎约5 cm×2.5 cm,可见手术瘢痕(阴茎下弯矫正术后),尿道口位于冠状沟处,直径0.3 cm.     

超声误诊左冠状动脉窦右房瘘合并左冠状动脉窦瘤1例

患者男,38岁.因胸闷伴活动后气促1月余入院,于胸骨左缘2～4肋间可闻及Ⅲ/6级收缩期连续性杂音.术前超声心动图提示左冠状动脉窦扩张,似见左冠窦与左房间有一血管通道相连(图1).冠脉CTA及冠脉造影均提示左冠状动脉右房瘘可能,余冠脉及左冠分支均正常(图2).术中见有一直径约1cm管道起源于扩张的左冠窦,从外可见管道近端与左冠状动脉起始部重合,但从内与左冠状动脉开口分离,呈多孔型.管道于心底向主动脉后方绕行,在上腔静脉与右房连结处形成瘘口与右房相通.     

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).     

超声诊断膀胱-腹壁瘘道形成1例

患者男性,50岁.八个月前,因前尿道狭窄行尿道成形术,术后切口愈合好,排尿通畅.术中留置膀胱造瘘管,于术后二个月拔除二腔气囊尿道后至今,腹壁仍有少许尿液溢出.查体:腹下区耻骨联合上方可见手术疤痕.超声检查:下腹壁下方距体表约0.4cm处可见一2.2cm×1.8cm×1.8cm的低回声区,与周围组织界限不清晰,其内可见直径约0.8cm的无回声区,转动探头,可见无回声呈不规则管状,与膀胱前壁和腹壁相通(图1).超声提示:尿道狭窄,膀胱造瘘术后,膀胱前壁与下腹壁瘘道形成,瘘道周围组织炎性改变.     

肛门解剖与生理

肛管的境界有两种说法。通常所说的肌管指肛缘至齿状线的部分，即解剖肛管，外科肛管指肛缘至肛管直肠环上缘平面，包括齿状线以一卜约1．5cm的部分，长约4cm。肛缘向内约1．5cm有一环状沟样间隙，叫肛自线，足内外括约肌在体表的分界。齿状线距肛缘约2cm，由肛瓣、肛柱组成。齿线上下的结构存在明显差异(见表1)。     

阴囊纵隔表皮样囊肿超声表现1例

患者男,26岁,发现阴囊无痛性肿物3月余就诊.起初为单个,大小约1.0 cm,后逐渐增大增多,大小1～2 cm不等.发病以来局部无明显肿痛,无发热.查体:阴囊部可见7～8个类圆形肿块,沿阴囊纵隔纵行排列,并紧密相连,表面光亮,张力高,无明显挤压痛,挤压较大肿块时可略缩小.     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。