卵巢颗粒细胞瘤影像学表现

目的:分析卵巢颗粒细胞瘤的临床、超声及CT特征,旨在提高本病的诊断水平。材料与方法:回顾性分析24例经病理证实的卵巢颗粒细胞瘤患者的临床及影像学资料。所有患者均接受超声检查,其中11例同时接受CT检查。结果:超声检查中,2例表现为实性包块,21例表现为囊实混合性包块,1例表现为囊性包块;CT检查者中,1例表现为实性包块,9例表现为囊实混合性包块,1例表现为囊性包块。卵巢颗粒细胞瘤的超声、CT表现与病理表现基本一致。结论:卵巢颗粒细胞瘤的超声和CT表现虽具有一定特点,但特异性不高,最后诊断常需依赖病理证实。     

自身免疫性胰腺炎的经腹超声表现

目的 探讨自身免疫性胰腺炎(autoimmune pancreatitis,AIP)的经腹超声表现.方法 应用亚洲标准诊断AIP 16例,回顾性分析16例患者的经腹超声表现,对AIP的超声表现进行分型.结果 依据病变累及胰腺的范围将AIP的超声表现分为3种类型:弥漫型、节段型及局灶型,16例患者中8例表现为弥漫型(2例治疗前表现为弥漫型,治疗后1例表现为节段型,1例表现为局灶型),6例表现为节段型(包括治疗前表现为弥漫型的1例),4例表现为局灶型(包括治疗前表现为弥漫型的1例),6例回声较均匀,13例被膜增粗、增强、不光滑,3例病变内出现结节样改变,16例均无钙化,仅3例出现囊性变.结论 AIP的超声表现分为弥漫型、节段型及局灶型3种,经腹超声对其与胰腺肿瘤、普通胰腺炎有一定的鉴别诊断价值.     

卵巢畸胎瘤的MRI诊断及临床病理基础

目的：探讨卵巢畸胎瘤的MRI表现,提高对卵巢畸胎瘤的诊断水平。方法：回顾性分析经手术及病理证实的70例卵巢畸胎瘤的MRI表现。所有病例均行MRI平扫及增强扫描。结果：70例肿瘤单侧发病66例,双侧发病4例。病理类型：成熟性囊性畸胎瘤67例,未成熟性畸胎瘤1例,卵巢甲状腺肿2例。MRI表现：58例可见脂质信号,14例可见钙质信号,8例单纯表现水样信号,增强后实质大部分表现为轻度强化（40例）,部分无明显强化（28例）,2例呈明显强化。结论：卵巢畸胎瘤大部分MRI表现具有特征性,增强扫描有助于提高MRI诊断的正确率。     

肾移植术后特异性肺部感染的影像学诊断

【目的】探讨肾移植术后特异性肺部感染的X线及CT表现,提高对本病的诊断水平。【方法】回顾性分析肾移植术后特异性肺部感染32例,全部病例均摄有胸部X线片,其中13例同时行胸部CT检查。【结果】①巨细胞病毒性肺炎15例：12例早期胸片无改变或表现为肺纹理增粗、模糊,进而12例均表现为两肺间质性肺炎;3例直接表现为两肺间质性肺炎。②肺结核11例：6例粟粒性肺结核表现为两肺弥漫性小结节状密度增高影。5例表现为单纯片状浸润病灶。③真菌性肺炎6例：4例为肺曲霉菌病。2例表现为两肺多发片状影伴空洞形成、1例表现为多发小结节影、1例表现为单发团块状影;2例肺毛霉菌病表现为两肺弥漫性斑片状．小片状影,部分融合。【结论】肾移植术后特异性肺部感染的影像学表现多无特征性。CT扫描对早期发现病变及鉴剐诊断有重要价值,影像学诊断须结合临床资料。     

小儿美克尔憩室及其并发症的超声诊断

目的探讨小儿美克尔憩室及其合并症的超声表现特征及其诊断价值。方法回顾32例手术病理证实为美克尔憩室的患儿,术前行超声检查并分析超声表现及其特征。结果超声表现为管状结构或椭圆形囊性肿块7例,壁呈双层结构,内壁高回声,外壁低回声,内壁不规则,具有回肠壁的特征,壁上可测及血流信号,此为小儿美克尔憩室的特征性表现;表现为混合性肿块5例;以短期内反复发作肠套叠为主要表现6例;表现以肠梗阻为主6例,肠管积气3例;超声未见异常5例。结论超声在术前可诊断部分美克尔憩室,但病变如果以肠套叠或肠梗阻为主要表现时其声像图表现会掩盖憩室病变,憩室较小或肠气较多时超声易漏诊。     

卵巢Brenner瘤15例超声表现分析

目的：探讨超声在卵巢Brenner瘤中的诊断价值 方法：回顾性分析2014年1月至2018年11月期间武汉大学人民医院妇产科诊断为卵巢Brenner瘤的15例病例,分析其超声表现及彩色多普勒血流特点。 结果：15例卵巢Brenner瘤患者中,良性12例,恶性1例,交界性2例。12例良性者,表现为实性者5例,其中4例肿瘤内可见强回声钙化,后伴声影,1例肿瘤内未见钙化,表现为囊性者2例,内均未见钙化,1例良性者合并粘液性囊腺瘤,肿瘤呈囊性,未见钙化,余4例超声检查未见病灶,仅在显微镜下发现Brenner瘤病灶。2例交界性者,1例表现为囊性,未见钙化,1例表现为囊实性,可见钙化。1例恶性者表现为囊实性,内可钙化。彩色多普勒显示良性、交界性、恶性卵巢Brenner瘤内均表现为无血流或少许血流信号,三者间无明显差异。 结论：卵巢Brenner瘤可表现为实性、囊性或囊实性包块,良性者多表现为实性,恶性者多表现为囊实性,交界性者可表现为囊性或囊实性,混合其他肿瘤者声像图表现更加复杂。无论良性、交界性、恶性,肿瘤内均可出现钙化,彩色多普勒对三者之间的鉴别意义有限。     

多层螺旋CT诊断脾脏淋巴瘤14例分析

目的 探讨脾脏淋巴瘤的CT表现特征。方法 回顾性分析经病理证实的14例脾脏淋巴瘤的CT资料,探讨其影像表现特征。结果 13例继发,1例原发。弥漫粟粒型5例,增强扫描见脾脏弥漫或粟粒状低密度影;多发肿块型7例,表现为脾内多发结节状低密度灶,直径1.6~6.5 cm;单发肿块型2例,表现为脾脏内单发肿块,轻度强化,其中1例可见钙化及坏死。12例伴有脾外淋巴瘤。结论 脾脏淋巴瘤的CT表现具有一定特征性,腹腔内脾外病变的CT表现有助于诊断。     

消化道出血为首发表现的血液系统肿瘤的内镜表现和临床特点

目的探讨以消化道出血为首发表现的血液系统肿瘤患者的临床特点及内镜下表现,总结临床经验,提高诊治水平。方法回顾性分析2009年7月～2011年4月该院收治的14例以消化道出血为首发表现的血液系统肿瘤患者临床资料。结果所有患者均以消化道出血为首发表现,10例(71.4%)有发热表现。累及食管1例,胃6例,十二指肠1例,空肠2例,回肠4例,结肠2例。10例(71.4%)为单发病变。内镜下形态表现多样,以溃疡型病变为主要表现9例,浸润型2例,肿块型2例,多发结节型1例。内镜活检确诊者5例(35.7%)。结论原发于消化道的血液系统肿瘤临床表现不典型,内镜下形态具有多型性,提高对其内镜下表现的认识,结合多取及深挖活检对提高内镜确诊率具有重要的意义。     

纵隔畸胎瘤：CT与病理对照分析

目的：研究纵隔畸胎瘤的CT表现及其病理基础。方法：回顾分析56例经手术病理证实的纵隔畸胎瘤的CT表现,并与手术病理表现对照。结果：囊性畸胎瘤31例,良性实质性畸胎瘤20例,恶性畸胎瘤5例,CT表现与手术病理表现基本一致。结论：纵隔畸胎瘤的CT表现能反映其手术病理特征,具有一定的特异性,对术前诊断与鉴别诊断有很高的临床价值。     

以消化道出血为首要表现的多发性骨髓瘤临床分析

目的探讨以消化道出血为首要表现的多发性骨髓瘤的临床特征。方法以消化道出血为首要表现的多发性骨髓瘤患者为研究对象,分析其临床表现、实验室检查、内镜检查的特点。结果 6例以消化道出血为首要表现的多发性骨髓瘤患者,男性5例,女性1例,年龄33~70岁。消化道出血表现为便血1例,脓血便2例,黑便3例,其中2例伴呕血。内镜下表现胃溃疡2例,胃毛细血管扩张1例,结肠溃疡2例,小肠溃疡1例。结论多发性骨髓瘤临床表现多样,以消化道出血为首要表现的多发性骨髓瘤在临床上少见。对伴有免疫球蛋白升高、贫血、蛋白尿等多系统受累的患者应注意完善骨髓瘤方面的检查,及时诊断治疗。     

Splenic injury as a complication of endoscopy: two case reports and a literature review.

Two cases of splenic injury - one after a difficult colonoscopy and the other after routine ERCP - are reported. Splenic injury as a complication of endoscopic procedures is relatively rare, but over the past several years this complication has been increasingly reported. Review of the literature revealed 11 cases occurring after colonoscopy and one after ERCP. Although most of the patients presented with acute abdominal symptoms, some had mild vague symptoms. In two cases the injury was overlooked entirely. Diagnosis was established at laparotomy in four cases, by CT in four, by ultrasonography in two, by chance observation in two, by angiography in one and by paracentesis in one. All patients except the most recent three reported underwent surgery, with one mortality occurring three weeks after the operation.     

Relationships among migrainous, vascular and orthostatic symptoms

A headache symptom questionnaire was filled out by 766 undergraduate university students and 258 reported one or more headaches per month. Headaches characterized by one or more of the main migrainous symptoms (unilateral pain, gastrointestinal disturbance and focal neurological symptoms) were reported to be more severe, pulsatile, of longer duration, and associated with facial pallor and signs of cerebral vascular instability more frequently than headaches accompanied by few or none of the major migrainous symptoms. Additionally, hunger was reported to trigger headaches associated with migrainous symptoms more frequently than non-migrainous headaches. The results are consistent with the proposal that vascular involvement is one of the factors underlying a continuum of headache with migraine as one extreme.     

Sexual Risk Behavior Among Urban Women of Childbearing Age: Implications for Clinical Practice

Cox's interaction model of client health behavior was used as an organizing framework to describe the demographic characteristics, motivation, problem-solving, self-esteem, and sexual risk behaviors among urban women of childbearing age ( N = 125; average age = 32 years). Eighty-five percent of the women were African American. Sexual risk behaviors were defined as more than one sex partner and not using a condom. Eight women were at the highest risk in that they reported having more than one sex partner and not using condoms. Participants reported low self-esteem, intrinsic motivation, and adequate problem-solving abilities. Motivation scores were significantly different based on number of sex partners ( t = 2.26, p = .03). Women with more than one partner had lower scores compared to women with only one partner. There was a significant variation in reported self-esteem among women who used condoms ( t = 2.36; p = .22). Women who did not use condoms reported lower self-esteem than women who said that they used condoms.     

Measuring disability, the agreement between self evaluation and observation of performance

Purpose: In 1981, eight countries and the World Health Organization (WHO) reached consensus about applying a similar disability questionnaire in their health surveys that was related to the ICIDH. In 1992 a revised version, the WHOdisability questionnaire, was recommended. In this paper the concurrent validity of 10 items of the questionnaire is evaluated by measuring the agreement with observed performance of corresponding tasks. Method: The disability questionnairewas sent to 750 subjects. From the respondents (468) 93 were selected, based on their reported disability, and 10 performance tasks were observed. The agreement was measured for individual items and for all items together in distinguishing between persons with no, or at least one disability. Results: A low to moderate agreement was found between self reported and observed disability. In general, observation resulted in lower disability ratings. Among 24% of those who reported at least one disability, no disability was observed. Persons among whom at least one disability was observed, only 2% (n= 1) reported no disability in the questionnaire. Conclusions: Although the concurrent validity is low to moderate between the results of the WHO-disability questionnaire and observation, the questionnaire is highly sensitive for detecting persons with at least one disability. The specificity of the questionnaire must be increased by additional questions.     

中药配合肝动脉栓塞化疗辅助治疗原发性肝癌随机对照试验的质量评价

目的:对中药配合肝动脉栓塞化疗(Transcatheter Arterial Chemoembolization,TACE)辅助治疗原发性肝癌随机对照试验(Randomized controlledtrial,RCT)文献进行评价。方法:对国内外公开发表的有关中药配合TACE辅助治疗原发性肝癌的随机对照试验进行检索,检索数据库包括Cochrane图书馆临床对照试验库,MED-LINE、CBM、CNKI和VIP电子数据库。手工检索中文相关期刊以及附加检索相关会议论文集。质量评价采用Jadad评分量表、CONSORT标准和其他自拟评价指标进行分析。结果:共纳入103篇RCTs,其中Jadad评分得5分有1篇文献,3分1篇,2分10篇,71篇1分,其余20篇均为0分,有3篇文献报告了分配隐藏。按CONSORT标准,仅1篇(0.97%)RCT描述了如何产生随机顺序,没有RCT报道如何执行随机,其中1篇为半随机,有1篇(0.97%)RCT采用安慰剂对照,有54篇(52.43%)报道了终点指标,分别各有2篇(1.94%)报道了双盲和单盲,14篇(13.59%)进行了具体统计量计算,54篇(52.43%)提供了随访记录,7篇(6.80%)报道了阴性结果,16篇(15.53%)报道不良事件,仅有1篇(0.97%)进行样本含量计算与意向性分析(ITT),有2篇(1.94%)进行分层分析,属于多中心的仅有1篇(0.97%),均未进行伦理审批和知情同意。描述了中医证型的有3篇(2.91%)。结论:目前中药配合TACE辅助治疗原发性肝癌临床研究的方法学和报告质量尚低,且多数RCT可能存在选择性偏倚和测量性偏倚,期待更多高质量的随机双盲对照试验为临床应用提供可靠的依据。     

Nicotine effects on exercise performance and physiological responses in nicotine‐naïve individuals: a systematic review

The purpose of this systematic review was to evaluate the effects of smokeless forms of nicotine on physiological responses and exercise performance. Methodology and reporting were based on the PRISMA statement. The intervention was defined as any product containing nicotine that did not require smoking. Searches were conducted across two electronic databases with supplementary approaches utilized. Studies were selected following set inclusion and exclusion criteria and checked by two independent authors. A modified PEDro scale was utilized to rate study quality with studies averaging 9·3/13. Six studies assessed exercise performance with endurance‐based parameters reported as significantly improved with nicotine in one study, while anaerobic parameters were unaffected or decreased compared to placebo except in one study which reported enhanced leg extensor torque but no effect on countermovement jump or Wingate anaerobic capacity. Sixteen of 28 studies investigating physiological responses reported that nicotine significantly increased heart rate compared to placebo or control. Blood pressure and blood flow were also reported as significantly increased in multiple studies. While there is strong evidence of nicotine‐induced changes in physiological function that would benefit physical performance, beneficial effects have only been reported on leg extensor torque and endurance performance by one study each. Subsequently, there is need for more research with strong methodological quality to definitively evaluate nicotine's potential as an ergogenic aid.     

Analysis of a smoking policy in the workplace

Following implementation of the smoking policy, an overall decrease in tobacco consumption was reported among 33% of the employees; of these, 32% quit completely. Smokers who reported smoking more than one pack of cigarettes a day were three times more likely to decrease consumption than those who reported smoking one pack or less a day. Among those who decreased their tobacco consumption, 43% associated this decrease with the policy implementation. A notable inverse relationship existed between smokers' tobacco consumption and attitudes about the policy: as cigarette consumption decreased, attitude about the policy increased positively.     

The safety of Sonovue in abdominal applications: retrospective analysis of 23188 investigations

The aim of the present retrospective study was to assess the incidence of adverse events (AE) of a second-generation ultrasound contrast agent in real clinical practice. A total of 28 Italian Centres provided data on the postmarketing use of SonoVue (Bracco Spa, Milan, Italy) in abdominal examination performed between December 2001 and December 2004. A total of 23 188 investigations were reported. No fatal event occurred. AEs were reported in 29 cases, of which only two were graded as serious; the rest, 27, were nonserious (23 mild, three moderate and one severe). The overall reporting rate of serious AE was 0.0086%. Overall, only four AEs required treatment (two serious, two nonserious including one moderate and one severe AEs). In conclusion, the present large-scale retrospective analysis showed that SonoVue has a good safety profile in abdominal applications, with an AE reporting rate lower than or similar to that reported for radiologic and magnetic resonance contrast agents.     

Adverse reactions to food and food allergy in young children in Iceland and Sweden

OBJECTIVE: To investigate the prevalence of adverse reactions to food and food allergy in Icelandic and Swedish 18-month-old children. DESIGN: Prospective multicentre comparative study. SETTING: Primary health care centres in Sweden and Iceland. SUBJECTS: A total of 324 children in Iceland and 328 in Sweden who attended for regular 18-month check-up. MAIN OUTCOME MEASURES: Adverse reaction to food according to questionnaire, and food allergy according to skin prick tests and double blind food challenge tests. RESULTS: Adverse reactions to food were reported in 27% of children in Iceland and 28% in Sweden. Food allergy was confirmed in 2.0% in both countries. Allergy among other family members was reported in 45% of the Icelandic children and 62% in the Swedish (p < 0.001). Indoor smoking was reported by 30% of the Icelandic families and 3% of the Swedish. Respiratory infections were reported significantly more often in Icelandic children than Swedish. CONCLUSION: Adverse reactions to food and food allergy were similar in Icelandic and Swedish children. At the age of 18 months one can expect to confirm food allergy in approximately one out of 15 children with reported adverse reactions to food.     

Severe acid-base abnormalities associated with cocaine abuse

Severe acid-base disorders accompanying cocaine abuse have been reported but not emphasized in the literature. We report three cases of cocaine toxicity associated with profound acid-base derangements. Two cases demonstrated severe metabolic acidosis, one of which was not associated with known seizure activity. In addition, one case of profound alkalosis associated with cocaine use is presented. These cases are reported to emphasize the marked acid-base changes that can occur as a result of cocaine toxicity.