先天性右膈膨升症(附三例报告)

先天性右膈膨升症国内文献报道较少,我们遇到3例,现报告如下。 病例 例1,男,1岁10月。发热、咳嗽5天,腹泻1天。 体查:急性病容,气促发绀。右肺呼吸音减低,闻及少量细湿罗音,心正常。肝浊音界上段,肋下肝脾未扪及。X线检查:卧位胸部正位片示右膈位于第三前肋末端水平(图1)。人工气腹造影后摄立位胸部正位片示膈位于第三前肋,膈影呈线状,完整光滑,膈下有约1cm厚气影。肝上移,表面光滑。透视下膈随呼吸上下运动,无矛盾运动。诊断:先天性右膈膨升症。 例2,男,1岁3月。因咳嗽、气促、低热2天住院治     

超声诊断婴儿先天性膈膨升1例

<正>患儿女,以"咳嗽9d,加重伴喘息7d"为主诉就诊。曾就诊于外院,胸片示:两肺纹理稍增多,右下肺野弧形高密度影。腹部平片:右膈局限性膨隆,膈疝可能。给予对症治疗,患儿无明显好转,遂就诊本院。查体:体温36.9℃,咽部黏膜稍红。双肺呼吸音粗,可闻及喘鸣音及痰鸣音。血细胞分析:白细     

肝左叶疝入右侧胸腔一例报告

肝左叶疝入右侧胸腔罕见,我院收治一例报告如下: 患者女 27岁,胸透普查发现右下肺肿块。体检:气管居中,右肺呼吸音减弱,可闻少许湿罗音,语颤无增强,左肺呼吸音正常。实验室检查无异常。胸部正位片:右下肺底见约6.5cm×7cm大小椭圆形致密块影,边缘光滑,部份与右膈肌相连(附图)。右侧位片:肿块影靠前,底部与横膈重叠(透视下转位肿物可与心影分开,下缘无法与横膈分离)。肺门及纵隔影不宽。X线诊断:右下肺良性肿物考虑膈膨出。手术病理所见,右肺发育正常,表面光滑,右下肺与膈肌、胸膜、心包粘连,右膈肌腱膜较薄,可见约6.5cm×7cm大小肿物,质中光滑,无包膜,与肝脏颜色一     

肝固有动脉结扎治疗肝破裂1例报告

患者男,13岁。丈高坠下,右下胸及上腹疼疼1天,于1975年6月17日入院。入院时检查:体温38℃,脉率120次/分,血压80/30。右胸廓活动稍受限,右第七前肋具骨摩擦感,右下肺呼吸音稍低,心脏与左肺正常。腹膨隆,全腹明显压痛,轻度反跳痛,以上腹最明显。肝区有叩击痛,肝浊音区正常存在。肠鸣音消失。X线见两侧横膈活动受限,右肋膈角变钝。红细     

产前超声诊断先天性膈膨升及漏误诊分析

目的:探讨超声诊断胎儿先天性膈膨升的声像图特征并对漏诊、误诊进行分析.方法:分析2014年1月—2018年12月产前超声诊断先天性膈膨升的10例胎儿病例资料及随访结果,总结其胸腔横切面、冠状面、矢状面的产前超声图像特征,观察双侧膈肌的矛盾运动,并与产前MRI、产后胸片、解剖结果对比分析.结果:10例胎儿膈膨升中右侧6例...     

先天性左侧膈肌膨升一例

患者,男,41岁,咳嗽,上腹部不适就诊,一月前因受凉开始咳嗽,上腹部饱胀,无发热、胸痛、血痰、查体:咽部充血,双肺无干湿性罗音,左下肺呼吸音减低,腹部检查无异常。实验室检查:血、两便常规正常。 X线检查:胸部后前位(见附图),双肺野清晰,左膈顶示完整的弧形阴影,并明显抬高,位于第七后肋水平,膈下紧贴扩大的胃泡影及含气肠曲,纵膈向右侧移位。X线诊断:左膈肌先天性膨升。 讨论:一般认为膈膨升是由于膈肌全部或局部发育不全、萎缩和麻痹所引起的,在病理上膨升的膈为一层纤维性薄膜,除膈肌纤维先天性发育异常外,可能与继发于肺发育不全使膈下降能力减弱有关。后天性膈膨升可因神经原性和肌原性因素所致,如外伤、手术,     

类似为大量胸腔积液的右膈下巨大脓肿1例

患者男 ,46岁。入院前 1月行“上消化道穿孔修补术” ,术后 10天右侧肺呼吸动度减低 ,右胸中下部语颤减弱 ,叩浊音。化验检查 :ＷＢＣ :15 .5× 10 9/Ｌ。彩色超声检查 :右侧胸腔大量积液 ,右膈下脓肿。临床诊断 :①右膈下积液 ;②右侧胸腔中等量积液。Ｘ线胸部平片检查 :右侧第 3前肋上缘以下胸腔呈密度均匀一致致密影 ,上缘模糊 ,呈反弧形 ,右膈肌、肋膈角、右下心缘均完全被掩盖 ,心影略显左移 (图1) ,为典型中等量胸腔积液表现。次日行ＭＲＩ检查 :右侧膈肌清楚略显增厚 ,右膈下可见一周壁完整的巨大类圆形异常信号影 ,约 13ｃｍ× 13ｃ…     

巨大肺母细胞瘤1例

患者男,42岁.因刺激性咳嗽、胸闷3个月就诊.曾在当地医院诊断为"胸腔积液",行胸腔穿刺抽出液体1600 ml.体检:胸廓无异常,右下肺呼吸音低、扣浊.胸部平片:右中下肺野密度增高,并呈现为外高内低的弧形,水平裂密度增高呈条状,部分与中下肺野密度增高影融为一体,右心缘、右膈肌被掩盖(图1).胸部CT扫描检查,示右肺下叶内后基底段肿瘤并右侧胸膜腔积液,病灶约15 cm×12 cm×10 cm, 类圆形,有分叶,密度不均匀,其内见有条状或裂隙样密度减低区.增强扫描病灶明显强化,以其边缘部强化明显(图2).     

左旋心并右侧食管裂孔疝一例

男,11岁,出生后进食后呕吐,反复发作,加重两天。无呼吸困难、腹胀、腹痛。大小便正常。体检:营养不良,无发绀。左肺呼吸音清晰,右中、下肺可闻及湿性罗音,心脏听诊无病理性杂音。心电图:心律不齐; X线检查(结合透视):正位胸片显示心尖搏动位于左膈顶影上方;右下肺野区示一液气平影,其内密度不均。右膈顶影模糊,其上界置于第八后肋水平且示右膈     

成人膈肌膨升折叠术1例的手术配合

膈肌膨升的定义有狭义和广义两个范畴,狭义的膈肌膨升是膈肌先天性缺陷引起的膈肌膨出,称为先天性(或原发性)膈肌膨出症[1];广义的膈肌膨升指膈肌纤维因发育不良、萎缩而异常抬高,包括膈神经不明病因、不明部位的损伤造成     

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.     

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.