二维及三维超声心动图诊断单纯性二尖瓣前叶裂

目的 通过二维及三维实时超声心动图探讨单纯性二尖瓣前叶裂的诊断特点,进一步确认二尖瓣前叶裂的超声诊断标准.方法 对26例单纯性二尖瓣前叶裂患者的二维及三维实时超声心动图图像进行分析,观察裂的形态、位置及二尖瓣反流等.结果 26例患者中,23例二尖瓣前叶裂位于近联合处,3例位于二尖瓣前叶中间;8例合并二尖瓣脱垂及腱索断裂;15例二尖瓣前叶裂呈近"I"型,11例呈近"C"型或"S"型;5例二尖瓣口未见反流信号,9例伴二尖瓣中度以上反流.结论 动态图像下二尖瓣短轴切面显示二尖瓣前叶不连续,可探及回声失落处,是二尖瓣前叶裂的特异性诊断特点.二尖瓣裂致二尖瓣关闭不良者彩色多普勒显示二尖瓣反流源于裂口处.连续扫查二尖瓣配合三维超声心动图可以清晰显示二尖瓣裂的位置、形态以及程度.     

二尖瓣乳头状纤维弹力瘤超声表现1例

患者男,55岁,为体育老师.平素身体无感不适,经胸超声心动图检查中发现左室腔内二尖瓣后瓣腱索上见一圆形实性稍高团状回声,大小约10mm×8 mm,内回声均匀,活动度较小,收缩期不进入左房,二尖瓣开放好,房间隔连续,左房及左心耳未见团块回声.经食管超声心动图检查示:二尖瓣后瓣腱索上见一团块状异常回声,大小约8.3mm×5.6 mm×6.1 mm,收缩期与二尖瓣距离10mm,二尖瓣后瓣腱索长约27 mm.后在省级医院住院体外循环下行"二尖瓣后瓣腱索肿物切除术",病理结果为二尖瓣乳头状纤维弹力瘤.     

降落伞型二尖瓣合并主动脉瓣病变超声表现1例

<正>患者女,44岁,无自觉症状来我院体检。超声心动图示:二尖瓣仅有一组乳头肌,位于后内侧,前外侧乳头肌缺如;二尖瓣前瓣和后瓣腱索增粗,共同连于单组乳头肌;二尖瓣瓣叶回声稍增厚,动度可,前后叶呈反向运动,舒张期开口径16 mm;二尖瓣过瓣血流最大速度1.4 m/s,最大速度出现于腱索水平,血流经过腱索之间的空隙进入左室(图1);收缩期二尖瓣上可探及反     

多次超声心动图发现二尖瓣赘生物1例

<正>患者女,22岁,发热19 d。多次血培养细菌和真菌阴性,全身CT、血清降钙素原检查未见异常。超声检查:入院后4 d,二尖瓣形态未见异常,收缩早期二尖瓣微量反流,微量心包积液;入院后23 d,二尖瓣回声宽大冗长,前叶回声稍增强,二尖瓣轻度关闭不全;入院后26 d,二尖瓣前叶附着一团状等回声,大小     

超声心动图在双孔二尖瓣成形术治疗二尖瓣关闭不全围手术期中的应用

目的探讨超声心动图在二尖瓣关闭不全双孔二尖瓣成形术病例筛选以及术中、术后疗效评价中的应用价值.方法对6例(左心房黏液瘤3例,先天性心脏病3例)二尖瓣脱垂导致二尖瓣关闭不全的患者行双孔二尖瓣成形术,男4例,女2例,年龄4～60岁,平均(30±19.7)岁.心功能Ⅱ级2例,Ⅲ级3例,Ⅳ级1例.于术前应用经胸壁超声心动图,观察二尖瓣瓣膜回声及活动情况,了解造成二尖瓣关闭不全的原因,筛选适合成形修复术的病例,测量瓣口流速、跨瓣压差、返流面积、左心房及左心室内径.3例术中应用经食道超声心动图或经心外膜检查,复跳后除检查原发病治疗效果外,着重观察双孔大小、瓣口流速及跨瓣压差、有无返流,评估成形术效果.结果术后检查6例均为二尖瓣前叶脱垂导致关闭二尖瓣不全,左心房、二尖瓣环扩大,未见腱索断裂以及瓣叶回声异常,其中2例为二尖瓣重度返流,4例为中度返流.术后左心室短轴切面瓣叶开放呈"8"字形双孔,瓣叶对合良好,四腔切面见2束红色血流进入左心室.1例无返流,3例轻度返流,2例中度返流,二尖瓣返流明显减轻,左心房内径明显缩小(t=5.1,P＜0.01),二尖瓣口流速、跨瓣压差无显著变化,提示手术效果良好.结论超声心动图在双孔二尖瓣成形术的病例筛选、术中及术后疗效评估中具有重要的临床应用价值,可作为首选的影像诊断方法.     

自转型左房内烟雾状回声发生猝死1例

患者男,23岁,因劳累时出现气促3年入院。心尖区可闻及递减型隆隆样舒张期杂音,主动脉瓣第2听诊区可闻及Ⅱ级收缩期杂音。临床诊断为风心病。二维超声心动图见左房右室显著扩大,分别为72和43mm。二尖瓣前后叶反射增强增粗,以瓣缘明显,前叶舒张期穹隆明显,后叶活动基本消失,瓣口前后径4mm,左右径12mm。可见左房内有许多微小回声组成的典型烟雾状回声,边界不清,略呈球形,直径30～40mm。此烟雾状回声位     

老年心内膜弹力纤维增生症1例的超声表现

患者男 ,72岁。原因不明出现胸闷 ,憋气 ,伴双下肢水肿来诊。查体 :一般情况尚好 ,心界向两侧扩大。 CT示两侧胸腔少量积液。超声检查 :左房 43.6mm,左室 56.9mm,两腔内径均增大 ,左室腔内见一长 38.7mm,宽 3.1 mm条状回声 ,连接左室壁与室间隔。主动脉内径 2 5.6 mm,三瓣叶回声略增强、关闭略受限。二尖瓣前后叶回声可、启闭相对受限。三尖瓣、肺动脉瓣均正常。左室壁心内膜明显增厚 ,达1 9 .6 mm,回声略增强 (图 1、 2 )。左室后壁及室间隔厚度分别为 9.2 mm、8.2 mm,心肌运动普遍减弱。左心室内径收缩期与舒张期变化很小。右室前壁的前…     

二尖瓣前叶黏液瘤超声表现1例

患者女,51岁.因阵发性胸闷来诊.听诊:心尖区II级舒张期杂音.超声检查:左房侧见一稍高回声结节,大小:1.4 cm × 1.3 cm,形态规则,有蒂与二尖瓣前叶中央部相连接,随二尖瓣启闭活动,动度较大,舒张期二尖瓣开放时结节抵瓣口(图1),收缩期二尖瓣关闭时可回到左房.超声提示:二尖瓣前叶黏液瘤.磁共振检查诊断与超声相同.     

二尖瓣腱索黏液瘤超声心动图表现1例

患者男,54岁,腹胀、气促2个月,超声检查发现二尖瓣异常回声1 d入院。体格检查:体温36.5℃,心率87次/min,呼吸20次/min,血压124/98 mm Hg(1 mm Hg=0.133 kPa)。心前区无异常隆起,心界无扩大,未及震颤,心律不齐,第一心音强弱不等,未闻及明显病理性杂音。心电图检查:心房颤动,ST-T改变。超声心动图检查:左室内二尖瓣上见一大小约17 mm×15 mm中等不均质异常团块状回声,边界尚规则,似有蒂附着于二尖瓣后叶近瓣环处左室面,活动度较大,瓣叶活动未见异常(图1,2)。超声心动图提示:二尖瓣上异常回声(黏液瘤?赘生物?)。后行开胸探查,术中见:肿瘤位于二尖瓣后瓣腱索,呈卵圆形,半透明黏液状,大小约15 mm×12 mm×10 mm。术后病理诊断:二尖瓣黏液瘤。     

疑似黏液瘤的左房原发恶性肿瘤超声表现1例

正患者女,51岁。患者5d前开始出现活动后胸闷、憋气不适,伴咳嗽、咳血,夜间平卧入睡可憋醒,超声所见(图1):左房内见一中等偏低回声团块,附着于房间隔下部及二尖瓣前叶根部,形态不规则,内回声欠均匀,较松散,大小约2.9cm×2.2cm,舒张期经二尖瓣口脱入左室,致瓣口血流速度加快,最大流速3.7m/s,最大压差57mm Hg,收     

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.     

动态心电图临床操作标准化方法

动态心电图,又称Holter或Holter检查,是一种评价各种心脏病患者心电图异常的简便、高效、准确、安全的无创检查,广泛用于心律失常的相关症状评价,心肌缺血的诊断,心脏病患者的预后和日常生活能力评估,药物疗效评价,起搏器等埋藏式心脏电治疗装置监测等领域。目前动态心电图已广泛用于于临床各级医疗机构,为了更好地发挥其作用,有必要对该项技术进行规范化培训。本文参考相关指南、共识及专家建议,结合作者经验,撰写动态心电图临床操作标准化方法供临床使用时参考。