血管瘤样恶性纤维组织细胞瘤

血管瘤样恶性纤维组织细胞瘤患者男性，３５岁。发现右前臂包块６个月。查体：右前臂外侧包块１．５ｃｍ×１．３ｃｍ×０．８ｃｍ，质硬，界清，活动度差，有重压痛。手术完整切除送检。病理检查送检标本为不规则软组织包块一个，１．５ｃｍ×１．３ｃｍ×０．８ｃｍ，似...     

紫外线对犬动脉血栓中^125I纤维蛋白放射活性的影响

目的：探讨紫外线（ＵＶ）的溶栓效应。方法：３６只健康成年犬随机分为６组，复制左侧股动脉血栓模型，ＵＶ１、ＵＶ２、ＵＶ３（各５只）及ＵＶ＋ＵＫ（８只）４组均行胸腹部ＵＶ照射１次，剂量分别为４４７．７２ｍＪ／ｃｍ２×８００ｃｍ２，２２３．８６ｍＪ／ｃｍ２×２００ｃｍ２，１１９．９３ｍＪ／ｃｍ２×５０ｃｍ２，４４７．７２ｍＪ／ｃｍ２×８００ｃｍ２，其中ＵＶ＋ＵＫ组ＵＶ照射后即静脉给予ＵＫ（尿激酶）１４００单位／分钟；ＵＫ组８只（只给ＵＫ），观察血栓溶解及血栓中１２５Ｉ纤维蛋白放射活性的动态变化。结果：实验后２４小时时血栓溶通率ＵＶ１～ＵＶ３组及对照组（５只）均为０／５，ＵＫ组４／８，ＵＶ＋ＵＫ组７／８，血栓溶通时间ＵＶ＋ＵＫ组明显短于ＵＫ组（Ｐ＜０．０１）；ＵＶ１和ＵＶ２组血栓放射活性在ＵＶ照射后３～９小时间显著下降（Ｐ＜０．０１）；实验后７小时内血栓放射活性下降幅度依次为ＵＶ１组＜ＵＫ组＜ＵＶ＋ＵＫ组（Ｐ＜０．０１）。结论：强红斑量ＵＶ大面积照射犬皮肤对犬动脉血栓具有较弱的溶解作用，联合应用ＵＫ并ＵＶ照射后可增强对血栓溶解效应。     

自血疗法及紫外线照射治疗白癜风

自血疗法及紫外线照射治疗白癜风戴萦萦白癜风患者２０例，男１３例，女７例；年龄１６～４２岁；病程６个月～５年；共计３０个病灶，病灶面积０．２ｃｍ×１．０ｃｍ～２．０ｃｍ×３．０ｃｍ，分布在头面、颈及胸背等处，曾经多方治疗无效。采用５ｍｌ消毒针筒，７号针...     

超声治疗裸鼠移植癌的实验研究

目的观察高强度聚焦超声（ＨＩＦＵ）治疗裸鼠移植癌的疗效，探讨局部肿瘤非手术“切除”的可能性。方法将ＢＡＬＢ／Ｃ裸鼠背部接种Ｈ２２肿瘤细胞造模后，分为ＨＩＦＵ组２０只，对照组１０只。ＨＩＦＵ组采用频率为３．５ＭＨｚ超声，声头直径４ｃｍ，聚焦深度３．１ｃｍ，声强３００Ｗ／ｃｍ２，聚焦直径０．３５ｃｍ，纵深度０．５ｃｍ，连续波每次作用于病变局部３０秒，热电偶电极测得靶区温度为８５℃，每周５次，共４周累计１０分钟。检测作用前后肿瘤直径，观察肿瘤抑制率及病理组织变化。结果ＨＩＦＵ作用４周后，ＨＩＦＵ组与对照组肿瘤直径分别为（１．１０±０．４８）ｃｍ和（２．４５±０．８７）ｃｍ，Ｐ＜０．０５，肿瘤抑制率为９５％。其中５只裸鼠肿瘤完全脱落，而周围正常组织完好，未发现转移病灶。病理切片可见癌组织大片坏死，及癌巢间大片空泡变性；对照组裸鼠全部死亡。结论ＨＩＦＵ疗法是一种治疗局部肿瘤无创性的有效治疗方法。     

尿道海绵体软组织内原发非何杰金淋巴瘤1例

患者男性，３５岁。发现尿道海绵体肿物３月余，增大不明显，无疼痛，无血尿。术中见尿道海绵体部肿物，０．７ｃｍ×０．５ｃｍ×０．５ｃｍ，表面光滑，质略硬，推之可活动，边界较清楚。病理检查灰白灰红色结节状肿物１个，大小为０．７ｃｍ×０．５ｃｍ×０．５ｃｍ，...     

无功能性胰岛细胞瘤九年追踪观察一例

患者女，３４岁。平时体健，无上腹痛及其它临床症状。１９８８年１０月Ｂ超查体发现胰腺头颈部见一４．０ｃｍ×２．９ｃｍ×３．０ｃｍ低回声区（见图１），边界清晰，边缘规整，内部回声均匀，中心部有小片状无回声区，约０．８ｃｍ，胰管０．２ｃｍ，无明显扩张，肿物...     

B超诊断蹄铁型肾1例

Ｂ超诊断蹄铁型肾１例浙江省新昌县人民医院陈亚新患者，女性，１７岁。体检时发现脐上方可触及鸡蛋小实质性肿块，境界清，质中，无压痛，活动度小。Ｂ超检查：脐右上方及脐左测方分别可见７．０ｃｍ×５．５ｃｍ×３．４ｃｍ和７．３ｃｍ×５．０ｃｍ×３．５ｃｍ肾脏回...     

B超诊断脾脏多发性血管内皮肉瘤1例

Ｂ超诊断脾脏多发性血管内皮肉瘤１例安微医科大学附属医院孔晓春，张长乐患者，女性，５１岁。因右上腹痛伴呕吐入院。查体：Ｔ３７．５℃，墨菲氏征（＋＋）．脾及其它腹部脏器未见明显阳性体证。Ｂ超探查示：胆囊大小为３．０ｃｍ×３．３ｃｍ×８．３ｃｍ，囊壁粗且增...     

B超诊断再生胆囊1例

Ｂ超诊断再生胆囊１例广东省东莞市厚街医院Ｂ超室张伟患者女，４０岁，曾因慢性胆囊炎急件发作，行胆囊摘除术，后因时有腹痛五年来诊，Ｂ超检查见胆总管下段结石１．９ｃｍ×１．０ｃｍ、肝内外胆管中度扩张；于胆总管前方见胆囊佯液性暗区，大小为６６ｃｍ×３．１ｃｍ...     

B超在妇科检查中的诊断分析

Ｂ超在妇科检查中的诊断分析辽河油田油气集输卫生院Ｂ超室邮政编码１２４０１０王新华我院Ｂ超室在妇科检查中确定（１）子宫肌瘤者４８例，占受检人数的３％，其中３０岁以上者为４６例，瘤体大者为１５．３ｃｍ×１１．６ｃｍ×１２．５ｃｍ，小者０．５ｃｍ×０．６ｃ...     

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.     

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.