二维超声在急性胰腺炎诊断分型中的价值探讨

目的探讨二维超声在胰腺炎的诊断价值并试图分型。方法对116例急性胰腺炎进行一次或多次B超检查。结果B超分型①急性水肿型73例(63％)，超声表现为胰腺弥漫性肿大，边缘清晰，实质回声减低。其中4例手术后，病理主要表现为胰腺间质的水肿、充血。超声表现与病理大致吻合；②出血坏死型21例(18％)，超声表现为胰腺增大，边缘模糊，回声减低且不均匀，其中16例手术，病理主要为胰腺实质的局灶性或融合性坏死，细胞结构消失。超声表现与病理吻合。结论二维超声根据超声表现，结合临床，对急性胰腺炎初步分型，能为临床提供有价值的参考。     

162例急性胰腺炎的超声诊断体会

对162例急性胰腺炎的声像图进行测量、分析,并结合临床表现和实验室结果。162例中超声诊断为急性胰腺炎158例,漏诊4例。158例中,急性水肿型121例,超声表现为胰腺弥漫性肿大、边界清晰、实质回声减低呈不均匀的片状低回声、无回声或弱回声,夹杂有稀疏光点,少部分出现胰周少量积液。急性出血坏死型37例,超声表现为超声主要改变为胰腺体积弥漫性轻度增大,边缘模糊、回声减低且不均匀,胰腺周围积液。超声诊断急性胰腺炎方法直接、简便、无痛、无创、迅速,对制定治疗方案与评估预后,具有重要的临床应用价值,应作为首选检查手段之一。     

急性胰腺炎39例早期声像图改变与年龄的关系

目的探讨超声对早期急性胰腺炎不同年龄段的声像变化及其诊断价值。胰腺实质回声随年龄增长呈增强趋势,老年人应依据其超声测值和回声特点来判断。方法对确诊的39例急性胰腺炎的超声图像进行综合分析,并对39例急性胰腺炎胰周积液情况和其中的30例急性水肿型胰腺炎胰腺大小、回声特征分19~40岁,41~60岁,61~79岁3个年龄组重点讨论。内容包括胰腺大小、边界、内部回声、周围结构、胰周积液及病理分型等。结果39例急性胰腺炎中急性水肿型30例(76.9%),急性出血坏死型9例(23%),小网膜囊积液17例(43.6%),有30例胰腺呈弥漫性或局限性不同程度的肿大,7例大小正常,2例因肠腔气体干扰显示不清。超声诊断符合率94.9%。急性水肿型胰腺炎表现为胰腺形态饱满,22例肿大,7例回声偏低,18例弥漫性增强,边界清晰或稍显模糊,尚规则,10例小网膜囊积液,8例主胰管扩张。其中在18例回声增强中19~40岁11例回声增强2例(18.2%),41~60岁11例回声增强9例(81.8%),61~79岁8例回声增强7例(87.5%),回声高低与年龄增长有相关性;急性出血坏死型胰腺炎表现为胰腺形态欠规则或极不规则,回声强弱不均,8例肿大,以头尾肿大显著,边界模糊或清晰,7例伴有程度不等的小网膜囊窄带状,不规则片状无回声或低回声积液,2例主胰管扩张。39例急性胰腺炎胰周积液17例19~40岁13例发生3例(17.6%),41~60岁15例发生10例(58.8%),61~79岁11例发生4例(23.5%)。41~60岁年龄段小网膜囊积液发生率增高,不同年龄回声各有其特征。结论超声对不同年龄段急性胰腺炎有较高的诊断价值,但仍有一定的局限性。     

超声经脾肾切面显像诊断急性胰腺炎的临床价值

目的 探讨经上腹常规切面超声不能显示胰腺或胰尾部显示不清的急性胰腺炎，应用超声经脾肾切面显像诊断的临床价值。方法 回顾性分析经脾肾切面显像诊断，并经CT扫描和临床及手术病理证实的急性胰腺炎86例。结果 86例急性胰腺炎，超声检出83例，超声检出率96．5％(83／86)，漏诊3例，占3．5％(3／86)。结论 应用超声经脾肾切面显像诊断急性胰腺炎，能避免胃肠道积气的干扰，对急性胰腺炎的检出率较高，并能做出分型诊断，具有较高的临床应用价值。     

彩超对不同分型肉芽肿性小叶性乳腺炎的诊断价值

目的探讨超声对不同分型肉芽肿性小叶性乳腺炎的诊断价值。方法选择手术或粗针穿刺后病理确诊为肉芽肿性小叶性乳腺炎158例患者的超声表现进行回顾性研究,肉芽肿性小叶性乳腺炎依据文献分为片状回声型、结节(或)肿块型、弥散型三种类型。结果 158例肉芽肿性小叶性乳腺炎病灶中,误诊26例,超声诊断肉芽肿性小叶性乳腺炎的符合率为83.5%。结节(或)肿块型23例,超声诊断符合率为30.4%(7/23);片状回声型56例,超声诊断符合率为87.5%(49/56);弥散型79例,超声诊断符合率为96.2%(76/79)。结论超声对肉芽肿性小叶性乳腺炎的诊断具有较高的临床价值,其诊断符合率与超声分型有关。     

CT平扫在急性胰腺炎诊断中的应用

[目的]探讨CT平扫对急性胰腺炎的诊断价值.[方法]回顾性分析80例经临床证实急性胰腺炎病例的CT资料,观察其CT表现特征及范围.[结果]轻中型急性胰腺炎68例,大多数痛人胰腺体积局部或弥漫性增大,胰腺密度均匀或不均匀,吉氏筋膜增厚,少数病人可无阳性CT表现;重型胰腺炎12例,胰腺体积增大,胰腺边界模糊,胰周脂肪间隙消失,胰周可见积液(小网膜囊和结肠间隙),胰腺坏死密度减低.[结论]CT平扫是诊断急性胰腺炎的简便、有效的方法,有助于急性胰腺炎的早期诊断及分型.     

慢性胰腺炎的超声内镜表现与诊断

目的探讨超声内镜在慢性胰腺炎(CP)早期诊断中的应用价值。方法对30例CP患者的胰腺超声内镜表现进行分析,并与对照组30例(胃或食道良性小隆起病变)患者的胰腺超声内镜表现进行对照,筛选出超声内镜诊断CP的敏感指标,并行CP超声内镜分型。结果CP组超声内镜表现:(1)胰头增大24例(24/30),与对照组比较差异有非常显著性(P<0.01);(2)假性囊肿6例(6/30),胰石及多发钙化2例,与对照组比较差异无统计学意义(P>0.05);(3)胰腺实质出现腹背分界不清、点状或线状高回声聚集,管壁回声增强分别为22例(22/30)、23例(23/30)、22例(22/30),特异性为70%、46.7%、40%,与对照组比较差异无统计学意义;(4)胰腺背侧腺体回声不均、主胰管大小异常、胰腺边缘细波纹状或模糊、胰腺大小异常、实质异常回声块特异性高均为80%以上,敏感性亦均为50%,与对照组比较差异有统计学意义(P<0.05)。结论CP超声内镜表现具有多样性,包括胰腺大小、实质、胰管、边缘、异常回声块多种声像表现,其中胰腺背侧腺体回声不均,主胰管大小异常,胰腺边缘细波纹状或模糊,胰腺大小异常,实质异常回声块是5个最敏感的指标。     

急性胰腺炎早期CT检查的价值

目的:探讨急性胰腺炎的CT征象、分级与临床分型、预后的关系以及CT对急性胰腺炎早期诊断的价值。方法:对56例手术病理或复查证实急性胰腺炎的CT资料进行回顾性分析,并按CT分为A、B、C、D、E五级的各组病例分别与血尿淀粉酶进行分析。结果:CT表现胰腺肿胀49例(87.5%),胰腺渗液38例(67.8%),胰腺坏死18例(33%),假性囊肿形成11例(19.64%),合并感染或脓肿形成8例(14.28%)。血尿淀粉酶与CT比较:A级5例(8.92%)血尿淀粉酶轻度升高,B级13例(23.21%)中度升高,C级11例(19.64%)显著升高,D级8例(14.28%)血尿淀粉酶趋向下降,E级19例(33.92%)显著下降。结论:CT对急性胰腺炎的早期诊断有非常重要价值,应作为诊断急性胰腺炎的首选方法。     

IgG4相关自身免疫性胰腺炎的超声表现及特征分析

目的总结Ig G4相关自身免疫性胰腺炎(Ig G4-AIP)的超声表现及特征。方法回顾性分析2014年12月至2019年4月首都医科大学附属北京友谊医院收治的40例Ig G4-AIP患者的临床及影像学资料,观察胰腺大小、形态、回声,有无肿物及肿物的大小、形态、回声及血流情况,同时观察主胰管、肝内外胆管有无狭窄或扩张,胆管壁有无增厚,腮腺、颌下腺有无肿大或肿物,其中3例行超声造影检查,观察胰腺病灶的增强-消退过程。结果本组患者男女比例为5. 7︰1,50～79岁者占90%。临床表现以黄疸、腹痛为主。胰腺超声表现分为3型:节段型8例(20. 0%),胰腺大小、形态正常,局部回声不均匀,以回声减低为主;弥漫型17例(42. 5%),胰腺弥漫性肿大,回声不均匀减低;肿块型15例(37. 5%),胰腺局限性肿大,回声与周围胰腺类似或减低,"肿块"位于胰头10例,胰尾5例。3例肿块型病变行超声造影检查,2例动脉期呈高或等增强,延迟期呈等增强,1例动脉期及延迟期均呈低增强。本组合并Ig G4相关胆管炎29例(72. 5%),其中超声确诊胆管炎10例,表现为肝内和(或)肝外胆管管壁不均匀增厚;合并IgG4相关涎腺炎6例(15. 0%),表现为腮腺和(或)颌下腺回声弥漫不均匀,伴或不伴有纤维条索样高回声。结论 Ig G4-AIP超声表现以弥漫型及肿块型为主,超声检查在发现胰腺病变的同时,联合胆管、涎腺等多器官扫查可为临床提供更有价值的信息。     

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.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.