对称性肱骨头股骨头缺血性坏死

患者男,51岁,两年前自觉右肩部及右髋部疼痛,Ｘ线片示骨质正常,诊为肩周炎与右髋关节炎,长期服用“消炎痛”以缓减症状,坚持日常农业劳动。近三个月双肩关节及双髋关节疼痛加重,功能受限,不能坚持正常行走和站立,双肩不能上抬。Ｘ线检查:双肱骨头变扁,关节面碎裂呈分节状,密度不均匀性增高,解剖颈宽而短,肱骨头向上移呈半脱位状态;右髋关节间隙变窄,髋臼与股骨头关节面不光滑,股骨头变扁,与颈部均示囊样不规则密度减低区;左髋关节间隙正常,股骨头内亦示囊样不规则密度减低区,关节面光滑无变形。诊断:双肱骨头股骨头缺血性坏死。讨论　股骨头…     

髂骨海绵状血管瘤1例

患儿女,9岁。2010年7月13日因右侧髂髋部疼痛、活动受限3个月入院就诊。该患儿3个月前无明显诱因自觉右侧髂髋部疼痛并逐渐加重,跛行。近1个月明显加重,出现静息痛。入院后行X线骨盆平片检查示:右侧髂骨翼外侧见一椭圆形骨质低密度区,其边缘骨质硬化,周围软组织未见明显肿胀及静脉石(见封2图1)。MRI检查示:右侧髂骨翼外侧见类椭圆形T1低信号T2高信号,边界清晰,临近骨质硬化,肌肉体积略变小(见封2图2～4)。诊断右髂骨血管瘤。     

胫骨骨内原发恶性腱鞘巨细胞瘤一例

正病例资料女,68岁,8个月前无明显诱因出现右侧膝关节内侧疼痛,呈阵发性的灼痛,气温升高时加重,休息后缓解,疼痛影响夜间睡眠,近期体重无明显减轻。影像学检查:膝关节平片(图1)示右胫骨平台内侧关节面下骨质破坏透光区,约2.2 cm×1.6 cm×2.5 cm,周边见骨质硬化带,未见骨膜反应,未见死骨,周边软组织肿胀。膝关节MRI(图2)示右胫骨平台内侧骨质破坏,T1WI呈低信号,T2WI呈稍高信号,胫骨内侧见软组织团块包绕,胫骨上段骨髓水肿。综合影像考虑骨巨细胞瘤与感染性病变鉴别。病理活检:右胫骨上段内侧纵向行3.0 cm切口,骨刀     

颅内非典型性黑色素瘤1例

病例男,68岁.2周前无明显诱因出现双小腿困乏、记忆力下降、言语欠流利,未行特殊诊治.入院前3天出现夜间睡眠障碍,当地医院行头颅CT检查示:右额部类圆形占位性病变,密度略欠均匀,直径约5 cm,周围脑水肿,右侧侧脑室受压,中线结构略向左移.继而转来我院,入院查体患者无发热,精神食欲较好,大小便正常,入院后系统查体其他部位未见明确异常.头颅MRI检查(图1)示:右侧额叶见一类圆形囊实性占位病灶,T1WI序列病灶囊性部分信号与脑白质信号相似,T2WI序列呈高信号,实性结节位于囊前外侧靠近脑表面呈短T1等T2信号,病灶境界尚清,外周环绕片状稍长T1长T2水肿信号,局部脑沟变浅消失,右侧侧脑室前角受压;增强示:右侧额叶病灶呈环形不规则强化,局部结节较大明显强化,病灶大小约为4.0 cm×4.2 cm×5.0 cm.     

侧脑室神经鞘瘤一例

女,29岁,间断性头痛8个月伴加重3 d。查体:颅神经检查未见异常,四肢肌张力正常,双侧肢体肌力5级,肢体无瘫痪,腱反射正常,病理征阴性。MRI检查:右侧顶部及侧脑室后角不规则囊实性信号影,大小为3.8 cm×3.4 cm×3.4cm,肿瘤实性部分呈TIWI等信号T2WI稍高信号(图1A、1B),T2 FLAIR及扩散加权成像(diffusion weighted imaging,DWI)呈稍高信号(图1C、1D),表观扩散系数(apparent diffusion coefficient,ADC)图信号未见明显降低,ADC值为0.2×10^-3 mm^2/s(图1E),囊性部分各序列与脑脊液信号相仿,内可见低信号分隔,增强扫描病灶实性部分呈明显较均匀强化,其内可见斑点状无强化区,囊壁及分隔未见明显强化(图1F、1G),周围脑组织呈TIWI稍低信号T2WI稍高信号。     

产前超声检出胎儿胸膜肺母细胞瘤1例

孕妇33岁,于孕32周经产前超声检查发现胎儿肺部多个低回声结节(图1 A );孕38周超声示胎儿肺部结节较前增多、增大,周围肺组织回声增强,CDFI均未见明显血流信号(图1B).孕妇既往体健,孕2产1,与其丈夫均无家族及遗传病史;孕期胎儿发育无明显异常.孕38周胎儿MRI:双肺见数枚类圆形 T1稍高信号、T 2低信号结...     

半肢骨骺异样增殖症超声表现1例

患儿女, 8个月, 因双下肢不等长行双侧髋关节超声检查, 检查见双侧髋关节骨性臼顶及软骨臼顶覆盖良好, 骨性髋臼上缘锐利, 股骨头大小正常, 位于髋臼窝内;右髋关节Y形软骨内可见数个强回声团, 较大者约0.6 cm×0.3 cm(图1), 后方伴声影, 彩色多普勒血流显像未测及明显异常血流信号;左侧髋关节回声及结构未见异常。超声提示右侧髋关节Y形软骨内多发强回声团。双侧髋关节X线检查示:右侧髋关节骨骺较对侧增厚, 内伴钙化(图2)。双侧髋关节MRI检查见:右侧髋关节Y形软骨内多发骨化灶(图3), 余双髋关节骨端髓内未见异常信号灶。临床诊断为:半肢骨骺异样增殖症(dysplasia epiphysealis hemimelic, DEH)。     

腰大肌血管内皮细胞肉瘤1例

病例介绍患者男,40岁,因右髋部酸痛并放射至右大腿外侧疼痛1个月入院。入院1个月前腰椎X光片检查未见明显异常。血常规示白细胞达20×109/L,在外院经抗炎治疗无效,疼痛逐渐加剧,收住我院骨外科。体检:T36.2℃,P78次/分,R22次/分,BP14/10kPa。右髋关节、右膝关节被动活动无明显受限,主动屈髋及被动伸髋时酸痛加重。右后腰部轻度酸痛,无红肿,脊柱无畸形及叩痛,腹部无明显肿痛。实验室检查白细胞18×109/L,余均在正常范围。影像学检查:X线平片示右侧腰大肌明显肿胀,腰椎骨质未见明显破坏或增生(见图1)。CT扫描示右侧腰大肌内见4cm×5cm×1…     

CT、MRI诊断滑膜骨软骨瘤病1例

患者男 ,39岁。右髋部疼痛 2年余。查体 :右侧 4字试验 ( ) ,无叩痛 ,活动尚可。Ｘ片诊断 :右髋关节炎性改变 ,周围软组织内淋巴结钙化 ?于我院行ＣＴ示 (图 1) :右髋关节囊内及关节周围见多个小结节状和环形钙化灶 ,关节囊滑膜明显增厚 ,右股骨头及髋臼轻度骨质增生。ＭＲＩＦ     

皮下结节型脂膜炎MRI表现1例

患者男,37岁,主因“右上臂三角区肿块3个月,局部皮肤桔皮样改变1个月”就诊.查体:右上肢三角肌区见类圆形肿块,质硬,活动度差,表面皮肤桔皮样改变.血常规及肿瘤标记物正常.右上肢X线片:右侧肱骨骨质及周围软组织未见明显异常(图1).右上肢MR:右侧肱骨三角肌外侧缘皮下脂肪组织内见边界清楚的类圆形肿块,与表皮组织粘连明显,T1WI、T2WI于略低信号基础上见絮状稍高信号(图2),考虑为纤维瘤.行右上肢体表肿物切除术.术后病理诊断:脂膜炎.     

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.