超声诊断胰腺外伤3例

病例1,男,22岁,因车祸中被钝器击中腹正中就诊,来院时上腹部有明显压痛.超声检查肝、胆、脾、肾均未见明显异常回声,扫至胰腺处示胰头厚3.0 cm,胰体厚1.5 cm,胰尾厚1.9 cm,胰头明显增大并可见范围约2.8 cm×1.5 cm实质回声减弱(图1)、杂乱不均区,被膜连续性差,可见较明显的断端及局限游离液性无回声区,胰体及胰尾回声均匀,少量饮水后示主胰管未见积液征象.超声诊断:①胰腺破裂;②腹腔局限性积液(考虑积血);③肝、胆、脾、肾、膀胱、前列腺未见异常.手术结果示:胰腺破裂头部有约2.8cm×1.0 cm挫裂口,行缝合术,检查其他脏器无异常,愈合良好.     

胰腺囊肿内血管破裂出血1例

患者 ,女 ,12岁 ,因持续性腹痛 2ｄ入院 ,查体 :心肺正常 ,腹部平坦 ,腹肌紧张 ,全腹压痛 ,以左上腹为主 ,肝脾肋下 (-) ,腹水 (-)。超声检查 :肝、胆、脾、双肾未见异常 ,胰头体部未见异常 ,胰尾显示不满意 ,于左上腹胰尾区 ,脊柱左侧、脾脏与左肾上极之间测及 8ｃｍ× 6ｃｍ× 7ｃｍ大小中等回声团块 ,部分边界清晰 ,内部回声较均匀 ,后方回声稍有增强效应。团块周围见肠道回声 ,腹盆腔内见少量无回声区。彩色多普勒血流显像 (ＣＤＦＩ)示 :团块内未见血流信号 ,周边可见血流信号 ,Ｖｍａｘ44ｃｍ /ｓ ,ＲＩ0 .5 4(图 1)。超声诊断 :①左…     

先天性胰腺囊肿超声表现1例

患者男,50岁.无多囊肝、肾、脾病史,来院行腹部超声常规体检,超声表现:胰腺明显增大,形态失常,轮廓不光滑,胰头厚约3.53 cm,胰体厚约3.50 cm,胰尾厚约3.03 cm,内可见多个大小不等的囊性无回声区,其间可见胰腺组织,囊壁光滑较薄,后壁增强不明显,内透声好(图1).肝、肾、脾未见异常回声.超声提示:先天性胰腺囊肿.     

肾上腺血肿的超声表现1例

患者女 ,2 1岁。因 5个月前无明显诱因出现左上腹胀痛不适 ,近日加重就诊。查体 :左侧脾肾区压痛及扣击痛 ,余未见明显阳性体征。血尿常规正常。B超示 :脾、肾间见 11.7cm× 9.1cm× 9.3cm的囊实性回声区 (图 1) ,其周边有完整包膜 ,其内有多条分隔并可见 6 .4 cm× 5 .9cm的中等不均质实性回声区 ,与左肾上极及胰尾无明显界限 ,随呼吸运动不明显。脾未见异常。B超诊断 :脾肾间囊实性回声区 ,考虑来源于左肾上腺肿物。外院 MRI示 :左肾上腺占位性病变 ,大部分液化坏死。手术所见 :肿瘤位于后腹膜 ,质地硬 ,包膜基本完整。翻开降结肠 ,暴露…     

腹膜后异位副脾并表皮样囊肿超声表现1例

患者女,28岁.既往健康,健康体榆时超声发现左上腹膜后囊实性占位性病变入院.超声检查:脾内下方、左肾的外前方、胰尾的外侧见一分叶状囊实性团块,边界清晰,内回声不均,内显示多个大小不等的类圆形相互连通的无回声区,其形态规则,边缘齐整,内透声尚好,后方见声增强效应;团块实质内见较丰富点、条状血流信号;测其动脉Vmax 36.5cm/s,R10.56;团块与脾和胰尾紧依,与左肾上极邻近;脾和左肾位置、形态、大小及内回声无异常.超声提示:左上腹膜后囊实性占位病变,建议CT进一步检查.     

超声诊断胰腺多形性肉瘤1例

正患者男,37岁,既往体健,以"间断上腹痛20余天"就诊于我院,入院后腹部CT印象:胰腺体尾部囊实性占位伴出血,见图1a。胰腺MR平扫+增强印象:胰腺体尾部囊性病变伴出血,考虑良性,见图1b。超声检查示:胰腺体尾部可见一囊性回声,壁较厚,不光滑,内可见分隔回声,见图1c～d;胰尾区可见一低回声团块,边界尚清,内回声不均匀,可见小片状无回声区。彩色多普勒超声:未见明显血流信号。超声印象:胰体尾部囊性及囊实性占位。患者术后病理结果为:(胰腺体尾部肿物)考虑多形性肉瘤。     

肾嗜酸细胞瘤超声表现一例

患者男,70岁,左腰部胀痛2年余,无发热及肉眼血尿。查体:左肾区轻度叩痛,其余阴性。实验室检查示:血常规、尿常规+沉渣、肾功能等均未见异常。腹部超声检查示:左肾体积增大,外形异常,于中下极探及孤立实性中等偏高回声团块,大小为7.5cm×6.9cm×6.5cm,边界清楚,类圆形,似有包膜,局部外凸,内回声不均,中心部可见星形低回声区(图1);彩色多普勒血流成像示:团块周边见血流信号绕行,中心部低回声区未见明显血流信号,其余内部可见短条     

超声诊断胎儿部分型尿直肠隔序列、右侧多囊性发育不良肾合并左侧重复肾重复输尿管1例

<正>孕妇,33岁,孕2产1,无家族遗传病史。产前血清学筛查正常。孕23周产前系统超声检查:胎儿各项生物学指标测值与孕周相符。右肾区未见正常肾形态和轮廓,见一大小3.5 cm×2.1 cm包块,由多个大小不等的囊性无回声区构成,较大无回声区大小1.5 cm×1.5 cm,内透声可,囊与囊未见交通(图1)。左肾大小1.9 cm×1.0 cm,形态结构及回声均未见异常。左侧输尿管内径0.3 cm。CDFI示右肾动脉细小,左肾动脉正常。反复探查胎儿肛门靶环征不清,较宽的结肠内径0.6 cm,可见絮状高回声肠内容物蠕动。胎儿左房室沟处见扩张的冠状静脉窦,大小0.4cm×0.3 cm,肺动脉左侧见一直径0.2 cm血管,汇入冠状静脉窦,未见无名静脉声像。羊水指数12.8 cm。超声提示:胎儿右     

胰腺肝样癌超声造影表现1例

正患者男,48岁,体检发现胰腺占位1周。甲胎蛋白61 887.16ng/mL,异常凝血酶原22 930.78mAU/mL,乙肝小三阳。CA199、CA125、CA153、CEA未见异常。超声提示肝左叶及胰头间7.8cm×4.9cm低回声团块,边界不清,形态不规则,CDFI:内部未见明显血流信号。超声造影所见:团块在20s时呈不均匀高增强,见图1,2min 21s呈低增强,见图2。完善相关检查后行胰十二指肠切除术,术后病理诊断胰腺肝样癌。     

超声诊断多房性囊性肾细胞癌1例

患者男,22岁.以间断性全腹隐痛十余天入院.外院B超、CT检查均提示为左侧肾囊肿.彩超检查:左肾大小13.0 cm×5.6 cm×5.9 cm,左肾实质回声不均匀,于肾下极见一8.8 cm×6.7 cm×6.8 cm的囊性肿物,形态规则,略向被膜外突,与肾实质分界清,囊壁厚薄不均,后壁回声略增强;内部见多条较强回声光带将其分隔成大小不等、形态不一的"蜂窝"状无回声区,其中较大一3.0 cm×2.6 cm,集合系统尚明亮集中,略有挤压向后移位(图1).CDFI:囊壁及内部见少许点状血流信号.提示:左肾实质多房性囊性占位病变,肾癌可能.术中快速冰冻提示为良性,术后病理诊断:(左肾)多房性囊性肾细胞癌(图2).     

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.