非霍奇金淋巴瘤浸润心脏超声表现一例

<正>患者男性,44岁,因"发热,咳嗽,胸闷2个月余"入院,入院查体:双肺呼吸音清晰,未闻及干湿罗音和胸膜摩擦音。经胸超声心动图检查示:各房室内径正常;右心室前侧壁房室环沟至心尖部可探及大小约80 mm×43 mm×57 mm的实性低回声包块,形态不规则,与右心室壁及心包分界不清,内回声不均质,该包块未见明显活动,部分突入右心室腔内,致右心室流出道狭窄,最窄处内径约12 mm,     

淋巴瘤心脏浸润超声随访1例

患者女,38岁.主因胃痛、纳差3个月入院,曾于3个月前因胸闷行超声心动图检查,未见明显异常.入院当日行胃镜检查提示:胃多发性占位性病变.胃镜检查当日夜间患者突发胸闷、气促、呼吸困难,急诊超声心动图提示:左房增大,左心房壁、房间隔下段、房室瓣环上及肺静脉周边可见大量团块状低回声.心包腔内大量无回声区,心包脏层可见片状低回声,右心房室舒张受限.超声诊断:(1)左房内、心包脏层多发占位性病变,考虑转移;(2)心包积液(大量);(3)心包填塞.     

超声诊断右侧房室沟处横纹肌肉瘤1例

<正>患者男,53岁。胸闷不适3年伴呼吸困难1年入院。心脏超声示(图1):右侧房室沟处见一中低回声肿块,形态尚规则,肿物与室壁分界不清,大小约3.8cm×4.2cm×2.3cm,心包腔内并可见无回声区,左室后壁后方约1.8cm,心尖部约2.3cm。CDFI(图2):二、三尖瓣口可见少量蓝色反流信号。超声提示:(1)右房室沟处心脏占位,恶性肿瘤?(2)二、三尖瓣少量反流。(3)心包积液。入院查体:生命体征平稳,心前区触及震颤和心包摩擦     

右心房巨大血管肉瘤超声表现1例

患者女 ,49岁。因进行性胸闷、气短 3个月 ,加重 1周入院。入院前 3个月无明显诱因出现咳嗽 ,无痰 ,无发热。于外院就诊Ｘ线胸片提示右侧胸腔积液 ,胸腔穿刺抽出淡黄色胸水 ,诊断为结核性胸水。给予抗结核治疗 ,其间逐渐出现胸闷、憋气等不适症状。行超声心动图检查提示 :右侧心包区囊实性肿物 ,约 3 .7ｃｍ× 2 .8ｃｍ ,右房受压 ,心包积液 ,右侧胸腔积液。患者于入院前 1周胸闷、气短明显加重 ,不能平卧 ,稍活动就有胸闷、憋气 ,复查超声心动图 :右侧心包区肿物明显增大 ,约 9.5ｃｍ× 8.9ｃｍ× 8.8ｃｍ ,呈囊实性 (周围呈不规则中等回声…     

右房原发性恶性肿瘤合并急性心包填塞超声诊断1例

<正>患者男,42岁。自觉胸闷逐渐加重1年余。3d前胸闷、心前区吸气时疼痛入院就诊,心前区无异常隆起,心界扩大,心音遥远。入院时血压66/45mm Hg,心率68次/min,急诊心脏超声检查示:右心房内见一大小约30mm×23mm不规则分叶状中低回声,边界不清,表面欠光整,无明显活动,一侧附着房间隔中上段,房间隔受累及,心包腔见液性无回声区包绕心脏,在各处的舒张末宽度为:左室后壁侧宽20mm,右室前壁侧宽17mm,心尖部16mm(图1)。超声心动图诊断:右心房内中等回声占位,     

右心房血管肉瘤超声表现1例

患者男,46岁。无明显诱因突感胸闷,随即晕厥入院。查体:血压85/60 mm Hg(1 mm Hg=0.133 kPa),心率80次/min,律齐,心音低钝,各瓣膜听诊区未闻及明显杂音;腹平软;双下肢不肿。血常规:白细胞20.8×109/L,红细胞4.3×1012/L,中性粒细胞93.3%。肝功能:谷草转氨酶262 U/L,谷丙转氨酶198 U/L。CT检查提示:心包、纵隔积液(大量)。磁共振提示:纵隔及心包腔内异常信号考虑为出血。行心包穿刺,抽出不凝血100 ml。彩色多普勒超声检查:于右心房顶部及后侧壁上可测及4处圆形中等强度的回声,向心房腔内突出,最大者约2.4 cm×2.9 cm,最小者约1.5 cm×1.…     

超声心动图诊断心脏转移性肿瘤2例

例1:患者男,54岁。因消瘦半年、咳嗽、胸闷3d入院。查体:心率84次/min,血压100/70mmHg,口唇发绀,肺气肿(+)。超声心动图检查(胸骨旁左室长轴及心尖四腔切面):左房内径35mm,其内探及大小约31mm×16mm×16mm及17mm×24mm×13mm的实质略强回声,边界清晰,欠规整,基底部与左房侧壁紧密相连,且界限不清,无移动。余腔室未见异常。心包腔探及液性暗区,舒张期右室前壁厚7mm,左室后壁17mm(图1)。超声诊断:左房多发实质性占位,心包大量积液。CT报告:左肺中央型肺癌,并侵及左主气管、肋骨、心包及左房;前上方纵隔多发淋巴结转移。T:肿块;PE:心包积液;…     

锁骨下静脉留置导管引流大量心包积液1例

锁骨下静脉留置导管引流大量心包积液１例余清报告经锁骨下静脉留置导管引流大量心包积液患者１例的体会如下。１病历简介患者男，６０岁，因劳累后胸闷、气短半年，加重伴不能平卧１周，于１９９６年８月２９日急诊入院。门诊超声心动图检查示大量心包积液，拟“心包积液...     

原发性心脏纤维肉瘤超声表现1例

患者男 ,3 1岁。因胸闷、气短 1个月入院。查体 :发育正常 ,营养不良。血压 10 0 /60ｍｍＨｇ(1ｍｍＨｇ =0 .13 3ｋＰａ) ,颈静脉轻度怒张 ,奇脉征 (+ )。心界向双侧扩大 ,心率 94次 /ｍｉｎ ,律齐 ,心音弱而遥远 ,未闻及病理性杂音。肝脾未触及 ,腹水征 (-)。躯干及四肢未触及包块 ,双下肢无水肿。胸部Ｘ线平片显示心影呈球形增大 ,右侧胸腔少量积液。超声心动图检查 :各房室腔及大血管内径正常。心包腔内见大量积液 ,最宽处 4.5ｃｍ。心包腔内可见 6.0ｃｍ× 3 .2ｃｍ的卵圆形稍高回声团 ,内部回声欠均匀 ,边界清晰 ,基底部宽1.8ｃｍ ,附…     

超声心动图诊断Bentall术后双侧冠状动脉吻合口漏并假性动脉瘤形成1例

<正>患者女，64岁，20年前因马凡综合征、升主动脉瘤样扩张于外院行Bentall术，术后长期口服华法林，现因“无明显诱因出现活动后胸闷10⁺d”来我院就诊，1周前曾有胸痛症状。体格检查：胸廓畸形，双下肢未见明显浮肿。心电图检查：心功能Ⅲ级，心尖区可闻及Ⅱ～Ⅲ期/6级收缩期杂音。心电图提示：(1)异位心律(心房颤动)；(2)室内传导阻滞；(3)室性早搏；(4)ST-T改变。超声心动图检查：升主动脉根部人工血管与双侧冠状动脉吻合口处回声连续性中断，探及2处缺口，左、右侧大小分别约14 mm、19 mm；彩色多普勒于缺口处探及五彩镶嵌血流信号，可见高速血流出入，峰值流速3.04 m/s，峰值压差37 mm Hg(1 mm Hg=0.133 kPa)。人工血管与自体血管之间可见分离液性无回声区，局部由自体血管包绕形成2处搏动性无回声区，向     

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.     

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.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.