二维及频谱多普勒诊断甲状腺肿瘤的应用价值

目的:应用二维及频谱多普勒检测甲状腺肿瘤血管,并进行分析,探讨其在甲状腺肿瘤诊断和鉴别诊断中的价值,更好地为临床服务。方法:入选35例甲状腺良性肿瘤(结甲21例,腺瘤14例)和21例甲状腺癌患者术前均行二维及频谱多普勒检查,包括最高流速(Vmax),阻力指数(RI)。对良恶性肿瘤的二维图像特征及血流动力学参数差异进行分析。结果:甲状腺良恶性肿瘤的二维图像特征及血流动力学参数(Vmax、RI)存在极显著差异(P<0.01)。结论:二维及频谱多普勒对鉴别甲状腺良恶性肿瘤具有重要意义。     

心肺复苏中即时气管插管与延时气管插管的救治效果对比

【目的】总结研究急诊医护人员在心肺复苏无困难情况下实施即时气管插管的重要性。【方法】对107例心肺复苏患者随机分为治疗组为无困难插管组（即时插管）54例和对照组为困难插管组（延时插管）53例，通过观察两组患者心肺复苏成功率与存活率，比较即时插管与延时插管的救治效果。【结果】即时插管的患者心肺复苏的成功率为40．7％，存活率为18．5％；延时插管的患者心肺复苏的成功率为11．3％，存活率为1．9％，两组相比较差异显著（P〈0．05）。【结论】急诊医护人员在心肺复苏患者咽部无障碍的情况下即时气管插管可提高心肺复苏的成功率与患者的存活率。     

医学超声图像三域滤波去噪算法

针对视频格式的医学超声图像序列,提出了一种同时利用空间域、灰度域和时间域的相关信息的三域滤波算法。首先对每一帧图像,充分利用空间域和灰度域的相关信息构建自适应邻域,接着进行空间域和灰度域加权滤波,最后利用相邻帧之间的时域相关性进行时域加权滤波。三个域的滤波均采用高斯核函数加权,从而减小了滤波结果对阈值选取的敏感度,提高了算法的稳定性。实验结果表明,三域滤波算法能有效地抑制图像中的噪声,并保留边缘细节,有利于图像的特征提取、识别和分析。     

Increased risk of leukaemia in patients with juvenile chronic arthritis treated with chlorambucil

Two cases of acute leukaemia have developed in a group of 77 patients treated with chlorambucil (Chl) because of severe juvenile chronic arthritis. The total follow-up from the beginning of Chl treatment in these patients was 560 years, indicating a highly increased risk of leukaemia. Despite favourable results, especially in patients with secondary amyloidosis, Chl should only be used in selected cases.     

Prevalence and aetiology of neurological impairment in extremely low birthweight infants

Objective : To determine the prevalence and perinatal predictors of cerebral palsy, intellectual impairment, visual impairment and deafness in a cohort of extremely low birthweight (ELBW) infants at two years of age.
Methodology : The study population comprised 199 of the 224 (89%) ELBW infants managed at the Mater's Mothers Hospital, Brisbane, between July 1977 and February 1990 and who survived to two years. The prevalence of cerebral palsy, intellectual impairment, blindness and deafness was measured by clinical, psychometric and audiological assessment and the association with 24 risk factors examined.
Results : Cerebral palsy occurred in 20 children (10%). Risk of cerebral palsy was associated with ventricular dilatation, intraventricular haemorrhage, necrotizing enterocolitis and multiple birth, though only ventricular dilatation (OR 4.41; 95% Cl 1.32-14.8) remained significant in the adjusted analysis. Intellectual impairment occurred in 20 children (10%) and was independently associated with ventricular dilatation (OR 15.0; 95% Cl 2.2-102.8), ventilation F _iO₂ >80% (OR 3.4; 95% Cl 1.01-11.5), vaginal delivery (OR 3.5; 95% Cl 1.09-11.4) and male sex (OR 6.1; 95% Cl 1.67-22.3). No perinatal predictor was statistically associated with risk of deafness. Retinopathy of prematurity (OR 36.9; 95% Cl 2.8-495.5) was associated with risk of later visual impairment.
Conclusions : Intellectual impairment was associated with a broad range of perinatal variables. Cerebral palsy was associated with fewer variables, all of which were also associated with intellectual impairment. Neurologic injury was associated with male sex and multiple birth, which are not biological insults themselves, but may be markers of susceptibility to injury.     

Abnormal anatomy of the lumbosacral region imaged by magnetic resonance in children with anorectal malformations

OBJECTIVE: To investigate the frequency of lumbosacral anomalies, the association with urogenital abnormalities, and the correlation with defaecation pattern by magnetic resonance imaging (MRI). METHODS: A prospective analysis was performed of routine MRI in patients with anorectal malformations. Between 1990 and 1994, MRI was performed in 43 such patients: 31 boys and 12 girls. Twenty four had a high anorectal malformation, 16 had a low anorectal malformation, and three had Currarino's triad. MRI was performed before reconstruction in 26, and postoperatively in 17. Urogenital anomalies were found in 21. RESULTS: Abnormalities of the spinal cord and spine were found with MRI in 20 patients (46.5%); caudal regression syndrome in 10, tethered cord in two, a combination of both in three, and other spinal anomalies in five. These anomalies were found in 30% of the patients with low anorectal malformations, and in 50% with high anorectal malformations. In patients with urogenital malformations, MRI more often showed spinal anomalies (13/21, 62%) than in patients without (7/22, 32%). In high anorectal malformations, defaecation was more often a problem in patients with spinal anomalies (12/15, 80%) than in patients without (2/8, 25%). CONCLUSIONS: Spinal anomalies in the lumbosacral region were found with MRI in 46.5% of patients with anorectal malformations. Since presence of these anomalies seems to be related to clinical outcome, MRI should be performed routinely in all such patients.     

Biofeedback training in chronic constipation

Twenty nine patients, aged 5-16 years, were studied to evaluate whether biofeedback training is effective in treating children with chronic constipation and encopresis; the clinical outcome at six weeks and 12 months was also evaluated. Patients received on average five biofeedback training sessions. The existence of external anal contraction or decreased rectal sensation in 16 (55%) and eight (27%) of the children, respectively was identified on manometry. After biofeedback training, 26 (90%) of the patients learned to relax the external anal sphincter; 18 (63%) normalised rectal sensation. The training resulted in a significant increase in defecation frequency and a significant decrease in encopresis. At six weeks, 16 (55%) of the patients were clinically symptom free. At follow up after 12 months the results were sustained. Only three patients showed a relapse within six months, of whom two were successfully treated with one extra training session. Biofeedback training might be a useful therapeutical approach in children with chronic constipation and encopresis.     

中药抗疲I号对训练Wistar大鼠急进高原并运动力竭后心肌及其酶谱的影响

目的通过训练大鼠急进高原模型从心肌组织形态和酶谱改变,研究训练对心肌损伤的防护。方法于海拔1520m实地环境设实验组(EG)采用中药抗疲I号加入常规饲料中喂养,对照组(CG)常规饲料喂养,EG、CG各40只游泳训练4周后,各选35只3h急进海拔3850m实地静息1.5h,从中各选10只作为静息对照采集标本,EG、CG各20只游泳至力竭后1h、24h采集标本;测定比较各组心肌酶谱指标等,镜下观察比较各组心肌形态变化。结果EG血中心肌酶谱指标1h、24h指标均优于CG1h、24h结果;心肌组织学结构从纵断面看,EG心肌结构清晰,肌丝细密,横纹清楚,核周无空隙;横断面心肌纤维群间隙小,毛细血管平均为10～12个/HPF;CG心肌纤维界限不清晰,肌丝分散,横纹不清楚,横断面心肌纤维群间隙增宽,毛细血管平均为3～5个/HPF,毛细血管腔扩张,红细胞堆积,提示有水肿。结论急进高海拔地区运动后可使心肌纤维缺氧水肿,血中心肌酶谱增高,同时会使心肌营养不良而发生结构改变,对心肌的供氧能力好坏必然决定运动能力强弱,过度训练、改变运动集训环境或强体力劳动均可引起心肌供血能力下降,本研究是通过抗疲I号加入食品干预训练大鼠的,有利于改善心肌营养与供氧状况,并能降低心肌纤维水肿发生。