Anticoagulants and reduced thrombus load in abdominal aortic aneurysms assessed with three-dimensional contrast-enhanced ultrasound examination

ObjectiveThe relationship between intraluminal thrombus (ILT) and abdominal aortic aneurysm (AAA) growth and rupture risk remains ambiguous. Studies have shown a limited effect of antiplatelet therapy on ILT size, whereas the impact of anticoagulant therapy on ILT is unresolved. This study aims to evaluate an association between antithrombotic therapy and ILT size assessed with three-dimensional contrast-enhanced ultrasound (3D-CEUS) examination in a cohort of patients with AAA.MethodsIn a cross-sectional study, 309 patients with small AAAs were examined with 3D-CEUS. Patients were divided into three groups based on prescribed antithrombotic therapy: anticoagulant (n = 36), antiplatelet (n = 222), and no antithrombotic therapy (n = 51). Patient ILT size was calculated in volume and thickness and compared between the three groups.ResultsPatients on anticoagulants had a significantly lower estimated marginal mean ILT volume of 16 mL (standard error [SE], ±3.2) compared with 28 mL (SE, ±2.7) in the no antithrombotic group and 30 mL (SE, ±1.3) in the antiplatelet group when adjusting for AAA volume (P < .001) and comorbidities (P < .001). In addition, patients on anticoagulant therapy had significantly lower estimated marginal mean ILT thickness of 10 mm (SE, ±1.1) compared with 13 mm (SE, ±0.9) in the no antithrombotic group of and 13mm (SE, ±0.4) in the antiplatelet group when adjusting for AAA diameter (P = .03) and comorbidities (P = .035).ConclusionsA 3D-CEUS examination is applicable for ILT assessment and demonstrates that patients with AAA on anticoagulant therapy have lower ILT thickness and volume than patients with AAA on antiplatelet therapy and those without antithrombotic therapy. Causality between anticoagulants and ILT size, and extrapolation to AAA growth and rupture risk, is unknown and merits further investigations, to further nuance US-based AAA surveillance strategy.     

新疆喀什市周边地区驴体内滞留寄生虫的检查报告

为了解新疆喀什市周边地区驴体内携带寄生虫种类和感染率、危害等情况,采用常规寄生虫病原学检查方法,对喀什市周边的疏勒县104份驴的粪样和疏附县的50份驴粪样进行了检查．其结果显示马圆线虫的感染率可达50％～82．7％,且该两个采样区域驴所感染的马圆线虫和毛细线虫混合感染情况较严重,其感染可达42％～48％。     

军事飞行学员医学停飞疾病谱分析

目的 总结分析空军某航空大学近年军事飞行学员医学停飞病征（疾病或体征）特点,为今后军事飞行学员医学选拔和医学鉴定提供客观依据. 方法 对近年空军航空大学医学停飞的614名飞行学员按照所患疾病或病征及病征所隶属体检科室（专业）进行分类统计. 结果 614名医学停飞学员共涉及病征90余种.飞行学员停飞病征排前10位的是视力不足超标、血压超标、频发心律失常、外伤（骨折）、腰椎间盘病变、鼻中隔偏曲、慢性鼻窦炎、胆囊息肉、晕厥及其他心电图异常.医学停飞病征所涉及体检科室（专业）排序依次为眼科、内科、外科、耳鼻喉科、神经内科、心电图检查、超声检查、放射科检查和检验科检查,其中以眼科和内科病征为主,分别占全部医学停飞病征的50.00％、14.86％. 结论 导致在校军事飞行学员医学停飞的主要病征是视力不足超标、血压超标.针对飞行人员职业特点,普及航空医学教育,加强卫生监督,加强可变的功能性病征的矫治、训练,采取积极保护性的干预和心理疏导等措施,对降低在校飞行学员的医学停飞率,提高军事飞行学员的成才率具有重要意义.     

Undetected patricide: Inaccuracy of cause of death determination without an autopsy

Patricide (killing the father) is uncommon form of homicide. Usually the assaults occur at home in the absence of witnesses and adult sons are frequently involved. Homicides in a domestic context usually do not tend to recurrence, because the motivation for the crime ends with the death of the parent. However, this is not what was observed in the present case study dealing with the death of a 70 years old white man originally misclassified as accident and discovered three years later only after an additional homicide in a family context of a 60 years old white lady. Multiple stab wounds to the neck and thorax were misinterpreted at the external male body examination as blunt trauma falling down stairs. No forensic autopsy was requested and no comparison of medical findings with the results from the death scene, such as a bloodstain analysis was performed by the police officers nor required by the judicial authority. This was quite surprising because an additional but preliminary post-mortem external examination performed by a general practitioner on the male body already raised the suspicion that the external lesions were stab wounds thus requiring a forensic autopsy. Only the exhumation of the elderly body, performed years later, confirmed the diagnostic hypothesis raised by the first physician. The present case is quite representative of a death investigation not run professionally and performed by individuals with no specific training where most of the medico-legal investigations (especially for traumatic and violent deaths) are restricted to an external body examination without subsequent autopsy. Although misinterpretation of external lesions is inevitable and significant discrepancies between external body examination and forensic autopsy are not rare, in the case of contradictory results of post-mortem external examination or unclear/suspicious cause and manner of death, investigation should proceed necessarily with a forensic autopsy.     

立位耐力监测系统与常规立位耐力试验的对比研究

目的 对自行研制的立位耐力监测系统的稳定性和可行性进行评价。方法 试验对象为６１名健康飞行人员,以常规立主动立位耐力试验为标准方法,应用立位耐力监测系统与常规主动立位耐力试验进行心率、收缩率、压缩压和平均动脉压监测,对各生理参数进行对比分析。立位耐力监测系统是由控制监测台和自动记录包括有１０余项生理参数和图形的立位耐力评价系统。结果 经校正后,两种方法在立位即刻心率分别为,立位耐力监测系统７６．６     

十二指肠血管压迹的影像学观察

目的探讨胃肠钡餐造影检查中十二指肠横部血管压迹的来源.材料和方法对比研究50例钡餐造影所见的十二指肠横部血管压迹与相应CT层面上十二指肠横部、腹主动脉、肠系膜上动、静脉及下腔静脉之间的关系;3例血管造影与钡餐造影联合检查,证实该压迹的来源.结果所有病例十二指肠横部血管压迹均与腹主动脉相吻合;肠系膜上动脉等血管与该压迹的位置及宽度不符;下腔静脉偶可导致另一压迹.结论十二指肠横部血管压迹,为腹主动脉压迫所致,称其为"十二指肠腹主动脉压迹”较为准确.     

Digital rectal examination and the diagnosis of prostate cancer--a study based on 8 years and three screenings within the European Randomized Study of Screening for Prostate Cancer (ERSPC), Rotterdam

Background

Evidence indicates that an abnormal digital rectal examination (DRE) is a risk factor for high-grade prostate cancer (PC).

Objective

To determine whether men with an initially suspicious DRE, a prostate-specific antigen (PSA) level ≥3.0 ng/ml, and a benign prostate biopsy are at higher risk for significant PC at rescreening than men with an initially normal DRE, and whether an adaptation of the rescreening interval is warranted for this group.

Design, Setting, and Participants

Within the European Randomized Study of Screening for Prostate Cancer (ERSPC), Rotterdam, 2218 men underwent biopsy of the prostate (from 1993 to 2000) with a benign result at initial screening. The serum PSA was determined every 4 yr. A PSA level of ≥3.0 ng/ml prompted a DRE and a lateralised sextant biopsy.

Measurements

Number and characteristics of PCs found at repeat screenings and as interval cancers (ICs) were compared between men with or without a suspicious DRE result at initial screening. Multivariate logistic regression analyses were performed to evaluate if an initially suspicious DRE was a significant predictor for detecting cancer at consecutive screenings.

Results and Limitations

After 4 yr, the total number of PCs detected in men with and without an initially suspicious DRE was, respectively, 27 (6%) versus 103 (6%) (p = 0.99). After 8 yr these numbers increased, respectively, to,45 (10%) versus 167 (10%) (p = 0.88). The proportion of clinically significant PCs was 2% and 3%, respectively, for the group with initially normal and abnormal DRE after 8 yr. Having a suspicious DRE result at initial screening was not a significant predictor for detecting PC after 4 yr [odds ratio (OR) = 1.15, p = 0.59) or 8 yr (OR = 1.41, p = 0.43)]. A limitation of this study is the relatively short follow-up of 8 yr.

Conclusions

During a follow-up of 8 yr after initial cancer-negative biopsy, an initially suspicious DRE did not influence the chance for detection of cancer or significant cancer at later screens. An adaptation of the rescreening interval on the basis of the initial DRE-outcome is not warranted in future population-based screening for prostate cancer.     

多层螺旋CT在胃癌术前检查中的应用

目的探讨多层螺旋CT对胃癌的临床应用价值。方法对53例胃癌患者进行螺旋CT增强检查以及MPR和CTVE重建,对其图像进行分析。结果53例患者中,除1例早期胃癌漏诊外;其余病例病灶大小、部位、形态、范围、有无淋巴结及远处转移情况均有良好显示;MPR可在不同方位显示胃壁肿瘤周围空间关系;CTVE可获得类似食管胃纤维内镜显示胃壁及胃腔内病变的效果。结论多层螺旋cT增强检查能对胃癌患者进行准确术前评价．是对冒部疾患除常规胃镜、胃肠钡餐检查外的又一种有效检查方法。     

Prevalence of elevated serum prostate-specific antigen in rural Nigeria

BACKGROUND: Recent hospital and cancer registry data show increasing prostate cancer incidence in Nigeria, which was previously regarded as a low incidence region. This study investigates the prevalence of prostate cancer risk in a previously unscreened cohort of rural Nigerians. METHODS: Rural Nigerian men, 40 years and older, were screened by serum prostate-specific antigen (PSA) and digital rectal examination (DRE) and those with PSA >/= 4 ng/mL and/or abnormal DRE were referred for prostate biopsy. RESULTS: Of 200 consecutive men invited, 151 (75.5%) presented for screening, the mean age was 56.45 + 15.1 and 95 (61.6%) were >/= 50 years of age. Of the 140 who consented to a blood test, PSA correlated with age (r = 0.3, P < 0.01), 14 (10.0%) had abnormal PSA >/= 4 ng/mL, increasing from 3 (3.6%) in men < 60 years to 4 (50%) in men >/= 80 years. The rate was 13 (15.7%) for men >/= 50 years and there was no evidence of increased incidence of prostatitis in the community. Mean (median) PSA in ng/mL increased from 1.17 (0.60) in the youngest to 13.75 (4.45) in the oldest cohort. Of those who accepted DRE, 38 (29.0%) had an enlarged prostate, including two who had nodular prostate, one-third with symptoms, increasing from 4 (5.4%) in those < 50 years to 6 (75.0%) in men >/= 80 years. The proportion of men with PSA >/= 4 ng/mL among those with enlarged vs normal prostate is 27.0 to 3.4%, P < 0.001, and the pattern was similar for men >/= 60 years and those < 60 years of age. The 40 (32.0%) men referred for prostate biopsy defaulted mainly because they did not fully understand the need for further investigation because they were symptom free or afraid of the possible side-effects of the procedure or diagnosis of cancer. CONCLUSION: The proportion of men with PSA >/= 4 ng/mL is comparable to that of previously unscreened populations with high incidence of prostate cancer such as African-American men. A larger study is required to confirm these findings and intensify efforts to determine the prostate cancer detection rate by biopsy in this population. A prostate cancer awareness and education campaign will be useful in this community.