Giant cell arteritis presenting as a stroke in the internal carotid artery territory: a case-based review

Giant cell arteritis (GCA) is a large-vessel vasculitis, typically affecting the aorta and its branches. The involvement of vertebral and internal carotid arteries occurs in a limited number of cases, and stroke as a presenting symptom of GCA is extremely unusual: this subset of the disease has a poor prognosis and rarely responds to immunosuppression.We report the case of a 70-year-old woman, who presented to the Emergency Department for ischemic stroke, which appeared to be the first and only symptom of GCA. The prompt administration of steroids and tocilizumab (TCZ) led to clinical and radiological resolution, with no residual disability at 6-month follow-up.Our case-based review, highlighting the rarity of a large vessel vasculitis presenting only with a cerebrovascular accident, provides new evidence for the efficacy of TCZ even in more unusual varieties of GCA: in these cases, TCZ should be immediately prescribed, in order to prevent mortality and severe long-term morbidity.     

高频超声引导下胸腔积液置管引流

胸腔积液临床常见,少量积液常无症状,中大量积液可致患者出现呼吸困难、无法平卧等表现,需通过胸腔穿刺置管引流及时加以缓解。胸腔积液穿刺引流不仅可用于临床治疗,还可辅助诊断不明原因胸腔积液。在超声直视下操作置管可提高穿刺成功率[1-2]。本研究观察高频超声在辅助引导置管引流胸腔积液中的效果。     

超声诊断宫腔粘连临床应用进展

宫腔粘连(IUA)是妇科常见病,严重危害女性健康。超声可清晰显示子宫内膜、宫腔形态及血流变化,为IUA诊断和治疗提供直观影像学依据。本文对超声在IUA中的应用进展进行综述。     

超声引导下经皮微波消融治疗恶性胸、腹壁肿瘤

目的 观察超声引导下经皮微波消融（MWA）治疗恶性胸、腹壁肿瘤的效果。方法 对11例恶性胸、腹壁肿瘤患者行超声引导下经皮MWA治疗,共治疗14个病灶,腹壁6个,胸壁8个;术后随访,观察治疗效果及不良反应。结果 11例超声引导下MWA治疗均成功,技术成功率100%。术后1个月8例治疗有效,3例肿瘤残存。2例术后出现局部疼痛,经对症治疗后缓解;1例局部脂肪液化,予局部消毒换药1个月后痊愈。未见气胸、肠道损伤、皮肤烧伤等严重并发症。4例术前合并病灶周围神经痛,术后疼痛得到有效控制。术后随访4~28个月,中位随访时间8个月;期间2例失访、2例死亡;至随访终点7例疗效较好,未见复发及转移。结论 超声引导下经皮MWA治疗恶性胸、腹壁肿瘤安全、有效。     

超声引导下多点注射抗生素治疗射频消融术后子宫感染

目的 观察超声引导下多点注射抗生素治疗射频消融术后子宫感染的疗效。方法 回顾性分析5例子宫肌瘤射频消融术后并发子宫感染并经超声引导下多点注射抗生素治疗患者,观察其疗效。结果 5例均顺利完成超声引导下多点注射抗生素,未出现相关并发症。5例中,3例治愈;1例好转,经静脉滴注抗生素1周后治愈;1例首次治疗无效,经再次治疗后治愈。治疗后7天,子宫体积显著小于治疗前（t=4.939,P<0.05）。结论 超声引导下多点注射抗生素治疗射频消融术后子宫感染安全、有效。     

经阴道超声在早孕期流产后宫腔残留物诊断中的应用价值

目的探讨经阴道超声在早孕期流产后宫腔残留物诊断中的应用价值。方法选取2018年1月至2020年1月医院收治的早孕期人工流产、自然流产及药物流产后行宫腔残留物诊断的患者80例,均采用经阴道超声检查,以病理结果为金标准,分析经阴道超声的诊断效能。结果以病理结果为金标准,经阴道超声对早孕期流产后宫腔残留物的诊断灵敏度为97.22%,特异度为62.50%,准确度为93.75%。结论经阴道超声应用于早孕期流产后宫腔残留物诊断中,具有较高的诊断灵敏度、准确度,可为临床治疗提供依据。     

三维超声对产前胎儿畸形的诊断价值

目的探讨三维超声产前诊断胎儿畸形的临床应用价值。方法对2003年1月至2006年12月应用三维超声进行产前检查发现的29例24~40周胎儿畸形超声影像与临床资料进行回顾性分析。结果唇裂11例、无脑儿7例、四肢短小4例、脐膨出3例、颈部淋巴囊肿3例、羊膜带综合征1例,与临床产出胎儿所见畸形特征完全一致。结论三维超声对胎儿畸形的检出率高,是有效的产前筛查方法。     

Neurohumoral control of gallbladder motility in healthy subjects and diabetic patients with or without autonomic neuropathy

Patients affected by diabetes mellitus are reported to have an increased incidence of gallbladder abnormalities. The pathophysiologic mechanisms for this phenomenon are unclear. In the present study ultrasonography was used to determine gallbladder emptying in response to a meal or separate cephalic or hormonal stimulation in 21 diabetic patients and 10 healthy subjects. Gallbladder emptying and refilling after a meal were similar in diabetic patients and healthy subjects. When diabetics were divided according to the presence or absence of cardiac autonomic neuropathy (AN), a significant reduction of gallbladder emptying in response to cephalic stimulation was found in diabetics with AN (P<0.01 in comparison with diabetics without AN or healthy subjects). A dose-response curve of gallbladder emptying in response cerulein, a cholecystokinin analog, at concentrations of 0.25, 1, and 4 g/kg/min was evaluated. No differences of gallbladder emptying were found in the three groups of subjects, indicating that gallbladder sensitivity to hormonal stimulation is not changed in diabetic patients with or without AN. Diabetic patients with AN have a significant reduction of gastric acid output and pancreatic polypeptide (PP) secretion in response to cephalic stimulation (P<0.05 in comparison with diabetic patients without AN or healthy subjects). Cerulein-induced PP secretion was similar in all three groups of subjects (P>0.05). This study indicates that in diabetic patients with AN, gallbladder emptying as well as gastric acid and PP secretions induced by neural stimulation are markedly reduced in comparison to diabetics without AN.     

正常人和脑梗死患者颈动脉血流超声多普勒时频分析

目的：分别对正常人和脑梗死患颈动脉血流超声多普勒时频分析,为临床应用提供参考资料。方法：检测正常人和脑梗患（大多有颈动脉粥样硬化斑块）的颈动脉多普勒血流时频谱,以其峰值频率（fmax),模式频率（fmode),平均频率（fmean),低值频率（fmin),重脉波频率（fp)和频弥散宽度（fw)为定量指标。结果：正常人颈动脉血流信号时频谱的fmax,fmean和fmode曲线在一个心动周期中具有总体相似的形状,相互嵌套,其中收缩期的fmax最高,均大于3kHz,fmin最低不低于1kHz,脑梗死患颈动脉时频谱的fmax与fmean和fmode两曲线分开,fmax减低（＜3kHz),fp消失,舒张末期fmin减低显（均低于0．5kHz),结论：颈动脉多普勒血流时频分析及所遴选的定量指标对颈动脉粥样硬化斑块十分敏感,可供诊断试验,且可集成在便携式计算机里,适用于社区人群中筛选易中风病变个体。     

胎粪吸入综合征患儿肾血流动力学的改变

目的：探索新生儿窒息并发胎粪吸入综合征（meconium aspiration syndrome,MAS）时肾血流动力学的改变。方法：应用彩色超声血流显像技术,对窒息合并MAS的新生儿的肾动脉血流参数及心输出量进行检测。结果：并发MAS的窒息儿肾动脉血流速度和血流量降低,但阻力无改变;心输出量降低;肾血流量与心输出量的比值也降低。结论：并发MAS的窒息儿,其肾脏损害加重,早期检测肾血流动力学变化,早期发现肾功改变并指导治疗。