2016年 · 第96卷第33期

gastroesophageal varices (GOV) are a common complication in patients with cirrhotic portal hypertension, and are seen in approximately 50% of patients with cirrhosis. esophagogastric variceal bleeding (EVB) has the characteristics of dangerous disease and high mortality rate, and its clinical management is difficult. In order to standardize the prevention and treatment of GOV and EVB, the Hepatology Branch, the Gastroenterology Branch and the Digestive Endoscopy Branch of the Chinese Medical Association promulgated the Guidelines for the Prevention and Treatment of Esophagogastric Variceal Bleeding in Cirrhosis and Portal Hypertension in 2016.^[1], offering many new recommendations.

Case 1: A 44-year-old female was admitted to hospital for more than 1 year due to low back pain accompanied by frequent urination, urgency, painful urination and hematuria. Ultrasonic findings: The bladder is well filled, and the bladder walls around the bilateral ureteral openings are irregularly thickened and the surface is uneven. Ultrasound revealed changes around the vesicoureteral opening, considering inflammation or space occupation; Further examination is recommended. Cystoscopy showed dozens of follicles with a diameter of 0.4 to 0.5 cm scattered in the bladder triangle. Intraoperative pathological examination showed follicular cystitis.

A 39-year-old woman was admitted with the complaint of finding a posterior mediastinal mass for 10 days. CT of the chest and upper abdomen showed that the posterior mediastinum occupied space, considering the possibility of cyst, esophageal cyst or bronchial cyst was suspected (Figure 1)。 Further endoscopic ultrasound examination revealed a smooth spherical bulge in the esophagus 30-38 cm away from the incisors. The ultrasound probe was placed at the bulge and scanned, and a hypoechoic mass in the third and fourth layers of the local esophageal wall ultrasound structure was found. The ultrasound section size was 7.0 cm ×6.5 cm, adjacent to the aorta. Submucosal mass of the esophagus, consider: (1) stromal tumor, (2) cyst. Physical examination and laboratory tests showed no positive results. An artificial pneumothorax thoracoscopic exploration + thoracoscopic assisted posterior massive mediastinal mass resection was performed on 11 Jan 2016.

A 34-year-old female suffered from intermittent headache and dizziness for 5 years, which worsened with nausea in the last month. Physical examination: full moon face, buffalo back and centripetal obesity, skin congestion and ecchymosis immediately after minor trauma. Enhanced magnetic resonance imaging (MRI) of the pituitary gland showed that a circular hyposignal shadow was seen in the right part of the pituitary gland, with a size of about 0.7 cm ×0.5 cm, and the enhancement degree was lower than that of the normal parenchyma of the pituitary gland. Transnasal sphenoidal pituitary tumor resection was performed on 31 Mar 2016. The pathological diagnosis was an adrenocorticotropic hormone (ACTH) type pituitary adenoma. The surgical approach was transnasal sphenoidal pituitary tumor resection. The patient underwent routine potassium supplementation after operation, but had transient severe hypokalemia symptoms. The changes of serum potassium ion levels before and after surgery in patients are shown inFigure 1。

Gestational trophoblastic diseases (GTD) are a group of trophoblastic diseases derived from abnormal spreading capacity and invasive properties. Generally including 5 diseases: hydatidiform mole, erosive hydatidiform mole, choriocarcinoma (referred to as choriocarcinoma for short), placental trophoblastic tumor and epithelial trophoblastic tumor, the general incidence rate is 0.8%^[1]Hydatidiform mole is the most common disease. Except for hydatidiform mole, all other four diseases are malignant diseases, collectively referred to as gestational trophoblastic tumor (GTN). Doppler ultrasound is a non-invasive examination method that can accurately assess and measure blood flow. Doppler ultrasound includes: color Doppler, energy Doppler, and spectral Doppler. Color Doppler evaluates the direction of blood flow based on changes in frequency. The energy Doppler mechanism lies in amplitude variations and is therefore more sensitive to low flow rate blood flow, but does not provide flow direction information. Spectral Doppler can measure blood flow velocity and its related parameters by changing the waveform. The most commonly used Doppler indexes are: systolic-diastolic ratio (S/D), resistance index (RI) and pulsatility index (PI). Studies have found that ultrasound Doppler examination in patients with GTN can obtain the same results as pelvic arteriography, such as tumor size and tumor location, so ultrasound Doppler instead of arteriography is increasingly widely used and clinical^[2]。 The application of ultrasound in trophoblastic diseases is reviewed as follows.

In recent years, with the advancement of medical technology in intensive care units (ICUs), more and more critically ill patients have survived, but many patients are often accompanied by muscle weakness that lasts for months to years after discharge. This myasthenia acquired by critically ill patients during ICU hospitalization is called ICU-acquired weakness (ICUAW), and the most common causes are critical illness myopathy (CIM) and critical illness polyneuropathy (CIP), but both can also exist at the same time, which is called critical illness polyneuromyopathy (CIPNM).^[1,2]。 At present, it is considered that the incidence of CIM is at least 3 times higher than that of CIP, accounting for more than 50% of ICUAW^[1]。