超声引导Nd：YAG激光凝固羊肝灰阶定量分析

本文报道超声引导ND:YAG激光凝固羊肝灰阶定量分析。经皮穿刺超声引导导入激光对羊肝进行组织间凝固(interstitial laser photocoagulation ILp),靶区进行灰阶定量分析,观察其灰阶变化规律。结果显示:随着激光功率及作用时间延长,靶区灰阶强度逐渐增加,很快达到最高强度,维持这一高强度水平,靶区以外肝组织灰阶强度无明显变化。说明激光作用靶区肉眼可见从一强光点到强光团,最后形成强回声区,而且,灰阶定量仪处理结果亦证明这一变化规律。结论:超声显像能准确显示激光作用靶区变化情况。     

超声引导Nd：YAG激光凝固羊肝组织实验研究

本文报道应用连续波掺钕钇铝石榴石(Nd:YAG)激光对离体猪、活体羊肝脏,超声引导组织间激光凝固(ILP)实验,观察不同激光功率、不同时间凝固肝组织的声像图表现及其病理学改变。拟寻求激光对肝组织凝固的最佳功率和最佳时间。结果:凝固坏死区温度50℃以上;声像图表现以光纤尖端为中心的强回声光团,随着激光功率增加或持续时间延长逐渐向四周扩散形成强回声区,且成正相关关系,但损伤曲线最终出现“平顶征”。功率为6瓦,时间为8至10分钟时靶区凝固效果最佳,损伤范围直径2.5cm左右。组织病理改变为凝固坏死。实际损伤范围与声像图测值有良好的相关性。结论:超声引导经皮穿刺激光凝固肝组织方法简便、定位准确;超声测值基本能说明实际凝固范围;最佳功率为6瓦,最佳时间为8至10分钟。     

射频消融术中二维声像图强回声区大小与消融范围的相关性研究

目的 探讨射频消融术中二维声像图所见强回声区大小与消融范围的相关性.方法 对新鲜离体牛肝组织及肝癌患者的病灶进行冷循环射频消融,测量声像图中强回声区大小、凝固灶大小和术后超声造影无增强区域大小,并分析其相关性及一致性.结果 离体实验中声像图强回声区大小与凝固灶范围呈高度线性相关并具有良好的一致性;临床研究中声像图强回声区大小与超声造影无增强区域大小高度线性相关并具有良好的一致性.结论 射频消融过程中对强回声区大小的观察有助于预测消融范围,避免损伤邻近重要脏器.     

原发性肝癌射频消融灶的超声声像特征研究

目的 研究原发性肝癌射频消融灶超声声像特征.方法 超声引导30例原发性肝癌50个病灶射频消融治疗术后1～3个月,对原发性肝癌射频消融灶进行二维及彩色多普勒超声检查,记录声像图表现,并对部分射频消融灶行超声引导下穿刺活检,观察病理改变.结果 二维超声检查50个射频消融灶内部呈高回声型占82.0%;低回声型占12.0%;混合回声型占6.0%.原发性肝癌射频消融灶超声声像特征:高回声周边可见1～5mm晕环、内部可见伞状强回声带.结论 原发性肝癌射频消融灶超声声像具有特征性,二维超声及彩色多普勒超声检查对射频消融灶的识别和诊断有临床价值.     

超声观察胎儿肛门对诊断肛门闭锁的意义

目的：探讨产前应用超声观察胎儿肛门结构的存在诊断胎儿肛门闭锁的临床价值.方法：选择16～38周单胎孕妇42496例为研究对象,观察胎儿肛门声像图,其表现为周边环绕低回声、中央呈圆点样强回声“靶环征”.若无法探及“靶环征”声像图则认定为肛门闭锁.结果：所有胎儿中未探及肛门“靶环征”声像图的有13例,引产、流产或生后均证实为肛门闭锁.1例为单纯闭锁,12例合并其他畸形及异常,7例出现了肠管扩张,2例肠管内可见强回声的胎粪.结论：正常情况下肛门声像图是可以显示的,它可以用来提示肛门闭锁的可能性.     

高频超声诊断胸壁结核48例分析

目的:探讨高频彩超对胸壁结核的诊断价值。方法:对48例胸壁结核进行了超声检查,并对15例进行穿刺活检。结果:典型的胸壁结核声像图表现为回声不同的3个区,中央为不规则无回声区;其外侧为粗颗粒偏强回声带;最外为均匀低回声带,该区域内多能探及血流信号。它们分别对应的病理改变是液化区、干酪坏死区和增殖区。结论:高频彩超能清晰显示胸壁结核的结构特征,胸壁结核声像图表现与病理变化有较好的对应关系。     

超声引导激光凝固肝肿瘤的基础与临床研究进展

近年来随着物理医学的发展,多种介入性肝癌治疗手段逐渐进入临床.经过一系列基础与临床研究,超声引导间质性激光热凝固(interstitiallaser photo-coagulaction ILP)肝癌,被认为是一种有前途的治疗方法.一、基本原理与技术ILP治疗肿瘤是使用连续波Nd:YAG激光,利用照射时产生的高温效应和机械效应造成肿瘤组织的气化,碳化和凝固坏死.其波长1060nm,有较好的组织穿透性,功率多在1～8W范围.ILP能满足照射靶区肿瘤组织达到发生坏死所必须的温度,坏死区与周围组织界线清楚,周围区组织受损轻微.ILP治疗体腔内肿瘤时光能的传输通过与Nd:YAG相连接的直径约200-600um柔韧的光纤,超声引导下将19号穿刺针经皮插入照射靶区肿瘤内,拨出针芯,光纤插入穿刺针内,使裸露     

Er:YAG激光与Nd:YAG激光在种植术中联合应用及研究进展

正Er:YAG激光和Nd:YAG激光目前被广泛应用于各种牙科治疗手术中。Er,Nd:YAG激光杀菌能力强,能够保证患者术区清晰,出血量小。并且无明显疼痛。其自身的优势正在逐步显现,逐渐替代原有的传统牙科器械。二者应用于口腔种植体周围炎治疗以及口腔种植一、二期手术也成为目前研究     

高强度聚焦超声定位损伤幼猪肌肉组织的即时和延迟反应

目的观察高强度聚焦超声损伤幼猪肌肉组织后即时和延迟的超声影像学改变和病理学改变,为临床应用提供依据。方法实验幼猪后肢皮下肌内层高强度聚焦超声照射后即刻和存养2周后,观察照射靶区超声影像学改变和病理改变。结果高强度聚焦超声(HIFU)照射后靶区灰度明显增加,与正常组织界限清晰。光镜下靶区组织呈凝固性坏死。HIFU照射2周后凝固灶回声较前减弱,靶区灰度强弱不等,凝固灶体积较前有缩小。与正常组织的界限清晰度较前下降。光镜下发现靶区肉芽组织生成。结论高强度聚焦超声能有效地损伤幼猪肌肉组织,使之发生凝固性坏死,治疗2周后靶区肉芽组织生成。为HIFU治疗软组织肿瘤提供了实验依据。     

高频超声对正常成人皮肤厚度测量及声像研究

目的 探讨成人正常皮肤声像图及皮肤(表皮和真皮)厚度差异性.方法 应用14 MHz高频探头对60名正常成人不同部位皮肤声像图观察,并测量皮肤(表皮 真皮层)的厚度.结果 14 MHz高频超声可显示皮肤各层结构.皮肤表皮表现为平滑线状强回声,真皮为低回声带,不同部位皮肤真皮与皮下组织分界清晰或不清晰.表皮和真皮层彩色多普勒血流显像超声未检出血流信号.选择17点部位皮肤观察,其中男女组间12点相同部位皮肤厚度差异具有显著统计学意义.人体不同部位皮肤厚度也存在显著性差异.结论 应用高频超声测量皮肤厚度是可行的方法 .     

睾丸精原细胞瘤二维及彩色多普勒显像及其病理基础

本文报道7例睾丸精原细胞瘤声像特征、彩色多普勒显像及其病理基础,结果表明:精原细胞瘤呈低回声反射,当其变性坏死时,回声增强,彩色血流信号异常丰富,动脉阻力指数明显增高。其病理基础可能与其组织结构不同含量及分布有关。     

肾上腺嗜铬细胞瘤声像图及病理基础研究

本文通过对19例肾上腺嗜铬细胞瘤声像图表现及其病理基础的研究,结果表明:肾上腺嗜铬细胞瘤的典型声像图特点是具有包膜反射的形态规则的低回声肿块。随着肿瘤内部结构的不同,其回声强弱有变化。肿瘤的回声强弱取决于肿瘤细胞、血管、纤维组织的含量多少和分布状态。     

激光消融正常活体兔肝的超声表现及影响因素

目的 探讨激光消融活体兔肝的超声表现及影响因素.方法 用Echolaser集成激光介入超声系统消融正常兔肝,观察消融灶坏死程度、病理改变及解剖表现.结果 消融灶呈类椭圆形,二维表现为中心规则强回声及周边稍强回声区,后方有轻度声衰减.超声造影显示消融灶呈"充盈缺损区".解剖后,肉眼观消融灶中间为碎渣样碳化区,周边为褐白色样坏死区.HE染色显示消融灶中心呈"空洞样"无染色剂浸染区,周边呈不规则无核红染区,外围可见浸润的炎性细胞.不同功率及时间对消融效果及消融范围有影响且消融灶的大小与功率和时间呈正相关;3 w 10 min组和5 W 6 min组消融范围稳定、可导致消融区组织的完全坏死且两组间的消融范围差异有统计学意义(t=6.78,P<0.05).结论 激光消融对活体兔肝能造成快速、精准、有效、安全的凝固性坏死,消融灶的大小与功率和时间呈正相关.

Abstract：

Objective To explore the ultrasound performance and related factors on the role of normal living rabbit's liver by laser ablation. Methods The rabbit's liver tissue were ablated by Echolaser integrated laser interventional ultrasound system, and the necrosis of the lesion and performance of pathology and anatomy were observed. Results The outline of the lesion was ellipse like. The two-dimensional US showed regular hyperecho area in the center, mild strong echo in the peripheral and mild attenuation backward. Contrast enhanced ultrasound (CEUS) showed a "filling defect" of contrast media in the ablated area. After dissection, the center of the lesion was slag-like carbon, the peripheral was necrosis area; HE staining showed: the center of the lesion was cavity like and dye-free,peripheral area was irregular red staining, the surrounding area was infiltrative inflammatory cells. Different power and time leaded to differences of the ablative effect and lesion size:the more power and time,the bigger of the ablative size. The ablative effect and lesion size was stable in 3 W 10 min and 5 W 6 min groups and caused the complete necrosis of the zone, there existed statistical differences among the two groups. Conclusions Laser ablation can cause fast, precise, effective and safe necrosis of the liver tissue, and the more power and time, the bigger of the ablative size.     

Induction of systemic serum procalcitonin and cardiocirculatory reactions after isolated limb perfusion with recombinant human tumor necrosis factor-alpha and melphalan

OBJECTIVES: Isolated, hyperthermic limb perfusion (ILP) with recombinant human tumor necrosis factor-alpha (rhTNF-alpha) and melphalan is a highly effective treatment for locoregional metastases of malignant melanoma and for advanced soft tissue sarcoma of the limb. The major systemic side effects are characterized by the induction of a systemic inflammatory response syndrome (SIRS). Procalcitonin (PCT), a serum marker of bacterial sepsis, was investigated with respect to its role in SIRS after ILP. SETTING: University surgical oncology division with an integrated eight-bed intensive care unit. PATIENTS: Thirty-seven patients were treated by ILP with rhTNF-alpha and melphalan (n = 26) or with cytostatics alone (n = 11) for soft tissue sarcoma or malignant melanoma. INTERVENTIONS: The course of serum PCT, interleukin (IL)-6, and IL-8 was analyzed intra- and postoperatively. Hemodynamic variables including heart rate, mean arterial pressure, cardiac index, pulmonary arterial pressure, pulmonary capillary occlusion pressure, and pulmonary and systemic vascular resistance were recorded in parallel. MEASUREMENTS AND MAIN RESULTS: PCT was significantly elevated over baseline after ILP with a maximum between 8 hrs (peak level 16.0+/-18.8 (SD) ng/mL) and 36 hrs (13.8+/-15.7 ng/mL) (p < .001). The increase in serum PCT was significantly more pronounced after ILP with rhTNF-alpha/melphalan than after ILP with cytostatics alone (p < .001). IL-6 and IL-8 were also significantly increased after ILP (p = .001), reaching peak concentrations at 1 hr and 4 hrs postoperatively. Significant changes in heart rate, mean arterial pressure, cardiac index, and systemic vascular resistance were observed during and after ILP; however, PCT levels could not be correlated to these variables. Pulmonary arterial pressure, pulmonary capillary occlusion pressure, and pulmonary vascular resistance showed no significant changes. CONCLUSIONS: Serum procalcitonin is induced as part of the SIRS after ILP with rhTNF-alpha/melphalan. It may be induced directly by rhTNF-alpha or other cytokines, because serum peaks of IL-6 and IL-8 precede the peak of PCT. Because there is no correlation between serum levels of PCT and hemodynamic variables, this marker cannot be applied to assess the severity of SIRS reaction after ILP.     

Microcirculation in venous ulcers and the surrounding skin: findings with capillary microscopy and a laser Doppler imager

BACKGROUND: To obtain more information about microcirculatory disturbances in venous ulcers, we studied their laser Doppler flux images and capillary densities. MATERIALS AND METHODS: On photographs of venous ulcers and the adjacent skin of 17 patients, four regions of interest were marked: one non-granulation tissue area (NGTA) within the venous ulcer, one granulation tissue area (GTA) within the ulcer, one adjacent skin area (ASA) and one distant skin area (DSA). Within these four regions the average laser Doppler area fluxes and capillary densities were determined for each patient using a laser Doppler imager and capillary microscopy respectively. RESULTS: The laser Doppler area flux (mean +/- SD in AU) was significantly lower in NGTA (1.39 +/- 1.12) than in GTA (4.06 +/- 1. 52) or DSA (3.86 +/- 1.54) (P < 0.00001). In addition, the ASA flux (1.95 +/- 1.39) was significantly lower than the GTA or DSA flux (P < 0.0001). Capillary density (capillaries per mm2) in NGTA (0.82 +/- 1.98) was significantly lower than that in GTA (6.00 +/- 2.55), ASA (13.88 +/- 5.16) or DSA (10.29 +/- 3.41) (P < 0.0001). In addition, the capillary density of ASA was significantly higher than that of GTA or DSA (P < 0.05). CONCLUSION: The four areas showed the following characteristics: NGTA, low laser Doppler area flux and lowest capillary density (possible sign of ulcer area without healing tendency); GTA, high laser Doppler area flux and second lowest capillary density (possible sign of wound healing); ASA, low laser Doppler area flux and highest capillary density (possible sign of healing process nearly completed; scar); DSA, high laser Doppler area flux and second highest number of capillaries (sign of microcirculation of chronic venous disorder).     

Surgical resection of a large hypopharyngeal hemangioma in an adult using neodymium-doped yttrium aluminum garnet laser: A case report

BACKGROUND Generally,hemangiomas do not require surgical intervention;however,cases of large hemangiomas,potentially involving the throat and trachea,necessitate surgical therapy.Here,we present a case of hypopharyngeal hemangioma in an adult that was successfully treated with neodymium-doped yttrium aluminum garnet(Nd-YAG)laser.CASE SUMMARY Laryngoscopic examination of a 61-year-old man demonstrated the presence of a large,submucosal vascular lesion that extended into the epiglottis,left arytenoid cartilage,lateral to the aryepiglottic fold,and pyriform sinus.The lesion was resected and photocoagulated with limited hemorrhage using Nd:YAG laser.The hypopharyngeal hemangioma was completely excised.The patient showed no recurrence of hypopharyngeal hemangioma during the 1.5-year follow-up period.CONCLUSION Laser therapy is one of the effective tools for treating hemangiomas with rapid,uncontrolled growth or in functional areas,with few side effects and complications.The present case of a male patient with a large hypopharyngeal hemangioma,treated with YAG laser,demonstrates the efficacy of laser photocoagulation in treating cases of hemangiomas,without the risk of bleeding or airway obstruction.The favorable postoperative outcomes demonstrated by our patient with Nd:YAG laser therapy indicate its consideration in the therapy of similar cases.     

低频与高频超声诊断胆囊腺肌增生症的比较分析

目的探讨低频与高频超声下胆囊腺肌增生症的声像图特征,比较二者的诊断符合率。方法收集28例术后病理证实为胆囊腺肌增生症的患者,将其术前超声诊断与术后病理诊断进行对照研究,比较低频超声和高频超声的声像图特征及临床诊断符合率。结果 28例胆囊腺肌增生症患者中,经低频联合高频超声检查法检出23例,常规低频超声法检出17例,诊断符合率分别为82.1%和60.7%。两种方法比较,差异有统计学意义(P0.01)。结论高、低频超声联合检查可提高罗-阿氏窦的显示率,从而提高对胆囊腺肌增生症的诊断符合率,具有重要临床价值。     

Mucosal insulin delivery systems based on complexation polymer hydrogels: effect of particle size on insulin enteral absorption.

Insulin-loaded polymer (ILP) microparticles composed of poly(methacrylic acid) and poly(ethylene glycol), which have pH-dependent complexation and mucoadhesive properties have been thought to be potential carriers for insulin via an oral route. Nevertheless, further optimization of the polymer delivery system is required to improve clinical application. Therefore, the effect of particle size of the ILP (L-ILP: 180-230 microm, S-ILP: 43-89 microm, SS-ILP: <43 microm) on insulin absorption was studied in the in situ loop system, hypothesizing smaller particle sizes of ILP could induce bigger hypoglycemic effects due to increase mucoadhesive capacity. To verify the hypothesis, the adhesive capacities of differently sized ILPs to the mucosal tissues were evaluated. Additionally, the intestinal site-specificity of ILP for insulin absorption was investigated. Intra- and inter-cellular integrity and/or damage were also examined by lactate dehydrogenase leakage and membrane electrical resistance change to ensure the safety of ILP as a carrier for oral route. As hypothesized, the smaller sized microparticles (SS-ILP) showed a rapid burst-type insulin release and higher insulin absorption compared with the microparticles having larger sizes, resulting in greater hypoglycemic effects without detectable mucosal damage. In fact, SS-ILP demonstrated higher mucoadhesive capacity to the jejunum and the ileum than those of L-ILP. Moreover, SS-ILP's enhancement effect of insulin mucosal absorption showed a site-specificity, demonstrating maximum effect at the ileal segment. These results imply that the particle size and delivery site are very important factors for ILP with respect to increasing the bioavailability of insulin following oral administration.     

三维超声在盆底器官脱垂中应用的初步研究

目的三维超声观察盆底器官脱垂（POP）患者的肛提肌裂孔形态改变。方法POP组33例,普通妇科疾病患者为对照组29例,经会阴三维超声检查获取在静息及盆底肌收缩状态下的图像,观察肛提肌形态变化和肛提肌裂孔大小。结果三维横切面可清晰显示位于耻骨联合和肛门直肠连结间的肛提肌,以及穿过肛提肌裂孔的尿道、阴道、直肠。POP组盆底结构较对照组松弛,肛提肌回声欠均匀;POP组静息及缩肛状态下的肛提肌裂孔面积、矢状位肛提肌裂孔较对照组大,差异均有统计学意义（P〈0．05）。结论经会阴三维超声可较好地显示盆底的解剖结构。     

Diary of forthcoming events

Summary

Interstitial laser photocoagulation (ILP) is currently limited by deficient per-procedural monitoring. The purpose of this study was to evaluate MR control of ILP of hepatic metastases. Twenty-two laser activations were used to treat eight metastases in seven patients under local anaesthesia and sedation. Laser energy was delivered via optical fibres positioned in the tumour under ultrasound guidance. T1-weighted FLASH and spin-echo sequences were used to monitor the procedure. Enhanced CT was performed at 24 h to assess thermal necrosis. FLASH imaging showed an enlarging area of signal change during ILP. The final extent of this correlated closely with the extent of tissue necrosis on CT. Spin-echo imaging was disappointing because of poor contrast between the treated tissue and normal liver/untreated tumour. Per-procedural MR imaging accurately and reliably depicts ILP-induced necrosis. MR control may permit more widespread application of ILP to the treatment of hepatic tumours.