盆腔脏器多重造影在出口梗阻性便秘诊断中的应用

目的：研究出口梗阻性便秘(outlet obstructive constipation，OOC)病人盆腔器官及盆底形态结构变化。方法：对38例OOC病人及12例正常自愿受试者行排粪造影检查，结合盆腔、膀胱造影，及在女性阴道内放置浸钡标志物(以下简称“多重造影”)测量肛直角、会阴位置、盆底腹膜位置、膀胱位置情况。结果：经多重造影诊断直肠内脱垂37例，直肠前突5例，盆底痉挛综合征5例。经物理检查上述诊断分别为12例、4例、1例，所有病例均得到造影证实。多重造影检查还发现盆底及腹膜疝9例，膀胱脱出6例，会阴下降综合征3例，子宫后倒或脱垂10例。与对照组相比，OOC组力排相肛直角增大，静息相及力排相会阴异常下降，力排相Douglas陷凹加深；OOC组中有泌尿系症状者静息相及力排相膀胱异常下降。结论：多重造影诊断直肠内脱垂和直肠前突的阳性率明显高于物理诊断；对临床症状隐匿、物理检查难以诊断的盆底腹膜疝，以及膀胱、子宫和阴道脱出提供了诊断依据，有助于选择正确合理的治疗方式。     

出口梗阻性便秘病人的盆腔、阴道、膀胱及排粪同步造影

目的：研究出口梗阻性便秘（Outlet Obstructive Constipation,OOC)病人盆腔器官及盆底形态结构变化。方法：对38例出口梗阻性便秘病人及12例正常对照者行盆腔、阴道、膀胱及排粪同步造影（以下简称“四重造影”）,包括盆腔造影,阴道涂以钡剂,结合排尿膀胱造影和排粪造影。测量肛直角、会阴位置、盆底腹膜位置、膀胱位置。结果：四重造影诊断直肠内脱垂37例,直肠前突5例,盆底痉挛综合征5例,而物理检查拟诊断分别为12例,4例,1例,均100％得到造影检查证实。四重造影检查还发现盆底及腹膜疝9例,膀胱脱出6例,会阴下降综合征3例,子宫后倒或脱垂10例。与对照组相比,OOC组和排相肛直角增大,静息相及力排相会阴异常下降,力排相Douglas陷凹加深;OOC组中有泌尿系症状者,静息相及力排相膀胱异常下降。结论：四重造影诊断直肠内脱垂和直肠前突的阳性率明显高于临床物理诊断;而且对临床隐匿、物理检查难以诊断的盆底及腹膜疝、膀胱及子宫、阴道脱出等提供了形象客观的诊断依据,提高了诊断的准确性,有助于选择正确合理的手术方式。     

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目的 研究出口梗阻性便秘（OCC）病人盆腔器官及盆底形态结构变化及其临床意义。方法 对38例OOC病人及12位健康自愿者（对照组）行空，阴道，膀胱及排粪同步造影（以下简称“四重造影”），测量肛直角，会阴位置，盆底腹膜位置，膀胱位置。结果 四重造影诊断直肠内脱垂直37例，直肠前突5例，盆底痉挛综合征5例。四重造影检查还发现盆底及腹膜疝9例，膀胱脱出6例，会阴下降综合征3例，子宫后倾或脱垂10例。与对照组相比，OOC组力排相肛直角增大，静息相及力排相会阴异常下降，力排相Douglas陷凹加深；OOC组中有泌尿系统症状者，静息相及力排相膀胱异常下降。结论 四重造影诊断直肠内脱垂和直肠前突的阳性率较高，而且对临床隐匿，物理检查难以诊断的盆底及腹膜疝，膀胱及子宫异常，阴道脱出等疾病提供了形象客观的诊断依据，提高了诊断的性，有助于选择正确合理的治疗方式。     

耻骨直肠肌综合征的影像学诊断及临床意义

目的探讨排粪造影、CT和磁共振成像(MRI)在耻骨直肠肌综合征(PRS)的诊断价值及局限性。方法收集83例PRS患者的临床资料,包括排粪造影、盆底静息和最大用力排便时的CT、MRI扫描结果。分别测量肛直角(ARA)及其压迹长度、深度和耻骨直肠肌的厚度;并与56位正常人的排粪造影、CT和MRI检查结果进行对照分析。结果正常人ARA力排相较静息相明显增大。83例PRS患者中62例ARA力排相较静息相明显减小,且均伴有耻骨直肠肌(PRM)压迹,PRM压迹长度为(3．52±0．65)cm,深度为(1．68±0．49)cm;另外21例患者的静息、力排时ARA均无变化,钡剂不排或少排且均出现“搁架征”。CT、MRI断面图像上,PRS患者PRM较正常人厚度明显增加(P＜0．01);且还能清晰显示出盆底肌群、筋膜及其周围间隙。结论排粪造影显示的PRM功能性异常是诊断PRS较可靠的方法。CT、MRI能直接清楚地显示PRM位置、形态大小及与邻近结构的关系,将三者有机结合对早期、全面诊断PRS及指导治疗具有重要意义。     

盆腔四重造影在出口梗阻性便秘诊断中的作用和意义

目的研究出口梗阻性便秘(OOC)患者盆底形态变化和盆腔脏器间的相互关系。方法对59例经物理检查初步诊断为OOC的患者和12例正常自愿者行排粪造影,结合盆底、膀胱造影,女性阴道放置浸钡标记物(四重造影)检查,测量肛直角、会阴位置、盆底腹膜位置、膀胱位置。结果在59例OCC患者中,经盆腔四重造影诊断直肠内脱垂46例,盆底腹膜疝29例,直肠前突7例,盆底肌痉挛综合征7例,会阴下降综合征5例;还发现膀胱脱垂6例,子宫后倾或脱垂10例。与正常自愿者相比,OOC组力排相肛直角明显增大(P<0.05),静息相和力排相会阴异常下降(P<0.05,P<0.01),力排相盆底腹膜位置下降非常显著(P<0.01)。OOC组中伴泌尿系症状者静息相和力排相膀胱位置均显著低于正常自愿者(P<0.05,P<0.01)。结论盆腔四重造影可有效诊断直肠内脱垂和直肠前突;对临床症状隐匿、物理检查难以诊断的盆底腹膜疝以及膀胱、子宫脱垂提供了诊断依据;有助于选择正确合理的治疗方法。     

功能性出口处梗阻所致便秘的治疗

便秘不是一个病,而是多种疾病的一个症状,一般指排便不规则、次数少、排便困难、不适或疼痛。便秘的原因很多,近年来通过排粪造影(Defecogra-phy)发现一些功能性出口处梗阻所致的便秘,这些梗阻只在排便时才明显,临床及内窥镜检查很难发现。而排粪造影可对肛门括约肌和肛门直肠作静态及动态检查,通过快速摄片(每秒2～4张),可拍摄排粪各时期的照片(如开始排粪、强忍粪便及用力排粪等)。除可以发现大肠器质性病变外,它还可显示肛管直肠的功能异常,包括直肠套叠、会阴下降综合征、孤立性直肠溃疡综合征、直肠前突及盆底肌痉挛综合征等。     

盆腔多重造影对慢传输型便秘合并出口梗阻患者手术疗效的评价

目的 探讨盆腔多重造影对慢传输型便秘合并出口梗阻患者手术疗效评价的临床意义.方法 通过结肠传输实验筛选,经盆腔多重造影诊断慢传输型便秘伴有出口梗阻的患者48例,针对不同的病因实施外科手术.术后1个月行盆腔多重造影,分别测量术前和术后的肛直角、会阴位置、盆底腹膜位置和膀胱位置,观察脏器相互位置改变及排粪梗阻解除的影像学表现.结果 48例患者根据术前的盆腔多重造影检查结果分别施行直肠前突修补术、直肠黏膜部分切除加固定术和子宫悬吊术等手术,术后全部获得6～58（平均19）个月的随访,46例（95.8%）患者术后排粪频率平均1.9次/d.影像学测量结果：肛直角变化（度）：术前力排相和差值分别为128.09±13.82和11.14±12.58,术后则分别为180.26±9.98和20.01±13.11（P＜0.05） 会阴位置变化（cm）：术前力排相和差值分别为-2.05±0.83和2.23±0.78,术后则分别为-0.50±1.13和2.18±1.04（P＜0.05） 盆底腹膜位置（cm）：术前力排相和差值分别为4.91±1.32和1.32±0.89,术后则分别为2.62±2.53和3.28±0.68（P＜0.05） 膀胱位置（cm）：有泌尿系症状者术前力排相和差值分别为3.92±2.51和1.39±1.27,术后则分别为2.15±1.55和1.98±1.54（P＜0.05） 差异均具有统计学意义.结论 盆腔多重造影对慢传输型便秘合并出口梗阻患者的手术疗效能提供客观的分析依据和评价手段.     

排粪造影对直肠肛管周围脓肿及瘘管的诊断价值

目的：探讨排粪造影(defecography)对直肠、肛管周围脓肿及瘘管的诊断价值。方法：对两组共93例疑有肛管直肠周围脓肿和瘘管或仅因便秘就诊的患者进行排粪造影或选择性排粪造影检查。结果：其中56例直肠肛管周围脓肿、瘘管显影，两组选择性排粪造影显示率分别为90．9％(20／22)和42．6％(26／61)。结论：用稀钡悬液做选择性排粪造影为诊断肛直肠周围脓肿、瘘管提供了一个功能与形态相结合的新方法。     

肛肠疾患病人的排粪造影

1985～1987年,该院为92人(男21,女71,年龄55±18岁)行排粪造影100次(包括8人治疗后复查).依病史将病人归类为便秘、失禁、粪便污染内裤及其它四组.本研究将排粪造影与其它肛肠试验结果对照,全部数据均经统计学处理,结果如下:1.排粪造影:依Mahieu法进行.在不提供任何临床资料的情况下,由3位医生对排粪前、中、后的3张100mm照片作回顾性分析.(1)肛直角:后肛直角明显小于轴线肛直角(即中央肛直角-译者注).失禁者的肛直角大于便秘者;     

排粪造影检测方法的改进及探讨：（附100例无排粪障碍者正常 …

排粪造影是近年来在国内外逐渐开展的一项对诊断排粪障碍的重要检查手段。本文介绍了用钡悬液灌肠同时置浸钡棉条显示肛管、肛缘涂钡标记进行排粪造影的检查方法。对肛直角、功能性肛管长度、骶耻线及会阴下降度等的测量方法进行了改进。报告了我们对１００例无排粪障碍的健康志愿障碍的健康志愿者的排粪造影片所测量的结果，并探讨了国人排粪造影的正常值，同时指出直肠前突可发生在无排粪障碍的女性，其发生率与顽固性便秘的患者几     

The evolution of modern endoscopic photography

Most of the problems of endoscopic photography through rigid and flexible instruments have been overcome. Within the not-too-distant future, it should be possible to take good endoscopic photographs through a standard 4-mm telescope using 200-ASA film, light being provided by a high-powered external flash unit transmitting light to the telescope through a liquid-filled light guide. It may, however, be better to suggest a compromise in which operative procedures and urethral photography can be carried out through the 30 degrees, 4-mm diameter telescope, but bladder inspection and photography performed through a 5.5- or 6-mm telescope. The standard set would then become a 0 degrees and 30 degrees, 4-mm diameter telescope, and a 70 degrees larger instrument for bladder photography and inspection.     

Clinical photography among African cleft caregivers

Objective:

The aim of this paper is to document the practice of photography among clinicians whose daily work depends and is influenced so much by medical photography.

Materials and Methods:

Questionnaires documenting the bio data, place of practice, and experience of cleft caregivers with clinical photography were distributed. Knowledge of rules guiding clinical photography and adherence to them were also asked. Types of camera used were documented and knowledge of the value of clinical photographs were also inquired.

Results:

Plastic surgeons constitute the highest proportion of 27 (38.6%), followed by Oral and Maxillofacial surgeons with 14 (20.0%). Twenty one (30.0%) of the respondents always, 21 (30.0%) often, 12 (17.1%) frequently, while 9 respondents sometimes took photographs of their patients. Suggested uses of clinical photographs included training, 52 (74.3%), education, 51 (72.9%), medicolegal, 44 (62.9%) and advertisement, 44 (62.9%) among others. Twenty two (31.4%) did not know that there were standard guidelines for taking clinical photographs. Twenty three (32.9%) of them did not seek the consent of the patients before taking clinical photographs.

Conclusion:

While the practice of clinical photography is high among African cleft caregivers, there is a need for further education on the issues of standard rules and obtaining consent from patients.KEY WORDS: Africa, clinical photography, consent     

Is digital photography an accurate and precise method for measuring range of motion of the shoulder and elbow?

Background

Accurate measurements of shoulder and elbow motion are required for the management of musculoskeletal pathology. The purpose of this investigation was to compare three techniques for measuring motion. The authors hypothesized that digital photography would be equivalent in accuracy and show higher precision compared to the other two techniques.

Photographic surgery: Standards in clinical photography

The role of clinical photography in aesthetic plastic surgery requires it to set high standards for the quality of the photos taken. The comparable portrayal of a series of dynamic changes leaves little room for artefacts. Even very small variations in the pictures may cause drastic changes in the value of clinical photography in aesthetic plastic surgery. The basic variations are discussed and illustrated. It is stressed that unless stringent criteria for clinical photography are met, photographs lose their value with regard to both patients and their didactic value for surgeons. This has implications not only for the individual surgeon, but also for the art of aesthetic plastic surgery as a whole.     

Photographic surgery: standards in clinical photography

The role of clinical photography in aesthetic plastic surgery requires it to set high standards for the quality of the photos taken. The comparable portrayal of a series of dynamic changes leaves little room for artefacts. Even very small variations in the pictures may cause drastic changes in the value of clinical photography in aesthetic plastic surgery. The basic variations are discussed and illustrated. It is stressed that unless stringent criteria for clinical photography are met, photographs lose their value with regard to both patients and their didactic value for surgeons. This has implications not only for the individual surgeon, but also for the art of aesthetic plastic surgery as a whole.     

Should ‘smart phones’ be used for patient photography?

BACKGROUND:

Within the field of plastic surgery, clinical photography is an essential tool. ‘Smart phones’ are increasingly being used for photography in medical settings.

OBJECTIVE:

To determine the prevalence of smart phone use for clinical photography among plastic surgeons and plastic surgery residents in Canada.

METHODS:

In 2014, a survey was distributed to all members of the Canadian Society of Plastic Surgeons. The questions encompassed four main categories: smart phone use for clinical photos; storage of photos; consent process; and privacy issues. The survey participation rate was 27% (147 of 545) with 103 surgeons and 44 residents. In total, 89.1% (131 of 147) of respondents have taken photographs of patients using smart phones and 57% (74 of 130) store these photos on their phones. In addition, 73% (74 of 102) of respondents store these photos among personal photos. The majority of respondents (75% [106 of 142]) believe obtaining verbal consent before taking clinical photographs is sufficient to ensure privacy is respected. Written consent is not commonly obtained, but 83% (116 of 140) would obtain it, if it could be done more efficiently. Twenty-six percent (31 of 119) of respondents have accidentally shown a clinical photograph on their phone to friends or family. A smart phone application that incorporates a written consent process, and allows photos to be immediately stored externally, is perceived by 59% (83 of 140) to be a possible way to address these issues.

CONCLUSION:

Smart phones are commonly used to obtain clinical photographs in plastic surgery. There are issues around consent process, storage of photos and privacy that need to be addressed.     

The use of smartphone-application based medical photography for open fractures: A national survey of orthoplastic affiliated Major Trauma Centres in England

IntroductionBAPRAS/BOAST 4 guidelines recommend the use of medical photography for peri-operative management of open fractures. Smartphones are a common commodity for the modern day plastic surgeon and there is evidence their utilization improves guideline compliance at Major Trauma Centres (MTCs).AimTo capture national data assessing the prevalence and intricacies of smartphone app-based photography systems used for open fractures in plastic surgery units at MTCs in England.MethodA structured questionnaire survey was used to collate and analyze the responses of plastic surgeons and trainees at all MTCs in England. The survey included participant demographics, type and use of medical photography systems, and opinions on the usefulness of integrating a dedicated app in practice. We later explore the background, costs, download process, functionality and NHS governance applicability of each application.ResultsThe most popular clinical imaging modalities included professional photographers (65%) and departmental cameras (60%). Only 6 (26%) of MTCs use the following four smartphone app-based photography systems: Oxford University Hospital FotoApp, Medical Data Solutions and Services, Haiku and Secure Clinical Image Transfer. All systems are GDPR compliant and three systems auto upload images onto hospital databases. Five units report using messaging apps (Forward, Siilo, Whatsapp) with photography functionality. All participants agreed that a dedicated imaging smartphone app would be useful in open fracture management.ConclusionPlastic surgery is a highly visual specialty and clinical photography complements patient care. In the era of COVID-19 where resources are finite and professional photography not always available, this national survey highlights a demand for integrating smartphone app-based photography to improve guideline compliance, inter- and intra-disciplinary team communication and patient care.     

Study of the Incidence and Nature of "Very Subtle Epidermal Melasma" in Relation to Intense Pulsed Light Treatment

BACKGROUND: Skin rejuvenation with intense pulsed light (IPL) is effective for clearing epidermal pigment disorders. Complications are mild and limited to epidermal burns caused by excessive settings. Some patients, however, experience IPL-induced melasma-like hyperpigmentation despite the appearance of normal skin. These patients seem to have very subtle epidermal melasma not visible to the naked eye. Ultraviolet photography has been useful in identifying these patients and preventing complications. OBJECTIVE: The study investigated the incidence of very subtle melasma in patients using UV photography, and assessed this tool in identifying high-risk patients. SUBJECTS AND METHODS: 223 Japanese women, 30-69 years old, participated in the study. Very subtle melasma invisible to the naked eye under normal light was diagnosed by UV photography by two physicians, and any relationship among the disease incidence, age, and regular sunscreen use was examined. RESULTS: Sixty-three cases of very subtle melasma (28.3%) were identified among the 223 subjects, with a significantly lower incidence in sunscreen users. CONCLUSIONS: Patients diagnosed with subtle epidermal melasma and treated with mild IPL parameters did not suffer induced secondary hyperpigmentaion. To help avoid complications after treatment, IPL users should be aware of the age and sunscreen-related incidence of this phenomenon in Asian patients.     

Image Is Everything: Pearls and Pitfalls of Digital Photography and PowerPoint Presentations for the Cosmetic Surgeon

BACKGROUND: Cosmetic surgery and photography are inseparable. Clinical photographs serve as diagnostic aids, medical records, legal protection, and marketing tools. In the past, taking high-quality, standardized images and maintaining and using them for presentations were tasks of significant proportion when done correctly. Although the cosmetic literature is replete with articles on standardized photography, this has eluded many practitioners in part to the complexity. A paradigm shift has occurred in the past decade, and digital technology has revolutionized clinical photography and presentations. Digital technology has made it easier than ever to take high-quality, standardized images and to use them in a multitude of ways to enhance the practice of cosmetic surgery. PowerPoint presentations have become the standard for academic presentations, but many pitfalls exist, especially when taking a backup disc to play on an alternate computer at a lecture venue. OBJECTIVE: Embracing digital technology has a mild to moderate learning curve but is complicated by old habits and holdovers from the days of slide photography, macro lenses, and specialized flashes. Discussion is presented to circumvent common problems involving computer glitches with PowerPoint presentations. CONCLUSION: In the past, high-quality clinical photography was complex and sometimes beyond the confines of a busy clinical practice. The digital revolution of the past decade has removed many of these associated barriers, and it has never been easier or more affordable to take images and use them in a multitude of ways for learning, judging surgical outcomes, teaching and lecturing, and marketing. Even though this technology has existed for years, many practitioners have failed to embrace it for various reasons or fears. By following a few simple techniques, even the most novice practitioner can be on the forefront of digital imaging technology. By observing a number of modified techniques with digital cameras, any practitioner can take high-quality, standardized clinical photographs and can make and use these images to enhance his or her practice. This article deals with common pitfalls of digital photography and PowerPoint presentations and presents multiple pearls to achieve proficiency quickly with digital photography and imaging as well as avoid malfunction of PowerPoint presentations in an academic lecture venue.     

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??Comparative study of elastosonography and molybdenum X-ray photography in the diagnosis of breast diseases WANG Han-feng??HUAI Qi-liang??SHANG Yan-kun??et al??Department of Breast Surgery??Zouping Family Planning Maternal and Child Health Service of Binzhou??Binzhou 256200??China
Corresponding author??WANG Han-feng??E-mail??Hansinwang@163.com
Abstract Objective To investigate the value of elastosonography and molybdenum X-ray photography in the diagnosis of breast diseases. Methods From March 2009 to August 2010, 65 female patients with 72 lesions in breast were examined with elastosonography and molybdenum X-ray photography in Zouping Family Planning Maternal and Child Health Service of Binzhou City of Shandong Province.Pathology was used as the golden diagnosing criterion. The accuracy of elastosonography and molybdenum X-ray photography for diagnosing breast diseases was compared. Results Pathological examination showed 53 nodules were benign and 19 nodules were malignant.The sensitivity, specificity and Youden index of elastosonography were 84.2%,96.2% and 0.804 respectively.Those of molybdenum X-ray photography were 68.4%,92.4% and 0.608 respectively. Conclusion The accuracy of elastosonography is much higher than that of molybdenum X-ray photography.The combinative use of elastosonography and molybdenum X-ray photography can elevate the accuracy for differentiating the benign from malignant breast tumours.