Lower extremity mass

Soft tissue sarcomas are rare tumors accounting for less than 1% of all malignancies. Multidisciplinary approach is used in the management of these patients.     

乳腺肿块超声影像学诊断分析

目的:评价超声影像学方法对乳腺肿块的诊断价值。方法:回顾分析超声检查931例乳腺肿块患者的临床资料,其中343例接受手术,将超声诊断与手术病理进行对照。结果:超声诊断敏感性57.1%~94.3%、特异性39.6%~99%、准确性45.2%~94.8%。结论:超声影像对乳腺肿块的诊断有一定临床意义。     

Phenotype determination of hemoglobinopathies by mass spectrometry

Objectives

Nowadays, nearly 1000 hemoglobin (Hb) variants are known. The standard biochemical techniques used in Hb analysis are mainly: isoelectric focusing, cation-exchange liquid chromatography (LC) and reversed-phase LC. In addition to this approach, a protein analysis is achieved by mass spectrometry (MS) and additional DNA studies are performed. The aim of this review is to emphasize the significance of MS methods applied to Hb variants analysis.

Results and perspectives

To perform Hb studies, different MS techniques are currently used such as electrospray ionization (ESI), matrix-assisted laser desorption ionization (MALDI) and tandem mass spectrometry (MS/MS). As shown here, MS is an efficient tool for identification of all types of variants (substitution of a single amino acid residue, several substitutions in the same globin chain, insertions/deletions, fusion Hbs). The use of MS in neonatal screening of Hb variants is also presented.

Conclusions

MS is a powerful technique for Hb analysis. It appears as being an important additional method in the set of biochemical techniques.     

Omental mass combined with indirect inguinal hernia leads to a scrotal mass: A case report

BACKGROUNDPrimary omental tumors are uncommon, and omental fibromas account for 2% of these tumors. Due to the low incidence of omental fibromas and the limited relevant literature, it is challenging for clinicians to make an accurate diagnosis of this condition, especially before surgery.CASE SUMMARYA 30-year-old man was admitted to the hospital because of a left epididymal mass with vague discomfort for more than 1 mo. A physical examination was performed, and the findings showed that the epididymal mass may have entered the abdominal cavity. Pelvic computed tomography was performed in our hospital and revealed a left inguinal hernia with a mass in the hernial contents, and no masses were found in the left epididymis. A traditional inguinal hernia incision was made. Intraoperative hernia contents were found to be of the greater omentum, and a 2.5 cm-diameter mass was found at the distal end of the greater omentum. The scrotum and epididymis did not exhibit other masses. Then, the mass of the greater omentum was excised. Intraoperative frozen pathological examination suggested a spindle cell tumor. The postoperative pathological examination suggested that the mass was an omental angiofibroma. Postoperatively, the patient recovered well and was discharged. Outpatient re-examinations were performed at 1 mo and half a year after the operation and showed no obvious abnormalities.CONCLUSIONDue to the low morbidity rate associated with and latent nature of omental tumors, these tumors are difficult to diagnose preoperatively; thorough medical history taking, detailed physical examinations, and necessary imaging auxiliary examinations can help clinicians diagnose and treat these cases.     

126例青春期女性盆腔包块的病因及诊治分析

目的 探讨青春期妇科盆腔包决的临床特点、病因及诊治方法.方法 回顾性分析126例以盆腔包块入院治疗的青春期生殖系统疾病的临床资料.结果 126例女性患者年龄10.0～19.0岁,平均年龄17.6岁.异位妊娠38例(30.2%),年龄17.0～19.0岁,平均(18.6 ±0.5)岁.卵巢肿瘤35例(27.8%),年龄10.0～19.0岁,平均(17.1±2.1)岁,其中卵巢生殖细胞肿瘤20例,占57.1%,成熟性畸胎瘤18例,卵巢内胚窦瘤1例,未成熟性畸胎瘤1例;卵巢上皮肿瘤13例,占37.2%,其中浆液性囊腺瘤8例,粘液性囊腺瘤3例,浆液性囊腺瘤合并粘液性囊腺瘤1例,交界性粘液性囊腺瘤1例;卵巢单纯性囊肿2例,占5.7%.生殖道先天畸形14例,占11.1%,年龄13.0～19.0岁,平均(14.7±2.2)岁,其中处女膜闭锁7例,残角子宫畸形2例,阴道下段闭锁3例,阴道纵隔合并残角子宫l例,阴道斜隔1例.黄体囊肿破裂11例,占8.7%,年龄13.0～19.0岁,平均(18.1±1.9)岁.输卵管系膜囊肿6例.卵巢巧克力囊肿5例.输卵管积水4例,输卵管及卵巢脓肿6例.葡萄胎5例.盆腔结核2例.手术治疗116例,保守治疗10例.结论 青春期盆腔包块的病因根据青春期的不同划分有所不同,青春早期多为卵巢肿瘤;青春中期则多以生殖道畸形为主;青春晚期,性腺基本发育成熟,盆腔包块中常见的原因是异位妊娠、卵巢肿瘤、生理性赘生物.手术是治疗的主要方法.     

超声心动图诊断双心房占位

目的探讨双心房占位病变的临床表现及超声心动图特征。方法回顾性分析双心房占位患者8例,分析其临床资料及超声心动图表现,并与术后病理相对照。结果双心房占位的8例患者中,双心房血栓5例,肿瘤3例,其中良性1例,恶性2例。6例表现为活动后胸闷憋气,2例为下肢水肿,1例为右胸痛。双心房血栓占位主要表现为基底部较宽,无蒂,较易附着于心房顶部、心房侧壁心耳开口处及心耳内血流缓慢处。良性肿瘤主要为黏液瘤,表现为多发,瘤体松散,活动度大,有较窄的蒂与心房壁或房间隔相连。恶性肿瘤占位主要表现为向心房壁或间隔壁浸润性生长,位置固定,宽基底并伴中-大量心包积液。结论应用超声心动图可探查双心房占位的原发病变,可为临床治疗方案提供依据。     

Subserous uterine adenomyosis mimicking an adnexal mass on sonography

Uterine adenomyosis usually manifests as diffuse disease involving the myometrium and the endometrial-myometrial junction, but it may also manifest as a focal lesion. It is usually only a few millimeters in diameter but may sometimes be larger. We report the case of a 32-year-old woman with a large isolated mass in the uterine wall. Transvaginal sonography demonstrated the cystic nature of the mass and its characteristic hemorrhagic pattern, whereas CT confirmed its uterine origin. The patient underwent laparoscopic resection of the mass, and pathologic examinations led to the diagnosis of adenomyosis.     

PACS海量数据中心

目的 本介绍了PACS数据中心的设计思想和关键技术，提出了解决PACS海量存储和“瓶颈效应”的一些方法。方法 PACS数据中心主要由PACS控制器、PACS管理服务器和PACS数据库服务器组成。PACS控制器负责响应PACS客户端的存储和查询／提取请求；PACS管理服务器负责对医学图像进行管理和归档；PACS数据库服务器负责对病人及其图像信息进行更新。在PACS数据中心内，各个服务器之间相互镜像，形成稳定的容错体系结构。PACS数据中心把各种存储设备融合成一个虚拟的海量存储池，图像分别以在线、近在线和离线等方式进行存储。在图像的传输上，PACS数据中心采用了自动路由和多通道并行等技术。结果 在上海华东医院两年多的临床运行中，PACS数据中心稳定可靠，无图像丢失，并且具有很高的查询提取速率。结论 PACS数据中心解决了医院内部海量数据的长期存储问题和PACS中常见的图像传输“瓶颈效应”问题。     

An automated mechanism for protection of mass spectrometry sampling tubing

The usefulness of medical mass spectrometers in intensive care units can be limited by too frequent obstruction of the tubing that transports gases from the patients to the analyzing unit. To overcome this problem, we developed an automated system consisting of an infrared light sensor and a three-way valve. One port of the three-way valve connects to 2.4-m disposable tubing that collects gases from the patient's airway. The second port is connected to a mass spectrometer analyzing unit through 30-m permanently installed tubing. The third port is connected to a pressurized oxygen source. An infrared light sensor is placed on the shorter tubing, between the patient and the three-way valve. When increased optical density is detected, due to entrainment of respiratory secretions, the three-way valve is activated. Gas flow is closed between the patient and the mass spectrometer and opened between the pressurized oxygen source and patient tubing to flush its contents. During the six years that the protection system has been in use, the frequency with which the disposable gas collection tubing is changed has been halved. Furthermore, periodic tests of delay and response times, performed at each bedside station, indicate that permanent connection tubing only needed cleaning at 2- to 3-year intervals. The system has decreased the cost of operating our mass spectrometers while also reducing periods of unavailability due to equipment failure.     

腹股沟肿块超声分型的临床价值

目的 探讨超声图像分型法在诊断腹股沟肿块中的临床价值。方法 将经手术病理证实的６８例腹沟肿块超声图像分为;囊性（Ⅰ型）、囊实性（Ⅱ型）、实质性（Ⅲ型）和含气性（Ⅳ型）。结果 Ⅰ型与Ⅳ型均为良性病变;Ⅱ型和Ⅲ型则有良、恶性重叠。Ⅱ型肿块以良性多见,而Ⅲ型肿块除隐睾外,大多为恶生病变。结论 该法对腹股沟肿块的诊断具较大临床实用价值。     

Determination of creatinine in urine by tandem mass spectrometry

BACKGROUND: Electrospray tandem mass spectrometry (TMS) is a very powerful tool that enables one to perform high sample throughput analysis. This paper describes a method to determine creatinine in urine by tandem mass spectrometry with direct sample infusion into an ion source. METHODS: Samples (50 microl) were diluted with internal standard (IS) (450 microl of 0.667 mmol/l deuterated creatinine). Diluted samples were introduced into mass spectrometer with no prior pretreatment and after purification on ion-exchange 96-column cartridge. Tandem mass spectrometry analyses were performed in selected reaction monitoring mode. Creatinine and creatinine-d(3) were monitored using precursor and product ion settings (m/z 114 to 86 and m/z 117 to 89, respectively). The time of an analysis was 3.015 min. Both TMS methods were compared mutually and with the results obtained by enzymatic and Jaffe method. RESULTS: Linearity was obtained in the range 0.06-60 mmol/l. Detection limit was 0.2 mumol/l and recoveries were in the range 95.1-98.3% for both the assays with and without ion-exchange column. Results of both assays are in good agreement with those obtained by enzymatic and Jaffe method based on log-transformed Bland-Altman plots. Electrospray tandem mass spectrometry method utilizing both approaches with and without ion-exchange column is acceptable according to CLIA criteria. CONCLUSION: Tandem mass spectrometry allows rapid, sensitive and selective determination of creatinine in untreated urine.     

Appendiceal submucosal mass as presentation of intestinal endometriosis

Submucosal lesions are mass‐like protuberances into the gastrointestinal lumen covered by normal mucosa. Making a definitive diagnosis is difficult because of the number of benign and malignant lesions and extrinsic compression. Here we report the case of a 42‐year‐old woman referred for colon polypectomy. Colonoscopy revealed a polypoid formation with externalization from the appendicular orifice covered by normal mucosa and another formation at the sigmoid colon. The histopathology of both lesions was normal. Endoscopic ultrasound showed a hypoechoic lesion that was slightly heterogeneous in the fourth layer, and CT colonography confirmed the findings. Surgical therapy with ileocolic resection and resection of the sigmoid lesion was performed. Surgical specimens revealed an appendicular intussusception by endometriosis and endometrial foci in the sigmoid. Intestinal endometriosis may have several presentations, but it should always be considered in the differential diagnosis of a submucosal lesion in the colon.     

超声对盆腔炎性肿块的诊断价值

目的 探讨超声对盆腔炎性肿块的诊断价值。方法 使用Moka-630型、AolentDx型超声诊断仪对228例盆腔炎性肿块的妇科病人，经腹超声检查。结果 228例病人，其中手术证实112例，超声引导下穿刺证实33例，抗炎治疗治愈83例；228例中，超声有异常发现的224例(占98．25％)。结论 盆腔炎性肿块的声像图尽管变化多端，但还是有规律可循，同时具有一定的临床应用价值。     

Body mass index

Objective To examine the association between body mass index (BMI) and mortality in adult intensive care unit (ICU) patients.Design A prospective multi-center study.Interventions None.Methods A cohort study (yielding the OUTCOMEREA database) was conducted over 2 years in 6 medical-surgical ICUs. In each participating ICU, the following were collected daily: demographic information, admission height and weight, comorbidities, severity scores (SAPS II, LOD, and SOFA), ICU and hospital lengths of stay, and ICU and hospital mortality rates.Results A total of 1,698 patients were examined and divided into 4 groups based on BMI: <18.5, 18.5–24.9, 25–29.9, and >30 kg/m². These groups differed significantly for age, gender, admission category (medical, scheduled surgery, unscheduled surgery), ICU and hospital lengths of stay, and comorbidities. Severity at admission and within the first 2 days was similar in the 4 groups, except for the SOFA score. Overall hospital mortality was 31.3% (532 out of 1,698 patients). By multivariate analysis, a BMI below 18.5 kg/m² was independently associated with increased mortality (odds ratio 1.63; 95% confidence intervals 1.11–2.39). None of the other BMI categories were associated with higher mortality and even a BMI>30 kg/m² was protective of mortality (odds ratio 0.60, 95% confidence intervals 0.40–0.88).Conclusions A low BMI was independently associated with higher mortality and a high BMI with lower mortality in this large cohort of critically ill patients. Since BMI is absent from currently available scoring systems, further studies are needed to determine whether adding BMI would improve the effectiveness of scores in predicting mortality.Electronic Supplementary Material Supplementary material is available in the online version of this article at http://dx.doi.org/10.1007/s00134-003-2095-2.The members of the OUTCOMEREA study group are listed in the appendix.Financial support: OUTCOMEREA is supported by non-exclusive educational grants from Aventis Pharma, France, Wyeth, and the Centre National de la Recherche Scientifique (CNRS).     

超声弹性成像对甲状腺肿块的诊断进展

结节性甲状腺疾病的发病率逐渐上升,其中约5%～10%为恶性结节.早期发现恶性病变有利于治疗方案的选择.超声是甲状腺肿块的一种重要检查手段,但二维及彩色多普勒超声已不能满足临床需要,逐渐兴起的弹性成像技术具有无创及可提供病变组织硬度信息的优点.本文就近年来超声弹性成像对甲状腺肿块的诊断进展做一综述.     

群体性锡中毒的抢救及护理

目的探讨锡中毒患者的抢救及护理。方法严密组织与安排,迅速建立静脉通道,准确抽取血标本,密切观察病情和进行有效的心理护理等。结果67例患者全部治愈出院。结论明确诊断,迅速组织人员,合理分工,及早治疗和细心护理是抢救成功的关键。     

彩色多普勒超声在盆腔炎包块的诊断中的应用

本文报告应用CDFI超声诊断的72例盆腔炎性包块,检出血流者53例.占73.61%,为急性亚急性包块.结果提示CDFI对盆腔炎性包块有明显的诊断价值.     

Regional fat mass by DXA: High leg fat mass attenuates the relative risk of insulin resistance and dyslipidaemia in obese but not in overweight postmenopausal women

Objective. To investigate the influence of regional fat mass (FM) on insulin resistance and dyslipidaemia in obese postmenopausal women (BMI >30?kg/m²) compared to overweight women (BMI <30?kg/m²). Leg FM may attenuate the increased risk of cardiovascular disease and diabetes imposed by increased trunk FM in normal and overweight postmenopausal women. Material and methods. Cross‐sectional and consecutively referred patients comprising 63 obese and 36 overweight postmenopausal women. Body composition and regional FM by dual X‐ray absorptiometry (DXA), fasting glucose, fasting insulin and C‐peptide, insulin resistance by homeostasis model assessment (HOMA‐IR), insulin sensitivity by quantitative insulin sensitivity check index (QUICKI) and metabolic clearance rate (MCRestOGTT), insulin secretion (HOMAsecr) and serum lipids were assessed. Results. In obese subjects, leg FM was favourably associated with HOMA‐IR (p<0.05), QUICKI (p<0.05), fasting glucose (p<0.05), fasting insulin (p<0.05), HOMAsecr (p<0.05) and total cholesterol/HDL ratio (p<0.05). Trunk FM was unfavourably associated with MCRestOGTT (p<0.01), QUICKI (p<0.05) and fasting insulin (p<0.05). Compared to leg FM, leg/trunk FM ratio was more strongly associated with fasting insulin (p<0.001), fasting C‐peptide (p<0.001), HOMA‐IR (p<0.001), MCRestOGTT (p<0.001), QUICKI (p<0.001), HOMAsecr (p<0.001), fasting glucose (p<0.01) and triglycerides (p<0.01). Stepwise multiple regression demonstrated that leg/trunk FM ratio was the most important variable with partial R² = 0.26 (p<0.001) for HOMA and R² = 0.37 (p<0.001) when QUICKI was used as the dependent variable. In overweight women, no associations between fat mass and parameters of insulin resistance or dyslipidaemia were found. Conclusions. A high leg/trunk FM ratio as measured by DXA may give relative protection against diabetes and cardiovascular disease in obese postmenopausal women, but not in overweight women.     

Extraperitoneal mass effect by ascites under tension

Benign ascites may cause an extraperitoneal mass effect when it becomes loculated by adhesions or when peritoneal recesses are enlarged by ascites under tension. Five symptomatic patients were examined by computed tomography demonstrating ascites as the cause of an apparent mediastinal mass in 1, a retrogastric mass in 1, and a retroperitoneal mass displacing the right kidney anteriorly in 4.     

A diagnostic pitfall of a sternal mass

Primary sternal lymphoma represents a rare entity which must be evoked in front of a sternal mass especially as its treatment is different from that of sarcomas, the principal etiology of sternal masses.