自发性宫内外同时妊娠超声表现1例

患者女,30岁。因停经43天,不规则阴道流血12天来院就诊,疑宫外孕收入院。孕2产0流1,既往月经规律,图1宫内外同时妊娠经阴道B超表现,宫内妊娠囊内见羊膜囊变形,右输卵管间质部妊娠囊从右宫角膨出,呈“同心圆征”其内未见胚芽图2术前经阴道彩色多普勒血流图表现,宫内妊娠囊绒毛间隙彩色血流呈环状分布,边缘一支血流向宫角延伸,充盈于输卵管间质部妊娠囊内自然受孕。经阴道B超表现:子宫增大,形态失常,右宫角部膨隆,宫内至右宫角见43mm×28mm混合回声团,呈葫芦形,分为宫内与宫角2个囊,宫内呈胚囊样回声,内见变形的羊膜囊结构,未见胚芽;右宫角为…     

超声诊断宫角早期妊娠1例

患者女,26岁。停经2个月,不规则阴道流血3天。平常月经规律,末次月经为2004年10月28日,无早孕反应,无其他妇科疾病。妇检:子宫前位,宫体略增大,如孕40天大小,质软,双侧附件未见明显触压痛及包块。B超检查:子宫前位,宫体略增大,内膜居中,厚8mm,宫腔内未见孕囊回声。于左侧宫角处可探及范围约65cm×48cm×47cm的混合包块。35cm×25cm的妊娠囊,内可见胎芽10mm及胎心搏动(图1)。双侧附件未见异常。诊断:左宫角早期妊娠。术后病理:左宫角妊娠(未破裂型),40cm×50cm大小。讨论:宫角妊娠是指妊娠囊种植在子宫角的妊娠,较为罕见,仅占所有异位妊娠的…     

MRI诊断输卵管间质部妊娠二例

例1 女,23岁.停经80 d,阴道出血1个月余.B超示:左侧予宫角处可见3.4 cm×3.2 cm的偏高回声团块,边界清楚,内部回声不均匀.彩色超声多普勒血流显像(CDFI)示团块血供丰富,与内膜相距约0.35 cm,诊断为左侧子宫角处混合性团块,输卵管间质部妊娠或子宫角妊娠可能性大.     

宫角妊娠的超声特征与误诊分析

目的 分析宫角妊娠的声像学特征及误诊原因,以提高超声诊断符合率.方法 对经病理证实的15例宫角妊娠患者的术前超声检查资料,进行分析.结果 宫角妊娠的超声声像图特征:(1)子宫增大,两侧宫角不对称,向外隆起侧宫角部可见妊娠囊或包块回声;(2)妊娠囊或包块与子宫内膜向连;(3)妊娠囊或包块周围均有较完整的子宫肌层包绕;(4)彩超显示来自宫角部的血流供应妊娠囊或包块.15例宫角妊娠中,超声宫角妊娠诊断符合率约为66.7%(10/15),误诊率约为33.3%(5/15),误诊5例,其中2例误诊为输卵管间质部妊娠,2例误诊为宫腔偏宫角部妊娠,1例误诊为子宫肌瘤1例.结论 超声对宫角妊娠有较高诊断价值,检查者应提高对该病的认识及鉴别诊断避免误诊.     

右宫角妊娠超声误诊为右侧输卵管间质部妊娠1例

患者 女,27岁.3年前曾有过一次宫外孕病史,现停经70天,尿妊娠试验阳性,阴道少量流血伴剧烈腹痛来我院就诊,临床疑宫外孕而行超声检查.超声所见:子宫前位,宫体略增大,肌层回声均,子宫体腔内近中轴未见孕囊,内膜厚0.5cm,子宫形态异常,纵切宫底部向外膨隆,内见一完整孕囊,大小3.9cm×3.1cm×2.8cm,形态尚规则,孕囊极度靠近宫底(图1),横切证实膨隆部位为右宫角,孕囊位于其内并偏于宫腔一侧,呈"偏心圆"征,囊内可见胎芽,长1.0cm,未见心管搏动(图2),CDFI:孕囊周围可见环形血流信号.双侧卵巢未见异常,盆腔未见游离积液,腹腔可见中等量游离积液,最深处位于肝周,深5.2cm.超声提示:①右侧输卵管间质部妊娠,胚胎死亡;②腹腔积液.当日在本院手术,手术及病理诊断:右宫角妊娠.     

彩色超声诊断宫颈妊娠1例

1 病历简介 患者,女,22岁.停经40天,因下腹部不适伴少量阴道流血来诊.妇检: 阴道通畅,少量血性分泌物,子宫前位,稍大,宫颈外口关闭,光滑,无举痛,双侧附件区未扪及包块,尿HcG( ).超声检查: 子宫前位,稍大,子宫底体部正常,内膜线清晰居中,宫颈部稍增大,内探及1.1cm×0.7cm的孕囊回声,囊内见胚芽及原始心管搏动(图1).超声诊断: 宫颈妊娠.行刮宫术,术中吸出绒毛组织.病理诊断: 宫颈妊娠.     

经阴道彩超对输卵管间质部妊娠的诊断(附28例分析)

目的 探讨经阴道彩超(TVCDU)对输卵管间质部妊娠诊断的临床价值.方法 对经手术和病理证实的28例输卵管间质部妊娠二维图像、血流分布情况及频谱特征进行回顾性分析.结果 术前超声诊断为间质部妊娠17例,超声检出率为61%(17/28),其图像特征为子宫不对称性增大,一侧宫角部较对侧官角膨隆,在膨隆处的宫角处探及妊娠囊或包块,包块与宫内膜不延续,包块围绕着肌层厚薄不一.超声图像可分为3种类型:孕囊型(7例)、不均质包块(16例)和破裂型(5例).结论 TVCDU对输卵管问质部妊娠的早期诊断与鉴别诊断具有重要的临床价值.     

实性子宫妊娠分娩1例

患者,32岁,孕1产0,停经34+5周,右骶前,皮肤瘙痒1月余,查胆酸23μg/L(我院正常值0.23~1.72μg/L),于2003-08-13以“妊娠合并肝内胆汁淤积症,1/0妊34+5周右骶前,单角子宫?”入院。产科检查:宫高29 cm,腹围87cm,骨盆外测量正常,胎心胎动正常。入院后给予促胎肺成熟及保肝利胆中药等对症治疗。曾因婚后2年不孕,B超示:子宫前位,大小4.0 cm×0.3 cm×4.9 cm,宫底形态失常。右宫角显示角清,子宫输卵管碘油造影报告;宫腔呈柱状,左侧单角子宫,边缘光滑,清晰,左输卵管全程显影,造影剂进入盆腔顺利。意见:左侧单角子宫,左输卵管通畅。于15日自然破膜,…     

超声诊断宫颈机能不全致羊膜囊膨出1例

患者女,42岁。孕24周,既往2次中期妊娠自然流产史,以自觉阴道少量排液1天就诊,无明显腹痛。超声检查：单胎,胎头双顶径约6．0cm,脑中线居中,双侧脑室不扩张,胎心次／分,胎动好,胎盘位于子宫前壁厚约2．0cm羊水最大前后径约5．6cm,宫颈口处可见羊膜囊脱出。超声提示：①中孕、单胎、存活;②羊膜囊突入宫颈内口。患者住院保胎治疗,3天后复查彩超,胎儿死亡。于当晚行引产术。     

超声诊断早孕期不完全纵隔子宫合并宫角妊娠1例

孕妇,26岁.G1P0L0A0,因"停经58天,尿孕检阳性,要求行人工流产术"入院.专科检查:子宫前位,孕2+月,形态正常.经阴道超声检查:子宫体积增大,宫腔内偏右侧宫角处探及大小约19 mm×23 mm×24 mm孕囊样回声,内见胎芽及原始心管搏动,胎芽长约10 mm,符合7周(图1A～1C),偏左侧宫腔内探及范围约...     

Colonoscopy with computed tomography with volume reconstruction. The results and a comparison with endoscopy and surgery

PURPOSE: Virtual CT colonoscopy is a novel technique whose diagnostic accuracy and clinical yield are currently investigated. Several studies have shown its capabilities in detecting colon and rectal cancers. We report the results of a preliminary experience with the volume rendering technique and compare CT colonoscopy with endoscopy and surgery. MATERIAL AND METHODS: Our series consisted of 25 patients with colon cancer confirmed at endoscopy and/or surgery. All examinations were carried out with a spiral CT scanner Philips Tomoscan AVE1. Intestinal preparation was adequate in all patients, consisting in gas insufflated immediately before acquisition, after the injection of 100 mL iodinated contrast agent. All examination were performed in prone position using axial 5 mm slices with 5 mm table feed (pitch 1) and 2 mm reconstruction index; 120 kV and 200-250 mA were used. Images were transferred to a workstation (Easy Vision, Philips, release 4.2.1.1) for processing. We acquired multiplanar (MPR) and virtual endoscopic images with volume rendering; the selected threshold was -250 to -600 Hounsfield Units. Virtual endoscopic images could be obtained in 23 of 25 cases. The results of the radiological study were compared with endoscopic and surgical findings in 25 and 17 cases, respectively. RESULTS: Endoscopy and surgery detected 46 lesions: 29 were malignant and 17 benign. Axial CT and MPR alone detected 35 lesions (76%), 29 of them malignant and 6 benign. The 11 benign lesions missed by axial CT ranged 6-8 mm in diameter. There were no false positives. CT colonoscopy alone detected 66 lesions, but 22 of them were false positive due to residual stool in the colon (21 cases) and to residual barium in the colon (1 case). Combining CT colonoscopy and axial and MPR images enabled to correct the false positive diagnoses made by CT colonoscopy alone and to decrease the false negative ratio of axial and MPR images. Forty-one of 44 lesions (93%) were detected. Thirty-seven lesions were found in the 17 surgical patients; 34 of them were correctly identified combining CT colonoscopy and axial and MPR findings, while endoscopy detected only 31 lesions. Thus, CT had 92% sensitivity, versus 83% of fiberoptic endoscopy. CONCLUSION: In this preliminary experience volume rendering CT colonoscopy exhibited high sensitivity in detecting colon cancers, but their correct evaluation and characterization can be obtained if axial and MPR studies are combined. Further investigation and technological developments are necessary to define the yield of this new technique.     

Bronchogenic carcinoma: staging with MR compared with staging with CT and surgery

Thirty-three patients suspected of having bronchogenic carcinoma were studied prospectively using magnetic resonance (MR). In this group, 30 underwent examination with computed tomography (CT), 15 underwent thoracotomy, six had mediastinal biopsy procedures performed, and eight underwent bronchoscopy. MR studies, which included transaxial spin-echo imaging (TR, 0.5 and 2.0 sec; TE, 28 and 56 msec) of all patients and sagittal or coronal imaging of 18, were performed without knowledge of CT findings, using only plain radiographs as a guide. CT and MR studies were interpreted separately. CT and MR provided comparable information regarding the presence and size of mediastinal lymph nodes. MR better discriminated mediastinal nodes from vascular structures. However, in two of 11 patients who had multiple mediastinal lymph nodes that were normal in size at CT examination and surgery, MR suggested a confluent abnormal mass, probably because of its poorer spatial resolution. MR was superior to CT in showing enlarged hilar lymph nodes, but CT was better for demonstrating bronchial abnormalities. In three of four patients who had a proved hilar mass with distal obstructive pneumonia, MR (TR, 2.0 sec) helped distinguish between the mass and collapsed lung.     

Quantitative evaluation of muscle perfusion with CEUS and with MR

Functional imaging might increase the role of imaging in muscular diseases, since alterations of muscle morphology alone are not specific for a particular disease. Perfusion, i.e., the blood flow per tissue and time unit including capillary flow, is an important functional parameter. Pathological changes of skeletal muscle perfusion can be found in various clinical conditions, such as degenerative or inflammatory myopathies or peripheral arterial occlusive disease. This article reviews the theoretical basics of functional radiological techniques for assessing skeletal muscle perfusion and focuses on contrast-enhanced ultrasound (CEUS) and magnetic resonance imaging (MRI) techniques. Also, the applications of microvascular imaging, such as in detection of myositis and for discriminating myositis from other myopathies or evaluating peripheral arterial occlusive disease, are presented, and possible clinical indications are discussed. In conclusion, dedicated MR and CEUS methods are now available that visualize and quantify (patho-)physiologic information about microcirculation within skeletal muscles in vivo and hence establish a useful diagnostic tool for muscular diseases. Invited review article to European Radiology.     

Radiotherapy with and without temozolomide in elderly patients with glioblastoma

Background and purpose

The optimal treatment for elderly patients (age ???70?years) with glioblastoma (GBM) remains controversial. We conducted a retrospective analysis in 43 consecutive elderly patients with glioblastoma who either underwent radiotherapy (RT) or radiotherapy plus concomitant temozolomide (TMZ).

Patients and methods

A total of 43?patients (???70?years of age, median age 75.8?years) with newly diagnosed glioblastoma and a Karnofsky performance status (KPS) ???70 were treated with RT alone (median 60?Gy in 2?Gy single fractions) or RT plus TMZ at a dose of 75?mg/m² per day. The two groups were well-balanced; univariate (log-rank test) and multivariate Cox proportional hazards analysis were used to identify relevant prognostic factors.

Results

The median overall survival (mOS) of the entire patient cohort was 264?days (8.8?months) and the median progression-free survival (PFS) was 192?days (6.4?months). The factors age, sex, previous surgery, KPS, and concomitant use of TMZ had no significant influence on OS/PFS; multivariate analysis was performed to obtain adjusted hazard ratios. TMZ use resulted in a trend toward poorer overall survival when applied concomitantly (314?days compared to 192?days within the TMZ group, p?=?0.106). The subgroup analysis revealed that TMZ use resulted in significantly worse survival rates in patients with KPS70 (p?=?0.027), but for patients with KPS80 this difference was not detectable.

Conclusion

TMZ should only be used carefully in elderly patients with unfavorable KPS. In this patient cohort, radiotherapy alone is a reasonable option. Standard RT plus concomitant TMZ may be an advantageous treatment option for elderly patients with newly diagnosed glioblastoma who present with good prognostic factors.     

Intrahepatic arterioportal fistula and its treatment with detachable balloon and transcatheter embolization with coils and microspheres

BACKGROUND: Although intrahepatic arterioportal fistula (APF) due to acquired or congenital causes are infrequent, they are listed among the causes of portal hypertension. PURPOSE: The aim of this study was to present the results of intrahepatic APF treatment with embolotherapy in six cases. MATERIAL AND METHODS: Transarterial detachable balloon and coil embolization was used on six consecutive cases with traumatic intrahepatic APF from 1989 to 2003. Six-month follow-up angiography was obtained in every case. RESULTS: Successful disconnection of hepatic arterial and portal system was achieved in five cases. At least symptomatic improvement was achieved in one. CONCLUSION: Transcatheter embolization may be the first line of treatment for intrahepatic APF.     

肝癌经肝动脉栓塞术后癌灶化脓性感染的诊断和治疗

报道了７例肝癌经肝动脉栓塞术（ＴＡＥ）后合并感染、脓肿的病例。发生此一严重并发症的机率约为１．４％（７／４９５）。诊断主要依靠临床症状及ＣＴ、Ｂ超影像。在ＣＴ导向下的有效引流和对残癌组织用无水酒精冲洗则是最主要的治疗方法。其转归大概可分为：（１）脓肿痊愈、肿瘤姑息；（２）脓肿痊愈，活癌子灶仍存；（３）死于无法控制的感染。     

艾滋病合并肠管淋巴瘤X线、CT表现与病理

目的：探讨艾滋病合并肠管淋巴瘤的影像学特征表现与病理。方法：回顾性分析3例经活检及尸体解剖病理确诊的艾滋病合并肠管淋巴瘤患者的CT与病理资料。3例均经CT检查,其中2例经上消化道造影,1例钡剂灌肠造影。1例剖腹探查,切除部分增厚肠管组织病理证实,1例尸体解剖病理组织分析证实。结果：2例肠管淋巴瘤发生在空肠,1例发生在降结肠,影像与大体病理均表现为肠管壁不均匀增厚,管腔狭窄,充盈缺损,病理分型均为B细胞淋巴瘤。结论：艾滋病合并肠管B细胞淋巴瘤CT表现与病理符合度高。     

Suicide with moclobemide and perazine

A 51-year-old woman who was diagnosed as suffering from depression was found dead in her flat. The autopsy revealed no morphological changes sufficient to explain death. Toxicological analysis was performed and the drugs moclobemide (49.9 mg/l), perazine (1.27 mg/l) and some metabolites were identified in the blood. A combined drug intoxication resulting in synergistic effects to cardiovascular disorders was proposed as the cause of death. Received: 10 November 1997 / Received in revised form: 29 January 1998     

Three homicides with darts tainted with succinylcholine: autopsy and toxicology

In emergency departments, intoxication with the muscle relaxant succinylcholine (SUX) often leads to a potentially lethal respiratory paralysis or other deleterious side effects. However, homicide cases with SUX poisoning are very rare because the toxic or lethal concentration ranges of SUX have not yet been determined. We described three uncommon homicide cases due to acute poisoning by darts contaminated with SUX. All the victims died quickly (less than 30 min) after being shot by an especially designed dart gun. Succinylmonocholine (SMC), a metabolite of SUX, was used as a marker to detect the latter. HPLC-MS/MS analysis demonstrated the presence of SUX in the droplet residues of the darts and SMC in the blood and urine in all cases. SMC concentrations of 0.45, 14.0, and 17.9 ng/ml were detected in the victims’ blood and 259.0 ng/ml in the urine from the third case. The main pathological changes consisted of hemorrhage of the injured soft tissues, visceral congestion, severe pulmonary edema, and multifocal petechial hemorrhage of the heart and lungs. Taken together, the findings supported a diagnosis of fatal SUX poisoning. Futhermore, our study provided a reference for the lethal concentrations of SUX poisoning.