Influence of handedness on calcaneal ultrasound: Implications for assessment of osteoporosis and study design

Calcaneal ultrasound has been increasingly studied for its potential in the assessment of osteoporotic fracture risk. The accuracy of such an assessment is, in part, dependent on the reproducibility of the measurement. This study examines the impact of handedness on ultrasound measurements [broadband ultrasound attenuation (BUA) and velocity of sound (VOS)] in the calcaneus. Two hundred and sixty-four subjects (57 men and 297 women) aged 51.1+13.6 years (mean ± SD) were studied. For each subject, calcaneal ultrasound measurements were performed on both heels with a McCue CUBA ultrasound densitometer. Right-handed dominance (94.7%) was determined by structured interview. In men, BUA measurements were significantly higher on the dominant side: mean difference 4.1±1.5 dB/MHz (mean ± SD;p=0.009), equivalent to 4.2+1.5% and more than 4 times the average rate of annual change in BUA. The difference between sides was greater in young (<50 years) than old men (>50 years). Among the women, the difference was not statistically significant (0.7±0.9 dB/MHz;p=0.4); however, it was significant in younger women (20–30 years) (99±4 vs 90±4 dB/MHz,p=0.01). By contrast VOS did not differ between sides in either men or women irrespective of age. Within-subject standard deviation of BUA was 9.8 dB/MHz for men and 8.6 dB/ MHz for women and the component due to right and left difference was 8.4 dB/MHz for men and 6.9 dB/MHz for women. This variability of BUA between right and left heels could increase the false-positive rate by up to 28% for a cut-off of 2 SD below the mean. These data indicate that variation between left and right heel measurements of BUA is higher than that of random error measurements, particularly in men and younger, presumably more physically active subjects. Although VOS measurements were not side dependent, in the smaller number of studies examining VOS and fracture risk, VOS appears to have a weaker predictive power than BUA. Clinical and epidemiological studies involving calcaneal BUA measurements should standardize the side measured to either the dominant or non-dominant heel, to reduce within-subject variation and increase their power.     

Sonographic patterns in extranold abdominal lymphomas

Between 1980 and 1993, 680 patients with non-Hodgkin's lymphomas (NHL) and Hodgkin's disese (HD) were studied by ultrasonography. In 210 patients a total of 254 extranodular abdominal lymphoma inflitrates were diagnosed. Infiltrates were confirmed histologically in 118 patients and through the clinical course and follow-up studies in 92 patients. Lymphoma infiltrates were seen most frequently in the spleen (N = 101), the gastrointestinal tract (n=70), the liver (n = 47), the kidneys (n = 17) and other organs (n = 19). The sonographic features of lymphomatous infiltrates in different extranodal sites are described, and possible correlations between lymphoma subtypes and sonographic texture characteristics are investigated. Different infiltration patterns of lymphoma subtypes could be indentical in liver and spleen. High-grade NHLs most frequently showed large-nodular lesions, whereas low-grade NHLs and HD showed a tendency towards small-nodular or diffuse lesions. The role of ultrasonography in the clinical management of lymphoma pateins is discussed.Correspondece to: C. Görg     

Imaging studies of the cadaver hand using transmission ultrasound

Ultrasonic transmission imaging has already demonstrated potential for evaluating structures in the hand. In this study, a cadaver hand was imaged using a transmission scanner with improved imaging capability. The hand was then frozen and serially sectioned and comparisons were made between the sectional anatomy and the corresponding image. Bone (in silhouette), muscle, cartilage, and tendon were visualized with high resolution.     

230例隐睾临床分析

目的　总结隐睾及其并发症的诊治经验 ,提高对隐睾合理治疗年龄的认识。　方法　回顾性分析 1996至 2 0 0 1年 2 30例 2 99侧隐睾患者诊治资料。就诊时年龄 1～ 5 9岁 ,平均 (9.5± 9.0 )岁。左侧 88例 ,右侧 73例 ,双侧 6 9例。合并尿道下裂 11例 ,隐匿性阴茎 2例。　结果　 2岁以内手术治疗患者 2 5例 (10 .9% )。手术治疗 2 89侧 ,其中行一期下降固定术 2 73侧 ,另外疑为萎缩或恶变而行手术切除送病理 15侧 ,探查缺如 1侧。手术 2 89侧中 2 73例下降固定术后随访 4个月～ 5年 ,2 70例未见睾丸回缩及萎缩 ,成功率 98.9% (2 70 / 2 73侧 )。腹外型 2 6 0侧 (90 .0 % ) ,腹内型 2 5侧 (8.7% ) ,缺如 4侧 (1.4 % )。合并斜疝 74侧 (2 5 .6 % ) ,鞘状突未闭 2 4侧 (8.3% ) ,睾丸附睾分离 33侧 (11.4 % )。14 6侧腹外型隐睾B超检查符合率 86 .3% (12 6 / 14 6 ) ,查体符合率 6 3.0 % (92 / 14 6 ) ,P <0 .0 0 5。　结论　 2岁以内最佳手术时机的隐睾患者诊治率明显偏低 ,应引起重视。B超对隐睾的定位诊断符合率较高。     

后房型人工晶状体植入术后的超声生物显微镜观察

目的：探讨后房型人工晶状体植入术后眼前节结构的改变。确切定位人工晶状体襻的位置。观察人工晶状体襻对于周围组织的影响。方法：白内障摘除及后房型人工晶状体植入术的50名患者（50眼）于术前，术后1周及三个月进行超声生物显微镜观察。结果：术后前房深度，房角宽度押送术前显著增加。人工晶状体中囊袋内植入者36枚（72%）。睫状沟植入者6枚（12%），不对称植入者8枚（16%）。人工晶状体光学部倾斜1眼（2%）。人工晶状体襻推挤虹膜根部2眼（4%）。人工晶状体襻睫状沟侵蚀3眼（6%）。术后1周2眼（4%）眼压升高。皮质少量残留5眼（10%）。结论：囊袋内为后房型人工晶状体植入的理想位置。可保证人工晶状体的良好位置。避免人工晶状体襻对于色素膜组织的干扰及对血-房水屏蔽的损伤，从而减少并发症的发生。     

Amebic abscess of the liver manifested by “hemoptysis”: US,CT, and MRI findings

Ultrasonographic (US), computed tomographic (CT), and magnetic resonance imaging (MRI) findings of a patient suffering from an amebic abscess of the liver complicated by a bronchohepatic fistula are presented. Subsequent to US, CT provided the specific diagnosis. Multiplanar MRI was valuable to directly visualize the secondary diaphragmatic rupture and the bronchohepatic fistula.     

Invited. Brain edema development after MRI-guided focused ultrasound treatment

The aim of this study was to investigate a potential technique for image-guided minimally invasive neurosurgical interventions. Focused ultrasound (FUS) delivers thermal energy without an invasive probe, penetrating the dura mater, entering through the cerebrospinal fluid (CSF) space, or harming intervening brain tissue. We applied continuous on-line monitoring by MRI to demonstrate the effect of the thermal intervention on the brain tissue. For this, seven rabbits had a part of their skull removed to create access for the FUS beam into the brain through an acoustic window of 11 mm in diameter. Dura was left intact and skin was sutured. One week later, the rabbits were sonicated for 3 seconds with 21 W acoustic power, and the FUS focus was visualized with a temperature-sensitive T1-weighted MRI pulse sequence. The tissue reaction was documented over 7 days with T2-weighted images of the brain. The initial area of the central low signal intensity in the axial plane was .4 ± .3 mm², and for the bright hyperintensity surrounding the lesion, it was 2.3 ± .6 mm² (n = 7). In the coronal plane, the corresponding values were .4 ± .1 mm² and 3.4 ± .9 mm² (n = 5). The developing brain edema culminated 48 hours later and thereafter diminished during the next 5 days. Histology revealed a central necrosis in the white matter surrounded by edematous tissue with inflammatory cells. In summary, the image-guided thermal ablation technique described here produced a relatively small lesion in the white matter at the targeted location. This was accomplished without opening the dura or the need for a stereotactical device. MRI allowed on-line monitoring of the lesion setting and the deposition of thermal energy and demonstrated the tissue damage after the thermal injury.     

Ultrasound for diagnosis of apophyseal injuries

Avulsion injuries of the apophysis is a problem in young athletes. A correct diagnosis is necessary for establishing the appropriate treatment and the rehabilitation program. However, it is often difficult to distinguish between a simple muscle strain and an avulsion fracture. The X-ray examination is helpful only when an ossification center of the apophysis exists. Ultrasonography is considered the suitable diagnostic tool for these cases. From June 1988 to June 1993, 243 young athletes were seen with an anamnestic and clinically suspected apophyseal injury of the lower extremity. In all cases X-ray examination and ultrasound examination were performed. In 80 cases the diagnosis was confirmed by X-ray examination and in 97 by ultrasonography. Four criteria were defined for the sonographic examination: (a) a hypoechogenic zone, (b) increased distance to the apophysis, (c) dislocation of the apophysis, and (d) mobility of the apophysis on dynamic examination. These criteria are correlated to (a) edema, (b) lysis, (c) avulsion, and (d) unstable avulsion of the apophysis. Ultrasonography is a proven technique for the detection of apophyseal injuries. In comparison to X-ray examination, it has the advantages of no radiation exposure, early detection even without ossification center, and dynamic examination.     

超声波介导的基因输送技术

近年来超声波介导的基因输送技术由于其相对安全性和操作上的简单得到关注。本文对超声波导致的声致穿孔的机制,空化核的作用——增强基因输送的效率,以及细胞和在体基因输送效率作了综述,讨论了超声波介导的基因输送效率的影响因素。此方法充满希望并且载药的空泡可以作为一种新型药物载体在超声作用下实现药物的靶向输送     

69,XXY伴严重生长迟缓及眼球突出病例的产前诊断

目的分析孕中期血清筛查数据和胎儿彩色多普勒与染色体异常之间的关系。方法对一孕中期血清产前筛查18三体风险1:10,血清Free-hCGβ异常减低(值为1.29ng/ml即0.08MOM),胎儿系统结构检查提示胎儿小于孕周,头腹围比(1.63)大于正常(1.25),上唇连续性中断延至鼻底的孕妇进行羊膜腔穿刺,抽取羊水进行细胞遗传学检查。结果羊水细胞染色体核型:69,XXY。结论中孕期妇女血清Free-hCGβ异常减低和胎儿头胸围发育不同步、胎儿唇腭裂提示胎儿染色体畸变可能,血清和超声联合筛查有助于染色体疾病的检出。