Computer analysis of echographic textures in Hashimoto disease of the thyroid

Ultrasound B-scan images of the thyroid obtained from 10 patients with Hashimoto disease were digitized and processed by a computer method of image analysis that segments complex B-scan images into regions of homogeneous texture. The method was first applied to B-scan images of the normal thyroid and it consistently classified the normal tissue into a unique region. When applied to Hashimoto disease B-scan images, the same method segmented the thyroid into two regions. Detailed analysis of these regions revealed that their gray-level histograms were very different from that of the normal thyroid in eight cases. In two cases the histogram of one of the regions was similar to that of the previous eight cases, whereas the histogram and the tissue of the other region were similar to those of the normal tissue. This paper shows how these results can be interpreted according to the natural history of the Hashimoto disease.     

Clinical significance of focal echogenic liver lesions

During a 4-year period, 53 focal echogenic liver lesions were demonstrated by sonography in 41 patients, in whom there was no evidence of metastatic origin. Most of the lesions were hemangiomas.One of the purposes of this study was to determine the characteristic ultrasound features for liver hemangioma. Small (less than 2 cm), homogeneous, echogenic, well-circumscribed, subcapsular lesions almost prove their hemangiomatous nature. Lesions with a diameter of more than 2 cm are usually more lobulated and heterogeneous. They are located more centrally in the liver and nearly all show a close anatomical relation with 1 of the hepatic veins. Very large lesions (greater than 5 cm) with a heterogeneous and irregular aspect suggest focal nodular hyperplasia, which must be proven by a Tc-isotopic liver scan.     

Accuracy of genotyping for HPV16 and 18 to triage women with low-grade squamous intraepithelial lesions: a pooled analysis of VALGENT studies

Background: Genotyping for the most carcinogenic human papillomavirus (HPV) types (HPV16/HPV18) can identify high risk of underlying cervical precancer and guide further management.

Research design and methods: A pooled analysis was performed of the clinical accuracy of high-risk HPV (hrHPV) testing and HPV16/18 genotyping in triage of women with low-grade squamous intraepithelial lesions (LSIL). Data regarding 24 assays evaluated in four VALGENT validation panels were used.

Results: In women with LSIL, hrHPV had a pooled sensitivity for CIN2+ of 95.5% (95% CI: 91.0–97.8%) and a specificity of 25.3% (95% CI: 22.2–28.6%). HPV16/18 genotyping had a sensitivity and specificity for CIN2+ of 52.9% (95% CI: 48.4–57.4%) and 83.5% (95% CI: 79.9–86.5%), respectively. The average risk of CIN2+ was 46.1% when HPV16/18-positive, 15.5% in women who were HPV16/18-negative but positive for other hrHPV types and 4.3% for hrHPV-negative women.

Conclusions: Triage of women with LSIL with HPV16/18 genotyping increases the positive predictive value compared to hrHPV testing but at the expense of lower sensitivity. Arguably, women testing positive for HPV16/18 need further clinical work-up. Whether colposcopy referral or further surveillance is recommended for women with other hrHPV types may depend on the post-test risk of precancer and the local risk-based decision thresholds.     

Cutaneous metastasis of esophageal adenocarcinoma with an unusual presentation

We describe an unusual presentation of a cutaneous metastasis of esophageal adenocarcinoma in the left tempero-parietal skull and the sonographic features that helped establish the diagnosis. The patient had a primary tumor surgically resected 4 years earlier and was in clinical remission at the time of presentation. The patient presented to our radiology department with a lump on the head after a fall, and sonographic examination was recommended to assess the presumed posttraumatic hematoma. The examination revealed typical features of malignancy: a superficial solid mass invading the skull surrounded by an irregular network of blood vessels. This was confirmed on CT, and a definitive diagnosis was obtained on histologic analysis following sonographically guided biopsy.     

Visceral leishmaniasis with multiple nodular lesions of the liver and spleen:

Visceral leishmaniasis is a severe disease caused by the intracellular protozoa Leishmania donovani. Diagnosis is based on examination of bone marrow or serology. The role of imaging techniques as diagnostic tools remains to be established in visceral leishmaniasis. We report multiple nodular lesions in the liver and spleen on ultrasonography and computed tomography in a patient with visceral leishmaniasis. To our knowledge, this is the first reported case of multiple nodular hepatosplenic lesions in visceral leishmaniasis.     

内镜下套扎治疗胃肠道隆起性病变(附67例分析)

目的 探讨内镜下尼龙绳套扎治疗宽基底或粗蒂胃肠道隆起性病变的疗效。方法 采用内镜下尼龙绳套扎法，对67例宽基底或粗蒂胃肠道隆起性病变进行套扎治疗。结果 67例71枚胃肠道宽基底或粗蒂隆起性病变均一次性套扎成功，15例同时加高频电切除；术后60例复查示49例隆起病变完全脱落消失(含已电凝切除者)，9例部分脱落，2例未脱落；7例失访。1例同时加高频电切后并创面小动脉出血。治愈、有效、无效率分别为81．7％(60／49)、15．0％(9／60)、3．3％(2／60)。结论 尼龙绳套扎法对宽基底或粗蒂胃肠道隆起性病变的治疗效果满意，是一种安全、有效、经济、操作简便的方法，值得推广。     

Breast masses with mixed cystic-solid sonographic appearance

Retrospective analysis was performed for 56 breast masses with mixed cystic and solid sonographic patterns encountered in the last 5 years at Keio University Hospital, with the objective of elucidating their significance. The lesions were classified into two major groups: tumor with cyst (TWC—solid mass with cystic component) and intracystic tumor (ICT—cystic mass with solid component). According to the pathological diagnosis, 57% were benign and 43% were malignant. Fifty eight percent of malignant lesions were shown to have a TWC pattern and 42% an ICT pattern. Among benign lesions, 66% were shown to be TWC and 34% ICT. In malignant tumors, 96% of the cases showed irregular shape and heterogeneous internal content. Even in benign lesions, a high incidence of irregular shape and rough border was found, although the predominant internal echo texture was homogeneous, and threedimensional (3-D) contour was not clear. In conclusion, we observed that in the TWC group, the lack of a defined 3-D contour is the most important criterion, and tumors with multiples cysts tend to be benign. © 1993 John Wiley & Sons, Inc.     

腘动脉外侧皮支单蒂皮瓣或联合腓动脉穿支双蒂皮瓣游离移植修复手足创面

目的 探讨腘动脉外侧皮支单蒂皮瓣或联合腓动脉穿支双蒂皮瓣游离移植修复手足皮肤软组织缺损的临床效果。方法 回顾性研究。纳入2013年3月—2020年6月东莞市长安新安医院手足显微外科收治的手足皮肤缺损伴肌腱、骨骼外露患者21例,其中男19例、女2例,年龄16~65岁（平均37.8岁）。手部创面8例,足部创面13例;软组织缺损面积3.5 cm×5.5 cm~10.0 cm×14.0 cm。观察患者术后皮瓣成活情况,采用英国医学研究会颁布的感觉功能恢复分级评价标准评估患者皮瓣感觉功能恢复情况,采用笔者参考皮瓣功能7项检查制定的皮瓣外观功能10项检查表进行皮瓣外观功能综合评价。结果 21例患者术后皮瓣全部成活。采用腘动脉外侧皮支单蒂皮瓣游离移植修复13例、腘动脉外侧皮支联合腓动脉穿支双蒂皮瓣游离移植修复8例,皮瓣切取面积4.0 cm×6.5 cm~10.0 cm×16.0 cm,供区创面直接缝合或植皮覆盖。术后随访6~36个月,皮瓣质地良好,厚薄适中,两点间辨别觉13~25 mm;皮瓣外观功能综合评价：优7例、良11例、可3例,优良率为85.7％。小腿供区无功能性影响。结论 腘动脉外侧皮支单蒂皮瓣或联合腓动脉穿支双蒂皮瓣游离移植修复手足创面,皮瓣血供有保障,成活率高,是修复手足软组织创面的有效术式之一。     

临床护理路径在复杂冠脉病变患者介入治疗中的作用

目的探讨临床护理路径在复杂冠脉病变患者介入治疗中的应用效果。方法将128例患者随机分成实验组和对照组各64例,实验组在实施常规护理的基础上采用临床护理路径方法进行干预,对照组实施常规护理。结果实验组术后并发症发生率明显低于对照组（P〈0.05）,平均术后住院时间短于对照组（P〈0.05）,患者满意度明显高于对照组（P〈0.05）。结论临床护理路径作为一种科学的管理模式,既可提高工作效率,又可提高护理质量。     

Protective effect of N,N’‐dimethylthiourea against stress‐induced gastric mucosal lesions in rats

In the present study, we examined the protective effect of N,N’‐dimethylthiourea (DMTU), a scavenger of hydroxyl radical (), against water‐immersion restraint stress (WIRS)‐induced gastric mucosal lesions in rats. When male Wistar rats fasted for 24 h were exposed to WIRS for 3 h, gastric mucosal lesions occurred with increases in the levels of gastric mucosal myeloperoxidase (MPO), an index of tissue neutrophil infiltration, pro‐inflammatory cytokines (tumor necrosis factor alpha and interleukin 1beta), lipid peroxide (LPO), and nitrite/nitrate (NOx), an index of nitric oxide synthesis, and decreases in the levels of gastric mucosal nonprotein SH and vitamin C and gastric adherent mucus. DMTU (1, 2.5, or 5 mmol/kg) administered orally at 0.5 h before the onset of WIRS reduced the severity of gastric mucosal lesions with attenuation of the changes in the levels of gastric mucosal MPO, pro‐inflammatory cytokines, LPO, NOx, nonprotein SH, and vitamin C and gastric adherent mucus found at 3 h after the onset of WIRS in a dose‐dependent manner. Serum levels of corticosterone and glucose, which are indices of stress responses, increased in rats exposed to WIRS for 3 h, but DMTU pre‐administered at any dose had no effect on these increases. These results indicate that DMTU protects against WIRS‐induced gastric mucosal lesions in rats by exerting its antioxidant action including scavenging and its anti‐inflammatory action without affecting the stress response.