探讨彩色多普勒超声检查在卵巢肿瘤中的临床诊断价值

目的探讨彩色多普勒超声检查在卵巢肿瘤中的临床诊断价值。方法选取我院60例卵巢肿瘤患者,对其进行彩色多普勒超声检查,分析其临床诊断效果。结果使用彩色多普勒超声检查的结果与病理诊断符合率达96.67%,其中良性肿瘤的符合率是97.44%,恶性肿瘤的符合率为90.48%,两者对比差异较明显(P0.05)。结论在临床诊断卵巢肿瘤时,使用彩色多普勒超声检查具有较好的诊断效果,可以在卵巢肿瘤的早期判断出肿瘤为良性或恶性,为治疗提供准确依据,值得临床的广泛应用。     

The role of colour doppler ultrasonography of facial and occipital arteries in patients with giant cell arteritis: A prospective study

ObjectiveColour Doppler Sonography (CDS) in giant cell arteritis (GCA) allows the study of involvement of cranial arteries other than the temporal arteries, which are inconvenient to biopsy, such as the facial (FaA), and occipital (OcA) arteries. We aimed to estimate the frequency of the FaA, and OcA involvement in GCA; and to explore the clinical characteristics of these subgroups of patients.MethodsFrom 1 January 2014 to 31 December 2016 we prospectively performed a CDS of the FaA, and OcA in addition to the temporal (TA), and the extracranial supra-aortic arteries in all newly diagnosed patients suspected of having GCA. All the arteries were evaluated in two planes for the highly specific halo sign.ResultsDuring the 36-month observation period we performed a CDS of the cranial and extra-cranial arteries in 93 GCA patients. We observed the halo sign on the FaA, and OcA in 38 (40.9%), and 29 (31.2%) cases, respectively. The FaA, or OcA were affected in 4/22 (18.2%) patients with a negative TA CDS. FaA involvement significantly correlated with jaw claudication and with severe visual manifestations, including permanent visual loss.ConclusionsA fifth of patients with a negative CDS of the TAs had signs of vasculitis on the CDS of the FaA, or OcA. The addition of FaA and OcA CDS to the routine CDS of the TAs could identify 4.3% more patients and thus further improve the sensitivity of the CDS in the suspected GCA.     

Do negative CCT and CSF findings exclude a subarachnoid haemorrhage? A retrospective analysis of 220 patients with subarachnoid haemorrhage

Objective: Subarachnoid haemorrhage (SAH) constitutes a neurological emergency. In most cases, the diagnosis is easy to establish; however, in rare cases, verification of the diagnosis is difficult. In this retrospective analysis, we report the clinical characteristics of patients with SAH who were admitted to our neurological intensive care unit. We focus on the additional diagnostic approaches in patients with a high suspicion of SAH but failure of the ‘classic’ diagnostic tools. Methods: A retrospective chart review was performed for all patients in whom SAH was diagnosed between 1996 and 2008. Two hundred and twenty patients were analysed for presenting symptoms, radiological and laboratory findings, hospital course and outcome. Results: A total of 220 patients were identified (mean age 50.5 years, 127 women). In 217 patients, the diagnosis was based upon cerebral computed tomography (CCT) or lumbar puncture. In three patients, the diagnostic work‐up was continued because of distinct clinical signs even though CCT and cerebrospinal fluid (CSF) were negative for SAH. In these patients, vasospasm was detected by transcranial doppler sonography (TCD) and/or diagnosis of aneurysm was confirmed by conventional angiography. Conclusion: Subarachnoid haemorrhage with negative CCT and CSF is a rare presentation of a severe acute neurological emergency. Further diagnostic as TCD/computed tomography (CT)‐A or MR‐A should be considered in all patients with typical clinical presentation for SAH but unremarkable CCT and CSF as an additional diagnostic tool. Ultimately, a conventional angiography should be performed if distinct clinical signs of SAH are presented.     

彩色多普勒超声心动图在先天性心脏病诊断中的价值分析

目的探讨利用超声彩色多普勒显像技术诊断先天性心脏疾病的准确率。方法对来我院就诊的287例先心病患儿术前行常规超声心动图检查，将其彩色多普勒超声心动图诊断结果与心外科手术后诊断结果进行比较。结果252例术前彩色多普勒超声心动图检查结果与心外科手术后诊断相符，35例与心外科术后诊断不一致。结论超声彩色多普勒在诊断胎儿先天性疾病中有重要的应用价值，诊断准确率高，可以作为先天性心脏病患者术前诊断的主要手段和依据。     

臂踝脉搏波传导速度和踝臂指数对下肢动脉粥样硬化的诊断价值

目的研究应用臂踝脉搏波传导速度(brachial-ankle pulse wave velocity,BaPWV)和踝臂指数(ankle-branchial index,ABI)对下肢动脉粥样硬化的诊断价值。方法连续选取2015年5月~2015年10月就诊于吉林大学白求恩第一医院门诊或住院的健康或脑血管病患者173例,分别对入组患者行双下肢动脉彩超、BaPWV和ABI检查,根据双下肢动脉彩超正常的入组者所收集数据采用均数加减1.96倍标准差分别计算出BaPWV和ABI的正常参考值范围;根据双下肢动脉彩超结果分为:正常组、斑块组、轻度狭窄组、中度狭窄组、重度狭窄+闭塞组5组,并分别比较5组间BaPWV值和ABI值;同时假设分别以ABI=0.8、ABI=0.9、ABI=1.0、ABI=1.1为分界点,通过绘制、分析受试者操作特征曲线(ROC curve)明确区分下肢动脉正常与狭窄之间的最佳分界点,并计算其灵敏度、特异性、误诊率及漏诊率。结果 BaPWV的正常参考值范围是1078~1876 cm/s,ABI的正常参考值范围是1.02~1.31;5组间BaPWV值比较(P0.001),具有显著差异,进一步进行组间比较得出,BaPWV值可应用于中度狭窄病变以前的血管弹性评估,对重度狭窄及闭塞血管无诊断作用;5组间ABI值比较(P0.001),有显著差异,结合ROC曲线下面积得出,ABI值对于区分双下肢动脉正常与斑块、斑块与轻度狭窄、轻度狭窄与中度狭窄病变之间没有诊断价值,但对于区分中度狭窄与重度狭窄+闭塞之间有较高的诊断意义。结论 BaPWV可以作为评估下肢动脉血管弹性的指标,ABI可以作为下肢动脉狭窄的诊断工具。     

Strategies for investigating the maternal-fetal interface in the first trimester of pregnancy: What can we learn about pathology?

The pathologies of the pregnancy complications pre-eclampsia (PE) and fetal growth restriction (FGR) are established in the first trimester of human pregnancy. In a normal pregnancy, decidual spiral arteries are transformed into wide diameter, non-vasoactive vessels capable of meeting the increased demands of the developing fetus for nutrients and oxygen. Disruption of this transformation is associated with PE and FGR. Very little is known of how these first trimester changes are regulated normally and even less is known about how they are compromised in complicated pregnancies. Interactions between maternal and placental cells are essential for pregnancy to progress and this review will summarise the challenges in investigating this area. We will discuss how first trimester studies of pregnancies with an increased risk of developing PE/FGR have started to provide valuable information about pregnancy at this most dynamic and crucial time. We will discuss where there is scope to progress these studies further by refining the ability to identify compromised pregnancies at an early stage, by integrating information from many cell types from the same pregnancy, and by improving our methods for modelling the maternal-fetal interface in vitro.     

配合多普勒全程干预胎方位促进分娩的护理

目的:探讨配合多普勒全程干预胎方位加快第一产程和第二产程指导与护理方法。方法总结了医院自2010年1月-2010年9月对255例临产初产妇配合多普勒定胎方位并在活跃期采取了侧俯平卧位和宫口开全采取床头抬高约30°指导与护理。结果因头盆不称行剖腹产40例,剖腹产率明显下降,新生儿轻度窒息3例,产后出血均≤300ml,窒息率也下降。结论分娩过程中严密观察及护理是十分重要的,通过多普勒监测胎心和胎方位的确诊,及时发现胎儿宫内窘迫和全程干预胎方位有显著成效,即降低了剖腹产率、新生儿窒息率,也减少了产后出血率,提高了母婴安全的产时服务模式。     

双侧脑动静脉间脉搏波传导时间对腔隙性脑梗死的初步评价及与颈动脉硬化相关性分析

目的观察双侧脑动静脉间脉搏波传导时间(cerebral arerio-venous pulse wave time,CAV-PWT)对腔隙性脑梗死的初步评价,及与颈动脉硬化的相关性分析。方法选择58例腔隙性脑梗死患者和43例健康体检者,采用经颅多普勒(transcranialdoppleultransonograp,TCD)仪同步监测左右两侧颈内动脉终末段(terminal internal carotid artery,TICA)与两侧基底静脉(rosenthal’s veins;venae basalis,BVR)的脉搏波,用相移方法计算CAV-PWT,比较两侧CAV-PWT的差异性;对上述人群同时进行颈动脉超声检查,分析颈动脉硬化与CAV-PWT的相关性。结果腔隙性脑梗死组患者的双侧CAV-PWT均比对照组明显缩短(P0.05),腔隙性脑梗死组左右两侧CAV-PWT对比无明显统计学差异(P0.05);腔隙性脑梗死组颈动脉硬化发生率均高于对照组(P0.05),但不稳定斑块例数与对侧组相比无统计学差异。经Logistic回归结果显示:年龄、CHOL、CAV-PWT和高血压、颈动脉硬化是腔隙性脑梗死的危险因素(P0.05)。结论腔隙性脑梗死的脑动脉硬化具有全局性,无明显同侧相关性;与颈动脉硬化具有明显相关性,但也无同侧相关性。     

脉冲组织多普勒显像评价原发性高血压患者右室舒张功能

目的:应用脉冲组织多普勒显像(TDI)评价原发性高血压(EH)患者的右室舒张功能。方法:53例Ⅰ~Ⅱ级EH患者(EH组)及50例健康志愿者(对照组)于三尖瓣环与二尖瓣环行脉冲TDI检查,测量舒张早期峰值运动速度(e)、舒张晚期峰值速度(a),计算e/a。对比2组右室舒张功能参数,分析右室舒张功能参数与其他因素的相关关系。结果:EH患者三尖瓣环e明显减低,e/a明显下降,右室等容舒张时间延长,右室舒张功能参数与左室舒张功能参数呈紧密正相关。结论:轻、中度EH患者存在右室舒张功能障碍,两侧心室充盈参数之间相关性良好。脉冲TDI用于评价EH患者右室舒张功能是可行的。