原发性肝癌的彩色多普勒及三维血流能量成像特征及其临床意义

目的:探讨三维血流能量成像(3D-CPA)和彩色多普勒血流成像(CDFI)的临床应用价值。方法:对47例原发性肝癌的病灶进行二维、CDFI及3D-CPA的检查,比较CDFI及3D-CPA显示肿瘤瘤内或瘤周血流多普勒信号丰富程度及血管分布类型,并检测肿瘤的血流参数。结果:3D-CPA显示肿瘤血流分布丰富程度及血管分布类型与CDFI均有显著性差异(均P<0.05),CDFI均可探及肿瘤的搏动性动脉血流,其中,收缩期峰值血流速度(PSV)为43~157cm/s,阻力指数(RI)为0.49~0.82,大于0.65者45例。结论:3D-CPA结合彩色多普勒血流参数的检测可作为临床评价原发性肝癌血供及血管分布的常规检查方法。     

实时超声引导下显微手术切除脑深部病灶

目的探讨术中超声引导在脑深部病灶显微手术中的应用价值。方法自2004年开始我们在脑深部病灶显微手术中采用实时超声引导病灶定位,指引手术中皮层入路及路径的选择,并使用术中超声影像动态了解病变位置的变化情况、手术切除的范围,利用实时影像辅助判断病变切除程度。结果28例脑深部病灶,病灶直径为1.0～5.9cm,病理诊断包括蛛网膜囊肿5例,海绵状血管瘤2例,动静脉畸形2例,肿瘤7例,脑内血肿12例。所有病例均显微镜下全切,术后28例患者均恢复良好,神经功能保存良好,无新的神经功能损害,无手术并发症。结论术中超声引导是一种简便有效的脑深部病灶定位方法,操作简便,定位准确,能够实时指引手术路径和动态了解手术切除病灶的范围,与显微神经外科配合能够有效地避免额外的手术损伤,提高手术精度。     

Female pelvic floor. Descriptive anatomy and clinical exploration by transvaginal ultrasound

In order to assess the state and pathology of the woman's pelvis minor, a number of methods are commonly used among practitioners, encompassing clinical exploration, radiology, MRN, urodynamics, endoscopy and echography.

Echography has been poorly used in clinical pelvic exploration and its reliability is actually a matter of controversy 1. However, echographic surveys can provide us with valuable gynecological data on the state and pathologies of the soft pelvis, within the genital regions or even going beyond them, i.e. the rectal channel, bladder, urethra, anus, vascular plexuses, and all of their supporting tissues.

At our research unit, we have been employing Transvaginal Ultrasound echography (TVU) for a long time in conjunction with other pelvis-focused methods in order to study different kinds of pelvic alterations. TVU has proven to be friendly to use, fast, harmless and inexpensive, allowing serial explorations and producing high-quality dynamic images (loop-cinema, video-tape). Furthermore, this method is fairly aseptic in that the occurrence of faeces in the rectal ampolla is not a nuisance but a bonus in tracking the contours of the rectum walls and other topographical features which would be otherwise difficult to survey.

A complete pelvic floor TVU may add no longer than 5-8 minutes to a routine gynecological examination, can be implemented by the general gynecologist and generates data that can be further studied by the appropriate specialist for a more insightful evaluation 2.     

B超引导下经皮肺穿刺针吸活检对周围型肺肿块的诊断价值

目的探讨Ｂ超引导下经皮肺穿刺针吸活检对周围型肺肿块的诊断价值。方法对３１例患者施行Ｂ超引导肺穿刺针吸活检５６次，进行细胞学和细菌学检查。结果穿刺取材成功率为９３．６％，所获细胞学资料与手术病理诊断或临床治疗随访对照，定性诊断符合率为８９．７％。结论该诊断方法简便实用，并发症轻微，适于临床推广应用。     

Spleen sizing by ultrasound in polycythaemia and thrombocythaemia: comparison with SPECT

Detection of non-palpable early splenic enlargement may aid diagnosis of primary polycythaemia (PP) and primary thrombocythaemia (PT). In this study linear spleen sizing by ultrasound has been compared with spleen volume estimation by single photon emission computerized tomography (SPECT) in 26 patients. Spleen length by ultrasound correlated well with SPECT volume estimation.
Ultrasound spleen length was also measured in 60 normal control subjects where the upper limit of the 95% reference range was 11.6 cm. Changes in spleen length with both age and body weight were substantial and overshadowed the imperfect reproducibility of this method. Therefore, interpretation of an individual's measured spleen length should be in relation to that predicted for adults of the same age and weight, particularly at the extremes of the younger, heavier patients and also the older, lighter patients.
Ultrasound spleen lengths of different patient groups (21 PP, 26 PT, 17 idiopathic erythrocytosis, 12 secondary polycythaemia, nine apparent polycythaemia) were compared both using the measured overall reference range and the differences from the values predicted for their age and weight. The comparison showed that almost all patients with PP whose spleens were not palpable had spleen lengths greater than the upper limit for the normal control group, but separation from the other patient groups was incomplete.
Detection of non-palpable splenomegaly by ultrasound length should remain a 'minor' criterion amongst the 'proposed modified diagnostic criteria' of PP.     

用头孢西丁三相试验检测大肠埃希菌及肺炎克雷伯菌的质粒AmpC酶

目的：检测质粒介导的持续高产AmpC酶在大肠埃希菌及肺炎克雷伯菌中的携带率，为临床治疗提供指导。方法：采用头孢西丁纸片药敏试验（K-B法）作AmpC酶的初筛试验，头孢西丁三相试验间接法作AmpC酶的确证试验。结果：在检测的86株菌中，有9株菌K-B法初筛结果为阳性。在这9株菌中经头孢西丁三相试验确证有5株产AmpC酶，阳性率为5.8%。其中大肠埃希菌3株，肺炎克雷伯菌2株。结论：头孢西丁K-B法筛选试验结合头孢西丁三相试验可准确检出质粒介导的AmpC酶，可用于临床常规检测。     

脑梗死老年患者康复治疗前后的脑血流动力学

目的　观察脑梗死老年患者康复治疗期的脑血流动力学变化。　方法　应用经颅多普勒超声仪检测30例脑梗死康复期老年患者治疗前后以及 2 0例老年健康对照组的双侧大脑中动脉 (MCA)血流参数 :收缩期血流速度 (Vs)、舒张期血流速度 (Vd)、平均流速 (Vm)、阻力指数 (RI)、搏动指数 (PI)。　结果　 (1)与对照组比较 ,脑梗死组 MCA流速 Vs、Vd、Vm显著降低 ,RI、PI显著增高 (P<0 .0 1) ;(2 )体疗组经海水浴体疗运动 4疗程后 MCA流速 Vs、Vd、Vm明显增高 (P<0 .0 1) ,RI、PI显著降低 (P<0 .0 1) ,而休养组患者则改变不明显 (P>0 .0 5 )。　结论　脑梗死老年患者恢复期脑循环及血管贮备功能尚差 ,海水浴体疗运动一定疗程后可改善患者心脑血氧供应和脑血流动力学状况。     

SURGERY OF PERIURETERIC OBSTRUCTION IN 101 CHILDREN OVER ONE YEAR OF AGE

One hundred and one children over 1 year of age have had surgery for pelviureteric obstruction over an 11 year period. The common clinical features were abdominal pain, urinary infection or haematuria, but number presented as an incidental finding. Less commonly, the patients presented with an abdominal mass or with hypertension. The diagnosis was usually made on intravenous pyelography (IVP) but in the latter part of the series, renal nuclide scan (RNS) and ultrasonography (US) were preferred. Ninety–three patients had unilateral pyeloplasty, three had bilateral pyeloplasty and five had nephrectomy or heminephrectomy. Whereas initially nephrostomy drainage was used in the majority of patients after pyeloplasty, trend away from nephrostomy evolved in the latter part of the series. With experience, the incidence of postoperative complications was also reduced and there was reduction in the period of hospitalization. Clinical results were consistently satisfactory. Postoperative assessment after pyeloplasty was made by IVP and/or RNS and also US. A review of these investigations showed that RNS provided more factual information of the result when compared with the IVP.