Mammographic Breast Density: Comparison Across Women with Conclusive and Inconclusive Mammography Reports

AimsTo compare breast density (BD) across women with conclusive and inconclusive reports to establish whether BD impacts decisions to recall patients in Nigeria.MethodsA total of 653 mammograms with associated radiologists' reports were retrieved from mammography archives across Nigeria. Ultrasound and biopsy results of cases reported as inconclusive and referred for additional examination were examined. Data were divided into two groups based on radiologists' reports (conclusive, 1 and inconclusive, 2). Each group was subgrouped into A–B and C–D, representing cases with low- and high-mammographic BD, respectively. A Mann–Whitney U test was used to compare breast densities (A–B vs. C–D) in subjects with conclusive and inconclusive mammographic reports.ResultAbout 75.4% (n = 492) of mammograms had a conclusive report and comprised negative (n = 216), benign (n = 208), and equivocal to highly suggestive of malignancy (n = 68). A total of 161 cases had inconclusive reports, of which, 103 demonstrated high mammographic BD (C–D). Low BD (A–B) was significantly higher in subjects with conclusive mammography reports (mean = 0.88 ± 0.36) compared with high BD (z-score = 4.5; P = .0001). High BD (C–D) was significantly higher in subjects with inconclusive reports (mean = 0.64 ± 0.48) compared with low BD (z-score = 5.2; P = .005).ConclusionFindings demonstrate that high mammographic BD impact on radiologists' inconclusive decisions in Nigeria, suggesting a need to explore avenues to improve reader efficiency.     

老年颈动脉硬化与血脂及载脂蛋白AI对比研究

目的：探讨颈动脉硬化与血液中脂类成分的关系。方法：用二维超声观察及测量颈动脉内膜－中层厚度（IMT）及斑块的形成，同时抽血检查血脂及载脂蛋白。结果：颈动脉硬化者血脂及载脂蛋白除脂蛋白AI（apoAI)明显降低外，其它均正常。颈动脉硬化与ApoAI呈强负相关。颈动脉斑块组：血apoAI较正常组下降6．3％，颈动脉管壁增厚组；较正常下降4．3％，具有非常显著性差异（P＜0．01）。结论：颈动脉硬化时血apoAI明显低于正常组，且这两项检测均为无创检查，对脑血管病变的预后，治疗有一定的临床价值。     

Relationship of asymmetric dimethylarginine with flow-mediated dilatation in subjects with newly detected severe hypercholesterolemia

Background: Little is know about the relationship between asymmetric dimethylarginine (ADMA) and percent flow‐mediated dilatation (%FMD) in subjects with severe hypercholesterolemia (HH). Aim: The aim the present study was the evaluation of the relationship of ADMA to %FMD, as well as to lipid parameters and other markers of endothelial dysfunction in newly detected subjects with severe HH. Methods: One hundred and twenty asymptomatic patients with severe, newly detected HH and 100 controls were evaluated. The plasma level of ADMA was tested by ELISA and total homocysteine (tHcy) – through fluid chromatographic analysis. The %FMD was evaluated by the diameter of brachial artery with 7·5 MHz transducer of HP SONOS 5500. Results: Significant difference was found between patients and controls, (P<0·05) regarding lipid total cholesterol, triglycerides, high‐density lipoprotein, low‐dencity lipoprotein, atherogenic indices) and non‐lipid markers (ADMA, sICAM‐1, sVCAM‐1), as well as the endothelium dependent %FMD in contrast to flow independent vasodilation. (P>0·05) No significant difference was found between the groups with respect to tHcy, P‐selectine and E‐selectine. (P>0·05) A strong negative correlation was found between %FMD and ADMA. (r_xy = ?0·895; P<0·001), Apolipoprotein‐B (r_xy = ?0·687; P<0·0001, tHcy (r_xy = ?0·560; P<0·001) and Apolipoprotein index –B/A1 (r_xy = ?0·518; P<0·001). The subsequent linear and multiple regression analysis selected ADMA as the most significant factor in relation to %FMD. Conclusion: It is concluded that ADMA is the basic modulator of %FMD among all tested atherogenic risk biomarkers in in newly detected subjects with severe HH.     

In vivo validation of image-directed Doppler measurement of superior mesenteric artery blood flow.

Image-directed Doppler measurement of superior mesenteric artery blood flow in volunteers was validated in two artificial models with either a venous or an arterial flow profile. In the "venous" model, the Doppler device overestimated the real flow velocity by 86 +/- 7%, and in the "arterial" model by 24 +/- 9%. The areas under the time-frequency curves (AUCs) from the arterial model were measured by planimetry. A correction factor of 1.47 between flow velocities calculated after planimetry and real flow was established. Correction for this factor resulted in a flow velocity of 19.5 +/- 4.7 cm/s and a blood flow rate of 377 +/- 166 ml/min in the volunteers.     

Gallbladder sludge formation after bone marrow transplant: Sonographic observations

We prospectively studied 12 patients before and after bone marrow transplantation (BMT) with serial sonography to evaluate gallbladder sludge formation. Patients were studied on four separate occasions to assess the gallbladder for sludge and stones: prior to BMT and conditioning chemoradiation, and on days 3, 13, and 28 after BMT. During two of the sonographic studies, gallbladder volume measurements were made before and after administration of cholecystokinin octapeptide (CCK-OP) and the ejection fraction (EF) was calculated. Medical records were reviewed for symptoms of cholecystitis, narcotic use, and dietary intake. Sludge and/or stones developed in eight of 12 patients (67%), and in four patients sludge was observed by day 3 post-BMT. Ejection fraction was normal (>50%) pre-BMT in six of the eight patients who developed sludge, and in four of these six post-BMT. Furthermore, five of the eight patients developed sludge and/or stones in the absence of fasting and/or narcotic use. We conclude that gallbladder sludge develops frequently and early in BMT patients and may resolve or progress to stone formation. We did not demonstrate a relationship between impaired contractility and the development of sludge and/or stones, nor did we find a strong association between sludge formation and conditions presumed to cause gallbladder stasis, such as narcotic use and fasting. These findings suggest that other factors apart from impaired gallbladder contractility may play a role in the formation of sludge in the BMT patient.     

Prenatal sonographic features of isolated hypoplastic left heart syndrome

Hypoplastic left heart syndrome (HLHS) is a spectrum of fetal conditions associated with severe hypoplasia of the left ventricle and left ventricular outflow tract. The purpose of this series was to focus on the sonographic prenatal features of isolated HLHS. Based on the 5 cases presented here, the prenatal sonographic features of HLHS include small-sized left ventricle, atretic or hypoplastic mitral valves with restricted motion and a small amount of antegrade flow or regurgitation, and hypoplastic ascending aorta. Retrograde flow in the transverse aortic arch strongly suggests inadequate systemic output from the left heart. Tricuspid regurgitation is common and increases the chance for the development of hydrops. Other findings may be helpful, including left ventricular hyperechoic endocardium and increased nuchal translucency at 11-14 weeks. With careful fetal echocardiography, HLHS may be readily observed on a 4-chamber view as either a small or even absent left ventricle.     

高能聚焦超声治疗良性前列腺增生的临床应用

目的探讨Sonablate500高能聚焦超声治疗仪在良性前列腺增生治疗中的临床应用。方法自2002年12月~2003年12月使用Sonablate500高能聚焦超声治疗仪对113例良性前列腺增生患者进行经直肠超声消融。结果术后使用国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率以及经直肠B超检测前列腺体积作为评价指标随访12个月。IPSS评分由术前21.6分降至8.8分(P<0.001)。QOL评分由术前4.9降至2.2(P<0.001)。最大尿流率由(5.3±3.5)ml/s增加至(12.3±5.2)ml/s(P<0.01)。前列腺体积由48.9ml降至36.5ml(P<0.01)。术后患者均有轻微的血尿,3例出现附睾炎(占2.7%),35例出现短期血精(占31%),15例出现逆向射精(占13%)。结论高能聚焦超声在良性前列腺增生治疗中具有微创、安全、术中无出血、疗效确切、痛苦少、恢复快、并发症少等优点,特别对一些高危的老年患者尤为适合,值得推广应用。     

经阴道超声引导卵泡穿刺术治疗多囊卵巢综合征不孕症的临床研究

目的 探讨超声引导下经阴道穿刺未成熟卵泡对多囊卵巢综合征(PCOS)不孕患者卵巢基础窦卵泡计数及其内分泌功能的影响.方法 23例PCOS不孕患者在超声引导下进行未成熟卵泡穿刺,抽吸卵泡液,对比观察穿刺抽吸前后患者卵巢基础窦卵泡计数以及内分泌功能的变化,并观察卵巢有无恢复排卵及妊娠.结果 23例患者经过2～3个周期的穿刺治疗后,所有患者血睾酮水平均显著降低、黄体生成素(LH)与卵泡刺激素(FSH)比值也明显降低,与治疗前相比,差异有统计学意义.17例患者术后卵巢基础窦卵泡计数降至10个以下,完成卵泡穿刺治疗后连续观察6个月,共有10例患者妊娠.结论 超声引导下卵泡穿刺术能改善PCOS不孕患者内分泌状况,减少卵巢基础窦卵泡计数,促进卵巢排卵,为PCOS患者提供了一条简便可行的辅助生育治疗途径.     

血管内超声/光声联合成像研究进展

血管内超声/光声联合成像技术将血管内超声成像(IVUS)和血管内光声成像(IVPA)相结合、生成血管的组合图像。这种新的成像技术可获得高对比度和高分辨率的血管壁及管腔图像,可快速定位风险斑块并辨别其成分。本文就IVUS/IVPA联合成像的可行性及研究现状进行综述。