艾滋病病人腹部超声检查的表现及其临床价值

腹部超声检查能够检测到艾滋病(Acquired im-munodeficiency syndrome,AIDS)病人腹部脏器的隐匿性病变,可为临床诊断、治疗、预后评估等提供有价值的诊断依据。收集南宁市及其周边地区AIDS病人的超声检查资料进行分析研究,现将结果报告如下。1材料与方法病例资料来源于2008年1月至     

壶腹部肿瘤的腔内超声诊断进展

1诊断价值1.1壶腹部肿瘤的分期壶腹癌EUS诊断标准①癌瘤较小位于胰头及下腔静脉之右侧;②内部回声多数增强;③胰头正常,有时胰头内胆管扩张,管内可见肿瘤回声.EUS适于发现有蒂的壶腹部肿瘤,易于区分大体上浸润组织的肿瘤和早期癌变,适于T分期诊断.EUS对壶腹部肿瘤的T分期如下TX早期肿瘤不能发现;T1肿瘤局限于Vater壶腹部或Oddis括约肌;T2胰腺侵及十二指肠壁,特别是十二指肠固有肌层;T3肿瘤累及胰腺但未超过2cm;T4肿瘤累及胰腺达2cm以上和侵犯其他邻近脏器十二指肠乳头癌术前EUS检查,有报道诊断正确率T1期为60%;T2期92.3%;T3期91.7%;T4期50%.Yasudaetal采用US,EUS,CT和血管造影等方法对34例壶腹部乳头肿瘤患者分期研究,诊断准确率分别为21%,74%,21%和65%,证实EUS对壶腹部肿瘤的分期诊断效果明显优于其他方法.当肿瘤累及胰腺时,表现为胰腺局部外突,回声减低,其边界清晰或有时模糊不清.Kuboetal报道当壶腹部肿瘤累及胰腺时,EUS诊断精确率达80%,敏感性达83%,特异性87%1.2十二指肠乳头癌正常十二指肠乳头区显现为轮状低回声,其周围十二指肠壁可显示高回声→低回声→高回声→低回声→高回声五层结构.十二指肠乳头癌通常显示为乳头区的低回声占位,对比其与肠壁五层结构的位置关系可判断癌瘤累及肠壁的深度EUS除能直接显示肿大的乳头及外露于乳头开口部的肿瘤并采取活体组织外,还能通过扫描直接显示肿瘤图象及胆总管或主胰管扩张等继发性病变,诊断正确率可达90%～100%,对直径<20mm的乳头癌的显示率也达90%,EUS还能发现螺旋CT漏诊的可切除的小肿瘤.EUS与ERCP对十二指肠乳头癌的直接显示率相同,但EUS能诊断乳头癌浸润十二指肠壁的深度及发现周围淋巴结,并能避免ERCP造影后可能引起的并发症.1.3淋巴结转移EUS判断淋巴结转移有一定局限性.EUS能发现直径≥3cm～5cm肿大的淋巴结,但较难鉴别转移性淋巴结和炎症性反应肿大淋巴结.转移性淋巴结多为圆形,类圆形,短轴半径≥10mm,低回声改变,黑洞样或回声值与肿瘤组织相似,边界清晰,内部回声均质或不均质.而非特异性炎症肿大的淋巴结,常呈高回声改变,边界回声模糊,内部回声均匀.Yasudaetal应用EUS对34例壶腹部乳头肿瘤患者进行研究,发现EUS诊断淋巴结转移正确率为67%,而Bansa等研究得出的准确率仅为54%.1.4壶腹部肿瘤的鉴别EUS较难鉴别外部边缘均不规则的壶腹部腺瘤和腺癌.Menzeletal报道EUS发现5例癌瘤和4例腺瘤,但诊断正确率不高,分别为65.5%和50%.2局限性使用超声内镜(7.5MHz-12MHz)存在以下缺点①在一个器械中将内镜和超声影象术联合使用,增加了超声内镜的直径(12mm～13mm);②较大直径的内镜不易完全导入胰胆系统;③小病变的图象质量和分辨率并不让人满意;④常规超声影象术要求与常规内镜检查分离的再次检查,增加了患者的痛苦.最近发展起来的微型超声探头(ultrasonicprobe;USP),其导管式探头外径仅2mm～3mm,频率12MHz～20MHz,能穿过标准内镜工作管道,提供高频超声图象,这些微探头可克服EUS以上缺陷,提高诊断准确性,减轻患者痛苦,具有较好的应用前景.     

B型超声诊断腹部闭合性损伤的临床价值

目的探讨B型超声检查对腹部闭合性损伤（BAT）的诊断价值。方法对2004-2009年经CT、手术确诊的289例BAT患者的B型超声表现进行回顾性分析,并对检查结果与CT及手术结果比较。结果B型超声对257例腹部实质性脏器损伤的诊断符合（确诊＋疑诊）率为86．2％（225／257）,漏诊32例;对32例腹部非实质性脏器损伤的诊断符合率为71．88％（23／32）,漏诊9例。结论B型超声检查对BAT的诊断符合率较高,且具有方便快捷、费用低廉、无创及可重复性好等特点。     

腹部手术后常见并发症的超声诊断价值

目的探讨腹部外科手术后常见并发症的超声诊断价值。方法总结2009-05~2014-12该院腹部手术后1年内出现发热、腹部疼痛、包块、腹胀、下肢肿胀等症状的91例患者超声声像图表现。结果经治疗后随访或病理证实超声诊断为血肿22例,脓肿18例,腹腔积液15例,腹壁脂肪液化坏死15例,肠梗阻10例,切口疝6例,下肢深静脉血栓5例,均具有特征性声像图表现。结论超声对腹部外科手术后常见并发症具有一定的诊断价值。     

腹部超声与阴道超声对异位妊娠检出率对比分析

目的 探讨经腹部超声与经阴道超声在异位妊娠中的诊断价值.方法 选择2004-09～2012-03在该院和外院经手术和病理证实为异位妊娠的85例患者分别进行腹部超声检查和阴道超声检查,并对两种方法 检查结果 进行分析比较.结果 85例异位妊娠中,破裂流产型62例,未破裂型23例.经腹部超声检出80例,检出率为94.1%,其中破裂流产型62例,检出率为100%;未破裂型18例,检出率为78%.经阴道超声检出82例,检出率为96.5%,其中诊断破裂流产型59例,检出率为96%,未破裂型23例,检出率为100%.两种检查方法 检出率比较差异均无统计学意义(P均>0.05).经腹部和经阴道超声联合应用诊断异位妊娠85例,超声诊断符合率达100%.结论 经腹部超声诊断破裂流产型异位妊娠占优势,经阴道超声诊断未破裂型异位妊娠占优势.经腹部和经阴道超声联合运用,能取长补短,明显提高异位妊娠的检出率,具有较高的临床应用价值.     

探讨腹部超声联合浅表超声对急性肠套叠患儿检出率的影响

目的 研究急性肠套叠患儿采用腹部超声联合浅表超声技术对病情进行诊断的临床价值.方法 选择在我院接受手术治疗的证实为急性肠套叠的患儿76例,根据治疗前检查方法 的不同分成对照组和研究组,每组38例.对照组在术前单纯采用腹部超声技术进行检查;研究组在术前采用腹部超声联合浅表超声技术进行检查.比较两组病情诊断准确性、诊断导致的纠纷事件、检查操作时间.结果 研究组研究对象病情诊断准确性高于对照组;仅有1例诊断导致的纠纷事件发生,少于对照组的6例;检查操作时间长于对照组.有统计学意义(P<0.05).结论 急性肠套叠患儿采用腹部超声联合浅表超声技术对病情进行诊断,虽然检查时间会有一定的延长,但能够使准确的准确性提高,降低误诊率和漏诊率,减少纠纷事件的发生.     

登革热

2002～2003年广州及周边地区1032例登革热的临床特征；澳门登革热989例。     

腹部超声对小儿肠套叠的诊断价值分析

目的观察探讨腹部超声对小儿肠套叠的诊断价值分析。方法选取我院自2005年1月-2010年12月收治急性腹痛腹部包块患者20例,临床上怀疑是肠套叠患者所以采用腹部超声检查,确诊治疗后超声复查评估疗效。结果20例急性腹痛腹部包块患者经腹部超声检查后并且确诊13例为肠套叠患者,7例经保守治疗后复查腹部包块均消失。结论在临床治疗上,腹部超声检查对实质性脏器的疾病诊断率较高,并且其鉴别诊断为临床实践提供了可靠有效的参考依据。在小儿肠套叠诊断中有较好有效的实用价值和诊断价值,值得我们大力推广使用。     

微探头内镜超声联合腹部超声对胃癌临床分期的应用价值

胃癌的浸润深度及有无淋巴结转移,对于患者治疗方案的选择及预后有着十分重要的意义。微探头超声内镜近几年在我国一些大中医院开始使用,但目前尚不十分普及用于胃癌的诊断报道较少。我院应用微探头内镜超声和腹部超声检查胃癌患者,就其对胃癌分期的准确性、特异性进行了前瞻性研究,报告如下。     

腹部超声显像指标诊断血吸虫病患病的一致性分析

目的探讨不同B超指标诊断日本血吸虫病患病的一致性程度和最佳指标组合。方法选取6个B超指标对湖南省汉寿县全兴村居民血吸虫病病情进行调查,计算不同B超指标之间的诊断一致性系数Kappa值和不同B超指标组合内部一致性的克朗巴哈α系数。结果以“肝实质Ⅱ级以上”与“肝锁骨中线肋下”和“肝门脉内径”的一致性系数Kappa值较高,分别为0.4131和0.4655,仅为中等程度的一致性,其余为弱一致性或无明显一致性。在不同B超指标的组合中,以“肝实质Ⅱ级以上”、“肝锁骨中线肋下”和“肝门脉内径”3个指标组合的克朗巴哈α系数最大,为0.6566,具有较强的内部一致性。结论6个B超指标不应该互相替代评估血吸虫病患病,在广泛应用B超评估血吸虫病患病之前,有必要对这些B超指标间的诊断一致性及其最佳组合进行研究。     

Evaluation of Platelets as Predictive Parameters in Dengue Fever

Dengue is an arboviral disease and occurs in tropical countries where over 2.5 billion people are at risk of infection. Each year an estimated 100 million cases of dengue fever (DF) occur and between 2.5 and 5 lakh cases of dengue hemorrhagic fever (DHF) are reported to WHO. Severe thrombocytopenia and increased vascular permeability are two major characteristics of DHF. A study was conducted to note the relationship between the platelet counts and severity of the disease in pediatric cases of dengue fever. Platelet counts were found to be predictive as well as recovery parameter of DF/DHF/DSS.     

Abdominal Ultrasonography in Patients with Uncharacteristic Abdominal Symptoms

Ultrasonography (US) was performed in a prospective study of 48 patients with uncharacteristic abdominal symptoms. All patients had been examined in other hospitals, but no diagnosis had been established. Pathologic US findings were encountered in five patients: fatty liver in two patients, gallstones in one patient, ovarian cyst in one, and liver metastases in another patient. US may be used as a diagnostic approach in patients with uncharacteristic abdominal complaints when conventional X-ray examinations are negative. In patients with psychosomatic disease a negative US result may be of importance in the psychiatric approach to these patients' disease.     

中国成人家族性地中海热1例

病例：患者女,1944年12月13日出生,汉族,籍贯上海。因“反复间歇性发作腹痛伴发热4年余”多次入住上海市各医院消化科或感染科。患者2006年3月无明显诱因出现腹痛,为脐周剧痛,无放射痛,蜷曲位时稍缓解。腹痛发作期间纳差,伴呕吐,呕吐物为胃内容物,未见咖啡色液体,粪便无明显异常。腹痛出现数小时后自觉乏力,体温升高,最高达39．8℃,伴畏寒,无寒战。无皮疹、关节疼痛,无咳嗽、咳痰,无尿频、尿急,无皮肤巩膜黄染。腹软,全腹压痛,有反跳痛。     

云南省登革热流行病学调查分析

本对以往云南省登革热病原学、血清学和蚊媒调查资料进行了整理分析。从采自河口市的２９批雌性白纹伊蚊（Ａｅｄｅｓ ａｌｂｏｐｉｃｔｕｓ）中分离到登革４型病毒１株。从采自西双版纳地区（景洪、勐腊、勐海）的７２批２７２６只雌性白纹伊蚊中分离到登革病毒４株,其中４株３株,３型１株。批阳性率５．６％,现场感染比为１：６８２。本省２４个省、市人血清中登革ＣＦ抗体阳性率为１０．９１％（１８５／１６９６）,１５个     

Unfurling the Rationale Use of Platelet Transfusion in Dengue Fever

Dengue fever and dengue haemorrhagic fever have emerged as a global public health problem in recent decades. The practice of platelet transfusion has been adapted into the standard clinical practice in management of hospitalized dengue patients. The exact indications and situations in which platelet have to be transfused may vary greatly. Blood components especially platelet concentrates due to their short shelf life are frequently in limited supply. Hence, appropriate use of blood is required to ensure the availability of blood for patients in whom it is really indicated, as well as to avoid unnecessary exposure of the patients to the risk of transfusion reactions and transmission of blood borne infection. The present study was conducted to evaluate the appropriateness of platelet transfusion done in dengue patients with thrombocytopenia. The present study was conducted on 343 serologically confirmed dengue patients admitted at JSS University Hospital between 1st January and 30th August 2009. Clinical data, platelet count and platelet requirements were analyzed. Among the 343 serologically confirmed cases, the prevalence of thrombocytopenia (platelet count < 100,000/cumm) was 64.72% (222 patients) and bleeding manifestations were recorded in 6.12% (21 patients). 71 (20.7%) patients of dengue cases received platelet transfusion. Among them 34 (47.89%) patients had a platelet count <20,000/cumm, 28 patients (39.44%) had platelet counts in the range of 21–40,000/cumm while the remaining 9 (12.67%) patients had platelet count between 41–100,000/cumm. Out of 37 patients with a platelet count >20,000/cumm 11 patients had haemorrhagic manifestations such as petechiae, gum bleeding, epistaxis etc., which necessitates the use of platelet transfusion. However, the remaining 26 patients with platelet count >20,000/cumm and with no haemorrhagic manifestations received inappropriate platelet transfusion. Transfusion of 36.62% of platelet concentrate was inappropriate. The study emphasizes the need for development of specific guidelines for transfusion of blood components, constant interaction and co-ordination amongst clinicians and transfusion centre for implementation of these guidelines and a regular medical audit to review the optimal utilization of blood components.     

Regional Differences in the Growing Incidence of Dengue Fever in Vietnam Explained by Weather Variability

Dengue fever is a major health problem in Vietnam, but its incidence differs from province to province. To understand this at the local level, we assessed the effect of four weather components (humidity, rainfall, temperature and sunshine) on the number of dengue cases in nine provinces of Vietnam. Monthly data from 1999 to 2009 were analysed by time-series regression using negative binomial models. A test for heterogeneity was applied to assess the weather-dengue association in the provinces. Those associations were significantly heterogeneous (for temperature, humidity, and sunshine: P < 0.001 heterogeneity test; for rainfall: P = 0.018 heterogeneity test). This confirms that weather components strongly affect dengue transmission at a lag time of 0 to 3 months, with considerable variation in their influence among different areas in Vietnam. This finding may promote the strategic prevention of dengue disease by suggesting specific plans at the local level, rather than a nationally unified approach.     

Serum cortisol in dengue and dengue hemorrhagic fever: is there any clinical implication?

Dengue is an important mosquito-borne viral infection. This infection can be seen in many tropical countries and caused many infectious cases annually. The biochemical profile change during infection is very interesting. Here, the authors studied on a rarely mentioned parameter, serum cortisol. The levels of serum cortisol in the cases with dengue and dengue hemorrhagic fever were studied, reported and discussed.