异位妊娠的超声诊断——附53例临床资料及声象图分析

本文报告临床拟诊为异位妊娠53例的超声诊断结果.所有病例均经手术验证。超声诊断异位妊娠的正确率为86.8%(46例),误诊7例。异位妊娠的典型声象表现为子宫略大于正常,宫内无妊娠囊或宫内回声紊乱;出现假妊娠囊,宫外包块可有低、高和混合性回声三种表现,腹、盆腔内可有积液。异位妊娠的不同声象表现与妊娠囊的破裂与否以及破裂后距超声检查时间长短有关。作者认为在异位妊娠囊破裂前作出正确的超声诊断是可能的。对于临床表现不典型而声象图有类似异位妊娠表现的病例,尚须与附件炎症包块、过期流产和双角子宫妊娠相鉴别.     

盆腔异位妊娠CT表现及与MRI对比分析

目的探究盆腔异位妊娠的CT及磁共振成像(MRI)表现。方法回顾性分析我院收治的32例行CT和/或MRI检查的异位妊娠患者的临床资料,所有患者均经手术证实,其中18例行CT检查,14例行MRI检查。结果 32例患者中输卵管妊娠18例(56.25%),切口妊娠8例(25.00%),卵巢妊娠4例(12.50%),宫角妊娠2例(6.25%);异位妊娠CT及MRI表现为子宫内膜外囊性或混杂信号肿块,增强扫描呈边缘强化或不均匀强化;18例行CT检查的病例术前明确诊断12例,未能明确定性3例,误诊3例;14例行MRI检查的病例术前明确诊断10例,未能准确定性2例,误诊2例。结论不同部位异位妊娠的CT、MRI表现均有一定特征,临床上可结合停经史、临床症状及实验室指标明确诊断。     

超声对特殊部位异位妊娠的诊断价值

目的探讨特殊部位异位妊娠的超声表现及诊断价值.方法 回顾性分析12例经手术及病理证实特殊部位异位妊娠的超声表现.结果 12例中,子宫疤痕处妊娠5例,均位于子宫肌壁下段原疤痕处;子宫角妊娠2例(左,右侧各1例);输卵管间质部妊娠2例;子宫颈妊娠2例;右卵巢内妊娠1例.本组伴发子宫腺肌症3例,腹壁切口子宫内膜异位症1例.超声诊断病灶部位与临床结果基本一致.结论 特殊部位异位妊娠的超声表现有其特殊部位的特点,对临床早期明确诊断及治疗有重要价值.     

子宫内膜异位囊肿破裂MRI分析

目的：探讨MRI对子宫内膜异位囊肿破裂的诊断价值。方法回顾性分析20例MRI诊断为子宫内膜异位囊肿破裂的患者临床资料、MRI图像,全部病例均由手术及病理证实。结果子宫内膜异位囊肿破裂16例,MRI主要表现有囊壁信号异常,囊壁半环形强化征,“哑铃征”,盆腔积血,相邻肠管粘连征、单房囊肿间隔征、“卫星囊征”;其他卵巢囊肿破裂出血4例,具有以上类似MR表现。结论子宫内膜异位囊肿破裂是临床上不可忽视的急腹症之一,熟悉MRI表现有助病灶定位、定量和定性,对鉴别其他急腹症、术前诊断有重要意义。     

剖宫产瘢痕妊娠的MRI影像学表现与诊断价值

目的探讨剖宫产瘢痕妊娠的MRI影像学表现和诊断价值。方法收集我院2017年1月～2019年4月期间经手术病理证实为剖宫产瘢痕妊娠的患者27例,回顾性分析其MRI图像特征:其中15例行MRI增强扫描,12例行MRI平扫。观察剖宫产瘢痕妊娠的MRI表现、诊断准确率。结果26例表现为子宫前壁峡部瘢痕处囊性或囊实性妊娠囊。瘢痕处肌层明显变薄。20例妊娠囊表现为囊性T1WI低T2WI高信号;6例表现囊实性,囊性信号内混杂T1WI稍低T2WI较高信号。15例增强扫描均见强化。1例未能确诊。结论剖宫产瘢痕妊娠的MRI影像学表现具有特征性,对其诊断和治疗具有重要价值。     

超声检查在异位妊娠诊断中的应用

目的:探讨超声在异位妊娠诊断中的临床价值.方法:2002～2009年收治异位妊娠患者150例,进行腹部超声检查,探头频率3.5MHZ,观察子宫的大小,异位妊娠的位置、妊娠囊大小、形态、有无胚胎组织及原始心管搏动;附件区有无包块,包块的形态、大小、与子宫的关系,有无盆腔积液.结果:150例患者中,未破裂型宫外孕48例(输卵管妊娠16例,输卵管流产型32例),破裂型宫外孕76例(其中输卵管妊娠74例,卵巢妊娠1例,残角子宫妊娠1例),陈旧型20例,误诊6例,(误诊为阑尾炎2例,误诊为不全流产4例).均经手术病理检查确诊,诊断符合率96%.结论:超声检查可为临床早期诊断异位妊娠提供重要的诊断依据,是诊断异位妊娠的重要手段之一.     

应用阴道超声、MRI检查在剖宫产术后瘢痕妊娠的诊断价值分析

目的探究经阴道超声和MRI检查对剖宫产术后子宫瘢痕妊娠的诊断价值。方法选取本院2017年9月至2019年3月收治的82例剖宫产后瘢痕妊娠患者,收集患者临床及影像学资料,观察分析经阴道超声检查和MRI检查剖宫产术后子宫瘢痕妊娠的影像学表现,以术后病理诊断为“金标准”,对比经阴道超声检查和MRI检查的准确性、敏感性、特异性。结果经阴道超声检查对剖宫产术后子宫.瘢痕妊娠的.诊断灵敏.性、特异性和准确性分.别为6220.%、6463.%、7195%,低于MRI检查8902%、9024%、8659%。MRI检查对剖宫产术后子宫瘢痕妊娠的诊断灵敏.性、特异性和准确性明显高于经阴道超声检查(P<005)。纯妊娠囊型胎囊较大时超声可见胎囊丰富低阻血流,混合回声包块型内见无回声,子宫下段常见局部隆起,包块与膀胱间的子宫肌层常明显变薄。MRI检查妊娠囊黏附于子宫前下壁呈类圆形或卵圆形,明显前凸反“3”字征或“C”字征;T1WI上呈低信号、混杂斑片状高信号,T2WI呈混杂高信号,病灶周围可见低环形线状低信号包膜带。结论MRI检查对CSP的诊断灵敏性、特异性和准确性优于阴道超声检查,可提供更多有价值的影像学资料。     

盆腔囊性肿块的超声鉴别诊断

目的: 探讨盆腔囊性肿块的声像图表现及鉴别诊断。方法: 对86例行阴道超声检查,均诊断盆腔囊性肿块,并分析盆腔囊性肿块声像图表现及特征。结果: 超声诊断卵巢子宫内膜异位囊肿37例,卵巢囊性畸胎瘤31例,卵巢血肿14例,均被超声追踪或手术病理结果证实。1例输卵管卵巢脓肿和1例卵巢囊性畸胎瘤误诊为卵巢子宫内膜异位囊肿,2例输卵管积水误诊为卵巢囊肿。术前超声诊断与术后病理诊断符合率为94.8%。结论: 超声对卵巢子宫内膜异位囊肿及卵巢囊性畸胎瘤诊断率高,但仍需与其它囊性肿块相鉴别。     

异位妊娠的CT诊断

目的　探讨异位妊娠的CT诊断价值。方法　选择 1 2例经手术病理证实的异位妊娠患者的CT检查资料 ,并结合临床及病理进行分析。结果　 1 2例异位妊娠均发生在输卵管 ,9例位于壶腹部 ,2例位于伞端 ,1例位于间质部 ,CT表现盆腔囊实性肿块 ,密度高低不均 ,与子宫界面不清晰 ,增强后囊壁强化而内部无强化 ,合并盆腔积血。结论　异位妊娠有其特殊的CT征象 ,可作为临床诊断的重要检查方法     

特殊部位异位妊娠超声检查的特点分析

目的分析特殊部位异位妊娠超声检查的特点。方法回顾性分析本院2018年1月至2019年12月经临床手术证实的80例特殊部位异位妊娠患者的临床资料,所有患者均给予超声(经腹联合经阴道)诊断,以手术结果为标准,分析超声诊断对特殊部位异位妊娠诊断与手术结果的一致性及特殊部位异位妊娠的超声影像特征。结果经Kappa检测,超声诊断不同类型特殊部位异位妊娠与手术诊断结果的一致性较好(Kappa=0.810,P=0.000),超声诊断的特殊部位异位妊娠的误诊率为13.75%;瘢痕妊娠孕囊型的超声特点:孕囊完全或部分着床于子宫瘢痕位置,血流信号可见环状或条索状滋养血流,局部肌层存在缺损或肌层较薄;混合型包块的超声特点:瘢痕位置可见不均匀回声,浆膜层局部外凸或不完整,包块周边可见低速低阻血流信号。输卵管间质部的超声特点:宫腔内未见孕囊,子宫旁一侧可见孕囊或不均匀包块,孕囊周边肌层厚度<5 mm,孕囊周边可见环状高回声,呈间质线样征,周边肌层较薄弱或有缺损。宫角妊娠的超声特点:孕囊位于一侧宫角且宫角增大膨出,孕囊或包块与宫腔内膜互通,且周边存在完整肌层包绕。卵巢妊娠的超声特点:宫腔内未见孕囊,孕囊型一侧卵巢内可见孕囊、卵黄囊、胚芽及胎心管搏动,囊壁较厚且绒毛膜光环明显,包块型可见混合型回声,周边卵巢实质内可见卵泡或黄体,包块内可见条状、点状血流信号。腹腔妊娠:原发性腹腔妊娠超声特点,子宫大小、形态、回声正常,宫旁一侧可见孕囊样回声,周边呈增强厚壁回声,可探及胚芽且可见心管搏动,甚至可探及不均匀的胎盘回声,内散在斑点状强回声,腹腔可探及腹腔积液,内见条索状分隔,且胎盘周边可见丰富蓝红色血流包绕;继发性腹腔妊娠超声特点,子宫增大、子宫内膜增厚且呈不均匀回声,可见腹腔积液,大网膜上可探及羊膜囊、内见胎儿、胎心搏动、胎盘组织,羊膜囊与膀胱间未见子宫肌壁层。结论不同类型特殊部位异位妊娠的超声特点存在较大差异,但仍存在误诊情况,故临床上应充分了解患者病史,扩大扫查范围,以提高临床诊断的准确性。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.