产前超声诊断胎儿单侧手残缺畸形1例

孕妇 27岁,孕1产0,孕26周.夫妻双方身体健康,无先天性畸形及遗传性疾病.常规来我院行产前超声检查.超声所见:单胎,头位,双顶径6.7cm,头围24.8cm,腹围19.2cm,股骨长径4.6cm,胎儿颅内结构未见明显异常,脊柱排列整齐,胸腹腔脏器及颜面部器官未见明显异常.胎儿四肢扫查,右手掌未见显示,右上肢末端仅见3节长短不一残缺手指;实时三维显示胎儿右手残缺不全.胎盘位于后壁,成熟度Ⅰ级,羊水指数16.6cm.超声提示:①单胎中期妊娠;②胎儿右手残缺畸形.引产一死男婴,可见右上肢末端仅3节手指,长短不一,较大的手指可触及手指骨.     

产前四维超声筛查胎儿唇裂最佳时间的临床分析

目的：探讨产前四维超声筛查胎儿唇裂的最佳时间临床价值。方法利用四维超声检查对202例不同孕周孕妇的检查图像进行对比分析,探讨对胎儿唇裂的最佳诊断时间。结果本文202例孕妇经四维超声检查后获得满意的面部图像192例,而因为羊水过少、胎儿位置不当等因素而导致超声图像不满意者10例。在192例获得满意胎儿面部图像中孕18周～49例,满意显示率为79．03％,此期胎儿面部瘦削,图像质量显示稍差;孕22周～72例,满意显示率为92.31％;随孕周的增长,胎儿面部越来越丰满,鼻唇部结构越来越清晰。孕26周～34例,满意显示率为82．93％;孕32～36周16例,满意显示率为76．19％;超声显示不佳,可能与面部羊水过少、胎龄过大,面部与其它器官接触较近,难于分辨有关。经统计学分析发现孕22～26周孕妇的四维超声显示效果最高,其满意显示率明显优于孕18周～、孕26～、孕32～36,且差异具有统计学意义。结论四维超声检查最好在孕中期进行,我们体会最佳时间应在22～26周,是胎儿畸形检查的最佳时期。     

正常单胎孕11～14^＋6周胎儿超声心动图研究

目的探讨孕11-14^＋6周行胎儿超声心动图扫查的可行性。方法经腹扫查322例11～14^＋6周正常单胎胎儿心脏,尽量取得四腔心切面、左右室流出道切面及三血管切面、主动脉长轴切面,分析不同孕周各切面的显示情况。结果相同孕周心脏各主要切面显示率不同,不同孕周同一切面显示率亦不同。随孕周增大,各切面显示率逐渐提高。孕11～11^＋6周、12-12^＋6周及13-13^＋6周各切面显示率组间比较差异有统计学意义（P〈0．05）,但13—13^＋6周与14～14^＋6周四腔心切面显示率差异无统计学意义（P〉0．05）。不同孕周,四腔心切面显示率最高,三血管切面显示率最低。13周后,心脏各个切面显示率可达80～90％。结论于早孕晚期和中孕早期行胎儿超声心动图扫查,有利于早期发现胎儿严重先天性心脏病。     

胎儿小囊状淋巴瘤超声诊断1例

1病历摘要: 孕妇,28岁,孕1产0,孕28周,常规产前超声检查显示:单胎,颅骨光环完整,BPD 7.6 cm,FL 5.7 cm,胎儿头部及颈部周围围绕一大囊肿18 cm×15 cm壁厚,内见分隔,胎儿全身皮肤水肿增厚.胎心规律,胎盘后壁Ⅰ级,羊水深度5.0 cm.超声提示:①中孕,宫内单活胎;②胎儿小囊状淋巴瘤;③胎儿水肿,引产证实诊断.     

彩色多普勒超声诊断胎儿四肢畸形的价值及显示效果最佳的孕周

目的探讨彩色多普勒超声诊断胎儿四肢畸形的临床应用价值及显示效果最佳的孕周。方法对我院接受产前彩色多普勒超声四肢畸形筛查的6862例孕妇纳入本次研究,其中经彩色多普勒超声检查发现四肢畸形68例,所有阳性病例均经引产后经放射性诊断及胎儿尸检后确诊存在四肢畸形,笔者对统计分析了彩色多普勒超声诊断四肢畸形的最佳孕周。结果 6862例孕妇经彩色多普勒超声筛查后,共诊断出四肢畸形患儿68例,漏诊8例,诊断符合率为89.47%。在漏诊的8例患者中5例为多指畸形,3例为并指畸形。孕13~18周是观察手部畸形的最佳孕周,在这期间对手部清楚显示率最高,达92.55%;而孕19~24周则是观察脚部畸形的最佳孕周,在这期间对脚部清楚显示率最高,达92.84%。结论产前超声筛查胎儿四肢畸形具有较高的准确率,避免有肢体畸形的胎儿出生,其中孕13~18和孕19~24w分别是显示胎儿手部和脚部是否发生畸形的最佳时机。     

胎儿胃的超声评价:不显影的意义

为了在常规的产科超声检查中确定妊娠时间、羊水量过多或过少对于胎儿胃显影的影响、以及超声检查中胃不显影胎儿的最终分娩结果,作者对孕龄14周以上的995例胎儿进行前瞻性超声检查。作者见到,在总计1071次检查中,共有1051次(98%)胎儿胃显影。在胃不显影的胎儿中,孕龄14周以上的55%、孕龄19周以上的100%分娩结果异常(包括胃肠道的和中枢神经系统畸形等)。就胃显影而言,异常羊水量对其影响是主要的,其中羊水过少胎儿的17%胃不能显示。作者认为,孕龄14周以上胎儿胃不显影是一个有意义的超声改变,进行重复检查和随访观察是必要的,而对于孕龄小于14周胎     

脐带绕颈的超声显像分析及探讨

本文报告我院应用超声诊断脐带绕颈并与分娩结果进行对照分析 ,旨在探讨超声对脐带绕颈的诊断价值。1　材料与方法图 1　脐带绕颈 1周 ,FH :胎头 ,“U”型压迹　图 2　脐带绕颈 2周 ,FH :胎头 ,“W”型压迹　图 3　脐带绕颈 4周 ,FH :胎头 ,锯齿状压迹　　检查对象为我院 2 0 0 3年 1 1月～ 2 0 0 4年 1 1月住院分娩的初产妇 1 1 2 4例 ,孕 35周～ 4 2周 ,头先露 1 0 71例 ,臀先露 5 3例。检查方法 :常规检查胎儿、胎盘、羊水、脐带 ,并着重观察胎儿颈部 :首先找到胎头光环 ,然后找到胎儿脊柱 ,探头与胎儿脊柱尽量保持平行 ,清晰显示脊…     

超声诊断胎儿四肢发育短小畸形1例

<正>孕妇,36岁。妊娠32周,孕4产1。行妇科检查时,临床疑羊水过多。超声所见:胎儿双顶径8.6cm(与孕周相符)。上肢肱骨长2.0cm,指骨短小无分节现象,股骨弯曲状,长2.7cm(如孕20周,明显小于孕周)。羊水最大深度16cm。胎心节律正常,且感头与躯体比例失调,躯体总长仅13.7cm,胸围明显小于腹围。超声印象:(1)胎儿四肢发良短小畸形。(2)羊水过多。随住院引产,证实超声诊断。     

超声检查在产前诊断胎儿唇腭裂的临床价值分析

目的探讨超声检查在胎儿唇腭裂早期不同孕周中的图像差异。方法选取我院行常规超声检查收治的11～13~(+6)孕周的孕妇200例作为观察对象,按照孕周区间分为11～11~(+6)孕周44例、12～12~(+6)孕周75例、13～13+~6孕周81例。对三组胎儿进行鼻后三角超声检查,比较三组胎儿的图像质量、唇腭裂出现情况差异。结果孕妇200例的胎儿中,182例胎儿取得合格鼻后三角切面图像,其中11～11~(+6)孕周合格40例,12～12~(+6)孕周合格69例,13～13~(+6)孕周合格73例,三组孕周合格率比较无统计学差异;在合格鼻后三角超声图像中,存在6例,鼻后三角形态异常,其中包括2例鼻后三角右侧腭骨回声中断,超声诊断右侧唇腭裂,2例鼻后三角左侧腭骨回声中断,诊断为左侧腭裂,1例鼻后三角顶点缺失,双侧回声中断,诊断为正中唇裂并双侧腭裂,1例双侧回声中断,诊断为双侧腭裂。结论超声检查可早发现妊娠早期胎儿鼻腭部位的异常情况,提高妊娠质量。     

超声识别椎体以定位中晚孕期胎儿脊髓圆锥位置的价值

目的探讨超声识别椎体定位中晚孕期胎儿脊髓圆锥位置的临床价值。方法选取我院门诊接诊的80例单胎孕妇作为研究对象,对胎儿进行二维超声检查及表面三维成像检查,以识别胎儿椎体,记录胎儿脊髓圆锥位置,分析不同孕周胎儿的脊髓圆锥位置。结果 80例胎儿脊髓圆锥的二维超声成像与三维表面成像水平基本相同,二维超声与三维表面成像获得的脊髓圆锥末端至骶尾部最后一个骨化中心段内椎体个数分布相同,Kappa值为1.0(≥0.75),二维超声成像与三维表面成像结果的一致性较好。22~35孕周胎儿的脊髓圆锥位于L1~L4椎体,各孕周的脊髓圆锥椎体分布无明显差异(P0.05)。孕23周、24周胎儿脊髓圆锥主体分布与其余各孕周对比,存在显著性差异(P0.05);孕28~35周胎儿的脊髓圆锥主体分布与孕22~27周胎儿比较有显著性差异(P0.05);孕30~35周的脊髓圆锥椎体位置分布对比无显著性差异(P0.05)。线性回归结果显示脊髓圆锥椎体位置与孕妇孕周存在正相关关系,R=0.815,P0.05。结论对中晚孕期胎儿进行超声检查,能够清楚地观察胎儿脊髓圆锥的形态,识别脊髓圆锥位置,二维超声检查与表面三维超声成像结合,能够提高胎儿脊髓圆锥位置判断的准确性。     

胎儿先天性肢体畸形的MRI诊断探讨

目的 探讨MRI在胎儿先灭性肢体畸形诊断中的应用价值.方法 回顾性分析胎儿先天性肢体畸形的MRI表现.16例孕妇年龄22～40岁,平均29岁;孕龄22～39周,平均29周.产前常规行超卢(US)检查后24～48 h内行MR检查,采用二维快速稳态自由进动序列(2D FIESTA),行胎儿颅脑脊柱胸腹部常规及肢体重点扫描,将产前MRI、US表现与出牛后影像表现或外观(4例胎儿)、引产后尸体解剖或外观检查结果 (12例孕妇共13例胎儿,其中1例孕妇为双胎)对照.结果 16例孕妇共检出胎儿17例.包括先天性双上肢完全截肢1例,人体鱼序列征1例,短肢畸彤6例,双手腕内翻畸形2例,右手多指畸形1例,单纯有手缺指畸形1例,右手截指畸形1例,单纯马蹄内翻足2例,脊柱裂脑积水伴马蹄内翻足2例(其中1例还伴双手叠指样屈曲).16例孕妇随访结果 与产前MRI诊断完全一致14例,不完全一致2例.结论 MRI在胎儿先天性肢体畸形诊断方面具有一定的应用价值,能提供超声以外的额外信息,甚至更正超声的诊断.     

Use of femur length/abdominal circumference ratio in detecting the macrosomic fetus

The femur length/abdominal circumference ratio, expressed as FL/AC X 100, was determined in 156 fetuses and evaluated as a predictor of fetal macrosomia within one week prior to delivery. The normal range (mean +/- 2 SD) in the 105 normal-weight fetuses was 22.0 +/- 2, while the normal range in the 51 macrosomic fetuses was 20.5 +/- 2; these differences were highly significant (P = less than .0001). The predictive power of a positive ratio was 68%, with a sensitivity of 63%. This ratio was particularly useful in the subset (n = 9) of macrosomic fetuses whose mothers were diabetic, correctly identifying 89% of this group. Because it is age independent, this ratio should prove most helpful in identifying fetuses at risk for macrosomia in patients whose dates are not known, since it may become abnormal before the fetal weight falls above the 90th percentile at term (3,900 g). In patients whose dates are known, early fetal macrosomia is best predicted by evaluating the abdominal circumference against normal standards for age.     

Sex determination by the length of metacarpals and phalanges: X-ray study on Egyptian population

Measurements of hand bones length have been shown to be sexually dimorphic in many nationalities. The aim of this study is to assess the accuracy of sex determination from the length of all metacarpals and phalanges of right and left hands using X-ray radiographs and to develop a discriminant formula that can be used in the Egyptians. One hundred Egyptians are included in the study (50 adult males and 50 adult females) in the period from December 2009 to January 2011 with mean age 31.60 ± 9.44. Each is subjected to X-ray radiographs on both hands. The results reveal that males have significantly greater mean values than females for all metacarpals and phalanges of both hands and the Egyptian population has greater measurements in comparison to the other ones (e.g. Turkish and European Americans). In addition there is no significant difference between the right and the left hands in either males or females. The correct classification reached an accuracy of 88%–94% by using both hands, while that for right hand only is 88% and 88%–90% for the left hand only. Regarding the accuracy of each bone, the present results revealed that 1st DP & PP and 3rd and 4th MC in the right and left hands are the best bones that can be used in correct sex determination. It is concluded that the length of metacarpals and phalanges (especially the 1st DP & PP and 3rd and 4th MC) could be used for sex determination. The right hand could be used as the left hand in determination of sex. Also the X-ray radiographs are good non invasive and simple tool in the determination of sex from the hand bones. Furthermore the regression equation for both hands and each hand separately is specific to Egyptian population and should be used after validation of the results in other ones.     

Effect of weightlessness on the skeletal development of the rat fetus

The size of the ossified areas of skeletal bones of fetuses of white rats flown onboard Cosmos-1514 during their pregnancy days 13 to 18 was compared with that of synchronous and vivarium controls. The effect of zero-g on the pregnant animals in the course of an active formation of fetal bones involved a distinct (13-17%) arrest of the development of nearly every area of the fetal skeleton. The signs of the arrest development were more manifest in less mature skeletal structures. Since the Ca2 content was identical in the flight and control rats, it can be concluded that the inhibited ossification of the flight fetuses was produced by the impairment of mechanisms controlling Ca2+ incorporation into the growing skeleton. The ossified areas in the skeleton of the flight newborns were significantly larger than those of the synchronous and vivarium controls. This means that during the readaptation period (pregnancy days 18 to 23) the inhibited ossification of the fetal skeleton was completely compensated and that the flight newborns (i. e. the rats whose prenatal development occurred in part in zero-g) were ahead of the controls with respect to the ossification rate.     

Radiographic changes in the hands of rock climbers.

Radiographs of the hands of 36 rock climbers were compared with radiographs of the hands of controls matched for age and sex. Subchondral cysts were present in the hands of 17 climbers and only two controls. Osteophytes or bony spurs were present in 14 climbers but not in any of the controls, and the only two cases of frank osteoarthrosis were in the hands of climbers. Cortical thickness of the proximal and middle phalanges was significantly greater in the hands of climbers (P = < 0.01). Pronounced 'scalloping' of the necks of the proximal phalanges was only seen in climbers, and is due to thickening of the attachment of the distal end of the fibrous A2 pulley of the flexor sheath.     

Fetal body volume: use at MR imaging to quantify relative lung volume in fetuses suspected of having pulmonary hypoplasia

PURPOSE: To retrospectively determine an algorithm based on fetal body volume (FBV) by using magnetic resonance (MR) imaging to calculate relative lung volume in fetuses with normally developed lungs and prospectively assess the use of this algorithm in predicting pulmonary hypoplasia in the late second and early third trimesters for fetuses at risk for pulmonary hypoplasia. MATERIALS AND METHODS: Oral informed consent was obtained for the prospective component of this ethics committee-approved study. MR imaging lung volumetry was performed in 36 fetuses with normally developed lungs between 18 and 39 weeks gestational age by using T2-weighted single-shot fast spin-echo imaging in fetal transverse and sagittal planes. Findings were then correlated with biometric variables and gestational age. The best-performing algorithm was applied to 37 fetuses (between 18 and 29 weeks gestational age) at risk for pulmonary hypoplasia to determine observed-expected lung volume ratio. This group was stratified according to pregnancy management, and observed-expected ratios were correlated with outcome. In fetuses with isolated congenital diaphragmatic hernia (CDH) (n = 19), observed-expected ratio was correlated with lung-head ratio, neonatal survival in pregnancies managed expectantly (n = 13), and/or lung-body weight ratio at necropsy (n = 9). For that purpose, linear regression correlation was used with the Pearson correlation coefficient; P < .05 was considered to indicate a significant difference. RESULTS: Total fetal lung volume correlated best with total FBV (r = 0.96, P < .05). Observed-expected ratio based on FBV correlated with lung-head ratio in patients with CDH (r = 0.71, P < .001) and with lung-body weight ratio at necropsy (r = 0.68, P < .05) and could be used to help predict neonatal survival. CONCLUSION: FBV measured with MR imaging can be used as a single parameter in an algorithm and showed closest correlation with normal total fetal lung volume. In the transition from second to third trimester, this algorithm enabled calculation of the observed-expected ratio and prediction of outcome in fetuses at risk for pulmonary hypoplasia.     

肾性骨病的骨膜下骨吸收

笔者采用手骨直接Ｘ线放大摄影和双手Ｘ线平片来研究慢性肾衰血透病人５１例。特征性的指骨骨膜下吸收放大摄影发现２５例占４９％;平片为１１例占２１．６％,结果表明,放大摄影的阳性率明显高于平片（Ｐ＜０．００５）,骨膜下吸收的二,三指中间指骨桡侧及指骨末端是肾性骨病的“靶区”,认为二者无显著差异（Ｐ＞０．５０）。骨膜下吸收还与血透时间,血磷,血钙和碱性磷酸酶水平相关。     

Effacement of the fetal cisterna magna in association with myelomeningocele

The cisterna magna is effaced in association with myelomeningocele. The authors retrospectively investigated the size of the fetal cisterna magna as a predictor of fetal myelomeningocele in 67 pregnant women (17-38 menstrual weeks) referred for prenatal sonography because of an elevated serum alpha-fetoprotein level (n = 61) or a suspicion of fetal ventriculomegaly on previously obtained sonograms (n = 6). Twenty fetuses had myelomeningocele, 14 had isolated ventriculomegaly, and 33 were normal. A normal-sized cisterna magna (range, 4-9 mm in depth) was present in all normal fetuses. In 19 of 20 fetuses with myelomeningocele, the views of the posterior fossa were adequate, and in each of these the cisterna magna was effaced (n = 18) or very small (n = 1). The cisterna magna was effaced in five of 13 (38%) fetuses with isolated ventriculomegaly in whom the posterior fossa was adequately imaged. Although effacement of the cisterna magna is a nonspecific finding, the high negative predictive value of this sign is useful during routine screening of the fetal neural axis.     

Radial alveolar count as a tool for the estimation of fetal age

A total of 53 normal fetuses with a gestational age ranging from 15 up to 39 weeks was investigated and the radial alveolar count (RAC) was estimated as a parameter for lung maturation. Values lower than 2.0 could only be found in lungs of fetuses aged less than 18 weeks. Between 18 and 25 weeks of gestation, relatively constant levels of RAC were observed but with considerable interindividual variation. In fetuses with a gestational age of more than 25 and especially 30 weeks, a slight or rapid increase in RAC occurred respectively. Values lower than 3.0 were found up to a fetal age of less than 30 weeks and a RAC of more than 4.0 was only found in lungs of fetuses aged more than 30 weeks. Values exceeding 6.0 occurred only in fetuses at near full-term birth. Since the estimation of RAC overcomes the effects of varying degrees of alveolar collapse, such an analysis also seems to be useful for the determination of fetal age in cases of advanced putrefaction. Received: 9 August 1996 / Received in revised form: 22 November 1996     

骨斑点症的X线分析（附5例报告及文献复习）

目的分析骨斑点症的影像学表现。方法5例临床怀疑骨斑点症患者经头颅、胸部、肩关节、双肱骨、双尺桡骨、双手骨、脊柱、骨盆、双股骨、双胫、腓骨及足骨X线摄影检查，对全部患者的X线照片结合文献复习进行分析。结果病变以骨盆、腕骨、跗骨、指（趾）骨和长管状骨的骨骺及干骺端为好发部位，很少累及颅骨、肋骨、脊柱、胸骨、锁骨。病变呈对称性分布，以松质骨内0．2～1．5cm散在多发的大小不等的圆形或卵圆形致密阴影为特征，越靠近关节病灶越密集。结论骨斑点症是一种罕见的无临床症状的遗传性疾病，可依据其特征性X线表现进行确诊和鉴别诊断。