产前超声筛查诊断胎儿肢体畸形的价值

目的:探讨超声筛查诊断胎儿肢体畸形的价值.材料和方法:超声筛查13 919例孕15～34周的孕妇,主要运用二维超声,采用连续顺序追踪超声检测法重点检测胎儿四肢.结果:引产后胎儿肢体畸形33例,产前超声检出32例,14例双足内翻、7例四肢短小畸形、3例肢体姿势异常、3例双侧桡骨缺失、1例双上肢前臂缺如、1例右小腿缺如、1例人体鱼序列征、3例多指(趾).其中22例合并其他畸形,1例漏诊及4例部分漏诊.结论:二维超声连续顺序追踪检测法是产前胎儿肢体畸形筛查的有效方法,能及早发现胎儿肢体畸形.     

胎儿肢体畸形的产前超声诊断价值

目的探讨超声筛查诊断胎儿肢体畸形的价值。方法超声筛查8 368名孕16~34周的孕妇,运用二维连续顺序追踪超声检测法(SCSA)结合三维超声表面及透明成像模式检查胎儿肢体。结果引产后胎儿肢体畸形22例,产前超声检出21例[9例双足内翻,1例一足外翻,2例四肢短小畸形,1例左小腿缺如,1例双上肢前臂缺如,3例肢体姿势异常,1例双侧桡骨缺失,3例多指(趾)]。其中19例合并其他畸形,1例漏诊及3例部分漏诊。结论二维超声连续顺序追踪检测法结合三维超声表面及透明成像法是产前检出胎儿肢体畸形的有效方法。     

超声筛查在胎儿肢体畸形诊断中的临床应用

目的 探讨超声筛查在胎儿肢体畸形诊断中的应用价值.方法 对24 350例产前超声筛查过程中出现的胎儿肢体畸形结果进行分析.结果 经超声筛查检出肢体畸形123例,其中86例经产前超声检查和引产后证实,其余37例合并其它畸形.对不同孕周的产前超声肢体畸形检出情况进行比较发现孕18～24周和孕25～32周的产前超声肢体畸形检出率最高,分别达到94.12％、93.75％,分别与孕11～14周和孕33周～足月比较,产前超声肢体畸形检出率均明显提高,且差异具有统计学意义（x2=6.32、5.85、4.58、4.69,P＜0.05）.结论 超声筛查是产前诊断胎儿肢体畸形的必要手段,能早发现胎儿肢体畸形,减少相应的漏诊.     

连续顺序追踪超声法在产前超声筛查胎儿肢体畸形中的应用价值

目的探讨连续顺序追踪超声法（SCSA）在筛查胎儿肢体畸形中的应用价值。方法应用超声诊断仪对2011年5月至2013年5月在我院产前超声筛查的3680名孕18～24周的孕妇,行胎儿肢体SCSA检测,观察胎儿有无肢体形态、结构、姿势、运动等异常,仔细排查有无其他合并畸形,分析各种类型胎儿肢体畸形的超声声像图特征。结果SCSA共检出26例,13种69处胎儿肢体畸形,2例3处漏诊,其中单纯肢体畸形9例,肢体畸形合并其他结构异常19例,以上所有畸形病例均在我院引产后得到证实。结论SCSA是筛查胎儿肢体畸形的重要影像学诊断方法。     

产前超声诊断胎儿肢体-体壁综合征

目的 探讨产前超声诊断胎儿肢体-体壁综合征(LBWC)的价值,提高对LBWC的认识。资料与方法 回顾性分析经产前超声诊断的20例胎儿LBWC的声像图表现及随访结果,分析胎儿LBWC的超声声像图特点。结果 20例LBWC胎儿均有较大的体壁缺损及脊柱异常,其中16例腹壁缺损,4例胸腹壁缺损;脊柱异常中8例脊柱侧凸畸形,2例后凸畸形,3例扭曲成角,1例扭曲呈S形,6例椎体排列紊乱;脐带异常16例,11例脐带过短,1例无脐带,单脐动脉7例(3例伴脐带过短);肢体异常5例,左下肢缺如2例,左上肢缺如1例,左足内翻、右足稍内翻1例,左足足尖下垂1例。结论 产前超声检查可以及时发现并诊断胎儿LBWC,为临床早期干预提供依据。     

产前超声筛查技术诊断高海拔地区多民族早孕期胎儿异常的价值

目的:探讨产前超声筛查技术诊断高海拔地区多民族早孕期(11周～13⁺⁶周)胎儿异常的价值。方法:收集2020年7月—2021年7月来我院行颈部透明层(NT)厚度检查的1 969例胎儿超声表现,评估早孕期超声诊断胎儿异常的价值。结果:产前超声诊断胎儿异常87例,畸形发生率4.42%,其中结构畸形44例;NT增厚43例(其中颈部淋巴水囊瘤11例)。其中,汉族畸形发生66例,少数民族(包括藏族、回族、土族、撒拉族、蒙古族、满族)畸形发生21例。结论:在早孕期进行超声检查能较早地检出胎儿异常:严重结构畸形、为染色体畸形胎儿提供线索,临床早期处理,最大程度减轻对孕妇的损伤,具有重要的临床意义。     

产前系统性超声筛查在中晚期孕妇检查中的诊断价值

目的：探讨产前系统性超声筛查在中晚期孕妇检查中的诊断价值。方法总结和分析仪征市中医院2010年5月至2014年3月对孕22-32周3550例中晚期孕妇进行产前系统性超声筛查结果。结果本组3550例胎儿筛查中,胎儿畸形共80例（2．25％）,单发畸形71例,多发畸形9例,其中漏诊5例（0．14％）。在单发畸形中,神经系统畸形17例、泌尿系统畸形12例、心脏畸形10例、消化系统（包括腹部）畸形11例、骨骼系统畸形5例、呼吸系统畸形4例、颈面部8例、其他畸形4例。在漏诊5例中,胎儿复杂心脏畸形1例、腭裂1例、膀胱部分外翻1例、足内翻1例、肛门闭锁1例。结论产前系统性超声筛查对胎儿诊断检查中具有较高特异性和准确性,应作为产前孕妇检查的常规检查手段。     

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。     

产前超声诊断胎儿眼部异常的声像图特征及临床价值

目的探讨产前超声诊断胎儿眼部异常的声像图特征及临床价值。方法回顾性分析36例产前超声诊断为胎儿眼部异常的临床资料,总结其声像图特征。结果 40 000例胎儿(妊娠11～40周)中共检出眼部异常36例(0.09%),其中先天性白内障21例(双侧16例,单侧5例),小眼畸形3例,独眼2例,无眼1例,眼距异常9例(眼距过宽3例,眼距过窄6例);其中14例合并其他畸形。引产后病理结果证实31例与产前超声诊断相符,5例失访。结论超声检查能直观显示胎儿眼部的结构,胎儿眼部异常的声像图特征明显,超声筛查11～40周孕期胎儿眼部异常具有无可比拟的优势。     

超声检查在胎儿畸形筛查中的应用效果及与染色体异常相关性研究

目的评价超声检查应用于胎儿畸形筛查的效果及胎儿畸形与染色体异常的相关性。方法从2012年1月～2017年10月我院接受产前筛查的孕妇中选取1000例为观察对象,回顾分析孕妇超声检查胎儿畸形筛查结果,并分析胎儿畸形与染色体异常存在的关系。结果产后显示受检者中共有16例畸形胎儿,超声检查共检出15例,准确率为93.75%(15/16),漏诊率为6.25%(1/16);15例畸形胎儿均引产,与大体标本观察结果比较,超声诊断符合率为93.75%;先天性足或手畸形、四肢短小发生率最高,所占比例分别为40.00%、13.33%;10例行胎儿染色体检查,提示染色体正常为7例(70.00%),染色体异常为3例(30.00%)。结论超声检查中,胎儿畸形显示存在典型图像特征,可获得较高检出率,胎儿肢体畸形常与染色体异常存在一定相关性。     

The role of early sonography in the management of the acute abdomen

A prospective study was set up in a busy teaching hospital to evaluate the role of a 24 h emergency ultrasonography service in patients presenting with acute abdominal pain. Seventy-five patients due for admission via the accident and emergency department with acute onset of upper or lower abdominal pain were imaged at the request of our surgical colleagues. In 14 patients (18.7%), a diagnosis was made up by sonographic examination which had not been clinically expected. Twelve of this group were female with gynaecological pathology and all 14 had their proposed emergency surgery deferred following the sonographic examination. In 26 patients (34.7%), sonography confirmed the first diagnosis suspected clinically and in nine cases (12%) confirmed the second or third differential diagnosis. Sonography made no contribution to the diagnosis in 24 patients (32%) and in two cases (2.6%) was considered misleading. The results of this study demonstrate that emergency ultrasonography is most useful in the diagnosis of female patients presenting with mid to lower abdominal pain.     

肝脏炎性假瘤的声像图表现(附23例分析)

目的探讨肝脏炎性假瘤(imflammatory pesudotumor of the liver,IPL)的声像学表现特点。方法回顾分析23例经手术或穿刺活检病理证实的肝脏炎性假瘤的声像学资料。结果B超多表现为不规则低回声,边界尚清,内部多无血流信号,少数内部可见低速、低阻的动脉血流频谱,部分多发病灶可见相互融合征象。结论IPL声像图上有一定的特征,但定性诊断较难,结合临床资料和其他影像学检查应能提高诊断率,确诊尚需依靠病理。     

分时段系统超声检查对筛查胎儿形态结构异常的意义

目的评价分时段系统超声检查对筛查胎儿形态结构异常及提高人口出生质量的意义。方法自2004年1月至2009年10月，我院超声科利用分时段系统超声检查对5173例胎儿于3个重要的孕周时段：孕10～14周，22～24周及30-32周进行了形态结构异常的筛查。结果在5173例接受了分时段系统超声检查的胎儿中，共检出形态结构异常者299例，检出率为5．78％，与2004年的检出率2．43％（46／1890）比较，提高了3．35％。随后，大多数形态结构异常胎儿得到包括终止妊娠在内的临床干预措施，有效地降低了缺陷儿的出生率。结论分时段系统超声检查是筛查胎儿形态结构异常的一种敏感的影像技术，对提高人口出生质量有重要意义。     

Comparing the diagnosis of white matter injury in premature newborns with serial MR imaging and transfontanel ultrasonography findings

BACKGROUND AND PURPOSE: The accurate identification of white matter injury in premature neonates is important for counseling parents and for targeting these high risk neonates for appropriate rehabilitation services. The objective of this study was to compare the diagnosis of white matter injury detected by serial MR imaging and ultrasonography of a contemporary cohort of premature neonates. METHODS: Each of the 32 consecutively enrolled neonates was studied with MR imaging at a median postconceptional age of 31.9 weeks (range, 27.6-38.1 weeks) and again at a median postconceptional age of 36.5 weeks (range, 33.4-42.9 weeks) and with serial ultrasonography according to a clinical protocol. Because periventricular echogenicity shown on ultrasonograms evolves over time, both the highest grade of echogenicity and the grade of echogenicity shown on the last neonatal ultrasonogram were used in the analysis to determine the predictive values and correlation (Spearman's rho) of ultrasonography for predicting white matter abnormalities shown on MR images. RESULTS: White matter abnormalities were diagnosed in 18 (56%) neonates based on MR imaging, consisting of foci of scattered T1 hyperintensity in the periventricular white matter, and in 22 (69%) neonates based on ultrasonography, consisting of abnormal periventricular echogenicity. The severity of white matter abnormalities shown by MR imaging was not correlated with the highest grade of white matter abnormalities detected with ultrasonography (rho=0.18, P=.3) or with the grade of white matter abnormalities shown on the last ultrasonogram (rho = 0.16, P=.4). CONCLUSION: Although ultrasonography is commonly used to screen premature neonates for white matter injury, it was not a sensitive predictor of the milder spectrum of MR imaging-defined white matter abnormalities.     

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     

老年下肢动脉硬化闭塞症的腔内治疗

目的 探讨老年下肢动脉硬化闭塞症(LEAOD)腔内治疗的技术方法及疗效.资料与方法 回顾性分析2007-06～2010-06在我院行腔内治疗的60例老年LEAOD患者腔内治疗技术、围术期处理特点、临床效果、并发症及随访情况.结果 68条肢体获得技术成功,成功率为94.44％ (68/72);并发症发生率为6.94％ (5/72),其中2例发生心衰,l例发生造影剂肾病,2例发生导丝穿破血管壁,无围术期死亡;踝/肱指数(ABI)由术前的(0.55±0.13)增至术后7d的(0.82±0.15) (t=11.54,P＜0.001);术后12个月、24个月肢体一期通畅率分别为88.46％ (46/52)和71.88％ (23/32),二期通畅率分别为92.31％ (48/52)和78.13％ (25/32),术后24个月肢体保全率为100.00％ (32/32).结论 下肢动脉腔内治疗技术成功率高、并发症少,是老年LEAOD安全有效的治疗方法.     

A comparison of 18F-FDG gamma camera PET, mammography and ultrasonography in demonstrating primary disease in locally advanced breast cancer

BACKGROUND: Positron emission tomography (PET) imaging using [18F]fluorodeoxyglucose (18F-FDG) is recognized to have a major role in oncological imaging. Over recent years there has been a steady increase in the use of gamma camera PET (GCPET) systems as these are less expensive than dedicated PET scanners and facilitate the full range of nuclear medicine imaging. However, there is ongoing debate about their application and usefulness in the management of oncological patients. OBJECTIVES: To assess the feasibility of GCPET in a nuclear medicine department in a district general hospital remote from a cyclotron, compared with other imaging modalities in demonstrating disease in patients with large or locally advanced breast cancer. METHODS: 18F-FDG was transported by road from a production unit 100 miles from the imaging department. Twenty-five patients (mean age 68 years) with primary breast tumours measuring > or =20 mm on clinical examination were studied. All patients underwent triple assessment prior to PET imaging with an ADAC Solus camera with molecular coincidence detection capability. Histopathology was obtained in 20 cases following surgery. RESULTS: GCPET detected 24/25 primary breast tumours (sensitivity 96%). This compared with 22/25 (88%) for ultrasound and 15/25 (60%) for mammography. The lesion missed by PET was a grade 1 tumour, 8 mm in size. CONCLUSION: In this pilot study GCPET has been shown to be feasible in a district general hospital, enabling a limited on-site PET imaging service to be provided. In the cases studied it was more sensitive than mammography or ultrasonography. GCPET may provide additional information that could be important in planning the management of some patients with breast cancer.     

Ankle–Arm Index,Angiography, and Duplex Ultrasonography After Recanalization of Occlusions in Femoropopliteal Arteries: Comparison of Long-Term Results

Purpose Comparison of the relative values of the ankle-arm index (AAI) at rest and after exercise, angiography, and duplex ultrasonography for the follow-up of percutaneous transluminal angioplasty (PTA) in patients with peripheral vascular disease. Methods Thirty-two patients were prospectively followed after technically and clinically successful PTA of a femoropopliteal occlusion. The patency of the femoropopliteal artery was assessed for 1 year using AAI measurements at rest and after exercise; duplex ultrasonography at 4, 12, 24, 36, and 52 weeks; and angiography at 3 and 12 months after PTA. Results Patency was highly dependent on the measurement technique. The cumulative patency after 1 year determined with the AAI at rest and during exercise, by angiography, and by duplex ultrasonography was 74%, 19%, 31%, and 32%, respectively. Seventy-five percent of the restenoses occurred at the site of the treated occlusion. Conclusion Duplex ultrasonography is most suitable for this assessment, as it causes no patient discomfort and the specificity is better than AAI after exercise because vascular disease in other, proximal segments does not interfere with the results.     

Improved outcome of extremely premature infants in the 1990s.

OBJECTIVE: To study the impact of new treatment modalities on premature infants, we compared the effects of surfactant and antenatal steroid use on outcome in two military medical centers. STUDY DESIGN: We performed a retrospective chart review of 234 infants delivered at 22 to 26 weeks estimated gestational age (EGA) at our institutions between 1986 and 1996. The patients were divided into two groups: the presurfactant group included deliveries from 1986 to 1989; and deliveries from 1990 to 1996 were in the surfactant group. RESULTS: At 23 weeks EGA or less, there was only one survivor. At 24 weeks EGA, survival was improved in the surfactant group (46% vs. 5%; p < 0.005). Survival rates at 25 and 26 weeks EGA did not differ significantly. Combined survival at 24 to 26 weeks in the surfactant group exposed to antenatal steroids was 75% versus 44% in the presurfactant group (p = 0.02) Among survivors, the incidence of grade 3 or higher intraventricular hemorrhage was less in the surfactant group (18% vs. 42%; p = 0.038). CONCLUSIONS: Use of surfactant and antenatal steroids are associated with improved survival and decreased incidence of severe intraventricular hemorrhage among the most premature infants delivered in our institutions.     

Cephalopagus conjoined twins presented with encephalocele: diagnostic role of ultrafast MR imaging

Conjoined twinning is a rare abnormality and cephalopagus is a very rare form of conjoined twins. We report a case of cephalopagus conjoined twins with encephalocele and omphalocele which diagnosed by ultrasonography and ultrafast magnetic resonance (MR) imaging at 24 weeks of the gestation. Ultrafast MR imaging can provide image quality superior to two dimensional ultrasonography and should be considered an adjunct to ultrasound for antenatal characterization of some anomalies. To the best of our knowledge, this is the first case of cephalopagus conjoined twins with encephalocele and omphalocele which diagnosed by ultrasound and ultrafast MR imaging.