超声对扁桃体周围脓肿的诊断价值

超声对扁桃体周围脓肿的诊断价值于晓伟，邹佳霖，于诗香，王其有，兰信堂扁桃体周围脓肿（ＰＴＡ）是临床上常见的头颈部脓肿。及时鉴别ＰＴＡ和扁桃体周围炎（ＰＴＣ）是必要的，因为二者的处理原则不一样：前者需要切开引流，而后者抗生素治疗即可。但是，有时区别是很...     

经口腔超声诊断咽旁肿物

目的：报告用普通相控阵探头经口腔超声诊断咽旁肿物，有利于鉴别良恶性。方法：用经颌下和经口腔超声（ＩＯＵ）两种方法对比检查１０例咽旁肿物。结果：１０例中５例为良性，５例为恶性，检出率经颌下法为５０％，ＩＯＵ法为１００％，结论：ＩＯＵ法可直观、准确地检出咽旁肿物，并为诊断良恶性提供重要依据。ＩＯＵ法明显优于经颌下法，是一种诊断咽旁肿物的实用可行的新方法。     

扁桃体周围脓肿的超声诊断价值

扁桃体周围脓肿 (ＰＴＡ)是临床上常见的头颈部脓肿。本研究的目的是评价超声扫描对ＰＴＡ的诊断价值。1　资料和方法随机选取 35名临床上怀疑是ＰＴＡ的病人 ,其中 ,男 2 0例 ,女 1 5例 ;平均年龄 2 7岁 ( 1 5～ 55岁 )。所有病人均给予双侧超声扫描。采用ＤｉａｓｏｎｉｃｓＳｐｅｃｔｒａＶＭＳ机型 ,将凸阵探头 ( 3 5ＭＨｚ)置于下颌角中央区 ,朝向扁桃体窝 ,扫描整个扁桃体区。并用双功彩色多普勒显示脓肿与颈内动脉的位置关系。所有病人一回到诊室 ,即施行穿刺。最后把穿刺抽吸和超声扫描的结果相比较。2　结果超声扫描可以得到扁桃体…     

心肌肌钙蛋白I对诊断急性心肌梗塞的价值

目的：探讨心肌肌钙蛋白Ｉ（ＣＴｎＩ）诊断急性心肌梗塞（ＡＭＩ）的价值。方法：采用固相层析免疫技术定性检测三组分别确诊为ＡＭＩ、不稳定性心绞痛（ＵＡ）、陈旧性心肌梗塞（ＯＭＩ）病人血清中的ＣＴｎＩ,同时检测病人血清肌酸激酶同工酶（ＣＫＭＢ）。结果：１８例ＡＭＩ病人ＣＴｎＩ阳性,１５例ＵＡ病人１例为阳性,其余为阴性,７例ＯＭＩ病人均为阴性。对应的ＣＫＭＢ增高分别为１４例、４例和２例。ＣＴｎＩ诊断ＡＭＩ的敏感性为１００％,ＣＫＭＢ为７７８％;ＣＴｎＩ诊断ＡＭＩ的特异性为９５５％,ＣＫＭＢ为７２７％。结论：ＣＴｎＩ对诊断ＡＭＩ有很高的特异性和敏感性。     

超声在腹腔镜胆囊切除术中建立气腹的价值

目的 探讨超声在腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）中安全建立气腹的应用价值。方法 应用超声检测110例行LC的患者建立气腹前脐下周围腹壁与肠管间滑动征象诊断有无粘连，并与术中诊断结果比较，同时与术者共同标定最佳第一入腹点，计算超声诊断粘连的敏感性、特异性、准确性、阳性预测值和阴性预测值，记录并发症例数。结果 比较110例行LC的患者超声诊断和术中诊断脐下周围粘连发生率，两者间差异无显著性（P〉o．05），超声诊断脐下周围粘连的敏感性为100％，特异性为98．7％，准确性为99％，阳性预测值为97％，阴性预测值为100％。该组LC成功率为100％，第1孔穿刺并发症为0例。结论 超声可准确地检测脐下周围有无粘连，标定最佳第1入腹点，有效避免第1孔穿刺并发症的发生。     

小脑横径／腹围比率对宫内生长迟缓的诊断价值

本文应用超声检测８７例有宫内生长迟缓（ＩＵＧＲ）倾向的孕妇，为评价ＴＣＤ／ＡＣ比率对ＩＵ－ＧＲ的诊断可靠性进行了前瞻性研究。结果显示敏感性为８１％，特异性为８７％，阳性预测值８４％，阴性预测值７６％。ＴＣＤ／ＡＣ比率能脱离孕周计算独立评估ＩＵＧＲ，有其特殊价值。但在严重病例时可能有误差     

消化性溃疡6338例胃镜检查结果分析

目的：了解消化性溃疡（ＰＵ）的发病特点。方法：对我院１６年间２２０１４例胃镜检中发现的６３３８例ＰＵ,逐年按月统计,对ＰＵ的检出率、性别、年龄、季节分布、溃疡部位及并发症等进行了统计学处理分析。结果：ＰＵ检出率为２８．７９％,其动态由８０年代２５．６７％至９０年代初２７．５４％至现在３０．９７％,其中十二指肠球部溃疡（ＤＵ）４８３２例（７６．２４％）,胃溃疡（ＧＵ）１１８４例（１８．６８％）,复合     

下肢深静脉血栓超声不同方法的对比研究

本文对４４例临床疑诊下肢深静脉血栓（ＤＶＴ）患者进行了二维彩色多普勒血流显像（２Ｄ－ＣＤＦＩ）和上行性静脉造影对比，旨在评估超声不同方法诊断ＤＶＴ的准确性。超声诊断ＤＶＴ的方法包括：血栓回声法（ＴＨ法）、探头加压法（ＣＯＭ法）、脉冲Ｄｏｐｐｌｅｒ法（ＰＤ法）和彩色Ｄｏｐｐｌｅｒ法（ＣＤ法）。３０条静脉造影确诊为ＤＶＴ，１４条阴性。单一指标以ＣＯＭ法最好，敏感性为９０．０％、特异性９２．８％和准确性９０．９％；不同指标联合以ＣＯＭ＋ＰＤ＋ＣＤ和ＴＨ＋ＣＯＭ＋ＰＤ＋ＣＤ法最佳，其敏感性均为９６．７％、特异性１００％和准确性９７．６％。超声是无创伤性评价下肢ＤＶＴ的敏感方法，全方位检查可更准确地诊断ＤＶＴ。     

彩色多普勒能量图对闭塞性动脉粥样硬化病的诊断价值

目的：探讨彩色多普勒能量图（ＣＤＥ）对闭塞性动脉粥样硬化病（ＡＳＯ）的诊断价值。方法：对１９例ＡＳＯ４１个闭塞动脉节段进行二维超声（２Ｄ）、彩色多普勒血流显像（ＣＤＦＩ）、ＣＤＥ和脉冲多普勒（ＰＤ）的联合检查，并比较ＣＤＥ和ＣＤＦＩ对ＡＳＯ闭塞血管内血流检出的情况。结果：①ＣＤＥ诊断ＡＳＯ的准确性为９５％，对闭塞部位定位准确性为９８％。②ＣＤＥ和ＣＤＦＩ对ＡＳＯ闭塞血管内血流信号的检出率分别为８５％和６３％，二者差别显著（Ｐ＜０．０５）。③ＰＤ检出ＡＳＯ闭塞血管内及其远端的血流频谱为单相收缩期流速减低、舒张早期反向血流消失、无频窗的“锯齿波”或连续性“带状波”，其检出率为１００％。④２Ｄ对ＡＳＯ血管壁钙化斑块的检出率为１００％。结论：ＣＤＥ结合２Ｄ及ＰＤ检查，可为ＡＳＯ提供可靠的病因、定位和定量诊断，ＣＤＥ比ＣＤＦＩ对ＡＳＯ闭塞血管内血流状态的显示具有更高的灵敏性     

脉冲多普勒超声检测胎儿大脑中动脉的搏动指数

应用脉冲多普勒超声检测１１５例晚期妊娠胎儿大脑中动脉的搏动指数（ＭＣＡＰＩ）。正常胎儿ＭＣＡＰＩ随孕龄增长而下降，呈显著负相关。宫内发育迟缓（ＩＵＧＲ）组ＭＣＡＰＩ低于均值的二个标准差截止点水平的百分数（８３．８７％）显著高于正常组（４．７６％），以此截止点水平诊断ＩＵ－ＧＲ，敏感性为８３．８７％，特异性为９５．２３％，阳性预测值８６．６７％，阴性预测值９４．１２％。脉冲多普勒超声检测胎儿脑血流是一项有用的方法。     

Ultrasound-guided drainage of peritonsillar abscess by the emergency physician

The diagnosis of peritonsillar abscess (PTA) poses a challenge to emergency physicians (EPs). The decision to perform an invasive procedure with potential complications is based on clinical judgment that is often inaccurate. Although there is some mention of intraoral ultrasound in otolaryngology practice, there is none in the emergency medicine (EM) literature. However, this bedside emergency application of ultrasonography has the potential to be of considerable use in EM practice, and could allow EPs who previously deferred blind needle aspiration of a potential abscess to perform the procedure themselves. We report the cases of 6 patients who presented with probable PTA and were evaluated with intraoral ultrasound at the bedside by an EP. All 6 patients then underwent needle aspiration. As diagnosed on ultrasound, 3 of the patients had negative aspirations and were diagnosed with peritonsillar cellulitis. Three others were found to have PTA, with 2 requiring real-time ultrasound needle guidance to accomplish abscess drainage after multiple failures with the blind approach.     

Test characteristics of ultrasound for the diagnosis of peritonsillar abscess: A systematic review and meta-analysis

Background

Distinguishing peritonsillar abscess (PTA) from peritonsillar cellulitis using clinical assessment is challenging as many features overlap for both conditions, and physical examination is only about 75% sensitive and 50% specific for diagnosing PTA. The primary objective of this systematic review was to determine the test characteristics of ultrasound for diagnosing PTA when compared to a reference standard of computed tomography or acquisition of pus via needle aspiration or incision and drainage.

Methods

This systematic review was performed in accordance with the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy (PRISMA-DTA) guidelines. We searched seven databases from 1960 to November 2022. Two independent reviewers completed study selection, data extraction, and QUADAS-2 risk-of-bias assessment. We used a bivariate random-effects model to calculate pooled sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR–). We also conducted subgroup analyses on radiology ultrasound compared to point-of-care ultrasound (POCUS) and intraoral compared to transcervical scanning techniques.

Results

From 339 citations, we identified 18 studies for inclusion. Because one study only reported positive cases of PTA (thereby preventing the calculation of specificity), it was excluded from the analysis, so the analysis included a total of 17 studies with 812 patients, of whom 541 had PTA. Pooled bivariate sensitivity was 86% (95% confidence interval [CI] 78%–91%), specificity 76% (95% CI 67%–82%), LR+ 3.51 (95% CI 2.59–4.89), and LR– 0.19 (95% CI 0.12–0.30). On subgroup analysis, radiology-performed ultrasound had a sensitivity and specificity of 89% and 71%, compared to POCUS, which had a sensitivity and specificity of 74% and 79%. Comparing the two different techniques, intraoral had a sensitivity and specificity of 91% and 75% while transcervical had a sensitivity and specificity of 80% and 81%.

Conclusions

Ultrasound demonstrates high sensitivity for ruling out PTA, but it only has moderate specificity for ruling in the diagnosis.     

Abscess Management: An Evidence-Based Review for Emergency Medicine Clinicians

BackgroundAbscesses are commonly evaluated and managed in the emergency department. Recent research has evaluated the use of ultrasonography, packing, incision and drainage (I&D), and antibiotics. There are evidence-based nuances to the management of specific types of abscesses, such as Bartholin, breast, dental, hidradenitis suppurativa, peritonsillar, and pilonidal abscesses.ObjectiveThis review provides emergency medicine clinicians with a summary of the current literature regarding abscess management in the emergency department.DiscussionUltrasound is valuable in diagnosing abscesses that are not clinically evident and in guiding I&D procedures. Although I&D is traditionally followed by packing, this practice may be unnecessary for small abscesses. Antibiotics, needle aspiration, and loop drainage are suitable alternatives to I&D of abscesses with certain characteristics. Oral antibiotics can improve outcomes after I&D, although this improvement must be weighed against potential risks. Many strategies are useful in managing Bartholin abscesses, with the Word catheter proving consistently effective. Needle aspiration is the recommended first-line therapy for small breast abscesses. Dental abscesses are often diagnosed with clinical examination alone, but ultrasound may be a useful adjunct. Acute abscess formation caused by hidradenitis suppurativa should be managed surgically by excision when possible, because I&D has a high rate of abscess recurrence. Peritonsillar abscesses can be diagnosed with either intraoral or transcervical ultrasound if clinical examination is inconclusive. Needle aspiration and I&D are both suitable for the management of peritonsillar abscesses. Pilonidal abscesses have traditionally been managed with I&D, but needle aspiration with antibiotics may be a suitable alternative.ConclusionsThis review evaluates the recent literature surrounding abscess management for emergency medicine clinicians.     

Clinical findings in needle aspiration of peritonsillar abscess.

A retrospective study was undertaken of all patients admitted through the casualty department of St Mary's Hospital, London W2, with the diagnosis of peritonsillar abscess over a period of 4 years. Patients were divided into those in whom pus was aspirated from the peritonsillar swelling, and those in whom no pus was aspirated from the peritonsillar swelling. These two groups may be described clinically as peritonsillar abscess, and peritonsillar cellulitis respectively (Shoemaker et al., 1986). Relevant details from the history, examination, and investigations were recorded. The results were compared in order to determine whether there was any difference in the details recorded between those patients with pus aspirated, and those with no pus found. Of the 70 patients admitted with this diagnosis over the last 4 years, full data was available in 55 cases. Pus was found on routine needle aspiration of the peritonsillar swelling in 35(63%) cases. There was no pus found in 20(37%). There was no significant information recorded that would have predicted the presence or absence of pus in the peritonsillar space.     

Bilateral peritonsillar abscesses: not your usual sore throat

We describe a rare case of a previously healthy 30-year-old man who presented to the Emergency Department (ED) with bilateral peritonsillar abscesses. The clinical presentation of fever, trismus and odynophagia was consistent with pertonsillar abscess (PTA), but the presence of symmetric tonsillar swelling and midline uvula confounded the diagnosis. The true incidence of bilateral peritonsillar abscesses is unknown, but the incidence of unsuspected contralateral peritonsillar abscess identified at tonsillectomy has been reported to be between 1.9% and 24%. The diagnosis of bilateral peritonsillar abscesses should be considered when the clinical presentation suggests the diagnosis of PTA, but the physical examination reveals bilateral swollen tonsils with a midline uvula.     

The diagnostic value of levovist in Doppler imaging of visceral arteries in patients with abdominal angina before and after angioplasty

PURPOSE: To assess the diagnostic value of Levovist in the ultrasound imaging of visceral arteries in patients with clinical symptoms of abdominal angina, before and after percutaneous transluminal angioplasty (PTA). MATERIAL AND METHOD: During a 12-month period (2000/2001) five patients with visceral arterial stenoses had ultrasound examinations and a subsequent PTA procedure. Indications for ultrasound examination were abdominal angina symptoms persisting for 3-5 years, (postprandial abdominal pain, diarrhea, and vomiting). In all patients ultrasound examinations were performed using color and spectral Doppler before and after Levovist injections. Color Doppler images and maximum blood flow velocity in stenosed visceral arteries were assessed. Patients underwent control Doppler examinations with Levovist injections to assess the effect of PTA. RESULTS: In three patients conventional Doppler examination did not allow proper evaluation of visceral arteries, because of weak color and spectral Doppler signal and in two remaining patients visceral arteries were not visualized at all. In all five patients strong enhancement of color and spectral Doppler signal was observed after Levovist administration. In all these cases a hemodynamically significant stenosis was diagnosed: coeliac trunk-2 and superior mesenteric artery-3. PTA was performed successfully in these patients. In one of them ultrasound examination done before Levovist injection allowed good visualization of treated SMA and showed good PTA result. In the remaining four patients Doppler examination with the use of Levovist demonstrated visceral arteries well and confirmed successful PTA procedures. CONCLUSIONS: The use of Levovist makes the diagnostic efficiency of Doppler examinations much higher. In most cases it allows an unequivocal diagnosis of visceral artery stenosis in patients with abdominal angina symptoms. The Doppler examination with the use of Levovist is the method of choice in follow-up after PTA.     

高频及多普勒超声诊断甲状旁腺腺瘤及其并发症的价值

目的:探讨高频及多普勒超声诊断甲状旁腺腺瘤(PTA)及其并发症的价值。方法:回顾性分析了由超声检查发现并经手术证实的PTA 12例,同时检查胆囊、胰腺、肾、输尿管、膀胱、前列腺及软组织剧烈疼痛处。结果:高频超声对甲状旁腺肿瘤的定位和定性非常重要,尤以12MHz探头对发现较小瘤体极有价值。彩色多普勒可提供肿瘤血供情况,有助于PTA与甲状腺腺瘤的鉴别。PTA合并肾结石7例,膀胱结石3例,胆结石2例,下肢软组织钙化1例,前列腺钙化2例,复发性胰腺炎并胰管结石1例。结论:高频及多普勒超声可较准确地诊断PTA及其并发症。     

经静脉声学造影诊断下肢动脉病变的初步研究

目的：探讨经静脉声学造影诊断下肢动脉病变的应用价值,方法：12例患者接受造影检查,造影剂经左前臂静脉注射,结果：注射造影剂后,下肢动脉彩色血流信号增多,血流束增宽,8例股,Guo动脉得造影前闭塞段及其远侧血管均无彩色血流信号,造一闭塞段仍无彩色血流信号,但远侧2例胫前动脉和6例胫后动脉有细窄彩色血流束,并可见侧支血流汇入,另4例股,国动脉狭窄者,造影前3例胫前动脉和2例胫后动脉无彩色血流信号,但造影后仅2例胫产动脉无彩色血流信号,4例胫后动脉均有彩色血流,结论：经静脉超声造影有助于准确诊断下肢血管病变。