Diagnostic validity of radionuclide phlebography in the detection of clinically occult deep venous thrombosis in patients with thromboembolism

Diagnostic reliability of radionuclide phlebography (RNP) compared to contrast phlebography in the detection of deep veins' thrombosis (DVT) in patients with confirmed thromboembolism of the lungs (TEL) was evaluated. RNP. These findings were compared to contrast phlebography (CP), performed in the group of 25 patients in whom TEL was confirmed clinically, radiologically, scintigraphically and biochemically, but without clinical signs and symptoms of DVT. In 15 patients where RNP revealed unilateral DVT, CP finding was confirmed in all: in 6 (40%) on the left, and in 9 (60%) on the right side. In 10 patients with bilateral signs of DVT observed by scintigraphy, DVT finding was confirmed in 7 (70%), while in 3 (30%) patients, scintigraphic signs of DVT were falsely positive. In the segments of deep venous system, specificity of RNP in the detection of DVT in the lower leg was 60%, sensitivity was 100%, accuracy was 64% with 62% falsely positive findings. In the upper legs specificity was 79%, sensitivity was 100%, and accuracy was 86% with 24% falsely positive findings, while in the pelvis specificity was 87%, sensitivity was 100%, accuracy was 83% with 14% falsely positive findings.     

内镜治疗Roux-en-Y术后并发急性梗阻性化脓性胆管炎的新方法——经腹壁小肠造瘘逆行进镜ERC

目的 探讨上消化道重建术后患者无法经口完成内镜逆行胆管造影术(ERC)时经腹壁入路小肠造瘘ERC的价值.方法 2例胆管癌根治术后再发急性梗阻性化脓性胆管炎患者,因无功能空肠襻迂曲、过长,无法完成经口ERC,先行腹壁切开找到输入襻小肠造瘘,自瘘口送入胃镜,沿无功能空肠襻逆行进镜找到胆肠吻合口,行ERC并胆管支架置入术(ERBD).结果 行腹壁切开并成功于无功能空肠襻小肠造瘘,经造瘘口沿空肠襻逆行进镜发现胆肠吻合口狭窄,肝内胆管可见大量脓性黏液,遂扩张吻合口行ERC,并于扩张的肝内胆管主要分支内置入支架,患者术后恢复顺利.结论 胆管癌根治、Roux-en-Y上消化道重建术后患者罹患胆管疾病无法经口完成ERC时,经腹壁入路小肠造瘘逆行进镜行诊断及治疗性ERC是安全、有效的方法.     

Evaluation of low contrast resolution in cone beam CT using FPD

We examined the low contrast resolution of cone beam CT (CBCT) equipped with an indirect-type flat panel detector and compared it with a commercial CT unit (Robusto) . In CBCT, the X-ray tube voltage of 110 kV was used, and in the Robusto, the usual 120 kV was used for examinations. The computed tomography dose index (CTDI) of the two systems was measured, and images scanned at about the same exposure to radiation were compared. The modulation transfer factors of the two systems were measured, and the convolution kernel that was the nearest to the characteristic of CBCT was chosen among kernels of the Robusto. A water phantom with a diameter of 200 mm was scanned, Wiener spectra were calculated, and signal-to-noise ratios were compared. The low contrast resolution phantom was scanned, and detectability and contrast-to-noise ratio (CNR) were measured. In addition, we placed diluted contrast medium into a phantom, scanned the phantom, and measured the detectability and CNR. When the X-ray irradiation condition of CBCT was 75 mAs at 110 kV, the equal dose of radioactivity in the Robusto was 50 mAs at 120 kV. In the low contrast resolution phantom, detectability was 8.7%mm in CBCT, and 9.4%mm in the Robusto. In the low contrast resolution evaluation phantom, CNR was 1.39 in CBCT, and 2.69 in the Robusto. With diluted contrast medium, CNR was 1.28 in CBCT, and 0.60 in the Robusto. CBCT was inferior to the Robusto in a low contrast resolution phantom, but CBCT was superior to the Robusto using diluted contrast medium. We found that CBCT was useful in examinations using contrast media.     

Sonographic diagnosis of biliary atresia in pediatric patients using the "triangular cord" sign versus gallbladder length and contraction

OBJECTIVE: A retrospective review was performed to evaluate the importance of the "triangular cord" sign in comparison with gallbladder length and contraction for the diagnosis of biliary atresia in pediatric patients. MATERIALS AND METHODS: Fifty-five fasting infants with cholestatic jaundice were examined on sonography. The examinations focused on the visualization of the triangular cord sign and assessment of gallbladder length and contraction. The diagnosis of neonatal hepatitis or of other causes of infantile cholestasis was made if symptom resolution occurred during follow-up. RESULTS: A triangular cord sign was found in 27 of 29 infants with biliary atresia and in one of 26 infants with neonatal hepatitis or other causes of infantile cholestasis. The diagnostic accuracy was 95%, sensitivity was 93%, and specificity was 96%. The gallbladder was thought to be abnormal if it was less than 1.5 cm long, was not detectable, or was detectable but had no lumen. The gallbladder was abnormal in 21 of 29 infants with biliary atresia, whereas it was abnormal in eight of 26 infants with neonatal hepatitis or other causes of infantile cholestasis. The diagnostic accuracy was 71%, sensitivity was 72%, and specificity was 69%. The gallbladder was detectable on sonography in 13 infants with biliary atresia and 26 infants with neonatal hepatitis or other causes of infantile cholestasis. Gallbladder contraction was not confirmed in 11 of 13 infants with biliary atresia and seven of 26 infants with neonatal hepatitis or other causes of infantile cholestasis. The diagnostic accuracy was 77%, sensitivity was 85%, and specificity was 73%. CONCLUSION: The triangular cord sign was a more useful sonographic finding for diagnosing biliary atresia than gallbladder length and contraction.     

听骨链螺旋CT三维表面遮盖显示技术的临床应用

目的 探讨听小骨螺旋CT三维表面遮盖显示技术(SSD)的临床应用价值及相关的技术要点。资料与方法 对43例患者进行螺旋高分辨率CT扫描，利用密集放大的重建图像，采用手动编辑，先移去听小骨周围的骨质，仅保留听小骨，用经编辑的轴位图像进行SSD三维成像。结果 40侧正常耳的听小骨三维SSD显示了听小骨的细微结构，还反映了听小骨之间的关系。病变听小骨的三维SSD重建图像与轴位图像的表现基本相符；慢性中耳炎25耳中，22耳进行了听小骨SSD成像，10耳见有骨质破坏；先天性外、中耳畸形16耳均见有听小骨发育不良；外伤后听力下降5耳中，1耳锤砧关节脱位和1耳并有移位的锤骨骨折在听小骨三维SSD成像直观地显示。结论 螺旋CT扫描和三维SSD有利于听小骨的显示和病变的诊断。     

椎弓根外穿刺撬拨复位椎弓根钉固定治疗胸腰椎骨折

目的探讨经椎弓根外穿刺撬拨复位椎弓根螺钉固定治疗胸腰骨折的可行性和有效性。方法回顾性分析2012年2月—2015年3月深圳平乐骨伤科医院收治的64例胸腰椎骨折患者,观察组和对照组各32例,观察组采用经椎弓根外穿刺撬拨复位、植骨、椎弓根钉内固定治疗,对照组采用椎弓根钉棒撑开复位固定、经伤椎椎弓根穿刺植骨治疗。记录手术时间、术中出血量、术后引流量、住院时间;测量术前、术后伤椎体前、后缘高度比和后凸Cobb角;同时对两组患者进行手术前、后VAS评分和Oswestry功能障碍指数评分。结果观察组与对照组相比较,术前VAS评分[(6.782±1.821)%vs.(6.827±1.762)%]、术前伤椎体前缘高度百分比[(57.658±23.645)%vs.(58.162±24.852)%]、术前伤椎体后缘高度百分比[(88.645±8.624)%vs.(87.927±7.848)%]、术前后凸Cobb角[(28.665±4.824)°vs.(29.134±5.508)°]、手术时间[(135.675±23.318)min vs.(130.731±21.761)min]、术中出血量[(456.214±63.525)m L vs.(461.532±60.753)m L]、术后引流量[(43.847±16.358)m L vs.(42.971±15.523)m L]、住院时间[(10.878±2.148)d vs.(11.323±2.512)d]、术后末次随访VAS评分(0.184±0.263 vs.0.195±0.325)和Oswestry功能障碍指数(2.463±0.652 vs.2.624±0.765),差异均无统计学意义(P0.05)。观察组与对照组相比较,术后末次随访伤椎体前缘高度百分比(98.083±1.635)%vs.(93.157±2.019)%、后缘高度百分比[(98.504±2.572)%vs.(96.248±4.824)%]和后凸Cobb角[(3.623±2.563)°vs.(7.626±3.613)°],差异均有统计学意义(P0.05)。结论经椎弓根外穿刺撬拨复位椎弓根螺钉固定治疗Denis B型、D型胸腰椎体压缩骨折、B型椎体爆裂骨折,可较好恢复椎体前、后缘高度,矫正后凸Cobb角。     

Thermal ablation of the gallbladder

Gallbladder ablation by means of injection of hot contrast medium was attempted in 13 dogs. Room temperature contrast medium was injected into the gallbladders of two additional dogs (controls). After midline laparotomy was performed to expose the gallbladder, temperature probes were placed in the liver adjacent to the gallbladder, and on the surface and in the lumen of the gallbladder. A 7-F catheter with multiple side holes was placed into the gallbladder. The cystic duct was clamped during the procedure. After injection of boiling contrast medium, the mean temperature in the gallbladder lumen was 80 degrees C; in the adjacent liver, 43.5 degrees C; and on the gallbladder surface, 45.8 degrees C. After the procedure, the cystic duct was unclamped, temperature probes and catheter were removed, and the laparotomy was closed in standard fashion. In the hot contrast medium group, one dog each was sacrificed at 2, 4, 8, and 12 weeks, and at 6 months. Six animals were sacrificed at 1 year. The gallbladder was completely ablated in 11 of 13 animals in the hot contrast medium group. One dog was sacrificed at 8 days because of bile leakage, and another was sacrificed at 17 days because of gallbladder rupture. The two control animals were sacrificed at 12 and 13 weeks, and their gallbladders were normal at that time.     

参芪扶正注射液联合化疗治疗恶性肿瘤的临床研究

目的比较参芪扶正注射液联合化疗与单纯化疗治疗恶性肿瘤的临床疗效及不良反应。方法入选的62例患者随机分为两组,观察组32例,采用参芪扶正联合化疗,平均化疗5.7周期。对照组30例,单纯化疗,平均化疗5.6周期。结果观察组完全缓解（CR）3例,部分缓解（PR）12例,稳定（NC）11例,进展（PD）6例,总有效率46.9%。对照组CR 1例,PR 9例,NC 11例,PD 9例,总有效率33.3%。治疗组与对照组比较,治疗组T细胞亚群CD3、CD4和CD4/CD8比值明显升高,差异有显著性（P〈0.01）。治疗组生活质量较对照组明显改善。结论参芪扶正注射液联合化疗治疗恶性肿瘤可以减轻化疗的不良反应,使患者化疗依从性更好,增强机体的免疫功能,改善患者生活质量。     

血管内超声在1例颈内动脉闭塞患者介入治疗中的应用

目的 探讨血管内超声(IVUS)技术在颈内动脉闭塞经皮腔内血管成形术(PTA)中的应用价值.方法 1例患者CTA明确颈内动脉闭塞,脑灌注成像见低灌注区与缺血相关症状符合,在IVUS导引下接受PTA治疗.采用微导丝及微导管同轴技术通过闭塞段,IVUS确认位于真腔内,微导管造影确认闭塞远端血管通畅,调整后放置栓塞保护器;IVUS测评斑块及管腔情况,球囊预扩张后再次测评;血管内恢复正向血流后通过IVUS虚拟组织学序列分析斑块稳定性,斑块纤维帽稳定且管腔狭窄率＜40％仅作单纯球囊扩张治疗.结果 单纯球囊扩张治疗后闭塞血管再通,恢复正向血流.IVUS全程检测狭窄段斑块纤维帽稳定,管腔狭窄率＜40％,脑灌注成像显示低灌注状态明显改善.结论 IVUS技术在PTA治疗颈内动脉闭塞中起重要导引作用,可增加再通手术成功率,降低并发症发生率.     

纠正型大动脉转位double switch术后超声心动图随访

目的:评估双调转术(double switch operation)治疗纠正型大动脉转位(corrected transposition of the great ar-tery,CTGA)的手术效果。方法:35例CTGA行Double switch术,其中Senning+ASO(大动脉调转术)20例,Senning+Rastelli术15例。采用回顾性研究的方法,术后1次或多次行超声心动图随访,平均随访(16.8±20.9)月,最长术后8年,最短术后1月。结果:术后右室心肌工作指数较术前明显下降,术后三尖瓣反流减轻。术后总的肺静脉梗阻发生率5.7%,腔静脉梗阻发生率2.8%,左心流出道梗阻发生率11.4%,右心流出道梗阻发生率11.4%,残余分流发生率17.1%。Senning+Rastelli组左室流出道梗阻发生率较高。结论:Double switch术可改善右室功能,减轻三尖瓣反流,术后残余分流及梗阻发生率较低,是治疗CTGA的理想手术方法。     

原发纵隔囊肿影像学表现

目的探讨原发纵隔囊肿影像表现特征,提高影像诊断的准确率。方法回顾性分析经手术病理证实且资料完整的42例原发纵隔囊肿的影像学表现。所有病例均摄胸部后前位与侧位片,胸部CT平扫29例,其中15例行增强扫描,胸部MRI平扫6例。观察病变的部位、大小、形态、密度(信号)、边缘、壁及其厚度、邻近结构。每一病种均分为影像征象典型与不典型2类。结果病变位于前纵隔28例,中、后纵隔各7例。上纵隔9例,中纵隔24例,下纵隔9例。支气管囊肿9例,囊性淋巴管瘤4例,胸腺囊肿11例,心包囊肿5例,成熟性囊性畸胎瘤13例。影像征象典型38例,不典型4例。结论90%的纵隔囊肿,根据CT、MRI显示的病变部位与内部密度、信号特征,可做出正确的影像诊断;不典型者确诊仍依靠手术病理。     

放弃医学治疗临终最晚期癌症患者全营养食疗研究报告

目的:通过对放弃医学治疗临终最晚期癌症患者进行全营养食疗,提供给患者所有正常细胞活动所需的全部营养成分,包括碳水化合物、蛋白质(全部氨基酸)、脂肪酸(多种)、维生素、矿物质、微量元素和干细胞营养物质(简称再牛物质),同时结合生物钟饮食计划,使人体中80%的细胞按其自身的活动或休息所需的不同营养,得到不同的营养成分.最大可能地保障各种营养食物充分消化、吸收和利用,使所有正常细胞得到强壮,实现组织器官再生和功能恢复,抵抗癌细胞对正常细胞的伤害,起到营养抗癌的目的.探索全营养食疗对临终最晚期癌症患者具有抗癌效果的可能性.方法:患者或家属在网上注册并填写全营养食疗申请表,上传病历资料.专家组根据病历资料进行审核,将符合研究条件的患者纳入本研究,提供美宝牌胃肠胶囊和膳素,患者或家属按要求1d～3d汇报病情及每餐的饮食成分和量,专家在网上结合牛物钟饮食计划给予饮食指导和解答患者、家属咨询.结果:1.参加全营养食疗超过15d的患者总的存活率73.04%,死亡率26.96%.最晚期癌症临终期生存率44.44%,死亡率55.56%;最晚期癌症进展期生存率84.00%,死亡率16.00%;最晚期癌症相对稳定期生存率100%.2.参加全营养食疗超过1个月的患者总的存活率72.91%,死亡率27.09%.最晚期癌症临终期牛存率44.44%,死亡率55.56%;最晚期癌症进展期生存率83.87%,死亡率16.13%;最晚期癌症相对稳定期生存率100%.3.参加全营养食疗超过2个月的患者总的存活率71.58%.死亡率28.42%.最晚期癌症临终期生存率41.67%,死亡率58.33%;最晚期癌症进展期生存率83.48%,死亡率16.52%;最晚期癌症相对稳定期生存率100%.4.参加全营养食疗超过3个月的患者总的存活率67.70%,死亡率32.30%.最晚期癌症临终期牛存率40.00%,死亡率60.00%;最晚期癌症进展期生存率79.35%,死亡率20.65%;最晚期癌症相对稳定期生存率100%.5.参加全营养食疗超过4个月的患者总的生存率57.35%,死亡率42.65%.最晚期癌症临终期牛存率33.33%,死亡率66.67%;最晚期癌症进展期生存率61.54%,死亡率38.46%;最晚期癌症相对稳定期生存率100%.结论:无论是总的生存率,还是各期最晚期癌症和各种癌症的生存率都明显提高,能明显改善患者的胃肠道功能,提高部分患者的睡眠质量,增加部分患者体重,增强部分患者的体力,减轻部分病人疼痛,达到延长患者生命,提高患者生活质量和减轻患者痛苦等作用.其结果与我们在细胞学和动物实验学实验中的规律相同.     

营口市2015年流行性出血热疫情分析及2016年预测

目的：分析2015年营口地区流行性出血热的流行病学特征,并对2016年流行性出血热发病趋势进行预测,为制定防控措施提供科学依据。方法采用描述性流行病学分析方法对2015年营口市流行性出血热疫情以及鼠密度和鼠带毒率进行分析。结果营口市2015年流行性出血热发病64例,发病率为2.74／10万,发病高峰为3月份和5月份,均占发病总数的42.31％;春季鼠密度为2.11％,鼠带毒率为5.88％;秋季鼠密度2.02％,鼠带毒率为3.77％。发病率与鼠密度间的相关系数0.989,P值为0.000,提示发病率与鼠密度呈正相关关系。而发病率与鼠带毒率间的相关系数0.047,P值为0.449（＞0.05）,鼠密度与鼠带毒率间的相关系数0.071,P值为0.423（＞0.05）,尚不能认为发病率与鼠带毒、鼠密度与鼠带毒存在线性关系。结论营口地区流行性出血热发病率与鼠密度密切相关,由于近年来鼠密度监测无太大差异,预测2016年流行性出血热发病仍将维持2012－2015年平均水平。     

糖尿病大鼠胃窦平滑肌细胞内钙离子的变化及意义

目的　探讨糖尿病大鼠胃窦平滑肌细胞内钙离子(Ca2 + )的改变及其意义。方法　 5 0只大鼠随机分为对照组 (n =2 0 )和糖尿病模型组 (n =30 ) ,用链尿佐菌素建立大鼠糖尿病模型 ,3个月后测定胃排空时间 ,并用流式细胞仪测定平滑肌细胞凋亡发生率 ,用激光共聚焦方法测定细胞内Ca2 + 浓度。结果　与对照组大鼠相比 ,模型组大鼠胃排空时间明显延长(P <0 0 1) ,平滑肌细胞凋亡发生率及细胞内Ca2 + 浓度明显增加 (P <0 0 1)。结论　糖尿病大鼠胃窦平滑肌细胞内Ca2 + 增加 ,从而使平滑肌细胞受损 ,平滑肌功能发生相应改变。     

X线透视引导下碘化油肺减容的动物实验研究

目的:研究X线影像引导下碘化油灌注联合丙烯酸树脂骨水泥封堵支气管实现肺减容的可行性。方法:20只健康新西兰白兔分为试验组12只,对照组8只,常规麻醉消毒,行气管切开,在数字多功能X线机下,置入导管,60%碘普罗胺支气管造影,然后选择性支气管插管,先后将适量的40%碘化油和骨水泥注射到所选肺叶内,对照组不注射骨水泥。常规喂养,术后20 d处死,肺组织病理切片。结果:试验组死亡4例,术后轻度发热6例,精神萎靡、活动减少、呼吸急促8例。胸部X线片示:术后见封堵肺叶内大片高密度影8例,第3～14天范围逐渐缩小,其余肺叶内有散在高密度影5例。解剖见封堵肺叶不张、体积缩小约2/3左右。病理切片:封堵肺组织弥漫性不张、机化,大量炎性渗出物和炎细胞浸润,胸膜明显增厚,未见脓肿形成。对照组:死亡1例,轻度发热2例,精神萎靡、活动减少6例,呼吸急促3例,3 d后症状消失。胸部X线片示:多处肺野散在点片状高密度影,7 d后减少,14 d后大部分消失。病理切片未见明显异常。结论:X线影像引导下,使用碘化油加骨水泥封堵支气管可导致肺炎变、机化和不张,从而实现微创下肺减容。     

Craniovertebral junction tuberculosis: a review of 29 cases

PURPOSE: The purpose of this work was to describe the various imaging findings in craniovertebral tuberculosis and the importance of imaging in treatment in these patients. METHOD: A retrospective review of MR and CT scans in 29 patients with craniovertebral tuberculosis was performed. The images were reviewed, paying special attention to both bony (skull base, atlas, and axis) and soft tissue involvement in addition to atlantoaxial dislocation, lateral subluxation of the dens, and compression of the spinal cord. RESULTS: Suboccipital pain with neck stiffness was the most common presenting symptom in our patients. The skull was involved in 19 of the 29 cases, clivus involvement was seen in 11 patients, and occipital condyle involvement was present in 14 patients. Detailed analysis of atlas involvement due to tuberculosis showed the lateral masses to be predominantly affected. The dens was involved in 18 cases (62%). Soft tissue masses in the prevertebral area were seen in 22 patients, paravertebral in 27 patients, and epidural involvement in 25 patients was identified. Atlantoaxial displacement was present in seven cases, lateral mass-dens subluxation in five, and superior subluxation of the dens through the foramen magnum compressing the medulla was seen in two cases. Spinal cord compression with intrinsic cord changes was noted in 12 cases. All patients received multidrug antituberculous therapy for 1 year. The presence of neurologic deficit and instability of the atlantoaxial complex was pivotal in further management in these patients. CONCLUSION: A high degree of clinical suspicion is necessary when confronted with patients with neck stiffness and tenderness over the upper cervical vertebrae. MRI in these patients provides a sensitive method for the diagnosis of craniovertebral tuberculosis.     

Long term results of Cathetron high dose rate intracavitary radiotherapy in the treatment of carcinoma of the cervix.

Between 1967 and 1974, 371 patients with carcinoma of the cervix have been treated by a combination of external beam radiotherapy and fractionated high dose rate brachytherapy using the Cathetron. A retrospective review was undertaken in 1986 and median follow-up time was 6 years. Life table analysis of survival and complications to 16 years was undertaken. International Federation of Gynaecology and Obstetrics (FIGO) stage distribution was 26%, 46% and 28% for Stages I, II and III, respectively, and 5 year survival was likewise 94% 63% and 37%. Age and histological type or grade were not found to influence survival. Recurrent disease was recorded in 142 patients; the first site was within the pelvis in 25% and as distant metastases in 17%. Following development of pelvic recurrence median survival was 28 weeks. Salvage surgery was performed in 32 patients, of whom five probably obtained survival benefit. Significant late morbidity was seen in a total of 71 patients (19%); in seven patients this was at more than one site. Late morbidity to the small bowel was recorded as Grade 2 in 10 patients and Grade 3 in 13; to the rectum, Grade 2 in 10 patients and Grade 3 in two patients; to the bladder, Grade 2 in 15 patients and to the vagina Grade 2 in 29 patients. Median time to onset for small bowel morbidity was 14 months, for rectum 18 months, for vagina 20 months and for bladder 52 months. 82% of all late morbidity had been seen by 5 years of follow-up, no case of late morbidity of recurrence was seen between 11 and 18 years of follow-up. These results are comparable to those reported for other methods in use at the time the patients were treated.     

Compensation for influence on image deterioration occurring because of gantry inclination--compensation of image quality obtained by a newly devised phantom

The influence of gantry inclination on image quality was examined in the Y and Z directions and an increase in the volume of a scan part. FWHM (full width at half maximum) in the Y direction decreased at the rate of 2.53%, which was caused by leaving the center of the gantry, and spatial resolution was improved. FWHM (y) in the Z direction increased at a rate of y=2.4x (1/costheta)+0.91 which was caused by an increase in the gantry angle of inclination, and spatial resolution was declined. The relation between FWHM (y) and pitch (x) was y=0.19x+3.12. The increase in FWHM caused by the increase in the gantry angle of inclination was revised with pitch from two formulae, and it became constant. Noise was corrected in the same way, and it became constant. The increase in the noise that occurs due to the increase in the volume of the body caused by the gantry tilt angle was corrected with the tube current, and applied to AEC (automatic exposure control). The influence of gantry inclination on image quality was adjusted, and image quality was improved.     

Fatal injections of heroin. Interpretation of toxicological findings in multiple specimens

We report two fatalities due to injection of heroin. The first case was witnessed but during the early phase of the police investigation the question was raised whether the injection was self-administered. Multiple samples were collected from different sites and analysed in order to establish drug distribution and to determine the site of injection. Fresh injection marks were found in both antecubital fossae but histological examination failed to settle which one was the last. However, toxicological analysis of the tissues at the injection sites indicated that the injection in the right arm was the last one. This was consistent with the suspicion that the victim was given the injection by another person although probably in agreement with the deceased. In the second case, a similar toxicological procedure was used. This fatality was not witnessed, however ample evidence indicated that it was an isolated event in a former intravenous heroin addict and there was only one fresh injection mark. Even in this case, the concentration of morphine was much higher in the tissue sample from the injection mark than in any of the blood samples. Received: 19 January 1998 / Received in revised form: 23 April 1998     

Sonography of the glenoid labrum: a cadaveric study with arthroscopic correlation

OBJECTIVE: We assessed the usefulness of sonography in evaluating the glenoid labrum in cadaveric specimens using arthroscopy as a standard of reference. MATERIALS AND METHODS: Eighty labral quadrants in 20 cadaveric shoulders were examined by two musculoskeletal radiologists using 5- to 7-MHz linear and curvilinear transducers. Agreement was reached by consensus. After sonography, arthroscopy was performed by an experienced orthopedic surgeon. Each labral quadrant was classified at the time of sonography and arthroscopy as normal, degenerated, or torn. RESULTS: Concordance between sonography and arthroscopy was 86% (69/80 quadrants). In differentiating abnormal labrum (tear or degeneration) from normal labrum using sonography, sensitivity was 63%, specificity was 98%, positive predictive value was 94%, negative predictive value was 86%, and accuracy was 88%. In differentiating labral tears from other labral conditions (degeneration or normality), sensitivity was 67%, specificity was 99%, positive predictive value was 67%, negative predictive value was 99%, and accuracy was 98%. CONCLUSION: Sonography has a promising role in the evaluation of the glenoid labrum, particularly in excluding labral tears when the labra appear normal on sonography. Further studies are required using normal and symptomatic patients to determine the usefulness of sonography in the diagnosis of labral abnormalities.