X线鉴别诊断责门痉挛和责门失弛缓症

作者报告135例贲门痉挛和25例贲门失弛缓症,患者年龄为11～71岁,按食管管径分为四度。一度贲门痉挛4例,二度51例,三度71例,四度9例。二度贲门失弛缓症9例,三度12例,四度4例。作者从食管宽径、形状、第一口钡剂能否顺利入胃、食管狭窄段形态、食管运动机能、钡剂排出和排出时钡流宽窄等方面叙述了两者的鉴别。贲门痉挛:一度患者食管宽2～2.5厘米,钡剂通过无障碍,蠕动正常,远段食管狭窄段轮廓光滑,钡剂在贲门之下有暂短性停留,此期患者X 线     

小儿贲门失弛缓（附15例报告）

目的：为了研究小儿贲门失弛缓的Ｘ线表现，材料与方法，回顾性分析１５例（其中１２例手术证实）贲门失弛缓的临床，Ｘ线表现。结果：食管钡餐检查显示：（１）食管下端鸟嘴样改变和不能松弛的狭窄；（２）食管轻～重度扩张，其内可见分泌液和钡剂潴留；（３）食管蠕动减弱或消失，通常可见３级蠕动波。结论：食管钡餐检查是诊断本病的主要方法。     

贲门失弛缓症球囊扩张成形术食管迟发破裂一例

患者男，55岁。反复呕吐、吐隔夜食30余年，透视见右纵隔影显著增宽。吞钡见食管扩大近10cm，内有大量潴留物，胸3平面见-长约6cm之液平，钡剂絮样沉积，贲门呈鸟嘴样狭窄，钡剂不能进入胃内。X线诊断：贲门失弛缓症。于2002年1月30在我科行贲门失弛缓症球囊扩张成形术。常规口咽黏膜麻醉，经口置入0．35黑泥鳅导丝通过贲门入     

实时数字采集电影回放技术对食管病变的诊断价值

目的:探讨实时数字采集电影回放技术对食管病变的临床诊断价值。方法:用日本岛津Shmadzu数字胃肠系统(DGIS)检查并诊断40例食管病变患者。患者立位口服钡剂,同时运用实时数字采集技术7.5帧/秒。通过电影回放观察食管双对比像及运动功能像作出诊断。结果:40例中食管癌16例,其中早期食管癌5例,中、晚期食管癌11例;食管癌手术后吻合口狭窄14例;食管憩室2例;食管静脉曲张5例;贲门失弛缓症2例;弥漫性食管痉挛1例。26例经病理及食管镜检查证实,14例术后吻合口狭窄经临床随访证实。主要X线表现:不同病变在双对比像上均有不同程度及性质的轮廓和粘膜改变,在运动功能像上则表现为特征性的运动功能失常。结论:实时数字采集电影回放技术能提供全面的造影信息,在食管病变诊断中有一定的优势及价值,且数字化的造影信息更方便传输与存储。     

食管贲门失弛缓症并发食管癌二例报告

例1 男,31岁。10年前曾因进食不畅在外院两次X线检查诊断为“贲门痉挛”。近三个月进食梗噎感加重,伴胸骨后疼痛和反复呕吐,吐出物内带血。查体及实验室检查未见明显异常。X线检查,食管中段有一约3.0×6.0cm的不规则充盈缺损,粘膜破坏,管腔明显狭窄。食管下端变尖呈萝卜根状,其上方食管扩张,蠕动消失,钡剂通过受阻(图1)。胃泡消失。X线诊断为贲门失驰缓症合并食管中段癌或肉瘤。     

小儿食管裂孔疝的X线诊断

目的：分析与复习小儿食管裂孔疝的X线诊断。方法：回顾分析我院60例X线钡餐造影发现食管裂孔疝后经手术证实的病例，结合相关文献复习其影像学特征。结果：60例患儿中有32例胸片可见膈上出现疝囊，吞钡后呈囊状、漏斗状或葫芦状，膈上可见胃粘膜及食管一胃环。当腹压增高时疝囊明显，减小时可消失，并多伴有食管持续反流；14例胸片心影后方可见软组织包块影，有时有气液面。吞钡后胃的部分突入胸腔，贲门位置有11例位于膈下，3例位于膈上；4例食管短而直，贲门位置在胸7—8水平。60例患儿中有1例合并食道狭窄，2例合并有贲门失弛缓症。结论：食管裂孔疝有典型的X线征象，X线检查可以明确不同类型的诊断，为临床提供手术依据。     

食管动力的放射学评价

作者回顾了经放射学和食管测压检查的170例胸痛病人,以明确放射学检查对食管动力的正常和异常的价值。女106例,男64例,年龄23～87岁。以食管测压做为诊断标准,测得食管动力正常114例,异常56例,其中非特异性食管动力异常(NEMD)27例,坚果钳样食管16例,弥漫性食管痉挛(DES)10例,贲门失弛缓症2例。用遥控设备做食管多相检查,病人俯卧斜位一次咽下钡剂后透视观察通过食管的长度,注意原发蠕动状态和其它异常功能。     

贲门失弛缓症合并食管上段癌1例报告

食管贲门失弛缓症合并食管上段癌较少,我院遇到一例X线表现较典型并经胃镜病理证实,报告如下。     

贲门失弛缓症内窥镜气囊扩张术后食管改变

作者报告16例贲门失弛缓症病人经内窥镜胶囊扩张术后的食管造影表现,所有病人术前都摄了食管X线片以利对照,采用Wited胶囊扩张器扩张后24小时内即行食管造影检查以排除食管穿孔。扩张术后6个月～24个月里采取稀钡造影定期复查。作者见到,扩张术后,16例中14例吞钡困难症状得到改善,1例并发穿孔需外科手术。贲门部扩张前平均宽径为3.5mm,扩张后平均宽径增加至10mm,     

腹腔镜在治疗胃食管反流病和贲门失弛缓症中的应用

 目的 探讨腹腔镜手术在治疗胃食管反流病和贲门失弛缓症中的临床应用价值.方法 经腹腔镜手术治疗胃食管反流病和贲门失弛缓症30例,其中胃食管反流病21例,行食管裂孔疝修补加Toupet胃底折叠17例,单纯Toupet式胃底折叠4例;贲门失弛缓症9例,行Heller肌切开加Dor胃底折叠术.结果 本组无中转开腹.手术时间70～300 min,平均110 min.术中出血量10～200 ml,平均15 ml.住院时间6～16 d.29例临床症状基本消失,术后食管测酸、测压均恢复正常范围.3例胃食管反流病患者术后存在轻度的反酸、烧心症状,1例贲门失弛缓症患者又出现间歇性吞咽困难,均经内科短期治疗后缓解.结论 腹腔镜手术治疗胃食管反流病和贲门失弛缓症具有显露好、创伤小、恢复快、疗效好等优点,值得推广应用.     

二维超声和数字胃肠对照诊断贲门癌的价值

目的:探讨二维超声与数字胃肠检查对贲门癌的诊断价值。方法:将68例经胃镜活检或手术证实的贲门癌患者的超声及胃肠检查结果与病理结果进行对照。结果:超声与胃肠检查对贲门癌的诊断符合率分别为86.8%、92.6%,无明显差异。对早期贲门癌胃肠检查诊断符合率为77.3%,高于超声的诊断符合率59.1%。而在癌肿对周围组织浸润及远处转移方面的诊断,超声具有无法比拟的优势。结论:超声与胃肠检查相结合诊断贲门癌,可以为临床提供较全面的诊断信息,对临床决策及选取手术方案具有重要价值。     

法乐氏五联症的X线和二维脉冲多普勒超声的诊断(附10例报告)

目的：评价Ｘ线和二维脉冲多普勒超声对法乐氏五联症的诊断价值。方法：１０例患者,男性５例,女性５例;年龄２．５～２４岁。平均１０．６岁。１０例Ｘ线胸片,其中７例曾行右心导管和右心室造影检查。１０例均行二维脉冲多普勒超声检查。结果：手术证实,１０例均为法乐氏五联症。结论：本组１０例法乐氏五联症患者的术前检查意见与手术中所见对比分析,认为右心导管和右心室造影是法乐氏五联症术前必不可缺的检查。Ｘ线和超声检查相结合,能对法乐氏五联症做出更全面的术前诊断。     

Detection of groin hernia with physical examination, ultrasound, and MRI compared with laparoscopic findings

OBJECTIVE: To determine the diagnostic accuracy of physical examination, ultrasound, and dynamic MRI in patients with inguinal hernia. METHODS: In 41 patients with clinically evident herniations, 82 groins were evaluated using a standard ultrasound and MRI protocol, the latter including T1- and T2-weighted sequences as well as two dynamic sequences. All ultrasound examinations and MRI scans were reviewed without knowledge of clinical findings. In all cases, correlation with findings at laparoscopic surgery was made. RESULTS: At surgery, 55 inguinal herniations were found. Physical examination revealed 42 herniations (one false-positive finding), whereas ultrasound made the diagnosis of a hernia in 56 cases (five false-positive and four false-negative findings). MRI diagnosed 53 herniations (one false-positive and three false-negative findings). Thus, sensitivity and specificity figures were 74.5% and 96.3% for physical examination, 92.7% and 81.5% for ultrasound, and 94.5% and 96.3% for MRI. CONCLUSIONS: In patients with clinically uncertain herniations, MRI is a valid diagnostic tool with a high positive predictive value.     

经直肠超声在妇科疑难病例检查中的应用

目的：探讨经直肠超声在妇科疑难病例检查中的应用价值。方法选取2011年7月～2013年7月在我院不适合经阴道超声检查的疑难病例74例,分别进行常规经腹超声检查和经直肠超声检查,根据手术后的病理或临床随访检验经直肠超声检查的正确率,对比经过两种不同途径超声诊断的结果。结果对于不适合经阴道超声检查部分疑难病例,常规经腹超声检查符合率74．3％,经直肠超声检查符合率96．0％,二者之间的差异有统计学意义（ P ＜0．05）。结论相对于经腹超声,直肠超声具有明显的优越性,在妇科临床检查中,对不适合经阴道超声检查的患者,经直肠超声能够弥补腹部超声的不足,具有较高的应用价值,值得在临床广泛推广。     

Ultrasonic detection of nonopaque renal calculi

Four patients with 5 nonopaque renal calculi composed of uric acid were examined by ultrasound. The calculi varied in size from a 1.5 X 1.5-cm intrapelvic stone to a staghorn calculus measuring 4 cm. All stones were satisfactorily imaged by ultrasound, allowing a diagnosis of nephrolithiasis to be made with confidence in each case. In 2 patients with poor excretion on urography, the diagnosis was not suspected prior to the ultrasound examination. The authors feel that ultrasound has great potential value in the investigation of nonopaque filling defects of the renal pelvis and in patients with urographic nonvisualization who have a high risk of uric acid lithiasis.     

纵隔肿瘤声像图特征与病理对照分析

目的 :探讨纵隔肿瘤超声诊断的价值。材料和方法 :将怀疑纵隔肿瘤的 3 8例患者的声像图与病理诊断进行对照分析。结果 :超声诊断纵隔肿瘤 2 9例 ,漏、误诊 9例 ,诊断符合率为 76 4%。结论 :超声检查能直接观察纵隔肿瘤的内部结构 ,鉴别其属实质性或囊性 ,探查其与血管的关系。超声检查纵隔肿瘤有一定的诊断价值。     

Ultrasound evaluation of ectopic pregnancy including correlation with human chorionic gonadotrophin levels

A total of 267 patients referred for ultrasound examination because of clinical suspicion of ectopic pregnancy were studied prospectively. The outcome was correlated with the ultrasound findings and human chorionic gonadotrophin levels using a quantitative serum assay. The value of the following in the diagnosis of ectopic pregnancy are assessed: ultrasound criteria for early diagnosis of intrauterine pregnancy before visualization of a viable fetus, the discriminatory zone of hCG and extrauterine abnormalities.     

The indications for scrotal ultrasound

Scrotal ultrasound scanning is now a routine and mandatory investigation of the patient presenting with scrotal symptoms. The need for scrotal ultrasound scanning when the physical examination reveals no significant abnormality has not been previously assessed. We conducted a retrospective study of 160 patients attending for scrotal ultrasound over a period of 1 year. The accuracy of clinical examination was compared with the gold standard of ultrasound for identifying clinically significant lesions. The sensitivity, specificity and positive and negative predictive values were calculated. Four clinically relevant groups were used for analysis purposes: Group I, acutely painful scrotum with or without swelling; Group II, chronic testicular pain without swelling; Group III, chronic scrotal swelling with or without pain; and Group IV, the asymptomatic testis. In Group I, sensitivity was 100%, specificity was 81.3%, the positive predictive value was 92.1% and the negative predictive value was 100%. In Group II, sensitivity was 71.4%, specificity was 90.9%, the positive predictive value was 76.9% and the negative predictive value was 88.2%. In Group III, sensitivity was 88.9%, specificity was 66.7%, the positive predictive value was 92.3% and the negative predictive value was 57.1%. In Group IV, sensitivity was 33.3%, specificity was 100%, the positive predictive value was 100% and the negative predictive value was 93.9%. All clinically significant abnormalities were identified on clinical examination. Clinically insignificant lesions identified by ultrasound alone did not affect the clinical management. It is recommended that scrotal ultrasound is used in the acutely painful scrotum where a confident diagnosis cannot be made or there is failure to respond to treatment, and in the chronic swelling where a confident clinical diagnosis cannot be made.     

Comparison analysis between conventional ultrasonography and ultrasound elastography of thyroid nodules

Objective

To compare the effectiveness of conventional ultrasonography and ultrasound elastography in differential diagnosis of thyroid nodular diseases.

Methods

244 patients with 291 thyroid nodules were examined by ultrasonography and ultrasound elastography respectively; the examination results were compared against pathological findings to determine the effectiveness of these two examination methods.

Results

The sensitivity and positive predictive value of conventional ultrasonography is higher than those of ultrasound elastography, but its specificity, accuracy, and negative predictive value is lower than those of the later.

Conclusions

Ultrasound elastography is superior to conventional ultrasonography in differential diagnosis of thyroid nodules. However, ultrasonography is the basis of examination; only on this basis, an additional ultrasound elastography examination could greatly improve the diagnostic rate of thyroid nodular diseases.     

Initial experience with magnetic resonance fluoroscopy in the evaluation of oesophageal motility disorders. Comparison with manometry and barium fluoroscopy

The aim of this paper was to assess the diagnostic value of magnetic resonance (MR) fluoroscopy in the study of oesophageal motility disorders and to compare MR fluoroscopy results with those of manometry and barium contrast radiography. Twenty-five subjects referred for dysphagia and three patients in follow-up after pneumatic dilatation of the lower oesophageal sphincter to treat severe achalasia underwent esophageal manometry, barium contrast radiography and MR fluoroscopy. Examinations were performed on a 1.5 T scanner. Dynamic turbo- fast low angle shot (turbo-FLASH) sequences acquired during oral contrast agent administration were used to perform MR fluoroscopy. MR fluoroscopy correctly diagnosed achalasia in nine patients, uncoordination of esophageal body motility in ten and scleroderma oesophagus in one. Diagnostic performance was satisfactory, with a sensitivity of 87.5% and a specificity of 100% in the general depiction of motility alterations. Our work demonstrates that MR fluoroscopic examination in subject affected by oesophageal motility disorders is feasible and can properly depict motility and morphology alterations, achieving correct diagnosis in the majority of cases. Studies on larger populations are necessary to obtain statistically significant results.