B超诊断双角子宫右宫颈狭窄合并妊娠1例

１病历简介 女,４３岁。因停经４０天来诊。Ｂ超检查：子宫呈双角,右侧约 ５．８ｃｍ × ４．２ｃｍ,左侧约 ４．８ｃｍ × ３．６ｃｍ,右侧宫腔内示一约 ２．６ｃｍ ×１． ４ｃｍ的液性暗区,壁完整,内可见胎芽,但未见胎心搏动。提示：双角子宫,右侧胚胎停止发育。收入院。既往月经规律,曾经妊娠２次,顺产１女,１男胎,均为左侧子宫妊娠,此次为第３次妊娠。首次右侧子宫妊娠,停经后乳房胀痛明显,无腹痛及阴道流血,无明显恶心、呕吐。血常规ＷＢＣ ７．０×１０~９／Ｌ, ＲＢＣ ４．８ × １０~２／Ｌ, Ｌ ０．２５, Ｍ０…     

双侧卵巢子宫内膜异位囊肿1例报告

１　病例报告刘××　女,２３岁,未婚。以下腹部疼痛半年加重２０ｄ入院。查体：Ｔ３６．４℃,Ｐ７５次／ｍｉｎ,Ｒ１７次／ｍｉｎ,ＢＰ１４／１０ｋＰａ,两肺呼吸音清,心脏听诊未闻及异常,腹平软,肝脾肋下未触及,全身浅表淋巴结无肿大。肛诊：右侧附件区可触及一７ｃｍ×６ｃｍ×５ｃｍ肿物,质中等,活动度差。Ｂ超：于右侧附件区可见一大小约７．０ｃｍ×７．８ｃｍ×１０．１ｃｍ之透声暗区,呈类圆形,后壁及后方回声增强。诊断：右附件区囊性占位性病变。ＣＴ平扫及增强：右侧附件区显示一囊性病变区,最大横截面为８．０ｃ…     

CO2激光和Nd:YAG激光吻合家犬肝切创的实验研究

目的 探讨ＣＯ２激光和Ｎｄ：ＹＡＧ激光吻合肝切创的可行性,为临床应用激光吻合肝破裂提供实验依据。方法 普通家犬５只,静脉麻醉后剖腹,暴露肝脏,在其表面做两条长２￣％ｃｍ、深４￣１０ｍｍ切口。分别用ＣＯ２激光和Ｎｄ：ＹＡＧ激光照射创口,ＣＯ２激光的输出功率为３Ｗ,照射距离０．５￣２．０ｃｍ,光斑直径０．２ｃｍ,垂直照射２０￣９０ｓ,能量密度１９１０￣８５９５Ｊ／ｃｍ＾２;Ｎｄ：ＹＡＧ激光光纤末端功率     

小剂量溶栓结合PTA和支架治疗外周动脉慢性阻塞性病变

本文报告５例６支动脉阻塞经导管使用微量泵持续灌注尿激酶（５６，０００单位／小时）溶栓治疗，灌注时间５．５￣５８（平均２６）小时。阻塞位于髂外动脉２例，其中１例伴同侧股动脉阻塞；髂总和髂外动脉联合受累１例，Ｇｕｏ动脉１例；股Ｇｕｏ动脉１例。病程１￣２４（平均９．４）个月，阻塞长度８￣２５ｃｍ（平均１５．３ｃｍ），开通率达１００％。对溶栓后残存狭窄实施ＰＴＡ３例、血管内放置支架１例；随访２￣９（平均５     

B超诊断肝癌晚期并发胆汁性肝脓肿1例

１病历简介 患者,男,５６岁。２个月前经Ｂ超、ＣＴ诊断为肝癌,近日右上腹痛加剧伴反复高热。查体：皮肤巩膜极度黄染,上腹部尤其剑突下明显膨隆,肝剑下７ｃｍ,右肋缘下５ｃｍ,质硬,有压痛。血常规ＷＢＣ１５．５×１０／Ｌ,中性０．８１。 Ｂ超检查肝不规则肿大、右前叶及左叶分别见 ６．８ｃｍ×１０．５ｃｍ． ７．０ｃｍ×９．７ｃｍ较强回声四块,其内可见多个大小不等、形态各异的块中块征。肝右后叶见－９．１ｃｍ×８．５ｃｍ椭圆形液性暗区,周边规整,回声较强,壁厚０．２５ｃｍ,其内可见点状回声,上部稀疏散在,底部…     

连续输出Nd：YAG激光治疗口腔颌面部恶性肿瘤60例经验

１９８５～１９８６年对６０例口腔颌面部恶性肿瘤病人进行了临床和组织学观察。ＮｄＹＡＧ激光的输出功率３０～４０Ｗ，光斑直径０．２～０．３ｃｍ，辐照时间５～１０秒，距离０．５～１．０ｃｍ，能量密度２１２３～１２７３２Ｊ／ｃｍ２。结果：治愈率８６．０％。临床观察９年３例、８年８例、６年５例、５年２例、４年４例和３年以下２７例没有复发；失败８例。结论：ＮｄＹＡＧ激光适宜治疗年老体弱病人和高分化、外突型早期鳞状上皮癌病人。     

中药湿敷治疗慢性唇炎和唇部扁平苔癣20例临床观察

我院自１９８９年以来,对于我港患慢性唇炎和唇部扁平苔癣的露天工作人员,采用中药湿敷疗法,经临床观察疗效满意,现报告如下。 一、临床资料 ｌ．一般资料： （１）慢性唇炎１４例。分型：干燥脱屑型９例,其中病变累及上下唇者３例,病变限于下唇者６例;糜烂型唇炎５例,其中糜烂面波及整个下唇唇红１例,糜烂面约２ｃｍ×１ｃｍ者３例,糜烂面０．５ｃｍ × ０．５ｃｍ者１例。病程１／２～３年。 （２）唇部扁平苔癣糜烂型６例。分别为下唇糜烂面２．５ｃｍ×１．５ｃｍ者１例,下唇糜烂面ｌ．５ｃｍ×１ｃｍ者２例,下唇糜烂面约０…     

超声引导穿刺组织学与细胞学检查在胸部病变的应用

对９２例胸部病变患者者超声引导穿刺活检，病变来自胸膜８例、胸壁７例、纵隔７例、肺周边部５９例及中心部８例。取材成功率达９７％（８９／９２），其中≤３ｃｍ的病灶也达９７％（２８／２９）。在穿刺过程中，手感和取材部位的确认是取材成功的关键因素。对比细胞学和组织学检查，前者成功率和诊断准确率分别达９７％（８６／８９）和９２％（８２／８９），后者为８８％（７８／８９）和８２％（７３／８９）。结合应用两种方法，将有利于提高准确率。本文的并发症发生率为５．４％（５／９２），３例咳嗽伴少量血痰，２例轻度气胸，均未治疗而自愈。     

Gd—DTPA造影增强MRA诊断脑膜瘤的初步研究

目的：评价Ｇｄ－ＤＴＰＡ造影增强ＭＲＡ诊断脑膜瘤，特别是显示肿瘤血运情况的价值。材料与方法：４８例脑膜瘤患者行增强ＭＲＡ检查，其中２５例经手术病理证实，男８例，女１７例，男女之比为１２．３。年龄３６～７２岁，平均５４±１１岁。应用１．０Ｔ磁共振成像机（ＳｉｅｍｅｎｓＩｍｐａｃｔ），Ｇｄ－ＤＴＰＡ为磁显葡胺和／或马根维显，剂量０．１ｍｍｏｌ／ｋｇ，静脉团注后１０～１５分钟内行三维ＴＯＦ脑ＭＲＡ检查，以ＭＩＰ法重建图像。另外，１０例患者仅行平扫ＭＲＡ检查，作为对照组。结果：２５例患者显示２８个脑膜瘤，最小为１．２ｃｍ×１．２ｃｍ×１．４ｃｍ，最大达７．２ｃｍ×７．８ｃｍ×８．１ｃｍ，均有明显肿瘤染色。２７个肿瘤（９６％）主要由颈外动脉的分支供血，其中６个有“双重供血”。２５个肿瘤（８９．３％）显示引流静脉及其引流途径，２个肿瘤直接累及静脉窦。２１个肿瘤（７５％）显示脑内动脉及其分支有不同程度的移位。而对照组仅１个肿瘤显示轻度肿瘤染色，４个（４０％）显示脑内动脉及其分支的移位。结论：增强ＭＲＡ显示脑膜瘤的血运情况与术中所见相符，能代替Ｘ线脑血管造影行精确术前诊断，值得推广应用。     

近地轨道卫星舱内辐射测量

在我国１９９２年１０月发射的返回式卫星舱内，测量的７ｄ累积辐射剂量为０．７４ｍＧＹ，平均日剂量为０．１１ｍＧＹ，舱内次级热中子注量为１．３×ｌ０４～２．３×ｌ０４ｎ／ｃｍ２，平均日通量为１．９×１０４～３．３×１０４ｎ／ｃｍ２，重核粒子径迹密度为１２～１５径迹／ｃｍ２．ｄ－１。研究发现，质量厚度不同的卫星头部与裙部的剂量水平无显著差异，说明３００ｋｍ左右的近地轨道飞行器舱内辐射剂量主要来自银河宇宙线。     

Factors affecting diagnostic accuracy of CT-guided coaxial cutting needle lung biopsy: retrospective analysis of 631 procedures

PURPOSE: To analyze variables affecting diagnostic accuracy of computed tomography (CT)-guided percutaneous coaxial cutting needle biopsy of lung lesions. MATERIALS AND METHODS: A retrospective analysis of factors affecting diagnostic accuracy of CT-guided percutaneous coaxial cutting needle lung biopsy was performed in 631 consecutive procedures with confirmed final diagnoses. Benign and malignant needle biopsy results were cross-examined with correct and incorrect final outcomes to determine diagnostic accuracy. Factors affecting diagnostic accuracy were determined by multivariate logistic regression analysis of variables thought to affect diagnostic accuracy. A P value less than 0.05 was interpreted as statistically significant. RESULTS: The overall diagnostic accuracy of CT-guided percutaneous coaxial cutting needle biopsy of lung lesions was 95% (95% CI: 92.7%-96.2%). Sensitivity was 93%, specificity 98%, negative predictive value 6%, positive predictive value 99%, false-positive rate 0.7%, and false-negative rate 15%. The factors affecting diagnostic accuracy were final diagnoses (benign, 86%; malignant, 99%; chi(2) test, P < 0.001) and lesion size (lesions <1.5 cm, 84%; lesions 1.5-5.0 cm, 96%; lesions >5 cm, 93%; chi(2) test, P = 0.06). CONCLUSION: Benign lung lesions, lung lesions smaller than 1.5 cm (which pose technical difficulty), and lung lesions larger than 5 cm (which are associated with a higher necrosis rate) affect diagnostic accuracy of CT-guided percutaneous coaxial cutting needle biopsy of lung lesions.     

CT-guided cutting needle biopsy of lung lesions--safety and efficacy of an out-patient service

AIM: To determine the safety and efficacy of CT-guided cutting needle biopsy of lung lesions as an out-patient procedure. MATERIALS AND METHODS:A total of 185 consecutive biopsies were performed under CT guidance on 183 patients between January 1991 and December 1998 using 20-gauge (n= 33), 18-gauge (n= 151) or 14-gauge (n= 1) core biopsy needles. A chest radiograph was taken after observation in the Radiology department for 1 h and asymptomatic patients were discharged. RESULTS: The histology was malignant in 150 biopsies (81. 1%) and benign in 23 (12.4%) with 12 false-negative results (6.5%); there were no false-positive results. The sensitivity was 92.6%; specificity 100%; negative predictive value 65.7%; and overall accuracy 93.5%. Pneumothoraces occurred in 48 patients (25.9%); one required aspiration only and four required insertion of an intercostal drain. One patient developed a pneumothorax after discharge. Small haemoptyses occurred in 13 patients without pneumothorax (7.0%), one of whom was admitted. In-patient treatment was required in 10 patients (5.4%). CONCLUSION: Computed tomography-guided cutting needle biopsy of pulmonary lesions is a safe technique with a diagnostic accuracy and complication rate comparable to reported figures for fine needle aspiration biopsy. It can be safely performed on an out-patient basis.     

Risk factors for pneumothorax and bleeding after CT-guided percutaneous coaxial cutting needle biopsy of lung lesions.

PURPOSE: To evaluate risk factors for pneumothorax and bleeding after computed tomography (CT)-guided percutaneous coaxial cutting needle biopsy of lung lesions. MATERIALS AND METHODS: This study involved 117 consecutive patients with 117 intrapulmonary lesions. Statistical analysis of factors related to patient characteristics, lung lesions, and biopsy technique was performed to determine possible contribution to the occurrence of pneumothorax and bleeding. Interactions between related factors were considered to prevent colinearity. RESULTS: Pneumothorax occurred in 12% (14 of 117) of patients. Needle aspiration of two moderate asymptomatic pneumothoraces were performed; there was no chest tube insertion. Lesion depth (P =.0097), measured from the pleural puncture site to the edge of the intrapulmonary lesion along the needle path, was the single significant predictor of pneumothorax. The highest risk of pneumothorax occurred in subpleural lesions 2 cm or shorter in depth (this represented 33% of lung lesions but caused 71% of all pneumothoraces; OR = 7.1; 95% CI, 1.3-50.8). Bleeding presented as lung parenchyma hemorrhage and hemoptysis in 30 patients (26%). Hemoptysis occurred in four patients (3%). Univariate analysis identified lesion depth (P <.0001), lesion size (P <.015), and pathology type (P =.007) as risk factors for bleeding. Multivariate logistic regression analysis identified lesion depth as the most important risk factor, with the highest bleeding risk for lesions more than 2 cm deep (14% of lesions caused 46% of all bleeding; OR = 17.3; 95% CI, 3.3-121.4). CONCLUSIONS: In CT-guided coaxial cutting needle biopsy, lesion depth is the single predictor for risk of pneumothorax, which occurs at the highest rate in subpleural lesions. Increased risk of bleeding occurs in lesions deeper than 2 cm.     

US-guided transthoracic cutting biopsy for peripheral thoracic lesions less than 3 cm in diameter

PURPOSE: To evaluate the safety and accuracy of ultrasonography (US)-guided transthoracic cutting biopsy for diagnosing peripheral thoracic lesions (<3 cm). MATERIALS AND METHODS: Fifty consecutive patients with peripheral thoracic lesions less than 3 cm in diameter underwent US-guided percutaneous transthoracic cutting biopsy with a modified technique. Fifty lesions (43 parenchymal lung, two pleural, two chest wall, and three anterior mediastinal lesions) were sampled for biopsy. The final diagnosis was based on histopathologic analysis of surgical specimens (n = 18) or clinical follow-up (n = 32). RESULTS: The histology recovery rate was 98% (49 lesions), and the correct diagnosis was obtained in 48 lesions (96%). Twenty-four (48%) lesions were malignant, and 26 (52%) were benign. The diagnostic accuracy for malignant lesions was 92% (22 of 24 lesions). A specific benign diagnosis was made in 17 (65%) of the 26 benign lesions, and the negative predictive value for malignancy was 93% (26 of 28 lesions). Only two patients (4%) developed postbiopsy pneumothorax, and three (6%) developed postbiopsy hemoptysis. Biopsy helped prevent surgery or thoracoscopy in 32 patients (64%): 18 patients with benign disease and 14 with multiple metastases or inoperable cancer. CONCLUSION: US-guided transthoracic cutting biopsy appears to be a safe and effective method for diagnosing peripheral thoracic lesions less than 3 cm in diameter. The high diagnostic accuracy for benign lesions and metastatic lung cancer can help prevent surgery in many cases.     

Accuracy of adrenal biopsy guided by ultrasound and CT

We reviewed the results of fine needle biopsy of the adrenal glands guided by ultrasonography or CT in 56 patients. The final diagnoses, obtained at operation, autopsy or follow-up were: metastasis (n = 22), adenoma (n = 21), adrenal cyst (n = 6), hematoma (n = 3), lymphoma (n = 1), pheochromocytoma (n = 1), lymph node (n = 1), and amyloid mass (n = 1). Sufficient cytologic material was obtained in 96.4% (54/56). The overall accuracy to differentiate benign from malignant disease was 85.7% (48/56), 2 were false-negative, one was false-positive. The biopsy was inconclusive ("possibly malignant") in 3 patients, 2 of whom had an additional cutting needle biopsy yielding a correct positive finding. No complications occurred. We conclude that in disseminated malignant disease with suspected adrenal metastases diagnostic results can be obtained with guided fine needle biopsy. Biopsy in primary adrenal lesions is helpful, especially if the aspirate of the lesion turns out to be composed of something other than adrenal cells.     

CT-guided transthoracic cutting needle biopsy of intrathoracic lesions: comparison between coaxial and single needle technique

Purpose

To evaluate the complication rates and diagnostic accuracy of two different CT-guided transthoracic cutting needle biopsy techniques: coaxial method and single needle method.

Methods

This study involved 198 consecutive subjects with 198 intrathoracic lesions. The first 98 consecutive subjects received a single needle cutting technique and the next 100 consecutive subjects received a coaxial technique. Both groups were compared in relation the diagnostic accuracy and complication rates.

Results

No significant difference was found between the two groups concerning patient characteristics, lesions and procedure variables. There was a borderline statistical difference in the incidence of pneumothorax at within 24-h post biopsy between patients in the single needle group (5%) and the coaxial group (13%) (P = 0.053). Little difference was found in the pneumothorax rate at immediately post biopsy between the two groups, which was 28% in the single needle group and 31% in the coaxial group. There was no significant difference in the hemoptysis rate between the two groups, which was 9.2% in the single needle group and 11% in the coaxial group. Both techniques yielded an overall diagnostic accuracy of 98% for malignant lesions with similar sensitivity (single needle: 96.9% vs. coaxial: 96.4%) and specificity (single needle: 100% vs. coaxial: 100%).

Conclusion

There is little difference in the pneumothorax rates and bleeding complications between patients who either received a single needle or a coaxial transthoracic cutting biopsy. Both techniques produce an overall diagnostic accuracy of 98% for malignant lesions.     

Ultrasound-guided transthoracic co-axial biopsy of thoracic mass lesions

PURPOSE: To compare the diagnostic yield of fine-needle aspiration biopsy (FNAB) and cutting needle biopsy in thoracic lesions. MATERIAL AND METHODs: Thirty patients with thoracic mass lesions were subjected to ultrasound-guided co-axial FNAB and cutting needle biopsy using 0.7 mm aspirating and 1.0-mm cutting needles, respectively. The diagnostic yield of the individual modalities was compared with the combined yield. RESULTS: A conclusive diagnosis was obtained in 76.6% (n=23) of patients by FNAB and in 66.6% (n=20) by cutting needle biopsy. The combined diagnostic yield of FNAB and cutting needle biopsy was 93.3% (n=28) with a significant statistical difference (p<0.03) as compared to cutting biopsy alone. Of the patients, 23.2% (n=7) had benign and 76.6% (n=23) malignant aetiologies. The diagnostic yield of FNAB versus cutting needle biopsy in benign lesions was 57.1% (n=4) and 100% (n=7), respectively. The diagnostic yield of FNAB versus cutting needle biopsy in malignant lesions was 82.6% (n=19) and 56.5%, (n=13). Two patients remained undiagnosed by either modality. There were no complications. CONCLUSION: FNAB and cutting needle biopsy are complementary to each other and attempts should be made to obtain small tissue cores in addition to routine cytologic specimens in diagnosing thoracic lesions, especially in benign pathologies. US provides a safe guidance modality for lesions abutting the chest wall.     

Image-guided coaxial fine needle aspiration biopsy with a side-exiting guide

PURPOSE: The aim of this study was to evaluate the diagnostic accuracy and complication rates of a side-exiting coaxial needle system for fine needle aspiration (FNA) biopsies. METHOD: Between 1995 and 1998, 127 nonconsecutive biopsies were performed on 122 patients (74 males, 48 females). CT guidance was used in 111, ultrasound guidance was used in 14, and both were used in 2 biopsies. Patient history, biopsy site, needle performance, complications, and cytology results were recorded. RESULTS: Diagnostic rate and accuracy were 92.9 and 99.2%, respectively. There were minor complications from 14 biopsies, and all of them arose from chest biopsies: pneumothorax in 13 of 47 and hemoptysis in 1 of 47. There were no major complications. CONCLUSION: The side-exiting coaxial needle system is a safe and effective alternative to the conventional end-exiting coaxial needle system for performance of image-guided FNA biopsies.     

CT导向下骨骼穿刺活检

目的：探讨CT导向下骨骼穿刺活检的方法，安全性及准确率，资料与方法：38例骨骼病变患者，脊柱16例，其他22例，分别在CT导向下行抽吸，切割或同轴式活检。结果：穿刺成功率为100％，准确率为92％，无严重并发症发生。结论：CＴ导向下骨骼穿刺活检安全有效，尤其对于脊柱等特殊部位应予采用。     

Coaxial transthoracic fine-needle biopsy in patients with a history of malignant lymphoma.

Efficacy and safety of coaxial transthoracic fine-needle biopsy were evaluated in 54 patients with a history of malignant lymphoma and new chest lesions. Twenty-one patients had recurrent lymphoma. Correct diagnosis was made in 17 of the 21 patients (81%) after one biopsy. The sensitivity increased to 95% with repeat needle biopsy in three patients. Immunophenotyping (determining phenotype by means of immunologic examination) was essential for a definitive diagnosis of lymphoma in three patients. Non-lymphomatous malignancies were correctly diagnosed in 14 patients. An infectious organism was identified in 11 of 19 patients (58%) with benign lesions. Pneumothorax occurred in eight patients (15%), necessitating placement of a chest tube in two (4%). Mild hemoptysis was observed in four patients (7%). The authors conclude that coaxial transthoracic fine-needle biopsy in patients with a history of lymphoma is safe and accurate. The use of large cutting needles or surgical biopsy can be restricted to patients with false-negative findings at percutaneous biopsy and to patients in whom histologic transformation of lymphoma is suspected.