Clinical application and laboratory protocols for performing contrast echocardiography

Technically difficult echocardiographic studies with suboptimal images remain a significant challenge in clinical practice despite advances in imaging technologies over the past decades. Use of microbubble ultrasound contrast for left ventricular opacification and enhancement of endocardial border detection during rest or stress echocardiography has become an essential component of the operation of the modern echocardiography laboratory. Contrast echocardiography has been demonstrated to improve diagnostic accuracy and confidence across a range of indications including quantitative assessment of left ventricular systolic function, wall motion analysis, and left ventricular structural abnormalities. Enhancement of Doppler signals and myocardial contrast echocardiography for perfusion remain off-label uses. Implementation of a contrast protocol is feasible for most laboratories and both physicians and sonographers will require training in contrast specific imaging techniques for optimal use. Previous concerns regarding the safety of contrast agents have since been addressed by more recent data supporting its excellent safety profile and overall cost-effectiveness.     

自主神经病变诊断方法的临床对比研究

目的探讨早期诊断自主神经系统病变的方法。方法分别用Ewing试验和心率变异性检测188例受试者自主神经病变，并对检出率进行比较。结果①心率变异性时域、频域指标与Ewing试验均有相关性；②心率变异性对自主神经系统病变检出率（49．5％）高于Ewing试验（26．1％），p〈0．01。结论在早期评价自主神经功能异常方面，心率变异性比Ewing试验灵敏。     

Adverse reactions to ultrasound contrast agents: is the risk worth the benefit?

The introduction of ultrasound contrast agents has led to a marked improvement in diagnostic capabilities in echocardiography. As no serious adverse events were seen during the preclinical development phase, ultrasound contrast agents were thought to be safe. Recently, three fatal and 19 severe, non-fatal adverse reactions were reported in a post marketing analysis of more than 150,000 studies of Sonovue, which has led to the addition of several contra-indications for the use of this ultrasound contrast agent. Although a strong relationship was established between the non-fatal cases and administration of Sonovue, a causal relationship between the fatal cases and the use of Sonovue is debatable. Therefore, the risk associated with the use of this ultrasound contrast agent should be judged carefully, taking into consideration the prevalence of adverse effects of other contrast media and diagnostic procedures used in cardiology.     

Role of contrast enhanced ultrasonography in the assessment of hepatic metastases: A review

Contrast enhanced ultrasonography (CEUS) has improved both the detection and characterization of focal liver lesions. It is now possible to evaluate in real time the perfusion of focal liver lesions in the arterial, portal and late contrast phases, and thus to characterize focal liver lesions with high diagnostic accuracy. As a result, CEUS has taken a central diagnostic role in the evaluation of focal liver lesions that are indeterminate upon computed tomography (CT) and magnetic resonance imaging. The combined use of second generation contrast agents and low mechanical index techniques is essential for the detection of liver metastases, and it now allows the examination of the entire liver in both the portal and late phases. Several studies have shown that using CEUS instead of conventional ultrasonography without contrast agents significantly improves sensitivity in detection of liver metastases. Furthermore, the detection rate with CEUS seems to be similar to that of CT. This review describes the clinical role of CEUS in detecting liver metastases, including details about examination techniques, features of metastases observed with CEUS, and clinical results and guidelines.     

Functional and pathologic effects of multiple echocardiographic contrast injections on the myocardium, brain and kidney

Myocardial contrast echocardiography can define in vivo the area at risk for necrosis after coronary occlusion. However, if this technique is to be used, it cannot be intrinsically toxic to the heart or other critical organs. To determine the functional and pathologic effects of contrast echocardiography, six intracoronary, six intrarenal and six intracarotid artery injections of 2 to 6 cc of a commonly employed contrast agent (agitated Renografin-saline solution) were performed in five dogs. A sixth dog served as a sham to assess any deleterious effects of the model preparation. Two-dimensional echocardiographic images and electrocardiograms were recorded during intracoronary injections, and heart rate, blood pressure, left ventricular end-diastolic pressure and rate of rise of left ventricular pressure (dP/dt) were continuously monitored. At 24 hours, echocardiographic and hemodynamic measurements were repeated, the dogs were killed and the heart, brain and kidneys were removed and prepared for light microscopic examination. Quantitative analysis of left ventricular wall motion was performed on control, peak contrast, post-contrast and 24 hour studies. With each intracoronary injection, there were transient decreases in blood pressure (p = 0.05 versus control) and increases in left ventricular end-diastolic pressure (p = 0.04 versus control). These were associated with depression of wall motion in contrast-enhanced regions (p = 0.01 versus control) and ST-T segment changes on the electrocardiogram. No significant change in heart rate or left ventricular dP/dt was noted. All variables normalized with the clearance of the contrast effect and remained normal to 24 hours. Light microscopic examination revealed no myocardial or cerebral changes attributable to the contrast agent injections.(ABSTRACT TRUNCATED AT 250 WORDS)     

DNCB skin test in cases of malignant melanoma

Summary Two hundred sixty-nine patients suffering from malignant melanoma were sensitized with DNCB acetone solution. The intensity of the skin reaction was normally independent of both the current stage and the further progression of the disease.     

Asthma in pregnancy--immunological changes and clinical management

Asthma is one of the most common diseases complicating pregnancy and a risk factor for several maternal and fetal complications, posing a special challenge for physicians treating asthmatic pregnant women. Asthma influences the outcome of pregnancy and - vice versa - pregnancy affects asthma severity with bidirectional immunological interactions that are currently being examined. Supporting pregnancy-induced immunotolerance is the observation that attenuation of allergic responses can be detected in controlled asthmatic pregnant patients. However, uncontrolled asthmatic pregnant women show significant asthma-associated immune reactions, such as diminished pregnancy specific regulatory T cell proliferation, that may - besides other factors - influence fetal growth. Uncontrolled, symptomatic asthma may increase the risk of adverse perinatal outcomes; thus adequate regular anti-asthmatic treatment resulting in optimal asthma control represents a vital need during pregnancy. This review summarizes immunological changes characterizing pregnancy in asthmatic women together with the clinical implications of asthma management during pregnancy.     

Contrast echocardiography in acute myocardial ischemia. II. The effect of site of injection of contrast agent on the estimation of area at risk for necrosis after coronary occlusion

Myocardial contrast echocardiography has been shown to accurately assess the area at risk for necrosis after acute coronary occlusion in the experimental model. The area at risk as determined by this method, however, has been defined in different ways depending on the model used. Some investigators have injected the contrast agent proximal to the site of coronary occlusion (left main coronary artery or aorta) and defined the area at risk as the segment of myocardium not showing a contrast effect (negative risk area). Others have injected the contrast agent directly into the occluded vessel and have defined the area at risk as that showing contrast enhancement (positive risk area). To evaluate whether the areas at risk determined by these two techniques are identical, six open chest dogs were studied using both methods. The area at risk was slightly but significantly larger when the contrast agent was injected into the occluded vessel than when it was injected proximally into the left main coronary artery (4.98 +/- 1.69 versus 3.97 +/- 1.27 cm2, p less than 0.01). It is concluded that the site of injection of the contrast agent significantly influences the determination of area at risk. Therefore, data obtained by the two techniques should not be used interchangeably, and in a given study the area at risk should be measured consistently using one technique.     

Osteoarthritis in hemodialysis patients: relationships with bone mineral density and other clinical and laboratory parameters

Objective The aim of this study was to determine the role that hemodialysis (HD) plays in radiologically assessed osteoarthritis (OA) of the hand, knee, and hip.Materials and methods Eighty patients who had been on regular HD for at least 2 years were included. Anterior-posterior radiographs of the pelvis, weight-bearing knees, and hands and wrists of each patient were examined. Bone mineral density (BMD) of spine, femur, and forearm was measured.Results Radiologic assessment of the 80 patients hands showed that 41 individuals had osteopenia, 12 had midphalangeal subperiosteal resorption, 11 had cystic bone lesions, eight had bone erosion, four had osteophytic lesions, and three had subchondral sclerosis. Bone erosion in the hands was significantly associated with HD duration, forearm T score, and serum parathyroid hormone level. Radiologically, OA was demonstrated in eight knee and ten hip joints. Minimum joint space in the tibiofemoral compartment correlated with body mass index, and minimum joint space in the hip correlated with age. The mean BMD measurements at all three sites studied in the HD patients were low. Only the duration of HD significantly correlated with forearm BMD.Conclusion Osteoarticular complications are common in HD patients.     

原发性肝癌超声造影诊断的特征性声像图表现

目的探讨超声造影诊断原发性肝癌的特征性声像图表现。方法对经病理检查或穿刺活组织检查确诊的25例(30个病灶)原发性肝癌患者实施超声造影检查,观察患者病灶特征和声像图表现,并将诊断结果与常规超声诊断结果进行比较,判断两种诊断方式的敏感性。结果原发性肝癌的内部结节数目不多,多为单发,病灶与正常组织间界限清楚,边缘处较为整齐,回声除小部分不均匀外,其余皆比较均匀,其形状表现为圆形或类圆形。有19例患者诊断为肝细胞癌,声像图表现为"快进快出","快进快出"表现越为明显患者,其肿瘤分化程度也越低。有6例患者诊断为肝内胆管细胞癌,声像图主要表现为"快进快出",病灶图像在动脉期呈现为网格状增强,部分显示无增强;在门静脉期时,病灶周边环状不规则增高,病灶内部则表现为网格状增强或无增强;当处于门静脉期时,病灶周边环状不规则增强明显消退。超声造影诊断敏感度为96%,与常规超声的72%比较,存在明显差异(P0.05)。结论超声造影诊断原发性肝癌可以清楚的显示病灶图像特征,较常规超声诊断敏感性高。     

老年冠心病患者介入治疗术后随访期症状限制性运动试验评估研究

目的　通过运动试验方法评估老年人介入治疗后随访结果。　方法　对成功介入治疗后的患者在随访期间进行症状限制性自行车运动试验 ,分为老年组与非老年组 ,对运动量及心电图等参数进行比较。　结果　老年组和非老年组分别有 2 3例及 30例 ,患者于术后 (1 4 8± 1 2 0 )个月和(1 2 4± 1 2 1 )个月进行了运动试验。老年组和非老年组运动中的心率增加分别为 (92 1± 1 2 6 )次 /min和 (96 5± 1 3 8)次 /min(P >0 0 5 ) ,收缩压增加分别为 (5 9± 1 7)mmHg和 (6 9± 1 6 )mmHg(P >0 0 5 )。老年组和非老年组的最大运动量分别为 (5 8± 1 5 )代谢当量和 (7 2± 1 4)代谢当量 (P <0 0 1 ) ,运动时间为 (6 5± 2 2 )min和 (8 9± 2 6 )min(P <0 0 1 ) ,老年组较非老年组在运动中更易出现症状 (2 1 7%对 3 3% ,P <0 0 5 )及心电图改变 (43 5 %对 1 6 7% ,P <0 0 5 )。　结论　老年人介入治疗后运动量及运动时间均小于非老年人 ,运动中易出现症状及心电图心肌缺血表现。采用症状限制性运动试验进行随访观察是有价值的     

Role of microbubble ultrasound contrast agents in the non-invasive assessment of chronic hepatitis C-related liver disease

Patients who are chronically infected with the hepatitis C virus often develop chronic liver disease and assessment of the severity of liver injury is required prior to considering viral eradication therapy. This article examines the various assessment methods currently available from gold standard liver biopsy to serological markers and imaging. Ultrasound is one of the most widely used imaging modalities in clinical practice and is already a first-line diagnostic tool for liver disease. Microbubble ultrasound contrast agents allow higher resolution images to be obtained and functional assessments of microvas-cular change to be carried out. The role of these agents in quantifying the state of hepatic injury is discussed as a viable method of determining the stage and grade of liver disease in patients with hepatitis C. Although currently confined to specialist centres, the availability of microbubble contrast-enhanced ultrasound will inevitably increase in the clinical setting.     

血糖浓度和立其丁试验在诊断嗜铬细胞瘤中的临床意义

目的为进一步了解立其丁试验在诊断嗜铬细胞瘤中的阳性参考值和探讨行立其丁试验时监测血糖浓度在诊断嗜铬细胞瘤中的临床意义。方法选取术前行立其丁试验,术后病理确诊为嗜铬细胞瘤86例患者。根据立其丁试验结果分为3组:立其丁试验阳性、立其丁试验可疑、立其丁试验阴性,同时所有患者行立其丁试验时监测血糖浓度。结果86例嗜铬细胞瘤中立其丁试验阳性42例(占48.84%),可疑34例(占39.53%),阴性10例(占11.63%)。低血糖并立其丁试验阳性在诊断嗜铬细胞瘤中检出率最高,与非低血糖并立其丁试验阳性比较差异具有显著性(P<0.05);低血糖并立其丁试验可疑组比非低血糖并立其丁试验可疑组检出率亦高(P<0.05)。结论诊断嗜铬细胞瘤时立其丁试验阳性参考值应降低,可疑阳性者应高度怀疑为嗜铬细胞瘤;立其丁试验同时监测血糖浓度,更有助于早期诊断嗜铬细胞瘤。     

肝移植临床化学指标实验诊断价值

目的:探讨临床化学指标对指导肝移植实验诊断价值.方法:分析98例肝移植受者病历,按出院诊断标准分为治愈组、治愈合并并发症组、死亡组3组.分析3组受者12项临床化学指标变化规律和特征.结果:ALT,AST, ALD,GLDH是预测缺血-再灌注损伤的良好指标.TB,DB,TBA是预测移植肝脏存活,恢复其胆汁分泌、排泄功能的指标.PA,CHE是反映移植肝脏存活、恢复其合成蛋白质功能的指标.急性排斥反应ALT,GGT, ALP, TB,DB有诊断价值.抗排异药物毒性反应ALT,AST, GGT, TB,DB有特异性.胆道狭窄/梗阻TB,DB有诊断价值.胆道感染时ALT, GGT有诊断特点.肺部感染时ALT,TB,DB有诊断意义.切口感染时ALT,GGT, GLDH有诊断价值.肝脏无功能临床化学指标3个特点:PA,CHE逐渐降低;TB,DB居高不降,甚至逐渐升高;ALD,GLDH进行性升高.结论:临床化学指标的变化规律和特点对判断肝脏存活、肝功能恢复,诊断、鉴别不同并发症以及指导临床治疗有诊断价值.     

Ultrasound contrast agent, Levovist microbubbles are phagocytosed by Kupffer cells-In vitro and in vivo studies.

Phase contrast microscopy showed that Levovist microbubbles were phagocytosed by cultured Kupffer cells and moved gradually toward the nucleus from the cell surface. They were diminished in size and disappeared within 30min by diffusion of the gas contained within the microbubbles. In an in vivo study, confocal laser scanning microscopy demonstrated that Levovist microbubbles were trapped and phagocytosed by Kupffer cells. No microbubbles were observed attached to the sinusoidal endothelium. Our findings suggest that liver-specific images obtained following intravenous injection of Levovist are composed of signals from microbubbles phagocytosed by Kupffer cells.     

Differentiation between malignant and benign nodules in the liver： Use of contrast C^3-MODE technology

AIM: To investigate the value of contrast-enhanced C3-MODE technology in differentiating malignant nodules of liver from the benign ones. METHODS: Forty-six nodules in 36 patients (29 men and 7 women) were studied by contrast-enhanced C3-MODE technology and contrast-enhanced CT in 1 wk before the biopsy or operation. A low MI monitor and a high MI flash imaging were intermittently performed. After the injection of contrast agent, the period from 10 to 30 s and the time later than 100 s were respectively defined as early arterial phase and the late phase. The vascularities of the liver nodules in the two phases were combined for differential diagnosis. Corresponding to the pathological diagnosis, the accuracy, sensitivity and specificity of contrast-enhanced C3-MODE technology were compared to those of contrast-enhanced CT. RESULTS: By C3-MODE technology, 33 of the 46 liver nodules were demonstrated as defected area in the late phase and were diagnosed as malignant tumors. Of them, 28 with hypervascularity in the early arterial phase were assessed as hepatocellular carcinoma, the other five nodules with rim-like enhancement in the early arterial phase were diagnosed as metastatic tumors. Thirteen nodules were shown as iso or hypervascularity in the late phase as well as centripetal filling in the early arterial phase and we made a diagnosis of hemangioma. Corresponding to the pathological results, the sensitivity, specificity and accuracy of contrast-enhanced C3-MODE technology in differentiating malignant and benign nodules in the liver were 97.0%, 92.3% and 95.7%, respectively. With comparison to those of contrast CT (sensitivity, 94.1%; specificity, 91.7%; accuracy, 93.5%), the difference was not significant. CONCLUSION: Contrast-enhanced C3-MODE technology can effectively differentiate malignant liver tumors from the benign nodules. It highly agrees diagnostically with the pathology. We suggest that it provides a new approach for differential diagnosis of liver nodules in addition to contrast-enhanced CT.     

Appropriateness and clinical outcome of chest computed tomography without intravenous contrast: A study conducted in Pakistan

Background

Chest computed tomography (CT), including high-resolution CT (HRCT), has become an integral part of modern healthcare. It enables the physician to arrive at a diagnosis using a noninvasive approach. Our practice has shown that various chest CT scans without intravenous (IV) contrast, including HRCT, have no proper clinical indication. For the same reason, we have assessed the appropriateness of chest CT without IV contrast based on the evidence-based American College of Radiology (ACR) appropriateness criteria.

超声评估膈肌功能及其临床应用进展

膈肌是最重要的呼吸肌,承担着约75％的呼吸做功。可通过超声测量膈肌厚度、膈肌移动度等指标来评估膈肌功能,进而辅助临床医师作出相应决策。膈肌超声在预测机械通气患者脱机结局、协助诊断COPD、预测全麻术后肌松残余、预测术后肺部并发症、评估康复训练效果等方面有潜在价值。本文就膈肌的超声评估方法及临床应用情况进行综述,以期指导临床医生应用超声相关指标来评估膈肌功能,希望对临床工作提供帮助。     

Research and clinical challenges in paediatric inflammatory bowel disease

Inflammatory bowel disease in childhood has become the subject of intense scientific debate during the last two decades, when there has been a significant rise in its incidence. There is a commonly agreed view that the disorder in children has peculiarities both in terms of underlying mechanisms and clinical management. This review highlights the emerging pathophysiologic concepts and clinical issues in paediatric inflammatory bowel disease and their effects on the management of children with this disorder are discussed. Particular emphasis is given to the link between the improvement of the research in the pathogenetic mechanisms and the development of novel therapeutic strategies able to promote a change in the natural course of the disorder.