腹膜后肿物的二维图像及双功能多普勒超声诊断

本文报告了１７例经二维及双功能多普勒超声诊断的腹膜后肿物，其中良性肿物３例（１７．６％），恶性肿瘤１３例（７６．５％），有恶性倾向的肿瘤１例。恶性组中原发性肿瘤６例，转移性肿物７例。在二维图像上，除脂肪肉瘤及横纹肌肉瘤外，大多数腹膜后肿物为低回声团块，但良性肿物外形规整，内部回声均质，而恶性肿瘤外形不规整，内部回声不均质。在双功能多普勒超声中，恶性肿瘤内部血流更为丰富，阻力指数（ＲＩ）较高。作者认为患者年龄较小，肿瘤内部回声不均质，血流丰富，阻力指数较高（ＲＩ＞０．６５）可作为原发性恶性腹膜后肿瘤的特征。转移性肿物以无血流者多见，其原发肿瘤的病史及其他部位的转移灶可助诊断。     

Assessment of articular disc displacement of temporomandibular joint with ultrasound

Purpose

To assess pattern of articular disc displacement in patients with internal derangement (ID) of temporomandibular joint (TMJ) with ultrasound.

Materials and methods

Prospective study was conducted upon 40 TMJ of 20 patients (3 male, 17 female with mean age of 26.1 years) with ID of TMJ. They underwent high-resolution ultrasound and MR imaging of TMJ. The MR images were used as the gold standard for calculating sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) of ultrasound for diagnosis of anterior or sideway displacement of the disc.

Results

The anterior displaced disc was seen in 26 joints at MR and 22 joints at ultrasound. The diagnostic efficacy of ultrasound for anterior displacement has sensitivity of 79.3 %, specificity of 72.7 %, accuracy of 77.5 %, PPV of 88.5 %, NPV of 57.1 %, PLR of 2.9 and NLR of 0.34. The sideway displacement of disc was seen in four joints at MR and three joints at ultrasound. The diagnostic efficacy of ultrasound for sideway displacement has a sensitivity of 75 %, specificity of 63.6 %, accuracy of 66.7 %, PPV of 42.8, NPV of 87.5 %, PLR of 2.06, and NLR of 0.39.

Conclusion

We concluded that ultrasound is a non-invasive imaging modality used for assessment of anterior and sideway displacement of the articular disc in patients with ID of TMJ.     

门脉栓子的双功多普勒检查

应用双功多普勒检测了４５例原发性肝癌患者门脉血流动力学。检出门脉栓子１３例，并对门脉栓子前方、后方及栓子处残余管腔内、栓子内部的血流状态、血流速度、血流量进行了检测。结果表明，本技术不仅可显示门脉栓子的部位、大小和形态，尚能判断栓塞是否完全及了解其它血流动力学信息，指导临床治疗方式的选择和预后判断，并有助于对门脉栓子良恶性的鉴别。     

Neurological influences of the temporomandibular joint

This study reviews recent advances in temporomandibular joint (TMJ) or masticatory system related neurology, and suggests the TMJ as a neurological window and lever.The TMJ is integrated with the brainstem centers via the sensorimotor system, including the body balance and coordination control systems. A dysfunctioning TMJ may reflect not only local problems, but also the underlying remote or systemic problems. Neurological examination, including balance testing, for example, may reveal the contributing imbalances and provide an additional evaluation of the appropriateness of TMJ therapeutics being attempted.Repetitive or tonic sensory stimulations involving the TMJ may be related to therapeutic interventions, contributing to neural plasticity, which may be adopted as a therapeutic approach in treatment of neurological disorders, including dystonia and movement disorders.TMJ related therapeutics, such as use of an occlusal splint, cranial manipulation, muscle/myofascial therapy, and acupuncture, ideally need to be practiced along with neurological monitoring, to ensure neurologically desirable effects.     

肝硬化血流动力学变化的双功多普勒观察

本文报告３０例正常对照组，４２例肝硬化患者血流动力变化的双功多普勒（ＤＵ）观察结果。显示肝硬化时门静脉（ＰＶ）增宽，ＰＶ血流参数明显低于对照组，肝动脉增多，肝动脉频谱显示率高达９７．６％（４１／４２），明显高于对照组６２％。肝静脉频谱的负向波减低或消失，严重时肝静脉频谱可呈动脉化。肠系膜上动脉（ＳＭＡ）的阻力指数减低，显示肝硬化时肠系膜区大循环系统呈低阻抗状态。本文对其变化的病因病理进行了探讨，认为ＤＵ检查对肝硬化的诊断及病情变化的监测有一定价值。     

胎儿脑血管的双功彩色多普勒检测

本文报道应用高分辨双功能超声显象仪对75例胎儿的525条颅内动脉解剖结构及血流动力学状况的检测结果。本研究认为,胎龄20周以上即可获得颅内主要动脉的检测数据。观察到胎儿脑动脉血流动力学在其发育不同阶段的变化,并且受生理状态多种因素影响。结果表明:应用超声全面检测胎儿颅内动脉解剖结构及血流动力学是可行的,并且是可靠的。     

Multidetector computed tomography of temporomandibular joint: A road less travelled

This article reviews the imaging anatomy of temporomandibular joint(TMJ), describes the technique of multi-detector computed tomography(MDCT) of the TMJ, and describes in detail various osseous pathologic afflictions affecting the joint. Traumatic injuries affecting the mandibular condyle are most common, followed by joint ankylosis as a sequel to arthritis. The congenital anomalies are less frequent, hemifacial microsomia being the most commonly encountered anomaly involving the TMJ. Neoplastic afflictions of TMJ are distinctly uncommon, osteochondroma being one of the most common lesions. MDCT enables comprehensive evaluation of osseous afflictions of TMJ, and is a valuable tool for surgical planning. Sagittal, coronal and 3D reformatted images well depict osseous TMJ lesions, and their relationship to adjacent structures.     

双功多普勒检测门脉血流动力学的临床应用

应用双功多普勒检测了３２例正常对照者，３８例慢性肝炎，１７例肝硬化和３２例原发性肝癌患者的门脉血流动力学，发现肝硬化，原发性肝癌组门静脉内径显著大于正常对照组和慢性肝炎组；门脉血流速度则三组患者均显著低于对照组；门脉血流量仅慢性肝炎组显著低于对照组；三组患者的门脉充血指数均显著大于对照组。本文初步探讨了门脉血流动力学检测的临床意义及各种生理因素对门脉血流的影响。     

双功能彩色多普勒经颅探查的方法研究

本文报告150例颅底主要血管的双功彩色多普勒检查方法。5例因颞骨鳞部过厚,经颞窗探查失败,其余145例大脑中动脉、大脑前动脉、大脑后动脉的检出率分别为99％(287/290);96.7％(281/290);99.7％(289/290);检出率较高。通过有关颅脑断层解剖的研究,结果表明熟悉超声解剖定位很易获得多普勒频谱及彩色血流图,有利于提高检出率,缩短探查时间。作者认为经颅彩色多普勒是一种快速、简便、准确的探查手段。     

Duplex pulsed Doppler echocardiography in mitral regurgitation

The accuracy of duplex pulsed Doppler echocardiography (d-PDE) for detecting mitral regurgitation was evaluated in 35 patients undergoing d-PDE, cardiac auscultation, and left ventriculography. With three transducer positions, the overall d-PDE sensitivity was 95%, specificity was 100%, positive predictive value was 100%, negative predictive value was 94%, and diagnostic accuracy was 97% compared with ventriculography. This technique was superior to auscultation (sensitivity 74%, specificity 94%, positive predictive value 93%, negative predictive value 75%, diagnostic accuracy 83%). No false-positive d-PDE results occurred, but discordant false-negative results occurred frequently among the three transducer positions. If discordant negative results are considered to be false negative, then d-PDE is both sensitive and specific when mitral regurgitation is defined as systolic spectral broadening in any one transducer position.     

双功能彩色多普勒检查颅内血管

本文报告37例健康成年人颅内主要血管的双功能彩色多普勒检查结果。1例因颅骨过厚检查失败,其余36例大脑中动脉、大脑前动脉、大脑后动脉的检出率分别为100％(72/72);98.6％(71/72),88％(62/72)。大脑中动脉、大脑前动脉的检出率高于经颅三维多普勒,重复性检查中相关性好(r=0.92)。同时可检测各血管的峰值流速,平均流速、阻力指数、搏动指数、收缩期与舒张期流速比值。本研究表明:双功能彩色多普勒检查颅内血管可部分克服TCD的不足,有较好发展前途。     

应用双功能经颅彩色多普勒诊断高血压病脑血管状况的研究

本文报告４０例高血压病患者脑血管状况双功经颅彩色多普勒结果。根据彩色多普勒血流图、频谱图、流速、搏动指数、音频改变可分为三种类型：（１）动脉硬化流速加快型；（２）动脉硬化流速减慢型；（３）动脉硬化狭窄型。我们认为双功彩色多普勒对估估高血压脑血管病的血流速度，确定脑血和狭窄的部位具有重要价值。该技术能为医生提供诊断和评价疗效的依据。     

下肢静脉畸形骨肥大综合征的双功能彩色多普勒的诊断及临床意义

目的：探讨下肢静脉畸形骨肥大综合征（KTS）的双功能彩色多普勒（DCDU）的诊断和临床意义。方法：对56例KTS进行DCDU检查诊断,经手术及静脉造影证实,对KTS的影像特征进行分析总结。结果：KTS共56例,其中浅静脉异常型16例;深静脉异常型28例,其中髂外静脉狭窄2例,股浅静脉狭窄19例,Guo静脉狭窄3例,股浅静脉及瓣膜缺如4例;海绵状血管瘤样扩张型3例;混合型9例。结论：DCDU检查较静脉造影对KTS的诊断具有更全面的临床影像学资料,可基本替代静脉造影。     

Ultrasound detection of abscesses in the temporomandibular joint following surgical reconstruction

The purpose of this investigation is to report the technique and assess the utility of ultrasound diagnosis of abscess in the postoperative temporomandibular joint (TMJ). Fourteen patients had 18 ultrasound examinations of the postoperative temporomandibular joint (TMJ) to detect a possible abscess. Ultrasound examinations were performed with either a 5-MHz linear array and/or a 7.5-MHz sector probe following placement of implants (16) and autogenous costochondral grafts (2). The TMJ was scanned in both coronal and axial planes. In 14 examinations, an abscess was not detected; there were no false-negatives. Soft-tissue edema was found in 1 of these 14 examinations; at surgery, there was no abscess. Four examinations were positive for an abscess; 3 of these were confirmed at surgery. One examination was false-positive. We conclude that ultrasonography can detect an abscess in the symptomatic postoperative TMJ. A negative examination is reliable. © 1994 John Wiley & Sons, Inc.     

行关节腔内注射醋酸强的松龙治疗颞颌关节紊乱综合征

目的采用醋酸强的松龙作关节上腔或关节下腔注射1～3次,针对治疗观察疼痛、弹响或杂音和开口障碍三大症状的疗效。方法86例颞颌关节紊乱综合征患者（TMJDS）中,关节上腔注射治疗Ⅰ类翼外肌亢进型的弹响开口过大症状22例,Ⅱ类关节囊松弛、盘突失调的可复性盘前移者40例,Ⅲ类关节窝、关节结节骨质改变者8例,关节下腔注射治疗Ⅲ类髁突骨质改变者16例。结果关节腔注射醋酸强的松龙对治疗TMJDS的Ⅰ、Ⅱ、Ⅲ类的弹响杂音有效治疗率分别为90％、87．5％、70．8％。对Ⅱ、Ⅲ类的疼痛不适的有效治疗率分别为72．2％、75％;对Ⅰ、Ⅱ、Ⅲ类的开口障碍治疗有效率分别为44．4％、50％、46％。结论该疗法对TMJDS三类之弹响杂音症状的疗效较为满意,对三类之疼痛症状的疗效一般,对三类之开口障碍症状的疗效欠佳,提示对TMJDS患者以弹响杂音为主要症状的治疗首选此法较好。     

双功能彩色多普勒对颈动脉体瘤的诊断及手术指导意义(附6例报告)

本文报告6侧颈动脉体瘤的彩色多瞢勒超声诊断经验,并经手术和病理证实。该法能有效显示肿瘤大小、形态及血供情况,易与颈部其它肿瘤鉴别。声像圈诊断依据为:①位于颈总动脉分叉部的卵圆形肿物,与颈动脉关系密切;②颈内、外动脉夹角受压、增大、移位。③有丰富的动脉血流供血。认为对临床诊断和手术方案设计具有很高的价值。     

颞下颌关节滑膜软骨瘤病的影像诊断

目的对颞下颌关节滑膜软骨瘤病的临床、影像、病理学进行综合分析,提高对该病的认识。方法对8例具有完整病例资料并经手术病理证实的颞下颌关节滑膜软骨瘤病患者的临床资料、影像学征象及病理改变进行总结。结果临床表现:8例患者均有耳前区疼痛、肿胀伴张口受限,术中见关节腔内大量游离体。影像学表现:X线示颞下颌关节间隙增宽、髁突周围多发不透亮区;CT示关节腔内软组织密度影伴周围多发钙化,4例见骨质破坏;MR示关节腔内软组织肿块伴积液,周围多发长T_1WI、短T_2WI信号,增强后呈不均匀强化,动态增强扫描时间-信号强度变化曲线呈平坦型。病理表现:关节腔内游离体由透明软骨构成,伴周围纤维化、钙化。电镜下见大量透明软骨细胞覆盖以成纤维样滑膜细胞。结论颞下颌关节滑膜软骨瘤病具有典型的临床、影像及病理特点。     

氧化应激反应在颞下颌关节内粘连形成中作用的研究

目的通过兔颞下颌关节内氧化应激-粘连模型的建立和氧化应激反应的检测,阐明氧化应激在此过程中的作用机制并应用关节镜技术证实粘连的形成。方法取20只6月龄家兔进行分组实验,动物的左侧颞下颌关节局麻下于关节上腔内注入不同浓度的H2O2为实验侧,右侧关节作为空白对照侧。根据干预的不同梯度浓度分为4个浓度组(每组5只):0.5 mmol/L,2 mmol/L,5 mmol/L,10 mmol/L,连续注射7 d,每天2 ml进入关节腔后头颅绷带限制下颌活动正常进食。各组在注射后的第30天,应用颞下颌关节镜下检查各组家兔实验侧和对照侧关节内滑膜组织的变化和关节内粘连的形成情况,获得的致颞下颌关节内粘连的有效浓度的H2O2组动物和时间点,应用氧化应激检测试剂盒,酶联免疫吸附(ELISA)法检测实验侧和对照侧丙二醛(MDA)、8-羟基脱氧鸟苷(8-OHd G,被公认为DNA氧化损伤和细胞氧化应激的指示剂)的变化。结果 4个浓度组中5 mmol/L,10 mmol/L组的动物,左侧关节腔内在第30天通过关节镜证实,获得了关节内粘连,右侧均无粘连的出现。抽取关节内滑液2 ml,12 000 r/min离心5 min,取上清100μl,ELISA试剂盒测定氧化应激检测,2,5,10 mmol/L组较空白对照组明显升高,差异有统计学意义(P<0.05)。结论成功建立氧化应激-关节内粘连的动物模型,证明5 mmol/L以上浓度的活性氧自由基H2O2可通过氧化应激途径使颞下颌关节发生病理性变化,形成关节腔内的粘连。     

颞下颌关节盘穿孔诊断和治疗的研究进展

关节盘穿孔(disc perforation,DP)是颞下颌关节紊乱病晚期的症状之一,与关节内结构紊乱和髁突骨关节病有密切关系,主要表现为关节区疼痛、张口受限等症状,严重时甚至导致颌面部畸形.症状的相似性和关节的结构复杂性使DP的诊断存在一定的挑战.MRI在临床上广泛用于颞下颌关节成像,可能是一种识别DP简便有效的方法...     

肾重复畸形的B型超声诊断

本文对35例小儿肾重复畸形做B型超声检查,结果:在一侧肾区显示两个集合系统,是B超诊断重复肾的特有影象。B超可准确地显示重复肾的位置、大小,形态。部分病例见到重复输尿管及输尿管囊肿影象。B超方法简便迅速、无损伤、直观感强,与IVP、SPECT检查比较,显象条件不依赖于重复肾功能,而与重复肾形态,肾盂的大小有关。B超检查结果为临床诊断及治疗提供重要依据。