血清免疫抑制酸性蛋白检测在妇科肿瘤中的应用价值

目的　评估血清免疫抑制酸性蛋白 (immunosuppressiveacidicprotein ,IAP)在妇科良、恶性肿瘤鉴别诊断及预后转归中的价值。方法　术后病理确诊的妇科疾病患者 15 0例 ,其中恶性 2 1例。术前全部检测血清IAP ,部分患者同时检测CA12 5。恶性患者化疗后及术后 2年随访IAP、CA12 5。结果　恶性肿瘤患者血清IAP高于良性疾病组 (P <0 .0 1) ;IAP阳性组中恶性肿瘤患者IAP值与良性疾病患者差异无显著性 (P >0 .0 5 ) ,但与除外炎症的良性疾病患者IAP值相比差异有显著性 (P <0 .0 1) ,随访化疗后及术后 2年恶性肿瘤患者IAP水平明显下降 (P <0 .0 1)。结论　IAP可作为妇科肿瘤鉴别诊断及预后随访的参考指标之一 ,IAP结合CA12 5检测有助于提高妇科恶性肿瘤的检出率     

“Tethered Fat Sign”: The Sonographic Sign of Omental Infarction

Our purpose is to describe the ultrasound sign for a correct non-invasive diagnosis of omental infarction in children. From January 2014 to December 2018, a total of 234 children (109 boys and 125 girls, age range 3–15 y) with acute right-sided abdominal pain, admitted to our hospital with a presumptive diagnosis of acute appendicitis, were prospectively evaluated. In all patients, abdominal ultrasound was performed, and the omental fat was always evaluated. In 228 patients, the omental fat resulted to be normal or hyperechogenic, never tethered, and they results affected by other causes of abdominal pain different from omental infarction (such as appendicitis, pancreatitis, urolithiasis and others). In the remaining 6 children, we found a hyperechoic mass between the anterior abdominal wall and the ascending or transverse colon in the right abdomen quadrant, suggesting the diagnosis of omental infarction. This subhepatic mass was always tethered to the abdominal wall, motionless during respiratory excursions. We named this finding the “tethered fat sign.” The diagnosis was confirmed with laparoscopy in 4 children. The other 2 children were treated with conservative therapy. In these 2 patients, a sonographic follow-up was performed, showing a progressive reduction in size of the right-sided hyperechoic mass. In conclusion, our study suggests that the presence of the “tethered fat sign” may be an accurate sonographic sign for non-invasive diagnosis of omental infarction in children.     

The diagnostic value of levovist in Doppler imaging of visceral arteries in patients with abdominal angina before and after angioplasty

PURPOSE: To assess the diagnostic value of Levovist in the ultrasound imaging of visceral arteries in patients with clinical symptoms of abdominal angina, before and after percutaneous transluminal angioplasty (PTA). MATERIAL AND METHOD: During a 12-month period (2000/2001) five patients with visceral arterial stenoses had ultrasound examinations and a subsequent PTA procedure. Indications for ultrasound examination were abdominal angina symptoms persisting for 3-5 years, (postprandial abdominal pain, diarrhea, and vomiting). In all patients ultrasound examinations were performed using color and spectral Doppler before and after Levovist injections. Color Doppler images and maximum blood flow velocity in stenosed visceral arteries were assessed. Patients underwent control Doppler examinations with Levovist injections to assess the effect of PTA. RESULTS: In three patients conventional Doppler examination did not allow proper evaluation of visceral arteries, because of weak color and spectral Doppler signal and in two remaining patients visceral arteries were not visualized at all. In all five patients strong enhancement of color and spectral Doppler signal was observed after Levovist administration. In all these cases a hemodynamically significant stenosis was diagnosed: coeliac trunk-2 and superior mesenteric artery-3. PTA was performed successfully in these patients. In one of them ultrasound examination done before Levovist injection allowed good visualization of treated SMA and showed good PTA result. In the remaining four patients Doppler examination with the use of Levovist demonstrated visceral arteries well and confirmed successful PTA procedures. CONCLUSIONS: The use of Levovist makes the diagnostic efficiency of Doppler examinations much higher. In most cases it allows an unequivocal diagnosis of visceral artery stenosis in patients with abdominal angina symptoms. The Doppler examination with the use of Levovist is the method of choice in follow-up after PTA.     

超声造影在小体积肾肿瘤中的诊断价值

目的探讨超声造影在小体积肾肿瘤中的诊断价值。方法对38例直径小于30 mm的肾脏实质性占位病例进行超声造影,做出良性或恶性病变的诊断,与手术后病理检查和随访结果进行比较。结果 38例患者中35例手术。超声造影检查诊断出恶性肿瘤25例,全部手术,结果 24例为恶性肿瘤,1例为良性肿瘤。另超声造影检查诊断良性肿瘤13例,其中10例手术,8例为良性肿瘤,2例为恶性肿瘤。未手术3例中,2例随访失联,1例随访中。超声造影对小肾脏肿瘤诊断的灵敏度为92.30%,特异度为90.00%,诊断指数182.30%,约登指数82.30%,诊断符合率91.66%。超声诊断与病理诊断结果进行χ2检验分析,P=0.5637。结论超声造影在小体积肾脏肿瘤中的良恶性鉴别有较高的价值。     

Contrast-Enhanced Ultrasound for Blunt Abdominal Trauma

Sonography is widely used in the initial diagnostic assessment of blunt abdominal trauma in adults and children. It has been formally incorporated worldwide into the routine armamentarium available for emergency diagnosis and treatment as a means of rapid detection of free abdominal fluid, normally referred to as FAST (Focused Assessment with Sonography in Trauma). However, there is some controversy regarding its value because free abdominal fluid may be lacking in patients with abdominal organ injuries from blunt trauma. More recently, a new ultrasound technique has been developed using contrast agents. Contrast-enhanced ultrasound performs better than the non-contrast-enhanced technique for the detection of abdominal solid organ injuries and can play an important role in the prompt evaluation of patients with blunt trauma. Furthermore, contrast-enhanced ultrasound can be used in the follow-up of patients who have solid organ lesions and are managed with nonoperative treatment, avoiding radiation and iodinated contrast medium exposure.     

X线评分量表联合腹部超声可较好识别新生儿坏死性小肠结肠炎:89例前瞻性研究

目的评估腹部X线评分量表（DAAS）联合腹部超声检查对新生儿坏死性小肠结肠炎（NEC）的诊断价值。方法前瞻性纳入2017年1月~2019年12月在本院接受诊治的97例疑似NEC患儿作为研究对象,其中男性59例,年龄6.4±3.5 d;女性38例,年龄6.9±2.8 d。对所有患儿行腹部X线检查、超声检查。以手术病理结果为金标准,分别评估DAAS、超声检查及DAAS联合超声检查对NEC检出的一致率、敏感度、特异性、阳性预测值、阴性预测值;采用ROC曲线分析3种检查方式的诊断效能;对不同分期患儿的DAAS对比,对不同肠道病变患儿的DAAS比较。结果经手术病理证实,89例确诊为NEC。对比手术病理结果,DAAS、腹部超声检查以及DAAS联合超声检查对于NEC的诊断一致率、敏感度、特异性均高于85%。3种检查方式对于NEC诊断效能的曲线下面积分别为0.96、0.94和0.98,DAAS联合超声检查的诊断效能最高。随着疾病严重程度的增加,DAAS明显增高,差异具有统计学意义（P < 0.05）。对比不同肠道病变患儿的DAAS,肠穿孔组患儿显著高于肠坏死组,两者差异具有统计学意义（P < 0.05）。结论DAAS联合腹部超声检查能较好的识别NEC,具有重要的临床运用价值。      

实时超声引导心包,胸,腹腔穿刺行腔内灌注介入化疗

报道实用超声引导心包腔或胸、腹腔穿刺进行腔内灌注化疗药液，治疗恶性肿瘤并浆膜腔转移４３例，取得良好效果。作者认为，本方法具有穿刺准确、安全简便，并发症少等诸多优点，可协助临床观察疗效或评价疗效提供依据，是腔内化疗的新途径，值得进一步推广应用。     

Current value of peritoneal tap in blunt abdominal trauma.

This study aimed to establish the diagnostic value of paracentesis (peritoneal tap) in the assessment of patients with blunt abdominal trauma. Paracentesis, using a four-quadrant puncture technique, was performed in blunt abdominal trauma victims presenting to the emergency department of a tertiary-care university medical centre. Pregnant patients, those under 18 or those having an abdominal scar were excluded from the study. All patients then underwent one of the following procedures as indicated: emergency ultrasound, abdominal computed tomography scan, diagnostic peritoneal lavage or laparotomy. Paracentesis results were compared with the results of other tests and surgery in diagnosing haemoperitoneum. Haemoperitoneum was confirmed surgically in six of the seven patients with a positive paracentesis. Nine out of 65 patients with positive clinical findings but negative taps underwent surgical intervention, and abdominal bleeding was confirmed in eight. Three seriously injured patients died before diagnostic studies or laparotomy could be performed. In conclusion, a positive paracentesis result may be used to guide decision-making in the setting of blunt abdominal trauma if other diagnostic methods are unavailable. Its high false-negative rate limits its overall usefulness.     

小儿急性阑尾炎的超声诊断分析

目的　分析小儿急性阑尾炎的超声表现、阑尾病变程度与时间的相关性、探讨小儿急性阑尾炎的超声诊断价值。方法　回顾性分析4 4例急性阑尾炎患儿的超声图像,4 0例均行手术,经病理证实。4例抗炎对症治疗。结果　单纯性阑尾炎、急性化脓性阑尾炎、坏疽穿孔性阑尾炎及阑尾周围脓肿的显示率分别为5 7%、95 %、75 %、83%。阑尾炎的最大外径与腹痛时间呈正相关(r=0 .5 9,P<0 .0 1)。结论　超声检查为小儿急性阑尾炎的诊断、分型提供了客观依据,病变阑尾的最大外径反映了阑尾的病变程度。     

Extracorporeal focused ultrasound surgery for treatment of human solid carcinomas: early Chinese clinical experience

The objective of this article is to introduce the early Chinese clinical experience of using extracorporeal focused ultrasound (US) surgery (FUS) for the treatment of solid tumors. From December 1997 to October 2001, a total of 1038 patients with solid tumors underwent FUS ablation in 10 Chinese hospitals. The tumors included primary and metastatic liver cancer, malignant bone tumors, breast cancer, soft tissue sarcomas, kidney cancer, pancreatic cancer, abdominal and pelvic malignant tumors, uterine myoma, benign breast tumors, hepatic hemangioma and other solid tumors. In this article, pathologic changes in tumors treated with FUS, real-time diagnostic imaging for targeting, monitoring and assessment of results by follow-up images are presented. Early clinical results and complications of the technique are also reported.     

Paediatric focal nodular hyperplasia: A case study of typical contrast-enhanced ultrasound findings with quantitative analysis and correlated with magnetic resonance imaging

IntroductionFocal nodular hyperplasia, a benign liver tumour, is the second most common focal benign liver lesion, after a cavernous haemangioma. Contrast-enhanced ultrasound is used increasingly for the diagnostic work up and follow-up of focal liver lesions in adults, but is particularly valuable in the paediatric population, with the ability to reduce radiation and the nephrotoxic contrast agents used in computed tomography or magnetic resonance imaging. Confident recognition of focal nodular hyperplasia is important; it is benign, usually asymptomatic, of no clinical significance, of no clinical consequence or malignant potential. We present a case of focal nodular hyperplasia of the liver with its characteristic findings on conventional ultrasound, contrast-enhanced ultrasound with quantitative analysis and correlated with magnetic resonance imaging.Case presentation: A 15-year-old female with right upper quadrant abdominal pain was referred for liver ultrasound. A focal liver lesion was detected on B-mode ultrasound examination, and colour Doppler demonstrated no specific features. Contrast-enhanced ultrasound examination demonstrated early arterial enhancement, with a characteristic spoke-wheel pattern, centrifugal uniform filling of the lesion on the late arterial phase and sustained enhancement on the portal venous phase. Quantitative contrast-enhanced ultrasound has been performed, showing a typical curve of enhancement, as well as characteristic parametric images, supporting the interpretation of contrast-enhanced ultrasound and assisting the diagnosis. Magnetic resonance imaging demonstrated a central T2 hyperintense scar and similar enhancement characteristics as contrast-enhanced ultrasound on T1 gadolinium-enhanced sequences.ConclusionContrast-enhanced ultrasound is a useful technique for the differentiation of benign from malignant liver lesions and has the potential to establish the diagnosis of focal nodular hyperplasia, based on the enhancement pattern, which is similar to that observed on magnetic resonance imaging but can be better appreciated with superior temporal, contrast and spatial resolution of contrast-enhanced ultrasound.     

Intraductal ultrasound for the evaluation of patients with biliary strictures and no abdominal mass on computed tomography

BACKGROUND AND STUDY AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is the diagnostic procedure of choice in patients with biliary strictures and no culprit mass lesion on abdominal imaging, but it is limited in its diagnostic accuracy. The aim of this prospective study was to determine the value of intraductal ultrasound (IDUS) in distinguishing between benign and malignant biliary strictures in this clinical setting. PATIENTS AND METHODS: Sixty-one patients with painless jaundice and no mass lesion on abdominal computed tomography, who were found to have a biliary stricture at ERCP, underwent IDUS with a high-frequency (20-MHz) wire-guided probe. Histopathological confirmation or clinical follow-up was used to establish the final diagnosis. The diagnostic performances of IDUS, ERCP, and IDUS plus ERCP in the identification of malignant strictures were evaluated. RESULTS: Forty-three patients had malignant strictures and 18 had benign strictures. ERCP produced 25 false-negative diagnoses, 22 of which were identified as malignant by IDUS. IDUS provided seven false-negative and three false-positive diagnoses. The proportion of patients with malignant strictures who tested positive with IDUS was 2.06 times that of ERCP (95 % CI, 1.37 - 3.10; 83.3 % vs. 40.5 %, P = 0.0004). When used in conjunction, IDUS increased the accuracy of ERCP from 58 % to 90 %. Patients with operable lesions on IDUS and no contraindication to surgery underwent resection; most patients with pancreatic parenchymal invasion on IDUS underwent EUS, which identified a pancreatic mass in more than 50 % of cases. Patients with negative IDUS and a low clinical suspicion for malignancy were treated endoscopically, while a more aggressive work-up was performed in all patients with high pretest probability, regardless of the IDUS results. CONCLUSIONS: IDUS is a valuable adjunct to ERCP in the characterization of biliary strictures in patients who present with painless jaundice in the absence of a culprit mass on abdominal imaging.     

常规超声及超声造影在儿童腹膜后常见恶性肿瘤中的应用进展

目前诊断儿童腹膜后肿瘤的主要方法为常规超声、CT及MRI。近年来,超声造影逐步应用于儿童肝脏等疾病,但在儿童腹膜后肿瘤中的应用较少。本文就常规超声和超声造影在儿童腹膜后常见恶性肿瘤中的应用进展进行综述。     

Acute phase after haematopoietic stem cell transplantation: bleeding and thrombotic complications

The transplantation of allogeneic or autologous haematopoietic stem cells is an established treatment for many malignant and non-malignant diseases of the bone marrow. Intensive cytoreductive regimens administered before transplantation induce prolonged and severe cytopenia of all haematopoietic lineages. Thrombocytopenia leads to an increased risk of bleeding, which may be further aggravated by consumption of plasmatic factors as a result of tumour lysis or after antibody administration. At the same time, patients after transplantation are also at increased risk of thrombotic complications. Endothelial damage induced by radio- and chemotherapy, indwelling catheters, prolonged immobilization and a high incidence of systemic infection all contribute to the frequent occurrence of thromboembolic events in this population. This review discusses the incidence and risk factors for haemorrhagic and thrombotic complications after stem cell transplantation. Special emphasis is given to complications occurring specifically in the context of transplantation such as diffuse alveolar haemorrhage, haemorrhagic cystitis, veno-occlusive disease, and transplant associated microangiopathy.     

Clostridium difficile-associated disease in children with solid tumors

GOALS OF WORK: The goal of this study was to describe the incidence of Clostridium difficile-associated disease (CDAD) in children with solid tumours. PATIENTS AND METHODS: After documentation of a case of C. difficile-associated pseudomembranous colitis in a patient with neuroblastoma, the presence of C. difficile toxins A and B was prospectively tested in all children undergoing antineoplastic chemotherapy for solid tumours or lymphomas at the "G. Gaslini" Children Hospital in Genoa who presented abdominal pain. MAIN RESULTS: From January 2005 to December 2006, nine (6%) out of 141 patients treated for solid tumours had C. difficile toxin A detected in their stools in the presence of abdominal symptoms including vomit, abdominal pain and diarrhoea. The majority of patients had a normal neutrophil count at onset of gastrointestinal disease No patient developed pseudomembranous colitis, and none died. All patients received antibiotics and/or antineoplastic drugs previously associated with CDAD. CONCLUSIONS: CDAD may be a complication of children with solid tumours. Since this disease may be life threatening and cause epidemic clusters, this possibility must be kept in mind for the differential diagnosis of abdominal diseases in children with cancer, especially in absence of neutropenia.     

青春期卵巢肿瘤98例临床分析

目的探讨青春期卵巢肿瘤的临床病理特点。方法回顾性分析1999年1月至2009年12月我院收治的98例10～20岁青春期卵巢肿瘤患者的临床资料。结果青春期卵巢肿瘤发病率为5.8%,临床表现主要为腹痛、腹胀、下腹部肿物、月经异常,部分为体检或自己触诊发现。98例均行手术治疗,病理结果为生殖细胞肿瘤56例,上皮性肿瘤36例,性索间质肿瘤4例,混合型生殖细胞肿瘤2例。治疗首选保守性手术,良性肿瘤90例,行卵巢肿瘤剔除术68例,患侧附件切除术22例;8例恶性肿瘤6,例行患侧附件切除术、大网膜切除术;2例行卵巢肿瘤剔除术。恶性肿瘤患者术后辅以化疗。随访至今,除1例内胚窦瘤患者死亡外,其余患者至今均生存良好。结论青春期卵巢肿瘤临床表现、病理类型及其治疗原则均与成年女性存在差异。建议对青春期少年开展普查性体检,必要时行B超检查,治疗应兼顾治愈肿瘤和保留生育功能。     

Adjuvant chemotherapy with and without radiotherapy in stage II breast cancer

The influence of several variables on the effectiveness of adjuvant cyclophosphamide, methotrexate and 5-fluorouracil (CMF) chemotherapy given to 87 patients with stage II breast cancer was retrospectively analyzed. CMF was given in optimal doses (greater than or equal to 85% of the planned dose) to 17% of the patients; in intermediate doses (66-84% of the planned dose) to 50% of the patients; and in low doses (less than or equal to 65% of the planned dose) to 33% of the patients. Radiotherapy before CMF was given to 68% of the patients; simultaneous radio- and chemotherapy to 17% of the patients; and the remaining 15% received CMF only. At a median follow-up of 8 yr, 61% of the patients were still alive; 54% of them were disease-free. Patients receiving radio- and chemotherapy concomitantly had a higher relapse-free survival (RFS) than those given both treatments sequentially (77% versus 46%; P = 0.05). Dose levels of CMF did not influence RFS. Delay in initiation of CMF, mainly due to the administration of prior radiotherapy was deleterious: patients started on CMF within 3 months of diagnosis had a 77% 8 yr RFS, as compared with 44% for those with a delay of over 3 months (P = 0.01). No differences in local relapse rates were observed between irradiated and non-irradiated patients, although 87% of all distant failures occurred in patients who received radio- and chemotherapy sequentially. The data of this study indicate that delay in onset of CMF is deleterious, and can be avoided by the simultaneous administration of both treatment modalities, since this approach was well tolerated, without significant myelotoxicity.     

下肢深静脉血栓形成腹部超声检查的临床意义

目的探讨对下肢深静脉血栓(DVT)形成患者行常规腹部超声检查的临床意义.方法回顾性分析同时行常规腹部超声检查的263例DVT患者的临床资料,分析DVT形成与腹部疾病的关系.结果经腹部超声扫查发现并经其他方法证实腹部疾病为DVT可能致病病因者38例,占全部病例的14.4%,其中恶性肿瘤24例,占全部病例的9.2%,与临床相关的其他疾病14例,占全部病例的5.2%.结论对下肢DVT患者行常规腹部超声检查对发现DVT的腹部病因具有重要临床意义.     

Neopterin as tumour marker serum and urinary neopterin concentrations in malignant diseases

Serum and urinary neopterin concentrations were measured in 142 patients suffering from various malignant diseases. Increased serum and urinary neopterin levels were found in 48% and 55% of patients respectively. Neopterin showed sufficient sensitivity in the detection of haematological disorders and hypernephroma, whereas the sensitivity of neopterin was rather poor in patients with other solid tumours. Comparison of serum alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) concentrations and serum or urinary neopterin levels in testicular cancer patients showed that determination of neopterin provides no further information in the management of these patients. In testicular cancer patients receiving adjuvant chemotherapy, a significant increase in serum (p less than 0.005) and urinary (p less than 0.0005) neopterin concentrations was measured after chemotherapy, reflecting the release of neopterin from macrophages during the damage by cytotoxic drugs. In the adjuvant testicular tumour patients, known to be tumour free, 1 out of 16 patients showed elevated serum and 3 out of 15 patients showed false positive urinary neopterin levels. False positive serum (24%) and urinary (37%) neopterin values were also obtained in 28 patients with various nonmalignant diseases, but no evidence for an inflammatory process. In 23 patients with inflammatory diseases pathological serum and urinary neopterin levels were measured in 55% and 59% respectively. When a RIA was compared with a HPLC method, higher urinary neopterin values were obtained with the RIA, indicating that non-oxidized pterines are also determined by the RIA method. In conclusion, neopterin might be a helpful biological marker in monitoring patients with malignant haematological disorders and renal cell carcinoma, but provides no additional information in other solid tumours studied.     

Screening for occult cancer in patients with acute deep vein thrombosis or pulmonary embolism.

Patients with acute venous thromboembolism have an increased risk for occult malignancy. Limited screening for these malignancies has become common practice but little is known about its usefulness. This is a prospective cohort follow-up study in consecutive patients with acute venous thromboembolism. All patients underwent a routine clinical evaluation for malignancy, if negative, followed by a limited diagnostic work-up consisting of abdominal and pelvic ultrasound and laboratory markers for malignancy. Clinical follow-up was conducted to detect screening failures. The routine clinical evaluation was performed in 864 patients and revealed malignancy in 34 (3.9%) of them. Among the remaining 830 patients the limited diagnostic work-up revealed 13 further malignancies. During follow-up, cancer became symptomatic in 14 patients who were negative for cancer at screening (sensitivity of limited diagnostic work-up, 48.1%). Malignancies that were identified by the limited diagnostic work-up were early stage in 61% of cases vs. 14% in cases occurring during follow-up. Most patients with occult cancer had idiopathic venous thromboembolism and were older than 70 years. A limited diagnostic work-up for occult cancer in patients with venous thromboembolism has the capacity to identify approximately one-half of the malignancies. Identified malignancies were predominantly in an early stage.