Celiac Artery Compression Syndrome Evaluated with 3-D Contrast-Enhanced Ultrasonography: a New Approach

This study was performed to estimate the value of 3-D contrast-enhanced ultrasonography (3-D-CEUS) in the diagnosis of celiac artery compression syndrome (CACS). Patients suspected of having CACS were assessed with 3-D-CEUS and contrasted with computed tomography angiography. Diagnostic accuracy was evaluated with a receiver operating characteristic curve. Three-dimensional CEUS revealed 19 positive and 9 negative cases. In the negative group, the contrast agent did not change with respiration. In the positive group, the contrast agent exhibited a hook-shaped stenosis on expiration and returned to normal on inspiration. Computed tomography angiography indicated 1 false-positive case and 1 false-negative case. The sensitivity and specificity of 3-D-CEUS were 95% and 89%, respectively. The area under the receiver operating characteristic curve was 0.982 (p?<0.01). In conclusion, 3-D-CEUS can accurately reveal the characteristic hooked appearance and dynamic nature of CACS with respiration, and thus, it represents a new, non-invasive approach to CACS diagnosis.     

彩色多普勒超声诊断中弓韧带压迫综合征

目的 探讨彩色多普勒超声诊断中弓韧带压迫综合征（MALS）的价值。方法 采用彩色多普勒超声对41例腹痛患者的腹腔动脉进行筛查,观察腹腔干起始段走行、管腔内径,再分别测量起始段狭窄处平静状态、深吸气末、深呼气末收缩期峰值速度（PSV_calm、PSV_insp、PSV_exp）,并计算深呼气末与深吸气末血流速度变化率（流速变化率）。对照组为100例接受腹部超声检查的无腹痛患者,分别测量上述各参数,比较MALS患者（MALS组）和对照组各参数的差异。以CTA结果为金标准,构建ROC曲线分析PSV_exp、流速变化率以及两者联合诊断MALS的价值。结果 彩色多普勒超声共检出20例MALS,CTA检出19例。超声诊断MALS的敏感度为89.47%（17/19）、特异度为86.36%（19/22）、准确率为87.80%（36/41）、阳性预测值为85.00%（17/20）。MALS组腹腔干起始段血流峰值速度及流速变化率明显高于对照组（P均<0.01）。PSV_exp、流速变化率的ROC曲线下面积分别为0.936、0.920（P<0.01）。以PSV_exp=330 cm/s为阈值,诊断MALS的敏感度和特异度分别为85.7%和90.9%。当流速变化率=120%时,诊断MALS的敏感度和特异度分别为87.7%和89.4%。结论 彩色多普勒超声可清晰显示腹腔干狭窄的部位、狭窄程度;将PSV_Exp≥330 cm/s或流速变化率≥120%或两者联合作为超声参考指标评估MALS,均有较高的诊断价值,且两者联合诊断的特异度最高。     

3例正中弓状韧带综合征患者的围术期护理

正中弓状韧带综合征是一种临床不常见的疾病,以不能缓解的餐后腹痛为主要症状,好发于中青年女性,其真正的发病率目前未知,但慢性持续性腹痛严重影响着患者的生活质量。本文总结了我科收治的3例正中弓状韧带综合征合患者的围术期护理方法,主要包括术前心理护理、慢性持续性腹痛的管理,术后腹部体征的观察、疼痛护理、生命体征观察、饮食指导及信息化的随访指导等,使患者顺利康复出院。     

Consideration of Testicular Torsion in Young Males With Abdominal Pain Is Essential: A Case Review

Testicular torsion is a surgical emergency and requires prompt recognition and treatment. Health care personnel often forget this differential diagnosis in males who present with abdominal pain as their only complaint. There is a 4- to 6-hour window from the onset of symptoms to the surgical intervention to salvage the testes. It is imperative for health care personnel to consider testicular torsion in any male presenting with abdominal pain and to complete a genitourinary examination. The purpose of this case review is to highlight the importance of a genitourinary examination in recognizing testicular torsion.     

Median arcuate ligament syndrome with multivessel involvement: diagnosis with spiral CT angiography

Intestinal angina may be caused by compression of the celiac artery by the median arcuate ligament of the diaphragm. Aortography can suggest the diagnosis, but the diaphragm cannot be visualized by this examination. We report a symptomatic woman in whom spiral computed tomography-guided angiography demonstrated stenosis of the celiac artery, superior mesenteric artery, and both renal arteries due to diaphragmatic compression. Surgery was beneficial. Received: 15 August 1995/Accepted: 26 September 1995     

Applying case definition criteria to irritable bowel syndrome

Objective: The quality of documentation of signs and symptoms and validation of the diagnosis of irritable bowel syndrome (IBS) according to case definition criteria of Manning, Rome I and Rome II in an office setting has not been previously described. We sought to identify and validate cases of IBS based on the Manning, Rome I and Rome II diagnostic criteria in a rural practice setting.