经阴道宫腔声学造影诊断子宫内膜息肉的价值

目的:探讨经阴道子宫腔造影技术(Transvaginal sonohysterography,SHG)诊断子宫内膜息肉的价值。材料和方法:对39例有异常阴道出血者行SHG检查,并将检查结果与经阴道超声(Transvaginal sonography,TVS)、诊断性刮宫或宫腔镜所获得的结果进行比较分析。结果:病理证实的子宫内膜息肉34例,粘膜下子宫肌瘤3例,子宫内膜增生1例。SHG诊断子宫内膜息肉32例,均可清晰地显示宫腔轮廓和病灶的形态,30例与内膜界限清楚,可见病灶附着部位,23例于结节内部或蒂部显示血流信号;TVS诊断子宫内膜息肉26例,均可见子宫内膜稍强回声结节,其中19例边界清楚,6例可见病灶附着部位;8例结节内部或蒂部显示血流。使用TVS34例均未显示宫腔的轮廓。本组子宫内膜病例在宫腔轮廓及病灶附着部位方面SHG和TVS的显示率分别为94.1%、88.2%和0%、17.6%。SHG明显优于TVS(P<0.001)。SHG诊断粘膜下子宫肌瘤3例,回声与基底部的子宫肌层相似,略低于子宫内膜,病灶基底部与子宫肌层无界限,表面可见内膜与造影剂构成的亮线,1例可见蒂部,CDFI显示2例内部血流丰富,1例见肌层血管穿入病灶。TVS诊断粘膜下子宫肌瘤2例,表现为为子宫内膜低回声结节,1例子宫内膜呈非均质改变,CDFI可见内部丰富的血流信号(SHG显示宫腔内为2枚粘膜下子宫肌瘤,已得到HSC证实)。结论:SHG能明显提高病变的显示率,对于子宫内膜息肉的术前诊断具有重要的临床价值。     

老年腹主动脉瘤非手术治疗的长期超声随访研究

目的超声随访观察经非手术治疗的老年腹主动脉瘤的发展变化规律。方法超声随访诊断明确、病历及影像学资料完整的老年腹主动脉瘤非手术治疗患者37例，按首次发现时瘤体大小分3组，定期测量并记录各组腹主动脉扩张最明显处横切面直径，计算年增长量。结果37例腹主动脉瘤首次发现时瘤径大小平均为4．68cm，随访年限0．5～11年，平均6．1年，瘤径平均每年增长0．47cm。14例瘤径小于4．0cm，平均年增长0．23cm，15例瘤径小于6．0cm，平均年增长0．37cm，8例瘤径大于6．0cm，平均年增长0．67cm。随访期间死亡5例，其中因动脉瘤破裂死亡2例，破裂前瘤径大小分别为8．35cm、8．91cm。7例随访期间因瘤径短期内明显增大而行腹主动脉瘤腔内支架隔绝术。结论老年腹主动脉瘤瘤径小于6．0cm者随增龄增长缓慢，大于6．0cm者随增龄增长快，应进行积极的外科干预。     

经阴道超声及宫腔造影对鉴别子宫内膜息肉与其他病变的意义

目的分析子宫内膜病变的声像图和血流特征,并评价经阴道彩色多普勒超声宫腔造影对子宫内膜息肉的诊断价值。方法采用经阴道彩色多普勒加宫腔造影,分别对19例子宫内膜息肉和32例子宫内膜其他病变之声像图、彩色血流及频谱表现进行对比,全部病例经宫腔镜及手术后的病理证实。结果经阴道彩色多普勒超声检诊子宫内膜息肉,清晰显示了内膜与黏膜下肌层之界限和息肉的病变边界,还显示了息肉蒂基底的彩色血流或黏膜下肌瘤周边彩色血流环,适时加做宫腔造影则更有益于对细小病变的诊断。结论经阴道彩色多普勒超声加做宫腔造影可大大提高对子宫内膜息肉与子宫内膜其他病的鉴别诊断水平。     

绝经后阴道出血852例临床分析

探讨经经后阴道出血的原因，相关因素来指导临床实践。方法；对我院收治的８５２例绝经后阴道出血的临床资料进行回顾性分析。结果；以阴道炎最多２６９例、慢性宫颈炎１８８例，功能失调性子宫出血１０２例，宫内节育器９８例，恶性肿瘤５９例，以内膜癌 ３３例，卵巢恶性肿瘤次之１６例。     

Acro-pectoro-renal field defect with contralateral ureteropelvic junction obstruction

Ureteropelvic junction obstruction was noted in a newborn male infant with acro-pectoro-renal field defect. To our knowledge, this association has not previously been reported. Ultrasonography of the urinary tract should be performed on all children with aplasia of the pectoralis major muscle.     

B超诊断先天性无睑裂囊性眼临床分析(附2例报告)

报告 2例先天性无险裂囊性眼的B超图像,例 1左眼球前后径 28.2 mm,横径 31.3 mm,未见角膜、前房、虹膜及晶体回声,整个眼球均为暗区;例2右眼球均为暗区,前后径16.6 mm,未见角膜、前房、虹膜及晶体回声,眼球前外方另见13.8 mm×9.1 mm 的暗区。并对其发病机理与B超图像的关系进行讨论。     

Post-biopsy arteriovenous fistulas of the native kidneys diagnosed by Doppler US

Two patients with arteriovenous fistulas of the native kidney occurring after needle biopsy were evaluated using duplex and color Doppler ultrasonography. The first patient had a fistula with associated pseudoaneurysm: color Doppler showed the lesion as a small rounded area with whirling flow; spectral analysis allowed recognition of both the afferent artery with low impedance flow and the draining vein with pulsatile, arterialized flow. The second patient had a normal color Doppler study; however, spectral analysis demonstrated signals with low vascular impedance from an intra-parenchymal artery at the lower pole, and a jet of turbulent flow. Following disappearance of clinical findings, such Doppler abnormalities were no longer detectable. When a iatrogenic arteriovenous fistula is considered on clinical grounds, both color and Doppler spectral analysis of waveforms from intra-parenchymal vessels should be performed. Possibly, further advances in color Doppler technology will permit the use of this examination as the first imaging procedure in these clinical situations.Correspondence to: L. E. Derchi     

妇科盆腔肿块超声误诊漏诊原因分析

本文报道经手术病理证实的１６７例妇科盆腔肿块超声检查结果，超声诊断总的符合率为９０．４２％（１５１／１６７）。其中子宫肌瘤、畸胎瘤、卵巢囊肿、卵巢囊腺瘤以及卵巢交响癌符合率较高，对于其它疾病引起的盆腔肿块也有参考价值，本文着重分析误诊漏诊原因，以吸取教训，供超声诊断借鉴。     

Early assessment of renal resistance index after kidney transplant can help predict long-term renal function.

BACKGROUND: Color Doppler ultrasonography of intrarenal arterial resistance index (RI), performed early after kidney transplant, has proven to reliably predict short-term allograft function. The aim of this study was to assess whether it could also predict long-term renal function. METHODS: We retrospectively analysed 76 kidney transplant patients who underwent RI assessment within 1 month after the transplant, subdivided into two groups according to RI values, lower (group A) or higher (group B) than its median value (0.635). RESULTS: Compared with group A subjects, the patients of group B were older at the time of transplant (42 +/- 9 vs 35 +/- 8 years; P = 0.001), the donor age was also older (41 +/- 16 vs 33 +/- 13 years; P = 0.02) and had a slightly higher proteinuria (0.54 +/- 0.5 vs 0.32 +/- 0.2 g/24 h; P = 0.02). Serum creatinine, ciclosporin or tacrolimus trough level, arterial blood pressure, number of human leukocyte antigen (HLA) mismatches, anti-hypertensive medications and incidence of delayed graft function were not significantly different between the two groups. By univariate analysis, RI turned out to directly correlate with the recipient age, donor age and daily proteinuria (P = 0.007, P = 0.0007 and P = 0.02, respectively). Multivariate analysis showed that only donor and recipient age maintained their independent predictive value on RI. Kaplan-Meier analysis, considering a serum creatinine increase >50% as the endpoint of the study, showed a statistically significant different graft survival in the two groups (log-rank test = 5.489; P = 0.01). The univariate relative risk of deterioration of graft function among patients with higher RI was 3.77. Proteinuria and recipient age increased the risk as well. CONCLUSIONS: Our data seem to suggest that early determination of RI can help predict long-term graft function in kidney transplant recipients.