B超测量胎儿腹径在巨大儿预测中的应用--附168例分析

目的 探讨一种Ｂ超预测巨大儿物简便、实用的方法。方法 回顾性分析１９９４年１月 １９９８年１２月间出生的巨大儿共１６８例。结果 胎儿腹径「ＡＤ＝（ＴＡＤ＋ＡＰＡＤ）／２」≥１１０ｍｍ者１４５例,预测巨在儿符合率为８６．３１％。与ＡＣ、ＡＤ＋ＢＰＤ、ＡＤ＋ＦＬ、ＡＤ＋ＢＰＤ＋ＰＬ相似,优于ＢＰＤ、ＦＬ、ＢＰＤ＋ＦＬ及宫高＋腹围。结论 Ｂ超测量胎儿腹径预测巨大儿简便、实用、准确,值得临床推广应用。     

超声评价低频脉冲中药导入治疗乳腺囊性增生病临床疗效

目的：超声观察低频脉冲中药导入治疗乳腺囊性增生病的临床疗效。方法：将１５０例患者随机分为治疗组（１００例）和口服乳增宁片对照组（５０例）,超声观察治疗前后乳腺病变组织的变化情况。结果：经２个疗程治疗后,治疗组治愈率６２％,总显效率８３％,总有效率９８％;对照组治愈率３６％,总显效率６６％,总有效率９０％。治疗组的治愈率和总显效率均显著优于对照组（Ｐ〈０．０１,Ｐ〈０．０５）。结论：低频脉冲中药导入     

彩色多普勒超声对甲状腺肿块的诊断价值

目的 探讨彩色多普勒超声（ＣＤＦＩ）对甲状腺肿块的诊断价值。方法 采用彩色多普勒超声观察４５例患者５９个甲状腺肿块周边部及内部的彩色血流和异常高速的血流信号。结果 ①良性甲状腺肿块周边部及内部常显示稀少的彩色血流信号（７７．４％）,而恶性甲状腺肿块周边部及中央部多显示丰富的彩色血流流信号（８２．１％）。②恶性甲状腺肿块的异常高速血流（〉７０ｃｍ／ｓ）检出率与良性甲状腺肿块差异无显著性（Ｐ〈０．０５     

The Influence of Site of Care on the Content of Prenatal Care for Low-Income Women

Objective: To assess whether site of prenatal care influences the content of prenatal care for low-income women. Design: Bivariate and logistic analyses of prenatal care content for low-income women provided at five different types of care sites (private offices, HMOs, publicly funded clinics, hospital clinics, and other sites of care), controlling for sociodemographic, behavioral, and maternal health characteristics. Participants: A sample of 3405 low-income women selected from a nationally representative sample of 9953 women surveyed by the National Maternal and Infant Health Survey, who had singleton live births in 1988, had some prenatal care (PNC), Medicaid participation, or a family income less than $12,000/year. Outcome Measures: Maternal report of seven initial PNC procedures (individually and combined), six areas of PNC advice (individually and combined), and participation in the Women Infant Children (WIC) nutrition program. Results: The content of PNC provided for low-income women does not meet the recommendations of the U.S. Public Health Service, and varies by site of delivery. Low-income women in publicly funded clinics (health departments and community health centers) report receiving more total initial PNC procedures and total PNC advice and have greater participation in the WIC program than similar women receiving PNC in private offices. Conclusions: Publicly funded sites of care appear to provide more comprehensive prenatal care services than private office settings. Health care systems reforms which assume equality of care across all sites, or which limit services to restricted sites, may foster unequal access to comprehensive PNC.     

Prenatal diagnosis of galactosemia

The experience from three different European centres with the prenatal diagnosis of galactose-1-phosphate-uridyltransferase (GALT) deficiency is presented and the question whether or not there is a need for prenatal diagnosis of this disorder is discussed. Most prenatal diagnoses (n=50) have been performed by assay of GALT activity in cultured amniotic fluid cells. The assay used is reliable and clearly distinguishes homozygous affected fetuses (n=11; 0%–2.3% of mean control enzyme activity) from non-(homozygous)-affected fetuses. The GALT assay for cultured amniocytes was adapted to assay the enzyme directly in chorionic villi. The experience with chorionic villi comprises 23 cases with 5 affected fetuses (0%–4.2% of mean control enzyme activity). In 36 cases galactitol was determined in amniotic fluid supernatant by gas chromatography-mass spectrometry. This method also differentiated affected (n=11; galactitol 5.9–10.6 mol/l) and unaffected pregnancies (galactitol 0.23–1.6 mol/l) clearly and has the advantage of providing a result within a day or two after amniocentesis. Prenatal diagnosis of galactosemia is undertaken rarely and sometimes for the wrong reasons, but it should perhaps be considered more seriously until better methods of treatment are established.     

Enzyme studies in GM2 gangliosidiosis,and their application in prenatal diagnosis

Assay of hexosaminidase A and B enzymes in four cases with developmental regression and cherry red spot on fundus examination confirmed that three cases had Tay-Sachs disease, and one case had Sandhoff disease. Prenatal diagnosis was carried out by hexosaminidase enzyme assay in amniotic fluid and cells in one family, and chorionic villus sample in the second family. The fetus was diagnosed to be unaffected in one, and affected in the other family. Assay of hexosaminidase A and B is useful for specific diagnosis of GM₂ gangliosidosis, and for prenatal diagnosis to reduce the burden of these disorders.     

Physician Response to Prenatal Substance Exposure

Objectives: To examine physician responses to suspected prenatal substance exposure and the reasons underlying these responses. Methods: National mail survey of practicing obstetricians and pediatricians who see neonates. Response rate: 63%. Results: More than 70% of physicians reported having ever suspected prenatal substance exposure. Response rates did not vary by specialty. Twenty-seven percent reported that they had never suspected prenatal substance exposure. The most common lifetime pattern (60%) was some response whenever prenatal substance exposure was suspected; next most common was no suspicion (27%). Just over 10% had a discretionary response: acting in some cases of suspected prenatal substance exposure but ignoring others. Two percent consistently ignored their suspicions. Getting help for the patient and protecting the fetus were the most common reasons to act. Among those who had ignored their suspicions, lack of sufficient evidence of substance use was the most often cited reason. There were some important specialty differences in reasons for response and non-response and in specific responses likely to be taken. Obstetricians are far more likely to provide the patient with information and get a substance use history; pediatricians are more inclined to involve outsiders. Conclusions: Obstetricians and pediatricians seem quite willing to act on their suspicions of prenatal substance exposure, and generally respond by taking positive actions. Specialty differences are few and reflect practice differences.     

Molecular cytogenetic characterization of 16p11.2 microdeletions with diverse prenatal phenotypes: Four cases report and literature review

ObjectiveChromosome 16p11.2 deletions have been recognized as a genetic disorder with well-described postnatal phenotypes. However, the prenatal manifestations are atypical for lacking of enough evidence.Case reportFour pregnant women underwent amniocentesis for cytogenetic analysis and chromosomal microarray analysis (CMA) because of various indications for prenatal diagnosis: prenatal ultrasound abnormalities (cases 1, 2 and 4) and the childbearing history of cerebral palsy child (case 3). No overlapping phenotypes were observed in cases 1, 2 and 4, which might indicate phenotypic diversities in prenatal phenotypes for 16p11.2 microdeletion. All four fetuses showed normal karyotypic results while CMA identified 0.303–0.916 Mb microdeletions of 16p11.2, encompassing BP2–BP3 and BP4–BP5 regions separately. According to the parental CMA verification, case 1 carried a maternal inherited duplication in the region of Xp22.33 and a de novo deletion in the region of Xp21.1. All parents opted for the termination of pregnancies based upon genetic counselling.ConclusionOur findings enriched the intrauterine phenotypic features of 16p11.2 microdeletions, which would be beneficial for genetic counselling in clinic. In addition, preimplantation genetic testing was recognized as a first-tier approach for such carriers if they intended to conceive again.     

Tubular ectasia of the rete testis: a potential pitfall in scrotal imaging

Tubular ectasia of the rete testis (TERT) is a benign entity due to dilation of the tubules of the rete testis. Most of the time it is discovered incidentally on scrotal sonograms and may be misinterpreted as malignant. This article outlines the diagnostic criteria of TERT, its possible causes, its incidence and its potential evolution. Recognizing this entity owing to its characteristic clinical, sonographic and, if necessary, MRI features is important to avoid unnecessary surgery or biopsies. Received: 4 August 1998; Revised: 15 April 1999; Accepted: 19 April 1999     

慢性病毒性肝炎胆囊声像异常与肝组织炎症坏死程度的关系

目的：探讨慢性病毒性肝炎胆囊声像异常与肝组织炎症程度的关系。方法：分析了１１２例慢性肝炎患胆囊壁厚度,光滑度,胆囊大小异常,合并胆囊结石及息肉的发生率,并与肝组织病理炎症坏死程度分级进行比较及相关分析。结果：胆囊声像异常总发生率为５７．１４％,胆囊壁厚在轻、中、重度慢性肝炎相互间比较差异均有显性,与肝脏炎症坏死程度呈显性正相关（ｒ＝０．６７,Ｐ〈０．０００１）。胆囊壁不光滑及胆囊大小异常发生