Application of trans-abdominal chorionic villus sampling in prenatal diagnosis of chromosomal diseases in first trimester of gestation

Objective:To evaluate the feasibility and safety of prenatal diagnosis by traneabdominal chorionic villus sam-pling(TA-CVS)via the guidance of B-mode ultrasound in the first trimester of gestation.To explore the technique of long time culture and chromosome preparation of villi in early pregnancy.To evaluate the feasibility of the above techniques in the application of the prenatal cytogenetic diagnosis.Methods:One hundred and thirty-five singleton pregnancies at risk were referred from January 2001 to Decem-ber 2007.Results:The average maternal age was 35.2 years.TA-CVS was performed in the 10～13th weeks of gestation and the average gestational age was 10.89 weeks.All attempts at sampling were successful.The rate of operation-associated fetal loss was 0.74%.The failure rate of prenatal diagnosis because of inadequate amount of specimen was 0.The average culture time was 5-7 days.The success rate of the cell culture was 98.5%.No maternal con-temination and bacterial contamination happened.Fifteen cases of abnormal karyotype and one case of confined pla-cantel mosaiciem were diagnosed.Conclusion:TA-CVS appears to be safe and feasible and might to be offered in the prenatal diagnosis in the first trimester of gestation.The technique of long time culture and chromosome preparation of villi is stable and reliable.It is feasible to apply these techniques in the clinical practice of prenatal cytogenetic diagnose in the early pregnancy.     

B超引导下脐静脉穿刺术临床应用

目的分析B超引导下脐静脉穿刺术的临床应用价值。方法对1200例临床怀疑异常的孕妇进行B超引导下脐静脉穿刺术,检测、分析所抽取的脐静脉血。结果成功率99.7%,发现异常胎儿349例。结论B超引导下脐静脉穿刺术成功率高,应用广泛,是一项安全的产前诊断方法。     

冠心病患者颈动脉超声检测的临床意义

目的通过分析颈动脉粥样硬化与冠心病的关系探讨颈动脉超声对诊断冠心病的临床意义。方法将120例入选对象分为对照组,稳定性心绞痛(SA)组,不稳定性心绞痛(UA)组,急性心肌梗死(AMI)组,每组30例,分别给予超声检测颈动脉内-中膜厚度(IMT),同时测定3组冠脉造影结果:正常组21例,单支病变组18例,多支病变组29例。结果冠心病患者IMT较正常对照组有显著增厚(P<0.01),且冠脉造影正常组与单支、多支病变组间亦存在显著性差异(P<0.05)。结论颈动脉超声检测对冠心病的预测具有确切的临床意义。     

彩色多普勒超声在介入穿刺性血管损伤诊断中的价值

目的用彩色多普勒超声观察穿刺性血管损伤的声像图特征。方法26例周围血管穿刺后出现局部肿块、血管杂音,用彩色多普勒超声显示肿块的形态、回声、与周围血管的关系,观察肿块内、破口处、肢体动脉和静脉内的血流信号。结果3例单纯性血肿,彩色血流成像肿块内无血流信号;19例假性动脉瘤,肿块内有低速的动脉血流信号,动脉与肿块的破口处有五彩镶嵌的彩色血流信号和收缩期高速湍流血流频谱;4例动静脉瘘,在瘘口处可见有一股五彩镶嵌的彩色血流信号和连续性高速分流频谱。结论彩色多普勒超声能为穿刺性血管损伤提供准确的诊断。     

B超诊断脐带绕颈的价值

目的 通过对胎儿脐带绕颈的超声图像表现和产后临床诊断结果进行对比分析，评价超声诊断脐带绕颈的价值。方法 将2000例37—42孕周胎儿的超声检查结果与产后临床诊断进行对比分析。结果 2000例胎儿中超声检出有脐带绕颈的有422例，产后证实为脐带绕颈的有386例。脐带绕颈的发生率为19．3％，诊断准确率为91％。结论超声能准确诊断胎儿脐带绕颈，为临床医生制定治疗方案提供了可靠依据，有助于降低围产儿的死亡率。     

乳腺叶状肿瘤超声特征及与病理对照分析

目的:研究乳腺叶状肿瘤的超声声像图特征,并与病理结果相对照,以期从超声角度提高对本病的认识。方法:分析经病理证实的16例乳腺叶状肿瘤的二维及彩色多普勒超声表现,并与病理结果对照分析。结果:二维图像肿块体积大小范围变化大,形态不规则可分叶,可有包膜,内部多为不均匀弱回声,可有液性暗区。CDFI良性血流0~Ⅰ级,恶性Ⅱ~Ⅲ级,阻力指数偏高。结论:乳腺叶状肿瘤的二维声像图具有一定特点,但无明显特异性,肿块的大小与良恶性之间无明显联系,结合肿块内部囊性变、彩色多普勒超声显示丰富的血流及高速高阻频谱,对提示恶性有意义。     

乳腺髓样癌的超声表现及临床意义

目的:探讨乳腺髓样癌的超声和病理之间关联性,以便确定超声在区别典型髓样癌(TMC)和非典型髓样癌(AMC)的临床意义。方法:我们回顾性分析了20例确诊为乳腺髓样癌(MC)的组织切片和超声图像。依照严格的组织学分类标准,我们将肿瘤分为TMC和AMC。比较了二者在超声图像和组织学类型之间的关联。结果:20例MC中的8例(40%)确定为TMC,12例(60%)确定为AMC。在超声图像中,8例TMC中有6例(75%)显示了整齐平滑的边缘,而12例AMC却没有此特征。12例AMC中的10例(83%)其超声图像显示为锯齿样边缘,2例(17%)的病灶边缘光滑伴局部不规则。从而发现在TMC和AMC中,其肿瘤边缘变化规律性上具有统计学上的显著意义(P<0.001)使用四格表确切概率法检验。结论:如果超声图像显示了肿瘤锯齿样边缘或病灶边缘光滑伴局部不规则,对诊断AMC有一定的帮助,应对整个肿瘤进行认真的病理学分型,以便正确评估预后,采取正确治疗方案。     

踝关节侧副韧带损伤的超声表现

目的 分析踝关节侧副韧带损伤的超声图像特征并评价其诊断价值。方法 采用7～13MHz线阵探头探查136例临床怀疑踝关节侧副韧带损伤患者，观察胫舟、胫距前、胫跟、距腓前、跟腓、胫距后、距腓后韧带，共计952条韧带，其中，51例的超声结果与手术比较。结果 46例侧副韧带完全及部分撕裂伤的超声诊断与手术结果符合。侧副韧带挫伤以肿胀为主，部分撕裂伤超声表现为韧带局部连续性中断（跟腓韧带）和不规则低-无回声区内见丝状结构相连，完全撕裂伤超声表现为韧带连续性中断，断端挛缩（跟腓韧带）和不规则低-无回声区贯穿整条韧带，无明显断端挛缩征。结论 高频超声对踝关节侧副韧带损伤的诊断无创、较准确、廉价，具有较高的临床应用价值。     

Localization of parathyroid enlargement: experience with technetium-99m methoxyisobutylisonitrile and thallium-201 scintigraphy,ultrasonography and computed tomography

Technetium-99m methoxyisobutylisonitrile (MIBI), like thallium-201, has recently been introduced as a myocardial perfusion agent and is now also showing very promising results in parathyroid scintigrapy. The results of ²⁰¹Tl/^99mTc-pertechnetate and ^99mTc-MIBI/^99mTc-pertechnetate subtraction scintigraphy, ultrasonography and computed tomography are presented in a series of 43 patients operated on for hyperparathyroidism. All four imaging modalities were confirmed to be reliable, scintigraphy being the most accurate. Sensitivities ranged from 81% to 95%, that of ^99mTc-MIBI being the highest. Moreover this tracer, which has more favourable physical and also biochemical properties, yielded images of superior quality. This allowed localization of the lesion by visual inspection only in as many as 86% of the patients with positive ^99mTc-MIBI/^99mTc-pertechnetate subtraction scintigraphy. We believe that the higher sensitivity, superior image quality and lower cost of ^99mTc-MIBI imaging will make ^99mTc-MIBI the new radiopharmaceutical of choice for parathyroid scintigraphy (when one takes into account the stability of labelling with large activities it is possible to perform three or four cardiac studies together with one parathyroid scintigraphic examination using one lyophililzed vial).     

泡型肝包虫病的超声诊断再探讨-附100例分析

目的:探讨泡型肝包虫病的B超特征,提出分型依据。方法:综合分析100例经手术或穿刺病理证实的B超声像图表现,并结合部分经CT、MRI检查病例对比研究。结果:100例泡型肝包虫,B超主要表现为①肝内不规则强回声团块80例,其中团块内呈弥漫性粗颗粒状强回声类似"落雪状"改变25例,团块内合并坏死液化20例,团块内钙化25例,钙化和液化同时出现10例。②肝内呈结节状改变20例。结论:泡型肝包虫病表现有其特征性,团块内粗颗粒状强回声,不规则液化坏死,斑片状钙化,周边无低回声暗晕以及彩超团块内无血流信号是与肝癌等肿块鉴别的重要依据。