物理查体、X线和超声波检查测量乳腺肿瘤大小的差异

目的　肿瘤大小是乳腺癌临床分期中的决定因素 ,为此我们比较了物理查体、X线检查和超声波检查在乳腺肿瘤测量中的差异。方法　本研究系统回顾分析了我院 1997年 9月～ 1999年 2月有资料可考的乳房单个良恶性肿瘤共 15 5例 ,其中良性肿瘤 3 0例 ,恶性肿瘤 12 5例。分别用以上三种方法测定平卧位时肿瘤水平面的最大直径 ,并且将其与病理学测量的最大径值作比较。结果　研究发现 ,对于良性肿瘤而言 ,各种测量方法与病理学测量的差异不大。对于恶性肿瘤 ,病理学测量的直径为 0 .5～ 8cm(平均为 2 .7cm ) ,物理学查体所测结果最大 ,直径为 1.0～ 12cm (平均为 3 .7cm) ;其次为X线 ,直径为 0 .5～ 7cm (平均为 2 .9cm ) ;超声波检查的测量结果最小 ,直径为 0 .5～ 4cm(平均为 2 .4cm )。与病理学检查相关性最近的是X线检查 ,相关系数为 0 .93 ,标准误为 0 .2 1。结论　三种检查方法与病理学检查均有一定的差距 ,其中以X线检查与病理学检查的差距最小。     

经阴道三维超声在诊断输卵管积水方面的应用初探

目的探讨三维经阴道超声检查技术在诊断输卵管积水中的,临床实用价值。方法对我院2005年4月-2007年12月收治的68例输卵管积水患者进行传统的二维经腹扫查和经阴道扫查,常规二维经阴道超声仔细扫查卵巢周围,当探及卵巢旁腊肠样或串珠样无回声,开启三维表面重建及能量多普勒重建扫描程序,进行容积扫查。结栗68例后经手术或造影证实的病例中43例为双侧榆卵管积水,35例为单侧积水。阴道三维诊断率为94．6％（35／37）,阴道二维超声诊断率为86．5％（58／67）。结论较二维超声,阴道三维超声的适当应用能更全面立体的提供输卵管积水空间结构,更清晰的显示的内部回声信息及周围脏器的比邻关系,对输卵管积水的定性帮助较大,其不仅降低了扫差难度,而且降低了诊断难度。     

超声造影用于儿童泌尿生殖系统疾病的进展

超声造影（CEUS）无电离辐射、无肾毒性、安全性高,具有可动态实时成像等优势,适用于对儿童泌尿生殖系统病变进行观察及随访。经静脉CEUS显示微循环灌注能力好,可用于评估和随访肾脏局灶性病变、移植肾及肾外伤等;经尿道或经膀胱CEUS能较好地显示尿路形态,可用于检测先天性泌尿生殖系统异常。本研究围绕CEUS用于常见儿童泌尿生殖系统疾病的进展进行综述。     

应用组织多普勒成像技术评价冠心病病人左心室长轴功能的变化

目的应用组织多普勒成像(TDI)技术测定冠心病病人左心室长轴功能,并探讨其临床应用价值。方法选择在我院接受治疗的冠心病病人48例,应用TDI技术获得二尖瓣环沿左心室长轴的运动频谱,测量收缩期心肌峰值运动速度(SM)、收缩期位移(DS)及收缩前期时间(PCTM),舒张早期心肌峰值运动速度(EM),心房收缩期心肌峰值运动速度(AM),计算EM/AM比值及左心室射血分数(EF)。结果冠心病组与正常对照组比较,SM和DS显著减小(t=2.78、9.61,P<0.01);PCTM显著增加(t=2.49,P<0.05);EM显著减小(t=5.45,P<0.01);EM/AM比值显著减小(t=4.94,P<0.01);冠心病病人SM和DS与EF、EM呈明显正相关(r=0.58~0.72,P<0.01)。结论冠心病病人存在左心室长轴功能受损,TDI技术为准确评价左心室长轴功能提供了一条新途径。     

Application of Shear-Wave Elastography in the Evaluation of Hamstring Stiffness in Young Basketball Athletes

BackgroundPrevious literature has postulated a relationship between greater hamstring stiffness and a higher risk of sustaining injury. Shear wave elastography (SWE) presents a relatively new means for non-invasive evaluation of soft tissue elasticity pre- and post- injury or intervention.Purpose1. To establish baseline hamstring stiffness measures for young competitive athletes and (2) determine effect of targeted neuromuscular training (TNMT) on shear wave stiffness of the hamstring.Study DesignUn-blinded, prospective, non-randomized, cohort study.MethodsSix-hundred forty-two lower extremities from 321 high school and collegiate basketball athletes (177 F: 139 M) were examined for hamstring stiffness prior to the start of their competitive basketball season. Teams were cluster assigned to either the control or intervention (TNMT) group. Subjects in the control group underwent regular season activities as directed, with no influence from the research team. For the TNMT group, the research team introduced a hamstring targeted dynamic warm-up program as an intervention focused on activating the hamstring musculature.ResultsCollegiate status was significant to hamstring stiffness for both sexes (p ≤ 0.02), but hamstring stiffness did not correlate to age or sex (r² ≤ 0.08). Intervention was a significant factor to hamstring stiffness when the hip was positioned in extension (p ≤ 0.01), but not in deeper flexion (p = 0.12). This effect was sex-specific as TNMT influenced hamstring stiffness in females (p = 0.03), but not in males (p ≥ 0.13). Control athletes suffered three HAM injuries; TNMT athletes suffered 0 hamstring injuries.ConclusionHigher SWE measurements correlated with increased risk of injury, male sex, and collegiate athletics. TNMT intervention can lessen muscle stiffness which may reduce relate to injury incidence. Intervention effectiveness may be sex specific.Level of EvidenceII     

脑功能损害危重患儿经颅多普勒超声监测的临床研究

目的 应用经颅多普勒超声(transcranial Doppler ultrasonography,TCD)观察脑功能损害患儿脑血流动力学变化,探讨TCD在监测与评估脑损害患儿预后中的价值.方法 以大脑中动脉为靶血管,检测脑功能损害组20例及无脑损害组(对照组)20例患儿的脑血流动力学参数[收缩期峰流速(Vs)、平均血流速度(Vm)、舒张期流速(Vd)、搏动指数(PI)、阻力指数(RI),对比两组患儿各参数间的差异.脑功能损害组患儿按Glasgow评分、预后再分组,比较不同Glasgow评分(≤6分组和7~13分组)、不同预后患儿的TCD各参数的差异.每日动态监测脑功能损害组患儿的TCD直至TCD参数正常,将TCD参数达正常时间与Glasgow评分、意识障碍持续时间进行相关分析.对比脑功能损害组不同Glasgow评分、不同预后患儿TCD达正常时间的差异.结果 (1)脑功能损害组大脑中动脉的Vs、PI、RI均较对照组高,Vd较对照组低,差异均有统计学意义(P均<0.05).(2)脑功能损害组Glasgow评分≤6分患儿的PI(0.91±0.21)高于Glasgow评分7~13分患儿(0.83±0.14),两组比较差异有统计学意义(P<0.05);而Vs、Vd、RI两组比较差异均无统计学意义(P均>0.05).脑功能损害组不同预后患儿间的大脑中动脉血流动力学各参数比较差异均无统计学意义(P均>0.05).(3)脑功能损害组患儿TCD参数达正常时间与入院当日Glasgow评分呈负相关(r=-0.653,P<0.01);TCD参数达正常时间与意识障碍持续时间呈正相关(r=0.923,P<0.01).不同Glasgow评分、不同预后患儿的TCD参数达正常时间差异均有统计学意义,Glasgow评分≤6分、预后差患儿的TCD达正常时间更长(P均<0.05).结论 脑功能损害患儿的脑血流动力学异常,脑损害程度越重者,PI越高,TCD参数恢复正常的时间越长;动态监测TCD可反映脑血流变化,对评估病情和预后有一定价值.     

经颅多普勒超声在昏迷危重患儿中的应用

目的应用经颅多普勒超声(TCD)观察昏迷患儿脑血流动力学的一般情况及变化趋势,以及了解脑血流动力学与颅内压之间的联系。方法以大脑中动脉(MCA)为靶血管,观察昏迷组及对照组患儿(其中56例昏迷患儿)脑血流变化;腰穿或应用甘露醇前后各指标的变化;昏迷患儿不同时期及不同昏迷程度时的各指标的变化。结果昏迷组收缩期峰流速(Vp)、平均血流速度(Vm)、脉动指数(PI)、阻力指数(RI)明显高于对照组;昏迷患儿在治疗前Vp、Vm、PI、RI均高于治疗后;患儿在腰穿前大脑中动脉Vp、Vm、PI、RI均高于腰穿后;甘露醇使用前Vp、Vm、PI、RI均高于其使用后;Glasgow评分分值低者Vp、舒张期流速(Vd)、Vm偏低,而RI、PI偏高。结论昏迷患儿的脑血流动力学异于正常,TCD可反映颅内脑血流灌注情况,脑血流动力参数可随颅内压而变;因此TCD有助于判断病情、指导临床治疗和评估预后。     

糖尿病早期NOS亚型的蛋白表达及其在血流变化中作用的实验研究

目的探讨在糖尿病早期,3种亚型一氧化氮合酶(NOS)在大鼠视网膜不同组织细胞中蛋白表达的变化,及其与视网膜血流变化的关系。方法将Wistar大鼠随机分成正常对照组与链脲佐菌素(STZ)腹腔注射诱导的糖尿病组各10只,采用彩色多谱勒对大鼠视网膜中央动脉(CRA)进行血流参数的测量,运用免疫组织化学技术观察视网膜eNOS、iNOS、nNOS蛋白表达的变化。结果8wk糖尿病大鼠视网膜尚未出现病变,但血流参数已显著异常,表现为糖尿病组大鼠CRA的血流速度较对照组显著降低(P<0.05),而阻力指数则显著增高(P<0.05),搏动指数高于对照组,但尚未有显著意义。3种亚型NOS在糖尿病与正常对照组视网膜中表达部位一致;但与正常对照组比较,iNOS免疫反应的强度在糖尿病大鼠视网膜中的内核层显著增强,而eNOS与nNOS的免疫反应强度则未见显著变化。结论在糖尿病早期,大鼠视网膜已开始出现血流灌注不良,此时NOS亚型中iNOS在视网膜中的表达上调可能与之相关。     

Clinical features of polyhydramnios associated with fetal anomalies

The purpose of this study was to examine the clinical features of pregnancy complicated by polyhydramnios associated with fetal anomalies. Sixty-nine patients with a singleton pregnancy complicated by polyhydramnios were retrospectively analyzed. Based on prenatal ultrasonographic findings, 13 cases were considered to have idiopathic polyhydramnios and the remaining 56 cases were associated with fetal anomalies. Between these two groups, no significant difference was found in the gestational weeks when polyhydramnios developed. However, significant difference was noted in the maximum amniotic fluid index (AFI) values during the pregnancy period; 25.4 +/- 2.7 cm in the former, and 30.6 +/- 8.9 cm in the latter (P = 0.0004). In all of 13 cases with idiopathic polyhydramnios, AFI values remained less than 30 cm until delivery. Twenty-two patients (39%) with fetal anomalies required a prenatal treatment such as amnioreduction and tocolysis, whereas only one patient (7.7%) with idiopathic polyhydramnios needed tocolysis therapy (P = 0.03). There was a significant risk of premature delivery with fetal anomalies (35.6 +/- 3.9 weeks' gestation vs. 38.8 +/- 1.5 weeks' gestation, P = 0.004) because of refractory polyhydramnios, rupture of membranes, non-reassuring fetal status, and intrauterine fetal death, and although most infants with idiopathic polyhydramnios were appropriate-for-dates, many of the infants with congenital anomalies were small-for-dates. Significant risk of fetal anomalies should be considered in pregnant women with severe polyhydramnios (AFI > or = 30 cm), an increased trend of amniotic fluid during the pregnancy period, polyhydramnios requiring a prenatal treatment, or fetal growth restriction. On the other hand, based on our experience, a fetus without these conditions seems to have a low risk of congenital anomalies even if polyhydramnios is noted.     

经颅多普勒超声在儿童颅内压增高性疾病中的应用

经颅多普勒超声(transcranial doppler ultrasonography,TCD)是一种非侵入性评价颅内动脉的检测手段,自上世纪80年代问世以来,已被广泛性应用于临床工作的各个领域.由于其操作简便、重复性好,可以对患者进行床旁连续、动态观察,尤其适用于监测危重症患者.颅内压增高是儿童致病致死的再要原因之一,它可使脑血流灌注下降,造成脑功能障碍等严重后果,因此颅内压监测有重要临床意义.TCD作为一种无创性监测工具,可根据其血流速度、相关参数及血流频谱的变化对颅内压增高患者脑血流动力学进行动态监测与评估,从而达到监测颅内压改变的目的.本文着重阐述TCD在几种常见的儿童颅内高压性疾病中的应用进展.