Ultrasonography in patients without trauma in the emergency department: impact on discharge diagnosis.

OBJECTIVE: The aim of this study was to examine to what extent findings on ultrasonography performed in the emergency department (ED) after hours confirm or alter the referral diagnosis in patients without trauma as reflected in the discharge diagnosis. METHODS: In this prospective study, data from 136 ultrasonographic examinations performed in patients without trauma after hours in the ED during January and February 2002 were evaluated against the suspected preimaging diagnosis of the referring ED physician and the actual discharge diagnosis from the ED or after hospitalization. The rate of preimaging and postimaging concordance was statistically analyzed and compared by calculation of confidence intervals and by the McNemar test. RESULTS: Normal ultrasonographic findings were documented in 54 patients (40%), and pathologic findings were documented in 82 (60%). Thirty-four (25%) of the 136 examinations were concordant with the initial referring physician's diagnosis. Of the 102 studies that were not concordant with the initial referral suspected diagnoses, that is, being either a study with normal findings or offering an alternative diagnosis, 81 (79.4%) were concordant with the discharge diagnosis. CONCLUSIONS: After-hours ultrasonographic findings in patients without trauma seen in the ED seem to have a high impact on the discharge diagnosis and are concordant with it in more than 80% of cases.     

经腹超声测量膀胱内前列腺突入程度在良性前列腺梗阻诊断中的价值

目的:探讨经腹超声测定膀胱内前列腺突入程度(IPP)在良性前列腺梗阻(BPO)诊断中的价值。方法:收集2005年4月～2006年12月以下尿路症状就诊的BPH患者109例,应用经腹超声测定IPP,同时行尿流动力学检查测定最大尿流率(Qmax)、最大尿流率时逼尿肌压力(PdetQmax),并计算AG数(Pdetmax-2Qmax),根据AG数>40为梗阻,将所有患者分别归入非梗阻组(n=40)和梗阻组(n=69)。结果:在梗阻组和非梗阻组中IPP存在显著差异(P<0.01),IPP与AG数呈显著正相关(r=0.729,P=0.001)。若以IPP≥10mm为标准判断BPO,敏感度为89.9%,特异度97.5%,准确度为92.7%。结论:应用经腹超声测定IPP对BPO有良好的诊断价值。     

经腹和经阴超声诊断卵巢囊性肿块的比较研究

目的探讨腹部超声和阴道超声对卵巢囊性肿块的诊断及鉴别诊断的临床价值。方法对186例门诊拟诊为卵巢囊肿患者的临床资料进行回顾性分析，比较其经腹部及经阴道超声的诊断符合率。结果经腹部超声检查阳性患者88例，误诊17例，临床诊断符合率为80．68％。经阴道超声检查阳性患者98例，误诊8例，临床诊断符合率为91．83％。经x2检验，两组临床诊断符合率比较差异有统计学意义（P〈0．05）。结论高分辨率的阴道超声检查在诊断卵巢囊性肿块中具有明显的优势，较腹部超声检查具有更高的准确性，必要时可联合应用经阴超声和经腹超声，正确识别声像图特征，提高诊断的准确性。     

Intracranial hemorrhage in hypothermic low-birth-weight neonates

We studied periventricular/intraventricular type intracranial hemorrhage (ICH) by cranial ultrasonography in 82 low-birth-weight (LBW) newborn infants with admission hypothermia against the gestational-age-matched 82 normothermic neonates. The incidence of ICH was higher in the hypothermic infants during the 1st week of life (34/82 vs 20/82, P<0.02). Although the distribution of individual grades of ICH was not significantly different between the groups, the first ultrasound scan showed higher incidence of major ICH (grades 3 and 4) in the hypothermic infants. Most of the minor ICH (grades 1 and 2) after the first ultrasound appeared in infants who were small for their gestational age. Our data do not support the contention that admission hypothermia can precipitate the development of IVH in LBW infants. However, the detection of admission hypothermia in a LBW neonate should make one suspect the possibility of ICH and regard it as a manifestation of the severity of ICH rather than the cause. Most likely, this close relationship between hypothermia and neonatal ICH originates from perinatal asphyxia and the cumulative adverse effects of asphyxia-related events.     

Bladder exstrophy-epispadias complex: prostatic evaluation by transrectal ultrasonography

Seven patients with bladder-exstrophy-epispadias complex underwent high resolution prostatic ultrasonography in order to establish the presence and appearance of their prostate gland and seminal vesicles. Six patients had been born with classic bladder exstrophy, and one patient with complete epispadias. The size of the prostate gland was in the normal range in three patients. Three patients had small glands, and in one patient no prostatic tissue could be identified. Two patients showed an unusual position or echoappearance of their glands. The seminal vesicles in five patients were relatively large, contained multiple cystic spaces, and/or extended posteriorly and inferiorly to the prostate gland proper. Our study demonstrates that the prostate gland and seminal vesicles are present in patients with bladder exstrophy. The unusual appearance, position, and size in most patients, however, suggests faulty embryologic development or changes secondary to surgery reflecting the complex nature of the condition. Likewise, the enlarged seminal vesicles may indicate impaired drainage of these structures secondary to the initial bladder closure or subsequent bladder neck reconstruction.     

微栓子监测新进展

自1990年以来,微栓子监测技术已广泛应用于临床和实验研究并取得了一些进展.文章就近年来微栓子监测在临床研究中取得的新进展、面临的问题以及新的发展方向进行了综述.     

脑梗死患者颈动脉粥样硬化斑块形成的研究

目的 探讨脑梗死(CI)患者颈动脉粥样硬化斑块形成的状况.方法 对138例CI患者行颈动脉彩色多普勒超声检查,观察其颈动脉斑块形成、性质及部位,并与正常对照组比较.结果 CI组138例中120例(87.7%)检出颈动脉粥样硬化斑块175块,正常对照组140人检出斑块为36人(25.7%)(P＜0.01).CI组中不稳定性斑块比率(80.8%)显著高于稳定性斑块(19.2%)(P＜0.01);斑块位于颈总动脉(CCA)(81.1%)显著高于颈内动脉(ICA)(18.9%)(P＜0.01);位于CCA分叉处(66.3%)又显著高于主干(14.9%)(P＜0.05).结论 CI患者颈动脉粥样硬化斑块的发生率高,多位于CCA分叉处,且大多为不稳定性斑块.提示CI与颈动脉粥样硬化有密切关系.     

Ultrasound in gynecology

This paper reviews the various examination thechniques, the clinical indications, and the imaging findings for US studies of the female pelvis in patients with gynecological problems. Ultrasound, in fact, is the preferred imaging modality in the study of the female pelvis, and provides information of basic importance in detecting and characterizing pelvic masses of uterine, ovarian, or adnexal origin, providing also criteria useful in predicting their benign vs malignant nature. In patients with abnormal bleeding, transvaginal US helps in determining the presence of morphological and structural changes of the endometrium and, with the use of sonohysterography, provides excellent delineation of the endometrial cavity, guiding appropriate planning of therapeutic procedures. Ultrasound plays a very important role in the evaluation of patients with acute pelvic pain. It allows identification of ovarian torsion and has both diagnostic and therapeutic capabilities in patients with pelvic inflammatory disease through guidance of abscess drainage via the transvaginal route. In suspected ectopic pregnancy, US, together with quantitative measurements of hCG levels, can be considered the best imaging procedure to guide to the diagnosis. Ultrasound has an important role also in the study of female infertility. In this field it can be used to identify and document the integrity of the reproductive tract as a conduit for the passage of gametes and embryos, to detect pathological changes that may be causes or contributing factors of female infertility, to monitor cyclic changes of pelvic organs to document normal physiology or pathological situations, and to guide infertility treatment. Electronic Publication