Adrenal histoplasmosis: clinical presentation and imaging features in nine cases

Background: We describe a retrospective analysis of the clinical presentation and imaging features in nine patients with adrenal histoplasmosis in nonimmunocompromised patients from a nonendemic region.Methods: Clinically, a tuberculosis-like presentation in four patients and a tumor-like presentation in five patients were seen. All patients were seronegative for the human immunodeficiency virus. Ultrasound (US) in all patients, computed tomography (CT) in six, and magnetic resonance imaging (MRI) in three showed suprarenal masses. CT-guided (in five) and US-guided (in four) biopsy and fine-needle aspiration cytology established a definite diagnosis. The work-up for malignancy and tuberculosis was negative.Results: On cross-sectional imaging, eight patients had bilateral adrenal masses and one had a unilateral adrenal mass. Imaging features were variable. All adrenal masses were hypoechoic on US, homogeneous in five, and heterogeneous in four patients. All adrenal masses were hypodense on CT, homogeneous in four, and heterogeneous in two. Heterogeneous enhancement was seen in three, homogeneous enhancement in two, and no enhancement in one patient. MRI in three patients showed that the masses were of variable signal intensity on all pulse sequences.Conclusion: Our case series showed that adrenal histoplasmosis does occur in immunocompetent persons living in areas not endemic for the disease. The imaging features were variable.     

Intravenous carbon dioxide as an echocardiographic contrast agent

Intravenous carbon dioxide (CO₂) was employed to cause echocardiographic contrast in 40 patients. One to 3 cc of medically pure CO₂ were agitated with 5 to 8 cc of 5% dextrose in water and rapidly injected into an upper extremity vein. Contrast was obtained in all patients. In 33 patients contrast density from 5% dextrose was compared with that from 5% dextrose-CO₂ injections. Six of these patients had no contrast on the initial 5% dextrose injection and definite contrast with the subsequent injection containing CO₂. Of the 33, 12 patients had initial contrast with 5% dextrose injections and greater contrast density when CO₂ was added; 15 showed no definite difference; and none had less contrast with intravenous CO₂-5% dextrose than with 5% dextrose alone. Intravenous CO₂-5% dextrose is a useful method of increasing contrast in those patients who fail to demonstrate echocardiographic contrast when routine techniques are employed. It is also safe, provided precautions emphasized in this paper are observed.     

Utility of transient elastography (fibroscan) and impact of bariatric surgery on nonalcoholic fatty liver disease (NAFLD) in morbidly obese patients

Background

Controlled attenuation parameter (CAP) is a novel, noninvasive technique for assessing hepatic steatosis. However, its role in morbidly obese individuals is unclear. The effect of bariatric surgery on inflammation and fibrosis needs to be explored.

超声对壶腹癌诊断价值及检查方法的探讨

目的总结壶腹癌的声像图特征,探讨提高其显示率的方法。方法对我院超声诊断并经手术或CT证实的23例壶腹癌的声像图进行回顾性分析总结,扫查时对胆总管扩张者按常规追踪胆总管至壶腹部,显示不清者令患者一次饮水500ml以上,采取不同的体位,仔细观察胆总管下段、胰头及充盈的十二指肠壶腹,必要时令患者深呼吸、局部加压或咳嗽,动态观察病变部位及其与以上三者的关系。结果1.饮水后右侧卧位比平卧位、坐位图像清晰,配合深呼吸、咳嗽,动态观察有意义。2.壶腹癌声像图分以下四型团块型11例(48%);乳头型3例(13%);厚壁狭窄型5例(22%);末端堵塞型2例(9%);2例仅显示胆管全程扩张型,未见明显占位病灶。结论超声检查并辅以简便易行的辅助方法能较好地显示壶腹癌及其与周围结构的关系,是壶腹癌诊断重要的检查手段。     

B超对胆总管下段梗阻性疾病的病因诊断

目的：评价B超对胆总管下段梗阻性疾病的病因诊断价值。方法：回顾69例经手术及病理检查证实的胆总管下段梗阻性疾病的B超表现。结果：B超正确诊断56例，其中胆总管结石9例、恶性病变31例、其他良性病变16例。结论：B超对大部分胆总管下段梗阻性疾病的病因可作出正确诊断，诊断率约81．2％。     

甲状腺超声检查时对偶发性甲状旁腺腺瘤的发现和诊断

目的　探讨对甲状腺疾病患者进行甲状腺超声检查时偶发性甲状旁腺腺瘤发现率。方法　对 1667例患者进行甲状腺超声检查 ,甲状腺实质后方组织发现椭圆形、均匀低回声团块记为可疑病例 ,并对其进行甲状旁腺功能亢进的血生化检查 ,与手术病理对照。结果　发现可疑病例 2 2例 ,与手术病理结果比较 ,其中 8例为甲状旁腺腺瘤 (3 6.4% ,8/ 2 2 ) ,偶发性甲状旁腺腺瘤的发生率为 0 .47% (8/ 1667)。结论　甲状腺超声检查时可以发现偶发性甲状旁腺腺瘤。对于甲状腺疾病患者 ,超声对于预先确定甲状旁腺组织的价值较低。偶然发现的甲状腺旁腺腺瘤可伴有或不伴有甲状旁腺功能亢进     

Absence of mutagenic effects of continuous and pulsed ultrasound in cultured (AL) human-hamster hybrid cells

Mutagenic effects of continuous and pulsed ultrasound were looked for using an in vitro assay system, the A_L hybrid, that is up to 100 times more sensitive for mutagens such as x-rays and neutrons than the assays used previously to evaluate ultrasound. Cells in suspension in rotated plastic test tubes were insonated with continuous wave ultrasound at I MHz, I_SPTP, = 0.62–40 W/cm² for 0–40 min. Cells attached in the central region of culture flasks received pulsed exposures at f_c = 2.5 MHz, PRF = 1 kHz, 2 and 8 cycles per pulse, with p_ = 1.2 MPa (I_SPTA = 31–180 mW/cm²) for 0–30 min. Although these exposures were cytotoxic (the plating efficiency was decreased to 65% by the highest doses), induction of mutation, if any occurred, was less than would be expected in this test system from 10–30 cGy of x-ray.     

超声造影剂及超声辐照对TIMP-1 siRNA在肝纤维化大鼠肝组织中表达的影响

目的观测超声造影剂及超声辐照对TIMP-1 siRNA质粒转染肝纤维化大鼠肝组织内TIMP-1基因表达的影响。 方法采用二甲基亚硝胺（DMN）方法建立大鼠肝纤维化模型，72只造模大鼠在第6周随机均分成3组，质粒组（P组）、质粒＋造影剂及超声照射组（P＋U组）、对照组。2d、6d及12d后各组分别随机取8只处死、取肝、肾、肺、脑、心肌组织快速冷冻切片，荧光显微镜下观察各组织内TIMP-1 siRNA荧光表达；FQ—PCR测定肝组织TIMP-1 mRNA表达。 结果2d后，P组肝、肾、肺、脑、心肌组织内均有少量TIMP-1 siRNA绿色荧光表达，组间无显著差异，P＞0．05；P＋U组肝组织内TIMP-1 siRNA荧光表达明显增强，较其它组织差异显著，P＜0．001。P组及P＋U组肝组织TIMP-1 mRNA表达量均较对照组明显降低，P＜0．001；P＋U组降低较P组显著，P＜0．001；P＋U组6d时TIMP-1 mRNA表达量最低，后依次为48h、12d。 结论TIMP-1 siRNA对肝纤维化大鼠TIMP-1基因表达抑制作用明显；超声造影剂及超声辐照能够明显增高基因转染效率，并有将基因载体靶向定位于肝组织释放的作用。     

宫腔镜联合B超检查在诊断异常子宫出血中的作用及临床观察

目的：探讨宫腔镜联合B超检查在诊断异常子宫出血中的作用。方法：选择2000年5月－2000年12月我院176例经宫腔镜联合B超检查并行组织病理诊断的异常子宫出血患者，分析宫腔镜联合B超检查与病理诊断的符合情况。结果：176例宫腔镜联合B超检查与病理诊断的总符合率为83.00%，与初诊总符合率（29.50%）及单纯B超检查总符合率（59.10%）比较均有显著性差异（P＝0.000）。176例宫腔镜联合B超检查中子宫粘膜下肌瘤（3／3）、宫颈肌瘤（3／3）、宫颈息肉（7／7）、宫腔内胚胎残留（13／13）病理诊断的符合率均为100.00%，子宫内膜息肉为95.60%（43／45）、慢性子宫内膜炎为86.00%（43／50）、子宫内膜增生过长为63.04%（29/46）、子宫内膜癌为50.00%（1／2）。结论：宫腔镜联合B超检查可明显提高异常子宫出血症状诊断的准确性，但不能取代组织病理学诊断。     

超声刀在冠心病患者外科治疗中的应用

目的 探讨应用超声刀切取桡动脉用于冠状动脉旁路移植术的效果. 方法 冠心病患者60例.使用超声刀改进"不接触"技术切取桡动脉,用于冠状动脉旁路移植术. 结果 共切取桡动脉63条,全部血流良好并成功用于冠状动脉旁路移植术,无并发症发生. 结论 超声刀具有良好的切割止血作用,切取桡动脉简便、快速、安全,可以明显减少对桡动脉的刺激.