微型血管多普勒在改良腹股沟下显微精索静脉结扎术中的应用：附视频

目的 探讨微型血管多普勒在改良腹股沟下显微精索静脉结扎术中的应用价值.方法 回顾分析2012年1月至2013年1月期间中山大学附属第一医院东院收治的89例精索静脉曲张患者的临床资料.患者均行改良的腹股沟下显微精索静脉结扎术,2012年9月之前术中未应用微型血管多普勒,2012年9月之后术中常规应用微型血管多普勒辨别动脉和静脉.比较两组患者的临床资料.结果 89例患者共138次手术均获成功,术后随访3～6个月,未见睾丸萎缩和鞘膜积液发生.非多普勒组术中有1例精索内动脉被误扎,2例术中精索动静脉辨认不清,术后1例复发;多普勒组术中辨别动脉和静脉准确,无动脉损伤和误扎情况发生,术后无复发.结论 在微型血管多普勒辅助下行显微精索静脉结扎术更安全有效.     

胆囊穿刺造瘘后双通道胆道镜保胆取石与腹腔镜胆囊切除术治疗老年患者结石性胆囊炎疗效的比较

目的比较超声引导双通道胆囊穿刺造瘘联合胆道镜保胆取石与胆囊穿刺造瘘后行腹腔镜胆囊切除术（1aparoscopiccholecystectomy,LC）治疗老年患者急性结石性胆囊炎的临床疗效。方法回顾性分析2012年1～9月接受双通道胆囊穿刺造瘘联合胆道镜保胆取石治疗的30例老年结石性胆囊炎（保胆取石组）和胆囊穿刺造瘘后行Lc治疗的30例老年结石性胆囊炎（Lc组）的临床资料,比较2组手术操作时间、术中出血量、住院时间、消化不良症状发生率等。结果60例均穿刺置管成功,带管时间14d-2个月,平均30d。4～8周后,保胆取石组30例成功行胆道镜取石,结石取净率100％,取石过程中无出血、漏胆、继发胆总管结石、切口感染等手术并发症。LC组28例三孔法完成LC,2例因粘连组织难以分离中转开腹手术,术中、术后均无严重并发症。保胆取石组术中出血量（8．8±1．7）ml,显著少于LC组（18．9±1．2）ml（t=-25．968,P=0．000）;保胆取石组住院时间（4．4±0．6）d,显著短于LC组（5．6±0．5）d（t=-8．243,P=0．000）。保胆取石组术后随访3、6、12个月,B超检查1例复发,5例有上腹部不适、腹泻、食欲不佳等消化不良症状,发生率16．7％（5／30）,LC组术后21例有消化不良症状,发生率70．o％（21／30）,2组比较有显著性差异（x2=17．376,P=0．000）。结论超声引导双通道胆囊穿刺造瘘联合胆道镜保胆取石操作简便,在术中出血量、住院时间、远期生活质量等方面均优于胆囊造瘘后行LC。     

Ultrasound-guided quadratus lumborum and subcostal transversus abdominis plane blocks

Abdominal field blocks are commonly used for postoperative analgesia in major abdominal surgeries. The original transversus abdominis plane (TAP) block is limited in its dermatomal coverage to T10-L1. However, modifications made to the classic TAP block technique can enhance the spread of local anesthetic and provide more effective analgesia. In this article, we describe 2 of such modifications of the classic TAP block, namely quadratus lumborum and subcostal TAP blocks.     

Ultrasound guided transversus abdominis plane block versus local wound infiltration in children undergoing appendectomy: A randomized controlled trial

BackgroundThe transversus abdominis plane block (TAP) has been described for pain management following abdominal surgery in adults, but there are only few reports on its use in pediatrics. The aim of this study was to evaluate the analgesic effect of ultrasound guided TAP block in patients scheduled for open appendectomy versus an active comparator (wound infiltration).MethodsForty-four children aged 4–16 years (ASA 1–2) were enrolled. Patients were randomized into two groups (22 in each). Patients in group (T) were assigned to receive ultrasound guided TAP block using 0.4 ml/kg of bupivacaine 0.25%, and those in group (L) were assigned to receive local infiltration by the surgeon. Maximum pain scores, the time to the first analgesic requirement and the number of analgesic requirements were recorded over 48 h.ResultsThe ultrasound guided TAP block increased the mean time to the first analgesic requirement (10.4 ± 1.5 h) in comparison with the local infiltration group (5.4 ± 1.5). The cumulative number of doses of analgesic was significantly lower in TAP group than in local infiltration group (3.7 ± 1.1 versus 5.3 ± 2.1) and the Pain Scale score was significantly lower in the TAP group over the study period. Besides, there were no complications attributable to the ultrasound guided TAP block.ConclusionUltrasound-guided TAP block with (0.4 ml/kg) 0.25% bupivacaine provides prolonged postoperative analgesia and reduced analgesic use without any clinical side-effects after appendectomy in children.     

Assessment of testicular volume: A comparison of fertile and sub-fertile West African men

BackgroundWhile the semen analysis appears to be the cornerstone in the evaluation of testicular function, the testicular volume has long been associated with testicular function. However, racial variations in testicular volume do exist. Neither the critical minimum testicular volume that guarantees adequate function, nor the optimal testicular volume that indicates peak testicular function are also known.ObjectiveTo evaluate the relationship between testicular volume and function using scrotal ultrasound scan in black West African men.Patients and methodsThe study examined 236 subjects over a period of one year. The subjects comprised of 136 patients with diagnosis of male infertility, as well as 100 healthy individuals as control. The relevant clinical history of each patient was extracted from their case notes. All the subjects had their testes examined using a high frequency (7.5 mHz) linear transducer of an ultrasound scanner. The results were expressed as percentages and tests of significance were done using the chi-square and Student's t-test. A P-value < 0.05 was considered statistically significant.ResultsThe mean testicular volume for the sub-fertile patients was 15.32 ml while it was 19.89 ml in the control group. There was a statistically significant difference between the testicular volumes in fertile and infertile men at different age groups, while there was an inverse relationship between testicular volume and severity of oligospermia. This was, however, not directly linear as a mean testicular volume of 18–20 ml was associated with highest semen density. Volumes higher than 20 ml and lower than 18 ml were associated with reduced sperm density. There was also a sharp decline in sperm density when the mean testicular volume reduced from 14 ml to 13 ml. Severe oligospermia (<5 million/ml) was associated with mean testicular volume less than 12 ml.ConclusionTesticular volume on scrotal ultrasound correlates well with severity of oligospermia in men with sub-fertility. While the critical mean testicular volume necessary for adequate spermatogenesis has not been determined, it appears there is an optimal testicular volume of 18–20 ml at which spermatogenesis is at its peak in sub-fertile Nigerian men.     

Shear wave elastography contribution in ultrasound diagnosis management of breast lesions

PurposeTo determine the diagnosis performance of shear wave elastography in the differentiation of benign and malignant breast lesions and the factors influencing the elasticity values. To suggest an appropriate management of breast lesions using the ultrasound-elastography combination.Patients and methodsMonocentric retrospective study of 167 breast lesions classified by conventional ultrasound as BI-RADS category 3 or higher that underwent an elastography study and histological analysis.ResultsThe analysis of qualitative parameters, according to the classification established in this study, allows us to obtain a sensitivity of 91.1% and a specificity of 92.3%. These values are very close to or better than the quantitative parameters Emax and Emean. Different Emax thresholds values were established based on the long axis of the lesion and its palpable character, which appeared to be significant factors influencing elasticity. The management of breast lesions by combining ultrasound and elastography, as proposed here, allows us to keep the sensitivity of an ultrasound (96%), while doubling its specificity (86.2% versus 43.1%).ConclusionWith the complementary nature of their performance, the combination of conventional ultrasound and shear wave elastography can improve the management of breast lesions. The qualitative classification proposed appears to be relevant assistance in lesion characterization.     

超声引导下经皮激光消融治疗甲状腺微小乳头状癌(附3例报告)

目的:探讨超声引导下经皮激光消融(percutaneous laser ablation,PLA)治疗甲状腺微小乳头状癌的可行性、安全性及治疗效果。方法:对3例单发甲状腺微小乳头状癌行超声引导下PLA治疗。术后采用常规超声,随访观察消融灶大小、血供,术后即刻和术后3 d采用超声造影评价激光消融范围,并观察有无并发症发生。术后30 d对消融灶进行超声引导下细针穿刺活检。结果:3例均采用局部麻醉,成功进行PLA治疗,未发生严重并发症。术后常规超声随访,发现原病灶消失,消融区无彩色血流信号。术后即刻和术后3 d超声造影,显示消融区无造影剂灌注,完全覆盖原病灶。术后30 d超声引导下细针穿刺活检,可见坏死组织及炎性细胞,未见肿瘤细胞。结论:超声引导下PLA治疗是一种安全、有效、可行的方法。     

男性乳腺癌38例临床病理分析

目的 分析男性乳腺癌的临床病理及分子分型特点。方法 回顾分析宁波市临床病理诊断中心2013年1月至2019年3月38例男性乳腺癌病例的临床病理和分子分型资料。结果 38例男性乳腺癌病人,占同期乳腺癌病人0.83%,中位年龄68.5（24～88）岁,病灶位于左侧20例,位于右侧18例。其中29例为浸润性导管癌,2例为分泌性癌,1例为实性乳头状癌伴微浸润, 2例为导管内乳头状癌伴微浸润,4例为包裹性乳头状癌（其中2例伴微浸润）。浸润性导管癌组织学分级Ⅰ级2例,Ⅱ级20例,Ⅲ级7例。16例伴淋巴结转移。免疫组化染色：36例ER 阳性,35例PR阳性。分子分型Luminal A型18例,Luminal B型16例,基底细胞型2例。结论 男性乳腺癌少见,发病年龄较晚,临床分期较高,预后较差,且发生第2种原发性癌的可能性增加,加强对其认识,争取早期诊断、治疗及监测非常重要。男性乳腺癌仍须扩大样本量进一步研究。     

Ultrasound evaluation of the quadriceps muscles in pronated foot posture

ObjectiveThe main goal of this study was to investigate the size of all portions of the quadriceps muscles in individuals with pronated foot posture compared to normal foot posture using ultrasound imaging.DesignTwenty nine females with pronated foot posture and 29 age-, body weight-, body height-matched females with normal foot posture were recruited from university communities. The muscle thicknesses of the rectus femoris (RF), vastus medialis (VM), vastus medialis oblique (VMO), vastus lateralis (VL) and vastus intermedius (VI) were measured using ultrasound imaging.ResultsThe thicknesses of the RF and VMO were significantly smaller in individuals with pronated foot posture compared to normal foot posture (p < 0.05). No significant differences were observed in the VM, VL, and VI muscle thicknesses in both groups.ConclusionBased on the results of the present study, it seems that besides the foot and lower leg muscles, an integrated assessment of proximal knee muscles, especially quadriceps, is required in individuals with pronated foot posture.     

The comparative accuracy of a handheld and console ultrasound device for neuraxial depth and landmark assessment

BackgroundThe study aimed to compare the accuracy of epidural depth estimation of a handheld ultrasound device, with an integrated algorithm that estimates epidural depth (AU; Accuro, Rivanna Medical), to that of a console ultrasound machine (GU; GE LOGIC^TM S8).MethodsWomen requesting labor epidural analgesia consented to this prospective cohort study. The L2/3, L3/4, and L4/5 interspaces and the respective depths to the epidural space were identified, marked and measured using an AU and GU. An anesthesia provider who was blinded to ultrasound depth measurements performed epidural analgesia at one of the ultrasound identified insertion points and recorded the Tuohy needle depth at loss-of-resistance. Bland Altman analysis was used to measure the agreement between the epidural depths measured by the AU and GU.ResultsA total of 47 women were analyzed. The mean ± standard deviation body mass index of the study cohort was 29 ± 5 kg/m² [range 23–45]. The mean difference between the epidural depths measured by the AU and GU was −0.29 cm [95% limit of agreement 0.50 to −0.91]. The mean difference between the depth to the epidural space measured by the GU versus the needle depth was −0.33 cm [95% CI −0.49 to −0.16]. The previously reported AU versus needle depth was −0.61 cm [95% CI −0.79 to −0.44].ConclusionThe AU and GU provided comparable epidural depth estimates. The AU device may be a reasonable alternative to more sophisticated ultrasound devices in determining the epidural space and depth in a non-obese obstetric population.