X线、超声联合导向介入治疗布-加氏综合征

目的:探讨X线、超声联合导向下对布 加氏综合征的介入治疗方法和临床应用价值。方法:本组病人 30例,采用X线和超声联合导向。穿刺下腔静脉闭塞或狭窄部位,经球囊扩张后在X线、超声联合定位置入支架 成形。结果:28例成功,占93%。无严重并发症。术后患者症状明显缓解,下腔静脉压基本恢复正常(治疗前 2.8±0.51kPa,治疗后0.7±0.2kPa)。结论:采用X线、超声联合导向介入治疗布 加氏综合征是一种成功率高、 损伤小、效果可靠的治疗方法。     

双侧内囊前肢毁损术治疗难治性强迫症疗效及随访研究

目的　对难治性强迫症进行双侧内囊前肢毁损术治疗 ,评定手术疗效并进行 2年随访 ,以进一步探索脑外科手术对难治性强迫症的疗效 ,并探讨手术治疗的良好适应症。方法　对 2 8例难治性强迫症患者进行双侧内囊前肢毁损术治疗 ,并分别在手术前、手术后二周、手术后三月、手术后六月、手术后一年、手术后二年进行Y BOCS、HAMA、HAMD量表评定及术后疗效评定。结果　 (1)强迫症患者手术后各期Y BOCS评分、HAMA评分与手术前比较均下降 ,有极显著差异 (P <0 .0 0 1) ;(2 )手术后各期Y BOCS的强迫思维评分均有明显下降 (P <0 .0 0 1) ,强迫行为在手术后 1年和 2年 ,与手术前比较无明显改变 (P >0 .0 5 ) ;(3)手术后 2年的总有效率为 5 3.5 % ,明显低于手术后 3月的总有效率 (P <0 .0 1)。结论　采用双侧内囊毁损术有相当的治疗效果 ,对于难治性强迫症患者可作为一种补充治疗手段 ;手术治疗对强迫行为的长期疗效较差 ,以严重的强迫思维为主的难治性强迫症患者为手术更好的适应症。     

预移植在胚胎移植中的意义

目的 :评价预移植在胚胎移植中的作用。　方法 :在超声波引导下胚胎移植 114个周期 ,其中 10 1个周期进行预移植。比较预移植与未预移植周期临床妊娠率和胚胎种植率 ;按预移植与实际胚胎放置深度差值分组 ,并比较两组妊娠率和胚胎种植率。　结果 :预移植周期与未预移植周期临床妊娠率和种植率统计学差异无显著性(5 9.4 1%和 6 1.5 4 % ,35 .81%和 31.4 3% ,P均 >0 .0 5 ) ;按预移植与实际胚胎放置深度差值分组后 ,两组妊娠率和种植率统计学差异也无显著性 (6 1.5 4 %和 5 8.6 7% ,4 0 .79%和 34.0 9% ,P均 >0 .0 5 )。　结论 :在胚胎移植技术中 ,预移植不能准确指引胚胎移植深度     

Diagnostic ultrasound of acute colonic diverticulitis by surgical residents

Background: Recent studies have documented the feasibility of ultrasonography (US) to diagnose acute colonic diverticulitis (ACD). This prospective observational trial determined the sonomorphology of ACD and evaluated the diagnostic accuracy of routine US performed on admission by surgeons in training. Methods: Fifty-seven consecutive patients with a confirmed episode of ACD were entered into this study, and the sonomorphology of the involved colon was assessed. US findings were compared to the results of the clinical evaluation and correlated to the clinicopathological outcome. Results: The sonomorphology of ACD was characterized by segmental inflammatory transformation of the colon averaging 9.9 ± 3.2 cm (range, 6–20) in length and visualized as target phenomena of a mean 3.5 ± 0.8 cm (range, 2.4–4.8) width. Targets were caused by hypoechogenic thickening of the colonic wall of an average 7.7 ± 2.6 mm (range, 4–18). In 40% of cases, a hyperechogenic halo representing peridiverticulitis (average width, 2.3 ± 0.6; range, 1.2–3 cm) was noted. Diverticula were seen in almost half of the cases. Of the 57 cases with confirmed ACD, the diagnosis was made by US in 48, for a global accuracy of 84.2%. US was false negative in nine patients, suggesting perforated appendicitis in five cases and acute appendicitis in one (the final diagnoses were perforated sigmoid diverticulitis in five cases and cecal diverticulitis in one case). In three patients, US was nondiagnostic. Conclusion: In the hands of sonographically trained surgeons, ultrasound is a useful modality to image acute colonic diverticulitis. US reveals diagnostic sonomorphology in most cases of ACD and therefore facilitates early confirmation of the diagnosis and assessment of severity. Received: 3 October 1996/Accepted: 9 May 1997     

Sonoanatomy of the foot

Summary To show the possibilities of imaging diagnostic procedures using high and extremely high resolution ultrasonic probes we investigated the anatomic structures of the foot. We examinated 10 cadaver foots of the anatomic institute and in a clinical trial 20 healthy patients with 10 to 20-MHz-probes and could identify correctly single tendons and ligaments even in the toe region. Especially the possibility of dynamic examination had to be mentioned beside the other advantages of ultrasound diagnostic (saving of expenses, lack of radiation, side-to-side comparison).      

乙型肝炎与肝癌关系的流行病学研究—广西HBsAg携带者及肝损害者的分布及发生肝癌的前瞻性研究

本文对20岁以上22830人按HBsAg状况和肝损害表现分队列进行随访,平均追踪6.8年,在肝癌高发区和低发区均以HBsAg携带者并有重度肝损害者(肝大+肝功能异常)的肝癌死亡率和相对危险性最高,相对危险性分别为37.3和22.5倍。以无肝大和肝功能异常的非携带者最低,肝癌的发生和肝损害的程度呈平行关系。HBsAg携带者发生肝癌死亡的相对危险性高于非携带者7倍,并发现HBsAg携带并有重度肝损害的肝癌死亡的平均年龄显著提前。认为肝癌高发区人群中HBV的持续感染和肝损害的广泛存在是导致肝癌高发和早发的重要因素。     

Ultrasound in tropical pyomyositis

Tropical pyomyositis is an infection of muscles mainly presenting in black people, occurring in the trunk and limbs. At Hoima Hospital, Uganda, 58 patients (30 men and 28 women) with a mean age of 21 years have been investigated by ultrasound; a total of 81 lesions were present. Two different characteristic images were found; abscess was present in 65 cases while 16 patients showed a diffuse infiltration among the muscular fibers. These two different images correspond to the two stages of histologic and clinical progression described by other authors. Ultrasound is useful to demonstrate the progression of pyomyositis and to determine when and where to drain any abscess.     

Randomized clinical trial of ascorbic acid in the treatment of pressure ulcers

The objective of this study was to assess the effects of ascorbic acid supplementation, 500 mg twice daily in the treatment of pressure ulcers as an adjunct to standardized treatment.

The design consisted of a multicenter blinded randomized trial. The control group received 10 mg of ascorbic acid twice daily.

Patients from 11 nursing homes and 1 hospital participated.

Main outcome measures included wound survival, healing rates of wound surfaces, and clinimetric changes over 12 weeks.

Eighty-eight patients were randomized. Intention-to-treat analysis showed that the wound closure probability per unit time (i.e., the closure rate) was not higher in the intervention group than in the control group (Cox hazard ratio of 0.78 [90% precision interval, 0.44–1.39]). Mean absolute healing rates were 0.21 and 0.27 cm²/week in the intervention and control group, respectively (PI of the adjusted difference: −0.17 to 0.13). Relative healing rates and healing velocities did not show favorable results of ascorbic acid supplementation, either. A panel scored slides of the ulcers with a report mark between 1 (bad) and 10 (excellent). The improvement was 0.45 and 0.72 points per week in the intervention and control group, respectively (PI of the adjusted difference: −0.50 to 0.20). With another clinimetric index we could not show any differences, either.

These data do not support the idea that ascorbic acid supplementation (500 vs. 10 mg twice daily) speeds up the healing of pressure ulcers.     

Dynamic contrast-enhanced ultrasound with carbon dioxide microbubbles as adjunct to arteriography of liver tumors

Purpose The goal of the study is to evaluate utility of contrast enhanced ultrasound (US) with carbon dioxide microbubbles in evaluation of hepatic lesions.Methods Twenty eight patients with single or multiple t hepatic lesions (11 hepatocellular carcinoma, 8 hemangiomas, 5 metastases, 1 adenoma, 1 focal nodular hyperplasia, 2 regenerative nodules) were examined. US exam was performed during intraarterial injection of 10 ml of CO₂ through the same catheter employed for liver arteriography. The US exam was videotaped in its salient phases. Characteristics of enhancement were evaluated and correlated with histological findings or patient follow up.Results Sonographic angiography clearly demonstrated vascularization of the lesions. Hepatocellular carcinoma, hemangioma, metastases, focal nodular hyperplasia, and regenerative nodules had very characteristic patterns. The injection of CO₂ allowed detection of small additional nodules.Conclusion Sonographic angiography can improve characterization and staging of hepatic tumors. Low cost and the simplicity of the technique should encourage further experimentation.     

B型超声对诊断半月板损伤的临床价值

自１９８７年以来，我院采用Ｂ超对半月板进行实验研究并对２６４例病人进行检测，结果表明Ｂ超不仅能显示半月板图象还能区分正常与异常半月板。Ｂ超诊断的临床符合率为８６．３６％，手术符合率为９５％。本检查具有无创性，不接触ｘ射线，操作简便等优点。