B超诊断腰椎间盘突出症的临床价值(附64例分析)

报告经CT检查和临床治疗证实的64倒腰椎间盘突出症的B超检查结果,B超检出70个突出之椎间盘,CT检出73个,阳性率之比为70/73。70个突出椎间盘中,中央型5个,偏中央型20个,后外侧型44个,极外侧型1个;轻度30个,中度28个,重度12个。分型分度与临床表现及治疗选择有密切关系。B超检查与CT相此较,具有近似的诊断价值,但经济、实用,操作简单方便,值得推广。     

超声引导下肿瘤内注射^90钇玻璃微球的肝癌综合治疗

超声引导下对２８例肝癌病人进行了肿瘤内注射＾９０钇玻璃微球（Ｙ－９０ＧＴ ＭＳ）为主的综合性治疗（部分病人配合肿块周边注射无水酒精及门静脉穿刺化疗）。随访２～１６个月（平均７．９个月），病人全健在。肿瘤缩小率为９１％，其中显著缩小达７５％；肿块回声呈致密增强，少数呈混合型或等回声型；肿瘤内及周边血流信号显著减少；原甲胎蛋白升高者１３例，１１例显著下降，其中６例降至正常；病人症状减轻，全身情况改善。     

Microembolic signals and clinical outcome in patients with acute stroke – a prospective study

The occurrence of microembolic signals (MES) in patients with transient ischemic attack (TIA) or stroke has already been described; the influence of the time interval between onset of symptoms and transcranial Doppler monitoring (TCD) on the MES rate or MES prevalence and the possible prognostic value of the early detected MES rate on the outcome of TIA or stroke symptoms in a 3 month interval are discussed. In a prospective study we evaluated 61 patients consecutively admitted to our stroke unit after their first ischemic neurological deficit involving the vascular territory of MCA and/or ACA. All of the patients underwent a 30-minute bilateral transcranial Doppler monitoring of their MCAs for the identification of MES. Monitoring was performed within 12.3 + -9.3 (average mean + -SD) hours of stroke onset for the first time, the second time 48 hours after first TCD monitoring. Prognosis for the recovery of neurological deficits was evaluated by using the Barthel index (BI) and Scandinavian Stroke Scale (SSS) at the time of admission of the patient to the stroke unit, and with Barthel indices after one month and after 3 months. As a result, 56% of all patients showed MES in at least one of the two registrations. MES were recorded not only on the symptomatic side. The MES prevalence between both TCD monitorings was significantly different (total MES prevalence: 1st TCD: 26 patients: 2nd TCD: 13 patients; p < 0.04; ipsilateral MES prevalence: 1st TCD: 19 patients; 2nd TCD: 9 patients; p < 0.01). The regression analysis showed a significant influence of the total MES rate on both neurological scores at admission (SSS: 0.03; Barthel index: 0.04), but not for the Barthel scores after one and three months. In conclusion, we found an influence of the time interval between onset of neurological symptoms of TIA or stroke on the MES rate and the prevalence of MES. The prevalence of MES or the MES rate, found after a short time interval to the onset of symptoms, did not have a prognostic value on the outcome of neurological deficits up to a three month follow-up.     

Evaluation of the inner-surface morphology of an artificial heart by acoustic microscopy

The total artificial heart (TAH) is being developed for permanent replacement of the natural heart instead of heart transplantation. The need for detecting the material fatigue in the TAH is increasing in order to guarantee long-term use. In this study, the inner surface morphology of the TAH was evaluated by a specially developed scanning acoustic microscope (SAM) system operating in the frequency range of 100-200 MHz. The inner sac of our TAH consisted of polyvinylchloride coated with polyurethane, and the SAM investigations were performed before and after the implantations in goats. The amplitude images of the SAM demonstrated protein adhesion on the inner surface of the TAH after the animal experiment, and the phase images showed distortion of the wall with spatial resolution of 0.2 microm. These results suggest the feasibility of a high-frequency ultrasound for evaluating the material fatigue of TAH.     

核素显像和B超测算甲状腺重量的对比研究

对照研究核素显像和Ｂ超测算甲状腺重量的相关性，为临床提供较准确及简易的方法。３６３例甲亢病人１３１Ｉ治疗前分别进行γ显像和Ｂ超检查，以测算甲状腺体积（重量），其中６５例弥漫性甲状腺肿合并甲亢病人１３１Ｉ治疗后６个月重复两种检查。３６３例病人显像和Ｂ超测算甲状腺重量相关良好（ｒ＝０９３，Ｐ＜００１），总体上显像所得重量平均值大于Ｂ超值，腺体厚度是影响测算结果的主要因素；１３１Ｉ治疗后腺体厚度缩小最著，显像值大于Ｂ超值更明显。甲状腺重量测算在一定范围内两种方法可互相替代。１３１Ｉ治疗后，Ｂ超测定值为准。存在结节时，以显像为优。     

Comparison of ultrasonic and histopathological features of carotid artery stenosis

Abstract

Besides the degree of carotid artery stenosis, the composition of the plaque may help to predict the thromboembolic risk. Low echogenicity on ultrasound and hemorrhage into the atheroma demonstrated histopathologically have been shown to be associated with a higher risk of embolism. Twenty-nine consecutive patients with carotid artery stenosis and scheduled for carotid endarterectomy were investigated preoperatively by B-mode ultrasound. Post-operatively the endarterectomy specimens were examined histopathologically. Neither atheroma with hemorrhage nor atheroma without hemorrhage were significantly associated with echolucent ultrasound presentation. Out of the 10 lesions echolucent and homogeneous on ultrasound, six corresponded to atheroma with hemorrhage, two corresponded to atheroma with hemorrhage plus thrombus, two corresponded to fibrous plaque plus thrombus, and one corresponded to pure thrombus. Out of the 4 lesions heterogeneous and predominantly echolucent, one corresponded to atheroma without hemorrhage plus thrombus, one corresponded to atheroma with hemorrhage, one corresponded to atheroma with hemorrhage plus thrombus, one corresponded to atheroma with hemorrhage plus fibrous plaque. Seven out of the 18 atheromas with hemorrhage did not present as purely or predominantly echolucent lesions, six of them were even homogeneouslyechogenic. Plaque surface could not reliably be predicted by ultrasound. In our study, there was no significant correlation between ultrasound and histology of the lesion. [Neural Res 1997; 19: 380-384]     

甲状腺微小癌病灶钙化超声表现及其诊断意义

目的探讨钙化在甲状腺微小癌(thyroid microcarcinoma,TMC)中的表达及超声诊断意义。方法回顾分析68例TMC和60例甲状腺良性疾病的病灶钙化情况和相关资料。结果 TMC和甲状腺良性疾病病灶钙化超声检出率分别为67.6%和33.3%(P<0.01);病理检查结果病灶钙化率分别为72.1%和35.0%(P<0.01)。微钙化在良、恶性钙化结节中所占比例各为20.8%和79.2%(P<0.01)。结节钙化中有70.0%为恶性,无钙化结节中32.8%为恶性(P<0.01)。TMC病灶微钙化发生率为55.9%,乳头状癌微钙化率为72.5%。女性及年龄<45岁TMC患者的病灶钙化率较良性疾病均明显为高,(P<0.01)。结论 TMC绝大多数为乳头状癌,微钙化是TMC特异性最高的超声表现特征,对TMC的诊断有十分重要意义。     

Comprehensive analysis of intravascular ultrasound and angiographic morphology of culprit lesions between ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome

Background

Some plaques lead to ST-segment elevation myocardial infarction (STEMI), whereas others cause non-ST-segment elevation acute coronary syndrome (NSTEACS). We used angiography and intravascular ultrasound (IVUS) to investigate the difference of culprit lesion morphologies in ACS.

Methods

Consecutive 158 ACS patients whose culprit lesions were imaged by preintervention IVUS were enrolled (STEMI = 81; NSTEACS = 77). IVUS and angiographic findings of the culprit lesions, and clinical characteristics were compared between the groups.

Results

There were no significant differences in patients' characteristics except for lower rate of statin use in patients with STEMI (20% vs 44%, p = 0.001). Although angiographic complex culprit morphology (Ambrose classification) and thrombus were more common in STEMI than in NSTEACS (84% vs 62%, p = 0.002; 51% vs 5%, p < 0.0001, respectively), SYNTAX score was lower in STEMI (8.6 ± 5.4 vs 11.5 ± 7.1, p = 0.01). In patients with STEMI, culprit echogenicity was more hypoechoic (64% vs 40%, p = 0.01), and the incidence of plaque rupture, attenuation and “microcalcification” were significantly higher (56% vs 17%, p < 0.0001; 85% vs 69%, p = 0.01; 77% vs 61%, p = 0.04, respectively). Furthermore, the maximum area of ruptured cavity, echolucent zone and arc of microcalcification were significantly greater in STEMI compared with NSTEACS (1.80 ± 0.99 mm² vs 1.13 ± 0.86 mm², p = 0.006; 1.52 ± 0.74 mm² vs 1.21 ± 0.81 mm², p = 0.004; 99.9 ± 54.6° vs 77.4 ± 51.2°, p = 0.01, respectively). Quantitative IVUS analysis showed that vessel and plaque area were significantly larger at minimum lumen area site (16.6 ± 5.4 mm² vs 14.2 ± 5.5 mm², p = 0.003; 13.9 ± 5.1 mm² vs 11.6 ± 5.2 mm², p = 0.003, respectively).

Conclusion

Morphological feature (outward vessel remodeling, plaque buildup and IVUS vulnerability of culprit lesions) might relate to clinical presentation in patients with ACS.     

子痫前期子宫螺旋动脉血流与孕妇血清胎盘生长因子表达的相关研究

目的观察子宫螺旋动脉血流动力学参数与孕妇血清中胎盘生长因子（PLGF）含量,两者结合分析子痫前期的严重程度。方法对30例初诊子痫前期孕妇及154名健康孕妇,通过彩色多普勒超声技术（CDFI）检测子宫螺旋动脉血流动力学参数：搏动指数（PI）值、阻力指数（RI）值、收缩期峰值流速与舒张末期血流速度之比值（S／D）。使用酶联免疫吸附试验（ELISA）法测定孕妇血清中PLGF的含量。结果（1）子痫前期组的PI值、RI值、S／D值较对照组有所增高,差异有统计学意义（P〈0．01）。子痫前期重度组较轻度组的值增高,差异有统计学意义（P〈0．001）。（2）子痫前期组的血清PLGF含量较对照组降低,差异有统计学意义（P〈0．001）,子痫前期重度组低于轻度组,差异有统计学意义（P〈0．001）。（3）子痫前期血清PLGF分别与PI（r=-0．55,P〈0．05）、RI（r=-0．58,P〈0．05）、S／D（r=-0．62,P〈0．05）,呈显著负相关。结论（1）彩色多普勒超声技术检测子宫螺旋动脉血流、孕妇血清PLGF含量都与子痫前期严重程度相关。（2）子宫螺旋动脉血流动力学参数与子痫前期孕妇血清PLGF表达之间呈显著负相关。     

Detection of renal artery stenosis: experimental and clinical analysis of velocity waveforms

Mass screening of hypertensive patients by a noninvasive method could uncover the 10% of those cases where renal artery stenosis is the primary etiology. Treatment by transluminal angioplasty or surgery could replace a long-term medical regimen. To investigate an ultrasonic technique, normal velocity waveforms were obtained from the abdominal aorta, celiac artery and renal arteries in seven mongrel dogs using a 5 MHz, continuous-wave Doppler detector. Renal artery pressure gradients, volume flow rates and velocity recordings were subsequently made during induced proximal renal artery stenoses. The ratio of peak renal artery frequency to peak aortic frequency was 88% sensitive to stenoses of greater than 20 mm Hg pressure gradient, while the renal artery systolic frequency window was 79% sensitive to the same obstructions. Ninety-five hypertensive and vascular surgical patients were examined using a 3 MHz duplex scanner with 175 of the 190 (92%) renal arteries adequately detected (clear signal with high diastolic component). Analysis of velocity waveforms based on peak frequency, proximal to distal peak frequency changes, evidence of flow disturbances and associated bruit were compared to contrast arteriograms in 84 vessels. Of the 76 (90%) arteries adequately examined by duplex scanning, 59 of 61 (97%) with 0-59% diameter reduction, 10 of 12 (83%) with 60-99% diameter reduction and 1 of 3 (33%) occlusions were correctly identified. Velocity waveform analysis can accurately detect renal artery stenosis and may prove effective in mass screening of hypertensive patients for renovascular disease.