超声波扫描术——鳕鱼性别测定的一种非损伤性方法

超声波扫描术是一种快速、精确且非损伤性的测定鳕鱼(Gadus mor-hua)性别的方法。作者采用该法对1～6龄的788尾养殖鳕鱼的性别进行了测定。从10月到4月,其精确率可以达到95%以上。

床旁超声评估胃残余量在脓毒症肠内营养中的应用

脓毒症病人常出现急性胃肠功能损伤,胃残余量监测目前仍然是临床中评估病人胃肠动力情况、肠内营养(EN)耐受情况及返流、误吸风险的重要指标,注射器间断回抽胃管测定胃残余量的方法已沿用多年,随着床旁超声在重症病人诊疗应用的逐步深入,超声测量胃窦面积间接估算胃残余量的方法己在指导营养治疗中起着重要作用,为重症病人营养监测和治疗提供了新思路。

颈动脉粥样硬化的超声检测及与危险因素的关系

为探讨能否用超声测定颈动脉内膜中膜厚度来评价颈动脉粥样硬化与主要危险因素的关系。对 14 7例受试者进行了双侧颈动脉超声检查 ,测量了动脉内膜中膜厚度 ,并以内膜中膜厚度大于 1.0mm为诊断标准将受试者分为颈动脉粥样硬化组和非颈动脉粥样硬化组 ,对颈动脉动脉粥样硬化的多项可能危险因素在两组间进行了比较。结果发现 ,年龄、吸烟指数、收缩压、舒张压、总胆固醇、体质指数、糖尿病、冠心病家族史及男性性别为颈动脉粥样硬化的主要危险因素 (P <0 .0 5～P <0 .0 1)。多元回归分析 (P <0 .0 1)发现 ,颈动脉粥样硬化的主要危险因素为男性性别、年龄增高、收缩压增高、吸烟及血清高胆固醇水平。此结果提示 ,颈动脉粥样硬化的主要危险因素与导致冠心病的主要危险因素基本一致 ,提示所测各项主要危险因素对全身的动脉粥样硬化病变均有促进作用。

急性阑尾炎超声诊断手法的探讨

目的:探讨急诊急性阑尾炎超声诊断的扫查手法。方法:对150例腹痛急诊疑为急性阑尾炎的患者进行超声扫查,阑尾定位方法为在盲肠起始端、腰大肌前方及髂血管前方寻找阑尾。依据病理学分型并结合声像图特点将阑尾分四类:①正常;②急性单纯性阑尾炎;③急性化脓性和坏死性阑尾炎;④阑尾周围脓肿包块形成。若阑尾肿大,壁增厚、腔内积液、周围伴无回声和不均质包块等则判断为阑尾炎,必要时可采取适当加压等灵活的手法扫查进一步判断,最后与手术和组织学结果对照。结果:7例没有阑尾炎的患者被检查排除;急性单纯性阑尾炎69例中49例术前得到准确诊断,符合率为71.0%;急性化脓性和坏死性阑尾炎63例,术前诊断了58例,符合率为92.1%;11例阑尾周围包块形成均准确诊断。总的准确度为83.3%。结论:参照周围的器官对阑尾定位,运用灵活的手法仔细扫查,可以获得阑尾炎满意的诊断。

不同穿刺点颈内静脉和颈总动脉解剖关系变化的研究

目的研究中国人颈内静脉和颈总动脉的解剖关系,以寻找颈内静脉穿刺最佳入路,提高穿刺成功率。方法选择需要中心静脉穿刺的择期手术患者280例,应用超声波扫描术测定甲状软骨上缘水平、环状软骨水平、第二气管环水平颈部3个平面双侧颈内静脉和颈总动脉的位置关系。结果自上而下,双侧颈内静脉横径逐渐增加,双侧颈总动脉横径逐渐减小(P<0.05),颈内静脉从颈总动脉外侧逐渐移向颈总动脉前面,即动静脉夹角逐渐变小,动脉重叠率和静脉重叠率均逐渐增加(P<0.01),静脉未重叠量逐渐减小(P<0.01)。同一扫描平面左右对比,右侧颈内静脉横径宽于左侧(P<0.01),双侧颈总动脉横径相似。在甲状软骨上缘和第二气管环水平,右侧动静脉夹角大于左侧(P<0.01),静脉重叠率小于左侧(P<0.01),3个扫描平面右侧静脉未重叠量均大于左侧(P<0.01)。280例患者中共有13例存在一个或多个扫描平面颈内静脉在颈总动脉内侧。在甲状软骨上缘水平,右侧颈总动脉有9例(3.2%)已分叉,左侧颈总动脉有16例(5.7%)已分叉。结论颈内静脉和颈总动脉的解剖位置存在较多变异。了解颈内静脉与颈总动脉的解剖关系有助于降低颈内静脉穿刺时误穿颈总动脉的发生率。

喉罩通气对颈内静脉与颈总动脉解剖关系的影响

目的研究喉罩置入对颈内静脉与颈总动脉解剖关系的影响,寻找喉罩全身麻醉下,颈内静脉穿刺适合的入路,提高穿刺成功率。方法选择喉罩全身麻醉择期手术患者30例,应用超声波扫描术,在胸锁乳突肌三角顶点和锁骨上窝2 cm位置,头部偏转0°、30°、60°和最大角度,在喉罩置入前后分别测定双侧颈内静脉与颈总动脉的夹角和动脉重叠率。结果胸锁乳突肌三角顶点和锁骨上窝2 cm位置,随患者转头角度的增加,双侧颈内静脉与颈总动脉的夹角逐渐减小(P<0.05),动脉重叠率逐渐增高(P<0.05)。胸锁乳突肌三角顶点位置,喉罩置入后,与相同转头角度喉罩置入前比较,动静脉夹角明显减小(P<0.05),而动脉重叠率明显增高(P<0.05)。锁骨上窝2 cm位置,喉罩置入对动静脉夹角和动脉重叠率均无明显影响(P>0.05)。结论转头与喉罩置入充气可改变颈内静脉与颈总动脉解剖关系,增加穿刺难度,了解这一变化规律有助于选择适宜的穿刺路径,降低颈内静脉穿刺时误伤颈总动脉的发生率。

组织追踪和应变率成像评价腹主动脉运动特征与冠状动脉病变的关系

目的利用组织追踪和应变率成像检测腹主动脉位移、应变和应变率等运动特征,并与冠状动脉病变程度的关系进行分析。方法应用GE Vivid 7超声诊断仪,对70例健康人(对照组)及69例冠心病患者(冠心病组)进行腹主动脉位移、应变和应变率检测。冠心病组患者以冠状动脉病变支数分为单支病变组和多支病变组2个亚组。结果冠心病组患者腹主动脉前后壁位移、后壁最大应变、前壁应变率s、后壁应变率s、e、a与对照组比较差异均有显著性。单支与多支冠脉病变组比较,腹主动脉前后壁位移、应变、应变率差异均有显著性。结论腹主动脉位移、应变和应变率对冠心病具有预测价值,其变化与冠状动脉病变严重程度相一致。

最新医学信息文摘

孕龄为11-14周的21三体胎儿的上颌骨长度 目的 筛检21三体时测定孕龄为11-14周胎儿的上颌骨长度。方法 在对11-14周的妊娠进行绒毛采样以确定染色体组型前,对970个胎儿进行超声检查以测定其顶臀长(CRL),颈部半透明度和上颌骨长度,并检查其鼻骨是否缺如。60个病案经同一个操作者两次测量以计算测量被观查者间的差异性。结果

Occult sporadic insulinoma: Localization and surgical strategy

Insulinomas continue to pose a diagnostic challenge to physicians, surgeons and radiologists alike. Most are intrapancreatic, benign and solitary. Biochemical diagnosis is obtained and imaging techniques to localize lesions continue to evolve. Surgical resection is the treatment of choice. Despite all efforts, an occult insulinoma (occult insulinoma refers to a biochemically proven tumor with indeterminate anatomical site before operation) may still be encountered. New localization preoperative techniques decreases occult cases and the knowledge of the site of the mass before surgery allows to determine whether enucleation of the tumor or pancreatic resection is likely to be required and whether the tumor is amenable to removal via a laparoscopic approach. In absence of preoperative localization and intraoperative detection of an insulinoma, blind pancreatic resection is not recommended.

Imaging of the small bowel in Crohn's disease: A review of old and new techniques

The investigation of small bowel morphology is often mandatory in many patients with Crohn's disease. Traditional radiological techniques (small bowel enteroclysis and small bowel follow-through) have long been the only suitable methods for this purpose. In recent years, several alternative imaging techniques have been proposed. To review the most recent advances in imaging studies of the small bowel, with particular reference to their possible application in Crohn's disease, we conducted a complete review of the most important studies in which traditional and newer imaging methods were performed and compared in patients with Crohn's disease. Several radiological and endoscopic techniques are now available for the study of the small bowel; each of them is characterized by a distinct profile of favourable and unfavourable features. In some cases, they may also be used as complementary rather than alternative techniques. In everyday practice, the choice of the technique to be used stands upon its availability and a careful evaluation of diagnostic accuracy, clinical usefulness, safety and cost. The recent development ofinnovative imaging techniques has opened a new and exciting area in the exploration of the small bowel in Crohn's disease patients.

Portalsystemic hemodynamic changes in chronic severe hepatitis B: An ultrasonographic study

AIM： To evaluate portalsystemic hemodynamic changes in chronic severe hepatitis B. METHODS： Hemodynamic parameters included portal vein diameter （PVD）, portal vein peak velocity （PVPV）, portal vein volume （PW）, spleen length （SPL）, spleen vein diameter （SPVD）, spleen vein volume （SPW） and umbilical vein recanalization. They were measured by Color Doppler ultrasonography in 36 patients with chronic severe hepatitis B, compared with 51 normal controls, 61 patients with chronic hepatitis B, 46 patients with compensable cirrhosis, and 36 patients with decompensable cirrhosis. RESULTS： In the group of chronic severe hepatitis B, PVD （12.38 ± 1.23 mm） was significantly different from the normal control, compensable cirrhosis and decompensable cirrhosis groups （P = 0.000-0.026）, but not significantly different from the chronic hepatitis group. PVPV （16.15 ± 3.82 cm/s） dropped more significantly in the chronic severe hepatitis B group than the normal control, chronic hepatitis B and compensable cirrhosis groups （P = 0.000-0.011）. PW （667.53 ± 192.83 mL/min） dropped significantly as compared with the four comparison groups （P = 0.000-0.004）. SPL （120.42 ± 18.36 mm） and SPVD （7.52 ± 1.52 mm） were longer in the normal control and chronic hepatitis B groups （P = 0.000-0.009）, yet they were significantly shorter than those in the decompensable cirrhosis group （P = 0.000）. SPW （242.51 ± 137.70 mL/min） was also lower than the decompensable cirrhosis group （P = 0.000）. The umbilical vein recanalization rate （75%） was higher than the chronic hepatitis B and compensable cirrhosis groups. In the course of progression from chronic hepatitis to decompensable cirrhosis, PVD, SPL and SPVD gradually increased and showed significant differences between every two groups （P = 0.000-0.002）. CONCLUSION： Patients with chronic severe hepatitis B have a tendency to develop acute portal hypertension, resulting in significantly reduced portal vein perfusion, Observation of the portalsystemic hemodynamic changes may be contributed to the disease progression of chronic liver disease.

Relationship between preoperative staging by endoscopic ultrasonography and MMP-9 expression in gastric carcinoma

AIM: To investigate the relationship between the staging by endoscopic ultrasonography (EUS) and the expression of carcinoma metastasis associated gene in the patients with gastric carcinoma. METHODS: Sixty-three patients with gastric cancer were diagnosed by electric gastroscopy and EUS. The preoperative staging of gastric cancer was measured by EUS and compared with pathologic staging and MMP-9 expression. Peripheral serum level of MMP-9 was measured with enzyme-linked immunosorbent assay (ELISA), while the expression of MMP-9 protein was tested with immunohistochemistry and hybridization in situ in the gastric carcinoma tissues. RESULTS: The total accuracy of EUS in estimating invasive depth of gastric cancer was 80.95%, while that in estimating lymphatic metastasis was 73.02%. Serum MMP-9 levels were consistent with the expression of MMP-9 protein and MMP-9 mRNA in tissue, a result closely correlated with invasive degree, staging with EUS and lymphatic metastasis in gastric cancer (P < 0.05). The total accuracy of estimating invasive depth in gastric cancer was 95.22% using both EUS and MMP-9. CONCLUSION: The MMP-9 level of preoperative serum presents the reference value for preoperative staging by EUS in the patients with gastric cancer. When serum MMP-9 level in gastric cancer is significantly high, physicians should pay closer attention to the metastasis which reaches the serosa or beyond. Combining EUS and MMP-9 improves the accuracy in deciding the invasion and metastasis in the patients with gastric carcinoma.

Usefulness of contrast-enhanced ultrasonography in determining treatment efficacy and outcome after pancreatic cancer chemotherapy

AIM:To investigate if contrast-enhanced ultrasonography(CE-US) is useful for determining treatment efficacy and outcome in the early stages of pancreatic cancer chemotherapy by assessing changes in intratumor hemodynamics using CE-US with a contrast agent.METHODS:The subjects were 34 patients with unresectable advanced pancreatic cancer treated by chemotherapy.CE-US was assessed after every treatment(course) completion under the same conditions,and patients were divided into two groups according to the intratumor enhancement pattern:Vascular rich(R) group and vascular poor(P) group.RESULTS:After the second course of treatment,R group in intratumor hemodynamics had 18 patients,and P group had 16 patients.The reduction rates of serum CA19-9 level after chemotherapy which decreased to half or less of the baseline level were 2/15(0.1%) in P group,but 11/16(69%) in R group(P = 0.006).When the mean number of courses of chemotherapy and outcome were compared,P group had a mean number of courses of 4.9(R group,10.2) and mean survival time(MST) of 246 d(R group,402 d),showing that outcome was significantly better in R group(P=0.006).CONCLUSION:CE-US revealed that the change in intratumor blood flow correlated with both serum CA19-9 level and outcome.Patients with serum CA19-9 that decreased to less than half the baseline level,and patients with an abundant intratumor blood flow,had a significantly better outcome.Thus,CE-US is potentially useful for evaluating treatment efficacy and outcome in the early stages of pancreatic cancer chemotherapy.

Advanced imaging and visualization in gastrointestinal disorders

Advanced medical imaging and visualization has a strong impact on research and clinical decision making in gastroenterology. The aim of this paper is to show how imaging and visualization can disclose structural and functional abnormalities of the gastrointestinal (GI) tract. Imaging methods such as ultrasonography, magnetic resonance imaging (MRI), endoscopy, endosonography, and elastography will be outlined and visualization with Virtual Reality and haptic methods. Ultrasonography is a versatile method that can be used to evaluate antral contractility, gastric emptying, transpyloric flow, gastric configuration, intragastric distribution of meals, gastric accommodation and strain measurement of the gastric wall. Advanced methods for endoscopic ultrasound, three-dimensional (3D) ultrasound, and tissue Doppler (Strain Rate Imaging) provide detailed information of the GI tract. Food hypersensitivity reactions including gastrointestinal reactions due to food allergy can be visualized by ultrasonography and MRI. Development of multi-parametric and multi-modal imaging may increase diagnostic benefits and facilitate fusion of diagnostic and therapeutic imaging in the future.

Diagnostic laparoscopy and laparoscopic ultrasonography withlocal anesthesia in hepatocellular carcinoma

Diagnosis of hepatocellular carcinoma (HCC), a common digestive malignancy, remains a challenge. The aim of this study was to evaluate the feasibility of performing laparoscopy and laparoscopic ultrasound with local anesthesia as a diagnostic procedure in HCC. Laparoscopy and laparoscopic ultrasound with local anesthesia was performed in the gastrointestinal endoscopy unit in three patients diagnosed of HCC. Endoscopy staged diffuse liver disease. Laparoscopic ultrasonography identified all liver tumors not visible during endoscopy and guided needle biopsy in one case. No complications happened. In conclusion, laparoscopy and laparoscopic ultrasound,performed as a minimally invasive diagnostic procedure can be a safe and very promising tool in planning therapy of HCC.

DIAGNOSTIC VALUE OF MINIPROBE ULTRASONOGRAPHY IN ESOPHAGEAL PROTRUDING LESIONS

Objective To investigate the diagnostic value of miniprobe ultrasonography (MPS) in the protruding lesions of esophagus. Methods Sixty-two patients with protruding lesions of esophagus were examined with MPS. Results The MPS examination showed diseases of esophageal polyp, inflammatory protruding, esophageal leiomyoma, esophageal leiomyosarcoma, esophageal venous aneurysm, esophageal lipoma, esophageal cyst, esophageal carcinoma, and extra esophageal compression including aorta compression, lung tumor compression and spina compression. Fourteen patients were verified by surgical operations and pathological examinations, resulting in 92.86% (13/14) diagnosis accuracy rate. Forty-eight cases had results of gastroscope examination consistent with that of MPS. Twelve cases had results of CT and MRI examination consistent with that of MPS. Follow-up was completed on 22 patients. Conclusion Besides imaging the esophageal layer, MPS can precisely locate the histological layer of the esophageal protruding lesions and predict their characters. This indicates its value in the diagnosis and differential diagnosis of the protruding lesions of esophagus. Furthermore, the miniature probe used in MPS examination can pass the structured esophagus, enabling wider application of the examination.

Effects of ultrasonic dispersion on structure of electrodeposited Ni coating on AZ91D magnesium alloy

To obtain the refined electrodeposited nickel layer on AZ91D magnesium alloy,ultrasonic technology was applied in the processes of pre-treatment and electrodeposition.The phases of pre-treatment layer and the nickel coating were analyzed by X-ray diffractometry(XRD)and X-ray photoelectron spectroscopy(XPS),and the microstructure was observed by scanning electron microscopy(SEM).Then,the effects of ultrasonic dispersion on the microstructure of pre-treatment layer and the grain refinement of electrodeposited nickel layer were discussed.The results showed that the pre-treatment electrodeposited Cu-Sn layer with compact microstructure could be synthesized in alkaline copper-tin liquid with ultrasonic agitation,as a result,smooth and refined nickel coating formed on AZ91D magnesium alloy.On the other hand,preferred orientation in the coating decreased because of the refined grains.

高频超声对颈动脉粥样硬化病变的多因素分析

目的通过应用高频超声检查颈动脉病变，探讨颈动脉粥样硬化与年龄、性别、高血压、糖尿病、冠心病及高脂血症的关系。方法高频超声对305例受试者进行双侧颈动脉超声检查，测量颈动脉内中膜厚度、斑块大小及管腔的狭窄、闭塞与年龄、性别、高血压、高血脂、糖尿病及冠心病的关系。结果年龄、性别、高血压、糖尿病、冠心病、高脂血症是颈动脉粥样硬化的危险因素：①随着年龄增高，患者颈动脉斑块、管腔狭窄及闭塞发生率显著增高；②男性患者与同一年龄段的女性患者相比颈动脉斑块、管腔狭窄及闭塞发生率显著增高；③伴有高血压、糖尿病、冠心病及高脂血症一种或一种以上疾病患者颈动脉斑块、管腔狭窄及闭塞发生率显著增高。结论年龄、性别、高血压、糖尿病、冠心病及高脂血症为颈动脉粥样硬化的密切相关因素。

Ultrasonography for non-displaced and mini-displaced humeral lateral condyle fractures in children

Objective： To evaluate the value of ultrasonography in non-isplaced and mini-displaced humeral lateral condyle fractures in children. Methods： Nine children aged 2-9 years with non-displaced or mini-displaced humeral lateral condyle fractures were examined by high-resolution ultrasonography. The fracture line through the joint surface was visualized by ultrasonography in 6 case, in which closed reduction and percutaneous pinning was performed on 3 patients and other 3 patients did not receive the treatment because of patients＇ or their parents＇refusal. In the remaining 3 children, ultra- sonography did not reveal the cartilaginous trochle involvement at the joint surface and conservative treatment was adopted. Results： The average follow-up period was 8 months. The sonographic findings were confirmed by magnetic resonance imaging in one child who received conservative treat-ment and another child who received percutaneous pinning. The elbow function and fracture healing were good in cases received closed reduction and percutaneous pinning. Among the three cases who refused to receive closed reduction and internal fixation, re-displacement occurred in 1 case and delayed union in 1 case. All three cases receiving conservative treatment had good results both in elbow function and fracture healing. Conclusion： High-resolution ultrasonography enable to reveal non-displaced and mini-displaced humeral lateral condyle fractures as well as to ascertain whether the cartilaginous trochlea humeri was involved. For these cases, arthrography or magnetic resonance imaging is unnecessary.

Scanning near-field acoustic microscope and its application

Scanning near-field acoustic microscope （SNAM） combines the ultrasonic detection technology with scanning near-field microscopy. The main characteristic of such microscope is that the acoustic wave is produced or detected in near-field area whether ultrasonic transducer acts as generator or detector. The resolution of SNAM can reach to nanometer scale. First, two typical SNAMs, scanning electron acoustic Inicroscope and scanning probe acoustic microscope, will be introduced in this paper. The working principle of our homemade SNAM based on a commercial scanning probe microscope will be reported, together with some recent results from this homemade SNAM.