电子膀胱软镜在后尿道狭窄(闭锁)患者中的临床应用与价值

目的:探讨电子膀胱尿道软镜在后尿道狭窄(闭锁)患者的临床应用与价值,为手术治疗提供客观依据。方法:总结2009年7月～2010年12月收治98例后尿道狭窄(闭锁)患者的电子膀胱尿道软镜检查资料。结果:98例患者后尿道狭窄(闭锁)长度为1.5～7.0 cm,术中发现尿道假道6例,尿道直肠瘘6例,后尿道结石患者19例,狭窄段接近前列腺者26例,后尿道完全闭锁者22例。结论:电子膀胱尿道软镜具有可弯曲,创伤小,无视野盲区,可以方便的观察患者后尿道的情况,为选择手术方式及手术中的具体操作提供可靠的依据。

“PALPATION BY IMAGING”:MAGNETIC RESONANCE ELASTOGRAPHY

Elasticity is an important physical property of human tissues. There is a tremendous difference in elasticity between normal and pathological tissues. Noninvasive evaluation of the elasticity of human tissues would be valuable for clinical practice. Magnetic resonance elastography(MRE)is a recently developed noninvasive imaging technique that can directly visualize and quantitatively measure tissue elasticity. This article reviewed the MRE technique and its current status.

Enzyme inhibition assay for pyruvate dehydrogenase complex: Clinical utility for the diagnosis of primary biliary cirrhosis

Primary biliary cirrhosis (PBC) is usually diagnosed by the presence of characteristic histopathological features of the liver and/or antimitochondrial antibodies (AMA) in the serum traditionally detected by immunofluorescence. Recently, new and more accurate serological assays for the detection of AMA, such as enzyme-linked immunosorbent assay (ELISA), immunoblotting, and enzyme inhibition assay, have been developed. Of these, the enzyme inhibition assay for the detection of anti-pyruvate dehydrogenase complex (PDC) antibodies offers certain advantages such as objectivity, rapidity, simplicity, and low cost. Since this assay has almost 100% specificity, it may have particular applicability in screening the at-risk segment of the population in developing countries. Moreover, this assay could be also used for monitoring the disease course in PBC. Almost all sera of PBC-suspected patients can be confirmed for PBC or non-PBC by the combination results of immunoblotting and enzyme inhibition assay without histopathological examination. For the development of a "complete" or "gold standard" diagnostic assay for PBC, similar assays of the enzyme inhibition for anti-2-oxoglutarate dehydrogenase complex (OGDC) and anti-branched chain oxo-acid dehydrogenase complex (BCOADC) antibodies will be needed in future.

Application of Real-time Ultrasound Elastography in Diagnosing Benign and Malignant Thyroid Solid Nodules

Objective Real-time ultrasound elastography(US-E) is a helpful tool in diagnosing thyroid nodules.This study aims to evaluate thyroid solid nodules,to establish the accuracy of US-E in providing information on the nature of these nodules,and to assess the clinical value of elasticity scores(ES) and strain ratio(SR) in differentiating thyroid solid nodules and to explore its distribution characteristics using pathological analysis as reference. Methods Traditional ultrasonography and US-E were performed on 131 thyroid solid nodules(99 benign ones and 32 malignant ones) in 120 patients(78 females and 41 males).Three radiologists evaluated the nodules based on a four-degree elasticity scoring system.The nodules were classified according to the ES as soft(ES 1-2) or hard(ES 3-4).The SR was calculated online. Results The sensitivity and specificity of the ES for thyroid cancer diagnosis were 78%and 80%,respectively.SR values > 2.9 used as a standard to distinguish benign from malignant nodules had a sensitivity of 87%and a specificity of 92%.The SR of the benign lesions was 1.64±1.37,which was significantly different from that of malignant lesions,which was 4.96±2.13(P<0.01). Conclusions Both the ES and SR were higher in malignant nodules than those in benign ones.Real-time US-E was a useful index in the differential diagnosis of thyroid solid nodules.It can provide quantitative information on thyroid nodule characterization and improve diagnostic confidence.

TRANSCRANIAL DOPPLER CHARACTERISTICS IN PERSISTENT VEGETATIVE STATUS,LOCKED-IN SYNDROME AND BRAIN DEATH

Aim. Comparison of the trascranial Doppler (TCD) characteristics of cerebral circulation in persistent vegetative status (PVS), locked in syndrome and brain death patients. Methods. Using TCD ultrasound to detect the flow velocity and waveform patterns of middle cerebral artery (MCA) and basilar artery (BA) in patients with PVS, locked in syndrome and brain death. Results. The mean velocities of middle cerebral artery (Vmca) and basilar artery (Vba) were 30.0cm/s and 24.3cm/s in PVS patients respectively, which decreased 45.0% and 14.4% in comparing with normal value. For patients with locked in syndrome, Vmca and Vba were 49.7cm/s and 9.8cm/s, which decreased 5.0% and 61.7% than the normal value respectively. These results showed that the decrease of anterior circulation was predominant in PVS, and the decrease of posterior circulation was predominant in locked in syndrome. A unique diastolic reverse flow, short peak systolic wave or undetectable flow signal in middle cerebral artery were predominant in brain death patients, which was completely different from that of either PVS or locked in syndrome. Conclusion. TCD was a valuable tool in distinguishing PVS, locked in syndrome and brain death patients according to the differences in velocities and patterns of anterior and posterior cerebral arteries.

Value of Fiberoptic Ductoscopy in Diagnosing and Treating Multiporous Nipple Discharge

OBJECTIVE To explore the value of fiberoptic ductoscopy in diagnosing and treating bilateral and polyporous nipple discharge (ND).METHODS Fiberoptic ductoscopy was conducted in 29 patients with bilateral and polyporous ND.After the ductoscopy,the patients with intraductal papilloma (IDP) underwent a surgical procedure,and the others,identified with galactostasis,mammary duct ectasia (MDE) and obstructive galactophoritis (OG),received a ductoscopy-guided interventional therapy. RESULTS Among 29 cases,and with 79 galactophores examined,IDP was found in 11 cases (37.9% of the total cases),or 13.9% of the galactopores examined.IDP was found in 9 of 11 cases with a bloody nipple discharge,while IDP was seen in 2 of the 18 cases with a non-bloody nipple discharge.The excision accuracy achieved 100% in the cases,and postoperative pathological diagnosis accordance rate reached 88.9%. CONCLUSION Fiberoptic ductoscopy has many features such as ability to see the lesion,and accurate preoperative localization,thus eliminating excessive excision of tissue during surgery.For most patients with ND,especially those suffering galactostasis,OG or MDE,washout under fiberoptic ductoscopy and interventional therapy may achieve a thorough cure of the disease.

OMNIPLANE TRANSESOPHAGEAL ECHOCARDIOGRAPHY IMAGING PLANES EXPLORATION

One hundred and twenty-four patients with heart disease were examined by omniplane TEE in order to systematically research every views of omniplane TEE, and further explore anatomy and image feature of each view. The result showed that omniplane TEE transducer can be rotated in probe from 0°to 180°.obtain many views at various angles behind the heart and fully demonstrate the structure and pathology of the heart and great vessels. It was useful for clinical diagnosis because of getting more information about the heart and great vessels. As omniplane TEE probe was little rotated in esophagus, it lessened esophagus stimulation. Meanwhile, it was suitable for three-dimensional reconstruction of left ventriculum.

The diagnostic evaluation of fine needle aspiration cytology of thyroid and its clinical application

Objective:The aim of the study was to investigate the diagnostic value of fine needle aspiration cytology (FNAC) and its clinical application.Methods:From April 2009 to February 2011,thyroid FNAC were performed in a total of 186 patients with thyroid nodule or mass in our hospital and 78 of those 186 patients subsequently underwent thyroidectomy.The FNAC findings were compared with the results of the corresponding histological diagnosis.Results:The results of thyroid FNAC for 186 patients showed that,(1) 166 cases of benign lesions,the detection rate was 89.24% (166/186),including 96 cases of nodular colloid goiter (51.61%),28 cases of simple colloid goiter (15.05%),38 cases of Hashimoto's thyroiditis (HT) (20.43%) and 4 cases of thyroid adenoma (2.15%);(2) 4 cases of suspicious malignant lesion,the detection rate was 2.15% (4/186);(3) 16 cases of malignant tumor,the detection rate was 8.60% (16/186).Seventy eight patients including malignant (16),suspicious malignant (4),HT (20) and nodular colloid goiters (38) cases diagnosed by FNAC were performed operation with thyroidectomy and the postoperative histopathologic results showed that there were 2 cases HT combined thyroid papillary carcinoma in HT 20 cases by FNAC,15 cases of thyroid papillary carcinoma and 1 case of follicular carcinoma in 16 cases of malignant tumor by FNAC and 4 case of thyroid papillary carcinoma in 4 cases of suspicious malignant by FNAC.Conclusion:Thyroid FNAC is a valuable and reliable method for the diagnosis of the thyroid nodules or mass or even most diffuse thyroid diseases.Diagnosis of HT and thyroid papillary carcinoma can be made by thyroid FNAC.There was larger hint value for nodular colloid goiter and simple colloid goiter according to thyroid FNAC.

Application of Computed Tomographic Colonography in Diagnosis of Colonic Polyps

Objective To assess the clinical values of computed tomographic colonography （CTC） in diagnosis of colonic polyps. Methods Forty-two patients who were clinically suspicious of colonic polyps or underwent colonic polyps screening received examinations with both CTC and conventional colonoscopy. Sixteen- or 64-slice spiral computed tomography and professional imaging processing techniques were used for evaluation. Per-polyp and per-patient results were analyzed. Those by per-polyp were subsequently divided into ≥10 mm group, 5-10 mm group, and ≤5 mm group. Sensitivity, positive predictive value （PPV）, specificity, negative predictive value （NPV）, and accuracy were calculated using statistical method for diagnostic studies, with conventional colonoscopy as a gold standard. Results Ninety and 61 polyps were found by CTC and conventional colonoscopy, respectively. The per-polyp sensitivity/PPV were 80.3%/55.6% in total, and 100%/92.9%, 93.8%/65.2%, and 68.8%/ 41.5% in the ≥10 mm group, 5-10 mm group, and ≤5 turn group, respectively. The per-patient sensitivity, PPV, specificity, NPV, and accuracy were 97.1%, 89.5%, 42.9%, 75.0%, and 88.1%, respectively. Conclusion CTC can clearly reveal the morphology of colonic polyps and be used as a routine monitoring method for the clinical diagnosis of polyps.

CLINICAL APPLICATION OF OMNIPLANE TRANSESOPHAGEAL ECHOCARDIOGRAPHY

One hundred and twenty-four patients with heart disease(75 cases of rheumatic heart disease,26 cases of congenital heart disease,13 cases of aortic disease and 10 cases of other disease)were examined by Omniplane transesophageal echocardiography(TEE).The result showed that Omniplane TEE transducer can be rotated from 0°to 180°in probe and had the advantages of broader scope,obtaining more information,less stimulation to esophagus and easy to manipulate.It suggests that Omniplane TEE is a efficient technique in clinical diagnosis and can be extensively used in the future.

Application of ultrasound in the diagnosis of clinical anesthesia

During the past 10 years, the rapid development of ultrasound technology in clinical anesthesia has become one of the hot clinical researches. Researches in this area home and abroad also made great progress. On the one hand due to improved high-resolution portable ultrasound instrument and probe technology, ultrasound changed from a purely clinical diagnostic into the operating room; on the other hand, with the traditional method of anesthesia increasingly unable to meet the clinical requirements, it is an objective need of technological innovation for clinical anesthesia. And ultrasound has non-invasive, real-time, visible and repeatable characteristics which are able to provide accurate data and rich means for preoperative assessment, intraoperative monitoring and treatment of pain in pre-clinical anesthesia

Clinical utility of proton magnetic resonance spectroscopy in the diagnosis of breast tumors

Proton magnetic resonance spectroscopy (1H MRS) can provide specific biochemical information within breast lesions and the elevated composite choline concentration as a useful diagnostic tool has been used to distinguish malignant from benign breast lesions, early evaluate response to therapy and predict prognosis. However, several obstacles including poor spatial resolution, low signal-to-noise ratio (SNR), long acquisition time and the difficulty of "extra" lipid suppression may have a negative impact on the routine application of in vivo 1H MRS for human breast cancer. At present, optimization H MRS methodology for breast studies has been performed.

Color doppler ultrasound in the application of breast intraductal papilloma

Objective:The aim of this study was to evaluate the application value of high-frequency color Doppler ultrasound in the diagnosis of intraductal papilloma (IDP). Methods:A retrospective analysis of 64 IDP cases was done, the pathology proven by surgery with 89 lesions. According to the ultrasonic performance, the lesions were divided into different types and the solid focal were evaluated according to the classification BI-RADS-US standard. Results:There were 47 patients corresponds with the 64 cases of surgical pathology, the accuracy was 73.4%, according to the ultrasonic performance could be divided into two types, named catheter type and solid type, catheter diagnostic accuracy was 22/25 (88%), compared the morphological features of the solid type, grouped according to their size (≥ 2 cm or < 2 cm lesions), discovered there was no statistically significant difference between the benign and malignant lesions by BI-RADS-US grading standard. Conclusion:Two-dimensional ultrasound and Color Doppler flow imaging (CDFI) can make a definite diagnosis and positioning for IDP, but there are still some limitations to differentiate the benign and malignant, it need to pay more attention to the clinical application of substantive IDP and improve the understanding, provide more relevant information for clinic, the focal will be earlier treated to reduce the possibility of malignant happened change.

Clinical application of specific antibody against glypican-3 for hepatocellular carcinoma diagnosis

Glypican-3(GPC3) is a promising tumor marker for hepatocellular carcinoma(HCC) diagnosis with high sensitivity and specificity.The aim of this study was to establish an immunohistochemical detection method for GPC3 using the 7D11 monoclonal antibody(7D11 mAb) and evaluate its application for HCC diagnosis.The feasibility of the 7D11 mAb was evaluated by immunohistochemistry performed on adjacent normal liver and intrahepatic cholangiocarcinoma(ICC) samples,Furthermore,the serum GPC3 levels were evaluated in 40 HCC patients,7 ICC patients and 50 healthy donors.The results showed that GPC3 was expressed in 85% of HCC tissues(34/40),but was undetectable in ICC tissues and adjacent normal tissues.GPC3 was significantly increased in the serum of HCC patients(17/40,42.5%) but was undetectable in the serum of ICC patients(0/7,0%) and healthy donors(0/50,0%).This prospective study evaluated the clinical usefulness of 7D11 mAb for GPC3 detection in HCC patients.In conclusion,the use of 7D11 mAb might be good for GPC3 large-scale applications for clinical diagnosis of HCC.