视网膜母细胞瘤的超声诊断

对３２例视网膜母细胞瘤的超声表现与病理进行比较分析。结果Ｂ超与病理诊断符合率为９７％（３１／３２）。Ｂ趋声像图表现为实质性回声而钙化病例少（１８．７５％）。

乳腺癌79例超声表现

本院1997～1998年间住院治疗的乳腺癌病人中,随机抽取79例,均先经B超检查再作手术,最后经病理证实。现将结果报告如下。 1 材料与方法 1.1 方法:应用日本RT2000及东芝140B型超声诊断仪,探头频率5NHz和7NHz。患者平卧,双臂上举,充分暴露乳房。先作患侧肿块触诊,将探头涂上耦合剂对着肿块进行多方向切面扫查观察肿瘤部位、形态、大小、内部回声、周边回声、衰减程度及与周围组织粘连情况。

B超诊断异常早期妊娠147例

异常早期妊娠包括早期妊娠死胎(即妊娠12周内,胚胎在宫腔内死亡者。)、早期妊娠流产、异位妊娠、葡萄胎等。本文通过对192例早期孕期临床表现异常患者的回顾性研究,探讨B超检查在诊断异常早期妊娠中的应用。资料与方法 192例患者。年龄24～38岁,均有停经史和不同程度的妊娠反应,停经距就诊时间6～12周。主要有阴道流血、下腹疼痛,子宫大小与孕期不符等不同临床表现。使用Aloka SSD-280LS型线阵超声显像诊断仪。探头频率为3.5MH_Z。结果本组192例,B超诊断异常早期妊娠147例占76.56%(147/192例)。

Prenatal diagnosis of congenital fetal heart abnormalities and clinical analysis

Objective: To study the value of detecting fetal congenital heart disease (CHD) using the five transverse planes technique of fetal echocardiography. Methods: Nine hundred and eighty-two high-risk pregnancies for fetal CHD were included in this study, the fetal heart was scanned with the five transverse planes technique of fetal echocardiography described by Yagel, autopsy was conducted when pregnancy was terminated. Blood from fetal heart was collected for fetal chromosome analysis. A close follow-up was given for normal fetal heart pregnancies and neonatal echocardiography was performed to check the accuracy of prenatal diagnosis. Results: (1) Forty-six cases (4.68%) were found to have fetal heart abnormalities in this study, 69.56% of them were diagnosed by single four-chamber view, another 30.43% fetal CHD were found by combining other views; (2) Forty-one parents of prenatal fetuses with CHD chose to terminate pregnancy, thirty-two of them gave consent to conduct autopsy, 93.75% of which yielded unanimous conclusion between prenatal fetal echocardiography and autopsy; (3) Thirty-two of 46 cases underwent fetal chromosome analysis, 8 cases (25%) were found to have abnormal chromosome; (4) Five cases were found to have right ventricle and atrium a little bigger than those on the left side, with the unequal condition being the same after birth, but there were no clinical manifestations and they are healthy for the time being; (5) Nine hundred and thirty-six cases were not found with abnormality in this study, but one case was diagnosed with ventricular septal defect after birth, one case was diagnosed with patent ductus arteriosus, one case had atrial septal defect after birth. Conclusions: (1) The detected CHD rate was 4.68% by screening fetal heart with five transverse planes according to Yagel’s description of high risk population basis for CHD. The coinciding rate of prenatal diagnosis and autopsy was 93.75%; (2) The sensitivity of detecting fetal heart abnormality is 92%, the specificity is 99.6% using the five transverse planes technique of fetal echocardiography; (3) Fetuses with mild or moderate disproportion of right and left side in the heart are potentially healthy babies.

Values of endoscopic ultrasonography for diagnosis and treatment of duodenal protruding lesions

Objective： The diagnoses of patients with duodenal protruding lesions are difficult when using conventional examinations such as computed tomography （CT） and conventional endoscope etc. Thus, we investigated the clinical value of endoscopic ultrasonography （PUS） with miniature ultrasonic probes on the diagnosis and treatment of duodenal protruding lesions. Methods： Patients with duodenal protruding lesions who were indicated for PUS were examined by PUS with 12-15 MHz miniature ultrasonic probes and double-cavity electronic endoscope. According to diagnosis of PUS, those patients were indicated for biopsy and treatment received biopsy, endoscopic resection or surgical excision. The postoperative histological results were compared with the preoperative diagnosis of PUS. Those patients without endoscopic resection or surgical excision were periodically followed up with PUS. Results： A total of 169 patients with duodenal protruding lesions were examined by PUS, of which 40 were diagnosed with cysts, 36 with inflammatory protruding or polyp, 25 with Brunner＇s gland adenoma, 19 with ectopic pancreas, 17 with gastrointestinal stromal tumor, 12 with extrinsic compression, 12 with minor papilla, 6 with lipoma, 1 with adenocarcinoma and 1 with lymphoma. After PUS examinations, 75 patients received biopsy, endoscopic resection or surgical excision respectively. The postoperative histological results of 70 patients were completely consistent with the preoperative diagnosis of PUS, with 93.33% diagnostic accuracy. The results of follow-up with PUS indicated that duodenal cyst, Brunner＇s gland adenoma, ectopic pancreas, gastrointestinal stromal tumor and lipoma remained unchanged within 1-3 years. No related complications occurred among all patients that received PUS examinations. Conclusion： PUS is an effective and reliable diagnostic method for duodenal protruding lesions.

SONOGRAPHIC PATTERNS AND DIFFERENTIAL DIAGNOSIS OF CYSTIC RENAL CARCINOMAS

OBJECTIVE: To study the sonographic features and patterns of cystic renal carcinomas. METHODS: Thirteen cases of cystic renal carcinoma confirmed by operation and pathology were examined by ultrasonography, and the cystic walls, septa and solid mural nodules were studied. RESULTS: Solid mural nodules of some cases and irregular thickening of the cystic walls and septa were characteristic findings for the ultrasonic diagnosis of cystic renal carcinomas. According to their pathologic mechanisms and sonographic features, cystic renal carcinomas were classified into 3 patterns: unilocular cystic mass, multiloculated cystic mass and cystic-solid mass. CONCLUSIONS: Typical cystic renal carcinomas can be well diagnosed, while atypical cases may be misdiagnosed as benign renal cysts by ultrasonography. Color Doppler ultrasonography and needle aspiration guided by ultrasonography are helpful in the diagnosis of these atypical cases.

Diagnosis of pancreatic tumors by endoscopic ultrasound-guided fine-needle aspiration

AIM： To evaluate the diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration （EUS-FNA） for pancreatic solid tumors larger or smaller than 3 cm, and cystic lesions.METHODS： From January/1997 to December/2006, 611 patients with pancreatic tumors were subjected to EUSFNA. The final diagnosis was obtained either by surgery （356 cases） or after a mean clinical follow-up of 11.8 mo in the remaining patients.RESULTS： There were 405 solid tumors, 189 cystic lesions and 17 mixed. Pancreatic specimens for cytological assessment were successfully obtained by EUS-FNA in 595 （97.4%） cases. There were 352 （57.6%） malignancies and 259 （42.4%） benign tumors. Among the malignancies, pancreatic adenocarcinomas accounted for 67% of the lesions. Overall, the sensitivity, specificity, positive and negative predictive values, and accuracy of EUS-FNA were, respectively, 78.4%, 99.2%, 99.3%, 77.2% and 87.2%. Specifically for solid tumors, the same parameters for neoplasms larger and smaller than 3 cm were, respectively, 78.8% ys 82.4%, 100% ys 98.4%, 100% vs 99%, 54.8% vs 74.1% and 83.1% vs 87.8%. For cystic lesions, the values were, respectively, 72.2%, 99.3%, 97.5%, 91% and 92.2%.CONCLUSION： EUS-FNA can be used to sample pancreatic tumors in most patients. Even though the negative predictive value is inadequate for large solid tumors, the results are rather good for small solid tumors, especially concerning the sensitivity, negative predictive value and diagnostic accuracy. Among all pancreatic lesions, EUS-FNA for cystic lesions can reveal the best negative predictive value and diagnostic accuracy, both higher than 90%.

FEASIBILITY STUDY OF AN ULTRASOUND CONTRAST AGENT(LEVOVIST) IN COLOR DOPPLER IMAGING OF LIVER NEOPLASMS

The purpose of this study was to determine the efficacy of using an ultrasound contrast agent(levovist)to enhance the color Doppler imaging of liver neoplasms.Thirty patients with hepatic tumors were enrolled in this study.After intravenous administration of levovist,the color Doppler signals of normal hepatic vessels were enhanced.In various hepatic tumors,the different patterns of tumor vascularity were observed,which had not been demonstrated in conventional non contrast color Doppler imaging.In 11 of 16 patients with hepatocarcinoma,additional color Doppler signals were observed in the central part of the tumors.On the contrary,3 patients with metastatic liver lesions the enhanced color Doppler signals appear only at the peripheral of tumors.A typical rim like color enhancement was seen in 2 of the 3 cases.In six patients with hepatic hemangiomas contrast enhanced color Doppler imaging demonstrated the blood vessels at the margin of the neoplasms.Contrast enhanced color Doppler imaging improves the visualization of the hepatic neoplasm vascularity.This technique holds great promise for detecting small liver tumors and differentiating hepatic neoplasms.

Pancreatic cancer–Endosonography

EUS is the most sensitive imaging procedure for the detection of small solid pancreatic masses and is accurate in determining vascular invasion of the portal venous system. Even compared to the new CT-techniques EUS provides excellent results in preoperative staging of solid pancreatic tumors. Compared to helical CT-techniques EUS is less accurate in detecting tumor involvement of superior mesenteric artery. EUS staging and EUS-guided FNA can be performed in a single-step procedure, to establish the diagnosis of cancer. There is no known negative impact of tumor cell seeding due to EUS-FNA. Without FNA EUS and additional methods are not able to reliably distinguish between inflammatory and malignant masses.

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.

INTRAOPERATIVE ULTRASOUND FOR HEPATIC NEOPLASM DURING SURGERY

Objective.The purpose of this study was to determine the impact of intraoperative ultrasound(IOUS)on the management of patients with neoplasms of the liver. Methods.Forty nine patients operated on for liver or other pathologic processes were examined intraoperatively with 5.0 MHz special ultrasound transducers during surgical exploration of the abdomen.Subjects were evaluated because of known or suspected disease of the liver.Preoperative imaging studies included percutaneous ultrasound(n=49),magnetic resonance imaging(n=11),and computed tomography(n=34).Intraoperative evaluation on all patients included inspection,bimanual palpation,and ultrasonography.Comparison between preoperative imagings and IOUS were analysed. Results.Sensitivity for detection of hepatic neoplasms showed in intraoperative ultrasound,percutaneous ultrasound,magnetic resonance imaging and computed tomography as 100%(23/23),74%(17/23),74%(14/19) and 75%(6/8).Specificity showed 100%(26/26),100%(26/26),93%(14/15) and 67(2/3).In seven patients(14%),the neoplasms were not found by inspection,bimanual palpation,and identified only by IOUS. Conclusions.Intraoperative ultrasound is the most sensitive and specific method for detection and surgery of liver neoplasms,especially the occult neoplasms and small size lesion(<2cm).

Endoscopic and Endosonographic Diagnostic

Endoscopy together with endoscopic ultrasonography (EUS) are the most important diagnos- tics for esophageal cancer and staging of the primary. The results have important clinical consequences concerning type of resection or multimodal approach. Further re?nements of endoscopy will increase its signi?cance especially for early cancer. EUS has an accuracy of 80% for the primary compared to 60% for the N-staging. Therefore EUS represents the gold standard for T-staging but it is of little value for detection of lymph node metastasis.

The ultrasound diagnosis of fetal gastric teratoma

Objective: The aim of the study was to discuss the value of ultrasound examination in the diagnosis of fetal gastric teratoma. Methods: We retrospectively analyzed 2 cases with fetal gastric teratoma in our hospital (Department of Gynecology and Obstetrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China). It involved clinical, ultrasonic, X-ray, CT and MRI, biochemical, pathological, karyotype and immunohistochemical data. Results: There both were hybrid echo masses in the abdominal of the fetus with the sonography and the ultrasound features which mostly like the teratomas. Two cases were dead after induced abortion. The pathological results of the mass were gastric immature teratoma in one, and stomach mature teratoma in another. Conclusion: Fetal gastric teratoma is rarely seen and easily be misdiagnosed in clinic. The diagnosis depends finally on pathological examination. Ultrasound scan as the easy and direct method is helpful to clew the diagnosis of fetal gastric teratoma.

Value of contrast-enhanced ultrasound in diagnosis of focal liver lesions

Objective： By observing the pattern of the focal liver lesions （FLL） in different phases by real time contrast-enhanced ultrasound （CEUS）, compared to enhanced CT, investigate the value of CEUS in diagnosing focal liver lesions. Meth. ods： 35 patients with unconfirmed focal liver lesions were studied by contrast agent SonoVue and Technos DU 8 produced by Esaote company. Results： Among the 14 cases of hepatocellular carcinoma （HCC）, 10 were typical, presented with early artery enhancement and immediate wash-out. The enhancement patterns of 6 livers metastasis were diverse, including peripheral or entire degree enhancement. The wash-out time in malignant tumors was eadier than other focal liver lesions （P 〈 0.05）, appeared as hypoechoic in the portal phase or parenchyma phase. The 6 cases of hemangioma were enhanced centripetally nodular in artery phase and washed out after several minutes. The patterns of different lesions were similar compared to contrast-enhanced CT, without significant statistic differences. Conclusion： The contrast enhanced ultrasound technique can significantly improved the value of diagnosing focal liver lesions.

Validation of the use of foreign gas rebreathing method for non-invasive determination of cardiac output in heart disease patients

Objective: To compare a new device (Innocor) for non-invasive measurement of cardiac output (CO) by foreign gas rebreathing method with conventional techniques used in the measurements of cardiac function. Methods: Cardiac outputs measured by Innocor (CORB) were compared with CO obtained by echocardiography (COEC), Swan-Ganz thermodilution (COTD), and left ventricle radiography (COLVR) in 34 patients subjected to cardiac catheterization. Values obtained from the four methods were analyzed by linear regression and paired values were compared by the method of Bland and Altman in SPSS. Results: There was strong positive correlation (r=0.94) between Innocor cardiac output values and the corresponding values obtained by ther-modilution and between COEC and COLVR values. Thermodilution appears to overestimate cardiac output when compared to the values obtained with Innocor by (0.66±0.22) L/min (P<0.0001). There was no correlation between data obtained by Innocor and the corresponding COEC and COLVR values. Conclusion: Innocor CORB is an easy, safe and well established method for non-invasive measurement of cardiac output with good prospects for clinical application in heart disease patients.

Diagnosis and Treatment Value of Ultrasound for Hepatobiliary and Pancreatic Disease

As an innovative technology, ultrasound has been applied to agriculture, medical, military, aerospace, machinery and other fields widely, as well as the medical industry, such as ultrasound diagnosis, ultrasound therapy. Ultrasonic technology has many advantages, and it certainly will promote the progress in medical area as a new method.

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.

急性肾功能衰竭的双功能多普勒评价──RI和肾皮质厚度

应用双功能多普勒超声观察急性肾小管坏死，分别于少尿期、多尿前期、多尿后期及恢复期测量段动脉，叶间动脉和弓形动脉的阻力指数（ＲＩ）和肾皮质厚度值。其结果显示：少尿期内各小动脉的指数是０．８５±０．１８，肾皮质厚度值是１２．１±２．３ｍｍ，与多尿期和恢复期相比较有显著差异（ＲＩ０．５４±０．０８，０．５４±０．０７和皮肾厚度值９．２±１．２ｍｍ，７．７±１．２ｍｍ，Ｐ＜０．０１）。这证明用双功能超声测量急性肾功能衰竭肾内各级动脉血流阻力指数（ＲＩ）以及肾皮质厚度对诊断急性肾衰以及肾衰疗效评价是十分有价值的，尤其是阻力指数在肾衰各期变化明显是一个敏感的指标。

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.