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Abstract Objective The immediate referral of patients with risk factors for placenta accreta spectrum (PAS) to specialized centers is recommended, thus favoring an early diagnosis and an interdisciplinary management. However, diagnostic errors are frequent, even in referral centers (RCs). We sought to evaluate the performance of the prenatal diagnosis for PAS in a Latin American hospital. Methods A retrospective descriptive study including patients referred due to the suspicion of PAS was conducted. Data from the prenatal imaging studies were compared with the final diagnoses (intraoperative and/or histological). Results A total of 162 patients were included in the present study. The median gestational age at the time of the first PAS suspicious ultrasound was 29 weeks, but patients arrived at the PAS RC at 34 weeks. The frequency of false-positive results at referring hospitals was 68.5%. Sixty-nine patients underwent surgery based on the suspicion of PAS at 35 weeks, and there was a 28.9% false-positive rate at the RC. In 93 patients, the diagnosis of PAS was ruled out at the RC, with a 2.1% false-negative frequency. Conclusion The prenatal diagnosis of PAS is better at the RC. However, even in these centers, false-positive results are common; therefore, the intraoperative confirmation of the diagnosis of PAS is essential.
Resumo Objetivo Recomenda-se o encaminhamento imediato de pacientes com fatores de risco para espectro placentário acreta (PAS, na sigla em inglês) para centros especializados, favorecendo assim o diagnóstico precoce e o manejo interdisciplinar. No entanto, erros diagnósticos são frequentes, mesmo em centros de referência (CRs). Buscou-se avaliar o desempenho do diagnóstico pré-natal para PAS em um hospital latino-americano. Métodos Um estudo descritivo retrospectivo incluindo pacientes encaminhados por suspeita de SAP foi realizado. Os dados dos exames de imagem do pré-natal foram comparados com os diagnósticos finais (intraoperatórios e/ou histológicos). Resultados Foram incluídos 162 pacientes no presente estudo. A idade gestacional mediana no momento da primeira ultrassonografia suspeita de PAS foi de 29 semanas, mas as pacientes chegaram ao CR de PAS com 34 semanas. A frequência de resultados falso-positivos nos hospitais de referência foi de 68,5%. Sessenta e nove pacientes foram operadas com base na suspeita de PAS com 35 semanas e houve 28,9% de falso-positivos no CR. Em 93 pacientes, o diagnóstico de PAS foi descartado no CR, com frequência de falso-negativos de 2,1%. Conclusão O diagnóstico pré-natal de PAS é melhor no CR. Entretanto, mesmo nestes centros, resultados falso-positivos são comuns; portanto, a confirmação intraoperatória do diagnóstico de SAP é essencial.
الموضوعات
Humans , Female , Pregnancy , Placenta Accreta , Surgical Procedures, Operative , Ultrasonography, Prenatal , Ultrasonography , False Positive Reactionsالملخص
Neonatal meconium aspiration syndrome( MAS) is a common critical disease and one of the main risk factors leading to death in newborns. MAS was diagnosed mainly by chest X-ray in the past,but can now easily be diagnosed with lung ultrasound. It can reflect the degree of pathological changes in different parts of the lung through multi-angle scanning,and has many advantages over X-ray including accuracy,relia-bility,low-cost and simplicity,as well as the fact that ultrasound incurs no risk of radiation damage. It is therefore feasible and convenient to perform at the bedside in a neonatal ward. This paper summarized the sonographic characteristics of MAS,and introduced other applications of lung ultrasonography in the clinical treatment of MAS.
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Portal hypertension is a clinical syndrome of portal vein circulation disorder caused by multiple diseases.The assessment of portal vein pressure has important prognostic and clinical implications.However,there are great difficulties to carry out the hepatic venous pressure gradient.Recent non-invasive approaches to assess the portal vein pressure,including serum markers,ultrasonic testing,imaging and digital medical diagnosis technology has a steady progress.This article reviewed the recent approaches of the non-invasive assessment and the progress.
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PURPOSE: Ultrasonography is non-ionizing, easy to operate, and performed at bedside in neonatal intensive care unit (NICU). We investigated the incidence of respiratory distress syndrome (RDS) with or without using lung ultrasound (LUS) in late preterm infants with postnatal respiratory difficulties. METHODS: We retrospectively reviewed medical records of 494 late preterm infants born at 34–36 weeks' gestation at Keimyung University Dongsan Medical Center. Fifty infants with postnatal respiratory difficulties were admitted to the NICU between May 2015 to October 2015 (period I), and forty-one were between November 2015 to February 2016 (period II). The diagnosis of RDS was based on chest radiography in period I. LUS was additionally performed at bedside in period II. All infants with RDS were received exogenous surfactant therapy. RESULTS: The overall incidence of RDS with surfactant replacement therapy was decreased in period II period II (9.4%, 20/212) compared to period I (14.5%, 41/282) (P=0.088). In terms of infants with postnatal respiratory difficulties, the incidence of RDS in period II (48.8%, 20/41) was significantly lower than that in period I (82.0%, 41/50) (P=0.001). There are no difference in the rate of reintubation, repeated doses of surfactant, oxygen demand at 48 hours after birth, air leak syndrome, pulmonary hemorrhage, persistent pulmonary hypertension of newborn, and mortality (P> 0.05). CONCLUSION: We could decrease the incidence of RDS with surfactant replacement therapy by using LUS in late preterm infants with postnatal respiratory difficulties. Further prospective studies are needed to apply LUS clinically to diagnose RDS.
الموضوعات
Female , Humans , Infant , Infant, Newborn , Pregnancy , Diagnosis , Hemorrhage , Incidence , Infant, Premature , Intensive Care, Neonatal , Lung , Medical Records , Mortality , Oxygen , Parturition , Persistent Fetal Circulation Syndrome , Prospective Studies , Radiography , Respiratory Distress Syndrome, Newborn , Retrospective Studies , Thorax , Ultrasonographyالملخص
Objective: To investigate the diagnostic value of ultrasound for dissecting aneurysm of isolated superior mesenteric artery. Methods: 4 patients with dissecting aneurysm of isolated superior mesenteric artery who were diagnosed by angiography, the diagnostic gold standard, were examined by ultrasound, and the results were compared and analyzed. And then the accuracy and sensitivity of ultrasonic diagnosis of dissecting aneurysm of isolated superior mesenteric artery were further researched by using retrospective analysis. Results:In the 4 patients, 3 cases were correctly diagnosed as dissecting aneurysm of isolated superior mesenteric artery by ultrasound. And in the 3 cases, the area of dissection, range, true and false cavity, peeled intima echo and relevantly hemodynamic status were clearly showed in the results of ultrasound. The sensitivity, positive predictive value, false negative rate and accurate rate of ultrasonic diagnosis were 80 %, 100 %, 20 % and 80 %, respectively. Conclusion:The ultrasound detection has better sensitivity and accuracy in diagnosis of dissecting aneurysm of isolated superior mesenteric artery when angiography is no convenient and unconditional. And it provides effective and rapid detection for diagnosis of dissecting aneurysm of isolated superior mesenteric artery.
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Ovarian pregnancy is a rare ectopic pregnancy.In recent years,the development and popularization of assisted reproductive technology increase the incidence of ovarian pregnancy.This article focused on the ultrasound features of ovarian pregnancy following in vitro fertilization and embryo transfer (IVF-ET) by comparing those of pregnant corpus luteum and tubal pregnancy,and analyzed the advantages of transabdominal ultrasonography (TAS) and transvaginal ultrasonography (TVS) in the diagnosis.
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Objective To investigate correlative relations between the ultrasonic classification diagnosis and the clinicopathological features of thyroid calcification lesions.Methods The clinical data of 198 cases diagnosed as thyroid calcification lesions by ultrasonic,surgery and pathology were retrospectively analyzed.Spearman method was used to analyze the relationship of TCL ultrasonic diagnosis,clinical pathological traits and the classification of differentiated thyroid carcinoma(DTC).Results Among the 198 TCL cases,ultrasonic diagnosis and pathologic diagnosis were accordant in 178 (90.40％) cases.Among 119(60.10％) cases of thyroid carcinoma (TC),101 cases(84.87％)were papillary carcinoma,11 cases(9.24％)were follicular carcinoma,5 cases(4.20％) were medullary carcinoma and 2 cases(1.68％)were anaplastic carcinoma.Among 79 cases (39.90％) of benign lesions,34 cases(43.04％)were adenoma,27 cases(34.18％)were nodular goiter,and 18 cases(22.78％)were hashimoto's thyroiditis (HT).Calcified classification were as following 74 cases (37.37％)were type Ⅰ a and 4 cases (2.02％) were type Ⅰ b(both were TC);20 cases(10.10％)were type Ⅰ c,among which 19 cases were nodular goiter,and 1 case was TC.Among the 37 cases (23.74％) of type Ⅱ,28 cases were TC,and 19 cases were benign lesions.Among the 20 cases(10.10％) of type Ⅲ,8 cases were TC,and 12 cases were benign lesions.Among 22 cases(11.11％) of type Ⅳ,2 cases were TC,and 20 cases were benign lesions.Among 11 cases(5.56％) of type V patients,2 cases were TC,and 9 cases were benign lesions.The rate of TC with cervical metastasis was 41.18％(49/119).68.91％(82/119) of carcinoma nodules were grade Ⅱ-Ⅲ in color Doppler flow imaging (CDFI),grade 0-Ⅰ were mainly benign nodules,and grade Ⅲ with mussy blood flow in CDFI were HT.Conclusions Type Ⅰ a and Ⅰ b micro calcification is the pathological basis of ultrasonic diagnosis of papillary thyroid carcinoma and follicular carcinoma,which is closely related to DTC.Calcified isolation nodule of type Ⅱ and Ⅲ with level Ⅱ-Ⅲ bleeding is a risk factor for TC.Type Ⅰ c,Ⅲ,Ⅳ and Ⅴcalcification is closely related to benign TCL.CDFI has important value for identifying benign and malignant CLT.
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Objective To investigate the clinical characteristics and surgical methods of children with thyroglossal duct cyst (TDC).Methods A retrospective analysis was made on the clinical data and imaging characteristics from 98 cases of children with primary thyroglossal duct cyst and 40 cases of children with recurrent thyroglossal duct cyst during the time 2012 to 2015 in Kunming children's Hospital's Otolaryngology Head and Neck Department.For new-onset cases,the classic Sistrunk operation method was chosen;for postoperative recurrence cases,the enlarged Sistrunk operation method was chosen.Results Thyroglossal duct cyst CT appeared single cystic lesion and polycystic lesions;the single cystic lesion was located under the level of the hyoid bone and on the level of the hyoid bone;polycystic lesions were located in the upper and lower hyoid bone,and highly related to hyoid and thyroid;B ultrasonic results showed low echo or heterogeneous echo,no substance,with posterior echo enhancement.Sistrunk operation and the enlarged Sistrunk operation treatment efficacy was positive for new-onset cases and postoperative recurrence patients.No recurrence was found in 2 years of follow-up.Conclusions The pathogenic and anatomical characteristics of thyroglossal duct cyst should be fully understood.The hyoid bone and the surrounding area of the glossal blind aperture in the base of the tongue are the focal point of surgical operation;ring ligation is the key after resection of the diseased tissue.
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OBJECTIVE@#To discuss the liver function damage mechanism of patients with clonorchiasis by analyzing the ultrasound characteristics, liver function, change of the serum inflammatory factors and cell apoptosis factors.@*METHODS@#Color Doppler ultrasound technique was adopted to detect the portal vein and blood flow change of patients with clonorchiasis; ELISA was used to determine the level of different serum inflammatory factors. The levels of serum total bilirubin, serum albumin and glutamic-pyruvic transaminase were detected by automatic biochemical analyzer. Western blot was used to determine the expression of proteins relevant to apoptosis.@*RESULTS@#Compared with the health control group, the trunk diameter of portal vein and the thickness of spleen, as well as the hepatic artery pulsation index of clonorchiasis patients increased obviously, the mean blood flow velocity of portal vein (P < 0.05 or P < 0.01) decreased. The content of total bilirubin and transaminase in plasma increased significantly, but albumin decreased (P < 0.05). Levels of TNF-α, IL-6 and IFN-γ increased remarkably, and the level of every factor was significantly different among patients with Child-Pugh , Child-Pugh II and Child-Pugh III classification of liver function (P < 0.05 or P < 0.01). With the exacerbation of liver dysfunction, levels of TNF-α, IL-6 and IFN-γ gradually increased (P < 0.05). Compared with the healthy control group, the expression quantity of apoptosis protein Fas, FasL, Bax and Caspase-3 increased significantly (P < 0.05 or P < 0.01), but Bcl-2 decreased (P < 0.05).@*CONCLUSIONS@#Changes of ultrasonic characteristics and liver dysfunction, caused by liver fluke infection, may be related to that both inflammatory response and apoptosis response have participated in the pathogenic process and liver damage course of clonorchiasis.
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Objective To discuss the liver function damage mechanism of patients with clonorchiasis by analyzing the ultrasound characteristics, liver function, change of the serum inflammatory factors and cell apoptosis factors. Methods Color Doppler ultrasound technique was adopted to detect the portal vein and blood flow change of patients with clonorchiasis; ELISA was used to determine the level of different serum inflammatory factors. The levels of serum total bilirubin, serum albumin and glutamic-pyruvic transaminase were detected by automatic biochemical analyzer. Western blot was used to determine the expression of proteins relevant to apoptosis. Results Compared with the health control group, the trunk diameter of portal vein and the thickness of spleen, as well as the hepatic artery pulsation index of clonorchiasis patients increased obviously, the mean blood flow velocity of portal vein (P < 0.05 or P < 0.01) decreased. The content of total bilirubin and transaminase in plasma increased significantly, but albumin decreased (P < 0.05). Levels of TNF-α, IL-6 and IFN-γ increased remarkably, and the level of every factor was significantly different among patients with Child-Pugh, Child-Pugh II and Child-Pugh III classification of liver function (P < 0.05 or P < 0.01). With the exacerbation of liver dysfunction, levels of TNF-α, IL-6 and IFN-γ gradually increased (P < 0.05). Compared with the healthy control group, the expression quantity of apoptosis protein Fas, FasL, Bax and Caspase-3 increased significantly (P < 0.05 or P < 0.01), but Bcl-2 decreased (P < 0.05). Conclusions Changes of ultrasonic characteristics and liver dysfunction, caused by liver fluke infection, may be related to that both inflammatory response and apoptosis response have participated in the pathogenic process and liver damage course of clonorchiasis.
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With the development of ultrasonic imaging technique,the thyroid nodule detection rate is ever increasing.However,there is still no unique characteristic for the identification of benign and malignant lesions in ultrasonogram.On the basis of conventional ultrasound performance of nodules,thyroid imaging reporting and data system for the correct classification of thyroid nodules is conducive to their differential diagnosis.Contrast enhanced ultrasound (CEUS) can show the microvascular status of the lesion,and the benign and malignant thyroid nodules can be analyzed by observing the different enhancement patterns.By evaluating the difference in hardness between different tissues,the ultrasonic elastography (.UE) provides a complementary method for the identification of benign and malignant thyroid nodules.Ultrasound-guided fine-needle aspiration biopsy (US-FNAB) can accurately locate and offer pathological basis for preoperative diagnosis of thyroid nodules.It is helpful to preoperatively diagnose the thyroid cancer by detecting the molecular marker of the biopsy specimens which are difficult to be diagnosed clearly.
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Objective To investigate the relationships between axillary lymph node metastasis and clinicopathologic features in the patients with cT1-2 N0 breast cancer and clarify the law of axillary lymph node metastasis,and to find the risk factor,and provide the theoretical basis for individuation therapy.Methods 687 patients with cT1-2 N0 breast cancer were divided into negative group and positive group according to the pathological results of axillary lymph node,and the clinicopathologic features were layered.The risk factors of axillary lymph node metastasis were screened out by Chi-square test and Logistic regression analysis.Results In 687 cases of cT1-2 N0 breast cancer,156 (22.7%)cases were observed with axillary lymph node metastasis. The age,cT stage,pT stage, pathological type,vascular invasion,perineural invasion estrogen receptor (ER),progesterone receptor (PR), and molecular subtyping were the factors that influenced axillary lymph node metastasis in univariate analyses.The age < 35 years, cT2 , invasive ductal carcinoma, vascular invasion positive and Luminal subtyping were the independent risk factors of axillary lymph nodes metastasis in multivariate analyses (r = 3.440,P = 0.010;r =1.770,P =0.007;r = 3.397,P = 0.001;r = 7.434,P = 0.000;r = 2.212,P = 0.015).Conclusion In the patients with cT1-2 N0 breast cancer,the age,cT,pathological type,vascular invasion and molecular subtyping are important predictors of axillary lymph node metastasis and vascular invasion was the most important predictor.The preoperative comprehensive analysis and evaluation of clinical data and preoperative pathological results obtained will help to select the right surgical operation.
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The high prevalence of non-alcoholic fatty liver disease (NAFLD) all around the world is a great threat which cannot be ignored. It shows urgent need for the appropriate methods of NAFLD diagnosis because of the broad spectrum of hepatic derangements and the undetectable characteristic in the early stage of this disease. Ultrasonic diagnosis for NAFLD is widely used in clinic clue to its advantages such as low cost, weak radiation and good compliance for patients. For the studies in animal models, the pathological progression of NAFLD can be evaluated by a variety of noninvasive ultrasonic methods recently. To improve the convenience, accuracy and reliability of the estimation of NAFLD progression in animal models, the applications and the principles of the ultrasonic technics are introduced. Diverse qualitative and semi-quantitative methods for animal NAFLD detection are reviewed.
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Objective To analyze the diagnosis value of Color Doppler Uitrasound for the formation of rectus abdominis muscle laceration hematoma after strenuous exercise in children. Methods 29 cases of children patients with rectus sheath hematoma were selected as the research object from January 2009 to January 2014 in our hospital, all patients received rectus abdominal ultrasonography before treatment,got the two-dimensional ultrasonic images and color Doppler image of patients of abdominal rectus. Results Rectus sheath hematoma in the detection rate of the study group was significantly higher than the control group, the misdiagnosis and missed diagnosis ratio were significantly lower than the control group, the average size of hematoma was significantly higher than the control group, the difference was statistically significant(P<0.05); Ultrasonographic study group in regular shape, boundary definition, sensitivity, specificity, accuracy were significantly higher than that of control group,al the differences were statistically significant(P<0.05). Conclusion Children's blood vessels that supply the prone to rupture after strenuous exercise muscle, the rectus sheath hematoma formation, and color Doppler ultrasound compared with two-dimensional ultrasound in diagno-sis is more suitable to occur after strenuous exercise rectus sheath hematoma.
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Objective To explore the ultrasonographic features and diagnostic value of the axillary masses. Methods Ultrasonographic findings of 275 cases confirmed suffering from axillary mass by operation or puncture biopsy and pathology were analyzed retrospectively. Results All cases were classified as follows, 86 cases of accessory, 158 cases of lesions of lymph node, 23 cases of benign tumor, 2 cases of abscess, 6 cases of radical mastectomy of breast cancer axillary effusion. Diagnosis sensitivity rate of ultrasound was 98.2%, diagnosis coincide rate of ultrasound was 97.1%. Conclusion Axillary masses have certain ultrasonographic features, Ultrasonic examination can be used as an important means of the diagnosis of axillary mass.
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Objective To explore the ultrasonography findings and pathological features of adrenal ganglioneuroma and to improve diagnostic level. Methods Ultrasonography appearance and clinical pathological data of 12 cases of primary adrenal ganglioneuroma were retrospectively analyzed. The location, shape, size, echo characteristics, with or without calcification, the color signal of blood flow and its neighboring structure relationship on ultrasound were analyzed. Re-sults In 12 cases, 9 cases were found in the right adrenal gland and 3 cases in the left. All the tumors were solitary and the diameter was between 1.8 and 12 cm. The tumors were round or oval, some irregular or"embedded" growth. E-chogenic focus were found in 5 cases which was pathologically confirmed calcification, 3 cases of tumor showed a small dot color flow signal, all tumors with clear boundaries around the surrounding tissue. Pathology of tumor was mainly composed of ganglion cells and Schwann cells. Conclusion Ultrasonography is of great value in the diagnosis of adrenal ganglioneuroma owing to some specific sonograms.
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Objective To investigate the diagnostic value of the instant gastrointestinal ultrasound contrast agent in the digestive diseases. Methods Five hundred and seventy-nine patients received the examination of the color Doppler after they drinked the ultrasonic contrast agent. Then the results were analyzed by consistency analysis. Results There was high consistency between the two examinations in the normal control, gastritis, peptic ulcer, gastric cancer and gastric leiomyoma. The Kappa value was 0.768, 0.913, 0.925, 0.939 and 1.000, respectively. But the consistency in the gastric polyp was low , the Kappa value was 0.368. Conclusion The color Doppler through the instant gastrointestinal ultrasound contrast agent has high diagnostic value in the common diseases of the digestive system.
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Since the advent of percutaneous cardiopulmonary support (PCPS), its application has been extended to massively injured patient. Cardiac injury following blunt chest trauma brings out high mortality and morbidity. In our cases, patients had high injury severity score by blunt trauma and presented sudden hemodynamic collapse in emergency room. We quickly detected cardiac tamponade by focused assessment with sonography for trauma and implemented PCPS. As PCPS established, their vital sign restored and then, they were transferred to the operation room (OR) securely. After all injured lesion repaired, PCPS weaned successfully in OR. They were discharged without complication on day 26 and 55, retrospectively.
الموضوعات
Humans , Cardiac Tamponade , Emergencies , Extracorporeal Circulation , Heart Rupture , Hemodynamics , Injury Severity Score , Retrospective Studies , Thorax , Vital Signsالملخص
Objective: To evaluate the application of two-dimension and color Doppler ultrasound in diagnosis and differential diagnosis of fascial space infection in maxillofacial region. Methods: Retrospective analysis was conducted on 87 cases of maxillofacial space infections, among which there were 6 suspected cases of accompanying tumor.Results: In the 87 cases, 53 had abscess formation, confirmed by operative drainage or puncture biopsy. The pathological studies revealed 2 cases of Non-Hodgkin's lymphoma, and 1 case of branchial cleft cyst accompanied with infection. The 3 cases showed characteristic appearance in ultrasonic imaging. The space infection presented stronger echogenicity than that in tumors. In this study, 95% (83/87) cases showed grey or medium echogenic dots, while 4.5% (4/87) cases did not show obvious echogenic dots due to a large amount of abscess, and 2 cases of tumors, however, did not show any echogenic dots. In addition, 87% (76/87) cases had few blood flow in the lesion areas, and 22% (2/87) cases had much blood flow in the lesion areas. All cases showed that the lesion areas and the blood flow reduced obviously with enhanced echo following anti-inflammatory treatment except 2 cases accompanied with tumor without obvious changes in lesion areas and blood flow.Conclusion: The ultrasonic diagnosis with two dimension and color Doppler ultrasound has high accuracy in diagnosis of maxillofacial space infection, with accordance rate up to 96.6%, much higer than CT/MRI. It is suggested that the two dimension and color Doppler ultrasound can be used as a prior choice of diagnosis.
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Objective:To discuss the value of ultrasonography in the diagnosis and differential diagnosis of inguinal masses in children. Methods:Five hundred and eighty-two patients were examined by ultrasonography,and the sonogram features were observed. Results:The feature of sonogram of majority cases were distinctive,which were can be separated into three kinds as spina bifida cystica,parenchymatous and hyperechogenicity. Conclusion:The ultrasonic examination should be used as the regular differential diagnostic method for inguinal masses in children.