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@#Objective To investigate the optimal administration combination of β-aminopropionitrile (BAPN) and Angiotensin Ⅱ (Ang-Ⅱ) in the establishment of SD rat aortic dissection (AD) model and the related complications. Methods Forty-two three-week-old male SD rats were randomly divided into 7 groups: a group A (0.25% BAPN), a group B (0.40% BAPN), a group C (0.80% BAPN), a group D [1 g/(kg·d) BAPN], a group E [1 g/(kg·d) BAPN+ 1 μg/(kg·min) saline], a group F [1 g/(kg·d) BAPN+1 μg/(kg·min) Ang-Ⅱ] and a group G (control group). There were 6 rats in each group. The intervention period was 4 weeks (groups E and F were 4 weeks+5 days). Rats were dissected immediately if they died during the experiment. After the intervention, the surviving rats were sacrificed by pentobarbital sodium, and the whole aorta was separated and retained. Hematoxylin-eosin staining was used to observe the changes of aorta from the pathological morphology. Results There was no statistical difference in the survival rate among the groups after 4 weeks of BAPN intervention (P>0.05). After 5 days of mini-osmotic pumps implantation, the survival rate of rats was higher in the group E than that in the group F (P=0.008), and the incidence of AD in the group E was lower than that in the group F (P=0.001). BAPN could affect the food and water intake of rats. After BAPN intervention for 4 weeks, the body weight of rats in the group G was higher than those in the intervention groups (P<0.05). BAPN combined with Ang-Ⅱ could make the aortic intima thick, elastic fiber breakage, arrangement disorder, and inflammatory cell infiltration in rats, which conformed to the pathological and morphological changes of AD. BAPN could also affect mental state and gastrointestinal tract. Conclusion The combination of BAPN [1 g/(kg·d)] and Ang-Ⅱ [1 μg/(kg·min)] can stably establish AD model in rats, which will provide a stable carrier for further study of the pathogenesis and therapeutic targets of AD. However, the complications in this process are an unstable factor. How to balance the influence of BAPN on other tissues and organs in the process of AD model establishment remains to be further studied.
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@#Objective To assess the safety and clinical outcomes of segmentectomy in one- or two-staged video-assisted thoracoscopic surgery (VATS) for bilateral lung cancer. Methods We retrospectively enrolled 100 patients who underwent VATS segmentectomy for bilateral lung cancer at the Department of Thoracic Surgery of Peking Union Medical College Hospital from December 2013 to May 2022. We divided the patients into two groups: a one-stage group (52 patients), including 17 males and 35 females with a mean age of 55.17±11.09 years, and a two-stage group (48 patients), including 16 males and 32 females with a mean age of 59.88±11.48 years. We analyzed multiple intraoperative variables and postoperative outcomes. Results All 100 patients successfully completed bilateral VATS, and at least unilateral lung received anatomical segmentectomy. Patients in the one-stage group were younger (P=0.040), had lower rate of comorbidities (P=0.030), were less likely to have a family history of lung cancer (P=0.018), and had a shorter interval between diagnosis and surgery (P=0.000) compared with patients in the two-stage group. Wedge resection on the opposite side was more common in the one-stage group (P=0.000), while lobectomy was more common in the two-stage group. The time to emerge from anesthesia in the one-stage group was longer than that in the first and second operations of the two-stage group (P=0.000, P=0.002). Duration of surgery and anesthesia were similar between two groups (P>0.05). Total number of lymph node stations for sampling and dissection (P=0.041) and lymph nodes involved (P=0.026) were less in the one-stage group. Intraoperative airway management was similar between two groups (P>0.05). The one-stage group was associated with lower activities of daily living (ADL) scores. Conclusion Segmentectomy is safe in one- or two-staged VATS for bilateral lung cancer, including contralateral sublobectomy and lobectomy. Duration of surgery and perioperative complications are similar between two groups, but the one-stage group is associated with lower ADL scores. On the basis of comprehensive consideration in psychological factors, physical conditions and personal wishes of patients, one-staged sequential bilateral VATS can be the first choice.
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Objective:To explore the risk factors of renal function progression in patients with acute renal injury (AKI) after moderate hypothermic circulatory arrest surgery in acute aortic dissection (AD).Methods:Retrospective analysis was made base on the data of 290 patients with acute AD who underwent surgical treatment from January 2014 to August 2022 in the Affiliated Hospital of Jining Medical University. According to the Kidney Disease: Improving Global Outcomes (KDIGO) AKI diagnostic criteria in 2015, patients with AKI after surgery were selected as the study objects. Patients with progressive deterioration of renal function or required continuous renal replacement therapy after AD operation were defined as the progression group of AKI, the other patients with gradual improvement of renal function after AD operation were defined as the improvement group of AKI. The clinical data of the two groups were compared, and the risk factors for the progression of AKI after AD were analyzed by multivariate logistic regression.Results:A total of 290 AD surgeries were completed, of which 143 cases developed AKI after surgery, including 81 cases in AKI progression group and 62 cases in AKI improvement group. In the progression group of AKI, before surgery the proportion of patients with coronary heart disease: 24.7% (20/81) vs.11.3% (7/62), serum creatinine (Scr) >133 μmol/L: 24.7% (20/81) vs. 3.2% (2/62), pericardial tamponade: 22.2% (18/81) vs. 8.1% (5/62), lower limb ischemia: 25.9% (21/81) vs. 3.2% (2/62) were significantly increased. Postoperative acute physiology and chronic health evaluation Ⅱ (APACHE) score: 14.00 (9.00, 19.75) scores vs. 10.00 (7.00, 12.00) scores, ICU hospitalization days: 8 (5, 13) d vs. 5 (3, 7) d, postoperative mortality: 24.7%(20/81) vs. 1.6%(1/62), the proportion of KDIGO phase 3 ratio: 46.9%(38/81) vs. 3.2%(2/62), postoperative infection: 61.7%(50/81) vs. 38.7% (24/62), low cardiac output syndrome: 29.6% (24/81) vs. 6.5% (4/62), cerebral infarction complications: 38.2%(31/81) vs. 16.1%(10/62), and mortality after surgery were also higher. Compared with improvement group of AKI, all differences were statistically significant ( P<0.05). Multivariate Logistic regression analysis showed that preoperative lower limb ischemia ( OR = 9.430, 95% CI 1.975 to 45.032, P = 0.005), postoperative low cardiac output syndrome ( OR = 5.288, 95% CI 1.543 to 18.126, P = 0.008), and postoperative infection ( OR = 2.273, 95% CI 1.022 to 5.057, P = 0.044) were independent risk factors for the progression of AKI after AD surgery. Conclusions:The independent risk factors of renal function progression in patients with AKI after hypothermic circulatory arrest surgery in acute AD include preoperative lower limb ischemia, postoperative low cardiac output syndrome, and postoperative infection.
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Objective:To explore the features and application value of MRI in the spectrum of fetal cloaca malformation.Methods:The clinical, MRI and ultrasound data of 6 fetuses with spectrum of cloaca malformation were retrospectively analyzed in Guangzhou Women and Children′s Medical Center Affiliated to Guangzhou Medical University from January 2017 to February 2021, and the MRI features of each subtype were analyzed.Results:Among the 6 fetuses of spectrum of the cloaca malformation, 5 were confirmed by postnatal imaging and surgery, and 1 was confirmed by induced labor autopsy, including 3 persistent cloaca, 1 posterior cloaca, 1 cloaca variant, and 1 urogenital sinus. The high signal on T 1WI of the rectal meconium disappeared or became weaker, and the signal on T 2WI of meconium of the dilated colon increased in the 3 cases of persistent cloaca and 1 case of posterior cloaca. All 6 cases showed colonic dilatation. All cases except 1 persistent cloaca showed vaginal and/or uterine effusion. Two cases of persistent cloaca, 1 case of posterior cloaca and 1 case of cloaca variant showed duplicated genital tract. Two cases of persistent cloaca showed only 1 perineal opening, which opened at the urethral orifice. One case of cloaca variant showed 2 openings, which opened at the urethral orifice and in front of the normal anus, respectively. Conclusion:Prenatal MRI can help to clarify the diagnosis of cloacal malformation spectrum and to determine its specific classification.
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Objective:To investigate the perioperative complications and risk factors of postoperative death in patients with acute Stanford type A aortic dissection (ATAAD).Methods:The perioperative data of 228 patients with ATAAD who underwent continuous surgery in the Affiliated Hospital of Jining Medical University from January 2013 to July 2021 were retrospectively analyzed. The complications were analyzed. According to the survival within 30 days after surgery, they were divided into death group (24 cases) and survival group (204 cases). The risk factors of postoperative death were analyzed by univariate and multivariate logistic regression. The receiver operating characteristic (ROC) curve was drawed to evaluate the predictive efficacy of various risk factors on postoperative death of ATAAD patients.Results:The first three complications before operation were hypoxemia (10.1%, 23/228), pericardial tamponade (7.9%, 18/228), renal insufficiency (5.3%, 12/228), the first three complications after surgery were hypoxemia (75.8%, 173/228), renal insufficiency (26.8%, 61/228) and liver insufficiency (26.3%, 60/228). A total of 24 patients died, the fatality rate was 10.5%(24/228). Logistic regression analysis showed that age≥55 years old ( OR=7.733, 95% CI: 1.986-30.111, P=0.003), preoperative pericardial tamponade ( OR=5.641, 95% CI: 1.546-20.577, P=0.009), cardiopulmonary bypass time (CBP)≥200 min ( OR=1.008, 95% CI: 1.002-1.014, P=0.007) and postoperative renal insufficiency ( OR=5.875, 95% CI: 1.927-17.907, P=0.002) were independent risk factors for early death after ATAAD. The area under the ROC curves of joint prediction was 0.905 (95% CI: 0.820-0.950, P<0.01). The sensitivity and specificity of joint prediction were 88.4%, 76.5%, respectively. Conclusions:ATAAD has many perioperative complications and high mortality. Age≥55 years old, preoperative pericardial tamponade, CPB time≥200 min, and postoperative renal insufficiency were independent risk factors for postoperative death in ATAAD patients.
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Clinical data of 4 cases of infants with hemophilia complicated with hematorrhachis diagnosed in Guangzhou Women and Children′s Medical Center from January 2017 to December 2018 was retrospectively analyzed.The clinical manifestations of 4 children was atypical, only showing irritability and crying, poor spirit and weak head in the early stage, and torticollis and limb weakness in the late stage may easily contribute to a misdiagnosis.The spinal magnetic resonance imaging is an important diagnosis of hematorrhachis.The most common site of disease was cervicothoracic and thoracolumbar spinal epidural hemorrhage.Of the 4 patients in this article, 1 patient was treated with surgery combined with infusion factor Ⅷ replacement therapy.Three patients were treated with infusion factor Ⅷ replacement therapy alone to obtain clinical rehabilitation.The prognosis of early diagnosis was good, the time from onset to diagnosis in 3 cases was within 1 week, after treatment all had rehabilitation; 1 case within 2 weeks of diagnosis, partial rehabilitation.It is suggested that hemophilia complicated with hematorrhachis in infants is hidden, and it can only be irritable and crying in the early stage, and neurological symptoms appear in the late stage.Improving diagnostic awareness, early diagnosis and early infusion factor replacement therapy are critical for prognosis.
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Objective:To analyze the characteristics of prenatal MRI and postnatal CT images of fetal congenital mesoblastic nephroma (CMN).Methods:We retrospectively recruited three women with a singleton pregnancy suspected of having fetal CMN by prenatal imaging examination and confirmed by postpartum surgical resection and pathological examination at Guangzhou Women and Children Medical Center from August 2017 to April 2019. The prenatal MRI, postnatal CT, and pathological examination data were analyzed to summarize the image features of fetal CMN using descriptive statistical analysis.Results:(1) The total number of deliveries in the setting during the same period was 57 716, and the incidence of CMN was 0.005% (3/57 716). All the cases were male and born through cesarean section due to polyhydramnios for case 1 and 2 and sudden fetal distress, fetal pericardial effusion with enlarged mass in the third trimester for case 3. (2) Prenatal MRI examination found that the lesions in case 1 and 3 were located in the left kidney, and in the right kidney in case 2. The tumors in the three cases were all around with clear borders and hyperintense signal on T2-weighed imaging (T2WI). Iso-signal on T1WI was noted for case 1 and 2, a slightly hypointense signal on T1-weighed imaging (T1WI), and a hyperintense signal on diffused weighed imaging were noted for case 3. (3) Postnatal CT plain scan showed uniform density tumor in cases 1 and 2 with "packing sign" in CT enhancement. Non-uniform density, internal, larger and high-density bleeding tumor was found in case 3, and the CT enhancement manifested as nodular, non-uniform, and intratumoral bleeding. (4) Postoperative pathological examination revealed that cases 1 and 2 were classic types, and case 3 was cellular type.Conclusions:In this study, the prenatal MRI characteristic of CMN is a uniform signal, iso-signal on T1WI for classic type and non-uniform signal, and reduced signal on T1WI for cellular type. In classic type cases, postnatal CT enhancement showed a "packing sign." In contrast, in cellular type cases, the CT plain scan is manifested as non-uniform, intratumoral bleeding, and the enhancement pattern showed nodular and non-uniform enhancement. However, the results of this study is limited due to the small sample size and studies with larger sample size is needed in the future.
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BACKGROUND@#Low dose computed tomography (LDCT) for lung cancer screening is widely employed in China as a result of increasing cancer screening awareness. Although some pulmonary lesions detected by LDCT are cancerous, most of the pulmonary nodules are benign. It is important to make effective preoperative differentiation of pulmonary lesions and to obviate the need for surgery in some patients with benign disease.@*METHODS@#From January 1, 2017 to December 31, 2018, patients in our institution with surgical pathology confirmed benign pulmonary lesions in which malignancy could not be excluded in preoperative assessment were enrolled in this study. Retrospective analysis of clinical data was conducted.@*RESULTS@#297 cases were collected in this study. Prevalence of benign disease in patients underwent resection for focal pulmonary lesions is 9.8% in our institution. In 197 patients (66.3%), pulmonary lesions were detected by LDCT screening. A total of 323 assessable pulmonary lesions were detected by chest CT. The average diameter of pulmonary lesions was (17.9±12.1) mm, and 91.0% of which were greater than or equal to 8 mm. Solid nodules accounted for 65.6% of these lesions. Imaging characteristics suggesting malignancy were common, including spicule sign (71/323, 22.0%), lobulation (94/323, 29.1%), pleural indentation (81/323, 25.1%), vascular convergence sign (130/323, 40.2%) and vacuole sign (23/323, 7.1%). 292 patients (98.3%) underwent video-assisted thoracoscopic surgery (VATS). Pulmonary wedge resection was performed in 232 cases (78.1%), segmental resection in 13 cases (4.4%) and lobotomy in 51 cases (17.2%). Surgical complications occurred in 4 patients (1.3%). The most frequent findings on surgical pathology analysis were: infectious lesions in 98 cases (33.0%), inflammatory nodules in 96 cases (32.3%), and hamartoma in 64 cases (21.5%).@*CONCLUSIONS@#Solid nodules accounted for most of these benign pulmonary lesions in which malignancy could not be excluded preoperatively, and imaging characteristics suggesting malignancy were common. VATS is an important biopsy method to identify etiology and pathology for lesions. The most frequent benign pulmonary diseases that are suspected to be malignant and underwent surgical resection are: infectious lesions, inflammatory nodules and hamartoma.
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BACKGROUND@#Low dose computed tomography (LDCT) for lung cancer screening is widely employed in China as a result of increasing cancer screening awareness. Although some pulmonary lesions detected by LDCT are cancerous, most of the pulmonary nodules are benign. It is important to make effective preoperative differentiation of pulmonary lesions and to obviate the need for surgery in some patients with benign disease.@*METHODS@#From January 1, 2017 to December 31, 2018, patients in our institution with surgical pathology confirmed benign pulmonary lesions in which malignancy could not be excluded in preoperative assessment were enrolled in this study. Retrospective analysis of clinical data was conducted.@*RESULTS@#297 cases were collected in this study. Prevalence of benign disease in patients underwent resection for focal pulmonary lesions is 9.8% in our institution. In 197 patients (66.3%), pulmonary lesions were detected by LDCT screening. A total of 323 assessable pulmonary lesions were detected by chest CT. The average diameter of pulmonary lesions was (17.9±12.1) mm, and 91.0% of which were greater than or equal to 8 mm. Solid nodules accounted for 65.6% of these lesions. Imaging characteristics suggesting malignancy were common, including spicule sign (71/323, 22.0%), lobulation (94/323, 29.1%), pleural indentation (81/323, 25.1%), vascular convergence sign (130/323, 40.2%) and vacuole sign (23/323, 7.1%). 292 patients (98.3%) underwent video-assisted thoracoscopic surgery (VATS). Pulmonary wedge resection was performed in 232 cases (78.1%), segmental resection in 13 cases (4.4%) and lobotomy in 51 cases (17.2%). Surgical complications occurred in 4 patients (1.3%). The most frequent findings on surgical pathology analysis were: infectious lesions in 98 cases (33.0%), inflammatory nodules in 96 cases (32.3%), and hamartoma in 64 cases (21.5%).@*CONCLUSIONS@#Solid nodules accounted for most of these benign pulmonary lesions in which malignancy could not be excluded preoperatively, and imaging characteristics suggesting malignancy were common. VATS is an important biopsy method to identify etiology and pathology for lesions. The most frequent benign pulmonary diseases that are suspected to be malignant and underwent surgical resection are: infectious lesions, inflammatory nodules and hamartoma.
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Objective To kxplork thk valuk of dktkcting brain mktabolitks of prktkrm infants at full tkrm for prkdicting thk nkurodkvklopmkntal lkvkl,and to providk thk basis for karle clinical intkrvkntion. Methods Thirte casks of prktkrm infants wkrk collkctkd from thk Nkonatal Intknsivk Cark Rnit and Nkuro - Akhabilitation Dkpartmknt of Guangzhou Zomkn and Childrkn＇s Mkdical Ckntkr bktwkkn Mae 2015 and March 2016,thkn thke wkrk chkcckd be adopting brain magnktic rksonanck imaging and magnktic rksonanck spkctroscope at corrkctkd full tkrm,and assksskd be using Llbkrta Infant Motor Scalk(LIMS)and Gkskll dkvklopmkntal scalk kvaluation at corrkctkd agk of 6 months and corrkctkd of agk 1 ekar old. ResuIts In thk 30 casks of prktkrm infants,19 casks wkrk malk,11 casks wkrk fkmalk,and thk gkstational agk was 27+3 -31 wkkcs,and avkragk gkstational agk was(28. 8 ± 1. 0)wkkcs,and thk birth wkight was 800-1 400 g[(1 176. 3 ± 145. 1)g]. Thk stude found that meo-inositol( MI),MI╱crkatink( Cr)in basal ganglia wkrk nkgativkle corrklatkd with thk dkvklopmknt quotiknt at corrkctkd agk of 1 ekar old(r﹦ -0. 465,-0. 532;all P＜0. 05). Factic acid(Fac)╱Cr in hippocampus was nkgativkle corrklatkd with dkvklopmkntal quotiknt at corrkctkd agk of 6 months(r﹦ -0. 420,P＜0. 05);Fac,Fac╱Cr in pkrivkntricular wkrk nkgativkle corrklatkd with dkvklopmkntal quo-tiknt at corrkctkd agk of 1 ekar old(r ﹦ -0. 405,-0. 386;all P ＜0. 05). Fac╱Cr in pkrivkntricular was nkgativkle corrklatkd with LIMS scorks at corrkctkd agk 1 ekar old(r﹦ -0. 380,P＜0. 05);Fac,Fac╱Cr in ckrkbkllum wkrk nkga-tivkle corrklatkd with dkvklopmknt quotiknt at corrkctkd agk of 1 ekar old(r﹦ -0. 393,-0. 394;all P＜0. 05). Thkrk was no corrklation bktwkkn frontal lobk mktabolitks and nkurodkvklopmkntal lkvkl(P＞0. 05). ConcIusions Prktkrm infants brain mktabolitks at full tkrm contributk to prkdicting nkurodkvklopmkntal lkvkl. MI,Fac,MI╱Cr,Fac╱Cr ark of valuks for prkdicting nkurodkvklopmkntal lkvkl,and MI╱Cr is thk bkst prkdictor. Lmong frontal lobk,basal ganglia, hippocampus,pkrivkntricular and ckrkbkllum,thk pkrivkntricular is thk bkst arka for prkdicting nkurodkvklopmkntal lkvkl. Corrkctkd agk of 1 ekar old maebk thk bkst timk to prkdicting nkurodkvklopmkntal lkvkl.
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Objective To investigate the clinical and CT features of basal cell adenomas (BCA)of parotid gland,and to improve the understanding of the disease.Methods Clinical and CT data of 1 8 patients with BCA of parotid gland confirmed by surgery and pathology were collected.The characteristics of age,sex,clinical symptom,lesion site,number,size,shape,density and CT dualGphase enhancement of the lesions were retrospectively analyzed.Results (1)Age and sex of onset:1 2 cases(6 6.6 7%)of age stage from 30 to 5 9,5 cases (27.78%)of the elder over 60,1 case of the younger below 29,5 cases (27.78%)for males,1 3cases (72.22%)for females,the incidence ratio of male to female being 1 ︰ 2.5.(2)Clinical manifestations:there were sporadic masses in the parotid region,3 cases were accompanied by mild pain and all patients had no facial nerve symptoms.(3)Location site,number,size:23 lesions in 18 cases, of which 15 cases (83.3%)were single and 3 cases (16.7%)had multiple lesions on one side.17 lesions (73.9%)were located in superficial lobe, and 6 lesions (26.1%)were located in the deep lobe;(4)Shape and cross section diameter:the shape of the tumor was round or ellipse with wellG defined margin,13 cases (56.5%)of the round shape,10 cases (43.5%)of the ellipse;the maximum cross section diameter was (2.49±1.3 8)cm,the superficial lobe group was (2.05 ±1.02)cm,and the deep lobe group was (3.73 ±1.59)cm.The difference between the two groups on the maximum cross section diameter was significant (P＜ 0.05).(5)Density:the density of most lesions was heterogeneous.17 lesions were accompanied by central or peripheral cystic degeneration of varying degrees,of which 10 lesions with cystic regions ＞ 50% and 2 lesions with maximum transverse diameter ＜ 0.8 cm.(6)CT dualGphase enhancement:19 lesions showed obvious homogeneous or heterogeneous enhancement on the arterial phase,and persistent enhancement on the venous phase.4 lesions showed progressive heterogeneous enhancement,and the enhancement degree of venous phase was even higher than that of arterial phase.Conclusion The BCA of the parotid gland aremainly occuring in middleGaged and older women,displaying regular shape of lesions,developing to cystic degeneration easily and presenting＂fastGelevation and sustained enhancement＂or progressive enhancement patterns in the dualGphase enhanced scans.These characteristics are helpful to make a diagnosis preoperatively.
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Objective@#To investigate the clinical manifestations, diagnosis, and treatment of H1N1 influenza A-associated encephalopathy (IAE) in children.@*Methods@#The clinical manifestations, laboratory tests, cranial magnetic resonance imaging (MRI), electroencephalography (EEG) examinations and treatments of seven children with H1N1 IAE hospitalized in Guangzhou Women and Children′s Medical Center from December 2018 to January 2019 were retrospectively analyzed.@*Results@#Five of the seven children with H1N1 IAE were female. The age at admission was 4 years and 5 months (range 7 months-9 years). Neurological symptoms occurred simultaneously or early (0-3 days) after the flu-like symptom appeared. The main clinical manifestations of neurological symptoms were seizures (repeated seizures in five cases and status convulsion in two cases, including one case of unexpected fever and repeated seizures in a nine-year old girl) accompanied with altered consciousness (drowsiness in five cases and coma in two cases). Cranial MRI in three cases displayed multifocal lesions, mainly in the bilateral thalamus, brainstem and cerebellar hemisphere. MRI also showed reversible splenial lesion in the corpus callusumin in three cases. EEG tracings were characterized by diffuse slow wave activity in four cases, and status epilepticus was monitored in one case. All the 7 cases were treated with oral oseltamivir. Three cases were treated with pulsed methylprednisolone and intravenous immunoglobulin. One case was treated with intravenous immunoglobulin alone and all the patients received oral oseltamivir. All the patients survived, with three patients had minor neurological sequelae at discharge.@*Conclusions@#The main clinical manifestations of H1N1 IAE are seizures and altered consciousness. Cranial MRI combined with EEG is helpful for early diagnosis. Intravenous immunoglobulin and (or) methylprednisolone should be considered for severe cases.
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Objective To investigate the prenatal imaging features of fetal congenital esophageal atresia and to further evaluate the value of MRI and ultrasound scan in the same condition.Methods This study recruited 12 singleton gravidas whose fetuses were initially suspected with congenital esophageal atresia by prenatal ultrasound scan and then confirmed by surgery and/or upper gastrointestinal angiography after birth at Guangzhou Women and Children's Medical Center from May 2011 to May 2017.Imaging features of prenatal MRI and ultrasonography of the 12 fetuses were retrospectively analyzed.Differences in imaging findings of these two methods were analyzed by Chi-square test.Results All 12 women received prenatal ultrasound examination and eight of them underwent MRI scan when fetal congenital esophageal atresia was suggested by ultrasound.Both ultrasound and MRI were capable of identifing polyhydramnios and absent or small stomach bubble (12/12 and 8/8,respectively).However,MRI was superior to ultrasound in detecting "pouch sign "/"oral filling sign" or poor filling of small intestine (7/8 vs 3/12 and 8/8 vs 0/12,x2 were 7.500 and 20.000,both P＜0.01).While,no statistical difference was shown in detecting curved tracheal between MRI and ultrasound (2/8 vs 0/12,x2=3.333,P=0.067).For Gross Ⅰ or Gross Ⅲ congenital esophageal atresia fetuses,no statistically significant difference was found in their imaging features (all P＞0.05).The total detection rates after 32 weeks of gestation of Gross Ⅰ and Gross Ⅲ cases were both 3/6.Conclusions Prenatal MRI is a vital supplement to ultrasound due to its high display rate of characterized features of congenital esophageal atresia.Thus,the combined use of ultrasound and MRI is of great importance for prenatal diagnosis of this fetal abnormality.
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Objective To explore the value of HRCT and contrast-enhanced MRI in diagosis of facial nerve injuries.Methods HRCT and contrast-enhanced MRI were performed in 18 cases of facial nerve injuries.CPR of the facial nerve and canal was performed on the Philips EBW workstation,and the temporal bone involved location,fracture type and involvement of facial nerve and canal and its course were observed.The involved location,size,signal variation of facial nerve were analyzed compared with contralateral side on the GE AW 4.5 workstation.Results Among 18 cases,8 cases of longitudinal fractures,5 cases of transverse fractures and 5 cases of mixed fractures were found.HRCT axial scan and CPR of facial canal revealed that 18 cases had temporal bone fractures,including 1 case of labyrinthine segment,2 cases of geniculate fossa,4 cases of tympanic segment,2 cases of geniculate fossa,tympanic segment and hematoma of middle ear cavity,3 cases of tympanic segment with adjacent hematoma of middle ear cavity and 6 cases without obvious fracture of facial canal.Contrast-enhanced MRI and CPR of facial nerve revealed facial nerve injuries in all 18 cases,including 12 cases of internal auditory meatus segment,14 cases of labyrinthine segment,18 cases of geniculate ganglion,16 cases of tympanic segment and 15 cases of mastoid segment.Signal intensity ratio of affected internal auditory meatus segment,labyrinthine segment,geniculate ganglion,tympanic segment and mastoid segment were higher than those of contralateral side (all P＜ 0.001).Conclusion HRCT and contrast-enhanced MRI can clearly reveal the involvement of different segment of traumatic facial nerve,HRCT CPR and MR CPR are helpful to visualiz the involvement of traumatic facial nerve and canal.
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Objective To investigate the normal development of anterior and posterior acetabulum in children through measuring anterior and posterior acetabular indexes with the baseline from the thinnest point of acetabulum to the center of femoral head.Methods MRI data in 165 normal children aged 0-12 years were collected.The baselines were drawn from the center of the femoral head to the thinnest point of acetabulum (method 1) and from the one midpoint of Y cartilage to the contralateral (method 2),then the anterior or posterior bony acetabular index (A/PBAI) and anterior or posterior cartilaginous acetabular indexes (A/PCAI) were measured.The consistency of above parameters measured using two methods and between two observers was observed,and the correlation with parameters-gestational ages was analyzed.Results The consistency of ABAI (ICC=0.832) measured with two methods was good,and the consistency of ACAI (ICC=0.535),PBAI (ICC=0.565) and PCAI (ICC=0.472) was fair.The consistency between two observers was good (all ICC＞0.75).ABAI,ACAI and PBAI were negatively correlated with age (r=-0.762,-0.475,-0.368,all P＜0.001),and PCAI had no correlation with age (r=-0.190,P＜0.005).Before 4 years old,ABAI gradually decreased with age and gradually stabilized after 4 years of age.ACAI and PBAI decreased slightly with aging.PCAI did not change obviously with aging.Conclusion The measuring method of anterior and posterior acetabular indexes with the baseline from the thinnest point of acetabulum to the center of femoral head can accurately evaluate the normal development of anterior and posterior acetabulum in children.
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Objective To evaluate the diagnostic value of MRI-measured fetal percent predicted lung volume (PPLV) for the prognosis of left congenital diaphragmatic hernia (CDH) in fetus. Methods Clinical data of 32 children who were admitted to Women and Children's Medical Center of Guangzhou from September 2012 to December 2017 for prenatally diagnosed left CDH were retrospectively analyzed. These children were divided into two groups, the survival group (n=24) and the death group (n=8), according to the postoperative outcomes at 30 days after CDH repair. Moreover, they were also divided into non-pulmonary hypertension (non-PH) group (n=20) and PH group (n=12), based on whether they suffered from PH or not. Clinical data such as gestational age, birth weight, Apgar score and PPLV values in different groups were compared with t- or Fisher's exact test. The receiver operating characteristic (ROC) curve of the MRI-measured fetal PPLV values of the 32 children was plotted. Results (1) Comparing with the death group, fetal PPLV was significantly higher [(39.5±2.5)% vs (20.4±2.1)%, t=4.27], the gestations on initial diagnosis of CDH was later [(31.6±4.2) vs (25.4±4.6) gestational weeks, t=3.40], Apgar score of the neonates at 5 min was higher (8.7±1.5 vs 5.7±3.8, t=3.26), and fewer cases of PH were reported in the survival group [16.7% (4/24) and 8/8], all P<0.01. The area under the ROC curve of PPLV values for mortality prediction was 0.930 (95%CI: 0.843-1.016, P<0.01). When the PPLV value was 28.55%, its sensitivity and specificity for death prediction in children with left CDH were 100% and 79%, respectively. (2) Comparing with the PH group, fetal PPLV was significantly higher [(41.7±2.6)% vs (23.0±2.0)%, t=4.98], the gestations on initial diagnosis of CDH was later [(32.3±3.4) vs (26.3±5.2) gestational weeks, t=3.81], neonatal Apgar score at 5 min was higher (8.6±1.4 vs 6.8±2.5, t=2.62) and death rate was lower [0(0/20) vs 8/12] in the non-PH group (all P<0.01). The area under the ROC curve of the PPLV values for predicting PH was 0.902 1 (95%CI : 0.800-1.004, P＜0.01). When the PPLV value was 33.67%, its sensitivity and specificity for PH prediction was 100% and 75%, respectively. Conclusions Prenatal MRI measurement of PPLV can be used to predict death or as a warning sign of PH in children with left CDH, which may provide evidence for prenatal evaluation and rational clinical decision-making.
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Objective To investigate the diagnosis and surgical therapy of delayed diaphragmatic rupture.Methods Forty patients with traumatic diaphragmatic rupture with delayed presentation were collected in Peking Uniom Medical College Hospital from January 2000 to December 2016.In all 40 patients, 36 patients had traumatic past history, 32 patients had clini-cal manifestations when diagnosed.Left-sided diaphragmatic rupture was found in 32 patients and right in 8 patients.1 patient received emergency surgery and 39 received selective surgery.38 patients received transthoracic surgery and 2 patients received combined thoracic-abdominal surgery.36 patients received direct diaphragm suture and 4 patients received patch repair.Re-sults All patients were recovered from the hospital.The median length of postoperative hospital stay was 11 days( range, 5-26 days).1 patient was found intestinal obstruction and received enterolysis 19 days after surgery.Conclusion Delayed traumat-ic diaphragmatic rupture is a rare but serious disease.Careful past history, physical examination and CT scan with reconstruc-tion of diaphragm are helpful in diagnosis and differential diagnosis.Surgical therapy after diagnosis is the best treatment.
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Objective To explore the application value of 256-slice high resolution CT(HRCT)and reconstuction technique in the preoperative assessment of ossicular chain trauma.Methods 106 cases of temporal bone trauma were scanned using 256-slice HRCT,38 cases of ossicular chain trauma were collected.The multi-planar reformaition(MPR),curved plannar reformation(CPR) and three-dimensional volume rendering reformation (3D VR)of the ossicular chain were performed on Philips work station.The locations, types and the involving structures were analyzed,then these cases were followed up.The display rates of AX,MPR,CPR,3D VR were evaluated.Results Among 106 cases of temporal bone trauma,38 cases(76 ears)were found ossicular chain trauma,in which there were 43 ears of ossicular dislocation,22 ears incudomalleolar joint separation,6 ears incudomalleolar and incudostapedial joint separation,3 ears incudostapedial joint separation,11 ears translocation of the ossicles,1 ear stapediovestibular dislocation;4 ears ossicular fractures,2 ears fracture of the malleus,1 ear fracture of the incus,1 ear fracture of the stapes.Among 38 cases,11 cases underwent surgery,and the surgical results were consistent with CT findings.The display rates of AX,MPR,CPR,3D VR were 97.87％,100％, 97.87％,82.98％ respectively.Conclusion 256-slice HRCT and reconstuction technique can clearly reveal the whole structure of ossicular chain trauma,which are effective methods for diagonsis of ossicular chain trauma before surgery.
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Objective To explore the value of HRCT for the diagnosis of internal ear injuries caused by temporal bone trauma.Methods Totally 106 patients with temporal bone trauma were scanned by HRCT,and 12 patients with internal ear injuries were collected.MPR of temporal bone (cochlea,vestibule,horizontal semicircular canal,anterior semicircular canal and posterior semicircular canal) was performed on Philips workstation.The locations,types,and the involving structures were observed.Results Among the 106 cases of temporal bone trauma,12 cases were internal ear injuries,including 8 cases of fractures of inner ear,3 cases of pneumolabyrinth,and 1 case of foreign body in the cochlea,which 3 cases complicated with traumatic labyrinthine ossification.Conclusion HRCT and MPR can clearly reveal internal ear injuries,which are effective methods for diagnosis of internal ear injuries.
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Objective To explore the application value of 256-slice high resolution CT(HRCT)and reconstuction technique in the preoperative assessment of ossicular chain trauma.Methods 106 cases of temporal bone trauma were scanned using 256-slice HRCT,38 cases of ossicular chain trauma were collected.The multi-planar reformaition(MPR),curved plannar reformation(CPR) and three-dimensional volume rendering reformation (3D VR)of the ossicular chain were performed on Philips work station.The locations, types and the involving structures were analyzed,then these cases were followed up.The display rates of AX,MPR,CPR,3D VR were evaluated.Results Among 106 cases of temporal bone trauma,38 cases(76 ears)were found ossicular chain trauma,in which there were 43 ears of ossicular dislocation,22 ears incudomalleolar joint separation,6 ears incudomalleolar and incudostapedial joint separation,3 ears incudostapedial joint separation,11 ears translocation of the ossicles,1 ear stapediovestibular dislocation;4 ears ossicular fractures,2 ears fracture of the malleus,1 ear fracture of the incus,1 ear fracture of the stapes.Among 38 cases,11 cases underwent surgery,and the surgical results were consistent with CT findings.The display rates of AX,MPR,CPR,3D VR were 97.87％,100％, 97.87％,82.98％ respectively.Conclusion 256-slice HRCT and reconstuction technique can clearly reveal the whole structure of ossicular chain trauma,which are effective methods for diagonsis of ossicular chain trauma before surgery.