[Hemodynamic response in cirrhotic patients with transjugular intrahepatic portosystemic shunt].

Objective: To discuss the effects of transjugular intrahepatic portosystemic shunt (TIPS) procedure on hemodynamics in cirrhotic patients. Methods: A total of 23 cirrhotic patients for TIPS insertion were enrolled from January 2018 to October 2018. Serum N-terminal pro-B-type natriuretic peptide (NT-proBNP), transthoracic echocardiography and non-invasive cardiac output measurement based on impedance cardiogram were carried out before and 24h, 1 month, 6 months after TIPS in order to observe cardiac function and hemodynamic changes after TIPS. Results: Significant increases in right atrial area [(17.2±4.0) cm(2) vs. (15.0±3.4) cm(2), P<0.05], right ventricular area [(15.1±3.8) cm(2) vs. (13.7±3.5) cm(2), P<0.05] and left ventricular volume [(97.4±21.5) ml vs. (91.1±22.7) ml, P<0.05] were observed 24 h after TIPS. These changes were accompanied with significant reduction in collapsible index of inferior vena cava [(20.7± 8.1)% vs. (28.6±11.3)%, P<0.01] and elevation in pulmonary arterial systolic pressure [(36.0±8.4) mmHg (1 mmHg=0.133 kPa) vs. (31.8±5.4) mmHg, P<0.01]. There also existed significantly elevated serum NT-proBNP [(551.2±325.1) ng/L vs. (124.2±94.4) ng/L, P<0.01], cardiac output [(5.82±0.96) L/min vs. (5.12±1.28) L/min, P<0.01], cardiac index [(3.47±0.64) L·min(-1)·m(-2) vs. (3.05±0.78) L·min(-1)·m(-2), P<0.01], early diastolic filling rate [(59.0±14.3)% vs. (54.5±11.0)%, P<0.05], and reduced systemic vascular resistance index (SVRi) [(1 798.4±357.3) dyne·s·cm(-5)·m(-2) vs. (2 195.7±508.7) dyne·s·cm(-5)·m(-2), P<0.01] 24 h after TIPS. At the end of 6-month follow-up, all these parameters, but not SVRi, returned towards baseline values. Moreover, peak early to late diastolic tissue velocity ratio at the level of lateral mitral annulus (E'/A') was significantly higher at the end of 6-month follow-up than that at baseline (1.06±0.32 vs. 0.90±0.45, P<0.05). Neither the right ventricular fractional area changes nor the left ventricular ejection fractions during the follow-up period were different from those at baseline (P>0.05). Conclusion: Cirrhotic patients who had no cardiovascular pathologies had adequate adaptation and good compensation ability to reach a new hemodynamic homeostasis for the increased volume load after TIPS insertion.

[Clinical research on robot-assisted percutaneous pelvic and acetabular screws surgery].

OBJECTIVE: To evaluate the security and efficiency of a surgical robotic assisted percutaneous screw fixation for the treatment of pelvic and acetabular fractures. METHODS: In the study, 12 patients with pelvic and acetabular fractures who were treated in Beijing Jishuitan Hospital from January to April in 2016 were involved in this research. The research subjects were randomly divided into two groups: the experimental group and the control group. Robotic-assisted percutaneous sacroiliac screw internal fixations were performed under the guidance of fluoroscopy navigation in the experimental group; in the control group, doctors operated manually guided by fluoroscopy. Statistical analysis was performed on the total operation time, the intraoperative fluoroscopy time, the adjustment numbers of intraoperative guide wires, the excellent rate of screw placement and the incidence of adverse events in order to evaluate the security and efficiency of a surgical robotic assisted percutaneous screw fixation for the treatment of pelvic and acetabular fractures. RESULTS: Eleven screws were placed in 7 patients from the experimental group, while 7 screws were placed in 5 patients from the control group in total. All the screw placement positions were satisfactory according to postoperative CT images. The excellent rates of screw placement position were 100% in both groups. However, the P value was 0.016 based on the comparison between the screws' distribution in the two groups which meant that the screw distribution of the experimental group was better than that of the control group. The average fluoroscopy time needed for screw insertion was (7.36±2.63) s in the experimental group while (41.80±13.99) s in the control group (P<0.001). This suggested that the difference between the two groups had statistical significances. Intra-operative fluoroscopy time of the experimental group was significantly smaller than that of the control group. The number of the average screw adjustment was (0.36±0.48) times in the experimental group while (9.00±3.06) times in the control group (P=0.003). This suggested that the difference of the number of the guide needle adjustment between the two groups had statistical significances, and the number of the experimental group was smaller than that of the control group. The average operation time was (43.86±49.06) min in the experimental group while only (29.00±12.14) min were needed in the control group (P=0.528). This suggested that the difference between the two groups had no statistical significance. That is, the total operation time of the two groups was equal. All the screws were in satisfactory positions according to validation results of CT scans. No complications such as screw breaking out the bone cortex and entering into the knee joint cavity, wound infection occurred. CONCLUSION: Surgical robots are suitable for robot-assisted percutaneous screw fixation in pelvic and acetabular fractures. Robot-assisted treatment of pelvic and acetabular fractures has significant advantages over manual operations including high accuracy, small perspective radiation, safety and efficiency.

[Efficacy of biventricular pacing on preventing heart failure in patients with high degree atrioventricular block (BIVPACE-AVB Trial)].

OBJECTIVE: To investigate the long-term effect of biventricular (BIV) and right ventricular apical (RVA) pacing on cardiac function in patients with high-degree atrioventricular block (AVB) and left ventricular ejection fraction(LVEF)over 35%. METHODS: A total of 118 consecutive patients with high-degree AVB in six hospitals from East China between May 2009 and December 2012 were enrolled in this randomized, double-blind and parallel controlled study. Patients were randomly assigned to BIV and RVA pacing with or without LV lead on after one-week cardiac resynchronization therapy (CRT). Cardiac function including New York Heart Association(NYHA), 6 minute walking distance (6MWD), Minnesota living with heart failure (MLHF) score, LVEF, left ventricular end-diastolic volumes/diameters (LVEDV/LVEDD) and other echocardiography parameters, as well as N-terminal pro-B-type natriuretic peptide (NT-proBNP)were assessed at 6 months and 12 months. RESULTS: A total of 114 patients were successfully implanted with CRT. Cardiac function was significantly improved after one-week BIV pacing (n=57) compared with pre-CRT: rate of patients with NYHA Ⅲ (25.44%(29/114) vs. 9.65%(11/114)), MLHF score (17.1±13.6 vs. 26.9±21.6), 6MWD ((315.4±121.8)m vs. (291.8±102.9)m) and NT-proBNP (157.0(70.0, 639.0) ng/L vs. 444.7(144.0, 1 546.0)ng/L, all P<0.05). In BIV group, 6MWD extended from (314.8±142.7)m to (332.7±117.5)m at 6 months (P<0.05), LVEF increased from (60.7±7.9)% at 1 week to (56.6±10.7)% at 6 months(P<0.05), both LVEDV and LVEDD decreased at 12 months compared with at 1 week ((116.2±39.5)ml vs. (131.4±49.6)ml and (50.2±5.6)mm vs. (52.5±6.8)mm, P<0.05). In RVA group (n=57), 6MWD increased at 6 months compared that at 1week ((342.4±109.9)m vs. (310.2±105.1)m, P<0.05), NT-proBNP was higher at 12 months than that at 1 week (349.5(191.8, 884.3)ng/L vs. 127.0(70.3, 336.7)ng/L, P<0.05). Compared with RVA group, BIV group had a bigger shrink in LVEDV decrease at 12 months was more significant in BIV group ((-16.68±24.30)ml vs. (9.09±29.30)ml, P<0.05). CONCLUSIONS: Cardiac pacing could acutely improve the cardiac function in patients with high-degree AVB and LVEF over 35%. Improvements on cardiac function and remodeling are more significant after 12-month BIV pacing than that of RVA pacing. Clinical Trail Registry: Chinese Clinical Trial Registry, ChiCTR-TRC-10000832.

Sonographic features of xanthogranulomatous pyelonephritis.

PURPOSE: The purpose of this study was to describe the various sonographic features of xanthogranulomatous pyelonephritis (XGP). METHODS: We retrospectively reviewed the CT, sonographic, and medical records of patients diagnosed with XGP from January 1981 to December 1998. Twenty-seven patients for whom XGP was histopathologically confirmed were included in the study. There were 12 men and 15 women, with an age range of 21-86 years (mean, 57 years). All patients had undergone sonography of the kidneys. The renal size, shape, and outline were recorded. The presence of perinephric fluid accumulation, of obstructive uropathy, or of internal echoes in the dilated collecting system and the echotexture of the renal parenchyma were documented. RESULTS: We categorized the XGP into 4 groups on the basis of the sonographic features: (1) diffuse hydronephrotic, 12 patients (44%); (2) diffuse parenchymal, 9 patients (33%); (3) diffuse contracted, 4 patients (15%); and (4) segmental or focal, 2 patients (7%). A localized perinephric fluid collection was present in 4 patients (15%). The preoperative sonographic diagnoses were pyonephrosis (n = 14, 52%), renal pelvic tumor with possible associated infection (n = 5, 19%), renal parenchymal mass (n = 2, 7%), hydronephrosis (n = 2, 7%), and chronic pyelonephritis with renal atrophy (n = 4, 15%). XGP was considered a possible diagnosis in only 11 patients (41%). CONCLUSIONS: XGP has no specific sonographic features but is suggested by parenchymal thinning and hydronephrosis, sonographic signs of chronic obstructive uropathy caused by stones; echoes in the dilated collecting system; and a perinephric fluid collection. CT, needle biopsy, or both are recommended to further evaluate and confirm sonographically suspected XGP.

Evaluation of breast tumors with color Doppler imaging: a comparison with image-directed Doppler ultrasound.

Doppler ultrasound is an adjunct to other imaging modalities in differentiating benign from malignant breast tumors. Two groups of patients with breast nodules were examined using a 10/4.5 MHz (imaging frequency/pulsed Doppler frequency) image-directed Doppler probe and a 7.0/5.0 MHz color Doppler imaging probe, separately. Whenever flow signals were detected within or at the margin of the breast nodule, the lesion was considered to be malignant. In detecting malignant breast tumors, the sensitivity was 77.3% and 94.5%, specificity 83.3% and 40.1%, accuracy 81% and 63.4% for image directed Doppler and color Doppler imaging, respectively. We found color Doppler to be easier and more efficient in detecting the flow signals of neovascularity in breast tumor. Color Doppler exhibits a higher sensitivity in detecting the malignant breast tumors. However, more false-positive diagnoses were made. Color Doppler ultrasound also expedited the examination, and the whole procedure could be shortened from 35 minutes to 8 minutes compared with our previous examination performed by image-directed Doppler ultrasound. Due to its higher sensitivity and saving in examination time, we use color Doppler imaging as a routine procedure when solid lesions are observed in x-ray mammography or sonography, as a supplement to the diagnosis of breast tumors.

Detection of renal allograft dysfunction with color Doppler flow ultrasound.

Thirty-six color Doppler flow (CDF) ultrasound studies were performed on 28 allograft kidneys to assess the capability of this technique in diagnosing transplant dysfunction through morphology and Doppler spectra. The composite score obtained from ultrasound images showed no statistical significance. Quantitative studies with Pulsatility Index (PI) and Resistive Index (RI) after localization of the arcuate, interlobar, segmental and main renal arteries by CDF revealed significant differences between normal functioning graft kidneys and the group of acute rejection, as well as the group of acute tubular necrosis (ATN) (P < 0.05). No apparent change was demonstrated in patients with chronic rejection. When PI was greater than 1.60 or RI was greater than 0.80, the transplant kidney was more likely to be rejected, though possibility of ATN should be considered. RI was easier to calculate, and correlated better than PI with the serum creatinine level. CDF expedited the Doppler spectrum study.

[Sonographic patterns and pathological correlation of neuroblastoma].

This study prospectively correlated pathological findings with sonographic results in two cases of neuroblastoma, and retrospectively analyzed the sonographic pattern of neuroblastomas encountered in our hospital in past years. Prospectively, among the five pathologically proved neuroblastomas, only two received operation. The removed specimens were scanned by high resolution ultrasound, and selected areas were guided by a needle for pathological correlation. Pathologically, the hyperechoic region represented tumor necrosis, hemorrhage and calcifications, as well as hypercellularity and irregular arrangement of the neurofilaments. The hypoechoic areas showed less cellularity with loose tumor cells. No pseudorosette formation was noted. In the retrospective study, 26 neural crest tumors were collected, but only 14 cases received sonographic examination. The most common sonographic findings were heterogenous mixed pattern (65%) and heterogenous hyperechoic pattern (21%). Eleven cases showed calcifications. Two cases presented with echogenic lobule. Most of the tumors were larger than 8 cm, ill-defined and grew across the midline (73%). Sonography is advantageous for diagnosis of abdominal mass in children and might be helpful in differentiating neuroblastomas from other tumors.

[High resolution real-time sonographic evaluation of superficial lesions].

One hundred and thirty-one cases of suspected superficial soft tissue lesions, excluding parotid, thyroid, parathyroid, breast and scrotum, were collected in 7-year-period in Veterans General Hospital-Taichung. High resolution (10MHz transducer) real-time ultrasound was applied as imaging modality. Among them, 46 cases were proved pathologically or clinically. We retrospectively evaluated the sonographic features and divided them into five major patterns. I. Cystic lesion with smooth margin, II. Cystic lesion with blurred margin, III. Solid lesion with smooth margin, IV. Solid lesion with blurred margin, V. Diffuse infiltrative lesion. In addition, gas or calcification in the lesion and the echogenicity were included in the evaluation. Some of the lesions considered to be of vascular origin were evaluated with doppler. Ultrasonography can accurately recognize cystic, solid, or infiltrative lesions. In spite of the fact that most of the findings are non-specific, several lesions do have characteristic sonographic patterns that can easily be diagnosed, especially in conjunction with the anatomical location, ie. Backer's cyst, branchial cyst, lymphangioma, and abscess. Lesions with cystic or hyperechoic solid patterns can be considered as benign, if the margin is smooth. Lesions with hypoechoic solid pattern and blurred margin, however except for abscess, can be considered as malignant. We conclude that high resolution real-time sonography is a good imaging modality for evaluating superficial soft tissue lesions.

[Magnetic resonance imaging of ovarian cystic teratoma].

Two patients with ovarian cystic teratoma were imaged using real-time ultrasound and 1.0-T magnetic resonance imaging (MRI) devices. The ultrasound appearance of cystic teratoma varies with the internal contents. If bone or teeth is present, highly echogenic foci with posterior shadow will be identified. The cysts may contain solid areas, septa and fluid-fluid levels. The dermoid cyst filled with fat showing characteristic echogenic appearance might confused with the pelvic fact tissue. MRI is well suited to the evaluation of pelvic disorders. The T1 and T2 relaxation times in different tissues might present with different signal intensities by changing the pulse sequences. Fat, with its relatively short T1 and long T2 times, appears bright on the T1-weighted images (short TE and TR) and T2-weighted images (long TE and TR). However, old hemorrhage has the MRI characteristics of short T1 and long T2 times as fat. The inversion recovery sequence with short inversion time (STIR) will suppress signal from fat tissue and this is of particular value in differentiating dermoid from hemorrhagic cyst. MRI is quite efficient in cases where ultrasound study is equivocal or difficult in the technique.