Thyrotropin-secreting adenoma in multiple endocrine neoplasia type 1: one case report and literature review / 中华内分泌代谢杂志

Objective:To improve the understanding of thyrotropin-secreting adenoma in multiple endocrine neoplasia type 1(MEN1) through analyzing the clinical diagnosis and treatment process, as well as outcomes in one case of this disorder.Methods:The clinical manifestations, biochemical and hormone levels, imaging presentations, medical and surgical treatments, and post-operational pathologic findings in the process of diagnosis and treatment of a patient with thyrotropin-secreting adenoma in MEN1 were analyzed. The next generation sequencing followed by Sanger method was used for analyzing MEN1 and related genes. The results were evaluated with online PolyPhen2 and PROVEAN for variation hazard.Results:One 19-year old male patient was diagnosed with hyperthyroidism due to thyrotoxicosis and high level of thyroid hormones(THs) with measurable TSH(2.78 mIU/L) and negative thyrotropin receptor antibody(TRAb). Meanwhile, primary hyperparathyroidism was suggested by hypercalcemia, hypophosphatemia, and elevated intact parathyroid hormone(PTH) level, all the parameters were returned to normal after surgical resection of the mass which was below the left thyroid lobe indicated by ultrasound and 99mTc scan. Thyrotoxicosis remained in spite of one year treatment with antithyroid drug, thyrotropinoma was then suspected, and subsequent MRI scan found a macroadenoma at right pituitary. TSH and THs returned to normal 1 month after transsphenoidal removal of the adenoma. As expected, immunohistochemical staining revealed TSH positive. In addition, a pancreatic mass was found by both CT and MRI scan, which was considered as a silent neuroendocrine tumor. Gene analysis revealed a missense mutation of MEN1 as c. 415C>T and p. His139Tyr(H139Y), which was predicted highly hazard. Only five cases of thyrotropinoma in MEN1 were previously reported. Conclusion:Thyrotropinoma should be cautiously identified from hyperthyroidism to avoid misdiagnosis and mistreatment, and it should keep in mind that thyrotropinoma may be associated with MEN1 though it would be very rare.

Application value of contrast-enhanced ultrasound with SonoLiver software in intraoperative diagnosis of glioma / 中华超声影像学杂志

Objective:To explore the application value of contrast-enhanced ultrasound with SonoLiver software including quantitative analysis and dynamic vascular pattern (DVP) in the intraoperative diagnosis of glioma.Methods:SonoLiver software was used to analyze the contrast-enhanced ultrasound (CEUS) process of 252 cases with different grades of gliomas in General Hospital of Southern Theatre Command of PLA from 2006 to 2016. Among them, 144 were in the low-grade gliomas (LGG) group and 108 were in the high-grade gliomas (HGG) group. The quantitative parameters included maximum intensity (IMAX), time to peak (TTP) and mean transit time (mTT). The images of each CEUS were obtained, and the microvessel density (MVD) of corresponding pathology was compared, so as to analyze their correlations and characteristics.Results:There were significant differences in IMAX, TTP and mTT between the CEUS parameters of gliomas with different grades. IMAX in HGG group was significantly higher than that in LGG group( P<0.001), while TTP was shorter ( P=0.017) and mTT was longer( P=0.030). By correlation analysis between MVD and the CEUS parameters, MVD was positively correlated with IMAX ( r s=0.736, P<0.001) and mTT( r s=0.184, P=0.003), but negatively correlated with TTP( r s=-0.186, P=0.003). Compared with DVP images, the tumor areas of LGG group were mainly warm and black colors with small spots of cool-colored areas, and most of the surrounding areas were more obvious black areas. In HGG group, the tumor areas were mainly warm colors. Most of which were scattered in patchy cold colors areas, and the surrounding black areas were less ( P<0.05). There were significant differences in differentiating gliomas boundary before and after using DVP technique ( P<0.05). After using DVP, the boundary of glioma was clearer and more discernible. The discernibility of HGG group was up to 99%, and that of LGG group reached 97%. Conclusions:SonoLiver software can effectively and quantitatively analyze the CEUS parameters of gliomas with different grades, and its DVP images can directly reflect the contrast perfusion characteristics of gliomas, providing a new way to distinguish the boundary of gliomas and a new imaging method for the differential diagnosis of high and low grades of gliomas.

Thyrotropin-secreting adenoma in multiple endocrine neoplasia type 1: one case report and literature review / 中华内分泌代谢杂志

Objective@#To improve the understanding of thyrotropin-secreting adenoma in multiple endocrine neoplasia type 1(MEN1) through analyzing the clinical diagnosis and treatment process, as well as outcomes in one case of this disorder.@*Methods@#The clinical manifestations, biochemical and hormone levels, imaging presentations, medical and surgical treatments, and post-operational pathologic findings in the process of diagnosis and treatment of a patient with thyrotropin-secreting adenoma in MEN1 were analyzed. The next generation sequencing followed by Sanger method was used for analyzing MEN1 and related genes. The results were evaluated with online PolyPhen2 and PROVEAN for variation hazard.@*Results@#One 19-year old male patient was diagnosed with hyperthyroidism due to thyrotoxicosis and high level of thyroid hormones(THs) with measurable TSH(2.78 mIU/L) and negative thyrotropin receptor antibody(TRAb). Meanwhile, primary hyperparathyroidism was suggested by hypercalcemia, hypophosphatemia, and elevated intact parathyroid hormone(PTH) level, all the parameters were returned to normal after surgical resection of the mass which was below the left thyroid lobe indicated by ultrasound and 99mTc scan. Thyrotoxicosis remained in spite of one year treatment with antithyroid drug, thyrotropinoma was then suspected, and subsequent MRI scan found a macroadenoma at right pituitary. TSH and THs returned to normal 1 month after transsphenoidal removal of the adenoma. As expected, immunohistochemical staining revealed TSH positive. In addition, a pancreatic mass was found by both CT and MRI scan, which was considered as a silent neuroendocrine tumor. Gene analysis revealed a missense mutation of MEN1 as c. 415C>T and p. His139Tyr(H139Y), which was predicted highly hazard. Only five cases of thyrotropinoma in MEN1 were previously reported.@*Conclusion@#Thyrotropinoma should be cautiously identified from hyperthyroidism to avoid misdiagnosis and mistreatment, and it should keep in mind that thyrotropinoma may be associated with MEN1 though it would be very rare.

Application of Low Pressure Contrast Injection in Transvaginal Ultrasound Three-dimensional Hysterosalpingo-contrast Sonography / 中国医学影像学杂志

Purpose To explore the clinical value of reducing the incidence of reflux and improving patients' comfort by low pressure contrast injection during transvaginal ultrasound real time three-dimensional hysterosalpingo-contrast sonography (TVS RT-3D-HyCoSy).Materials and Methods Data ofTVS RT-3D HyCoSy using low pressure contrast injection of 498 infertile women were analyzed.The peak pressure,the incidence of reflux and adverse reactions were recorded.Compared these parameters between bilateral tubals.Results The peak pressure in patency,partially patency and fully obstructed of bilateral tubals were (22.47±5.96) kPa,(37.24±8.83) kPa and (44.64±7.73) kPa.There was significant difference among the three groups (F=70.35,P＜0.05).Among all 498 patients,the incidence of reflux was 26.31％.The incidence in patency,partially patency and fully obstructed of bilateral tubals were 18.00％,30.21％ and 43.59％.There was significant difference among the three groups (x2=15.59,P＜0.05).Different degrees of adverse reactions were 88.96％,10.64％ and 0.4％.Conclusion By using low pressure contrast injection during HyCoSy,the incidence of reflux can be reduced and examination comfort can be improved.

Ultrasound evaluation in recombinant human bonemorphogenic protein-2 ( rhBMP-2 ) artificial bone angiogenesis / 中华超声影像学杂志

Objective To evaluate the application value of ultrasound in vascularization of different artificial bones . Methods A total of 15 New Zealand rabbits were utilized for model establishment of classic segmental bone defect in bilateral radius . Recombinant human bonemorphogenic protein-2 ( rhBMP-2 ) coralline hydroxyapatite(CHA) and CHA were implanted into left and right limbs . Each CHA was divided into 4 equal parts which were examined with conventional ultrasonography and contrast-enhanced ultrasonography( CEUS ) on 3 d ,7 d ,11 d ,15 d ,30 d and 45 d respectively . CEUS quantitative was performed by time-intensity curve(TIC) ,which parameters including the basic intensity(BI) ,peak intensity (PI) ,increased signal intensity ( ΔSI) and time to peak ( TTP) . Then the results were analyzed and compared to pathology . Results Within the same duration ,the vascularization degree in rhBMP-2 group was stronger than that in the ordinary group with advanced vascularization time . Positive correlation was detected between ΔSI and time of both groups ( r =0 .938 ,0 .890 ;P =0 .000) ,and negative correlation was found between BI/PI or TTP and time ( BI/PI: r = -0 .798 ,-0 .899 ; P = 0 .000 ;TTP= r -0 .874 ,-0 .868 ;P = 0 .000 ) . No statistical significance was observed among four observation points of both CHA ,which indicated no obvious difference in vascularization degree of each observation point . Conclusions The structure of bone graft can be clearly displayed by conventional ultrasound ,and CEUS is able to show the early blood perfusion in two CHA grafts and to accurately evaluate the difference of CHA microvascular growth before and after rhBMP-2 application . The combination of these two techniques is a promising approach of evaluating bone graft vascularization in clinical practice .

Evaluation of application value of acoustic radiation force impulse imaging of transplant liver in early recovery after transplantation / 器官移植

Objective To evaluate the application value of acoustic radiation force impulse imaging (ARFI) in the early recovery of transplant liver.Methods Nineteen patients undergoing orthotopic liver transplantation were assigned into the study group and 12 healthy adults were recruited in the control group.In the study group,patients received bedside conventional ultrasound and ARFI examination at 1,2,3,5 and 7 d after liver transplantation to observe the change of transplant liver elasticity,and those in the control group underwent once conventional ultrasound and ARFI examination.Two-dimensional liver ultrasound,color Doppler ultrasound and ARFI findings were statistically compared between the study and control groups.Results Conventional ultrasound demonstrated that the liver graft was properly recovered within 1 week after liver transplantation.ARFI revealed that the shear ware velocity (SWV) at 1,2,3,5 and 7 d after liver transplantation was significantly higher than that in the control group (all P＜0.05).The SWV at postoperative 1 d was significantly higher than that at postoperative 7 d (P＜0.05).Conclusions ARFI can distinguish the liver stiffness between patients early after liver transplantation and healthy controls,and reflect the early variation of liver stiffness with good clinical application value.

Application of ultrasound in extracorporeal membrane oxygenation for the liver donation after brain-cardiac death / 器官移植

Objective To evaluate the application value of ultrasound in extracorporeal membrane oxygenation (ECMO)for protecting the liver donation after brain-cardiac death (DBCD).Methods Forty patients with brain death or irreversible brain injury,admitted to Guangzhou General Hospital of Guangzhou Military Command from April 2006 to November 201 4,were eligible for liver donation.The hepatic artery blood flow (QHA),portal vein blood flow (QPV)and ECMO-induced ECMO flow of hepatic artery (VE)of the donor liver were monitored by ultrasound before,5 min after the initiation of ECMO and immediately after ECMO.The changes of total bilirubin (TB),alanine transaminase (ALT)and lactic acid were observed at corresponding time points.Hepatic recovery was subsequently evaluated within 3 months after liver transplantation.Results The mean time of ECMO was (1 .0 ±0.2)h.There was no significant difference in QHA and QPV before and after ECMO (both in P >0.05).And there was no significant difference in liver function parameters before and after ECMO (all in P >0.05).At different time points within postoperative 3 months,the results of ultrasound evaluation and liver function test revealed that the transplant liver function was well recovered in 40 recipients.Conclusions Through monitoring QHA by ultrasound,the best ECMO flow should be chosen,which protects DBCD liver and averts perfusion injury and hypoperfusion.

Ultrasonographic diagnosis of splenic artery steal syndrome after liver transplantation / 器官移植

Objective To evaluate the value of ultrasonography in the diagnosis of splenic artery steal syndrome (SASS ) after liver transplantation. Methods Routine ultrasonography and contrast enhanced ultrasound (CEUS)were performed in 10 cases with SASS (SASS group)and 8 cases of control patients with normal liver function after liver transplantation. The ultrasonographic findings of SASS were summed up. The diagnostic efficacy of CEUS was compared with that of digital subtraction angiography (DSA). Results In the SASS group,2D ultrasonography showed that the hepatic parenchyma was normal or there were some tiny necrosis foci in it,and color Doppler flow imaging (CDFI)showed that the blood flow signal of the hepatic artery was sparse or punctiform. CEUS showed the delayed and weak contrast-enhanced signals in hepatic artery after transplantation. The internal diameter of the splenic artery increased while that of the hepatic artery decreased. There was no significant difference between CEUS and DSA. Conclusions The routine ultrasonography and CEUS have a high value on the detection of suspected abnormal vascular system of transplant liver after liver transplantation as the noninvasive diagnostic tools.

Value of real time three-dimensional hysterosalpingo-contrast-sonography in the assessment of fallopian tube patency / 中华超声影像学杂志

Objective To access the diagnostic accuracy and clinical value of transvaginal real time three-dimensional hysterosalpingo-contrast sonography (RT-3D-HyCoSy) in evaluating the fallopian tube patency.Methods 428 infertile women were under went transvaginal RT-3D-HyCoSy and 32 of them were underwent laparoscopically salpingoraphy to evaluate the fallopian tube patency.Results 846 fallopian tubeswere studied by RT-3D-HyCoSy,271 of them were unobstructed,202 of them were obstructed,373 of them were partially passable.Compared with laparoscopically salpingography,sensitivity,specificity,positive predictive value and negative predictive value of transvaginal RT-3D HyCoSy were 84.0％,100％,87.5％ and 90.9％,respectively.The transvagianl RT-3D HyCoSy and the laparoscopy with a Cohen's Kappa was 0.788.Conclusions Transvagianl RT-3D HyCoSy could dynamic show the visualization of the course from uterus to distal tubal and the both ovary consecutively.It has more advantage in assessing the patency of tubal and distal tubal function.

Ultrasound Contrast Agent Injection Volume in Evaluating Tubal Patency / 中国医学影像学杂志

Purpose To explore the association between ultrasound contrast agent injection volume as well as regurgitation and tubal patency. Methods SonoVue contrast agent was used for 515 cases of infertility transvaginal four-dimensional ultrasound imaging hysterosalpingography, recorded the amount of contrast agent injection, regurgitation, and compared contrast agent injection volume and regurgitation in different patency. Results The ultrasound contrast agent injection volume between bilateral patency with bilateral passable and one side patency one side passable as well as one side patency one side barrier, between one side patency one side passable and one side patency one side barrier had no significant difference (U=1467.0-4843.0, P>0.05);and it had statistical difference between any other two conditions (U=273.5-6160.0, P0.05), and it had statistical difference between any other two conditions (U=919.5-5126.5, P<0.05). Conclusion Ultrasound contrast agent injection volume and regurgitation in hysterosalpingography are associated with tubal patency, which can be used as objective indexes for assessing tubal patency, and provide basis for tubal patency.

Contrast-enhanced ultrasound in the splenic artery steal syndrome of liver transplantation / 中华超声影像学杂志

Objective To investigate the utilization of contrast-enhanced ultrasound (CEUS) for the detection of splenic artery steal syndrome (SASS) after orthotropic liver transplantation (OLT).Methods Color Doppler flow imaging (CDFI) were performed at various time points post-operatively.CEUS and celiac angiography were conducted in patients suspected of SASS.Results 9 patients were suspected of SASS by slim or undetectable hepatic arterial Doppler blood signals by CDFI at various time points postoperatively.CEUS in 9 patients showed a delayed and weak contrast-enhanced blood signal in the hepatic artery associated with a rapid and intense enhancement of portal venous blood.No narrowing of a hyperintense signal was observed in the hepatic artery by CEUS.The 9 diagnoses of SASS were proven by celiac angiography.Conclusions SASS is identified as a sluggish and weak hyperintense blood signal in the hepatic artery without the narrowing and interruption of hypeintense signal in CEUS.CEUS is an effective imaging modality for detection of SASS following OLT.

Extracorporeal membrane oxygenation support for liver donation after cardiac death / 中华肝胆外科杂志

ObjectiveTo summarize the early clinical experience of the extracorporeal membrane oxygenation (ECMO) for protecting the liver donation after cardiac death (DCD).Methods Review and analysis the clinical data of 17 cases of liver transplantation with the donors from Chinese citizen after cardiac death from July 2009 to May 2011 in our liver transplantation center,and comprehend the primary diseases and the relevant index of the donors,the flow-sheet of donation and obtain of the organs from the donation after cardiac death,and the apply methods of extracorporeal membrane oxygenation during those processes.ResultsAll 17 cases had been diagnosed as brain death before,and waited for cardiac death,so all were clearly the donation of brain death plus cardiac death(DBCD).During the processes waiting for cardiac death,extracorporeal membrane oxygenation were introducted in every case,and the using time were 51-380 (mean 187)min.The donation after brain death plus cardiac death (DBCD) were all harvested liver donors and were transplanted to 17 receivers respectively.In our center,there was no operational death in liver transplantation in this series.The post-operation liver function recovered satisfactory,without transplant liver non-function or recovering delay.One case died of the pulmonary infection one month later after operation,and the other 16 cases all survived and were followed up to now.The longest survival time was 29 months.ConclusionThe donation after brain death plus cardiac death (DBCD) was the special donation type for citizen in China.The extracorporeal membrane oxygenation (ECMO) could well control the warm ischemia for protecting the liver donor just without ethics dispute.So,the using of the extracorporeal membrane oxygenation (ECMO) for the liver donation after cardiac death(DCD)of citizen in our China have very important contribution.

Contrast-enhanced ultrasound for blunt hepatic trauma: an animal experiment.

OBJECTIVE: The aim of this study was to study the value of contrast-enhanced ultrasound (CEUS) in the diagnosis of active hemorrhage and intraparenchymal lesions in blunt hepatic trauma versus conventional ultrasound (US). METHODS: Twenty heparinized and anesthetized domestic pigs have been created to animal models with blunt hepatic trauma by a special impacting device. Conventional US and CEUS were performed to determine if hepatic traumas were present. RESULTS: Active hemorrhage, the presence of intraparenchymal lesions, and sonographic pattern were evaluated for conventional US and CEUS, as compared with laparotomy and pathologic findings. Contrast-enhanced US detected active hemorrhage from the injured livers in all cases, but conventional US did not find that in any case. The sensitivity of CEUS and conventional US in diagnosing intraparenchymal lesions of blunt hepatic trauma were 100% and 60%, respectively. CONCLUSIONS: Contrast-enhanced US is more sensitive than conventional US in determining the active hemorrhage and intraparenchymal lesions in blunt hepatic trauma.

Value of blood perfusion quantitatively in grading cerebral gliomas during operation by contrast-enhanced ultrasonography / 中华超声影像学杂志

Objective To explore the clinical application of blood perfusion quantitatively by contrastenhanced ultrasonography(CEUS) to grade cerebral gliomas during operation. Methods Thirty-one patients with cerebral gliomas were examined by CEUS with Sonoliver software during operation. Maximum intensity (IMAX), time to peak (TTP), rising time (RT) and mean transit time(mTT) of the regions of interest (ROIs) of normal brain tissue and high- and low-grade gliomas were respectively determined and comparatively analyzed. Results Fifteen high-grade gliomas and sixteen low-grade gliomas were postoperatively confirmed by pathologic results. The administration of contrast agent led to higher echo enhancement in cerebral gliomas than normal brain tissues in all cases. The TTP of high- and low-grade gliomas were significantly shorter than that of normal cerebral tissues ( P ＜0.05) ,and the mTT was longer than that of normal brain tissue( P ＜0. 05). There was significant differences of IMAX and TTP between high- and low-grade gliomas(P ＜0.05), but there was no significant difference of RT and mTT between the two groups ( P ＞0.05). Conclusions CEUS with quantitative analysis software on blood perfusion of the tumors can provide valuable information to grade cerebral gliomas.