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Objective To evaluate the accuracy of preoperative MRI in the diagnosis of malformations associated with MRKH syndrome and identification of uterine endometrium to optimize the clinical management.Methods 1 8 females with primary amenor-rhea were studied with MRI performed with a 1.5T or 3.0T imager.All patients were examined in the supine position using a phased-array coil and underwent pelvic MRI.Two experienced radiologists evaluated all the examinations in consensus to assess the pres-ence,position and morphology of vagina,uterus,ovaries and any pelvic abnormalities.Results One or two rudimentary uteri were identified in 17 patients (94.4%).A total of 16 patients (88.9%)had bilateral rudimentary uteri,1 (5.6%)had unilateral rudimentary uteri(it was left sided).1 (5.6%)had no uterine remnants.4 (12.1%)of 33 uterine buds in 4 patients showed differentiation of the center of the uterus into three layer.Bilateral ovaries were present in 1 7 patients,and their shapes,sizes and signals are normal.The vagina and cervix were absent in all cases.Conclusion MRI is a useful diagnostic tool in the preoperative evaluation of MRKH syndrome and the endometrium to further optimize the treatment plan.
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Purpose To explore the dynamic contrast-enhanced (DCE) MRI curve type and hydrogen proton magnetic resonance spectroscopy (1H-MRS) in the diagnosis of primary osteosarcoma.Materials and Mothods This was a prospective study.Dynamic contrast enhancement and 1H-MRS scanning wcre performed in forty-one osteosarcoma patients who were eligible for the study.According to the pathological findings,patients were divided into high malignant osteosarcoma group and low malignant osteosarcoma group.The time-signal intensity curves (TIC) were obtained and classified by the analysis software.Among them,18 patients with stable 1H-MRS spectrum were analyzed,and Cho as well as Cho/Cr value was obtained and statistically analyzed,respectively.Results The type Ⅰ and type Ⅱ TIC curves in high malignant osteosarcoma group were 20 and 10 cases,respectively.The type Ⅰ,type Ⅱ and type Ⅲ TIC curves in low malignant osteosarcoma group were 2,5 and 4 cases,respectively.The difference of TIC type distribution between high and low malignant osteosarcoma was statistically significant (x2=10.876,P＜0.05).The difference of Cho/Cr value between high and low malignant osteosarcoma was statistically significant (Z=-2.445,P＜0.05).Consider Cho/Cr value as the diagnostic index,the best cut-off value was 2.3.Conclusion TIC type and Cho/Cr value have certain reference value for evaluating the malignant degree of osteosarcoma.
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Objective To explore the value of DWI and 1 H-MRS in evaluation of malignant degree of primary osteosarcoma.Methods A retrospective analysis was performed in 41 patients with osteosarcoma confirmed pathologically and examined with DWI and 1 H-MRS.The b values were 0,400,800,1 000 and 1 500 s/ mm2 in DWI,respectively.ADC map was obtained,and ROIs were selected to measure ADC values.Eighteen cases which had stable spectral lines in MRS were selected and analyzed.The spectral lines,Choline (Cho),Creatine (Cr) and Cho/Cr ratio were obtained.Analysis of ADC values of high and low grade osteosarcoma were performed with Kruskal-Wallis H test,and Cho/Cr values were analyzed with Mann-Whitney U test.Results When b values were 400,800,1 000 s/mm2,ADC values of high and low grade osteosarcoma were significantly different (x2=6.26,4.37,4.87,P=0.01,0.04,0.03).When b value was 1 500 s/mm2,ADC value of high and low grade osteosarcoma had no statistical difference (x2 =2.39,P=0.12).Moreover,when 400 s/mm2 was taken as the optimal b value,the specificity and sensitivity of ADC value for identifying high grade osteosarcoma was 73.30 ％ and 72.70 ％,respectively.Cho/Cr values between high and low grade osteosarcoma were significantly different (Z=-2.45,P＜0.05).As a diagnostic parameter,the best threshold value of Cho/Cr was 2.21.And the specificity and sensitivity for diagnosing high grade osteosarcoma was 75.00 ％ and 92.90 ％,respectively.Conclusion ADC (b=400 s/mm2) and Cho/Cr values may be helpful to identifying malignant degree in osteosarcoma.
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Objective To assess MR characteristics of supratentorial intraparenchymal ependymomas(SIEs)in different age groups.Methods 40 patients with SIEs confirmed by surgery and pathology were analyzed retrospectively.All patients were examined by head MRI without or with contrast.Patients were divided into two groups according to age:child and adult group.T test was used to analyze the difference of tumor volume of two groups.Mann-Whitney U test was used to compare cystic,edema and pathological types of two groups.χ2test was used to distinguish sexual distinction.Results 39 cases of SIEs were located in cerebral surface,1 case located in inside cerebral essence.SIEs of child group(n=13)were male dominance(n=11),5 cases were located in the frontal lobe,all lesions were cystic solid masses.In the adult group(n=27),13 cases were male,9 cases were located in the frontal lobe,solid tumors were seen in 3 cases.There were significant difference among two groups in sexual distinction(χ2=3.921,P=0.048)and cystic change(U=98.50,P=0.02).There were no significant difference in the volume of tumor(t=1.828,P=0.087),edema(U=219.00,P=0.49)and pathological types(U=258.00,P=0.10).Conclusion There are MR characteristics differences in the SIEs in different age groups.Child has a superiority of male,tumors are mainly as cystic-solid mass,edema of the tumor is mild and has a high incidence cystic necrosis,the border is clear.In adult group,tumors are mainly as cystic-solid mass,and can also be solid mass, the solid portion of the lesion is easy to bleed,edema of the tumor is serious.
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Objective Analyzing and summarizing the characteristics and clinical data of 238 cases of unexplained fever in patients with normal or decreased white blood cell count, to guide the clinical diagnosis and treatment in feverish pa-tients with normal or decreased white blood cell count.Methods In the department of hematology 238 cases of fever in pa-tients with normal or decreased white blood counts have been collected from January 2009 to December 2013.Retrospectively analyze their clinical manifestations, related auxiliary examination, and diagnostic process and treatment.Results 234 cases in the total 238 cases had confirmed diagnoses, of which the rate was 98.3%.Of the total 238 cases, 176 cases (73.8%) were diagnosed with infectious diseases; 17 cases (7.2%) were diagnosed with malignancy; 6 cases (2.5%) were diag-nosed with connective tissue disease;35 cases (14.8%) were diagnosed with other diseases;diagnoses of 4 cases (1.7%) were not confirmed.Conclusion Most patients with fever can have a confirmed diagnosis after a detailed history and physical examination.The main cause of fever is infection.Fevers with normal or decreased white blood cell count have their particular clinical manifestations which should be concerned, targeted and treated accordingly as soon as possible.
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Objective To investigate the effect of bibliotherapy in soothing the postoperative pain in children and relieving the perioperative anxiety of children and their care givers. Methods Hospitalized children and their care givers from August 2007 to March 2009 were studied. 153 cases from August 2007 to May 2008 were assigned to the control group and the other 153 cases to the intervention group. Routine surgical nursing were applicated in the control group by introduction of perioperative nursing procedures.Bibliotherapy were applicated in the intervention group on the basis of the control group-using "bibliotherapy materials for hospitalized children" which was designed by ourselves and correspond with the theory of bibliotherapy to interfere in the 153 cases in the intervention group. The variance of preoperative anxiety of care givers and perceptions of postoperative pain of children between the two groups were compared with scales of mYPAS, STAI and FLACC and Wong- Baker Facial Scale. Results The scores of mYPAS in children of the intervention group and the control group was (35.875+4.441)and(46.796+8.606 )respectively and the variance was significant. The scores of STAI in care givers of the two groups was(38.125+4.371 )and (49.901 +7.420) respectively and revealed significant variance. The scores of Wong-Baker and FLACC in children of both groups 1 hour after operation were compared and revealed no statistical significance. The scores of Wong-Baker and FLACC in children at 6 hours and 24 hours postoperative were compared subjectively and objectively and revealed statistic significance. Conclusions Bibliotherapy can ameliorate the anxiety level of both children and their care givers, relieve the perception of postoperative pain in children and improve their comforts. Bibliotherapy thus conduces to the recovery of postoperative children.
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ety, reduce the risk of infection and improve the efficiency of nursing service.
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Objective To evaluate the efficacy and feasibility of laparoscopie intervention for congenital obstructive megaureter in children. Methods Eleven children with congenital obstructive megaureter(left in 4,right in 7)underwent laparoseopie ureteroplasty.One had congenital ureter oririce stenosis,9 had been diagnosed as simple congenital ureter orifice stricture,1 had recurrent ureter orifice stricture after open ureterovesical reimplantation.B-ultrasound and IVU showed severe hydronephrosis in 7 cases and moderate in 4. Results The operation was successful in all cases and none had urine leakage.The mean operating time was 103.0±35.3 min(range 70-190 min).The mean blood loss was 18.0±9.5 ml(range 10-40 ml)and the mean postoperative hospital stay was 8.0±1.4 d(range 7-10 days).The double J stent was removed 6 weeks after operation.The patients were followed up for 3-24 months(mean,6 months).Cystography showed no reflux in all cases during follow-up. Conclusion Laparoscopical ureteroplasty could be a minimal invasive,less suffering technique for the treatment of congenital obstructive megaureter in children.