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Objective:To explore the application of real-time transrectal ultrasound (TRUS) during seminal vesiculoscopy in infertile men with azoospermia or oligoasthenospermia.Methods:We retrospectively analyzed the clinical data of 25 cases of azoospermia or oligoasthenospermia due to ejaculate ducts obstruction who were treated with real-time transrectal ultrasound-guided seminal vesiculoscopy between September 2011 and December 2015. Patients’ age was(29.4±4.5) years. All patients accepted semen analysis, serum sex hormone, MRI, TRUS and then diagnosed as obstructive azoospermia, and 13 cases had intractable obstructive azoospermia or oligoasthenospermia after the failure of simple seminal vesiculoscopy(the path to the ejaculatory duct and seminal vesicle couldn’t be found). All patients were treated with seminal vesiculoscopy under real-time guidance with TRUS. We assessed the success rate of surgery, surgical time and complications.Results:The scope was successfully inserted into the seminal vesicle in 21 of the 25 cases (success rate, 84%). The median operative time was 75(31, 148) min. None of the patients developed severe complications. Among 4 failure cases (4/25, 16%), 1 was due to abnormal congenital development. In 2 cases, a clear outlet of the dual ejaculatory duct could not be found after it was inserted into the prostatic utricle. One case was considered as a Müllerian tubular cyst, and the seminal vesicle scope was used to assess the cystic side wall. The 21 patients were followed up for 3 to 6 months, semen volume 2.0(0-5.2)ml, total sperm 28(0-832) ×10 6/ejaculate, sperm density 5.6(0-110.3)×10 6/ml, mobility rate of sperm 5.4%(0-63.6%), and the differences were significant as compared to that before the surgery [semen volume 0.4(0-2.8)ml, total sperm 0(0-342)×10 6/ejaculate, sperm density 0(0-90.7)×10 6/ml, mobility rate of sperm 0(0-24.1%), all P<0.05]. Among the 17 patients who underwent follow-up of 5 to 9 years, 3 patients was conceived naturally and 9 patients’ postoperative sperm quality has improved and pregnancy in vitro fertilization by extracting sperm from semen. Conclusions:Intraoperative real-time transrectal ultrasound guidance can improved the success rate of seminal vesiculoscopy and promoted operative safety.
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Objective@#To explore the clinical characteristics of renal angiomyolipoma (AML) with inferior vena cava (IVC) tumor thrombus and to improve the diagnosis and treatment of the disease.@*Methods@#The clinical data of 3 patients with renal AML and inferior vena cava tumor thrombus was retrospectively reviewed. The patients were all female, aged 19 to 70 years. Among them, 2 patients presented with lumbago on the right side, and the other one was diagnosed by physical examination. The body mass index ranged from 18.4 to 24.6 kg/m2, with a median value of 20.4 kg/m2. According to the American Society of Anesthesiologists (ASA), they were classified as grade Ⅱ. Color doppler ultrasound examination of the kidney and IVC was performed in all the 3 patients, all of which showed hyperechoic solid mass in the right kidney. Color doppler ultrasound of IVC showed hyperechoic band in the IVC, indicating blood flow signals and the tumor thrombus. All the 3 cases showed irregular fat density or mixed density in the right kidney and multiple irregular fat density were observed in the right renal vein and inferior vena cava on CT. Two of them received MRI examination of IVC, which showed irregular lesions in the right kidney, short T1 and long T2 signals, low lipids, and no definite limited diffusion on DWI. Irregular fat signal were seen in the right renal vein and inferior vena cava. All 3 patients were diagnosed with right renal mass with IVC tumor thrombus, with 1 patient of Mayo grade Ⅲ tumor thrombus and the other 2 of Mayo gradeⅡtumor thrombus. One underwent laparoscopic radical nephrectomy and inferior vena cava tumor thrombectomy, another one underwent open right partial nephrectomy and tumor thrombectomy, and the third one suffered preoperative AML rupture, undergoing open radical nephrectomy and tumor thrombectomy.@*Results@#The operation time was 168 to 659 min, with median of 220 min. Intraoperative blood loss ranged from 50 to 300 ml, with the median of 50 ml. Postoperative indwelling time of drainage tube was 5 to 11 days, with the median of 6 days. Postoperative hospital stay ranged from 7 to 14 days, with a median of 8 days. Postoperative follow-up ranged from 12 to 16 months, with a median follow-up of 13 months. All the three patients underwent operation without postoperative complications. Postoperative pathology proved to be right renal angiomyolipoma. After 3 months of follow-up, the patients showed no tumor recurrence or metastasis.@*Conclusions@#Renal AML is a benign lesion, which is rarely concurrent with inferior vena cava cancer thrombus. Enhanced CT examination is the main diagnostic method, surgical resection of the lesion is the preferred treatment, partial nephrectomy combined with thrombectomy can be performed in patients with AML, if permitted, and postoperative prognosis turns out to be propitious.
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Objective To explore the clinical characteristics of renal angiomyolipoma (AML) with inferior vena cava (IVC) tumor thrombus and to improve the diagnosis and treatment of the disease.Methods The clinical data of 3 patients with renal AML and inferior vena cava tumor thrombus was retrospectively reviewed.The patients were all female,aged 19 to 70 years.Among them,2 patients presented with lumbago on the right side,and the other one was diagnosed by physical examination.The body mass index ranged from 18.4 to 24.6 kg/m2,with a median value of 20.4 kg/m2.According to the American Society of Anesthesiologists (ASA),they were classified as grade Ⅱ.Color doppler ultrasound examination of the kidney and IVC was performed in all the 3 patients,all of which showed hyperechoic solid mass in the right kidney.Color doppler ultrasound of IVC showed hyperechoic band in the IVC,indicating blood flow signals and the tumor thrombus.All the 3 cases showed irregular fat density or mixed density in the right kidney and multiple irregular fat density were observed in the right renal vein and inferior vena cava on CT.Two of them received MRI examination of IVC,which showed irregular lesions in the right kidney,short T1 and long T2 signals,low lipids,and no definite limited diffusion on DWI.Irregular fat signal were seen in the right renal vein and inferior vena cava.All 3 patients were diagnosed with right renal mass with IVC tumor thrombus,with 1 patient of Mayo grade Ⅲ tumor thrombus and the other 2 of Mayo grade Ⅱ tumor thrombus.One underwent laparoscopic radical nephrectomy and inferior vena cava tumor thrombectomy,another one underwent open right partial nephrectomy and tumor thrombectomy,and the third one suffered preoperative AML rupture,undergoing open radical nephrectomy and tumor thrombectomy.Results The operation time was 168 to 659 min,with median of 220 min.Intraoperative blood loss ranged from 50 to 300 ml,with the median of 50 ml.Postoperative indwelling time of drainage tube was 5 to 11 days,with the median of 6 days.Postoperative hospital stay ranged from 7 to 14 days,with a median of 8 days.Postoperative follow-up ranged from 12 to 16 months,with a median follow-up of 13 months.All the three patients underwent operation without postoperative complications.Postoperative pathology proved to be right renal angiomyolipoma.After 3 months of follow-up,the patients showed no tumor recurrence or metastasis.Conclusions Renal AML is a benign lesion,which is rarely concurrent with inferior vena cava cancer thrombus.Enhanced CT examination is the main diagnostic method,surgical resection of the lesion is the preferred treatment,partial nephrectomy combined with thrombectomy can be performed in patients with AML,if permitted,and postoperative prognosis turns out to be propitious.
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Objective To assess the differences in carotid artery stiffness properties and endothelium-independent dilation (EID)between elderly and young patients,and evaluate the echotracking (ET)system for vascular stiffness at different ages.Methods A total of 79 outpatients with multiple cardiovascular risks were recruited.Clinical data including medical history,height,weight,blood pressure,fasting blood glucose and blood lipid were collected.We evaluated the arterial stiffness parameters of carotid artery and EID using an ultrasonic ET system in 46 elderly subjects,compared with 33 sex-matched non-elderly subjects.The impaired EID function was defined as brachial artery nitroglycerin mediated dilation (NMD)below 4％.Results All stiffness parameters including pressure-strain elasticity modulus stiffness index β (Ep),pulse wave velocity β (PWVβ)and augmentation index (AI)were significantly increased in elderly group compared with the non-elderly group [(138.9±64.7)kPa vs.(100.6±30.8)kPa,(10.9±4.7)vs.(8.2±2.3),and (6.9±1.4)m/s vs.(6.1±0.9)m/s,P＜0.05 respectively],while the exception of arterial compliance (AC)was reduced (0.9±0.3)mm2/kPa vs.(1.0±0.5)mm2/kPa(P＜0.05).The incidence of impaired EID in elderly group was higher than in non-elderly group [56.5％ (26 cases) vs.33.3％ (11 cases),P＜0.05].ET parameters including Ep,stiffness index β,PWVβ,AC and AI were related to age (r=-0.44,-0.45,-0.40,-0.40,0.34,all P＜0.01)； Ep,stiffness index β,PWVβ and AC were also related to impaired EDI (r=-0.38,-0.40,-0.34,-0.29,all P＜0.01).Conclusions Arterial stiffness properties and EID measured by ET system was more serious in elderly with multiple cardiovascular risks than in non-elderly subjects.As a convenient and accurate assessment of stiffness parameters,ET system is optimal option for measuring arterial stiffness and EID in elderly people.
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The present residents training for ultrasound departments depends mostly on poorlyscheduled rotation and clinical clerkship,with repeated and obsolete subjects in their training.The authors identified these setbacks and such characteristics as complication of ultrasound medicine,complex and variable ultrasonic scan technique,and the high threshold for beginners.In view of this,the authors adopted the tutorial system training mode for cultivating the residents in their medical care,teaching,research and foreign language competencies.A questionnaire survey of 44 residents so trained evaluated outcomes of the mode,with constructive suggestions raised on expansion of the training base,improvement of teachers’competency and reduction of trainees' workload.
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50% in 7 patients and
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Objective To evaluate the usefulness of ultrasound during the operation of 125 I permanent brachytherapy for pancreas carcinoma.Methods According to the mass size,the total radiation dosage and the amount of radioactive seeds were calculated before operation.Then all needles were inserted evenly in the mass and radioactive seeds were implanted through the needles under ultrasonic guidance during the operation. At the end of operation,ultrasonography and/or abdominal radiography were applied to examine the distribution of seeds and to find if any place was left out. Results Thirteen patients were operated on successfully and the mass was displayed clearly with ultrasonography. Under the guidance of ultrasound,needles were exactly inserted in the mass and the whole process of implantment was easily observed. Locations were proved exactly by ultrasonography and abdominal radiography after operation. Conclusions Ultrasound has some important values in this procedure,such as precise orientation,real-time monitoring,follow-up evaluation,etc. Application of ultrasonography has the broad prospect in this field.