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Objective: To investigate the changes of tissue structure in the ablation area after microwave ablation of thyroid nodules and to identify the appropriate time for pathological evaluation of the ablation area. Methods: From January 2017 to December 2018, a total of 69 core-needle biopsy tissue samples from the ablation area of thyroid nodules in 60 patients were investigated histologically using H-E and immunohistochemical staining. The samples were taken after microwave ablation at different stages and from different areas. Cellular morphology and tissue structure as well as thyroid transcription factor 1 (TTF1) in the tissues from the central zone and marginal zone of ablation area were observed immediately, 1 month, 3 months, 6 months and 12 months after microwave ablation. Results: Successful biopsies were achieved in 69, 12, 19, 25 and 13 ablation areas immediately, 1 month, 3 months, 6 months and 12 months after microwave ablation. There was no necrosis but only coagulated degeneration in both the central zone and marginal zone of the 69 (100.00%) ablation areas immediately after microwave ablation. At 1 month after microwave ablation, 9 (75.00%) samples of central zone and 9 (75.00%) samples of marginal zone showed complete necrosis. At 3 months, 16 (84.21%) samples of central zone and 15 (78.95%) samples of marginal zone showed complete necrosis. At 6 and 12 months, all (100.00%) samples of central zone and marginal zone became necrotic completely. Conclusion: The histopathologic feature of thyroid nodules after microwave ablation varies with time. There is only coagulated degeneration in the freshly ablated thyroid tissue, and no necrosis is found. Necrosis occurs and progresses to the whole ablation area in all patients. It suggests that the reliable therapeutic effect of microwave ablation on thyroid nodules is due to complete necrocytosis. Necrosis occurs in all the ablation area at 6 months after microwave ablation, indicating the 6th month is an appropriate time for pathological evaluation of the ablation area.
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Objective To study the adverse effect of mirror artifacts generated from the specular reflection of trachea wall on microwave ablation (MWA) treatment of thyroid nodules and the causes. Methods Perioperative ultrasound imaging data of 304 patients who received MWA of thyroid nodules in Shanghai International Medical Center from Jan. 2018 to Oct. 2018 were systemically studied. The occurrence rate, sources, acoustic characteristics of the mirror artifacts and the adverse effects of mirror artifacts on MWA were summarized. The factors contributing to specular reflection of trachea were analyzed. Results A total of 169 cases (55.59%) presented tracheal mirror reflection artifacts in this study. The sources of mirror artifacts included thyroid nodules (20 cases, 11.83%), injection needle (133 cases, 78.70%), ablation electrode (16 cases, 9.47%), hydro-dissection zone (137 cases, 81.07%), and remote ablated area of thyroid nodule (8 cases, 4.73%). We also found that 88.17% (149/169) of mirror artifacts were during the MWA operative period. Conclusion Mirror artifacts generated from the specular reflection of trachea wall are commonly seen in the perioperative period of thyroid nodule MWA. Lesion close to the trachea, flattened tracheal wall, and flat interface linearity larger than the real source dimension are the important causes of mirror artifacts. Direct compression on the tracheal wall caused by thyroid nodules, ablated areas and hydro-dissection zone are the main causes of flattened tracheal wall.
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Background@#Little study has investigated the differences between Talatomyces marneffei (T. marneffei) respiratory infection and tuberculosis and the prognostic factors of such infection. This study investigated the characteristics and prognostic factors of T. marneffei infections with respiratory lesions and the causes of misdiagnosis.@*Methods@#Clinical characteristics and prognoses of patients with T. marneffei infections with respiratory system lesion were investigated. T. marneffei diagnosis followed isolation from clinical specimens using standard culture, cytology, and histopathology. Survival curves were estimated by using Kaplan-Meier analysis, with log-rank test to compare differences in survival rates between groups. Univariate and multivariate Cox regression analyses were also performed to assess significant differences in clinical characteristics of overall survival.@*Results@#Of 126 patients diagnosed with T. marneffei infections, 63 (50.0%) had T. marneffei respiratory system infections; 38.1% (24/63) were misdiagnosed as having tuberculosis. Human immunodeficiency virus (HIV) infection, CD4/CD8 < 0.5, percentage of CD4+ T cells <42.8%, and length of time from onset to confirmation of diagnosis >105 days were potential risk factors for poor prognoses. Length of time from onset to confirmation of diagnosis persisted as an independent predictor of all-cause mortality in multivariate analysis (odds ratio: 0.083, 95.0% confidence interval: 0.021–0.326, P < 0.001). However, the size of the lung lesions, dyspnea, thoracalgia, mediastinal lymphadenopathy, and pleural effusion did not significantly predict overall survival. There was no significant difference in prognosis according to the type of treatment.@*Conclusions@#T. marneffei infections involving the respiratory system are common. The critical determinants of prognosis are HIV infection, CD4/CD8, percentage of CD4+ T cells, type of treatment, and the time range from onset to confirmation of diagnosis. Rapid and accurate diagnosis is crucial for improving prognosis.
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BACKGROUND@#Little study has investigated the differences between Talatomyces marneffei (T. marneffei) respiratory infection and tuberculosis and the prognostic factors of such infection. This study investigated the characteristics and prognostic factors of T. marneffei infections with respiratory lesions and the causes of misdiagnosis.@*METHODS@#Clinical characteristics and prognoses of patients with T. marneffei infections with respiratory system lesion were investigated. T. marneffei diagnosis followed isolation from clinical specimens using standard culture, cytology, and histopathology. Survival curves were estimated by using Kaplan-Meier analysis, with log-rank test to compare differences in survival rates between groups. Univariate and multivariate Cox regression analyses were also performed to assess significant differences in clinical characteristics of overall survival.@*RESULTS@#Of 126 patients diagnosed with T. marneffei infections, 63 (50.0%) had T. marneffei respiratory system infections; 38.1% (24/63) were misdiagnosed as having tuberculosis. Human immunodeficiency virus (HIV) infection, CD4/CD8 105 days were potential risk factors for poor prognoses. Length of time from onset to confirmation of diagnosis persisted as an independent predictor of all-cause mortality in multivariate analysis (odds ratio: 0.083, 95.0% confidence interval: 0.021-0.326, P < 0.001). However, the size of the lung lesions, dyspnea, thoracalgia, mediastinal lymphadenopathy, and pleural effusion did not significantly predict overall survival. There was no significant difference in prognosis according to the type of treatment.@*CONCLUSIONS@#T. marneffei infections involving the respiratory system are common. The critical determinants of prognosis are HIV infection, CD4/CD8, percentage of CD4 T cells, type of treatment, and the time range from onset to confirmation of diagnosis. Rapid and accurate diagnosis is crucial for improving prognosis.
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Objective:To evaluate the influence of different CO2 pneumoperitoneum pressure on intestinal mucosal injury and intestinal function recovery in patients undergoing laparoscopic radical gastrectomy.Methods:A total of 120 patients undergoing laparoscopic radical gastrectomy were randomly divided into group A,B and C.Each group included 40 patients.CO2 pneumoperitoneum pressure ingroup A,B and C were 8～10 mmHg,11～13 mmHg and 14～16 mmHg,respectively.The degree of intestinal mucosa damage,plasma D-lactate(2,24 and 48 hours after the treat-ment),intestinal function recovery and complication ration were compared between the three groups.Results:Damage degree of intestinal mucosa after operation in A,B and C groups were 0～1,1～2 and 2～3 respectively.There was significant change in intestinal mucosa injury after operation in both B and C groups.The level of D-lactic acid in group C (2,24 and 48 hours after the treat-ment) were significantly higher those in group A and group B (P＜0.05).The bowel sounds appeared time,exhaust time and intake time in group C were significantly longer than group A and group B (P＜0.05).The incidence of complications were not significantly difference during the three groups.Conclusion:The high pressure of CO2 pneumoperitoneum will cause intestinal mucosa damaged,and not conducive to the patients' intestinal rehabilitation.We suggest that the CO2 pneumoperitoneum pressure should be as low as possible under clear visualization during operation.
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Objective To introduce the hydro-dissection technique and its application in ultrasound-guided percutaneous thermal ablation therapy of neck nodular lesions. Methods A total of 1 126 patients suffering from neck nodular diseases received percutaneous thermal therapy using radiofrequency ablation or microwave ablation from May 2005 to April 2013. As a part of the treatment procedure, ultrasound-guided injection of separating liquid was performed into between the target nodules and surrounding structures to form a separating zone prior to ablation. The roles of hydro-dissection technique in improving the safety of puncture route, reducing the thermal injury to normal tissues, and enhancing the curative effects of ablation were analyzed. Results Hydro-dissection technique was successfully performed in as many as fourteen parts related to the thyroids, parathyroids, submandibular glands and lymph nodes. The key points and ultrasonic characteristics of this maneuver were well established and understood. Compared with those not receiving the technique, those receiving the technique had significantly reduced heat damage to lesion-adjacent structures (0.7% vs 15%, P < 0.01) and decreased incomplete ablation rate of the lirst try (0.29% vs 7.4%, P < 0.01). Conclusion Hydro-dissection technique under ultrasound-guidance is easy to perform, has good repeatability and reliable effect; it may serve as a safe and effective supplementary measure for thermal ablation of various neck nodular lesions.
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Objective To establish treatment strategies using percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) for benign parathyroid nodules and to investigate the related techniques, procedures, safety and efficacy. Methods Percutaneous RFA and MWA were conducted on 317 benign parathyroid nodules in 96 patients using an auto-controlled bipolar electrode system (Celon ProBreath, Germany) and thyroid-specified microwave antenna (Thy-ablation™, China). The ablation strategy, optimal puncture route, protection of vital neck vessels and recurrent laryngeal nerve, reduction of bleeding from core-needle biopsy, indicator for complete therapy, ablation time (AT) for single nodule, and total operation time (TOT) for each case were investigated and analyzed. The focal changes of ablated region on multimode ultrasound, serum parathyroid hormone (PTH) level, serum calcium values, clinical manifestations and pathological alterations were assessed during follow-up. Results Cross section simultaneously demonstrating the ablation target, ablation needles and vital anatomic structures was essential for a safe ablation procedure of parathyroid lesions. Liquid isolating zone maneuver was beneficial for creating safe puncture route and for protecting laryngeal nerves, esophagus and trachea from heat damage. Thermal blocking of blood flow prior to core-needle biopsy effectively reduced bleeding and successfully treated one patient with intensive subcutaneous hemorrhage. Contrast-enhanced ultrasound was an important and essential indicator for a complete therapy. In primary hyperparathyroidism (PHPT) group the TOT for each case was about (572. 47 ± 75. 79) s and AT for single nodule was about (194. 82 ± 46. 39) s, and the numbers in secondary hyperparathyroidism (SHPT) group were (1 548. 47 ± 323.83) s and (217. 55 ± 52. 42) s, respectively. Two months after ablation, the ablated region began to shrink, and RFA was superior to MWA regarding the speed and extent of shrinkage. At the end of twelfth month, ultrasound scanning revealed that the ablated region was completely dissolved in 73. 1%(19/26) of nodules in PHPT group and 53. 6% (156/291) of nodules in SHPT. Pre-ablative 99mTc-MIBI disclosed 93. 1% (295/317) of the parathyroid lesions and none of them were visible after ablation. Ultrasound elastography disclosed hardening of the ablated region, and it gradually became soft, paralleling with shrinkage of the ablated region. Serum PTH level decreased rapidly after ablation, particularly in PHPT patients. In the later course PTH levels had relapse in some patients, but the relapses were quite different in timing and extent between PHPT and SHPT groups. Two cases with hyperparathyroidism crisis regained consciousness two hours after ablation therapy. Conclusion Ultrasound-guided percutaneous thermal therapy of parathyroid benign nodules is a new modality of surgical intervention for hyperparathyroidism. The ablative procedure is precise, accurate, safe, and time-saving. The lesion can be completely inactivated and the absorbed. Rapid dropping of PTH level makes it valuable for emergency treatment of crisis. The relapse of PTH may indicate new parathyroid lesion.
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Objective To determine the parathyroid hormone (PTH) content in ultrasound-guided fine-needle aspiration sample of normal parathyroid based on ultrasound characteristics previously screened out, so as to verify the reliability of the ultrasound characteristics of normal parathyroid. Methods Between Oct. 2012 and Jan. 2013, 10 healthy volunteers were enrolled in the present study after obtaining written informed consent and approval by the ethics committee of our institution. Ultrasound-guided percutaneous aspiration from both the ultrasonic parathyroid area and well-recognized neck lymph node was conducted by using 22G fine needles. The aspirates were taken for cytology purpose and the washing of the left-over in the canula was taken for PTH evaluation by electrochemiluminescence. Simultaneously samples of venous blood were obtained also for PTH evaluation as controls. Results The aspiration procedures were successfully for all the 10 subjects, and cytological examination all found cells, with no intraoperative or and postoperative complications. PTH level in the washing of left-over extracted from the parathyroid aspirates averaged (287. 12 ± 35. 41) pg/mL and ranged 232. 53-357. 38 pg/mL, and that from the lymph node averaged (16. 03 ± 8. 47) pg/mL and ranged 8. 67-34. 28 pg/mL; while the serum PTH level averaged (37. 44 ± 7. 26) pg/mL and ranged 32. 64-47. 85 pg/mL. Three of the ten aspirates of parathyroid did not have enough cells to make predication, and the other seven aspirates had enough cells, with four likely from parathyroid and three from indefinite origins. All the ten aspirates from the lymph node areas were confirmed to have definite lymphocytes. Conclusion PTH evaluation results by fine-needle washing after ultrasound-guided aspiration are highly consistent with the ultrasonic parathyroids and lymph nodes, which preliminarily proves the reliability of the previously identified ultrasound characteristics of normal parathyroids.
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Objective To screen for and validate the principal ultrasonographic features of normal human parathyroid glands, so as to provide guidance for diagnostic ultrasound in parathyroid pathologies and protection of normal parathyroid during total thyroidectomy. Methods From Apr. 2008 to Dec. 2012, the neck ultrasonograms focusing on the thyroids and adjacent structures were obtained from 600 healthy subjects. One-by-one identification and exclusion was performed based on anatomical evidences, and the most probable parathyroid images (termed as presumed parathyroid sonogram) of normal human parathyroid were obtained. Based on those presumed parathyroid sonograms, we compared the detection rates of parathyroid in subjects with or without hypoparathyroidism following total thyroidectomy, and we also analyzed the ultrasonic features of patients with hyperparathyroidism. Moreover, we assessed the influence of intraoperative ultrasonography on the occurrence of hypoparathyroidism following total thyroidectomy. The accuracy and reliability of the presumed parathyroid sonogram were discussed. Results It was verified that the normal parathyroid appeared as a small well-circumscribed nodule with fine and homogenous internal hyperechoes. Their configuration varied, with oval shape as the commonest one; the texture was softer than that of adjacent thyroid parenchyma, with the quantitative strain ratio below 1 on elastography. About 62. 5% of the normal parathyroids were filled with color Doppler flow signals. The gland was small, with the mean length, width, and thickness being (6.38 + 1.46), (3.76 + 1.02), and (2.75 + 1.99) mm, respectively, and the mean volume was (0.13 + 0.06)mL by VOCAL method. The inferior glands were much better displayed than the superior ones. As for the patients who had experienced a total thyroidectomy, among five cases complicated with postoperative hypoparathyroidism, 4 (80%) developed the absence of parathyroid on ultrasonography, which was not seen in 35 patients with normal parathyroid function. As for the patients with hyperparathyroidism, normal parathyroid glands were invisible in the area of adenomatous or hyperplastic parathyroids. One patient (3. 3%) with intraoperative ultrasonography and six patients (20%) without intraoperative ultrasonography developed postoperative hypoparathyroidism (P<0. 01). Two patients with thyroid agenesis showed 2 normal ipsilateral normal parathyroids. Conclusion In the present study we have successfully obtained the ultrasonic features of normal parathyroids using non-invasive research strategies, which have been preliminarily validated in clinical application.
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Objective To quantitatively analyze and compare the texture features of thermal and chemical lesions on the porcine striated muscle, in vitro extracted from high-frequency ultrasonograms using computer-assisted image analysis technique, and to investigate the application values. Methods The thermal lesion and chemical lesion were induced in vitro in porcine striated muscle by microwave ablation and anhydrous acetic acid injection, respectively. The two dimension (2D) ultrasonographic ifndings were qualitatively compared between the groups of thermal and chemical lesion models, in which eight textural features in geometric mathematics extracted from 2D ultrasonograms were quantitatively analyzed by a technique of computer-assisted image analysis named multiscale decomposition method of echo intensity of interface relfections. Results As expected, microwave ablation and anhydrous acetic acid caused signiifcant changes of several texture features extracted from ultrasonograms. There were significant differences between the normal group and microwave ablation group in grayscale mean (Mean), irregularity (IRGL) and periodicity of distribution (POD) as follows (Mean: 1.9143±0.2914 vs 1.2334±0.3357, t=-5.306, P=0.000; IRGL: 0.5577±0.0334 vs 0.5092±0.0459, t=-2.957, P=0.007; POD: 0.000 27±0.000 005 vs 0.000 29±0.000 008, t=4.782, P=0.000). There were signiifcant differences between the normal group and anhydrous acetic acid injection group in number of blobs (NOB), size of blobs (SOB) and periodicity of distribution (POD) as follows (NOB: 51.0324±13.6998 vs 31.6042±4.8315, t=4.633, P=0.000; SOB:16.4843±3.9349 vs 25.6230±2.3555, t=6.903, P=0.000;POD:0.000 26±0.000 015 vs 0.000 29±0.000 008, t=-4.459, P=0.000). For each group of injured regions, there were significant differences between the microwave ablation group and anhydrous acetic acid injection group in Mean, IRGL, NOB and SOB as follows (Mean: 1.2664±0.2688 vs 1.9143±0.2914, t=-5.661, P=0.000; IRGL: 0.5220±0.0422 vs 0.5577±0.0334, t=-2.295, P=0.032;NOB:51.0324±13.6998 vs 34.5856±2.6362, t=4.048, P=0.000;SOB:16.4843±3.9349 vs 25.3176±2.3501, t=-6.676, P=0.000). Conclusion Technique of computer-assisted image analysis named multiscale decomposition method of echo intensity of interface relfections, based on multiscale blob features extraction, was useful to differentiate ultrasonic texture features between the groups injured in our study, which established quantitative muscle ultrasound as a practical and reliable tool for the muscle injury diagnosis to distinguish the structural changes induced by different physiochemical factors.
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Pulmonary sparganosis mansoni is rare in humans and bronchial sparganosis mansoni has not been reported. We reported a patient with a soft-tissue mass in the right hilum area on a chest computed tomography (CT) scan that was suspected of being lung cancer. Bronchoscopy identified sparganum larvae. Bronchial sparganosis mansoni accompanied by abnormal hyperplasia was diagnosed by histopathology. We introduced our experience and reviewed the clinical characteristics of three pulmonary sparganosis mansoni cases and three pleural cavity sparganosis mansoni cases that have been reported.
Subject(s)
Aged , Humans , Male , Bronchi , Pathology , Bronchial Diseases , Pathology , Bronchoscopy , Hyperplasia , Schistosomiasis mansoni , Pathology , Sparganosis , PathologyABSTRACT
<p><b>OBJECTIVE</b>To study the prevalence of Tannerella forsythensis (T. forsythensis) in the subgingival plaque of type 2 diabetes, analyze the relationship between Tforsythensis and related factors, discuss the role of T. forsythensis in the chronic periodontitis and type 2 diabetes.</p><p><b>METHODS</b>160 subgingival plaque samples were collected from type 2 diabetic patients and pathogens genomic DNA were extracted by phenol and chloroform from plaque. T. forsythensis was detected by polymerase chain reaction, and Pearson correlation and Logistic regression analysis were used to analyze the relationship between T. forsythensis and systemic factors and periodontal status.</p><p><b>RESULTS</b>The prevalence of T. forsythensis in mild, moderate, severe periodontitis group was 47.82%, 48.71%, 67.39% respectively, and the prevalence was higher in the severe periodontitis group than in mild, moderate group (P < 0.05). There was no T. forsythensis in 6 diabetic patients with healthy periodontium. Logistic regression analysis illustrated that the prevalence of T. forsythensis was associated with simplified oral hygiene index (OHI-S) and diabetic duration (OR = 1.947, OR = 0.873).</p><p><b>CONCLUSION</b>The prevalence of T. forsythensis in type 2 diabetes with chronic periodontitis was related with oral hygiene, periodontal status and diabetic duration.</p>
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Aged , Humans , Bacteroides , Chronic Periodontitis , Dental Plaque , Diabetes Mellitus, Type 2 , Periodontitis , Polymerase Chain Reaction , Porphyromonas gingivalis , PrevalenceABSTRACT
<p><b>OBJECTIVE</b>To detect the putative periodontal pathogens in the subgingival plaque of chronic periodontitis (CP) patients with type 2 diabetes mellitus (DM) and to discuss the role of the periodontal pathogens in the CP and type 2 DM patients.</p><p><b>METHODS</b>The study included 154 CP patients with type 2 DM (DM graup), one hundred and twenty subjects with CP (CP group) and 40 healthy subjects. Subgingival plaque samples were obtained with sterile subgingival curettes and pathogens genomic DNA were extracted by phenol and chloroform from plaque. Taking Porphyromonas gingivalis (Pg), Actinobacillus actinomycetemcomitans (Aa), Fusobacterium nucleatum (Fn), Prevotella intermedia (Pi), Tannerella forsythia (Tf) and Treponema denticola (Td) as aim pathogens, polymerase chain reaction (PCR) method was used to determine the prevalence of Pg, Aa, Fn, Pi, Tf and Td in the subgingival plaque samples.</p><p><b>RESULTS</b>Pg, Aa, Fn, Pi, Tf and Td were all found in the subgingival plaque of DM group. In serious periodontitis, the detection rate of Pg, Aa and Tf in DM group [Pg: 78% (72/92), Aa: 27% (25/92), Tf: 67% (62/92)] was significantly higher than in the CP group [Pg: 58% (35/60), Aa: 17% (10/60), Tf: 43% (26/60)], P < 0.05. In slight periodontitis, the detection rate of Pi in DM group was significantly lower than in the CP group. At the same time, the average gradation (AVG) ratio of PCR product of Aa and Tf in DM group was significantly higher than in the CP group and the AVG ratio of Pi in DM group was significantly lower than in the CP group (P < 0.05).</p><p><b>CONCLUSIONS</b>Compared with the pure CP, the quantity of Pg, Aa and Tf in the subgingival plaque of the periodontitis patients with type 2 DM increased, but the Pi quantity reduced.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Aggregatibacter actinomycetemcomitans , Chronic Periodontitis , Microbiology , Diabetes Mellitus, Type 2 , Microbiology , Fusobacterium nucleatum , Gingiva , Microbiology , Polymerase Chain Reaction , Porphyromonas gingivalis , Prevotella intermedia , Treponema denticolaABSTRACT
<p><b>OBJECTIVE</b>To evaluate the clinical outcome of periodontal initial therapy on the patients with aggressive periodontitis.</p><p><b>METHODS</b>A total of 48 patients with aggressive periodontitis, including 20 patients with localized aggressive periodontitis (LAgP) and 28 patients with generalized aggressive periodontitis (GAgP), were chosen for the study from the patients referred to the Department of Periodontology of the School of Stomatology of China Medical University from September 2006 to December 2008. All subjects were performed periodontal initial therapy. Probing depth (PD), clinical attachment loss (CAL), bleeding index (BI) and tooth mobility were recorded at baseline and 1, 3 and 6 months after initial treatment.</p><p><b>RESULTS</b>At 1, 3 and 6 months after periodontal initial therapy, there were significant improvements in PD, CAL, BI and tooth mobility of patients with LAgP and GAgP than those in the baseline (P < 0.05). In patients with LAgP, statistical differences were detected in PD and CAL between 1 and 3 months after periodontal initial therapy (P < 0.05). And in patients with GAgP, statistical differences were detected in PD and CAL between 3 and 6 months after therapy (P < 0.05). At 1, 3, and 6 months after therapy, first molars of all patients showed more significant therapeutic effects than central incisors (P < 0.05).</p><p><b>CONCLUSION</b>Periodontal initial therapy showed effectiveness in treatment of aggressive periodontitis. In the mid-term, there were differences in therapeutic effect between patients with LAgP and GAgP.</p>
Subject(s)
Adult , Female , Humans , Male , Aggressive Periodontitis , China , PeriodontitisABSTRACT
Objective: To introduce our experience on treatment of melanoma metastasis to lymph nodes by percutaneous radiofrequency ablation combined with microwave coagulation therapy under contrast-enhanced ultrasound guidance and to assess the subsequent clinical efficacy. Methods: The 64 years old male patient with right sole melanoma had an enlarged right inguinal lymph node and received surgical resection twice within 9 months. During the following 2-7 months, more than 20 enlarged lymph nodes appeared along the right iliac artery and right lower limb, complicated with lower limb swelling. Surgical resection was ruled out due to the involvement of the iliac artery and the great number of the enlargements. Chemotherapy and Chinese herb medication were proven to be less effective, then a combined thermotherapy by radio frequency ablation (CelonLab-ENT, Germany) and microwave coagulation (YWY-2T, China) was employed percutaneously under the guidance of contrast-enhanced ultrasound for the treatment. The patient was followed up for 6 months. Results: Intra- and post-operation contras-enhanced ultrasound scanning and biopsy pathology showed avascularity, necrosis, and atrophy in all the treated lymph nodes, with no obvious complications. The general condition of the patient was good and there was no new lesion found in other sites, except a few ones still receiving ablation in the right lower limb. Conclusion: Percutaneous radiofrequency ablation combined with microwave coagulation therapy under the guidance of contrast-enhanced ultrasound shows a stable killing effect for melanoma metastasis to lymph nodes in this patient, without obvious complications, and should be considered for more clinical applications.
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Objective: To summarize the ultrasound features of renal arteriovenous fistula (RAVF) under various ultrasound imaging modes, so as to avoid missed diagnosis of RAVF on initial ultrasound examination. Methods: The clinical data of 6 patients with RAVF, including the ultrasound evidence, the timing of ultrasound diagnosis, the modes of ultrasound diagnosis, and the agreement between ultrasound diagnosis and selective renal arterial angiography, were retrospectively analyzed. Results: 2D ultrasound had 1 case of correct diagnosis, 1 case of misdiagnosis and 4 cases of missed diagnosis. Color Doppler and spectral Doppler both had all the 6 cases correctly diagnosed. Ultrasound angiography in 3 cases demonstrated that the contrast agent reached the renal veins earlier than reached the renal parenchyma; large fistula lumen was associated with ischemia of downstream areas. 3D ultrasound vividly reflected the structure of fistula lumen volume, and provided us with the profiles of blood signal in fistula at different planes and angles, improving our knowledge of blood flow on the fistula. Conclusion: Ultrasound is the first line screening method for RAVF. Color Doppler plays a decisive role in the diagnosis of RAVF and pulsed spectral Doppler plays a synergetic role and contributes to differential diagnosis. Contrast-enhanced ultrasound may help to discover the abnormality of venous circulation and the ischemic parenchyma area due to shunting. 2D ultrasound has a poor diagnostic value and is liable to lead to misdiagnosis and missed diagnosis.
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Objective: To assess the diagnostic value of oral SonoVue in contrast-enhanced ultrasound examination of stomach, so as to pave a way for future clinical research and application. Methods: Four patients with pathologically-confirmed advanced gastric cancer underwent contrast-enhanced ultrasound examination of stomach using the following 3 contrast strategies: oral intake of Chinese herb solution, oral intake of SonoVue solution and intravenous injection of SonoVue. The 3 sonograms of each patient were reviewed, in a blind manner, by 9 ultrasound specialists taking into consideration of the following 6 indications: the clearness of tumor on the gastric internal surface, the appearance of tumor ulceration, the appearance of tumor intrusion, width of tumor infiltration, depth of tumor infiltration, and gastric obstruction severity. The findings were statistically analyzed and the diagnostic value of oral SonoVue for gastric diseases was assessed. Results: Oral intake of SonoVue solution obtained the best sonogram among the 3 contrast strategies. The inter-observers variability was minimal for sonograms of patients in oral SonoVue group considering the first 3 and the last indications mentioned above; the variability was minimal for sonograms of patients who received intravenous injection of SonoVue considering metastasis degree and infiltration depth. Conclusion: Oral gastric contrast-enhanced ultrasound examination using oral SonoVue is stable in demonstrating gastric cancer. The quality of sonograms using oral SonoVue is better than that using oral Chinese herbs.
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Objective: To evaluate the perfusion defect of superficial lesions by high-frequency contrast-enhanced ultrasound through comparing the results of low-frequency and high-frequency contrast-enhanced ultrasound, and to put forward the preliminary countermeasures. Methods: Twenty-three patients (9 male and 14 female, aged 45.87 ± 9.32 years, ranging 34-73 years) with 6 sorts of superficial lesions, including 1 parotid pleomorphic adenoma, 3 thyroid adenomas, 5 thyroid adenocarcinomas, 5 cervical metastases, 7 breast carcinomas and 2 of testicular seminomas, were examined by both low-frequency and high-frequency contrast-enhanced ultrasounds. CEUS with SonoVue under CPS-Cadence mode was performed for each lesion using abdominal probe (low-frequency probe) 5 min before small parts probe (high-frequency probe). ACQ software was used to determine the peak intensity (PI) and the results were analyzed by Student's t test in pairs. Results: The PI values of all the 6 types of lesions were significantly lower in high-frequency contrast-enhanced ultrasound images than those in the low-frequency contrast-enhanced ultrasound images (P<0.001). Conclusion: The micro-vascular enhancement of superficial lesions by high-frequency CEUS might be lower than the real enhancement intensity. Abdominal low-frequency probe should be recommended for revealing the perfusion status of superficial lesions after high-frequency probe, which is used for observing the morphology and internal structures of superficial lesions.
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Objective: To investigate the safety and efficacy of percutaneous microwave ablation (PMWA) for huge liver cavernous hemangiomas(LCHs), and to assess the potential advantages of extracting blood from the hemangioma during the ablation procedures. Methods: A water-cooled microwave antenna named KY-2100 compatible with a frequency of 2,450 MHz generator was used to perform heating ablation in 19 patients for their LCHs guided by contrast-enhanced ultrasound under general anesthesia; the patients had multiple LCHs, at least with one having a diameter longer than 6 cm. Twenty lesions matched in their maximal size in 10 patients were ablated assisted with or without extracting blood from the hemangiomas. The relevant factors for the safety and ablation duration, thoroughness of ablation, and complications were comprehensively assessed. Results: The ablation durations varied from 39 to 163 min in the 19 patients, with an average of (93±39.85) min. For those maximum-length matched lesions, blood extraction significantly shortened the ablation duration compared to non-blood extraction group ([29.61±14.07] min vs [41.57±14.93] min, P<0.05). Except for slight elevation of serum ALT level ([133.58±46. 29] U/L) in 75% patients, there were no other complications such as intra-peritoneal bleeding, bile leakage, or hemoglobinemia. The average hospital stay was (4±0.95) days. All the ablated LCHs shrank markedly, with the maximal diameter decreased by 82.54%. The hemangioma-induced symptoms were relieved in all patients. Conclusion: PMWA is technically feasible, safe and effective for treating LCHs. It can be an attractive alternative for surgical resection of hemangiomas at high-risk locations. And prompt extraction of focal blood can reduce the bleeding risk and shorten ablation duration.
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<p><b>OBJECTIVE</b>To investigate the type 2 diabetic patient's periodontal condition and to analyze the influencing factors of periodontitis.</p><p><b>METHODS</b>A total of 182 type 2 diabetic patients were included in the survey and requested to fill out a questionnaire, and their periodontal status was evaluated by measuring probing depth (PD), attachment level (AL), sulcus bleeding index (SBI), simplified oral hygiene index (OHI-S).</p><p><b>RESULTS</b>The prevalence of periodontitis in this group of patients was 96.7% (176/182), including 20 patients with mild periodontitis, 156 with moderate to advanced periodontitis. The mean PD and AL of the 182 patients were (2.92 +/- 0.67) mm and (2.87 +/- 1.31) mm. At least one tooth was lost in 57.1% (104/182) of the patients. The factors related to periodontitis were age, gender, smoking, living in town or country, and 2 h plasma glucose of oral glucose tolerance test (OGTT). There was no relationship between the severity of periodontitis and education level. The majority of patients did not receive any periodontal therapy.</p><p><b>CONCLUSIONS</b>Periodontal status was bad in patients with type 2 diabetes. It is important to develop an education program on oral health for type 2 diabetic patients.</p>