Avaliação ultrassonográfica de variações anatômicas entre vasos femorais realizada por estudantes de medicina / Ultrasonographic evaluation of anatomical variations in femoral vessels done by medical students

Introdução: A punção venosa central é um procedimento médico tradicionalmente realizado seguindo os marcadores anatômicos como referência para atingir o vaso, às cegas. No entanto, nem sempre o sucesso nessa técnica é alcançado, fato que se deve principalmente às variações anatômicas. A ultrassonografia point of care (US-POC) é utilizada para auxiliar a cateterização central por visualização direta do vaso, aumentando a segurança do procedimento. Objetivo: Avaliar a prevalência das variações anatômicas de vasos femorais através da utilização da US-POC por estudantes de medicina submetidos a curto período de treinamento. Material e Métodos: Cinco estudantes de medicina, sem experiência prévia em US-POC, foram submetidos a oito horas de treinamento teórico-prático. Foram avaliados os vasos femorais de cem voluntários. Resultados: A veia femoral direita foi encontrada mais frequentemente na posição medial (43%) em relação à artéria femoral direita. À esquerda, a posição posteromedial foi a mais observada (45%).Conclusão: A técnica tradicional de punção de acesso central se baseia em marcadores anatômicos e não leva em consideração as variações anatômicas existentes. Um treinamento de curto período para uso da US-POC é capaz de capacitar o profissional para reconhecer o posicionamento real dos vasos e evitar punções inadvertidas.

Introduction: Central vein puncture is a medical procedure traditionally done following anatomical landmarks as a reference to successfully achieving the vessel. However, this traditional technique is commonly unsuccessful due to anatomical variations that may be found. Point of care ultrasonography (POC-US) is used to assist central catheterization by directly visualizing the vessel, increasing procedure security and minimizing risks. Objective: Evaluate anatomical variations prevalence in femoral vessels, utilizing POC-US, done by medical students submitted to a short period of time training in ultrasonography. Material and Methods: Five medical students, without previous experience on the use of ultrasonography, were submitted to an eight-hour theorical practical training in POC-US. The students evaluated one hundred femoral vessels of volunteers. Results: The right limb femoral vein was found more frequently in the medial position (43%) in comparison to the right limb femoral artery. On the left limb, the posteromedial position was the most found (45%). Conclusion: The insertion of a central catheter following the traditional technique is based on anatomical landmarks, and does not take into account existing anatomical variations. With a short period of training, POC-US is capable of qualifying professionals to acknowledge the real location of the vessel and avoid inadvertent punctures and complications.

Effect of shear wave elastography in predicting pathological responses to neoadjuvant chemotherapy in patients with breast cancer / 中华超声影像学杂志

Objective:To investigate the clinical value of shear wave elastography (SWE) in predicting pathological responses to neoadjuvant chemotherapy in breast cancer.Methods:According to the postoperative pathological responses, 56 patients who received neoadjuvant chemotherapy followed by surgical excision in the Fujian Cancer Hospital from August 2019 to September 2020 were divided into responders and non-responders. The relative change rates of tumor maximum diameter(ΔD2, ΔD4) and SWE stiffness (ΔEmax2, ΔEmax4, ΔEmean2, ΔEmean4) were assessed before NAC and after different NAC cycles (t2, t4). Clinical information, including age, T, N stages, ER, PR, HER2, Ki67, and molecular subtype were also considered as the variables. The independent influencing factors of pathological responses after neoadjuvant chemotherapy were obtained by logistic regression analysis and diagnostic test was carried out.Results:There were 23 cases as responders (41.0%, 23/56), and 33 cases as non-responders (58.9%, 33/56). Results of multivariate analysis showed ΔEmax4 and HER2 index were independent influencing factors of pathological responses ( OR=1.11, P<0.001; OR=31.81, P=0.002). Area under curve of the ΔEmax4 (AUC: 0.869, 95% CI: 0.746-0.941) was higher than that of HER2 (AUC: 0.690, 95% CI: 0.545-0.834). The combination of ΔEmax4 and HER2 gave the best prediction of pathological responses (AUC 0.930, 95% CI: 0.829-0.981). the sensitivity, specificity, diagnostic accuracy, postive predictive value, and negative predictive value were 78.26%, 96.97%, 75.23%, 94.73%, and 86.49%, respectively. Conclusions:ΔEmax4 and HER2 are independent predictors of pathological responses after neoadjuvant chemotherapy for breast cancer. Combined ΔEmax4 and HER2 can improve the predictive diagnostic efficacy of pathological responses to chemotherapy for breast cancer.

Clinical significance of ultrasound in the diagnosis of uterine adnexal mass / 中国基层医药

Objective@#To study and explore the clinical significance of ultrasound in the diagnosis of uterine adnexal mass.@*Methods@#From January 2014 to December 2016, 160 patients with uterine adnexal cystic lesions in our hospital were selected.All the patients received ultrasound examination, the kinds of lesions were judged, and according to the results of pathological diagnosis of operation, pathological diagnosis of biopsy and clinical follow-up, the consistency between ultrasonic diagnosis and confirmed diagnosis results was analyzed.@*Results@#Of 160 cases with adnexal cystic lesions, a total of 36 cases of endometrial ectopic cyst, 37 cases of ovarian cystadenoma, 19 cases of tubal ectopic pregnancy, 28 cases of inflammatory mass, 19 cases of ovarian cystadenocarcinoma, 21 cases of teratoma.After calculation, ultrasound examination of the uterus endometriosis cyst, cystadenoma of ovary, fallopian tube ectopic pregnancy, inflammatory mass, ovarian cyst, teratoma were 91.67%, 91.89%, 84.21%, 89.29%, 89.47%, 90.48%, respectively, and confirmed the consistency with the results, there were no statistically significant differences (χ2=0.166, 0.163, 0.291, 0.206, 0.125, 0.114, all P>0.05).@*Conclusion@#Ultrasound in the diagnosis of uterine adnexal cystic lesions can effectively detect and distinguish different types of lesions, it has high diagnostic value.

Value of modified TI-RADS in the diagnosis of medullary thyroid carcinoma / 中华肿瘤杂志

Objective@#To investigate the value of modified thyroid imaging reporting and data system (TI-RADS) in the sonographic diagnosis of medullary thyroid carcinoma (MTC), and to evaluate the sonographic differences among MTC, papillary thyroid carcinoma (PTC) and benign nodules in order to improve the ultrasound diagnostic accuracy of MTC.@*Methods@#646 cases of thyroid lesions confirmed by pathology in our hospital were divided into the MTC group (64 cases), PTC group (414 cases) and benign group (168 cases). The ultrasonographic characteristics of these groups were retrospectively analyzed. All of the 646 cases were classified by modified TI-RADS grading criteria. The diagnostic accuracy of MTC and ultrasonic manifestations of MTC, PTC and benign nodular were assessed.@*Results@#The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of modified TI-RADS for MTC were 87.5%, 89.9%, 72.6%, 88.8%, and 67.2%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of modified TI-RADS for PTC were 96.1%, 59.5%, 85.4%, 86.2% and 85.6%. The intraclass correlation coefficient (ICC) of three different physicians for thyroid nodules was 0.983 by the modified TI-RADS. MTC were mostly located in middle and upper parts of the thyroid (85.9%, 55/64), hypoechoic or extremely hypoechoic (89.1%, 57/64), with relatively smooth margin (35.9%, 23/64), aspect ratio<1 (53.1%, 34/64), abundant blood flow (31.2%, 20/64), and high lymph node metastasis rate (51.6%, 33/64). These differences were statistically significant when compared to PTC (P<0.05).@*Conclusions@#Repeatability of modified TI-RADS for MTC was high, and is slightly lower than that for PTC. MTC had specific features: mostly located in middle and upper parts of the thyroid, hypoechoic or extremely hypoechoic, relatively smooth margin, aspect ratio<1, abundant blood flow and high lymph node metastasis rate.

A Retrospective Analysis of Ultrasonographic Misdiagnosis of Thyroid Multiple Nodules With Thyroid Carcinoma / 昆明医科大学学报

Objectives To explore the ultrasonic features in the differential diagnosis of thyroid multiple nodules with thyroid carcinoma and summarize the causes of misdiagnosis,and to improve the accuracy of ultrasonic diagnosis of thyroid carcinoma.Methods The ultrasound images from the 40 patients with thyroid carcinoma were selected,whose diagnosis of thyroid carcinoma was confirmed by the pathological examinations after surgery but misdiagnosed or not identified by ultrasound examination.These ultrasound images were retrospectively analyzed through observing the carcinomatous nodules in size,aspect ratio,shape,border,envelope,internal echo,calcification characteristics,posterior echo,acoustic halo,the distribution of blood flow,and the relationship with thyroid capsule and anterior organization,whether to transfer to neck or spraclavicular lymph nodes,and the performance of elasticity imaging,and then these features were compared with the ultrasonic features of the benign thyroid nodules.Results The ultrasonic features of thyroid multiple nodules with thyroid carcinoma were complicated and each nodule should be observed and analyzed individually.The ultrasonic features of carcinomatous nodules were:(1) irregnlar shape,(2)aspect ratio ≥ 1,(3)unclear border,(4)no capsule,(5)heterogeneous hypo echo inside of the carcinomatous nodules,(6)scattered distribution of clustered microcalcifications,(7)incomplete acoustic halo or absent,(8)blood supply to the centrality inside of the carcinomatous nodules,(9)invaded thyroid capsule and anterior organizations,(10)transformation to neck or supraclavicular lymph nodes in the minority of patients,(11) elasticity imaging score of 3 ～ 5.Conclusions It is quite difficult to identify the ultrasonic features of thyroid multiple nodules with thyroid carcinoma and it is with high misdiagnosis rate.A comprehensive analysis of sonographic features is essential in clinical practices,and it will contribute to improving the accuracy of the ultrasonic diagnosis of thyroid multiple nodules with thyroid carcinoma.

Ecobiometria ocular de cães glaucomatosos / Ocular echobiometry in glaucomatosus dogs

Foram estudados olhos glaucomatosos de cães referidos no serviço de diagnóstico por imagem. Os pacientes foram submetidos à ultrassonografia em modo B de alta resolução para realização de biometria ocular, por meio da qual foram realizadas as seguintes medidas: espessura central da córnea, profundidade da câmara anterior, espessura da lente e profundidade da câmara vítrea. Para tal, foi realizada contenção física e instilado colírio anestésico. Foram aferidas a PIO e a paquimetria da córnea e, em seguida, foi realizada a ultrassonografia em modo B nos dois olhos. Além da diferença óbvia de PIO, maior nos bulbos glaucomatosos, os resultados mostraram-se estatisticamente significativos em dois parâmetros: aumento da profundidade da câmara vítrea nos casos de glaucoma crônico (1,24±0,26cm; P=0,01) quando se comparou aos olhos controle e aumento da espessura da córnea também nos casos de glaucoma agudo (0,987±0,28cm; P=0,027), quando se comparou aos olhos controle e aos olhos com glaucoma crônico. Observou-se que a câmara vítrea é a estrutura intraocular que mais contribui no processo de expansão de volume do bulbo (buftalmia) durante o glaucoma...

Dogs with glaucomatous eyes referred to the Diagnostic Image Service at the Veterinary Hospital in the Federal University of Parana were studied using B-mode ultrasonography. Patients were submitted to a high resolution B-mode ultrasonography examination in order to perform ocular echobiometry. The following measurements were performed: central corneal thickness, anterior chamber depth, lens thickness and vitreous chamber depth. Physical restraint was performed and anesthetic eye drops were used. Corneal pachymetry and IOP were evaluated first and then B-mode ultrasonography was carried out in both eyes. Besides an obvious difference in IOP, which is higher in glaucomatous eyes, vitreous chamber depth significantly increases in cases of chronic glaucomatous eyes (1.24±0.26cm P=0.01), when compared to control eyes; and corneal thickness also increases in cases of acute glaucoma (0.987±0.28cm P=0.027), when compared to control eyes and to chronic glaucomatous eyeballs as well. Vitreous chamber is the intraocular structure that most contributes to the process of volume expansion of the globe (buphthalmos)...

Value of ultrasound imaging on atherosclerosis of abdominal aorta in rabbits / 中华老年医学杂志

Objective To evaluate the agreement between contrast-enhanced ultrasound imaging and histopathology in rabbit model of abdominal aortic atherosclerosis (AS)in early and development period.Methods Twenty-four healthy Japanese white rabbits were randomly divided into three groups:control group,hypercholesterolemic diet group for 8 weeks and 16 weeks (each for 8 rabbits).Contrast-enhanced ultrasonography for abdominal aorta was performed using sonicated perfluorocarbon albumin contrast agent.Imaging characteristics of abdominal aorta plaque of rabbits were monitored by two-dimensional mode,ultrasound visual grades were analyzed quantitatively before and after injection of contrast agent.Histopathologic changes were observed by HE staining.Results Contrast-enhanced ultrasound imaging allowed early detection of AS and showed gradual progression of atherosclerosis over time.After contrast agent injected,intimal indentification and plaques checking-out ratio were improved.The ultrasound visual grades were increased after contrast imaging in hypercholesterolemic diet group for 8 weeks [(2.26± 0.27)vs.(1.79 ±0.25)] and 16 weeks [(3.54 ±0.43) vs.(3.20 ±0.25)] (all P＜0.05).The plaque detection rate was improved after contrast-enhanced ultrasound imaging than before angiography in hypercholesterolemic diet group for 8 weeks [77.8％ (7/9) vs.55.6％ (5/9)] and 16 weeks [88.2％ (15/17) vs.70.6％ (12/17)](P ＞ 0.05).The imaging of ultrasound agreed well with pathological examination results.Conclusions Contrast-enhanced ultrasonography can effectively improve intimal and plaque imaging,and increase the detection accuracy of early and progressive pathology.

Evaluation of cystic renal mass with contrast enhanced ultrasonography / 中华泌尿外科杂志

Objective To investigate the value of contrast enhanced ultrasonography in evaluating cystic renal mass. Methods According to the imaging diagnosing standard, 29 cystic renal mass lesions were studied with contrast enhanced ultrasonography(CEUS), unenhanced ultrasonography (US), contrast enhanced CT(CECT) and then correlated their results with final histopathological results. The data were tested by receiver operating characteristic(ROC) curve. Results The area under ROC curve of CEUS and US was 0. 721, 0. 997, respectively. There was significant difference between the 2 groups (P=0. 003). The area under ROC curve of CEUS and CECT was 0. 997, 0. 997,respectively. There was no significant difference between the 2 groups (P= 1. 000). Conclusions CEUS is better than US and similar to CECT in evaluating cystic renal mass. CEUS with the Bosniak classification is useful for evaluating cystic renal mass.

Effect of ultrasound-guided transverses abdominis plane block on efficacy of postoperative analgesia in patients undergoing abdominal hysterectomy / 中华麻醉学杂志

Objective To investigate the effect of ultrasound-guided transverses abdominis plane (TAP)block on the efficacy of postoperative analgesia in patients undergoing abdominal hysterectomy. Methods Sixty ASA Ⅰ - Ⅱ patients scheduled for abdominal hysterectomy under general anesthesia were randomly divided into 2groups (n = 30 each): ropivacaine group (group R) and normal saline (group NS). After induction of anesthesia,ultrasound-guided bilateral TAP block was performed, and 0.375% ropivacaine 40 ml was injected in group R,while the equal volume of normal saline was used instead in group NS. The patients received patient-controlled intravenous analgesia (PCIA) with sufentanil after operation. The VAS score was maintained ≤ 3, the level of sedation was evaluated with Ramsay sedation score, and the comfort level was evaluated with Bruggrmann comfort scale (BCS) score at 2, 6, 8, 12 and 24 h after operation. The hemodynamic parameters were recorded. The consumption of sufentanil during operation and within 24 h after operation, the number of successfully delivered doses ( D1 )and the number of attempts ( D2 ) within 24 h after operation were recorded. D1/D2 was calculated. The adverse reactions were also recorded. Results SP, DP, HR, SpO2 and RR were in the normal range and there was no significant differences between the two groups ( P ＞ 0.05). The consumption of sufentanil were significantly lower,while the BCS score and D1/D2 higher in group R than in group NS (P ＜ 0.05). There were no adverse reactions in both groups. Conclusion Ultrasound-guided TAP block reduces the perioperative sufentanil consumption and enhances the efficacy of postoperative analgesia in patients undergoing abdominal hysterectomy.

Evaluation of ventricular systolic and diastolic synchronicity in elderly patients with complete right bundle branch block by Doppler tissue velocity imaging / 中华老年医学杂志

Objective To evaluate the ventricular systolic and diastolic synchronicity in elderly patients with the complete right bundle branch block (CRBBB) by Doppler tissue velocity imaging (TVI) technology. Methods The 35 elderly CRBBB patients were selected as CRBBB group, while 31 healthy people were chosen as control group to evaluate myocardial function. The time to peak velocity at systolic and early diastolic phase (Ts and Te) in the base and interlude 14 segments of left and right ventricles was measured. The average time of Ts in right ventricular 2 segments(Ts-2-RV), Ts and Te in left ventricular 12 segments (Ts-12-LV and Te-12-LV), and the standard deviation in left ventricular 12 segments (Ts-12 SD and Te-12-SD), the maximum Ts and Te difference (Ts-diff and To-dill) were calculated. The left ventricular end-systolic and end-diastolic diameter (LVEDs and LVEDd) and volume (LVEVs and LVEVd) were measured. Results (1)The time to peak velocity at systolic phase in 14 segments of left and right ventricles was longer in CRBBB group than that in control group(P<0.05 or P<0.01). Compared with the control group, the Ts-12-LV,Ts-12-SD and Ts-diff showed significant prolongation (P<0.01). The Ts-2-RV was longer than Ts-12-LV in CRBBB group[(226.3±37.4 ) ms vs. (195.5±69.5) ms, P < 0.05]. (2) There was no significant difference in the time to peak velocity at early diastolic phase in 14 segments between CRBBB group and control group(P>0.05), but the Te-12-SD and Te-diff was longer in CRBBB group than that in control group (P< 0.01). (3) The LVEDs and LVEDd were obviously increased in CRBBB group compared with controls (P<0.05 and P<0.01), but no significant difference was showed in LVEVs and LVEVd(P>0.05). Conclusions Compared with normal people, the Ts at systolic phase is longer, especially in the right ventricle, the LVEDs and LVEDd are significantly increased, and the ventricular systolic and diastolic synchronicity is not well in CRBBB patients.

Pulsatility Index Detected by Carotid Ultrasonography Can Predict Increased Intracranial Pressure

PURPOSE: A rapid, portable, and noninvasive means of detecting increased intracranial pressure (IICP) is required when conventional imaging methods are unavailable. The purpose of this study is to show the predictive value of IICP using ultrasonographic measurement of pulsatility index (PI), through the common carotid artery. METHODS: We performed a prospective study of emergency department patients who have hemorrhage finding on brain conputed tomography (hemorrhage group) and normal group for 9 months prospectively. Hemorrhage group was divided into IICP group and non IICP group by brain CT findings. The PI was calculated using systolic flow velocity and diastolic flow velocity acquired from common carotid ultrasonography. For each patient, brain computed tomography (CT) was also evaluated for signs of IICP. RESULTS: 140 patients were enrolled; 70 patients were normal group and hemorrhage group included 70 patients; 38 had IICP (IICP group) and 32 had no signs of IICP on CT (non IICP group). Mean PI of normal group was 1.46+/- 0.30, non IICP group was 1.40+/-0.31 and mean PI value of IICP group was 2.39+/-0.78. Cutoff value was 1.69, sensitivity was 81.6% and specificity was 81.4%. CONCLUSION: The PI from common carotid artery is a simple, fast, and noninvasive procedure. The PI is a potentially useful tool the assessment of and themonitoring of patients suspected of having IICP.

Relationship between pregnancy-associated plasma protein A level and restenosis after elective coronary stenting / 中华老年医学杂志

Objective To investigate the relationship between pregnancy-associated plasma protein A(PAPP-A)level and restenosis after elective coronary stenting by coronary artery angiography(CAG)and intravascular ultrasound(IVUS). Methods The study consisted of 132patients with successful coronary stent placement:left anterior descending coronary artery(LAD)62,left circumflex coronary artery(LCX)36,right coronary artery(RCA)34.The follow-up CAG and IVUS were Derformed at the 6th month after stent placement.Diameter stenosis≥50%on CAG was regarded as in-stent restenosis.Neointimal areas(IA),stent volume(SV)and neointimal volume(IV)were measured by IUVS during follow-up.According to the PAPP-A level,lesions were divided into 2groups:high PAPP-A group(PAPP-A level≥12.11 mIU/L)and low PAPP-A group(PAPP-A level＜12.11 mIU/L). Results Total restenosis rate was 31.8%.There were no significant differences in age.sex and risk factors of coronary heart disease(hypertension,diabetes,smoking)between restenotic and nonrestenotie groups(all P＞0.05).The restenotic group had higher PAPP-A level than nonrestenotic group[(18.14±2.26)mIU/L vs. (10.95±2.12)mlU/L,P＜0.01].Angiographic restenosis occurred in 28 of 66 lesions(42.4%)in the high PAPP-A group and in 14 of 66 lesions(21.2%)in the low PAPP-A group(P＜0.01).Plasma PAPP-A level was positively correlated with IA,IV(r=0.47 and 0.54 respectively,all P＜0.05). Conclusions Elevated PAPP-A level is correlated well with the severity of the intimal hyperplasia.Plasma PAPP-A level affects restenosis after elective stent placement by promoting intimal hyperplasia.

Value of noneinvasive vascular examinations in diagnosing deep venous thrombosis / 中华全科医师杂志

Objective To evaluate the different value of color Doppler ultrnsonography and Doppler vascular examinations in diagnosis for deep venous thrombosis(DVT)in the lower extremities.Methotis Imaging of color Doppler ultrasound scanning was employed as diagnostic criteria for DVT on 178 lower extremities of 146 suspected patients,as compared to the result by Doppler vascular examinations.Results Color Doppler ultrasonograph showed hish accuracy in diagnosis for DVT,as compared to that by Doppler vascular examination with 97.9 percent(142/145)positive for the femoral and popliteal veins and relatively lower positive diagnostic vallie for thrombosis in the inferior vena cava,iliac vein,anterior tibial vein,posterior tibial vein and calf veins.Conclusions Color Doppler ultrasonography is superior to Doppler vascular examination in determining DVT of the lower extremities and can be used as a main diagnostic method for it.Doppler vasculiar examination can be used as an initial screening method for DVT and deep venous angiography should not be used as a routine diagnostic measure for it.

Use of Sonography in the Differential Diagnosis between Phylloides Tumor and Giant Fibroadenoma / 영남의대학술지

Phylloides tumor is very similar to giant fibroadenoma in that they have benign appearance in breast radiologic image. Fibroadenoma has no malignant potential, but phylloides tumor is locally recurrent, invasive and may occasionally metastasize. It thus appears that evaluation of the differential point of the two tumor groups by radiologic study is very important. We retrospectively compared sonographic find;.ngs of 6 cases of phylloides tumor with those of 4 cases of fibroadenoma, which proved pathologically in Ye mgnam University Hospital from 1984 to 1986. The mean age of the patients were 31.8 years old(from 14 to 41 years old) in phylloides tumor and 28.8 years old (from 17 to 40 years old) in giant fibroadenoma, respectively. The viewpoints of this analysis were size, shape and contour of the masses, internal echo pattern, posterior enhancement, and especially the existence of peripheral cyst or septal band echo. We found that diffenentiation of these two tumors by sonography was difficult. But peripheral cyst was found only in phylloides tumor and septal band echo was found largely in giant fibroadenoma. Although the existence of peripheral cyst or septal band echo in the breast mass was not pathognomonic findings, we suggest that the existence of septal band echo is preferential finding to fibroadenoma, and peripheral cyst is preferential finding to phylloides tumor.