1例新生儿先天性H型气管食管瘘诊断逐渐明确的过程

气管食管瘘系由于先天性胚胎发育异常形成气管与食管间由瘘道相连通的一种疾病。新生儿可出现进食呛咳和反流。本例为V型:占0.5%～6.5%,食管通畅,但有斜行瘘管向前上方与气管相通,又称H型。由于H型用橡皮导管插入食管时不会遇阻,所以本病诊断困难。     

11例新生儿先天性气管狭窄临床分析

目的 分析11例先天性气管狭窄(CTS)的临床资料.方法 回顾性分析2016年7月至2019年10月我院收治的CTS病例11例的临床资料,并文献复习CTS的相关诊疗方案.结果 11例CTS患儿中,男8例,女3例;由纤维支气管镜确诊6例,胸部CT(含气道重建)确诊5例.10例CTS患儿均有不同程度地青紫及呼吸困难,10例...     

症状不典型的子宫腹膜瘘1例报道

正1病例简介患者,女,46岁,因"下腹部包块"于2016年4月收入院。2011年患者带环妊娠,行取环术加人工流产术。2012年再次妊娠,药物流产失败后行人工流产术,自述清宫过程有撕裂样疼痛,后未诉不适。2013年患者子宫体后方扪及一直径约6~7cm包块,于外院行剖腹探查术。术中见子宫大小正常,子宫后壁与肠管、左侧附件粘连,分离粘连见左侧卵巢粘     

未明确诊断意义的宫颈不典型鳞状细胞患者86例病理分析

目的分析阴道脱落细胞学结果为未明确诊断意义的不典型鳞状细胞(atypical squamous cell of un-determined significance,ASCUS)患者的组织病理,为临床上治疗方法的选择提供依据。方法对2002年1月至2003年6月在新疆医科大学附属肿瘤医院就诊的86例阴道脱落细胞学TBS分类检查结果为ASCUS的患者在阴道镜下取活检。结果86例患者中炎症55例(63.9%),轻度不典型增生7例(8.1%),中度不典型增生14例(16.3%),重度不典型增生5例(5.8%),原位癌3例(3.5%),宫颈癌2例(2.3%)。结论阴道脱落细胞学结果为ASCUS的患者,其病理组织学检查结果范围广,必须在阴道镜下取活检明确诊断,为临床治疗方法的选择提供合理的依据。     

新生儿青紫型先天性心脏病156例的早期诊治分析

目的 了解青紫型先天性心脏病在新生儿期的临床表现、分布情况、治疗和转归。方法 1999年11月至2004年7月上海儿童医学中心对156例青紫型先天性心脏病(CHD)新生儿进行临床分析。结果 (1)青紫型CHD在新生儿期主要表现为中央性紫绀、心功能不全，个别可合并心律紊乱。(2)新生儿期青紫型CHD以完全性大动脉转位(TGA)居首位，其他依次为肺动脉闭锁(PA)、完全性肺静脉异位引流(TAPVC)和肺动脉狭窄(PS)。(3)内科治疗包括强心、利尿、扩血管药物和前列腺素E1(PGE1)的运用；156例中57例施行外科手术，其中以TGA最多。结论新生儿青紫型CHD心脏畸形复杂，病情多危重，在生后尽早明确诊断并给予适当的内外科治疗有助于提高其生存率和改善预后。 Abstract Objective To investigate the clinical manifestation,distribution,treatment and prognosis of congenital heart disease in neonatal period.Methods Analyze 156 cases of neonatal cyanotic congenital heart disease clinically.Results ① Neonatal cyanotic CHD was manifested with central cyanosis,heart failure,and arrhythmia occasionally.② D TGA stand first on the list of neonatal cyanotic CHD and the others ordinal was PA,TAPVC and PS.③ Internal medical therapy included using of cardiotonic,diuretic and prostaglandin E157 patients were given surgical operations and TGA lead the first.Conclusion For complex anomaly and critical condition in most cases,neonatal cyanotic CHD should be diagnosed as soon as possible and treated appropriately in order to improve the viability and prognosis of these neonates. Key words NeonateHeart disease;Congenital     

高危型人乳头瘤病毒检测在宫颈未明确诊断意义的不典型鳞状上皮细胞中的价值

目的:评价人乳头瘤病毒(HPV)分型检测在宫颈未明确诊断意义的不典型鳞状上皮细胞(ASCUS)分层处理中的临床价值。方法:对宫颈液基细胞涂片结果判读为ASCUS的351例患者行高危型HPV分型检测、阴道镜下宫颈活组织检查及宫颈管内膜诊刮术。分析ASCUS患者病理检查结果与HPV分型检测结果的关系。结果:①351例ASCUS病例中,病理证实宫颈上皮内瘤变(CIN)共69例(69/351,19.6%),其中CINⅡ及以上检出26例,占总数的7.4%(26/351)。②351例ASCUS病例中,高危型HPV阳性率为55.6%(195/351)。高危型HPV阳性及HPV感染阴性组CINⅡ及以上病变检出率分别为11.8%(23/195)、2.1%(3/142),相比差异有统计学意义(P<0.05)。高危型HPV阳性对检出CINⅡ及以上病变的敏感度、特异度、阳性预测值及阴性预测值分别为88.46%,48.00%,11.79%,98.07%。③195例高危型阳性病例中,HPV16亚型及58亚型阳性率分别为45.6%及21.0%。HPV16亚型及58亚型阳性组中CINⅡ及以上检出率分别为7.7%(15/195)、2.6%(5...     

宫颈无明确诊断意义的非典型鳞状细胞的临床意义及处理

目的:探讨宫颈无明确诊断意义的非典型鳞状细胞(ASCUS)的临床意义.方法:对22036例患者行宫颈液基细胞学检查(LPT),对其中417例被诊断为ASCUS的病例,同时用免疫组织化学法行人乳头瘤病毒(HPV)检测、阴道镜检查及宫颈活组织检查或宫颈管内膜刮出术.结果:高危型别HPV阳性率随病理学病变的严重程度而增加.而宫颈活检阳性率和阴性率的比值,高危型别HPV感染活检阳性率高于低危型别和HPV阴性患者.几个年龄段的HPV感染率差异无统计学意义.各年龄段ASCUS患者中炎症与CIN及宫颈癌的检出率差异无统计学意义.宫颈管内膜刮除术(ECC)43例,发现异常为8例(18.60%),宫颈活组织检查372例发现异常119例(31.99%),宫颈活组织检查阳性率高于ECC.结论:对ASCUS患者应重视HPV检测,特别是HPV高危型的检查,ECC可作为一种辅助宫颈活组织检查的诊断手段,细胞学异常而伴有高危型别HPV感染但是阴道镜无明显异常发现的患者,可行ECC检查提高诊断率而避免漏诊.     

HPV检测在宫颈未明确诊断意义的不典型鳞状上皮

目的:探讨宫颈人乳头瘤病毒(HPV)DNA检测对宫颈未明确诊断意义的不典型鳞状上皮细胞(ASCUS)患者的诊断价值.方法:对98例薄层液基细胞学(TCT)检测结果为ASCUS的患者进行高危型HPV DNA检测,根据检测结果分为HPV DNA阳性组和HPV DNA阴性组.所有患者行阴道镜检查并活检,以病理检查结果为金标准,病理检查结果为CINⅠ、CINⅡ、CINⅢ、宫颈浸润癌判定为宫颈活检阳性,并进行比较.结果:高危型HPV DNA检测阳性组中宫颈活检阳性率为58.92%,高危型 HPV DNA检测阴性组中宫颈活检阳性率为28.57%,两组比较差异有高度统计学意义(X~2=0.8906,p<0.01).结论:HPV检测对ASCUS患者行进一步诊断有临床意义.     

未明确诊断意义的不典型子宫颈鳞状细胞伴DNA倍体异常的临床意义

目的通过宫颈细胞学和DNA倍体分析,探讨未明确诊断意义的不典型鳞状细胞（ASCUS）伴有DNA倍体异常的临床意义。方法选择2010年7月至2011年7月湖北省宜昌市妇幼保健院在夷陵地区进行宫颈癌筛查的635例农村妇女的宫颈细胞学、病理学及DNA倍体分析资料进行分析。将宫颈脱落细胞制成两张玻片,一张巴氏染色行TBS诊断,另一张Feulgen染色行DNA倍体分析。结果在635例宫颈细胞学标本中,正常细胞学418例,ASCUS 145例,不除外高度鳞状上皮内病变（ASC-H）17例,低度鳞状上皮内病变29例,高度鳞状上皮病变26例,其中伴DNA倍体异常（非整倍体细胞）者所占比例分别为2.6%（11/418）、22.8%（33/145）、76.5%（13/17）、89.7%（26/29）和96.2%（25/26）。在阴道镜下活检的145例ASCUS患者中,伴DNA倍体异常者33例,其中10例（30.3%）为CIN2及以上病变;DNA倍体正常者112例,其中9例（8.0%）为CIN2;两者比较,差异有统计学意义（P〈0.01）。17例ASC-H患者中,13例（76.5%）DNA倍体异常者均检出CIN2及以上病变;4例DNA倍体正常者检出1例CIN2,两者比较,差异有统计学意义（P〈0.01）。结论 ASCUS、ASC-H伴有DNA倍体异常患者检出CIN2及以上病变风险增高。     

未明确诊断意义的不典型鳞状上皮细胞临床处理方法的探讨

目的:探讨宫颈液基细胞学检查(LCT)结果为未明确诊断意义的不典型鳞状上皮细胞(ASCUS)的临床处理方法.方法:LCT检查结果为ASCUS的患者454例,将其随机分为3组:A组,151例,3月后复查LCT;B组,152例,随即进行高危型人乳头瘤病毒(HPV)检测:C组.151例,随即进行阴道镜检查,并在阴道镜下活检.比较3组ASCUS患者宫颈上皮内瘤变(CIN)的检出情况.结果:①A组复查LCT,细胞学异常(≥ASCUS)39例(25.83%),阴道镜下活检病理结果为宫颈炎24例,CINⅠ5例,CINⅡ9例,CINⅢ1例.95例复查LCT正常者阴道镜下活检,病理结果为宫颈炎88例,CINⅠ4例,CINⅡ2例,CINⅢ1例.②B组有60例(39.47%)高危型HPV检测阳性,其阴道镜下活检病理结果为宫颈炎32例,CINⅠ13例,CINⅡ13例,CINⅢ2例.80例HPV阴性者阴道镜下活检,病理均为宫颈炎.③C组151例ASCUS直接进行阴道镜检查及阴道镜下活检,病理结果为宫颈炎115例,CINⅠ12例,CINⅡ18例.CINⅢ6例.④复查LCT和检测高危型HPV对预测ASCUS患者中宫颈高级别病变的准确性差异无统计学意义(P＞0.05).结论:复查LCT是有效的分流ASCUS的方法.对于依从性差或高危人群,宜作高危型HPV检测进行分流,或直接行阴道镜检查及镜下活检明确诊断,随即作相应处理.     

先天性心脏畸形的产前诊断及临床分析

目的探讨先天性心脏畸形的产前诊断及临床意义。方法本研究应用Yagel5个心脏横面和心脏长轴切面进行胎儿心脏扫描，并有效多普勒血流技术、彩色血流、M型超声等超声仪器各项功能技术，对2002至2004年982例先天心脏畸形高危患者进行胎儿心脏全方位检查，并对引产胎儿进行尸体解剖核对产前诊断的正确性，并进行胎儿染色体分析；对产前诊断未发现明显异常的胎儿进行临床随访，胎儿出生后进行新生儿或要儿心脏超声检查，判定产前诊断的正确性。结果（1）982例先天心脏畸形高危患者中，检查发现胎儿心脏结构异常为46例（4．7％）。其中应用单纯四腔心即能诊断的先天性胎儿心脏结构异常为32例，其余14例需同时结合其他心脏检测平面诊断。（2）41例引产胎儿中，32例进行尸体解剖，病理结果与产前超声检查符合率为93．8％（30／32），其中1例患者病理诊断为永存动脉干畸形，产前诊断为法洛四联症；另1例为右心室双流出道畸形，产前诊断为大动脉转位。（3）46例患者中，32例进行胎儿染色体检测，合并染色体异常8例（25．0％）。（4）5例为产前诊断右心系统略大胎儿，分娩后新生儿或要儿心脏超声检查，结果与产前基本相同，表现为单纯右心系统略大，但新生儿和要儿无任何临床症状。（5）936例产前诊断为正常胎儿心脏患者，新生儿或要儿心脏超声检查发现室间隔缺损1例，动脉导管未闭2例，房间隔缺损1例。结论（1）应用本研究方法，以先天心脏畸形高危患者为筛查对象，产前诊断先天性心脏畸形阳性率为4．7％，产前诊断与尸体解剖符合率为93．8％。（2）应用本研究方法可使高危人群产前诊断胎儿先天性心脏畸形的敏感性达92．0％，特异性达99．6％。（3）单纯左右心比例轻中度失调胎儿可能有较好的临床预后。     

心脏轴测定在胎儿先天性心脏病产前超声诊断中的临床意义

目的探讨超声心动图测定心脏轴变化在胎儿先天性心脏病（先心病）产前诊断中的临床意义。方法应用Ａｃｕｓｏｎ１２８×Ｐ／１０彩色多普勒超声诊断仪检查５１８例胎龄１８～４０周的先心病高危胎儿和９０例正常胎儿,在心脏超声四腔观基础上测定胎儿心脏轴,并从多切面观察胎儿心内结构,以确定胎儿有无先心病。结果正常胎儿心脏轴为（４４．８±１０．３）度,先心病胎儿心脏轴为（５８．１±１５．７）度,两者比较,差异有显著性（Ｐ＜０．０１）。单纯四腔观检测胎儿先心病的敏感性为６８．５％,应用心脏超声四腔观加心脏轴测定检测胎儿先心病的敏感性为９１．４％,两者比较,差异有显著性（Ｐ＜０．０５）;５１８例先心病高危胎儿中,产前超声正确诊断先心病３４例,假阳性１例,假阴性１例。结论正常胎儿心脏轴范围２０～７５度,如心脏轴＞７５度,应高度怀疑胎儿先心病;心脏轴测定在胎儿先心病筛查中具有重要作用,可作为一种常规测量指标。     

Prenatal diagnosis of pyriform sinus fistula using ultrasonography by detecting the communication to the pharynx

ObjectivePyriform sinus fistula (PSF) is a congenital anomaly which originates from the pharyngeal pouch. PSF is initially recognized as a cyst around the fetal neck, but accurate prenatal diagnosis of the disease is challenging. We aimed to report the key findings and tips in accurately distinguishing PSF from other differential diagnosis by which enables detection of the communication of the nuchal cyst and the pharynx.Case reportWe report a case in which we were able to diagnose PSF as early as 18 weeks of gestation with ultrasonography. We used epiglottis as a landmark, and detected an unilobular cyst arising from the pharynx.ConclusionUltrasonography is a powerful tool in prenatal diagnosis of PSF especially at early stage of pregnancy. By detecting the epiglottis, it can locate the communication of the nuchal cyst and the pharynx, and thereby enables an accurate diagnosis of PSF.     

Three-Level view of fetal brain imaging in the prenatal diagnosis of congenital anomalies

Objective: To determine whether a systematic stream-lined approach could be routinely used in the evaluation of fetal intracranial anatomy.

Methods: Nine thousand six hundred uncomplicated pregnancies were evaluated using a three-level view of fetal brain imaging. An axial scan, which passed through the level of the lateral ventricles, was first obtained. This was followed by a second view passing through the cavum septum pellucidum anteriorly, the thalami medially, and the 3rd ventricle centrally. Finally, a third view was made passing through the posterior fossa.

Results: Although the fetus had different presentations, we were able to fully image the fetal brain in all three levels in most cases. The intracranial anatomy could be scrutinized in most cases. Ninety-six percent of abnormal cases (126/133) were diagnosed using Levels I, II, or III independently or in combination.

Conclusions: The three-level view provides a comprehensive and systematic sonographic approach to the evaluation of the fetal intracranial anatomy, and for the diagnosis of anomalous fetal brain development.     

Prenatal diagnosis of intra hepatic arterio venous fistula: case report and review of the literature

Aim: To describe the prenatal features and management of a congenital intra hepatic fistula.

Material and methods: Case report

Results: Congenital intra hepatic fistula are extremely rare. The prenatal ultrasound seiology is described.

Conclusion: Prenatal diagnosis of these anomalies may improve pre and post natal management.     

Patterns of parental emotional reactions after a pre- or postnatal diagnosis of a congenital anomaly

Objective: This study aimed to describe parental reactions at disclosure of a diagnosis of congenital anomaly and to investigate both the existence of distinct patterns of intensity of reactions and their association with post-diagnosis psychosymptomatology. Background: When receiving the news of a pre- or postnatal diagnosis of congenital anomaly, parents usually display acute grief reactions. However, questions arise regarding the variability and intensity of those reactions and their clinical significance. Method: Fifty-one women and 42 men whose infants were diagnosed with a congenital anomaly completed, one month after the disclosure, the Brief Symptom Inventory-18 and retrospectively evaluated their emotional experience at disclosure. Results: Negative emotions, and also hope, were experienced with greater intensity at disclosure. There was variability of emotional reactions, as two distinct patterns were identified: one pattern fits the acute grief reactions pattern, and another of less-intense emotional reactions. No gender differences were found on emotional reactions. Higher-intensity reactions at disclosure were associated with more psychosymptomatology one-month later only for fathers. Conclusion: Findings suggest the need for healthcare professionals to adjust their practice to meet parental needs in the early post-diagnosis stage. Both parents should be given the opportunity to express their emotions as a couple and individually.     

Modifiers of stress related to timing of diagnosis in parents of children with complex congenital heart disease

Objective: Prenatal diagnosis of congenital heart disease (CHD) reportedly increases parental stress compared with postnatal diagnosis. We investigated the association of timing of diagnosis with parental stress and modifiers of this relationship.

Methods: We enrolled parents with a fetus/infant diagnosed prenatally (Group 1) or postnatally (Group 2) with CHD requiring intervention prior to newborn discharge. Parents completed a Basic Symptom Inventory (BSI) – at diagnosis, birth, and follow-up. Adjusted mixed effects regression models compared scores.

Results: The BSI was completed by 105 families (Group 1, n?=?60 and Group 2, n?=?45). On regression modeling, anxiety and global stress were lower in Group 1 (effect size ?0.19 to ?0.62) at diagnosis and birth though not at follow-up. When stratified by gender, Group 1 scores for anxiety and stress were primarily lower in fathers. Within Group 1, mothers scored higher in all domains and later gestational age at diagnosis was associated with higher anxiety and stress.

Conclusions: Contrary to prior reports, parents of prenatally diagnosed infants with CHD had lower anxiety and stress than those diagnosed postnatally after adjusting for severity. Identifying those most vulnerable and modifiable risk factors will allow us to appropriately target psychosocial services for families with a CHD diagnosis.     

The safety of postnatal transport of newborns prenatally diagnosed with duct-dependent congenital heart disease

Objective: Critical congenital heart disease is increasingly recognized prenatally. Following the diagnosis, families are advised to deliver in a facility where neonatal cardiac interventions are available. We studied the safety of transport of neonates who had been prenatally diagnosed with duct-dependent congenital heart lesions.

Methods: We performed a retrospective chart review of all fetuses diagnosed with duct-dependent congenital heart disease in our fetal program between 2007 and 2011. Demographic data, dose of prostaglandin infusion, respiratory status, blood gas data, as well as complications of the transport were collected.

Results: Twenty-nine neonates qualified for inclusion in the study. Ten were intubated (7 electively) prior to the transport. One of these required intervention for desaturation during the transport. One of the 19 unintubated patients required emergent intubation during the transport. Thus, the overall rate of incidents was 6.9%. All 4 patients who developed apnea requiring intubation did so within 1?h of starting prostaglandin.

Conclusions: Elective postnatal transport of neonates prenatally diagnosed with duct-dependent congenital heart lesions is safe. Prophylactic intubation of these infants may not be necessary. It would be advantageous to schedule the elective transport an hour after starting prostaglandin or later.