The use of a dedicated rectosigmoidoscope for ultrasound staging of tumours of the upper and middle third of the rectum

OBJECTIVE: Tumours of the upper rectum, and many in the middle third, are not accessible to endorectal ultrasound staging because of the difficulty in reaching all sites of the rectum with a rigid probe. The aim of this prospective study was to assess whether using a dedicated rectosigmoidoscope, endorectal ultrasonography (ERUS) can accurately stage any rectal lesion irrespective of its distance from the anal verge. METHOD: A total of 173 consecutive patients with a primary rectal tumour were included. A rotating, high multifrequency (5.0-10 MHz) endoprobe was introduced through a dedicated rectosigmoidoscope and advanced above the lesion. A computer allowed for three-dimensional (3D) reconstruction of 2D images. Treatment was selected on the basis of 3D-ERUS findings. ERUS staging was correlated with pathological staging. RESULTS: The depth of invasion was correctly determined by 3D-ERUS in 78.2% of tumours of the lower rectum, 76.4% of tumours extending between the lower and middle third of the rectum, 80.9% of tumours of the middle third of the rectum, 78.5% of tumours extending between the middle and upper third of the rectum and 78.9% of tumours of the upper rectum. The accuracy for the absence of lymph node metastases was 81.2% for tumours of the lower rectum, 78.5% for tumours extending between the lower and middle third of the rectum, 85.7% for tumours of the middle third of the rectum, 83.3% for tumours extending between the middle and upper third of the rectum and 78.5% for tumours of the upper rectum. Analysis showed that there was no difference between the various tumour sites. CONCLUSION: Our findings indicate that using a dedicated proctosigmoidoscope, tumours of the upper and middle third of the rectum are equally accessible to ultrasonographic evaluation. The distance of the tumour from the anal verge does not influence the accuracy of examinations considered adequate by the operator.     

The common ultrasonographic features of pilomatricoma.

OBJECTIVES: The purpose of this series was to describe typical ultrasonographic features of 20 cases of pilomatricoma and to improve its diagnostic rate with the use of an ultrasonographic approach. METHODS: For 20 pilomatricomas in 19 patients with preoperative ultrasonography from 1995 to 2004, we reviewed age, sex, symptoms, duration, referring clinician, and tumor sites. The ultrasonographic findings were retrospectively analyzed for tumor location, shape, size, margin, echo texture, echogenicity, presence, amount, and shape of calcification, presence of a hypoechoic rim, and Doppler flow pattern. RESULTS: The mean age of the 19 patients was 6.9 years (range, 1-21 years), and the female-male ratio was 1.1:1. Patients had a painful palpable mass in 10 cases (50%). Nine lesions occurred in the neck, 5 in the cheek, 2 in the preauricular region, and 4 in the extremity. All tumors were located in the subcutaneous layer. The mean size of the tumors was 13.4 mm. Fourteen pilomatricomas (70%) appeared as well-defined oval masses. Tumors were heterogeneously hyperechoic in 80% of cases. All tumors had internal echogenic foci. A hypoechoic rim was seen in 17 cases (85%). Doppler flow signals were observed in the peripheral region in 14 cases (70%). A correct preoperative diagnosis was made in 33% on the basis of clinical findings and in 76% by ultrasonography. CONCLUSIONS: Diagnosis of pilomatricoma should be considered when a well-defined mass with inner echogenic foci and a peripheral hypoechoic rim or a completely echogenic mass with strong posterior acoustic shadowing in the subcutaneous layer of the head, neck, or extremity is found on ultrasonography.     

STANDARD IMAGING TECHNIQUES OF ENDOSCOPIC ULTRASOUND‐GUIDED FINE‐NEEDLE ASPIRATION USING A CURVED LINEAR ARRAY ECHOENDOSCOPE

Standard imaging techniques using a curved linear array echoendocope are summarized to facilitate the attainment of expertise in endoscopic ultrasonography and endoscopic ultrasound‐guided fine needle aspiration, and to promote the widespread use of this diagnostic and therapeutic tool. Typical images of the mediastinal organs, the bilio‐pancreatic systems and neighboring organs by scanning from the esophagus, stomach, duodenal bulb, and descending portion of the duodenum, are shown in a sequential manner. The basic techniques of endoscopic ultrasound‐guided fine needle aspiration are also presented.     

Evaluation of Hemoperitoneum Using a Single- vs Multiple-view Ultrasonographic Examination

Objective: To compare the sensitivities, specificities, and accuracies between a single-view ultrasonography (US) technique and a multiple-view technique for identifying hemoperitoneum in multiple-trauma patients.
Methods: Data from a prior prospective study of US for trauma diagnosis at a level I trauma center were retrospectively analyzed. A convenience sample of adult patients (≥ 18 years of age) who had presented with major blunt or penetrating torso trauma and had undergone rapid trauma US examinations to detect hemoperitoneum were reviewed. The US interpretations by emergency physicians had been recorded prior to obtaining other diagnostic tests. Five views were evaluated, including the right intercostal oblique view examining Morison's pouch. Evidence of free intraperitoneal fluid by exploratory laparotomy, CT, or diagnostic peritoneal lavage (DPL) was used as the criterion standard.
Results: Of the 245 patients entered into the study, 37 had free intraperitoneal fluid, confirmed by CT, DPL, or exploratory laparotomy. With the multiple-view technique, US was 87% (95% CI = 71%, 96%) sensitive, 100% (95% CI = 97%, 100%) specific, and 98% (95% CI = 95%, 100%) accurate. The single-view technique, evaluating only Morison's pouch, was 51% (95% CI = 34%, 68%) sensitive, 100% (95% CI = 98%, 100%) specific, and 93% (95%. CI = 89%, 96%) accurate.
Conclusions: An initial trauma US examination using a multiple-view technique is more sensitive than that using a single-view technique for detecting hemoperitoneum in trauma patients.     

高频彩超对颈部淋巴结囊性病变的诊断价值

①目的探讨高频彩超对颈部淋巴结囊性病变的诊断价值。②方法回顾性分析25例颈部淋巴结囊性病变的高频彩超表现。③结果颈部淋巴结囊性病变见于颈淋巴结囊性转移瘤、化脓性淋巴结炎及淋巴结结核。其中13例为颈部淋巴结囊性转移瘤，其特征性超声表现为颈部淋巴结囊性肿大，伴囊壁实性结节；较大囊壁结节内常可探及动脉血流信号，部分囊壁结节可见微钙化。7例为颈部急性化脓性淋巴结炎，其主要超声表现为上颈部淋巴结呈单发、圆形囊性肿大；囊壁略厚，且较均匀；囊液呈细密点状回声。5例为颈部淋巴结干酪脓肿型结核，其主要超声表现为单侧或双侧中下颈部淋巴结呈多发、椭圆形囊性肿大，部分可融合成团；内壁毛糙，囊液内散在分布点状高回声。④结论高频彩超检查对颈部淋巴结囊性病变的诊断和鉴别诊断具有重要价值。     

阴茎折断临床分析

目的 探讨阴茎折断伤的病因和诊治。方法 对2l例阴茎折断伤的临床资料进行回顾性分析。结果 致伤原因以粗暴性交13例，手淫5例，跌伤、撞击伤各l例，拒绝说明原因l例。B超确诊12例，阴茎海绵体造影确诊l例。12h内手术13例，超过12h手术3例，保守治疗5例。12h内手术组有2例发生阴茎白膜硬结，术后性功能正常；超过12h手术组和保守治疗组各有l例和2例并发阴茎硬结、阴茎成角畸形和勃起功能障碍。结论 阴茎折断致伤原因以粗暴性交和手淫为主；B超检查是诊断阴茎折断首选方法；早期手术能减少其并发症的发生；术中采用纵行小切口容易准确找到白膜破裂位置，且创伤小，适于临床应用。     

AN EPIDEMIOLOGICAL SURVEY OF CHOLELITHIASIS IN SHANGHAI

Objective To obtain a general overview of gallstone disease in Shanghai. Methods 3415citizens aged >20 in the community of Shanghai were randomly selected to undergo a clinical epidemiological study and an ultrasound examination to screen for cholelithiasis. Results Overall prevalence rate of gallstones was 6.5% (8.6% in women and 5.1% in men). Among the 3415 persons investigated, 65 had already undergone cholecystectomy. The percentage of asymptomatic gallstone was 70 .5% . Prevalence of gallstone diseases (gallstones plus cholecystectomy) increased with age significantly. Conclusion Compared to the research in Shanghai ten years ago, especially for the persons older than 50 years, the gallstone disease has become more frequent. The proportion of asymptomatic gallstones and the awareness is increasing.     

彩色多普勒超声检查对卵巢肿瘤的诊断价值

①目的 探讨彩色多普勒超声检查对卵巢肿瘤的诊断价值。②方法 对67例疑诊为卵巢肿瘤的病人术前行彩色多普勒超声检查及血流动力学分析，测其动脉血流收缩期峰值流速(PSV)和阻力指数(RI)，并与手术及病理结果对照。③结果 67例卵巢肿瘤经手术及病理证实良性49例，恶性18例，经彩色多普勒超声诊断为良性41例，恶性15例，超声诊断符合率分别为83．7％和83．3％。④结论 彩色多普勒超声对卵巢肿瘤的良恶性判断具有较高价值。     

经颅多普勒频谱参数与急性颅脑损伤患者颅内压的关系

目的探讨急性颅脑损伤患者的经颅多普勒频谱参数与颅内压的关系。方法应用TCD检测20例急性中、重型颅脑损伤患者双侧大脑中动脉,同时行颅内压监测。结果经颅多普勒频谱参数cf、PI、af、RI、ae均和ICP正相关,Vd、ac和ICP负相关,其中cf与ICP的相关系数最大。建立TCD相关参数与ICP的多元线性回归方程:ICP=0.312MAP-1.531Vd+21.437PI-15.059ac+38.722cf(P<0.001,R2=0.920估计值的标准差=4.0972mmHg)。结论经颅多谱勒频谱参数可以反应颅脑损伤患者的颅内压的改变。综合研究经颅多谱勒频谱参数、血压与颅内压的关系是应用经颅多普勒无创监测颅内压的方向。