Renal artery stenosis as a complication from radiation therapy is not common, but it is life threatening and needs to be corrected urgently in order to prevent renal failure even losing kidney. The diagnostic criteria of renal artery stenosis in the adults by color duplex ultrasonography have been established, which may play an important role in screening radiation induced renal artery stenosis.

As a complementary teaching way, ultrasonography is considered an important teaching tools and methods to improving medical students’ skills and understanding the real time human anatomy . We success-fully integrated ultrasound into anatomy teaching by using portable ultrasound and interactive panel discussion ses-sions. The integrated curriculum not only allows medical students to see the complexity real-time three-dimension-al human anatomy, but also can improve medical students’ interest in anatomy teaching. Integrated ultrasound into anatomy teaching established close ties between basic medical science and its clinical application, and overcome the phase difficulties of anatomical knowledge application from preclinical to clinical.

We have previously reported that the diameter of the inferior vena cava(IVC) reflects the amount of body fluid in hemodialyzed (HD) patients. The present study was undertaken to depict the criteria of IVC diameters for determining dry weight (DW) in anuric HD patients. In healthy subjects, the maximal diameters during quiet expiration (IVCe) and the minimal diameters during quiet inspiration (IVCi) were (16.7±3.2) and (5.7±5.4)mm,respectively (mean±SD).The collapsibility index (CI,1-IVCi/IVCe), which inversely correlates with the central venous pressure,was 0.68±0.29. In anuric HD patients,the IVCe/CI values before and after HD were 14.9±3.2/0.68±0.24 and 8.2±2.3/0.94±0.09, respectively. IVCe decreased proportionally to the amount of ultrafiltration. In HD patients with hypervolemic pulmonary edema, the IVCe and CI values were 22.4±2.9 and 0.22±0.11, respectively. We proposed that IVCe/CI after HD is (8±3)mm/0.9 ± 0.1 as the markers of DW in anuric HD patients and that an IVCe value≥22mm together with a CI≤0.22 implies the warning level of body fluid retention.

Purpose To analyze the sources of errors and discuss the techniques to eliminate pitfalls in detecting deep vein thrombosis (DVT) of the proximal lower extremities with color duplex ultrasonography (CDUS). Methods Sixty-eight cases with initial and repeat venous CDUS of the proximal lower extremities were retrospectively reviewed. The repeat was done within 24 hours after initial CDUS scanning. Comparing repeated images to initial ones, the pitfalls and sources of error in CDUS of the proximal lower extremities were discussed. Results In total 68 repeat studies, there were 62 results as same as initials and 4 cases of false negative DVT and 2 cases of false positive DVT. Conclusion Venous CDUS in detecting DVT is observer dependent. Some pitfalls and errors can be eliminated and corrected with proper scan techniques. CDUS is the most valuable imaging modality for assessing suspected DVT in the proximal lower extremities.

AIM To investigate the short-term and long-term therapeutic effect of traditional medicine preparation andIFN-α1 b on hepatic fibrosis due to chronic hepatitis B.METHODS Fifty-two patients with hepatic fibrosis of hepatitis B were treated by IFN-alb and traditionalmedicine preparation, then observed the change of serum indexes of hepatic fibrosis, liver biopsy,ultrasonography and fibergastroscopy.RESULTS The serum indexes of hepatic fibrosis decreased significantly after 3-month treatment(P<0.05). The improvement of liver fibrosis was confirmed by liver biopsy, ultrasonography andfibergastroscopy. After 3-year continuous follow-up, the conditions of patients were got better. Symptomsand signs were disappeared. The pathohistologic change of liver, serum index of hepatic fibrosis and liverfunction were continuously improved.CONCLUSION The good short-term and long-term effects were obtained by using IFN-α1b to suppressduplication of hepatitis B virus and traditional medicine preparation to reverse hepatic fibrosis.

支气管内超声引导针吸活检术的麻醉方法

目的 观察支气管内超声引导针吸活检术(EBUS-TBNA)的不同麻醉方法的效果,寻求较佳的EBUS-TBNA手术麻醉方法.方法 60例择期EBUS-TBNA手术患者,ASA Ⅰ～Ⅱ级,随机分为3组:舒芬太尼组(S组)、瑞芬太尼组(R组)和舒芬太尼+瑞芬太尼组(SR组),每组20例.麻醉方式采用静脉输注丙泊酚全麻复合TCI舒芬太尼和或瑞芬太尼辅助2％利多卡因局部表面麻醉,术中维持双频谱指数( BIS)50 ～60.记录患者进入手术室后5min(T0)、手术开始后30min( T1)和术毕定向力恢复时(T2)心率、平均动脉压、脉搏氧饱和度及呼吸频率、手术开始后30min动脉血气、术中呛咳次数、丙泊酚和利多卡因用量、术毕至定向力恢复时间、患者满意度和不良反应发生情况.结果 (1)R组T1时呼吸频率下降明显(P＜0.05),S组和R组动脉二氧化碳分压高于SR组(P＜0.05).(2)R组和SR组术中呛咳次数、术毕至定向力恢复时间明显减少(与S组比,P＜0.05).(3)三组患者丙泊酚、利多卡因用量、麻醉满意度及不良反应差异无统计学意义(P＞0.05).结论 静脉输注小剂量舒芬太尼与瑞芬太尼,同时复合丙泊酚静脉全麻并辅助局部麻醉可以满足EBUS-TBNA的手术要求,安全、有效,可作为EBUS-TBNA的常规麻醉方法之一.

Efficacy of volume navigation in assessment of extent of breast cancer

Methods of early detection: would clinical breastexamination and breast ultrasonography be a good alternative to mammography?

Breast cancer is one of the leading causes of cancer deaths among women[1].In the past 40 years,breast cancer incidence has doubled or even tripled in developed countries such as South Korea and Japan; whereas it is about 20% to 30% in China and India in the past decade[2-4].An increasing incidence rate of 3% each year was observed in mainland China[5].

Although ultrasound measurements have been used in previous studies on carpal tunnel syn-drome to visualize injury to the median nerve, whether such ultrasound data can indicate the severity of carpal tunnel syndrome remains controversial. The cross-sectional areas of the median nerve at the tunnel inlet and outlet can show swelling and compression of the nerve at the carpal. We hypothesized that the ratio of the cross-sectional areas of the median nerve at the carpal tunnel inlet to outlet accurately relfects the severity of carpal tunnel syndrome. To test this, high-resolution ultrasound with a linear array transducer at 5–17 MHz was used to assess 77 pa-tients with carpal tunnel syndrome. The results showed that the cut-off point for the inlet-to-outlet ratio was 1.14. Signiifcant differences in the inlet-to-outlet ratio were found among patients with mild, moderate, and severe carpal tunnel syndrome. The cut-off point in the ratio of cross-section-al areas of the median nerve was 1.29 between mild and more severe (moderate and severe) carpal tunnel syndrome patients with 64.7% sensitivity and 72.7% speciifcity. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.52 between the moderate and severe carpal tunnel syndrome patients with 80.0% sensitivity and 64.7% speciifcity. These results suggest that the inlet-to-outlet ratio relfected the severity of carpal tunnel syndrome.

用彩色多普勒超声法研究西地那非不响应和响应者的不同血液动力学反应

Aim:To determine if there are different penile hemodynamic patterns between sildenafil non-responders and responders by using color Doppler ultrasonography. Methods: A total of 69 erectile dysfunction (ED) patients aged 22-79 years were enrolled into the present study. Thirty-eight (55.1%) men with ED who did not respond to four attempts of treatment with 100 mg sildenafil after re-education were classified as sildenafil non-responders. A combination of three vasodilator drugs, 1.25 mg papaverine, 0.4 mg phentolamine and 5 μg prostaglandin El, was given by intracavernous injection before penile Doppler ultrasonography was carried out. The erectile response to intracavernous injection and vascular parameters including peak systolic velocity (PSV), resistance index (RI), end diastolic velocity (EDV) and cavernosa artery diameter (CD) were measured and the results between sildenafil nonresponders and responders were compared. Results: No statistical difference in vascular parameters measured by Doppler ultrasonography studies between non-responders and responders was noted. Sildenafil non-responders had a poorer penile rigidity response to intracavernous injection than responders (P ＜ 0.05). Among patients with adequate PSV (≥ 30 cm/s) and abnormal EDV (＞ 5 cm/s), individuals in the non-responder group had fewer positive responses to intracavernous vasodilator injection than in the responder group (35.3% vs. 72.2%, P ＜ 0.05). Advanced age and comorbidity with diabetes mellitus were significantly associated with sildenafil non-response (P ＜ 0.05).Conclusion: Sildenafil non-responders were characterized by a poorer penile rigidity response to intracavernous injection and had an associated impaired veno-occlusive mechanism. Advanced age and comorbidity with diabetes mellitus were two common factors associated with non-response.

Objective:Understanding the role of Multi-slice CT Urography(MSCTU) over Ultrasonography(US) in patients presenting with hematuria .Materials and Methods:Retrospective study enrolled 131 patients presen-ting with hematuria [ microscopic hematuria ( n=60 ) ] and macroscopic hematuria ( n=71 ) ] who have undergone both MSCTU and US of urinary tract system simultaneously .Results of tests were compared with respective surgical and histopathological analysis of lesion .The cases obtained were bladder carcinoma , ureter carcinoma , renal carci-noma, urinary tract calculi and bladder inflammation .PASW-18th statistical tool was used for obtaining statistical analysis and final interpretation of results .Results:The sensitivity and specificity of MSCTU and US for recognition of lesions presenting with macroscopic hematuria were 95.38%,83.33% and 81.54%,66.67% respectively and for those with microscopic hematuria were 96.08%,88.89%and 86.27%, 77.8%respectively.The positive and negative likelihood ratios of MSCTU and US in macroscopic category were 5.73, 0.055 and 2.46, 0.277 respec-tively while for those in microscopic category were 8.65, 0.044 and 3.88, 0.176 respectively.In context to the sensitivity of MSCTU and US in patients presenting with macroscopic hematuriathedifferenceswere significant ( Mc-Nemar′s test,P=0.039)suggesting the tests are not similar whereas for those with microscopic hematuria the differ-ences were not significant(McNemar′s test, P=2.68) indicatingsimilarity between these tests.Conclusion:Diag-nostic efficacy of MSCTU is found to be far superior over US for patients presenting with macroscopic hematuria , thus current practice of using it as a first line modality seems to be justified .However, for those presenting with mi-croscopic hematuria MSCTU and ultrasonography shows near to similar resultsin accordance to MSCTU , thus US alone seems sufficient to exclude significant urinary tract lesions .

超声内镜下大肠黏膜下癌的高频声像特征

[ Objective] The aim of this study was to evaluate the role of miniprobe ultrasonography on colonoscope in the diagnosis of submucosal tumor of the large intestine and determine it's imaging characteristic. [ Methods] Thirty- five patients with submucosal tumors of the large intestine underwent miniprobe (Olympus UM -2R,12 MHz; UM -3R, 20 MHz) ultrasonography on colonoscope. The results were compared with pathological findings of specimens by biopsy and surgical resection. [ Results] Lipomas were visualized as hyperechoic homogeneous masses located in the submucosa with a distinct border. Leiomyomas were visualized as hypoechoic homogeneous mass originated from the muscularis propria. Leiomyosarcomas were shown with inhomogeneous echo and irregular border.Carcinoids waere presented as a submucosal hypoechoic mass with a homogenous echo and distinct border. Lymphangiomas were shown as submocosal hypoechoic masses with cystic septal structures. Malignant lymphomas displayed as hypoechoic mass from mucosa to muscularis propria, while pneumatosis cystoids intestinalis originated from submucosa with a special sonic shadow. One large leiomyoma was misdiagnosed as leiomyosarcoma. [ Conclusion ]Endoscopic miniprobe ultrasonography can provide precise information about the size, layer of origin, border and has a high accuracy in the diagnosis of submucosal tumor of the large intestine. Pre - operative miniprobe ultrasonography on colonoscope may play an important role in the choice of therapy for submucosal tumor of the large intestine.

Objective: To study the curative effect of wilsoniiinjecta on severe head injury (SHI).Methods: A total of 120 patients with SHI weredivided randomly into 2 groups, the patients treated withconventional methods as Group A (n = 60) and the patientstreated with wilsonii injecta as Group B (n = 60). Thechanges of neural function indexes were evaluated withGlasgow Coma Scale (GCS) before treatment and withGlasgow Outcome Scale ( GOS ) after treatment,simultaneously, the paramneters of hemorrheological indexes(HI), brain electrical activity map ( BEAM ) andtranscranial Doppler sonography (TCD) were observedbefore and after treatment.Results: In Group B, the clinical GCS, the HI, theBEAM and the prognosis GOS were improved much morethan those in Group A. And the TCD parameters in GroupB decreased, which had significant difference comparedwith that in Group A (P ＜0.01).Conclusions: Wilsonii injecta can rapidly improve theinjured persons' conscious states, the abnormal BEAM and the surviving quality. It suggests that the improvement of the HI is related to the relief of the vasospasm of thearterial blood vessels in the brain, which may be one of theimportant mechanisms of wilsonii injecta in improving theprognosis.