Objective: To evaluate the value of high resolution ultrasonography for diagnosis of secondary hyperparathyroism(HPT) in uremia and its relationship with serum parathyroid hormone(PTH). Methods: Ultrasonography was used to examine parathyroid gland and serum PTH, calcium,phosphorus in 55 cases of uremic patients. Results: Totally 64 parathyroid glands in 52 patients(94%) and over 2 glands in 11 cases(20%) were found. The volumes of parathyroid gland was larger and the value of PTH was abviously increased in over 2 glands than in single gland( P

Leukoencephalopathy with ataxia (LKPAT) is a rare autosomal recessive disorder caused by mutations of CLCN2 gene. LKPAT is clinically characterized by cerebellar ataxia, headache and cognition impairment. Brain magnetic resonance imaging showed characteristic hyperintensities along the pyramidal fiber tracts. Few cases have been reported so far. This article reported the clinical data of a 48 years old female patient with LKPAT for clinical reference.

Objective To summarize the therapeutic efficacy of electrocoagulation for varicose veins of the lower extremities.Methods Totally 168 cases(238 limbs)of varicose veins of the lower extremities were treated with electrocoagulation in our department from April 2000 to April 2007.Through a small ankle incision,electrocoagulation probe was inserted ascendingly into the groin via the great saphenous vein.After high ligation of the great saphenous vein,the varicose veins and great saphenous trunk were electrocoagulated.Results The patients were discharged from hospital in one to two days after the operation.None of them had incisional infection.The ulcers at the ankle were healed in four weeks.Postoperative complications in this series,included Ⅰ degree burn injury in one limb,Ⅱ degree burn injury in one limb,superficial phlebitic pain in two limbs(two cases);and numbness around the ankle in 14 limbs(10 cases).Totally 148 cases with 208 limbs were followed up for 2 to 9 years with a mean of 6.6 years.During the period,the rate of recurrent varicosity was 3.4%(7/208);and healing rates of ache,dermatitis and eczema,ankle pigment,swelling around the calf and ankle were 95.3%(162/170),85.7%(12/14),41.7%(15/36)and 36.4%(16/44)respectively.Conclusion Electrocoagulation is a minimally invasive and effective method for the treatment of varicose veins of the lower extremities,with quick recovery and low rate of recurrence.

Objective To investigate the ultrasonic and pathological features of porcine striped muscle injury from thermal and chemical factors respectively, and to analyze the limitation of ultrasound diagnosis given by doctors with different skill levels. Methods An experimental study using fresh porcine striped muscle in vitro was designed, where the injury were caused by microwave ablation (2 450 MHz) and Anhydrous acetic acid (99.8%) injection separately. Blind to pathologic results, the two-dimensiona sonograms taken from each model were analyzed by sonographers with different skill levels independently. Finally, the diagnoses were evaluated and compared among them. Results Two-dimensional sonograms showed distinct changes of the textures in both injury models, which was characterized as the disappearance of regular tissue structure. However, the corresponding histopathology revealed obvious differences between the two interventions on ultrasonograms. There was no statistical difference between chief physician and attending doctor (both of them had over 5-year experiences on skeletal muscle ultrasound ) in identifying the ultrasonic features of boundary, shape and muscle texture (Kappa=0.933, 0.845, 0.789;Kappa=0.790, 0.935, 0.865, all P<0.05). Compared with residents′diagnosis, there were signiifcant differences in identifying the ultrasonic features of echo level and muscle texture in both injury models:Echo level in thermal injury group:chief physician vs residents, Kappa=0.323;attending doctor vs residents, Kappa=0.297. Texture feature in thermal injury group:chief physician vs residents, Kappa=0.259;attending doctor vs residents, Kappa=0.112. Texture feature in chemical injury group:chief physician vsresidents, Kappa=0.253;attending doctor vs residents, Kappa=0.070. Conclusions Microwave ablation and Anhydrous acetic acid can cause different histopathologic changes in correspondence with various features on two-dimensional sonograms. But ultrasonographers with different skill levels leads to signiifcant variations in identiifcation and qualitative diagnosis, which is impossible to be quantitatively analyzed. Chief physician and attending doctor can draw a consistent conclusion and demonstrate the ultrasounic characteristics in porcine striped muscle injury model from thermal or chemical factors.

Objective: To study the chemical co nstituents obtained from Hedysarum multijugum . Methods: The compounds were separated by liquid-liquid extraction a nd chromatography, their structures were identified by spectral analyses. Results: Seven compou nds were obtained triacontyl alcohol (1); tetra cosanoic acid (2); 5,7-dihydro xy-6, 8-di-C-prenyl -4′-methoxy -isoflavone (3); 4′-hydroxy-trans-cinnamic acid docosyl ester (4); stigmasterol (5); 5, 7-dihydroxy-6-C-prenyl-4′-methoxy-isofl avone (6, Gancaonin M); caffeic acid tetracosyl ester (7). Conclusion: Compounds 3 and 4 were new natural compoun ds and the rest were obtained from the plant for the first time.

Objective To investigate the technical feasibility and clinical significance of non-vascular contrast-enhanced ultrasound(NVCEUS) in screening pyelogenie cyst out of simple renal cysts so as to avoid damage to the urinary tract from absolute ethanol while undergoing percutaneous aspiration and ethanol sclerotherapy(PAEST). Methods Following an inclusion criteria 23 patients with renal cysts were selected to receive NVCEUS scanning by means of administrating SonoVue contrast agents through puncture needle into their renal cyst lumen prior to the injection of absolute ethanol for sclerosing treatment. By the demonstration of hyperechoic contrast agents leaving from intra cyst into renal collecting system,a pyelogenic cyst was defined. The patients with this kind of cyst was not allowed for further ethanol sclerotherapy. Results NVCEUS made 3 patients with pyelogenic cyst resembling simple ones free from ethanol selerotherapy,and 4 patients suspicious of pyelogenic cyst due to weird cyst configuration remain in the list of simple cyst for further selerotherapy. Conclusions NVCEUS of renal cyst is highly capable of differentiating pyelogenie cyst from simple cyst and highly valuable in increasing the safety for the procedure of PAEST.

Objective To represent the high-resolution ultrasonic profiles of diffuse sclerosing variant of papillary thyroid carcinoma (DSVPTC) and highlight the importance of ultrasound examination for detecting this rare entity. Methods The document of clinical presentations and thyroid ultrasound imaging information leading to correct diagnosis were reviewed in association with the microscopic findings of excised thyroid specimen. Results The average age of the eight patients was (18.88 ± 3.59) years(range from 12 to 24) with a gender ratio of 2 males to 6 females. Their predominant clinical presentations were enlargement (8/8) and hardening(6/8) of the involved thyroid lobes. The ultrasound imaging features were increase in the width and thickness of involved thyroids, hypoechoic and heterogeneous internal echoes, containing multiple,diffuse,and fine hyperechoic spots but without formation of any masses, and multiple enlarged lymph nodes in the bilateral jugular chains due to cancer cell metastasis. Ultrasound diagnosis of the first case was malignant thyroid tumor, but the following consecutive 7 patients were all definitely interpreted as DSVPTC. Conclusions The clinical presentations alone is less valuable in diagnosis of DSVPTC, but the characteristic features on high-resolution ultrasonography are highly sensitive and indicative.

Objective To detect fat emboli in cardiac chamber of the patients undergoing total knee arthroplasty(TKA) by transesophageal echocardiography(TEE), and to discuss the relevant clinical value.Methods Eleven female patients with 12 osteoarthritis(OA) knees were underwent TKA. According to whether using tourniquet or not,12 knees were divided into 2 groups at random:tourniquet-related group (6 knees) and control group(6 knees). Echo intensity and ultrasonic characteristics of fat emboli in cardiac chamber were studied dynamically by multiplane TEE in various periods of the whole operation. Results All of the patients were implanted knee prostheses successfully. In different periods of TKA, fat emboli appeared as isoechoic or hyperechoic particles, which were found in right atrium, but nothing could be found in left heart. The imaging of the particles was flowing with duration time of 10～600s, like dots, lines, "moving star" or "shower". While femur expanding(0～3mins),the particles in right atrium and ventricle became more and more, and the echo intensity became significantly higher than those in other periods. After releasing tourniquet(0～5mins),most particles with highest echo intensity were observed in right heart,showing like "snowstorm" in tourniquet-related group, and more emboli were still detected at the end of monitoring (10 min after releasing tourniquet) by TEE,compared to the control group. No patient suffered from fat embolism syndrome(FES) with clinical manifestation. Conclusions Fat emboli in cardiac chamber can be observed sensitively by real-time TEE dynamically during TKA. It should be encouraged and promoted to analyze ultrasonic characteristics to facilitate the early detection, early diagnosis and early clinical intervention for the subclinical type of FES.

Objective To make a comparative assessment on both the therapeutic effects and side effects between percutaenous lauromacrogol injection therapy(PLIT) and percutaenous ethanol injection therapy(PEIT) for simple hepatic or renal cyst.Methods In group A,55 patients with simple hepatic or renal cysts underwent ultrasound-guided aspiration and successive PLIT.The intra-operative side effects were investigated and the therapeutic effects assessment by using ultrasonography was conducted 3 months after the treatment.In group B,60 patients with simple hepatic or renal cysts had received ultrasound-guided aspiration and PEIT sometime before.The intra-operative side effects and therapeutic effects on the thirdmonth ultrasonography were independently reviewed according to their case records.Results In group A,3 patients(5.5 ％) expressed slight discomfort but not pain while receiving lauromacrogol injection.Follow-up ultrasound examination at the end of third month demonstrated the cysts in 43 patients completely regressed,while cysts in rest 12 patients shrank over 50 ％ in size,showing the overall response rate(ORR) and completely cure rate(CCR) were 100％ (55/55) and 78.2％ (43/55) for PLIT respectively.In group B,12 patients(20％) suffered from slight to moderate irritating pain or drunk performance.The third-month ultrasound examination disclosed that cysts in 47 patients completely vanished,and cysts in the other 13patients shrank more than a half,indicating the ORR and CCR were 100％ (60/60) and 78.3 ％ (47/60) for PEIT respectively.Conclusions Although their therapeutic efficacy are perfectly similar,PLIT is much more superior to PEIT in term of less and minor side effects.

Objective To investigate the risk factors of cerebral microbleeds (CMBs) in patients with acute isch?emic stroke of large-artery atherosclerosis. Methods One hundred twelve patients with acute ischemic stroke of large-ar?tery atherosclerosis admitted from July 2013 to January 2014 in Nanjing First Hospital affiliated to Nanjing Medical Uni?versity were enrolled. According to the results of MRI magnetic sensitive weighted imaging, the patients were divided into CMBs group or non-CMBs group. The history, general clinical data, serum biochemical results and MRI in both groups were enrolled. All the data were analyzed by the univariate and multivariate analysis. Results The results of univariate analysis showed that there were significant differences in age (61.620±11.479 vs. 70.620±11.185), serum uric acid (UA) level (278.920±69.512 vs. 353.460±111.206), serum creatinine (Cr) level (71.360±19.797 vs. 90.450±44.989), serum ho?mocysteine (Hcy) level (12.587±2.664 vs. 21.715±10.437) between the two groups (P<0.05). There were significant differ?ences in constituent ratio of Fazekas' s grade of periventricular hyperintensities and deep white matter hyperintensities between the two groups (P<0.05). The results of multivariate analysis showed that age (OR=0.963, 95%CI:0.905~1.025, P<0.05) and serum Hcy level (OR=1.487, 95%CI:1.219~1.813, P<0.05) were the independent risk factors for CMBs in patients with acute ischemic stroke of large-artery atherosclerosis. Conclusions Age and serum Hcy level are the inde?pendent risk factors for CMBs in patients with acute ischemic stroke of large-artery atherosclerosis.