Objective To explore the value of real time contrast-enhanced ultrasound (CEUS) in differential diagnosis of benign and malignant adrenal lesions.Methods Totally,57 adrenal lesions (26malignant and 31 benign) underwent conventional ultrasound and real-time CEUS.The enhancement patterns including types of time-intensity curve,centripetal fill-in,homogeneity and intensity of enhancement were analyzed.Results The enhancement pattern of normal adrenal gland was homogeneous,centrifugal and rapid perfusion from the medulla to the cortex.Four enhancement patterns were significantly different between benign and malignant adrenal lesions (P ＜0.05).If enhancement in the early arterial phase and rapid washout was suggestive of malignancy,the sensitivity and specificity of CEUS were 96.2％ and 77.4％,respectively.If peripheral to central filling was suggestive of malignancy,the sensitivity and specificity of CEUS were 76.9 ％ and 80.7 ％,respectively.Conclusions The patterns of real-time CEUS are helpful in differential diagnosis of malignant and benign adrenal lesions.

Objective To explore oral contrast-enhanced ultrasonography findings in superior mesenteric artery syndrome (SMAS).Methods Twenty-nine patients with SMAS were examined using oral contrast-enhanced ultrasonography,which was confirmed by contrast-enhanced spiral computerized tomography.Results Abdominal ultrasonography with oral contrast-enhanced ultrasonography revealed a significant reduction of the SMA angle and diminished SMA-aorta distance in 29 subjects.Duodenum was showed the indentation and funnel shaped or dumbbell shaped findings which was caused by pressure of the SMA in patients with recumbent position.The proximal part of duodenum expanded distinctively with contrast media movement fro.Ultrasonography and CT examinations had a good agreement in diagnosing pathological aortomesenteric angle and distance.Conclusions Oral contrast-enhanced ultrasonography presents characteristic findings in patients with SMAS,which is useful in epidemiological screening of suspicious cases of SMAS in children.

OBJECTIVE: To evaluate the prognosis of Draf II b surgery in treating fontal sinus inverted papilloma. METHOD: A retrospective study was carried out among 15 patients diagnosed as fontal sinus inverted papilloma, which had underwent endoscopic Draf II b surgery. The clinical success rate and surgical success rate were calculated by survival analysis. RESULT: In all patients, there were 1 (6.67%) recurrence,1 (6.67%) stenosis, 4 (26.67)% complete closure, and 1 (6.67%) mucocele cyst. The 3-year clinical success rate was 93.3%, and the 3-year surgical success rate was 65.0%. CONCLUSION Draf II b surgery is feasible when the frontal sinus inverted papilloma is involved in the area of the pupil center line, and the frontal neo-ostium stenosis or complete closure is a common complication after surgery. Thus a close follow-up is recommended during the first year after the surgery. Further study is necessary to find a better way to reduce the complication rate.
Constriction, Pathologic ; pathology ; Endoscopy ; Frontal Sinus ; pathology ; Humans ; Mucocele ; pathology ; Nasal Surgical Procedures ; methods ; Neoplasm Recurrence, Local ; Papilloma, Inverted ; surgery ; Paranasal Sinus Neoplasms ; surgery ; Postoperative Complications ; pathology ; Prognosis ; Retrospective Studies ; Survival Analysis ; Treatment Outcome

OBJECTIVETo validate the discharge, inflammation, polyps/edema (DIP) scoring system for the assessment of endoscopic sinus surgery (ESS) outcomes in patients with chronic rhinosinusitis (CRS).

METHODSThirty patients with CRS were included in this prospective study. All patients were evaluated before and 2 months after surgery. Baseline measures and postoperative outcomes were evaluated using sino-nasal outcome test-20 (SNOT-20), visual analogue scale (VAS) symptom score and Lund-Mackay CT score (in baseline only). All endoscopic videos were recorded before surgery and in the end of follow-up. All videos were scored blindly by two rhinologistis using the DIP and Lund-Kennedy system for investigating the inter-rater and test-retest reliability, as well as the correlations with the existing subjective and objective scoring systems.SPSS17.0 software was used to analyze the data.

RESULTSThe average scores of VAS, SNOT-20, Lund-Kennedy, and DIP before and after surgery were listed below. Baseline, 29.73 ± 13.05, 24.43 ± 13.76, 7.70 ± 3.25 and 32.67 ± 13.48. Post-surgical, 13.60 ± 8.67, 10.40 ± 7.45, 5.03 ± 2.04 and 16.97 ± 8.37. All scores were declined significantly from baseline (t value were 7.43, 6.49, 6.88 and 10.93, all P < 0.001). The DIP system showed a higher inter-rater and rest-rest reliability than Lund-Kennedy system (interclass coefficient,ICC > 0.75). The Pearson analysis revealed that VAS scores were significantly correlated with SNOT-20 scores both in baseline and post-surgical assessments (r = 0.518 6, P = 0.003, and r = 0.546 7, P = 0.000). Before surgery, Lund-Kennedy scores were significantly correlated with DIP and Lund-Mackay CT scores (r = 0.937 5, P = 0.000 and r = 0.748 0, P = 0.000). DIP scores were significantly correlated with Lund-Mackay CT scores (r = 0.712 2, P = 0.000). After surgery,DIP scores were significantly correlated with Lund-Kennedy scores (r = 0.869 6, P = 0.000). But there were no significant correlations between subjective scores (VAS and SNOT-20) and objective scores (Lund-Kennedy, DIP and Lund-Mackay CT), (all P > 0.05).

CONCLUSIONSThe DIP scoring system shows substantial inter-rater and test-retest reliability.It is also significantly correlated with existing objective scoring parameters. It is suitable and reliable to use.

Chronic Disease ; Edema ; Endoscopy ; Female ; Humans ; Inflammation ; Male ; Nasal Polyps ; diagnosis ; Paranasal Sinuses ; Polyps ; Postoperative Period ; Prospective Studies ; Reproducibility of Results ; Rhinitis ; diagnosis ; Sinusitis ; diagnosis

OBJECTIVETo analyse the severity of chronic sinusitis osteitis and the correlation factors by global osteitis scoring scale(GOSS).

METHODSThree hundreds and thirty-four patients with chronic rhinosinusitis with or without nasal polyps(CRSwNP/CRSsNP) were enrolled prospectively in a large tertiary referral center. Preoperative sinus CT was analysed by PHILIPS MxLiteView software.Using grading and classification of GOSS, the association between GOSS and gender, age, smoking, CRS course, asthma, skin prick test(SPT), aspirin sensitive asthma (ASA), nasal polyp, Lund-Mackay, Lund-Kennedy, the number of previous sinus surgeries was examined.Finally a marker factors of severity of CRS osteitis was concluded.

RESULTSThere was no association between CRS osteitis and gender(P = 0.542), age(P = 0.092), smoking(P = 0.695), SPT(P = 0.182). Multiple liner regression analysis showed that there was no association between CRS osteitis and nasal polyps, ASA and asthma (all P > 0.05). The severity of CRS osteitis was correlated with the number of previous sinus surgeries, Lund-Mackay scores, Lund-Kennedy scores, CRS course (r1 = 0.528, r2 = 0.170, r3 = 0.193, r4 = 0.146, respectively, all P < 0.01).

CONCLUSIONSOsteitis is an important reason of refractory chronic rhinosinusitis. The number of previous sinus surgeries can be used as an important marker for the severity of the osteitis.

Adolescent ; Adult ; Aged ; Chronic Disease ; Factor Analysis, Statistical ; Female ; Humans ; Male ; Middle Aged ; Osteitis ; etiology ; Rhinitis ; etiology ; Severity of Illness Index ; Sinusitis ; etiology ; Young Adult

Allergic rhinitis (AR) is a global health problem that causes major illnesses and disabilities worldwide. Epidemiologic studies have demonstrated that the prevalence of AR has increased progressively over the last few decades in more developed countries and currently affects up to 40% of the population worldwide. Likewise, a rising trend of AR has also been observed over the last 2–3 decades in developing countries including China, with the prevalence of AR varying widely in these countries. A survey of self-reported AR over a 6-year period in the general Chinese adult population reported that the standardized prevalence of adult AR increased from 11.1% in 2005 to 17.6% in 2011. An increasing number of original articles and imporclinical trials on the epidemiology, pathophysiologic mechanisms, diagnosis, management and comorbidities of AR in Chinese subjects have been published in international peer-reviewed journals over the past 2 decades, and substantially added to our understanding of this disease as a global problem. Although guidelines for the diagnosis and treatment of AR in Chinese subjects have also been published, they have not been translated into English and therefore not generally accessible for reference to non-Chinese speaking international medical communities. Moreover, methods for the diagnosis and treatment of AR in China have not been standardized entirely and some patients are still treated according to regional preferences. Thus, the present guidelines have been developed by the Chinese Society of Allergy to be accessible to both national and international medical communities involved in the management of AR patients. These guidelines have been prepared in line with existing international guidelines to provide evidence-based recommendations for the diagnosis and management of AR in China.
Adult ; Asian Continental Ancestry Group* ; China ; Comorbidity ; Developed Countries ; Developing Countries ; Diagnosis* ; Epidemiologic Studies ; Epidemiology ; Global Health ; Humans ; Hypersensitivity* ; Prevalence ; Rhinitis, Allergic*

OBJECTIVETo evaluate the impact of nasal function after Draf III frontal sinus surgery (Draf III) or the modified endoscopic Lothrop procedure (EMLP).

METHODSIt was a prospective study with self-control. The pre-operative clinical data of 30 patients (from 2010 to 2013, Beijing Tongren Hospital) who underwent Draf III surgery, with the testing results of T&T olfactory testing, acoustic rhinometry and rhinomanometry before and 1 year after operation in these patients were collected in this study. All patients complete visual analogue scale (VAS), a telephone follow-up questionnaire of olfactory function used by Wormald and Lund-Kenndy endoscopy score simultaneously with testings above. Most of 30 patients were chronic rhinosinusitis (CRS) with recurrent nasal polyps or systemic risk factors like asthma and aspirin-intolerance, called refractory rhinosinusitis. SPSS 19.0 software was used to analyze the data.

RESULTS89.3% (25/28) of these patients improved in nasal obstruction 1 year after operation, and the cure rats was 57.1% (16/28, VAS = 0). The level of improvement in nasal obstruction was significantly correlated with pre-operative nasal obstruction severity (r = 0.909, P < 0.01). 76.7% (23/30) improved in olfactory function 1 year after operation in all 30 patients, and 88.2% improved in patients with nasal polyps (CRSwNP). It was also found that olfactory function 1 year after operation was significantly related to Lund-Kennedy endoscopy scores (r = 0.671, P < 0.01), but was not correlated with VAS scores of nasal obstruction (P = 0.349).

CONCLUSIONThe Draf III frontal sinus surgery has a significantly positive effect on olfactory and ventilation function post-operatively, especially on refractory rhinosinusitis.

Animals ; Asthma ; Chronic Disease ; Endoscopy ; Frontal Sinus ; surgery ; Humans ; Nasal Obstruction ; Nasal Polyps ; Paranasal Sinuses ; Prospective Studies ; Rats ; Retrospective Studies ; Rhinomanometry ; Rhinometry, Acoustic ; Risk Factors ; Sinusitis ; Smell ; Treatment Outcome

Humans ; Adult ; Serum Albumin, Human ; Consensus ; Cardiac Surgical Procedures ; Thoracic Surgery