Objective To observe the value of gastrointestinal ultrasound contrast agents for evaluating gastric emptying status in patients with superior mesenteric artery syndrome(SMAS).Methods Gastrointestinal ultrasound was prospectively performed in 30 SMAS patients(SMAS group)and 24 healthy subjects(control group).The diameter of proximal duodenum(D),the maximum diameter of duodenum at the angle between superior mesenteric artery and abdominal aorta(d),as well as the degree of duodenum compression(D-d/D)were measured after gastrointestinal contrast agents passing through immediately.Gastric residual volume(GRV)at 5 min(T0),30 min(T1),60 min(T2),90 min(T3)and 120 min(T4)after taking contrast agent were recorded,and the ratio of T1-T4 GRV to T0 GRV(GRV1-GRV4)were calculated and compared between groups.Pearson correlation analysis was performed to explore the correlation of(D-d)/D with GRV1-GRV4 in SMAS patients.Results D,(D-d)/D,GRV1,GRV2,GRV3 and GRV4 in SMAS group were all higher,while d in SMAS group was lower than those in control group(all P＜0.05).(D-d)/D in SMAS patients was moderately and positively correlated with GRV4(r=0.509,P=0.007),but not significantly correlated with GRV1-GRV3(all P＞0.05).Conclusion Gastrointestinal ultrasound contrast agents could be used to real-time dynamically observe gastric emptying status in patients with SMAS and quantitatively analyze GRV.

Pancreatic panniculitis (PP) is a necrotizing inflammation of subcutaneous fat that is a rare complication of pancreatic disease appearing in 2% to 3% of all patients. It is more common in the elderly and often affects the extremities. It presents as skin inflammation with pain and erythema nodules. We report a case of acute pancreatitis associated with PP in an old female. She was admitted for vomiting and abdominal pain for 3 days and presented with a 2-week history of erythematous subcutaneous nodules on her legs. Laboratory and ultrasonic findings revealed acute pancreatitis. High frequency ultrasound showed hypoechoic foci in subcutaneous soft tissue layer and adipose layer. Histopathological examination confirmed the diagnosis of PP. Nodules disappeared with the resolution of acute pancreatic inflammation. PP may be the first manifestation of pancreatic disease. Imaging features of this pathology are seldom described and ultrasonic diagnosis experience is worth to be accumulated.
Acute Disease ; Aged ; Female ; Humans ; Inflammation/complications* ; Pancreatic Diseases/diagnostic imaging* ; Pancreatitis/diagnostic imaging* ; Panniculitis/etiology* ; Ultrasonography

Objective:To analyze the factors of missed diagnosis and misdiagnosis of gallbladder adenomyomatosis(GBA) by ultrasonography according to the contrast between ultrasonography and pathology.Methods:Four hundred and forty-six cases of patients with pathological diagnosis of GBA and complete preoperative case informations were retrospectively collected from January 2010 to November 2018 in the PLA General Hospital, and the preoperative ultrasound diagnosis, clinical symptoms, pathological classification were analyzed. The coincidence rate and missed diagnosis rate of GBA by ultrasound were calculated. The ultrasonic diagnosis of GBA missed diagnosis and misdiagnosis factors were analyzed according to the multiple factors and single factor Logistic regression.Results:The coincidence rate of ultrasonic diagnosis was 46.9%(200/426), the missed diagnosis rate was 35.2%(150/426), and the misdiagnosis rate was 17.8%(76/426). Misdiagnosed cases included 65 cases (85.5%) of gallbladder occupation, 7 cases (9.2%) of gallbladder stones, and 4 cases (5.3%) of chronic cholecystitis. The results of multi-fact OR Logistics regression analysis showed that gallbladder stones ( OR=5.112, P<0.001), chronic cholecystitis ( OR=4.613, P<0.001), gallbladder occupation ( OR=6.565, P<0.001) and cholesterol crystals ( OR=8.634, P<0.001) were independent influencing factors for accurate diagnosis of GBA by ultrasound. Conclusions:Ultrasound has a high rate of missed diagnosis and misdiagnosis for GBA operation group at present. Since most cases are complicated with other gallbladder diseases, it is important to scan carefully for GBA besides the diagnosis of a single gallbladder disease.

Objective: To compare the efficacy of percutaneous transluminal angioplasty (PTA) and neo-anastomosis in juxta-anastomotic stenosis of autologous arteriovenous fistula (AVF) of diabetic hemodialysis patients. Methods: Diabetic patients with juxta-anastomotic stenosis in Beijing Tsinghua Changgung Hospital from February 2016 to December 2018 were retrospectively analyzed. The clinical data, success rate, patency time of PTA and vascular neo-anastomosis were compared. Results: Thirteen patients received PTA, including 1 case of surgical failure and 1 case of thrombosis, and the success rate was 11/13. Vascular neo-anastomosis were performed in 15 cases, and 13 cases succeeded. The success rate was 13/15, and the success rate between two groups had no significant (P > 0.05). The median patency time was 11(7-12) months and 15(5-22) months (P > 0.05). The volume of bleeding [3(2-4) ml vs. 20(10-40) ml], the length of blood vessel wastage [0 vs. (3.6 ± 1.2) cm] and the operating time [(0.6 ± 0.7) h vs. (1.8 ± 0.5) h] of PTA patients were less than those of vascular neo-anastomosis group, and there were significant differences (P < 0.05). Conclusions There are no significant differences between PTA and neo-anastomosis with respect to patency. PTA has the advantages of less vascular injury, shorter operation time, less bleeding and can dilate arteries at the same time.

Currently,medical imaging (ultrasound,mammography,CT,MRI) is of great value in diagnosis of breast lesions,and has a high sensitivity and accuracy in qualitative diagnosis.Based on medical imaging and with the rapid development,three dimensional (3D) printing and 3D reconstruction techniques can provide more information about accurate position,anatomical structures,morphology and volume of lesions and so on.And it is helpful in efficient communication with patient,making precise surgical plan,postoperative individual reconstruction and assessment of the effect after chemotherapy.The progresses of 3D reconstruction and printing techniques based on medical imaging in diagnosis of breast lesions were reviewed in this paper.

Objective To compare the ultrasound features of papillary thyroid carcinoma with or without cervical lymph node metastasis (LNM). Methods Patients suspected of thyroid cancer underwent the conventional ultrasound and contrast-enhanced ultrasound (CEUS) examinations. Patients' age,sex,and ultrasound characteristics of lesions were recorded. With the surgical pathology as the golden standard,the ultrasound features were compared between the cervical LNM group and non-LNM group. Results Of 144 patients,51 had cervical LNM and 93 did not. Patients' ages,sex and number of lesions had no significant difference between two groups (all P>0.05). Tumor with LNM had maximum size greater than 0.85 cm,ill-defined margin (P=0.000),irregular shape (P=0.007),internal heterogeneous echogenicity (P=0.007),microcalcification (P=0.020),internal heterogeneous low-enhancement (P=0.002),peripheral non-enhancement ring (P=0.030),and extracapsular extension (P=0.000). Conclusion Conventional ultrasound and CEUS are helpful for predicting the cervical LNM of PTC. CEUS can obtain more accurate diagnostic results for the extracapsular extension,which contributes to the prediction of cervical LNM.

Objective To explore the clinical value of thermal tomography (TT) in the diagnosis of breast diseases.Methods Totally 222 breast diseases patients underwent examinations by color Doppler ultrasound and TT.Some stable TT images were selected,and the TT curves of the lesions were analyzed according to the malignant tumor TT curve diagnosing standard,so that the benign and malignant tumors could be determined.Color Doppler ultrasound was used to describe the site,size and property of the lesion.Results Pathological examination found 95 cases of malignant tumors and 127 benign ones.TT had 198 results coincident with those by pathological examination while the remained 24 ones not,with 15 false positive results and 9 false negative ones.When compared with pathological examination,TT had the accuracy,sensitivity and specificity being 89.19％,90.43％ and 88.28％ respectively.Conclusion TT is non-invasive,accurate and sensitive when used to screen and diagnose breast diseases,and should be applied if possible in medical facilities.

Objective To present our initial experience with modified branched stent gratis in endovacular repair of common iliac artery aneurysms.Methods In 5 patients,3 were aortobiiliac aneurysms and 2 were single common iliac aneurysms,receiving endovascular repair by a novel modified branched stent graft to keep at least one internal iliac artery patency.Results All cases were successfully completed with patent external and internal iliac artery on the target side.There were no inhospital mortality nor major complications after graft stenting.During a follow-up period of 27.6 months (21 to 33 months),there have been no stenting related endoleak and branch occlusion.Conclusions Modified branched stent graft is safe and efficient,providing an effective way to protect internal iliac artery in endovascular treatment of common iliac aneurysms.

Purpose To investigate the prognosis and influencing factor of hematoma complicated from ultrasonography-guided EnCor vacuum-assisted breast biopsy system in minimally invasive surgery for breast lesions, and to provide reference for clinical treatment. Materials and Methods 280 female patients with 486 benign breast lesions underwent minimally invasive excision using a ultrasonography-guided EnCor vacuum-assisted device, occurrence and the inlfuence factors of hematoma complicated from the operation was observed. Results All the 486 lesions were completely excised with EnCor system, hematoma (≥1cm) were found in 47 cases after 24 hours and almost disappeared in 6 months. After analysis of the occurrence of hematoma, it was found that the following situations would lead to a higher incidence of hematoma, which included lumps ≥ 2.5 cm, more than two lesions removed at one time, lumps locating deep inside the areola or the edge of breasts, bigger and less dense breasts, operation in menstrual period, pressure bandaging after operation less than 12 hours and operation without using adrenaline (P<0.05 or P<0.01). Conclusion Benign lesions breast can be effectively excised using ultrasonography-guided EnCor vacuum device, and the factors listed below could affect the occurance of hematoma complicated from the surgery, including the size, location and number of the resected nodules, breast shape, surgery during menstrual period, postoperative pressure bandaging and the use of hemostatics.

Objective To evaluate the value of supersonic shear wave elastrography(SWE) in the diagnosis of benign and malignant breast lesions.Methods SWE was performed on 134 breast lesions of 123 female patients and 74 normal breast glands to determine the values of overall elastic modulus and dispersion,and ROC curves were used to assess the diagnosis boundary value of two kinds of data respectively.Results According to the diagnostic gold standard-histopathology,the values of overall elastic modulus and dispersion were statistically significant when comparing benign lesions and malignant lesions with normal glands.ROC curve displayed that,when the Youden index reached to maximum,the diagnosis boundary value of overall elastic modulus was 41.01 kPa,the sensitivity and specificity of the value were 68.5％ and 83.8％ respectively; the diagnosis boundary value of dispersion was 12.25 kPa,the sensitivity and specificity of the value were 87.0％ and 88.7％ respectively.Conclusions The values of overall elastic modulus and dispersion for solid breast lesions can be used to reflect the elastic characteristics of lesions quantificationally,which is useful to diagnose benign and malignant breast lesions in clinical.