Ultrasonographic and radiographic diagnosis of breast nodules in young women]

Mammography as a priority method of diagnosis of breast nodules in young women is of low efficacy as a result of a dense background of the breast as distinct from echography permitting the detection of abnormal lesion against this background. Altogether 126 patients with clinical manifestations of breast nodules were investigated. Apparatus methods used for investigation of 38 of them, revealed but manifestations of fibrocystic mastopathy. Assessment of the efficacy of x-ray and ultrasound diagnostic methods was performed in 88 patients with breast nodules (the patients varied in age from 14 to 40). Radiodiagnostic accuracy in benign tumors was 54.1%, that in malignant tumors--78.1%. Ultrasound investigation proved to be the most informative method for diagnosis of breast nodules in young women, and the use of a proposed algorithm would permit optimization of the diagnostic process.     

A complex x-ray study of patients with enterocutaneous fistulas

The paper is concerned with analysis of the results of x-ray examination of 78 patients with enterocutaneous fistulas of various etiology and site. The authors have shown the characteristic features of x-ray examination of patients in whom the fistulas were at the acute phase of their development. They have also defined the diagnostic value of the employed methods and their efficacy for the diagnosis not only of fistulas but also of related complications (inflammatory infiltrates and abscesses of the abdominal cavity, fatty phlegmon, purulent "fillings", complicated fistulas, etc.). During combined x-ray investigation accurate diagnosis of fistulas was established in 97.4% of the patients, purulent complications were revealed in 94.6%.     

Differential ultrasonic diagnosis of jaundice

Multiprojection ultrasound investigation was performed in 87 patients with jaundice. Echography was shown to be an effective method of differential diagnosis of parenchymatous and obstructive jaundice. The accuracy of ultrasound introscopy in the detection of parenchymatous jaundice was 84.3%, that in the detection of mechanical jaundice was 100% (the general accuracy being 85.7%). The authors proposed an algorithm for the use of ultrasound tomography, x-ray and clinico-instrumental methods in differential diagnosis of jaundice of different etiology.     

Computed tomography in the comprehensive diagnosis of acute diseases and injuries

The author presents the results of a CT use during combined investigation on 2500 patients and the wounded who were admitted to hospital on emergency as well as patients who developed serious complications during treatment, especially in the postoperative period. CT findings were verified during operation, at autopsy or during a follow-up. They were indicative of a high effectiveness of emergency CT of different organs and systems in the diagnosis of lesions, acute diseases and their complications. The use of CT permitted considerable reduction of a diagnostic (preoperative) period, a decrease in use of routine invasive x-ray and surgical methods, and the improvement of therapeutic results.     

The robot and the satellite for tele-operating echographic examination in Earth isolated sites, or onboard ISS

The objective was to design and validate a method for tele-operating (from an expert site) an echographic examination in an isolated site. METHOD: The isolated places, defined as areas with reduced medical facilities, could be secondary hospitals 20 to 50 km from the university hospital, or dispensaries in Africa or Amazonia, or a moving structure like a rescue vehicle or the International Space Station (ISS). At the expert center, the ultrasound medical expert moves a fictive probe, connected to a computer (n degrees 1) which sends, the coordinate changes of this probe via an ISDN or satellite line to a second computer (n degrees 2), located at the isolated site, which applies them to the robotic arm holding the real echographic probe. RESULTS: The system was tested at Tours Hospital on 105 patients. A complete investigation (visualization) of all the organs requested for different clinical cases was obtained in 76% of the cases with the robot, and 87% at the reference echography: In 11% of the cases, at least one of the organ visualized at reference echo could not be investigated by the robot, thus the diagnostic was not done. The number of repositioning was higher for the robot (6.5 +/- 2) than for the reference echo (5.1 +/- 2 = or > 24% more with robot). The duration of the examination was higher with the robot (16 +/- 10 min) than for the reference echography (11 +/- 4 min = or > +43% with the robot compare to reference echography. The system was also tested successfully using satellite links in a limited number of cases (approx 30).     

The Ultrasonic Evaluation of Nonfunctioning Thyroid Nodules

Thyroid echography was carried out on 100 patients with thyroid abnormalities to evaluate the diagnostic accuracy of ultrasound in differentiating simple thyroid cysts from solid thyroid nodules.In all 46 proven cases, the ultrasonic diagnosis of the solid or cystic nature of thyroid nodules was correct.A proposed diagnostic workup of a hypofunctioning (cold) thyroid nodule is suggested with primary needle aspiration and cytologic examination of the cyst fluid being recommended if the nodule is shown to be entirely cystic by ultrasound.     

Radiodiagnosis of echinococcosis of the lungs]

The paper is devoted to analysis of radio-diagnostic findings of 79 patients with parietal round pulmonary formations. All the patients were investigated by x-ray and ultrasound, perfusion scintigraphy of the lungs with a postural test was performed in 43 of them. Diagnostic x-ray and echographic methods were compared and evaluated in terms of defining the origin of pulmonary formations. The origin of pulmonary formations was established by x-ray in 50 of 79 patients (63.3 per cent) whereas ultrasound findings proved correct in 74 of 79 patients (93.6 per cent). Perfusion scintigraphy can be recommended to patients with pulmonary echinococcosis only for limited indications when a necessity arises to assess the lesser circulatory state in terms of patients' functional operability.     

X-ray diagnosis of complications of purulent processes in the wrist

To reveal the spreading of a purulent process to the antebrachial fatty spaces a study was made of an x-ray picture of soft tissues of the radiocarpal articulation and the forearm distal half in 126 patients with hand paronychia and phlegmon. In 24 of 95 patients with an unclear clinical picture of purulent discharge, typical x-ray symptoms of changes in soft tissues of the distal third of the forearm were found: typical deformity of fatty spaces with its distinct dynamics with relation to a stage of development of a pathological process. X-ray investigation permits the recognition of complications in hand purulent processes in order to take necessary therapeutic measures.     

Clinical and radiologic manifestations of pleural and pulmonary complications in sepsis]

Proceeding from the investigation and therapy of 106 patients with pleuropulmonary complications of sepsis the authors described clinical and x-ray features of different types of their course, complications and outcomes. In 58% of cases pulmonary lesions were detected at the stage of pyodestruction and pleural empyema; interstitial-focal and infiltrative pneumonias of considerable spreading with the development of a respiratory type of septic shock were observed less frequently. Pulmonary lesions in 24% were the only sign of septicopyemia, in 58% they prevailed in the clinical picture of polyorganic lesions; pleural complications developed in 32% of the patients. Convalescence was observed in 88 (83%) patients; they had residual bullous-sclerotic pulmonary changes. The lethality rate was 17%.     

中晚期肝癌患者采用超声介入治疗引发并发症影响因素分析

摘要 目的：分析中晚期肝癌患者采用超声介入治疗引发并发症影响因素。方法：选取2019年2月～2023年2月在本院接受超声介入治疗的120例中晚期肝癌患者进行研究,治疗后记录患者的并发症发生率,并根据并发症发生情况将患者分为有并发症组（36例）和无并发症组（84例）,分别对两组患者的一般特征{性别、年龄、有无基础疾病、TNM分期、Child-Pugh分级、形态分型、肿瘤体积、腹水、门静脉高压、血供情况、白蛋白（ALB）及血清学指标[血红蛋白（Hb）、血小板（PLT）、凝血酶原时间（PT）、总胆红素（TBIL）、谷丙转氨酶（ALT）、谷草转氨酶（AST）]}进行分析,并建立logistic模型,对一般特征在中晚期肝癌患者超声介入治疗后引发并发症的影响中进行单因素和多因素分析。结果：120例患者经超声介入治疗后的并发症发生率为30.00%。有并发症组Child-Pugh B级、腹水+、ALB＜30 g/L的患者明显高于无并发症组,差异有统计学意义（P＜0.05）。单因素分析结果显示,Child-Pugh分级、腹水、ALB是导致中晚期肝癌患者超声介入治疗后引发并发症的影响因素（P＜0.05）。多因素logistic分析结果显示,Child-Pugh B级、腹水、ALB＜30 g/L均是导致中晚期肝癌患者超声介入治疗后引发并发症的独立危险因素（P＜0.05）。结论：Child-Pugh分级、腹水和ALB均是导致中晚期肝癌患者超声介入治疗后引发并发症的独立因素,只有尽早针对该类影响因素加强防治干预,才能有效降低中晚期患者的并发症发生率。     

Ultrasound diagnosis of gallbladder and bile duct diseases]

The paper is concerned with analysis of the potentialities of ultrasound introscopy in the diagnosis of various diseases of the gall bladder and biliferous ducts in 174 patients aged 19 to 76. The accuracy of the detection of calcium containing concrements of the gall bladder was 98.8%, that of choledocholithiasis--75%, noncalculous cholecystitis--88.4%, choledochodilatation--71.4%. In the absence of pathological changes in the gall bladder and biliferous ducts the reliability of echography was 27.7 and 93.1%, respectively. Causes of diagnostic errors in ultrasound tomography of the biliary system were discussed, methods of their prevention were proposed. A diagnostic algorithm of the sequence of use of ultrasound introscopy and other diagnostic methods to be employed in clinical practice was devised.     

Radiologic diagnosis of urinary tract disorders in genital endometriosis]

The paper is concerned with the results of combined investigation of 157 women suffering from genital endometriosis, operated on for this disease. The involvement of the lower parts of the ureters in a pathological process was detected in 48 patients before operation and in 6 patients at operation. Comparison of x-ray and operative findings with histology specimens made it possible to define endogenous and exogenous forms of ureteral endometriosis and three variants of an x-ray picture in this pathology (the absence of abnormal changes of the urinary tract, hydroureter is over the narrowed part of the ureter, hydroureteronephrosis). The authors have shown a high informative value of combined x-ray investigation and the effectiveness of its use in clinical practice.     

Arthrosonography in the diagnosis of rheumatoid arthritis of the knee joint

The paper presents the capacities of echography in the estimation of the activity of rheumatoid gonitis. A study of knee joints in 126 patients with rheumatoid arthritis has provided the basic ultrasound criteria that are characteristic for the first, second, and third degrees of its progression, which include the pattern of proliferative changes in the synovium, the qualitative and quantitative assessments of intraarticular exudate and its viscosity. The capacities of X-ray study and MRI in the detection of the progression of rheumatoid arthritis are discussed. An algorithm of knee joint radiation study is proposed for patients with rheumatoid arthritis.     

X-ray-ultrasonic parallels in tumors of the stomach and intestines]

Combined clinical, radio and ultrasound investigation of 46 patients was carried out. It was shown that routine transabdominal UTS could be employed in diagnosis of gastric and intestinal tumors but mainly at more advanced stages (T3, T4). Potentialities of the method were shown to depend, to a great extent, on a tumor site, growth, type, sizes, and spreading, as well as on the resolving power of an US diagnostic apparatus. The use of a high resolution apparatus made it possible to detect tumor invasion, but topography of a tumor was difficult to define. The x-ray or endoscopic method can be used as an adjuvant method of specified diagnosis of gastric and intestinal tumors.     

Echotomography in the diagnosis of pleural effusion]

USI of the pleural cavities was performed in 119 patients (65 men and 54 women) aged 30 to 90 with different abnormalities. Pleural fluid in 106 patients was the leading symptom of the main pathological process, in 13 patients it was a sign of pleural disease. USI was combined with routine x-ray methods. Minimum amounts of pleural fluid could be clearly visualized by ultrasound scanning. Echo-tomographic symptoms of free and encapsulated fluid as well as ultrasound signs permitted differentiation of pleural thickening and exudate accumulation. A program of diagnostic algorithm was worked out for pleural fluid.     

Barium reduction of intussusception in infancy

Barium enema reduction was used as the initial routine treatment in 29 infants with intussusception. In 22 of them the intussusception was reduced by this means. In three of eight patients operated upon the intussusception was found to be reduced. Four of the remaining five patients had clinical or x-ray evidence of complications before reduction by barium enema was attempted.Twenty-one of the patients, all of whom were observed in private practice, were treated without admission to the hospital. After reduction, these patients were observed closely by the clinician. None of these patients showed clinical or x-ray signs of complications before reduction. Certain clinical and roentgen criteria must be satisfied before it can be concluded that reduction by barium enema is complete. If there are clinical signs of complications with x-ray evidence of small bowel obstruction, only a very cautious attempt at hydrostatic reduction should be made. As the time factor is generally a reliable clinical guide to reducibility, the late cases should be viewed with greater caution. Long duration of symptoms, however, is not per se a contraindication to an attempt at hydrostatic reduction.     

Diagnosis of abdominal masses with percutaneous biopsy guided by ultrasound.

OBJECTIVE--To assess the accuracy and safety of percutaneous biopsy of abdominal masses guided by ultrasound. DESIGN--Prospective study. SETTING--Combined gastroenterology service, Scarborough Hospital. PATIENTS--108 Consecutive patients identified as having a discrete mass on diagnostic ultrasound examination of the abdomen. INTERVENTION--A sample of tissue was obtained with an aseptic technique under local anaesthesia: an 18 steel wire gauge needle (Tru-Cut) was mounted in a spring loaded firing device (Biopty gun) that was advanced under simultaneous ultrasound scanning, permitting precise localisation of the target organ. MAIN OUTCOME MEASURE--Results of histological examination of tissue specimens. RESULTS--Biopsy failed in four patients. Adequate histological specimens were obtained in 104 patients with masses in the liver (31), pancreas (37), kidney (10), and adrenal glands (six) and in 20 undiagnosed abdominal and retroperitoneal masses. Follow up was until death or confirmation of the diagnosis. Three complications but no deaths occurred. Malignancy was suspected in 84 patients before biopsy. This was confirmed in 70 patients, in 26 of whom confirmation of dissemination obviated the need for further investigation. In 10 patients biopsy indicated a previously unsuspected primary tumour, and in 12 it showed only a benign lesion. Among 24 patients considered to have benign disease biopsy showed an unsuspected neoplasm in seven. Use of biopsy thus had a major effect on clinical management in 55 patients. Four false negative but no false positive diagnoses resulted from the procedure. CONCLUSION--Percutaneous biopsy of abdominal and retroperitoneal masses under ultrasound guidance is a safe and accurate method of obtaining a histological diagnosis. The results obtained have a considerable effect on clinical management.     

X-ray diagnosis of peptic ulcers of the jejunum

The paper is devoted to a study of the results of clinicoroentgenological and endoscopic investigation of 188 patients aged 23 to 60 who developed jejunal peptic ulcer. It was done to specify the features of an x-ray picture of jejunal peptic ulcers with relation to the cause of ulcer development and optimum methods of x-ray investigation. The predominant localization of peptic ulcer in the jejunal efferent loop and its typical ulcero-cicatricial deformity were established. Jejunal peptic ulcers developing as a result of an insufficient area of resection, are characterized by a relatively benign course of the disease. In case ulcer development was determined by the residual antral stomach mucosa at the duodenal stump or by the Zollinger-Ellison syndrome, considerable pathological changes (gigantic ulcer sizes greater than 2.5 cm and a sharp deformity of the jejunal efferent loop) were noted.     

The state of the veins of the esophagus and the stomach in chronic diffuse liver diseases (based on data from a combined roentgeno-endoscopic and echographic study)

Combined roentgenological and endoscopic investigation was used to study the state of the esophageal submucous veins. Echography was used for investigation of the gastric subserous veins and esophageal abdominal veins. The results obtained indicate that in the presence of portal hypertension there are two types of shunting: via the esophageal submucous (82%) and subserous (18%) veins. In patients with the predominant affection of the esophageal subserous veins x-ray investigation and endoscopy do not allow correct estimation of the presence and a degree of the gastroesophageal shunt. Echography results enable one to arrive at a correct conclusion in all patients.     

X-ray diagnosis of a phlegmon of the retroperitoneal space tissue]

The paper is concerned with the results of a combined x-ray study of 36 patients with phlegmon of retroperitoneal fat (RF). The x-ray procedure was described, potentialities and effectiveness of each method (panoramic polypositional investigation of the chest and peritoneal cavity, a contrast study of the G.I. tract) were shown. X-ray semeiotics of phlegmon of RF of different sites, the main differential and diagnostic signs to distinguish between phlegmon and accumulation of gases of other sites and its causes, were described in detail. The accuracy of phlegmon detection with these methods was 97.2%; phlegmon was detected in 35 of 36 patients.