Accuracy of ultrasonography in early pregnancy diagnosis in the ewe

Nonbred and pregnant ewes were examined ultrasonographically at intervals of 4 to 6 days on Days 17 to 34 after estrus. Each ewe was diagnosed as pregnant or nonpregnant, and a score for degree of certainty in the diagnosis was recorded. The goal of the study was to define criteria that could be used for identification and accuracy of diagnosis of an early conceptus and to ascertain the confidence which the operator had in makeing the diagnosis. Pregnancy was retrospectively confirmed by ultrasonographic detection of an embryo proper and by embryonic heartbeat on Days 21 to 34, and later judged against the number of lambs born to each ewe. The percentage of ewes accurately diagnosed pregnant by ultrasonography was not significantly higher than that by guessing (50%) before Day 24, but reached 85% on Days 32 and 34. However, the ability to detect nonpregnant ewes by ultrasonography was higher (P<0.01), with a greater specificity starting on Days 21 to 23 (80%) and reaching 98% by Days 32 to 34. Before Day 24, the diagnosis of pregnancy in many cases was based primarily upon the ultrasonographic appearance of the uterine lumen and location of the uterus in relation to the bladder rather than upon detection of the conceptus. For the certainty score there was a main effect of day (P<0.01) but not for the reproductive status (pregnant vs nonpregnant). The certainty score increased in all ewes among days, and was highest on Days 32 to 34. It was concluded that real time transrectal ultrasonographic scanning of sheep between Days 24 and 34 of gestation offers a safe, accurate and practical means for diagnosing pregnancy.     

Comparison of ultrasonography, bovine pregnancy-specific protein B, and bovine pregnancy-associated glycoprotein 1 tests for pregnancy detection in dairy cows

At Days 26 to 58 after AI, 138 Holstein-Friesian dairy cows were repeatedly examined by ultrasonography, using a 7.5 MHz linear-array rectal transducer. The total calving rate was 37.6% (52/138), and late embryonic mortality occurred 8.6% of the cows (12/138). On the days of ultrasound scanning, blood samples were drawn from the jugular vein for measuring the concentration of bovine pregnancy-specific protein B (bPSPB) and bovine pregnancy-associated glycoprotein 1 (bPAG 1). When compared with calving results, there were no significant differences in accurate diagnosis of pregnant cows were found between the 3 methods. However, when recognition of an embryo proper with a beating heart was used as the criterion for positive ultrasonographic diagnosis significantly fewer (P < 0.001) pregnant cows were correctly identified than by the other 2 tests. When compared with the noncalving cows, significantly fewer (P < 0.001) false positive diagnoses were made by the 2 ultrasonographic tests than by the PSPB and bPAG 1 tests, while significantly fewer (P < 0.001) false positive diagnoses were made by the bPSPB test than by the bPAG 1 test. The accuracy of detecting nonpregnant animals by both protein tests was limited by the relatively long half-life of these proteins after calving and by early embryonic mortality.     

Evaluation of false ultrasonographic pregnancy diagnoses in sows by measuring the concentration of unconjugated estrogens in feces

On Days 26, 28, and 30 after AI, ultrasonographic pregnancy diagnoses were performed on 207 gilts and sows by using a 3.5 MHz linear-array transducer. Fecal samples were taken from the rectum after each ultrasonographic examination, and the concentrations of unconjugated estrogens in selected samples (n = 73) were measured by RIA. Fecal unconjugated estrogen concentration of 11.7 ng/g feces or higher was indicative of pregnancy. The overall sensitivity and specificity of the ultrasonographic test was 99% for farrowing sows and 73.1% for nonfarrowing sows. With one exception, sows with a false negative diagnosis by ultrasonography on Day 26 were correctly diagnosed pregnant by elevated fecal unconjugated estrogens or repeated ultrasonographic examinations on Days 28 or 30. Return to estrus around the sampling period may cause false positive results in the unconjugated estrogen assay, while early embryonic mortality can result in false positive diagnoses in both the ultrasonographic test and estrogen assay. Although there was a positive correlation between the concentrations of unconjugated estrogens in the feces and litter size at farrowing in the selected sows, it seems very unlikely that fecal estrogens can provide an accurate tool for predicting litter size.     

超声内镜引导下细针穿刺活检联合基因检测对胰腺癌的诊断价值

目的:研究超声内镜引导下细针穿刺活检(EUS-FNA)联合K-ras基因检测对胰腺癌的诊断价值,为临床诊疗提供依据。方法:选取2013年11月到2015年11月我院收治的胰腺占位病变患者90例,患者入院次日行EUS-FNA,检测患者血清及活检物中K-ras基因阳性率,比较EUS-FNA单独与EUS-FNA联合K-ras基因检测对胰腺癌诊断的准确率与敏感性。结果:90例胰腺占位病变者中,经病理证实胰腺癌56例,EUS-FNA单独与EUS-FNA联合K-ras基因分别检出胰腺癌50例、53例,准确率分别为89.29%、94.64%,敏感性分别为92.59%、98.15%,两组比较差异均有统计学意义(P0.05)。胰腺癌患者活检物中K-ras阳性率为83.93%,明显高于血清中的41.07%(P0.05)。结论:EUS-FNA联合K-ras基因检测可提高对胰腺癌诊断的准确率与敏感性。     

Prospective comparison of three non-invasive tests for pancreatic disease.

Ultrasonography, computed tomography (CT), and an oral pancreatic function test were evaluated prospectively in 107 consecutive patients suspected of having pancreatic disease, the final diagnosis being made independently of these tests. Seventeen patients proved to have either chronic pancreatitis or a pancreatic neoplasm. Five had an unfused ventral pancreas and 10 had "minimal change" pancreatograms. Seventy five patients did not have pancreatic disease. Among the 17 patients with pancreatic disease the sensitivities of ultrasound, CT, and the pancreatic function test were 70%, 71%, and 76% respectively; among those without disease values of specificity of the three tests were 75%, 87%, and 72%. All three tests failed to detect most of the patients with unfused ventral pancreases or minimal change pancreatograms. The predictive values of a positive result for the three tests were 43%, 67%, and 34%. The predictive value of a negative result was greater than 90% for all the tests. Results improved when CT was combined with either of the two other tests. These findings show that CT is the most accurate of the three tests in diagnosing pancreatic disease but that a combination of ultrasound and the oral pancreatic function test offers a more widely applicable and almost as accurate alternative.     

二维及实时三维超声对胎儿全前脑畸形的诊断价值探讨

目的：探讨二维及实时三维超声联合诊断胎儿全前脑畸形的价值。方法：二维超声系统检查发现胎儿颅脑结构异常者进行胎儿颅脑和颜面部实时三维成像,并将超声诊断结果与引产后尸检结果进行对照分析。结果：在20918例孕16~41周的胎儿中,经引产后尸检证实的全前脑畸形5例,其中无叶全前脑3例,半叶全前脑2例,均与产前超声检查结果相符合,二维联合实时三维超声检查对胎儿全前脑畸形诊断符合率为100%。结论：二维超声联合实时三维超声检查是诊断胎儿全前脑畸形可靠有效的方法,两者联合应用可提高产前全前脑的诊断率。     

超声内镜对消化道隆起性病变的诊断价值

目的:探讨超声内镜(EUS)对消化道隆起性病变的诊断价值。方法:回顾性分析2013年2月到2017年6月于我院行EUS检查并经内镜下黏膜剥离术(ESD)、内镜粘膜切除术(EMR)或超声内镜引导下细针穿刺(EUS-FNA)获取诊断的293例有消化道隆起性病变的患者,分析病变的超声特点,对比病变的诊断结果。结果:在293例患者中,270例超声诊断与最终诊断相符,EUS诊断消化道隆起性病变的准确性为92.3%。在多种隆起性病变中,以平滑肌瘤(30.7%)及间质瘤(32.4%)最多见,超声对平滑肌瘤及间质瘤的诊断准确性分别为87.8%、95.8%。结论:EUS对消化道隆起性病变是一种有效的、准确的初步诊断方法。     

脐血管前置产前超声表现及临床效果分析

目的:研究脐血管前置产前超声表现及临床效果。方法:回顾性分析2017年1月至2018年12月期间本院收治的34例脐血管前置孕妇临床资料,均进行产前超声检查,将结果与产后病理结果进行比较,分析超声表现。结果:同产后病理检查结果相比较,34例孕妇的产前超声诊断准确率、误诊率分别为97.06%、2.94%,数据对比差异无统计学意义(P>0.05),产前超声检查显示的胎盘及脐带入口情况主要为帆状胎盘、脐带胎盘边缘附着、边缘性前置胎盘、低置性前置胎盘、副胎盘等。结论:产前超声检查具有较高的脐血管前置诊断准确率,可为临床分娩结局的改善提供指导,适合推广应用在临床中。     

Diagnosing Pancreatic Cancer: An Analysis of Several Strategies

The usefulness of a clinical examination was compared with several other procedures (ultrasonography, pancreatic function tests, endoscopic retrograde cholangiopancreatography and angiography) for diagnosing pancreatic cancer. We used a simplified form of decision analysis to show the effects of different strategies on direct diagnostic costs, missed diagnoses and false-positive diagnoses.Our analysis indicates that existing laboratory tests are either too non-specific or too invasive to be used successfully as screening tests for pancreatic cancer. To decrease the number of unnecessary laparotomies due to false-positive test findings, patients should have a high probability of pancreatic cancer, based on clinical criteria, before further testing is carried out. In fact, existing clinical criteria are both sensitive and specific for pancreatic cancer.     

Transrectal real-time ultrasound scanning for diagnosing pregnancy and for monitoring embryonic mortality in dairy cattle

A total of 309 ultrasonographic tests was performed on 100 inseminated dairy cows during the course of the first trimester of pregnancy and on 13 noninseminated controls. The reliability (defined as the proportion of cows pregnant or nonpregnant by rectal palpation at 60–90 days compared to those diagnosed as pregnant or nonpregnant by ultrasonography) and accuracy (defined as the proportion of cows correctly identified as pregnant or nonpregnant) of the ultrasonographic results at different intervals after A.I., are reported. It was found that near 100% reliable results could be obtained for positive diagnosis from 45 days onwards and that the ultrasonographic results were 100% reliable for negative diagnosis from 40 days onwards. Furthermore, 7 out of 100 inseminated cows which were diagnosed as negative by early pregnancy diagnosis 21–24 days after A.I. were found to be positive at the ultrasonographic test after 30 days but interestingly enough failed to carry the conceptus until rectal palpation occurred (60 days). The total late embryonic mortality was 23%.     

Prediction of gall-stone pancreatitis by computer.

The clinical features at presentation of 53 patients admitted with primary acute pancreatitis due to gall stones were compared with those of 31 patients in whom the disease was due to other causes. Between these two groups 10 significant differences existed. By listing the frequency of symptoms and signs for each group a computer data base was prepared and incorporated into a program used in the differential diagnosis of acute abdominal pain. A program written to predict the presence of gall stones in patients with acute pancreatitis was accurate in 92% of the patients studied. A predictive index devised from the presence of three of the significantly differing clinical features correctly identified 82% of patients with gall-stone pancreatitis. Predicting the presence of gall stones on admission by analysing the presenting symptoms and signs with a computer had an accuracy comparable to that of ultrasonography or radiology and may be of value in the management of patients with acute pancreatitis.     

Accuracy in clinically evaluating pigmented lesions.

OBJECTIVE--To determine the ability of three doctors experienced in managing melanocytic lesions to diagnose correctly melanoma, dysplastic naevi, and various benign pigmented lesions. DESIGN--Independent clinical evaluation and histopathological assessment. SETTING--Pigmented lesion clinic, which patients attend without an appointment for early diagnosis of melanoma. PATIENTS--86 Patients with lesions that were judged to be benign by at least one of the three doctors. INTERVENTIONS--The lesions were excised under local anaesthesia and sent for histopathological examination in coded bottles without clinical details. MAIN OUTCOME MEASURE--Comparison of clinical with histopathological diagnosis for each lesion. RESULTS--A total of 120 lesions were evaluated by at least two of the three doctors. The histopathological diagnoses were made by the same pathologist. The overall sensitivity (diagnostic accuracy) for the three doctors for all types of lesion was 50%. Of the 39 dysplastic naevi, only 19 were identified correctly by all observers, and a further 24 banal lesions were wrongly diagnosed as dysplastic by at least one doctor. Particular difficulty was experienced with small (less than 5 mm), flat lesions, which can be banal or potentially malignant. CONCLUSIONS--Critical diagnosis and management decisions concerning pigmented lesions should always be based on a combination of clinical and histopathological assessments and the history of the patient.     

Clinical value of serum immunoreactive trypsin concentration.

The clinical value of estimation of serum concentrations of immunoreactive trypsin was evaluated by studying 46 healthy controls, 23 controls in hospital, 44 patients with chronic pancreatic disease, and 184 patients with non-pancreatic conditions in which pancreatic disease commonly enters into the differential diagnosis. Serum trypsin concentration had a log normal distribution in the controls, and the calculated normal range was considerably wider than that previously reported. The concentration was abnormal in only 13 out of 27 patients with chronic pancreatitis and was extremely variable in patients with pancreatic cancer. Abnormal results occurred in 11% of the patients with non-pancreatic disease. Eighteen patients had a subnormal trypsin concentration, of whom six did not have pancreatic disease and 12 had either chronic pancreatitis or pancreatic cancer. There was no correlation between serum trypsin concentration and mean tryptic activity as measured by the Lundh test. Of 11 patients with pancreatic steatorrhoea, only seven had subnormal trypsin concentrations. There results suggest that the serum concentrations of immunoreactive trypsin has a low specificity and sensitivity for pancreatic disease and does no reflect the degree exocrine insufficiency in patients with proved chronic pancreatitis.     

甲状腺结节良恶性的彩色多普勒超声特征及其诊断价值分析

目的:研究甲状腺结节良恶性的彩色多普勒超声特征及其诊断价值。方法:选取从2016年3月~2019年2月于我院接受手术治疗的甲状腺疾病患者300例作为研究对象,均予以彩超检查,比较甲状腺良恶性结节的超声特征(主要包括直径、钙化情况、边界、回声、血流状况)。以病理活检结果为金标准,分析彩超诊断甲状腺结节良恶性的敏感性、特异性以及准确度。对比甲状腺良恶性结节的血流分型情况以及各项血流动力学参数。结果:恶性结节超声特征直径≥2 cm、有钙化、边界模糊、无回声/低回声、血流丰富人数占比均高于良性结节(均P<0.05)。以手术病理组织活检结果作为金标准,彩色多普勒超声诊断甲状腺结节的敏感性、特异性以及准确度分别为97.73%、86.11%、96.33%。甲状腺良性结节血流分型为Ⅰ型、Ⅱ型人数占比高于恶性结节,而Ⅲ型、Ⅳ型人数占比低于恶性结节(均P<0.05)。甲状腺良性结节的收缩期峰值血流速度(PSV)、阻力指数(RI)均低于恶性结节,而舒张末期血流速度(EDV)高于恶性结节(均P<0.05)。结论:彩色多普勒超声对甲状腺结节良恶性的鉴别价值较高,且具有较高的敏感性、特异性以及准确度,可为甲状腺良恶性结节的早期诊断、临床治疗提供重要的参考依据。     

Cross sectional study of contribution of clinical assessment and simple cardiac investigations to diagnosis of left ventricular systolic dysfunction in patients admitted with acute dyspnoea.

OBJECTIVE: To assess the comparative contribution of clinical assessment, electrocardiography, and chest radiography to the diagnosis of left ventricular systolic dysfunction in patients admitted to a general medical ward with acute dyspnoea. DESIGN: Prospective cross sectional study. SETTING: Acute medical admissions ward of a teaching hospital. SUBJECTS: 71 randomly selected patients admitted with acute dyspnoea. MAIN OUTCOME MEASURES: Sensitivity and specificity of each investigation and logistic regression analysis of each variable in identifying left ventricular systolic dysfunction. RESULTS: Clinical assessment in this cohort of patients with severe dyspnoea was generally sensitive (sensitivity 81%). Patients were divided into three groups on the basis of clinical assessment. In the first group (37 patients) the diagnosis of systolic dysfunction was clear, in the second (22) it was in doubt, and in the third (12) it was unlikely. The sensitivity of clinical assessment in identifying left ventricular systolic dysfunction was 81% and the specificity was 47%. The specificity of diagnosis was improved by electrocardiography (69%) and chest radiography (92%). Logistic regression analysis showed that isolated pulmonary crepitations were a comparatively poor predictor of left ventricular systolic dysfunction chi 2 = 10.215, P = 0.0014) but that a full clinical examination had reasonable predictive value (chi 2 = 24.82, P < 0.00001). The combination of clinical assessment and chest radiography improved the accuracy of diagnosis (chi 2 = 28.08, P < 0.00001), as did the combination of clinical assessment and electrocardiography (chi 2 = 32.41, P < 0.00001). CONCLUSION: Clinical assessment in patients admitted with acute dyspnoea is comparatively accurate. Patients with abnormal results on chest radiography, electrocardiography, and clinical examination have a high likelihood of having left ventricular systolic dysfunction. Echocardiography contributes little more to the diagnosis in these patients and may be more efficiently directed towards patients in whom the diagnosis is still in doubt after clinical assessment, chest radiography, and electrocardiography.     

Ultrasonography for pregnancy diagnosis and evaluation in queens

In the present paper, we describe the clinical utility of ultrasonography for diagnosing and evaluating pregnancy in domestic cats. Ultrasonography is a non-invasive technique that permits an accurate diagnosis of pregnancy and allows serial evaluation of the developing embryo/fetus and the extrafetal structures. The first ultrasonographic indication of pregnancy is a gestational chamber seen on day 10 after mating as a small circular anechoic structure. From day 30, it is possible to recognize different fetal organs, and between 38 and 43 days, the gender of the fetus can be determined. Measurements obtained during the second half of gestation can be used to determine fetal age and calculations can then be made that may more accurately predict the time of parturition. Further studies are needed in the queen to determine the applicability of the echo-Doppler technique used routinely in human obstetric medicine. This type of ultrasonography could potentially provide useful information about fetal health and the maturity of the placenta.     

Silent Renal Stones in Primary Hyperparathyroidism: Prevalence and Clinical Features

Objective(1) To evaluate the prevalence of silent nephrolithiasis in patients with primary hyperparathyroidism (PHPT) compared with controls, and (2) To characterize clinically PHPT patients with silent renal stones.MethodsWe reviewed clinical data for 141 patients with PHPT and without symptoms or history of nephrolithiasis in whom renal ultrasonography was performed at diagnosis. A total of 141 sex- and age- matched subjects with abdomen ultrasonography obtained for reasons different from urinary symptoms served as controls.ResultsSilent nephrolithiasis was more prevalent in PHPT patients than in controls (11.35% vs. 2.13%, P = .003). Among patients with PHPT, those with silent renal stones showed higher serum calcium and parathyroid hormone levels and met surgical criteria, regardless of nephrolithiasis, more frequently than those without renal stones.ConclusionThe prevalence of silent nephrolithiasis is increased in patients with PHPT as compared with controls. Moreover, it seems likely that silent renal stone disease could identify a subset of PHPT patients with more severe disease. Accordingly, we suggest ultrasonographic screening of nephrolithiasis in all PHPT patients. Further studies are needed to better characterize this clinical entity. (Endocr Pract. 2014;20:1137-1142)     

经阴道超声与宫腔镜对子宫内膜病变患者的诊断价值比较研究

目的:探讨经阴道超声与宫腔镜检查诊断子宫内膜病变的临床价值,为临床诊断子宫内膜病变提供理论依据。方法:选取2011年3月-2014年3月间我院收治的158例疑似子宫内膜病变患者,分别采用经阴道超声和宫腔镜进行检查,并以病理诊断结果为"金标准",比较两种检查方法的诊断价值。结果:病理检查结果中,143例患者被确诊为子宫内膜病变,其中子宫内膜增生23例(16.08%),子宫内膜息肉31例(21.68%),子宫粘膜下肌瘤24例(16.78%),子宫内膜癌19例(13.29%),慢性非特异性子宫内膜炎46例(32.17%)。宫腔镜对子宫内膜病变诊断的准确率为94.41%,高于阴道超声的81.12%,差异有统计学意义(P0.05),其中阴道超声和宫腔镜对子宫粘膜下肌瘤、子宫内膜癌诊断的准确率比较差异无统计学意义(P0.05),阴道超声对子宫内膜增生、子宫内膜息肉及慢性非特异性子宫内膜炎的诊断准确率均较宫腔镜降低,差异有统计学意义(P0.05)。阴道超声对子宫内膜病变诊断的特异度较宫腔镜更低(P0.05),但两者灵敏度、AUC比较差异无统计学意义(P0.05)。结论:经阴道超声诊断子宫内膜病变简单、有效,而宫腔镜诊断子宫内膜病变具有准确率以及特异度较高的特点。     

Endoscopic ultrasound-guided fine needle aspiration of the pancreas. Diagnostic utility and accuracy

OBJECTIVE: Endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNAB) is regarded as a safe and reliable procedure for diagnosing and staging of pancreatic neoplasms. This study retrospectively evaluated both the diagnostic utility and accuracy of pancreatic EUS-FNABs and potential cytologic pitfalls when using Diff-Quik stain for on-site evaluation. STUDY DESIGN: Pancreatic EUS-FNABs performed between 1995 and 1998 were identified from the files of the Department of Pathology. All patients were studied via a linear-array ultrasound endoscope with an FNAB device. Immediate evaluation of the specimen by a pathologist using air-dried slides and Diff-Quik stain was done on all cases. An average of five passes (range, three to nine) were performed. Five cytologic categories were identified: nondiagnostic, benign, atypical, suspicious and malignant. EUS disease staging, histologic correlation and clinical follow-up were reviewed. RESULTS: Sixty-nine consecutive pancreative FNABs were evaluated in the study period. The patients comprised 38 females and 31 males with a mean age of 65 years (range, 36-83). Histologic correlation was available on 40 patients, and follow-up was available on the remaining 29. The cytologic diagnoses included: 31 malignant, 8 suspicious, 6 atypical, 20 benign and 4 nondiagnostic. Forty-three cases were true positive, 9 were true negative, 2 were false positive, and 11 were false negative. The overall sensitivity was 80% and specificity was 82%. CONCLUSION: The study showed that cytologic evaluation of pancreatic EUS-FNABs has 80% sensitivity and 82% specificity. False negative diagnosis was usually due to sampling error. A nondiagnostic cytologic diagnosis should be rendered in the absence of adequate sampling of a lesion. On-site cytologic evaluation of EUS-FNABs aids in guaranteeing specimen adequacy, and the pathologist should be trained to evaluate Diff-Quik-stained samples.     

Ultrasonographic Features of Hip Joints in Mucopolysaccharidoses Type I and II

Objectives

The primary aim of this study was to assess the ultrasonographic features of hip joints in patients with mucopolysaccharidosis (MPS) type I and II in comparison with healthy population. The secondary aims were to correlate these features with clinical measures and to evaluate the utility of ultrasound in the diagnosis of MPS disease.

Materials and Methods

Sixteen MPS I (n = 3) and II (n = 13) patients were enrolled in the present study and underwent clinical and radiological evaluation, and bilateral high-resolution ultrasonography (US) of hip joints. The distance from the femoral neck to joint capsule (synovial joint space, SJS), joint effusion, synovial hyperthrophy, and local pathological vascularization were evaluated. The results were compared to the healthy population and correlated with clinical and radiological measures.

Results

1. There was a difference in US SJS between children with MPS disease and the normative value for healthy population (7mm). Mean values of SJS were 15.81 ± 4.08 cm (right hip joints) and 15.69 ± 4.19 cm (left joints). 2. No inflammatory joint abnormalities were detected in MPS patients. 3. There was a clear correlation between US SJS and patients’ age and height, while no clear correlation was observed between SJS and disease severity.

Conclusions

1. Patients with MPS I and II present specific features in hip joint ultrasonography. 2. The data suggests that ultrasonography might be effective in the evaluation of hip joint involvement in patients with MPS and might present a valuable tool in facilitating the diagnosis and follow up of the disease.