ObjectiveTo analyze the safety and effectiveness of ultrasound-guided endovascular treatment for femoropopliteal arteriosclerosis obliteran (ASO). MethodsThe clinical data of patients with femoropopliteal ASO were collected and analyzed. The patients were treated by ultrasound-guided endovascular intervention in the Xijing Hospital of Air Force Military Medical University, from March 2015 to June 2021. The endovascular intervention methods included the arterial balloon dilation (ABD) alone, stent implantation (SI), Rotarex mechanical thrombus removal (Abbreviationas: Rotarex), and thrombolytic catheter implantation (CDT), etc. ResultsAll 112 patients (121 affected extremities) who met the research criteria were collected. Among them, there were 13, 68, and 40 affected extremities by the Rutherford classification of 2, 3, and 4, respectively, while 41, 39, and 41 affected extremities by the Trans-Atlantic Inter-SocietyConsensus Ⅱ classification of A, B, and C, respectively. Among 121 affected extremities, 61 underwent the ABD alone, 27 underwent ABD plus Rotarex, 12 underwent ABD plus SI, 6 underwent ABD plus SI plus Rotarex, 3 underwent ABD plus SI plus CDT, 7 underwent ABD plus CDT plus Rotarex, and 5 underwent ABD plus CDT. The ultrasound-guided endovascular treatments were completed successfully in 118 affected extremities (the success rate was 97.5%), and 3 affected extremities were not completely completed by ultrasound guidance. After operation, 5 affected extremities had pseudoaneurysm and 7 affected extremities had hematoma at the puncture site, which were cured after conservative management. The ankle-brachial index (ABI) of the affected extremities immediately after surgery was statistically higher than that before surgery [0.89±0.13 vs. 0.53±0.09, mean difference (95% confidence interval)=0.36 (0.34, 0.38), paired t-test (t=–25.17), P<0.001]. After a follow-up of 12 months, one patient had a metatarsal amputation and one patient died (acute myocardial infarction). The restenosis rate and reintervention rate of the target lesions were 25.0% (30/120) and 15.0% (18/120) at 12 months postoperatively, and the late loss of diameter was (0.88±0.25) mm. The ABI was still higher than before surgery [0.78±0.13 vs. 0.53±0.09, mean difference (95% confidence interval)=0.25 (0.22, 0.27), paired t-test, t=–17.61, P<0.001]. ConclusionFrom analysis results of this data, it can be seen that, ultrasound-guided endovascular intervention is a safe and effective treatment for selective femoropopliteal ASO.
目的 总结穿刺抽液及无水乙醇局部注射在老年良性甲状腺囊性疾病患者中的应用方法及效果。方法 回顾性分析2008年1月至2011年6月期间在我院行穿刺抽液及无水乙醇注射治疗的老年良性甲状腺囊性疾病患者的临床资料。结果 共84例患者接受穿刺抽液及无水乙醇注射，男11例，女73例；年龄（69±6.4）岁（60～82岁）。术前彩超检查包块均为囊性，直径（4.8±1.7） cm。术前所有患者均主诉吞咽或活动时颈部不适感。54例患者注射无水乙醇后出现面色潮红、局部皮肤发红等症状，在1～2d内消失。无感染、死亡等发生。术前、术后甲状腺功能比较无变化。术后半年复查彩超，包块直径缩小为（1.9±1.2） cm。术后患者主诉颈部不适感症状减轻或消失。结论 对于老年良性甲状腺囊性疾病患者行穿刺抽液及无水乙醇注射安全，可有效缓解患者局部压迫不适，其远期疗效还有待长期观察。
ObjectiveTo explore the value of ultrasound-guided core needle biopsy (CNB) in diagnosis of thyroid nodules. MethodsThe clinical data of 347 patients with thyroid nodules who underwent ultrasoundguided CNB were retrospectively analyzed, and the results of CNB pathology were compared with postoperative wax pathology results. ResultsAll patients completed CNB successfully and satisfaction rate for tissue samples was 100%. After CNB, local hematoma occurred in two cases and relieved by conservative therapy. The CNB pathology results of 347 cases of patients were as follows: 117 cases were malignancy, including papillary thyroid cancer in 115 cases, undifferentiated adenocarcinoma in 1 case, and squamous cell carcinoma in 1 case; 230 cases were benign, including thyroiditis in 53 cases, and nodular goiter in 141 cases, adenoma in 16 cases, and nodular goitre coexisting thyroiditis in 20 cases. In 132 cases of patients underwent surgery including 113 cases of malignancy and 19 cases of benign disease, the CNB pathology results in 127 cases were consistent with postoperative wax pathology results and false negative occurred in 5 cases. The diameter of thyroid nodules were not more than 0.5 cm in 4 cases, 0.5-1.0 cm in 59 cases, 1-2 cm in 46 cases, and more than 2 cm in 23 cases, and the accuracy rate of CNB pathology results was 75.0%（3/4）, 98.3%（58/59）, 97.8%（45/46）, and 91.3%（21/23）, respectively, which was the highest in 0.5-2.0 cm. The accuracy, sensibility, specificity, positive predictive value, negative predictive value, failure rate, and misdiagnosis rate of ultrasound-guided CNB for differential diagnosis of thyroid malignant nodules from benign nodules were 96.21% (127/132), 95.76% (113/118), 100% (14/14), 1 (113/113), 0.74 (14/19), 4.24%(5/118), and 0 (0/14), respectively. ConclusionUltrasound-guided CNB has important value on differential diagnosis of thyroid nodules, and important guiding significance on treatment of thyroid diseases.
目的 探讨Mammotome切除乳腺纤维腺瘤的价值。方法 对我院2006年12月至2008年3月期间超声诊断为乳腺纤维腺瘤的107例患者共129枚病灶行超声引导下Mammotome旋切术。结果 129枚肿瘤超声显示完整切除，肿物切除时间5~40 min，平均16 min。1例发生血肿，3例皮下瘀血，2例乳头溢血，无一例感染。2例皮肤切割者以创可贴拉合后2 d愈合。病理结果显示124枚为良性病变，5枚为恶性。年龄≥40岁者共20例，其中恶性3例。超声显示有钙化灶者共6枚，其中3枚为恶性。103例获门诊随访，随访时间2～12个月，平均 5个月，超声发现2例复发。结论 Mammotome切除乳腺纤维腺瘤可同时达到诊断及治疗目的，美容效果好，对≥40岁及伴有钙化者要警惕恶性病变。
ObjectiveTo explore the value of modified method for intratumoral injection of thrombin in the treatment of iatrogenic pseudoaneurysms.MethodsClinical data of 28 patients with iatrogenic pseudoaneurysms after interventional treatment in our hospital from October 2012 to June 2018 were retrospectively analyzed. Twenty-one cases were treated with ultrasound-guided thrombin injection for pseudoaneurysms (Ultrasound group), and seven cases were treated with DSA-mediated balloon occlusion and thrombin injection for pseudoaneurysms (DSA group). The patients were followed-up at 1 day, 1 month and 3 monthS after operation.ResultsThe total success rates of the two groups were 100%. There was no treatment-related complications in the two groups. There was no recurrence after 1–3 months of treatment.ConclusionsIntratumoral injection of thrombin can be used for the treatment of iatrogenic pseudoaneurysm. The effect of the improved treatment is more significant. These two methods can be used as the best way to treat iatrogenic pseudoaneurysm with different neck diameters.
Objective To investigate the efficacy on clinical condition assessment and the safety of ultrasound-guided osteofascial chamber puncture manometry in evaluating the pressure of the osteofascial chamber in patients with venomous snake bites. Methods Patients with venomous snake bites admitted to the Department of Emergency Medicine of West China Hospital of Sichuan University between April 2021 and January 2023 were prospectively included, and their basic information, physiological indicators (heart rate, blood pressure), laboratory examination indicators, physical signs, treatment methods and prognosis were collected. The patients whose extremal pressure was measured by osteofascial chamber puncture under ultrasound guidance were selected as the manometry group. Patients who were bitten by venomous snakes at the same time without puncture pressure measurement were randomly selected as the control group at a ratio of 1∶1. The bleeding, infection, nerve injury, length of hospital stay and long-term prognosis of the two groups were compared to explore the safety of ultrasound-guided osteofascial chamber puncture manometry. The correlation between the pressure measured in the manometry group and creatine kinase (a representative index of acute poisoning severity score) was analyzed to explore the efficacy of ultrasound-guided osteofascial chamber puncture manometry in evaluating the disease. Results There was no significant difference between the manometry group and the control group in new or aggravated infection, bleeding, nerve injury (such as numbness and anesthesia), hospital treatment time, final detumescence time of the affected limb, or final adverse prognosis (P>0.05). There was a positive correlation between the measured pressure and creatine kinase (rs=0.286, P=0.002). Conclusions The higher pressure measured by ultrasound-guided osteofascial chamber puncture manometry is, the more serious the poisoning condition may be. In addition, ultrasound-guided osteofascial chamber puncture manometry does not prolong the hospital time of patients or the final swelling reduction time of the affected limb, and does not increase the incidence of bleeding, infection, nerve damage or eventual adverse prognosis events. It has clinical practicability and feasibility.
Objective To summarize and analyze the preliminary clinical outcomes of the KokaclipTM transcatheter edge-to-edge mitral valve repair system for severe degenerative mitral regurgitation (DMR). Methods This study was a single-arm, prospective, single-group target value clinical trial that enrolled patients who underwent the KokaclipTM transcatheter edge-to-edge repair (TEER) system for DMR in the Department of Heart Surgery of Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute from June 2022 to January 2023. Differences in the grade of mitral regurgitation (MR) during the perioperative and follow-up periods were compared, and the incidences of adverse events such as all-cause death, thoracotomy conversion, reoperation, and severe recurrence of MR during the study period were investigated. Results The enrolled patient population consisted of 14 (50.0%) females with a mean age of 70.9±5.4 years. Twenty-eight (100.0%) patients were preoperatively diagnosed with typeⅡ DMR, with a prolapse width of 12.5 (11.0, 16.1) mm, a degree of regurgitation 4+ leading to pulmonary venous reflux, and a New York Heart Association cardiac function class≥Ⅲ. All patients completed the TEER procedure successfully, with immediate postoperative improvement of MR to 0, 1+, and 2+ grade in 2 (7.1%), 21 (75.0%), and 5 (17.9%) patients, respectively. Mitral valve gradient was 2.5 (2.0, 3.0) mm Hg. Deaths, thoracotomy conversion, or device complications such as unileaflet clamping, clip dislodgement, or leaflet injury were negative. Twenty-eight (100.0%) patients completed at least 3-month postoperative follow-up with a median follow-up time of 5.9 (3.6, 6.8) months, during which patients had a mean MR grade of 1.0+ (1.0+, 2.0+) grade and a significant improvement from preoperative values (P<0.001). There was no recurrence of ≥3+ regurgitation, pulmonary venous reflux, reoperation, new-onset mitral stenosis, or major adverse cardiovascular events. Twenty-two (78.6%) patients’ cardiac function improved to classⅠorⅡ. Conclusion The domestic KokaclipTM TEER system has shown excellent preliminary clinical results in selected DMR patients with a high safety profile and significant improvement in MR. Additional large sample volume, prospective, multicenter studies, and long-term follow-up are expected to validate the effectiveness of this system in the future.
ObjectiveTo compare the effectiveness of ultrasound-guided closed reduction and Kirschner wire fixation for different unstable humeral lateralcondylar fractures of children. Methods The clinical data of 94 children with unstable humeral lateralcondylar fractures admitted to three medical centers between January 2021 and October 2022 were retrospectively analyzed. The children were divided into three groups according to the Song classification and whether the elbow joint was dislocated or not, including 42 cases of Song 4 type (group A), 38 cases of Song 5 type (group B), and 14 cases of elbow joint dislocation (group C). There was no significant difference in gender, age, side, cause of injury, and time from injury to operation among the three groups (P>0.05). All children were treated with ultrasound-guided closed reduction and Kirschner wire fixation. The operation time and complications of the three groups were recorded and compared, and the failure of closed reduction was evaluated by ultrasound. X-ray examination was performed at last follow-up to measure the Baumann angle, condylar angle, carrying angle, and lateral osteophyte of the affected side; the extension, flexion, pronation, and supination range of motion of the affected elbow joint were measured; the function of the elbow joint was evaluated by Mayo score. ResultsThe operation time in group A was significantly longer than that in groups B and C (P<0.05). There were 7, 2, and 5 cases of closed reduction failure in groups A, B, and C, respectively, and there was no significant difference in the incidence of the closed reduction failure (P>0.05). All patients were followed up 6-28 months, with an average of 15.7 months. There was no significant difference in the follow-up time among the three groups (P>0.05). Complications: in group A, there were 2 cases of delayed union, 4 cases of needle tract infection, 1 case of trochlear necrosis, and 39 cases of lateral osteophyte; in group B, there was 1 case of malunion, 5 cases of needle tract infection, 1 case of redisplacement, and 26 cases of lateral osteophyte; in group C, there were 2 cases of needle tract infection and 10 cases of lateral osteophyte. There was no significant difference in the incidence of complications among the three groups (P>0.05). No cubitus varus or cubitus valgus deformity was found in all patients. At last follow-up, except that the condylar angle in group A was significantly greater than that in groups B and C (P<0.05), there was no significant difference in other imaging indicators, elbow range of motion, or Mayo score between groups (P>0.05). ConclusionThe Song type 4 of humeral lateralcondylar fracture treated with ultrasound-guided closed reduction and Kirschner wire fixation has a longer operation time, more postoperative complications, and is more prone to lateral osteophyte.