Objective To explore the intraoperative imaging to monitor the prosthetic fixation for the total hip arthroplasty (THA) and to increasethe accuracy of the primary THA prosthetic fixation. Methods From April 2000 to August 2005, 69 patients (75 hips) underwent THA monitored by the imaging (the imaged THA group, Group I), and 72 patients (78 hips) underwent THA with the standard method (the standard THA group, Group S). There were 32 males and 37 females in Group S. The mean ages of the patients in Group I and Group S were 62.3 years and 60.5 years respectively, ranging 46-75 years in Group I and 43-75 years in Group S. Preoperative diagnoses were femoral neck fracture (Garden Ⅲ,Ⅳ) in 23 patients (23 hips) in Group I and 25 patients (25 hips) in Group S, acetabular dysplasia (Campbell Ⅰ, Ⅱ) in 9 patients (10 hips) in Group I and 11 patients (13 hips) in Grouop S, osteoarthritis in 16 patients (17 hips)in Group I and 15 patients (15 hips) in Group S, femoral head osteonecrosis (Ficat Ⅲ,Ⅳ) 15 patients (16 hips) in Group I and 17 patients (17 hips) in Group S, and rheumatoid arthritis in 6 patients (9 hips) in Group I and 4 patients (8 hips) in Group S. There were 21 hips of cement prostheses in Group I and 22 hips in Group S, 12 hips of cementless prostheses in Group I and 11 hips in Group S, 42 hips of cement and cementless prostheses in Group I and 45 hips in Group S. Group I used the standard THA and the intraoperative X-ray monitoring the prosthetic fixation in the numerical measure of abduction angle, anteversion angle, femoralneck length, and femoral offset distance. The items compared betweem Group I and Group S included incisional length, intraoperative bleeding, transfusion, operative time, frequency of X-ray imaging, infection, postoperative functional recovery, and prostheric position of postoperative X-ray imaging. Results The follow-up on 62 patients in Group I and 64 patients in Group S for 6-64 months averaged 42 months revealed that there were statistically significant differences in incisional length, intraoperative bleeding, transfusion, operative time, frequency of X-ray imaging, postoperative functional recovery, prosthetic position of postoperative X-ray imaging, and the Harris score between Group I and Group S one year after operation. The results of Group I were significatly better than those of Group S. Conclusion The intraoperative X-ray imaging can increase the accuracy of the THA prosthetic fixation and reduce the incidence of THA maloperation by The X-ray imaging can also be used in county hospitals if Carm fluoroscopy can be provided.
Cerebral small vessel disease is a common neurological disease, including acute and non-acute categories. With the development of neuroimaging, cerebral small vessel disease has attracted substantial attention in recent years. However, the categories and concepts of cerebral small vessel disease and the related imaging markers usually confuse people. The purpose of this study was to discuss the relationships among acute and non-acute cerebral small vessel disease and the imaging markers, so as to improve the understanding of cerebral small vessel disease, and to shed light on clinical practice and research.
ObjectiveTo investigate the morphology of brain regions undergoing multiple sclerosis (MS) MRI, and furthermore, to investigate possible diagnostic values of MRI for MS. MethodsMRI images of 42 MS patients (34 females and 8 males, aged between 35 and 81 years old, averaging at 58) who visited the hospital during the time from December 2007 to December 2013 were collected and analyzed. Routine T1, T2 and fluid attenuated inversion recovery (FLAIR) scans were performed on all the 42 patients. Sagittal T1, T2 and FLAIR scans were performed when necessary. Contrast-enhanced MRI was performed on 9 of the 42 patients. The abnormal findings from MRI scans of all the 42 patients were analyzed. The analysis was further concluded to yield general characteristics of MS patients under MRI. ResultsA total of 286 lesions were identified in 42 patients. Ninety (31.6%) of the 286 lesions (seen in 35 patients) were found to locate around lateral ventricles; 67 (23.4%) at centrum semiovale (seen in 29 patients); 59 (20.6%) in deep white matter (seen in 28 patients); 46 (16.1%) around corpus callosum (seen in 30 patients); 21 (7.3%) in brain stem, basal ganglia and cerebellar hemispheres (seen in 9 patients); and 3 (1.0%) at cervical spinal cord. In routine MRI images, the lesions showed up as low T1 signal, high T2 signal and high FLAIR signal with the shape of ovoid or round. No mass effect was observed in lesions. In the contrast-enhanced MRI images, the 25 observed lesions showed mild enhancements with the shape of ring, semi-ring and arc. ConclusionCertain characteristic features can be observed in MS MRI images. MRI is an effective diagnostic method for multiple sclerosis diagnosis.
Objective To explore the manifestations and features of multi-slice spiral CT （MSCT） in the diagnosisof papillary thyroid carcinoma （PTC）. Methods Preoperative MSCT data of 35 cases of PTC proved by operation and pathology in our hospital form May. to Jun. in 2013 were observed retrospectively， to analyze the manifestations and characteristics of MSCT for it. Results Of 35 patients with PTC， MSCT totally showed 48 lesions， 68.6% （24/35） of patients with single lesion， 31.4% （11/35） of patients with 2-3 lesions， and 62.9% （22/35） of patients with lymph node metastasis. Of the 48 lesions， 29.2% （14/48） of lesions located in the left lobe， 70.8% （34/48） of lesions located in the right lobe；the lesions’ maximum diameter were 0.4-5.8cm， with the average maximum diameter of 1.3cm. There were 39.6% （19/48） of lesions with uneven density， 25.0% （12/48） of lesions with irregular shape， 47.9% （23/48） of lesions with blurred edges， 18.8% （9/48） of lesions had papillary enhanced tumor nodules， 10.4% （5/48） of lesions had peritumoral incomplete enhanced ring sign， 22.9% （11/48） of lesions invaded surrounding tissue or organs. There were 35.4% （17/48） of lesions had calcification， in which 76.4% （13/17） of lesions were fine granular calcification， 11.8% （2/17） of lesions were mixed calcification， and 11.8% （2/17） of lesions were coarse calcification. Conclusion MSCT manifestations of PTC have certain characteristics， which can provide imaging basis for clinical treatment options.
ObjectiveTo explore the clinical, imaging, and pathological features of patients with synchronous double primary hepatocellular carcinoma and intrahepatic cholangiocarcinoma (sdpHCC-ICC), to enhance our understanding of the disease and reduce the rate of misdiagnosis and missed diagnosis.MethodsThe clinical, imaging, and pathological data of patients who were histologically confirmed as sdpHCC-ICC in West China Hospital of Sichuan University between January 1st 2014 and December 31st 2018 were studied retrospectively.ResultsA total of 11 patients with sdpHCC-ICC were screened for the study, of which 10 were male and 1 was female. The median age of patients was 55.6 years (ranged from 47 to 73 years). Eight patients were chronically infected with hepatitis B virus. Both increased alpha-fetoprotein and carbohydrate antigen 19-9 were observed in 8 patients. Contrast enhanced CT was performed in 8 cases, color doppler ultrasound in 4 cases, enhanced MRI in 3 cases, and contrast-enhanced ultrasound in 1 case. Among them, one solitary lesion was found in 2 patients, and two or more lesions were observed in 9 patients. Most of the patients had typical imaging performance of hepatocellular carcinoma (HCC): 8 patients showed strong enhancement of HCC during the hepatic arterial phase and progressive hyper-attenuation on venous and delayed phases, 1 patient showed peripheral rim enhancement in the arterial phase of intrahepatic cholangiocarcinoma (ICC) in another lesion could be observed at the same time. None of the 11 patients with sdpHCC-ICC was diagnosed accurately before operation. All patients underwent surgical treatment. HCC lesions were distributed in all parts of the liver, while ICC lesions were located in the right lobe of the liver in 10 cases. The median diameter of HCC and ICC was 3.5 cm and 2.1 cm, respectively. All of them were confirmed by hematoxylin-eosin staining and immunohistochemistry.ConclusionsThe clinical characteristics of sdpHCC-ICC are usually atypical. It is difficult to make an accurate preoperative diagnosis. Tumor markers may be valuable to the diagnosis of sdpHCC-ICC. The definite diagnosis of sdpHCC-ICC depends on pathological examination.
ObjectiveTo investigate and analyze the clinical manifestations and imaging features of the eyes with bullous retinal detachment. MethodsRetrospective case series study. Eleven eyes of 11 patients with bullous retinal detachment diagnosed in Department of Ophthalmology, Peking University People's Hospital from July 2015 to September 2021 were enrolled. There were 10 males and 1 female, with the mean age of (39.27±6.81) years. All patients had monocular bullous retinal detachment, with mean duration ranged from 3 months to 14 years. The basic information and medical history of all patients were collected. All patients underwent best corrected visual acuity (BCVA), indirect ophthalmoscopy, color fundus photography, optical coherence tomography (OCT), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and B-scan ultrasonography. BCVA was performed using a standard logarithmic visual acuity chart, which was converted to logarithm of the minimum angle of resolution (logMAR) visual acuity. The clinical data and imaging features of BCVA, OCT, FFA and ICGA were retrospectively analyzed and summarized. ResultsThe mean logMAR BCVA of the 11 eyes was 0.91±0.45. Nine patients had bilateral disease, but bullous retinal detachment occurred in only 1 eye, and CSC manifestations were present in the contralateral eye. Six patients had received systemic or topical hormone therapy prior to onset. Yellowish-white material was observed in 6 eyes and retinal folds were observed in 5 eyes. OCT examination showed serous retinal detachment in the macular area with granular or patchy hyperreflective signals in the subretinal area in all eyes, and a few granular hyperreflective substances in the neuroretina in 6 eyes. Neuroretina cystoid degeneration was observed in 6 eyes, adhesion between the detached neuroretina and retinal pigment epithelial (RPE) was observed in 6 eyes, RPE tear was observed in 6 eyes, and different forms of retinal pigment epithelial detachment (PED) were observed in 6 eyes. FFA showed multiple fluorescence leakage spots in 10 eyes, and the average number of fluorescence leakage spots in all eyes was 3.82±2.44. There were multiple diffuse RPE lesions in 9 eyes. The results of ICGA examination showed that choroidal vessels were dilated and multiple hyperfluorescent leaks were observed in all eyes. B-scan ultrasonography examination of all affected eyes showed retinal detachment. Retinal reattachment can be achieved at (2.0±1.0) months after photodynamic therapy (PDT), while SRF can be completely absorbed at (2.36±0.81) months. The mean logMAR BCVA can be improved to 0.50±0.33, and no recurrence was found in the follow-up period up to 6 months. ConclusionsBullous retinal detachment is often associated with the use of hormones, while yellow-white material in the subretina and hyperreflective material in the OCT are common. It is characterized by neuroretina cystoid degeneration in the macular area, adhesion between the neuroretina and RPE, RPE tear and PED, with multiple fluorescence leakage spots and diffuse RPE lesions. PDT is an effective treatment for bullous retinal detachment.
Objective To improve the knowledge of cryptogenic organizing pneumonia ( COP) , and reduce misdiagnosis and mistreatment. Methods The medical records of 22 patients with biopsy-proven COP from January 2006 to October 2011 were retrospectively reviewed. The clinical presentation, laboratory data, radiographic results and treatment were collected and analyzed. Results The clinical presentations were nonspecific, and the most common symptomof COPwas cough ( 95. 45% ) . The laboratory data analysis revealed that elevated erythrocyte sedimentation rate in 71. 43% of the COP patients. The COP patients usually presented with a restrictive ventilation dysfunction and decreased diffuse function on pulmonary function test. The most common patterns of lung abnormality on chest CT scan were bilaterally multifocal patchy consolidation or ground-glass opacification ( 63. 64% ) , which distributed along the bronchovascular bundles or subpleural lungs. Patchy consolidation with air bronchograms was also a common feature ( 54. 55% ) . Migration over time and spontaneous remission of consolidation were important pointers.Histopathology by transbronchial lung biopsy was a valuable means for diagnosis. The majority of COP patients were non-response to antibiotics, but responded rapidly and completely to oral administration of corticosteroids with good prognosis. Conclusions The clinical presentations and laboratory data of COP patients are nonspecific. Initial imaging findings of COP are similar with pneumonia. Strengthening the recognition of COP is conducive to reducing misdiagnosis and reasonable antibiotics use.
Objective To evaluate the value of 16slice spiral computed tomography (SCT) and its threedimensional reconstruction in diagnosis of aortic dissection (AD). Methods Fortyfive cases with AD underwent 16slice SCT, performed with unenhanced, contrastenhanced scanning and threedimensional reconstructions. Emphasis was placed on the true and false lumen, intimal flap, the entry and reentry tear and the involvement of branches of AD. Eleven cases were confimed by operation. Results True and false lumen and intimal flap of AD could be shown in all 45 cases (100%), the entry and reentry tears were revealed in 44 cases (97.8%) and 33 cases (73.3%), respectively. The right common iliac arteries were most easily involved by AD, 21 cases (46.7%). The thrombi in false lumen were shown in 29 cases (64.4%). Compared with surgery, the location and size of initial entry sites of 11 cases were consistent with the former. Conclusion 16slice SCT can exactly and completely diagnose AD, and provide detailed imaging information for clinical therapy. It’s very important for the selection of treatment methods and the observation of curative effect of patients.
ObjectiveTo observe the clinical characteristics of elderly patients with demyelinating optic neuritis (DON), and preliminarily analyze the related factors affecting their visual prognosis. MethodsA observational clinical case-control study. A total of 107 patients with DON who were diagnosed and hospitalized in Beijing Tongren Hospital and its medical alliance Department of Ophthalmology, Beijing Puren Hospital from March 2019 to October 2023 were included in this study. Detailed medical histories were recorded, including time of onset, presence of ocular pain, treatment modalities, and follow-up status. All affected eyes underwent best-corrected visual acuity (BCVA) testing, orbital magnetic resonance imaging (MRI), and laboratory tests, including erythrocyte sedimentation rate (ESR), antinuclear antibodies (ANA), extractable nuclear antigens (ENA), aquaporin-4 (AQP4) antibodies, and myelin oligodendrocyte glycoprotein (MOG) antibodies in peripheral blood. Based on age, patients were categorized into the elderly DON group (≥50 years) and the young and middle-aged DON group (＜50 years), comprising 50 and 57 cases, respectively. Furthermore, the elderly DON group was subdivided by serum-specific antibody status into the AQP4 antibody-positive ON group (AQP4-ON group), the MOG antibody-positive ON group (MOG-ON group), and the double-negative ON group (DN-ON group), with 18, 10, and 22 cases respectively. The median follow-up duration was 36 months. Follow-up assessments were conducted using the same equipment, methods, and relevant examinations as those applied at baseline. Binary logistic regression analysis was performed to identify factors associated with visual prognosis in elderly DON patients. ResultsCompared with the DON group of young and middle-aged people, the incidence of binocular disease, accelerated ESR, MRI imaging score, the incidence of combined cardiovascular and cerebrovascular diseases, diabetes, tumors, and the proportion of adverse reactions of glucocorticoids in the elderly group were higher, and the proportion of ocular pain was lower. The differences were statistically significant (P＜0.05). Six months after the treatment, the number of cases with BCVA＞0.3 in the affected eyes in the elderly DON group and the young and middle-aged DON group was 28 (56.0%, 28/50) and 42 (73.7%, 42/57), respectively. The number of patients with BCVA＞0.3 in the elderly DON group was significantly lower than that in the young and middle-aged DON group, and the difference was statistically significant (P=0.034). Moreover, with the increase of age, the degree of improvement in visual acuity showed a decreasing trend. The proportion of females in the AQP4-ON group, the proportion of optic chiasm and posterior optic pathway involvement in acute MRI, and the positive rate of ANA/ENA were significantly higher than those in the MOG-ON group and the DN-ON group, and the differences were statistically significant (P＜0.05). The rate of optic disc edema in the MOG-ON group was significantly higher than that in the AQP4-ON group, and the difference was statistically significant (P=0.031). One and six months after treatment, the BCVA in the MOG-ON group was significantly better than that in the AQP4-ON group and the DN-ON group, and the difference was statistically significant (P＜0.05). The results of binary logistic regression analysis showed that at the onset of the disease, BCVA＜0.01 [odds ratio (OR) =2.60, 95% confidence interval (CI) 1.23-5.52, P=0.013] and accelerated ESR (OR=4.68, 95%CI 1.08-20.18, P=0.039) was an independent risk factor affecting the prognosis of BCVA in elderly patients with DON. ConclusionsThere are different clinical characteristics between elderly DON patients and young and middle-aged patients. The risk of combined systemic diseases and side effects of glucocorticoids is higher, and the visual prognosis is worse. There are also differences in clinical characteristics and visual prognosis among subgroups of different serological antibodies in elderly DON. Advanced age, the lowest visual acuity at onset and immune inflammatory indicators are all factors affecting the visual prognosis of DON.
ObjectiveTo observe the clinical effect of 3D digital head-up vitreoretinal surgery and conventional optical microscope surgery in the treatment of persistent fetal vasculature (PFV).MethodsA retrospective case analysis study was performed. From November 2017 to August 2019, the enrolled patienres included that 20 eyes of 19 patients with PFV undergoing 3D digital head-up vitreoretinal surgery and 26 eyes of 26 patients with PFV undergoing traditional microscopic vitrectomy in the Eye Center of Beijing Tongren Hospital. The operation age of patients in the two groups were ≤14 years old and followed up for at least 1 month. There were no significantly statistical differences in gender (χ2=0.114), age (t=0.337), axial length (t=0.578) between the two groups (P=0.267, 0.782, 0.650). All the patients were operated under general anesthesia by the same doctor. All the surgical procedures were completed by the surgeon watching the 3D screen with 3D glasses, and all the surgical process were observed by the other medical staff including the nurses and the anaesthetists in the observation group. While in the observation group, the surgical doctor and one assistant doctor watched the surgery through the operating microscope, the other doctors watched the 2D surgical video system. The general information, pre-and postoperative visual acuity, anatomical changes and surgical complications were reviewed and compared between the two groups. Difficulty and complexity of each surgery were classified by the chief surgical doctor into 5 scores. 1: easy, 2: a little difficult, 3:much difficult, 4 very difficult; 5:most difficult. Opinions of medical staff majored in or not majored in ophthalmology were also recorded. Independent sample t test was used to compare the count data between the two groups, while chi-square test was used to compare the measurement data.ResultsThe average operating time was 34.7±8.5 minutes and the difficulty score was 2.8±0.9 in the observation group. The average operating time was 37.5±1.6 minutes and the difficulty score was 3.1±1.1 in the comparison group. There was no significant statistically differences between the two groups (t=0.782, 0.938; P=0.703, 0.562). Seven eyes had visual acuity improvement at last visit while 13 eyes with no changes compared with pre-operative visual acuity in the observation group, 8 eyes showed visual acuity improvement at last visit while 18 eyes showed no changes compared with pre-operative visual acuity in the comparison group. There was no significantly statistical differences between the two groups (χ2=0.279, P=0.254). No surgical complications such as endophthalmitis or secondary glaucoma were observed in the two groups. 3D digital system showed better stereoscopic pictures and better resolution compared with traditional microscopic vitrectomy. All the medical staff which participated in the surgery preferred to the 3D digital vitrectomy system.Conclusions3D heads-up digital vitrectomy shows better stereoscopic pictures and better resolution. 3D heads-up digital vitrectomy and traditional microscopic vitrectomy yielded comparable visual and anatomical outcomes for treatment of pediatric vitreoretinal diseases, however, there is not a significant difference in clinical outcomes.