2014 Vol. 5, No. 1

Display Method:
Original Contributions
Abstract:
  Objective  To explore the sonographic findings of primary thyroid lymphoma (PTL) and evaluate the role of ultrasound-guided core-needle biopsy in diagnosing this disease.  Methods  The clinical data, sonographic, and biopsy modes of 22 patients (age range, 32-81 years; median, 61 years) with pathologically confirmed PTL were retrospectively analyzed. The sonographic findings of PTL were divided into three types:diffuse type, nodular type, and mixed type.  Results  The main pathologic types of PLT in these 22 patients included mucosa-associated lymphoid tissue lymphoma (n=10, 45.5%) and diffuse large B-cell lymphoma (n=8, 36.4%). In 16 patients (72.7%), the initial symptom was enlarged neck mass. Among the 22 patients with a diagnosis of PTL, 16 (72.7%) were sonographically diagnosed as malignancies or suspected malignancies and 6 (27.3%) as benign lesions. In 10 patients who had received ultrasound-guided fine-needle aspiration biopsy, only 2 were diagnosed as suspected malignancies. In 9 patients who had received ultrasound-guided core-needle biopsy, 8 (88.9%) achieved definitive pathological diagnoses. In 15 patients who had undergone surgical biopsy, pathological diagnoses were obtained in all of them. The distribution of the sonographic findings of PTL was asfollows:diffuse type, n=10 (45.5%); nodular type, n=9 (40.9%); and mixed types, n=3(13.6%).  Conclusions  Ultrasonography is helpful for PTL diagnosis, especially in patients with rapid thyroid enlargement. Ultrasound-guided core-needle biopsy is safe and accurate, and therefore remains a preferred method for diagnosing thyroid lymphoma.
Abstract:
  Objective  To investigate the usefulness of the thin-layer liquid-based cytology in ultrasound-guided fine needle aspiration (UG-FNA) of thyroid gland lesions.  Methods  From January 2008 to July 2008, 57 thyroid lesions from 57 patients aged from 18 to 78 in Peking Union Medical College Hospital were sampled by ultrasound-guided fine needle aspiration. The cytologic materials were prepared for both conventional and thin-layer liquid-based cytology by PRPSTAIN Processor (Tripath Imaging, BD, USA). All cytological diagnoses were compared with those confirmed by surgical pathology and clinical follow-up. The UG-FNA results were classified as benign, malignant, suspicious, or unsatisfactory. The various cytologic features on liquid-based cyto-logy and conventional preparation were compared.  Results  Cytomorphologic features showed some differences between the two methods. Liquid-based cytology slides had a clear background and less or dense colloid. It demonstrated more cell shrinkage and showed increased disruption of the cytoplasm and numerous naked nuclei. Among the 57 thyroid lesions, surgical pathology and clinical follow-up confirmed that 6 were malignant and 51 were benign. The thin-layer technology showed that 48 (84.2%) were benign, 4 (7.0%) were malignant, and 5(8.8%)were unsatisfactory for interpretation. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 66.7%, 100%, 94.5%, 100%, and 96.2%, respectively, which were similar with conventional method.  Conclusions  Liquid-based cytology technique has certain different cellular features when compared with conventional smears but with similar diagnostic accuracy. It is an accurate and reliable method for the preoperative cytological diagnosis of thyroid nodules.
Abstract:
  Objective  To evaluate the efficacy of ultrasound-guided core-needle biopsy (CNB) in diagnosis of thyroid foci.  Methods  The ultrasound-guided CNB was performed on 117 thyroid foci in Peking Union Medical College Hospital from November 2004 to June 2011. The diagnostic data of 117 thyroid foci were retrospectively analyzed.  Results  All patients completed CNB successfully and the satisfaction rate for tissue samples was 98.3%. The CNB pathologic results of 117 patients were as follows:85 cases were benign, 28 cases were malignant, 2 case were suspected malignant, and 2 cases were inadequate for diagnosis; 37 cases had diffuse lesions and 80 cases had nodules. In 29 patients (including 24 cases of malignancy and 5 cases of benign disease) who had undergone surgery, the CNB pathologic results in 5 cases were false negative compared with the pathologic results of surgery. The diameters of thyroid nodules were less than 1 cm in 2 cases, 1-2 cm in 21 cases, and more than 2 cm in 57 cases.  Conclusions  Ultrasound-guided CNB is valuable for the differential diagnosis of thyroid foci. It is a supplement to the routine fine needle aspiration and can be used for the diagnosis of special thyroid foci such as the thyroid lymphoma.
Abstract:
  Objective  To investigate the sonographic characteristics of secondary thyroid cancer.  Methods  The clinical records of 10 patients with histologically proven metastasis to thyroid who were treated in Peking Union Medical College Hospital between April 1988 and July 2013 were retrospectively reviewed. The ultrasound images and reports were reviewed, and the sonographic characteristics of the metastatic thyroid cancer were summarized.  Results  In 1 patient with lung cancer and 1 with esophageal cancer, the metastatic lesions were presented as enlarged thyroid gland and uneven diffuse echo; in the remaining 8 patients, thyroid nodules were found. In the 8 lesions, 5 were multiple and 3 were solitary; right lobe was involved in 2 cases, left lobe in 1 case, and both lobes in 5 cases; the maximal size of the metastatic nodule averaged 3.8 cm (ranged between 0.6 and 6.6 cm); 5 were ill-defined and 3 were well-defined; 7 were irregular and 1 wasn't reported; 7 were hypoechoic and 1 was hyperechoic; 6 were solid and 2 were solid and cystic; calcification was observed in 6 cases; rich blood flow was detected in 4 cases, blood flow was detected in internal and peripheral parts of the lesion in 1 case, few bloodflow was seen in peripheral part of the lesion in 1 case, and no blood flow in 1 case. The sonographic characteristics of the secondary thyroid cancer were similar to those of the primary tumor.  Conclusions  The sonographic characteristics of secondary thyroid cancer are diverse, among which the thyroid nodule is a common manifestation and uneven diffuse echo can also be observed. The sonographic features that help to identify secondary thyroid cancer include multiple and large lesions, with ill-defined and irregular borders; the mass is solid, hypoechoic, and calcified, with rich blood flow. Ultrasound helps to select suspicious nodule for fine needle aspiration or surgery.
Abstract:
  Objective  To summarize the clinical and ultrasonic features of multiple primary thyroid and breast cancers.  Methods  The clinical and ultrasonic features of 24 patients with pathologically confirmed multiple primary thyroid and breast cancers who were treated in our hospital between January 1990 and March 2013 were retrospectively analyzed and compared.  Results  All patients were women. For 9 patients (37.5%) with breast carcinoma after thyroid carcinoma, the intervals between these two diagnoses were less than 12 months in 2 patients (22.2%).For 15 patients (62.5%) with thyroid carcinoma after breast carcinoma, the intervals between these two diagnoses were less than 12 months in 6 patients (40.0%). Most of thyroid carcinomas and breast carcinomas were presented as solid mass (86.4% and 84.2%), rregular shape (63.6% and 94.7%), aspect ratio > 1 (50.0% and 57.9%), indistinct margin (63.6% and 78.9%), hypoechoic appearance (90.9% and 100%), punctuate calcification (50.0% and 47.4%), and focal extensive blood flow (50.0% and 68.4%).  Conclusions  The clinical and ultrasonic features of multiple primary thyroid and breast cancers are similar to those of patients with thyroid carcinoma or breast carcinoma. The ultrasonography can effectivelydetect this condition, especially within the first year after the diagnosis of breast carcinoma.
Abstract:
  Objective  To propose a breast cancer risk prediction model by analyzing the clinical characteristics and sonographic features of breast lesions.  Methods  A total of 116 consecutive breast lesion samples obtained by biopsy in our hospital from July 2007 to January 2009 were retrospectively examined. Open biopsies were performed on each patient. The pathological results were used as the golden standard of diagnosis.Multivariate logistic regression analysis was used to identify the independent risk factors of breast cancer including age, family history of breast cancer, the hardness, mobility, shape, margin, orientation, posterior acoustic features, and calcification of the masses. The prediction model was developed and a receiver operating characteristic (ROC) curve was used to evaluate the efficacy of the prediction model.  Results  Of the 116 breast lesions examined, 52 breast lesions were diagnosed as breast cancer. The independent risk factors included the patient's age ofmore than 50 years old (OR=6.61, 95%CI 1.07-40.72), hard mass (OR=6.56, 95%CI 1.32-32.58), irregular shape (OR=19.93, 95%CI 2.49-159.45), instinct margins(OR=21.32, 95%CI 1.98-230.14) and angular or speculated margins (OR=31.33, 95%CI 2.61-376.02). The whole accuracy of this prediction model was 96.7%.  Conclusions  We developed a breast cancer risk prediction model and proposed independent risk factors, which can help predict the risk of breast cancer in clinical practices.
Abstract:
  Objective  To evaluate the usefulness of contrast-enhanced ultrasound (CEUS) in the diagnosis of breast intraductal papilloma.  Methods  CEUS was performed after administration of sulphur hexafluoride microbubbles(SonoVue) in 96 patients scheduled for surgical tumor removal among whom 11 were histologically confirmed to be intraductal papillomas. The enhancement morphologies were classified as non-enhancement, peripheral enhancement, homogeneous enhancement, regional enhancement, and heterogeneous enhancement.The histologic slides were reviewed and compared with CEUS findings.  Results  Of all 11 intraductal papillomas, 6 cases were detected by routine ultrasound and the sizes of lesions were 1.6-3.9 cm; 4 cases were detected by CEUS with a mode of hemogeneous enhancement, and the sizes of lesions were 0.5-1.2 cm. Homogeneous enhancement, regional enhancement, and non-enhancement were found in 6 cases(54.5%), 4 cases(36.4%), and 1 case(9.1%), respectively. The contrast enhanced area corresponded to the intraductal papiloma, whereas the non-enhanced area corresponded to the ductal ectasis, fibrosis.  Conclusion  Intraductal papilloma mainly shows homogeneous or regional enhancement, and the CEUS findings correlate with histologic features.
Abstract:
  Objective  To summarize the clinicopathological and sonographic features of breast malignant tumors in young women.  Methods  We retrospectively analyzed the clinical, pathological, and sonographic data of 40 young women (≤ 35 years) with pathologically proven malignant tumors of the breast udergoing operation in our hospital from January 2007 to December 2008.  Results  The mean age of these 40 women was (29.88±5.12) years. The tumors grew rapidly in 14 patients (35%). Three women were at pregnancy or lactation period. Thirty-five patients with a total of 40 malignant tumors underwent ultrasound examination, among which 5 tumors (12.5%) were missed, 4 (10.0%) misdiagnosed as benign tumors, and 31 correctly diagnosed as malignant tumors, yielding an accuracy of 77.5%. The sonographic features of the malignant tumors in young women were as follows:irregular shape (97.1%), ill-defined margin (82.9%), heterogeneous echostructure(97.1%), microcalcifications (74.3%), and rich blood flow (gradeⅡ-Ⅲ) (80.0%). Fifteen women (37.5%) underwent breast-conserving surgery, 4(10.0%) underwent simple breast resection, and 21(52.5%) underwent modified radical mastectomy. Invasive ductal carcinoma was the most common pathological type (n=27, 67.5%). Axillary lymph node metastasis was found in 22 women (55%). During the follow-up[(64.08±5.87) months; range, 56-78 months], 8 (20%) patients suffered from recurrence or metastasis. The average time for recurrence was (17.17±12.02) months (range, 4.0-36.0 months) after the surgery.  Conclusion  The recurrent rate and lymph node metastasis rate of breast malignant tumors are high in young women after surgical treatment, along with complicated and diverse sonographic features.
Abstract:
  Objective  To compare the values of ultrasound and magnetic resonance imaging (MRI) in the diagnosis of hand and wrist joint involvement in rheumatoid arthritis(RA) patients and summarize the distribution pattern of these lesions.  Methods  A total of 11 RA cases were included. The detection rates of synovitis, bone erosion, and tenosynovitis of different joints were calculated based on ultrasound and MRI findings. The diagnostic efficiency of ultrasound was evaluated by using the MRI as golden standard.  Results  Totally 103 joints and 112 tendon areas were evaluated. The detection rates of synovitis, bone erosion, and tenosynovitis of wrist and hand joints were 59.2%, 11.7%, and 18.8% by ultrasound and 62.1%, 14.6%, and 32.1% by MRI. The detection rate of wrist joint was higher than metacarpophalangeal (MCP) or proximal interphalangeal(PIP) joints. The detection rate of extensor lesions was higher than that of flexor lesions at the wrist level; at the MCP level, however, the detection rate of flexor lesions was higher than that of extensor lesions. Compared with MRI, for the diagnosis of synovitis, bone erosion, and tenosynovitis, the ultrasound had a sensitivity of 92.2%, 73.3%, and 59.5%, a specificity of 94.9%, 97.7%, and 98.6%, a positive predictive value of 96.7%, 84.6%, and 96.2%, and a negative predictive value of 88.1%, 95.6%, and 80.2%.  Conclusions  Wrist joint involvement is more common than MCP and PIP joints involvement in RA patients. The tendon involvement is more common in extensor at the wrist level, while in flexor at the MCP level. Compared with MRI, the diagnostic efficiency of ultrasound is higher for wrist lesions than for hand joints lesions. However, ultrasound is less sensitive in the diagnosis of extensor lesions at the MCP level.
Abstract:
  Objective  To investigate the enhancement pattern features of hepatocellular carcinoma(HCC) on contrast-enhanced ultrasound (CEUS) and explore the diagnostic value of CEUS for predicting tumor differentiation.  Methods  CEUS features of 81 cases of pathologically confirmed HCC were retrospectively analyzed. The enhancement pattern was defined as "quick in-quick out" when the lesion was enhanced in arterial phase and showed as hypoechoic in portal phase; when the lesion was enhanced in arterial phase and showed as hypoechoic in late phase, the enhancement pattern was defined as "quick in-slow out". According to the final pathological results, HCCs were categorized into well-differentiated group and poorly-to-moderately differentiated group. The diagnostic value of CEUS for the HCC differentiation was summarized.  Results  Of these 81 HCC patients, 38 were diagnosed as well-differentiated HCCs and 43 as poorly-to-moderately differentiated HCCs. The enhancement pattern was "quick in-slow out" in 17 patients (21.0%, 17/81) with well-differentiated HCCs, "quick in-quick out" in 21 patients (25.9%, 21/81)with well-differentiated HCCs, and "quick in-quick out" in 43 patients (53.1%, 43/81) with poorly-to-moderately differentiated HCCs. The "quick in-slow out" pattern was more common in the well-differentiated HCC group than in the poorly-to-moderately differentiated HCC(χ2=24.35, P < 0.01).Its diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rate were 44.7%, 100%, 100%, 67.2%, and 74.1%, respectively.  Conclusion  The "quick in-slow out" enhancement pattern may be helpful for predicting and diagnosing the well-differentiated HCC.
Abstract:
  Objective  To evaluate the application of virtual touch tissue quantification (VTQ) technique in immunoglobulin A nephropathy (IgAN).  Methods  A total of 28 patients were included in present study who underwent kidney biopsy in Peking Union Medical College Hospital from January 1, 2012 to April 30, 2012. On sonography, conventional[length(L), thickness (T), resistive index(RI)], and VTQ (shear wave velocity, SWV) parameters of left kidney were measured. Then using Spearman correlation analysis, the correlations between SWV and clinicopathologic parameters[chronic kidney disease(CKD) stage, Lee grade, glomerular sclerosis index (GSI), tubular atrophy(TA), interstitial fibrosis(IF)] and the association of SWV and conventional ultrasound measurements were evaluated.  Results  No significant correlation was found between conventional ultrasound measurements and SWV, as well as clinicopathologic parameters (all P > 0.05). However, Spearman analysis indicated that SWV showed significant correlations with CKD stage (r=-0.382, P=0.045), Lee grade (r=-0.407, P=0.031), and IF (r=-0.397, P=0.036).  Conclusions  As a novel sono-elastography technique, VTQ correlates with multiple clinicopathologic parameters by measuring renal cortical stiffness. Therefore it is of great value in clinical application and warrants further investigation.
Abstract:
  Objective  To assess the value of endorectal ultrasound (ERUS) for staging rectal cancer after neoadjuvant chemoradiation.  Methods  We retrospectively analyed the clinical data of 62 patients with rectal cancer between September 2011 and September 2012 in our hospital. ERUS was performed before and after chemoradiation therapy in all patients. All patients underwent subsequent total mesorectal excision (TEM) and completed pathologic staging. The results of ERUS were compared with the postoperatively pathologic staging.  Results  After chemoradiation, 8 patients had no residual disease at pathologic staging(pT0N0)which was not correctly predicted by ERUS. Of 30 patients who responded well to the chemoradiation therapy, only 7 achieved correct ultrasonic staging (uT). The overall accuracy of ERUS for uT was only 40.3%(25/62), while 36 patients (58.1%)were overstaged and 1 patient (1.6%)was understaged. The sensitivity, specificity, and positive and negative predictive values for nodal staging were 60.0%, 84.6%, 42.9%, 91.7%, respectively.  Conclusions  The ERUS uT of rectal cancer after chemoradiation is inaccurate, especially in patients with evidence of response. Meanwhile, ERUS cannot reliably predict tumor pathological complete remission. However, ERUS has high specificity and negative predictive value for nodal staging and therefore is valuable in predicting the prognosis.
Abstract:
  Objective  To assess the value of the sonographic quantification of non-alcoholic fatty liver (NAFL) in type 2 diabetes mellitus (T2DM) patients and explore the association of serum biochemical indicators with NAFL.  Methods  Totally 64 patients with T2DM were recruited from Peking Union Medical College Hospital from November 2011 to May 2013. All subjects underwent both serum biochemical test and ultrasonography at the same day. According to the ultrasound findings, all participants were divided into normal, mild, and moderate-severe fatty liver groups. Hepatorenal ratio and hepatic attenuation index were obtained from ordinary ultrasound images using computer software.  Results  There were statistical differences in hepatic attenuation index and triglyceride (TG) among the three groups[0.954±0.103, 1.206±0.198, and 1.546±0.400; and (1.10±0.71), (1.82±0.84), and (2.86±1.75)mmol/L; respectively](all P < 0.05). For hepatorenal ratio, there were differences between normal, mild, and moderat-severe fatty liver group(0.926±0.175, 1.350±0.302, and 1.628±0.829, respectively; P < 0.05). Hepatorenal ratio, hepatic attenuation index, and TG were positively correlated with the grading of NAFL (r=0.678, P < 0.001;r=0.788, P < 0.001; and r=0.609, P < 0.001, respectively).  Conclusions  Hepatorenal ratio and hepatic attenuation index can be used as objective quantitative indexes in the diagnosis of NAFL in T2DM patients. They can be used as an easy and effective tool for follow-up and evaluation of NAFL treatment efficacy in these patients.
Abstract:
  Objective  To investigate the diagnositic value of ultrasonography in fetuses with transposition of the great arteries.  Methods  In a retrospective analysis, the sonographic findings of 4 fetuses with transposition of the great arteries who were treated in Peking Union Medical College Hospital from March 2010 to July 2013 were reviewed and compared with the pathological findings.  Results  Of these 4 fetuses with transposition of the great arteries, a normal four-chamber view was seen in 3 cases and ventricular septal defect in 1 case. At the level of left and right ventricular outflow tract, abnormal ventricular-arterial connection was detected. At the level of 3 vessel and tracheal view, two vessels rather than three were seen in all cases.  Conclusions  Fetal transposition of the great arteries has specific echocardiographic findings. The left and right outflow tract view and the three vessel and tracheal view are helpful in the accurate diagnosis.
Abstract:
  Objective  To explore the relationship among the hemodynamic parameters of middle cerebral artery (MCA), umbilical artery (UmA), and uterine artery (UtA) and fetal growth in the second trimester.  Methods  From June 2011 to July 2012, a total of 206 normal pregnant women with a gestation age of 20-24+6 weeks were examined by color Doppler ultrasound after routine screening scanning. The anatomic parameters including biparietal diameter (BPD), head circumference (HC), abdomen circumference, and femur length were recorded. Also, the hemodynamic parameters including peak flow velocity (PSV) of MCA, and pulsatility index (PI) and resistance index (RI) of MCA, UmA and UtA were measured. The cerebral placenta ratios (CPR=MCA-PI/UmA-PI; CRR=MCA-RI/UmA-RI) were calculated based on the measurements.  Results  The MCA-PSV (ranged from 13.63-37.96 cm/s) indicated a mild elevation trend during the gestation; however, the other parameters including RI, PI of MCA, UmA, UtA and CPR, CRR remained stable during this period. The MCA-RI and MCA-PI were significantly correlated with UmA-RI and UmA-PI, respectively (r=0.51, P < 0.01; r=0.65, P < 0.01). However, there was no correlation within the corresponding indexes between UtA and MCA or UmA. The MCA-PSV(cm/s) showed a significantly linear relationship with the gestational age (GA, week):MCA-PSV=-0.17+1.02×GA (r=0.67, P < 0.01). The MCA-PSV was significantly correlated with BPD and HC (r=0.29, P < 0.01; r=0.32, P < 0.01).  Conclusions  The RI and PI of MCA are closely correlated with those of UmA, but show no such correlation with those of UtA.The PSV in fetal brain is closely associated with the gestational week and affected by brain development.
Abstract:
  Objective  To analyze the correlation between ultrasound parameters of uterine scar after cesarean section and the amount of intraoperative blood loss in patients with cesarean scar pregnancy(CSP).  Methods  A total of 35 CSP patients who received operational treatment from November 2011 to January 2013 were enrolled in this study. The 2-and 3-dimensional ultrasound examinations were performed before the surgery, and the following parameters were recorded:maximum diameter of lesion(Dmax), average diameter of lesion(Dmean), implantation area of lesion(S), implantation volume of lesion(V), and implantation depth of lesion(Dimp). All these cases were divided into different groups according to the following characteristics separately:with/without fetal heart beat, lesion shown as gestational sac/mass, vasculature grade poor/median/rich, whetheror not combined with methotrexate(MTX) treatment prior to operations. The amount of bleeding during the operation was recorded. The correlation between the above parameters and the amount of intraoperative bleeding was analyzed. The bleeding amount of different groups was compared. Also, the patients were divided into two groups according to bleeding amount ≥ 200 ml and < 200 ml, and the potential independent risk factors of bleeding were analyzed using Logistic regression.  Results  Dmax and S had a linear correlation with bleeding amount (P=0.009 and 0.008). Dmean, V, and Dimp had no linear correlation with bleeding amount(P=0.017, 0.044, and 0.423, respectively). The difference of bleeding amount between groups with and without fetal heart beat was significant(23.38 ml vs 13.47 ml, P=0.004). There were no significant differences between groups of lesion types, color grades, and with/without MTX treatment(P=0.131, 0.044, and 0.047, respectively). The Logistic regression showed that S was an independent risk factor of operation bleeding amount(P=0.007), with an area under the receiver operating characteristic(ROC) curve of 0.839(0.606-1.071).  Conclusions  The Dmax and S of CSP as well as with/without fetal heart beat obtained from the 2-and 3-dimensional ultrasound have close correlations with the intraoperative bleeding amount in CSP patients. In particular, the S of the CSP is an independent risk factor for bleeding.
Abstract:
  Objective  To investigate the ultrasonographic characteristics of the Takayasu's arteritis (TA) with carotid artery involvement and explore the role of carotid wall thickness in the assessment of disease activity.  Methods  Totally 58 consecutive TA patients in our hospital were examined by carotid ultrasonography. The sonographic features were investigated and the wall thicknesses were measured.They were further divided into active TA group and inactive TA group. In addition, 58 healthy subjects were enrolled as the control group.The wall thicknesses of the carotid arteries were compared among the active TA group, inactive TA group, and control group. The receiver operating characteristic (ROC) curve was drawn to evaluate the efficacy of the wall thickness of carotid artery in the assessment of disease activity.  Results  Of these 116 common carotid arteries (CCAs) in 58 patients, 106 CCAs were affected.A characteristic homogeneous isoechoic/hypoechoic, circumferential thickening was shown in 76 involved CCAs(71.7%).In addition, 35 CCAs (33.0%)showed a typical "macaroni" sign, while 67 (63.2%) showed quadri-layer changes and a "target" sign in cross section. The CCA wall was significantly thicker in the TA patients than that in control group (P < 0.001), and it was also thicker in the active TA group than in inactive TA group(P < 0.05). When the ROC analysis was performed with 2.25 mm taken as the cutoff value of wall thickness to evaluate TA activity, the sensitivity was 71.4% and specificity was 66.0%. In stenosis group, the sensitivity rose to 90.0% when 2.40 mm was used as the cutoff value; in non-stenosis group, the specificity rose to 81.5% when 2.25 mm was used as the cutoff value.  Conclusions  The target sign may become a new sonographic feature for the diagnosis of TA in carotid ultrasonography, and increased wall thickness may be a useful indicator of active disease.
Abstract:
  Objective  To analyze the efficacy and prognosis of pneumatic retinopexy for primary rhegmatogenous retinal detachment.  Methods  Totally 16 patients (16 eyes) diagnosed as primary rhegmatogenous retinal detachment and received pneumatic retinopexy in our hospital from August 2008 to July 2012 were enrolled in this study. All the patients received the procedure under topical anesthesia, positioned properly after operation, and underwent retinal photocoagulation 1 to 3 days after the operation. The retinal reattachment rate, visual acuity, and complications of the operation were summarized.  Results  There were 8 males and 8 females aging 19 to 68 years old (mean 46.4±14.4 years). Their disease course ranged from 3 to 60 days (mean 16.8±14.7 days), and the follow-up time was 1 to 28 months (mean 7.3±7.0 months). Retinal breaks were within the upper 8 clock-hour in 15 cases, and located at the subtemporal retina in 1 case. Fourteen cases had round or horseshoe shaped holes, with 1 hole in 10 cases, 2 holes in 3 cases, and 3 holes in 1 case. The other 2 cases had multiple cribriform holes, but limited in 3 clock-hour extent. Postoperative intraocular pressure rose in 2 cases, and returned to normal after using topical ocular hypotensive medications. Pneumatic retinopexy resulted in reattachment in 13 cases, but redetachment happened in 5 eyes after 4 days to 4 months, including 3 cases of unclosed holes and 2 cases of new retinal holes. Reoperations were carried out for 8 patients, and the final retinal reattachment rate was 100%. Among the 8 cases that succeeded after primary pneumatic retinopexy, visual acuity was improved in 5 cases and stable in 3 cases, with 5 cases attaining visual acuity of 0.5 or more. Among the 8 cases that received two or more operations, visual acuity was improved in 5 cases, stable in 1 case, and decreased in 2 cases, with 3 cases attaining visual acuity of 0.5 or more. Visual acuity improved in 77.8%(7/9) of macular-off cases and 42.9%(3/7) of macular-on cases.  Conclusions  Pneumatic retinopexy is a simple procedure for primary rhegmatogenous retinal detachment. It can achieve satisfied results in properly selected cases. However, the incidences of new retinal holes and redetachments can be high, so strict indications and close follow-up are particularly important for this procedure.
Abstract:
  Objective  To investigate morphological change of uveoscleral outflow pathway after travoprost and pilocarpine are given alone or in combination.  Methods  Of 28 normal albino rabbits, 4 were randomly selected as the control group (treated with normal saline for one day), and the remaining 24 rabbits were divided into three parallel groups and treated with 2% pilocarpine (3 times per day), 0.004%travoprost (per night), and their combination. On the 7th, 14th, and 24th day of the treatment, 2 rabbits in each drug-treated group were executed. Two rabbits in the control group were executed after treated with normal saline for one day. Eyeballs taken from these rabbits were fixed, and then the pathological specimens were prepared with hematoxylin-eosin (HE) staining and smooth muscle antibody (SMA) immunohistochemical staining. The morphological changes of ciliary smooth muscle and intracellular space were observed with optical microscope. Two normal rabbits from the control group were executed after normal saline treated for 1 day and 2 normal rabbits in each drug-treated group were executed after 24 days of treatment. All eyes of these rabbits were taken and emission electronic microscope specimens were made to observe the microstructure of ciliary muscle and extracellular matrix (ECM).  Results  Specimens of pilocarpine group showed the contraction of ciliary muscle. Specimens of travoprost group showed the relaxation of ciliary muscle, enlargement of the extracellular space, and decompose of ECM. Specimens of the combination group showed the contraction of anterior 1/3 part of ciliary muscle but the relaxation of posterior 2/3 part of ciliary muscle. Decomposition of ECM was more distinct in combination group than those of individual groups.  Conclusions  Compared with pilocarpine alone or travoprost alone, the combination of these two drugs does not increase the resistance of uveoscleral outflow pathway and probably can promote the aqueous fluid outflow by increasing the decomposition of ECM.
Abstract:
  Objective  To observe the clinical efficacy of vitrectomy on vitreomacular traction syndrome.  Methods  The clinical data of 22 evaluable eyes of 22 patients with vitreomacular traction syndrome who were diagnosed by spectral-domain optical coherence tomography (SD-OCT) and underwent vitrectomy from January 2008 to December 2012 were retrospectively analyzed. Patients were followed up for an average of 8 months(1-51 months), and the changes of best corrected visual acuity (BCVA) and retinal thickness of macular fovea were recorded.  Results  After the treatment, BCVA improved significantly in 12 eyes (54.5%), improved mildly in 6 eyes (27.3%), stabilized in 3 eyes (13.6%), and decreased in 1 eye (4.5%). The proportion of patients with BCVA ≥ 0.3 increased from 13.6% before operation to 59.1% after operation. The mean retinal thicknesses of macular fovea were(545±175)μm preoperatively and (220±105) μm postoperatively, respectively (P < 0.01).  Conclusion  Vitrectomy is an effective way to improve vision and decrease macular edema in patients with vitreomacular traction syndrome.
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