Roundworm obstruction: Sonographic diagnosis

We describe the sonographic findings in five pediatric patients with roundworm obstruction. All patients were referred with a clinical diagnosis of acute appendicitis. On ultrasonography (US), an individual worm, when viewed along its longitudinal axis, appeared as a hypoechoic tubular structure with well-defined, echogenic walls. Frequently, the individual body segments could be distinctly visualized. The alimentary canal of the worm was seen either as a single central echogenic line (when in a collapsed state) or as two parallel hyperechoic bands with a hypoechoic center (when distended). When examined transaxially, the individual worm resembled a target with its circular, echogenic body wall and its central dot-like alimentary canal. On prolonged scanning, the worms always showed curling movements. In two patients, a bolus of worms mixed with fecal matter and air produced an unusual appearance of a complex, echogenic mass (helminthoma). Although, an individual worm occasionally resembled an inflammed appendix, visualization of the alimentary canal and individual body segments along with its curling movements helped establish the correct diagnosis. All patients promptly responded to a hypertonic saline enema and no patient was subjected to surgery. Sonographic findings in roundworm obstruction are fairly characteristics to advocate the routine use of sonography for diagnosing this entity.     

Carcinoma of the gallbladder: CT findings in 50 cases

Fifty patients with histologically proven carcinoma of the gallbladder were examined by computed tomography (CT). The gallbladder masses were categorized into two broad groups: group 1 (74%) included patients in whom the gallbladder was identified along with a mass lesion; and group 2 (26%), where a large mass was present in the gallbladder fossa with no identifiable gallbladder. Group 1 was further divided into three types according to the nature of the tumor: Type 1, mass almost filling the entire gallbladder lumen; Type 2, a polypoidal mass projecting into the lumen; type 3, an infiltrating tumor seen as focal or diffuse wall thickening. Liver involvement, in the form of localized invasion in the vicinity of the primary gallbladder malignancy, was the most common associated finding (80%). Other ancillary features included presence of calculi, lymphadenopathy, and biliary obstruction. CT was found useful for characterizing and defining the extent of carcinoma of the gallbladder. However, it may not consistently demonstrate involvement of the gastrointestinal tract, omentum, and abdominal wall. CT can also be used for aspiration/biopsy guidance of the gallbladder mass in selected cases.     

多层螺旋CT扫描在膀胱移行细胞癌中的应用分析

目的探讨多层螺旋CT诊断膀胱移行细胞癌的应用价值。方法收集48例经手术病理证实的膀胱移行细胞癌患者的CT影像资料与临床资料,展开回顾性的研究。结果 48例患者中,CT术前检测出45例,未检出3例;单发病灶25例,多发病灶20例;菜花状28例,乳头状8例,局限性膀胱壁增厚9例。结论多层螺旋CT能够准确地诊断出膀胱移行细胞癌,在病理诊断的基础上,充分结合CT影像资料,将极大提高分期诊断的准确率。     

Cystadenoma of the seminal vesicle: US and CT findings

Ultrasonographic (US) and computed tomographic (CT) features of a cystadenoma of the seminal vesicle are presented.     

Actinomycosis of the retroperitoneum and an extremity: CT features

A patient presenting with thigh and flank masses and back pain for 3 months proved to have actinomycosis involving the retroperitoneum and quadriceps muscle. Retroperitoneal involvement without intraperitoneal disease is rare. Computed tomography (CT), however, showed disease transgressing adjacent anatomic compartments with direct extension through the body wall and involvement of adjacent bony structures which is characteristic of actinomycosis.     

Hepatocellular carcinoma: Prospective assessments of the T-factor with CT,US, and MR imaging

The capabilities of computed tomography (CT), ultrasonography (US), and magnetic resonance (MR) imaging were studied in order to determine the role of each of these noninvasive examinations for estimating the T-factor of hepatocellular carcinomas (HCCs). Fifty-one patients with surgically proven HCCs received CT (50 patients), US (46 patients), and MR (44 patients). The images of CT, US, and MR were prospectively evaluated for main tumor size, intrahepatic metastases, and vascular invasion, which compose the T-factor of HCC, and compared to pathological results. The sizes of the main tumor were estimated correctly by all examinations. For estimating intrahepatic metastases, US (74%) and MR (73%) were superior to CT (65%). For estimating portal invasion, CT (79%) was superior to US (70%) and MR (66%), because CT could demonstrate the segmental staining caused by portal invasion. The estimates of hepatic venous invasion were difficult during any of the examinations. We conclude that presurgical evaluations of the T-factor require the use of US and CT or MR and CT.     

企业组织管理危机的早期诊断及预警管理

为了考察我国企业组织管理现状,笔者对湖北、四川、广东、河北、江苏、重庆等14个省及直辖市的150多家有代表性企业的管理人员,进行了企业组织管理抽样问卷调查,共回收问卷308份,其中有效问卷261份。根据问卷统计结果,确定了反映企业组织管理行为、机构管理和人员管理危机征兆的早期诊断指标。1企业组织结构的适应程度。     

螺旋CT及后处理技术在肩胛骨隐匿性骨折中的诊断价值

目的探讨螺旋CT及后处理技术在临床上对肩关节隐匿性骨折的诊断价值。方法回顾性分析2012年7月至2014年6月来我院检查的137例肩关节外伤患者,对比普通X线检查及CT扫描结果。结果 62例X线摄片未见确切骨折患者,通过CT扫描后并进行后处理技术诊断27例骨折。结论螺旋CT扫描及进行图像后处理分析可以提供更为直观、准确的整体骨骼显示情况,从而提高外伤及急诊患者影像诊断准确率,减少特殊部位及重叠骨骼骨折漏诊等情况,从而为人民群众提供更为满意的医疗服务。     

CT appearance of calcified tumor thrombus in the inferior vena cava

We report the unusual occurrence of calcined tumor thrombus in the inferior vena cava (IVC) in a patient with renal cell carcinoma diagnosed by computed tomography (CT).     

Pediatric gastroesophageal reflux disease and acid-related conditions: trends in incidence of diagnosis and acid suppression therapy

Abstract

Objective: To describe the incidence of diagnosis of gastroesophageal reflux disease and acid-related conditions (GERD/ARC) throughout childhood and characterize patterns of diagnosis and treatment with proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H₂RAs).

Methods: Cohorts of GERD/ARC children (age 0–18 years) were identified from a large US administrative claims database covering 1999–2005 using ICD-9 codes. Incidence, healthcare utilization (HCU), costs, therapy discontinuation and switching rates were compared between various age and patient groups.

Results: Between 2000 and 2005 annual incidence of GERD/ARC diagnosis among infants (age ≤1 year) more than tripled (from 3.4 to 12.3%) and increased by 30% to 50% in other age groups. Patients diagnosed by GI specialists (9.2%) were more likely to be treated with PPIs compared to patients diagnosed by primary care physician (PCP). PPI-initiated patients doubled (from 31.5% in 1999 to 62.6% in 2005) and, when compared with H₂RA-initiated patients, were associated with 30% less discontinuation and 90% less therapy switching in the first month, and with higher comorbidity burden and pre-treatment total HCU and costs when diagnosed by GI specialists.

Limitations: The use of an exploratory definition for GERD/ARC, administrative claims data and potential coding errors in diagnosis codes used in selection process may limit the generalizability of the results.

Conclusions: GERD/ARC incidence increased for children of all ages between 2000 and 2005. PCPs made the majority of diagnoses. PPI initiations have now surpassed H₂RA initiations.     

CT三维仿真成像技术在输尿管膀胱的临床应用

目的探讨输尿管膀胱疾病采取CT三维仿真成像技术的临床应用价值。方法通过静脉注入碘海醇造影剂,将泌尿系完全充盈后,取螺旋CT薄层扫描原始图像,并将其数据传输到工作站中,进行图像后期处理,取得多种三维立体和仿真内镜图像。结果输尿管膀胱疾病包括膀胱肿瘤、前列腺增生、输尿管狭窄以及神经源性膀胱伴有输尿管扩张,依次为6例、9例、5例、2例。另外,纤维膀胱肿瘤6例,前列腺增生6例及输尿管狭窄4例。结论输尿管膀胱疾病采取CT三维仿真成像技术,可将各种病理形态改变完全显示出来,对制订临床治疗方案和评估预后起到非常关键的作用。     

Cost effectiveness of a 92-gene assay for the diagnosis of metastatic cancer

Objectives:

To estimate the clinical and economic trade-offs involved in using a molecular assay (92-gene assay, CancerTYPE ID) to aid in identifying the primary site of difficult-to-diagnose metastatic cancers and to explore whether the 92-gene assay can be used to standardize the diagnostic process and costs for clinicians, patients, and payers.

Methods:

Four decision-analytic models were developed to project the lifetime clinical and economic impact of incorporating the 92-gene assay compared with standard care alone. For each model, total and incremental costs, life-years, quality-adjusted life-years (QALYs), incremental cost–effectiveness ratios (ICERs), and the proportion of patients treated correctly versus incorrectly were projected from the payer perspective. Model inputs were based on published literature, analyses of SEER (Surveillance Epidemiology and End Results) data, publicly available data, and interviews with clinical experts.

Results:

In all four models, the 92-gene assay increased the proportion of patients treated correctly, decreased the proportion of patients treated with empiric therapy, and increased quality-adjusted survival. In the primary model, the ICER was $50,273/QALY; thus, the 92-gene assay is therefore cost effective when considering a societal willingness-to-pay threshold of $100,000/QALY. These findings were robust across sensitivity analyses.

Conclusions:

Use of the 92-gene assay for diagnosing metastatic tumors of uncertain origin is associated with reduced misdiagnoses, increased survival, and improved quality of life. Incorporating the assay into current practice is a cost-effective approach to standardizing diagnostic methods while improving patient care. Limitations of this analysis are the lack of data availability and resulting modeling simplifications, although sensitivity analyses showed these to not be key drivers of results.     

单排螺旋CT对小儿气管支气管异物的诊断应用价值

目的利用单排螺旋CT,采用冠状位平扫,探讨其对小儿气管支气管异物的诊断应用价值。方法分析我院70例小儿气管支气管异物单排螺旋CT冠状位扫描的影像表现,并与支气管镜检查所见结果进行对照。结果 70例患儿中,CT诊断气管内异物5例,右侧支气管内异物37例,左侧支气管内异物27例,1例双侧支气管内异物。经支气管镜检查,68例符合,2例未取出异物。CT诊断符合率97.1%。结论用单排螺旋CT,采用冠状位扫描,对直接显示小儿气管支气管异物,具有确定的临床诊断价值。     

应用耐信量表临床诊断胃食管反流病

目的：探讨采用耐信量表临床诊断胃食管反流病（GERD）的可行性。方法：出现上消化道反酸、烧心等症状初诊患者,先行耐信量表（RDQ）测定,8分以上者均行C13呼气试验查幽门螺杆菌（HP）、胃镜检查、给予耐信抑酸降阶梯治疗或清菌基础上的降阶梯治疗;14周后再行RDQ测定,并随访6个月以上,同时比较各种方法的效价。结果：118例患者中男女比例为1.95：1,平均年龄41.7岁。RDQ分值≥8分且〈12分者为32例,占27.1%;RDQ分值≥12分者86例,占72.9%,最高29分,平均19.08分。表现为烧心的频度和程度都高于其它症状。当RDQ分值≥12分为GERD时,其内镜诊断为RE且HP为阳性的几率为56.98%。而当RDQ分值≥8分且〈12分时,内镜下无RE表现、HP为阴性的可能性为37.50%。86例患者经16周抑酸降阶梯或清菌基础上的抑酸降阶梯治疗后,复测的RDQ分值均有不同程度下降。如采用RDQ,则接受系统清菌治疗总费用为1336元（与传统治疗组每例1636元比较,P〈0.05）,无需接受系统清菌治疗者为1036元（传统组每例1336元,P〈0.05）,与传统诊疗方法之间均存在显著差异。结论：利用RDQ分值初诊GERD有一定可行性,较传统内镜方法可明显降低医疗费用。当设定RDQ分值≥12分为GERD时,其中56.98%患者表现为反流性食管炎和幽门螺杆菌感染;当RDQ分值〈12分时,内镜下无RE表现且HP为阴性的可能性为37.50%。