Fetal hyperthyroidism can occur secondary to maternal autoimmune hyperthyroidism. The thyroid-stimulating hormone receptor antibody (TRAb) transferred from the mother to the fetus stimulates the fetal thyroid and causes fetal thyrotoxicosis. Fetuses with this condition are difficult to detect, especially after maternal Graves disease therapy. Here, we present two cases of fetal hyperthyroidism with maternal hypothyroidism and review the assessment and intrauterine therapy for fetal hyperthyroidism. Both women were referred at 22+ and 23+ weeks of gestation with abnormal ultrasound findings, including fetal heart enlargement, pericardial effusion, and fetal tachycardia. Both women had a history of Graves disease while in a state of hypothyroidism with a high titer of TRAb. A sonographic examination showed a diffusely enlarged fetal thyroid with abundant blood flow. Invasive prenatal testing revealed no significant chromosomal aberration. Low fetal serum TSH and high TRAb levels were detected in the cord blood. Fetal hyperthyroidism was considered, and maternal oral methimazole (MMI) was administered as intrauterine therapy, with the slowing of fetal tachycardia, a reduction in fetal heart enlargement, and thyroid hyperemia. During therapy, maternal thyroid function was monitored, and the dosage of maternal levothyroxine was adjusted accordingly. Both women delivered spontaneously at 36+ weeks of gestation, and neonatal hyperthyroidism was confirmed in both newborns. After methimazole and propranolol drug treatment with levothyroxine for 8 and 12 months, both babies became euthyroid with normal growth and development.

Objective:To establish the reference ranges of fetal prenasal thickness (PT) and nasal bone length (NBL) based on a Chinese population and to assess their predictive value for trisomy 21, 18, and 13 in the second trimester of pregnancy.Methods:Pregnant women who underwent ultrasound during the second trimester were included in this study. The PT and NBL were measured retrospectively in 253 normal fetuses and in 55 fetuses with trisomy 21, 18, and 13.Results:The mean PT [PT=-4.959+0.565GA-0.01GA2 (R2=0.725, P＜0.001)] and NBL [NBL (mm)=-5.656+0.761GA-0.01GA2 (R2=0.891, P＜0.001)] both increased with the gestational age, while the PT/NBL ratio (R2=0.004, P=0.376) remained stable. For the fetuses with trisomy 21, 18, and 13, 26.3% (10/38), 36.4% (4/11), and 16.7% (1/6) had a PT below the 5th percentile, and 42.1% (16/38), 36.4% (4/11), and 33.3% (2/6) had a NBL below the 5th percentile. The detection rate increased remarkably when PT/NBL ratio were used as a new marker for trisomy 21 fetuses, but not for trisomy 18 and 13 fetuses [65.8% (25/38), 45.5% (5/11), and 16.6% (1/6), respectively].Conclusion:Fetal PT/NBL ratio could be used as an effective predictive maker for trisomy 21, 18, and 13.

目的:探究妊娠期糖尿病患者胎儿心脏超声参数及血糖控制效果对其影响程度.方法:选取2020年6月—2022年12月期间香港大学深圳医院收治的40例妊娠期糖尿病孕妇为观察组,并选择同阶段的40名健康孕妇为对照组.检测及比较两组胎儿的心脏结构参数(室间隔厚度、左右心房内径、左右心室内径)及功能参数(左、右室短轴缩短率、左室射血分数、二尖瓣及三尖瓣血流指标),并比较观察组中不同血糖控制效果者的检测结果.结果:观察组的心脏结构参数及左、右室短轴缩短率、左室射血分数显著高于对照组,二尖瓣及三尖瓣E/A等心功能参数均显著低于对照组(P＜0.05);观察组中血糖控制较差者的心脏结构参数及左、右室短轴缩短率、左室射血分数显著高于血糖控制较好者,二尖瓣及三尖瓣E/A等心功能参数均显著低于血糖控制较好者,差异有统计学意义(P＜0.05).结论:妊娠期糖尿病患者胎儿心脏超声参数相对异于健康同龄孕妇的胎儿,且血糖控制效果对检测结果影响较大,在本类孕妇胎儿心脏状态监测中的价值较高.

目的 探讨研究经腹壁超声与经阴道超声对诊断孕晚期孕妇前置胎盘的临床意义.方法 将从收治的疑似孕晚期前置胎盘孕妇中随机抽出100例作为观察对象,均以经腹壁超声、经阴道超声顺序进行检查,以最终分娩结果为金标准,评估单一检查和联合检查对胎盘前置的诊断价值,包括诊断敏感性、特异性和准确性及符合率.结果 100例疑似孕晚期前置胎盘孕产妇中,证实80例,非胎盘前置20例,分别为边缘性前置胎盘8例,部分性前置胎盘20例,完全性前置胎盘52例;经腹壁超声联合经阴道超声检出78例,单一经腹壁超声检出60例,联合检查检出率高于单一检查(P<0.05);经腹壁超声联合经阴道超声检查的敏感性、准确性分别为93.75％、92.00％,均高于单一检查的70.00％、72.00％(P<0.05),但两种检查方法的特异性比较无明显差异(P>0.05);联合检查对前置胎盘的诊断符合率为80％,属于较高水平指标.结论 经腹壁超声联合经阴道超声用于孕晚期孕妇前置胎盘诊断中,不仅能提高诊断敏感性和准确性,且具有较高诊断符合率,对保障母婴分娩安全有重要现实意义,值得临床上大力推广.

目的 探讨彩色多普勒超声与多层螺旋CT诊断宫颈癌的临床应用价值.方法 选取2017年9月至2021年9月该院需要行彩色多普勒超声与多层螺旋CT诊断宫颈癌的患者100例作为研究对象,随机分为彩色多普勒超声组和多层螺旋CT组,各50例.分别采用2种方法进行检查.比较2组患者误诊的例数和患者的诊断符合率.结果 多层螺旋CT诊断符合率(92.00％)高于彩色多普勒超声诊断符合率(88.00％);多层螺旋CT组Ⅰb、Ⅱa、Ⅱb期误诊例数均明显少于彩色多普勒超声,差异均有统计学意义(P<0.05).结论 彩色多普勒超声检查方便、移动性好,并且能进行动态观察.多层螺旋CT比彩色多普勒超声准确率要高,2种方式都有各自的优点,在临床上结合使用更好.

目的 探讨超声检测胎儿大脑中动脉、脐动脉血流参数诊断胎儿发生宫内窘迫的价值.方法 选取2019年10月至2021年12月在香港大学深圳医院产检并分娩的160例孕妇作为研究对象,根据是否发生胎儿宫内窘迫分为窘迫组(有宫内窘迫,80例)和对照组(无宫内窘迫,80例),两组均接受超声检查,比较两组胎儿的大脑中动脉、脐动脉血流参数指标,根据出生后Apgar评分将新生儿缺氧程度分为轻度、重度并分层比较大脑中动脉、脐动脉血流参数指标,采用线性相关分析法分析大脑中动脉、脐动脉血流参数与Apgar评分的相关性.结果 窘迫组胎儿的大脑中动脉阻力指数(RI)、搏动指数(PI)、收缩期峰值/舒张期峰值血流速度(S/D)值均低于对照组,差异有统计学意义(P<0.05);窘迫组胎儿的脐动脉RI、PI、S/D值均高于对照组,差异有统计学意义(P<0.05).大脑中动脉RI、PI、S/D值诊断胎儿宫内窘迫的曲线下面积(AUC)分别为0.779、0.863、0.778;脐动脉RI、PI、S/D值诊断胎儿宫内窘迫的AUC分别为0.794、0.844、0.750.重度缺氧组胎儿的大脑中动脉RI、PI、S/D值均高于轻度缺氧组,差异有统计学意义(P<0.05);重度缺氧组胎儿的脐动脉RI、PI、S/D值均低于轻度缺氧组,差异有统计学意义(P<0.05).窘迫组胎儿的大脑中动脉RI、PI、S/D值与新生儿出生后1 min Apgar评分呈正相关(P<0.05);窘迫组胎儿的脐动脉RI、PI、S/D值与新生儿出生后1 min Apgar评分呈负相关(P<0.05).结论 超声检测胎儿大脑中动脉、脐动脉血流参数变化可诊断宫内窘迫的发生,并且与新生儿缺氧程度有关.

目的 探究动静脉内瘘血流量对维持性血液透析患者心功能的影响.方法 选取香港大学深圳医院2016年7月至2017年7月利用动静脉内瘘进行血液透析的120例慢性肾衰竭患者为研究对象.根据动静脉内瘘血流量(AVFB)测量值的大小分为3组,不足400 ml/min的37例患者为低流量组;400～600 ml/min的44例患者为中流量组;超过600 ml/min的39例患者为高流量组.动静脉内瘘吻合术后患者进行1年维持性血液透析,期间观察患者内瘘失功能和高危事件发生的情况.研究过程中采用彩色多普勒超声显像仪,分别测定患者在透析前(动静脉内瘘吻合术后1个月)、透析1年后测定心脏指数(CI)、心排出量(CO)和射血分数(EF).结果 三组患者的高危事件发生率差异显著具统计学意义(P＜0.05),高流量患者高危事件的发生率较高于中流量组和低流量组(P＜0.05).三组患者内瘘失功能发生率差异明显具有统计学意义(P＜0.05),低流量组内痿失功能的发生率较高于中流量组和高流量组(P＜0.05).透析后,三组的心脏指数、心排出量和射血分数差异显著具有统计学意义(P＜0.05),三组的CI、CO及EF水平较透析前有所升高,高流量组的各项指标升高程度较低流量组和中流量组明显(P＜0.05).结论 维持性血液透析患者建立动静脉内瘘时,要注意对血流量的限制,要防止血流量过大导致的心力衰竭,同时要避免血流量过低引起的内瘘功能丧失.

Objective To observe the value of urtrasound image in positioning fetal conus medullaris normal conus medullaris(CM).Methods Totally 438 fetuses underwent routine fetal ultrasonographic examinations,and were divided into second-trimester group(261 fetuses,with gestational age 20+6—26+2weeks) and third-trimester group(177 fetuses,with gestational age 29+2—40+3weeks).The position of CM was recorded and analyzed.Sixty-one fetuses were extracted as control group.The range of normal position and mean position of CM were calculated.Results The normal range of CM was at the level of L2—3.5 vertebrae body in the second-trimester group,and at the level of L1—3 vertebrae body in the third-trimester group,moved up forward about 0.66 vertebrae body than the former(P0.001).In the control group,compared with the second trimester,CM position moved up forward about 0.89 vertebrae body in third-trimester(P0.001).Conclusion Fetal spinal cord moves up with gestational age increasing.Three-dimensional ultrasound can accurately locate fetal CM position during the second-trimester.

Objective The accuracy of transperineal sonography was investigated in the diagnosis of posterior wall and lateral posterior wall by comparing with transabdominal sonography.Methods The results of of the transperineal and the transabdominal sonography were compared through retrospectively analyzing 60 cases placenta previa of posterior wall and lateral posterior wall.Results There was no significant difference between the two methods in the diagnosis of total placenta previa and partial placenta previa of posterior wall and lateral posterior wall(P>0.05).There was significant difference between the two methods in the diagnosis of lower and marginal placenta previa of posterior wall and lateral posterior wall(P<0.01).Conclusions It is obviously clear that transperineal sonography is superior to the transabdominal sonography in the diagnosis of lower and marginal placenta previa of posterior wall and lateral posterior wall.

Objective To study the assessment value of speckle tracking technology (STI) on left ventricular radial systolic function after stent implantation in patients with acute coronary syndrome, so as to explore the efficacy of reperfusion therapy by percutaneous coronary intervention (PCI). Methods STI testing was conducted in 32 patients with acute coronary syndrome before PCI and 3 months after PCI for left ventricular radial motion indicator strain rate (SRs), peak systolic radial strain (SR), and the radial displacement (DR). Results Three months after PCI, LVEF, ESV and EDV were significantly improved compared with those before PCI (P<0.01), SV showed statistically significant difference with that before PCI, and the SRs, SR, DR were all increased significantly compared. Conclusion STI is an effective method for evaluating the changes in the segmental wall motion of patients with acute coronary syndrome.

Objective To investigate the application of ultrasound speckle tracking imaging(STI) in the evaluation of left ventricular function after stent implantation in patients with acute coronary syndrome.Methods Forty patients with acute coronary syndrome were enrolled in this study.The levels of papillary muscle and apical wall segments l8 a peak systolic radial strain(SR) and circumferential strain(CS) were determined and compared with the basal level of left ventricular before surgery and 1 month after PCI.Results After PCI,the apical ventricular septal CR value,basal level before the interval,the anterior wall of the CR value,the interval before the level of papillary muscles,anterior CR value was significantly increased compared with those before PCI(P<0.05).Interval before the apex level of CR value,basal level before the interval,the anterior wall of the CR value,the level of papillary muscle before the interval,the anterior wall of the CR value before PCI showed statistically significant difference with those before PCI(P<0.05).Conclusion STI is an effective manner in evaluating left ventricular myocardial function after stent implantation in patients with acute coronary syndrome.

Objective To investigate the clinical value of type-B ultrasonic in diagnosing hysteromyoma.Methods 143 patients,who visit our hospital from May,2009 to June,2010 were examined by type-B ultrasonic to get the size,shape and echo features of the focus.Results The coincidence cases of type-B ultrasonic diagnosis and pathologic diagnosis were 125,and the diagnosis coincidence rate was 88.9%.The cases were divided into four types: high echo-level type,low echo-level type,middle echo-level type and mix echo-level type,which account for 25.2%、34.3%、21.0% and 19.6%,respectively.Conclusions Type-B ultrasonic is the best method to diagnose hysteromyoma although there is certain misdiagnosis rate.

目的 探讨产前彩色多普勒超声诊断胎儿右室流出道梗阻的临床价值.方法 回顾分析32例产前超声诊断胎儿右室流出道梗阻的超声资料,总结其声图像特征.结果 (1)单纯肺动脉瓣狭窄时常于肺动脉瓣口局部显示五彩镶嵌血流信号,频谱多普勒显示其峰值流速常大于1.8 m/s;(2)动脉导管早闭时常于动脉导管处显示五彩镶嵌血流信号,频谱多普勒显示峰值流速常大于1.8 m/s,且为双期同向血流频谱；(3)法洛四联症及右室双出口伴肺动脉狭窄时常于肺动脉主干内显示其血流信号稍鲜艳,但频谱多普勒显示峰值流速常小于1.8 m/s,严重狭窄时肺动脉主干内血流信号暗淡,甚至其动脉导管内出现反向血流信号及频谱；(4)肺动脉瓣闭锁时常于动脉导管及肺动脉内显示反向血流信号及反向频谱,频谱多普勒显示峰值流速常小于1.8m/s.结论 彩色多普勒血流显像及频谱形态分析能为胎儿右室流出道梗阻的产前诊断提供有价值的信息.

Objective: To investigate the early placental ultrasound diagnosis and clinical analysis. Methods: Retrospective analysis of 50 cases by surgery in our hospital confirmed ultrasonographic appearance of placental abruption. Results: Ultrasound examination of suspected 50 cases of placental abruption, in which ultrasound diagnosis was 84%(42/50), missed diagnosis rate was 16% (8/50). Conclusion: Ultrasound diagnosis of placental abruption is rapid, accurate and it has clinical value.

Objective The purpose of this study was to analyze the sonographic features of thyroglossal duct cysts(TDCs) in children and its diagnostic value.Methods We analyzed and summarized the sonograms from 38 children with pathologically proven TDCs retrospectively.The lesions were evaluated for location,shape,internal echo pattern,internal septa,wall thickness,posterior enhancement,solid components,margins,and fistulas.Results Most TDCs were at midline(30 cases),located at the hyoid bone(18 cases) or were infrahyoid(14 cases),showed posterior enhancement(31 cases),were unilocular(33 cases),without internal septa(34 cases),and had a thin wall(28 cases).None had a solid component.The internal echo patterns were classified into 3 types: anechoic(11 cases),homogeneously hypoechoic(9 cases),and heterogeneous(18 cases).Inflammation was confirmed in 8 cases of the lesions with wall thickening and 4 cases of the lesions with internal septa.Conclusions The ultrasonography is of relatively high clinical value in the diagnosis of thyroglossal duct cyst.

血管环(vascular ring)是较少见的先天性主动脉弓及分支血管畸形，由Wolman于1939年首先报道，约占先天性心脏病的1％～2％[1]。血管环包绕气管和食管，可能压迫气管与食管产生呼吸困难或吞咽困难等临床症状。最常见的完全血管环包括双主动脉弓(double aortic arch，DAA)和右位主动脉弓(right aortic arch,RAA)、左位动脉导管(left ductus arteriosus,LDA)并迷走左锁骨下动脉(aberrant left subclavian artery,ALSA)。

目的 探讨宫外孕与妊娠黄体的经阴道彩色多普勒血流显像及频谱形态特征,以提高超声对宫外孕的诊断符合率.方法 对126例宫外孕及132例宫内或宫外孕伴黄体囊肿进行经阴道彩色多普勒超声检测,检测结果与其临床病理进行对照分析.结果 (1)宫外孕血流常显示为宫外孕病变处某局部富血流信号,血流均不来源于卵巢,而妊娠黄体血流则常显示黄体周边环状血流信号,血流均来源于卵巢内;(2)宫外孕的多普勒血流频谱可表现为多种形态:包括极低阻力型血流频谱、低阻力型血流频谱、高阻力型频谱、无舒张期血流频谱及舒张期反向血流频谱;而妊娠黄体则常表现为低阻力型及高阻力型血流频谱.结论 经阴道彩色多普勒血流显像及频谱形态特征能为宫外孕与妊娠黄体的鉴别诊断提供有价值的信息.

Objective To evaluate the value of three-dimensional ultrasound in the diagnosis of intrauterine abnormalities . Methods Thirty-six patients with intracavitary abnormalities were examined with 3-dimentional image reconstruction. Results The hyperechoic masses were shown in uterine cavity in 16 cases with endometrial polyp. The hypochoic masses were displayed in uterine cavity in 10 cases with submucous myoma. The separatrix of hyperplastic endometrium and myometrium was clear in 8 cases with simple hyperplasia. Conclusion Three dimensional imaging has better performance in the diagnosis and differentiation of lesion characteristics.

自2002年7月～2003年4月,在我院妇科门诊确诊早孕要求终止妊娠常规进行三维超声检查的被检者中检出5例子宫畸形合并早期妊娠,孕龄为5～8周.其中3例为不全纵隔子宫合并妊娠,1例完全纵隔子宫合并妊娠,1例双角子宫合并妊娠.全部病例均经宫腔镜取胚术和术后病理诊断证实.仪器:Medison V730三维超声成像系统,经阴道三维容积探头,频率5～9 MHz.

患者,女,28岁.4年前患结核性胸膜炎,经治疗已愈.因右侧胸壁肿块伴轻微疼痛20余天就诊.查体:右侧胸壁腋前线7～9肋间见一58 mm×36 mm隆起性包块,质硬,固定,轻度压痛.表面皮肤颜色无异常.超声检查:于腋前线7～9肋间皮下探及一哑铃形厚壁囊性肿块(图1),壁呈低回声,毛糙,中央为液暗区,内见光点回声.肿块浅部30 mm×16 mm,长轴与肋间长轴平行.肋骨显示连续,回声正常.深部50 mm×40 mm,位于肋骨后方,中间以管道相通,探头加压,见液体自浅部流向深部.右侧肋膈角处胸膜增厚并向肝脏面隆起.超声提示:右侧胸壁结核性脓肿.手术示肋骨浅深处见两脓疡,沿肋骨上下呈哑铃状排列,内为脓液及干酪样物.行胸壁结核切除.病理示结核性肉芽肿.