我院收治硅胶假体隆乳术后双侧乳房血肿伴重度贫血及凝血功能异常病人1例,病人病情危重,病程经过复杂,经过整形外科及血液内科等多个科室会诊确诊为获得性血友病A,经积极治疗,病人病情稳定.

Objective To explore the diagnostic value of ultrasonography (US), contrast-enhanced ultrasonography (CEUS), (99mTc-MIBI) single photon emission computed tomography/computed tomography (SPECT/CT) in refractory secondary hyperparathyroidism. Methods From August 2015 to August 2017, 18 cases of refractory hyperparathyroidism admitted to the Affiliated Hospital of Qingdao University were collected. All patients underwent US, CEUS, 99mTc-MIBI SPECT/CT imaging before operation. The diagnostic efficiency of the three methods was compared with the pathological results as the gold standard. Results A total of 73 nodules were removed from 18 cases, 71 of them were parathyroid nodules confirmed by pathology. The imaging sensitivity of US, CEUS, 99mTc-MIBI SPECT/CT was 98.59%, 94.37% and 78.87% respectively, and the accuracy was 97.26%, 94.52% and 78.08% respectively. There was no significant difference between US and CEUS in locating parathyroid hyperplasia nodules (P=0.250). The diagnostic value of US and CEUS was superior to 99mTc-MIBI SPECT/CT (P=0.001, 0.012), and the specificity was increased when combination of US with CEUS (50.00% vs 100.00%). When combined with 99mTc-MIBI SPECT/CT imaging, the accuracy of localization was further improved (98.63% vs 100.00%). Conclusion For refractory secondary hyperparathyroidism, comprehensive preoperative diagnosis can be made after combined application of US, CEUS and 99mTc-MIBI SPECT/CT. Key words: Ultrasonography; Technetium Tc 99m sestamibi; Tomography, spiral computed; Hyperparathyroidism

Objective To provide valuable references for ultrasonic diagnosis of pelvic organ prolapsed (POP) by finding an eas ily detecting referential line based on MRI.Methods Data of 107 patients who underwent pelvic MRI were retrospectively analyzed.All the patients were divided into 6 groups according to age:Group 1 (20 29 years old),group 2 (30-39 years old),group 3 (40-49 years old),group 4 (50-59 years old),group 5 (60-69 years old) and group 6 (≥70 years old group).Four reference lines were set basing on the median sagittal view of T2WI:PS-PS line (the line connecting the two endpoint of the pubic symphysis),PIAS line (the line connecting the inferior margin of pubic symphysis and the bottom of sphincter internal anal sphincter),PPC line (the line connecting of the inferior margin of pubic symphysis and the point of the pubococcygeous attached on the rectum) and PM line (the line connecting of the inferior margin of pubic symphysis and the M point [the midpoint of the line from the crosspoint of PPC line and the front wall of the rectum mucosa to the bottom of sphincter internal anal sphincter]).The angles between the horizontal line and PS-PS line,PIAS line,PM line,PPC line (angle 1,angle 2,angle 3,angle 4) were measured,respectively.The differences of the angle among various age-groups were compared.The consistency between the two observes were evaluated.Results PM line was the closest line to the horizontal line.There was no statistical differences of angle 1,angle 2 and angle 3 among the 6 groups (all P＞0.05).The difference of angle 4 among the 6 groups were significant (F=3.42,P=0.01).Intergroup pairwise comparisons showed that significant differences were found between group 1 and group 4,group 5,group 6,between group 2 and group 4,group 5,group 6,between group 3 and group 4,group 5,group 6,respectively (all P＜0.05).And no significant difference was found in the other comparisons.The consistency of the two observers in meaning angle 1,angle 3 and angle 4 were good,but the consistency of angle 2 was poor.Conclusion Of all the referential lines,PM is the closest to the horizontal line and is less influenced by the patient's age.However,the feasibility of using PM lines as the ultrasound referential line is still unclear.