UltrasonographyUltrasoundhasfoundincreasedapplicationtothelowergenitourinarytract.Itresultsinminimaldiscomfort;givesa3-dimensionalappreciationoftheshape,size,andvolumeoforgansanddisease;andcanprovidedirectintervention.Varioustransducersareavailable;high-megahertztransducersarerequiredforsuperficialstructures(forexample,scrotalstructures)toassesstesticulardisease(includingtumorsandtorsion),whilelow...[
阅读全文]
DiagnosticClinicalApplicationsQuantitativeLuminalMeasurementsAbroadspectrumoftherapeuticdecisionshingeonassessmentofcoronaryluminaldimensions.Accordingly,indiagnosticandinterventionalpractice,quantitationofvasculardimensionsrepresentsacommonclinicalapplicationofintravascularultrasound.Recently,acommitteeoftheAmericanCollegeofCardiologyandtheEuropeanSocietyofCardiologydefinedstandardsfortheacquisit...[
阅读全文]
CoronaryIntravascularUltrasoundImaging:IntroductionAftermorethanadecadeofcontinuousdevelopment,coronaryintravascularultrasoundhasachievedgeneralacceptanceasanessentialelementinallcontemporarycatheterizationlaboratories.Althoughangiographycontinuestoserveastheprimaryimagingmodalityusedtoassesstheanatomyofcoronaryarterydisease,intravascularultrasoundrepresentsanimportantalternativemethodforexaminati...[
阅读全文]
EssentialsofDiagnosisRiskfactorsincludedelayedchildbearing,positivefamilyhistoryofbreastcancerorgeneticmutations(BRCA1,BRCA2),andpersonalhistoryofbreastcancerorsometypesofmammarydysplasia.Mostwomenwithbreastcancerdonothaveidentifiableriskfactors.Earlyfindings:Single,nontender,firmtohardmasswithill-definedmargins;mammographicabnormalitiesandnopalpablemass.Laterfindings:Skinornippleretraction;axilla...[
阅读全文]
EssentialsofDiagnosisPainful,oftenmultiple,usuallybilateralmassesinthebreast.Rapidfluctuationinthesizeofthemassesiscommon.Frequently,painoccursorincreasesandsizeincreasesduringpremenstrualphaseofcycle.Mostcommonageis30–50.Rareinpostmenopausalwomennotreceivinghormonalreplacement.GeneralConsiderationsThisdisorderisthemostfrequentlesionofthebreast.Itiscommoninwomen30–50yearsofagebutrareinpostmenopa...[
阅读全文]
BenignProstaticHyperplasia(BPH)Incidence&EpidemiologyBPHisthemostcommonbenigntumorinmen,anditsincidenceisage-related.TheprevalenceofhistologicBPHinautopsystudiesrisesfromapproximately20%inmenaged41–50,to50%inmenaged51–60,andtoover90%inmenolderthan80.Althoughclinicalevidenceofdiseaseoccurslesscommonly,symptomsofprostaticobstructionarealsoage-related.Atage55,approximately25%ofmenreportobstruct...[
阅读全文]
EssentialsofDiagnosisTotalserumcholesterolgreaterthan200mg/dLontwosamplesatleast2weeksapartLDLcholesterolgreaterthan100mg/dLHDLcholesterollessthan40mg/dLTriglyceridesgreaterthan200mg/dLGeneralConsiderationsInrecentyears,agreatdealofemphasishasbeenplacedontherelationshipbetweenelevatedserumcholesterollevels—especiallylow-densitylipoproteincholesterollow-densitylipoproteincholesterolcomplex(LDL-C)—...[
阅读全文]
PhysicalFindingsPhysicalExaminationThephysicalexaminationislessimportantthanthehistoryinpatientswithischemicheartdisease,butitisofcriticalvalueinpatientswithcongenitalandvalvularheartdisease.Inthelattertwocategories,thephysiciancanoftenmakespecificanatomicandetiologicdiagnosesbasedonthephysicalexamination.Certainabnormalmurmursandheartsoundsarespecificforstructuralabnormalitiesoftheheart.Thephysic...[
阅读全文]
SonographyBasicPrinciplesSoundisthemechanicalpropagationofpressurechanges,orwaves,throughadeformablemedium.Awavefrequencyofonecycle/second(cps)iscalledahertz(Hz).Soundfrequenciesgreaterthan20kHzarebeyondtherangeofhumanhearingandarecalledultrasound.Medicalsonographyusesultrasoundtoproduceimages(Figures6–22,6–23,6–24,6–25,6–26,and6–27).Thefrequenciescommonlyusedinmedicalsonographyarebetween3.5...[
阅读全文]
Appendix17–3.RecommendationsforIntracoronaryPhysiologicMeasurements(DopplerUltrasound,FFR)
ClassINoneClassIIaLevelofEvidence1.Assessmentofthephysiologiceffectsofintermediatecoronarystenosis(30to70percentluminalnarrowing)inpatientswithanginalsymptoms.CoronarypressureorDopplervelocimetrymayalsobeusefulasanalternativetoperformingnoninvasivefunctionaltesting(e.g.,whe...[阅读全文]
