2017年 · 第97卷第39期

From 1980s to now, transcranial Doppler ultrasound (TCD) has been used in the field of neurological diseases for nearly 40 years. In 2003, a German TCD expert believed: TCD is facing "death"! Because there are too many examinations such as CT angiography (CTA), magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) can visualize intracranial and extracranial vascular lesions more intuitively. More than ten years have passed, and now it seems that TCD has not only not "died", but has glowed with vitality in many fields. In China, more and more neurologists and surgeons are learning to use TCD. The advantages of TCD, such as portability, cheapness, easy diagnosis of severe patients at bedside, and easy dynamic observation of disease evolution, are not found by other imaging methods. However, due to historical reasons, there are many cases of TCD abuse, and the clinical wrong TCD operation and its report make many clinicians question the value of TCD. Based on this, we organized experts in related fields to write this operating specification, hoping to have the effect of "breaking" to "establishing".

Generalized neurosonology includes transcranial Doppler, transcranial color Doppler ultrasound, cervical vascular ultrasound, transcranial parenchymal ultrasound, peripheral nerve ultrasound and muscle ultrasound^{[1,2,3,4,5,6]}。 The diagnostic value of neuroultrasound for clinical work depends largely on the technical and knowledge background of the operator. In order to facilitate the work of the majority of neuroultrasound medical staff, the Neuroultrasound Professional Committee of Neurologist Branch of Chinese Medical Doctors Association and the Neuroimaging Collaborative Group of Neurology Branch of Chinese Medical Association have written this operating specification for standardized training of neuroultrasound physicians at all levels.

The patient was a 54-year-old female. He was admitted to the hospital on May 1, 2012 due to ultrasound revealing a right thyroid nodule for 1 month. Previous 2-year history of radiotherapy for nasopharyngeal carcinoma. Admission physical examination: A hard mass about 2.0 cm ×1.8 cm in size could be accessed on the right thyroid gland, and several hard lymph nodes could be accessed on the right neck, the larger one was about 2.0 cm ×2.0 cm, and the remainder was negative. Laboratory tests were all normal. CT of head and neck showed: (1) post-radiotherapy of nasopharyngeal carcinoma; (2) Right cervical lymph nodes were swollen. Ultrasound examination showed: (1) A hypoechoic nodule about 2.1cm ×1.6cm ×1.8cm in size was seen at the lower pole of the right thyroid gland, with clear boundary and uneven internal echo (Figure 1)； (2) Several hypoechoic nodules were seen in the right neck and front of the neck, about 2.5 cm ×1.5 cm ×2.1 cm in size, with clear boundaries and uneven internal echoes (Figure 2)。 Ultrasound revealed "right thyroid nodule, nature to be determined; right cervical and anterior cervical lymph node enlargement, metastatic cancer?". "Total thyroidectomy + right paratracheal lymph node biopsy" was performed on 11 May 2012 under general anesthesia + cervical plexus anesthesia. Intraoperative findings: A mass of 2.0 cm ×1.8 cm was accessible to the right thyroid gland, which was hard in texture, with poor boundary and poor mobility. An enlarged lymph node of 2.0 cm ×2.0 cm was seen in front of the trachea, which was hard in texture and poor mobility. The mass adhered to the lymph node and invaded the esophagus. The left thyroid gland did not reach the mass. Intraoperative frozen pathology suggests that: (1) poorly differentiated right thyroid carcinoma with large necrosis, combined with clinical, nasopharyngeal carcinoma metastasis cannot be excluded; (2) The right anterior cervical lymph node was cancerous tissue under the microscope. Postoperative immunohistochemical staining showed that keratin antibody (34BE12) focal area (+), cytokeratin 5/6 (CK5/6) focal area (+), cytokeratin 7 (CK7) (-), cytokeratin AE1/AE3 (+), Epstein-Barr virus encoded RNAs (EBER) (-), Epstein-Barr virus (EBV) (-), tumor suppressor gene P63 (+), thyroglobulin (TG) (-), and thyroid transcription factor 1 (+) were weak. Pathological diagnosis: right thyroid nodule, consistent with metastasis of nasopharyngeal non-keratinizing squamous cell carcinoma (undifferentiated type), and right anterior cervical lymph node as cancerous tissue. After 4 years of follow-up, he was alive and had no recurrence or metastasis.

Pregnant woman 37 years old due to menopause 31^＋2Weeks, dyspnea and decreased fetal movement for 1 week, and was admitted to the Department of Obstetrics of Zhongnan Hospital of Wuhan University on May 16, 2016. I occasionally feel holding my breath in the first trimester, cough after catching a cold 1 week ago, blood in sputum, and dyspnea, accompanied by decreased fetal movement. The treatment with "penicillin" in the local hospital did not improve, and the outpatient color ultrasound showed an increase in pulmonary artery systolic blood pressure. One natural birth in 2001 and one ectopic pregnancy in 2009. In June 2015, my menstrual flow began to increase, lasting for 8~10 days, so the intrauterine ring was removed, and the pregnancy was obtained after the ring was removed. Suffered from "tuberculosis" in 2014. Physical examination at admission: blood pressure 130/89 mmHg (1 mmHg =0.133 kPa), oxygen saturation 85%-95%, heart rate 120 beats/min, breathing 20 beats/min, fine wet rales audible in the left lower lung, harmonic heart rhythm, and gestational bulge in the abdomen. Specialist examination: uterine height 26 cm, abdominal circumference 92 cm, buttock presentation, floating, fetal heart rate 150 beats/min. Blood routine at admission: white blood cells 12.18×10⁹/L [Reference range (3.5-9.5) ×10⁹/L, same below], red blood cells 3.27×10¹²/L [(3.8-5.1) ×10¹²/L], hemoglobin 94.00 g/L (115-150 g/L), platelets 203×10⁹/L [(125-350) ×10⁹/L], neutrophils 86.00% (40%-70%); Detection of liver, kidney and blood glucose: alanine aminotransferase (ALT) 42 U/L, aspartate aminotransferase (AST) 68 U/L (13-35 U/L), total bilirubin (TBIL) 12.9 μ mol/L, albumin 31.2 g/L (40-55 g/L); glucose 4.03 mmol/L; Urea nitrogen 3.29 mmol/L. Fetal heart electronic monitoring (NST) is shown as a sine wave. Obstetric B-ultrasound showed fetal weight of 1 424+ / -208 g; The amniotic fluid index was 11.9 cm, and the peak end-systolic (S) /end-diastolic (D) blood flow velocity of the umbilical artery was 1.71, suggesting a single live fetus in breech position in late pregnancy. Admission diagnosis: pregnancy 2 delivery 1 pregnancy 31^＋2Weekly expectant delivery; Fetal distress; Breech position; The cause of dyspnea to be investigated: pulmonary embolism? Tuberculosis? Lung infection?; Pulmonary hypertension; Moderate anemia.

Ovarian mucinous tumors are a rare subtype of ovarian epithelial tumors with unique biological characteristics. Among them, mucinous adenocarcinoma accounts for 2% ~4% of ovarian epithelial carcinomas, and borderline mucinous adenoma accounts for 30% ~50% of borderline ovarian tumors^[1,2]。 At present, the etiology of mucinous adenocarcinoma is still unclear. Because the ovary does not have normal mucinous epithelial components in anatomical structure, mucinous metaplasia of epithelial cells in the ovarian cortex is also very rare^[2,3]Based on the above, the glandular epithelium of ovarian mucinous tumors is similar to gastrointestinal epithelial cells in pathological morphology, although the overall prognosis of ovarian mucinous tumors is good, the overall survival rate of borderline tumors can reach 100%^[4]The 5-year disease-free survival rate of mucinous adenocarcinoma can reach 80% ~90%^[5,6]However, considering that ovarian mucinous tumors may originate from the appendix or other digestive organs, once considered as ovarian mucinous tumors, the source of gastrointestinal tumors, especially the source of colon, should be excluded first, and preventive appendicectomy should be required. However, the clear relationship between mucinous ovarian tumor and appendix tumor in etiology and metastasis rate has not been confirmed, and the necessity of appendectomy in the treatment of ovarian myxoma is still controversial.

Because of its high morbidity, disability and mortality, stroke has become the first cause of death in China. Carotid atherosclerotic stenosis is one of the main causes of ischemic stroke, and more than 20% of ischemic strokes are caused by carotid atherosclerotic stenosis^[1]。 Atherosclerosis often progresses statically over many years until symptoms appear. The first clinical symptom is usually a transient ischemic attack or stroke^[2]。 At present, the risk assessment and treatment modalities of patients with asymptomatic carotid stenosis (ACS) are still controversial. This paper summarizes the research progress of ACS in recent years.